Relationships Between Measures of the Physical Activity-Related Built Environment and Excess Weight in Preschoolers: A Retrospective, Population-Level Cohort Study.

Background: The built environment can impact health outcomes. Our purpose was to examine relationships between built environment variables related to physical activity and excess weight in preschoolers. Methods: In this retrospective, population-level study of 4- to 6-year-olds, anthropometric measurements were taken between 2009 and 2017 in Calgary and Edmonton, Alberta, Canada. Based on BMI z-scores (BMIz), children were classified as normal weight (-2 ≤ BMIz <1) or excess weight (BMIz ≥1; overweight and obesity). Physical activity-related built environment variables were calculated (distances to nearest playground, major park, school; street intersection density; number of playgrounds and major parks within an 800 m buffer zone). Binomial logistic regression models estimated associations between physical activity-related built environment variables and excess weight. Results: Our analysis included 140,368 participants (females: n = 69,454; Calgary: n = 84,101). For Calgary, adjusted odds ratios (aORs) showed the odds of excess weight increased 1% for every 100-intersection increase [1.010 (1.006-1.015); p < 0.0001] and 13.6% when there were ≥4 playgrounds (vs. 0 or 1) within an 800 m buffer zone [1.136 (1.037-1.243); p = 0.0059]. For Edmonton, aORs revealed lower odds of excess weight for every 100 m increase in distances between residences to nearest major park [0.991 (0.986-0.996); p = 0.0005] and school [0.992 (0.990-0.995); p < 0.0001]. The odds of excess weight decreased as the number of major parks within the 800 m buffer zone increased from 0 to 1 [0.943 (0.896-0.992); p = 0.023] and from 0 to ≥3 [0.879 (0.773-0.999); p = 0.048]. Conclusion: The physical activity-related built environment was associated with excess weight in preschoolers, although relationships varied between cities that differed demographically and geographically.

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.

Assessing the Impact of Neighborhood and Built Environment on Pediatric Perioperative Care: A Systematic Review of the Literature.

CONTEXT: Neighborhood and built environment encompass one key area of the Social Determinants of Health (SDOH) and is frequently assessed using area-level indices. OBJECTIVE: We sought to systematically review the pediatric surgery literature for use of commonly applied area-level indices and to compare their utility for prediction of outcomes. DATA SOURCES: A literature search was conducted using PubMed, Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print, PsycInfo, and an artificial intelligence search tool (1/2013-2/2023). STUDY SELECTION: Inclusion required pediatric surgical patients in the US, surgical intervention performed, and use of an area-level metric. DATA EXTRACTION: Extraction domains included study, patient, and procedure characteristics. RESULTS: Area Deprivation Index is the most consistent and commonly accepted index. It is also the most granular, as it uses Census Block Groups. Child Opportunity Index is less granular (Census Tract), but incorporates pediatric-specific predictors of risk. Results with Social Vulnerability Index, Neighborhood Deprivation Index, and Neighborhood Socioeconomic Status were less consistent. LIMITATIONS: All studies were retrospective and quality varied from good to fair. CONCLUSIONS: While each index has strengths and limitations, standardization on ideal metric(s) for the pediatric surgical population will help build the inferential power needed to move from understanding the role of SDOH to building meaningful interventions towards equity in care. TYPE OF STUDY: Systematic Review. LEVEL OF EVIDENCE: Level III.

A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities.

The characteristics of a neighborhood's built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13-24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.

Exploring the combined cooling effect of street canyon geometry and the surrounding built environment.

Exploring the impact of complex urban morphology on the urban heat island (UHI) effect is essential for sustainable environmental management and enhancing human well-being. This study explored the combined cooling effect of street canyon geometry and the surrounding built environment using a CatBoost model and the Shapley method. The findings indicated that in streets with low building height and density, a high proportion of sky and vegetation and a flatter skyline are conductive to mitigate UHI effect. In streets with high building height and density, a lower proportion of sky and vegetation, and a well-proportioned skyline, can effectively mitigate UHI effect. Regardless of the building density and height around the street, street trees are the optimal choice for greening construction and improvement of large and medium-sized cities in China, given their high controllability and the current urban stock background. Therefore, reasonable control and allocation of street trees can effectively adjust the street canyon geometry, providing suitable cooling strategies for streets with different surrounding built environments. This study proposed a method to mitigate the UHI effect through street canyon geometry, which can be extended to other high-density urban thermal environment studies and guide policymakers on street construction and urban design.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians.

