The impact of the built environment on health across the life course: design of a cross-sectional data linkage study

The moderating role of parent perceptions in relationships between objectively measured neighbourhood environment attributes and pre-schooler's physical activity: Findings from the PLAYCE study

We examined the moderating effects of parent perceptions of the neighbourhood environment on associations between objectively measured neighbourhood environment attributes and physical activity among pre-schoolers. The number of neighbourhood parks was positively associated with pre-schooler energetic play when parents had above average perceptions of access to services. Objectively measured street connectivity was associated with fewer minutes of energetic play when pedestrian and traffic safety was perceived to be below average by parents. Greater understanding of the role played by parents in pre-schooler's exposure to physically active supportive environments is needed to inform environmental interventions for specific age groups.

Data to Decisions: Methods to Create Neighbourhood Built Environment Indicators Relevant for Early Childhood Development

Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks, are associated with a range of health and wellbeing outcomes across the life course, but evidence with early years’ outcomes is still emerging. Data linkage techniques were used to assemble a dataset of spatial (objectively-measured) neighbourhood-built environment (BE) measures linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children living in the 21 most populous urban and regional Australian cities (n = 235,655) to help address this gap. This paper describes the methods used to develop this dataset. This linked dataset (AEDC-BE) is the first of its kind worldwide, enabling opportunities for identifying which features of the built environment are associated with ECD across Australia at scale, allow comparisons between diverse contexts, and the identification of where best to intervene. National data coverage provides statistical power to model real-world complexities, such as differences by city, state/territory, and remoteness. The neighbourhood-built environment can be modified by policy and practice at scale, and has been identified as a way to help reduce inequitable early childhood development outcomes.

The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study

The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.

Associations between Park and Playground Availability and Proximity and Children's Physical Activity and Body Mass Index: The BEACH Study

A cross-sectional study was designed to evaluate the relationship between the availability and proximity to parks and playgrounds and physical activity (PA). Moreover, the accessibility to parks and playgrounds and its association with active commuting to/from school (ACS) and body mass index (BMI) were analyzed. The sample was composed of children aged 6-12 years old from the BEACH (Built Environment and Active CHildren) study in Valencia, Spain. The availability and proximity to parks and playgrounds were calculated at different buffer sizes (250, 500, 1000 and 1250 m) using geographical information system data. PA out of school was assessed using accelerometers. Sociodemographics and ACS were measured with a parent questionnaire. Objectively measured weight and height were used to calculate BMI. Mixed linear regression analyses were conducted for each exposure variable, adjusting for sociodemographics, neighborhood walkability level, and participant clustering. The number of parks and playgrounds were positively associated with moderate to vigorous PA (MVPA) and total PA (TPA); including light PA and MVPA, during weekdays, in different buffer sizes. A negative relationship between distance to the nearest playground and TPA during weekdays was found. In addition, the number of playgrounds was positively related to ACS in different buffer sizes, whereas park land area was negatively related to the BMI percentile. This study highlights the importance of assessing the availability and proximity to parks and playgrounds in children's neighborhoods when PA behavior and weight status are analyzed. Study findings may help policymakers when targeting interventions to promote health-enhancing behaviors in children.

Impact of Housing and Infrastructure on handwashing in Peru

BACKGROUND

The metropolitan area of Lima, Peru has a third of the nation's population living in slum dwellings that are hypothesized to contribute to inefficient household hygienic practices. The purpose of this study was to quantitatively assess which living conditions have the greatest impact on handwashing practices.

METHODS

A cross-sectional epidemiological design of participants ≥16 y of age from San Juan de Miraflores, a slum on the outskirts of Lima, Peru, was used. Poisson regression was applied to assess the impact of living conditions on handwashing practices.

RESULTS

We could not demonstrate a relationship between living conditions (home structure, overcrowding, water, grey water disposal) and reported handwashing. The reported lack of handwashing is associated with the number of children in the home (those with children <5 y of age were more likely not to report washing their hands) and length of stay in the slum in years.

CONCLUSIONS

Living conditions play an important role in one's health, therefore improved study designs are needed to determine which strategies are likely to be the most effective in improving outcomes for slum dwellers.

