Evaluation of the health effects of a neighbourhood traffic calming scheme

Investigating physical activity levels in adults who are blind and vision impaired

BACKGROUND

It is well established that meeting physical activity (PA) guidelines has a range of physical and mental health benefits. For people who are blind and vision impaired (BVI) there may be additional benefits in terms of social inclusion and the prevention of sight deterioration.

OBJECTIVE

This study aimed to quantify PA levels, barriers to and motivators for PA in adults who are BVI.

METHODS

PA levels, perceived barriers to, and motivators for PA were measured via questionnaire of 310 self-identifying BVI adults (n = 310 mean age = 29.77 ± 11.37, 55.8% male).

RESULTS

PA levels were low, with 21.7% meeting PA guidelines. Median PA levels were not statistically significantly different between different age groups. There was no significant difference between genders, though mean days of PA for males was 0.382 days lower than for females. There was a significant difference between PA levels between the "no vision" (B1) and "useful vision" (B3) groups (p = 0.027), and the "no vision" (B1) and the "low vision" (B2) groups (p = 0.003). Transport (54.8%) and lack of access to enjoyable activities (47.0%) were the most commonly cited barriers, while "to relax" (36.4%) and "to have fun" (35.6%) were most commonly cited as very important motivators.

CONCLUSIONS

This study provides a valuable insight into the low levels of PA that persist amongst adults with BVI. Future research should seek to gain a deeper understanding of the PA barriers, motivators and facilitators in this cohort.

Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon

BACKGROUND

Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes.

METHODS

We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models.

RESULTS

Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8).

LIMITATIONS

Given the design of our study, findings are subject to recall and social desirability bias.

CONCLUSIONS

Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.

Built environment interventions and physical activity levels: A systematic review

Introduction:

Non-communicable diseases are the leading cause of death worldwide and physical activity is a key preventive strategy to reduce them. There is a relationship between the built environment and the practice of physical activity, but little evidence as to whether those built environment interventions not initially designed for promoting physical activity actually have an impact on promoting the behavior.

Objective:

To identify whether such built environment interventions were able to change physical activity in adults.

Materials and methods:

We conducted a systematic review of interventions targeting modifications to the built environment changes in urban areas.

Results:

Out of 5,605 articles reviewed, only seven met our inclusion criteria. The seven studies found higher levels of physical activity after the interventions.

Conclusions:

We recommend greater specificity regarding the study design, the timeline of interventions implementation and post-intervention measurements, as well as the use of more objective measures. Finally, we point out the need to make more explicit the mechanisms of change related to the interventions assessed.

Local walking and cycling by residents living near urban motorways: cross-sectional analysis

Background

Everyday activities, such as walking or cycling, may be a feasible and practical way to integrate physical activity into everyday life. Walking and cycling for transport or recreation in the area local to a person’s home may have additional benefits. However, urban planning tends to prioritise car use over active modes. We explored the cross-sectional association between living near an urban motorway and local walking and cycling.

Methods

In 2013, residents living in an area (a) near a new urban motorway (M74), (b) near a longstanding urban motorway (M8), or (c) without a motorway, in Glasgow, Scotland, were invited to complete postal surveys assessing local walking and cycling journeys and socio-demographic characteristics. Using adjusted regression models, we assessed the association between motorway proximity and self-reported local walking and cycling, as well as the count of types of destination accessed. We stratified our analyses according to study area.

Results

One thousand three hundred forty-three residents (57% female; mean age: 54 years; SD: 16 years) returned questionnaires. There was no overall association between living near an urban motorway and the likelihood of local walking or cycling, or the number of types of local destination accessed by foot or bicycle.

In stratified analyses, for those living in the area around the new M74 motorway, increasing residential proximity to the motorway was associated with lower likelihood of local recreational walking and cycling (OR 0.63, 95% CI: 0.39 to 1.00) a pattern not found in the area with the longstanding M8 motorway. In the area near the M8 motorway residential proximity was statistically significantly (p = 0.014) associated with a 12% decrease in the number of types of destination accessed, a pattern not found in the M74 study area.

