The contribution of objective and perceived crime to neighbourhood socio-inequity in loneliness

Loneliness tends to be more prevalent in socioeconomically disadvantaged neighbourhoods, yet few studies explore the environmental differences contributing to area-based inequity in loneliness. This study examined how perceived and objective crime contributed to differences in loneliness between advantaged and disadvantaged neighbourhoods. The study used cross-sectional data from 3749 individuals aged between 48 and 77 years, residing in 200 neighbourhoods in Brisbane, Australia. We found that participants in disadvantaged neighbourhoods reported higher levels of loneliness and perceived crime, and the most disadvantaged neighbourhoods also had highest prevalence of objective crime. However, while perceived and objective crime were positively correlated with loneliness, only perceived crime accounted for socio-economic inequity in loneliness. Consequently, perceived crime plays an important role in addressing loneliness in disadvantaged communities and requires equitable resourcing for multiple strategies that aim to decrease crime and increase perceived safety.

Neighbourhood socio-economic disadvantage and loneliness: the contribution of green space quantity and quality

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48-77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.

Examining the Contribution of the Neighborhood Built Environment to the Relationship Between Neighborhood Disadvantage and Early Childhood Development in 205,000 Australian Children

OBJECTIVE

We examined associations between neighborhood built environment features and early childhood development (ECD), and tested the contribution of the built environment to associations between neighborhood disadvantage and ECD.

METHODS

Spatial neighborhood built environment measures were linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children ∼5 years old living in Australia's 21 most populous cities. The 2015 AEDC contains teacher-reported national data on five key child development domains for children in their first year of formal full-time schooling (approximately 5 years old). AEDC scores were classified as 'developmentally vulnerable' (≤10th centile). Using multilevel modeling, 44 built environment measures were tested with developmental vulnerability on at least one domain of the AEDC, adjusting for socioeconomic factors and neighborhood disadvantage.

RESULTS

The dataset consisted of 205,030 children; 89.2% living in major cities. In major cities, children with more early childhood education and care services (OR 0.997) and preschool services (OR 0.991) exceeding Australian standards, and access to healthier food outlets within 3200 m of their home (OR 0.999) had decreased odds of developmental vulnerability, controlling for socioeconomic factors and neighborhood disadvantage. Neighborhood disadvantage remained significantly associated with developmental vulnerability after adjustment for child/family variables and neighborhood built environment characteristics.

CONCLUSIONS

The neighborhood built environment had small effects on the neighborhood disadvantage-ECD relationship at the national level. Few built environment measures were associated with ECD. Small effects at the population level may have wide-ranging impacts; modifying the built environment at scale are promising levers for supporting good child outcomes.

Data to Decisions: Methods to Create Neighbourhood Built Environment Indicators Relevant for Early Childhood Development

Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks, are associated with a range of health and wellbeing outcomes across the life course, but evidence with early years’ outcomes is still emerging. Data linkage techniques were used to assemble a dataset of spatial (objectively-measured) neighbourhood-built environment (BE) measures linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children living in the 21 most populous urban and regional Australian cities (n = 235,655) to help address this gap. This paper describes the methods used to develop this dataset. This linked dataset (AEDC-BE) is the first of its kind worldwide, enabling opportunities for identifying which features of the built environment are associated with ECD across Australia at scale, allow comparisons between diverse contexts, and the identification of where best to intervene. National data coverage provides statistical power to model real-world complexities, such as differences by city, state/territory, and remoteness. The neighbourhood-built environment can be modified by policy and practice at scale, and has been identified as a way to help reduce inequitable early childhood development outcomes.

Outdoor public recreation spaces and social connectedness among adolescents

Background

Outdoor public recreation spaces are important settings for leisure and physical activity. Adolescents’ use of these spaces may contribute to social connectedness via social interaction with peers and the community in these settings. However, research on this topic is limited. This exploratory study examined associations of frequency of visitation and physical activity in outdoor public recreation spaces with social connectedness among adolescents in Melbourne, Australia.

Methods

Adolescents self-reported their frequency of visitation to parks, trails, beach/lake, and sports facilities; frequency of physical activity in a park, local street or path, and their street; and social connectedness. Separate analyses were conducted for visitation (n = 349, 15.4 ± 1.6 years, 58% female) and physical activity (n = 441, 15.4 ± 1.6 years, 59% female) using multilevel linear regression models.

Results

No significant associations were observed for frequency of visitation to a park (B = 0.86, 95% CI = − 0.26, 1.99), trails (B = 0.41, 95% CI = − 0.61, 1.44), beach/lake (B = − 0.44, 95% CI = − 1.46, 0.57), or sports facilities (B = 0.64, 95% CI = − 0.43, 1.70), nor for frequency of physical activity in their street (B = − 0.07, 95% CI = − 0.46, 0.31), local street/path (B = − 0.05, 95% CI = − 0.43, 0.33) or in a park (B = 0.23, 95% CI = − 0.14, 0.60) with adolescents’ social connectedness.

Conclusions

The findings did not support the hypothesis that visiting and being active in outdoor public recreation spaces are associated with adolescents’ social connectedness. Future research should consider the duration and context of outdoor public recreation space use (e.g., sports, socialising, relaxing alone) and whether different types and/or a combination of public spaces are more/less conducive to social connectedness.

