A qualitative review of social media sharing and the 2022 monkeypox outbreak: did early labelling help to curb misinformation or fuel the fire?

BACKGROUND: Misinformation, defined as a claim that is false or misleading, considers information that is both shared with the intention of causing harm, and information that is false with no ill intent. Early attempts to downplay the risk of monkeypox (mpox) by singling out men who have sex with men (MSM) may have had the ill effect of stigmatising this group in discussions online. The aim of this study was to evaluate themes present on Instagram related to the 2022 mpox outbreak under #monkeypox. Specifically, this study sought to determine if the pervasive narratives surrounding the coronavirus disease 2019 (COVID-19) pandemic, particularly related to government mistrust and conspiracy, were penetrating discussions about mpox. METHODS: A total of 255 posts under #monkeypox (the top 85 posts per day, every 10days in July 2022) were collected on Instagram. A content analysis approach, which seeks to quantify themes present, was utilised to evaluate themes present in posts under #monkeypox. RESULTS: Contrary to previous research investigating public health misinformation online, the majority of posts under #monkeypox were categorised as accurate information (85.9%). Moreover, a surprising number of posts were classified as anti-misinformation (32.9%), whereby users actively worked to debunk false information being shared online related to mpox. CONCLUSIONS: We hypothesise that early labelling of the disease as one that strictly affects online MSM communities has resulted in the digital community coming together to fact-check and debunk misinformation under #monkeypox on Instagram.

Taking action towards climate-resilient, low-carbon, health systems: Perspectives from Canadian health leaders and healthcare professionals.

Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving "net zero" health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals' and health leaders' perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.

Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users.

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Increased urban greenness associated with improved mental health among middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVES: Some studies suggest that residential surrounding greenness is associated with improved mental health. Few of these studies have focussed on middle-aged and older adults, explored the modifying effects of social determinants of health, or accounted for the extent to which individuals interact with their neighbourhood environments. METHODS: We analysed cross-sectional data collected from 26,811 urban participants of the Canadian Longitudinal Study of Aging who were between 45 and 86 years of age. Participants provided details on socioeconomic characteristics, health behaviours, and their frequency of neighbourhood interactions. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses at a buffer distance of 500 m. Four self-reported measures of mental health were considered: The Center for Epidemiologic Studies Depression Scale (CES-D-10; short scale), past diagnosis of clinical depression, perceptions of mental health, and the Satisfaction with Life Scale (SWLS). Regression models were used to describe associations between greenness and these outcomes, and spline models were fit to characterize the exposure-response function between greenness and CES-D-10 scores. Stratified analyses evaluated whether associations varied by sociodemographic status. RESULTS: In adjusted models, we observed a 5% (Odds Ratio (OR) = 0.95; 95% CI = 0.90, 0.99) reduced odds of depressive symptoms in relation to an interquartile range increase of NDVI (0.06) within a 500 m buffer of the participant's residence. Similarly, we found an inverse association with a self-reported clinical diagnosis of depression (OR = 0.97; 95% CI = 0.92-1.01). Increases in surrounding greenness were associated with improved perceptions of mental health, and the SWLS. Our spline analyses found that beneficial effects between greenness and the CES-D-10 were strongest among those of lower income. CONCLUSIONS: These findings suggest that residential greenness has mental health benefits, and that interventions to increase urban greenness can help reduce social inequalities in mental health.

Rethinking walkability and developing a conceptual definition of active living environments to guide research and practice.

BACKGROUND: Walkability is a popular term used to describe aspects of the built and social environment that have important population-level impacts on physical activity, energy balance, and health. Although the term is widely used by researchers, practitioners, and the general public, and multiple operational definitions and walkability measurement tools exist, there are is no agreed-upon conceptual definition of walkability. METHOD: To address this gap, researchers from Memorial University of Newfoundland hosted "The Future of Walkability Measures Workshop" in association with researchers from the Canadian Urban Environmental Health Research Consortium (CANUE) in November 2017. During the workshop, trainees, researchers, and practitioners worked together in small groups to iteratively develop and reach consensus about a conceptual definition and name for walkability. The objective of this paper was to discuss and propose a conceptual definition of walkability and related concepts. RESULTS: In discussions during the workshop, it became clear that the term walkability leads to a narrow conception of the environmental features associated with health as it inherently focuses on walking. As a result, we suggest that the term Active Living Environments, as has been previously proposed in the literature, are more appropriate. We define Active Living Environments (ALEs) as the emergent natural, built, and social properties of neighbourhoods that promote physical activity and health and allow for equitable access to health-enhancing resources. CONCLUSIONS: We believe that this broader conceptualization allows for a more comprehensive understanding of how built, natural, and social environments can contribute to improved health for all members of the population.

