Correlates of the Built Environment and Active Travel: Evidence from 20 US Metropolitan Areas

‎The association between cumulative exposure to neighborhood walkability (NW) and diabetes risk, a prospective cohort study

PURPOSE

To examine the association between cumulative exposure to neighborhood walkability (NW) and diabetes risk.

METHODS

A total of 11,037 women free of diabetes at enrollment were included. We constructed a 4-item NW index at baseline, and a 2-item average annual NW across years of follow-up that captured both changes in neighborhood features and residential moves. We used multivariable Cox PH regression models with robust variance to estimate the hazard ratios (HRs) of diabetes by NW scores.

RESULTS

Compared with women living in areas with lowest NW (Q1), those living in areas with highest NW (Q4) had 33 % (26 %-39 %) reduced risk of incident diabetes, using baseline NW, and 25 % (95 % CI 11 %-36 %), using average annual NW. Analysis using time-varying exposure showed that diabetes risks decreased by 13 % (10 %-16 %) per -standard deviation increase in NW. The associations remained similar when using inverse probability of attrition weights and/or competing risk models to account for the effect of censoring due to death or non-response. The associations of average annual NW with incident diabetes were stronger in postmenopausal women as compared to premenopausal women.

CONCLUSION

Long-term residence in more walkable neighborhoods may be protective against diabetes in women, especially postmenopausal women.

Interactive impacts of walkability, social vulnerability, & travel behavior on COVID-19 mortality: A hierarchical Bayesian spatial random parameter approach

While existing research highlights the built and social environment impacts on COVID-19 mortality, no empirical evidence exists on how the built and social environments may interact to influence COVID-19 mortality. This study presents a rigorous empirical assessment of the interactive impacts of social vulnerability and walkability on neighborhood-level COVID-19 mortality rates. Based in King County, WA, a unique data infrastructure is created by spatially integrating diverse census tract-level data on COVID-19 mortalities, walkability characteristics, social vulnerability, and travel behavior measures. Advanced Markov Chain Monte Carlo (MCMC) based Full Bayes hierarchical spatial random parameter models are developed to simultaneously capture spatial and unobserved random heterogeneity. Around 46% of the neighborhoods had opposite levels of walkability and social vulnerability. Compared to low walkability and high social vulnerability, neighborhoods with high walkability and low social vulnerability (i.e., best case scenario) had on average 20.2% (95% Bayesian CI: -37.2% to -3.3%) lower COVID-19 mortality rates. Analysis of the interactive impacts when only one of the social and built environment metrics was in a healthful direction revealed significant offsetting effects - suggesting that the underlying structural social vulnerability issues faced by our communities should be addressed first for the infectious disease-related health impacts of walkable urban design to be observed. Concerning travel behavior, the findings indicate that COVID-19 mortality rates may be reduced by discouraging auto use and encouraging active transportation. The study methodologically contributes by simultaneously capturing spatial and unobserved heterogeneity in a holistic Full Bayesian framework.

Assessing the effectiveness of built environment-based safety measures in urban and rural areas for reducing the non-motorist crashes

Introduction

Built environment (BE) has a well-documented impact on non-motorist crashes. Interestingly, the urban-rural distinction of the impacts received scant attention in the literature. Moreover, the combined effect of these elements are less studied than their standalone effects.

Objective

This study explores the combined effectiveness of built environment-based safety measures in urban and rural settings.

Data and method

The study uses nine years (2011-2019) of non-motorist (pedestrian and bicyclist) crash data in Florida. It classifies urban and rural areas with the multivariate clustering method and models the crash count with Log-transformed Spatial Error Models.

Results

Findings suggest that urban areas, tracts with low median income, a lower percentage of senior citizens, and a higher percentage of black, white, and Hispanic people are significantly associated with a high number of nonmotorist crashes. The percentage of pedestrian and bicyclist commuters is positively associated with pedestrian and bicycle crash count, respectively. Among BE variables, more crashes are observed in tracts with more commercial land use (LU), less recreational LU, higher LU mix, more traffic, signalized intersection, transit stops, and sidewalks. Having more traffic and fewer transit stops pose lesser risk in urban areas than rural areas. The combined effects suggest that increasing commercial LU where LU entropy is high (or vice-versa) will help to reduce nonmotorist crashes. Also, in high entropy areas, increasing rural traffic is riskier whereas increasing urban traffic is safer.

Conclusion

This paper documents the need of considering urban-rural differences and interaction effects among BE elements for nonmotorist safety.