835Neighbourhoods and mental health in early childhood: what does the evidence tell us?

Background

Mental health inequities can emerge early in life and are shaped by the daily conditions and environments where children develop, including neighbourhoods. Synthesizing evidence around neighbourhoods, disadvantage, and early childhood mental health can advance understandings of neighbourhood features (e.g. housing, parks) associated with (1) optimal mental health and (2) narrowing inequities.

Methods

We systematically searched and critically reviewed the international quantitative literature investigating associations between the neighbourhood built environment and young children’s (0-8 years) mental health, including positive aspects (‘competence’) and difficulties.

Results

Eight of the 14 included studies examined nature or public open space (parks); seven found some association between greater access to neighbourhood nature or parks and better mental health. Significant gaps included few studies investigating: (1) social infrastructure (e.g. services, childcare), (2) competence, (3) the extent to which the neighbourhood built environment closed the gap (versus benefiting children generally), and (4) pathways between neighbourhoods, disadvantage, and mental health.

Conclusions

Emerging evidence suggests that features of the neighbourhood are associated with young children’s mental health. Future research should unpack the neighbourhood’s role in narrowing inequities in early childhood. Availability of population linked geospatial and child development data in Australia offers opportunities to address these gaps and is prioritized as the next step in this research program.

Key messages

The neighbourhood built environment holds potential for promoting young children’s mental health. Future research should examine its potential to reduce inequities during early childhood.

1461Neighbourhood disadvantage and early childhood mental health inequities across a population of children at school-entry

Background

Mental health inequities are shaped by the environments where children develop, including neighbourhoods. Children living in disadvantaged neighbourhoods tend to have poorer development outcomes, yet little evidence has examined positive mental health outcomes, like competence, in young children.

Methods

We examined associations between neighbourhood disadvantage and young children’s competence, as well as mental health difficulties (internalising and externalising), holding constant demographic characteristics and maternal education using multilevel logistic regression (Markov Chain Monte Carlo estimation). Data were from the 2018 Australian Early Development Census, including over 250,000 children entering their first year of school (age approximately 5 years).

Results

Children living in Australia’s most disadvantaged neighbourhoods had higher odds of externalising difficulties (AOR: 1.34; 95% credible interval 1.29 to 1.38), internalising difficulties (AOR: 1.29; 95% credible interval 1.24 to 1.33), and lower odds of competence (AOR: 0.72; 95% credible interval 0.69 to 0.74) than children in the least disadvantaged neighbourhoods.

Conclusions

Across both mental health difficulties and competence, neighbourhood-level inequities were evident. Future research should identify specific neighbourhood features that could address these inequities. Availability of population linked geospatial and child development data in Australia offers opportunities to address these gaps and is prioritised as the next step in this research program.

Key messages

Children in disadvantaged neighbourhoods face lower likelihood of positive mental health (competence) and higher likelihood of mental health difficulties. Identifying specific neighbourhood features that could address these inequities is a priority.

Activity-related typologies and longitudinal change in physical activity and sedentary time in children and adolescents: The UP&DOWN Study

BACKGROUND

Children and adolescents can be distinguished by different typologies (clusters) of physical activity and sedentary behavior. How physical activity and sedentary behaviors change over time within different typologies is not known. This study examined longitudinal changes in physical activity and sedentary time among children and adolescents with different baseline typologies of activity-related behavior.

METHODS

In this longitudinal study (3 annual time points) of children (n = 600, age = 9.2 ± 0.4 years (mean ± SD), 50.3% girls) and adolescents (n = 1037, age = 13.6 ± 1.7 years, 48.4% girls), participants were recruited in Spain in 2011-2012. Latent class analyses identified typologies based on self-reported screen, educational, social and relaxing sedentary behaviors, active travel, muscle strengthening activity, and sport at baseline. Within each typology, linear mixed growth models explored longitudinal changes in accelerometer-derived moderate-to-vigorous physical activity and sedentary time, as well as time by class interactions.

RESULTS

Three typologies were identified among children ("social screenies", 12.8%; "exercisers", 61.5%; and "non-sporty active commuters", 25.7%) and among adolescents ("active screenies", 43.5%; "active academics", 35.0%; and "non-sporty active commuters", 21.5%) at baseline. Sedentary time increased within each typology among children and adolescents, with no significant differences between typologies. No changes in physical activity were found in any typology among children. In adolescents, physical activity declined within all typologies, with "non-sporty active commuters" declining significantly more than "active screenies" over 3 years.

CONCLUSION

These results support the need for intervention to promote physical activity and prevent increases in sedentary time during childhood and adolescence. Adolescents characterized as "non-sporty active commuters" may require specific interventions to maintain their physical activity over time.

A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood

The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key-though not exhaustive-ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.

