Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users.

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

COVID-19 outcomes in patients with inflammatory bowel diseases in Latin America: Results from SECURE-IBD registry.

BACKGROUND AND AIM: One of the most impacted regions by the pandemic globally, Latin America is facing socioeconomic and health-care challenges that can potentially affect disease outcomes. Recent data suggest that inflammatory bowel disease (IBD) patients do not have an increased risk of the development of COVID-19 complications. However, the impact of COVID-19 on IBD patients living in least developed areas remains to be fully elucidated. This study aims to describe the outcomes of IBD patients diagnosed with COVID-19 in countries from Latin America based on data from the SECURE-IBD registry. METHODS: Patients from Latin America enrolled in the SECURE-IBD registry were included. Descriptive analyses were used to summarize clinical and sociodemographic characteristics. The studied outcomes were (i) a composite of need for intensive care unit admission, ventilator use, and/or death (primary outcome) and (ii) a composite of any hospitalization and/or death (secondary outcome). Multivariable regression was used to identify risk factors of severe COVID-19. RESULTS: During the study period, 230 cases (Crohn's disease: n = 115, ulcerative colitis: n = 114, IBD-unclassified [IBD-U]: n = 1) were reported to the SECURE-IBD database from 13 different countries. Primary outcome was observed in 17 (7.4%) patients, and the case fatality rate was 1.7%. In the adjusted multivariable model, the use of systemic corticosteroids (odds ratio [OR] 10.97; 95% confidence interval [CI]: 3.44-34.99) was significantly associated with the primary outcome. Older age (OR 1.03; 95% CI: 1.00-1.05), systemic corticosteroids (OR 9.33; 95% CI: 3.84-22.63), and the concomitant presence of one (OR 2.14; 95% CI: 0.89-5.15) or two (OR 10.67; 95% CI: 1.74-65.72) comorbidities were associated with the outcome of hospitalization or death. CONCLUSION: Inflammatory bowel disease patients with COVID-19 in Latin America appear to have similar outcomes to the overall global data. Risk factors of severe COVID-19 are similar to prior reports.

Where Latin Americans are physically active, and why does it matter? Findings from the IPEN-adult study in Bogota, Colombia; Cuernavaca, Mexico; and Curitiba, Brazil.

Latin America (LA) has a unique structural, political, cultural and social environment. This study aimed to identify the places where Latin American adults are physically active; and to determine the association of using public- and restricted-access places with physical activity (PA). We used data from the International PA Environment Network study in Bogota, Colombia (n=1000, accelerometry=249); Cuernavaca, Mexico (n=677, accelerometry=652); and Curitiba, Brazil (n=697, accelerometry=331) (2010-2011). Walking and moderate-to-vigorous PA for leisure were measured with the International Physical Activity Questionnaire. Overall PA and PA within 10-minute bouts were measured with accelerometers. Participants reported use of public- and restricted-access places for PA. Mixed-effects regression models were used to determine the association of using public- and restricted-access places with PA. The streets were the most frequently-reported place for PA, and walking was the most common PA in the studied places. 'Informal', non-exercise-or-sports places (e.g., shopping malls) ranked high for use for PA in Bogota and Cuernavaca. In Curitiba, use of 'formal' places for sports/exercise (e.g., gyms) was more prevalent. Using public-access places was directly related to walking for leisure in all cities, and to additional PA outcomes in Bogota and Cuernavaca. In Cuernavaca and Curitiba, using restricted-access places was also associated with PA. Our study highlights the importance of public-access places for PA in LA. In some contexts, places for social interaction may be as important for PA as places for exercise/sport. Strategies increasing the availability, accessibility and quality of these places may effectively promote PA in LA.

Personal, social and environmental correlates of physical activity in adults from Curitiba, Brazil.

BACKGROUND: Leisure-time physical activity is a complex behavior influenced by factors at multiple levels. OBJECTIVE: To examine the associations between intrapersonal, interpersonal, environmental factors and leisure-time walking (LTW) and leisure-time physical activities (LTPA), excluding walking. We also examined the moderating effect of sociodemographic characteristics on these associations. METHODS: A cross-sectional study was conducted with 1461 adults from Curitiba, Brazil (63.7% women). LTW and LTPA were assessed through the International Physical Activity Questionnaire (IPAQ), and a cutoff point of ≥ 150 min/week was used. Associations were examined through multilevel logistic regressions. RESULTS: LTW was positively associated with self-efficacy, enjoyment, social support from family and friends, presence of public places for leisure and neighborhood esthetics. LTPA was associated with self-efficacy, enjoyment, social support from family and friends, safety from crime and neighborhood esthetics. Safety from crime was a predictor of LTPA among older adults only. CONCLUSIONS: Factors at multiple levels were associated with LTW and LTPA. Interventions to promote LTPA would likely benefit from considering personal, social and environmental factors and different levels of influence.

