Creating healthy communities, healthy homes, healthy people: initiating a research agenda on the built environment and public health

Income and Sex Moderate the Association Between Population Density and Reproduction: A Multilevel Analysis of Life History Strategies Across 23 Nations

While previous studies guided by evolutionary life history theory have revealed several important socioecological moderators of the influence of population density (PD) on reproduction, absent is an understanding of how individual-level factors such as personal resources and sex differences might interact and play a role. Using data from a large sample of clients (N = 4,432,440) of an online dating company spanning 317 states nested within 23 countries, we contributed a robust multilevel analysis of life history effects by assessing the interaction between state-level PD and individual-level income on offspring quantity, and we further qualified this analysis by sex. Consistent with previous research, PD was negatively correlated with having children. Consistent with our novel hypotheses, this negative relationship was moderated by income such that the link between PD and low fertility became weaker with increasing levels of income and these patterns were stronger for men than for women. These results held despite controlling for a variety of country-level, state-level, and individual-level confounds. Findings are discussed together with theoretical and practical implications for the management of fertility based on evolutionary life history perspectives.

A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities

The characteristics of a neighborhood's built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13-24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.

Digital loneliness-changes of social recognition through AI companions

Inherent to the experience of loneliness is a significant change of meaningful relatedness that (usually negatively) affects a person's relationship to self and others. This paper goes beyond a purely subjective-phenomenological description of individual suffering by emphasizing loneliness as a symptomatic expression of distortions of social recognition relations. Where there is loneliness, a recognition relation has changed. Most societies face an increase in loneliness among all groups of their population, and this sheds light on the reproduction conditions of social integration and inclusion. These functions are essential lifeworldly components of social cohesion and wellbeing. This study asks whether "social" AI promotes these societal success goals of social integration of lonely people. The increasing tendency to regard AI Companions (AICs) as reproducers of adequate recognition is critically discussed with this review. My skepticism requires further justification, especially as a large portion of sociopolitical prevention efforts aim to fight an increase of loneliness primarily with digital strategies. I will argue that AICs rather reproduce than sustainably reduce the pathodynamics of loneliness: loneliness gets simply "digitized."

Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution

OBJECTIVES

To identify strategies and tactics communities use to translate research into environmental health action.

METHODS

We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks.

RESULTS

In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation.

CONCLUSIONS

CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

Visualization analysis of research progress for walkability

The study of walkability is of great significance to the construction of healthy cities. In this paper, taking 1283 articles of walkability, which were included in Web of Science, as the research object. This paper adopts to analysis the research progress by using the method of scientometrics and knowledge networks analysis. Objectively and systematically analyze the research progress of walkability abroad from the aspects of publication overview, knowledge foundation, research direction and hot spots, etc. It is found that foreign researches on walkability mainly include three core directions: walkability and physical activity, walkability evaluation, walkability and urban design. Among them, walkability and physical activity orientation have been studied from various perspectives, such as various groups, various environmental types, different behavioral patterns and various chronic diseases. With the increasingly prominent urbanization problems and the rapid development of new technologies, multiple data, new methods and interdisciplinary cooperation will actively promote the vigorous development of walking suitability research.

Public transit stop density is associated with walking for exercise among a national sample of older adults

BACKGROUND

Walking is the primary and preferred mode of exercise for older adults. Walking to and from public transit stops may support older adults in achieving exercise goals. This study examined whether density of neighborhood public transit stops was associated with walking for exercise among older adults.

METHODS

2018 National Health and Aging Trends Study (NHATS) data were linked with the 2018 National Neighborhood Data Archive, which reported density of public transit stops (stops/mile2) within participants' neighborhood, defined using census tract boundaries. Walking for exercise in the last month was self-reported. The extent to which self-reported public transit use mediated the relationship between density of neighborhood public transit stops and walking for exercise was examined. Covariates included sociodemographic characteristics, economic status, disability status, and neighborhood attributes. National estimates were calculated using NHATS analytic survey weights.

RESULTS

Among 4,836 respondents with complete data, 39.7% lived in a census tract with at least one neighborhood public transit stop and 8.5% were public transit users. The odds of walking for exercise were 32% higher (OR = 1.32; 95% confidence interval: 1.08, 1.61) among respondents living in a neighborhood with > 10 transit stops per mile compared to living in a neighborhood without any public transit stops documented. Self-reported public transit use mediated 24% of the association between density of neighborhood public transit stops and walking for exercise.

CONCLUSIONS

Density of neighborhood public transit stops was associated with walking for exercise, with a substantial portion of the association mediated by self-reported public transit use. Increasing public transit stop availability within neighborhoods may contribute to active aging among older adults.

The Children, Caregivers, and Community (C3) study of together growing strong: A protocol for an observational, place-based initiative in Sunset Park, Brooklyn

Reaching population-level impact for families in poverty requires moving beyond a sole focus on individuals, to a wider focus on interactions between individuals and their broader environmental contexts. Place-based initiatives have emerged as a policy response to promote community-level change around these broader interactions between individuals and their local communities through addressing long-standing disparities in housing, employment, education, and health. Together Growing Strong (TGS) is one such place-based initiative focused on transforming the health, wellbeing, and development of young children and their families in Sunset Park, Brooklyn. The Children, Caregivers, and Community (C3) Study is an outcomes-based study designed to assess the trajectories of children and families in Sunset Park along indicators such as family health and wellbeing and child development in relation to TGS program participation. The aims, scope, and protocol of the C3 Study are the subjects of this paper.

Promoting active transport in rural communities through infrastructural modifications: the PABEM needs assessment tool

The design of the built environment in communities influences active transport and physical activity levels of citizens. Existing instruments for quantitatively assessing built environments were developed for use in urban areas and mainly by experts. Participative assessment of built environment modifications (PABEM) is a needs assessment tool that involves citizens and community decision-makers within a structured process for identifying needed changes to promote walking and cycling in rural areas. This article describes the development of the PABEM process and evaluates its initial use in three rural towns in Austria. PABEM consists of the following seven steps: (i) qualitative interviews; (ii) expert assessment of the built environment; (iii) citizen assessment of the built environment; (iv) social media interaction; (v) household questionnaire; (vi) participatory workshop; and (vii) evaluation and scoring workshop. The main modifications identified as necessary in rural towns were the revitalization of existing walking and cycling facilities and the construction of new barrier-free and safe sidewalks. In addition cycling routes to schools, to public transport facilities and to central public places as well as cleaner and inviting seating, a car-free school environment, speed reduction in town centres, more crosswalks and improved cleanliness in public places were also deemed necessary modifications. PABEM's provisions to ensure collaborative participation of citizens and local decision-makers fostered a continuous dialogue about the requirements of the built environment, user needs and opportunities for realization throughout the whole process.

