Public greenspace and mental wellbeing among mid-older aged adults: Findings from the HABITAT longitudinal study.

We explored temporal associations between public greenspace and adults' mental wellbeing. Participants (n = 5,906) aged 40-65 years at baseline had data at >2 post-baseline waves of HABITAT, a multilevel longitudinal study (2007-16) in Brisbane, Australia. Participants self-reported mental wellbeing (short Warwick-Edinburgh Mental Wellbeing Scale) and neighbourhood self-selection reasons at Waves 2-5 (2009-11-13-16). We examined associations between Δgreenspace (within 1 km of home) and Δmental wellbeing using a linear fixed effects model, adjusting for time-varying confounders. Mental wellbeing increased (ß = 1.75; 95% Confidence Interval:0.25-3.26) with greenspace exposure, adjusting for self-selection. Urban planning and policy initiatives to increase public greenspace may benefit mental wellbeing.

The moderating effects of greenspace on the association between neighbourhood disadvantage and obesity among mid-to-older aged Australian adults.

This study examined whether the association between neighbourhood disadvantage and obesity was moderated by quantity and quality of greenspace. The sample included 2848 mid-to-older aged adults residing in 200 neighbourhoods in Brisbane, Australia from the HABITAT study. Self-reported height and weight were used to calculate body mass index (BMI), neighbourhood disadvantage was measured using a census-derived composite index and greenspace was measured geospatially. We found evidence of moderation by park quality: lower average BMI at higher levels of park quality was shown in the Q3 rather than the Q1 (least disadvantaged) neighbourhood disadvantage group. The findings suggest that, for reducing socioeconomic inequalities in obesity, the quality of greenspace is imperative.

Examining variation in the relationship between disability and physical activity across Australian local government areas.

Understanding the relationship between disability and physical activity and whether it differs across local government jurisdictions may aid in the development of placed-based approaches to reducing disability-related inequalities in physical activity. The objectives of this study were to examine the association between disability and physical activity and assess whether this association varied between Australian Local Government Areas. The sample included 13,315 participants aged 18-64 years from the Household Income and Labour Dynamics Australia Survey, 2017. Participants self-reported disability and physical activity. Linear mixed-effects models estimated the association between disability and physical activity. People with disability reported less physical activity per week. We did not find evidence that this association varied across LGAs. Our findings do not add evidence towards local government-based approaches in Australia to reducing physical activity inequalities between people with and without a disability.

Changes in neighbourhood walkability and body mass index: An analysis of residential mobility from a longitudinal multilevel study in Brisbane, Australia.

This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research.

Effects of qigong exercise on physical fitness and patient-reported health outcomes in lung cancer survivors.

PURPOSE: The aim of this study was to investigate the effects of a three-month Guolin Qigong (GQ) intervention on physical fitness and patient-reported health outcomes among patients with lung cancer. METHODS: This pilot study was a non-randomized controlled trial. Eligible participants who were over 18 years of age and diagnosed with stage I-IV lung cancer were enrolled in the study and received either the GQ intervention or usual care (UC). Participants in the GQ group performed GQ at least twice a week (one hour per session) for three months. Physical fitness (chair stand, arm curl, sit and reach, back scratch, 8-foot up and go, 6-min walk test) was assessed at baseline, post-intervention, six months, and 12 months. Self-reported quality of life and sleep (European Organization for Research and Treatment of Cancer Quality of Life questionnaire and Pittsburgh Sleep Quality Index) were assessed at baseline, post-intervention, and six months. RESULTS: Forty-nine participants (65% females, 59.1 ± 7.0 years old, ranging from 39 to 71 years old) were enrolled in the study, and 25 participants completed all tests at 12-month follow-up (13 in GQ vs. 12 in UC; 68% females, 59.3 ± 5.5 years old). Compared to the UC group, results for the chair stand and arm curl tests improved significantly in the GQ group from baseline to post-intervention (P = 0.024 and P = 0.041, respectively). Similarly, the 8-foot up and go test improved in the GQ group from baseline to post-intervention and 12 months (P = 0.004 and P = 0.008, respectively) when compared to the UC group. Between-group analyses also revealed a statistically significant improvement in global health status/quality of life from baseline to six months (P = 0.018) and quality of sleep from baseline to post-intervention (P = 0.034) in favor of the GQ group. CONCLUSION: GQ had a beneficial effect on lower and upper body strength, locomotor performance (speed, agility, and balance while moving), quality of sleep, and quality of life among lung cancer survivors, but further randomized controlled trials are warranted to confirm these findings. TRIAL REGISTRATION: The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR2200059145).

