Local Spatial Analysis and Dynamic Simulation of Childhood Obesity and Neighbourhood Walkability in a Major Canadian City

Parents' attitudes regarding their children's play during COVID-19: Impact of socioeconomic status and urbanicity

Objectives

The COVID-19 pandemic has had a profound impact on the daily routines of parents and children. This study explored the influence of socioeconomic status (SES) and urbanicity on parents' attitudes toward their children's active play opportunities 6 months and 1.5 years into COVID-19.

Methods

A sample of 239 Ontario parents of children aged 12 and younger completed two online surveys (August-December 2020; 2021) to assess parents' intentions, beliefs, and comforts concerning their child's eventual return to play, in addition to various sociodemographic and physical activity variables. Descriptive analyses were run as well as an exploratory factor analysis (EFA) was conducted to group the 14 attitude items into subscales for analysis, to ensure reliability and validity of attitude measures.

Results

In general, parents in communities with more urban features (e.g., densely populated areas), single-parents, full-time employed parents, and parents with lower-incomes were more hesitant to return their children to active play during the pandemic.

Conclusion

Findings from this work highlight SES and urbanicity disparities that continue to exist during COVID-19.

Quantifying the Impact of Supermarket Distance on Childhood Obesity in Greater London, United Kingdom: Exploring Different Access Measures and Modification Effects of Transportation

Background: Healthy food access may be relevant for predicting trends in childhood obesity. The goal was to determine associations between childhood overweight (including obesity) and distance to three nearest supermarkets stratified by transportation modes (walking, cycling, driving). Methods: Bivariate and multivariate linear regressions examine the relationship with obesity, including interacting active and inactive modes. Results: Proximity to at least three supermarkets shows small but significant positive association with obesity. Walking mode showed higher obesity rates than driving, and distance was not related to the mode of travel. Conclusions: Disparities in healthy food access may not contribute meaningfully to childhood obesity, as other individual factors may be largely at play.

System dynamics simulation models on overweight and obesity in children and adolescents: A systematic review

It has increasingly been recognized that developing successful obesity prevention policies and interventions requires understanding of the complex mechanisms driving the obesity pandemic and that models could be useful tools for simulating policies. This paper reviews system dynamics simulation models of mechanisms driving childhood overweight and obesity and/or testing of preventive interventions. A systematic literature search was conducted in six databases from inception to January 2023 using terms related to overweight/obesity, children, and system dynamics. Study descriptives, mechanisms, and where to intervene (the leverage points), as well as quality assessments of the simulation models were extracted by two researchers into a predetermined template and narratively synthesized. Seventeen papers describing 15 models were included. Models describing the mechanisms ranged from only intrapersonal factors to models cutting across multiple levels of the ecological model, but mechanisms across levels were lacking. The majority of interventions tested in the simulation models were changes to existing model parameters with less emphasis on models that alter system structure. In conclusion, existing models included mechanisms driving youth obesity at multiple levels of the ecological model. This is useful for developing an integrated simulation model combining mechanisms at multiple levels and allowing for testing fundamental system changes.

The built environment as determinant of childhood obesity: A systematic literature review

We evaluated the epidemiological evidence on the built environment and its link to childhood obesity, focusing on environmental factors such as traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, such as neighborhood walkability and availability and accessibility of parks and playgrounds. Eligible studies were (i) conducted on human children below the age of 18 years, (ii) focused on body size measurements in childhood, (iii) examined at least one built environment characteristic, (iv) reported effect sizes and associated confidence intervals, and (v) were published in English language. A z test, as alternative to the meta-analysis, was used to quantify associations due to heterogeneity in exposure and outcome definition. We found strong evidence for an association of traffic-related air pollution (nitrogen dioxide and nitrogen oxides exposure, p < 0.001) and built environment characteristics supportive of walking (street intersection density, p < 0.01 and access to parks, p < 0.001) with childhood obesity. We identified a lack of studies that account for interactions between different built environment exposures or verify the role and mechanism of important effect modifiers such as age.

