Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities

Cardiorespiratory fitness and socioeconomic influences in Chilean schoolchildren: a cross-sectional study

OBJECTIVE

To compare the cardiovascular risk and physical fitness, according to type of school in a national sample of Chilean school students.

METHODS

A total of 7,218 students participated, who completed all the national tests of the National System for Measuring the Quality of Education, which included physical fitness and anthropometric tests. The results were compared according to the type of educational establishment and anthropometric indicators were considered. Physical fitness was measured by lower extremity strength, abdominal strength, upper extremity strength, trunk flexibility, exertional heart rate, and cardiorespiratory fitness. Body mass index, heart rate, and waist-to-height ratio were analyzed as predictors of cardiovascular risk.

RESULTS

There were differences according to the type of establishment in the predictors of cardiovascular risk (p < 0.05). Differences were also found in the physical fitness tests evaluated (p < 0.01). Students in private schools (PSC) and subsidized schools (SC) had lower levels of cardiovascular risk and higher levels of physical fitness than public schools (PS) and schools with delegated administration (DA).

CONCLUSIONS

In conclusion, students in educational establishments with a higher socioeconomic level have lower levels of cardiovascular risk and better physical fitness than students in public establishments. The authors suggest considering specific school interventions to mitigate cardiovascular risk and improve physical fitness among this vulnerable population. To this end, future studies should analyze the characteristics of physical activity and nutritional habits in schools to determine the factors that affect the results.

[Promoting active mobility in old age through urban design]

In an ageing society, maintaining independent mobility into old age is an important objective. Mental and physical wellbeing depends not only on individual health status, but also to a large extent on the spatial conditions. Local politics and municipal administrations can influence this, especially in urban planning. This discussion article brings together perspectives from public health and urban planning on urban development and mobility against the background of health equity.The results of the AFOOT (Securing urban mobility of an ageing population) cross-sectional study on socio-spatial conditions in small- and medium-sized towns in northwestern Germany and walking and cycling by older people show the importance of residential environmental factors such as proximity to everyday destinations, walking and cycling infrastructure, and street connectivity. Preferences for the design of an age-friendly living environment and the quality of public spaces exist in terms of urban design quality, quality of stay, and safety in public spaces.In order to improve spatial conditions, the situation needs to be recorded using defined indicators and monitoring, and the perspectives of older people need to be integrated. Strategies and measures to promote active mobility in old age are aimed at the multifunctional design of public spaces, the prioritization of active mobility on everyday trips, and ensuring the accessibility of everyday destinations through urban development. Cross-sectoral cooperation between urban planning, transport planning, and public health is essential to promote the active mobility and health of older people.

Hair cortisol determinants in 11-year-old children: Environmental, social and individual factors

INTRODUCTION

Children's exposure to chronic stress is associated with several health problems. Measuring hair cortisol concentration is particularly useful for studying chronic stress but much is unknown about hair cortisol determinants in children and adolescents, and previous research has often not considered the simultaneous exposure of multiple variables. This research is focused on investigating the relationship between environmental, social and individual factors with hair cortisol concentration in children.

METHODS

The data used in this study are from the INMA prospective epidemiological cohort study. The assessment of chronic stress was made on the basis of hair samples taken at the age of 11 years in the INMA-Gipuzkoa cohort (n = 346). A metamodel summarizing the hypothesized relationships among environmental, social and individual factors and hair cortisol concentration was constructed based on previous literature. Structural Equation Modelling was performed to examine the relationships among the variables.

RESULTS

In the general model higher behavioural problems were associated with higher cortisol levels and an inverse relationship between environmental noise and cortisol levels was observed, explaining 5 % of the variance in HCC. Once stratified by sex these associations were only hold in boys, while no significant effect of any of the study variables was related with cortisol levels in girls. Importantly, maternal stress was positively related to behavioural difficulties in children. Finally, higher traffic-related air pollution and lower exposure to neighborhood greenness were related to higher environmental noise.

DISCUSSION

This study highlights that simultaneous exposure to different environmental, social and individual characteristics may determine the concentration of hair cortisol. More research is needed and future studies should include this complex view to better understanding of hair cortisol determinants in children.

How urban growth dynamics impact the air quality? A case of eight Indian metropolitan cities

Air pollution is a matter of great significance that confronts the sustainable progress of urban areas. Against India's swift urbanization, several urban areas exhibit the coexistence of escalating populace and expansion in developed regions alongside extensive spatial heterogeneity. The interaction mechanism between the growth of urban areas and the expansion of cities holds immense importance for the remediation of air pollution. Henceforth, the present investigation utilizes geographically weighted regression (GWR) to examine the influence of urban expansion and population growth on air quality. The examination will use a decade of data on the variation in PM2.5 levels from 2010 to 2020 in eight Indian metropolitan cities. The study's findings demonstrate a spatial heterogeneity between urban growth dynamics and air pollution levels. Urban growth and the expansion of cities demonstrate notable positive impacts on air quality, although the growth of infilling within expanding urban areas can significantly affect air quality. Given the unique trajectories of urban development in developing countries, this research provides many suggestions for urban administrators to foster sustainable urban growth.

Health equity in urban and rural settings: implementation of the place standard tool in Spain

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

The Urban Environment and Cardiometabolic Health

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.

Childhood exposure to outdoor air pollution in different microenvironments and cognitive and fine motor function in children from six European cohorts

BACKGROUND

Exposure to air pollution during childhood has been linked with adverse effects on cognitive development and motor function. However, limited research has been done on the associations of air pollution exposure in different microenvironments such as home, school, or while commuting with these outcomes.

OBJECTIVE

To analyze the association between childhood air pollution exposure in different microenvironments and cognitive and fine motor function from six European birth cohorts.

METHODS

We included 1301 children from six European birth cohorts aged 6-11 years from the HELIX project. Average outdoor air pollutants concentrations (NO2, PM2.5) were estimated using land use regression models for different microenvironments (home, school, and commute), for 1-year before the outcome assessment. Attentional function, cognitive flexibility, non-verbal intelligence, and fine motor function were assessed using the Attention Network Test, Trail Making Test A and B, Raven Colored Progressive Matrices test, and the Finger Tapping test, respectively. Adjusted linear regressions models were run to determine the association between each air pollutant from each microenvironment on each outcome.

RESULTS

In pooled analysis we observed high correlation (rs = 0.9) between air pollution exposures levels at home and school. However, the cohort-by-cohort analysis revealed correlations ranging from low to moderate. Air pollution exposure levels while commuting were higher than at home or school. Exposure to air pollution in the different microenvironments was not associated with working memory, attentional function, non-verbal intelligence, and fine motor function. Results remained consistently null in random-effects meta-analysis.

CONCLUSIONS

No association was observed between outdoor air pollution exposure in different microenvironments (home, school, commute) and cognitive and fine motor function in children from six European birth cohorts. Future research should include a more detailed exposure assessment, considering personal measurements and time spent in different microenvironments.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

The angiogenic growth of cities

Describing the space-time evolution of urban population is a fundamental challenge in the science of cities, yet a complete theoretical treatment of the underlying dynamics is still missing. Here, we first reconstruct the evolution of London (UK) over 180 years and show that urban growth consists of an initial phase of diffusion-limited growth, followed by the development of the railway transport network and a consequential shift from central to suburban living. Such dynamics-which are analogous to angiogenesis in biological systems-can be described by a minimalist reaction-diffusion model coupled with economic constraints and an adaptive transport network. We then test the generality of our approach by reproducing the evolution of Sydney, Australia, from 1851 to 2011. We show that the rail system coevolves with urban population, displaying hierarchical characteristics that remain constant over time unless large-scale interventions are put in place to alter the modes of transport. These results demonstrate that transport schemes are first-order controls of long-term urbanization patterns and efforts aimed at creating more sustainable and healthier cities require careful consideration of population-transport feedbacks.