Associations between changes in crime and changes in walking for transport with effect measure modification by gender: A fixed-effects analysis of the multilevel longitudinal HABITAT study (2007-2016).

Walking for transport is a potential solution to increasing physical activity in mid to older aged adults however neighbourhood crime may be a barrier. Using data from the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study 2007-2016, this study examined associations between changes in crime (perceived crime and objectively measured crime) and changes in transport walking, and whether this association differed by gender. Fixed effects regression modelled associations between changes in crime and changes in transport walking, with interaction terms examining effect modification by gender. Positive associations were found between crimes against person and walking for transport. There was no evidence of effect modification by gender. Understanding the relationship between crime and walking for transport can inform policies aimed at promoting transport walking.

Improving the accuracy of self-reported height and weight in surveys: an experimental study.

BACKGROUND: Many studies rely on self-reported height and weight. While a substantial body of literature exists on misreporting of height and weight, little exists on improving accuracy. The aim of this study was to determine, using an experimental design and a comparative approach, whether the accuracy of self-reported height and weight data can be increased by improving how these questions are asked in surveys, drawing on the relevant evidence from the psychology and survey research literatures. METHODS: Two surveys from two separate studies were used to test our hypotheses (Science Survey, n = 1,200; Eating Behaviours Survey, n = 200). Participants were randomly assigned to one of six conditions, four of which were designed to improve the accuracy of the self-reported height and weight data ("preamble"), and two of which served as the control conditions ( "no preamble"). Four hypotheses were tested: (H1) survey participants read a preamble prior to being asked their height and weight will report lower heights and higher weights than those not read a preamble; (H2) the impact of question-wording (i.e., preamble vs. no preamble) on self-reported weight will be greater for participants with higher BMIs; (H3) the impact of question-wording on height will be greater for older participants; (H4) either version of the weight question - standard or "weight-specific"-may result in participants reporting more accurate self-reported weight. One-way MANOVA was conducted to test Hypothesis 1; two-way analysis of variance were conducted to test Hypothesis 2; moderation analysis was used to test Hypothesis 3; independent samples t-test was conducted to test Hypothesis 4. RESULTS: None of the hypotheses was supported. CONCLUSIONS: This paper provides an important starting point from which to inform further work exploring how question wording can improve self-reported measurement of height and weight. Future research should explore how question preambles may or may not operationalise hypothesised underlying mechanisms, the sensitivity or intrusiveness of height and weight questions, individual beliefs about one's height and weight, and survey context.

Sociodemographic characteristics and social exclusion among the oldest old.