Correlates of dual trajectories of physical activity and sedentary time in youth: The UP & DOWN longitudinal study

Trajectories of physical activity and sedentary time (SED) may differ between subgroups of youth. The aim of this study was to identify group-based dual trajectories of physical activity and SED and explore individual, social, and environmental correlates of these trajectories. Longitudinal data (three time points, baseline 2011-2012) of Spanish youth (n = 1597, mean age = 11.94 ± 2.52, 50.9% boys) were used. Moderate-to-vigorous physical activity (MVPA) and SED were assessed objectively at each time point, and 21 potential correlates were self-reported at baseline. Parallel process growth mixture models identified shared categorical latent groups, adjusting for school and age. Multinomial logistic regression models identified baseline correlates of a given trajectory. Four shared categorical latent groups were identified: (1) stable MVPA and decreasing SED (4%); (2) stable MVPA and increasing SED (3%); (3) consistently higher MVPA (18%); and (4) stable low MVPA and slight increase in SED (75%). Multinomial logistic regression models with group 3 as reference found: negative affect (RRR = 0.90, 95% CI 0.84-0.97), parental screen-time rules (RRR = 1.15, 95% CI 1.00-1.33), and household media equipment (RRR = 1.17, 95% CI 1.05-1.30) predicted likelihood of group 1 membership; cons of reducing SED (RRR = 2.70, 95% CI 1.77-4.10) predicted likelihood of group 2 membership; and co-participation in physical activity with friends (RRR = 0.80, 95% CI 0.69-0.94), fathers' modeling of TV viewing (RRR = 1.22, 95% CI 1.02-1.47), and household media equipment (RRR = 1.16, 95% CI 1.02-1.31) predicted likelihood of group 4 membership. Results suggest that strategies to improve MVPA and SED behaviors among youth may need to be multifaceted, targeting all levels of influence.

Residential vs school neighborhoods: Associations with physical activity among adolescents

Adolescents have the potential to be active in multiple places across weekdays and weekends. While the built environment features around home are known to be important for adolescents' physical activity, specific built environment features that facilitate physical activity outside the home neighbourhood are not well explored. Given that adolescents spend most days of the week at school, the built environment surrounding school may be particularly important for supporting their physical activity. This study examined cross-sectional associations of objective built environments around home and school at multiple spatial scales with accelerometer assessed moderate-to-vigorous physical activity (MVPA) across the week. Moderating effects of adolescents' age were further explored. Data from up to 417 adolescents aged 12-20 years from 18 schools in Melbourne, Australia were used. Features of the built environment around school were positively associated with MVPA on weekdays; and a wide range of built environment features around home were found to be important for MVPA during weekends. Age was found to moderate the relationship between some built environment features around both home and school and MVPA across the week. Understanding the contribution of the built environment features around both home and school with MVPA could inform policy recommendations and public health interventions for each setting.

Does free public transit increase physical activity and independent mobility in children? Study protocol for comparing children's activity between two Finnish towns with and without free public transit

BACKGROUND

Children's habitual physical activity, including active travel and catching public transit (walking and cycling to and from destinations), and independent mobility (mobility without an adult) have decreased. Public transit trips are physically active and can provide access to hobbies independent of parents, but there is no device-measured data about children's total physical activity time following the introduction of free public transit. Our aim is to compare physical activity and independent mobility between children living in two Finnish towns, one with a recently introduced free public transit system, and the other without free public transit.

METHODS

The city of Mikkeli has provided free public transit for all comprehensive school children since 2017. Various districts from Mikkeli, and the reference town of Kouvola (towns from South-Eastern Finland with a comparative population size and geographical structure), are selected based on their accessibility and the availability of public transit services. Samples of 10-12-year-old children will be recruited through primary schools. We will compare moderate-to-vigorous physical activity time, sitting time (a thigh-worn Fibion® device) and independent mobility (a participatory mapping method, PPGIS) of children: 1) who live in towns with and without free public transit, 2) who live and go to school in districts with high vs. low perceived and objective access to free public transit, and 3) who report using vs. not using free public transit. In addition, ethnography will be used to get insights on the social and cultural effects of the free public transit on children's and parent's everyday life.

DISCUSSION

There is a need for scalable solutions that can increase children's physical activity independent of their socioeconomic background or place of residence. This project will give information on how a political action to provide free public transit for children is associated with their total physical activity time and independent mobility patterns, therefore providing highly relevant information for political decision-making and for promoting independent physical activity in children.

Deprivation matters: understanding associations between neighbourhood deprivation, unhealthy food outlets, unhealthy dietary behaviours and child body size using structural equation modelling

Background

Children residing in neighbourhoods of high deprivation are more likely to have poorer health, including excess body size. While the availability of unhealthy food outlets are increasingly considered important for excess child body size, less is known about how neighbourhood deprivation, unhealthy food outlets and unhealthy dietary behaviours are interlinked.

Methods

This study involves children aged 8–13 years (n=1029) and resided in Auckland, New Zealand. Unhealthy dietary behaviours (frequency of consumption of unhealthy snacks and drinks) and food purchasing behaviour on the route to and from school were self-reported. Height and waist circumference were measured to calculate waist-to-height ratio (WtHR). Geographic Information Systems mapped neighbourhood deprivation and unhealthy food outlets within individual, child-specific neighbourhood buffer boundaries (800 m around the home and school). Associations between neighbourhood deprivation (calculated using the New Zealand Index of Deprivation 2013), unhealthy food outlets, unhealthy dietary behaviours and WtHR were investigated using structural equation modelling in Mplus V.8.0. Age, sex and ethnicity were included as covariates, and clustering was accounted for at the school level.