Measuring the Built Environment in Studies of Child Health-A Meta-Narrative Review of Associations

Although the built environment (BE) is important for children’s health, there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative review was undertaken by a multi-disciplinary team of researchers to summarise ways in which the BE is measured, and how this links to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The most commonly addressed health-related outcomes were active travel, physical activity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (perceived) measurements of the BE. However, there was a wide variety, and sometimes inconsistency, in their definition and use. There were clear associations between the BE and children’s health. Objective physical activity and self-reported active travel, or obesity, were positively associated with higher street connectivity or walkability measures, while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Despite the high heterogeneity found in BE measures and health outcomes, the meta-narrative approach enabled us to identify ten BE categories that are likely to support children’s health and be protective against some non-communicable disease risk factors. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential unintended health consequences of making changes to the BE.

How urban and rural built environments influence the health attitudes and behaviors of people who use drugs

Research suggests that the built environment is associated with drug use. However, there is limited scholarship focusing on specific features of the built environment that influence drug use behaviors, experiences, and patterns and how risk factors for drug use are placed in distinctive urban and rural settings. Applying Neely and Samura's conceptual theory that describes space as contested, fluid and historical, interactional and relational, and defined by inequality and difference, we assessed data from semi-structured qualitative interviews conducted between 2019 and 2020 with consumers at syringe exchange programs (SEPs) in an urban location (New York City) and a rural location (southern Illinois). We aimed to contextualize how drug use manifests in each space. In total, 65 individuals, including 59 people who use drugs (PWUD) and six professionals who worked with PWUD, were interviewed. Findings illustrate that, in both the urban and rural setting, the built environment regulates the drug use milieu by mediating social reproduction, namely the degree of agency PWUD exert to acquire and use drugs where they desire. Processes of "stigma zoning," defined as socio-spatial policing of boundaries of behavior deemed undesirable or deviant, impacted PWUD's socio-geographic mobility, social conditions, and resource access, and modulated PWUD's broader capacity and self-efficacy. Similar patterns of drug use, according to social and economic inequities chiefly related to housing instability, were further observed in both settings.

Built Environment and HIV Linkage to Care in Rural South Africa

Background

We assessed built environment (residential density, landuse mix and aesthetics) and HIV linkage to care (LTC) among 1,681 (18–49 years-old) residents of 15 Mpumalanga villages, South Africa.

Methods

Multilevel models (linear-binomial) were used for the association between built environment, measured using NEWS for Africa, and LTC from a clinical database of 9 facilities (2015–2018). Additionally, we assessed effect-measure modification by universal test-and-treat policy (UTT).

Results

We observed, a significant association in the adjusted 3-month probability of LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2–10.1), however, no association for land-use mix (RD%: 2.4, 95%CI: −0.4, 5.2) and aesthetics (RD%: −1.2, 95%CI: −4.5–2.2). Among those diagnosed after UTT, residents of high land-use villages were more likely to link-to-care than those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1–8.1, p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: −2.1–8.0, p > 0.10).

Conclusion

Findings suggest, better built environment conditions (adequate infrastructure, proximity to services etc.) help facilitate LTC. Moreover, UTT appears to have a protective effect on LTC.

Designing healthier neighbourhoods: a systematic review of the impact of the neighbourhood design on health and wellbeing

Several studies have investigated the impact of neighbourhood design on health and wellbeing, yet there are limited reviews investigating the quality of the evidence and the most effective interventions at a population level. This systematic review aims to clarify the impact of the neighbourhood design on health and wellbeing and evaluate the quality of the evidence underpinning such associations. Eight electronic databases were searched for studies conducted between 2000 and 2016. Additional searches were conducted on Google to identify potentially eligible grey literature. A total of 7694 studies were returned from the literature search, and a final selection of 39 studies were deemed eligible for inclusion. Quality appraisal was conducted using the Quality Assessment Tool for Quantitative Studies. Findings from the studies showed important associations between neighbourhood design principles such as walkability, access to green space and amenities on health and wellbeing. Findings from this review also highlight areas with inconsistent findings and gaps in the evidence for future research.

Scoping review of health in office design approaches

Purpose

This paper aims to explore the literature on office design approaches (ODAs) in relation to employee health. The overall goal is to facilitate the practical use and theoretical development of design approaches to healthy offices.

Design/methodology/approach

A scoping review of 7,432 papers collected from 4 electronic databases and 5 scientific journals resulted in the selection of 18 papers for content analysis.