Integrating random forests and propagation models for high-resolution noise mapping.

The adverse effects of long-term exposure to environmental noise on human health are of increasing concern. Noise mapping methods such as spatial interpolation and land use regression cannot capture complex relationships between environmental conditions and noise propagation or attenuation in a three-dimension (3D) built environment. In this study, we developed a hybrid approach by combining a traffic propagation model and random forests (RF) machine learning algorithm to map the total environment noise levels for daily average, daytime, nighttime, and day-evening-nighttime at 30 m × 30 m resolution for the island of Montreal, Canada. The propagation model was used to predict traffic noise surfaces using road traffic flow, 3D building information, and a digital elevation model. The traffic noise estimates were compared with ground-based sound-level measurements at 87 points to extract residuals between total environmental noise and traffic noise. Residuals at these points were fit to RF models with multiple environmental and geographic predictor variables (e.g., vegetation index, population density, brightness of nighttime lights, land use types, and distances to noise contour around the airport, bus stops, and road intersections). Using the sound-level measurements as baseline data, the prediction errors, i.e., mean error, mean absolute error, and root mean squared error of daily average noise levels estimated by our hybrid approach was -0.03 dB(A), 2.67 dB(A), and 3.36 dB(A). Combining deterministic and stochastic models can provide accurate total environmental noise estimates for large geographic areas where sound-level measurements are available.

Tree characteristics and environmental noise in complex urban settings - A case study from Montreal, Canada.

Field studies have shown that dense tree canopies and regular tree arrangements reduce noise from a point source. In urban areas, noise sources are multiple and tree arrangements are rarely dense. There is a lack of data on the association between the urban tree canopy characteristics and noise in complex urban settings. Our aim was to investigate the spatial variation of urban tree canopy characteristics, indices of vegetation abundance, and environmental noise levels. Using Light Detection and Ranging point cloud data for 2015, we extracted the characteristics of 1,272,069 public and private trees across the island of Montreal, Canada. We distinguished needle-leaf from broadleaf trees, and calculated the percentage of broadleaf trees, the total area of the crown footprint, the mean crown centroid height, and the mean volume of crowns of trees that were located within 100m, 250m, 500m, and 1000m buffers around 87 in situ noise measurement sites. A random forest model incorporating tree characteristics, the normalized difference vegetation index (NDVI) values, and the distances to major urban noise sources (highways, railways and roads) was employed to estimate variation in noise among measurement locations. We found decreasing trends in noise levels with increases in total area of the crown footprint and mean crown centroid height. The percentages of increased mean squared error of the regression models indicated that in 500m buffers the total area of the crown footprint (29.2%) and the mean crown centroid height (12.6%) had a stronger influence than NDVI (3.2%) in modeling noise levels; similar patterns of influence were observed using other buffers. Our findings suggest that municipal initiatives designed to reduce urban noise should account for tree features, and not just the number of trees or the overall amount of vegetation.

Indoor nature exposure and influence on physiological stress markers.

Spending time in nature is beneficial for stress reduction and recovery. Using the properties of biophilic design, this study examined the influence of a nature-based indoor environment on physiological stress systems. An experimental study was designed to assess the influence of indoor natural elements on autonomic activity (heart rate variability or HRV), self-reported environmental assessments. No differences in heart rate variability were found between participants assigned to either condition. The room with natural elements was rated more positively than the room without natural elements. Participant preference had more impact on changes in HRV for participants without exposure to natural elements. The results suggest that natural elements in indoor environments may influence the regulation of stress response via environmental preference.Abbreviations: ANCOVA: Analysis of Covariance; ANS: Autonomic Nervous System; AVNN: Average of NN; DST: Digit Span Test; EAS: Environmental Assessment Scale; ECG: Electrocardiograph; fMRI: Functional magnetic resonance imaging; HF: High Frequency; HRV: Heart Rate Variability; INE: Indoor Nature Exposure; NR: Nature-Relatedness Scale; PANAS: Positive and Negative Affect Schedule; SAM: Search and Memory Test; SLSI: Student Life Stress Inventory; SMT: Sentence Making Test.

