Making cities mental health friendly for adolescents and young adults.

Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for young people. Here we show a set of ranked characteristic statements, grouped by personal, interpersonal, community, organizational, policy and environmental domains of intervention. Life skills for personal development, valuing and accepting young people's ideas and choices, providing safe public space for social connection, employment and job security, centring youth input in urban planning and design, and addressing adverse social determinants were priorities by domain. We report the adversities that COVID-19 generated and link relevant actions to these data. Our findings highlight the need for intersectoral, multilevel intervention and for inclusive, equitable, participatory design of cities that support youth mental health.

Rising wildfire risk to houses in the United States, especially in grasslands and shrublands.

Wildfire risks to homes are increasing, especially in the wildland-urban interface (WUI), where wildland vegetation and houses are in close proximity. Notably, we found that more houses are exposed to and destroyed by grassland and shrubland fires than by forest fires in the United States. Destruction was more likely in forest fires, but they burned less WUI. The number of houses within wildfire perimeters has doubled since the 1990s because of both housing growth (47% of additionally exposed houses) and more burned area (53%). Most exposed houses were in the WUI, which grew substantially during the 2010s (2.6 million new WUI houses), albeit not as rapidly as before. Any WUI growth increases wildfire risk to houses though, and more fires increase the risk to existing WUI houses.

The indicators and methods used for measuring urban liveability: a scoping review.

OBJECTIVES: Liveability is a multi-dimensional and hierarchical concept which consists of various criteria and sub-criteria and may be evaluated in different ways. The aim of this study was to systematically review indicators and methods used for the evaluation of urban liveability in literature. CONTENT: The five-stage methodological framework of Arksey and O'Malley was used to conduct this scoping review. A systematic search of electronic databases, including Scopus, Medline (via PubMed), Embase, Web of Science and EBSCO was done until May 29, 2019. Web searching, searching reference lists and hand searching was also conducted to retrieve more relevant articles. Two reviewers screened the papers for eligibility based on the inclusion criteria and extracted their key data and reported them descriptively. SUMMARY: Sixty seven (67) out of 3,599 papers met the selection criteria. This review showed five distinct domains considered to be important components of liveability. These were Economical, Environmental, Institutional, Social, and Governance (Political) domains. The most important subdomains (indices) which were frequently applied in various studies were Environmental friendliness and Sustainability, Socio-Cultural Conditions and Economic Vibrancy and Competitiveness. We also identified seven different methodologies and six ranking tools used for assessing urban liveability. Among the quantitative methods, three methods accounted for 89.6% of the articles. These methods were the Analytical hierarchy process and entropy (AHP; n=24; 50%), Factor analysis & Principle Component Analysis (FA & PCA; n=12; 25%) and Spatial Multi-criteria Decision-making Method (Spatial; n=7; 14.6%). Among the ranking tools used, three ranking tools accounted for 65.4% of the articles. These tools were the Livable City Scientific Evaluation Standards (LCSES; n=9; 34.6%), The Global Liveable Cities Index (GLCI; n=4; 15.4%) and the Economist Intelligence Unit (EIU; n=4; 15.4%). OUTLOOK: This paper discusses and summarizes the latest indicators and methods used for determining urban liveability. The information offered in the review can help future investigators to decide which method suits their purpose and situation better and measure urban liveability more systematically than before.

Identifying urban built environment factors in pregnancy care and maternal mental health outcomes.

BACKGROUNDS: Risk factors related to the built environment have been associated with women's mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting. METHODS: In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients' residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients' residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study. RESULTS: We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality. CONCLUSIONS: In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients' residing neighborhoods and healthy pregnancy.

Longitudinal association of built environment pattern with DXA-derived body fat in elderly Hong Kong Chinese: a latent profile analysis.