Findings

Various ODAs relating to building design features and health were identified. The findings highlight challenges for this emergent field, including a paucity of literature on ODAs, a lack of definitions of health and healthy offices, ambiguous design strategies and a lack of a holistic ODA.

Originality/value

ODAs are potentially valuable resources but an under-considered topic for healthy office development. To the best of the authors’ knowledge, this study is the first scoping review to map and compare different design approaches in the context of office design and its main contribution is in encouraging researchers and practitioners to bring a salutogenic and holistic perspective to their design approaches.

Children’s neighbourhood physical environment and early development: an individual child level linked data study

Background

Identification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features.

Methods

This cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child’s home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features.

Results

After adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability.

Conclusions

The neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.

Loneliness and depression among older European adults: The role of perceived neighborhood built environment

Depression and loneliness act in a synergistic way among older adults. We tested two indicators of the perceived neighborhood built environment (BE) as moderators of the association between these conditions in older European adults. Positive perceptions of neighborhood BE were related to lower levels of loneliness but not to major depressive disorder (MDD). Reporting low BE usability was significantly related to a higher likelihood of feeling lonely except for those suffering from MDD, whereas reporting low BE walkability was significantly related with a high likelihood of loneliness particularly among those with MDD. Therefore, improving neighborhood BE and, specifically, its walkability, might result in a reduction in the prevalence of loneliness.

Spatial Clusters of Diabetes and Physical Inactivity: Do Neighborhood Characteristics in High and Low Clusters Differ?

This study aims to find spatial clusters of diabetes and physical inactivity among a sample population in Kerala, India, and evaluate built environment characteristics within the high and low spatial clusters. Spatial clusters with a higher and lower likelihood of diabetes and physical inactivity were identified using spatial scan statistic at various radii. Built environment characteristics were captured at panchayat level and 1600 m buffer around participant location using Geographical Information Systems. Comparison of sociodemographic and built environment factors was carried out for participants within high and low spatial clusters using t tests. Ten high and 8 low spatial clusters of diabetes and 17 high and 23 low spatial clusters of physical inactivity were identified in urban and rural areas of Kerala. Significant differences in built environment characteristics were consistent for low spatial clusters of diabetes and physical inactivity in the urban scenario. Built environment characteristics were found to be relevant in both urban and rural areas of Kerala. There is an urgent call to explore spatial clustering of non-communicable diseases in Kerala and undo the one-size-fits-all approach for prevention and control of non-communicable diseases.

Exploring the association between urbanisation and self-rated health of older adults in China: evidence from a national population sample survey

OBJECTIVES

This study investigated the association between urbanisation and self-rated health of older adults in China, particularly how different dimensions, rate and level of urbanisation are related to older people's health. Additionally, it examined the moderating effect of education on the association between each of the four dimensions of urbanisation and older people's health.

DESIGN

The study uses a cross-sectional survey design.

PARTICIPANTS

This study analysed 236 030 individuals (aged 60-79 years) nested within 267 prefecture-level cities from 2005 China's 1% population sample survey.

OUTCOME MEASURES

Self-rated health was the outcome variable. Four groups of predictors assessed prefectures' level and rate of urbanisation: land-use conversion, economic growth, population concentration and health services. Multilevel logistic regression was used to examine the association between self-rated health and the level and rate of urbanisation, after adjusting for individual-level covariates. Multiplicative interactions explored variations by education.

RESULTS

The odd of reporting fair or poor health was negatively associated with the level and rate of population concentration (OR 0.93,95%CI 0.87 to 0.99 and 0.74,95%CI 0.59 to 0.93, respectively) and positively associated with the level of health services (OR 1.12, 95% CI 1.06 to 1.19). Land-use conversion, economic growth and health service improvements (the forms of rate of urbanisation) were not significantly associated with self-rated health. Education had a moderating effect on the association between urbanisation and self-rated health.

CONCLUSIONS

Older people living in more densely populated areas and areas undergoing rapid population concentration were less likely to report fair or poor health. This result supports healthy migration and 'salmon bias' hypotheses. No urban health penalty was observed for the older adults in China; therefore, the following pathways linking urbanisation to health are unclear: lifestyle changes, environmental pollution and cultivated land reduction.