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol

INTRODUCTION

The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.

METHODS AND ANALYSIS

DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration.

ETHICS AND DISSEMINATION

The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Urban environment during pregnancy and lung function, wheezing, and asthma in school-age children. The generation R study

The urban environment during pregnancy may influence child's respiratory health, but scarce evidence exists on systematic evaluation of multiple urban exposures (e.g., air pollution, natural spaces, noise, built environment) on children's lung function, wheezing, and asthma development. We aimed to examine the association of the urban environment during pregnancy with lung function, preschool wheezing, and school-age asthma. We included 5624 mother-child pairs participating in a population-based prospective birth cohort. We estimated 30 urban environmental exposures including air pollution, road traffic noise, traffic, green spaces, blue spaces, and built environment during pregnancy. At 10 years of age, lung function was measured by spirometry. Information on preschool wheezing and physician-diagnosed school-age asthma was obtained from multiple questionnaires. We described single-exposure associations with respiratory outcomes using an exposome-wide association study. We also identified patterns of urban exposures with hierarchical clustering on principal components analysis and examined their associations with respiratory outcomes using multivariate regression models. Single-exposure analyses showed associations of higher particulate matter (PM) with lower mid-expiratory flow (FEF25-75%) (e.g., for PM < 2.5 μm of diameter [PM2.5] z-score = -0.06 [-0.09, -0.03]) and higher forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) (e.g., for PM2.5 FEV1 0.05 [0.02, 0.08]) after correction for multiple-hypothesis testing. Cluster analysis described three patterns of urban exposures during pregnancy and showed that the cluster characterised by higher levels of air pollution, noise, walkability, street connectivity, and lower levels of natural spaces were associated with lower FEF25-75% (-0.08 [-0.17, 0.00]), and higher odds of preschool wheezing (1.21 [1.03, 1.43]). This study shows that the characteristics of the urban environment during pregnancy are of relevance to the offspring's respiratory health during childhood.

Adapting Schools to Climate Change with Green, Blue, and Grey Measures in Barcelona: Study Protocol of a Mixed-Method Evaluation

Under the framework of the Urban Innovative Actions program of the European Commission, in 2020, 11 primary schools in Barcelona were transformed into climate shelters by implementing green, blue, and grey measures. Schoolyards were also opened to the local community to be used during non-school periods. Here we present the study protocol of a mixed-method approach to evaluate the effectiveness of the interventions in terms of improving environmental quality and health for users. We evaluated school level through the following: (1) quantitative pre-post quasi-experimental study, and (2) qualitative evaluation. The quantitative study included measures of (a) environmental variables (collected via low-cost and non-low-cost sensors), (b) students' health and well-being (collected via health questionnaires, attention levels test, and systematic observations), and (c) teachers' health and well-being (collected via thermal comfort measurements and health questionnaires). The qualitative methods evaluated the perceptions about the effects of the interventions among students (using Photovoice) and teachers (through focus groups). The impact of the interventions was assessed at community level during summer non-school periods through a spontaneous ethnographic approach. Data collection started in August 2019 and ended in July 2022. The evaluation provides the opportunity to identify those solutions that worked and those that need to be improved for future experiences, as well as improve the evaluation methodology and replication for these kinds of interventions.

Urban greenspace and visual acuity in schoolchildren: a large prospective cohort study in China

BACKGROUND

Greenspace is known to have a positive impact on human health and well-being, but its potential effects on visual acuity have not been extensively studied.

OBJECTIVES

Our aim was to examine the relationship between long-term greenspace exposure and visual acuity in children, while also exploring the potential mechanisms in this association.

METHODS

We conducted this prospective cohort study based on the Children's growth environment, lifestyle, physical, and mental health development project (COHERENCE), which screened 286,801 schoolchildren in Guangzhou, China, starting in the 2016/17 academic year and followed them up for three academic years (2017/18-2019/20). Visual acuity was measured using a standardized logarithmic chart, and visual impairment was defined as visual acuity worse than 0.0 logarithm of the minimum angle of resolution (LogMAR) units in the better eye. We used the Normalized Difference Vegetation Index (NDVI), the Soil-Adjusted Vegetation Index (SAVI), and the Enhanced Vegetation Index (EVI) to assess the greenspace surrounding child's geocoded home and school at each visit.

RESULTS

Our analysis indicated that higher greenspace exposure was associated with greater visual acuity z-score at baseline and with slower decline in visual acuity z-score during the 3-year follow-up. An interquartile range increase in home-school-based NDVI 300m was associated with a 7% decrease [hazard ratios (HRs): 0.93, 95% confidence interval (CI): 0.92, 0.94] in the risk of visual impairment. We also found that air pollution, physical activity, outdoor time, and recreational screen time partially mediated the greenspace-visual acuity association.

CONCLUSION

Our findings suggest that increasing greenspace exposure could benefit children's visual acuity development and reduce the risk of visual impairment by reducing air pollution and recreational screen time while increasing physical activity and outdoor time. All results could have potential policy implications, given the individual and societal burdens associated with visual impairment.

Disentangling associations between multiple environmental exposures and all-cause mortality: an analysis of European administrative and traditional cohorts

Background

We evaluated the independent and joint effects of air pollution, land/built environment characteristics, and ambient temperature on all-cause mortality as part of the EXPANSE project.

Methods

We collected data from six administrative cohorts covering Catalonia, Greece, the Netherlands, Rome, Sweden, and Switzerland and three traditional cohorts in Sweden, the Netherlands, and Germany. Participants were linked to spatial exposure estimates derived from hybrid land use regression models and satellite data for: air pollution [fine particulate matter (PM2.5), nitrogen dioxide (NO₂), black carbon (BC), warm season ozone (O3)], land/built environment [normalized difference vegetation index (NDVI), distance to water, impervious surfaces], and ambient temperature (the mean and standard deviation of warm and cool season temperature). We applied Cox proportional hazard models accounting for several cohort-specific individual and area-level variables. We evaluated the associations through single and multiexposure models, and interactions between exposures. The joint effects were estimated using the cumulative risk index (CRI). Cohort-specific hazard ratios (HR) were combined using random-effects meta-analyses.

Results

We observed over 3.1 million deaths out of approximately 204 million person-years. In administrative cohorts, increased exposure to PM2.5, NO2, and BC was significantly associated with all-cause mortality (pooled HRs: 1.054, 1.033, and 1.032, respectively). We observed an adverse effect of increased impervious surface and mean season-specific temperature, and a protective effect of increased O3, NDVI, distance to water, and temperature variation on all-cause mortality. The effects of PM2.5 were higher in areas with lower (10th percentile) compared to higher (90th percentile) NDVI levels [pooled HRs: 1.054 (95% confidence interval (CI) 1.030-1.079) vs. 1.038 (95% CI 0.964-1.118)]. A similar pattern was observed for NO2. The CRI of air pollutants (PM2.5 or NO2) plus NDVI and mean warm season temperature resulted in a stronger effect compared to single-exposure HRs: [PM2.5 pooled HR: 1.061 (95% CI 1.021-1.102); NO2 pooled HR: 1.041 (95% CI 1.025-1.057)]. Non-significant effects of similar patterns were observed in traditional cohorts.

Discussion

The findings of our study not only support the independent effects of long-term exposure to air pollution and greenness, but also highlight the increased effect when interplaying with other environmental exposures.

