The impact of community design and land-use choices on public health: a scientific research agenda

Association between property investments and crime on commercial and residential streets: Implications for maximizing public safety benefits

Physical property investments enhance public safety in communities while alleviating the need for criminal justice system responses. Policy makers and local government officials must allocate scare resources for community and economic development activities. Understanding where physical property investments have the greatest crime reducing benefits can inform decision making to maximize economic, safety, and health outcomes. This study uses Spatial Durbin models with street segment and census tract by year fixed effects to examine the impact of physical property investments on changes in property and violent crime over an 11-year period (2008-2018) in six large U.S. cities. The units of analysis are commercial and residential street segments. Street segments are classified into low, medium, and high crime terciles defined by initial crime levels (2008-2010). Difference of coefficients tests identify significant differences in building permit effects across crime terciles. The findings reveal there is a significant negative relationship between physical property investments and changes in property and violent crime on commercial and residential street segments in all cities. Investments have the greatest public safety benefit where initial crime levels are the highest. The decrease in violent crime is larger on commercial street segments, while the decrease in property crime is larger on residential street segments. Targeting the highest crime street segments (i.e., 90th percentile) for property improvements will maximize public safety benefits.

Development of a Mission-Driven Research Agenda to Support Efforts to End Epidemics

CONTEXT

New York State continues efforts to end the AIDS and hepatitis C epidemics and reduce new infections of sexually transmitted infections.

PROGRAM

In 2022, the New York State Department of Health AIDS Institute released its first-ever Research Agenda. This Research Agenda was systematically developed following input from internal and external research and community stakeholders. We used a participatory and iterative process to prioritize research knowledge gaps related to HIV/AIDS; sexual health and sexually transmitted infections; hepatitis C; lesbian, gay, bisexual, transgender health; drug user health; health equity; and emerging issues such as COVID-19. Questions were prioritized on the basis of the alignment with the following 5 criteria: magnitude of impact; funding and resources; feasibility of conducting research; translatability; and addresses an internal priority area. Findings are anticipated to generate actionable results that can be readily translatable into programs, policies, and practices.

IMPLEMENTATION

This Research Agenda includes 79 research and program evaluation questions prioritized for internally led and collaborative research. Efforts on 35 of the 61 internally led questions and funding of 11 collaborative research projects related to Research Agenda priorities began in 2022.

EVALUATION

An evaluation survey was conducted among all stakeholders involved in the prioritization process. All were satisfied or very satisfied with the process, and results yielded recommendations for future processes including weighting of questions relative to one another within each focus area and other suggestions to streamline the process. In year 1, 10 of the 35 questions were completed.

DISCUSSION

Lessons learned include use of a participatory process to facilitate support and completion of Research Agenda, prioritize research questions to maximize impact and translatability, streamline the prioritization process by restricting proposed questions to those with clear potential for innovative research, emphasize anticipated resources necessary to implement the Research Agenda to set a realistic and actionable plan, and adaptability toward shifting priorities.

Artificial light at night and social vulnerability: An environmental justice analysis in the U.S. 2012-2019

BACKGROUND

Artificial Light at Night (ALAN) is an emerging health risk factor that has been linked to a wide range of adverse health effects. Recent study suggested that disadvantaged neighborhoods may be exposed to higher levels of ALAN. Understanding how social disadvantage correlates with ALAN levels is essential for identifying the vulnerable populations and for informing lighting policy.

METHODS

We used satellite data from the National Aeronautics and Space Administration's (NASA) Black Marble data product to quantify annual ALAN levels (2012-2019), and the Center for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) to quantify social disadvantage, both at the US census tract level. We examined the relationship between the ALAN and SVI (overall and domain-specific) in over 70,000 tracts in the Contiguous U.S., and investigated the heterogeneities in this relationship by the rural-urban status and US regions (i.e., Northeast, Midwest, South, West).

RESULTS

We found a significant positive relationship between SVI and ALAN levels. On average, the ALAN level in the top 20% most vulnerable communities was 2.46-fold higher than that in the 20% least vulnerable communities (beta coefficient (95% confidence interval) for log-transformed ALAN, 0.90 (0.88, 0.92)). Of the four SVI domains, minority and language status emerged as strong predictors of ALAN levels. Our stratified analysis showed considerable and complex heterogeneities across different rural-urban categories, with the association between greater vulnerability and higher ALAN primarily observed in urban cores and rural areas. We also found regional differences in the association between ALAN and both overall SVI and SVI domains.

CONCLUSIONS

Our study suggested ALAN as an environmental justice issue that may carry important public health implications. Funding National Aeronautics and Space Administration.

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.

A meta-synthesis of individual, interpersonal, and systemic factors impacting resilience after traumatic brain injury

PURPOSE/OBJECTIVE

Traumatic brain injuries (TBIs) are increasingly common and a major cause of death and long-term disability. Many individuals experience chronic stressors and adverse health outcomes, emphasizing the importance of cultivating resilience, (defined herein as individual, social, and systemic components engaged in response to the stressors that allow individuals to "bounce back," or move forward adaptively after TBI). Patients' perceptions of factors influencing resilience are critical to guide interventions that meet their needs. Here we offer the first metasynthesis of factors influencing resilience after TBI using a Social Ecological model framework. Research Methods/Design: We preregistered our metasynthesis on PROSPERO (CRD42021233975) and followed PRISMA guidelines. We searched 4 electronic databases for qualitative studies from inception up until June 2021. We included qualitative studies detailing perspectives of individuals with a history of moderate-severe TBI. We excluded case studies and systematic reviews. After removal of duplicates, we identified 124 articles for screening. We reviewed 49 articles for full text eligibility and included 38 studies. We extracted study characteristics and data (e.g., author interpretations and relevant quotes) relating to factors influencing resilience.

RESULTS

We synthesized findings using a Social Ecological model framework to guide thematic analysis. Persons with TBI identified barriers and facilitators to resilience at individual (e.g., physical and cognitive challenges, coping behaviors), interpersonal, (e.g., stigma and isolation) and systemic (e.g., access to resources, rehabilitation support) levels.