Interventions Designed to Support Physical Activity and Disease Prevention for Working from Home: A Scoping Review

Working from home (WfH) has public health implications including changes to physical activity (PA) and sedentary behavior (SB). We reviewed published and grey literature for interventions designed to support PA or reduce SB in WfH contexts. From 1355 published and grey literature documents since 2010, we screened 136 eligible documents and extracted ten intervention studies. Interventions designed specifically for WfH were limited and included structured exercise programs, infrastructure (e.g., sit-stand workstations), online behavioral and educational programs, health professional advice and peer support, activity trackers and reminder prompts. Evidence of interventions to improve PA and reduce SB in WfH contexts is emergent but lacking in variety and in utilization of local environments to promote good health. Evidence is needed on the adaptation of existing workplace interventions for home environments and exploration of opportunities to support PA through alternative interventions, such as urban planning and recreational strategies.

Assessing Measurement Invariance of a Land Use Environment Construct Across Levels of Urbanicity

Variation in the land use environment (LUE) impacts the continuum of walkability to car dependency, which has been shown to have effects on health outcomes. Existing objective measures of the LUE do not consider whether the measurement of the construct varies across different types of communities along the rural/urban spectrum. To help meet the goals of the Diabetes Location, Environmental Attributes, and Disparities (LEAD) Network, we developed a national, census tract-level LUE measure which evaluates the road network and land development. We tested for measurement invariance by LEAD community type (higher density urban, lower density urban, suburban/small town, and rural) using multiple group confirmatory factor analysis. We determined that metric invariance does not exist; thus, measurement of the LUE does vary across community type with average block length, average block size, and percent developed land driving most shared variability in rural tracts and with intersection density, street connectivity, household density, and commercial establishment density driving most shared variability in higher density urban tracts. As a result, epidemiologic studies need to consider community type when assessing the LUE to minimize place-based confounding.

How different are objective operationalizations of walkability for older adults compared to the general population? A systematic review

Background

Walking is an essential activity for everyone and for older adults in particular, given that it is the most accessible form of physical activity and one of the healthiest transportation modes. Understanding how walkability (the potential of the environment to enable and/or encourage walking) has been objectively measured and analyzed for older adults is critical to create more inclusive, healthy, and sustainable environments and to promote healthy aging. Despite the numerous reviews on physical activity among older adults and its relationship with the built environment, the literature still lacks comparison reviews focusing specifically on objective operationalizations of walkability for older adults vs. the general population.

Methods

We conducted a systematic review of 146 empirical studies that measured walkability objectively in relation to walking-related outcomes. We compared studies focused on older adults (n = 24) and the general population (n = 122). Content analysis included the characteristics of the study design, walkability measures, spatial extent, and associations found between walkability and walking-related outcomes.

Results

In both groups of publications, the majority of studies were conducted in the US, Canada, and Europe, and largely in high-income countries. They were mostly published in health-related journals and used cross-sectional designs, operationalized walkability by using indexes, employed self-reported measures for walking-related outcomes, and found positive associations between walkability and walking outcomes. However, we observed some differences among studies focusing on older adults. Compared to studies focusing on the general population, a larger proportion of studies on older adults was conducted in the Middle East and Asia, and they used longitudinal designs, mixed methods to measure walking-related outcomes, variables related with land-use characteristics, safety from traffic and crime, and greenery, and a larger proportion found positive, as well as no associations between walkability and walking-related outcomes.

Conclusion

Although there is a promising increase in interest in older adults-focused walkability studies in the last decade, there is still a need for more studies focusing on different settings, using wider spatial extents, longitudinal designs, objective or mixed methods to collect outcome data, and specific variables and/or specially created indexes for older adults and for settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03233-x.

The emergence of recreational cycling in Hanoi during the Covid-19 pandemic

OBJECTIVES

This study examined recreational cycling in Hanoi, Vietnam, with a particular focus on changes brought about by the Covid-19 pandemic. The research questions were: (1) Has recreational cycling increased during the Covid-19 pandemic?; (2) If so, what factors have led to the increase?; and (3) What are some of the typical traits and behaviors of recreational cyclists?

METHOD

Face-to-face surveys of 356 recreational cyclists were carried out in March-April 2021 in four areas of inner Hanoi. The survey data were modelled through two binary and one ordinal logit regression.

RESULTS

Recreational cycling has become much more popular in Hanoi during the Covid-19 pandemic, with early morning being the preferred time for this activity (to avoid heavy traffic). A quarter of the participants had starting cycling recreationally since the first lockdown in April 2020, and about three quarters reported having noticed an increase in cycling activity around them. Nearly half of the participants cycled regularly (more than four times per week). The groups that were most likely to have taken up cycling for recreations during the pandemic included men, those living with children in the home, and those not working or studying. Age and income were not significant. People have been embracing cycling as a way to maintain or increase physical activity levels, and to safely socialize at the time when social gatherings are limited, walking is prohibited in some zones, and social distancing rules apply everywhere.

