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Li B. Integrating climate resilience with sports, exercise, and public health expenditures on sustainable environment: Evidence from coastal regions of China. ENVIRONMENTAL RESEARCH 2024; 251:118616. [PMID: 38492833 DOI: 10.1016/j.envres.2024.118616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 03/18/2024]
Abstract
The adoption of environmentally-friendly habits has become more crucial in the present period as a means to mitigate the rate of environmental degradation and its detrimental consequences. The augmentation of sports, exercise and physical activities has been associated with favourable health outcomes, in addition to the ability to mitigate carbon emissions resulting from vehicular transportation. Consequently, the objective of this study is to examine the influence of sports, exercise, and physical activities, along with public health expenditure, on the environmental performance of China's coastal regions throughout the period spanning from 2010 to 2019. The proposed study employs the Feasible Generalized Least Squares (F.G.L.S) and the Generalized Method of Moments (G.M.M) methodologies. Results show that participation in sports and other forms of physical activity significantly improves environmental performance in China's coastal areas. Likewise, a robust negative correlation exists between air pollution and healthcare expenses, hence favouring enhanced environmental outcomes. Nevertheless, it is important to acknowledge that economic expansion has a direct correlation with increased emissions, hence harming environmental performance. There exists compelling evidence indicating a significant impact on environmental quality resulting from the combined influence of heightened health expenditures and increased engagement in sports. This is demonstrated by the presence of an interaction term between health expenses and sports activities. The findings of this study suggest that there is a requirement to re-evaluate healthcare spending initiatives and sporting activities in order to effectively pursue carbon neutrality goals and improve environmental sustainability.
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Affiliation(s)
- Bo Li
- Physical Education Department, Xi'an University of Finance and Economics, 64 Xiaozhai ERd, Yanta District, Xi'An, Shaanxi, 710064, China.
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2
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Anderson J, Benton JS, Ye J, Barker E, Macintyre VG, Wilkinson J, Rothwell J, Dennis M, French DP. Large walking and wellbeing behaviour benefits of co-designed sustainable park improvements: A natural experimental study in a UK deprived urban area. ENVIRONMENT INTERNATIONAL 2024; 187:108669. [PMID: 38677084 DOI: 10.1016/j.envint.2024.108669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
There is little robust evidence of how sustainable park interventions impact on physical activity and other behaviours important for wellbeing. This controlled natural experimental study aimed to examine the effects of co-designing a sustainable park intervention, in a deprived UK urban area, on walking and other wellbeing behaviours. Behaviour observations were conducted at two intervention sites and two matched comparison sites (n = 4,783). Walking observations (primary outcome), wellbeing behaviours (vigorous, sedentary, social and take notice activities) and demographic characteristics were assessed at pre-intervention, and post-intervention (3 and 15 months). Outcomes were compared between intervention and comparison groups, controlling for pre-intervention using multilevel negative binomial regression models. Additional behaviour observations were conducted in two unchanged nearby sites to assess changes in general local activity. Intercept surveys (n = 623) assessed change in self-reported outdoor space usage at intervention and control areas. Post-intervention, walking increased 203 % at 3 months (IRR 2·03, 95 % CI 1·01-4·09) and 351 % at 15 months (IRR 3·51, 95 % CI 2·07-5·93), for intervention sites relative to comparison sites. Large increases for other wellbeing behaviours were also observed. The proportion of non-white persons increased substantially post-intervention, compared to comparison sites. Nearby unchanged sites showed little evidence of general increased activity. Self-reported outdoor usage increased more in the intervention sites (p=<0·001). Sustainable solutions can yield large increases in walking and wellbeing in deprived areas, especially where interventions are co-designed with residents. More collaborative and robust natural experimental studies like this are needed to better inform decision-makers how to maximise health and wellbeing outcomes from sustainable interventions.
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Affiliation(s)
- Jamie Anderson
- Department of Geography, School of Education, Environment and Development, The University of Manchester, Manchester, UK; Manchester Urban Institute, School of Environment, Education and Development, The University of Manchester, Manchester, UK.
| | - Jack S Benton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Junyan Ye
- Department of Geography, School of Education, Environment and Development, The University of Manchester, Manchester, UK.
| | - Ellie Barker
- Department of Geography, School of Education, Environment and Development, The University of Manchester, Manchester, UK.
| | - Vanessa G Macintyre
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Jack Wilkinson
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - James Rothwell
- Department of Geography, School of Education, Environment and Development, The University of Manchester, Manchester, UK.
| | - Matthew Dennis
- Department of Geography, School of Education, Environment and Development, The University of Manchester, Manchester, UK.
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK.
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Kienast-von Einem C, Panter J, Ogilvie D, Reid A. Exploring residential relocation- differences between newcomers and settled residents in health, travel behaviour and neighbourhood perceptions. Health Place 2024; 87:103254. [PMID: 38701677 DOI: 10.1016/j.healthplace.2024.103254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
This study explores whether people who have recently moved to an area differ from longer-term residents in their health, travel behaviour, and perceptions of the environment. Using a large, representative sample from the UKHLS, Newcomers demonstrate significantly lower mental and physical health, reduced car commuting, and a higher likelihood of liking their neighbourhood. Area deprivation, urbanicity, household income, and age emerge as influential moderators with i.e. Newcomers in affluent areas experiencing lower physical health than Settled Residents, and rural Newcomers expressing less neighbourhood satisfaction. Our findings highlight that Newcomers' perceptions of their environment diverge and environmental influences vary among population segments, potentially impacting related health behaviours such as active travel. Furthermore, residential relocation introduces Newcomers with distinct characteristics into areas, affecting the context in which potential population health interventions aiming to influence health behaviours operate. This necessitates a deeper understanding of what influences reactions to the environment as well as ongoing adaptation of environmental interventions to respond to changing contexts within the same location over time.
