Neighbourhood residential density and childhood obesity

The Association Between a Neighborhood Adverse Childhood Experiences Index and Body Mass Index Among New York City Youth

Background: The role of neighborhood factors in the association between adverse childhood experiences (ACEs) and body mass index (BMI) has not been widely studied. A neighborhood ACEs index (NAI) captures neighborhood environment factors associated with ACE exposure. This study examined associations between BMI and an NAI among New York City (NYC) youth. An exploratory objective examined the NAI geographic distribution across NYC neighborhoods. Methods: Data for students attending NYC public general education schools in kindergarten-12th grade from 2006-2017 (n = 1,753,867) were linked to 25 geospatial datasets capturing neighborhood characteristics for every census tract in NYC. Multivariable hierarchical linear regression tested associations between BMI and the NAI; analyses also were conducted by young (<8 years), school age (8-12 years), and adolescent (>12 years) subgroups. In addition, NAI was mapped by census tract, and local Moran's I identified clusters of high and low NAI neighborhoods. Results: Higher BMI was associated with higher NAI across all sex and age groups, with largest magnitude of associations for girls (medium NAI vs. low NAI: unstandardized β = 0.112 (SE 0.008), standardized β [effect size]=0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.122 (SE 0.014), standardized β = 0.095, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.217 (SE 0.015), standardized β = 0.187, p < 0.001 for adolescent boys). Each borough of NYC included clusters of neighborhoods with higher and lower NAI exposure, although clusters varied in size and patterns of geographic dispersion across boroughs. Conclusions: A spatial index capturing neighborhood environment factors associated with ACE exposure is associated with higher BMI among NYC youth. Findings complement prior literature about relationships between neighborhood environment and obesity risk, existing research documenting ACE-obesity associations, and the potential for neighborhood factors to be a source of adversity. Collectively, evidence suggests that trauma-informed place-based obesity reduction efforts merit further exploration as potential means to interrupt ACE-obesity associations.

Understanding cross-data dynamics of individual and social/environmental factors through a public health lens: explainable machine learning approaches

Introduction

The rising prevalence of obesity has become a public health concern, requiring efficient and comprehensive prevention strategies.

Methods

This study innovatively investigated the combined influence of individual and social/environmental factors on obesity within the urban landscape of Seoul, by employing advanced machine learning approaches. We collected 'Community Health Surveys' and credit card usage data to represent individual factors. In parallel, we utilized 'Seoul Open Data' to encapsulate social/environmental factors contributing to obesity. A Random Forest model was used to predict obesity based on individual factors. The model was further subjected to Shapley Additive Explanations (SHAP) algorithms to determine each factor's relative importance in obesity prediction. For social/environmental factors, we used the Geographically Weighted Least Absolute Shrinkage and Selection Operator (GWLASSO) to calculate the regression coefficients.

Results

The Random Forest model predicted obesity with an accuracy of >90%. The SHAP revealed diverse influential individual obesity-related factors in each Gu district, although 'self-awareness of obesity', 'weight control experience', and 'high blood pressure experience' were among the top five influential factors across all Gu districts. The GWLASSO indicated variations in regression coefficients between social/environmental factors across different districts.

Conclusion

Our findings provide valuable insights for designing targeted obesity prevention programs that integrate different individual and social/environmental factors within the context of urban design, even within the same city. This study enhances the efficient development and application of explainable machine learning in devising urban health strategies. We recommend that each autonomous district consider these differential influential factors in designing their budget plans to tackle obesity effectively.

Long-Term Exposure to Walkable Residential Neighborhoods and Risk of Obesity-Related Cancer in the New York University Women's Health Study (NYUWHS)

BACKGROUND

Living in neighborhoods with higher levels of walkability has been associated with a reduced risk of obesity and higher levels of physical activity. Obesity has been linked to increased risk of 13 cancers in women. However, long-term prospective studies of neighborhood walkability and risk for obesity-related cancer are scarce.