Built environment and physical activity for transportation in adults from Curitiba, Brazil.

The goal of this study was to assess the association between features of the built environment and levels of walking and cycling as forms of transportation in the city of Curitiba, Brazil. Data collection was conducted through a telephone survey in 2008. The International Physical Activity Questionnaire was used to identify walking or cycling as forms of transportation. The built environment characteristics were obtained through the Geographic Information System for 1,206 adults. Density indicators were computed, considering a radius of 500 m around each individual's household. For the accessibility measures, the shortest distance to selected built environment features (e.g., bus stop, bike path) was used. The association between characteristics of the environment and the practice of walking or cycling was assessed through logistic regressions. After considering individual characteristics, higher-income areas (OR = 0.56, 95 % CI = 0.41-0.76), higher density of Bus Rapid Transit stations (OR = 1.50, 95 % CI = 1.22-1.84), and the proportion of residential (OR = 1.25, 95 % CI = 1.02-1.53) and commercial (OR = 1.47, 95 % CI = 1.13-1.91) areas were associated with any walking prevalence (≥ 10 min/week). Higher access to bike paths (OR = 0.80, 95 % CI = 0.64-1.00) was inversely associated with walking at recommended levels (≥ 150 min/week). Higher-income areas (OR = 0.26, 95 % CI = 0.08-0.81), greater number of traffic lights (OR = 0.27, 95 % CI = 0.09-0.88), and higher land use mix (OR = 0.52, 95 % CI = 0.31-0.88) were inversely associated with cycling. The neighborhood built environment may affect active commuting among adults living in urban centers in middle-income countries.

Obesity-related gene ADRB2, ADRB3 and GHRL polymorphisms and the response to a weight loss diet intervention in adult women.

The individual response to diet may be influenced by gene polymorphisms. This study hypothesized that ADRB2 (Gln27Glu, rs1042714 and Arg16Gly, rs1042713), ADRB3 (Trp64Arg, rs4994) and GHRL (Leu72Met, rs696217) polymorphisms moderate weight loss. The study was a seven weeks dietary weight loss intervention with Brazilian adult obese women (n = 109). The body mass index (BMI) was calculated and polymorphisms in these genes were assessed by real-time PCR assays. Two-way repeated-measures ANOVA (2 × 2) were used to analyze the intervention effect between polymorphisms and BMI over the period and after stratification for age and socioeconomic status (SES). The weight loss intervention resulted in decreased BMI over the seven-week period (p < 0.001), for high and low SES (p < 0.05) and mainly for participants with 30-49 y. The intervention did not result in a statistically significant difference in weight loss between polymorphism carriers and non-carriers, and although, the ADRB2, ADRB3 and GHRL polymorphisms did not moderate weight loss, the Gln27Glu polymorphism carriers showed a lower BMI compared to non-carriers in the low SES (p = 0.018) and the 30-39 y (p = 0.036) groups, suggesting a role for this polymorphism related to BMI control.

Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study.

Background: Population-based data on epidemiology of Inflammatory Bowel Diseases (IBD) in Brazil are scarce. This study aims to define temporal trends of incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in Brazil. Methods: All IBD patients from the public healthcare national system were included from January 2012 to December 2020. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using log-linear regression for incidence and binomial regression for prevalence. Moran's I autocorrelation index was used to analyse clustering of cities by level of prevalence. Findings: A total of 212,026 IBD patients were included. Incidence of IBD rose from 9.4 in 2012 to 9.6 per 100,000 in 2020 (AAPC=0.8%; 95% CI -0.37, 1.99); for UC, incidence increased from 5.7 to 6.9 per 100,000 (AAPC=3.0%; 95% CI 1.51, 4.58) and for CD incidence decreased from 3.7 to 2.7 per 100,000 (AAPC=-3.2%; 95% CI -4.45, -2.02). Prevalence of IBD increased from 30.0 in 2012 to 100.1 per 100,000 in 2020 (AAPC=14.8%; CI 14.78-14.95); for UC, from 15.7 to 56.5 per 100,000 (AAPC=16.0%; CI 15.94, 16.17); for CD from 12.6 to 33.7 per 100,000 (AAPC=12.1% CI 11.95, 12.02). A south-north gradient was observed in 2020 prevalence rates of IBD [I=0.40 (p<0.0001)], CD [I=0.22 (p<0.0001)] and UC [I=0.42 (p<0.0001)]. Interpretation: Incidence of CD is decreasing whereas of UC is increasing, leading to stabilization in the incidence of IBD from 2012 to 2020 in Brazil. Prevalence of IBD has been climbing with 0.1% of Brazilians living with IBD in 2020. Funding: None.