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Affiliation(s)
- Caroline Kienast-von Einem
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - Alice Reid
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
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Guell C, Ogilvie D, Green J. Changing mobility practices. Can meta-ethnography inform transferable and policy-relevant theory? Soc Sci Med 2023; 337:116253. [PMID: 37857239 DOI: 10.1016/j.socscimed.2023.116253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/24/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Social practice theories have attracted attention for their potential insights into how to change transport systems towards "healthier" states. However, most evidence is from small-scale qualitative case studies. We explored whether a synthesis of qualitative evidence on mobility practices in one country, informed by meta-ethnography and a Bourdieusian approach to practice, could produce theory that is of sufficient abstraction to be transferable, yet also capable of informing intervention planning. The synthesis identified three third order constructs: mobility practices result from habitus plus capital in fields; specific configurations of local mobility practices are shaped, but not determined, by material infrastructures and social structures; and changes in practice happen across a number of scales and temporalities. This body of evidence as a whole was then interpreted as an integrative "storyline": Mobility systems are complex, in that outcomes from interventions are neither unilinear nor necessarily predictable from aggregations of individual practice changes. Infrastructure changes may be a necessary, but not sufficient, condition for change. Moving systems towards "healthier" states requires changing habitus such that "healthier" practices align with fields, and that interventions take sufficient account of the power relations that materially and symbolically constrain or enable attachments to and changes in mobility practices. Meta-ethnography is a useful approach for integrating qualitative evidence for informing policy.
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Affiliation(s)
- Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Penryn, UK; Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK.
| | - David Ogilvie
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Judith Green
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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Paulsen L, Benz L, Müller C, Wallmann-Sperlich B, Bucksch J. Personal determinants of change agents' decision-making behavior in community health promotion: a qualitative study. BMC Public Health 2023; 23:1731. [PMID: 37670263 PMCID: PMC10481515 DOI: 10.1186/s12889-023-16590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Implementing environmental changes to promote healthier communities requires initial positive decisions by change agents from local politics and government. However, there is little research on what influences the change agents' decisions. This explorative, qualitative study aims to identify the personal determinants of the decision-making behavior of local change agents. METHODS We conducted semi-structured interviews to assess the personal determinants of decision-making behavior among 22 change agents from local politics and government. Relevant determinants were identified through a structured content analysis of the interview transcripts using the software MAXQDA 2020. RESULTS We found the following seven essential clusters of personal determinants of the decision-making behavior of change agents from local politics and government: Imprinting, socialization, and biography; experiences and involvement; attitudes and outcome expectations towards important issues and aspects; knowledge; emotions; personal benefits; and the perceived influences of others. CONCLUSIONS The identified personal determinants might serve as a source of understanding the decision-making behavior of change agents in community decision-making processes. Our findings can contribute to the effective planning and implementation of evidence-based multilevel interventions related to changing environmental conditions in communities and provide important information on which personal determinants should be considered when derive strategies for community health promotion within a systematic approach of developing an intervention program theory.
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Affiliation(s)
- Lisa Paulsen
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany.
| | - Lea Benz
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
| | - Christina Müller
- Institute of Sport Science, University of Würzburg, Judenbühlweg 11, 97082, Würzburg, Germany
| | | | - Jens Bucksch
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
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Wylie G, Kroll T, Witham MD, Morris J. Increasing physical activity levels in care homes for older people: a quantitative scoping review of intervention studies to guide future research. Disabil Rehabil 2023; 45:3160-3176. [PMID: 36093619 PMCID: PMC10503503 DOI: 10.1080/09638288.2022.2118869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Physical activity (PA) levels in older care home residents are low. This has detrimental effects on health. Little is known about the nature of interventions to increase physical activity in this population. METHODS A scoping review to: (1) identify and describe interventions to increase PA in older care home residents, and (2) describe the extent to which interventions address care home context, systemised by social-ecological models. We systematically searched databases for peer-reviewed intervention studies to increase PA in older people resident in care homes. Data were extracted using the template for intervention description and replication (TIDieR) and mapped against a social-ecological framework to locate the intervention focus. RESULTS The 19 included studies consisted of interventions tested in randomised or quasi-experimental trial designs. Interventions consisted of single or multiple components and predominantly addressed individual resident level factors (such as muscle strength) rather than broader social and environmental aspects of context. Interventions were not all fully described. For most interventions a distinct theoretical foundation was not identified. Interventions were mostly delivered by health professionals and research staff external to care homes. CONCLUSIONS Future interventions should address contextual care home factors and should be clearly described according to intervention description guidance.Implications for rehabilitationPhysical activity holds promise as an effective means of improving health and function in older care home residents, but physical activity levels in this population are low.Several reasons beyond the individual resident but related to care home contextual factors may explain low PA in care homesTo date, contextual factors influencing PA in care homes have been poorly addressed in interventions.Wider care home context (social, cultural, and environmental factors) must be considered in future interventions.
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Affiliation(s)
- Gavin Wylie
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Thilo Kroll
- Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, UK
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jacqui Morris
- School of Health Sciences, University of Dundee, Dundee, UK
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Rio CJ, Saligan LN. Understanding physical activity from a cultural-contextual lens. Front Public Health 2023; 11:1223919. [PMID: 37601221 PMCID: PMC10436229 DOI: 10.3389/fpubh.2023.1223919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
This paper aims to emphasize the need to acknowledge unique cultural and contextual meanings of physical activity to improve health outcomes in different communities. Leininger's Sunrise Model was used as the theoretical base to understand the complex cultural and contextual factors that influence physical activity. Beliefs and practices surrounding physical activity are influenced by a variety of cultural and contextual factors. Providing culturally relevant contexts to the meaning of physical activity allows opportunities for improving policies or programs that would engage individuals and communities in physical activity in culturally meaningful ways. Incorporating cultural and contextual factors is critical to promote physical activity, especially in minority and vulnerable communities.