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016-2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40-70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

The Impact of Design Factors on User Behavior in a Virtual Hospital Room to Explore Fall Prevention Strategies.

OBJECTIVES: Falls in hospitals pose a significant safety risk, leading to injuries, prolonged hospitalization, and lasting complications. This study explores the potential of augmented reality (AR) technology in healthcare facility design to mitigate fall risk. BACKGROUND: Few studies have investigated the impact of hospital room layouts on falls due to the high cost of building physical prototypes. This study introduces an innovative approach using AR technology to advance methods for healthcare facility design efficiently. METHODS: Ten healthy participants enrolled in this study to examine different hospital room designs in AR. Factors of interest included room configuration, door type, exit side of the bed, toilet placement, and the presence of IV equipment. AR trackers captured trajectories of the body as participants navigated through these AR hospital layouts, providing insights into user behavior and preferences. RESULTS: Door type influenced the degree of backward and sideways movement, with the presence of an IV pole intensifying the interaction between door and room type, leading to increased sideways and backward motion. Participants displayed varying patterns of backward and sideways travel depending on the specific room configurations they encountered. CONCLUSIONS: AR can be an efficient and cost-effective method to modify room configurations to identify important design factors before conducting physical testing. The results of this study provide valuable insights into the effect of environmental factors on movement patterns in simulated hospital rooms. These results highlight the importance of considering environmental factors, such as the type of door and bathroom location, when designing healthcare facilities.

Road Traffic Injuries and the Built Environment in Bogotá, Colombia, 2015-2019: A Cross-Sectional Analysis.

Nine in 10 road traffic deaths occur in low- and middle-income countries (LMICs). Despite this disproportionate burden, few studies have examined built environment correlates of road traffic injury in these settings, including in Latin America. We examined road traffic collisions in Bogotá, Colombia, occurring between 2015 and 2019, and assessed the association between neighborhood-level built environment features and pedestrian injury and death. We used descriptive statistics to characterize all police-reported road traffic collisions that occurred in Bogotá between 2015 and 2019. Cluster detection was used to identify spatial clustering of pedestrian collisions. Adjusted multivariate Poisson regression models were fit to examine associations between several neighborhood-built environment features and rate of pedestrian road traffic injury and death. A total of 173,443 police-reported traffic collisions occurred in Bogotá between 2015 and 2019. Pedestrians made up about 25% of road traffic injuries and 50% of road traffic deaths in Bogotá between 2015 and 2019. Pedestrian collisions were spatially clustered in the southwestern region of Bogotá. Neighborhoods with more street trees (RR, 0.90; 95% CI, 0.82-0.98), traffic signals (0.89, 0.81-0.99), and bus stops (0.89, 0.82-0.97) were associated with lower pedestrian road traffic deaths. Neighborhoods with greater density of large roads were associated with higher pedestrian injury. Our findings highlight the potential for pedestrian-friendly infrastructure to promote safer interactions between pedestrians and motorists in Bogotá and in similar urban contexts globally.

Enhancing removal of air contaminants in existing aircraft cabins by optimizing supply air direction based on Re-field synergy and Bayesian optimization.

There are a large number of airplanes currently being operated, in which the ventilation system needs to be improved to more effectively remove air contaminants. A potential approach is to adjust the supply air directions with the use of simple airflow deflectors. This study proposed a method for optimizing the supply air direction of ventilation in aircraft cabins based on the Re-field synergy index and Bayesian optimization. A validated numerical model was used to calculate the air distribution and air contaminant transport in a single-row single-aisle aircraft cabin to obtain the Re-field synergy values. The Bayesian optimization approach was used to identify the supply air direction which maximizes the Re-field synergy, namely, maximizes the mass transfer effectiveness. Finally, the air contaminant transport in a 7-row single-aisle aircraft cabin with the optimized supply air direction was evaluated to demonstrate the enhancement of ventilation performance. The results show that the proposed method based on the Re-field synergy index and Bayesian optimization can efficiently optimize the supply air direction in order to enhance the air contaminant removal in aircraft cabins. In the 7-row single-aisle aircraft cabin, the optimized supply air direction can reduce the average air contaminant concentration in the breathing zone of the passengers by up to 23 %.

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study.

BACKGROUND: Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). METHODS: The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. RESULTS: Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. CONCLUSION: Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India.

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Investigating built environment and traffic flow impact on crash frequency in urban road networks.

