Health and the built environment: 10 years after

The indoors microbiome and human health

Indoor environments serve as habitat for humans and are replete with various reservoirs and niches for microorganisms. Microorganisms enter indoor spaces with their human and non-human hosts, as well as via exchange with outdoor sources, such as ventilation and plumbing. Once inside, many microorganisms do not survive, especially on dry, barren surfaces. Even reduced, this microbial biomass has critical implications for the health of human occupants. As urbanization escalates, exploring the intersection of the indoor environment with the human microbiome and health is increasingly vital. The indoor microbiome, a complex ecosystem of microorganisms influenced by human activities and environmental factors, plays a pivotal role in modulating infectious diseases and fostering healthy immune development. Recent advancements in microbiome research shed light on this unique ecological system, highlighting the need for innovative approaches in creating health-promoting living spaces. In this Review, we explore the microbial ecology of built environments - places where humans spend most of their lives - and its implications for immune, endocrine and neurological health. We further propose strategies to harness the indoor microbiome for better health outcomes.

Capabilities, opportunities, motivations, and practices of different sector professionals working on community environments to improve health

OBJECTIVE

With rising healthcare costs in Canada from chronic conditions, individual behaviour change interventions in the clinical settings need to be complemented by a determinants of health approach, where multi-sector professionals assist in the creation of healthier community environments. This study sought to gain insights into capabilities, opportunities, motivations, and behaviours (COM-B) of Canadian multi-sector professionals for working together to improve built environments (BE) for health.

METHODS

A cross-sectional study was conducted with 61 multi-sector professionals. A 49-item questionnaire measuring constructs of COM-B for healthy BE practices was administered.

RESULTS

Public health (PH) professionals were more motivated by personal interest/values in healthy BE and the presence of scientific evidence on BE design health impacts as compared with planning and policy/program development (PPD) professionals. Planning professionals were more likely to be motivated by healthy BE legislation/regulations/codes than PPD professionals. The practice of taking responsibility for the inclusion of healthy features into BE designs was reported more often by planning and other professionals compared to PH professionals. Results trended towards significance for opportunities as a predictor of healthy BE practices among all professionals.

CONCLUSION

Though motivators vary among different sector professionals, opportunities may be the most important driver of healthy BE practices and potentially a target to improve multi-sector professional practices in Canada. Future research should confirm findings of this first study of professional practice drivers guided by a theoretical behaviour change framework.

The association between neighborhood conditions and weight loss among older adults living in a large urban city

To elucidate the role of neighborhood walkability and crime on weight loss, we examined data from older adults residing in Chicago who participated in a randomized controlled trial lifestyle intervention. Controlling for individual demographic characteristics and the intervention assignment, the neighborhood homicide rate was significantly associated with weight change. Participants who resided in neighborhoods above the 50th percentile of homicide rate actually gained weight between pre- and post-intervention. On the other hand, there was no significant relationship between the level of walkability and weight loss. Our findings suggest that the social environment related to neighborhood crime may play a more important role in weight loss than the built environment, such as walkability. Urban characteristics related to walkability, such as sidewalks, may increase physical activity, however, interventions aiming to increase physical activity to promote weight loss will benefit by addressing the neighborhood social environment that determines how people navigate space.

Perceived neighborhood environment walkability and health-related quality of life among predominantly Black and Latino adults in New York City

BACKGROUND

Measures of the built environment such as neighborhood walkability have been associated with health behaviors such as physical activity, the lack of which in turn may contribute to the development of diseases such as obesity, diabetes, cardiovascular disease, and cancer. However, limited research has examined these measures in association with health-related quality of life (HR-QoL), particularly in minoritized populations. We examined the relationship between perceived neighborhood environment and HR-QoL in a sample of mostly Black and Latino residents in New York City (NYC).

METHODS

This study utilized the baseline survey data from the Physical Activity and Redesigned Community Spaces (PARCS) Study among 1252 residents [34.6% Black, 54.1% Latino, 80.1% female, mean(±SD) age = 38.8 ± 12.5) in 54 park neighborhoods in NYC. Perceived built environment was measured using Neighborhood Environment and Walkability Survey, and mental and physical HR-QoL was estimated using Short Form (SF)-12. Using factor analysis, we identified two subscales of neighborhood walkability: enablers (e.g., trails, sidewalks, esthetics) vs. barriers (e.g., high crime and traffic). In addition, we included a third subscale on neighborhood satisfaction. Generalized Estimating Equation models adjusted for demographics and BMI and accounted for the clustering effect within neighborhood. Multiple imputation was used to account for missing data.

RESULTS

Mental HR-QoL was associated with barriers of walkability (β ± SE = - 1.63 ± 0.55, p < 0.01) and neighborhood satisfaction (β ± SE = 1.55 ± 0.66, p = 0.02), after adjusting for covariates. Physical HR-QoL was associated with only barriers of walkability (β ± SE = - 1.13 ± 0.57, p < 0.05).

CONCLUSIONS

Among NYC residents living in minoritized neighborhoods, mitigating negative aspects of the neighborhood environment may be more crucial than adding positive features in terms of HR-QoL. Our study points to the need to investigate further the role of the built environment in urban, minoritized communities.

Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings

Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.

Causal evaluation of the health effects of light rail line: A Natural Experiment

BACKGROUND AND OBJECTIVE

No research to date has causally linked built environment data with health care costs derived from clinically assessed health outcomes within the framework of longitudinal intervention design. This study examined the impact of light rail transit (LRT) line intervention on health care costs after controlling for mode-specific objectively assessed moderateto-vigorous physical activity (MVPA), participant-level neighborhood environmental measures, demographics, attitudinal predispositions, and residential choices.

DATA AND METHODS

Based on a natural experiment related to a new LRT line in Portland - 282 individuals divided into treatment and control groups were prospectively followed during the pre- and post-intervention periods. For each individual, we harness high-resolution data on Electronic Medical Record (EMR) based health care costs, mode-specific MVPA, survey-based travel behavior, attitudinal/perception information, and objectively assessed built environment measures. Simulation-assisted longitudinal grouped random parameter models are developed to gain more accurate insights into the effects of LRT line intervention.