OBJECTIVES

We evaluated the association between long-term average neighborhood walkability and obesity-related cancer risk in women.

METHODS

The New York University Women's Health Study (NYUWHS) is a prospective cohort with 14,274 women recruited between 1985 and 1991 in New York City and followed over nearly three decades. We geocoded residential addresses for each participant throughout follow-up and calculated an average annual measure of neighborhood walkability across years of follow-up using data on population density and accessibility to destinations associated with geocoded residential addresses. We used ICD-9 codes to characterize first primary obesity-related cancers and employed Cox proportional hazards models to assess the association between average neighborhood walkability and risk of overall and site-specific obesity-related cancers.

RESULTS

Residing in neighborhoods with a higher walkability level was associated with a reduced risk of overall and site-specific obesity-related cancers. The hazards ratios associated with a 1-standard deviation increase in average annual neighborhood walkability were 0.88 (95% CI: 0.85, 0.93) for overall obesity-related cancer, 0.89 (95% CI: 0.84, 0.95) for postmenopausal breast cancer, 0.82 (95% CI: 0.68, 0.99) for ovarian cancer, 0.87 (95% CI: 0.76, 0.99) for endometrial cancer, and 0.68 (95% CI: 0.49, 0.94) for multiple myeloma, adjusting for potential confounders at both the individual and neighborhood level. The association between neighborhood walkability and risk of overall obesity-related cancer was stronger among women living in neighborhoods with higher levels of poverty compared with women living in areas with lower poverty levels (p Interaction = 0.006 ).

DISCUSSION

Our study highlights a potential protective role of neighborhood walkability in preventing obesity-related cancers in women. https://doi.org/10.1289/EHP11538.

Environment and child well-being: A scoping review of reviews to guide policies

Background

Acting on social determinants is the most effective, efficient, and fairest strategy to improve population health and health equity. Because of their vulnerability and dependence, children are particularly exposed to the deleterious effects of their living environment. Taking these issues into account in the development of public policies and identifying levers for action are crucial. The objective of this scoping review of reviews is to identify the main environmental determinants on children's health and development, and their mechanisms of effect, to be addressed by public policies.

Methods

We conducted a scoping review of reviews in accordance with the method developed by Arksey and O'Malley, and Levac and colleagues' methodology advancement and the PRISMA guideline. Inclusion criteria were identified with the PICos (population-phenomena of interest-context-study design) framework. We used the PubMed database and conducted a thematic analyze.

Results

Forty-seven articles were selected. Their analysis allowed us to identify five categories of interdependent environmental determinants of child health: i) urban design ii) contaminants, iii) parenting environment, iv) social conditions, v) climate change. Together and in a systemic way, they act on the health of the child.

Conclusion

The review carried out allows us to propose a pragmatic framework for clarifying the effects of the physical, social, and economic environment on children's health and wellbeing.

Quality appraisal of spatial epidemiology and health geography research: A scoping review of systematic reviews

A scoping review of peer-reviewed literature was conducted to understand how systematic reviews assess the methodological quality of spatial epidemiology and health geography research. Fifty-nine eligible reviews were identified and included. Variations in the use of quality appraisal tools were found. Reviews applied existing quality appraisal tools with no adaptations (n = 32; 54%), existing quality appraisal tools with adaptations (n = 9; 15%), adapted tools or methods from other reviews (n = 13; 22%), and developed new quality appraisal tools for the review (n = 5; 8%). Future research should focus on developing and validating a quality appraisal tool that evaluates the spatial methodology within studies.

Association between the built environment and moderate to vigorous leisure-time physical activity among suzhou adolescents: a cross-sectional study

INTRODUCTION

Cardiovascular disease and obesity are both significantly influenced by physical inactivity. A rapidly expanding corpus of research contends that features of the built environment might encourage adolescents to lead active lives. There are still issues with the present evidence for determining which aspects of the built environment give adolescents the opportunity to engage in leisure-time physical activity (LTPA). This study looked at the relationship between the characteristics of the built environment and moderate-to-vigorous leisure-time physical activity (Leisure-time MVPA) of adolescents.