BACKGROUND: One major limitation of prior studies regarding the associations between built environment (BE) and obesity has been the use of anthropometric indices (e.g., body mass index [BMI]) for assessing obesity status, and there has been limited evidence of associations between BE and body fat. This study aimed to explore the longitudinal association between BE and body fat in a cohort of elderly Hong Kong Chinese and examine whether the BE-body fat associations differed by BMI categories. METHODS: Between 2001 and 2003, 3944 participants aged 65-98 years were recruited and followed for a mean of 6.4 years. BE characteristics were assessed via Geographic Information System. Body fat (%) at whole body and regional areas (trunk, limbs, android, and gynoid) were assessed by dual energy X-ray absorptiometry at baseline and three follow-ups. Latent profile analysis was used to derive BE class, and linear mixed-effects models were used to investigate the associations of BE class with changes in body fat. Stratified analyses by BMI categories were also conducted. RESULTS: Three BE classes were identified. Participants in Class 2 (characterized by greater open space and proportion of residential land use) had a slower increase in whole body fat (B = -0.403, 95% confidence interval [CI]: -0.780, -0.014) and limbs fat (-0.471, 95% CI: -0.870, -0.071) compared with participants in Class 1 (characterized by high proportion of commercial land use). There were significant interactions of BE class with BMI, and participants in Class 2 had a slower increase in whole body fat and regional fat compared with participants in Class 1 (B ranging from -0.987 [limbs] to -0.523 [gynoid]) among overweight and obese participants only. CONCLUSIONS: We found that those who resided in the areas characterized by greater open space and proportion of residential land use had a slower body fat increase.

Differential associations of the built environment on weight gain by sex and race/ethnicity but not age.

OBJECTIVE: To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults. METHODS: Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18-64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road intersection densities and counts of area supermarkets and fast food restaurants were measured with SmartMaps (800 and 5000-meter buffers) and categorized into tertiles. Linear mixed-effect models tested whether associations between BE features and weight gain at 1, 3, and 5 years differed by age, sex, and race/ethnicity, adjusting for demographics, baseline weight, and residential property values. RESULTS: Denser urban form and greater availability of supermarkets and fast food restaurants were associated with differential weight change across sex and race/ethnicity. At 5 years, the mean difference in weight change comparing the 3rd versus 1st tertile of residential density was significantly different between males (-0.49 kg, 95% CI: -0.68, -0.30) and females (-0.17 kg, 95% CI: -0.33, -0.01) (P-value for interaction = 0.011). Across race/ethnicity, the mean difference in weight change at 5 years for residential density was significantly different among non-Hispanic (NH) Whites (-0.47 kg, 95% CI: -0.61, -0.32), NH Blacks (-0.86 kg, 95% CI: -1.37, -0.36), Hispanics (0.10 kg, 95% CI: -0.46, 0.65), and NH Asians (0.44 kg, 95% CI: 0.10, 0.78) (P-value for interaction <0.001). These findings were consistent for other BE measures. CONCLUSION: The relationship between the built environment and weight change differs across demographic groups. Careful consideration of demographic differences in associations of BE and weight trajectories is warranted for investigating etiological mechanisms and guiding intervention development.

Land use and semen quality: A fertility center cohort study.

This study explored the association between built environment and semen parameters among men who sought fertility evaluation. We used a data of 5,886 men living in the Seoul capital area whose semen was tested at a single fertility center during 2016-2018. Distance to fresh water, the coast, major roadways, and neighborhood greenness measured by Normalized Difference Vegetation Index (NDVI) were evaluated. Outcome indicators were semen volume, sperm concentration, percentage of progressive motility, vitality, normal morphology, and total motile sperm count. Linear regression models were fitted to standardized values of six semen indicators. Majority of men were white-collar, clerical, and service workers. Linear associations between built environment features and semen quality indicators were not evident except for NDVI within 500 m and sperm vitality (ß = 0.05; 95% confidence interval (CI): 0.01, 0.09). The 2nd quartile of distance to fresh water was associated with lower progressive motility compared to the 1st quartile (ß = -0.10; 95% CI: -0.17, -0.03). Proportion of vitality was higher among men in the 2nd quartile of distance to roadways than those in the 1st quartile (0.08; 95% CI: 0.01, 0.15). Men in the 2nd quartile of NDVI had higher total motile sperm count (0.09; 95% CI: 0.01, 0.17). In the multi-exposure model, the positive association between NDVI and vitality remained (0.03; 95% CI: 0.00, 0.06). We observed potential evidence regarding the impact of built environment on male fertility, specifically a positive association between residential greenness and sperm vitality among men with a history of infertility.