RESULTS

Regarding the "average effect" of the LRT line intervention, no statistically significant reductions in health care costs were observed for the treated individuals over time. However, substantial heterogeneity was observed not only in the magnitude of effects but its direction as well after controlling for the within- and between-individual variations. For a subgroup of treated individuals, the LRT line opening decreased health care costs over time relative to the control group. Further comparative analysis based on the findings of heterogeneity-based models revealed that the effect of LRT intervention for the treated individuals differed by individual characteristics, attitudes/perceptions, and neighborhood level environmental features.

CONCLUSIONS

The study revealed the presence of significant effect modifiers and distinct subgroup structures in the data related to the effects of LRT line intervention on health care costs. Severe implications of ignoring unobserved heterogeneity are highlighted. Limitations and potential avenues for future research are discussed.

The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention

BACKGROUND

Shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes.

METHODS

This is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation.

RESULTS

20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors.

CONCLUSION

Evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications.

TRIAL REGISTRATION

PROSPERO CRD42019118834 .

Disparities in COPD Hospitalizations: A Spatial Analysis of Proximity to Toxics Release Inventory Facilities in Illinois

Disproportionate distribution of air pollution is a major burden on the health of people living in proximity to toxic facilities. There are over 1000 Toxics Release Inventory (TRI) facilities distributed across the state of Illinois. This study investigates and spatially analyzes the relationship between chronic obstructive pulmonary disease (COPD) hospitalizations and toxic emissions from TRI facilities. In addition, this study investigates the connection between COPD hospitalizations and socioeconomic variables. Accounting for dispersion of air pollution beyond the TRI facilities source was attained using the inverse distance weighting interpolation approach. Multiple statistical methods were used including principal components analysis, linear regression, and bivariate local indicators of spatial association (BiLISA). The results from the linear regression model and BiLISA clustering maps show there is a strong connection between COPD hospitalizations and socioeconomic status along with race. TRI emissions were not statistically significant, but there are three major clusters of high COPD hospitalizations with high TRI emissions. Rural areas also seem to carry a higher burden of pollution-emitting facilities and respiratory hospitalizations.

How active can preschoolers be at home? Parents' and grandparents' perceptions of children's day-to-day activity, with implications for physical activity policy

BACKGROUND

The importance of physical activity in early childhood for establishing long-term health is well understood, yet with the exception of recent WHO guidelines, public health initiatives rarely focus on children below school age. Moreover, little is known about how domestic spaces and day-to-day caring activities influence preschool-age children's physical activity. To examine this, we explore caregivers' perceptions of young children's activities within and outside the home, and we consider how lived experiences of caregiving align (or not) with current physical activity policy.

METHODS

Semi-structured interviews with 49 parents and grandparents from 16 families were conducted in Oregon, USA; each family had a child aged 3-5 years. Questions focused on caregivers' perceptions of and involvement with children's body weights, activities, and food practices. The interviews were analysed using thematic analysis. Our analysis drew on a materialities framework, attending to relationships between children, caregivers, spaces in and around the home, and everyday activities.

RESULTS

Four themes were developed: appropriateness of outside versus inside spaces for physical activity; making accommodations for physical activity in the home; active spaces of care, referring to relationships among space, activity type, and caregiver attention; and mundane movement, or the low-intensity movement of everyday life. Together, the results highlight that children's day-to-day activities cut across a spectrum of movement, mediated by available spaces and caregiving affordances.

CONCLUSIONS

Attending to the full spectrum of children's movements highlights how children's activities interlink with family routines, available indoor and outdoor spaces, and the intended uses of these spaces. These interplays between space, care, and physical activity enacted at the household level should inform an integrated, systems-level public health approach to increasing health and well-being for preschool-age children. Suggestions for improvement include coordinating policy development across multiple fields (e.g., housing design, urban planning) that structure the activities of children and their caregivers across 'home' and 'outside' spaces.

Development of an instrument to measure perceived gentrification for health research: Perceptions about changes in environments and residents (PACER)

Despite a myriad of potential pathways linking neighborhood change and gentrification to health, existing quantitative measures failed to capture individual-level, self-reported perceptions of these processes. We developed the Perceptions About Change in Environment and Residents (PACER) survey to measure the gentrification-related neighborhood change experienced by individuals relevant to health. We employed a multi-stage process to develop PACER including a scoping review, question refinement, content validity, and cognitive interviews. Content validity and cognitive interviews were assessed within the National Neighborhood Indicators Partnership (NNIP) and for residents of different tenure in both gentrifying and non-gentrifying neighborhoods to ensure PACER considers the complex nature of neighborhood change for different people within different urban contexts. We piloted the instrument to a sample from the resident panel BeHeardPhilly to assess acceptability and data quality. Finally, we assessed internal consistency, dimensionality, and criterion-related validity using Principal Components Analysis (PCA), descriptive statistics, and correlation coefficients. Testing showed good internal consistency for PACER questions, as well as for each of four resulting factors (Feelings, Built Environment, Social Environment, and Affordability). Correlations between factors and other context measures demonstrated strong criterion-related validity. PACER offers an unprecedented tool for measuring and understanding resident perceptions about gentrification-related neighborhood change relevant to health. Rigorously tested and tailored for health, PACER holds utility for application across different settings to examine changes from events that may impact and shift neighborhoods.

The urban public realm and adolescent mental health and wellbeing: A systematic review

Adolescent mental health is becoming a critical concern. Mental illness rates are rising and many psychological disorders first present symptoms during teenage years. Studies consistently show associations between the built environment and mental health, including internalising mental health disorders in adults, but the evidence for adolescents is less robust and few studies attempt to isolate causality. This review examines the relationship between the urban public realm and adolescent mental health and wellbeing. Our search yielded 24 studies for inclusion. We undertook qualitative synthesis of 20 cross-sectional studies and conducted a separate quality analysis of four longitudinal studies. Greenspace and neighbourhood quality are associated with adolescent mental health and wellbeing although this may be due more to residual confounding, selection effects and same-source bias than evidence for a causal effect. Furthermore, the few longitudinal studies that seek to test causality remain prone to these biases. Overall, we find little evidence of an effect of the urban public realm on adolescent mental health and wellbeing, which, we argue, reflects the difficulty of researching complex pathways between environments and health and highlights a challenge to the field. To address this challenge, we propose a research agenda that prioritises more and better data drawn from diverse study designs, and more and better theories developed from diverse epistemologies.

