An Overview of How the Built Environment Relates to Children's Health

PURPOSE OF REVIEW

Explore the varied pathways between the built environment and children's health. The review begins by describing how the built environment and transport infrastructure relate to conditions that lead to health outcomes. The review examines emissions, noise, and traffic dangers in relation to children's physical, mental, and social health.

RECENT FINDINGS

Evidence is increasing for walkable neighborhoods and health-related behavior such as physical activity. However, diverse land uses (often supporting walkability) were also found to increase traffic injuries. Cognitive impacts of motorways on children at schools were found. Finally, the relationships between social activities and built environment are beginning. The built environment's influence on various physical health outcomes is increasingly clear and is often through a transport pathway. However, the links with mental and social health are less developed, though recent findings show significant results. Having accessible child-relevant destinations is an important consideration for children's health.

Nowhere to go - Effects on elderly's travel during Covid-19

The COVID-19 pandemic has presented numerous, significant challenges for elderly in their daily life. In order to reach a deeper understanding of the feelings and thoughts of the elderly related to their possibilities to travel and engage in activities during the pandemic, this study takes a qualitative approach to exploring the views of the elderly themselves. The study focuses on experiences during the COVID-19 pandemic. A number of in-depth semi-structured interviews with elderly aged 70 and above, were conducted in June 2020. Applied Thematic Analysis (ATA) was applied, as a first stage, to investigate meaningful segments of data. In a second stage these identified segments were combined into a number of themes. This study reports the outcome of the ATA analysis. More specifically we report experiences, motivations and barriers for travel and activity participation, and discuss how these relate to the health and well-being of elderly, and vice versa. These findings highlight the strong need to develop a transport system that to a higher extent addresses the physical as well as the mental health of old people, with a particular focus on facilitating social interactions.

Insight into the nonlinear effect of COVID-19 on well-being in China: Commuting, a vital ingredient

BACKGROUND

COVID-19 had a devastating impact on people's work, travel, and well-being worldwide. As one of the first countries to be affected by the virus and develop relatively well-executed pandemic control, China has witnessed a significant shift in people's well-being and habits, related to both commuting and social interaction. In this context, what factors and the extent to which they contribute to well-being are worth exploring.

METHODS

Through a questionnaire survey within mainland China, 688 valid sheets were collected, capturing various aspects of individuals' life, including travel, and social status. Focusing on commuting and other factors, a Gradient Boosting Decision Tree (GBDT) model was developed based on 300 sheets reporting working trips, to analyze the effects on well-being. Two indicators, i.e., the Relative Importance (RI) and Partial Dependency Plot (PDP), were used to quantify and visualize the effects of the explanatory factors and the synergy among them.

RESULTS

Commuting characteristics are the most critical ingredients, followed by social interactions to explain subjective well-being. Commuting stress poses the most substantial effect. Less stressful commuting trips can solidly improve overall well-being. Better life satisfaction is linked with shorter confinement periods and increased restriction levels. Meanwhile, the switch from in-person to online social interactions had less impact on young people's life satisfaction. Older people were unsatisfied with this change, which had a significant negative impact on their life satisfaction.

CONCLUSIONS

From the synergy of commuting stress and commuting time on well-being, the effect of commuting time on well-being is mediated by commuting stress in the case of China. Even if one is satisfied with online communication, the extent of enhancement on well-being is minimal, for it still cannot replace face-to-face interaction. The findings can be beneficial in improving the overall well-being of society during the pandemic and after the virus has been eradicated.

Neighborhood deprivation and obesity: Sex-specific effects of cross-sectional, cumulative and residential trajectory indicators

