Activity-Friendly Built Environments in a Super-Aged Society, Japan: Current Challenges and toward a Research Agenda

Risk factors for falls among community-dwelling older adults during voluntary self-isolation: analysis based on frailty screening index subscales

[Purpose] This study aimed to assess fall-related risk factors among community-dwelling older adults during a period of voluntary self-isolation for preventing the spread of COVID-19. [Participants and Methods] This was a cross-sectional study. Survey questionnaire forms were distributed to 2,586 community-dwelling older adults in Takasaki City, Gunma Prefecture, Japan. Completed questionnaires were returned by mail. [Results] Of the 1,645 people who responded, 1,040 people aged 65 and over who did not apply for long-term care insurance and fully completed the questionnaire were included in this study. Since no in-person measurements were required, we utilized the Frailty Screening Index for the evaluations. We evaluated the relationship between questionnaire responses and fall rates among community-dwelling older adults. Among the results, “yes” responses to “Do you think you walk more slowly than before?” were identified as significantly associated with falls. [Conclusion] One must pay careful attention to subjectively assessing decreases in walking speed as a fall prevention measure during periods of self-restraint to prevent the spread of COVID-19 infection.

Urology and Geriatrics in Korea: Present Status and Future Directions

Globally, the population aged 65 years and over is growing faster than all other age groups. South Korea, in particular, is one of the most rapidly aging societies worldwide. With the increase in the older population, the incidence of urologic diseases has increased significantly along with that of chronic diseases. Urologic diseases are an important component of the health problems faced by an aging society. Among those, urinary incontinence and voiding dysfunction cause significant health and quality of life problems in older adults. To properly manage these diseases, especially in the field of urology, it is necessary to propose appropriate policies for the health care of older people. Accordingly, the significance of geriatrics, particularly geriatric urology, has increased. Although geriatric urology in South Korea began relatively recently, the founding of the Korean Society of Geriatric Urological Care represents a significant step in the development of geriatric urology as a subspecialty. The goal of this review is to elaborate on the concept of geriatrics and to provide an overview of geriatric urology with a focus on its current status in South Korea. Furthermore, future challenges in the face of rapid demographic changes are reviewed.

Workplace neighbourhood built-environment attributes and sitting at work and for transport among Japanese desk-based workers

Workplace settings—both internal and external—can influence how workers are physically active or sedentary. Although research has identified some indoor environmental attributes associated with sitting at work, few studies have examined associations of workplace neighbourhood built-environment attributes with workplace sitting time. We examined the cross-sectional associations of perceived and objective workplace neighbourhood built-environment attributes with sitting time at work and for transport among desk-based workers in Japan. Data were collected from a nationwide online survey. The Abbreviated Neighborhood Environment Walkability Scale (n = 2137) and Walk Score® (for a subsample of participants; n = 1163) were used to assess perceived and objective built-environment attributes of workplace neighbourhoods. Self-reported daily average sitting time at work, in cars and in public transport was measured using a Japanese validated questionnaire. Linear regression models estimated the associations of workplace neighbourhood built-environment attributes with sitting time. All perceived workplace neighbourhood built-environment attributes were positively correlated with Walk Score®. However, statistically significant associations with Walk Score® were found for sitting for transport but not for sitting at work. Workers who perceived their workplace neighbourhoods to be more walkable reported a longer time sitting at work and in public transport but a shorter sitting time in cars. Our findings suggest that walkable workplace neighbourhoods may discourage longer car use but have workplaces where workers spend a long time sitting at work. The latter finding further suggests that there may be missed opportunities for desk-based workers to reduce sitting time. Future workplace interventions to reduce sitting time may be developed, taking advantage of the opportunities to take time away from work in workplace neighbourhoods.

Sedentary Behavior and Happiness: The Mediation Effects of Social Capital

Background and Objectives

This study aimed to examine the associations between time spent in 6 different domains of sedentary behavior and happiness and whether social capital mediated such associations among adults and older adults living in a rural area of Japan.