Results

Structural equation models showed that unhealthy food outlets were unrelated to unhealthy dietary behaviours (estimate 0.029, p=0.416) and excess body size (estimate −0.038, p=0.400). However, greater neighbourhood deprivation and poorer dietary behaviours (estimate −0.134, p=0.001) were associated with greater WtHR (estimate 0.169, p<0.001).

Conclusion

Excess child body size is associated with neighbourhood deprivation and unhealthy dietary behaviours but not unhealthy outlet density or location of these outlets near home and school.

Built environment and physical activity among adolescents: the moderating effects of neighborhood safety and social support

BACKGROUND

Increasing emphasis has been placed on improving physical activity levels through multilevel interventions. This study aims to examine moderating effects of neighborhood safety (crime and traffic) and social support (from parent and sibling/peer) for physical activity in the relationship between the built environment and moderate-to-vigorous physical activity (MVPA) outside school hours among adolescents in Melbourne.

METHODS

Data were from the NEighbourhood Activity in Youth study conducted among adolescents in Melbourne, Australia (n = 358, 15.3 (SD = 1.5) years). MVPA outside school hours was assessed by accelerometer. Built environment features within 1 km and 2 km residential buffers including recreation facilities, park area, and walkability and its components were assessed using Geographic Information Systems. Neighborhood safety, social support for physical activity and sociodemographic information were self-reported by adolescents. Multilevel linear regression models were used to estimate associations.

RESULTS

Support for physical activity from sibling/peer positively moderated the relationship between recreation facilities (1 km), residential density (2 km) and MVPA. Recreation facility (count within 2 km), walkability (1 km and 2 km) and residential density (1 km) had significant positive associations with MVPA outside school hours.

CONCLUSION

The built environment appeared to have stronger facilitating effects on MVPA among adolescents who had favourable support for physical activity from their sibling or peer. Multilevel interventions that target the built environment and social factors are needed to promote MVPA outside school hours among adolescents.

Local Housing Characteristics Associated with Early Childhood Development Outcomes in Australian Disadvantaged Communities

Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The 2012 Australian Early Development Census (AEDC), a population-wide measure of early childhood development, and the Australian Bureau of Statistics Socio-economic Index for Areas Index of Relative Socio-economic Disadvantage were used to select fourteen disadvantaged local communities in five Australian states and territories based on those performing better (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their socio-economic profile. Between 2015-2017, qualitative and quantitative housing data were collected in the local communities. In total, 87 interviews with stakeholders, 30 focus groups with local service providers and parents, and Australian Census dwelling information were analysed. A comparative case study approach was used to examine differences in housing characteristics (e.g., public housing, density, affordability, and tenure) between disadvantaged local communities performing 'better than expected' and 'as expected' on early childhood development. Perceived better housing affordability, objectively measured housing tenure (ownership) and perceived and objectively measured lower-density public housing were housing characteristics that emerged as points of difference for disadvantaged local communities where children had relatively better early childhood development outcomes. These characteristics are potential modifiable and policy sensitive housing levers for reducing early childhood development inequities.

Activity-related behavior typologies in youth: a systematic review

BACKGROUND

Clusters of adolescents differentiated by patterns of physical activity and sedentary behavior (activity-related typologies) are common. Understanding both the characteristics of adolescents and modifiable correlates of these typologies, can help to develop interventions for those most at risk. This systematic review aimed to synthesize the socio-demographic characteristics and modifiable correlates of activity-related behavioral typologies among adolescents.

METHODS

A systematic search of seven electronic databases was conducted to identify quantitative studies using person-oriented statistical approaches to identify activity-related behavioral typologies among 12-18 year-olds. This systematic review was registered in Prospero (registration number: CRD42016046879).

RESULTS

Thirty-six studies met the inclusion criteria and were classified according to three sub-themes based on behaviors included in the typologies (1. physical activity and sedentary behavior only; 2. physical activity, sedentary behavior and risk-related behaviors; 3. physical activity, sedentary behavior and diet). Studies were mostly cross-sectional and relied on self-report measures. Methods were considerably heterogeneous, however results revealed some consistency in typologies within specific groups. For example, typologies characterized by unhealthy behavior patterns (e.g., characterized by physical inactivity, high sedentary behavior and poor diet or high risk-related behaviors) comprised more older adolescents. With the exception of socio-demographics (age, sex, body mass index and socio-economic status), very few correlates have been studied to date (mostly school-related behavioral factors and intrapersonal influences), with evidence largely from typologies comprised of physical activity, sedentary behavior and diet.

CONCLUSIONS

More research is needed to assess a range of modifiable correlates associated with activity-related behavior typologies among adolescents. This will allow for more targeted interventions, to achieve long-lasting, positive behavior change in adolescent populations.

Reducing Inequities in Early Childhood Mental Health: How Might the Neighborhood Built Environment Help Close the Gap? A Systematic Search and Critical Review

BACKGROUND

Optimal mental health in early childhood is key to later mental health, physical health, education, and social outcomes; yet, children facing disadvantage tend to have worse mental health and fewer opportunities to develop this foundation. An emerging body of research shows that neighborhoods provide important opportunities for the development of children's mental health. Synthesizing this evidence can advance understandings of the features of the neighborhood built environment (e.g., housing, parks) that (1) promote optimal mental health in childhood and (2) reduce mental health inequities.