Review of Associations between Built Environment Characteristics and Severe Acute Respiratory Syndrome Coronavirus 2 Infection Risk

The coronavirus disease 2019 pandemic has stimulated intensive research interest in its transmission pathways and infection factors, e.g., socioeconomic and demographic characteristics, climatology, baseline health conditions or pre-existing diseases, and government policies. Meanwhile, some empirical studies suggested that built environment attributes may be associated with the transmission mechanism and infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, no review has been conducted to explore the effect of built environment characteristics on the infection risk. This research gap prevents government officials and urban planners from creating effective urban design guidelines to contain SARS-CoV-2 infections and face future pandemic challenges. This review summarizes evidence from 25 empirical studies and provides an overview of the effect of built environment on SARS-CoV-2 infection risk. Virus infection risk was positively associated with the density of commercial facilities, roads, and schools and with public transit accessibility, whereas it was negatively associated with the availability of green spaces. This review recommends several directions for future studies, namely using longitudinal research design and individual-level data, considering multilevel factors and extending to diversified geographic areas.

Neighborhood Walkability, Personal Active Travel, and Health in Asian Americans: Does English Proficiency Matter?

INTRODUCTION

The present study investigated a model on how neighborhood walkability influences individual's active travel behavior, which in turn is associated with overall health status among Asian Americans. Given that English proficiency uniquely represents racial/ethnic minorities' ability to access resources and benefits in the host society, we also examined the moderating effects of English proficiency in the relationship.

METHODS

Using data from the Asian American Quality of Life Survey (N= 1,447), Structural Equation Modeling (SEM) was conducted to examine the proposed mediation model of active travel in the relationship between neighborhood walkability and health. The moderating effect by English proficiency was tested using a multiple-group analysis.

RESULTS

For the entire sample, neighborhood walkability was significantly associated with a higher level of active travel (β = .269, p < .001). However, the mediation effect of active travel was not significant (indirect effect = .004, p = .111, 95% bias-corrected CI = -.003 - .026). The results of the multiple group analysis showed that the neighborhood walkability was positively associated with active travel for both the English proficiency group (β =.329, p < .001) and the group with limited English proficiency (β =.201, p < .001). However, the mediation effect of active travel on health status was only significant in the English proficiency group (β = .110, p < .05), indicating that active travel influenced by the neighborhood walkability was positively associated with better health status only for the English proficiency group.

CONCLUSIONS

Our findings add to the growing literature on the influence of the neighborhood walkability on individual's active travel and health status. In addition, findings provide implications for tailored interventions to promote Asian Americans' health with respect to English proficiency.

Environmental health situation in Nigeria: current status and future needs

Environmental health-related risks are becoming a primary concern in Nigeria, with diverse environmental problems such as air pollution, water pollution, oil spillage, deforestation, desertification, erosion, and flooding (due to inadequate drainage systems) caused mostly by anthropogenic activities. This paper reviews the pre-existing and current environmental health problems, proffer future research and needs, policy needs, and recommendations necessary to mitigate Nigeria's environmental health situation. Data from the Institute of Health Metric and Evaluation on Global Burden of Disease (GBD) was used to ascertain the causes of Death and Disability-adjusted Life Years (DALYs) in Nigeria from 2007-2017 and published literatures where reviewed. According to the world health data report, most of the highest-ranked causes of DALYs in Nigeria are related to environmental risk factors. The lower respiratory infection associated with air pollution has advanced from the 4th in 2007 to the highest ranked cause of death in 2017. Other predominant causes of death associated with environmental risk factors include chronic respiratory diseases, cardiovascular diseases, enteric infections, diarrheal diseases, communicable, maternal, neonatal, and nutritional disease, which has resulted in approximately 800 thousand deaths and 26 million people living with DALYs per annum in Nigeria. Major environmental risk factors include household air pollution, ambient air pollution, water, sanitation, and hygiene (WaSH), which shows a prolonged but progressive decline. In contrast, ambient particulate matter pollution, ambient ozone pollution, and lead exposure show a steady rise associated with death and DALYs in Nigeria, indicating a significant concern in an environmental health-related risk situation. Sustaining a healthy environment is critical in improving the quality of life and the span of a healthy life. Therefore, environmentally sustainable development policies and practices should be essential to the population and policymakers for a healthy life.

Curriculum development in health and the built environment: creating a multidisciplinary platform to enhance knowledge and engagement

Purpose –

Our lived experiences are complex, dynamic and increasingly connected locally and globally through virtual realities that call for an evolution and responsiveness from the field of architecture education. To ensure future built environments are designed to nurture healing and health, this paper aims to address a critical need in architecture education to integrate knowledge of health and social-behavioral disciplines in students' course work. The authors will outline the process of preparing a new multidisciplinary course on health and the built environment (HBE) at the School of Architecture and Planning at Morgan State University in Baltimore, USA, as an effort to challenge the barriers of discipline-specific pathways to learning in the field of architecture.

Design/methodology/approach –

The central question is how to develop an active learning pedagogy to foster a multidisciplinary learning environment focused on the "practice" (how to) of human-design-oriented approaches to improve the capability of built and natural environments to promote health and healing. The course intentionally centered on the real-life experiences of students to ground their new understanding of health and well-being fields. The course proposal went through an extensive peer-review process of reviewers from the National Institute of Health (NIH) and other departments at Morgan State University to ensure a balance between health- and architecture-specific curricula with a transdisciplinary approach to understanding complex health issues.

Findings –

This paper shows the effectiveness of tools and techniques applied in the course to challenge architectural students to integrate various health and behavior perspectives in their designs and to apply health and healing principals to their current and future design projects.

Originality/value –

While there are courses in American universities that offer a traditional introduction to health concerns related to the built environment, there is limited focus on the perspective of the design field approach to improve health and healing outcomes.

Built Environment Evaluation in Virtual Reality Environments—A Cognitive Neuroscience Approach

To date, the predominant tools for the evaluation of built environment quality and impact have been surveys, scorecards, or verbal comments—approaches that rely upon user-reported responses. The goal of this research project is to develop, test, and validate a data-driven approach for built environment quality evaluation/validation based upon measurement of real-time emotional responses to simulated environments. This paper presents an experiment that was conducted by combining an immersive virtual environment (virtual reality) and electroencephalogram (EEG) as a tool to evaluate Pre and Post Purple Line development. More precisely, the objective was to (a) develop a data-driven approach for built environment quality evaluation and (b) understand the correlation between the built environment characters and emotional state. The preliminary validation of the proposed evaluation method identified discrepancies between traditional evaluation results and emotion response indications through EEG signals. The validation and findings have laid a foundation for further investigation of relations between people’s general cognitive and emotional responses in evaluating built environment quality and characters.