CONCLUSION

To sustain the growth in recreational cycling and widen the time-window for this activity while ensuring everyone's safety, Hanoi's planning and public health sectors should join forces to adopt a combination of 'hard' and 'soft' measures. The authors recommend creating multi-use paths for micromobility modes, launching a public bikesharing scheme, regulating motorised modes, and social marketing that promotes recreational cycling as trendy.

Sociodemographic inequities and active transportation in adults from Latin America: an eight-country observational study

Background

Active transportation is a crucial sort of physical activity for developing sustainable environments and provides essential health benefits. This is particularly important in Latin American countries because they present the highest burden of non-communicable diseases relative to other worldwide regions. This study aimed to examine the patterns of active transportation and its association with sociodemographic inequities in Latin American countries.

Methods

This cross-sectional study was conducted in eight countries. Participants (n = 8547, 18–65 years) self-reported their active transportation (walking, cycling, and total) using the International Physical Activity Questionnaire. Sex, age, ethnicity, socioeconomic level, education level, public and private transport use, and transport mode were used as sociodemographic inequities.

Results

Participants spent a total of 19.9, 3.1, and 23.3 min/day with walking, cycling, and total active transportation, respectively. Mixed and other ethnicity (Asian, Indigenous, Gypsy, and other), high socioeconomic level as well as middle and high education level presented higher walking than Caucasian, low socioeconomic and education level. Private transport mode and use of ≥ 6 days/week of private transport showed lower walking than public transport mode and ≤ 2 days/week of private transport. Use of ≥ 3 days/week of public transport use presented higher walking than ≤ 2 days/week of public transport. Men had higher cycling for active transportation than women. Use of ≥ 3 days/week of public transport use presented higher cycling than ≤ 2 days/week of public transport. ≥6 days/week showed lower cycling than ≤ 2 days/week of private transport use. Men (b: 5.57: 95 %CI: 3.89;7.26), black (3.77: 0.23;7.31), mixed (3.20: 1.39;5.00) and other ethnicity (7.30: 2.55;12.04), had higher total active transportation than women and Caucasian. Private transport mode (-7.03: -11.65;-2.41) and ≥ 6 days/week of private transport use (-4.80: -6.91;-0.31) showed lower total active transportation than public transport mode and ≤ 2 days/week of private transport use. Use of 3–5 (5.10: 1.35;8.85) and ≥ 6 days/week (8.90: 3.07;14.73) of public transport use presented higher total active transportation than ≤ 2 days/week of public transport use. Differences among countries were observed.

Conclusions

Sociodemographic inequities are associated differently with active transportation across Latin American countries. Interventions and policies that target the promotion of active policies transportation essential to consider sociodemographic inequities.

Trial registration

ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01524-0.

Socioeconomic inequalities in physical activity in Brazil: a pooled cross-sectional analysis from 2013 to 2019

BACKGROUND

Information on socioeconomic inequalities in physical activity over time is sparse in low- to middle-income countries. In this study, we examined trends in physical activity educational inequalities in adults from Brazil between 2013 and 2019.

METHODS

We analyzed data from seven cross-sectional studies including 359,038 adults (≥ 18 years) from the VIGITEL study conducted annually from 2013 to 2019. Participants responded to a questionnaire about physical activity (total, leisure, and commuting). Educational inequalities by sex and skin color were assessed through absolute (slope index of inequality - SII) and relative measures of inequality (concentration index - CIX).

RESULTS

We found large absolute and relative inequalities for leisure-time physical activity, favoring those with higher educational attainment (SII₂₀₁₉ = 35.4; CIX₂₀₁₉ = 11.82). Active commuting was more prevalent in intermediate education groups, with a slight inequality toward the less educated group (SII₂₀₁₉ = -2.8; CIX₂₀₁₉ = -0.4). From 2013 to 2019, the absolute educational inequality in physical activity (total, leisure, and commuting) remained unchanged; however, the relative inequality gap narrowed for total physical activity (CIX: 8.4 in 2013 to 5.5 in 2019) and leisure-time physical activity (CIX: 18.3 in 2013 to 11.8 in 2019). Educational inequality increased in leisure-time physical activity among women and non-white individuals, while it reduced among men and white individuals; for active commuting, inequality decreased among women, and increased among men and white individuals.

CONCLUSIONS

Inequality in total physical activity and leisure-time physical activity favors the most educated groups in Brazil. Over time, relative educational inequality decreased for total and leisure-time physical activity, while no progress was found for absolute inequality.

