Promoting health in the digital environment: health policy experts' responses to on-demand delivery in Aotearoa New Zealand.

Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes-the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts' proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities.

Occupant behaviour as a fourth driver of fuel poverty (aka warmth & energy deprivation).

A conceptual framework for occupant behaviour as a driver of fuel poverty is presented, comprising: housing and use of the home; heating and energy arrangements and thermal comfort; household structure and dynamics; health and well-being; household finances; and social activity and relations. This framework informs longitudinal analysis of movements into and out of fuel poverty among households in deprived communities in Glasgow. Household surveys across ten years yielded a longitudinal sample of 3297 cases where initial and subsequent fuel poverty status was recorded using an experiential measure. A third of households changed their fuel poverty status over time: 18% moving out of fuel poverty and 16% moving in. Factors strongly associated with movements into fuel poverty included: being a single parent (OR 2.27); experiencing a mental health problem (OR 2.74); and remaining out of work (OR 1.89). Movement out of fuel poverty was less likely among those with infrequent family contact (OR 0.55) and who moved home (OR 0.66); home improvements had no effect upon the experience of fuel poverty. It is argued that the policy problem should be considered one of 'warmth and energy deprivation', accompanied by a broader interpretation of vulnerability to as well as from fuel poverty.

Can housing improvements cure or prevent the onset of health conditions over time in deprived areas?

BACKGROUND: There is a need for more evidence linking particular housing improvements to changes in specific health conditions. Research often looks at generic works over short periods. METHODS: We use a longitudinal sample (n = 1933) with a survey interval of 2-5 years. Multivariate logistic regression is used to calculate the odds ratios of developing or recovering from six health conditions according to receipt of four types of housing improvements. RESULTS: Receipt of fabric works was associated with higher likelihood of recovery from mental health problems and circulatory conditions. Receipt of central heating was also associated with higher likelihood of recovery form circulatory conditions. No evidence was found for the preventative effects of housing improvements. CONCLUSIONS: Health gain from housing improvements appears most likely when targeted at those in greatest health need. The health impacts of area-wide, non-targeted housing improvements are less clear in our study.

Do changes to the local street environment alter behaviour and quality of life of older adults? The 'DIY Streets' intervention.

BACKGROUND: The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans 'DIY Streets') allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults' activities, health and quality of life. METHODS: Pre-post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records. RESULTS: The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants' moderate-to-vigorous activity levels rarely met UK health recommendations. CONCLUSIONS: Our study contributes to methodology in a longitudinal, pre-post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.

A case study of Missouri's deferred retirement incentive for state employees.

Delayed retirement incentives can promote employee retention. Survey data results (N = 261) were used to explore factors associated with retirement and participation in Missouri's Deferred Retirement Option Provision (BackDROP), using a social stratification framework. Logistic regression analyses found that older age for full-retirement benefit eligibility increased the odds of delayed retirement, as did working more years for the state of Missouri. Longer length of work for Missouri increased the likelihood of being aware of one's eligibility for BackDROP and of taking the BackDROP option, while working for pay in a non-state position decreased the odds of awareness and selection. Those who retired to do other things (rather than for health reasons or disliking the work) were also more likely to be knowledgeable of their BackDROP eligibility status. Race, sex, education, and marital status were not significant predictors. These findings inform design and implementation of delayed retirement policies in other states.

Quantifying access to on-demand alcohol in New Zealand.

INTRODUCTION: On-demand delivery (<2 h from ordering) of alcohol is relatively new to New Zealand. We aimed to quantify the number of services available and the number of outlets available to purchase from within on-demand services. We then tested whether access differed by neighbourhood demographics. METHODS: We identified six on-demand alcohol services and quantified access to these in Auckland, Wellington and Christchurch. Eighty-one addresses were sampled according to three variables: (i) density of physical alcohol outlet tertile; (ii) socio-economic deprivation tertile; and (iii) areas within the top 20th percentile of Maori within each city. RESULTS: The median number of alcohol outlets to purchase from across all on-demand delivery services was five, though this was higher in Christchurch. For all three cities combined, and for Wellington, the number of outlets available on-demand was highest in areas with the highest density of physical outlets. However, the number of outlets available virtually was not associated with physical outlet density in Auckland or Christchurch. There were no significant differences in access observed for neighbourhood socio-economic deprivation. DISCUSSION AND CONCLUSIONS: On-demand delivery services are changing local alcohol environments, and may be increasing overall access to alcohol at a neighbourhood level. On-demand access patterns do not consistently reflect the physical alcohol environment. The current legislative and policy environment in New Zealand pre-dates the emergence of on-demand alcohol services. Local councils need to consider 'virtual' access as well as physical access when developing Local Alcohol Policies.

