Do Community Social Capital and Built Environment Associate With Homebound in Older Adults? The JAGES Niigata Study.

BACKGROUND: Homebound status is one of the most important risk factors associated with functional decline and long-term care in older adults. Studies show that neighborhood built environment and community social capital may be related to homebound status. This study aimed to clarify the association between homebound status for community-dwelling older adults and community environment-including social capital and neighborhood built environment-in rural and urban areas. METHODS: We surveyed people aged 65 years and older residing in three municipalities of Niigata Prefecture, Japan, who were not certified as requiring long-term care. The dependent variable was homebound status; explanatory variables were community-level social capital and neighborhood built environment. Covariates were age, sex, household, marital status, socioeconomic status, instrumental activities of daily living, the Geriatric Depression Scale-15, self-rated health, number of diseases under care, and individual social capital. The association between community social capital or neighborhood built environment and homebound status, stratified by rural/urban areas, was investigated using multilevel logistic regression analysis. RESULTS: Among older adults (n = 18,099), the homebound status prevalence rate was 6.9% in rural areas and 4.2% in urban areas. The multilevel analysis showed that, in rural areas, fewer older adults were homebound in communities with higher civic participation and with suitable parks or pavements for walking and exercising. However, no significant association was found between community social capital or neighborhood built environment and homebound status for urban older adults. CONCLUSION: Community social capital and neighborhood built environment were significantly associated with homebound status in older adults in rural areas.

Walking and cycling, as active transportation, and obesity factors in adolescents from eight countries.

BACKGROUND: Evidence has shown that active transportation decreases obesity rates, but considering walking or cycling as separate modes could provide additional information on the health benefits in adolescents. This study aimed to examine the associations between walking and cycling as form active transportation and obesity indicators in Latin American adolescents. METHODS: Population-based study with 671 adolescents (mean age: 15.9 [standard deviation: 0.8] years) from eight countries participating in the Latin American Study of Nutrition and Health/Estudio Latino Americano Nutrition y Salud (ELANS). Walking and cycling for active transportation were measured using the International Physical Activity Questionnaire long version. Body mass index, waist circumference, neck circumference, and relative fat mass were used as obesity indicators. Associations were estimated using logistic regression models for the pooled data adjusted for country, sex, age, socio-economic levels, race/ethnicity, leisure-time physical activity and energy intake. RESULTS: Mean time spent walking and cycling was 22.6 (SD: 33.1) and 5.1 (SD: 24.1) min/day, respectively. The median values were 12.8 (IQR: 4.2; 25.7) and 0 (IQR: 0; 6.2) for walking and cycling. Participants reporting ≥ 10 min/week of walking or cycling for active transportation were 84.2% and 15.5%, respectively. Costa Rica (94.3% and 28.6%) showed the highest prevalence for walking and cycling, respectively, while Venezuela (68.3% and 2.4%) showed the lowest prevalence. There was no significant association between walking for active transportation and any obesity indicator. In the overall sample, cycling for ≥ 10 min/week was significantly associated with a lower likelihood of overweight/obesity based on BMI (OR: 0.86; 95%CI: 0.88; 0.94) and waist circumference (OR: 0.90; 95%CI: 0.83; 0.97) adjusted for country, sex, age, socio-economic level, race/ethnicity, leisure-time physical activity and energy intake compared to cycling for < 10 min/week. There were no significant associations between cycling for active transportation and neck circumference as well as relative fat mass. CONCLUSIONS: Cycling for active transportation was negatively associated with obesity indicators, especially body mass index and waist circumference. Programs for promoting cycling for active transportation could be a feasible strategy to tackle the high obesity rates in adolescents in Latin America. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Race/ethnicity, built environment in neighborhood, and children's mental health in the US.

The prevention and treatment of mental health disorders in childhood and adolescence is one among the major public health challenges in the United States today. Prior research has suggested that neighborhood is very important for children and adolescents' mental health. The present study extends the research on neighborhood and mental health by examining the association between childhood mental health and the identified specific built environment attributes in neighborhood as well as its intersection with race/ethnicity in the United States. Statistical analyses results of data from the 2016 National Survey of Children Health (NSCH) indicate that children's mental health and the built environment in neighborhood vary across racial/ethnic groups, with minority groups being more likely to live in the disadvantaged neighborhoods and to experience more mental health disorders, particularly American Indian children. Further, the relationship between built environment neighborhood mental health among children varies across race/ethnicity in the United States.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review.

BACKGROUND: A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence. METHODS: A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided. RESULTS: Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified. CONCLUSIONS: The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.

The Neighborhood Built Environment and Cognitive Function of Older Persons: Results from the Singapore Longitudinal Ageing Study.