CONCLUSIONS/IMPLICATIONS

Considering multifaceted factors at individual, interpersonal and systemic levels in clinical, research, and policy-setting contexts is important for cultivating resilience and optimizing recovery after TBI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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

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

Association Between Residence in Historically Redlined Districts Indicative of Structural Racism and Racial and Ethnic Disparities in Breast Cancer Outcomes

Importance

Historical structural racism may be associated with racial, ethnic, and geographic disparities in breast cancer outcomes, but few studies have investigated these potential relationships.

Objective

To test associations among historical mortgage lending discrimination (using 1930s Home Owners' Loan Corporation [HOLC] redlining data), race and ethnicity, tumor clinicopathologic features, and survival among women recently diagnosed with breast cancer.

Design, Setting, and Participants

This cohort study used a population-based, state cancer registry to analyze breast tumor clinicopathology and breast cancer-specific death among women diagnosed from 2008 to 2017 and followed up through 2019. Participants included all primary, histologically confirmed, invasive breast cancer cases diagnosed among women aged at least 20 years and who resided in a HOLC-graded area of New Jersey. Those missing race and ethnicity data (n = 61) were excluded. Data were analyzed between June and December 2021.

Exposures

HOLC risk grades of A ("best"), B ("still desirable"), C ("definitely declining"), and D ("hazardous" [ie, redlined area]).

Main Outcomes and Measures

Late stage at diagnosis, high tumor grade, triple-negative subtype (lacking estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression), breast cancer-specific death.

Results

Among a total of 14 964 women with breast cancer, 2689 were Latina, 3506 were non-Latina Black, 7686 were non-Latina White, and 1083 were other races and ethnicities (non-Latina Asian/Pacific Islander/Native American/Alaska Native/Hawaiian or not otherwise specified); there were 1755 breast cancer-specific deaths. Median follow-up time was 5.3 years (95% CI, 5.2-5.3 years) and estimated 5-year breast cancer-specific survival was 88.0% (95% CI, 87.4%-88.6%). Estimated associations between HOLC grade and each breast cancer outcome varied by race and ethnicity; compared with residence in HOLC redlined areas, residence in HOLC areas graded "best" was associated with lower odds of late-stage diagnosis (odds ratio [OR], 0.34 [95% CI, 0.22-0.53]), lower odds of high tumor grade (OR, 0.72 [95% CI, 0.57-0.91]), lower odds of triple-negative subtype (OR, 0.67 [95% CI, 0.47-0.95]), and lower hazard of breast cancer-specific death (hazard ratio, 0.48 [95% CI, 0.35-0.65]), but only among non-Latina White women. There was no evidence supporting associations among non-Latina Black or Latina women.

Conclusions and Relevance

Compared with redlined areas, current residence in non-redlined areas was associated with more favorable breast cancer outcomes, but only among non-Latina White women. Future studies should examine additional factors to inform how historical structural racism could be associated with beneficial cancer outcomes among privileged racial and ethnic groups.

Current and future threats to human health in the Anthropocene

It has been widely recognised that the threats to human health from global environmental changes (GECs) are increasing in the Anthropocene epoch, and urgent actions are required to tackle these pressing challenges. A scoping review was conducted to provide an overview of the nine planetary boundaries and the threats to population health posed by human activities that are exceeding these boundaries in the Anthropocene. The research progress and key knowledge gaps were identified in this emerging field. Over the past three decades, there has been a great deal of research progress on health risks from climate change, land-use change and urbanisation, biodiversity loss and other GECs. However, several significant challenges remain, including the misperception of the relationship between human and nature; assessment of the compounding risks of GECs; strategies to reduce and prevent the potential health impacts of GECs; and uncertainties in fulfilling the commitments to the Paris Agreement. Confronting these challenges will require rigorous scientific research that is well-coordinated across different disciplines and various sectors. It is imperative for the international community to work together to develop informed policies to avert crises and ensure a safe and sustainable planet for the present and future generations.

A Matter of Justice: "Fat" Is Not Necessarily a Bad Word

This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high-quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, "fat" is not necessarily a bad word, nor one that health care providers should avoid.

Impacts of Thermal Environments on Health Risk: A Case Study of Harris County, Texas

The loss of green spaces in urbanized areas has triggered a potential thermal risk in the urban environment. While the existing literature has investigated the direct relationship between urban temperatures and health risks, little is known about causal relationships among key components of urban sustainability and health risks, through a pathway involving urban temperature. This study examined the multiple connections between urbanized land use, urban greenery, urban temperatures and health risks in Harris County, Texas. The census tract-level health data from the 500 Cities Project (Centers for Disease Control and Prevention) is used for analysis. Structural equation model analyses showed that the urban temperature played a mediating role in associations between urbanized land use, urban greenery and health risk. Urban vegetation is associated with a decrease in health risks, while urban land use has associations with an increase in health risks. Findings suggest that proactive policies tailored to provide rich urban greenery in a neighborhood can alleviate urban land use effects on health risks.

Urban Design and Walkability: Lessons Learnt from Iranian Traditional Cities

Physical activity is connected to public health in many ways, and walking is its most popular form. Modern planning models have been applied to cities to manage rapid urban expansions. However, this practice has led to low level of walkability and strong car-dependency in today’s cities. Hence, this study aims to provide a review of the most promising urban design parameters affecting walkability, using Frank Lawrence’s theory of “Objectively Measured Urban Form” (density, connectivity and accessibility, and mixed-use development) as the basis of discussion. The second part of this paper takes a case study approach, through discussing the main design elements of traditional Iranian cities (mosques, bazaars, residential quarters, and alleyways) and analyses their impacts on promoting walkability. This study concludes that incorporating inherent values of traditional urban design elements will complement modern planning and design practices.

Transforming cities for sustainability: A health perspective

Transformational change is urgently needed to address planetary health challenges in cities. Through an interdisciplinary overview of the literature, we consider how to frame and unpack city-level transformation towards synergistic benefits for urban health and environmental sustainability. By describing the characteristics of a 'healthy sustainable city' and by bringing together the ideas underlying frameworks for health and sustainability, we develop a conceptual understanding of how cities may progress towards achieving significant improvements in health and the environment. We investigate how urban change works, and build a theoretical understanding of how urban change may be directed to integrate health and sustainability. We conclude that urban transformation needs to be a multi-scalar process across city sectors to meet the scale, speed and form of change required. We propose that this can best be achieved in practice through a composition of mechanisms, including strengthening city governance, enabling technological and social innovations, applying sustainable urban planning and infrastructure development, and impelling social behaviour change; supported by systems-driven policy and practice-focused scientific evidence.