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Affiliation(s)
| | - Leorey N. Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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Forde H, Chavez-Ugalde Y, Jones RA, Garrott K, Kotta PA, Greaves F, Targett V, White M, Adams J. The conceptualisation and operationalisation of 'marketing' in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis. BMC Public Health 2023; 23:1419. [PMID: 37488556 PMCID: PMC10367353 DOI: 10.1186/s12889-023-16293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Extensive public health research reports the nature, scope and effects of various marketing activities used by food and drinks companies to support the sale of their products. Such literature informs the regulation of food marketing that encourages unhealthy eating behaviours and poor diet-related health outcomes. However, it is not clear whether this literature consistently conceptualises and applies marketing, which could in turn influence the approach and efficacy of policies to regulate food marketing. We aimed to understand the conceptualisation and operationalisation of marketing in public health research of food marketing, eventually focusing on the conceptualisation of integrated marketing. METHODS We conducted a review of reviews that drew on scoping review methods and applied principles of critical interpretive synthesis. Five databases of peer-reviewed literature and websites of relevant organisations were searched in June - August 2020. Articles were screened against inclusion criteria to identify reviews examining food marketing in a health context. Informative text segments from included articles were coded using NVivo. Codes were grouped into synthetic constructs and a synthesising argument. RESULTS After screening against inclusion criteria, 60 publications were eligible for inclusion. Informative text segments from 24 publications were coded, after which no new codes were identified. Our synthesising argument was that the understanding of integrated marketing appeared inconsistent across publications, such as by differences in use of underlying conceptual frameworks and in the application of terms such as marketing strategy and tactics. CONCLUSIONS Using our synthesising argument, we suggest ways to improve the future study of food marketing in public health research, for example by using in-depth case studies to understand the integrated operation and effect of multi-component marketing strategies. Improving conceptual clarity in the study of food marketing in public health research has the potential to inform policy that is more reflective of the true nature of marketing, and thus more effective in combating food marketing effects and protecting public health. PROTOCOL REGISTRATION The review protocol was made publicly available on Open Science Framework prior to the start of the study (DOI: https://doi.org/10.17605/OSF.IO/VSJCW ).
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Affiliation(s)
- Hannah Forde
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Yanaina Chavez-Ugalde
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
- Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Kate Garrott
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Prasanti Alekhya Kotta
- Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Hospital, London, W6 8RP, UK
- National Institute for Health and Care Excellence, 2 Redman Place, London, E20 1JQ, UK
| | - Victoria Targett
- Department of Health and Social Care, London, UK
- Public Health England, London, UK
| | - Martin White
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Jean Adams
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
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Pan W, Gong L, Xiao G, Zhang L, Xiao Y, Xu C. Regular Tennis Exercise May Improve the Vascular Endothelial Function in Postmenopausal Women: The Influence of Hemodynamics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15749. [PMID: 36497824 PMCID: PMC9741065 DOI: 10.3390/ijerph192315749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Physical inactivity plays a role in the incidence of cardiovascular disease (CVD). Although the current guidelines for physical activity, such as the prescription of exercise, seek to combat CVD, attaining the recommended targets remains challenging. Tennis exercise has been proven to have a unique advantage in reducing the mortality of CVD, but little is known about the influence of playing tennis on impaired vascular endothelial function (VEF), which initiates CVD. Thus, this study aimed to investigate whether regular tennis participation could protect the VEF better than merely meeting the physical activity recommended by the current guidelines. A cross-sectional design was performed based on a sample of 38 healthy postmenopausal women who were matched for physical activity, of which 17 subjects had long-term tennis experience and 21 age-matched subjects regularly exercised but did not play tennis. The cardiovascular function and the body composition of all subjects were measured. We used cluster analysis to assess the overall health status. The modeling results showed that the tennis players performed better in terms of VEF than the nonplayers (10.55 ± 0.58 vs. 8.69 ± 0.52, p < 0.01, R2ad = 0.367), while the wall shear stress positively correlated with VEF (r = 0.505, p < 0.05), after controlling for age and physical activity levels. Regular tennis exercise may be a protective factor for VEF, and further study should be performed to research the role of hemodynamics in tennis exercise.
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Affiliation(s)
- Weifeng Pan
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing 100084, China
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China
| | - Lijing Gong
- Key Laboratory of Exercise and Physical Fitness, Ministry of Education, Beijing 100084, China
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China
| | - Guoan Xiao
- Beijing No.10 Middle School, Beijing 100039, China
| | - Lantian Zhang
- Sport Science College, Beijing Sport University, Beijing 100084, China
| | - Yiran Xiao
- Sport Science College, Beijing Sport University, Beijing 100084, China
| | - Chunyan Xu
- Sport Science College, Beijing Sport University, Beijing 100084, China
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Weber P, Birkholz L, Kohler S, Helsper N, Dippon L, Ruetten A, Pfeifer K, Semrau J. Development of a Framework for Scaling Up Community-Based Health Promotion: A Best Fit Framework Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084773. [PMID: 35457644 PMCID: PMC9032469 DOI: 10.3390/ijerph19084773] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022]
Abstract
Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this qualitative review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion. First, we conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework. From 80 articles, a total of 12 frameworks were eligible, and 5 were included for data extraction. The analysis yielded 10 a priori defined key components: “innovation characteristics”; “clarify and coordinate roles and responsibilities”; “build up skills, knowledge, and capacity”; “mobilize and sustain resources”; “initiate and maintain regular communication”; “plan, conduct, and apply assessment, monitoring, and evaluation”; “develop political commitment and advocacy”; “build and foster collaboration”; “encourage participation and ownership”; and “plan and follow strategic approaches”. We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework. We further identified “encourage participation and ownership” as a crucial component regarding health equity.
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Chatterjee A, Prinz A, Gerdes M, Martinez S. Digital Interventions on Healthy Lifestyle Management: Systematic Review. J Med Internet Res 2021; 23:e26931. [PMID: 34787575 PMCID: PMC8663673 DOI: 10.2196/26931] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. OBJECTIVE This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). METHODS We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. RESULTS Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. CONCLUSIONS This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions.
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Affiliation(s)
- Ayan Chatterjee
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Andreas Prinz
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Martin Gerdes
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Santiago Martinez
- Department of Health and Nursing Science, Centre for e-Health, University of Agder, Grimstad, Norway
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12
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Hunter RF, Adlakha D, Cardwell C, Cupples ME, Donnelly M, Ellis G, Gough A, Hutchinson G, Kearney T, Longo A, Prior L, McAneney H, Ferguson S, Johnston B, Stevenson M, Kee F, Tully MA. Investigating the physical activity, health, wellbeing, social and environmental effects of a new urban greenway: a natural experiment (the PARC study). Int J Behav Nutr Phys Act 2021; 18:142. [PMID: 34717650 PMCID: PMC8557552 DOI: 10.1186/s12966-021-01213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes. METHODS A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata. RESULTS The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI - 14.5 to - 7.4); - 30.5 (95% CI - 37.9 to - 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased. CONCLUSIONS Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration.