METHODS

2628 adolescents between the ages of 11 and 18 were chosen as study participants from 19 Suzhou urban communities. They must have resided in the neighborhood for longer than six months and be permanent residents there. The International Physical Activities Questionnaire (n = 2628) and the Neighborhood Environment Walkability Scale for Chinese Children (NEWS-CC) were used to collect the data. LTPA are connected to different modes: Walking, leisure-time MPA, and leisure-time VPA. Univariate analysis and multinomial logistic regression were used to screen for potential associations between the built environment and the leisure-time MVPA in adolescents.

RESULTS

Univariate analysis of the general demographic and built environment showed statistically significant differences in gender, residential density, accessibility, pedestrian safety, aesthetic and security (P < 0.05). Step by walking reference category, security (P < 0.05, OR = 1.131) were associated with adolescents' leisure-time MPA, aesthetics (P < 0.05, OR = 1.187) were associated with adolescents' leisure-time VPA, they both have a significant positive correlation.

CONCLUSION

Security was positively associated with adolescents' leisure-time MPA, aesthetics was positively associated with adolescents' leisure-time VPA. This suggests that built environment may associated with leisure-time MVPA of Suzhou adolescents.

Urban environment and health behaviours in children from six European countries

BACKGROUND

Urban environmental design is increasingly considered influential for health and wellbeing, but evidence is mostly based on adults and single exposure studies. We evaluated the association between a wide range of urban environment characteristics and health behaviours in childhood.

METHODS

We estimated exposure to 32 urban environment characteristics (related to the built environment, traffic, and natural spaces) for home and school addresses of 1,581 children aged 6-11 years from six European cohorts. We collected information on health behaviours including total amount of overall moderate-to-vigorous physical activity, physical activity outside school hours, active transport, sedentary behaviours and sleep duration, and developed patterns of behaviours with principal component analysis. We used an exposure-wide association study to screen all exposure-outcome associations, and the deletion-substitution-addition algorithm to build a final multi-exposure model.

RESULTS

In multi-exposure models, green spaces (Normalized Difference Vegetation Index, NDVI) were positively associated with active transport, and inversely associated with sedentary time (22.71 min/day less (95 %CI -39.90, -5.51) per interquartile range increase in NDVI). Residence in densely built areas was associated with more physical activity and less sedentary time, and densely populated areas with less physical activity outside school hours and more sedentary time. Presence of a major road was associated with lower sleep duration (-4.80 min/day (95 %CI -9.11, -0.48); compared with no major road). Results for the behavioural patterns were similar.

CONCLUSIONS

This multicohort study suggests that areas with more vegetation, more building density, less population density and without major roads are associated with improved health behaviours in childhood.

Benchmarking the driver acceleration impact on vehicle energy consumption and CO2 emissions

The study proposes a methodology for quantifying the impact of real-world heterogeneous driving behavior on vehicle energy consumption, linking instantaneous acceleration heterogeneity and CO₂ emissions. Data recorded from 20 different drivers under real driving are benchmarked against the Worldwide Harmonized Light Vehicle Test Cycle (WLTC), first by correlating the speed cycle with individual driver behavior and then by quantifying the CO₂ emissions and consumption. The vehicle-Independent Driving Style metric (IDS) is used to quantify acceleration dynamicity, introducing driving style stochasticity by means of probability distribution functions. Results show that the WLTC cycle assumes a relatively smooth acceleration style compared to the observed ones. The method successfully associates acceleration dynamicity to CO₂ emissions. We observe a 5% difference in the CO₂ emissions between the most favourable and the least favourable case. The intra-driver variance reached 3%, while the inter-driver variance is below 2%. The approach can be used for quantifying the driving style induced emissions divergence.