Social participation of older people in urban and rural areas: Canadian Longitudinal Study on Aging

BACKGROUND AND OBJECTIVES

Although the positive influence of social activity on health is now well-established, a complex relationship exists among social participation, personal, social and the environment. Social participation of older adults was examined in rural and urban settings to identify features of the built-environment and perception of neighborhood specific to the locale.

RESEARCH DESIGN AND METHODS

Using cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA), we examined social participation and health of older people (65 + yrs) in relation to the built environment and sociocultural contexts for urban and rural areas. A social participation index was derived from responses on the frequency of participating in 8 social activities over the past 12 months. Personal, household and neighborhood indicators were examined to develop multivariable regression models for social participation in urban and rural cohorts.

RESULTS

No meaningful differences were seen with the frequency of social participation between rural and urban settings; however, the type of community-related activities differed in that a greater proportion of urban participants reported sports and educational/cultural events than rural participants. Service club activities were greater for rural than urban participants. Different neighborhood features were statistically significant factors in explaining social participation in rural than in urban locales, although transportation was a significant factor regardless of locale. Trustworthiness, belonging and safety were perceived factors of the neighborhood associated with higher social participation for rural participants.

DISCUSSION AND IMPLICATIONS

The relationship between home and health becomes stronger as one ages. Social and physical features of built environment specific to urban and rural settings need to be considered when implementing appropriate social activities for older people.

A counterfactual analysis of opioid-involved deaths during the COVID-19 pandemic using a spatiotemporal random forest modeling approach

The global pandemic of SARS-CoV-2 (COVID-19) has been linked to adversely impacting individuals with opioid use disorder in the United States. This study focuses on analyzing opioid-involved mortality in the context of COVID-19 in the U.S. from a geospatial perspective. We investigated spatiotemporal patterns of opioid-involved deaths during 2020 and compared the spatiotemporal pattern of these deaths with patterns for the previous three years (2017-2019) to understand changes in the context of the COVID-19 pandemic. A counterfactual analysis framework together with a space-time random forest (STRF) model were used to estimate the increase in opioid-involved deaths related to the pandemic. To gain further insight into the relationship between opioid deaths and COVID-19-related factors, we built a space-time random forest model for the City of Chicago, that experienced a steep increase in opioid-related deaths during 2020. High ranking indicators identified by the model such as the number of positive COVID-19 cases adjusted by population and the change in stay-at-home dwell time during the pandemic were used to generate a vulnerability index for opioid overdoses during the COVID-19 pandemic in Chicago.

Association of County-degree Social Vulnerability with Chronic Respiratory Disease Mortality in the United States

Rationale: Chronic respiratory diseases, the third leading cause of death worldwide, have been associated with significant morbidity, mortality, and increased economic burden that make a profound impact on individuals and communities. However, limited research has delineated complex relationships between specific sociodemographic disparities and chronic respiratory disease outcomes among U.S. counties. Objectives: To assess the association of county-level sociodemographic vulnerabilities with chronic respiratory disease mortality in the United States. Methods: Chronic respiratory disease mortality data among U.S. counties for 2014-2018 was obtained from the CDC WONDER (Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research) database. The social vulnerability index (SVI), including subindices of socioeconomic status, household composition and disability, minority status and language, and housing type and transportation, is a composite, percentile-based measure developed by the CDC to evaluate county-level sociodemographic vulnerabilities to disasters. We examined county-level sociodemographic characteristics from the SVI and classified the percentile rank into quartiles, with a higher quartile indicating greater vulnerability. The associations between chronic respiratory disease mortality and overall SVI, its four subindices, and each county characteristic were analyzed by negative binomial regression. Results: From 2014 to 2018, the age-adjusted mortality per 1,000,000 population attributed to chronic lower respiratory disease was 406.4 (95% confidence interval [CI], 405.5-407.3); chronic obstructive pulmonary disease (COPD), 393.7 (392.8-394.6); asthma, 10.0 (9.9-10.2); interstitial lung disease (ILD), 50.5 (50.1-50.8); idiopathic pulmonary fibrosis (IPF), 37.0 (36.7-37.3); and sarcoidosis, 5.3 (5.2-5.4). Counties in the higher quartile of overall SVI were significantly associated with greater disease mortality (chronic lower respiratory disease, incidence rate ratios: fourth vs. first quartile, 1.43 [95% CI, 1.39-1.48]; COPD, 1.44 [1.39-1.49]; asthma, 2.06 [1.71-2.48]; ILD, 1.07 [1.02-1.13]; IPF, 1.14 [1.06-1.22]; sarcoidosis, 2.01 [1.44-2.81]). In addition, higher mortality was also found in counties in the higher quartile of each subindex and most sociodemographic characteristics. Conclusions: Chronic respiratory disease mortalities were significantly associated with county-level sociodemographic determinants as measured by the SVI in the United States. These findings suggested sociodemographic determinants may add a considerable barrier to establishing health equity. Multidegree public health strategies and clinical interventions addressing inequitable outcomes of chronic respiratory disease should be developed and targeted in areas with greater social vulnerability and disadvantage.

The urban built environment and adult BMI, obesity, and diabetes in Latin American cities

Latin America is the world's most urbanized region and its heterogeneous urban development may impact chronic diseases. Here, we evaluated the association of built environment characteristics at the sub-city -intersection density, greenness, and population density- and city-level -fragmentation and isolation- with body mass index (BMI), obesity, and type 2 diabetes (T2D). Data from 93,280 (BMI and obesity) and 122,211 individuals (T2D) was analysed across 10 countries. Living in areas with higher intersection density was positively associated with BMI and obesity, whereas living in more fragmented and greener areas were negatively associated. T2D was positively associated with intersection density, but negatively associated with greenness and population density. The rapid urban expansion experienced by Latin America provides unique insights and vastly expand opportunities for population-wide urban interventions aimed at reducing obesity and T2D burden.

Racial Disparities in COVID-19 Case Positivity and Social Context: The Role of Housing, Neighborhood, and Health Insurance

Research on racial-ethnic COVID-19 disparities has yet to employ housing variables measured at the individual level, limiting our understanding of housing's role in determining early exposure to the virus. To address this gap, we linked data from SARS-CoV-2 polymerase chain reaction (PCR) tests within the Duke University Health System between March 12, 2020, and July 31, 2020 (N = 23,057 individuals), with housing parcel data. We then analyzed how housing, neighborhood, and health insurance explain disparities in case positivity between and within racial-ethnic groups in Durham County, North Carolina. We find that 55% of the Black-White disparity and 25% of the Hispanic-White disparity in positive cases are explained by these social-contextual variables. Neighborhood-fixed effects explained the largest portion (27%) of the Black-White disparity, whereas health insurance type explained the largest portion (14%) of the Hispanic-White disparity. We conclude that housing, neighborhood, and health insurance had a significant role in producing racial-ethnic disparities in COVID-19 case positivity.