Parental Factors Related to Physical Activity among Adolescent Men Living in Built and Natural Environment: A Population-Based MOPO Study.

Introduction: Physical inactivity is a global concern, especially among adolescent men. Little research has been done on the association between parental factors and young adults' physical activity in the context of residential environment. We aimed to reveal what parental factors are associated with physical activity among adolescent men living in built and natural environments. Methods: A population-based sample of 1,904 men (mean age = 17.9, SD = 0.7 years) completed a questionnaire regarding physical activity, parental factors, and lifestyle in Northern Finland in 2012 and 2013. Geographical information system methods and dominant land-use type were used to define the residential environment in a 1-kilometer radius buffer zone surrounding each participant's home address. If the residential area included more artificial surfaces, it was defined as a built environment, and areas including more nature were defined as natural environments. Results: According to multivariable analyses, a mother's physical activity (OR = 1.9; 95% CI: 1.3-2.8) was positively associated with the physical activity of adolescent men living in built environments, and the father's physical activity was positively associated with the physical activity of adolescent men living in natural environments (2.8; 1.7-4.8). Self-rated health (built 5.9 [4.0-8.7]; natural 5.2 [3.0-9.0]) was positively associated with physical activity level. Those with symptoms of depression were more likely to be physically inactive (built 0.5 [0.3-0.8]; natural 0.3 [0.1-0.6]). Adolescent men were equally physically active regardless of the living environment. Conclusions: The level of physical activity of parents, self-rated health, and depressive symptoms should be considered when designing physical activity promotions for adolescent men according to their residential environments.

Does the built environment have independent obesogenic power? Urban form and trajectories of weight gain.

OBJECTIVE: To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults. METHODS: Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values. RESULTS: Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg. CONCLUSIONS: Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Change in walking steps and association with built environments during the COVID-19 state of emergency: A longitudinal comparison with the first half of 2019 in Yokohama, Japan.

In Japan, a state of emergency (SoE) was declared in early April 2020 until late May in response to the first wave of the coronavirus disease (COVID-19). This longitudinal study analyzed the step counts of 18,817 citizens in Yokohama city in the first half of 2020 compared to the previous year, and investigated the association between the change in step counts and the individuals' neighborhood environment by sex and age using generalized linear mixed models. Step counts decreased especially in women and non-elderly people during the SoE. Older women were more susceptible to the neighborhood environment: high walkability (i.e., high population density, proximity to railway stations) adversely affected their step counts, whereas proximity to large parks came to have a positive effect during the SoE.

COVID-19 street reallocation in mid-sized Canadian cities: socio-spatial equity patterns.

INTERVENTION: Street reallocation interventions in three Canadian mid-sized cities: Victoria (British Columbia), Kelowna (British Columbia), and Halifax (Nova Scotia) related to the COVID-19 pandemic. RESEARCH QUESTION: What street reallocation interventions were implemented, and what were the socio-spatial equity patterns? METHODS: We collected data on street reallocations (interventions that expand street space for active transportation or physical distancing) from April 1 to August 15, 2020 from websites and media. For each city, we summarized length of street reallocations (km) and described implementation strategies and communications. We assessed socio-spatial patterning of interventions by comparing differences in where interventions were implemented by area-level mobility, accessibility, and socio-demographic characteristics. RESULTS: Two themes motivated street reallocations: supporting mobility, recreation, and physical distancing in populous areas, and bolstering COVID-19 recovery for businesses. The scale of responses ranged across cities, from Halifax adding an additional 20% distance to their bicycle network to Kelowna closing only one main street section. Interventions were located in downtown cores, areas with high population density, higher use of active transportation, and close proximity to essential destinations. With respect to socio-demographics, interventions tended to be implemented in areas with fewer children and areas with fewer visible minority populations. In Victoria, the interventions were in areas with lower income populations and higher proportions of Indigenous people. CONCLUSION: In this early response phase, some cities acted swiftly even in the context of massive uncertainties. As cities move toward recovery and resilience, they should leverage early learnings as they act to create more permanent solutions that support safe and equitable mobility.