METHODS

We systematically searched and critically reviewed the international quantitative literature investigating associations between the neighborhood built environment and young children's mental health.

RESULTS

14 articles met inclusion criteria; most examined nature or public open space. Studies tended to find greater access to or quantity of neighborhood nature or public open space were associated with better mental health. Significant gaps included a lack of studies investigating social infrastructure, and few studies examined how the built environment related to positive mental health (i.e., functioning, rather than problems).

CONCLUSIONS

Current evidence suggests there is some relationship, but additional research is needed that addresses these gaps and examines differences in associations between child subgroups (e.g., diverse socioeconomic backgrounds).

Typologies of adolescent activity related health behaviours

OBJECTIVES

To identify typologies of activity-related behaviours and demographic characteristics of these typologies among Australian adolescents.

DESIGN

Cross-sectional study of 473 Secondary School students (41.4% boys, mean age 14.95±1.61 years) conducted in 2014-15.

METHODS

Active travel to school, sport participation, leisure-time sedentary and demographic variables were self-reported in a survey. Duration of sedentary time and moderate-to-vigorous physical activity (mins/day) were accelerometer-derived. Latent class analysis (LCA) was conducted to identify typologies of activity-related health behaviours. One-way ANOVAs and chi-square tests were used to explore differences by demographic characteristics.

RESULTS

Three typologies were identified: (1) "Physically inactive, highly sedentary" (44%); (2) "Moderately active, high screen-time" (42%); and (3) "Highly active, low sedentary" (14%). Differences between typologies were evident for age, sex, body mass index (BMI), cultural identity, employment status and socioeconomic position (SEP). Those in typology 3 (optimal behaviour pattern) tended to be younger, of higher SEP and lower BMI.

CONCLUSIONS

This study found that older adolescents have less active, more sedentary profiles than younger adolescents. The findings support the need for targeted interventions to improve adolescent activity-related behaviour engagement.

Kids in Communities Study (KiCS) study protocol: a cross-sectional mixed-methods approach to measuring community-level factors influencing early child development in Australia

INTRODUCTION

Healthy childhood development in the early years is critical for later adult health and well-being. Early childhood development (ECD) research has focused primarily on individual, family and school factors, but largely ignored community factors. The Kids in Communities Study (KiCS) will test and investigate community-level influences on child development across Australia.

METHODS AND ANALYSIS

Cross-sectional mixed-methods study exploring community-level effects in 25 Australian local communities; selection based on community socioeconomic status (SES) and ECD using the Australian Early Development Census (AEDC), a population measure of child development, to create a local community 'diagonality type', that is, those performing better or worse (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their SES. Data collection includes stakeholder interviews, parent and service provider focus groups, and surveys with general community residents and service providers, mapping of neighbourhood design and local amenities and services, analysis of policy documents, and the use of existing sociodemographic and early childhood education and care data. Quantitative data will be used to test associations between local community diagonality type, and ECD based on AEDC scores. Qualitative data will provide complementary and deeper exploration of these same associations.

ETHICS AND DISSEMINATION

The Royal Children's Hospital Human Research Ethics Committee approved the study protocol (#30016). Further ethics approvals were obtained from State Education and Health departments and Catholic archdioceses where required. ECD community-level indicators will eventually be derived and made publically available. Findings will be published in peer-reviewed journals, community reports, websites and policy briefs to disseminate results to researchers, and key stakeholders including policymakers, practitioners and (most importantly) the communities involved.

The effect of siblings and family dog ownership on children's independent mobility to neighbourhood destinations

OBJECTIVE

To investigate the effect of sibling age, gender and dog ownership on children's independent mobility and how this varies according to the destination visited.

METHODS

Parents reported whether their child had an older sibling; if the child and older sibling were of the same gender; the number of older siblings; if they owned a dog; and whether their child was allowed to independently travel to school, friends' or family house, park/oval/sporting field and local shop. Data were analysed for 181 children aged 8-15 years.

RESULTS

The strongest significant sibling effect for independently mobility to school, local shop and ≥3 destinations was for having an older sibling of the same gender (p≤0.05). For independent mobility to a friend's house and park, the strongest significant sibling effect was for having one older sibling (p≤0.05). Dog ownership was associated with increased odds of being independently mobile to ≥3 destinations (OR=2.43; 95%CI=1.03-5.74).

CONCLUSIONS

Parents may be more likely to grant children licence to travel to local places if they are accompanied by an older sibling or the family dog.

IMPLICATIONS

Understanding the effects of siblings and dog ownership on children's independent mobility will assist in identifying strategies through which independent mobility can be encouraged.

Can the Neighborhood Built Environment Make a Difference in Children's Development? Building the Research Agenda to Create Evidence for Place-Based Children's Policy

Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development. The relatively few studies exploring this relationship support associations between child development and neighborhood destinations, green spaces, interaction with nature, traffic exposure, and housing density. These studies emphasize the need to more deeply understand how child development outcomes might be influenced by the neighborhood built environment. Pursuing this research space is well aligned with the current global movements on livable and child-friendly cities. It has direct public policy impact by informing planning policies across a range of sectors (urban design and planning, transport, public health, and pediatrics) to implement place-based interventions and initiatives that target children's health and development at the community level. We argue for the importance of exploring the effect of the neighborhood built environment on child development as a crucial first step toward informing urban design principles to help reduce developmental vulnerability in children and to set optimal child development trajectories early.