BACKGROUND: We investigated the association of subjective (perceived) and objective (geographical information system [GIS]-based) measures of the neighborhood built environment (BE) attributes with cognitive function among older persons, and the mediating effect of transportation physical activity (TPA) and leisure time (physical, social and productive) activities (LTA). METHOD: A cross-sectional study of 402 residents aged 55 years and above in the Singapore Longitudinal Ageing Study. Perceived neighborhood BE attributes (residential density, street connectivity, land use mix - diversity, land use mix - access, infrastructure for walking or cycling, aesthetics, traffic safety, and crime safety) and objective GIS measures of walkability and accessibility were related to participants' cognitive global and domain-specific performance measured by Repeatable Battery for the Assessment of Neurocognitive Status (RBANS). RESULTS: Controlling for age, sex, education, race, chronic medical illnesses, self-rated health, Geriatric Depression Scale depression score, POMA measures of balance and gait, and other BE attributes, the subjective measure of land use mix-diversity (standardized coefficient ß = 0.161, p = 0.008) and GIS measure of walkability (ß = 0.163, p = 0.002) were positively and significantly associated with RBANS global z-score, and immediate and delayed memory recall, visuospatial/ constructional ability and language, except attention. In hierarchical modeling, TPA and LTA attenuated the effect estimates, but the associations remained significant. CONCLUSION: BE features which increase opportunities and easy access to a diversity of destinations for services and facilities that promote physical, social and cognitively stimulating activities is associated with better cognitive functioning in older people.

Neighborhood built environment, obesity, and diabetes: A Utah siblings study.

Background: This study utilizes innovative computer vision methods alongside Google Street View images to characterize neighborhood built environments across Utah. Methods: Convolutional Neural Networks were used to create indicators of street greenness, crosswalks, and building type on 1.4 million Google Street View images. The demographic and medical profiles of Utah residents came from the Utah Population Database (UPDB). We implemented hierarchical linear models with individuals nested within zip codes to estimate associations between neighborhood built environment features and individual-level obesity and diabetes, controlling for individual- and zip code-level characteristics (n = 1,899,175 adults living in Utah in 2015). Sibling random effects models were implemented to account for shared family attributes among siblings (n = 972,150) and twins (n = 14,122). Results: Consistent with prior neighborhood research, the variance partition coefficients (VPC) of our unadjusted models nesting individuals within zip codes were relatively small (0.5%-5.3%), except for HbA1c (VPC = 23%), suggesting a small percentage of the outcome variance is at the zip code-level. However, proportional change in variance (PCV) attributable to zip codes after the inclusion of neighborhood built environment variables and covariates ranged between 11% and 67%, suggesting that these characteristics account for a substantial portion of the zip code-level effects. Non-single-family homes (indicator of mixed land use), sidewalks (indicator of walkability), and green streets (indicator of neighborhood aesthetics) were associated with reduced diabetes and obesity. Zip codes in the third tertile for non-single-family homes were associated with a 15% reduction (PR: 0.85; 95% CI: 0.79, 0.91) in obesity and a 20% reduction (PR: 0.80; 95% CI: 0.70, 0.91) in diabetes. This tertile was also associated with a BMI reduction of -0.68 kg/m2 (95% CI: -0.95, -0.40). Conclusion: We observe associations between neighborhood characteristics and chronic diseases, accounting for biological, social, and cultural factors shared among siblings in this large population-based study.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians.

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016-2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40-70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

Correlation Between Neighborhood Built Environment and Leisure Walking Time Around a Riverside Park.

OBJECTIVES: This study aimed to investigate whether the distance to a riverside park and the neighborhood built environment are related to individuals' leisure walking time by examining the case of the Geumho riverside park in Daegu, South Korea. BACKGROUND: Walking, being an inexpensive means of transportation with numerous health benefits, is influenced by the conditions of neighborhood built environments. METHODS: A survey was conducted from October 12 to November 8, 2022, including 184 adults aged 18 years or older. The dependent variable was the total weekly minutes of leisure walking, and the independent variables included the neighborhood built environment measured objectively using geographic information systems as well as demographic/individual characteristics and health attitude data. Analysis of variance was conducted to determine whether leisure walking time differed depending on the distance to the riverside park, and regression analysis was conducted to examine the association between leisure walking time and the neighborhood built environment. RESULTS: Individuals living within a quarter-mile of the park walked an average of 155 min per week for leisure, which was significantly more than those living further than 1 mile (mean = 85.14 min/week). Moreover, greater access to the park, higher crosswalk density, and a lower road density were associated with more leisure walking time for residents. CONCLUSIONS: The findings of this study indicate that good access to riverside parks and pedestrian-centered neighborhood environments may be related to leisure walking among residents. These findings hold significance for urban planning and the formulation of public health policies.