OBJECTIVES: The socioeconomically disadvantaged oldest old (people aged 85 years and over) are more vulnerable to social exclusion than the general population. Using a population representative sample, this paper examined associations between sociodemographic characteristics and social exclusion among the oldest old. METHODS: This cross-sectional study included 307 participants aged 85 years and over from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Sociodemographic characteristics were measured using household composition, country of birth, housing tenure, income, education and neighbourhood-level disadvantage. Three social exclusion domains were derived representing unsupportive relationships, neighbourhood exclusion and community disengagement. Analysis was undertaken separately for men and women. RESULTS: Among men, living alone was associated with higher levels of unsupportive relationships (ß = 11.6, 95%CI 2.1, 21.0) and having a lower income was associated with lower levels of neighbourhood disunity (ß = -16.7, 95%CI -31.2, -2.2). Among women, living alone was associated with lower levels of community disengagement (ß = -7.2, 95%CI -13.4, -0.9) and neighbourhood disadvantage was associated with lower levels of neighbourhood disunity (ß = -10.4, 95%CI -19.6, -1.2). Both men and women with lower levels of education had higher levels of community disengagement (men: ß = 8.3, 95%CI 1.9, 14.7; women: ß = 17.0, 95%CI 8.6, 25.5). CONCLUSIONS: This study showed few and unexpected associations between sociodemographic characteristics and social exclusion among oldest-old Australians, suggesting a homogeneous effect of advancing age. Government approaches aimed at reducing social exclusion in this age group should consider gender and taking action across all socioeconomic stratification. Further research is warranted to understand the underlying mechanisms linking sociodemographic characteristics to social exclusion.

Individual socioeconomic position, neighbourhood disadvantage and mental well-being: a cross-sectional multilevel analysis of mid-age adults.

BACKGROUND: Socioeconomic disadvantage is associated with mental illness, yet its relationship with mental well-being is unclear. Mental well-being is defined as feeling good and functioning well. Benefits of mental well-being include reduced mortality, improved immune functioning and pain tolerance, and increased physical function, pro-social behaviour, and academic and job performance. This study aims to explore the relationship between individual socioeconomic position (SEP), neighbourhood disadvantage and mental well-being in mid-age adults. METHODS: Multilevel modelling was used to analyse data collected from 7866 participants from the second (2009) wave of HABITAT (How Areas in Brisbane Influence healTh and activiTy), a longitudinal study (2007-2018) of adults aged 40-65 years living in Brisbane, Australia. Mental well-being was measured using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). Exposure measures were education, occupation, household income, and neighbourhood socioeconomic disadvantage. RESULTS: The lowest MWB scores were observed for the least educated (ß = - 1.22, 95%CI = - 1.74, - 0.71), those permanently unable to work (ß = - 5.50, 95%CI = - 6.90, - 4.10), the unemployed (ß = - 2.62, 95%CI = - 4.12, - 1.13), and members of low-income households (ß = - 3.77, 95%CI = - 4.59, - 2.94). Residents of the most disadvantaged neighbourhoods had lower MWB scores than those living in the least disadvantaged neighbourhoods, after adjustment for individual-level SEP (ß = - 0.96, 95%CI = - 1.66, - 0.28). CONCLUSIONS: Both individual-level SEP and neighbourhood disadvantage are associated with mental well-being although the association is stronger for individual-level SEP. This research highlights the need to address individual and neighbourhood-level socioeconomic determinants of mental well-being.

Using machine learning to examine associations between the built environment and physical function: A feasibility study.

Linking geospatial neighbourhood design characteristics to health and behavioural data from population-representative cohorts is limited by data availability and difficulty collecting information on environmental characteristics (e.g. greenery, building setbacks, dwelling structure). As an alternative, this study examined the feasibility of Generative Adversarial Networks (GANs) - machine learning - to measure neighbourhood design using 'street view' and aerial imagery to explore the relationship between the built environment and physical function. This study included 3102 adults aged 45 years and older clustered in 200 neighbourhoods in 2016 from the How Areas in Brisbane Influence Health and Activity (HABITAT) project in Brisbane, Australia. Exposure data were Google Street View and Google Maps images from within the 200 neighbourhoods, and outcome data were self-reported physical function using the PF-10 (a subset of the SF-36). Physical function scores were aggregated to the neighbourhood level, and the highest and lowest 20 neighbourhoods respectively were used in analysis. We found that the aerial imagery retrieved was unable to be used to adequately train the model, meaning that aerial imagery failed to produce meaningful results. Of the street view images, n = 56,330 images were downloaded and used to train the GAN model. Model outputs included augmented street view images between neighbourhoods classed as having high function and low function residents. The GAN model detected differences in neighbourhood design characteristics between neighbourhoods classed as high and low physical function at the aggregate level. Specifically, differences were identified in urban greenery (including tree heights) and dwelling structure (e.g. building height). This study provides important lessons for future work in this field, especially related to the uniqueness, diversity and amount of imagery required for successful applications of deep learning methods.