Profile Resemblance in Health-Related Markers: The Portuguese Sibling Study on Growth, Fitness, Lifestyle, and Health

The co-occurrence of health-related markers and their associations with individual, family, and environmental characteristics have not yet been widely explored in siblings. We aimed to identify multivariate profiles of health-related markers, analyze their associations with biological, sociodemographic, and built environment characteristics, and estimate sibling resemblance in these profiles. The sample includes 736 biological siblings aged 9–20 years. Body fat was measured with a portable bioelectrical impedance scale; biological maturation was assessed with the maturity offset; handgrip strength, standing long jump, one-mile run, and shuttle run were used to mark physical fitness. Health behaviors, sociodemographic, and built environmental characteristics were recorded by questionnaire. Latent profile analysis and multilevel logistic regression models were used; sibling resemblance was estimated with the intraclass correlation (ρ). Two multivariate profiles emerged: “P1 = fit, lower fat and poorer diet” (86.7%) and “P2 = higher fat and lower fit, but better diet” (13.3%). Siblings whose fathers were less qualified in their occupation were more likely to belong to P2 (OR = 1.24, p = 0.04); those whose fathers with Grade 12 and university level education were more likely to fit in P2 compared to peers living with fathers having an educational level below Grade 12 (OR = 3.18, p = 0.03, and OR = 6.40, p = 0.02, Grade 12 and university level, respectively). A moderate sibling profile resemblance was found (0.46 ≤ ρ ≤ 0.55). In conclusion, youth health-related markers present substantial differences linked with their body composition, physical fitness and unhealthy diet. Furthermore, only father socio-demographic characteristics were associated with profile membership. Sibling´s profile resemblance mirrors the effects of genetics and shared characteristics.

The effects of changes to the built environment on the mental health and well-being of adults: Systematic review

There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.

Healthy urban living: Residential environment and health of older adults in Shanghai

A healthy residential environment, especially for older adults, has emerged as an important issue on political and planning agenda in China. This paper aims to investigate the direct and indirect impact of residential environment on the health of older adults in Shanghai, taking into account health-related behaviours, subjective well-being and socio-demographic factors in one comprehensive conceptual model. Our results show that the residential environment is associated with older adults' health directly, and also indirectly through a series of significant behavioural (physical and social activities) and perceptual (subjective well-being) factors. After combining the direct and indirect association, the results show that good housing and neighbourhood quality and a safe social environment contribute to better subjective, physical and mental health conditions of older adults. In addition, access to cultural facilities is positively related to older adults' mental and physical health and subjective well-being, while a higher proportion of older adults in a neighbourhood appears to promote physical and social activities but not health.

Mapping distance-decay of cardiorespiratory disease risk related to neighborhood environments

Neighborhood characteristics affect an individual's quality of life. Although several studies have examined the relationship between neighborhood environments and human health, we are unaware of studies that have examined the distance-decay of this effect and then presented the risk results spatially. Our study is unique in that is explores the health effects in a less developed country compared to most studies that have focused on developed countries. The objective of our study is to quantify the distance-decay cardiorespiratory diseases risk related to 28 neighborhood aspects in the Federal District, Brazil and present this information spatially through risk maps of the region. Toward this end, we used a quantile regression model to estimate risk and GIS modeling techniques to create risk maps. Our analysis produced the following findings: i) a 2500 m increase in highway length was associated with a 46% increase in cardiorespiratory diseases; ii) 46,000 light vehicles in circulation (considering a buffer of ≤500 m from residences) was associated with 6 hospital admissions (95% CI: 2.6, 14.6) per cardiorespiratory diseases; iii) 74,000 m² of commercial areas (buffer ≤1700 m) was associated with 12 hospital admissions (95% CI: 2.2, 20.8); iv) 1km² increase in green areas intra urban was associated with less two hospital admissions, and; vi) those who live ≤500 m from the nearest point of wildfire are more likely to have cardiorespiratory diseases that those living >500 m. Our findings suggest that the approach used in this study can be an option to improve the public health policies.