Walking for leisure among adults from three Brazilian cities and its association with perceived environment attributes and personal factors.

BACKGROUND: Walking is a popular form of physical activity and a convenient option to prevent chronic diseases. However, most of the evidence on this topic derives from high-income countries and little is known about walking patterns and its association with environmental features in low and middle income countries. OBJECTIVES: To describe walking for leisure and to identify its association with perceived environment and personal factors among residents of three state capitals from different regions of Brazil METHODS: Cross sectional phone surveys were conducted in Recife, Curitiba and Vitória (n = 6,166) in 2007, 2008 and 2009 respectively. Physical activity was measured using the leisure-time sections of the long version of the International Physical Activity Questionnaire (IPAQ). Perceived environment characteristics were assessed using a modified version of the Neighborhood Environment Walkability Scale (NEWS). Multivariable analysis tested the associations between walking for leisure and perceived environment characteristics across the cities using logistic regression. RESULTS: The proportions of respondents meeting physical activity recommendations through walking for leisure were 9.6%, 16.0% and 8.8% in Curitiba, Recife and Vitoria, respectively. Engaging in 150 min/wk or more of walking for leisure was significantly associated with younger age, higher education, better self-rated health and with lack of sidewalks on nearby streets. We did not find positive associations between walking for leisure and traffic conditions and safety related to cycling/walking during the day or night. CONCLUSION: Most environmental features were not associated with walking for leisure. Personal factors were stronger predictors of walking for leisure as compared with perceived environment factors.

The built environment and recreational physical activity among adults in Curitiba, Brazil.

OBJECTIVE: To examine the relationship between objective measures of the built environment (BE) and recreational physical activity (PA) in adults from Curitiba, Brazil. METHOD: A phone survey was carried among a random sample of 1206 people. Walking during leisure time (WLT) and moderate and vigorous recreational PA (MVPA) was measured using IPAQ. Characteristics of the BE were determined in an area of 500 m surrounding respondent's homes. Multivariate logistic regression analysis was used to estimate the associations between recreational PA and BE. RESULTS: After adjusting for confounders, WLT was associated with area income level US$971.45-3341.64 vs. US$167.05-461.06 (25.7% vs. 11.1% POR=2.5; 95% CI=1.5-4.4), having ≥ 2 gyms vs. none (26.1% vs. 12.7%, POR=1.9; 95% CI=1.2-3.0) and distance to recreation centers, 1769.1-2835.5 km vs. 2835.6-10,212.3 km (22.1% vs. 11.0%, POR=2.3; 95% CI=(1.0-2.5). MVPA was associated with neighborhood income US$971.45-3341.64 vs. US$167.05-461.06 (47.6% vs. 22.0% POR=3.0; 95% CI=1.5-5.9) and having ≥ 2 gyms vs. none (41.7% vs. 26.0%, POR=1.5; 95% CI=1.11-2.1). CONCLUSION: The presence of some recreational facilities for PA was associated with recommended levels of PA during leisure time in Curitiba, Brazil.

Capacity for childhood obesity research in Latin American and US Latino populations: State of the field, challenges, opportunities, and future directions.