Conclusions

Our findings suggest that associations between living near a motorway and local walking and cycling behaviour may vary by the characteristics of the motorway, and by whether the behaviour is for travel or recreation. The lack of associations seen in the study area with no motorway suggests a threshold effect whereby beyond a certain distance from a motorway, additional distance makes no difference.

What Is the Relationship between the Neighbourhood Built Environment and Time Spent in Outdoor Play? A Systematic Review

Outdoor play has been associated with children’s and adolescents’ healthy development and physical activity. Attributes of the neighbourhood built environment can influence play behaviours. This systematic review examined the relationship between attributes of the neighbourhood built environment and the time children and adolescents (0–18 years) spend in self-directed outdoor play. We identified and evaluated 18 relevant papers using the Mixed Methods Appraisal Tool and developed a narrative synthesis of study results. We found moderate evidence that lower traffic volumes (ages 6–11), yard access (ages 3–10), and increased neighbourhood greenness (ages 2–15) were positively associated with time spent in outdoor play, as well as limited evidence that specific traffic-calming street features such as fewer intersections, low traffic speeds, neighbourhood disorder, and low residential density were positively associated with time spent in outdoor play. To our knowledge, this is the first systematic review on this topic. The limited number of “good quality” studies identified highlights the need for additional research on the topic.

Restructuring the built environment to change adult health behaviors: a scoping review integrated with behavior change frameworks

Built environment restructuring can improve public health through increased opportunity for healthy behaviors. Behavioral science targets individual health behaviors within place, suggesting the potential to integrate these approaches. This scoping review was one of the first to summarise the impact built environment restructuring has on health outcomes and behaviors and integrate these findings with the Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework of behavior change. Potential studies were identified from 12 academic databases in urban design, psychology and public health. Search parameters involved 50 environment types, for example green space or healthy cities, combined with both an intervention (e.g. green infrastructure, active transport) and a measurable health outcome (e.g. exercise, wellbeing). Searches were limited to North America, Europe, or Australia/New Zealand. Of 536 potential studies reviewed against defined inclusion/exclusion criteria, 23 contributed to the findings. Evidence supported the positive influence of restructuring on varied health outcomes, many of which were drivers and domains of health behavior. Most studies indicated a clear contribution to increased physical activity. Recommendations include the need for explicit communication of theories guiding restructuring project design, consideration of health outcomes beyond physical activity, and better investigation of unanticipated barriers to health behaviors arising from built environment restructuring projects.

Cities and Mental Health

BACKGROUND

More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities.

METHODS

This review is based on a selective literature search, providing an overview of the risk factors for mental illness in urban centers.

RESULTS

Studies have shown that the risk for serious mental illness is generally higher in cities compared to rural areas. Epidemiological studies have associated growing up and living in cities with a considerably higher risk for schizophrenia. However, correlation is not causation and living in poverty can both contribute to and result from impairments associated with poor mental health. Social isolation and discrimination as well as poverty in the neighborhood contribute to the mental health burden while little is known about specific interactions between such factors and the built environment.

CONCLUSION

Further insights on the interaction between spatial heterogeneity of neighborhood resources and socio-ecological factors is warranted and requires interdisciplinary research.

Associations of perceived neighbourhood safety from traffic and crime with overweight/obesity among South African adults of low-socioeconomic status

BACKGROUND

The relationship between perceived neighbourhood safety from traffic and crime with overweight/obesity can provide intervention modalities for obesity, yet no relevant study has been conducted in sub-Saharan African contexts. We investigated the association between perceived neighbourhood safety from traffic and crime with overweight/obesity among urban South African adults.

METHODS

This cross-sectional study included 354 adults aged ≥35 years drawn from the Prospective Urban Rural Epidemiology (PURE) cohort study. The Neighborhood Walkability Scale-Africa (NEWS-A) was used to evaluate the perceived neighbourhood safety. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the associations between perceived neighborhood safety and overweight/obesity defined "normal weight" and "overweight/obese" using the 25 Kg/m2 cutoff criterion.