Developing gerontological competency: a curriculum approach.

This study describes a competency-based educational approach to course development, implementation, and evaluation. The course model is presented, including its philosophical base. The authors hypothesized that student participation in a competency-based graduate gerontology course would increase their perceived competency level. Results indicate that students (N = 74 students; 2008-2011) rated their competency skill level as higher at posttest than at the pretest (paired t-tests, p < .01), as measured by the Geriatric Social Work Competency Scale II. In addition, pretest/posttest results on the Myths of Aging checklist and Expectations Regarding Aging survey supported increases of perceived knowledge of older adults at posttest (p < .01). This project illustrates the benefits of organizing and implementing competency-based curriculum so that students are better prepared to work with older adults when they graduate.

Marital Quality and Alcohol Use among Couples in Mid- and Later-Life.

Spouses influence one another's drinking behavior, but little research has explored how relationship quality may impact older couples' alcohol use. Using data from the 2014-2018 waves of the Health and Retirement Study (HRS) and actor-partner interdependence models, we examined how marital quality is related to total alcohol consumption and risk of heavy drinking for married couples over age 50. Neither husbands' nor wives' perceptions of negative marital quality were related to changes in heavy drinking or number of drinks consumed over the observation period. However, wives' positive marital quality was associated with increased risk of heavy alcohol use for both wives and husbands, and with an increase in the number of drinks wives consume over time. Couples over age 50 do not appear to use alcohol as a way of coping with negative marital relationships, but rather may increase their drinking in the context of positive relationships.

Online on-demand delivery services of food and alcohol: A scoping review of public health impacts.

The increase in availability of online on-demand food and alcohol delivery services has changed the way unhealthy commodities are accessed and understood. We conducted a systematic scoping review of academic and grey literature to map the current knowledge of public health and regulatory/policy outcomes arising from on-demand food and alcohol delivery (defined as delivery within 2 h). We systematically searched three electronic databases and completed supplementary forward citation searches and Google Scholar searches. In total, we screened 761 records (de-duplicated) and synthesised findings from 40 studies by commodity types (on-demand food or alcohol) and outcome focus (outlet, consumer, environmental, labour). Outlet-focused outcomes were most common (n = 16 studies), followed by consumer (n = 11), environmental (n = 7), and labour-focused (n = 6) outcomes. Despite geographical and methodological diversity of studies, results indicate that on-demand delivery services market unhealthy and discretionary foods, with disadvantaged communities having reduced access to healthy commodities. Services that deliver alcohol on-demand can also subvert current alcohol access restrictions, particularly through poor age verification processes. Underpinning these public health impacts is the multi-layered nature of on-demand services and context of the COVID-19 pandemic, which creates ongoing complications as to how populations access food and alcohol. Changing access to unhealthy commodities is an emerging issue in public health. Our scoping review considers priority areas for future research to better inform policy decisions. Current regulation of food and alcohol may not appropriately cover emerging on-demand technologies, necessitating a review of policy.

Describing and characterising on-demand delivery of unhealthy commodities in New Zealand.

OBJECTIVE: To determine the geographical location and characteristics of on-demand delivery services operating in New Zealand. METHODS: We systematically searched the web and application (app) stores for on-demand services offering rapid delivery of food, alcohol, cigarettes or vaping products in New Zealand and mapped their geographic location as of May 2021. Using desktop review, data on service characteristics were collected and stratified including: types of commodities available, promotion strategies, and the legal aspects of access to age-restricted items. RESULTS: On-demand services for food, alcohol and nicotine products operate across urban and rural New Zealand. All services offered personal memberships and 97% used promotions. All services offering restricted items had an age verification process, however, only 87% had birth date entry and 73% had an 18+ message pop-up on website entry. Only 60% of services appeared to have number limits on restricted items. CONCLUSIONS: Much of New Zealand is serviced by on-demand delivery services. IMPLICATIONS FOR PUBLIC HEALTH: The trend towards on-demand delivery services may increase unhealthy food, alcohol and nicotine-related harms and it undermines current government actions, e.g. the Smokefree 2025 goal. This research informs policy to reduce the future health burden.

Food Outlet Access and the Healthiness of Food Available 'On-Demand' via Meal Delivery Apps in New Zealand.