Obesity is a long-term health issue that is becoming increasingly prevalent. Very few studies have considered the life course effects of neighborhood characteristics on obesity. In a sample of 35,856 adult participants (representative of the population of the Province of Quebec in Canada), we measured the association between neighborhood deprivation and obesity using logistic modelling on indicators of cross-sectional neighborhood deprivation, cumulative neighborhood deprivation and trajectories of neighborhood deprivation. For cross-sectional exposure, we found that females in our sample had higher odds of being affected by obesity when living in high-deprivation (OR 1.73, CI 1.41-2.13) or medium-deprivation neighborhoods (OR 1.27, CI 1.07-1.51) compared to females living in low-deprivation neighborhoods. Males also had higher odds of being affected by obesity when living in medium or high deprivation. For cumulative exposure to neighborhood deprivation, only females in the second highest category for longitudinal exposure to deprived neighborhoods had significantly higher odds of living with obesity (OR 1.89 CI 1.12-3.19) compared to females in the low cumulative exposure category. Using sequence analysis to determine neighborhood deprivation trajectories for up to 17 years, we found that females with a Deprived upward (OR 1.75 CI 1.10-2.78), an Average downward (OR 1.75 CI 1.08-2.84) or a Deprived trajectory (OR 1.81 CI 1.45-2.86) had higher odds of living with obesity compared to the Privileged trajectory. For males, there were no significant associations. Using trajectory indicators was beneficial to our analyses because this method shows that not only are individuals in low socioeconomic status neighborhoods at the end of their trajectory more susceptible to living with obesity, but so are those exposed to neighborhood deprivation at the beginning of their trajectory. These results could help to more precisely identify individuals at higher risk of developing obesity-related health issues.

User characteristics and service satisfaction of car sharing systems: Evidence from Hangzhou, China

Car sharing has become a new mode of transport during the past two decades in the world. Its rapid growth in China has attracted a wide range of users and posed some problems. The main focus is on service efficiency and user satisfaction. To explore possible service enhancement and management intervention, this study aims at capturing the user characteristics according to different user types and scrutinizing their satisfaction with station-based one-way car sharing service. The study firstly illustrates descriptive statistics of user profile. This is followed by a study of user satisfaction influenced by user rates on staffs, the efficiency of rental process, vehicle situation, the use of credit card and their familiarity towards rental station. Furthermore, by clustering users according to the total travel time and distance during one rent, two different types of users are identified and defined as User Group A (UGA) and User Group B (UGB). To examine how fully do users utilize the shared cars, ANOVA was conducted implying family car ownership, total travel distance and main travel purpose have strong impact on total rental time for UGB, while for UGA, travel purpose and age have strong impact. Finally, ordinal logistic regression was introduced to find that for UGB, “shopping” is the main travel purpose with longer rental time, whereas for UGA, “out for business”, “shopping”, “visit friends” or “pick up others” are the main travel purposes with longer total travel time. Based on the findings, advices for operators on how to improve service quality and suggestions for government management strategy are discussed, respectively.

Subjective well-being of Canadian children and youth during the COVID-19 pandemic: The role of the social and physical environment and healthy movement behaviours

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Self-reported emotional states during the pandemic, among Canadian children and youth, were explored.

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Latent Class Analysis shows 49.4% sample displayed patterns of low subjective well-being.

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Having access to friends, and indoor and outdoor spaces/places to play and exercise, were important.

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Decreased physical activity and increased screen time were associated with a low SWB during the pandemic.

The current COVID-19 pandemic has disrupted daily behaviours of children and youth. Yet, little is known about how they are mentally coping with the pandemic-time changes to their lives. This study explores children and youths’ self-reported subjective well-being (SWB) during the pandemic, and provides novel insights into the correlates of potential decrease, using data from a pan-Canadian online survey of 932 children/youth and their parents. SWB was measured based on perceived changes in 12 affective/emotional states. The results indicate that in spring 2020, at the height of the first wave of the pandemic, many children and youth were more bored (37.6%) and worried (31%) compared to pre-pandemic time. At the same time, many self-reported that they felt calmer (31.9%) and more rested (30%). A latent class analysis revealed that nearly half (49.4%) of surveyed children and youth reported patterns in changes in their emotional state that may contribute to lower SWB. Results from binomial logistic regression suggest that socio-demographic characteristics and size of the municipality were not associated with low pandemic-time SWB. Instead, other potentially modifiable factors such as having access to friends, indoor and outdoor spaces/places to play and exercise, and healthy movement behaviours during the pandemic, were correlated with a lower likelihood of reporting low SWB. The findings can inform pandemic-time public health policy relating to physical distancing, and in the longer term, mental and physical health promotion. The results will also help improve urban planning and design practices in creating healthier, more resilient and equitable communities.