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review

BACKGROUND

A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence.

METHODS

A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided.

RESULTS

Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified.

CONCLUSIONS

The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.

Moving Toward Physical Activity Targets by Walking to Transit: National Household Transportation Survey, 2001-2017

INTRODUCTION

Public transportation systems can help people engage in physical activity. This study assesses sociodemographic correlates and trends in the daily time spent walking to and from transit in the U.S. from 2001 to 2017.

METHODS

This cross-sectional study used data from the 2001, 2009, and 2017 National Household Transportation Survey. Data were analyzed in 2019 to assess the daily level of physical activity attained solely by walking to and from transit. Regression models were used to examine predictors of daily transit‒associated walking.

RESULTS

Compared with the full National Household Transportation Survey sample, transit users who walked to and from transit tended to be younger, from households earning <$25,000 per year, in areas with rail infrastructure, and did not have a household-owned car. Transit walkers spent a median of 20 minutes per day (95% CI=18.5, 21.5) walking to and from transit in 2017, compared with a median of 19 minutes (95% CI=17.5, 20.5) in 2001. Among transit walkers, daily transit-associated physical activity was 27% higher for those residing in areas with rail infrastructure (adjusted coefficient=1.27, 95% CI=1.11, 1.46) and 34% higher for those from households earning <$25,000 per year than those earning >$99,999 per year (adjusted coefficient=1.34, 95% CI=1.15, 1.56).

CONCLUSIONS

As documented in a growing literature, most public transit trips include at least some walking; thus, efforts to encourage transit use are favorable to public health. Continued monitoring by transportation surveys is important as new forms of mobility and changing demographics may impact future transit use and associated physical activity.

Assessing hospital treatment for alcohol-related injury in Minnesota using 2000 - 2015 hospital discharge data: Opportunities and challenges

OBJECTIVE

Excessive alcohol use, especially binge drinking, is an important risk factor for unintentional and intentional injuries. This study used hospital discharge data (HDD) to estimate the prevalence and trends of treatments for alcohol-related injury (ARI) in Minnesota, and discussed opportunities and challenges for public health surveillance.

METHOD

We examined hospital-treated ARI in Minnesota between 2000 and 2015 using HDD (age ≥12 years). ARI was defined as hospital discharges with an injury diagnosis and a diagnosis related to alcohol in any diagnosis field.

RESULTS

The number of hospital-treated injuries increased by 30 % between 2000 and 2015. The number of those injuries that were alcohol-related increased by 166 % from 2000 to 2015. ARI were more likely to be treated as inpatients than all injuries-in 2015, 34 % of ARI were inpatient, compared to 17 % of all injuries. Patients treated for ARI were more likely to be male and older than the average injury patient. In 2015, ARI were more likely than all injuries to be self-inflicted (11.6 % vs. 1.9 %), related to assault (14.4 % vs. 3.6 %), and less likely to be unintentional (63.8 % vs. 78.5 %).

CONCLUSIONS

These analyses suggest that the rate of hospital-treated ARI increased more steeply from 2000 to 2015 than all injuries. While there are significant challenges to using HDD for surveillance, further work to assess the validity of the data source is warranted.

The Role of Urban Morphology Design on Enhancing Physical Activity and Public Health

Along with environmental pollution, urban planning has been connected to public health. The research indicates that the quality of built environments plays an important role in reducing mental disorders and overall health. The structure and shape of the city are considered as one of the factors influencing happiness and health in urban communities and the type of the daily activities of citizens. The aim of this study was to promote physical activity in the main structure of the city via urban design in a way that the main form and morphology of the city can encourage citizens to move around and have physical activity within the city. Functional, physical, cultural-social, and perceptual-visual features are regarded as the most important and effective criteria in increasing physical activities in urban spaces, based on literature review. The environmental quality of urban spaces and their role in the physical activities of citizens in urban spaces were assessed by using the questionnaire tool and analytical network process (ANP) of structural equation modeling. Further, the space syntax method was utilized to evaluate the role of the spatial integration of urban spaces on improving physical activities. Based on the results, consideration of functional diversity, spatial flexibility and integration, security, and the aesthetic and visual quality of urban spaces plays an important role in improving the physical health of citizens in urban spaces. Further, more physical activities, including motivation for walking and the sense of public health and happiness, were observed in the streets having higher linkage and space syntax indexes with their surrounding texture.

Framing the discussion of microorganisms as a facet of social equity in human health

What do “microbes” have to do with social equity? These microorganisms are integral to our health, that of our natural environment, and even the “health” of the environments we build. The loss, gain, and retention of microorganisms—their flow between humans and the environment—can greatly impact our health. It is well-known that inequalities in access to perinatal care, healthy foods, quality housing, and the natural environment can create and arise from social inequality. Here, we focus on the argument that access to beneficial microorganisms is a facet of public health, and health inequality may be compounded by inequitable microbial exposure.

What do microbes have to do with social equity? This Essay explores the argument that access to beneficial microorganisms is a facet of public health, and that health inequality may be compounded by inequitable microbial exposure.