RéSUMé: INTERVENTION: Interventions de réaffectation de rues dans trois villes canadiennes de taille moyenne : Victoria (Colombie-Britannique), Kelowna (Colombie-Britannique) et Halifax (Nouvelle-Écosse) en lien avec la pandémie de COVID-19. QUESTION DE RECHERCHE: Quelles interventions de réaffectation de rues ont-elles été exécutées, et quelles ont été les tendances en matière d'équité socio-spatiale? MéTHODE: Nous avons collecté sur des sites Web et dans les médias des données sur la réaffectation de rues (les interventions ayant élargi l'espace viaire pour le transport actif ou la distanciation physique) entre le 1er avril et le 15 août 2020. Pour chaque ville, nous avons résumé la longueur des réaffectations de rues (en kilomètres) et décrit les stratégies de mise en œuvre et les communications. Nous avons évalué la structuration socio-spatiale des interventions en comparant les différences entre les endroits où les interventions ont été appliquées selon la mobilité, l'accessibilité et les caractéristiques sociodémographiques de la région. RéSULTATS: Deux éléments ont motivé la réaffectation de rues : la volonté de favoriser la mobilité, les loisirs et la distanciation physique dans les zones densément peuplées et la volonté de stimuler la reprise des affaires touchées par la COVID-19. L'envergure des interventions a varié d'une ville à l'autre; Halifax a allongé son réseau cyclable de 20 %, mais Kelowna n'a fermé qu'un seul tronçon de sa rue principale. Les interventions ont été faites dans les centres-villes et les zones à forte densité de population, à fort usage de transport actif et à proximité des destinations essentielles. En ce qui a trait aux caractéristiques sociodémographiques, les interventions ont eu tendance à être appliquées dans les zones avec moins d'enfants et moins de minorités visibles. À Victoria, les interventions ont été appliquées dans des zones de populations à faible revenu et à proportions élevées de personnes autochtones. CONCLUSION: À ce stade d'intervention précoce, certaines villes ont agi rapidement, même en présence d'incertitudes énormes. En s'engageant dans la voie de la reprise et de la résilience, les villes devraient tenir compte de leurs premières conclusions lorsqu'elles commencent à créer des solutions permanentes favorisant une mobilité sûre et équitable.

The moderating role of the built environment in prenatal lifestyle interventions.

This study examined whether the neighborhood built environment moderated gestational weight gain (GWG) in LIFE-Moms clinical trials. Participants were 790 pregnant women (13.9 weeks' gestation) with overweight or obesity randomized within four clinical centers to standard care or lifestyle intervention to reduce GWG. Geographic information system (GIS) was used to map the neighborhood built environment. The intervention relative to standard care significantly reduced GWG (coefficient = 0.05; p = 0.005) and this effect remained significant (p < 0.03) after adjusting for built environment variables. An interaction was observed for presence of fast food restaurants (coefficient = -0.007; p = 0.003). Post hoc tests based on a median split showed that the intervention relative to standard care reduced GWG in participants living in neighborhoods with lower fast food density 0.08 [95% CI, 0.03,0.12] kg/week (p = 0.001) but not in those living in areas with higher fast food density (0.02 [-0.04, 0.08] kg/week; p = 0.55). Interaction effects suggested less intervention efficacy among women living in neighborhoods with more grocery/convenience stores (coefficient = -0.005; p = 0.0001), more walkability (coefficient -0.012; p = 0.007) and less crime (coefficient = 0.001; p = 0.007), but post-hoc tests were not significant. No intervention x environment interaction effects were observed for total number of eating establishments or tree canopy. Lifestyle interventions during pregnancy were effective across diverse physical environments. Living in environments with easy access to fast food restaurants may limit efficacy of prenatal lifestyle interventions, but future research is needed to replicate these findings.