Exploring environmental measures in disability: Using Google Earth and Street View to conduct remote assessments of access and participation in urban and rural communities

The Americans with Disabilities Act has been in place since 1990. Yet, we still do not know the actual levels of accessibility in the nation, how access varies across communities or over time, or how it influences participation in community life. The present two studies explored the use of Google Earth (GE) and Google Street View (GSV) imagery as a database for examining the accessibility of rural and urban cities and towns in the United States. We developed procedures for selecting places in a community to observe multiple access features. Study 1 reports the findings from assessments of 25 communities across 17 states. We observed ≈50,000 m (31 miles) of pathways through the observed places. The Combined Access Score (CAS) averaged 65% across these communities. In Study 2, we evaluated 22 towns and cities in a large rural state. We observed ≈77,000 m (48 miles) of pathways through the Central Business Districts observed as core areas connecting people to community life. The CAS averaged 83.9% across these communities. We noted a Rural Access Penalty (RAP), such that rural areas tended to be less accessible, leading to less community participation. The method for using GSV to examine accessibility is discussed. This study demonstrates an inexpensive and reliable method for evaluating the accessibility of communities and participation in them. Future research should be conducted to gather a larger sample of communities in order to create a baseline from which to monitor changes in accessibility of infrastructure over time.

Air Pollution, Foreign Direct Investment, and Mental Health: Evidence From China

Recently, there has been interest in the relationship between mental health and air pollution; however, the results are inconsistent and the contribution of foreign direct investment (FDI) has received little attention. This article studies the effects of air pollution on mental health and the moderating role of FDI based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2015 and 2018 applying the fixed effects panel regression approach and the threshold model. The results show that mental health is adversely affected by air pollution, especially PM_2.5, PM₁₀, sulfur dioxide (SO₂), carbon monoxide (CO), and nitrogen dioxide (NO₂). Second, FDI has an alleviating influence on the negative relationship. Third, the effects of air pollution and FDI are heterogeneous based on regional characteristics, including location, medical resource and investment in science and technology, and individual characteristics covering education level, age, income, and physical health. Finally, the threshold effects show that FDI has a moderating effect when it is >1,745.59 million renminbi (RMB). There are only 11.19% of cities exceeding the threshold value in China. When the value of air quality index (AQI) exceeds 92.79, air pollution is more harmful to mental health. Government should actively introduce high-quality FDI at the effective level and control air pollution to improve mental health.

Race/ethnicity, built environment in neighborhood, and children's mental health in the US

The prevention and treatment of mental health disorders in childhood and adolescence is one among the major public health challenges in the United States today. Prior research has suggested that neighborhood is very important for children and adolescents' mental health. The present study extends the research on neighborhood and mental health by examining the association between childhood mental health and the identified specific built environment attributes in neighborhood as well as its intersection with race/ethnicity in the United States. Statistical analyses results of data from the 2016 National Survey of Children Health (NSCH) indicate that children's mental health and the built environment in neighborhood vary across racial/ethnic groups, with minority groups being more likely to live in the disadvantaged neighborhoods and to experience more mental health disorders, particularly American Indian children. Further, the relationship between built environment neighborhood mental health among children varies across race/ethnicity in the United States.

Building H.O.U.S.E (Healthy Outcomes Using a Supportive Environment): Exploring the Role of Affordable and Inclusive Housing for LGBTQIA+ Older Adults

Little is known about how permanent, inclusive, affordable, and supportive long-term housing may affect the health of low-income lesbian, gay, bisexual, transgender, queer, intersex, asexual and/or another identity (LGBTQIA+) older adults. Focus group interviews were conducted with 21 older adults to explore the lived experiences and potential health benefits of living in a new LGBTQIA+-welcoming senior housing. Participants reported that moving into the housing was associated with benefits for health and well-being, especially for psychological health. Community, social support, and in-house services were particularly important. However, the combined nature of LGBTQIA+-welcoming and older adult only housing evoked mixed feelings. Appropriate and accessible housing solutions are essential for LGBTQIA+ older adults and may help address health disparities for these populations.

Rural Latino health and the built environment: a systematic review

Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.

Google Street View-Derived Neighborhood Characteristics in California Associated with Coronary Heart Disease, Hypertension, Diabetes

Characteristics of the neighborhood built environment influence health and health behavior. Google Street View (GSV) images may facilitate measures of the neighborhood environment that are meaningful, practical, and adaptable to any geographic boundary. We used GSV images and computer vision to characterize neighborhood environments (green streets, visible utility wires, and dilapidated buildings) and examined cross-sectional associations with chronic health outcomes among patients from the University of California, San Francisco Health system with outpatient visits from 2015 to 2017. Logistic regression models were adjusted for patient age, sex, marital status, race/ethnicity, insurance status, English as preferred language, assignment of a primary care provider, and neighborhood socioeconomic status of the census tract in which the patient resided. Among 214,163 patients residing in California, those living in communities in the highest tertile of green streets had 16–29% lower prevalence of coronary artery disease, hypertension, and diabetes compared to those living in communities in the lowest tertile. Conversely, a higher presence of visible utility wires overhead was associated with 10–26% more coronary artery disease and hypertension, and a higher presence of dilapidated buildings was associated with 12–20% greater prevalence of coronary artery disease, hypertension, and diabetes. GSV images and computer vision models can be used to understand contextual factors influencing patient health outcomes and inform structural and place-based interventions to promote population health.

Sociodemographic inequities in tobacco retailer density: Do neighboring places matter?

We apply a spatial perspective to measure the extent to which the 2018 U.S. racial, ethnic, and socioeconomic composition of census tracts were each associated with tobacco retailer density within a tract and in its neighboring tracts (n = 71,409). A 10-percentage point increase in the Black population was associated with 0.07 (p < 0.05) more retailers per square mile within a focal tract and 0.35 (p < 0.001) more retailers per square mile in its neighbors on average. A greater percent of Hispanic/Latino residents was associated with more retailers per square mile, both within a focal tract (b = 0.95, p < 0.001) and in its neighbors 0.39 (p < 0.001). Inverse associations were observed for percent white. We also observed inequities by socioeconomic status. The overall magnitude of inequities may be underestimated if the spatial dependence between focal tracts and their neighbors are not taken into consideration. Policymakers should prioritize interconnected geographic areas experiencing high racialized and socioeconomic segregation when designing and implementing policies to reduce retail tobacco product availability.

Association between housing type and accelerated biological aging in different sexes: moderating effects of health behaviors

Introduction: Despite associated with multiple geriatric disorders, whether housing type, an indicator of socioeconomic status (SES) and environmental factors, is associated with accelerated biological aging is unknown. Furthermore, although individuals with low-SES have higher body mass index (BMI) and are more likely to smoke, whether BMI and smoking status moderate the association between SES and biological aging is unclear. We examined these questions in urbanized low-SES older community-dwelling adults.