Environments Associated with Moderate-to-Vigorous Physical Activity and Sedentary Behavior of Colorectal Cancer Survivors.

PURPOSE: Physical activity (PA) is an effective intervention for improving the quality of life of colorectal cancer survivors (CRC) and may reduce the risk of cancer recurrence and cancer specific and all-cause mortality. However, most CRC survivors are not sufficiently active to receive these benefits. Sedentary behavior (SB) has also been linked to morbidity and mortality risk independent of activity level, thereby presenting an additional opportunity to improve health outcomes of CRC survivors. The built environment is known to influence PA and SB; however, little is known about where CRC survivors engage in PA and SB. The objective of this exploratory study was to objectively identify locations where CRC survivors engage in PA and SB in order to inform health promoting interventions. METHOD: Activity and location of CRC survivors (n = 31) was monitored for 1 week between January 2014 and April 2015 in Nova Scotia, Canada. Bouts of PA and SB were time-matched with GPS data to attribute bouts to specific geographic locations. RESULTS: Participants' home environment was the main location for both time spent in PA bouts (73.7 %) and time spent in SB bouts (90.5 %). CONCLUSION: This study is the first to objectively identify environments where CRC survivors are active and sedentary. These findings highlight the importance of considering the home environment when developing intervention strategies to increase PA and reduce SB in CRC survivors.

Longitudinal active living research to address physical inactivity and sedentary behaviour in children in transition from preadolescence to adolescence.

BACKGROUND: Children can be highly active and highly sedentary on the same day! For instance, a child can spend a couple of hours playing sports, and then spend the rest of the day in front of a screen. A focus on examining both physical activity and sedentary behaviour throughout the day and in all seasons in a year is necessary to generate comprehensive evidence to curb childhood obesity. To achieve this, we need to understand where within a city are children active or sedentary in all seasons. This active living study based in Saskatoon, Canada, aims to understand the role played by modifiable urban built environments in mitigating, or exacerbating, seasonal effects on children's physical activity and sedentary behaviour in a population of children in transition from preadolescence to adolescence. METHODS/DESIGN: Designed as an observational, longitudinal investigation this study will recruit 800 Canadian children 10-14 years of age. Data will be obtained from children representing all socioeconomic categories within all types of neighbourhoods built in a range of urban designs. Built environment characteristics will be measured using previously validated neighbourhood audit and observational tools. Neighbourhood level socioeconomic variables customized to Saskatoon neighbourhoods from 2011 Statistics Canada's National Household Survey will be used to control for neighbourhood social environment. The validated Smart Cities Healthy Kids questionnaire will be administered to capture children's behaviour and perception of a range of factors that influence their activity, household (including family socioeconomic factors), parental, peer and neighbourhood influence on independent mobility. The outcome measures, different intensities of physical activity and sedentary behaviour, will be collected using global positioning system equipped accelerometers in all four seasons. Each accelerometry cycle will be matched with weather data obtained from Environment Canada. Extensive weather data will be accessed and classified into one of six distinct air mass categories for each day of accelerometry. Computational and spatial analytical techniques will be utilized to understand the multi-level influence of environmental exposures on physical activity and sedentary behaviour in all seasons. DISCUSSION: This approach will help us understand the influence of urban environment on children's activity, thus paving the way to modify urban spaces to increase physical activity and decrease sedentary behaviour in children in all four seasons. Lack of physical activity and rising sedentariness is associated with rising childhood obesity, and childhood obesity in turn is linked to many chronic conditions over the life course. Understanding the interaction of children with urban spaces will reveal new knowledge, and when translated to actions will provide a strong basis for informing future urban planning policy.

Using Global Positioning Systems (GPS) and temperature data to generate time-activity classifications for estimating personal exposure in air monitoring studies: an automated method.