RESULTS

In the overall sample, adults who agreed that "the speed of traffic on most nearby roads in their neighborhood was usually slow" were less likely to be overweight/obese (adjusted OR = 0.42; 95%CI 0.23-0.76). Those who agreed that "there was too much crime in their neighborhood to go outside for walks or play during the day" were more likely to be overweight/obese (OR = 2.41; 1.09-5.29). These associations were driven by significant associations in women, and no association in men, with significant statistical interactions.

CONCLUSION

Perceived neighborhood safety from traffic and crime was associated with overweight/obesity among South African adults. Our findings provide preliminary evidence on the need to secure safer environments for walkability. Future work should also consider perceptions of the neighbourhood related to food choice.

Systematic literature review of built environment effects on physical activity and active transport - an update and new findings on health equity

BACKGROUND

Evidence is mounting to suggest a causal relationship between the built environment and people's physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status.

METHODS

A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted.

RESULTS

Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost.

CONCLUSIONS

Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.

Cost-effectiveness of neighbourhood slow zones in New York City

BACKGROUND

Neighbourhood slow zones (NSZs) are areas that attempt to slow traffic via speed limits coupled with other measures (eg, speed humps). They appear to reduce traffic crashes and encourage active transportation. We evaluate the cost-effectiveness of NSZs in New York City (NYC), which implemented them in 2011.

METHODS

We examined the effectiveness of NSZs in NYC using data from the city's Department of Transportation in an interrupted time series analysis. We then conducted a cost-effectiveness analysis using a Markov model. One-way sensitivity analyses and Monte Carlo analyses were conducted to test error in the model.

RESULTS

After 2011, road casualties in NYC fell by 8.74% (95% CI 1.02% to 16.47%) in the NSZs but increased by 0.31% (95% CI -3.64% to 4.27%) in the control neighbourhoods. Because injury costs outweigh intervention costs, NSZs resulted in a net savings of US$15 (95% credible interval: US$2 to US$43) and a gain of 0.002 of a quality-adjusted life year (QALY, 95% credible interval: 0.001 to 0.006) over the lifetime of the average NSZ resident relative to no intervention. Based on the results of Monte Carlo analyses, there was a 97.7% chance that the NSZs fall under US$50 000 per QALY gained.

CONCLUSION

While additional causal models are needed, NSZs appeared to be an effective and cost-effective means of reducing road casualties. Our models also suggest that NSZs may save more money than they cost.

Healthy urban environments for children and young people: A systematic review of intervention studies

This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures.

The Impact of a Signalized Crosswalk on Traffic Speed and Street-Crossing Behaviors of Residents in an Underserved Neighborhood

Infrastructure improvements such as pedestrian crosswalks that calm traffic and increase access to physical activity opportunities could alleviate important barriers to active living in underserved communities with outdated built environments. The purpose of this study was to explore how the built environment influences street-crossing behaviors and traffic speeds in a low-income neighborhood with barriers to active living in Columbia, Missouri. In 2013, a signalized pedestrian crosswalk and 400-ft-long median was constructed along a busy 5-lane, high-speed arterial highway linking low-income housing with a park and downtown areas. Data collection occurred prior to June 2012, and after June 2013, completion of the project at the intervention site and control site. Direct observation of street-crossing behaviors was performed at designated intersections/crosswalks or non-designated crossing points. Traffic volume and speed were captured using embedded magnetic traffic detectors. At the intervention site, designated crossings increased at the new crosswalk (p < 0.001), but not at non-designated crossings (p = 0.52) or designated crossings at intersections (p = 0.41). At the control site, there was no change in designated crossings (p = 0.94) or non-designated crossings (p = 0.79). Motor vehicles traveling above the speed limit of 35 mph decreased from 62,056 (46 %) to 46,256 (35 %) (p < 0.001) at the intervention site and increased from 57,891 (49 %) to 65,725 (59 %) (p < 0.001) at the control site. The installation of a signalized crosswalk facilitated an increase in safe street crossings and calmed traffic volume and speed in an underserved neighborhood. We believe these findings have significant public health implications that could be critical to advocacy efforts to improve infrastructure projects in similar communities.