Methods: First, we analyzed complete blood count data using the cox proportional hazards model and derived measures for biological age (BA) and biological age acceleration (BAA, the higher the more accelerated aging) (N = 376). Subsequently, BAA was regressed on housing type, controlling for covariates, including four other SES indicators. Interaction terms between housing type and BMI/smoking status were separately added to examine their moderating effects. Total sample and sex-stratified analyses were performed.

Results: There were significant differences between men and women in housing type and BAA. Compared to residents in ≥3 room public or private housing, older adults resided in 1–2 room public housing had a higher BAA. Furthermore, BMI attenuated the association between housing type and BAA. In sex-stratified analyses, the main and interaction effects were only significant in women. In men, smoking status instead aggravated the association between housing type and BAA.

Conclusion: Controlling for other SES indicators, housing type is an independent socio-environmental determinant of BA and BAA in a low-SES urbanized population. There were also sex differences in the moderating effects of health behaviors on biological aging.

From Comparative and Statistical Assessments of Liveability and Health Conditions of Districts in Hong Kong towards Future City Development

Liveability is an indispensable component in future city planning and is practically linked with the health status of individuals and communities. However, there was nor comprehensive and universal district-level framework for assessing liveability due to geospatial and social discrepancies among different countries. In this study, using Hong Kong, a highly dense and international city as an example, the Liveability and Health Index (LHI-HK) consisting of 30 indicators was established, with 21 of them related to education, economy, housing, walkability/transport, environment, and health facilities aspects, while the health conditions of citizens in individual districts were examined by other 9 indicators. Respective scoring allocation was determined by statistical reasoning, and was applied to quantify the connections between liveability and health among the 18 districts of Hong Kong in both 2016 and 2019. Temporal changes of spatial features could be traced by this quantitative framework, and obvious correlations between liveability and health were attained, with R values of 0.496 and 0.518 in 2016 and 2019, and corresponding slopes of 0.80 and 0.88, respectively. Based on the statistical results, it was found that Sai Kung and Kwun Tong are the most and the least liveable district of Hong Kong in 2019. The LHI-HK index was well-validated by renowned AARP liveability index and The California Healthy Places Index (HPI), with R values of 0.90 and 0.70, and the potential uncertainties due to data projection were less than 2.5% for all districts, which implicates its relevancy and appropriateness in conducting similar spatial assessments in international cities. Further, both favorable and unfavorable spatial arrangements of each of the 3 district types in Hong Kong were identified, namely residential, commercial, and industrial districts. This opens new windows in enhancing liveability and health status within communities, with the aim of promoting the sustainability of cities in the long run.

A Systematic Review of Health Disparities Research in Plastic Surgery

BACKGROUND

In this systematic review, the authors report on the current state of health disparities research in plastic surgery and consider how equity-oriented interventions are taking shape at the patient, provider, and health care system levels.

METHODS

The authors performed a systematic literature search of the PubMed/MEDLINE and Embase databases using search terms related to the social determinants of both health and plastic surgery. Two independent reviewers screened the article titles and abstracts for relevance and identified the plastic surgery focus and study characteristics of the included literature. The articles were then categorized as detecting, understanding, or reducing health disparities according to a conceptual framework. This review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

RESULTS

One hundred forty-seven articles published between 1997 and 2019 met the inclusion criteria. Health disparities research in gender-affirming, craniofacial, cosmetic, and hand surgery was lacking relative to breast reconstruction. Racial/ethnic and socioeconomic disparities were reported across subspecialties. Place of residence was also a large determinant of access to care and quality of surgical outcomes. Half of the included studies were in the detecting phase of research. Meanwhile, 40 and 10 percent were in the understanding and reducing phases, respectively.

CONCLUSIONS

Investigators suggested several avenues for reducing health disparities in plastic surgery, yet there is limited evidence on the actual effectiveness of equity-oriented initiatives. More comprehensive research is needed to disentangle the patient, provider, and system-level factors that underlie inequity across subspecialties.

Functional Limitations and Perceived Neighborhood Walkability Among Urban Dwelling Older Adults

Older adults with functional limitations (FLs) often experience obstacles to walking. Although health promotion programs targeting physical activity are available in lower-income areas, few studies have compared the walking experiences of older adults who have FLs with those who do not in the community. The purpose of this cross-sectional survey was to compare perceptions of neighborhood walkability among older adults living in lower-income communities with and without FLs. Participants (N = 132) were recruited in 2018 at regional health clinics in Flint, Michigan. To be eligible, participants had to be 65 years of age or older, report no cognitive decline, and be Flint residents. Of the 132 participants, the mean age was 69.74 (SD = 4.97). The majority were female (66%); African American (77%); single, divorced, or widowed (72%); educated below the General Education Development level (57%), and had a FL (67%). Older adults with FLs were significantly (p < 0.05) less likely than those without to visit many places within walking distance, to have well-lit neighborhoods at night, and to reside in neighborhoods where sidewalks were separated from the road and traffic. Multiple regression analyses revealed that having a FL was associated with poorer neighborhood perceptions of mixed-land-use (b = −0.19, p < 0.05) and more walking hazards (b = −0.26, p < 0.05). Findings suggest that a FL is associated with perceptions of walkability. It is essential to develop disability-friendly support systems and accommodations to encourage walking in lower-income communities.

Walk/wheelability: An inclusive instrument-pair for participatory aging-friendly research and practice

BACKGROUND AND OBJECTIVES

Recent critical evaluations of age-friendly efforts have highlighted the need to prioritize the disenfranchised, including people with mobility limitations. This article examines the validity of a 13-item scale (SWAN13) to measure the "walk/wheelability" of street segments from the perspectives of people with mobility limitations.

RESEARCH DESIGN AND METHODS

Data were drawn from preliminary studies of the Stakeholders' Walkability/Wheelability Audit in Neighborhoods (SWANaudit) which was conducted in two Canadian metropolitan areas. Sixty-one participants who use mobility devices (e.g., walkers, power wheelchairs) and older adults from community organizations audited 195 street segments. We factor analyzed the data from their audits.

RESULTS

SWAN13 has a one-factor structure. Thirteen items were retained from 85 SWANaudit items. SWAN13 encompassed both physical and social aspects of walk/wheelability. The alpha for the scale was .79. Convergent validity was found with the University of Alabama (UAB) Life-Space Assessment (rho=.22, p=.003), especially at the neighborhood level (rho=.23, p=.002). Significant correlation was also found with subjective assessments of a priori walk/wheelability domains (rho=.63, p<.001).