BACKGROUND: Personal exposure studies of air pollution generally use self-reported diaries to capture individuals' time-activity data. Enhancements in the accuracy, size, memory and battery life of personal Global Positioning Systems (GPS) units have allowed for higher resolution tracking of study participants' locations. Improved time-activity classifications combined with personal continuous air pollution sampling can improve assessments of location-related air pollution exposures for health studies. METHODS: Data was collected using a GPS and personal temperature from 54 children with asthma living in Montreal, Canada, who participated in a 10-day personal air pollution exposure study. A method was developed that incorporated personal temperature data and then matched a participant's position against available spatial data (i.e., road networks) to generate time-activity categories. The diary-based and GPS-generated time-activity categories were compared and combined with continuous personal PM2.5 data to assess the impact of exposure misclassification when using diary-based methods. RESULTS: There was good agreement between the automated method and the diary method; however, the automated method (means: outdoors = 5.1%, indoors other =9.8%) estimated less time spent in some locations compared to the diary method (outdoors = 6.7%, indoors other = 14.4%). Agreement statistics (AC1 = 0.778) suggest 'good' agreement between methods over all location categories. However, location categories (Outdoors and Transit) where less time is spent show greater disagreement: e.g., mean time "Indoors Other" using the time-activity diary was 14.4% compared to 9.8% using the automated method. While mean daily time "In Transit" was relatively consistent between the methods, the mean daily exposure to PM2.5 while "In Transit" was 15.9 µg/m3 using the automated method compared to 6.8 µg/m3 using the daily diary. CONCLUSIONS: Mean times spent in different locations as categorized by a GPS-based method were comparable to those from a time-activity diary, but there were differences in estimates of exposure to PM2.5 from the two methods. An automated GPS-based time-activity method will reduce participant burden, potentially providing more accurate and unbiased assessments of location. Combined with continuous air measurements, the higher resolution GPS data could present a different and more accurate picture of personal exposures to air pollution.

Does urban greenness reduce loneliness and social isolation among Canadians? A cross-sectional study of middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVES: Urban greenness has been shown to confer many health benefits including reduced risks of chronic disease, depression, anxiety, and, in a limited number of studies, loneliness. In this first Canadian study on this topic, we investigated associations between residential surrounding greenness and loneliness and social isolation among older adults. METHODS: This cross-sectional analysis of the Canadian Longitudinal Study on Aging included 26,811 urban participants between 45 and 86 years of age. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses using a buffer distance of 500 m. We evaluated associations between the NDVI and (i) self-reported loneliness using the Center for Epidemiological Studies Depression Scale, (ii) whether participants reported "feeling lonely living in the local area", and (iii) social isolation. Logistic regression models were used to characterize associations between greenness and loneliness/social isolation while adjusting for individual socio-economic and health behaviours. RESULTS: Overall, 10.8% of participants perceived being lonely, while 6.5% reported "feeling lonely in their local area". Furthermore, 16.2% of participants were characterized as being socially isolated. In adjusted models, we observed no statistically significant difference (odds ratio (OR) = 0.99; 95% confidence interval (CI) 0.93-1.04) in self-reported loneliness in relation to an interquartile range (IQR) increase of NDVI (0.06). However, for the same change in greenness, there was a 15% (OR = 0.85; 95% CI 0.72-0.99) reduced risk for participants who strongly agreed with "feeling lonely living in the local area". For social isolation, for an IQR increase in the NDVI, we observed a 7% (OR = 0.93; 95% CI 0.88-0.97) reduction in prevalence. CONCLUSION: Our findings suggest that urban greenness plays a role in reducing loneliness and social isolation among Canadian urbanites.