Designing Urban Green Spaces for Older Adults in Asian Cities

Elderly populations in Asian countries are expected to increase rapidly in the next few decades. Older adults, particularly in high-density cities, spend a considerable amount of time in urban green spaces (UGSs). The World Health Organization noted that UGSs are key to improving the age-friendliness of neighborhoods. Thus, it is necessary to design UGSs for the promotion of healthy ageing to enhance preventive healthcare and relieve medical burdens. This study conducted interviews using a questionnaire with a sample size of 326 participants in the cities of Hong Kong (China) and Tainan (Taiwan region). The inter-relationships among the design of UGSs (e.g., spatial distribution and accessibility, characteristics of plants and UGSs), older adults' perceptions on safety and aesthetics quality of UGSs, and their self-reported health conditions (assessed by the self-reported SF-12v2 Health Survey) were investigated with bivariate Spearman rank correlation tests. The results indicate that the duration of visits to UGSs was positively associated with mental health and social functioning, two subscales evaluating health-related quality of life in SF 12v2. The statistical model (moderation analysis) showed that such a correlation was especially significant in women and those with low social support and social capital. A positive relationship was found between the physical health subscale and perceived safety in UGSs. This relationship was stronger among older adults living alone (moderation analysis). Furthermore, the color of plants and maintenance condition of UGSs were significant aspects affecting the subjective assessment of aesthetic quality. This study provides useful information regarding how to plan and design urban green spaces with certain characteristics that could improve the accessibility and aesthetic quality, which are preferred by older adults.

Assessing the micro-scale environment using Google Street View: the Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS)

Background

Altering micro-scale features of neighborhood walkability (e.g., benches, sidewalks, and cues of social disorganization or crime) could be a relatively cost-effective method of creating environments that are conducive to active living. Traditionally, measuring the micro-scale environment has required researchers to perform observational audits. Technological advances have led to the development of virtual audits as alternatives to observational field audits with the enviable properties of cost-efficiency from elimination of travel time and increased safety for auditors. This study examined the reliability of the Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS), a Google Street View-based auditing tool specifically designed to remotely assess micro-scale characteristics of the built environment.

Methods

We created Virtual-STEPS, a tool with 40 items categorized into 6 domains (pedestrian infrastructure, traffic calming and streets, building characteristics, bicycling infrastructure, transit, and aesthetics). Items were selected based on their past abilities to predict active living and on their feasibility for a virtual auditing tool. Two raters performed virtual and field audits of street segments in Montreal neighborhoods stratified by the Walkscore that was used to determine the ‘walking-friendliness’ of a neighborhood. The reliability between virtual and field audits (n = 40), as well as inter-rater reliability (n = 60) were assessed using percent agreement, Cohen’s Kappa statistic, and the Intra-class Correlation Coefficient.

Results

Virtual audits and field audits (excluding travel time) took similar amounts of time to perform (9.8 versus 8.2 min). Percentage agreement between virtual and field audits, and for inter-rater agreement was 80% or more for the majority of items included in the Virtual-STEPS tool. There was high reliability between virtual and field audits with Kappa and ICC statistics indicating that 20 out of 40 (50.0%) items had almost perfect agreement and 13 (32.5%) items had substantial agreement. Inter-rater reliability was also high with 17 items (42.5%) with almost perfect agreement and 11 (27.5%) items with substantial agreement.

Conclusions

Virtual-STEPS is a reliable tool. Tools that measure the micro-scale environment are important because changing this environment could be a relatively cost-effective method of creating environments that are conducive to active living.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7460-3) contains supplementary material, which is available to authorized users.

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.

Exploring the Relevance of Green Space and Epidemic Diseases Based on Panel Data in China from 2007 to 2016

Urban green space has been proven effective in improving public health in the contemporary background of planetary urbanization. There is a growing body of literature investigating the relationship between non-communicable diseases (NCDs) and green space, whereas seldom has the correlation been explored between green space and epidemics, such as dysentery, tuberculosis, and malaria, which still threaten the worldwide situation of public health. Meanwhile, most studies explored healthy issues with the general green space, public green space, and green space coverage, respectively, among which the different relevance has been rarely explored. This study aimed to examine and compare the relevance between these three kinds of green space and incidences of the three types of epidemic diseases based on the Panel Data Model (PDM) with the time series data of 31 Chinese provinces from 2007 to 2016. The results indicated that there exists different, or even opposite, relevance between various kinds of green space and epidemic diseases, which might be associated with the process of urban sprawl in rapid urbanization in China. This paper provides a reference for re-thinking the indices of green space in building healthier and greener cities.

Assessing Sidewalk and Corridor Walkability in Developing Countries

Finding a simple and less expensive method to assess and improve sidewalk and corridor conditions in developing countries is essential in order to motivate more people to walk. This study aimed to design and test a method that uses direct observations of driver behavior and street measurements to assess sidewalk and corridor walkability in developing countries. The proposed method includes different walkability indicators related to sidewalk features, crossing facilities, sidewalk facilities, and driver behavior to provide one score that represents the walkability of a sidewalk and one that represents the walkability of a corridor. The method was tested on streets from 10 neighborhoods in the city of Doha, Qatar. The results indicated that the developed method was easy to use and could efficiently measure various indicators, illustrating that it can be used to evaluate corridors with different characteristics to identify and rank areas that require improvement. The study’s findings will provide maintenance agencies, policymakers, and practitioners in developing countries with a simple, efficient, and cost-effective method to evaluate, plan, rank, and improve the walkability of sidewalks and corridors.

First Physical Activity Report Card for Children and Youth in Lebanon

Background: Evidence on physical activity (PA) indicators for children and youth at a national level is necessary to improve multilevel support for PA behaviors. Lebanon's first Physical Activity Report Card for children and youth (2018) aimed to fill this gap. Methods: In line with the recommended methods of "Global Matrix 3.0," nationally representative data were retrieved from peer-reviewed manuscripts, national surveys, and government reports. In addition to adopting the 10 indicators of "Global Matrix 3.0," publications that discussed weight status were also retained. A grade was assigned for each indicator using a standard rubric: A = 80% to 100%, B = 60% to 79%, C = 40% to 59%, D = 20% to 39%, F = <20%, and INC = incomplete data. Results: Four indicators (active play, family and peers, community and environment, and physical fitness) received an "INC." Three indicators (overall PA, active transportation, and school) received a "D." Sedentary behaviors received a "C-." Weight status received a "C." Government received a "C+." Organized sport received an "F." Conclusions: PA participation among Lebanese children and youth is low. Stakeholders should aim to improve low PA indicators grades. Gaps in the literature also need to be filled to inform on the status of all indicators.

