Walkability and its association with prevalent and incident diabetes among adults in different regions of Germany: results of pooled data from five German cohorts.

BACKGROUND: Highly walkable neighbourhoods may increase transport-related and leisure-time physical activity and thus decrease the risk for obesity and obesity-related diseases, such as type 2 diabetes (T2D). METHODS: We investigated the association between walkability and prevalent/incident T2D in a pooled sample from five German cohorts. Three walkability measures were assigned to participant's addresses: number of transit stations, points of interest, and impedance (restrictions to walking due to absence of intersections and physical barriers) within 640 m. We estimated associations between walkability and prevalent/incident T2D with modified Poisson regressions and adjusted for education, sex, age at baseline, and cohort. RESULTS: Of the baseline 16,008 participants, 1256 participants had prevalent T2D. Participants free from T2D at baseline were followed over a mean of 9.2 years (SD: 3.5, minimum: 1.6, maximum: 14.8 years). Of these, 1032 participants developed T2D. The three walkability measures were not associated with T2D. The estimates pointed toward a zero effect or were within 7% relative risk increase per 1 standard deviation with 95% confidence intervals including 1. CONCLUSION: In the studied German settings, walkability differences might not explain differences in T2D.

[Acoustic quality and urban health-more than just noise and silence]. / Akustische Qualität und Stadtgesundheit ­ Mehr als nur Lärm und Stille.

New approaches in urban development are required to transform cities into sustainable places. This demands a higher degree of urban density, which is hardly conceivable without an increase in sound - mostly in the form of noise. To achieve a high level of acceptance for densification, high-quality and acoustically pleasant urban spaces are essential. Noise reduction measures are necessary, but not sufficient. What is needed is a broadening of the perspective of noise. For urban public health we propose the soundscape approach from two different scientific disciplines. Here, sounds are qualities that can be designed in urban spaces and are an important resource for a healthy city. Linking knowledge about the acoustic environment with human perception will significantly improve our understanding of the relationships between urban acoustic environments, urban spatial contexts, and their effects on human health, both qualitatively and quantitatively. However, a systematic application of these approaches to urban soundscapes is still missing, as is the joint implementation of soundscape approaches in noise impact and urban public health research. This paper aims to introduce the terms sound and noise as well as two soundscape approaches. Subsequently, the aims and methods of the acoustic quality and health in urban environments (SALVE) pilot project are presented. The paper provides early insight into the new field of urban sound quality and soundscapes in the context of urban public health.

Residential Surrounding Greenness, Self-Rated Health and Interrelations with Aspects of Neighborhood Environment and Social Relations.

Previous research suggests that green environments positively influence health. Several underlying mechanisms have been discussed; one of them is facilitation of social interaction. Further, greener neighborhoods may appear more aesthetic, contributing to satisfaction and well-being. Aim of this study was to analyze the association of residential surrounding greenness with self-rated health, using data from 4480 women and men aged 45-75 years that participated in the German population-based Heinz Nixdorf Recall study. We further aimed to explore the relationships of greenness and self-rated health with the neighborhood environment and social relations. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within 100 m around participants' residence. As a result, we found that with higher greenness, poor self-rated health decreased (adjusted OR 0.90, 95% CI 0.82-0.98; per 0.1 increase in NDVI), while neighborhood satisfaction (1.41, 1.23-1.61) and neighborhood social capital (1.22, 1.12-1.32) increased. Further, we observed inverse associations of neighborhood satisfaction (0.70, 0.52-0.94), perceived safety (0.36, 0.22-0.60), social satisfaction (0.43, 0.31-0.58), and neighborhood social capital (0.53, 0.44-0.64) with poor self-rated health. These results underline the importance of incorporating green elements into neighborhoods for health-promoting urban development strategies.

The German Energiewende-a matter for health?

BACKGROUND: Germany's enormous transformation away from nuclear energy and fossil fuels towards a renewable and energy efficient system-called the Energiewende-is playing an essential role in Germany's economy and policymaking. This article summarises the current knowledge on possible health impacts of the Energiewende and describes the need and opportunities to incorporate health into energy-related policy. METHODS: A structural model helped to narrow down specific topics and to conceptualise links between the Energiewende, the environment and health. A comprehensive literature search was conducted within policy documents and scientific databases with English and German language selections. RESULTS: Of 7800 publications first identified only 46 explicitly related energy measures to health, of which 40 were grey literature. Notably, only 12% published by health authorities all others were issued by environmental, energy or consumer protection agencies, ministries or institutions. CONCLUSION: Our study shows that health impacts of the German Energiewende are rarely explicitly addressed. An integration of a health perspective into energy-related policy is needed including the involvement of public health authorities. A health impact assessment can be a suitable tool to support and evaluate Energiewende-related developments from a health perspective.