Community-level exposomics: a population-centered approach to address public health concerns

Environmental factors affecting health and vulnerability far outweigh genetics in accounting for disparities in health status and longevity in US communities. The concept of the exposome, the totality of exposure from conception onwards, provides a paradigm for researchers to investigate the complex role of the environment on the health of individuals. We propose a complementary framework, community-level exposomics, for population-level exposome assessment. The goal is to bring the exposome paradigm to research and practice on the health of populations, defined by various axes including geographic, social, and occupational. This framework includes the integration of community-level measures of the built, natural and social environments, environmental pollution-derived from conventional and community science approaches, internal markers of exposure that can be measured at the population-level and early responses associated with health status that can be tracked using population-based monitoring. Primary challenges to the implementation of the proposed framework include needed advancements in population-level measurement, lack of existing models with the capability to produce interpretable and actionable evidence and the ethical considerations of labeling geographically-bound populations by exposomic profiles. To address these challenges, we propose a set of recommendations that begin with greater engagement with and empowerment of affected communities and targeted investment in community-based solutions. Applications to urban settings and disaster epidemiology are discussed as examples for implementation.

Environmental health impacts and inequalities in green space and air pollution in six medium-sized European cities

BACKGROUND

The GoGreenRoutes project aims to introduce co-created nature-based solutions (NBS) to enhance environmental quality in six medium-sized cities (Burgas, Lahti, Limerick, Tallinn, Umeå, and Versailles). We estimated the mortality and economic impacts attributed to suboptimal exposure to green space and air pollution, economic impacts, and the distribution thereof the adult population by socioeconomic status.

METHODS

We retrieved data from publicly accessible databases on green space (NDVI and % Green Area), air pollution (NO2 and PM2.5) and population (≥20 years, n = 804,975) at a 250m × 250m grid-cell level, and mortality for each city for 2015. We compared baseline exposures at the grid-cell to World Health Organization's recommendations and guidelines. We applied a comparative risk assessment to estimate the mortality burden attributable to not achieving the recommendations and guidelines. We estimated attributable mortality distributions and the association with income levels.

RESULTS

We found high variability in air pollution and green spaces levels. Around 60% of the population lacked green space and 90% were exposed to harmful air pollution. Overall, we estimated age-standardized mortality rates varying from 10 (Umeå) to 92 (Burgas) deaths per 100,000 persons attributable to low NDVI levels; 3 (Lahti) to 38 (Burgas) per 100,000 persons to lack of % Green Area; 1 (Umeå) to 88 (Tallinn) per 100,000 persons to exceedances of NO2 guidelines; and 1 (Umeå) to 206 (Burgas) per 100,000 persons to exceedances of PM2.5 guidelines. Lower income associated with higher or lower mortality impacts depending on whether deprived populations lived in the densely constructed, highly-trafficked city centre or greener, less polluted outskirts.

CONCLUSIONS

We attributed a considerable mortality burden to lack of green spaces and higher air pollution, which was unevenly distributed across different social groups. NBS and health-promoting initiatives should consider socioeconomic aspects to regenerate urban areas while providing equally good environments.

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.

Mixtures of long-term exposure to ambient air pollution, built environment and temperature and stroke incidence across Europe

INTRODUCTION

The complex interplay of multiple environmental factors and cardiovascular has scarcely been studied. Within the EXPANSE project, we evaluated the association between long-term exposure to multiple environmental indices and stroke incidence across Europe.

METHODS

Participants from three traditional adult cohorts (Germany, Netherlands and Sweden) and four administrative cohorts (Catalonia [region Spain], Rome [city-wide], Greece and Sweden [nationwide]) were followed until incident stroke, death, migration, loss of follow-up or study end. We estimated exposures at residential addresses from different exposure domains: air pollution (nitrogen dioxide (NO2), particulate matter < 2.5 μm (PM2.5), black carbon (BC), ozone), built environment (green/blue spaces, impervious surfaces) and meteorology (seasonal mean and standard deviation of temperatures). Associations between environmental exposures and stroke were estimated in single and multiple-exposure Cox proportional hazard models, and Principal Component (PC) Analyses derived prototypes for specific exposures domains. We carried out random effects meta-analyses by cohort type.

RESULTS

In over 15 million participants, increased levels of NO2 and BC were associated with increased higher stroke incidence in both cohort types. Increased Normalized Difference Vegetation Index (NDVI) was associated with a lower stroke incidence in both cohort types, whereas an increase in impervious surface was associated with an increase in stroke incidence. The first PC of the air pollution domain (PM2.5, NO2 and BC) was associated with an increase in stroke incidence. For the built environment, higher levels of NDVI and lower levels of impervious surfaces were associated with a protective effect [%change in HR per 1 unit = -2.0 (95 %CI, -5.9;2.0) and -1.1(95 %CI, -2.0; -0.3) for traditional adult and administrative cohorts, respectively]. No clear patterns were observed for distance to blue spaces or temperature parameters.

CONCLUSIONS

We observed increased HRs for stroke with exposure to PM2.5, NO2 and BC, lower levels of greenness and higher impervious surface in single and combined exposure models.

Association between greenspace and cancer: evidence from a systematic review and meta-analysis of multiple large cohort studies

Cancer is a chronic disease that seriously endangers human health, and studies on its association with greenspace have been published. We aimed to systematically review the epidemiological evidence and obtain the best available evidence. PubMed, Web of Science, Embase, and Cochrane Library were used as search databases, the time limit was September 12, 2022, and the cited articles were manually supplemented. Two researchers independently performed literature screening and data extraction. We performed a meta-analysis of data using a normalized difference vegetation index (NDVI) as the greenspace measure, providing hazard ratio (HR) and corresponding 95% CI. After standardization of the data, we used a random effects model for pooling. We also assessed the risk of bias for each study and the quality of each evidence body. We identified 10,108 items and included 14 studies from 11 institutions in eight countries. All studies had a low risk of bias. Quantitative analysis of 13 studies found a beneficial association of greenspace with the mortality of lung cancer (pooled HR [95% CI]=0.965 [0.947, 0.983]) and prostate cancer (HR [95% CI]=0.939 [0.898, 0.980]) based on 0.1-unit NDVI increment and a potential beneficial association with the incidence of prostate, lung, and breast cancer. Greenspace had opposite associations with cancer mortality for urban and rural populations. Indirect comparisons did not find statistically significant differences in the effects of greenspace on different cancer outcomes. The evidence body assessment was considered to be "very low." This review indicated potential beneficial associations between greenspace for lung, prostate, and breast cancer outcomes. However, there was a lack of mediation analysis to explore the underlying mechanism of a causal association. Meanwhile, the interstudy heterogeneity was large. Therefore, future studies should consider more accurate exposure assessment and more comprehensive covariate coverage, while focusing on mediating analysis. PROSPERO: CRD42022361068.

Residential greenspace and risk of cancer: A prospective cohort study from the UK Biobank

BACKGROUND

Growing evidence suggests that proximity to greenspace is linked to multiple health outcomes, but its association with the risk of cancer is not fully understood. The mechanism for greenspace's influences on cancer incidence may be through reducing depressive symptoms and increasing physical activity. Our study aimed to investigate the associations between exposure to residential greenspace and the risk of common types of cancer and whether the associations were modified or mediated by depressive symptoms and physical activity.

METHODS

This prospective cohort study included 401,189 participants in the UK Biobank between 2006 and 2010 who were free of cancer and followed up until 2021. Residential greenspace was defined as the percentage of outdoor greenspace surrounding the residential location of each participant across 1000 m and 300 m buffers, which were estimated with land use data. Electronic health records were used to assess the incidence of 25 types of cancer. Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) per an interquartile range (IQR) increase of greenspace after multiple comparisons using Bonferroni correction.