Public open space, physical activity, urban design and public health: Concepts, methods and research agenda

Public open spaces such as parks and green spaces are key built environment elements within neighbourhoods for encouraging a variety of physical activity behaviours. Over the past decade, there has been a burgeoning number of active living research studies examining the influence of public open space on physical activity. However, the evidence shows mixed associations between different aspects of public open space (e.g., proximity, size, quality) and physical activity. These inconsistencies hinder the development of specific evidence-based guidelines for urban designers and policy-makers for (re)designing public open space to encourage physical activity. This paper aims to move this research agenda forward, by identifying key conceptual and methodological issues that may contribute to inconsistencies in research examining relations between public open space and physical activity.

Dog walking is associated with more outdoor play and independent mobility for children

OBJECTIVE

Dog ownership is positively associated with children's physical activity. It is plausible that dog-facilitated activity rather than dog ownership per se encourages children's physical activity behaviors. We examined relationships between dog walking and children's physical activity, and outdoor play and independent mobility.

METHOD

Cross-sectional survey data from the 2007 Perth (Western Australia) TRavel, Environment, and Kids (TREK) project were analyzed for 727 10-12 year olds with a family dog. Weekly minutes of overall physical activity and walking, local walking and outdoor play were collected from children and parents. Children's weekly pedometer steps were measured. Independent mobility was determined by active independent travel to 15 local destinations.

RESULTS

Overall, 55% of children walked their dog. After adjustment, more dog walkers than non-dog walkers walked in the neighborhood (75% vs. 47%), played in the street (60% vs. 45%) and played in the yard (91% vs. 84%) (all p ≤ 0.05). Dog walkers were more independently mobile than non-dog walkers (p ≤ 0.001). Dog walking status was not associated with overall physical activity, walking, or pedometer steps (p>0.05).

CONCLUSIONS

Dog-facilitated play and physical activity can be an effective strategy for increasing children's physical activity. Dog walking may provide a readily accessible and safe option for improving levels of independent mobility.

Street connectivity and walking for transport: role of neighborhood destinations

OBJECTIVE

Built environment attributes may be important determinants of physical activity. Greater street connectivity has been shown in several studies to be associated with adults' walking for transport (WFT). We examined the extent to which this association can be explained by the availability of utilitarian destinations.

METHODS

Adults (n=2544) participating in the Physical Activity in Localities and Community Environments (PLACE) study in Adelaide, Australia during 2003-2004, reported their WFT and perceived distances to 16 utilitarian destinations. Connectivity was calculated as the ratio of the number of intersections to Census Collection District land area. Marginal models via generalized estimating equations were used and the product-of-coefficients test was used to test mediation effects.

RESULTS

Connectivity was significantly associated with destination availability and with WFT frequency. The connectivity-WFT relationship was attenuated after taking availability of destinations into account, but remained significant. Availability of destinations accounted for 16% of the total effect of connectivity on WFT.

CONCLUSIONS

Higher connectivity can be associated with more frequent WFT, partly because more utilitarian destinations are available in areas with well-connected street networks. Further clarification of these relationships and other pathways through which connectivity influences residents' walking can inform urban design initiatives to promote physical activity.

Does walkable neighbourhood design influence the association between objective crime and walking?

Background

Few studies have investigated associations between objectively measured crime and walking, and findings are mixed. One explanation for null or counterintuitive findings emerges from criminology studies, which indicate that the permeable street layouts and non-residential land uses that underpin walkable neighbourhoods are also associated with more crime. This study examined associations between objective crime and walking, controlling for the characteristics of walkable neighbourhoods.

Methods

A population representative sample of adults (25–65 years) (n = 3,487) completed the Western Australian Health and Wellbeing Survey (2006–2008) demographic and walking frequency items. Objective environmental measures were generated for each participant’s 400 m and 1600 m neighbourhood areas, including burglary, personal crime (i.e., crimes committed against people) in public space, residential density, street connectivity and local destinations. Log-linear negative binomial regression models were used to examine associations between crime and walking frequency/week, with progressive adjustment for residential density, street connectivity and local destinations.

Results

Burglary and personal crime occurring within a participant’s 400 m and 1600 m neighbourhoods were positively and significantly associated with walking frequency. For example, for every additional 10 crimes against the person/year within 400 m of a participant’s home, walking frequency increased by 8% (relative change = 1.077, p = 0.017). Associations remained constant after controlling for residential density and street connectivity, but attenuated after adjusting for local destinations (e.g., for personal crime in 400 m: relative change = 1.054, p = 0.104). This pattern of attenuation was evident across both crime categories and both neighbourhood sizes.

Conclusions

The observed positive associations between objective crime and walking appear to be a function of living in a more walkable environment, as the presence of destinations has the capacity to both promote walking and attract crime. This study provides a plausible explanation for some mixed findings emerging from studies examining crime as a barrier to walking. In some settings, the hypothesised deterrent effect of crime on walking may be insufficient to outweigh the positive impacts of living in a more walkable environment.