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.

The Future of Shift Work: Circadian Biology Meets Personalised Medicine and Behavioural Science

Shift work is commonplace in modern societies, and shift workers are predisposed to the development of numerous chronic diseases. Disruptions to the circadian systems of shift workers are considered important contributors to the biological dysfunction these people frequently experience. Because of this, understanding how to alter shift work and zeitgeber (time cue) schedules to enhance circadian system function is likely to be key to improving the health of shift workers. While light exposure is the most important zeitgeber for the central clock in the circadian system, diet and exercise are plausible zeitgebers for circadian clocks in many tissues. We know little about how different zeitgebers interact and how to tailor zeitgeber schedules to the needs of individuals; however, in this review we share some guidelines to help shift workers adapt to their work schedules based on our current understanding of circadian biology. We focus in particular on the importance of diet timing and composition. Going forward, developments in phenotyping and "envirotyping" methods may be important to understanding how to optimise shift work. Non-invasive, multimodal, comprehensive phenotyping using multiple sources of time-stamped data may yield insights that are critical to the care of shift workers. Finally, the impact of these advances will be reduced without modifications to work environments to make it easier for shift workers to engage in behaviours conducive to their health. Integrating findings from behavioural science and ergonomics may help shift workers make healthier choices, thereby amplifying the beneficial effects of improved lifestyle prescriptions for these people.

Environmental Health Equity: A Concept Analysis

Public health practice and ethics address both individual and environmental health, in order to optimize the well-being of an entire population. Consideration of environmental health equity (EHE) is an evolving component of environmental ethics and public health, with evidence of disparities in exposure to vulnerable communities. Related terms for studying EHE include elements of justice, social determinants of health (SDOH), disparities, and environmental racism. The unequal protection from environmental exposures, specifically considering vulnerable and marginalized populations is significant to science, society, and health. Analyzing the environmental impact includes examining equity principles to assist policy and decision-making in the public arena, in order to address unfair burdens placed on vulnerable populations. However, the lack of a common and precise term for the idea makes it to instruct and evaluate the experiences of inequities in diverse populations. The purpose of this research is to use a concept analysis to examine the idea, utility, and conditions surrounding "EHE" for use in public health, nursing, environmental ethics, policy development, and interprofessional collaboration. A concept analysis will be conducted following the eight-step method developed by Walker and Avant (2011) Data sources will include empirical and descriptive literature; and the results will identify defining attributes of the concept. A set of operationalized standards for EHE is established through this concept analysis. This study proposes an examination of the concept in order to assess and evaluate the ethics and experiences in EHE, and determine how this impacts population health outcomes.

Urban health: an example of a "health in all policies" approach in the context of SDGs implementation

BACKGROUND

Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis.

AIM

The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America.

METHODS

We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies.

RESULTS

A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco.

CONCLUSIONS

By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.

What is the meaning of urban liveability for a city in a low-to-middle-income country? Contextualising liveability for Bangkok, Thailand

BACKGROUND

Creating 'liveable' cities has become a priority for various sectors, including those tasked with improving population health and reducing inequities. Two-thirds of the world's population will live in cities by 2050, with the most rapid urbanisation in low- and middle-income countries (LMIC). However, there is limited guidance about what constitutes a liveable city from a LMIC perspective, with most of the evidence relating to high-income countries, such as Australia. Existing liveability frameworks include features such as public transport, affordable housing, and public open space; however, these frameworks may not capture all of the liveability considerations for cities in LMIC contexts.

OBJECTIVES

This case study formed a multi-sectoral partnership between academics, policymakers (Bangkok Metropolitan Administration, Victorian (Australia) Department of Health and Human Services), and a non-government organisation (UN Global Compact - Cities Programme). This study aimed to: 1) conceptualise and prioritise components of urban liveability within the Bangkok, Thailand context; 2) identify alignment to or divergence from other existing liveability tools; and 3) identify potential indicators and data sources for use within a Pilot Bangkok Liveability Framework.

METHODS

The Urban Liveability Workshop involving technical leaders from the Bangkok Metropolitan Administration and a rapid review of liveability literature informed the conceptualisation of liveability for Bangkok. The Bangkok Metropolitan Administration Working Group and key informants in Bangkok provided input into the liveability framework. Indicators identified for Bangkok were mapped onto existing liveability tools, including the UN Global Compact CityScan.

RESULTS

Findings revealed commonalities with the Australian liveability definition, as well as new potential indicators for Bangkok. The resulting Pilot Bangkok Liveability Framework provides a structure for measuring liveability in Bangkok that can be implemented by the Bangkok Metropolitan Administration immediately, pending appropriate data acquisition and licensing. The Bangkok Metropolitan Administration Working Group and key informants identified core issues for implementation, including limited spatial data available at the district-level or lower.

CONCLUSIONS

This study conceptualised urban liveability for Bangkok, a city in a LMIC context, with potential for adjustment to other cities. Future work should leverage opportunities for using open source data, building local capacity in spatial data expertise, and knowledge sharing between cities.

Green space associations with mental health and cognitive function: Results from the Quebec CARTaGENE cohort

Supplemental Digital Content is available in the text.

Urban green space may be important to mental health, but the association between long-term green space exposures and depression, anxiety, and cognitive function in adults remains unknown.

Physical activity and the human body in the (increasingly smart) built environment

Physical activity in the built environment of high income countries may be changing faster than at any time prior to the 2000s, with the engagement of social media, smart devices and increasing urban smartness that has come with the Internet of Things. This article describes the most salient features of built environments that have facilitated physical activity between the 1980s and 2000s (most importantly walkability and active transport with bicycles). It goes on to use the anthropological three bodies framework in association with that of forms of capital, to explore how the use of smart devices and increasing incorporation of smartness and performativity into architecture and urban planning since the 2000s might influence physical activity. Smartness and use of smart devices in the built environment should favour increased physical activity through new types of sociality that they facilitate. In turn, engagement with such technologies offers an important opportunity for the empowerment of the individual body-self and the social body towards increased physical activity.

Changes in Physical Activity After Installation of a Fitness Zone in a Community Park

Introduction

Increases in physical activity can lead to decreases in the prevalence of chronic diseases. Parks provide an ideal setting for physical activity. We investigated the effect of a fitness equipment installation on the intensity of park users’ physical activity at a community park.