RESULTS

During a median follow-up of 12.4 years, a total of 43,273 incident cancer cases were documented. We found that exposure to greenspace at a 1000 m buffer was significantly associated with prostate cancer (HR = 0.93, 95 % CI: 0.89-0.96), and suggestively associated with oral cavity (HR = 0.86, 95 % CI: 0.76-0.98) and bladder cancer (HR = 1.08, 95 % CI: 1.01-1.15), but not with other cancers. Moreover, the association between greenspace and prostate cancer was mediated by physical activity, and was modified by depressive symptoms (P for heterogeneity = 0.022). Similar findings were also observed for greenspace at a 300 m buffer.

CONCLUSION

Our study revealed an association between exposure to greenspace and prostate cancer, but not with other cancers.

Evaluation of a smartphone-based methodology that integrates long-term tracking of mobility, place experiences, heart rate variability, and subjective well-being

This study presents MyGävle, a smartphone application that merge long-term tracking of mobility data, heart rate variability and subjective and objective well-being records. Developed to address the challenges faced in researching healthy and sustainable lifestyles, this app serves as a pioneering implementation of Real-life Long-term Methodology (ReaLM). After eight months' use by 257 participants from Gävle (Sweden), we evaluate the completeness, accuracy, validity, and consistency of all data collected. MyGävle produced remarkable results as a ReaLM method. On average, it precisely tracked participants daily locations for approximately 8 h and accurately collected heart-rate variability values throughout the day (12 h) and night (6 h). Participants reported 5115 subjective place experiences (ranging from 160 to 120 per week) and seasonal participation, although declining, is accurate. Our findings indicate that the amount of data collected through smartphone sensors, fitness wristbands and in-app questionnaires is consistent enough to be leveraged for integrated assessments of habits, environmental exposure, and subjective and physiological well-being. Yet, considerable variation exists across individuals; thus diagnostic analysis must precede use of these datasets in any particular research endeavors. By doing so we can maximise the potential of ReaLM research to delve into real life conditions conducive to healthy living habits while also considering broader sustainability goals.

Excess mortality attributed to heat and cold: a health impact assessment study in 854 cities in Europe

BACKGROUND

Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks.

METHODS

We included urban areas across Europe between Jan 1, 2000, and Dec 12, 2019, using the Urban Audit dataset of Eurostat and adults aged 20 years and older living in these areas. Data were extracted from Eurostat, the Multi-country Multi-city Collaborative Research Network, Moderate Resolution Imaging Spectroradiometer, and Copernicus. We applied a three-stage method to estimate risks of temperature continuously across the age and space dimensions, identifying patterns of vulnerability on the basis of city-specific characteristics and demographic structures. These risks were used to derive minimum mortality temperatures and related percentiles and raw and standardised excess mortality rates for heat and cold aggregated at various geographical levels.

FINDINGS

Across the 854 urban areas in Europe, we estimated an annual excess of 203 620 (empirical 95% CI 180 882-224 613) deaths attributed to cold and 20 173 (17 261-22 934) attributed to heat. These corresponded to age-standardised rates of 129 (empirical 95% CI 114-142) and 13 (11-14) deaths per 100 000 person-years. Results differed across Europe and age groups, with the highest effects in eastern European cities for both cold and heat.

INTERPRETATION

Maps of mortality risks and excess deaths indicate geographical differences, such as a north-south gradient and increased vulnerability in eastern Europe, as well as local variations due to urban characteristics. The modelling framework and results are crucial for the design of national and local health and climate policies and for projecting the effects of cold and heat under future climatic and socioeconomic scenarios.

FUNDING

Medical Research Council of UK, the Natural Environment Research Council UK, the EU's Horizon 2020, and the EU's Joint Research Center.

Association between residential greenness and all-cause mortality and the joint mediation effect of air pollutants among old people with disability: A prospective cohort study

BACKGROUND

Residential greenness offers health benefits to old people, but evidence of its association with the health of old people with disability is scarce. Moreover, due to the limited mobility of this vulnerable population, air pollutants may play an indispensable mediating role in that association, which however remains understudied.

OBJECTIVES

This study aimed to investigate the association between residential greenness and all-cause mortality risk and the joint mediation effect of air pollutants among old people with disability.

METHODS

A total of 34,075 old people with disability were included in the Chengdu Long-term Care Insurance cohort. Participants' residential greenness exposure was measured by an enhanced vegetation index within the 500 m buffer zone (EVI_500m). Causal mediation analysis was conducted to assess the total effect (TE) of residential greenness and the natural indirect effect (NIE) through PM_2.5, CO, NO₂, SO₂, and O₃ on all-cause mortality.

RESULTS

The TE of EVI_500m on the all-cause mortality risk in overall participants showed negative, which, decreased from the 2^nd quartile (HR = 0.93, 95 % CI: 0. 91, 0.95) to the 4^th quartile (HR = 0.81, 95 % CI: 0.76, 0.85); the NIE through the five air pollutants also decreased from the 2^nd quartile (HR = 0.96, 95 % CI: 0.95, 0.98) to the 4^th quartile (HR = 0.90, 95 % CI: 0.88, 0.93), with the proportion mediated decreased from 48 % to 44 %. The stronger TE or NIE were observed in participants aged <80 years old, men, with mild-moderate disability, and having outdoor experience every week.

CONCLUSION

Exposure to residential greenness was associated with a decreased risk of mortality, partially through the pathways of air pollutants, which varied by age, sex, degree of disability, and frequency of weekly outdoors. Our findings would provide evidence to develop aging-friendly cities.

Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review

Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.

Relationship between Built-Up Environment, Air Pollution, Activity Frequency and Prevalence of Hypertension-An Empirical Analysis from the Main City of Lanzhou

In the process of promoting the strategy of a healthy China, the built environment, as a carrier of human activities, can effectively influence the health level of residents in the light of its functional types. Based on the POI data of four main urban areas in Lanzhou, this paper classifies the built environment in terms of function into four types. The association between different types of built environments and the prevalence of hypertension was investigated by using the community as the study scale, and activity frequency, air pollution and green space were used as mediating variables to investigate whether they could mediate the relationship between built environments and hypertension. The results indicate that communities with a high concentration of commercial service facilities, road and traffic facilities and industrial facilities have a relatively high prevalence of hypertension. By determining the direct, indirect and overall effects of different functional types of built environment on the prevalence of hypertension, it was learned that the construction of public management and service facilities can effectively mitigate the negative effects of hypertension in the surrounding residents. The results of the study contribute to the rational planning of the structure of the built environment, which is beneficial for optimizing the urban structure and preventing and controlling chronic diseases such as hypertension.

Health and Environmental Co-Benefits of City Urban Form in Latin America: An Ecological Study

We investigated the association of urban landscape profiles with health and environmental outcomes, and whether those profiles are linked to environmental and health co-benefits. In this ecological study, we used data from 208 cities in 8 Latin American countries of the SALud URBana en América Latina (SALURBAL) project. Four urban landscape profiles were defined with metrics for the fragmentation, isolation, and shape of patches (contiguous area of urban development). Four environmental measures (lack of greenness, PM_2.5, NO₂, and carbon footprint), two cause-specific mortality rates (non-communicable diseases and unintentional injury mortality), and prevalence of three risk factors (hypertension, diabetes, and obesity) for adults were used as the main outcomes. We used linear regression models to evaluate the association of urban landscape profiles with environmental and health outcomes. In addition, we used finite mixture modeling to create co-benefit classes. Cities with the scattered pixels profile (low fragmentation, high isolation, and compact shaped patches) were most likely to have positive co-benefits. Profiles described as proximate stones (moderate fragmentation, moderate isolation, and irregular shape) and proximate inkblots (moderate-high fragmentation, moderate isolation, and complex shape) were most likely to have negative co-benefits. The contiguous large inkblots profile (low fragmentation, low isolation, and complex shape) was most likely to have mixed benefits.