DISCUSSION AND IMPLICATIONS

Walk/wheelability affects the life space of older adults and people with mobility limitations. It is an important latent variable that should be addressed to promote well-being and social participation. SWAN13 may be used in city-wide surveys to identify neighborhoods that may require age-friendly interventions from mobility perspectives. Detailed audits and interventions may be carried out in tandem using the paired SWANaudit instrument. Walk/wheelability is an inclusive and measurable concept that accounts for the needs of people with various mobility needs.

Understanding children's perceptions of, and priorities for, healthy neighbourhoods in Aotearoa New Zealand: study protocol for a cross-sectional study

INTRODUCTION

Neighbourhood environments can have significant and enduring impacts on children's physical, psychological and social health. Environments can impact health through promoting or hindering physical activity, active travel, and healthy eating in addition to opportunities for social interaction, cognitive development, rest and relaxation. There is a paucity of research that has examined neighbourhood and health priorities, strengths and needs from the perspectives of the community, and even less that has focused on the perspectives of children within communities. The aim of this article is to describe the research protocol for a project to gather child-identified needs and strengths-based solutions for promoting child health and well-being in urban neighbourhood environments.

METHODS AND ANALYSIS

This participatory research project is designed to partner with children in school settings in Tāmaki Makaurau Auckland and Ōtepoti Dunedin, Aotearoa New Zealand. An abundant communities approach will be used with children to identify needs and strengths related to neighbourhoods and health. Specific methods including collaborative, creative, play-based methods such as concept-mapping activities and co-creation of final dissemination material on the key messages are described. Plans for researcher reflections, data analysis and dissemination are also detailed.

ETHICS AND DISSEMINATION

This research has been approved by the University of Auckland Human Participants Ethics Committee. Results will be disseminated through child and researcher co-created output, a technical report and academic journal articles. By using evidence-based child-centred approaches to knowledge generation, we anticipate the research will generate new localised insights about children's preferences and needs for healthy neighbourhoods which will be shared with stakeholders in planning and practice. The detailed session protocol including critical researcher reflections is shared in this manuscript for application, development and refinement in future research.

Incorporating space and time into random forest models for analyzing geospatial patterns of drug-related crime incidents in a major U.S. metropolitan area

The opioid crisis has hit American cities hard, and research on spatial and temporal patterns of drug-related activities including detecting and predicting clusters of crime incidents involving particular types of drugs is useful for distinguishing hot zones where drugs are present that in turn can further provide a basis for assessing and providing related treatment services. In this study, we investigated spatiotemporal patterns of more than 52,000 reported incidents of drug-related crime at block group granularity in Chicago, IL between 2016 and 2019. We applied a space-time analysis framework and machine learning approaches to build a model using training data that identified whether certain locations and built environment and sociodemographic factors were correlated with drug-related crime incident patterns, and establish the top contributing factors that underlaid the trends. Space and time, together with multiple driving factors, were incorporated into a random forest model to analyze these changing patterns. We accommodated both spatial and temporal autocorrelation in the model learning process to assist with capturing the changes over time and tested the capabilities of the space-time random forest model by predicting drug-related activity hot zones. We focused particularly on crime incidents that involved heroin and synthetic drugs as these have been key drug types that have highly impacted cities during the opioid crisis in the U.S.

A Bioecosystem Theory of Negative Symptoms in Schizophrenia

Objective: Negative symptoms are a core feature of schizophrenia that has been linked to numerous poor clinical outcomes. Although person-level mechanisms have been identified for negative symptoms, psychosocial and pharmacological treatments targeting these mechanisms have been ineffective. The current theoretical paper proposes that limited treatment progress may result in part from a failure to identify and target environmental processes that cause and maintain negative symptoms. Methods: A novel theoretical model is outlined, called the bioecosystem theory of negative symptoms, that offers a conceptual framework for studying interactions among environmental systems and person-related biological and psychosocial factors. Results: Relying on Bronfenbrenner's developmental theory as an organizing framework, four interactive environmental systems are proposed to be critical for the genesis and maintenance of negative symptoms: (1) Microsystem: the immediate environment; (2) Mesosystem: the interactions among microsystems; (3) Exosystem: indirect environments that influence the individual through the microsystems; (4) Macrosystem: socio-cultural factors. The environmental factors within these systems are proposed to function as a network and have dynamic within-system interactions, as well as cross-system interactions that change over time and across phases of illness. Conclusions: Environmental contributions to negative symptoms have received minimal empirical attention, despite their potential to explain variance in negative symptom severity. The bioecosystem model of negative symptoms introduced here offers a novel conceptual framework for exploring environmental contributions to negative symptoms and their interaction with person-level biological and psychological factors. This theory may facilitate new avenues for identifying environmental treatment targets and novel systems-level interventions.

Transdisciplinary research outcomes based on the Transdisciplinary Research on Energetics and Cancer II initiative experience

Intractable public health problems are influenced by interacting multi-level factors. Dynamic research approaches in which teams of scientists collaborate beyond traditional disciplinary, institutional, and geographic boundaries have emerged as promising strategies to address pressing public health priorities. However, little prior work has identified, defined, and characterized the outcomes of transdisciplinary (TD) research undertaken to address public health problems. Through a mixed methods approach, we identify, define, and characterize TD outcomes and their relevance to improving population health using the Transdisciplinary Research on Energetics and Cancer (TREC) II initiative as a case example. In Phase I, TREC II leadership (n = 10) identified nine initial TD outcomes. In Phase II (web-based survey; n = 23) and Phase III (interviews; n = 26; and focus groups, n = 23) TREC members defined and characterized each outcome. The resulting nine outcomes are described. The nine complementary TD outcomes can be used as a framework to evaluate progress toward impact on complex public health problems. Strategic investment in infrastructure that supports team development and collaboration, such as a coordination center, cross-center working groups, annual funded developmental projects, and face-to-face meetings, may foster achievement of these outcomes. This exploratory work provides a basis for the future investigation and development of quantitative measurement tools to assess the achievement of TD outcomes that are relevant to solving multifactorial public health problems.

Neighbourhood characteristics associated with child pedestrian fatalities in Johannesburg, South Africa

The present study investigated the relationship between neighbourhood characteristics and childhood pedestrian fatalities (2001-2010) in Johannesburg, South Africa. This cross-sectional study used negative binomial regression models. Results indicate that: areas with high concentrated disadvantage have elevated childhood pedestrian deaths, especially for those aged 5 to 9 years. Areas marked by residential mobility are associated with high pedestrian deaths among children 0 to 4 years. Black childhood pedestrian deaths are higher in areas marked by a high concentration of female-headed households. The analyses highlight the value of further exploring the effects of neighbourhood characteristics and suggest points of entry for interventions to reduce or prevent childhood pedestrian traffic mortality.

