The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment

Systematic Review of the Health and Equity Impacts of Remediation and Redevelopment of Contaminated Sites

(1) Background: Globally there is a vast legacy of contaminated sites from past industrial, commercial and military activity, waste disposal, and mineral extraction. This review examined the extent to which the remediation of contaminated sites reduces health risks to new and existing populations. (2) Methods: Standard academic databases were searched for papers that reported on health-related outcomes in humans following remediation and redevelopment of contaminated sites. Title/abstract screening, followed by full-text screening identified sixteen papers that met the eligibility criteria. (3) Results: Most studies were set in the United States of America and reported changes in blood lead concentrations in children, following soil remediation and, in some cases, public health campaigns to reduce exposure. Two further studies examined the impacts of remediation on soil contaminated with chromium and sediments contaminated with polychlorinated biphenyls (PCBs). (4) Conclusions: Overall, the evidence suggests that remediation via removal, capping, and replacing soil, and planting vegetation is effective at reducing concentrations of lead and chromium in blood and urine in children. There is also evidence that sediment dredging can reduce PCB concentrations in umbilical cords in infants. Study designs are relatively weak and some recommendations are provided for those wishing to examine the health impacts of remediation.

Association between Olympic Games and children's growth: evidence from China

OBJECTIVES

To estimate the association between the 2008 Beijing Olympic Games (BOG) and growth of children in China.

METHODS

A total sample of 6 951 children aged 3-10 years were included, among which 3 201 were interviewed in 2014 and 3 750 were interviewed in 2018. The BOG was used as a natural experiment. Exposure to the BOG was established by triple differences measured by age group, survey period and whether child participants were living in BOG areas or not, respectively. Children's growth was assessed by binary variables of stunting, underweight, overweight and obesity. The difference-in-difference-in-differences (DDD) method was used to estimate the association between the BOG and children's growth.

RESULTS

DDD estimates showed that the BOG was significantly associated with decreased risks of children's underweight (OR 0.12; 95% CI 0.02 to 0.69) and overweight (OR 0.43; 95% CI 0.19 to 0.98) after controlling for multiple covariates in fractional polynomial models. There was significant sex heterogeneity with regard to the association between BOG and obesity, that is, lower odds of obesity (OR 0.24; 95% CI 0.06 to 0.94) were found in female children but not in male children.

CONCLUSION

The BOG was positively associated with healthier growth of children including decreased risks of both undernutrition and overnutrition. More attention should be given to the improvement of health surveillance and services before and after sporting events so that the active role of such mega-events in the lasting well-being of the public can be determined in more detail.

Active design of built environments for increasing levels of physical activity in adults: the ENABLE London natural experiment study

Background

Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited.

Objectives

The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined.

Design

The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment.

Setting

East Village, London, UK.

Participants

A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years.

Intervention

The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport.

Main outcome measure

Change in objectively measured daily steps from baseline to follow-up.

Methods

Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village.

Results

A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity.

Conclusions

Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).

Longitudinal associations between neighbourhood trust, social support and physical activity in adolescents: evidence from the Olympic Regeneration in East London (ORiEL) study

BACKGROUND

Most UK adolescents do not achieve recommended levels of physical activity (PA). Previous studies suggest that the social environment could contribute to inequalities in PA behaviours, but longitudinal evidence is limited. We examined whether neighbourhood trust and social support were longitudinally associated with four common forms of PA: walking to school, walking for leisure, outdoor PA and pay and play PA. We further assessed whether gender moderated these associations.

METHODS

We used longitudinal data from the Olympic Regeneration in East London (ORiEL) study. In 2012, 3106 adolescents aged 11-12 were enrolled from 25 schools in four deprived boroughs of East London, UK. Adolescents were followed-up in 2013 and 2014. The final sample includes 2664 participants interviewed at waves 2 and 3. We estimated logistic regression models using generalised estimating equations (GEEs) (pooled models) and proportional odds models (models of change) to assess associations between the social environment exposures and the PA outcomes, adjusting for potential confounders. Item non-response was handled using multilevel multiple imputation.

RESULTS

We found that different aspects of the social environment predict different types of PA. Neighbourhood trust was positively associated with leisure-type PA. Social support from friends and family was positively associated with walking for leisure. There was some evidence that changes in exposures led to changes in the PA outcomes. Associations did not systematically differ by gender.

CONCLUSION

These results confirm the importance of the social environment to predict PA and its change over time in a deprived and ethnically diverse adolescent population.