The Relationship of Urban Form on Children and Adolescent Health Outcomes: A Scoping Review of Canadian Evidence

Urban form can have an impact on health outcomes in children, and the synthesis of findings can identify gaps in the literature and regional reviews may help guide policymakers. This study aims to complete a scoping review of the research relating urban form to health outcomes in children and adolescents from urban Canadian settings. Thirteen online databases were searched to identify studies that had objective measures of urban form and health outcomes. Two research assistants independently reviewed 27,444 titles and abstracts, and 176 full-text articles, returning 32 unique studies with youth-specific data. The majority of the included studies were cross-sectional or ecological (n = 26). Six studies used Canada-wide data and the rest were from Ontario (n = 11), Alberta (n = 6), and Quebec (n = 6). Urban form characteristics included neighbourhood food environment (n = 11), parks/natural space/greenness (n = 10), road or intersection characteristics (n = 7), and aggregated urban form measures (n = 7). Studies examined a variety of health outcomes: the majority considered weight status (n = 16) and injury (n = 10). Although there is over-reliance on mainly cross-sectional study designs, there is evidence suggesting that urban form is associated with health outcomes in Canadian youth, with parks/greenspace, road connectivity, and road characteristics most consistently associated with health outcomes in youth.

Walkability indices and childhood obesity: A review of epidemiologic evidence

The lack of an active neighbourhood living environment can impact community health to a great extent. One such impact manifests in walkability, a measure of urban design in connecting places and facilitating physical activity. Although a low level of walkability is generally considered to be a risk factor for childhood obesity, this association has not been established in obesity research. To further examine this association, we conducted a literature search on PubMed, Web of Science and Scopus for articles published until 31 December 2018. The included literature examined the association between measures of walkability (e.g., walkability score and walkability index) and weight-related behaviours and/or outcomes among children aged under 18 years. A total of 13 studies conducted in seven countries were identified, including 12 cross-sectional studies and one longitudinal study. The sample size ranged from 98 to 37 460, with a mean of 4971 ± 10 618, and the age of samples ranged from 2 to 18. Eight studies reported that a higher level of walkability was associated with active lifestyles and healthy weight status, which was not supported by five studies. In addition to reviewing the state-of-the-art of applications of walkability indices in childhood obesity studies, this study also provides guidance on when and how to use walkability indices in future obesity-related research.

Foodscape: A scoping review and a research agenda for food security-related studies

Since 1995, the term ‘foodscape’, a contraction of food and landscape, has been used in various research addressing social and spatial disparities in public health and food systems. This article presents a scoping review of the literature examining how this term is employed and framed. We searched publications using the term foodscape in the Web of Science Core Collection, MEDLINE, and Scopus databases. Analyzing 140 publications, we highlight four approaches to the foodscape: (i) Spatial approaches use statistics and spatial analysis to characterize the diversity of urban foodscapes and their impacts on diet and health, at city or neighborhood scales. (ii) Social and cultural approaches at the same scales show that foodscapes are socially shaped and highlight structural inequalities by combining qualitative case studies and quantitative surveys of food procurement practices. (iii) Behavioral approaches generally focus on indoor micro-scales, showing how consumer perceptions of foodscapes explain and determine food behaviors and food education. (iv) Systemic approaches contest the global corporate food regime and promote local, ethical, and sustainable food networks. Thus, although spatial analysis was the first approach to foodscapes, sociocultural, behavioral and systemic approaches are becoming more common. In the spatial approach, the term ‘foodscape’ is synonymous with ‘food environment’. In the three other approaches, ‘foodscape’ and ‘food environment’ are not synonymous. Scholars consider that the foodscape is not an environment external to individuals but a landscape including, perceived, and socially shaped by individuals and policies. They share a systemic way of thinking, considering culture and experience of food as key to improving our understanding of how food systems affect people. Foodscape studies principally address three issues: public health, social justice, and sustainability. The review concludes with a research agenda, arguing that people-based and place-based approaches need to be combined to tackle the complexity of the food-people-territory nexus.