While numerous studies have examined the factors that influence crash occurrence, there remains a gap in understanding the intricate relationship between built environment, traffic flow, and crash occurrences across different spatial units. This study explores how built environment attributes, and dynamic traffic flow characteristics affect crash frequency by focusing on proposed traffic density-based zones (TDZs). Utilizing a comprehensive dataset from Greater Melbourne, Australia, this research emphasizes on the dynamic traffic flow variables and insights from the Macroscopic Fundamental Diagram model, considering parameters such as shockwave velocity and congestion index. The association between the potential influencing factors and crash frequency is examined using a random parameter negative binomial regression model. Results indicate that the data segmentation based on TDZs is instrumental in establishing a more refined crash model compared to traditional planning-based zones, as demonstrated by improved goodness-of-fit measures. Factors including density (e.g., employment density), network design (e.g., road density and highway density), land use diversity (e.g., job-housing balance and land use mixture), and public transit accessibility (e.g., bus route density) are significantly associated with crash occurrence. Furthermore, the unobserved heterogeneity effects of the shockwave velocity and congestion index on crashes are revealed. The study highlights the significance of incorporating dynamic traffic flow variables in understanding crash frequency variations across different spatial units. These findings can inform optimal real-time traffic monitoring, environmental design, and road safety management strategies to mitigate crash risks.

Built environment and loneliness in later life: productive engagement as the pathway.

OBJECTIVES: The built environment is increasingly recognized as being associated with late-life loneliness. However, the pathway remains understudied. This study investigated the mediating effects of productive engagement in relationships between the built environment and loneliness. METHODS: We conducted a cross-sectional analysis of data from 4,409 community-dwelling people aged 65 years and above in China. We employed the Chinese version of the De Jong Gierveld Loneliness Scale to assess loneliness. The built environment comprises residential density, street connectivity, park-based and vegetation-based green space, land use mix, and the number of and distance to the nearest recreational, health, shopping and community services within 300-meter and 500-meter buffer areas. Structural equation modeling was used. RESULTS: Only green space (parks) had a direct effect on loneliness. Residential density and green space (parks) had an indirect effect on loneliness through volunteering. The number of recreational services had an indirect effect on loneliness through recreational and sporting activities, although distance to the nearest recreational services did not. All the significant results were only found within 300-meter rather than 500-meter buffers. CONCLUSIONS: Our findings have implications for environmental gerontology theory and practice. Providing more green space and recreational services can significantly improve older adults' helping behavior, social activities and sporting activities, which can further reduce older adults' loneliness.

The association between neighborhood social and built environment on loneliness among young adults with cancer.

PURPOSE: Young adults with cancer (YAs, aged 18-39) are at increased risk of experiencing loneliness due to their unique challenges of coping with a cancer diagnosis and treatment during young adulthood. Understanding factors that impact loneliness is critical to improving survivorship outcomes for this vulnerable YA population. Neighborhoods are key determinants of health. However, little is known about how such neighborhood characteristics are associated with loneliness among YA survivors. METHODS: YA survivors (N = 181) drawn from the National Institutes of Health All of Us Research Program completed measures of neighborhood social environment (e.g., shared values), aspects of their neighborhood built environment (e.g., access to transit, recreational activities), and loneliness. Two total scores were calculated with higher scores reflecting higher neighborhood social cohesion and higher neighborhood walkability/bikeability (i.e., built environment). Hierarchical linear regression examined associations between the social and built environment on loneliness. RESULTS: Higher levels of neighborhood social cohesion (ß = - 0.28, 95% confidence interval (CI) = - 0.44, - 0.11) and neighborhood walkability/bikeability (ß = - 0.15, 95% CI = - 0.31, - 0.006) were significantly associated with lower levels of loneliness. CONCLUSIONS: Findings suggest that living within a cohesive social environment with neighborhood walkability/bikeability to built environment amenities such as green space, grocery stores, and public transportation is protective against loneliness among YA survivors. More longitudinal research is necessary to understand the dynamic changes in loneliness among YA survivors living in diverse social and built environments. IMPLICATIONS FOR CANCER SURVIVORS: YA survivors may benefit from cultivating neighbor relationships and living within neighborhoods with walkability/bikeability.

Building Sustainable Community-Academic Partnerships while Implementing a Nutrition-Based Blackberry Garden Program at a Senior Center.

Due to limited access to and consumption of fruits and vegetables, older adults are at increased risk of worsening or developing chronic diseases. This paper describes a community-academic partnership that provides a sustainable source of blackberries to attendees of a rural senior center. Qualitative research evaluated the partnership following implementation of a blackberry program. Focus groups and interviews included partners from a senior center, Cooperative Extension Service, and a detention center. Main themes: group power dynamics influenced communication between research and community leadership teams; unexpected project barriers emerged; and community leadership team suggested strategies to promote project longevity.