Environmental exposure during travel: A research review and suggestions forward

Daily travel through the urban fabric exposes urban dwellers to a range of environmental conditions that may have an impact on their health and wellbeing. Knowledge about exposures during travel, their associations with travel behavior, and their social and health outcomes are still limited. In our review, we aim to explain how the current environmental exposure research addresses the interactions between human and environmental systems during travel through their spatial, temporal and contextual dimensions. Based on the 104 selected studies, we identify significant recent advances in addressing the spatiotemporal dynamics of exposure during travel. However, the conceptual and methodological framework for understanding the role of multiple environmental exposures in travel environments is still in an early phase, and the health and wellbeing impacts at individual or population level are not well known. Further research with greater geographical balance is needed to fill the gaps in the empirical evidence, and linking environmental exposures during travel with the causal health and wellbeing outcomes. These advancements can enable evidence-based urban and transport planning to take the next step in advancing urban livability.

Neighbourhood and path-based greenspace in three European countries: associations with objective physical activity

Background

Greenspace has been associated with health benefits in many contexts. An important pathway may be through outdoor physical activity. We use a novel approach to examine the link between greenspace microenvironments and outdoor physical activity levels in the HEALS study conducted in Edinburgh (UK), the Netherlands, and Athens and Thessaloniki (Greece).

Methods

Using physical activity tracker recordings, 118 HEALS participants with young children were classified with regard to daily minutes of moderate to vigorous physical activity (MVPA); 60 were classified with regard to the metabolic equivalent task (MET)-minutes for each of the 1014 active trips they made. Greenspace indicators were generated for Normalised Difference Vegetation Index (NDVI), tree cover density (TCD), and green land use (GLU). We employed linear mixed-effects models to analyse (1) daily MVPA in relation to greenspace within 300 m and 1000 m of residential addresses and (2) trip MET-minutes in relation to average greenspace within a 50 m buffer of walking/cycling routes. Models were adjusted for activity, walkability, bluespace, age, sex, car ownership, dog ownership, season, weekday/weekend day, and local meteorology.

Results

There was no clear association between MVPA-minutes and any residential greenspace measure. For example, in fully adjusted models, a 10 percentage point increase in NDVI within 300 m of home was associated with a daily increase of 1.14 (95% CI − 0.41 to 2.70) minutes of MVPA. However, we did find evidence to indicate greenspace markers were positively linked to intensity and duration of activity: in fully adjusted models, 10 percentage point increases in trip NDVI, TCD, and GLU were associated with increases of 10.4 (95% CI: 4.43 to 16.4), 10.6 (95% CI: 4.96 to 16.3), and 3.36 (95% CI: 0.00 to 6.72) MET-minutes, respectively. The magnitude of associations with greenspace tended to be greater for cycling.

Conclusions

More strenuous or longer walking and cycling trips occurred in environments with more greenspace, but levels of residential greenspace did not have a clear link with outdoor MVPA. To build on our research, we suggest future work examine larger, more diverse populations and investigate the influence of greenspace for trip purpose and route preference.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10259-0.

Combining expert and crowd-sourced training data to map urban form and functions for the continental US

Although continental urban areas are relatively small, they are major drivers of environmental change at local, regional and global scales. Moreover, they are especially vulnerable to these changes owing to the concentration of population and their exposure to a range of hydro-meteorological hazards, emphasizing the need for spatially detailed information on urbanized landscapes. These data need to be consistent in content and scale and provide a holistic description of urban layouts to address different user needs. Here, we map the continental United States into Local Climate Zone (LCZ) types at a 100 m spatial resolution using expert and crowd-sourced information. There are 10 urban LCZ types, each associated with a set of relevant variables such that the map represents a valuable database of urban properties. These data are benchmarked against continental-wide existing and novel geographic databases on urban form. We anticipate the dataset provided here will be useful for researchers and practitioners to assess how the configuration, size, and shape of cities impact the important human and environmental outcomes.

From End Treatment to Source Prevention: Socio-Ecological Approaches to Promote Research on the Environment and Non-Communicable Chronic Diseases with Special Reference to China

Globally, the pandemic of non-communicable chronic diseases (NCDs) has become a critical public health problem. Although NCD prevention has been shifting from individual behavioral interventions to broad environmental interventions, it is still necessary to promote research on the environment and NCDs as a whole. Therefore, this conceptual paper aimed to develop a general and novel framework to advance this line of research. The framework uses socio-ecological approaches that emphasize source prevention rather than the end treatment. Specifically, this framework comprehensively covered integrative research approaches, prioritized areas, urgent efforts, innovative methodologies, and improved funding. The framework used China as a typical context, where its public health policies, similar to other nations, still focus on the end treatment of NCDs, placing emphasis on biomedical approaches and technologies. China’s relevant efforts may furnish new insights and approaches concerning NCD prevention, and these efforts may benefit the improvement of global health and well-being. Such social-ecological research efforts can help to accelerate a shift from existing individual interventions to environmental interventions, thereby ultimately achieving the effective source prevention of NCDs in China and around the globe.