Research Design and Methods

Cross-sectional data from 3,357 participants (mean age: 60 ± 16 years) were used. 6 domains of sedentary behavior, happiness, and social capital were assessed using a self-report questionnaire. Age-stratified multivariable linear regression models adjusted for covariates were used to examine the associations between 6 domains of sedentary behavior and happiness. For relationships where the direct effect was significant, we tested the mediating effects of 2 social capital measures.

Results

Among both adults and older adults, more time spent viewing television was significantly associated with lower happiness scores, and more time spent engaging in other leisure activities was significantly associated with higher happiness scores. In addition, more time spent using cell phones and computers was significantly associated with lower happiness scores among the adults. Engaging in activities with neighbors significantly mediated the relationship between other leisure activities and happiness in the adults and older adults, and between television viewing and happiness in the older adults.

Discussion and Implications

Our findings indicated that less television viewing and more mentally active sedentary behavior (e.g., talking with others and engaging in hobbies) were associated with greater happiness. One aspect of social capital, engaging in activities with neighbors, acts as a potential mediator for relationships between sedentary behavior and happiness.

Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.

Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.

Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).

Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Exploring the intensity, barriers and correlates of physical activity In Iranian pregnant women: a cross-sectional study

Objectives

To determine the intensity, barriers and correlates of physical activity (PA) in Iranian pregnant women.

Methods

This cross-sectional study was carried out with 300 eligible pregnant women referred to the Ilam health centres and bases using stratified random sampling with proportional allocation. Data collection tools included a demographic and obstetrical history questionnaire, the Pregnancy Physical Activity Questionnaire and the Exercise Benefits/Barriers Scale. The association between demographic and obstetrical characteristics and PA intensity and barriers were studied using multiple linear regression models.

Results

The mean and SD of the total score of PA intensity were 47.15 and 26.25 metabolic equivalent of task (MET)-hour/week, respectively. The highest and the lowest barriers were related to the time expenditure (42.77±18.04) and family discouragement (50.72±24.99) constructs, respectively. The PA intensity was significantly associated with prepregnancy or early pregnancy body mass index (B=25.6), ethnicity (B=16.94), level of education (B=−8.77), number of children (B=5.95), gestational age (B=0.81), participation in childbirth preparation classes (B=−11.27), habitual exercise before pregnancy (B=6.09), income (B=−9.22). The PA barriers were significantly associated with ethnicity (B=−4.96), income (B=2.23) and habitual exercise before pregnancy (B =−1.35).

Conclusion

PA intensity may be enhanced by encouraging individuals to be more physically active before pregnancy. Additionally, strategies to enhance support from friends and family to engage in PA throughout pregnancy and PA interventions focused on women with lower levels of income and education are required.

Association between hilliness and walking speed in community-dwelling older Japanese adults: A cross-sectional study

PURPOSE

This cross-sectional study investigated the association between hilliness and walking speed in community-dwelling older adults, and whether it varied according to their car-driving status.

METHODS

Data were collected from 590 participants aged 65 and older living in Okinoshima Town, Shimane prefecture, Japan, in 2018. Comfortable walking speed (m/s) was objectively assessed. Hilliness was measured by the mean land slope (degree) within a 500-m or 1000-m network buffer around each participant's home using a geographic information system. A multiple linear regression examined whether the land slope was associated with walking speed, adjusted for sex, age, body mass index, smoking habits, alcohol consumption habits, exercise habits, chronic disease, and living arrangements. A stratified analysis by car-driving status was also conducted.

RESULTS

After adjusting for all confounders, the land slope within the 500-m or 1000-m network buffer was negatively associated with walking speed (B = -0.007, 95% CI [-0.011, -0.002]; B = -0.007, 95% CI [-0.011, -0.003], respectively). The stratified analysis by car-driving status showed that living in a hilly area was negatively associated with walking speed among non-drivers in the 500-m or 1000-m network buffer (B = -0.011, 95% CI [-0.017, -0.004]; B = -0.012, 95% CI [-0.019, -0.006]), though there were no associations among drivers.

CONCLUSIONS

A hilly environment is positively associated with slow walking speed in community-dwelling older adults in Japan. Moreover, car-driving status potentially modifies the relationship between living in a hilly environment and slow walking speed.