Targeting the spatial context of obesity determinants via multiscale geographically weighted regression

BACKGROUND

Obesity rates are recognized to be at epidemic levels throughout much of the world, posing significant threats to both the health and financial security of many nations. The causes of obesity can vary but are often complex and multifactorial, and while many contributing factors can be targeted for intervention, an understanding of where these interventions are needed is necessary in order to implement effective policy. This has prompted an interest in incorporating spatial context into the analysis and modeling of obesity determinants, especially through the use of geographically weighted regression (GWR).

METHOD

This paper provides a critical review of previous GWR models of obesogenic processes and then presents a novel application of multiscale (M)GWR using the Phoenix metropolitan area as a case study.

RESULTS

Though the MGWR model consumes more degrees of freedom than OLS, it consumes far fewer degrees of freedom than GWR, ultimately resulting in a more nuanced analysis that can incorporate spatial context but does not force every relationship to become local a priori. In addition, MGWR yields a lower AIC and AICc value than GWR and is also less prone to issues of multicollinearity. Consequently, MGWR is able to improve our understanding of the factors that influence obesity rates by providing determinant-specific spatial contexts.

CONCLUSION

The results show that a mix of global and local processes are able to best model obesity rates and that MGWR provides a richer yet more parsimonious quantitative representation of obesity rate determinants compared to both GWR and ordinary least squares.

Exploratory Temporal and Spatial Analysis of Myocardial Infarction Hospitalizations in Calgary, Canada

Spatial and temporal analyses are critical to understand the pattern of myocardial infarction (MI) hospitalizations over space and time, and to identify their underlying determinants. In this paper, we analyze MI hospitalizations in Calgary from 2004 to 2013, stratified by age and gender. First, a seasonal trend decomposition analyzes the seasonality; then a linear regression models the trend component. Moran's I and hot spot analyses explore the spatial pattern. Though exploratory, results show that most age and gender groups feature a statistically significant decline over the 10 years, consistent with previous studies in Canada. Decline rates vary across ages and genders, with the slowest decline observed for younger males. Each gender exhibits a seasonal pattern with peaks in both winter and summer. Spatially, MI hot spots are identified in older communities, and in socioeconomically and environmentally disadvantaged communities. In the older communities, higher MI rates appear to be more highly associated with demographics. Conversely, worse air quality appears to be locally associated with higher MI incidence in younger age groups. The study helps identify areas of concern, where MI hot spots are identified for younger age groups, suggesting the need for localized public health policies to target local risk factors.

Schools, Air Pollution, and Active Transportation: An Exploratory Spatial Analysis of Calgary, Canada

An exploratory spatial analysis investigates the location of schools in Calgary (Canada) in relation to air pollution and active transportation options. Air pollution exhibits marked spatial variation throughout the city, along with distinct spatial patterns in summer and winter; however, all school locations lie within low to moderate pollution levels. Conversely, the study shows that almost half of the schools lie in low walkability locations; likewise, transitability is low for 60% of schools, and only bikability is widespread, with 93% of schools in very bikable locations. School locations are subsequently categorized by pollution exposure and active transportation options. This analysis identifies and maps schools according to two levels of concern: schools in car-dependent locations and relatively high pollution; and schools in locations conducive of active transportation, yet exposed to relatively high pollution. The findings can be mapped and effectively communicated to the public, health practitioners, and school boards. The study contributes with an explicitly spatial approach to the intra-urban public health literature. Developed for a moderately polluted city, the methods can be extended to more severely polluted environments, to assist in developing spatial public health policies to improve respiratory outcomes, neurodevelopment, and metabolic and attention disorders in school-aged children.