Availability and affordability of alcohol and tobacco products for the population: results of a pilot study in the Sverdlovsk Oblast

Aim. To analyze the availability and affordability of alcohol and tobacco outlets using the specialized software developed by the National Medical Research Center for Therapy and Preventive Medicine in the pilot subject of the Russian Federation — the Sverdlovsk Oblast.

Material and methods. For the first time, experts from the National Medical Research Center for Therapy and Preventive Medicine conducted a pilot study to assess the actual state of the infrastructure of a separate subject of the Russian Federation (Sverdlovsk Oblast). The study objects were the urban infrastructure elements in which alcohol and tobacco products are sold. In order to assess the infrastructure, special software was developed using Open Street Maps to perform data collection tasks. The infrastructure data collection for the pilot study took place from January to March 2022.

Results. The total number of tobacco outlets is 299, most of which are located in supermarkets (82,6%, n=247). The share of individual tobacco outlets accounts for 13,7% (n=41). Out of 357 supermarkets, 247 (69%) have tobacco sales section. The average lowest price of a cigarette pack is 121,6±15,7 RUB (minimum — 30 RUB, maximum — 207 RUB). Twentyseven (10,9%) of 247 supermarkets located <100 m from educational institutions carry tobacco products. The minimum distance is 64 m. There are 449 alcohol outlets in total, most of them are located in supermarkets — 57,0% (n=256). Individual alcohol outlets account for 40,8% (n=183). Out of 357 supermarkets, 256 (71,7%) have alcohol sales section. Out of 158 individual alcohol outlets, vodka is available in 101 (63%) outlets, wine — in 112 (68,3%) out of 162 outlets, beer — in 112 (68,3%) out of 164 outlets, alcoholic cocktails — in 71 (45,2%) out of 57 outlets. The average lowest selling price of vodka is 255,9±62,2 RUB (minimum — 230 RUB), wine — 180,2±89,3 RUB (minimum — 110 rubles), beer — 51,2±15,5 RUB (minimum — 33 rubles), alcoholic cocktails — 58,9±15,4 RUB (minimum — 37 rubles). In addition, 27 (10,5%) of 256 supermarkets with a liquor section (minimum distance of 64m) are located <100 m from educational institutions, as well as 10 (5,4%) out of 183 individual stores specializing in the alcohol sale (minimum distance of 50 m).

Conclusion. The results obtained with the help of the developed tool can be used as arguments for strengthening monitoring of compliance and making changes to the current legislation that restricts the availability of tobacco and alcohol products. The use of the developed tool will make it possible using evidence to make informed decisions in the development and implementation of public health programs at the municipal level.

Double-Sided Wearable Multifunctional Sensing System with Anti-interference Design for Human-Ambience Interface

Multifunctional sensing systems play important roles in a variety of applications, incluing health surveillance, intelligent prothetics, human-machine/ambinece interfaces, and many others. The richness of the signal and the decoupling among multiple parameters are essential for simultaneous, multimodal measurements. However, current multifunctional sensing fails to decouple interferences from various signals. Here, we propose a double-sided wearable system that both enables multifunctional sensing and avoids the interferences among multiple parameters. Specifically, the sensitivities of system modules to strain are controlled through customizing the pattern and morphology of sensing electrodes as well as the modification of active materials. Compensation of temperature drift and selection of sensing mechanisms ensure the thermal stability of the system. The encapsulation of modules resists the interferences of proximity, normal pressure, and gas molecules at the same time. A double-sided partition layout with serpentine interconnections reduces the effect of motion artifacts and ensures simultaneous operation of electrochemical-sensing modules. Cooperation among decoupled modules acts as the bridge between the perception of ambience changes and the timely feedback of the human body. In addition, to sense the signal at the interface, modules for energy harvesting and storage are also integrated into the system to broaden its application scenarios.

Parameters of the Infrastructure of the Residential Area and Their Relationship with Cardiovascular Risk Factors

Aim. This study determined the level of public satisfaction with neighborhood design features in Kemerovo Oblast and their connection to cardiovascular disease risk factors.

Subjects and methods. The study population included 1,598 respondents aged between 35 and 70, with 491 living in rural areas and others living in Kemerovo (1,221 women and 477 men). The assessment of neighborhood environment was done according to residents' subjective opinions about infrastructural features (the Neighborhood Environmental Walkability Scale). Depending on how participants responded to the questionnaire, some of these parameters were identified as adverse.

Results. The residents of Kemerovo and rural areas of Kemerovo Oblast identified the following neighborhood design features as adverse: the lack of interesting places in neighborhood environment, the remote location of parks and restaurants, the absence of pavement, busy traffic, and a long distance between home and workplace. In the city, arterial hypertension prevalence was high among men, when grocery, fruit and clothing stores were distant, and among women, when banks, public transport stops were distant and the traffic was heavy. Lipid metabolism disorders were more common among women in urban areas, when there were no interesting places around. Obesity prevalence was high among urban female population, when the following adverse factors were present: the remote location of grocery stores, fruit stores, bank, pharmacy and public transport stops and the absence of pavement. Among rural male population, this risk factor was common when there were no pavements. The highest rate of carbohydrate metabolism disorders was found among women living in villages where the traffic is heavy and public transport stops are far away.

Conclusion. The impact of infrastructure on the health status of the living population is a new direction of scientific research. Epidemiological studies in different geographic areas and population groups show significant differences in health status, morbidity and mortality from chronic noncommunicable diseases. To reduce the risks of developing diseases of the cardiovascular system, the formation of a socially comfortable health-saving environment is of great importance.

Green space exposure during pregnancy and umbilical cord blood levels of liver enzymes

Evidence has suggested better pregnancy outcomes due to exposure to greenspace; however, the studies on such an association with the level of liver enzymes in the cord blood are still nonexistent. Hence, this study investigated the relationship between exposure to greenspace during the entire pregnancy and gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in cord blood samples. We selected 150 pregnant women from our pregnancy cohort in Sabzevar, Iran (2018). Greenspace exposure was characterized based on (i) residential distance to green space, (ii) time spent in public/private green spaces, (iii) residential surrounding greenspace, (iv) visual access to greenspace, and (v) number of indoor natural pot plants at home. We developed linear regression models to investigate the adjusted associations of greenspace exposure with enzyme levels. Each one interquartile range (IQR) increase in the residential surrounding greenspace (100 m buffer) was related to a reduction of -12.58 (U/L) (95% CI -22.86, -2.29), -3.35 (U/L) (95% CI -5.50, -1.20), and -0.57 (U/L) (95% CI -1.12, -0.02) in the levels of GGT, AST, and ALT, respectively. Moreover, a similar association was observed for the time the participants spent in green spaces. A decrease in the residential distance to large green spaces was related with lower cord blood levels of AST, ALT, and GGT. Having a window with greenspace view at home was significantly related to lower AST level. The results for the indoor plant pots were not conclusive. Our findings suggested an inverse relationship between greenspace exposure during pregnancy and cord blood levels of liver enzymes. Further studies in other settings and populations are needed to confirm our findings.