Access to unhealthy commodities is a key factor determining consumption, and therefore influences the prevalence of non-communicable diseases. Recently, there has been an increase in the availability of food 'on-demand' via meal delivery apps (MDAs). However, the public health and equity impacts of this shift are not yet well understood. This study focused on three MDAs in New Zealand and aimed to answer (1) what is the health profile of the foods being offered on-demand, (2) how many food outlets are available and does this differ by physical access or neighbourhood demographics and (3) does the health profile of foods offered differ by physical access or neighbourhood demographics? A dataset was created by sampling a set of street addresses across a range of demographic variables, and recording the menu items and number of available outlets offered to each address. Machine learning was utilised to evaluate the healthiness of menu items, and we examined if healthiness and the number of available outlets varied by neighbourhood demographics. Over 75% of menu items offered by all MDAs were unhealthy and approximately 30% of all menu items across the three MDAs scored at the lowest level of healthiness. Statistically significant differences by demographics were identified in one of the three MDAs in this study, which suggested that the proportion of unhealthy foods offered was highest in areas with the greatest socioeconomic deprivation and those with a higher proportion of Maori population. Policy and regulatory approaches need to adapt to this novel mode of access to unhealthy foods, to mitigate public health consequences and the effects on population groups already more vulnerable to non-communicable diseases.

Neighborhood Engagement, Dogs, and Life Satisfaction in Older Adulthood.

OBJECTIVES: This study examined the relationships between dog ownership, dog walking, and the emotional bond with a dog to neighborhood engagement and life satisfaction among those over age 50. METHOD: Using data from the Health and Retirement Study (N = 476), two path analysis models were conducted to test the research hypotheses. RESULTS: Findings indicated that dog ownership did not have a direct or indirect relationship on life satisfaction. However, time spent in dog walking was associated with frequency of social interactions, which itself had a positive association with life satisfaction. The bond with a dog was not directly associated with life satisfaction but was associated with dog walking. DISCUSSION: Dog walking is a promising strategy for simultaneously promoting better health and social engagement, and these factors in turn can promote greater life satisfaction of older adults.

Access to primary care services using public transport in Otautahi Christchurch.

AIMS: Lack of transport is a contributor to poor access to healthcare and missed appointments. This research aimed to understand the accessibility of primary care for patients using public transport in Otautahi Christchurch, and to describe spatial and social distribution. METHODS: We measured access to primary care using geospatial analysis based on the time taken to reach the nearest general practice, the number of practices accessible within given time thresholds and the frequency of public transport services. Results are disaggregated by ethnicity, age, socioeconomic deprivation and car ownership. RESULTS: The poorest levels of access were in areas with the least deprivation and a greater NZ European population. Children aged 5-14 had low levels of access. Only 58.4% of the population in the most deprived areas had access to high-frequency bus services. CONCLUSIONS: This study highlights connectivity gaps between public transport and primary healthcare for key groups known to have a greater dependence upon public transport and poorer health outcomes. From an equity perspective, it highlights the need for further investigation into transport and health solutions to improve access to primary care for lower socioeconomic groups.

A case study of professional change: the impact of the National Gerontological Social Work Competencies Survey.

Our society is aging, and this demographic change necessitates that all social workers have basic competency in gerontology. This article describes the results of a competency survey conducted in 2000, and how these results helped transform basic social work curricula and enhance gerontology-related resources. Results were used to encourage and assist social work faculty to infuse gerontological content into social work curriculum, which helped practitioners to gain the necessary knowledge and skills to meet the needs of a growing aging population. This social work education framework can be replicated in an effort to infuse gerontology content throughout other disciplines.

Experiences of the Built Environment, Falls and Fear of Falling Outdoors among Older Adults: An Exploratory Study and Future Directions.

Falls can have serious impacts on the health, wellbeing and daily mobilities of older adults. Falls are a leading cause of injury and death amongst older adults and outdoor falls comprise a substantial proportion of pedestrian injuries. As well as physical injuries, the psychological impacts of experiencing a fall can result in older adults getting out of the house less often, resulting in lower levels of physical activity and social connection. Despite the known consequences of falls, relatively little research considers the impact of the urban built environment on falls among older adults. This research aimed to explore the experiences of older adults in the urban environment, falling and the fear of falling outdoors. We conducted an online survey with adults aged 50+ using a participatory mapping survey tool and a convenience sample. The study area was Greater Christchurch, New Zealand. Results suggest that both perceived accessibility and neighbourhood conditions are independently associated with fear of falling, after controlling for frequency of falling, gender and activities of daily living. Our findings demonstrate the need for much better understandings of the relationships between the urban environment, outdoor mobility, fear of falling and falling among older adults and we propose suggestions for future research.