Examining longitudinal patterns of individual neighborhood deprivation trajectories in the province of Quebec: A sequence analysis application

Exposure to neighborhood deprivation has been associated with a number of health, behavioral and sociological outcomes. However, many negative outcomes associated with deprivation have a long latency and may be influenced by varying exposure to neighborhoods throughout time. Capturing the longitudinal exposure to neighborhood deprivation is methodologically complex when one wishes to include life course notions of order, duration and timing. In a sample of 60,555 participants, aged 12 years and older (representative of the population of the Province of Quebec in Canada) our objectives were to: 1) Create an indicator for neighborhood deprivation trajectories; 2) compare trajectories with cross-sectional and cumulative neighborhood deprivation; 3) identify individual socioeconomic determinants of membership to a trajectory cluster. Using sequence analysis based on optimal matching and clustering around theoretical types, we grouped sequences in nine neighborhood deprivation trajectory clusters. We found that half (50%) of the participants were in a stable trajectory and did not transition significantly from one deprivation tertile to another during their sequence. A comparison between a cross-sectional indicator of neighborhood deprivation and the trajectories showed that only 42.2% of the participants had a cross-sectional deprivation at the index date representative of their whole trajectory. We also found, using logistic regression (adjusted for age, sex, number of residential moves) that having no high school diploma, living in a rural area and being an immigrant was strongly associated with a deprived stable trajectory. Sequence analysis is an effective tool to describe neighborhood deprivation trajectories in a sample representative of the Quebec population. Trajectories are a useful addition to a better understanding of the distribution of health outcomes because they provide information about the order and accumulation of longitudinal exposures to neighborhood and seem to be associated with specific individual socioeconomic characteristics such as education, urbanity, and immigration status.

Household practices in accessing drinking water and post collection contamination: A seasonal cohort study in Malawi

Lack of access to safe drinking water on premises remains widespread in low- and middle-income countries. Interventions to improve access to safe water at the point of collection are essential, but water safety at the point of consumption is also an important consideration. This research aimed to 1) improve understanding of household practices in collecting water with respect to seasonality, and 2) to further assess risk associated with post-collection contamination from the point of collection to the point of consumption. A seasonal cohort study, including 115 households, was conducted in Malawi. Along with household surveys and observations, samples of water were tested for microbial water quality at four different stages of water collection: water source, collection container, storage container, cup of drinking water. Using E. coli as an indicator of contamination (cfu/100 ml), the risk of post-collection contamination was assessed. The results indicate that most water sources were free from contamination; contamination was proportionally lower in the dry season when more sources were found to be classified as having a very low risk of contamination. However, the level of risk of contamination was more likely to increase following collection in water sources that were initially free from contamination. Results show that the degradation in water quality from the point of collection to the point of consumption was more important in the rainy season, which is likely to be driven by the effect of seasonality on the household environment. Filling the collection container at the point of collection and storage at the point of consumption were found to be critical stages for an increased risk of E. coli contamination. Understanding household practices in accessing and handling water during both rainy and dry season is necessary to target appropriate interventions to reduce post-collection contamination.

Evaluating self-reported measures and alternatives to monitor access to drinking water: A case study in Malawi

Monitoring access to drinking water is complex, especially in settings where on premises water supply is not available. Although self-reported data are generally used to estimate coverage of access to drinking water, the relationship between self-reported time travelled and true time travelled is not well known in the context of water fetching. Further, water fetching is likely to impact the quantity and quality of water a household uses, but data and measures supporting this relationship are not well documented. The objective of this study was to appraise the validity and reliability of self-reported measurements used to estimate access coverage. A case study was conducted in Malawi to enhance understanding of the self-reported measures and alternatives available to assess and monitor access to drinking water in view of generating global estimates. Self-reported data were compared with objective observations and direct measurements of water quantity, quality and accessibility. Findings from this study highlight the variations between different measures such as self-reported and recorded collection time and raise awareness with regard to the use of self-reported data in the context of fetching water. Alternatives to self-reported indicators such as GPS-based or direct observations could be considered in surveys in view of improving data accuracy and global estimates.