The relationship between job components, neighbourhood walkability and African academics' physical activity: a post-COVID-19 context

Research to date suggests that physical activity (PA) among academics is insufficient globally. Academics in many African countries were recently required to resume work while observing social distancing protocols. Physical inactivity (PI) was, therefore, expected to increase in such academics. Interestingly, walkable neighbourhoods are resources that could discourage excessive sitting and PI in this situation. This study, therefore, assessed the moderating role of neighbourhood walkability in the relationship between core job components (i.e. on-site teaching, online teaching, research and student assessment) and PA among academics. The study adopted a cross-sectional design that utilized an online survey hosted by Google Forms to gather data. Participants were volunteer full-time academics in Nigeria, Ghana, Kenya and Tanzania. A total of 1064 surveys were analysed, with a sensitivity analysis utilized to select covariates for the ultimate hierarchical linear regression model. After controlling for the ultimate covariates (e.g. gender, education and income), PA was found to be positively associated with the job component 'research work' but negatively associated with student assessment. Neighbourhood walkability increased the positive relationship of research work with PA and reduced the negative relationship of student assessment with PA. The non-significant negative relationship between 'teaching online' and PA was made positively significant by neighbourhood walkability. We conclude that research as a job component is positively associated with PA, but online teaching is negatively associated with PA among African academics in a post-COVID-19 context.

Assessing the Impact of a Hilly Environment on Depressive Symptoms among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study

Although some neighborhood environmental factors have been found to affect depressive symptoms, few studies have focused on the impact of living in a hilly environment, i.e., land slope, on depressive symptoms among rural older adults. This cross-sectional study aimed to investigate whether a land slope is associated with depressive symptoms among older adults living in rural areas. Data were collected from 935 participants, aged 65 years and older, who lived in Shimane prefecture, Japan. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) and defined on the basis of an SDS score ≥ 40. Land slopes within a 400 m network buffer were assessed using geographic information systems. Odds ratios (ORs) with 95% confidence intervals (CIs) of depressive symptoms were estimated using logistic regression. A total of 215 (23.0%) participants reported depressive symptoms. The land slope was positively associated with depressive symptoms (OR = 1.04; 95% CI = 1.01-1.08) after adjusting for all confounders. In a rural setting, living in a hillier environment was associated with depressive symptoms among community-dwelling older adults in Japan.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

PURPOSE

This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer.

METHODS

This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test.

RESULTS

A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90-96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31-90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7-36.5) and that of NOG was 12.5 months (95% CI: 2.4-22.6) (P = 0.012).

CONCLUSION

Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

Walking-friendly built environments and objectively measured physical function in older adults

BACKGROUND

Few studies have examined the associations between urban design attributes and older adults' physical function. Especially, it is not well known how built-environment attributes may influence physical function in Asian cities. The aim of this study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.

METHODS

Cross-sectional data collected in 2013 from 314 older residents (aged 65-84 years) living in Japan were used. Physical function was estimated from objectively measured upper- and lower-body function, mobility, and balance by a trained research team member. A comprehensive list of built-environment attributes, including population density, availability of destinations, intersection density, and distance to the nearest public transport station, were objectively calculated. Walk Score as a composite measure of neighborhood walkability was also obtained.

RESULTS

Among men, higher population density, availability of destinations, and intersection density were significantly associated with better physical function performance (1-legged stance with eyes open). Higher Walk Score was also marginally associated with better physical function performance (1-legged stance with eyes open). None of the environmental attributes were associated with physical function in elderly women.

CONCLUSION

Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia. Walking-friendly neighborhoods can not only promote older adults' active behaviors but can also support their physical function.