Methods

We used the System for Observing Play and Recreation in a Community to record physical activity in Eastgate Park in Garden Grove, California, in August 2015 (preintervention [n = 1,650 person-periods]) and in February 2016 (postintervention [n = 1,776 person-periods]). We quantified physical activity in target areas of the park during 15-minute observation periods in 2 ways: 1) we categorized each user’s activity level during the period (sedentary, walking, vigorous), and 2) we converted activity levels to numeric metabolic equivalent task (MET) scores and calculated the period-average score across users. We used mixed-effects regression models to assess 1) the proportional odds of higher activity level at postintervention and 2) the association between intervention status (pre vs post) and mean period-average MET scores.

Results

In the immediate zone around the fitness equipment, the odds ratio for a higher activity level was 1.58 (95% confidence interval [CI], 1.14–2.18; P = .006) and the mean period-average MET score was 0.33 (95% CI, −0.07 to 0.74; P = .11) units higher at postintervention. Across the park as a whole, the odds ratio for a higher activity level was 1.41 (95% CI, 1.21–1.63; P < .001), and the mean period-average MET score was 0.34 (95% CI, 0.12–0.56; P = .003) units higher at postintervention.

Conclusion

Installing fitness zones appears to be an effective intervention for increasing physical activity of park users. Further studies need to be conducted to understand the sustained impact of fitness zones over time.

Evaluating the impact of improvements in urban green space on older adults' physical activity and wellbeing: protocol for a natural experimental study

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.

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

BACKGROUND

Walking and bicycling are health-promoting and environmentally friendly alternatives to the automobile. Previous studies that explore correlates of active travel and the built environment are for a single metropolitan statistical area (MSA) and results often vary among MSAs.

OBJECTIVES

Our goal was to model the relationship between the built environment and active travel for 20 MSAs spanning the continental United States.

METHODS

We sourced and processed pedestrian and bicycle traffic counts for 20 U.S. MSAs (n=4,593 count locations), with 1–17 y of data available for each count location and the earliest and latest years of data collection being 1999 and 2016, respectively. Then, we tabulated land use, transport, and sociodemographic variables at 12 buffer sizes (100–3,000 m) for each count location. We employed stepwise linear regression to develop predictive models for morning and afternoon peak-period bicycle and pedestrian traffic volumes.

RESULTS

Built environment features were significant predictors of active travel across all models. Areas with easy access to water and green space, high concentration of jobs, and high rates of active commuting were associated with higher bicycle and pedestrian volumes. Bicycle facilities (e.g., bike lanes, shared lane markings, off-street trails) were correlated with higher bicycle volumes. All models demonstrated reasonable goodness-of-fit for both bicyclists (adj-R²: 0.46–0.61) and pedestrians (adj-R²: 0.42–0.72). Cross-validation results showed that the afternoon peak-period models were more reliable than morning models.

CONCLUSIONS

To our knowledge, this is the first study to model multi-city trends in bicycling and walking traffic volumes with the goal of developing generalized estimates of the impact of the built environment on active travel. Our models could be used for exposure assessment (e.g., crashes, air pollution) to inform design of health-promoting cities. https://doi.org/10.1289/EHP3389.

Co-designing Urban Living Solutions to Improve Older People's Mobility and Well-Being

Mobility is a key aspect of active ageing enabling participation and autonomy into later life. Remaining active brings multiple physical but also social benefits leading to higher levels of well-being. With globally increasing levels of urbanisation alongside demographic shifts meaning in many parts of the world this urban population will be older people, the challenge is how cities should evolve to enable so-called active ageing. This paper reports on a co-design study with 117 participants investigating the interaction of existing urban spaces and infrastructure on mobility and well-being for older residents (aged 55 + years) in three cities. A mixed method approach was trialled to identify locations beneficial to subjective well-being and participant-led solutions to urban mobility challenges. Spatial analysis was used to identify key underlying factors in locations and infrastructure that promoted or compromised mobility and well-being for participants. Co-designed solutions were assessed for acceptability or co-benefits amongst a wider cross-section of urban residents (n = 233) using online and face-to-face surveys in each conurbation. Our analysis identified three critical intersecting and interacting thematic problems for urban mobility amongst older people: The quality of physical infrastructure; issues around the delivery, governance and quality of urban systems and services; and the attitudes and behaviors of individuals that older people encounter. This identified complexity reinforces the need for policy responses that may not necessarily involve design or retrofit measures, but instead might challenge perceptions and behaviors of use and access to urban space. Our co-design results further highlight that solutions need to move beyond the generic and placeless, instead embedding specific locally relevant solutions in inherently geographical spaces, populations and processes to ensure they relate to the intricacies of place.

Associations between Urban Sprawl and Life Expectancy in the United States

In recent years, the United States has had a relatively poor performance with respect to life expectancy compared to the other developed nations. Urban sprawl is one of the potential causes of the high rate of mortality in the United States. This study investigated cross-sectional associations between sprawl and life expectancy for metropolitan counties in the United States in 2010. In this study, the measure of life expectancy in 2010 came from a recently released dataset of life expectancies by county. This study modeled average life expectancy with a structural equation model that included five mediators: annual vehicle miles traveled (VMT) per household, average body mass index, crime rate, and air quality index as mediators of sprawl, as well as percentage of smokers as a mediator of socioeconomic status. After controlling for sociodemographic characteristics, this study found that life expectancy was significantly higher in compact counties than in sprawling counties. Compactness affects mortality directly, but the causal mechanism is unclear. For example, it may be that sprawling areas have higher traffic speeds and longer emergency response times, lower quality and less accessible health care facilities, or less availability of healthy foods. Compactness affects mortality indirectly through vehicle miles traveled, which is a contributor to traffic fatalities, and through body mass index, which is a contributor to many chronic diseases. This study identified significant direct and indirect associations between urban sprawl and life expectancy. These findings support further research and practice aimed at identifying and implementing changes to urban planning designed to support health and healthy behaviors.