Transitioning From Successful Aging: A Life Course Approach.

Objective: The life course perspective and representative U.S. data are used to test Rowe and Kahn's Successful Aging (SA) conceptualization. Four sets of influences (childhood experiences, social structural factors, adult attainments, and later life behaviors) on SA transitions are examined to determine the relative role of structural factors and individual behaviors in SA. Method: Eight waves of Health and Retirement Study data for 12,108 respondents, 51 years and older, are used in logistic regression models predicting transitions out of SA status. Results: Social structural factors and childhood experiences had a persistent influence on transitions from SA, even after accounting for adult attainments and later life behaviors-both of which also impact SA outcomes. Discussion: The findings on sustained social structural influences call into question claims regarding the modifiability of SA outcomes originally made in presentation of the SA model. Implications for policy and the focus and timing of intervention are considered.

Longitudinal Associations Between Formal Volunteering and Cognitive Functioning.

Objectives: The present study examines the association between formal volunteering and cognitive functioning over time. We also examine the moderating roles of race, sex, education, and time. Method: Using 11,100 participants aged 51 years and older and nine waves of data from the Health and Retirement Survey, we simultaneously modeled the longitudinal associations between engaging in formal volunteering and changes in cognitive functioning using multilevel models. Results: Formal volunteering was associated with higher levels of cognitive functioning over time, especially with aspects of cognitive functioning related to working memory and processing. This association was stronger for women than it was for men, and for those with below average levels of education. The positive association between formal volunteering and cognitive functioning weakened over time when cognitive functioning was conceptualized as memory, but strengthened over time when conceptualized as working memory and processing. Discussion: Volunteering is a productive activity that is beneficial not just to society, but to volunteers' levels of cognitive functioning in older age. For women and those with lower levels of education, formal volunteering appears particularly beneficial to working memory and processing.

Human-Animal Interaction and Older Adults: An Overview.

Both pet ownership and animal-assisted therapy are becoming increasingly popular in the United States, and the science of human-animal interaction (HAI) seeks to explore how these relationships with animals can impact health and well-being. In particular, one burgeoning area of research is the role of HAI in healthy aging, given the potential for HAI as an important feature of health and well-being in older adults. The purpose of this review is to summarize and evaluate existing research in this innovative area of scholarship, identifying the potential benefits and risks of both pet ownership and animals in therapeutic settings for older adults. We will also identify recommendations for future research and applications in this developing area of scholarship.

Dog Walking, the Human-Animal Bond and Older Adults' Physical Health.

Purpose of the Study: This study explored the associations between dog ownership and pet bonding with walking behavior and health outcomes in older adults. Design and Methods: We used data from the 12th wave (2012) of the Health and Retirement Study which included an experimental human-animal interaction module. Ordinary least squares regression and binary logistic regression models controlling for demographic variables were used to answer the research questions. Results: Dog walking was associated with lower body mass index, fewer activities of daily living limitations, fewer doctor visits, and more frequent moderate and vigorous exercise. People with higher degrees of pet bonding were more likely to walk their dog and to spend more time walking their dog each time, but they reported walking a shorter distance with their dog than those with weaker pet bonds. Dog ownership was not associated with better physical health or health behaviors. Implications: This study provides evidence for the association between dog walking and physical health using a large, nationally representative sample. The relationship with one's dog may be a positive influence on physical activity for older adults.

Developing an audit checklist to assess outdoor falls risk.

Falls by older people (aged 65+) are linked to disability and a decrease in mobility, presenting a challenge to active ageing. As such, older fallers represent a vulnerable road user group. Despite this there is little research into the causes and prevention of outdoor falls. This paper develops an understanding of environmental factors causing falls or fear of falling using a walk-along interview approach with recent fallers to explore how older people navigate the outdoor environment and which aspects of it they perceived facilitate or hinder their ability to go outdoors and fear of falling. While there are a number of audit checklists focused on assessing the indoor environment for risk or fear of falls, nothing exists for the outdoor environment. Many existing street audit tools are focused on general environmental qualities and have not been designed with an older population in mind. We present a checklist that assesses aspects of the environment most likely to encourage or hinder those who are at risk of falling outdoors, developed through accounting for the experiences and navigational strategies of elderly individuals. The audit checklist can assist occupational therapists and urban planners, designers and managers in working to reduce the occurrence of outdoor falls among this vulnerable user group.