Walkability and its association with walking/cycling and body mass index among adults in different regions of Germany: a cross-sectional analysis of pooled data from five German cohorts.

OBJECTIVES: To examine three walkability measures (points of interest (POI), transit stations and impedance (restrictions to walking) within 640 m of participant's addresses) in different regions in Germany and assess the relationships between walkability, walking/cycling and body mass index (BMI) using generalised additive models. SETTING: Five different regions and cities of Germany using data from five cohort studies. PARTICIPANTS: For analysing walking/cycling behaviour, there were 6269 participants of a pooled sample from three cohorts with a mean age of 59.2 years (SD: 14.3) and of them 48.9% were male. For analysing BMI, there were 9441 participants of a pooled sample of five cohorts with a mean age of 62.3 years (SD: 12.8) and of them 48.5% were male. OUTCOMES: (1) Self-reported walking/cycling (dichotomised into more than 30 min and 30 min and less per day; (2) BMI calculated with anthropological measures from weight and height. RESULTS: Higher impedance was associated with lower prevalence of walking/cycling more than 30 min/day (prevalence ratio (PR): 0.95; 95% CI 0.93 to 0.97), while higher number of POI and transit stations were associated with higher prevalence (PR 1.03; 95% CI 1.02 to 1.05 for both measures). Higher impedance was associated with higher BMI (ß: 0.15; 95% CI 0.04 to 0.25) and a higher number of POI with lower BMI (ß: -0.14; 95% CI -0.24 to 0.04). No association was found between transit stations and BMI (ß: 0.005, 95% CI -0.11 to 0.12). Stratified by cohort we observed heterogeneous associations between BMI and transit stations and impedance. CONCLUSION: We found evidence for associations of walking/cycling with walkability measures. Associations for BMI differed across cohorts.

Residential Road Traffic Noise and High Depressive Symptoms after Five Years of Follow-up: Results from the Heinz Nixdorf Recall Study.

BACKGROUND: Traffic noise affects a large number of people, particularly in urbanized areas. Noise causes stress and annoyance, but less is known about the relationship between noise and depression. OBJECTIVE: We investigated the association of residential road traffic noise with depressive symptoms using 5-year follow-up data from a German population-based study. METHODS: We analyzed data from 3,300 participants in the Heinz Nixdorf Recall study who were between 45 and 75 years old and were without depressive symptoms at baseline (2000-2003). Depressive symptoms were defined based on the Center for Epidemiologic Studies Depression scale (CES-D) 15-item questionnaire (total score ≥ 17) and antidepressant medication intake. Road traffic noise was modeled according to European Parliament/Council Directive 2002/49/EC. High noise exposure was defined as annual mean 24-hr noise levels > 55 A-weighted decibels [dB(A)]. Poisson regression with robust variance was used to estimate relative risks (RRs) a) adjusting for the potential confounders age, sex, socioeconomic status (SES), neighborhood-level SES, and traffic proximity; b) additionally adjusting for body mass index and smoking; and c) additionally adjusting for the potential confounders/intermediates comorbidities and insomnia. RESULTS: Overall, 35.7% of the participants were exposed to high residential road traffic noise levels. At follow-up (mean = 5.1 years after baseline), 302 participants were classified as having high depressive symptoms, corresponding to an adjusted RR of 1.29 (95% CI: 1.03, 1.62; Model 1) for exposure to > 55 versus ≤ 55 dB(A). Adjustment for potential confounders/intermediates did not substantially alter the results. Associations were stronger among those who reported insomnia at baseline (RR = 1.62; 95% CI: 1.10, 2.59 vs. RR = 1.21; 95% CI: 0.94, 1.57) and appeared to be limited to those with ≤ 13 years of education (RR = 1.43; 95% CI: 1.10, 1.85 vs. 0.92; 95% CI: 0.56, 1.53 for > 13 years). CONCLUSION: Our results suggest that exposure to residential road traffic noise increases the risk of depressive symptoms. CITATION: Orban E, McDonald K, Sutcliffe R, Hoffmann B, Fuks KB, Dragano N, Viehmann A, Erbel R, Jöckel KH, Pundt N, Moebus S. 2016. Residential road traffic noise and high depressive symptoms after five years of follow-up: results from the Heinz Nixdorf Recall Study. Environ Health Perspect 124:578-585; http://dx.doi.org/10.1289/ehp.1409400.