People living in hilly residential areas in metropolitan Perth have less diabetes: spurious association or important environmental determinant?

Background

Variations in ‘slope’ (how steep or flat the ground is) may be good for health. As walking up hills is a physiologically vigorous physical activity and can contribute to weight control, greater neighbourhood slopes may provide a protective barrier to weight gain, and help prevent Type 2 diabetes onset. We explored whether living in ‘hilly’ neighbourhoods was associated with diabetes prevalence among the Australian adult population.

Methods

Participants (≥25 years; n = 11,406) who completed the Western Australian Health and Wellbeing Surveillance System Survey (2003–2009) were asked whether or not they had medically-diagnosed diabetes. Geographic Information Systems (GIS) software was used to calculate a neighbourhood mean slope score, and other built environment measures at 1600 m around each participant’s home. Logistic regression models were used to predict the odds of self-reported diabetes after progressive adjustment for individual measures (i.e., age, sex), socioeconomic status (i.e., education, income), built environment, destinations, nutrition, and amount of walking.

Results

After full adjustment, the odds of self-reported diabetes was 0.72 (95% CI 0.55-0.95) and 0.52 (95% CI 0.39-0.69) for adults living in neighbourhoods with moderate and higher levels of slope, respectively, compared with adults living in neighbourhoods with the lowest levels of slope. The odds of having diabetes was 13% lower (odds ratio 0.87; 95% CI 0.80-0.94) for each increase of one percent in mean slope.

Conclusions

Living in a hilly neighbourhood may be protective of diabetes onset or this finding is spurious. Nevertheless, the results are promising and have implications for future research and the practice of flattening land in new housing developments.

The impact of neighborhood walkability on walking: does it differ across adult life stage and does neighborhood buffer size matter?

We explored the impact of neighborhood walkability on young adults, early-middle adults, middle-aged adults, and older adults' walking across different neighborhood buffers. Participants completed the Western Australian Health and Wellbeing Surveillance System Survey (2003-2009) and were allocated a neighborhood walkability score at 200m, 400m, 800m, and 1600m around their home. We found little difference in strength of associations across neighborhood size buffers for all life stages. We conclude that neighborhood walkability supports more walking regardless of adult life stage and is relevant for small (e.g., 200m) and larger (e.g., 1600m) neighborhood buffers.

Neighborhood walkability and cardiometabolic risk factors in Australian adults: an observational study

BACKGROUND

Studies repeatedly highlight associations between the built environment and physical activity, particularly walking. Fewer studies have examined associations with cardiometabolic risk factors, with associations with obesity inconsistent and scarce evidence examining associations with other cardiometabolic risk factors. We aim to investigate the association between neighborhood walkability and the prevalence of obesity, hypertension, hypercholesterolaemia, and type-2 diabetes mellitus.

METHODS

Cross-sectional study of 5,970 adults in Western Australia. Walkability was measured objectively for a 1,600 m and 800 m neighborhood buffer. Logistic regression was used to assess associations overall and by sex, adjusting for socio-demographic factors. Mediation by physical activity and sedentary behavior was investigated.

RESULTS

Individuals living in high compared with less walkable areas were less likely to be obese (1,600 m OR: 0.84, 95% CI: 0.7 to 1; 800 m OR: 0.75, 95% CI: 0.62 to 0.9) and had lower odds of type-2 diabetes mellitus at the 800 m buffer (800 m OR: 0.69, 95% CI: 0.51 to 0.93). There was little evidence for an association between walkability and hypertension or hypercholesterolaemia. The only significant evidence of any difference in the associations in men and women was a stronger association with type-2 diabetes mellitus at the 800 m buffer in men. Associations with obesity and diabetes attenuated when additionally adjusting for physical activity and sedentary behavior but the overall association with obesity remained significant at the 800 m buffer (800 m OR: 0.78, 95% CI: 0.64 to 0.96).

CONCLUSIONS

A protective association between neighborhood walkability and obesity was observed. Neighborhood walkability may also be protective of type-2 diabetes mellitus, particularly in men. No association with hypertension or hypercholesterolaemia was found. This warrants further investigation. Findings contribute towards the accumulating evidence that city planning and policy related strategies aimed at creating supportive environments could play an important role in the prevention of chronic diseases.

The impact of the built environment on health across the life course: design of a cross-sectional data linkage study

INTRODUCTION

The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course.

METHODS AND ANALYSIS

This cross-sectional data linkage study involves 15 954 children (0-15 years), young adults (16-24 years), adults (25-64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australia's (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants' residential address was geocoded and features of their 'neighbourhood' were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages.

ETHICS AND DISSEMINATION

The University of Western Australia's Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents.

Measurement of children's physical activity using a pedometer with a built-in memory

OBJECTIVES

We evaluated the accuracy of the Accusplit AH120 pedometer (built-in memory) for recording step counts of children during treadmill walking against (1) observer counted steps and (2) concurrently measured steps using the previously validated Yamax Digiwalker SW-700 pedometer.

DESIGN

This was a cross-sectional validation study performed under controlled settings.