A sustainable urban design framework for the suburbanisation of coastal southeaster Australia

The suburbanisation of modern cities has forced many people in locations that are far less accessible than their prior residences, requiring motorised massive transport. Sustainable suburban development characteristics proposed to be relevant to transit-oriented development (TOD) are defined, including walking and cycling, population density, employment opportunities, urban form, open space and mixed-use land. In the study, an urban design proposal of Reedy Creek Town Centre is intended to guide the sustainable development of the outlying community as an integrated and dense urban centre based around the new rail station. Moreover, a range of residential development choices and commercial office uses supported by convenience retailing and associated services are providing for a diverse range of people having varying incomes and social interests who live and work in suburban area. This paper, which builds on the work of transit-oriented community proposal by dissecting the principles and approaches of TOD, establishes an urban design framework for suburban development to reveal the key sustainability strategies. The result concludes that transit-oriented development holds considerable promise for placing rapidly suburbanising cities on more comprehensive sustainable strategies, which give a basis to guide appropriate growth, change and development, and to prevent development inconsistency.

Validating a comprehensive plan scoring system for healthy community design in League City, Texas

Comprehensive plans provide an overall vision for a city's land use and development and influence community health conditions. As part of a community-engaged research project, a Healthy Living and Active Design Scorecard was applied to the comprehensive plan of League City, Texas, to identify health-promoting design and planning strategies. Although the plan scored similarly to published examples, several areas of improvement aligned with priorities from a community health assessment were identified, including improving public transportation and access to exercise and recreation. Future revisions of the plans and neighbourhood scaled designs targeting these issues could improve the health of the community.

Political Cycles and the Mix of Industrial and Residential Land Leasing

This paper studies how political cycles change the mix of industrial and residential land in urban land leasing. The mixture of different types of land leasing in cities affects urban landscape, resident welfare, and economic sustainability. Using prefecture-level panel data from China and statistical regressions, this paper finds that cities lease out 3% more industrial land, as a percentage of total annual urban land leasing, when their party committee secretaries have been in office for no more than two years. In the same period, they lease out 2% less residential land. This is explained by the strategic behaviors of party committee secretaries to increase their chances of political promotion. Urban land leasing fuels local economic performance and increases the chance of city leaders’ promotion. While the economic benefits of residential land are immediate, those of industrial land cannot be reaped until two years later. This divided timeline results in more aggressive leasing of industrial land early on in party committee secretaries’ service terms, and that of residential land later on. Mayors’ service terms do not have the same effect. This political cycle distorts the temporal and spatial distributions of industrial and residential land in cities, and results in inefficient land use and unstable real estate markets.

Identifying county characteristics associated with resident well-being: A population based study

Background

Well-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being.

Methods

We performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents’ well-being, captured by the Gallup-Sharecare Well-Being Index. Our cohort included 338,846 survey participants, randomly sampled from 3,118 US counties or county equivalents.

Findings

We identified twelve county-level factors that were independently associated with individual well-being scores. Together, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic (% black); social and economic (child poverty, education level [<high school, high school diploma/equivalent, college degree], household income, % divorced); clinical care (% eligible women obtaining mammography, preventable hospital stays per 100,000, number of federally qualified health centers); and physical environment (% commuting by bicycle and by public transit).

Conclusions

Twelve factors across social and economic, clinical care, and physical environmental county-level factors explained the majority of variation in resident well-being.

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.

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.

Lexical neutrality in environmental health research: Reflections on the term walkability

Neighbourhood environments have important implications for human health. In this piece, we reflect on the environments and health literature and argue that precise use of language is critical for acknowledging the complex and multifaceted influence that neighbourhood environments may have on physical activity and physical activity-related outcomes. Specifically, we argue that the term “neighbourhood walkability”, commonly used in the neighbourhoods and health literature, constrains recognition of the breadth of influence that neighbourhood environments might have on a variety of physical activity behaviours. The term draws attention to a single type of physical activity and implies that a universal association exists when in fact the literature is quite mixed. To maintain neutrality in this area of research, we suggest that researchers adopt the term “neighbourhood physical activity environments” for collective measures of neighbourhood attributes that they wish to study in relation to physical activity behaviours or physical activity-related health outcomes.

Relationships between Vacant Homes and Food Swamps: A Longitudinal Study of an Urban Food Environment

Research indicates that living in neighborhoods with high concentrations of boarded-up vacant homes is associated with premature mortality due to cancer and diabetes, but the mechanism for this relationship is unclear. Boarded-up housing may indirectly impact residents’ health by affecting their food environment. We evaluated the association between changes in vacancy rates and changes in the density of unhealthy food outlets as a proportion of all food outlets, termed the food swamp index, in Baltimore, MD (USA) from 2001 to 2012, using neighborhood fixed-effects linear regression models. Over the study period, the average food swamp index increased from 93.5 to 95.3 percentage points across all neighborhoods. Among non-African American neighborhoods, increases in the vacancy rate were associated with statistically significant decreases in the food swamp index (b = −0.38; 90% CI, −0.64 to −0.12; p-value: 0.015), after accounting for changes in neighborhood SES, racial diversity, and population size. A positive association was found among low-SES neighborhoods (b = 0.15; 90% CI, 0.037 to 0.27; p-value: 0.031). Vacant homes may influence the composition of food outlets in urban neighborhoods. Future research should further elucidate the mechanisms by which more distal, contextual factors, such as boarded-up vacant homes, may affect food choices and diet-related health outcomes.

Spatial Association of Canine Rabies Outbreak and Ecological Urban Corridors, Arequipa, Peru

In the city of Arequipa, Peru, a rabid dog was detected in March 2015, marking the reintroduction of the rabies virus in the area; more rabid dogs have been detected since then. The presence of free-roaming dogs in Arequipa seems to be higher in dry water channels, which are widespread in the city. We created a geographic information system (GIS) with surveillance data on the location of rabid dogs detected during the first year of the outbreak, as well as the water channels. We conducted a spatial analysis using Monte Carlo simulations to determine if detected rabid dogs were closer to the water channels than expected. Thirty rabid dogs were detected during the first year of the outbreak, and they were statistically associated with the water channels (average distance to closest water channel = 334 m; p-value = 0.027). Water channels might play a role in the ecology of free-roaming dog populations, functioning as ecological corridors. Landscape ecology could assist in understanding the impact of these urban structures on control activities and the persistence of transmission.