RéSUMé: OBJECTIFS: Il est démontré que la verdure urbaine confère de nombreux avantages pour la santé; elle réduit notamment les risques de maladies chroniques, de dépression et d'anxiété et, selon un petit nombre d'études, le risque de solitude. Dans cette première étude canadienne sur le sujet, nous avons étudié les associations entre la verdure de l'environnement résidentiel et la solitude et l'isolement social chez les adultes d'âge mûr. MéTHODE: Cette analyse transversale de l'Étude longitudinale canadienne sur le vieillissement a inclus 26 811 participantes et participants urbains de 45 à 86 ans. L'indice de végétation par différence normalisée (IVDN), un indicateur de verdure, a été assigné à l'adresse domiciliaire dans une zone tampon de 500 m. Nous avons évalué les associations entre l'IVDN et i) la solitude autodéclarée selon l'échelle de dépression du Center for Epidemiological Studies, ii) le fait de déclarer « vivre de la solitude dans sa zone locale ¼ et iii) l'isolement social. Des modèles de régression logistique ont servi à caractériser les associations entre la verdure et la solitude/l'isolement social, et nous avons apporté des ajustements pour tenir compte du statut socioéconomique et des comportements de santé individuels. RéSULTATS: Globalement, 10,8 % des participantes et des participants se sentaient seuls, et 6,5 % disaient « vivre de la solitude dans leur zone locale ¼. De plus, 16,2 % des participantes et des participants ont été caractérisés comme étant socialement isolés. Dans nos modèles ajustés, nous n'avons observé aucun écart significatif (rapport de cotes (RC) = 0,99; IC de 95 % : 0,93­1,04) dans la solitude autodéclarée en lien avec une augmentation de l'écart interquartile (EI) de l'IVDN (0,06). Cependant, pour le même changement dans la verdure, la probabilité pour les participantes et les participants d'être tout à fait d'accord avec l'énoncé qu'ils « vivent de la solitude dans leur zone locale ¼ était réduite de 15 % (RC = 0,85, IC de 95 % : 0,72­0,99). Et pour chaque augmentation de l'EI de l'IVDN, nous avons observé une baisse de 7 % (RC = 0,93, IC de 95 % : 0,88­0,97) de la prévalence de l'isolement social. CONCLUSION: Nos constatations indiquent que la verdure urbaine joue un rôle dans la réduction de la solitude et de l'isolement social chez les citadins et citadines au Canada.

Estimates of global mortality attributable to particulate air pollution using satellite imagery.

BACKGROUND: Epidemiological studies of the health effects of air pollution have traditionally relied upon ground-monitoring stations to measure ambient concentrations. Satellite derived air pollution measures offer the advantage of providing global coverage. OBJECTIVE: To undertake a global assessment of mortality associated with long-term exposure to fine particulate air pollution using remote sensing data. METHODS: Global PM(2.5) exposure levels were derived from the MODIS and MISR satellite instruments. Relative risks and attributable fractions of mortality were modeled using previously developed concentration-response functions for the association between PM(2.5) and mortality. RESULTS: The global fraction of adult mortality attributable to the anthropogenic component of PM(2.5) (95% CI) was 8.0% (5.3-10.5) for cardiopulmonary disease, 12.8% (5.9-18.5) for lung cancer, and 9.4% (6.6-11.8) for ischemic heart disease. CONCLUSION: This study demonstrates the feasibility of using satellite derived pollution concentrations in assessing the population health impacts of air pollution at the global scale. This approach leads to global estimates of mortality attributable to PM(2.5) that are greater than those based on fixed site ground-level measures of urban PM(2.5), but more similar to estimates based on global chemical transport model simulations of anthropogenic PM(2.5).

Temporal trends in ambient fine particulate matter and the impacts of COVID-19 on this pollutant in Grenada, West Indies.

Most Caribbean islands do not have air pollution surveillance programs. Those who live in these countries are exposed to ambient air pollution from a variety of sources including motor vehicles, ocean-going vessels, and Saharan dust. We conducted an air sampling exposure study in Grenada to describe daily changes in fine particulate matter (PM2.5) pollution, and during Saharan dust episodes. Further, we assessed the impacts of COVID-19 public health interventions on PM2.5 concentrations in 2020. Four fixed-site PurpleAir monitors were installed throughout Grenada, and one on the neighboring island of Carriacou. PM2.5 was measured between January 6 and December 31, 2020. We classified each of these days based on whether COVID-19 public health mitigation measures were in place or not. Descriptive analyses were performed to characterize fluctuations in PM2.5, and we assessed the impacts of public health restrictions on PM2.5 using multivariate regression. The mean daily PM2.5 concentration in 2020 was 4.4 µg/m3. During the study period, the minimum daily PM2.5 concentration was 0.7 µg/m3, and the maximum was 20.4 µg/m3. Daily mean PM2.5 concentrations more than doubled on Saharan dust days (8.5 vs 3.6 µg/m3; p < 0.05). The daily mean PM2.5 concentrations were estimated to be 1.2 µg/m3 lower when COVID-19 restrictions were in effect. Ambient PM2.5 concentrations in Grenada are relatively low compared to other countries; however, Saharan dust episodes represent an important source of exposure. Low-cost sensors provide an opportunity to increase surveillance of air pollution in the Caribbean, however their value could be enhanced with the development of correction algorithms that more closely approximate values from reference-grade monitors.Implications: This study describes daily fluctuations in ambient PM2.5 concentrations in Grenada in 2020. Overall, concentrations of PM2.5 were low; however, we found that Saharan dust events cause daily exceedances in PM2.5 above the current 24-hr limits of the World Health Organization. Moreover, the constructed models suggest that public health interventions to reduce the spread of COVID-19 reduced PM2.5 concentrations by 27%.