A health impact assessment of a proposed bill to decrease speed limits on local roads in Massachusetts (U.S.A.)

Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston’s regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries.

Association of street connectivity and road traffic speed with park usage and park-based physical activity

PURPOSE

The purpose of this study was to examine associations between street connectivity and road traffic speed and neighborhood residents' use of parks and park-based physical activity.

DESIGN

Cross-sectional.

SETTING

Kansas City, Missouri.

SUBJECTS

Participants were 893 adults from randomly selected households.

MEASURES

Both self-reported park use and park-based physical activity were dichotomized as some versus none. Intersection density was calculated around each participant, and network analysis was used to determine whether participants had to travel on or cross a road with traffic speed greater than 35 miles per hour (mph) to reach the closest park.

ANALYSIS

Multilevel logistic regression examined the association between intersection density and traffic speed wit park use and park-based physical activity.

RESULTS

Compared to those in the lowest intersection density quartile, participants in the third and fourth quartiles were more likely to use parks and to engage in physical activity in parks (odds ratio [OR] = 1.76-2.34; all p < .05). Likewise, compared to those who had a high-speed road on their way to the closest park, participants with slower traffic routes to parks were more likely to use the parks (OR = 1.47; 95% confidence interval [CI] = 1.05-1.92).

CONCLUSION

In addition to park proximity and the design of park features, ensuring direct and safe access to parks through street network design and traffic speed reduction strategies may be key to facilitating park-related physical activity.

The influence of the local neighbourhood environment on walking levels during the Walking for Wellbeing in the West pedometer-based community intervention

We investigated the relationship between walking levels and the local neighbourhood physical environment during the Walking for Wellbeing in the West (WWW) randomised pedometer-based community intervention. Walking activity was recorded as step counts at baseline (n = 76), and at 3 months (n = 57), 6 months (n = 54), and 12 months (n = 45) post-intervention. Objective physical environment data were obtained from GIS datasets and street surveys conducted using the SWAT audit tool. Sixty-nine environment variables were reduced to eight environment factors using principal axis factoring, and the relationship between environment factors and (i) step counts, and (ii) the change in step counts relative to baseline, was examined using hierarchical multiple linear regression, controlling for age, gender, income, and deprivation. Five environment factors were significant predictors of step counts, but none were significant predictors of the change in step counts relative to baseline. None of the demographic variables included in the analysis were significant predictors at any stage of the study. Total variance explained by the environment ranged from 6% (P < 0.05) to 34% (P < 0.01), with lowest levels during the initial stages of the study. The physical environment appears to have influenced walking levels during the WWW intervention, and to have contributed to the maintenance of walking levels post-intervention.

Roadway characteristics and pediatric pedestrian injury

Changing the built environment is a sound, but often underutilized approach to injury control. The authors reviewed the literature and conducted a meta-analysis to synthesize the evidence on the association of roadway characteristics with risk of pediatric pedestrian injury. To synthesize the data, they converted results to odds ratios based on direct results or abstracted outcomes and used Bayesian meta-analytic approaches by modeling outcomes as the logit of a normally distributed set of outcomes with vague prior distributions for the central measure of effect and its variance. On the basis of 10 studies of roadway features restricted exclusively to pediatric populations, the synthesized effect estimate for the association of roadway characteristics with pedestrian injury risk was 2.5 (95% credible interval: 1.8, 3.2). The probability of a new study showing an association between the built roadway and pediatric pedestrian injury was nearly 100%. The authors concluded that the built environment is directly related to the risk of pedestrian injury. This review and meta-analysis suggests that even modest interventions to the built roadway environment may result in meaningful reductions in the risk of pediatric pedestrian injury.