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Affiliation(s)
- Ruth F. Hunter
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Deepti Adlakha
- Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC 27607 USA
- School of Natural and Built Environment, Queen’s University Belfast, Belfast, Northern Ireland
| | - Christopher Cardwell
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Margaret E. Cupples
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Geraint Ellis
- School of Natural and Built Environment, Queen’s University Belfast, Belfast, Northern Ireland
| | - Aisling Gough
- School of Nursing, Queen’s University Belfast, Belfast, Northern Ireland
| | - George Hutchinson
- Gibson Institute and Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Therese Kearney
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Alberto Longo
- Gibson Institute and Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Lindsay Prior
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Helen McAneney
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Sara Ferguson
- School of Natural and Built Environment, Queen’s University Belfast, Belfast, Northern Ireland
| | - Brian Johnston
- School of Natural and Built Environment, Queen’s University Belfast, Belfast, Northern Ireland
| | - Michael Stevenson
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland, UK
| | - Mark A. Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, Northern Ireland
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Wendt A, Ricardo LIC, Costa CS, Knuth AG, Tenório MCM, Crochemore-Silva I. Socioeconomic and Gender Inequalities in Leisure-Time Physical Activity and Access to Public Policies in Brazil From 2013 to 2019. J Phys Act Health 2021; 18:1503-1510. [PMID: 34697257 DOI: 10.1123/jpah.2021-0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aims to describe changes in gender and wealth inequalities in leisure-time physical activity (PA) of Brazilians during a 6-year interval. It also aims to evaluate inequalities regarding PA public programs awareness, participation, and access to public spaces for PA. METHODS Data from 2 population-based surveys conducted in 2013 and 2019 were used. Leisure-time PA prevalence was assessed considering those reporting ≥150 minutes per week. The authors evaluated gender inequalities calculating differences and ratios, and wealth inequalities using the slope index of inequality and the concentration index- assessing changes over time. RESULTS National levels of leisure-time PA increased from 2013 to 2019, and an increase in inequalities was observed; women and the poorest groups still presented lower prevalence. A decline in socioeconomic inequalities was observed from 2013 to 2019 regarding the availability of public spaces and awareness about public programs. However, outcomes remained more common among the richest group. Inequalities did not vary for participation in public programs. CONCLUSION Although leisure-time PA increased from 2013 to 2019 at a national level, there were no improvements in gender inequalities, and wealth inequalities worsened over time. Indicators of public strategies for PA increased for the population, but inequalities remain.
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Mason KE, Pearce N, Cummins S. Geographical heterogeneity across England in associations between the neighbourhood built environment and body mass index. Health Place 2021; 71:102645. [PMID: 34388580 DOI: 10.1016/j.healthplace.2021.102645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Abstract
Effects of residential neighbourhood environments on health may vary across geographical space, with differences in local contexts influencing how much a given neighbourhood characteristic matters for the health of local residents. Linking UK Biobank data from 302,952 urban-dwelling adults in England, collected between 2006 and 2010, to publicly available Local Authority-level data, we examined (a) whether cross-sectional associations between body mass index (BMI) and two characteristics of the neighbourhood built environment (availability of formal physical activity facilities near home, and fast-food proximity) vary by Local Authority (LA), and (b) whether cross-level interactions with LA-level physical features (natural landcover) and socio-cultural attributes (local obesity norms) reveal evidence of effect modification by these features of the wider contexts in which neighbourhoods are located. We found variation across urban England in the relationship between availability of neighbourhood formal physical activity facilities and BMI, and some evidence suggesting this association was stronger among people living in areas with less natural landcover, especially in areas outside of London. We also found that the relationship between proximity of fast-food stores to people's homes and BMI varied geographically across England. Local descriptive obesity norms were not an important modifier of this association. This paper highlights the importance of considering potential geographical heterogeneity in relationships between the built environment and health, and the implications for generalisability of research findings. By seeking to better understand sources of geographical heterogeneity, we may be able to better adapt and target built environment interventions for population health improvement.
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Affiliation(s)
- Kate E Mason
- Department of Public Health, Policy and Systems, University of Liverpool, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK.
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, UK
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Szeszulski J, Lanza K, Dooley EE, Johnson AM, Knell G, Walker TJ, Craig DW, Robertson MC, Salvo D, Kohl HW. Y-PATHS: A Conceptual Framework for Classifying the Timing, How, and Setting of Youth Physical Activity. J Phys Act Health 2021; 18:310-317. [PMID: 33581685 PMCID: PMC8035289 DOI: 10.1123/jpah.2020-0603] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity. METHODS The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children's and adolescents' physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation. RESULTS The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure. CONCLUSIONS The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming.
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Hobbs M, Moltchanova E, Wicks C, Pringle A, Griffiths C, Radley D, Zwolinsky S. Investigating the environmental, behavioural, and sociodemographic determinants of attendance at a city-wide public health physical activity intervention: Longitudinal evidence over one year from 185,245 visits. Prev Med 2021; 143:106334. [PMID: 33227345 DOI: 10.1016/j.ypmed.2020.106334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/23/2020] [Accepted: 11/18/2020] [Indexed: 10/23/2022]
Abstract
Understanding the determinants of attendance at public health interventions is critical for effective policy development. Most research focuses on individual-level determinants of attendance, while less is known about environmental-level determinants. Data were obtained from the Leeds Let's Get Active public health intervention in Leeds, England. Longitudinal data (April 2015-March 2016) on attendance were obtained for n = 25,745 individuals (n = 185,245 total visits) with baseline data on sociodemographic determinants and lifestyle practices obtained for n = 3621 individuals. This resulted in a total of n = 744,468 days of attendance and non-attendance. Random forests were used to explore the relative importance of the determinants on attendance, while generalised linear models were applied to examine specific associations (n = 3621). The probability that a person will attend more than once, the number of return visits, and the probability that a person will attend on a particular day were investigated. When considering if a person returned to the same leisure centre after one visit, the most influential determinant was the distance from their home. When considering number of return visits overall however, age group was the most influential. While distance to a leisure centre was less important for predicting the number of return visits, the difference between estimates for 300 m and 15,000 m was 7-10 visits per year. Finally, calendar month was the most important determinant of daily attendance. This longitudinal study highlights the importance of both individual and environmental determinants in predicting various aspects of attendance. It has implications for strategies aiming to increase attendance at public health interventions.