Trends in access to water and sanitation in Malawi: progress and inequalities (1992-2017)

Billions of people globally gained access to improved drinking water sources and sanitation in the last decades, following effort towards achieving the Millennium Development Goals. Global progress remains a general indicator as it is unclear if access is equitable across groups of the population. Agenda 2030 calling for `leaving no one behind', there is a need to focus on the variations of access in different groups of the population, especially in the context of low- and middle-income countries including Malawi. We analyzed data from Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) to describe emerging trends on progress and inequalities in water supply and sanitation services over a 25-year period (1992-2017), as well as to identify the most vulnerable populations in Malawi. Data were disaggregated with geographic and socio-economic characteristics including regions, urban and rural areas, wealth and education level. Analysis of available data revealed progress in access to water and sanitation among all groups of the population. The largest progress was generally observed in the groups that were further behind at the baseline year, which likely reflects good targeting in interventions/improvements to reduce the gap in the population. Overall, results demonstrated that some segments of the population - foremost poorest Southern rural populations - still have limited access to water and are forced to practise open defecation. Finally, we suggest including standardized indicators that address safely managed drinking water and sanitation services in future surveys and studies to increase the accuracy of national estimates.

Drinking water accessibility and quantity in low and middle-income countries: A systematic review

BACKGROUND

Increasing the quantity of water available for consumption and hygiene is recognized to be among the most efficient interventions to reduce the risk of water-related infectious diseases in low and middle-income countries. Such impacts are often associated with water supply accessibility (e.g. distance or collection time) and used to justify investment in improving access.

OBJECTIVE

To assess the relationship between the water source location and the quantity of water available in households from low and middle-income countries by identifying the effects of interventions aiming to improve access, and to compare the indicators and measures used to collect information.

METHODS

We systematically searched seven databases (i.e. Cairn, Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Women's Studies International) along with grey literature for articles reporting indicators and measures of accessibility and quantity. We found 6492 records, of which 20 studies were retained that met the review's inclusion criteria.

RESULTS

Most studies were conducted in rural settings and provided suggestive findings to describe an inverse relationship between accessibility and quantity. Overall, a wide range of indicators and measures were used to assess water accessibility and quantity in the selected studies along with their association. The lack of consistency raised concerns regarding comparability and reliability of these methods.

CONCLUSIONS

The review findings support the hypothesis that the quantity of water available in households is a function of the source location, but the inconsistency in study outcomes highlights the need to further investigate the strength and effects of the relationship.

Access to drinking water: time matters

Despite the reported achievement of the Millennium Development Goals (MDGs) with respect to drinking water, lack of access to water remains widespread worldwide. The indicator used there to measure access to water in the MDGs refers to the use of an improved water source. However, the amount of time spent in collecting water is high in countries where access to drinking water supplies located on premises is not common. 26.3% of the world's population did not have such access in 2015. Thus the need to travel to a water point, possibly queue, fill water containers, and carry them home is prevalent. The amount of time and effort used in water collection can be considerable, and household surveys increasingly provide data on collection time. This study aims to demonstrate the effect of adding a 30-minute collection time component to monitor access to drinking water. This study draws on household surveys from 17 countries to highlight the widespread burden of fetching water and its significant impact on estimates of coverage. The proportion of the population with access decreased by 13% on average for these 17 countries when collection time was added as a consideration.

Does where you live matter? Leisure-time physical activity among Canadian youth: a multiple cross-sectional study

BACKGROUND

The aim of this study was to explore the population-wide distribution in the practice of leisure-time physical activity among Canadian youth and how physical activity level is influenced by contextual features of the environment.

METHODS

We studied the self-reported leisure-time physical activity of 54 832 Canadians aged 12 to 17 years. Observations were structured according to a 4-level geographic hierarchy. The outcome studied was a dichotomous indicator that referred to achieving (or not) the recommended daily level of leisure-time physical activity. To investigate the influence of the contextual features, we conducted multilevel logistic regressions.

RESULTS

For both girls and boys, significant variations were observed between health regions and between neighbourhoods within the provinces. Girls who lived in an urban setting showed lower odds of achieving the recommended physical activity level, as did those surveyed during the winter. Boys surveyed during the winter also showed lower odds of achieving the recommended level, but living in an urban setting had no effect on activity levels. Analysis of province-level residuals showed that girls living in Quebec were less likely to achieve the recommended activity level as compared with the national mean, and girls living in Ontario and British Columbia were more likely to achieve that threshold. Boys living in Ontario were more likely to achieve the recommended activity level as compared with the national mean. Youth had up to a 17% increased chance of achieving the recommended physical activity level if they lived in a context with a higher activity achievement level.

INTERPRETATION

Leisure-time physical activity was associated with environmental factors at multiple geographic scales among Canadian youth. The variation was more important at the neighbourhood level. The results provide rationale for further investigation into how leisure-time physical activity is promoted in different contexts.