Our environment, our health: a community-based participatory environmental health survey in Richmond, California

This study presents a health survey conducted by a community-based participatory research partnership between academic researchers and community organizers to consider environmental health and environmental justice issues in four neighborhoods of Richmond, California, a low-income community of color living along the fence line of a major oil refinery and near other industrial and mobile sources of pollution. The Richmond health survey aimed to assess local concerns and perceptions of neighborhood conditions, health problems, mobile and stationary hazards, access to health care, and other issues affecting residents of Richmond. Although respondents thought their neighborhoods were good places to live, they expressed concerns about neighborhood stressors and particular sources of pollution, and identified elevated asthma rates for children and long-time Richmond residents. The Richmond health survey offers a holistic, community-centered perspective to understanding local environmental health issues, and can inform future environmental health research and organizing efforts for community-university collaboratives.

Does social capital determine health? Evidence from eight transition countries

There is growing interest in the role of social relationships in explaining patterns of health. We contribute to this debate by investigating the impact of social capital on self-reported health for eight countries from the Commonwealth of Independent States. We rely on three indicators of social capital at the individual level (trust, participation in local organisations, social isolation) and employ alternative procedures to estimate consistently the impact of social capital on health. The three social capital indicators are choice variables and are hence, by definition, endogenously determined. We attempt to circumvent the endogeneity problems by using instrumental variable estimates. Our results show that the individual degree of trust is positively and significantly correlated with health, this being true with least squares estimators as well as when relying on instrumental variable estimators with (and without) community fixed effects. Similarly, social isolation is negatively and significantly associated with health, irrespective of the procedure of estimation. On the other hand, the effect of being a member of a Putnamesque organisation is more ambiguous and usually not significantly related to health.

The role of the built environment in explaining relationships between perceived and actual pedestrian and bicyclist safety

While the conventional approach to safety planning has emphasized crash analysis with police-reported crash information, transportation professionals increasingly recognize the importance of proactively identifying potential crash risk and considering environmental characteristics. In a proactive approach, individuals' perception of crash risk provides important information in identifying potential crash risk. As built environment characteristics influence the levels of pedestrian and bicycle safety, this study examined how perceived and actual crash risk are related with each other and with respect to built environmental characteristics. Our results showed that residents who live in low density-single residential neighborhoods are more likely to perceive their neighborhood as dangerous relative to residents of compact, mixed-use neighborhoods even though the latter exhibited higher actual crash rates. The results of path analyses confirmed that a simultaneous but opposite relationship exists between perceived and actual crash risks. Our results indicate that higher actual crash risk increases perceived crash risk, while higher perceived crash risk is negatively associated to actual crash rates. Consequently, low density and non-mixed land uses increase individuals perception of crash risk, and increased perception of risk and unfriendly environment for pedestrian and bikers reduces actual crash rates as a result of behavioral changes. From a policy standpoint, more attention and proactive interventions are desirable in suburban areas beyond the areas with high crash rates, as some of these areas have high-perceived risks.

Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice

Background

Transport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice.

Methods

Best available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers.

Results

Aside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA.

Conclusion

Principles of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy.

Are elderly pedestrians allowed enough time at pedestrian crossings in Cape Town, South Africa?

A descriptive, cross-sectional analytical study was conducted to determine whether the recommended walking speed of 1.2 ms(-1) would allow elderly pedestrians to safely clear pedestrian crossings in Cape Town, South Africa. Male and female volunteers (n = 47), aged 65-93 years and resident in four homes for older persons, were recruited. Pedestrian clearance intervals at 40 traffic lights within 5-km radius of the selected homes were measured. The mean walking speed required at these traffic lights was 0.86 +/- 0.32 ms(1). The maximal walking speed over 12 m was measured without carrying any load and when carrying a predetermined weight of an average shopping bag. Participants' emotions associated with pedestrian road safety were also assessed through an interview. The mean maximal unloaded and loaded walking speeds were 1.36 +/- 0.31 ms(-1) (0.73-2.03 ms(-1)), and 1.36 +/- 0.33 ms(-1) (0.58-2.12 ms(-1)), respectively. Over 30% of the participants walked slower than the recommended walking speed of 1.2 ms(-1). Participants felt that traffic lights did not allow for sufficient time to cross roads (51.1%) and reported emotions of apprehension (44.7%), anxiety (17.0%), and fear (10.6%) when crossing. A review of traffic planning and public policy is recommended to ensure older pedestrians safely clear pedestrian crossings.