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Affiliation(s)
- M Hobbs
- GeoHealth Laboratory, Geospatial Research Institute, University of Canterbury, Christchurch, Canterbury, New Zealand; Health Sciences, University of Canterbury, Christchurch, Canterbury, New Zealand.
| | - E Moltchanova
- School of Mathematics & Statistics, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - C Wicks
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - A Pringle
- Sport, Outdoor & Exercise Sciences, University of Derby, Derby, United Kingdom
| | - C Griffiths
- Leeds Beckett University, Leeds, United Kingdom
| | - D Radley
- Leeds Beckett University, Leeds, United Kingdom
| | - S Zwolinsky
- West Yorkshire & Harrogate Cancer Alliance, Wakefield, United Kingdom
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Benton JS, Cotterill S, Anderson J, Macintyre VG, Gittins M, Dennis M, French DP. A natural experimental study of improvements along an urban canal: impact on canal usage, physical activity and other wellbeing behaviours. Int J Behav Nutr Phys Act 2021; 18:19. [PMID: 33504358 PMCID: PMC7838466 DOI: 10.1186/s12966-021-01088-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are few robust natural experimental studies of improving urban green spaces on physical activity and wellbeing. The aim of this controlled natural experimental study was to examine the impact of green space improvements along an urban canal on canal usage, physical activity and two other wellbeing behaviours (social interactions and taking notice of the environment) among adults in Greater Manchester, UK. The intervention included resurfaced footpaths, removal of encroaching vegetation, improved entrances, new benches and signage. METHODS Two comparison sites were matched to the intervention site using a systematic five-step process, based on eight correlates of physical activity at the neighbourhood (e.g. population density) and site (e.g. lighting) levels. Outcomes were assessed using systematic observations at baseline, and 7, 12 and 24 months post-baseline. The primary outcome was the change in the number of people using the canal path from baseline to 12 months. Other outcomes were changes in physical activity levels (Sedentary, Walking, Vigorous), Connect and Take Notice behaviours. Data were analysed using multilevel mixed-effects negative binomial regression models, comparing outcomes in the intervention group with the matched comparison group, controlling for day, time of day and precipitation. A process evaluation assessed potential displacement of activity from a separate existing canal path using intercept surveys and observations. RESULTS The total number of people observed using the canal path at the intervention site increased more than the comparison group at 12 months post-baseline (IRR 2.10, 95% CI 1.79-2.48); there were similar observed increases at 7 and 24 months post-baseline. There was some evidence that the intervention brought about increases in walking and vigorous physical activity, social interactions, and people taking notice of the environment. The process evaluation suggested that there was some displacement of activity, but the intervention also encouraged existing users to use the canal more often. CONCLUSIONS Urban canals are promising settings for interventions to encourage green space usage and potentially increase physical activity and other wellbeing behaviours. Interventions that improve access to green corridors along canals and provide separate routes for different types of physical activities may be particularly effective and warrant further research. STUDY PROTOCOL Study protocol published in Open Science Framework in July 2018 before the first follow-up data collection finished ( https://osf.io/zcm7v ). Date of registration: 28 June 2018.
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Affiliation(s)
- Jack S. Benton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
| | - Sarah Cotterill
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jamie Anderson
- Urban Institute, Department of Geography, School of Environment, Education and Development, University of Manchester, Manchester, UK
| | - Vanessa G. Macintyre
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
| | - Matthew Gittins
- Urban Institute, Department of Geography, School of Environment, Education and Development, University of Manchester, Manchester, UK
| | - Matthew Dennis
- Department of Geography, School of Education, Environment and Development, University of Manchester, Manchester, UK
| | - David P. French
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
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Are Changes in Walking for Transportation in Brazilian Older Adults Associated With Attributes of the Neighborhood Environment? J Aging Phys Act 2021; 29:686-694. [PMID: 33412517 DOI: 10.1123/japa.2020-0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022]
Abstract
This study aims to examine the association between neighborhood environment attributes and changes in walking for transportation among older adults. Longitudinal analysis was performed considering a population-based study (EpiFloripa Idoso), carried out in 2009-2010 with follow-up in 2013-2014. Changes in walking, obtained with the International Physical Activity Questionnaire during both waves were associated with data from the environment perception, evaluated using individual items from the Neighborhood Environment Walkability Scale (baseline only) performing multinomial logistic regression. A total of 1,162 older adults (65.2% women, mean age = 73.7 years) participated. Those who reported the presence of parks and squares (OR = 2.44, 95% confidence interval [CI; 1.70, 3.51]), sidewalks (OR = 1.66, 95% CI [1.03, 2.70]), crosswalks (OR = 1.69, 95% CI [1.05, 2.72]), illuminated streets (OR = 2.80, 95% CI [1.24, 6.33]), and safety for day walks (OR = 1.93, 95% CI [1.14, 3.24]) were more likely to remain active or become active when commuting (≥150 min/week). Older adults are more active in neighborhoods that present more favorable attributes regarding walking for transportation.