Association between ageing population, median age, life expectancy and mortality in coronavirus disease (COVID-19)

As of May 5, 2020, the number of confirmed coronavirus disease (COVID-19) cases has been more than 3.5 million with 243,540 deaths. We aimed to determine the associations between ageing population, median age, life expectancy at birth and COVID-19 mortality. The numbers of COVID-19 cases and deaths in the European region were obtained from the World Health Organization database. The data on percentage of the population aged 65 and over, median age and life expectancy at birth were extracted from the World Factbook of Central Intelligence Agency. A total of 56 countries/areas in the Europe reported COVID-19 cases and deaths (1,121,853 cases and 100,938 deaths) on April 20, 2020. The results showed significant positive associations between COVID-19 mortality and ageing population (r =0.274; P =0.021), median age (r =0.255; P=0.029), male median age (r =0.284; P =0.017), female median age (r =0.224; P=0.049), life expectancy at birth (r =0.336; P=0.006), male life expectancy at birth (r =0.342; P=0.005), female life expectancy at birth (r =0.312; P=0.01) in the 56 European countries/areas. This study illustrated that COVID-19 mortality was positively associated with ageing population, median age, and life expectancy at birth.

Sex Differences in the Association between Living Environmental Factors and Nutritional Status in Community-Dwelling Elderly Koreans

The association between nutritional status and living environment among 703 community-dwelling participants (268 men and 435 women) aged 65 years and older was assessed. In this cross-sectional survey study, living environmental factors, health-related factors, and nutrition (the Nutrition Quotient for the Elderly scores; NQ-E) were assessed. NQ-E scores were significantly higher in men than women, as were diversity and behavior factor scores (diversity: men, 50.2 ± 16.1; women, 44.1 ± 17.5; behavior: men, 59.3 ± 16.9; women, 54.1 ± 16.6). Participants living with a spouse and engaging in frequent sports activities had significantly higher adjusted odds ratio (OR) for having a high NQ-E than those who lived alone and engaged in restful activities and hobbies (men: adjusted OR for high NQ-E = 8.99; 95% confidence interval (CI): 1.35-59.56; women: adjusted OR for high NQ-E = 5.62; 95%CI: 2.36-13.38). We confirmed that women's nutritional status, unlike men's, was better when proper nutrition education was provided and when food security was guaranteed. For all participants, social activities and networks were important for maintaining good nutritional status and a healthy life. We suggest that different nutritional management strategies are needed for elderly people depending on sex.

The Influence of Community-Level Built Environment Factors on Active Social Network Size in Older Adults: Social Activity as a Moderator

Background

This study examined the influence of built environmental factors in the community on active social network size as well as the moderating influence of different dimensions of social activity on this relationship.

Methods

This study employed the cross-sectional and correlational approaches to construct a scale measuring key community-level built environment factors and test the moderating influence of social activity on the association between these factors and active social network size in older adults. The study population was all 3,211 older adults who were resident in Accra and were part of the database of the Social Security and National Insurance Trust. Participants were 515 older adults in Accra aged 60 years or more who met some inclusion criteria. A self-reported questionnaire, including a new scale measuring the built environment factors, was used to collect data. Principal component analysis with varimax rotation and confirmatory factor analysis were used to validate the measurement scales, whereas Pearson’s correlation test and multiple linear regression analysis were used to test the associations of interest.

Results

After controlling for relevant demographic variables, built environment factors in the community have no significant influence on active social network size. Volunteering, support for social ties, and group activity positively moderated the influence of built environment factors on active social network size at p < .05 and β ≥ 0.2.

Conclusion

The study concludes that social activity is essential to the utilization of available built environmental factors by older adults to make active social ties in the community.

Psychometric Properties of a New Scale Measuring Neglect and Abuse of Older Adults in the Community: Implications for Social Activity

Background

Neglect and abuse of older adults are still prevalent in communities of developing countries, a situation that could discourage active and healthy behaviors in community-dwelling older adults.

Methods

This study used the cross-sectional and correlational approaches to construct a scale measuring neglect and abuse in older adults living in the community. The study population was all (3,211) older adults who were resident in Accra and were part of the database of the Social Security and National Insurance Trust. Participants were 515 individuals who met some inclusion criteria. Three steps were followed to determine an initial set of 11 items, and principal component analysis with varimax rotation and confirmatory factor analysis were used to select relevant items and assess the psychometric properties of the final scale.

Results

Principal component analysis with varimax rotation yielded a two-factor solution on all 11 items. The first factor extracted was “discrimination and exploitation,” which accounted for a variance of 53.9% out of total variance of 70.8%. The scale had a good internal consistency (Cronbach’s α = .90, factor loading ≥0.50). Confirmatory factor analysis confirmed the two-factor solution and produced satisfactory convergent and discriminant validity.