Built environment, physical activity, and obesity of adults in Pingshan District, Shenzhen City in Southern China.

BACKGROUND: The relation between neighbourhood built environment and obesity has been described as both nuanced and complex. AIM: The objective of this study was to examine the relationship between the built environment, physical activity, and obesity in a rapidly urbanised area of China. SUBJECTS AND METHODS: This is a cross-sectional study. Descriptive statistics were used to describe the socio-demographic variables, physical activity levels and BMI status. Multivariable logistic regression models were used to examine the association between neighbourhood environment, the likelihood of engaging in different types of physical activity, and BMI. RESULTS: A total of 842 respondents completed the questionnaires and were included (84.1% response rate). Among them, 56.4% reported meeting high physical activity levels, while 40.7% were overweight or obese. Multivariable regression analysis showed that better road conditions (ß = 0.122, t = 2.999, p = 0.003) and access to physical activity facilities (ß = 0.121, t = 3.193, p = 0.001) were significantly associated with higher levels of physical activity. Physical activity levels were inversely associated with the likelihood of being overweight (OR = 0.565, 95%CI: 0.3 4 9-0.917) or obese (OR = 0.614, 95%CI: 0.3 9 0-0.966). CONCLUSION: The built environment has an important impact on physical activity. However, the direct impact of leisure physical activity on BMI is not significant. This research provides a summary of recent evidence in Pingshan District on built environments that are most favourable for physical activity and obesity.

An evaluation of PlayStreets in the South Side neighborhood of Columbus, Ohio.

AIMS: Outdoor play, physical activity, and social cohesion are crucial indicators of community health. PlayStreets, a street play initiative to engage local children and families in outdoor play, physical activity, and social interactions, were implemented in a low-income neighborhood in Columbus, Ohio throughout the summer of 2019. This article aims to describe the implementation of a hospital-sponsored PlayStreets model executed through support from a community health initiative and to assess neighborhood impact through parent and child surveys. METHODS: Approximately 350 children attended the events and 69 surveys were collected. Descriptive statistics were used to analyze survey data. RESULTS: The mean age of children was 7 years, and the majority of children who attended were male. If not for PlayStreets, 55% of caregivers reported that their children would be inside. Event satisfaction levels were high, and 54% of caregivers said that they had more contact with their neighbors because of the events. CONCLUSIONS: Hospital buy-in and community support were crucial to the success of the event. We found that this model can successfully engage the local community while increasing opportunity for childhood outdoor play, physical activity, and neighborhood social interaction.

Associations between the built environment and physical activity among adults with low socio-economic status in Canada: a systematic review.

OBJECTIVE: To synthesize literature on the associations between the built environment and physical activity among adults with low socio-economic status (SES) in Canada. METHODS: Using a pre-specified study protocol (PROSPERO ID: CRD42019117894), we searched seven databases from inception to November 2018, for peer-reviewed quantitative studies that (1) included adults with low SES living in Canada and (2) estimated the association between self-reported or objectively measured built characteristics and self-reported or objectively measured physical activity. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Findings were synthesized using a narrative approach. SYNTHESIS: Of the 8338 citations identified by our search, seven studies met the inclusion criteria. Most studies included adults living in one province (Alberta, British Columbia, Ontario, or Quebec), with one study including a national sample. All studies were cross-sectional, and none controlled for residential self-selection. Sampling designs and data collection strategies were heterogeneous. Sample sizes ranged between 78 and 37,241 participants. Most studies measured SES using household income. Street connectivity, greenness, destination density, and walkability were positively associated with physical activity. Relative to the objectively measured built environment, associations between the self-reported built environment and physical activity were less consistent. Studies were of fair to good quality. CONCLUSION: Findings suggest that the neighbourhood built environment is associated with physical activity among adults with low SES in Canada. More rigorous study designs are needed to determine whether or not the built environment and physical activity are causally related within this vulnerable population.