Urban sprawl and childhood obesity

Urban sprawl is thought to be a risk factor for childhood obesity primarily because the physical environment it creates discourages children's physical activity while encouraging their sedentary behavior. However, there has not been any review on the association between urban sprawl and childhood obesity. This study filled this research gap by comprehensively reviewing literature focusing on associations between urban sprawl and weight-related behaviors and outcomes among children and adolescents. Only two longitudinal and three cross-sectional studies conducted in two countries were identified. Sample sizes ranged from 2324 to 129 781. Four studies used weight status, and only one study used both behaviors and weight status as outcome variables. All positive, negative, and non-significant associations were reported. This review could not identify a clear association between urban sprawl and childhood obesity. More longitudinal studies are needed for in-depth analyses on this important topic in more regions, which would be important not only for public health guidelines but also for research, practice, and policies in urban planning.

Neighbourhood residential density and childhood obesity

Residential density is considered an important attribute of the built environment that may be relevant to childhood obesity. However, findings remain inconclusive, and there are no reviews yet on the association between residential density and childhood obesity. This study aimed to systematically review the associations between residential density and weight-related behaviours and outcomes. A comprehensive literature search was conducted using the Cochrane Library, PubMed and Web of Science for articles published before 1 January 2019. A total of 35 studies conducted in 14 countries were identified, including 33 cross-sectional studies, one longitudinal study and one containing both study designs. Residential density was measured by Geographic Information Systems in 28 studies within a varied radius from 0.25 to 2 km around the individual residence. Our study found a general positive association between residential density and physical activity (PA); no significant associations were observed. This study provided evidence for a supportive role of residential density in promoting PA among children. However, it remained difficult to draw a conclusion between residential density and childhood obesity. Future longitudinal studies are warranted to confirm this association.

Natural environment and childhood obesity: A systematic review

The associations between built and food environments and childhood obesity have been studied extensively. However, the association between the natural environment and childhood obesity has received too little scholarly attention. This study reviewed the literature published before 1 January 2019, which described associations between a full range of natural environmental factors (e.g., rainfall, temperature, sunlight, natural disasters, flood and drought) and weight-related behaviours and childhood obesity. Five cross-sectional studies and one longitudinal study were identified. Measures of natural environmental factors varied across six included studies, falling into five broad categories: weather conditions, altitude, natural disaster risk, air quality and day length. It was found that temperature was a significant weather indicator in most included studies and was associated with a reduction of daily physical activity. Children living in high-altitude areas were more likely to be shorter and heavier than their counterparts in low-altitude areas. Findings of this study will contribute to helping multiple stakeholders, including policy makers and urban planners, and formulate health policies and interventions to mitigate the detrimental impact of the natural environment on childhood obesity. More longitudinal studies should be designed to confirm these effects and explore the potential health effects of more natural environmental factors.

Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS)

Lockdown measures including school closures due to COVID-19 may affect youths’ activity patterns and obesity status. This will be for the first time examined in China in this study on the basis of a large national sample from the COVID-19 Impact on Lifestyle Change Survey (COINLICS). Through an online questionnaire, 10,082 participants from high schools, colleges, and graduate schools, aged 19.8 ± 2.3 years, voluntarily reported their lifestyles and weight status before (January 2020) and after lockdown (April–May 2020). The significance of these changes was assessed between sexes and across education levels. We found that the youths’ average body mass index significantly increased from 21.8 to 22.1 kg/m², with the prevalences of overweight/obesity and obesity increasing from 21.4% to 24.6% and from 10.5% to 12.6%, respectively. Also, significant decreases were seen in the frequency of engaging in active transport, moderate-/vigorous-intensity housework, leisure-time moderate-/vigorous-intensity physical activity, and leisure-time walking, while significant increases were observed in the average sedentary time during workdays and weekends, the average sleeping time during workdays and weekends, and screen time. Our findings would serve as important evidence for shaping global strategies to counteract or reverse the lockdown effects on youths’ obesity.