The indirect influence of child play on the association between parent perceptions of the neighborhood environment and sense of community

The neighborhood is a critical setting that broadly affects health, although specific mechanisms that link relationships between the neighborhood environment and indicators of health are still emerging. Children playing is a simple, but underexplored marker that may explain how the neighborhood built environment is related to a psychological sense of community. A telephone survey was conducted among parents with children in the Greater Phoenix Metropolitan area (n = 251) to gather information on perceptions of the built environment, parent attitudes and physical activity behaviors, children's play, and sense of community in the neighborhood. Results of a structural equation modeling analysis (SEM) indicated that children playing in the neighborhood partially explained the relationship between perceptions of the built environment and sense of community (β = 0.031, CI = 0.007-0.067). Parent perceptions of the built environment were positively associated with both children playing (β = 0.229, CI = 0.120-0.341) and sense of community (β = 0.360, CI = 0.220-0.505), and children playing (β = 0.135, CI = 0.027-0.243) and parent attitudes (β = 0.440, CI = 0.319-0.546) were positively related to sense of community. As planners and community advocates consider strategies to build a sense of community within neighborhoods, the importance of favorable environmental conditions that facilitate children's play should be considered.

Environmental Quality Perceptions and Health: A Cross-Sectional Study of Citizens of Kaunas, Lithuania

The perception of urban environmental quality is an important contributor when identifying local problems in sustainable development and environmental planning policy. This study examined the associations between environmental and social residential characteristics, physical activity, obesity, and hypertension in Kaunas city, Lithuania. This cross-sectional study analyzed 580 citizens’ demographic-, socioeconomic-, health-, and lifestyle-related factors, environmental health concerns, and environmental quality perceptions. Using Geographic Information Systems and the multivariate logistic regression, we found that the less physically active group more often presented lower than mean ratings of the quality of pathways and cycling routes (32.9% and 45.6%, p = 0.042) and only irregularly visited the natural environment. Obese participants presented poorer ratings of air pollution, the quality of pathways and cycling routes, their possibility to reach green spaces by walking, and the available relaxing areas. The environmental issues associated with hypertension were poor possibilities to reach green spaces by walking (OR 1.94, 95% CI 1.14–3.32) and the availability of relaxation areas (OR 2.30, 95% 1.34–3.95). The quality of the neighborhood and individual-level characteristics were the factors that influenced a higher prevalence of health problems at the district level. Our findings suggest that a public health policy to improve the physical and social environment of the neighborhood would have a potential to increase citizens’ physical activity and health.

Assessing health related quality of life of school aged Saudi children in western province using the validated Arabic version of child health questionaire-parent form-50

Objectives:

To assess the health-related quality of life (HRQOL) of children from a community in Jeddah, Saudi Arabia, excluding those with known chronic illnesses.

Methods:

Four schools in Jeddah participated in this cross-sectional study, which was conducted from February 2018 to February 2019. The parents of 5-14 year-old children were surveyed using the validated Arabic version of the Child Health Questionnaire-Parent Form 50 (CHQ-PF50). It consisted of 50 items divided into 15 scales (namely, 11 multi-item and 4 single-item scales) and expressed as scores of 0-100, with higher scores indicating better HRQOL. The levels of HRQOL were analyzed and compared.

Results:

The parents of 498 children answered the questionnaire. The mean scores of CHQ-PF50 subscales were relatively high (>80) in 8 out of 15 domains. However, relatively low scores were observed for general health perception (70.01), behavior (73.70), and mental health (75.65). Boys scored lower in behavior (difference of means = -5.80), global behavior (-4.47), mental health (-4.81), general health perception (−2.59), parental impact-emotional (-5.11), family activities (-1.77), and family cohesion (-2.19). Furthermore, adolescent boys scored lower in global health, mental health, global behavior, and parental impact.

Conclusion:

This study showed globally adequate levels of HRQOL among Saudi children, with some limitations in behavior and mental health, especially in boys and adolescents.

Residential mobility and chronic disease among World Trade Center Health Registry enrollees, 2004-2016

Residential mobility is hypothesized to impact health through changes to the built environment and disruptions in social networks, and may vary by neighborhood deprivation exposure. However, there are few longitudinal investigations of residential mobility in relation to health outcomes. This study examined enrollees from the World Trade Center Health Registry, a longitudinal cohort of first responders and community members in lower Manhattan on September 11, 2001. Enrollees who completed ≥2 health surveys between 2004 and 2016 and did not have diabetes (N = 44,089) or hypertension (N = 35,065) at baseline (i.e., 2004) were included. Using geocoded annual home addresses, residential mobility was examined using two indicators: moving frequency and displacement. Moving frequency was defined as the number of times someone was recorded as living in a different neighborhood; displacement as any moving to a more disadvantaged neighborhood. We fit adjusted Cox proportional hazards models with time-dependent exposures (moving frequency and displacement) and covariates to evaluate associations with incident diabetes and hypertension. From 2004 to 2016, the majority of enrollees never moved (54.5%); 6.5% moved ≥3 times. Those who moved ≥3 times had a similar hazard of diabetes (hazard ratio (HR) = 0.78; 95% Confidence Interval (CI): 0.40, 1.53) and hypertension (HR = 0.99; 95% CI: 0.68, 1.43) compared with those who never moved. Similarly, displacement was not associated with diabetes or hypertension. Residential mobility was not associated with diabetes or hypertension among a cohort of primarily urban-dwelling adults.

Development of Environmental Health Competencies through Compulsory Education. A Polyhedral Approach Based on the SDGs

This paper focuses on the competencies in environmental health acquired by students during compulsory education. Questionnaires addressing environmental health problems were completed by 923 students of primary and secondary schools from five different Spanish regions. The results for five challenging situations related to hunger, consumerism, climate change, pollution in the cities and allergies are analysed according to the internal coherence of each sub-competency, i.e., addressing knowledge, skills and attitudes towards these topics. Our results show that problems related to air and water pollution were the most commonly described by the students. Focusing on competency achievement, the higher the educational level, the higher the score students obtained, especially regarding pollution and climate change, two problems that appear directly in the school curriculum. The complexity of the concept of environmental health matches with the necessary holistic perspective of the Sustainable Development Goals in a polyhedral approach including as many factors (facets) as necessary to complete the approach to this evolving concept.