RéSUMé: OBJECTIF: Faire une synthèse de la littérature scientifique sur les associations entre l'environnement bâti et l'activité physique chez les adultes de faible statut socioéconomique (SSE) au Canada. MéTHODE: À l'aide d'un protocole d'étude préétabli (numéro d'identification PROSPERO : CRD42019117894), nous avons interrogé sept bases de données, entre l'inception de chacune et novembre 2018, pour repérer les études quantitatives évaluées par les pairs qui : 1) incluaient des adultes de faible SSE vivant au Canada; et 2) estimaient l'association entre les caractéristiques autodéclarées ou objectivement mesurées de l'environnement bâti et l'activité physique autodéclarée ou objectivement mesurée. La qualité des études a été évaluée à l'aide de l'outil Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Nous avons fait la synthèse des constatations selon une démarche narrative. SYNTHèSE: Sur les 8 338 citations repérées dans notre recherche, sept études répondaient aux critères d'inclusion. La plupart incluaient des adultes vivant dans une province (Alberta, Colombie-Britannique, Ontario ou Québec), et une étude comportait un échantillon national. Toutes les études étaient transversales, et aucune ne tenait compte de l'auto-sélection de la résidence. Les modes d'échantillonnage et les stratégies de collecte de données étaient hétérogènes. La taille des échantillons variait de 78 à 37 241 participants. La plupart des études mesuraient le SSE à l'aide du revenu des ménages. La connectivité des rues, la verdure, la densité des destinations et la marchabilité étaient associées positivement à l'activité physique. Par rapport à l'environnement bâti objectivement mesuré, les associations entre l'environnement bâti autodéclaré et l'activité physique étaient moins constantes. La qualité des études était de moyenne à bonne. CONCLUSION: Nos constatations indiquent que l'environnement bâti du quartier est associé à l'activité physique chez les adultes de faible SSE au Canada. Des protocoles d'étude plus rigoureux sont nécessaires pour déterminer s'il existe ou non une relation causale entre l'environnement bâti et l'activité physique dans cette population vulnérable.

Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis.

BACKGROUND: We examined to what extent perceived neighbourhood crime moderates, associations between type 2 diabetes mellitus (T2DM) and perceived local amenities, recreational facilities, footpaths and public transit, and potential mediation of environmental characteristics-T2DM association by physical activity, social contact, sleep and body mass index (BMI). METHODS: The 45 and Up Study data of 36, 224 individuals collected from 2010 to 2015 were analysed in 2019 using multilevel logistic regression to examine the association between T2DM and clustering of unfavourable built environment, and any difference in the association with increasing unfavourable environment and area disadvantage. We performed causal mediation analyses stratified by crime to examine whether crime moderated the strength of identified local amenities-T2DM pathways. RESULTS: The results showed that irrespective of crime, perceived lack of local amenities was associated with increased odds of developing T2DM, and BMI mediated 40% and 30.3% of this association among those who reported unsafe and safe daytime crime, respectively. The proportion mediated by BMI among those who reported unsafe and safe night-time crime was 27.3% and 35.1%, respectively. Walking mediated 5.7% of the local amenities-T2DM association among those who reported safe daytime crime. The odds of T2DM increased with rising unfavourable environment and area disadvantage. CONCLUSIONS: The results suggest that the availability of neighbourhood amenities may lower T2DM risk by increasing walking and reducing BMI regardless of area crime. Policies to enhance access to local amenities and prevent crime, especially in disadvantaged areas, may support healthy behaviour and physical health that can potentially reduce T2DM risk.

Associations between the traditional and novel neighbourhood built environment metrics and weight status among Canadian men and women.