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Ikeda E, Mavoa S, Cavadino A, Carroll P, Hinckson E, Witten K, Smith M. Keeping kids safe for active travel to school: A mixed method examination of school policies and practices and children's school travel behaviour. TRAVEL BEHAVIOUR & SOCIETY 2020; 21:57-68. [PMID: 33014711 PMCID: PMC7473447 DOI: 10.1016/j.tbs.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 05/06/2020] [Accepted: 05/25/2020] [Indexed: 05/22/2023]
Abstract
Active school travel contributes to children's physical, mental and social wellbeing. The prevalence of children's active school travel, however, has been declining in many developed countries. Gaining insights into school culture and environments in relation to school travel behaviour is crucial to inform interventions. Using a multiphase mixed methods approach, this study aimed to provide a comprehensive understanding of how school policies and practices supported or inhibited school travel behaviour in Auckland, New Zealand. Data were drawn from Neighbourhoods for Active Kids, a cross-sectional study of 1085 children aged 8-13 years between February 2015 and December 2016. School representatives were interviewed regarding their policies and practices related to school travel behaviour and traffic around school, and the data were analysed thematically. An overarching theme, sub-themes and categories were contextualised for quantitative modelling using objectively measured school variables (school socioeconomic status, active school travel programme, built environments around school). Mixed effects multinomial logistic regression models were employed to determine associations between school travel mode and objectively measured child (sociodemographic characteristics, traffic safety perceptions) and school variables. Safety was the core concept of school travel policies, procedures and programmes. Significant differences in child variables, school socioeconomic status, and cycle lanes and traffic lights around school were found between children who actively travelled or used public transport to school and those driven to school. Overall, this study demonstrated the important role of school policy and procedures and the potential application of an intersectoral approach for interventions to support changes in school travel behaviour.
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Affiliation(s)
- Erika Ikeda
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
- Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Suzanne Mavoa
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- SHORE and Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Penelope Carroll
- SHORE and Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Erica Hinckson
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Karen Witten
- SHORE and Whāriki Research Centre, Massey University, Auckland, New Zealand
| | - Melody Smith
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Mason KE, Pearce N, Cummins S. Do neighbourhood characteristics act together to influence BMI? A cross-sectional study of urban parks and takeaway/fast-food stores as modifiers of the effect of physical activity facilities. Soc Sci Med 2020; 261:113242. [DOI: 10.1016/j.socscimed.2020.113242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/12/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
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Ding D, Ramirez Varela A, Bauman AE, Ekelund U, Lee IM, Heath G, Katzmarzyk PT, Reis R, Pratt M. Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health. Br J Sports Med 2020; 54:462-468. [PMID: 31562122 PMCID: PMC7146932 DOI: 10.1136/bjsports-2019-101001] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/25/2022]
Abstract
In the past few decades, the field of physical activity has grown and evolved in scope, depth, visibility and impact around the world. Global progress has been observed in research and practice in physical activity regarding surveillance, health outcomes, correlates/determinants, interventions, translation and policy. The 2012 and 2016 Lancet series on physical activity provide some of the most comprehensive global analysis on various topics within physical activity. Based on the Lancet series and other key developments in the field, literature searches, and expert group meetings and consultation, we provide a global summary on the progress of, gaps in and future directions for physical activity research in the following areas: (1) surveillance and trends, (2) correlates and determinants, (3) health outcomes and (4) interventions, programmes and policies. Besides lessons learnt within each specific area, several recommendations are shared across areas of research, including improvement in measurement, applying a global perspective with a growing emphasis on low-income and middle-income countries, improving inclusiveness and equity in research, making translation an integral part of research for real-world impact, taking an 'upstream' public health approach, and working across disciplines and sectors to co-design research and co-create solutions. We have summarised lessons learnt and recommendations for future research as 'roadmaps' in progress to encourage moving the field of physical activity towards achieving population-level impact globally.
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Affiliation(s)
- Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory Heath
- The Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | | | - Rodrigo Reis
- Research Group in Physical Actvity and Quality of Life (GPAQ), Pontifícia Universidade Católica do Paraná,Curitiba, Curitiba, Brazil
- Postgraduate Program in Urban Management (PPGTU), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Michael Pratt
- Institute for Public Health, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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Ogilvie D, Adams J, Bauman A, Gregg EW, Panter J, Siegel KR, Wareham NJ, White M. Using natural experimental studies to guide public health action: turning the evidence-based medicine paradigm on its head. J Epidemiol Community Health 2020; 74:203-208. [PMID: 31744848 PMCID: PMC6993029 DOI: 10.1136/jech-2019-213085] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/04/2022]
Abstract
Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population-wide and system-wide approaches that generate and sustain healthier behaviours. Population health interventions are often implemented as natural experiments, which makes their evaluation more complex and unpredictable than a typical randomised controlled trial (RCT). We discuss the growing importance of evaluating natural experiments and their distinctive contribution to the evidence for public health policy. We contrast the established evidence-based practice pathway, in which RCTs generate 'definitive' evidence for particular interventions, with a practice-based evidence pathway in which evaluation can help adjust the compass bearing of existing policy. We propose that intervention studies should focus on reducing critical uncertainties, that non-randomised study designs should be embraced rather than tolerated and that a more nuanced approach to appraising the utility of diverse types of evidence is required. The complex evidence needed to guide public health action is not necessarily the same as that which is needed to provide an unbiased effect size estimate. The practice-based evidence pathway is neither inferior nor merely the best available when all else fails. It is often the only way to generate meaningful evidence to address critical questions about investing in population health interventions.
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Affiliation(s)
- David Ogilvie
- MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Adrian Bauman
- Charles Perkins Centre and Prevention Research Collaboration, University of Sydney, Sydney, New South Wales, Australia
| | | | - Jenna Panter
- MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Karen R Siegel
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
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Prins RG, Kamphuis CBM, Van Lenthe FJ. The effects of small-scale physical and social environmental interventions on walking behaviour among Dutch older adults living in deprived neighbourhoods: results from the quasi-experimental NEW.ROADS study. Int J Behav Nutr Phys Act 2019; 16:133. [PMID: 31856841 PMCID: PMC6921563 DOI: 10.1186/s12966-019-0863-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 10/18/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods. METHODS Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates. RESULTS Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking. CONCLUSION Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults.
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Affiliation(s)
- R. G. Prins
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
- Mulier Instituut, Postbus 85445, 3508AK Utrecht, the Netherlands
| | - C. B. M. Kamphuis
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - F. J. Van Lenthe
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands
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Jackson MJ, Roche DM, Amirabdollahian F, Koehn S, Khaiyat OA. The Musculoskeletal Health Benefits of Tennis. Sports Health 2019; 12:80-87. [PMID: 31710819 DOI: 10.1177/1941738119880862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study sought to investigate whether regular tennis participation is more effective at enhancing MSK function than meeting the current international physical activity guidelines. HYPOTHESIS Tennis players will display significantly enhanced MSK function when compared with age-matched healthy active nonplayers. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness. RESULTS Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, -0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, -0.16 ± 1.70; P < 0.05). CONCLUSION The present study offers support for improved MSK functionality in tennis players when compared with age-matched healthy active nonplayers. This may be due to the hybrid high-intensity interval training nature of tennis. CLINICAL RELEVANCE The findings suggest tennis is an excellent activity mode to promote MSK health and should therefore be more frequently recommended as a viable alternative to existing physical activity guidelines.