Traffic-Related Air Pollution and Risk of Lung, Breast, and Urinary Tract Cancer in Halifax, Nova Scotia.

OBJECTIVES: We assessed the association of traffic-related air pollution (TRAP) with the incidence of lung, breast, and urinary tract cancer in Halifax, Nova Scotia. METHODS: Our case-control study included 2315 cancers and 8501 age-sex-matched controls. Land-use regression was used to estimate TRAP concentrations. Logistic regression was used to assess cancer risk in relation to TRAP, adjusting for community social and material deprivation. RESULTS: There was no association between the risk of lung, breast, or urinary tract cancer in relation to TRAP. Lung cancer risk was significantly increased in the most deprived communities, whereas breast cancer risk was highest in the least deprived communities. CONCLUSIONS: In a city characterized by low levels of ambient air pollution, there was no evidence of a linear increased lung, breast, or urinary tract cancer risk in relation to TRAP.

The Nova Scotia Community Cancer Matrix: A geospatial tool to support cancer prevention.

Globally, cancer is a leading cause of death and morbidity and its burden is increasing worldwide. It is established that medical approaches alone will not solve this cancer crisis. Moreover, while cancer treatment can be effective, it is costly and access to treatment and health care is vastly inequitable. However, almost 50% of cancers are caused by potentially avoidable risk factors and are thus preventable. Cancer prevention represents the most cost-effective, feasible and sustainable pathway towards global cancer control. While much is known about cancer risk factors, prevention programs often lack consideration of how place impacts cancer risk over time. Maximizing cancer prevention investment requires an understanding of the geographic context for why some people develop cancer while others do not. Data on how community and individual level risk factors interact is therefore required. The Nova Scotia Community Cancer Matrix (NS-Matrix) study was established in Nova Scotia (NS), a small province in Eastern Canada with a population of 1 million. The study integrates small-area profiles of cancer incidence with cancer risk factors and socioeconomic conditions, to inform locally relevant and equitable cancer prevention strategies. The NS-Matrix Study includes over 99,000 incident cancers diagnosed in NS between 2001 and 2017, georeferenced to small-area communities. In this analysis we used Bayesian inference to identify communities with high and low risk for lung and bladder cancer: two highly preventable cancers with rates in NS exceeding the Canadian average, and for which key risk factors are high. We report significant spatial heterogeneity in lung and bladder cancer risk. The identification of spatial disparities relating to a community's socioeconomic profile and other spatially varying factors, such as environmental exposures, can inform prevention. Adopting Bayesian spatial analysis methods and utilizing high quality cancer registry data provides a model to support geographically-focused cancer prevention efforts, tailored to local community needs.

Integrating health geography and behavioral economic principles to strengthen context-specific behavior change interventions.

The long-term economic viability of modern health care systems is uncertain, in part due to costs of health care at the end of life and increasing health care utilization associated with an increasing population prevalence of multiple chronic diseases. Control of health care spending and sustaining delivery of health care services will require strategic investments in prevention to reduce the risk of disease and its complications over an individual's life course. Behavior change interventions aimed at reducing a range of harmful and risky health-related behaviors including smoking, physical inactivity, excess alcohol consumption, and excess weight, are one approach that has proven effective at reducing risk and preventing chronic disease. However, large-scale efforts to reduce population-level chronic diseases are challenging and have not been very successful at reducing the burden of chronic diseases. A new approach is required to identify when, where, and how to intervene to disrupt patterns of behavior associated with high-risk factors using context-specific interventions that can be scaled. This paper introduces the need to integrate theoretical and methodological principles of health geography and behavioral economics as opportunities to strengthen behavior change interventions for the prevention of chronic diseases. We discuss how health geography and behavioral economics can be applied to expand existing behavior change frameworks and how behavior change interventions can be strengthened by characterizing contexts of time and activity space.