Properties of the Spanish Version of the Place Standard Tool

(1) Background: The social determinants that maintain health inequalities are organized in the physical, social, and economic contexts of neighborhoods and municipalities. Their characteristics influence the behaviors and choices of the people living in them, with an impact on their health and well-being. In recent years, several local applications and urban development tools have been designed to learn how to promote the development of health and wellness environments. Aim: The purpose was to test the properties of the Spanish adaptation of the Place Standard Tool through its implementation in a Valencian community municipality. (2) Methods: Metric properties were analyzed from a sample of 242 participants. Descriptive statistics were used to analyze the sociodemographic data and to describe item responses. Cronbach’s alpha was used to provide a measure of the internal consistency, whereas the Kaiser–Meyer Olkin test was relied upon to study the relationship between different variables. (3) Results: The questionnaire showed an internal consistency index of 0.849 and a KMO of 0.842, with a single factor variance of 81.50%. (4) Conclusions: The Spanish adaptation of the Place Standard Tool is a valid tool for assessing neighborhoods and municipalities with a focus on social determinants of health and equity.

Visualizing changes in physical activity behavioral patterns after redesigning urban infrastructure

The aim of this study was to explore effects of a major urban reconstruction on physical activity (PA) behavior by comparing PA intensity hotspots before and after the tunneling of a highway with a new infrastructure prioritized for walking and cycling. In total, 126 individuals participated before and after the tunneling. GPS loggers and accelerometers were used to assess location and PA levels. A geographic information system (GIS) was used to perform optimized hotspot analyses on PA data, both on transport and stationary data points. The results showed several changes in PA hotspots on trip data, even if total PA levels did not change. At follow-up, PA intensity hotspots were more connected, with the new infrastructure as a central connection. This was true for higher and lower educated individuals. Therefore, if changes in the built environment do not result in changes on population-level outcomes, this does not imply that they have no impact on behavior.

Effect of environmental education on the knowledge of aquatic ecosystems and reconnection with nature in early childhood

Blue and green ecosystems are considered a key for the improvement of cities sustainability, providing numerous ecosystem services and habitat for many species. However, urban streams are still neglected and degraded, specially in southern European countries. One important step towards the rehabilitation of these ecosystems is the awareness of their importance by citizens. This study aimed to assess the effect of 1-year of activities (field and laboratory) of an environmental education project on primary school children, in improving their knowledge on urban stream ecosystems and their problems. We analyzed students’ questionnaires before and after field and laboratory activities, drawings and group interviews. Initially, most children had incipient contact with rivers and streams, showing fears and lack of knowledge about them. As the project progressed, their perceptions changed, with a clear increase in the proportion of students recognizing the biodiversity associated to rivers (e.g., names of riparian trees, aquatic plants and invertebrates). Also, their fears decreased significantly, while their awareness to the impacts of artificialization and lack of riparian vegetation increased. Our results show that direct contact with nature have a positive role in the way it is understood by children, as well as promoting responsible and sustainable behaviors, being effective from the early primary-school years.

Vehicular Traffic in Urban Areas: Health Burden and Influence of Sustainable Urban Planning and Mobility

Vehicular traffic is one of the major sources of air pollution in European cities. This work aims to understand which characteristics of the urban environment could influence mobility-related air pollution, quantify the health impacts of exposure to traffic-derived PM2.5 and NO2 concentrations, and assess the potential health benefits expected from traffic interventions. The health benefits modeled are intended to provide a set of comparable data to support decision-makers and encourage informed decision-making to design healthier cities. Targeting a large geographical coverage, 12 European cities from 9 countries were comparatively assessed in terms of mean daily traffic volume/area, the number of public transport stops/area, and the percentage of green and outdoor leisure areas, among other urban indicators. This was implemented using an open-source data mining tool, which was seen as a useful engine to identify potential strategies to improve air quality. The comparison of urban indicators in the selected cities evidenced two trends: (a) cities with the most heterogeneous distribution of public transport stops, as an indicator of poor accessibility, are also those with the lowest proportion of km dedicated to cycleways and footways, highlighting the need in these cities for more sustainable mobility management; and (b) the percentage of green and outdoor leisure areas may influence the share of journeys by bicycle, pointing out that promoting the perception of green routes is relevant to enhance the potential of active transport modes. Socioeconomic factors can be key determinants of the urban indicators and would need further consideration. For the health impact assessment (HIA), two baseline scenarios were evaluated and compared. One is based on mean annual traffic contributions to PM2.5 concentrations in each target city (ranging between 1.9 and 13 µg/m3), obtained from the literature, and the second is grounded on mean annual NO2 concentrations at all available traffic and urban background stations within each city (17.2–83.5 µg/m3), obtained from the European Environment Agency database. The intervention scenarios modeled were designed based on traffic mitigation strategies in the literature, and set to ranges of 6–50% in traffic-derived PM2.5 concentrations and of 4–12.5% in NO2 concentrations. These scenarios could result in only a 1.7% (0.6–4%) reduction in premature mortality due to exposure to traffic-derived PM2.5, and 1.0% (0.4–2%) due to exposure to NO2, as the mean for all the cities. This suggests that more ambitious pollution abatement strategies should be targeted.

High-Performance Wearable Sensor Inspired by the Neuron Conduction Mechanism through Gold-Induced Sulfur Vacancies

Practical application of wearable gas-sensing devices has been greatly inhibited by the poorly sensitive and specific recognition of target gases. Rapid charge transfer caused by rich sensory neurons in the biological olfactory system has inspired the construction of a highly sensitive sensor network with abundant defect sites for adsorption. Herein, for the first time, we demonstrate an in situ formed neuron-mimic gas sensor in a single gas-sensing channel, which is derived from lattice deviation of S atoms in Bi₂S₃ nanosheets induced by gold quantum dots. Due to the favorable gas adsorption and charge transfer properties arising from S vacancies, the fabricated sensor exhibits a significantly enhanced response value of 5.6-5 ppm NO₂, ultrafast response/recovery performance (18 and 338 s), and excellent selectivity. Furthermore, real-time visual detection of target gases has been accomplished by integrating the flexible sensor into a wearable device.

Co-Creation Hub Is the First Step for the Successful Creation of a Unified Urban Ecosystem-Kaunas City Example

The identification of the main steps for the creation of a unified ecosystem from the institutional point of view and the framework for ecosystem design is presented and discussed. Based on the expertise and the knowledge gained during the time when the ELISE project had been implemented, a unified Kaunas city ecosystem is being designed using the Ecosystem Map method. As the review of the ELISE project reports helped to identify the main steps of each project partner in building ecosystems’ networks, Kaunas city chose to create a co-Creation Hub (c-CH), which is the first step in developing an ecosystem management model. The main tasks of such a hub are listed, and should involve the preparation of a long-term action plan involving not only the coordination of the stakeholder meetings, organisation of seminars, the preparation of new materials, and methodology but also the development of a clear strategy for each stakeholder based on national economy and government and municipality policies. The role of the c-CH is to ensure the ease of cooperation and knowledge distribution among stakeholders within the city, public authorities, and the national government. This approach could become a fundamental background tool for the regional and/or city municipal and stakeholder-based creation and development of unified ecosystem development.

Artificial Neural Networks for Modelling and Predicting Urban Air Pollutants: Case of Lithuania

This study focuses on the Vilnius (capital of Lithuania) agglomeration, which is facing the issue of air pollution resulting from the city’s physical expansion. The increased number of industries and vehicles caused an increase in the rate of fuel consumption and pollution in Vilnius, which has rendered air pollution control policies and air pollution management more significant. In this study, the differences in the pollutants’ means were tested using two-sided t-tests. Additionally, a 2-layer artificial neural network and a pollution data were both used as tools for predicting and warning air pollution after loop traffic has taken effect in Vilnius Old Town from July of 2020. Highly accurate data analysis methods provide reliable data for predicting air pollution. According to the validation, the multilayer perceptron network (MLPN1), with a hyperbolic tangent activation function with a 4-4-2 partition, produced valuable results and identified the main pollutants affecting and predicting air quality in the Old Town: maximum concentration of sulphur dioxide per 1 hour (SO2_1 h, normalized importance = 100%); carbon monoxide (CO) was the second pollutant with the highest indication of normalized importance, equalling 59.0%.