The influence of neighborhood built environment on school-age children's outdoor leisure activities and obesity: a case study of Shanghai central city in China.

Objective: The aim of this study was to examine the influencing pathways of the neighborhood built environment on children's outdoor leisure activities and obesity. Methods: A total of 378 elementary school students from 10 schools in central Shanghai were selected by a convenient sampling method for questionnaire survey and accelerometer tracking. Results: 1) The neighborhood built environment could affect children's obesity not only through direct effect (ß = 0.15, p < 0.05), but also through the mediating effect of outdoor leisure activities (ß = 0.19, p < 0.05). 2) For boys, the neighborhood built environment could affect children's obesity not only through direct effect (ß = 0.17, p < 0.05), but also through the mediating effect of outdoor leisure activities (ß = 0.26, p < 0.05). For girls, the neighborhood built environment could affect children's obesity only through the mediating effect of outdoor leisure activities (ß = 0.13, p < 0.05). Conclusion: The neighborhood built environment and outdoor leisure activities are important influencing factors in children's obesity. The neighborhood built environment and outdoor leisure activities could have direct and indirect effects on children's obesity, while there are gender differences in the influencing pathways of the neighborhood built environment on children's obesity. This study suggests that improving the neighborhood built environment and promoting outdoor leisure activities in children have important value for influencing children's obesity.

The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators.

Background: There have been few consistencies in the effects and pathways of neighborhood socioeconomic status (SES) on functional limitations. This study aimed to investigate whether neighborhood socioeconomic status influences ADL/IADL in older residents in China through the neighborhood built environment and social environment. Methods: Activities of daily living/IADL were assessed in a sample of 5,887 Chinese individuals aged 60 or older, utilizing data obtained from the 2011 China Health and Retirement Longitudinal Study (CHARLS 2011). Neighborhood SES was measured by the neighborhood per-capita net income. Neighborhood built environment was measured by the security resources, motion resources, living resources, service resources for older adults, and medical resources of neighborhood. Neighborhood social environment was measured by the organizations, unemployment subsidies, minimum living allowance, subsidies to persons older than 65, and pensions to persons older than 80 of the neighborhood. The two-level logistical regression model and multilevel structural equation model (MSEM) were used. Results: The rate of ADL/IADL loss among Chinese older adults aged 60 and above in 2011 were 32.17 and 36.87%, respectively. Neighborhood SES was significantly associated with ADL/IADL in older adults. Compared with the respondents living in communities with lower SES, those living in communities with higher SES possessed better ADL (ß = -0.33, p < 0.05) and IADL (ß = -0.36, p < 0.05) status. The path of neighborhood socioeconomic status on ADL was completely mediated by the neighborhood built environment (ß = -0.110, p < 0.05) and neighborhood social environment (ß = -0.091, p < 0.05). Additionally, the effect of neighborhood socioeconomic status on IADL was fully mediated by the neighborhood built environment (ß = -0.082, p < 0.05) and neighborhood social environment (ß = -0.077, p < 0.05). Conclusion: Neighborhood SES was significantly correlated with ADL/IADL through the neighborhood environment. Improving the ADL/IADL status of older adults residing in low socioeconomic neighborhoods requires enhancing the built and social environment by provisioning additional neighborhood resources.

A Path Analysis of the Effect of Neighborhood Built Environment on Public Health of Older Adults: A Hong Kong Study.

Introduction: Health deterioration among frail older adults is a public health concern. Among the multi-dimensional factors, the neighborhood built environment is crucial for one's health. Although the relationship between the built environment and health in the general population has been thoroughly investigated, it has been ignored in the case of frail older adults, who may have difficulties in their daily basic living skills. A path analysis is constructed to model the proposed theoretical framework involving the neighborhood built environment and health among frail older adults. This study thus aims to investigate the environmental influences on health, and to validate the theoretical framework proposed for health and social services. Methods: This study used secondary data collected in Hong Kong. A sample of 969 older community dwellers aged 60 or above were frail with at least one activity of daily living. Demographic information, neighborhood built environment data, service utilization, and health conditions were collected from these participants and their caregivers. A path analysis was performed to examine the proposed theoretical framework. Results: The health condition was of general concern, including frailty and incapacities in daily activities in frail older adults. Besides psychosocial factors, service use, and caregivers' care quality, the built environment had a significant impact on the health of older adults as well. Specifically, more facilities offering services and groceries, a shorter distance to the nearest metro station, and more greenery exposure are associated with a better-expected health condition among frail older adults. Discussion: The proposed theoretical framework successfully supplements past negligence on the relationship between the built environment and the health of frail older adults. The findings further imply that policymakers should promote the usability of transit and greenery in neighborhoods and communities. In addition, service utilization should be improved to meet the basic needs of frail older adults in the communities.