Heading in the Right Direction? Investigating Walkability in Galway City, Ireland

As cities and towns worldwide strive to improve quality of life for citizens, debates centred on mobility are at the forefront of transportation policy thinking and urban design and planning. The automobile radically transformed cities, not always for the better, and the transport paradigm espoused over previous decades has primarily focussed on cars. This is still largely evident, driven by policymakers and key decisionmakers using forecasting and transportation and economic models that justify such car-centric planning. However, it is now clear that this approach of increasing automobility is unsustainable. Urban planners across the world are coming to a similar conclusion; they are better off with fewer cars, and a new vision is required, which sees people embracing active and sustainable transportation and sharing public space, information, and new innovative services to make cities more attractive and liveable. Walkability is the measure of how pleasant an area is for walking. By promoting and encouraging people to walk more, we achieve the benefits of better personal health and safer, more convivial neighbourhoods and communities. Making cities more walkable involves incorporating features into urban landscapes that make walking an agreeable experience and bringing a range of necessary and interesting destinations within walking distances of homes and workplaces. Using data from the Mobilities and Liveability in Galway project, this paper seeks a richer understanding of issues relating to existing topographies of walkability and the barriers and pressures that exist with regards to the further development of walking in the city—a healthy and pleasurable way of getting about.

Policies, Politics, and Paradigms: Healthy Planning in Australian Local Government

Local government in Australia is critically positioned to provide built environment initiatives that respond to the increasing prevalence of non-communicable diseases (NCD), climate change, and various other human and ecological health considerations. However, action on the ground has not been as widespread as might be expected, particularly in improving community health. This research explores the barriers to and enablers of the implementation of healthy planning and active living initiatives through in-depth interviews with healthy planning and active living advocates. Advocates are seen to promote healthy planning in relatively weak policy settings, where politicised, largely reactive decisions by individual politicians or practitioners are the main determinants of project success. The most important factor affecting project uptake and implementation is how the ‘problem’ of healthy planning, or what might be considered a healthy planning paradigm, is presented. Such a paradigm includes a strong reliance on the co-benefits of projects; it is also subject to the way that healthy planning is communicated and framed. Potential problems around such a setting are subsequently examined, identifying the potential reasons for the slow delivery of healthy planning.

Using Green Building As A Model For Making Health Promotion Standard In The Built Environment

The built environment-the constructed physical parts of the places where people live and work-is a powerful determinant of both individual and population health. Awareness of the link between place and health is growing within the public health sector and among built environment decision makers working in design, construction, policy, and both public and private finance. However, these decision makers lack the knowledge, tools, and capacity to ensure that health and well-being are routinely considered across all sectors of the built environment. The green building industry has successfully established environmental sustainability as a normative part of built environment practice, policy making, and investment. We explore the value of this industry's experience as a template for promoting health and well-being in the built environment.

Urban Form, Air Pollution, and Health

PURPOSE OF REVIEW

Urban form can impact air pollution and public health. We reviewed health-related articles that assessed (1) the relationships among urban form, air pollution, and health as well as (2) aspects of the urban environment (i.e., green space, noise, physical activity) that may modify those relationships.

RECENT FINDINGS

Simulation and empirical studies demonstrate an association between compact growth, improved regional air quality, and health. Most studies are cross-sectional and focus on connections between transportation emissions and land use. The physical and mental health impacts of green space, public spaces that promote physical activity, and noise are well-studied aspects of the urban environment and there is evidence that these factors may modify the relationship between air pollution and health. Urban form can support efforts to design clean, health-promoting cities. More work is needed to operationalize specific strategies and to elucidate the causal pathways connecting various aspects of health.

Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review

Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is currently lacking. A systematic review of natural experiments of neighborhood built environment was conducted. The aims of this systematic review were to summarize study characteristics, study quality, and impact of changes in neighborhood built environment on physical activity and diet outcomes among residents. Natural experiments of neighborhood built environment change, exploring longitudinal impacts on physical activity and/or diet in residents, were included. From five electronic databases, 2084 references were identified. A narrative synthesis was conducted, considering results in relation to study quality. Nineteen papers, reporting on 15 different exposures met inclusion criteria. Four studies included a comparison group and 11 were pre-post/longitudinal studies without a comparison group. Studies reported on the impact of redeveloping or introducing cycle and/or walking trails (n = 5), rail stops/lines (n = 4), supermarkets and farmers' markets (n = 4) and park and green space (n = 2). Eight/15 studies reported at least one beneficial change in physical activity, diet or another associated health outcome. Due to limitations in study design and reporting, as well as the wide array of outcome measures reported, drawing conclusions to inform policy was challenging. Future research should consider a consistent approach to measure the same outcomes (e.g., using measurement methods that collect comparable physical activity and diet outcome data), to allow for pooled analyses. Additionally, including comparison groups wherever possible and ensuring high quality reporting is essential.

Residential Green Space Quantity and Quality and Child Well-being: A Longitudinal Study

INTRODUCTION

There are few studies on the potential benefits of green space quantity and quality for child well-being. The authors hypothesized that more and better quality residential green space would be favorable for well-being and that these associations could be subject to effect modification across childhood.

METHOD

Multilevel linear regression adjusted for demographic and socioeconomic confounders was used to track change in well-being (Strengths and Difficulties Questionnaire Total Difficulties Score and "internalizing" and "externalizing" subscales) across five separate occasions among a cohort of 4,968 Australian children aged 4-5 years beginning in 2004. Well-being was assessed with respect to objectively measured green space quantity and parent-reported green space quality, with interaction terms fitted with age to assess for potential effect modification. Data were analyzed in 2015.

RESULTS

Non-linear dose-response associations were observed for favorable well-being in relation to larger quantities of green space and also green space judged to be higher in quality. Favorable perceptions of green space quality were associated with larger quantities of green space regardless of neighborhood socioeconomic circumstances. Benefits for well-being appeared to top out at 21%-40% green space coverage and were reasonably consistent across childhood. Inequality in well-being (especially the internalizing subscale) emerged as children aged in relation to green space quality.

CONCLUSIONS

Approximately 21%-40% of residential land-use allocated to green space may be an optimal amount for promoting child well-being, but the quality of this green space increases in importance as children age.

Variations in Obesity Rates between US Counties: Impacts of Activity Access, Food Environments, and Settlement Patterns

There is much ongoing research about the effect of the urban environment as compared with individual behaviour on growing obesity levels, including food environment, settlement patterns (e.g., sprawl, walkability, commuting patterns), and activity access. This paper considers obesity variations between US counties, and delineates the main dimensions of geographic variation in obesity between counties: by urban-rural status, by region, by area poverty status, and by majority ethnic group. Available measures of activity access, food environment, and settlement patterns are then assessed in terms of how far they can account for geographic variation. A county level regression analysis uses a Bayesian methodology that controls for spatial correlation in unmeasured area risk factors. It is found that environmental measures do play a significant role in explaining geographic contrasts in obesity.