Do Differences in Social Environments Explain Gender Differences in Recreational Walking across Neighbourhoods?

Within a city, gender differences in walking for recreation (WfR) vary significantly across neighbourhoods, although the reasons remain unknown. This cross-sectional study investigated the contribution of the social environment (SE) to explaining such variation, using 2009 data from the How Areas in Brisbane Influence healTh and AcTivity (HABITAT) study, including 7866 residents aged 42-67 years within 200 neighbourhoods in Brisbane, Australia (72.6% response rate). The analytical sample comprised 200 neighbourhoods and 6643 participants (mean 33 per neighbourhood, range 8-99, 95% CI 30.6-35.8). Self-reported weekly minutes of WfR were categorised into 0 and 1-840 mins. The SE was conceptualised through neighbourhood-level perceptions of social cohesion, incivilities and safety from crime. Analyses included multilevel binomial logistic regression with gender as main predictor, adjusting for age, socioeconomic position, residential self-selection and neighbourhood disadvantage. On average, women walked more for recreation than men prior to adjustment for covariates. Gender differences in WfR varied significantly across neighbourhoods, and the magnitude of the variation for women was twice that of men. The SE did not explain neighbourhood differences in the gender-WfR relationship, nor the between-neighbourhood variation in WfR for men or women. Neighbourhood-level factors seem to influence the WfR of men and women differently, with women being more sensitive to their environment, although Brisbane's SE did not seem such a factor.

Neighbourhood built environment and physical function among mid-to-older aged adults: A systematic review.

This systematic review included 23 quantitative studies that estimated associations between aspects of the neighbourhood built environment and physical function among adults aged ≥45 years. Findings were analysed according to nine aspects of the neighbourhood built environment: walkability, residential density, street connectivity, land use mix, public transport, pedestrian infrastructure, aesthetics, safety and traffic. Evidence was found for a positive association of pedestrian infrastructure and aesthetics with physical function, while weaker evidence was found for land use mix, and safety from crime and traffic. There was an insufficient number of studies for walkability, residential density, street connectivity and access to public transport.

A multilevel study of neighborhood disadvantage, individual socioeconomic position, and body mass index: Exploring cross-level interaction effects.

This study examined associations between neighborhood disadvantage and body mass index (BMI), and tested whether this differed by level of individual socioeconomic position (SEP). Data were from 9953 residents living in 200 neighborhoods in Brisbane, Australia in 2007. Multilevel linear regression analyses were undertaken by gender to determine associations between neighborhood disadvantage, individual SEP (education, occupation and household income) and BMI (from self-reported height and weight); with cross-level interactions testing whether the relationship between neighborhood disadvantage and BMI differed by level of individual SEP. Both men (Quintile 4, where Quintile 5 is the most disadvantaged ß = 0.66 95%CI 0.20, 1.12) and women (Quintile 5 ß = 1.32 95%CI 0.76, 1.87) from more disadvantaged neighborhoods had a higher BMI. BMI was significantly higher for those with lower educational attainment (men ß = 0.71 95%CI 0.36, 1.07 and women ß = 1.66 95%CI 0.78, 1.54), and significantly lower for those in blue collar occupations (men ß = -0.67 95%CI -1.09, -0.25 and women ß = -0.71 95%CI -1.40, -0.01). Among men, those with a lower income had a significantly lower BMI, while the opposite was found among women. None of the interaction models had a significantly better fit than the random intercept models. The relationship between neighborhood disadvantage and BMI did not differ by level of education, occupation, or household income. This suggests that individual SEP is unlikely to be an effector modifier of the relationship between neighborhood disadvantage and BMI. Further research is required to assist policy-makers to make more informed decisions about where to intervene to counteract BMI-inequalities.