Exploring the Relationship Between Neighborhood-Built Environment and Elderly Health: A Research Based on Heterogeneity of Age and Gender Groups in Beijing.

Background: The built environment quality of neighborhoods has a significant impact on the health of the elderly. Although there has been a wealth of studies on low-density Western cities, research on the impacts of built environment on elderly health in high-density Chinese cities is far from sufficient. The pathways by which the built environment affects elderly health remain to be observed, particularly whether such pathways vary for different ages and genders. Methods: Based on the data of the "Fourth Survey on the Living Conditions of the Elderly in China" in 2015, a sample survey of 3,360 older adults, aged 60 years and over, in Beijing was conducted. We first explored the built environment factors that affect elderly health with a multilevel regression model. We then adopted a multilevel structural equation model (MSEM) to reveal the mediating effect of health activities. Moreover, a stratified analysis was applied to explore the impact of age and gender heterogeneity on the relationship between built environment and elderly health. Results: (1) Neighborhood-built environment measured within a 500 m buffer area had a higher correlation with elderly health when compared with other areas. (2) Physical activity and social interaction played a mediating role in the correlation between the built environment and elderly health. Even if the interference of residential self-selection was controlled within the subgroups, majority of the built environment elements had significant impacts on elderly health. (3) The impacts of built environment variables on elderly health vary among different age and gender groups. Population density mainly promoted elderly health through health activities in the middle-aged (aged 70-79) group and high-aged (aged 80+) group, and shorter distance to transit stations affects health by promoting the social interaction among high-aged males (aged 80+) group compared to with other groups, and high-quality built environment significantly promotes physical activity to alleviate loneliness only in elderly females. Conclusion: To effectively boost elderly health by improving the quality of the built environment, adequate considerations should also be given to the differentiated demands of adults of different age and gender groups, precise health behavior interventions should be provided, and the construction of personalized aging-friendly and livable spatial environments should be emphasized to realize healthy and active aging.

Association between Perceived Neighborhood Built Environment and Walking and Cycling for Transport among Inhabitants from Latin America: The ELANS Study.

PURPOSE: This study aimed to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in inhabitants from Latin American countries. METHODS: This cross-sectional study involved 9218 participants (15-65 years) from the Latin American Study of Nutrition and Health, which included a nationally representative sample of eight countries. All participants completed the International Physical Activity Questionnaire-Long Form for measure walking and cycling for transport and the Neighborhood Environment Walkability Scale-Abbreviated. Furthermore, perceived proximity from home to public open spaces and shopping centers was assessed. RESULTS: Perceived land use mix-access (OR: 1.32; 95%CI: 1.16,1.50) and the existence of many alternative routes in the neighbourhood (1.09 1.01,1.17) were associated with higher odds of reporting any walking for transport (≥10 min/week). Perceived slow speed of traffic (1.88 1.82,1.93) and few drivers exceeding the speed limits (1.92; 1.86,1.98) were also related to higher odds of reporting any walking for transport. The odds of reporting any cycling for transport (≥10 min/week) were higher in participants perceiving more walking/cycling facilities (1.87 1.76,1.99), and better aesthetics (1.22 1.09,1.38). CONCLUSIONS: Dissimilar perceived neighborhood built environment characteristics were associated with walking and cycling for transport among inhabitants from Latin America.

Relationship between built environment attributes and physical function in Japanese community-dwelling older adults.

AIM: To explore the relationships between the built environment and older adults' physical function. METHODS: The present cross-sectional study carried out in 2010-2012 used data drawn from 509 community-dwelling older adults aged 65-86 years living in Kasama City, a Japanese rural region. We evaluated physical function with the following performance tests: grip strength, sit-to-stand, timed up & go and walking speed. Using geographic information systems, we measured population density and the number of destinations related to daily life, community centers, medical facilities and recreational facilities within participants' neighborhoods. RESULTS: After adjusting for potential confounders, we found lower population density was related to poor performance of sit-to-stand and walking speed in both sexes, and grip strength in women (trend P < 0.05). A lower number of daily life-related destinations was related to poor performance of sit-to-stand and walking speed in men, and grip strength and sit-to-stand in women. Similarly, the number of community centers was related to walking speed in both sexes. The number of medical and recreational facilities was also related to some physical performance in both sexes. A lower land use mix score, calculated by principal component analysis, was related to lower performance of sit-to-stand and walking speed in men, and grip strength and sit-to-stand in women. CONCLUSION: The present study suggests that, although there are some sex differences, low population density, land use mix, and fewer daily life-related destinations, community centers, medical facilities and recreational facilities are negative determinants of physical function. Geriatr Gerontol Int 2017; 17: 382-390.