Childhood obesity is a major problem in Latin America and among US Latinos. Effective public health policies require contextually relevant evidence to guide them, which demands sustained research capacity. The objectives of this study are to determine research productivity in Latin America and in the United States focused on Latino populations and examine domains of research capacity (research infrastructure, training programs, mentoring, funding, and networks). We conducted a scoping review of indexed childhood obesity-related articles published June 2015-December 2019. We collected data on perceptions of capacity for childhood obesity research among Latin American investigators through an online survey. We identified 612 childhood obesity-related articles (505 from Latin America, 124 from the United States, and 17 US-Latin America collaborations). Brazil, Mexico, Chile, Colombia, and the United States are the top publishing countries. There are similar numbers of obesity, nutrition, and physical activity articles, but physical activity research capacity lagged in other domains (research training, funding, and networking opportunities). Complementary research areas, including sedentary behavior, systems science, and policy studies, are uncommon in Latin America but more prevalent in the United States, whereas sleep research is nascent across settings. Realizing the promise of an effective cross-border collaborative childhood obesity prevention agenda will require committed investment in all domains of research capacity and across all relevant topics.

Assessing physical activity in public parks in Brazil using systematic observation.

OBJECTIVES: We assessed park use in Recife, Brazil, and differences in physical activity and occupation rates in public parks with and without the Academia da Cidade Program (ACP), which provides cost-free, supervised physical activity classes. METHODS: We used the System for Observing Play and Recreation in Communities (SOPARC) in 128 targeted areas in 10 park sites (5 ACP sites, 5 non-ACP sites) to obtain data on the number of users and their physical activity levels and estimated age. Each area was assessed 4 times a day for 11 days over a 4-week period. RESULTS: A total of 32 974 people were observed during 5589 observation visits to target areas. People using ACP parks were more likely to be seen engaging in moderate-to-vigorous (64% vs 49%) and vigorous (25% vs 10%) physical activity. Relatively more participants in ACP sites than in non-ACP sites were females (45% vs 42% of park users) and older adults (14.7% vs 5.7% of park users). CONCLUSIONS: On the basis of systematic observation, ACP appears to be a useful strategy in promoting park use and physical activity among the population in Recife.

Capacidad de investigación en obesidad infantil en Latinoamérica y en las poblaciones latinas de Estados Unidos: estado de la investigación, problemas, oportunidades y líneas de trabajo para el futuro.

La obesidad infantil es un problema grave en Latinoamérica y entre la población latina de EE. UU. Para ser eficaces, las políticas de salud pública tienen que estar guiadas por evidencias contextuales pertinentes, lo cual exige una capacidad de investigación sostenida a través del tiempo. Los objetivos de este estudio son determinar la productividad de la investigación enfocada en las poblaciones latinas en Latinoamérica y Estados Unidos, y examinar los dominios de la capacidad de investigación (infraestructuras, programas de formación, mentoría, financiamiento y redes de contactos). Realizamos una revisión exploratoria de artículos indexados relacionados con la obesidad infantil publicados entre junio de 2015 y diciembre de 2019. Recabamos información sobre las percepciones de los investigadores latinoamericanos respecto a la capacidad de investigación en obesidad infantil a través de una encuesta en línea. Identificamos 612 artículos relacionados con la obesidad infantil (505 de Latinoamérica, 124 de EE. UU. y 17 de colaboraciones entre EE. UU. y Latinoamérica). Brasil, México, Chile, Colombia y Estados Unidos son los países con más publicaciones. Encontramos aproximadamente el mismo número de artículos sobre obesidad, nutrición y actividad física; sin embargo, observamos que la capacidad de investigación sobre actividad física está rezagada en otros dominios (formación en investigación, financiamiento y oportunidades para establecer contactos). Otras áreas de investigación complementarias, como el comportamiento sedentario, la ciencia de sistemas y los estudios de políticas, son poco frecuentes en Latinoamérica, pero más habituales en Estados Unidos, mientras que la investigación sobre el sueño es incipiente en ambas regiones. Para cumplir la promesa de crear un programa eficaz de colaboración transfronteriza para la prevención de la obesidad infantil será necesario invertir en todos los dominios de la capacidad de investigación y en todos los temas pertinentes.

Intensity-specific leisure-time physical activity and the built environment among Brazilian adults: a best-fit model.