Role of the Built and Online Social Environments on Expression of Dining on Instagram

Online social communities are becoming windows for learning more about the health of populations, through information about our health-related behaviors and outcomes from daily life. At the same time, just as public health data and theory has shown that aspects of the built environment can affect our health-related behaviors and outcomes, it is also possible that online social environments (e.g., posts and other attributes of our online social networks) can also shape facets of our life. Given the important role of the online environment in public health research and implications, factors which contribute to the generation of such data must be well understood. Here we study the role of the built and online social environments in the expression of dining on Instagram in Abu Dhabi; a ubiquitous social media platform, city with a vibrant dining culture, and a topic (food posts) which has been studied in relation to public health outcomes. Our study uses available data on user Instagram profiles and their Instagram networks, as well as the local food environment measured through the dining types (e.g., casual dining restaurants, food court restaurants, lounges etc.) by neighborhood. We find evidence that factors of the online social environment (profiles that post about dining versus profiles that do not post about dining) have different influences on the relationship between a user's built environment and the social dining expression, with effects also varying by dining types in the environment and time of day. We examine the mechanism of the relationships via moderation and mediation analyses. Overall, this study provides evidence that the interplay of online and built environments depend on attributes of said environments and can also vary by time of day. We discuss implications of this synergy for precisely-targeting public health interventions, as well as on using online data for public health research.

Rethinking the Causes and Consequences of Financial Wellness for People With Serious Mental Illnesses

Many people with serious mental illnesses live in poverty, which can worsen mental and overall health. The authors suggest strategies to improve health outcomes through behavioral health services and supports that directly target financial wellness while reducing dependence on public benefits. Although some services focus on financial education, this effort is likely insufficient for addressing poverty and its accompanying financial hopelessness. A social-ecological approach with the core goal of financial wellness may improve outcomes. Financial wellness is a social justice issue that must be elevated to a high-priority area of intervention in behavioral health services.

Air pollution risks human mental health: an implication of two-stages least squares estimation of interaction effects

The study investigates the relationship between air pollution and the status of human mental health using the data of the China Migrant Dynamic Survey (CMDS), 2014. Various econometric methods were used. Particularly, the ordinary least square (OLS) was used to estimate the parametric impact of mental health. Moreover, a robustness test was used to estimate negative impact of air pollution on mental health. Results found that air pollution significantly increased psychological disorder. The concentration of PM2.5 in the air leads to higher prominence of the four negative emotions such as nervous, depression, powerless, and restless or fidgety. After introducing the instrumental variable to solve the endogenous problem, the impact of air pollution on the level of the mental illnesses was still significant and negative. Results are also evident that air pollution has heterogeneity to the negative status of residents' mental health. Specifically, it has a significant and negative impact on women, rural and urban population, and middle- and low-income groups. The study results suggest that the government must have to revise the environmental regulation policy reduce the negative impact on human health.

Obesity and the Built Environment: A Reappraisal

The built environment (BE) has been viewed as an important determinant of health. Numerous studies have linked BE exposure, captured using a variety of methods, to diet quality and to area prevalence of obesity, diabetes, and cardiovascular disease. First-generation studies defined the neighborhood BE as the area around the home. Second-generation studies turned from home-centric to person-centric BE measures, capturing an individual's movements in space and time. Those studies made effective uses of global positioning system tracking devices and mobile phones, sometimes coupled with accelerometers and remote sensors. Activity space metrics explored travel paths, modes, and destinations to assess BE exposure that was both person and context specific. However, as measures of the contextual exposome have become ever more fine-grained and increasingly complex, connections to long-term chronic diseases with complex etiologies, such as obesity, are in danger of being lost. Furthermore, few studies on obesity and the BE have included intermediate energy balance behaviors, such as diet and physical activity, or explored the potential roles of social interactions or psychosocial pathways. Emerging survey-based applications that identify habitual destinations and associated travel patterns may become the third generation of tools to capture health-relevant BE exposures in the long term.

eHealth and mHealth Interventions for Ethnic Minority and Historically Underserved Populations in Developed Countries: an Umbrella Review

Health disparities among historically disadvantaged populations can undermine the effectiveness of eHealth and mHealth interventions and limit their acceptability among diverse community members. The twin aims of this umbrella review of systematic reviews (SRs) are to summarise the evidence on the characteristics and effectiveness of eHealth and mHealth interventions among underserved populations in developed counties and provide recommendations to community organizers, policy makers and researchers. Comprehensive searches were conducted in bibliographic databases, Google Scholar and references lists for SRs published in English between 2000 and 2019. SRs were selected following a protocol registered with PROSPERO. Two independent reviewers were involved in the selection appraisal process, quality assessment and data extraction process. Six SRs met the inclusion criteria for this umbrella review. The six SRs concerned interventions delivered by computer programmes, cell-phones or other electronic devices. The studies in the SRs reported improvements to physiological well-being, health knowledge and self-management, as well as improvements in psychosocial outcomes. This umbrella review concludes with recommendations for community organizers, policy makers and researches for the formation of guidelines, inclusion of target community members in the development of eHealth interventions and directions for future research.

Associations between local government expenditures and low birth weight incidence: Evidence from national birth records

Local governments play an integral role in providing public services to their residents, yet the population health benefits are frequently overlooked, especially when services are outside the traditional health domain. With data from the U.S. Census of Governments and national birth records (spanning from 1992 to 2014), we examined whether local government expenditures on parks and recreation services (PRS) and housing and community development (HCD) predicted county low birth weight outcomes (population incidence and black-white disparities). Hypotheses were tested using bias-corrected county-by-period fixed effects models in a sample of 956 U.S. counties with a total of 3619 observations (observations were defined as three-year pooled estimates), representing 24 million births. Adjusting for prior county low birth weight incidence, levels of total operational, health, and hospital expenditures, and time-varying county sociodemographics, an increase in per capita county PRS expenditures of $50 was associated with 1.25 fewer low birth weight cases per 1000. Change in county HCD expenditures was not associated with low birth weight incidence, and, contrary to hypotheses, neither expenditure type was linked to county black-white disparities. Further examination of the benefits to birth outcomes from increasing parks and recreation services is warranted.

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Rising parks and recreation expenditures are linked to declining low birth weight.

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Housing and community expenditures are not associated with low birth weight.

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‘Health’ was the only expenditure type linked to black-white perinatal disparities.

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Benefits of parks and recreation services may include healthier birth outcomes.

The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016

Objectives. To evaluate the effect of the Affordable Care Act (ACA) Medicaid expansions on national rates of home eviction and eviction initiation in the United States.Methods. Using nationally representative administrative data from The Eviction Lab at Princeton University, we estimated the effects of the ACA Medicaid expansions on county-level evictions and filings from 2000 to 2016 with a difference-in-difference regression design.Results. We found that Medicaid expansions were associated with an annual reduction in the rate of evictions by 1.15 per 1000 renter-occupied households (P < .001), a reduction of 1.59 eviction filings per 1000 renter-occupied households (P < .001), and a reduction in the average number of evictions by 46 (P < .05). We found additional evidence that increasing rates of African American residents in a county was associated with a greater rate of evictions filed, and increased rates of poverty and rent burdens relative to income were associated with more evictions both filed and completed.Conclusions. Evictions decreased after Medicaid expansion, demonstrating further evidence of the substantive financial protections afforded by this coverage. The reduction in the eviction filing rate suggests that Medicaid expansion could be reducing evictions by preventing the court proceeding entirely.