OBJECTIVES: Neighbourhood characteristics can impact the health of residents. This study investigated associations between objectively derived neighbourhood characteristics, including novel space syntax metrics, and self-reported body mass index (BMI) among Canadian men and women. METHODS: Our study included survey data collected from a random cross-section of adults residing in Calgary, Alberta (n = 1718). The survey, conducted in 2007/2008, captured participants' socio-demographic characteristics, health, and weight status (BMI). Participants' household postal codes were geocoded and 1600-m line-based network buffers estimated. Using a geographical information system, we estimated neighbourhood characteristics within each buffer including business destination density, street intersection density, sidewalk length, and population density. Using space syntax, we estimated street integration and walkability (street integration plus population density) within each buffer. Using adjusted regression models, we estimated associations between neighbourhood characteristics and BMI (continuous) and BMI categories (healthy weight vs. overweight including obese). Gender-stratified analysis was also performed. RESULTS: Business destination density was negatively associated with BMI and the odds of being overweight. Among men, street intersection density and sidewalk length were negatively associated with BMI and street intersection density, business destination density, street integration, and space syntax walkability were negatively associated with odds of being overweight. Among women, business destination density was negatively associated with BMI. CONCLUSION: Urban planning policies that impact neighbourhood design have the potential to influence weight among adults living in urban Canadian settings. Some characteristics may have a differential association with weight among men and women and should be considered in urban planning and in neighbourhood-focussed public health interventions.

RéSUMé: OBJECTIFS: Les caractéristiques du quartier peuvent avoir des incidences sur la santé des personnes qui y habitent. Notre étude porte sur les associations entre les caractéristiques du quartier objectivement dérivées, dont les nouvelles mesures de syntaxe spatiale, et l'indice de masse corporelle (IMC) autodéclaré chez les femmes et les hommes au Canada. MéTHODE: L'étude inclut des données d'enquête provenant d'un échantillon aléatoire d'adultes vivant à Calgary, en Alberta (n = 1 718). L'enquête, menée en 2007-2008, a saisi les caractéristiques sociodémographiques, l'état de santé et le statut pondéral (IMC) des participants. Nous avons géocodé le code postal du ménage de chaque participant et estimé les zones tampons d'un réseau de corridors linéaires de 1 600 mètres. À l'aide d'un système d'information géographique, nous avons estimé les caractéristiques du quartier dans chaque zone tampon, dont la densité de destinations d'affaires, la densité d'intersections de rues, la longueur des trottoirs et la densité de population. En faisant appel à la syntaxe spatiale, nous avons estimé l'intégration des rues et la marchabilité (intégration des rues plus densité de population) dans chaque zone tampon. À l'aide de modèles de régression ajustés, nous avons estimé les associations entre les caractéristiques du quartier et l'IMC (en continu) et les catégories d'IMC (poids-santé vs. surpoids, y compris l'obésité). Une analyse stratifiée selon le sexe a également été effectuée. RéSULTATS: La densité de destinations d'affaires était négativement associée à l'IMC et à la probabilité de surpoids. Chez les hommes, la densité d'intersections de rues et la longueur des trottoirs étaient négativement associées à l'IMC, et la densité d'intersections de rues, la densité de destinations d'affaires, l'intégration des rues et la syntaxe spatiale de marchabilité étaient négativement associées à la probabilité de surpoids. Chez les femmes, la densité de destinations d'affaires était négativement associée à l'IMC. CONCLUSION: Les politiques de planification urbaine qui touchent la conception des quartiers ont le potentiel d'influencer le poids des adultes en milieu urbain au Canada. Pour certaines caractéristiques, l'association avec le poids peut être différente entre les hommes et les femmes; il faudrait en tenir compte dans la planification urbaine et les interventions de santé publique au niveau des quartiers.

Severity analysis of crashes on express lane facilities using support vector machine model trained by firefly algorithm.