Older adults' quality of life - Exploring the role of the built environment and social cohesion in community-dwelling seniors on low income

The built environment and social cohesion are increasingly recognized as being associated with older adults' quality of life (QoL). However, limited research in this area still exists and the relationship has remained unexplored in the area of Metro Vancouver, Canada. This study examined the association between the built environment and social cohesion with QoL of 160 community-dwelling older adults (aged ≥ 65 years) on low income from Metro Vancouver. Cross-sectional data acquired from the Walk the Talk (WTT) study were used. Health-related QoL (HRQoL) and capability wellbeing were assessed using the EQ-5D-5L and the ICECAP-O, respectively. Measures of the environment comprised the NEWS-A (perceived built environment measure), the Street Smart Walk Score (objective built environment measure), and the SC-5PT (a measure of social cohesion). The primary analysis consists of Tobit regression models to explore the associations between environmental features and HRQoL as well as capability wellbeing. Key findings indicate that after adjusting for covariates, older adults' capability wellbeing was associated with street connectivity and social cohesion, while no statistically significant associations were found between environmental factors and HRQoL. Our results should be considered as hypothesis-generating and need confirmation in a larger longitudinal study.

Is neighbourhood access to tobacco outlets related to smoking behaviour and tobacco-related health outcomes and hospital admissions?

OBJECTIVES

Although the harms of tobacco use are widely accepted, few studies have examined the relationship between access to tobacco outlets and hospital admissions. This study aimed to examine the relationship between neighbourhood access to tobacco outlets, smoking and hospital admissions and self-reported morbidity.

METHODS

Responses as to smoking behaviour were obtained from 12,270 adult participants in Western Australia (2003-2009) and individually record-linked to hospital admissions and geographically linked to tobacco outlets.

RESULTS

Neighbourhood access to tobacco outlets was marginally positively associated with being a current versus a past smoker. Tobacco outlet access was also positively associated with heart disease for smokers but not non-smokers. For smokers, each additional outlet within 1600m of home was associated with a 2% increase in the odds of heart disease.

CONCLUSION

Smokers with greater access to tobacco outlets were more likely to be diagnosed with or admitted to hospital for heart disease. Regulating the density of tobacco outlets in the community has immense potential to improve health benefits and our results motivate the need for future longitudinal studies to confirm this hypothesis.

Can the Neighborhood Built Environment Make a Difference in Children's Development? Building the Research Agenda to Create Evidence for Place-Based Children's Policy

Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development. The relatively few studies exploring this relationship support associations between child development and neighborhood destinations, green spaces, interaction with nature, traffic exposure, and housing density. These studies emphasize the need to more deeply understand how child development outcomes might be influenced by the neighborhood built environment. Pursuing this research space is well aligned with the current global movements on livable and child-friendly cities. It has direct public policy impact by informing planning policies across a range of sectors (urban design and planning, transport, public health, and pediatrics) to implement place-based interventions and initiatives that target children's health and development at the community level. We argue for the importance of exploring the effect of the neighborhood built environment on child development as a crucial first step toward informing urban design principles to help reduce developmental vulnerability in children and to set optimal child development trajectories early.

The NIHR Public Health Research Programme: responding to local authority research needs in the United Kingdom

The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health.

A novel land use approach for assessment of human health: The relationship between urban structure types and cardiorespiratory disease risk

Extensive evidence shows that in addition to lifestyle factors, environmental aspects are an important risk factor for human health. Numerous approaches have been used to estimate the relationship between environment and health. For example, the urban characteristics, especially the types of land use, are considered a potential proxy indicator to evaluate risk of disease. Although several studies have used land use variables to assess human health, none of them has used the concept of Urban Morphology by Urban Structure Types (USTs) as indicators of land use. The aim of this study was to assess the relationship between USTs and cardiorespiratory disease risks in the Federal District, Brazil. Toward this end, we used a quantile regression model to estimate risk. We used 21 types of UST. Income and population density were used as covariates in our sensitivity analysis. Our analysis showed an association between cardiorespiratory diseases risk and 10 UST variables (1 related to rural area, 6 related to residential area, 1 recreational area, 1 public area and 1 commercial area). Our findings suggest that the conventional land use method may be missing important information about the effect of land use on human health. The use of USTs can be an approach to complement the conventional method. This should be of interest to policy makers in order to enhance public health policies and to create future strategies in terms of urban planning, land use and environmental health.