Conclusion

It is concluded that 11 items that make up 2 factors are potential indicators of neglect and abuse of older adults at the community level. Finally, neglect and abuse of older people in the community can contribute to an increase or decrease in social activity.

Hilly environment and physical activity among community-dwelling older adults in Japan: a cross-sectional study

OBJECTIVES

We investigated whether a moderate-to-vigorous physical activity (MVPA) level and walking time were associated with a hilly environment in rural Japanese older adults.

DESIGN

Cross-sectional study.

SETTING

Unnan city, Ohnan and Okinoshima towns in Shimane, Japan.

PARTICIPANTS

Data were collected from 1115 adults from the Shimane CoHRE study, who were aged 60 years and older and living in rural Japan in 2012.

MEASURES

We measured the total time spent on MVPA and walking using a Japanese short version of the International Physical Activity Questionnaire. The land slope in 400 or 800 m network buffers was assessed using the geographic information system. A multivariable Poisson regression model examined the prevalence ratios (PR) and 95% CIs of walking time or MVPA levels meeting the WHO guideline (>150 min/week) in the land slope categories (low, middle and high), adjusted for confounders.

RESULTS

Engaging in the recommended level of MVPA was significantly associated with middle land slope (PR=1.07; p=0.03) and high land slope (PR=1.06; p=0.07) compared with low land slope in the 400 m network buffer, as well as with middle land slope (PR=1.02; p=0.48) and high land slope (PR=1.04; p=0.25) compared with the low land slope in the 800 m network buffer. Walking time was significantly associated with middle land slope (PR=1.13; p=0.04) and high land slope (PR=1.17; p=0.01) compared with low land slope in the 400 m network buffer, and with middle land slope (PR=1.09; p=0.16) and high land slope (PR=1.17; p<0.01) compared with low land slope in the 800 m network buffer. The sensitivity analysis found only a positive association between walking time and land slope in the 400 and 800 m network buffers.

CONCLUSIONS

This study showed that a hilly environment was positively associated with walking time among older adults living in rural Japan.

Does Environmental Walkability Matter? The Role of Walkable Environment in Active Commuting

Since walkability plays an important role in active commuting, several cities are actively promoting its integration into urban and environmental planning policies. This study examined the association between walkability and active commuting in Seoul, Korea. A multilevel logistic regression model was used to examine the correlation between Walkability Score and the probability of active commuting after controlling for individual variables. The analysis used 129,044 individual samples nested within 424 administrative districts (dongs). In this study, three models were tested: Model 1 contained only individual variables, Model 2 contained individual variables and Walkability Score, and Model 3 included neighborhood-level variables in addition to the variables of Model 2. The results showed that the Walkability Score was significantly correlated with the odds of active commuting. Specifically, every additional one-point increase in Walkability Score was associated with 0.3% higher odds of active commuting (Model 2: odds ratio (OR) = 1.003, 95% confidence interval (CI) = 1.001-1.005; Model 3: OR = 1.003, 95% CI = 1.001-1.006). Additionally, public transportation density was also positively correlated with the odds of active commuting. The odds of active commuting were positively correlated with younger age, female, lower-income, and having no car. Based on the findings, policy recommendations in urban planning and design, transport engineering, and environmental planning are provided.

Epidemiology of a Femur Shaft Fracture in an Acute Critical Care Center in a Rural Area of Japan

Purpose:

Japan has the most rapidly aging population in the world. As of 2017, the number of people ≥65 years of age in Japan was 35.1 million, constituting 27.7% of the total population. The purpose of the study was to investigate the epidemiology in patients with a femur shaft fracture in a rural area with a super-aging population.

Methods:

Electronic medical charts from January 2011 to March 2019 were retrospectively reviewed for all patients with the main disease of ‘femur shaft fracture’ who had been transported to Numazu City Hospital. Subjects were divided into two groups based on the mechanism of injury: a Low-Energy (LE) group, which included patients who had been injured by falling down or suffered a fracture while walking; and a High-Energy (HE) group, which included patients who had been injured by traffic accidents or free fall from a high place (over 3 m). The variables were compared between the two groups.