Pathways to obesity: Identifying local, modifiable determinants of physical activity and diet

Many studies document small area inequalities in morbidity and mortality and show associations between area deprivation and health. However, few studies unpack the "black box" of area deprivation to show which specific local social and physical environmental characteristics impact upon health, and might be amenable to modification. We theorised a model of the potential causal pathways to obesity and employed path analysis using a rich data set from national studies in England and Scotland to test the model empirically. Significant associations between obesity and neighbourhood disorder and access to local high street facilities (local shops, financial services and health-related stores found in a typical small UK town) were found. There was a tendency for lower levels of obesity in areas with more swimming pools and supermarkets. In turn, policing levels, physical dereliction and recorded violent crime were associated with neighbourhood disorder. The analysis identifies several factors that are associated with (and are probably determinants of) obesity and which are outside the standard remit of the healthcare sector. They highlight the role that public and private sector organisations have in promoting the nation's health. Public health professionals should seek to work alongside or within these organisations to capitalise on opportunities to improve health.

Ethnic differences in the effect of environmental stressors on blood pressure and hypertension in the Netherlands

BACKGROUND

Evidence strongly suggests that the neighbourhood in which people live influences their health. Despite this, investigations of ethnic differences in cardiovascular risk factors have focused mainly on individual-level characteristics. The main purpose of this study was to investigate associations between neighbourhood-level environmental stressors (crime, housing density, nuisance from alcohol and drug misuse, quality of green space and social participation), and blood pressure (BP) and hypertension among different ethnic groups.

METHODS

Individual data from the Amsterdam Health Survey 2004 were linked to data on neighbourhood stressors creating a multilevel design for data analysis. The study sample consisted of 517 Dutch, 404 Turkish and 365 Moroccans living in 15 neighbourhoods in Amsterdam, the Netherlands.

RESULTS

Amongst Moroccans, high density housing and nuisance from drug misuse were associated with a higher systolic BP, while high quality of green space and social participation were associated with a lower systolic BP. High level of nuisance from drug misuse was associated with a higher diastolic BP. High quality of green space was associated with lower odds of hypertension. Amongst Turkish, high level of crime and nuisance from motor traffic were associated with a higher diastolic BP. Similar associations were observed among the Dutch group but none of the differences were statistically significant.

CONCLUSION

The study findings show that neighbourhood-level stressors are associated with BP in ethnic minority groups but were less evident in the Dutch group. These findings might imply that the higher BP levels found in some ethnic minority groups might be partly due to their greater susceptibility to the adverse neighbourhood environment in which many ethnic minority people live. Primary prevention measures targeting these neighbourhood stressors may have an impact in reducing high BP related morbidity and mortality among ethnic minority groups.

The physical environment and physical activity: a critical appraisal of review articles

BACKGROUND

Over the last few years an increasing number of studies investigating the association between the physical environment and physical activity have been published. Many reviews have also summarized this emerging body of research, and such review papers are frequently used by public health policymakers and researchers themselves to inform decision making.

METHODS

This paper systematically appraises methodologic aspects of literature reviews examining the relationship between physical activity and the physical environment published in peer-reviewed journals between 2000 and 2005. Eleven reviews and their antecedent source papers were examined.

RESULTS

The majority of these reviews omitted between one third and two thirds of the studies that could have been eligible for inclusion at the time they conducted the review. Methodologic information on how the review was conducted was not always provided. Furthermore, in some cases results of a study were reported incorrectly, or physical environmental aspects were conflated with social environmental or cognitive factors. Moreover, when results were reported incorrectly, physical environmental variables were almost always reported as significantly associated with physical activity, when these associations were nonsignificant, or were not assessed as part of the primary study.