Variations in active transport behavior among different neighborhoods and across adult lifestages

OBJECTIVE

Built environment characteristics are closely related to transport behavior, but observed variations could be due to residents own choice of neighborhood called residential self-selection. The aim of this study was to investigate differences in neighborhood walkability and residential self-selection across life stages in relation to active transport behavior.

METHODS

The IPEN walkability index, which consists of four built environment characteristics, was used to define 16 high and low walkable neighborhoods in Aarhus, Denmark (250.000 inhabitants). Transport behavior was assessed using the IPAQ questionnaire. Life stages were categorized in three groups according to age and parental status. A factor analysis was conducted to investigate patterns of self-selection. Multivariable logistic regression analyses were carried out to evaluate the association between walkability and transport behavior i.e. walking, cycling and motorized transport adjusted for residential self-selection and life stages.

RESULTS

A total of 642 adults aged 20-65 years completed the questionnaire. The highest rated self-selection preference across all groups was a safe and secure neighborhood followed by getting around easily on foot and by bicycle. Three self-selection factors were detected, and varied across the life stages. In the multivariable models high neighborhood walkability was associated with less motorized transport (OR 0.33 95%CI 0.18-0.58), more walking (OR 1.65 95%CI 1.03-2.65) and cycling (OR 1.50 95% CI 1.01-2.23). Self-selection and life stage were also associated with transport behavior, and attenuated the association with walkability.

CONCLUSION

This study supports the hypothesis that some variation in transport behavior can be explained by life stages and self-selection, but the association between living in a more walkable neighborhood and active transport is still significant after adjusting for these factors. Life stage significantly moderated the association between neighborhood walkability and cycling for transport, and household income significantly moderated the association between neighborhood walkability and walking for transport. Getting around easily by bicycle and on foot was the highest rated self-selection factor second only to perceived neighborhood safety.

Active commuting to school, weight status, and cardiometabolic risk in children from rural areas: the Cuenca study

PURPOSE

The aim of this study was to examine (a) whether distance from home to school is a determinant of active commuting to school (ACS), (b) the relationship between distance from home to heavily used facilities (school, green spaces, and sports facilities) and the weight status and cardiometabolic risk categories, and (c) whether ACS has a positive impact on schoolchildren's health.

METHOD

A cross-sectional study was conducted with 956 schoolchildren aged 10 to 12 years from the province of Cuenca, Spain. Height, weight, fat mass, waist circumference, blood pressure, fasting plasma lipid profile, insulin, fitness, physical activity, and ACS were measured. Distances from home to facilities were measured by a geographic information system, and a validated metabolic syndrome index was used.

FINDINGS

Children living closer to school (less than 600 m) commuted actively to school more frequently than children living further away (more than 800 m). Normoweight boys lived further away from sports facilities than overweight/obese peers, and children presenting higher cardiometabolic risk levels lived closer to school than those who did not. No differences were found between children who daily walked/cycled to school and those commuting actively to school less frequently in body mass index, metabolic syndrome index, fitness, and physical activity.

CONCLUSIONS

ACS had no positive impact on schoolchildren's health. Distance to school is an indicator of active commuting. However, it seems that not enough physical activity is done to prevent obesity and cardiometabolic risk factors in rural areas.

Does walkable neighbourhood design influence the association between objective crime and walking?

Background

Few studies have investigated associations between objectively measured crime and walking, and findings are mixed. One explanation for null or counterintuitive findings emerges from criminology studies, which indicate that the permeable street layouts and non-residential land uses that underpin walkable neighbourhoods are also associated with more crime. This study examined associations between objective crime and walking, controlling for the characteristics of walkable neighbourhoods.

Methods

A population representative sample of adults (25–65 years) (n = 3,487) completed the Western Australian Health and Wellbeing Survey (2006–2008) demographic and walking frequency items. Objective environmental measures were generated for each participant’s 400 m and 1600 m neighbourhood areas, including burglary, personal crime (i.e., crimes committed against people) in public space, residential density, street connectivity and local destinations. Log-linear negative binomial regression models were used to examine associations between crime and walking frequency/week, with progressive adjustment for residential density, street connectivity and local destinations.

