Is self-reported park proximity associated with perceived social disorder? Findings from eleven cities in Latin America.

Parks and greenspaces can enhance personal health in various ways, including among others, through psychological restoration and improved well-being. However, under certain circumstances, parks may also have adverse effects by providing isolated and hidden spaces for non-normative and crime-related activities. This study uses a survey conducted by the Development Bank of Latin America in a cross-sectional representative sample of 7,110 respondents in eleven Latin-American cities. We examine associations between self-reported park proximity with perceived social disorder (drug use/sales, gangs, prostitution and assault and/or crime), and whether these associations are modified by neighborhood characteristics (informal neighborhoods, poor street-lighting, abandoned buildings, illegal dumping). High self-reported park proximity was associated with lower perceptions of social disorder, but these associations were no longer significant following adjustment for neighborhood characteristics. Significant interactions were observed between park proximity and neighborhood characteristics suggesting that the likelihood of perceiving social disorder increases with high park proximity in informal neighborhoods and in the presence of certain neighborhood characteristics, such as poor street-lighting, abandoned buildings, and illegal dumping in residential streets. The differential associations between reported park proximity and perceived social disorder in different living environments highlight the importance of supportive social and physical infrastructure to maximize the restorative benefits of parks in all urban areas.

Park use, perceived park proximity, and neighborhood characteristics: Evidence from 11 cities in Latin America.

This study examines how park use may be associated with perceived park proximity, neighborhood-built environment and perceived social disorder in Latin American cities. The study uses self-reported data from the 2016 CAF survey, including 7,970 urban residents from 11 cities across Latin America. Results show positive graded associations between perceived park proximity and use, holding all others constant. Additional factors that were found to be associated with park use are neighborhood formality and related built-environment characteristics, including paved streets and sidewalks. Park use was mostly unrelated to perceived social disorder, with the exception of indigence, with which it is was positively associated. Stronger associations between park proximity and use were observed among those who reported higher prevalence of indigence or begging in their household block. These findings stress the importance of perceived park proximity in enhancing their use in urban Latin America, and challenge the role of social disorder and crime as a barrier for park use.

Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis.

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities.

BACKGROUND: Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES: We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS: In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS: A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION: Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.

Walking for transportation in large Latin American cities: walking-only trips and total walking events and their sociodemographic correlates.

Walking for transportation is a common and accessible means of achieving recommended physical activity levels, while providing important social and environmental co-benefits. Even though walking in rapidly growing urban areas has become especially challenging given the increasing dependence on motorised transportation, walking remains a major mode of transportation in Latin American cities. In this paper we aimed to quantify self-reported walking for transportation in Mexico City, Bogota, Santiago de Chile, Sao Paulo, and Buenos Aires, by identifying both walking trips that are conducted entirely on foot and walking events involved in trips mainly conducted on other means of transportation (e.g. private vehicle, public transit) among individuals ≥5-years old. We show how walking-only trips account for approximately 30% trips in the analysed cities, and we evidence how the pedestrian dimension of mobility is largely underestimated if walking that is incidental to other transportation modes is not accounted for: when considering all walking events, we observed an increase between 73% and 217% in daily walking time. As a result, we estimated that between 19% and 25% of residents in these cities meet the WHO physical activity guidelines solely from walking for transportation. The results of the study also suggest that the promotion of public transportation in large Latin American cities can especially help certain population groups achieve the daily recommended levels of physical activity, while among low-income groups accessibility and safety seem to be the key challenges to be addressed.

The equigenic effect of greenness on the association between education with life expectancy and mortality in 28 large Latin American cities.