Do greener areas promote more equitable child health?

Several recent studies have suggested that people in socioeconomically disadvantaged circumstances may benefit more from local green space ('equigenesis'). This study provides a test of this hypothesis in children aged 0-13 years old. Results from multilevel models suggest the odds of sub-optimal general health were 14% lower among children in areas containing >21.5% green space compared to those with <10%. Higher parent-reported quality green space was associated with 18% lower odds of sub-optimal child health. However, no effect modification of the association between child health and area disadvantage across strata of green space quantity or quality was observed.

Quantifying the Modern City: Emerging Technologies and Big Data for Active Living Research

Opportunities and infrastructure for active living are an important aspect of a community's design, livability, and health. Features of the built environment influence active living and population levels of physical activity, but objective study of the built environment influence on active living behaviors is challenging. The use of emerging technologies for active living research affords new and promising means to obtain objective data on physical activity behaviors and improve the precision and accuracy of measurements. This is significant for physical activity promotion because precise measurements can enable detailed examinations of where, when, and how physical activity behaviors actually occur, thus enabling more effective targeting of particular behavior settings and environments. The aim of this focused review is to provide an overview of trends in emerging technologies that can profoundly change our ability to understand environmental determinants of active living. It discusses novel technological approaches and big data applications to measure and track human behaviors that may have broad applications across the fields of urban planning, public health, and spatial epidemiology.

Green and lean: Is neighborhood park and playground availability associated with youth obesity? Variations by gender, socioeconomic status, and race/ethnicity

Parks and park features are important for promoting physical activity and healthy weight, especially for low-income and racial/ethnic minority youth who have disproportionately high obesity rates. This study 1) examined associations between neighborhood park and playground availability and youth obesity, and 2) assessed whether these associations were moderated by youth race/ethnicity and socioeconomic status (SES). In 2013, objectively measured height and weight were collected for all 3rd-5th grade youth (n=13.469) in a southeastern US county to determine body mass index (BMI) percentiles. Enumeration and audits of the county's parks (n=103) were concurrently conducted. Neighborhood park and playground availability were calculated as the number of each facility within or intersecting each youth's Census block group. Multilevel linear regression models were utilized to examine study objectives. For boys, no main effects were detected; however, SES moderated associations such that higher park availability was associated with lower BMI percentile for low-SES youth but higher BMI percentile for high-SES youth. For girls, the number of parks and playgrounds were significantly associated with lower BMI (b=-2.2, b=-1.1, p<0.05, respectively) and race/ethnicity and SES moderated associations between playground availability and BMI percentile. Higher playground availability was associated with lower BMI percentile for White and high-SES girls but higher BMI percentile for African American and low-SES girls. Considerable variation was detected in associations between park and playground availability and youth obesity by SES and race/ethnicity, highlighting the importance of studying the intersection of these characteristics when exploring associations between built environment features and obesity.

Strategic and integrated planning for healthy, connected cities: Chattanooga case study

The United States is facing unprecedented health challenges - such as obesity and cardiovascular disease - many of which are related to a lack of or insufficient physical activity. Maintaining or creating parks and other public recreation facilities that promote physical activity is particularly important for combating these. This brief describes a strategic planning initiative, known as "Healthy, Connected Chattanooga." The City of Chattanooga, Tennessee, partnered with The Trust for Public Land, a national nonprofit organization, to analyze the city for physical activity opportunities and identify areas where interventions were of highest need. Interventions include the creation of new parks and the activation of existing ones through the installation of fitness facilities known as Fitness Zones®. Maps and an on-line decision-support tool (web portal) were developed between 2013 and 2015, and are being used by the city to make strategic investment decisions. The decision-support analysis described in this brief has engaged a wide variety of stakeholders, opened the door to a broader base of funding sources for health-related interventions, and provided evidence for discussions about equity, access to resources, and prioritization of future projects. This brief presents a framework for integrating scientific models with community and social metrics, enabling more complete and accurate understanding of cities and the identification of more equitable, strategic, and investable solutions to current and pressing challenges.

Status report, The Public Health and Planning 101 project: strengthening collaborations between the public health and planning professions

INTRODUCTION

Land use planning is a complex field comprised of legislation, policies, processes and tools. A growing body of evidence supports the relationship between land use planning decisions, community design and health. The built environment has been shown to be associated with physical inactivity, obesity, cardiovascular disease, respiratory disease and mental illness. Consequently, there is a growing interest within public health to work with planners on land use planning initiatives such as official plans and transportation master plans.

METHODS

Two surveys were developed: one for public health professionals and the other for planning professionals (survey questions available upon request to the corresponding author). The surveys were pilot tested in two separate focus group sessions with public health and planning professionals. Focus group volunteers helped to validate the surveys by verifying survey questions, design and overall flow.

RESULTS

In early 2012, 304 public health professionals and 301 planning professionals completed the two separate surveys, comprising the total survey respondents for each respective profession used to calculate proportions. The survey results represent a convenience sample and are not generalizable to the entire population of public health and planning professionals in Ontario. Results compare survey responses from both groups where appropriate. Most respondents worked either as public health staff (78%) or planners/senior planners (58%). A smaller percentage of public health and planning professionals worked either as managers (15% and 11%, respectively) or directors (5% and 9%, respectively).

CONCLUSION

Health is associated with how communities are planned and built, and the services and resources provided within them. Inspired by the results of our survey and based on user feedback from the pilot tests, a free online training program entitled "Public Health and Planning 101: An Online Course for Public Health and Planning Professionals to Create Healthier Built Environments" was launched in 2016 by OPHA as a collaborative project with OPPI and PHAC. This course is designed to bridge the gaps between the two professions, as well as provide greater opportunities for developing collaborative partnerships to help create and foster healthy built environments.

Happiness and health across the lifespan in five major cities: The impact of place and government performance

RATIONALE

A growing body of research suggests that urban design has an effect on health and well-being. There have been very few studies to date, however, that compare these effects across the lifespan.