Behavior change interventions are challenged by lack of information about the contexts influencing decisions patients make as part of their daily routine such as when, where, and how health behaviors occur. A new approach is required to strengthen behavior change interventions by integrating contexts of time and activity space so that strategies can be scaled across populations to influence how individuals make decisions about improving their health behaviors. Incorporating ideas from health geography and behavioral economics into the design of behavior change interventions provides an opportunity to collect and investigate individual-level health information characterizing contexts of individuals' activities across space, connections to place, time management, and patterns in behavior over time. By visualizing and characterizing key spatiotemporal contexts about an individual's day-to-day routine, insight can be gained about where and for how long activities occur and what opportunities exist for adapting day-to-day routines. This paper will discuss how theory from health geography could be applied to understand contexts influencing behaviors and how spatiotemporal information could be applied for the purpose of tailoring behavioral economic strategies to strengthen the design of behavior change interventions.

Noise levels associated with urban land use.

Recent trends towards the intensification of urban development to increase urban densities and avoid sprawl should be accompanied by research into the potential for related health impacts from environmental exposure. The objective of the current study was to examine the effect of the built environment and land use on levels of environmental noise. Two different study areas were selected using a combination of small area census geography, land use information, air photography, and ground-truthing. The first study area represented residential land use and consisted of two- to three-story single-family homes. The second study area was characteristic of mixed-use urban planning with apartment buildings as well as commercial and institutional development. Study areas were subdivided into six grids, and a location was randomly selected within each grid for noise monitoring. Each location was sampled four times over a 24-h day, resulting in a total of 24 samples for each of the two areas. Results showed significant variability in noise within study areas and significantly higher levels of environmental noise in the mixed-use area. Both study areas exceeded recommended noise limits when evaluated against World Health Organization guidelines and yielded average noise events values in the moderate to serious annoyance range with the potential to obscure normal conversation and cause sleep disturbance.

Community SES, perceived environment, and physical activity during home-based cardiac rehabilitation: is there a need to consider the urban vs. rural distinction?

Physical activity (MVPA) levels during home-based cardiac rehabilitation (CR) remain problematic. Consequently, the present study examined the association between MVPA and urban vs. rural residential status and the perceived environment in patients attending home-based CR. A total of 280 patients completed a questionnaire assessing demographic, clinical, MVPA, and perceived environmental variables measured at baseline and 3 months later. Patient addresses were geocoded and linked to the 2006 Canadian census to establish the urban/rural distinction. Results showed that urban and rural patients had similar baseline MVPA and improvements in MVPA by 3 months. Several perceived environmental variables were significantly related to MVPA throughout home-based CR that were common and urban/rural-specific. Therefore, although there does not appear to be an urban vs. rural advantage in MVPA levels during home-based CR, there does appear to be environmental/MVPA-specific relationships specific to urban and rural patients that may warrant attention.

Is francophone language status associated with differences in the health services use of rural Nova Scotians?

OBJECTIVES: Research suggests that Canadian francophones living in minority contexts have little access to health services in French and are more likely to receive poorer health services. We examined whether francophones in one Nova Scotia (NS) community showed different patterns of health service use from anglophones in similar rural communities, or the NS population overall. METHODS: We used administrative data to calculate 10-year cumulative incidence rate ratios for the period 1996-2005 for treated cancers, circulatory diseases, diabetes and psychiatric disorders in Clare (population 8,815, predominantly francophone) and compared these with six predominantly Anglophone communities (total population 38,147) using data for the province overall as the reference standard. We also compared 10-year treated incidence rate ratios for visits to family physicians and specialists and for admissions to hospital. RESULTS: Treatment incidence rates for all four disease groups in all rural areas were dominated by family physician visits and hospital visits; visits to specialists for some disease outcomes were often lower in rural communities. Visits to psychiatric specialists were especially low in rural communities, irrespective of language status, being 30% less than for the province overall. No significant differences in treated disease incidence were detected between Clare and the comparison anglophone communities. Treated incidence rate ratios for diabetes and circulatory diseases were significantly higher in Clare and the rural anglophone communities relative to the province overall. CONCLUSION: The patterns of health care use and treated disease incidence seen in Clare and the comparison areas are more likely a function of rurality than they are of language.