Mental health in China: exploring the impacts of built environment, work environment, and subjective perception.

Introduction: The shifting living and working conditions have profound impacts on the residents' mental health. However, current research in this field has not remarkable investigated. Methods: This study used the China Labor-force Dynamic Survey (CLDS) dataset from 2018 and relied on a regression model to examine the effects of the built environment, work environment, and subjective perception on the mental health of Chinese citizens. It also considers the circumstances of both migrants and local residents. Results: This study revealed significant correlations between mental health and greening space rate, road network density, commuting time, work feelings, community trust, economic satisfaction, and other factors. Additionally, the mental health of local residents was shown to be significantly affected by community security, while it shows no significance in migrants. Furthermore, a significant spatial autocorrelation was found in terms of mental health within the central and eastern regions of China. Discussion: The findings of this study offer valuable insights that can be used to facilitate measures aimed at improving the mental health of residents and promoting the development of healthy cities.

Shadowing Stroke Patients to Explore the Rehabilitation Built Environment: Approach, Insights, and Lessons Learned.

Shadowing is a research method that combines observing events and short on-the-go interviews to investigate people's roles and behaviours in various settings. Even though it is not a widely used method in architectural research, it can be adapted to focus on the interaction of individuals with the built environment. This is especially important in healthcare environments, where people are vulnerable and more dependent on their surroundings. In this article, I reflect on the experience of adapting and using the shadowing method to explore stroke inpatients' interactions with the built environment during their recovery in rehabilitation centres. This research study was the first to employ shadowing in the stroke patient population on such a large scale. One day (12 consecutive hours) was spent with each of the 70 participating stroke inpatients, recording their interactions with the built environment in different forms - on the floor plans, as narrative descriptions, creating sketches of situations and noting down patients' remarks. This method was useful in capturing the built environment's role in patients' daily experiences in rehabilitation centres. Research in healthcare facilities includes various challenges, and close contact with the patient population of older adults with stroke introduces numerous unexpected events and ethical dilemmas in the field. At the same time, this method provides research insights that would otherwise be unobtainable. Researchers are given practical information and recommendations on how to prepare for using shadowing for architectural research and what to expect in the field.

Enriched Environments in Stroke Units: Defining Characteristics and Limitations.

BACKGROUND: Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units. OBJECTIVE: The aim of this systematic review was to compile the concept of an EE in stroke units. METHODS: The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included. RESULTS: This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements. CONCLUSIONS: To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.

Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California.

BACKGROUND: The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS: We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS: TLC guests and staff described an atmosphere where radical hospitality-welcoming guests with extraordinary warmth, generosity, and unconditional acceptance-was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. CONCLUSIONS: The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe.

Artificial intelligence-based assessment of built environment from Google Street View and coronary artery disease prevalence.

BACKGROUND AND AIMS: Built environment plays an important role in the development of cardiovascular disease. Tools to evaluate the built environment using machine vision and informatic approaches have been limited. This study aimed to investigate the association between machine vision-based built environment and prevalence of cardiometabolic disease in US cities. METHODS: This cross-sectional study used features extracted from Google Street View (GSV) images to measure the built environment and link them with prevalence of coronary heart disease (CHD). Convolutional neural networks, linear mixed-effects models, and activation maps were utilized to predict health outcomes and identify feature associations with CHD at the census tract level. The study obtained 0.53 million GSV images covering 789 census tracts in seven US cities (Cleveland, OH; Fremont, CA; Kansas City, MO; Detroit, MI; Bellevue, WA; Brownsville, TX; and Denver, CO). RESULTS: Built environment features extracted from GSV using deep learning predicted 63% of the census tract variation in CHD prevalence. The addition of GSV features improved a model that only included census tract-level age, sex, race, income, and education or composite indices of social determinant of health. Activation maps from the features revealed a set of neighbourhood features represented by buildings and roads associated with CHD prevalence. CONCLUSIONS: In this cross-sectional study, the prevalence of CHD was associated with built environment factors derived from GSV through deep learning analysis, independent of census tract demographics. Machine vision-enabled assessment of the built environment could potentially offer a more precise approach to identify at-risk neighbourhoods, thereby providing an efficient avenue to address and reduce cardiovascular health disparities in urban environments.