OBJECTIVE

The current study examines the direct and indirect effects of the city environment on happiness. It was hypothesised that citizens' ratings of their city along dimensions of performance (e.g., basic - usually government - services related to education, healthcare, social services, and policing) and place (e.g., the beauty of the city and a built environment that provides access to cultural, sport, park, transport, and shopping amenities) would be significant predictors of happiness but that the nature of these effects would change over the lifespan.

METHODS

5000 adults aged 25-85 years old living in Berlin, Paris, London, New York, and Toronto completed the Quality of Life Survey in 2007. Respondents reported their happiness levels and evaluated their city along place and performance dimensions.

RESULTS

The results of the study demonstrate an interesting, and complex relationship between the city environment and happiness of residents across the lifespan. Findings suggest that the happiness of younger residents is a function of having easy access to cultural, shopping, transport, parks and sport amenities and the attractiveness of their cities (i.e. place variables). The happiness of older residents is associated more with the provision of quality governmental services (i.e., performance variables). Place and performance variables also have an effect on health and social connections, which are strongly linked to happiness for all residents.

CONCLUSION

Younger adults' happiness is more strongly related to the accessibility of amenities that add to the quality of a city's cultural and place characteristics; older adults' happiness is more strongly related to the quality of services provided within a city that enable residents to age in place. These results indicate that, in order to be all things to all people, cities should emphasize quality services (e.g., good policing, schools, healthcare access), beauty and character, and provide easy access to transport amenities and cultural and recreational opportunities.

Green Space, Violence, and Crime: A Systematic Review

PURPOSE

To determine the state of evidence on relationships among urban green space, violence, and crime in the United States.

METHODS AND RESULTS

Major bibliographic databases were searched for studies meeting inclusion criteria. Additional studies were culled from study references and authors' personal collections. Comparison among studies was limited by variations in study design and measurement and results were mixed. However, more evidence supports the positive impact of green space on violence and crime, indicating great potential for green space to shape health-promoting environments.

CONCLUSION

Numerous factors influence the relationships among green space, crime, and violence. Additional research and standardization among research studies are needed to better understand these relationships.

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

BACKGROUND

The majority of people live in cities and urbanization is continuing worldwide. Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also a main source of pollution and disease.

METHODS

We conducted a review around the topic urban and transport planning, environmental exposures and health and describe the findings.

RESULTS

Within cities there is considerable variation in the levels of environmental exposures such as air pollution, noise, temperature and green space. Emerging evidence suggests that urban and transport planning indicators such as road network, distance to major roads, and traffic density, household density, industry and natural and green space explain a large proportion of the variability. Personal behavior including mobility adds further variability to personal exposures, determines variability in green space and UV exposure, and can provide increased levels of physical activity. Air pollution, noise and temperature have been associated with adverse health effects including increased morbidity and premature mortality, UV and green space with both positive and negative health effects and physical activity with many health benefits. In many cities there is still scope for further improvement in environmental quality through targeted policies. Making cities 'green and healthy' goes far beyond simply reducing CO2 emissions. Environmental factors are highly modifiable, and environmental interventions at the community level, such as urban and transport planning, have been shown to be promising and more cost effective than interventions at the individual level. However, the urban environment is a complex interlinked system. Decision-makers need not only better data on the complexity of factors in environmental and developmental processes affecting human health, but also enhanced understanding of the linkages to be able to know at which level to target their actions. New research tools, methods and paradigms such as geographical information systems, smartphones, and other GPS devices, small sensors to measure environmental exposures, remote sensing and the exposome paradigm together with citizens observatories and science and health impact assessment can now provide this information.

CONCLUSION

While in cities there are often silos of urban planning, mobility and transport, parks and green space, environmental department, (public) health department that do not work together well enough, multi-sectorial approaches are needed to tackle the environmental problems. The city of the future needs to be a green city, a social city, an active city, a healthy city.

Occupational physical activity assessment for chronic disease prevention and management: A review of methods for both occupational health practitioners and researchers

Occupational physical activity (OPA) is an occupational exposure that impacts worker health. OPA is amenable to measurement and modification through the hierarchy of controls. Occupational exposure scientists have roles in addressing inadequate physical activity, as well as excessive or harmful physical activity. Occupational health researchers can contribute to the development of novel OPA exposure assessment techniques and to epidemiologic studies examining the health impacts of physical activity at work. Occupational health practitioners stand to benefit from understanding the strengths and limitations of physical activity measurement approaches, such as accelerometers in smartphones, which are already ubiquitous in many workplaces and in some worksite health programs. This comprehensive review of the literature provides an overview of physical activity monitoring for occupational exposure scientists. This article summarizes data on the public health implications of physical activity at work, highlighting complex relationships with common chronic diseases. This article includes descriptions of several techniques that have been used to measure physical activity at work and elsewhere, focusing in detail on pedometers, accelerometers, and Global Positioning System technology. Additional subjective and objective measurement strategies are described as well.

Framing health for land-use planning legislation: A qualitative descriptive content analysis

PURPOSE AND SETTING

Framing health as a relevant policy issue for other sectors is not well understood. A recent review of the New South Wales (Australia) land-use planning system resulted in the drafting of legislation with an internationally unprecedented focus on human health. We apply a political science approach to investigate the question 'how and to what extent were health and wider issues framed in submissions to the review?'

METHODS

We investigated a range of stakeholder submissions including health focussed agencies (n = 31), purposively identified key stakeholders with influence on the review (n = 24), and a random sample of other agencies and individuals (n = 47). Using qualitative descriptive analysis we inductively coded for the term 'health' and sub-categories. We deductively coded for 'wider concerns' using a locally endorsed 'Healthy Urban Development Checklist'. Additional inductive analysis uncovered further 'wider concerns'.

FINDINGS

Health was explicitly identified as a relevant issue for planning policy only in submissions by health-focussed agencies. This framing concerned the new planning system promoting and protecting health as well as connecting health to wider planning concerns including economic issues, transport, public open space and, to a slightly lesser extent, environmental sustainability. Key stakeholder and other agency submissions focussed on these and other wider planning concerns but did not mention health in detail. Health agency submissions did not emphasise infrastructure, density or housing as explicitly as others.

CONCLUSIONS

Framing health as a relevant policy issue has the potential to influence legislative change governing the business of other sectors. Without submissions from health agencies arguing the importance of having health as an objective in the proposed legislation it is unlikely health considerations would have gained prominence in the draft bill. The findings have implications for health agency engagement with legislative change processes and beyond in land use planning.