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Affiliation(s)
| | - Denise M Roche
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
| | | | - Stefan Koehn
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
| | - Omid A Khaiyat
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
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Panter J, Guell C, Humphreys D, Ogilvie D. Title: Can changing the physical environment promote walking and cycling? A systematic review of what works and how. Health Place 2019; 58:102161. [PMID: 31301599 PMCID: PMC6737987 DOI: 10.1016/j.healthplace.2019.102161] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
Environmental changes aimed at encouraging walking or cycling may promote activity and improve health, but evidence suggests small or inconsistent effects in practice. Understanding how an intervention works might help explain the effects observed and provide guidance about generalisability. We therefore aimed to review the literature on the effects of this type of intervention and to understand how and why these may or may not be effective. We searched eight electronic databases for existing systematic reviews and mined these for evaluative studies of physical environmental changes and assessed changes in walking, cycling or physical activity. We then searched for related sources including quantitative or qualitative studies, policy documents or reports. We extracted information on the evidence for effects ('estimation'), contexts and mechanisms ('explanation') and assessed credibility, and synthesised material narratively. We identified 13 evaluations of interventions specifically targeting walking and cycling and used 46 related sources. 70% (n = 9 evaluations) scored 3 or less on the credibility criteria for effectiveness. 6 reported significant positive effects, but higher quality evaluations were more likely to report positive effects. Only two studies provided rich evidence of mechanisms. We identified three common resources that interventions provide to promote walking and cycling: (i) improving accessibility and connectivity; (ii) improving traffic and personal safety; and (iii) improving the experience of walking and cycling. The most effective interventions appeared to target accessibility and safety in both supportive and unsupportive contexts. Although the evidence base was relatively limited, we were able to understand the role of context in the success of interventions. Researchers and policy makers should consider the context and mechanisms which might operate before evaluating and implementing interventions.
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Affiliation(s)
- Jenna Panter
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Centre for Diet & Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Cornelia Guell
- European Centre for Environment & Human Health, Medical School, University of Exeter, Exeter, UK
| | - David Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Green Templeton College, University of Oxford, Oxford, UK
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Centre for Diet & Activity Research (CEDAR), University of Cambridge, Cambridge, UK
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26
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Obesity risk in women of childbearing age in New Zealand: a nationally representative cross-sectional study. Int J Public Health 2019; 64:625-635. [DOI: 10.1007/s00038-019-01239-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/10/2019] [Accepted: 03/25/2019] [Indexed: 12/27/2022] Open
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Hobbs M, Griffiths C, Green M, Christensen A, McKenna J. Examining longitudinal associations between the recreational physical activity environment, change in body mass index, and obesity by age in 8864 Yorkshire Health Study participants. Soc Sci Med 2019; 227:76-83. [DOI: 10.1016/j.socscimed.2018.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/14/2018] [Accepted: 06/23/2018] [Indexed: 11/16/2022]
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Kestens Y, Winters M, Fuller D, Bell S, Berscheid J, Brondeel R, Cantinotti M, Datta G, Gauvin L, Gough M, Laberee K, Lewis P, Lord S, Luan H(H, McKay H, Morency C, Muhajarine N, Nelson T, Ottoni C, Stephens ZP, Pugh C, Rancourt G, Shareck M, Sims-Gould J, Sones M, Stanley K, Thierry B, Thigpen C, Wasfi R. INTERACT: A comprehensive approach to assess urban form interventions through natural experiments. BMC Public Health 2019; 19:51. [PMID: 30630441 PMCID: PMC6327503 DOI: 10.1186/s12889-018-6339-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban form interventions can result in positive and negative impacts on physical activity, social participation, and well-being, and inequities in these outcomes. Natural experiment studies can advance our understanding of causal effects and processes related to urban form interventions. The INTErventions, Research, and Action in Cities Team (INTERACT) is a pan-Canadian collaboration of interdisciplinary scientists, urban planners, and public health decision makers advancing research on the design of healthy and sustainable cities for all. Our objectives are to use natural experiment studies to deliver timely evidence about how urban form interventions influence health, and to develop methods and tools to facilitate such studies going forward. METHODS INTERACT will evaluate natural experiments in four Canadian cities: the Arbutus Greenway in Vancouver, British Columbia; the All Ages and Abilities Cycling Network in Victoria, BC; a new Bus Rapid Transit system in Saskatoon, Saskatchewan; and components of the Sustainable Development Plan 2016-2020 in Montreal, Quebec, a plan that includes urban form changes initiated by the city and approximately 230 partnering organizations. We will recruit a cohort of between 300 and 3000 adult participants, age 18 or older, in each city and collect data at three time points. Participants will complete health and activity space surveys and provide sensor-based location and physical activity data. We will conduct qualitative interviews with a subsample of participants in each city. Our analysis methods will combine machine learning methods for detecting transportation mode use and physical activity, use temporal Geographic Information Systems to quantify changes to urban intervention exposure, and apply analytic methods for natural experiment studies including interrupted time series analysis. DISCUSSION INTERACT aims to advance the evidence base on population health intervention research and address challenges related to big data, knowledge mobilization and engagement, ethics, and causality. We will collect ~ 100 TB of sensor data from participants over 5 years. We will address these challenges using interdisciplinary partnerships, training of highly qualified personnel, and modern methodologies for using sensor-based data.