BACKGROUND: Recent studies highlight the equigenic potential of greenspaces by showing narrower socioeconomic health inequalities in greener areas. However, results to date have been inconsistent and derived from high-income countries. We examined whether urban greenness modifies the associations between area-level education, as a proxy for socioeconomic status, and life expectancy and cause-specific mortality in Latin American cities. METHODS: We included 28 large cities, >137 million inhabitants, in nine Latin American countries, comprising 671 sub-city units, for 2012-2016. Socioeconomic status was assessed through a composite index of sub-city level education, and greenness was calculated using the normalized difference vegetation index. We fitted multilevel models with sub-city units nested in cities, with life expectancy or log(mortality) as the outcome. FINDINGS: We observed a social gradient, with higher levels of education associated with higher life expectancy and lower cause-specific mortality. There was weak evidence supporting the equigenesis hypothesis as greenness differentially modified the association between education and mortality outcomes. We observed an equigenic effect, with doubling magnitudes in the violence-related mortality reduction by education in areas with low greenness compared to medium-high greenness areas among men (16% [95% CI 12%-20%] vs 8% [95% CI 4%-11%] per 1 SD increase in area-level education). However, in contradiction to the equigenesis hypothesis, the magnitude in cardiovascular diseases (CVD) mortality reduction by education was stronger in areas with medium-high greenness compared to areas with low greenness (6% [95% CI 4%-7%] vs 1% [95% CI -1%-3%] and 5% [95% CI 3%-7%] vs 1% [95% CI -1%-3%] per 1 SD increase in area-level education, in women and men, respectively). Similarly, each 1-SD increase in greenness widened the educational inequality in life expectancy by 0.15 years and 0.20 years, in women and men, respectively. The equigenic effect was not observed in violence-related mortality among women and in mortality due to communicable diseases, maternal, neonatal and nutritional conditions (CMNN). INTERPRETATION: Our results confirm socioeconomic health inequalities in Latin American cities and show that the equigenic properties of greenspace vary by health outcome. Although mixed, our findings suggest that future greening policies should account for local social and economic conditions to ensure that greenspaces provide health benefits for all, and do not further exacerbate existing health inequalities in the region. FUNDING: Wellcome Trust (Grant, 205177/Z/16/Z).

The Relationships between Adolescents' Obesity and the Built Environment: Are They City Dependent?

There is evidence that the built environment can promote unhealthy habits which may increase the risk for obesity among adolescents. However, the majority of evidence is from North America, Europe and Australia, and less is known about other world regions. The purpose of this study was to examine how the number of overweight and obese adolescents may vary in relation to the built environment, area socioeconomic status (SES), physical activity (PA) and nutritional home environment. We performed a telephone survey of 904 adolescents ages 15-18 from three different cities in Israel. The questionnaire included: reported PA, sedentary behaviors and nutritional home environment. Body Mass Index (BMI) was attained from records of Maccabi Healthcare Services (MHS). The built environment measures were calculated by Geographic Information System (GIS). Multivariable logistic regression analysis was performed to identify variables associated with adolescents' overweight and obesity. The highest level of overweight and obese adolescents was in Beer Sheva (29.2%). The three cities did not differ in built environment characteristics, PA and sedentary behaviors. In Haifa, a more positive nutritional home environment was reported (p = 0.001). Boys, in all three cities presented higher rates of overweight and obesity (29%). After adjusting for covariates, adolescents' overweight and obesity was associated with built environment measures only in a low SES peripheral city (OR = 0.72; 95% CI: 0.56-0.92), and positively associated with higher level of sedentary behavior in the total sample (OR = 1.23; 95% CI:1.03-1.47). This may imply a much more complex causal pathway between the built environment, SES and obesity than suggested in previous literature.

Is the Grass Always Greener in Suburban Neighborhoods? Outdoors Play in Suburban and Inner-City Neighborhoods.

Children's outdoors play (OP) is an important source of physical activity that has been decreasing in recent years due to changes in neighborhood design, parent safety concerns and child sedentary leisure. However, few studies examined such determinants from children's perspectives. This study explores environmental and socio-cultural aspects of children's OP using a qualitative and quantitative approach. Data was collected in two phases: (1) a survey on OP and related variables among 5th and 6th graders (10-12 years old) (n = 573); and (2) a mapping activity and semi-structured interview among a subsample of the survey (n = 80). The most common locations for routine OP were parks (40%) followed by public facilities (26%) and streets (17%). OP was significantly associated with perceived environment, independent mobility and gender, but not with neighborhood type. Inner-city participants reported a higher number and greater variety of OP areas (23 vs. 14). Three main barriers of OP were identified-low quality and poorly maintained play areas, other people in public spaces, and social norms that undermine OP. Thus, in order to encourage routine OP, environmental change to create safe and attractive OP settings should be accompanied by community interventions to enhance social norms that are supportive of OP.

Getting to Know a Place: Built Environment Walkability and Children's Spatial Representation of Their Home-School (h-s) Route.

The literature on environmental walkability to date has mainly focused on walking and related health outcomes. While previous studies suggest associations between walking and spatial knowledge, the associations between environmental walkability and spatial knowledge is yet to be explored. The current study addresses this lacuna in research by exploring children's mental representations of their home-school (h-s) route, vis.