METHODS

Forty five 9-12-year-olds walked on treadmills at speeds of 42, 66 and 90m/min to simulate slow, moderate and fast walking wearing Accusplit and Yamax pedometers concurrently on their right hip. Observer counted steps were captured by video camera and manually counted. Absolute value of percent error was calculated for each comparison. Bland-Altman plots were constructed to show the distribution of the individual (criterion-comparison) scores around zero.

RESULTS

Both pedometers under-recorded observer counted steps at all three walk speeds. Absolute value of percent error was highest at the slowest walk speed (Accusplit=46.9%; Yamax=44.1%) and lowest at the fastest walk speed (Accusplit=8.6%; Yamax=8.9%). Bland-Altman plots showed high agreement between the pedometers for all three walk speeds.

CONCLUSIONS

Using pedometers with built-in memory capabilities eliminates the need for children to manually log step counts daily, potentially improving data accuracy and completeness. Step counts from the Accusplit (built-in memory) and Yamax (widely used) pedometers were comparable across all speeds, but their level of accuracy was dependent on walking pace. Pedometers should be used with caution in children as they significantly undercount steps, and this error is greatest at slower walk speeds.

How far do children travel from their homes? Exploring children's activity spaces in their neighborhood

This study explored children's activity spaces. In 2007, children aged 10-12 years (n=1480) completed a survey and mapping activity, and wore a pedometer for seven days. Their parents completed a survey (n=1314). Over half traveled <25% of their 'neighborhood', defined as 800 m and 1600 m network buffers. More local destinations (boys β=-0.022; girls β=-0.013) and parent report of living on a busy road (girls β=-0.43) were associated with smaller activity spaces whereas being independently mobile resulted in larger (girls β=0.28) ones. Traditionally defined neighborhoods may not reflect children's movements. Freedom, fewer local destinations and traffic safety may be important for increasing spatial ranges.

A cross-sectional study of the individual, social, and built environmental correlates of pedometer-based physical activity among elementary school children

Background

Children who participate in regular physical activity obtain health benefits. Preliminary pedometer-based cut-points representing sufficient levels of physical activity among youth have been established; however limited evidence regarding correlates of achieving these cut-points exists. The purpose of this study was to identify correlates of pedometer-based cut-points among elementary school-aged children.

Method

A cross-section of children in grades 5-7 (10-12 years of age) were randomly selected from the most (n = 13) and least (n = 12) 'walkable' public elementary schools (Perth, Western Australia), stratified by socioeconomic status. Children (n = 1480; response rate = 56.6%) and parents (n = 1332; response rate = 88.8%) completed a survey, and steps were collected from children using pedometers. Pedometer data were categorized to reflect the sex-specific pedometer-based cut-points of ≥15000 steps/day for boys and ≥12000 steps/day for girls. Associations between socio-demographic characteristics, sedentary and active leisure-time behavior, independent mobility, active transportation and built environmental variables - collected from the child and parent surveys - and meeting pedometer-based cut-points were estimated (odds ratios: OR) using generalized estimating equations.

Results

Overall 927 children participated in all components of the study and provided complete data. On average, children took 11407 ± 3136 steps/day (boys: 12270 ± 3350 vs. girls: 10681 ± 2745 steps/day; p < 0.001) and 25.9% (boys: 19.1 vs. girls: 31.6%; p < 0.001) achieved the pedometer-based cut-points.

After adjusting for all other variables and school clustering, meeting the pedometer-based cut-points was negatively associated (p < 0.05) with being male (OR = 0.42), parent self-reported number of different destinations in the neighborhood (OR 0.93), and a friend's (OR 0.62) or relative's (OR 0.44, boys only) house being at least a 10-minute walk from home. Achieving the pedometer-based cut-points was positively associated with participating in screen-time < 2 hours/day (OR 1.88), not being driven to school (OR 1.48), attending a school located in a high SES neighborhood (OR 1.33), the average number of steps among children within the respondent's grade (for each 500 step/day increase: OR 1.29), and living further than a 10-minute walk from a relative's house (OR 1.69, girls only).

Conclusions

Comprehensive multi-level interventions that reduce screen-time, encourage active travel to/from school and foster a physically active classroom culture might encourage more physical activity among children.

Supporting an emerging workforce: Characteristics of rural and remote therapy assistants in Western Australia

OBJECTIVE

Multidisciplinary therapy assistants (TAs) are an emerging but poorly understood rural and remote allied health workforce. As an aid to planning and support of TA programs in rural and remote Western Australia (WA), the number, locality and a range of practice variables of rural and remote TAs in WA were determined.

DESIGN

Survey questionnaire.

SETTING

Rural and remote regions of WA.

PARTICIPANTS

Allied health professionals, TAs, TA coordinators and managers of allied health in country regions of WA.

MAIN OUTCOME MEASURES

Information was gathered on TA location, qualifications, employing organisation, allied health disciplines TAs work with, supervision practices, role and work scenarios.

RESULTS

Ninety-eight TAs were identified in rural and remote WA with a further 23 vacant TA positions. Most TAs work across multiple allied health disciplines, half are located at a distance to their supervisors, and very few have a recognised qualification for their TA work.

CONCLUSION

A substantial rural and remote TA workforce was found. A range of TA characteristics were identified that have considerable relevance to the future planning of TA initiatives in rural and remote WA.