Municipal investment in off-road trails and changes in bicycle commuting in Minneapolis, Minnesota over 10 years: a longitudinal repeated cross-sectional study

BACKGROUND

We studied the effect of key development and expansion of an off-road multipurpose trail system in Minneapolis, Minnesota between 2000 and 2007 to understand whether infrastructure investments are associated with increases in commuting by bicycle.

METHODS

We used repeated measures regression on tract-level (N = 116 tracts) data to examine changes in bicycle commuting between 2000 and 2008-2012. We investigated: 1) trail proximity measured as distance from the trail system and 2) trail potential use measured as the proportion of commuting trips to destinations that might traverse the trail system. All analyses (performed 2015-2016) adjusted for tract-level sociodemographic covariates and contemporaneous cycling infrastructure changes (e.g., bicycle lanes).

RESULTS

Tracts that were both closer to the new trail system and had a higher proportion of trips to destinations across the trail system experienced greater 10-year increases in commuting by bicycle.

CONCLUSIONS

Proximity to off-road infrastructure and travel patterns are relevant to increased bicycle commuting, an important contributor to overall physical activity. Municipal investment in bicycle facilities, especially off-road trails that connect a city's population and its employment centers, is likely to lead to increases in commuting by bicycle.

Evaluating the impacts of the clean cities program

The Department of Energy's Clean Cities program was created in 1993 to reduce petroleum usage in the transportation sector. The program promotes alternative fuels such as biofuels and fuel-saving strategies such as idle reduction and fleet management through coalitions of local government, non-profit, and private actors. Few studies have evaluated the impact of the program because of its complexity that include interrelated strategies of grants, education and training and diversity of participants. This paper uses a Difference-in-Differences (DiD) approach to evaluate the effectiveness of the program between 1990 and 2010. We quantify the effectiveness of the Clean Cities program by focusing on performance measures such as air quality, number of alternative fueling stations, private vehicle occupancy and transit ridership. We find that counties that participate in the program perform better on all these measures compared to counties that did not participate. Compared to the control group, counties in the Clean Cities program experienced a reduction in days with bad air quality (3.7%), a decrease in automobile commuters (2.9%), an overall increase in transit commuters (2.1%) and had greater numbers of new alternative fueling stations (12.9). The results suggest that the program is a qualified success.

A comprehensive scoring system to measure healthy community design in land use plans and regulations

Comprehensive land use plans and their corresponding regulations play a role in determining the nature of the built environment and community design, which are factors that influence population health and health disparities. To determine the level in which a plan addresses healthy living and active design, there is a need for a systematic, reliable and valid method of analyzing and scoring health-related content in plans and regulations. This paper describes the development and validation of a scoring tool designed to measure the strength and comprehensiveness of health-related content found in land use plans and the corresponding regulations. The measures are scored based on the presence of a specific item and the specificity and action-orientation of language. To establish reliability and validity, 42 land use plans and regulations from across the United States were scored January-April 2016. Results of the psychometric analysis indicate the scorecard is a reliable scoring tool for land use plans and regulations related to healthy living and active design. Intraclass correlation coefficients (ICC) scores showed strong inter-rater reliability for total strength and comprehensiveness. ICC scores for total implementation scores showed acceptable consistency among scorers. Cronbach's alpha values for all focus areas were acceptable. Strong content validity was measured through a committee vetting process. The development of this tool has far-reaching implications, bringing standardization of measurement to the field of land use plan assessment, and paving the way for systematic inclusion of health-related design principles, policies, and requirements in land use plans and their corresponding regulations.

Identifying mechanisms for facilitating knowledge to action strategies targeting the built environment

BACKGROUND

In recent years, obesity-related diseases have been on the rise globally resulting in major challenges for health systems and society as a whole. Emerging research in population health suggests that interventions targeting the built environment may help reduce the burden of obesity and type 2 diabetes. However, translation of the evidence on the built environment into effective policy and planning changes requires engagement and collaboration between multiple sectors and government agencies for designing neighborhoods that are more conducive to healthy and active living. In this study, we identified knowledge gaps and other barriers to evidence-based decision-making and policy development related to the built environment; as well as the infrastructure, processes, and mechanisms needed to drive policy changes in this area.

METHODS

We conducted a qualitative thematic analysis of data collected through consultations with a broad group of stakeholders (N = 42) from Southern Ontario, Canada, within various sectors (public health, urban planning, and transportation) and levels of government (federal, provincial, and municipalities). Relevant themes were classified based on the specific phase of the knowledge-to-action cycle (research, translation, and implementation) in which they were most closely aligned.

RESULTS

We identified 5 themes including: 1) the need for policy-informed and actionable research (e.g. health economic analyses and policy evaluations); 2) impactful messaging that targets all relevant sectors to create the political will necessary to drive policy change; 3) common measures and tools to increase capacity for monitoring and surveillance of built environment changes; (4) intersectoral collaboration and alignment within and between levels of government to enable collective actions and provide mechanisms for sharing of resources and expertise, (5) aligning public and private sector priorities to generate public demand and support for community action; and, (6) solution-focused implementation of research that will be tailored to meet the needs of policymakers and planners. Additional research priorities and key policy and planning actions were also noted.

CONCLUSION

Our research highlights the necessity of involving stakeholders in identifying inter-sectoral solutions to develop and translate actionable research on the built environment into effective policy and planning initiatives.

Trail Characteristics as Correlates of Urban Trail Use

Purpose.

The purpose of this study was to identify the environmental correlates of urban trail use.

Design.

Three multiuse urban trails at least 15 miles in length were selected. Trails were divided into one-half-mile segments (N = 102 total segments) and marked in the field. An audit of each trail was completed identifying built environmental features. A cross-sectional count of trail users was completed at each segment estimating the type of use, age, gender.

Setting.

Data collection occurred on urban trails in Chicago, Dallas, and Los Angeles.

Subjects.

Trained observers counted 17,338 users across the three trails.

Measures.

The SPACES for Trails instrument was used, and a trail count data collection sheet was developed.