CONCLUSIONS

Users of reviews in this field should be aware that there are significant methodologic variations among them, and that some reviews may include only a sample of the relevant primary studies. However, this is difficult to determine given the frequent incompleteness of review method reporting. Greater standardization in the reporting of review methods may assist with future efforts to summarize studies of the relationship between physical environments and physical activity.

Protecting health using an environmental impact assessment: a case study of San Francisco land use decisionmaking

Laws and regulations for an environmental impact assessment enable a health impact assessment whenever physical changes in the environment may significantly affect health. In this case study, I describe 2 instances in which a local public health agency used the procedural requirements for an environmental impact assessment to account for societal-level health determinants that are not traditionally evaluated in land-use decisions. These examples show that a public health critique can contribute both to the scope of analysis in an environmental impact assessment and to substantive changes in land-use decisions. I have evaluated this health appraisal approach as a form of a health impact assessment and will make recommendations for law, research, and practice that support its technical, cultural, and political feasibility.

Bicycle helmet legislation: can we reach a consensus?

Debate continues over bicycle helmet laws. Proponents argue that case-control studies of voluntary wearing show helmets reduce head injuries. Opponents argue, even when legislation substantially increased percent helmet wearing, there was no obvious response in percentages of cyclist hospital admissions with head injury-trends for cyclists were virtually identical to those of other road users. Moreover, enforced laws discourage cycling, increasing the costs to society of obesity and lack of exercise and reducing overall safety of cycling through reduced safety in numbers. Countries with low helmet wearing have more cyclists and lower fatality rates per kilometre. Cost-benefit analyses are a useful tool to determine if interventions are worthwhile. The two published cost-benefit analyses of helmet law data found that the cost of buying helmets to satisfy legislation probably exceeded any savings in reduced head injuries. Analyses of other road safety measures, e.g. reducing speeding and drink-driving or treating accident blackspots, often show that benefits are significantly greater than costs. Assuming all parties agree that helmet laws should not be implemented unless benefits exceed costs, agreement is needed on how to derive monetary values for the consequences of helmet laws, including changes in injury rates, cycle-use and enjoyment of cycling. Suggestions are made concerning the data and methodology needed to help clarify the issue, e.g. relating pre- and post-law surveys of cycle use to numbers with head and other injuries and ensuring that trends are not confused with effects of increased helmet wearing.

The Irvine-Minnesota inventory to measure built environments: development

BACKGROUND

Researchers and policymakers increasingly identify active living-including walking and bicycling for travel and recreation-as a potential strategy to increase rates of physical activity in the United States. Understanding the impact of the built environment on physical activity levels requires reliable methods to measure potentially relevant built environment features. This paper presents an audit tool-the Irvine Minnesota Inventory-that was designed to measure a wide range of built environment features that are potentially linked to active living, especially walking.

METHODS

The inventory was created through a literature review, focus group interviews, a panel of experts, and field testing in 27 settings. The inventory was developed in 2003-2004.

RESULTS

The Irvine Minnesota Inventory includes 162 items, organized into four domains: accessibility (62 items), pleasurability (56 items), perceived safety from traffic (31 items), and perceived safety from crime (15 items). (Some items are in multiple domains.) The inventory includes both a paper version and a version in Microsoft Access, to allow data to be input directly into the computer.

CONCLUSIONS

Limitations of methods used to develop the inventory are discussed. Strategies are offered for using the Irvine Minnesota Inventory to systematically and reliably measure characteristics of the built environment that are potentially linked to active living.

Neighborhood design and active aging

This qualitative analysis of focus groups describes how neighborhood design encourages active aging. Nine focus groups were conducted in 2002 and 2003 with residents (N=60) aged 55 and over living in Portland, OR, USA. Content analysis revealed that local shopping and services, traffic and pedestrian infrastructure, neighborhood attractiveness, and public transportation influence activity among older adults. This information will be useful for making policy recommendations relating to land use planning and transportation, to assist in senior-friendly developments and neighborhood improvements, and to design effective senior health interventions with an emphasis on neighborhood design influences.