Nighttime lights, urban features, household poverty, depression, and obesity

Nighttime Light Emission (NLE) is associated with diminished mental and physical health. The present study examines how NLE and associated urban features (e.g., air pollution, low green space) impact mental and physical wellbeing. We included 200,393 UK Biobank Cohort participants with complete data. The study was carried out in two steps. In Step1, we assessed the relationship between NLE, deprivation, pollution, green space, household poverty and mental and physical symptoms. In Step2, we examined the role of NLE on environment-symptom networks. We stratified participants into high and low NLE and used gaussian graphical model to identify nodes which bridged urban features and mental and physical health problems. We then compared the global strength of these networks in high vs low NLE. We found that higher NLE associated with higher air pollution, less green space, higher economic and neighborhood deprivation, higher household poverty and higher depressed mood, higher tiredness/lethargy and obesity (Rtraining_mean = 0.2624, P training_mean < .001; Rtest_mean = 0.2619, P test_mean < .001). We also found that the interaction between environmental risk factors and mental, physical problems (overall network connectivity) was higher in the high NLE network than in the low NLE network (t = 0.7896, P < .001). In areas with high NLE, economic deprivation, household poverty and waist circumference acted as bridge factors between the key urban features and mental health symptoms. In conclusion, NLE, urban features, household poverty and mental and physical symptoms are all interrelated. In areas with high NLE, urban features associate with mental and physical health problems at a greater magnitude than in areas with low NLE.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02754-3.

Study protocol of the European Urban Burden of Disease Project: a health impact assessment study

INTRODUCTION

Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also hotspots of pollution and disease partly due to current urban and transport practices. The aim of the European Urban Burden of Disease project is to evaluate the health burden and its determinants related to current and future potential urban and transport planning practices and related exposures in European cities and make this evidence available for policy and decision making for healthy and sustainable futures.

METHODS AND ANALYSIS

Drawing on an established comparative risk assessment methodology (ie, Urban and Transport Planning Health Impact Assessment) tool), in nearly 1000 European cities we will (1) quantify the health impacts of current urban and transport planning related exposures (eg, air pollution, noise, excess heat, lack of green space) (2) and evaluate the relationship between current levels of exposure, health impacts and city characteristics (eg, size, density, design, mobility) (3) rank and compare the cities based on exposure levels and the health impacts, (4) in a number of selected cities assess in-depth the linkages between urban and transport planning, environment, physical activity and health, and model the health impacts of alternative and realistic urban and transport planning scenarios, and, finally, (5) construct a healthy city index and set up an effective knowledge translation hub to generate impact in society and policy.

ETHICS AND DISSEMINATION

All data to be used in the project are publicly available data and do not need ethics approval. We will request consent for personal data on opinions and views and create data agreements for those providing information on current and future urban and transport planning scenarios.For dissemination and to generate impact, we will create a knowledge translation hub with information tailored to various stakeholders.

The Exposome and Immune Health in Times of the COVID-19 Pandemic

Growing evidence supports the importance of lifestyle and environmental exposures-collectively referred to as the 'exposome'-for ensuring immune health. In this narrative review, we summarize and discuss the effects of the different exposome components (physical activity, body weight management, diet, sun exposure, stress, sleep and circadian rhythms, pollution, smoking, and gut microbiome) on immune function and inflammation, particularly in the context of the current coronavirus disease 2019 (COVID-19) pandemic. We highlight the potential role of 'exposome improvements' in the prevention-or amelioration, once established-of this disease as well as their effect on the response to vaccination. In light of the existing evidence, the promotion of a healthy exposome should be a cornerstone in the prevention and management of the COVID-19 pandemic and other eventual pandemics.

Herzgesunde Städte – die Gene laden das Gewehr, die Umwelt zieht den Abzug

Die Weltgesundheitsorganisation gibt an, dass die Stadtplanung mittlerweile als kritischer Bestandteil einer umfassenden Lösung zur Bekämpfung umweltbedingter Gesundheitsschäden gesehen wird. Die vorliegende Übersicht befasst sich mit nicht übertragbaren Krankheiten mit dem Schwerpunkt auf Herz-Kreislauf-Erkrankungen und dem Urbanisierungsprozess in Bezug auf Umweltrisiken wie Lärm, Luftverschmutzung, Temperatur und Licht im Freien. Es wird dargelegt, warum sich Wärmeinseln in städtischen Gebieten entwickeln können und wie die Begrünung von Städten die öffentliche Gesundheit verbessern und Klimaprobleme, Nachhaltigkeit und Lebensfähigkeit adressieren kann. Darüber hinaus thematisieren wir Stadtplanung, Verkehrsinterventionen und neuartige Technologien zur Bewertung externer Umweltexpositionen, z. B. Einsatz digitaler Technologien, um zukünftig herzgesunde Städte zu fördern. Zuletzt heben wir neue Paradigmen des integrativen Denkens hervor, wie das Exposom und die planetare Gesundheit, indem wir den Zusammenhang zwischen Exposition und Gesundheitsauswirkungen kritisch evaluieren und unser Verständnis der Gesamtheit der Expositionen gegenüber der Umwelt des Menschen erweitern.

Physical Activity in Polluted Air-Net Benefit or Harm to Cardiovascular Health? A Comprehensive Review

Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. In this context, the World Health Organization estimated 4.2 and 3.2 million global deaths per year in response to ambient air pollution and insufficient physical activity, respectively. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease. Thus, determining the tradeoff between the health benefits of physical activity and the potential harmful effects of increased exposure to air pollution during physical activity has important public health consequences. In the present comprehensive review, we analyzed evidence from human and animal studies on the combined effects of physical activity and air pollution on cardiovascular and other health outcomes. We further report on pathophysiological mechanisms underlying air pollution exposure, as well as the protective effects of physical activity with a focus on oxidative stress and inflammation. Lastly, we provide mitigation strategies and practical recommendations for physical activity in areas with polluted air.

The Ideas of Sustainable and Green Marketing Based on the Internet of Everything—The Case of the Dairy Industry

The use of advanced computer technologies has dramatically changed marketing. Concepts such as smart, sustainable, and green marketing have emerged in the last 20 years. One of these new technologies is the Internet of Things (IoT), which has led to the development of the activities and performances of industries in various dimensions. For the various objects, such as people, processes, and data, involved in marketing activities, the Internet of Everything (IoE) as an evolved IoT is a possible future scenario. Some sectors pretend to be the first to implement this, and the more they rely on dynamic, unstable customer needs, the better a solution the IoE is for them. Therefore, this paper presents a clear vision of smart, sustainable marketing based on the IoE in one of the fast-moving consumer goods (FMCG) industries, the dairy industry. Key factors are identified to help readers understand this concept better. The expert interview makes it possible to draw a picture of the factors that have helped successfully implement the IoE in the dairy sector.

Large-scale citizen science provides high-resolution nitrogen dioxide values and health impact while enhancing community knowledge and collective action

We present outcomes from a large-scale air quality citizen science campaign (xAire, 725 measurements) to demonstrate its positive contribution in the interplay between advances in exposure assessment and developments in policy or collective action. A broad partnership with 1,650 people from communities around 18 primary schools across Barcelona provided the capacity to obtain unprecedented high-resolution NO₂ levels and an updated asthma Health Impact Assessment. It is shown that NO₂ levels vary considerably with at some cases very high levels. More than a 1,000 new cases of childhood asthma could be prevented each year by lowering NO₂ levels. Representativity of site selection and the minimal number of samplers for land use regression modelling are considered. Enhancement of community knowledge and attitudes towards collective response were observed and identified as key drivers for successful large-scale monitoring campaigns. The results encourage strengthening collaboration with local communities when exploring environmental health issues.