Results:

During the investigation period, there were 58 patients with the femur shaft fracture, including 28 patients in the HE group and 30 in the LE group. The male ratio, injury severity score and ratio of open fracture in the HE group were significantly greater than in the LE group. The age and systolic blood pressure in the HE group were significantly lower than in the LE group.

Conclusion:

Among patients with femur shaft fracture in the acute critical care center in a rural area of Japan, where the population is super-aging, the frequency of HE and LE femur shaft fracture was almost the same. The fragility of the femur shaft in elderly people may explain this tendency.

Dog-walking in dense compact areas: The role of neighbourhood built environment

There is a dearth of evidence about how high-density living may influence dog-walking behaviour. We examined associations between neighbourhood built environment attributes and dog-ownership and dog-walking behaviour in Japan. Data from 1058 participants were used. The dog-ownership was 18.8%. All neighbourhood built attributes (excluding availability of parks) were negatively associated with dog-ownership. Among dog-owners, these same attributes were positively associated with any dog-walking in a usual week and with achieving 150-min per week of physical activity through dog-walking alone. These findings provided evidence on the importance of neighbourhood built environment attributes on dog-ownership and dog-walking behaviour in dense and compact areas. The urban design and public health implication of these findings is that the built environment attributes in high-density living areas may have different impacts on dog-ownership and dog-walking: while living in a walkable neighbourhood may not be conducive to dog-ownership, it may support dog-walking in such areas. Programs targeting dog-owners in high-density areas might be needed to encourage them to walk their dogs more. If successful, these programs could contribute to higher physical activity levels among dog-owners.

Modal Shift from Cars and Promotion of Walking by Providing Pedometers in Yokohama City, Japan

Mobility management is a transportation policy aiming to change travel behavior from car use to sustainable transportation modes while increasing people’s physical activity. Providing pedometers and visualizing step counts, popular interventions in public health practice, may constitute a mobility management program. However, the ease of modal shifts and changeability of walking habits differ across neighborhood environments. Using questionnaire data from 2023 middle-aged and older participants from Yokohama, Japan, in May 2017, this study examined (1) the relationship between the physical and social environments of Yokohama Walking Point Program participants who volunteered to use free pedometers and their modal shifts from cars to walking and public transport, and (2) whether participants’ modal shifts were associated with increases in step counts. Multivariate categorical regression analyses identified the frequency of greetings and conversations with neighbors as well as health motivation as important explanatory variables in both analyses. Participants living in neighborhoods far from railway stations and in neighborhoods with a high bus stop density tended to shift to walking and public transport, a modal shift that was highly associated with increased step counts. These results suggest that mobility management should be promoted in collaboration with public health and city planning professionals.

Hilly neighborhoods are associated with increased risk of weight gain among older adults in rural Japan: a 3-years follow-up study

Background

Neighborhood environments have been regularly associated with the weight status. Although the evidence is mostly limited to adults residing in western urban settings, the weight status of older adults living in rural areas is also assumed to be significantly affected by their neighborhood environments. This study aimed to identify environmental attributes specific to rural areas that could affect the risk of longitudinal weight gain among older adults (≥ 65 years) in Japan.

Methods

We examined five environmental attributes, i.e., land slope, public transportation accessibility, residential density, intersection density, and the availability of parks and recreational centers, measured by the geographic information system. Our analysis was based on 714 subjects participated in Shimane Community-based Healthcare Research and Education study in 2012 and 2015. Multinomial logistic regression model was conducted to examine the association between each neighborhood environmental attribute and weight change status (gain, loss and unchanged).

Results

We observed a significant increase in the risk of weight gain as the steepness of the neighborhood land slope increased. There was no significant association between other environmental attributes and risk of weight gain as well as weight loss among older adults.

Conclusion

Living in hilly neighborhoods was associated with increased risk of weight gain among rural Japanese older adults. Future research should consider region-specific environmental attributes when investigating their effect on older adults’ weight status.