Analysis.

Univariate and multivariate Poisson regressions controlling for location of trail and density of the population within 1 mile of the trail.

Results.

Positive associations with trail use were observed for mixed views (β = .33, p < .0001), streetlights (β = .30, p < .0001), good trail condition (β = .28, p < .0001), and the presence of cafés (β = .38, p < .0001) and other trailside facilities (β = .08, p < .0001). Negative associations were observed for litter (β = −.22, p < .0001), noise (β = −.41, p < .0001), higher vegetation density (β = −.10, p > .001), drainage features (β = −.67, p < .0003), natural areas adjacent to the trail (β = −.39, p < .0001), and tunnel present (β = −.20, p < .04).

Conclusions.

These correlates should be confirmed in other studies and if supported should be considered in the promotion and design of urban trails.

Correlation analysis of lung cancer and urban spatial factor: based on survey in Shanghai

BACKGROUND

The density of particulate matter (PM) in mega-cities in China such as Beijing and Shanghai has exceeded basic standards for health in recent years. Human exposure to PMs has been identified as traceable and controllable factor among all complicated risk factors for lung cancer. While the improvement of air quality needs tremendous efforts and time, certain revision of PM's density might happen associated with the adjustment of built environment. It is also proved that urban built environment is directly relevant to respiratory disease. Studies have respectively explored the indoor and outdoor factors on respiratory diseases. More comprehensive spatial factors need to be analyzed to understand the cumulative effect of built environment upon respiratory system. This interdisciplinary study examines the impact of both indoor (including age of housing, interval after decoration, indoor humidity etc.) and outdoor spatial factors (including density, parking, green spaces etc.) on lung cancer.

METHODS

A survey of lung cancer patients and a control group has been conducted in 2014 and 2015. A total of 472 interviewees are randomly selected within a pool of local residents who have resided in Shanghai for more than 5 years. Data are collected including their socio-demographic factors, lifestyle factors, and external and internal residential area factors. Regression models are established based on collected data to analyze the associations between lung cancer and urban spatial factors.

RESULTS

Regression models illustrate that lung cancer presents significantly associated with a number of spatial factors. Significant outdoor spatial factors include external traffic volume (P=0.003), main plant type (P=0.035 for trees) of internal green space, internal water body (P=0.027) and land use of surrounding blocks (P=0.005 for residential areas of 7-9 floors, P=0.000 for residential areas of 4-6 floors, P=0.006 for business/commercial areas over 10 floors, P=0.005 for business/commercial areas of 7-9 floors, P=0.043 for business/commercial areas of 4-6 floors). Indoor spatial factors include age of housing (P=0.003) and indoor humidity (P=0.000).

CONCLUSIONS

The findings support the hypothesis that both indoor and outdoor spatial factors are independently associated with lung cancer incidence. Certain principles based on the modeling results are proposed to revise the criteria for lung cancer screening of high-risk individuals. It also provides empirical evidence for urban planning and design to improve built environment with more thorough consideration of respiratory health.

Multilevel Analysis of Municipal Officials' Participation in Land Use Policies Supportive of Active Living: City and Individual Factors

PURPOSE

To investigate individual- and city-level factors associated with municipal officials' participation in a local land use policy that supports active living.

DESIGN

Cross-sectional study.

SETTING

Eighty-three cities in eight states.

SUBJECTS

Four hundred thirteen elected and appointed officials with various job functions including mayors, city councilors, aldermen, selectmen, city or town managers, and heads of departments of planning, community development, public works, transportation, engineering, parks and recreation, neighborhood services, and public health.

MEASURES

A Web-based survey assessed perceived importance of physical activity and livability issues to job responsibilities; perceived resident support of local government action to address physical activity and livability issues; and residence. City-level factors obtained from Census data included percentage of commuters by walking, bicycling, and public transit. The dependent variable was self-reported participation in developing, adopting, or implementing a local land use policy supportive of active living.

ANALYSIS

Hierarchical (two-level: municipal official-city) logistic regression model, using R.

RESULTS

Municipal officials living in the city where they worked were significantly more likely to be involved in a land use policy. Higher perceived importance of livability issues was associated with participation. Perceived importance of physical activity was inversely associated with land use policy involvement. Higher city-level bicycling rates resulted in increased odds of participation in a land use policy. City-level walking rates were inversely associated with land use policy participation.

CONCLUSION

Municipal officials who worked in cities with a higher proportion of bicycle commuters, who prioritized livability issues, and who resided in the city where they worked were more likely to engage in land use policies supportive of active living.

Exploring the Cross-Sectional Association between Transit-Oriented Development Zoning and Active Travel and Transit Usage in the United States, 2010-2014

BACKGROUND

In response to traditional zoning codes that contribute to car-dependent sprawling and disconnected neighborhoods, communities are reforming their land use laws to create pedestrian-friendly areas that promote physical activity. One such reform is the adoption of transit-oriented developments or districts (TODs). TODs are higher density, compact, and mixed use areas located around transit stops that are designed to encourage walking.

PURPOSE

To identify the characteristics of communities that have adopted TODs in their land use laws and examine if communities that have included TODs in their zoning codes are more likely to have adults that commute by any form of active transportation (i.e., walking, biking, or public transportation) or by using public transportation specifically.

METHODS

Zoning codes effective as of 2010 were obtained for a purposeful sample of the largest 3,914 municipal jurisdictions located in 473 of the most populous U.S. counties and consolidated cities within 48 states and the District of Columbia. They were evaluated to determine whether they included TOD districts or regulations using a coding tool developed by the study team. Descriptive statistics together with t-tests and Pearson's chi-squared independence test were used to compare characteristics of jurisdictions with and without TOD zoning. Multivariate linear regressions were used to compute the adjusted association between TOD zoning and taking public or active transportation to work.

RESULTS

Jurisdictions with TOD zoning were located more in the South and West than non-TOD jurisdictions and were more populous, higher income, more racially diverse, and younger. Jurisdictions with TOD zoning had significantly higher percentages of occupied housing with no vehicle than those without TOD zoning. TOD zoning was associated with significantly higher rates of public transportation to work (β = 2.10, 95% CI = 0.88, 3.32) and active transportation to work (β = 2.48, 95% CI = 1.03, 3.94).