Neighborhood Recreation Facilities and Facility Membership Are Jointly Associated with Objectively Measured Physical Activity

Efforts to increase physical activity have traditionally included either individual-level interventions (e.g., educational campaigns) or neighborhood-level interventions (e.g., additional recreational facilities). Little work has addressed the interaction between spatial proximity and individual characteristics related to facility use. We aimed to better understand the synergistic impact of both physical activity environments and recreational facility membership on objectively measured physical activity. Using the New York City Physical Activity and Transit (PAT) survey (n = 644), we evaluated associations between counts of commercial physical activity facilities within 1 km of participants' home addresses with both facility membership and accelerometry-measured physical activity. Individuals living near more facilities were more likely to report membership (adjusted odds ratio for top versus bottom quartile of facility count: 3.77 (95% CI 1.54-9.20). Additionally, while amount of facilities within a neighborhood was associated with more physical activity, this association was stronger for individuals reporting gym membership. Interventions aiming to increase physical activity should consider both neighborhood amenities and potential barriers, including the financial and social barriers of membership. Evaluation of neighborhood opportunities must expand beyond physical presence to consider multiple dimensions of accessibility.

Residential density was negatively associated with excess body weight among adults in an urban region of China

BACKGROUND

Residential density was found to be associated with excess body weight among adults in Western societies but it remains unclear in China. We aimed to explore the relationship between residential density and excess body weight among adults in China.

METHODS

This cross-sectional study was conducted in 2017 in urban areas of Nanjing, China. A multi-stage sampling method was used to randomly select participants aged 35-74 years from 8 urban neighborhoods in Nanjing. Status of excess body weight was the outcome variable which was categorized as "yes (BMI≥24)" or "no (BMI<24)" according to specific recommendations for Chinese adults. Residential density was the main explanatory variable which was grouped into tertiles. Odds ratios (OR) and 95% confidence interval (CIs) were calculated to assess the relationship between residential density and excess body weight using mixed-effects regression models after adjusting for age, sex, education, occupation, marital status, redmeat, smoking, physical activity, diabetic status and potential neighborhood-level clustering effect.

RESULTS

A total of 1551 participants were recruited with a response rate of 98.9% (1551/1568). The mean age (standard deviation) of participants was 54.7 (11.1) years, and 46% of them were men. With adjustment for potential influential factors, participants in neighborhoods with lower (OR = 1.38, 95% CI = 1.06-1.81) and middle (OR = 1. 29, 95% CI = 1. 01, 1. 64) tertile of residential density were at significantly higher risk of gaining excess body weight relative to their counterparts in communities with upper tertile of residential density. Such a negative association between residential density and excess body weight was observed for men only after stratified analysis by gender.

CONCLUSIONS

A negative association between residential density and excess body weight was identified in overall and male urban Chinese adults, and the association was independent of physical activity. Results of our study have important implications in guiding public health policy making regarding prevention of excess body weight at community level via establishment of health-friendly neighborhood environment in China.

Building on the inherent strengths of green space environments: Promoting trust, democracy, and resilience among ethnically diverse groups

This quasi-experimental study examines the psychosocial and ecological impact of community service activities that utilize green space environments (i.e., community gardens, labyrinths, and urban forestry programs) on individual perceptions of the value and relevance of community service learning programs and the democratic processes that are typically associated with the development and maintenance of green space environments. Sixteen (16) volunteers participated in the current study and subjectively reported their experiences (i.e., perceptions in appreciating living things, experiencing a greater kinship with plants and animals; and a sense of belonging to nature) as they experienced a variety of different green space environments (i.e., community gardens, labyrinths, and parks). Participants were interviewed regarding how these experiences shaped their views regarding the importance of nature and green space environments within urban settings and how exposure to green space environments influenced their own personal perceptions of belongingness and connectedness to both their communities and nature itself. Suggestions for future research are offered.

Going "green" from gray: Providing opportunities of community development and sustainability within a correctional facilities program

This quasi-experimental study examined the community and psychosocial benefits in the development of a "green space" environmental project (apple fruit tree orchard) among community residents and inmates in a minimum security prison in St. Paul, MN. Seventeen (n = 17) participants volunteered in the development of an apple tree orchard located on the grounds of a prison facility located in Ramsey County, MN. Participants (inmates and community residents) prepared the planting area (two acres) and planted a variety of 60 fruit bearing apple trees (Frostbite©, HoneyCrisp©, SnowSweet©, and Haralson©) designed for an upper Midwest (zone 3a) environment. After the tree planting project, a survey was administered that examined perceptions of volunteering in community service programs and how connected individuals felt to their community after participation. A Pearson correlation coefficient test identified a highly significant correlation (r=.934; p<.001) between the variables of community service work as important activities for all persons with feeling better connected to the community. Suggestions for future research involving community service activities within correctional facilities are offered.

Designing a supportive emergency department environment for people with self harm and suicidal ideation: A scoping review

BACKGROUND

People with self harm and suicidal ideation are increasingly presenting emergency departments, resulting in significant economic impacts, increasing pressure on triage processes, and often poor outcomes and experiences. The emerging field of evidence-based design seeks to improve healthcare outcomes through considered design of the built environments delivering healthcare services.

METHODS

This scoping review aimed to (1) identify the current body of literature which examined the design of emergency departments for people with self harm and suicidal ideation, and (2) identify the ways in which the built environment could increase the efficacy of therapeutic efforts through improving service user outcomes and experiences.

RESULTS

Design strategies from the literature are collated and discussed. This review also developed a thematic network of key themes in the literature, to guide future evidence-based design researchers addressing the design of the built environment with the provision of care for people with self harm and suicidal ideation specifically in emergency departments.

CONCLUSIONS

Future research directions, limitations of the field and potential methodologies to address these limitations are presented, including clear definition of participant groups and settings, co-design processes engaging the service user voice alongside other stakeholders, and collaborative interdisciplinary research partnerships.

Risk Factors of Lyme Disease: An Intersection of Environmental Ecology and Systems Science

Lyme disease (LD) cases have been on the rise throughout the United States, costing the healthcare system up to $1.3 billion per year, and making LD one of the greatest threats to public health. Factors influencing the number of LD cases range from environmental to system-level variables, but little is known about the influence of vegetation (canopy, understory, and ground cover) and human behavioral risk on LD cases and exposure to infected ticks. We determined the influence of various risk factors on the risk of exposure to infected ticks on 22 different walkways using multinomial logistic regression. The model classifies the walkways into high-risk and low-risk categories with 90% accuracy, in which the understory, human risk, and number of rodents are significant indicators. These factors should be managed to control the risk of transmission of LD to humans.