BACKGROUND: There is little understanding about which sets of environmental features could simultaneously predict intensity-specific leisure-time physical activity (LTPA) among Brazilians. The objectives were to identify the environmental correlates for intensity-specific LTPA, and to build the best-fit linear models to predict intensity-specific LTPA among adults of Curitiba, Brazil. METHODS: Cross sectional study in Curitiba, Brazil (2009, n = 1461). The International Physical Activity Questionnaire and Abbreviated Neighborhood Environment Assessment Scale were used. Ninety-two perceived environment variables were categorized in 10 domains. LTPA was classified as walking for leisure (LWLK), moderate-intensity leisure-time PA (MLPA), vigorous-intensity leisure-time PA (VLPA), and moderate-to-vigorous intensity leisure-time PA (MVLPA). Best fitting linear predictive models were built. RESULTS: Forty environmental variables were correlated to at least 1 LTPA outcome. The variability explained by the 4 best-fit models ranged from 17% (MLPA) to 46% (MVLPA). All models contained recreation areas and aesthetics variables; none included residential density predictors. At least 1 neighborhood satisfaction variable was present in each of the intensity-specific models, but not for overall MVLPA. CONCLUSIONS: This study demonstrates the simultaneous effect of sets of perceived environmental features on intensity-specific LTPA among Brazilian adults. The differences found compared with high-income countries suggest caution in generalizing results across settings.

Bicycling and walking for transportation in three Brazilian cities.

BACKGROUND: Physical inactivity plays a role in the acquisition of heart disease, type 2 diabetes, and breast and colon cancer. The impact of such noncommunicable diseases on low- and middle-income countries is a major global health concern, but most studies in this area have focused on high-income countries. A better understanding of the factors that may influence physical activity in low- and middle-income countries is needed. PURPOSE: This study describes the prevalence of cycling and walking for transportation and their association with personal and environmental factors in adults from three state capitals in Brazil. METHODS: In 2007-2009, a random-digit-dialing telephone survey was conducted with residents (aged ≥18 years) of Curitiba, Vitoria, and Recife, sampled through a clustered multistage sampling process. Walking and cycling for transportation, perception of the environment related to physical activity, and demographic and health characteristics were collected. Poisson regression was used to examine associations between cycling and walking for transportation with covariates stratified by cities. All analyses were conducted in 2011. RESULTS: The prevalence of bicycling for transportation was 13.4%; higher in Recife (16.0%; 95% CI=13.7, 18.4) compared to Curitiba (9.6%; 95% CI=7.8, 11.4) and Vitoria (8.8%; 95% CI=7.34, 10.1); and 26.6% for walking regularly as a mode of transportation. The adjusted analysis showed that cycling is positively associated with being male (prevalence OR [pOR]=3.4; 95% CI=2.6, 18.4) and younger (pOR=2.9; 95% CI=1.8, 4.9) and inversely associated with having a college degree (pOR=0.3; 95% CI=0.2, 0.4). Walking for transportation is inversely associated with having a college degree (pOR=0.6; 95% CI=0.5, 0.8). No strong evidence of association was found of environmental indicators with walking or bicycling. CONCLUSIONS: The prevalence of active commuting was low and varied by city. Personal factors were more consistently associated with bicycling than with walking, whereas perceived environmental features were not related to active commuting.

Physical activity interventions in Latin America: expanding and classifying the evidence.

CONTEXT: Systematic reviews of public health interventions are useful for identifying effective strategies for informing policy and practice. The goals of this review were to (1) update a previous systematic review of physical activity interventions in Latin America which found that only school-based physical education had sufficient evidence to recommend widespread adoption; (2) assess the reporting of external validity elements; and (3) develop and apply an evidence typology for classifying interventions. EVIDENCE ACQUISITION: In 2010-2011, community-level, physical activity intervention studies from Latin America were identified, categorized, and screened based on the peer-reviewed literature or Brazilian theses published between 2006 and 2010. Articles meeting inclusion criteria were evaluated using U.S. Community Guide methods. External validity reporting was assessed among a subset of articles reviewed to date. An evidence rating typology was developed and applied to classify interventions along a continuum based on evidence about their effectiveness in the U.S. context, reach, adoption, implementation, institutionalization, and benefits and costs. EVIDENCE SYNTHESIS: Thirteen articles published between 2006 and 2010 met inclusion criteria and were abstracted systematically, yet when combined with evidence from articles from the previous systematic review, no additional interventions could be recommended for practice. Moreover, the reporting of external validity elements was low among a subset of 19 studies published to date (median=21% of elements reported). By applying the expanded evidence rating typology, one intervention was classified as evidence-based, seven as promising, and one as emerging. CONCLUSIONS: Several physical activity interventions have been identified as promising for future research and implementation in Latin America. Enhanced reporting of external validity elements will inform the translation of research into practice.