CONCLUSION

Communities that have or are considering developing public transit infrastructure may want to modify their zoning codes to include TODs to promote physical activity and active travel to work.

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.

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.

Everyday hazards and vulnerabilities amongst backyard dwellers: A case study of Vredendal North, Matzikama Municipality, South Africa

The populations of many small towns in South Africa continue to expand unmatched by parallel economic growth, entrenching high levels of poverty. The town of Vredendal, located close to the national route between Namibia and Cape Town in South Africa, is a West Coast development node and an emergent industrial and processing area that continues to attract an influx of people seeking economic opportunities. This is challenging the capacity of the local municipality, which has a waiting list for state-provided low-cost housing units, whilst the provision of adequate infrastructure to meet growing local need is also a developmental concern. In the suburb of Vredendal North this has resulted in the proliferation of unplanned informal dwellings in the backyards of formalised low-cost housing areas. Largely overlooked by urban researchers, little is known or understood about small town backyard populations. This prompted a brief study of Vredendal North backyard dwellers commissioned by the local municipality to identify their everyday hazards and livelihood vulnerabilities to inform future development planning. A community workshop identified critical development needs and suggested that backyard dwellers in small towns experience similar living conditions and hazards to those in the cities, although underlain by some unique differences.

Nature-Based Strategies for Improving Urban Health and Safety

Place-based programs are being noticed as key opportunities to prevent disease and promote public health and safety for populations at-large. As one key type of place-based intervention, nature-based and green space strategies can play an especially large role in improving health and safety for dwellers in urban environments such as US legacy cities that lack nature and greenery. In this paper, we describe the current understanding of place-based influences on public health and safety. We focus on nonchemical environmental factors, many of which are related to urban abandonment and blight. We then review findings from studies of nature-based interventions regarding impacts on health, perceptions of safety, and crime. Based on our findings, we suggest that further research in this area will require (1) refined measures of green space, nature, and health and safety for cities, (2) interdisciplinary science and cross-sector policy collaboration, (3) observational studies as well as randomized controlled experiments and natural experiments using appropriate spatial counterfactuals and mixed methods, and (4) return-on-investment calculations of potential economic, social, and health costs and benefits of urban greening initiatives.

How Important Is Having Amenities Within Walking Distance to Middle-Aged and Older Adults, and Does the Perceived Importance Relate to Walking?

OBJECTIVE

This study examined how important walking to amenities (e.g., food store, park) is to middle-aged and older adults and whether this relates to walking. The relationship between walking to amenities and overall activity level was also explored.

METHOD

The study was based on interviews conducted with 778 individuals aged 45 to 94 years. Overall activity level was measured objectively using pedometers.

RESULTS

A large proportion of participants did not think it was very important to have amenities within walking distance, and the majority of participants drove to get there, even among individuals who reported it was very important to have the amenities within walking distance. Self-reported walking to certain amenities (e.g., park) was associated with overall activity.

DISCUSSION

The study underscores the impact of a car culture where the tendency to drive is paramount. It suggests the need to promote the importance of walking as part of an active, healthy lifestyle.

Neighborhood Crime-Related Safety and Its Relation to Children's Physical Activity

Crime is both a societal safety and public health issue. Examining different measures and aspects of crime-related safety and their correlations may provide insight into the unclear relationship between crime and children's physical activity. We evaluated five neighborhood crime-related safety measures to determine how they were interrelated. We then explored which crime-related safety measures were associated with children's total moderate-to-vigorous physical activity (MVPA) and MVPA in their neighborhoods. Significant positive correlations between observed neighborhood incivilities and parents' perceptions of general crime and disorder were found (r = 0.30, p = 0.0002), as were associations between parents' perceptions of general crime and disorder and perceptions of stranger danger (r = 0.30, p = 0.0002). Parent report of prior crime victimization in their neighborhood was associated with observed neighborhood incivilities (r = 0.22, p = 0.007) and their perceptions of both stranger danger (r = 0.24, p = 0.003) and general crime and disorder (r = 0.37, p < 0.0001). After accounting for covariates, police-reported crime within the census block group in which children lived was associated with less physical activity, both total and in their neighborhood (beta = -0.09, p = 0.005, beta = -0.01, p = 0.02, respectively). Neighborhood-active children living in the lowest crime-quartile neighborhoods based on police reports had 40 min more of total MVPA on average compared to neighborhood-active children living in the highest crime-quartile neighborhoods. Findings suggest that police reports of neighborhood crime may be contributing to lower children's physical activity.

The impact of home safety on sleep in a Latin American country

OBJECTIVES

We sought to assess the impact of feelings of safety in one's neighborhood and home on sleep quality and sleep duration.

DESIGN

The design is a cross-sectional survey using face-to-face interviews, as part of the Argentine Social Debt Observatory assessment.

SETTING

The setting is a nationwide data from Argentina.

PARTICIPANTS

There are 5636 participants aged 18 years and older.

INTERVENTION (IF ANY)

N/A.

MEASUREMENTS

The relationships between both subjective sleep quality and self-reported sleep duration, categorized as short (<7 hours), normal (7-8 hours), and long (>8 hours) with safety in one's neighborhood and one's home, were analyzed. Age, sex, obesity, neighborhood socioeconomic status, and education were included as covariates.

RESULTS

Feeling unsafe in one's home was strongly associated with poorer sleep quality and with short sleep duration. Feeling unsafe in one's neighborhood was initially associated with reduced sleep quality but was no longer significant after controlling for home safety. In contrast, we found no correlation between safety measures and long sleep. In analyses stratified by sex, feeling unsafe in one's home was associated with poor sleep quality in women but not in men.

CONCLUSIONS

Our findings suggest that safety in the home has an important effect on both sleep quality and duration, particularly among women. In contrast, after accounting for safety in the home, neighborhood safety does not impact sleep. Further research is warranted to identify mechanisms underlying the sex differences in susceptibility to poor sleep quality and shorter sleep duration, as well as to assess whether interventions addressing safety in the home can be used to improve sleep and overall health.