OBJECTIVE: Express lanes (ELs) provide an alternative way for improving the capacity of the existing freeway network without considerably expanding the roadway footprint. Although much research has been done to explore factors contributing to crashes on these facilities, there is not much discussion on factors influencing their injury severity. This study explored factors influencing the injury severity of crashes on EL facilities. METHOD: A Support Vector Machine (SVM) model trained by the Firefly Algorithm was used to identify factors influencing the injury severity of crashes on EL facilities. The analysis was based on three years of crash data (2012-2014) from four EL facilities in California, totaling 61 miles. RESULTS: The results indicated that the following factors increased the probability of an injury or a fatality: concrete barriers, high average annual daily traffic, rolling or mountainous terrain, weekend, adverse road surface condition, and nighttime condition. Moreover, wide right and left shoulder widths decreased the probability of having an injury or a fatality. CONCLUSIONS: The results provide insights into the influence of different geometric characteristics and crash-related factors on the severity of crashes on EL facilities. The study findings may assist agencies to better understand the impacts of factors contributing to injury and fatal crashes on EL facilities and implement strategies to reduce the severity of these crashes.

Leveraging 31 Million Google Street View Images to Characterize Built Environments and Examine County Health Outcomes.

OBJECTIVES: Built environments can affect health, but data in many geographic areas are limited. We used a big data source to create national indicators of neighborhood quality and assess their associations with health. METHODS: We leveraged computer vision and Google Street View images accessed from December 15, 2017, through July 17, 2018, to detect features of the built environment (presence of a crosswalk, non-single-family home, single-lane roads, and visible utility wires) for 2916 US counties. We used multivariate linear regression models to determine associations between features of the built environment and county-level health outcomes (prevalence of adult obesity, prevalence of diabetes, physical inactivity, frequent physical and mental distress, poor or fair self-rated health, and premature death [in years of potential life lost]). RESULTS: Compared with counties with the least number of crosswalks, counties with the most crosswalks were associated with decreases of 1.3%, 2.7%, and 1.3% of adult obesity, physical inactivity, and fair or poor self-rated health, respectively, and 477 fewer years of potential life lost before age 75 (per 100 000 population). The presence of non-single-family homes was associated with lower levels of all health outcomes except for premature death. The presence of single-lane roads was associated with an increase in physical inactivity, frequent physical distress, and fair or poor self-rated health. Visible utility wires were associated with increases in adult obesity, diabetes, physical and mental distress, and fair or poor self-rated health. CONCLUSIONS: The use of computer vision and big data image sources makes possible national studies of the built environment's effects on health, producing data and results that may inform national and local decision-making.

A penalized-likelihood approach to characterizing bridge-related crashes in New Jersey.

OBJECTIVE: A roadway departure crash is one in which a vehicle crosses an edge line, a centerline, or otherwise leaves the traveled way. These crashes that involve run-off-road and cross-median/centerline head-on collisions tend to be more severe than other crash types. According to the NHTSA Fatality Analysis Reporting System database, a total of 7,833 people perished in crashes involving fixed roadside objects in 2017, accounting for 21 percent of the total number of fatalities in the United States. Several previous studies have reported that rural bridge-related crashes result in more fatalities due to their being mostly the fixed-object crash type. As such, further in-depth investigation of this type of crash is necessary. Due to the lack of a comprehensive database that includes bridge-related crashes and bridge characteristics, identifying the key factors contributing to this type of crash is a challenging task that is addressed in this paper. METHOD: Study team gathered and compiled five years (2011-2015) of crash data from the New Jersey crash database and the characteristics of bridges from the Long-Term Bridge Performance portal. A Firth's penalized-likelihood logistic regression model was developed to examine the impact of explanatory variables on crash severity. RESULTS: Based on the five years (2011-2015) of crash data, significant factors (i.e., driver age, weather conditions, surface conditions, lighting conditions, speed limit, roadway characteristics, and direction of traffic) were identified that affect the severity of bridge-related crashes in Middlesex County, New Jersey. CONCLUSION: This model is an appropriate tool for predicting the impact of all the confounding variables on the probability of bridge-related crashes while also considering the rareness of the event. Based on the obtained odds ratio, the various effects of the identified variables are discussed, and recommendations made regarding countermeasures policymakers can establish to reduce the number of these crashes in New Jersey.