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.

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.

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.

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.

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).

Can neighborhood green space mitigate health inequalities? A study of socio-economic status and mental health.

This study examined whether the association of psychological distress with area-level socio-economic status (SES) was moderated by the area and attractiveness of local green space. As expected, the odds of higher psychological distress was higher in residents in lower SES areas than those in higher SES areas. However, our results were inconclusive with regard to the moderating role of green space in the relationship between psychological distress and SES. Further investigations incorporating safety and maintenance features of green space and street-level greenery are warranted.

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.

The impact of parents' fear of strangers and perceptions of informal social control on children's independent mobility.

Declines in children's independent mobility are commonly attributed to parents' fear of strangers, yet few empirical studies have investigated this relationship. We examined: (1) the impact of parents' fear of strangers on children's independent mobility; and (2) whether informal social control (i.e., parents' confidence that other residents would look out for local children) mitigated any association. Gender stratified logistic regression models tested these associations for 10-12 year-olds and their parents (n=1231) in Perth, Australia. For girls, parental fear of strangers was associated with lower odds of independent mobility (OR=0.71, p=0.002), and informal social control and other social and built environment variables had little attenuating influence. This pattern was consistent for boys; however odds ratios were lower and statistical significance weaker. Initiatives that target parental fears combined with interventions that normalise children's walking may help increase independent mobility.

Reconnecting urban planning with health: a protocol for the development and validation of national liveability indicators associated with noncommunicable disease risk behaviours and health outcomes.

AIM: Liveable communities create the conditions to optimise health and wellbeing outcomes in residents by influencing various social determinants of health - for example, neighbourhood walkability and access to public transport, public open space, local amenities, and social and community facilities. This study will develop national liveability indicators that are (a) aligned with state and federal urban policy, (b) developed using national data (where available), (c) standard and consistent over time, (d) suitable for monitoring progress towards creating more liveable, equitable and sustainable communities, (e) validated against selected noncommunicable disease risk behaviours and/or health outcomes, and (f) practical for measuring local, national and federal built environment interventions. STUDY TYPE: Protocol. METHOD: Over two years, the National Liveability Study, funded through The Australian Prevention Partnership Centre (TAPPC), will develop and validate a national set of spatially derived built environment liveability indicators related to noncommunicable disease risk behaviours and/or health outcomes, informed by a review of relevant policies in selected Australian state and territory governments. To create national indicators, we will compare measures developed using national data with finer-grained state-level data, which have been validated against a range of outcomes. Finally, we will explore the creation of a national database of built environment spatial indicators. RESULTS: A national advisory group comprising stakeholders in state and federal government, federal nongovernment organisations and state-based technical working groups located in the ACT, Victoria, NSW, Queensland and WA has been established; a policy analysis is under way and work programs are being prepared. CONCLUSION: This project seeks to build the capacity for built environment and health systems research by developing national indicators to monitor progress towards creating healthy and liveable communities. This ambition requires multisector engagement and an interdisciplinary research team.

Driving down daily step counts: the impact of being driven to school on physical activity and sedentary behavior.

This study investigated whether being driven to school was associated with lower weekday and weekend step counts, less active out-of-school leisure pursuits, and more sedentary behavior. Boys aged 10-13 years (n = 384) and girls aged 9-13 years (n = 500) attending 25 Australian primary schools wore a pedometer and completed a travel diary for one week. Parents and children completed surveys capturing leisure activity, screen time, and sociodemographics. Commute distance was objectively measured. Car travel was the most frequent mode of school transportation (boys: 51%, girls: 58%). After adjustment (sociodemographics, commute distance, and school clustering) children who were driven recorded fewer weekday steps than those who walked (girls: -1,393 steps p < .001, boys: -1,569 steps, p = .009) and participated in fewer active leisure activities (girls only: p = .043). There were no differences in weekend steps or screen time. Being driven to and from school is associated with less weekday pedometer-determined physical activity in 9- to 13-year-old elementary-school children. Encouraging children, especially girls, to walk to and from school (even for part of the way for those living further distances) could protect the health and well-being of those children who are insufficiently active.

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.