Results

Burglary and personal crime occurring within a participant’s 400 m and 1600 m neighbourhoods were positively and significantly associated with walking frequency. For example, for every additional 10 crimes against the person/year within 400 m of a participant’s home, walking frequency increased by 8% (relative change = 1.077, p = 0.017). Associations remained constant after controlling for residential density and street connectivity, but attenuated after adjusting for local destinations (e.g., for personal crime in 400 m: relative change = 1.054, p = 0.104). This pattern of attenuation was evident across both crime categories and both neighbourhood sizes.

Conclusions

The observed positive associations between objective crime and walking appear to be a function of living in a more walkable environment, as the presence of destinations has the capacity to both promote walking and attract crime. This study provides a plausible explanation for some mixed findings emerging from studies examining crime as a barrier to walking. In some settings, the hypothesised deterrent effect of crime on walking may be insufficient to outweigh the positive impacts of living in a more walkable environment.

People living in hilly residential areas in metropolitan Perth have less diabetes: spurious association or important environmental determinant?

Background

Variations in ‘slope’ (how steep or flat the ground is) may be good for health. As walking up hills is a physiologically vigorous physical activity and can contribute to weight control, greater neighbourhood slopes may provide a protective barrier to weight gain, and help prevent Type 2 diabetes onset. We explored whether living in ‘hilly’ neighbourhoods was associated with diabetes prevalence among the Australian adult population.

Methods

Participants (≥25 years; n = 11,406) who completed the Western Australian Health and Wellbeing Surveillance System Survey (2003–2009) were asked whether or not they had medically-diagnosed diabetes. Geographic Information Systems (GIS) software was used to calculate a neighbourhood mean slope score, and other built environment measures at 1600 m around each participant’s home. Logistic regression models were used to predict the odds of self-reported diabetes after progressive adjustment for individual measures (i.e., age, sex), socioeconomic status (i.e., education, income), built environment, destinations, nutrition, and amount of walking.

Results

After full adjustment, the odds of self-reported diabetes was 0.72 (95% CI 0.55-0.95) and 0.52 (95% CI 0.39-0.69) for adults living in neighbourhoods with moderate and higher levels of slope, respectively, compared with adults living in neighbourhoods with the lowest levels of slope. The odds of having diabetes was 13% lower (odds ratio 0.87; 95% CI 0.80-0.94) for each increase of one percent in mean slope.

Conclusions

Living in a hilly neighbourhood may be protective of diabetes onset or this finding is spurious. Nevertheless, the results are promising and have implications for future research and the practice of flattening land in new housing developments.

Neighborhood walkability and cardiometabolic risk factors in Australian adults: an observational study

BACKGROUND

Studies repeatedly highlight associations between the built environment and physical activity, particularly walking. Fewer studies have examined associations with cardiometabolic risk factors, with associations with obesity inconsistent and scarce evidence examining associations with other cardiometabolic risk factors. We aim to investigate the association between neighborhood walkability and the prevalence of obesity, hypertension, hypercholesterolaemia, and type-2 diabetes mellitus.

METHODS

Cross-sectional study of 5,970 adults in Western Australia. Walkability was measured objectively for a 1,600 m and 800 m neighborhood buffer. Logistic regression was used to assess associations overall and by sex, adjusting for socio-demographic factors. Mediation by physical activity and sedentary behavior was investigated.

RESULTS

Individuals living in high compared with less walkable areas were less likely to be obese (1,600 m OR: 0.84, 95% CI: 0.7 to 1; 800 m OR: 0.75, 95% CI: 0.62 to 0.9) and had lower odds of type-2 diabetes mellitus at the 800 m buffer (800 m OR: 0.69, 95% CI: 0.51 to 0.93). There was little evidence for an association between walkability and hypertension or hypercholesterolaemia. The only significant evidence of any difference in the associations in men and women was a stronger association with type-2 diabetes mellitus at the 800 m buffer in men. Associations with obesity and diabetes attenuated when additionally adjusting for physical activity and sedentary behavior but the overall association with obesity remained significant at the 800 m buffer (800 m OR: 0.78, 95% CI: 0.64 to 0.96).

CONCLUSIONS

A protective association between neighborhood walkability and obesity was observed. Neighborhood walkability may also be protective of type-2 diabetes mellitus, particularly in men. No association with hypertension or hypercholesterolaemia was found. This warrants further investigation. Findings contribute towards the accumulating evidence that city planning and policy related strategies aimed at creating supportive environments could play an important role in the prevention of chronic diseases.