The potential for walkability to narrow neighbourhood socioeconomic inequalities in physical function: A case study of middle-aged to older adults in Brisbane, Australia.

Residents of disadvantaged neighbourhoods have poorer physical function than their advantaged counterparts, although the reasons for this remain largely unknown. We examined the moderating effects of walkability in the relationship between neighbourhood disadvantage and physical function using 2013 cross-sectional data from 5115 individuals aged 46-72 living in 200 neighbourhoods in Brisbane, Australia. The relationship between neighbourhood disadvantage and physical function differed by levels of walkability: positive associations as levels of walkability increased for those living in more disadvantaged neighbourhoods, and no difference for those living in more advantaged neighbourhoods. Further work is required to better understand the underlying mechanisms.

Land use proportion and walking: Application of isometric substitution analysis.

Entropy measures of land use mix are a commonly used component of walkability. However, they present methodological challenges, and studies on their associations with walking have produced mixed findings. This study examined associations of the proportion of discrete land uses with walking, using isometric substitution models that take the complementary nature of land use proportions into account. Analysis of data collected from middle-aged adults living in Brisbane, Australia (n = 10,794) found that replacing residential or other land with commercial land was associated with higher levels of walking. The isometric substitution approach may explain the potential impact of land use changes on residents' walking.

Neighborhood Disadvantage and Physical Function: The Contributions of Neighborhood-Level Perceptions of Safety From Crime and Walking for Recreation.

BACKGROUND: Residents of more socioeconomically disadvantaged neighborhoods are more likely to report poorer physical function, although the reasons for this remain unknown. It is possible that neighborhood-level perceptions of safety from crime contribute to this relationship through its association with walking for recreation. METHODS: Data were obtained from the fourth wave (collected in 2013) of the HABITAT (How Areas in Brisbane Influence HealTh and AcTivity) multilevel longitudinal study of middle- to older-aged adults (46-74 y) residing in 200 neighborhoods in Brisbane, Australia. The data were analyzed separately for men (n = 2190) and women (n = 2977) using multilevel models. RESULTS: Residents of the most disadvantaged neighborhoods had poorer physical function, perceived their neighborhoods to be less safe from crime, and do less walking for recreation. These factors accounted for differences in physical function between disadvantaged and advantaged neighborhoods (24% for men and 25% for women). CONCLUSION: This study highlights the importance of contextual characteristics, through their associations with behaviors, that can have in explaining the relationship between neighborhood disadvantage and physical function. Interventions aimed at improving neighborhood safety integrated with supportive environments for physical activity may have positive impact on physical function among all socioeconomic groups.

Neighborhood Disadvantage and Body Mass Index: A Study of Residential Relocation.

Natural experiments, such as longitudinal observational studies that follow-up residents as they relocate, provide a strong basis to infer causation between the neighborhood environment and health. In this study, we examined whether changes in the level of neighborhood disadvantage were associated with changes in body mass index (BMI) after residential relocation. This analysis included data from 928 residents who relocated between 2007 and 2013, across 4 waves of the How Areas in Brisbane Influence Health and Activity (HABITAT) study in Brisbane, Australia. Neighborhood disadvantage was measured using a census-derived composite index. For individual-level data, participants self-reported their height, weight, education, occupation, and household income. Data were analyzed using multilevel, hybrid linear models. Women residing in less disadvantaged neighborhoods had a lower BMI, but there was no association among men. Neighborhood disadvantage was not associated with within-individual changes in BMI among men or women when moving to a new neighborhood. Despite a growing body of literature suggesting an association between neighborhood disadvantage and BMI, we found this association may not be causal among middle-aged and older adults. Observing associations between neighborhood socioeconomic disadvantage and BMI over the life course, including the impact of residential relocation at younger ages, remains a priority for future research.