A Novel Crowdsourcing Model for Micro-Mobility Ride-Sharing Systems

Substantial research is required to ensure that micro-mobility ride sharing provides a better fulfilment of user needs. This study proposes a novel crowdsourcing model for the ride-sharing system where light vehicles such as scooters and bikes are crowdsourced. The proposed model is expected to solve the problem of charging and maintaining a large number of light vehicles where these efforts will be the responsibility of the crowd of suppliers. The proposed model consists of three entities: suppliers, customers, and a management party responsible for receiving, renting, booking, and demand matching with offered resources. It can allow suppliers to define the location of their private e-scooters/e-bikes and the period of time they are available for rent. Using a dataset of over 9 million e-scooter trips in Austin, Texas, we ran an agent-based simulation six times using three maximum battery ranges (i.e., 35, 45, and 60 km) and different numbers of e-scooters (e.g., 50 and 100) at each origin. Computational results show that the proposed model is promising and might be advantageous to shift the charging and maintenance efforts to a crowd of suppliers.

Brain correlates of urban environmental exposures in cognitively unimpaired individuals at increased risk for Alzheimer's disease: A study on Barcelona's population

INTRODUCTION

Urban environmental exposures might contribute to the incidence of Alzheimer's disease (AD). Our aim was to identify structural brain imaging correlates of urban environmental exposures in cognitively unimpaired individuals at increased risk of AD.

METHODS

Two hundred twelve participants with brain scans and residing in Barcelona, Spain, were included. Land use regression models were used to estimate residential exposure to air pollutants. The daily average noise level was obtained from noise maps. Residential green exposure indicators were also generated. A cerebral 3D-T1 was acquired to obtain information on brain morphology. Voxel-based morphometry statistical analyses were conducted to determine the areas of the brain in which regional gray matter (GM) and white matter (WM) volumes were associated with environmental exposures.

RESULTS

Exposure to nitrogen dioxide was associated with lower GM volume in the precuneus and greater WM volume in the splenium of the corpus callosum and inferior longitudinal fasciculus. In contrast, exposure to fine particulate matter was associated with greater GM in cerebellum and WM in the splenium of corpus callosum, the superior longitudinal fasciculus, and cingulum cingulate gyrus. Noise was positively associated with WM volume in the body of the corpus callosum. Exposure to greenness was associated with greater GM volume in the middle frontal, precentral, and the temporal pole.

DISCUSSION

In cognitively unimpaired adults with increased risk of AD, exposure to air pollution, noise, and green areas are associated with GM and WM volumes of specific brain areas known to be affected in AD, thus potentially conferring a higher vulnerability to the disease.

Congruence between the prioritisation of conservation problems at the local and national scale: an evaluation by environmental scientists in Poland

The anthropogenic pressure on the environment depends on the spatial scale. It is crucial to prioritise conservation actions at different spatial scales to be cost-efficient. Using horizon scanning with the Delphi technique, we asked what the most important conservation problems are in Poland at local and national scales. Twenty-six participants, PhD students, individually identified conservation issues important at the local and national scales. Each problem was then scored and classified into broader categories during the round discussions. Text mining, cross-sectional analyses, and frequency tests were used to compare the context, importance scores, and frequency of identified problems between the two scales, respectively. A total of 115 problems were identified at the local scale and 122 at the national scale. Among them, 30 problems were identical for both scales. Importance scores were higher for national than local problems; however, this resulted from different sets of problems identified at the two scales. Problems linked to urbanisation, education, and management were associated with the local scale. Problems related to policy, forestry, and consumerism were more frequent at the national scale. An efficient conservation policy should be built hierarchically (e.g. introducing adaptive governance), implementing solutions at a national scale with the flexibility to adjust for local differences and to address the most pressing issues.

The influence of residential greenness on mortality in the Asia-Pacific region: a systematic review and meta-analysis

AIMS

To critically appraise the evidence of the impact of exposure to salutogenic green environment on mortality, which is an important endpoint in epidemiological and clinical studies.

METHODS

We searched for studies published and indexed in three databases (PubMed, AMED, and CINAHL Plus) from inception until 31 March 2020, complemented with a search of cited literature for articles describing the effects of greenness on mortality in Asia-Pacific region. Eligible articles were screened and data were extracted independently by two reviewers. A random-effects model was utilised to obtain pool hazard ratio (HR) and risk ratio of all-cause mortality outcome.

RESULTS

The search identified 3239 studies, of which 20 studies reporting 133,363 participants from longitudinal cohort studies and 202 million people from population-based prevalence studies were included in the review. The majority of the studies (60%) were conducted in high-income countries in Asia-Pacific. All participants of the longitudinal cohort studies were aged 60 years or older, whereas the prevalence studies involved people of all age groups. A significant protective association of green environment exposure with all-cause mortality was reported in 18 studies. Pooled results from five studies showed increased level of greenness exposure was associated with a significant decrease in all-cause mortality (pooled HR = 0.97; 95% confidence interval (CI) = 0.93 to 1.02; p < 0.01; I²= 87.8%). Meta-analysis of total number of deaths in different quartiles of green spaces noted decreased risks of mortality with all causes of death with increased surrounding greenness.

CONCLUSIONS

Some limited evidence suggests that populations exposed to the greener environment have a lower risk of mortality, implying the potential role of greenness in increasing longevity. Further studies with standardised design and outcome reporting should be conducted in low- and middle-income countries and in populations of low socioeconomic status to glean more generalisable and complete evidence for public health policy implications.

Why a New Research Agenda on Green Spaces and Health Is Needed in Latin America: Results of a Systematic Review

(1) Background: Increasing and improving green spaces have been suggested to enhance health and well-being through different mechanisms. Latin America is experiencing fast population and urbanization growth; with rising demand for interventions to improve public health and mitigate climate change. (2) Aim: This study aimed to review the epidemiological evidence on green spaces and health outcomes in Latin America. (3) Methods: A systematic literature review of green spaces and health outcomes was carried out for studies published in Latin America before 28 September 2020. A search strategy was designed to identify studies published in Medline via PubMed and LILACS. The search strategy included terms related to green spaces combined with keywords related to health and geographical location. No time limit for the publication was chosen. The search was limited to English, Spanish, Portuguese, and French published articles and humans’ studies. (4) Findings: This systematic review found 19 epidemiological studies in Latin America related to green spaces and health outcomes. Nine studies were conducted in Brazil, six in Mexico, three in Colombia, and one in Chile. In terms of study design, 14 were cross-sectional studies, 3 ecological, and 2 cohort studies. The population included among the studies ranged from 120 persons to 103 million. The green space definition used among studies was green density or proximity (eight studies), green presence (five studies), green spaces index (four studies), and green space visit (two studies). The health outcomes included were mental health (six studies), overweight and obesity (three studies), quality of life (three studies), mortality (two studies), cardiorespiratory disease (one study), disability (one study), falls (one study), and life expectancy (one study). Eleven studies found a positive association between green spaces and health, and eight studies found no association. (5) Conclusion: This systematic review identified 19 epidemiological studies associating green spaces and health outcomes in Latin America. Most of the evidence suggests a positive association between green spaces and health in the region. However, most of the evidence was supported by cross-sectional studies. Prioritizing longitudinal studies with harmonized exposure and outcome definitions and including vulnerable and susceptible populations is needed in the region.