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Affiliation(s)
- Yan Kestens
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Meghan Winters
- Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Daniel Fuller
- Memorial University of Newfoundland, 230 Elizabeth Avenue, St. John’s, NF A1C 5S7 Canada
| | - Scott Bell
- University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2 Canada
| | - Janelle Berscheid
- University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2 Canada
| | - Ruben Brondeel
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Michael Cantinotti
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC G9A 5H7 Canada
| | - Geetanjali Datta
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Lise Gauvin
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Margot Gough
- University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2 Canada
| | - Karen Laberee
- Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Paul Lewis
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Sébastien Lord
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Hui ( Henry) Luan
- Memorial University of Newfoundland, 230 Elizabeth Avenue, St. John’s, NF A1C 5S7 Canada
| | - Heather McKay
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
| | - Catherine Morency
- Polytechnique Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4 Canada
| | - Nazeem Muhajarine
- University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2 Canada
| | - Trisalyn Nelson
- Arizona State University, PO Box 875302, Tempe, AZ 85287-5302 USA
| | - Callista Ottoni
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC G9A 5H7 Canada
| | - Zoe Poirier Stephens
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Caitlin Pugh
- Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Gabrielle Rancourt
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Martin Shareck
- University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Joanie Sims-Gould
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC G9A 5H7 Canada
| | - Meridith Sones
- Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Kevin Stanley
- University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2 Canada
| | - Benoit Thierry
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
| | - Calvin Thigpen
- Polytechnique Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4 Canada
| | - Rania Wasfi
- École de Santé Publique de l’Université de Montréal / Centre de recherche du CHUM, Pavillon S, Tour St–Antoine – 850 St–Denis – S03–280 –, Montreal, QC H2X 0A9 Canada
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Ingemann C, Regeer BJ, Larsen CVL. Determinants of an integrated public health approach: the implementation process of Greenland's second public health program. BMC Public Health 2018; 18:1353. [PMID: 30526534 PMCID: PMC6286563 DOI: 10.1186/s12889-018-6253-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined. Methods Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II’s implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination. Results Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee. Conclusion Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II’s integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation. Electronic supplementary material The online version of this article (10.1186/s12889-018-6253-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine Ingemann
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Studiestraede 6, 1455, Copenhagen K, Denmark. .,Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, de Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Barbara J Regeer
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, de Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Christina V L Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Studiestraede 6, 1455, Copenhagen K, Denmark.,Greenland Centre for Health Research, University of Greenland, Nuuk, Postbox 1061, 3905, Nuussuaq, Greenland
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Rohan EA, Chovnick G, Rose J, Townsend JS, Young M, Moore AR. Prioritizing Population Approaches in Cancer Prevention and Control: Results of a Case Study Evaluation of Policy, Systems, and Environmental Change. Popul Health Manag 2018; 22:205-212. [PMID: 30160605 DOI: 10.1089/pop.2018.0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Development and implementation of policy, systems, and environmental (PSE) change is a commonly used public health approach to reduce disease burden. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program conducted a demonstration with 13 programs to determine whether and to what extent dedicated resources would enhance the adoption of PSE strategies. This paper describes results of the qualitative portion of a longitudinal, mixed-methods evaluation of this demonstration. Case studies were conducted with a diverse subset of the 13 programs, and 106 in-depth interviews were completed with state/tribal program staff, community partners, and decision makers. Interviews addressed PSE change planning and capacity building, partnerships, local context, and how programs achieved PSE change. Dedicated PSE resources, including a policy analyst, helped increase PSE change capacity, intensify focus on PSE change overall, and accomplish specific PSE changes within individual jurisdictions. Stakeholders described PSE change as a gradual process requiring preparation and prioritization, strategic collaboration, and navigation of local context. Findings suggest that the demonstration program, including PSE-dedicated funds and a policy analyst, was successful in both increasing PSE change capacity and achieving PSE change itself. These results may be useful to other state, tribal, territorial, and public health organizations planning or implementing PSE change strategies.
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Affiliation(s)
- Elizabeth A Rohan
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gary Chovnick
- 2 Battelle Memorial Institute, Columbus, Ohio.,3 ICF International, Seattle, Washington
| | - John Rose
- 2 Battelle Memorial Institute, Columbus, Ohio
| | - Julie S Townsend
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monique Young
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela R Moore
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
In a Perspective, Martin White and Jean Adams discuss challenges in the evaluation of interventions intended to benefit population health.
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Benton JS, Anderson J, Cotterill S, Dennis M, Lindley SJ, French DP. Evaluating the impact of improvements in urban green space on older adults' physical activity and wellbeing: protocol for a natural experimental study. BMC Public Health 2018; 18:923. [PMID: 30053861 PMCID: PMC6062989 DOI: 10.1186/s12889-018-5812-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/06/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Creating or improving urban green space has the potential to be an effective, sustainable and far-reaching way to increase physical activity and improve other aspects of wellbeing in the population. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults' physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. All sites are located in deprived urban neighbourhoods in Greater Manchester, United Kingdom. METHODS Components of the interventions include tree and flower planting, and artificial tree decorations. Eight unimproved comparison sites were selected based on a systematic process of matching using several known objective and subjective environmental correlates of physical activity in older adults. The outcome measures are physical activity and two other behavioural indicators of wellbeing (Connect: connecting with other people; and Take Notice: taking notice of the environment), collected using a newly developed observation tool. The primary outcome is Take Notice behaviour due to largest effects on this behaviour being anticipated from improvements in the aesthetic quality of green space at the intervention sites. Baseline data collection occurred in September 2017 before the interventions were installed in November 2017. Follow-up data collection will be repeated in February/ March 2018 (6 months) and September 2018 (12 months). DISCUSSION The present study permits a rare opportunity to evaluate the causal effects of small-scale changes in urban green space in an understudied population and setting. Although the interventions are expected to have small effects on the outcomes, the present study contributes to developing natural experiment methodology in this field by addressing key methodological weaknesses causing high risk of bias in previous natural experimental studies. Key improvements to reduce risk of bias in the present study are rigorous matching of multiple comparison sites and appropriate statistical control of key confounders. TRIAL REGISTRATION Retrospectively registered with study ID NCT03575923 . Date of registration: 3 July 2018.
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Affiliation(s)
- Jack S. Benton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
| | - Jamie Anderson
- Urban Institute, Department of Geography, School of Environment, Education and Development, University of Manchester, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matthew Dennis
- Department of Geography, School of Education, Environment and Development, University of Manchester, Manchester, UK
| | - Sarah J. Lindley
- Department of Geography, School of Education, Environment and Development, University of Manchester, Manchester, UK
| | - David P. French
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
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