Developing indicators of age-friendly neighbourhood environments for urban and rural communities across 20 low-, middle-, and high-income countries.

BACKGROUND: By 2050, the global population of adults 60 + will reach 2.1 billion, surging fastest in low- and middle-income countries (LMIC). In response, the World Health Organization (WHO) has developed indicators of age-friendly urban environments, but these criteria have been challenging to apply in rural areas and LMIC. This study fills this gap by adapting the WHO indicators to such settings and assessing variation in their availability by community-level urbanness and country-level income. METHODS: We used data from the Prospective Urban and Rural Epidemiology (PURE) study's environmental-assessment tools, which integrated systematic social observation and ecometrics to reliably capture community-level environmental features associated with cardiovascular-disease risk factors. The results of a scoping review guided selection of 18 individual indicators across six distinct domains, with data available for 496 communities in 20 countries, including 382 communities (77%) in LMIC. Finally, we used both factor analysis of mixed data (FAMD) and multitrait-multimethod (MTMM) approaches to describe relationships between indicators and domains, as well as detailing the extent to which these relationships held true within groups defined by urbanness and income. RESULTS: Together, the results of the FAMD and MTMM approaches indicated substantial variation in the relationship of individual indicators to each other and to broader domains, arguing against the development of an overall score and extending prior evidence demonstrating the need to adapt the WHO framework to the local context. Communities in high-income countries generally ranked higher across the set of indicators, but regular connections to neighbouring towns via bus (95%) and train access (76%) were most common in low-income countries. The greatest amount of variation by urbanness was seen in the number of streetscape-greenery elements (33 such elements in rural areas vs. 55 in urban), presence of traffic lights (18% vs. 67%), and home-internet availability (25% vs. 54%). CONCLUSIONS: This study indicates the extent to which environmental supports for healthy ageing may be less readily available to older adults residing in rural areas and LMIC and augments calls to tailor WHO's existing indicators to a broader range of communities in order to achieve a critical aspect of distributional equity in an ageing world.

Exposure to natural space, sense of community belonging, and adverse mental health outcomes across an urban region.

In a rapidly urbanizing world, identifying evidence-based strategies to support healthy design is essential. Although urban living offers increased access to critical resources and can help to mitigate climate change, densely populated neighborhood environments are often higher in many of the physical and psychological stressors that are detrimental to health, and lower in the social capital that is beneficial to health. One component of urban form that can reduce these stressors and improve social capital is nature: greenspace, such as parks and street trees, and bluespace, such as rivers and oceans. In this project, we applied measures from a Natural Space Index previously developed for the Vancouver, Canada census metropolitan area to explore the relationship between distinct measures of natural space and prevalence of (1) major depressive disorder, (2) negative mental health, and (3) psychological distress. In addition, we examined direct associations between natural space exposure and neighborhood social capital, as measured via self-reported sense of community belonging (SoC), as well as the potential mental health benefits of natural space mediated via SoC. Using data from the population-based, cross-sectional 2012 Canadian Community Health Survey-Mental Health (weighted n = 1,930,048), we found no direct associations between any measure of natural space and mental health in models adjusted for 11 demographic, socioeconomic, household arrangement, health, and urban design variables. However, publicly accessible neighborhood nature was associated with increased odds of higher SoC. A 1% increase in the percentage of natural space (combined greenspace and bluespace) within 500 m had an odds ratio [95% confidence interval] of 1.05 [1.00, 1.10] for very strong vs. very weak SoC and 1.04 [1.01, 1.08] for somewhat strong vs. very weak SoC. In addition, higher levels of SoC were associated with improvements in all three mental health outcomes. Mediation tests indicated significant indirect effects of both publicly accessible neighborhood nature variables on reductions in psychological distress and reduced odds of negative mental health via increased sense of SoC. This suggests that natural space has the potential to address the pressing issue of social isolation and, in turn, poor mental health faced by residents of dense urban environments.

Beyond the Normalized Difference Vegetation Index (NDVI): Developing a Natural Space Index for population-level health research.

BACKGROUND: Natural spaces can provide psychological benefits to individuals, but population-level epidemiologic studies have produced conflicting results. Refining current exposure-assessment methods is necessary to advance our understanding of population health and to guide the design of health-promoting urban forms. OBJECTIVES: The aim of this study was to develop a comprehensive Natural Space Index that robustly models potential exposure based on the presence, form, accessibility, and quality of multiple forms of greenspace (e.g., parks and street trees) and bluespace (e.g., oceans and lakes). MATERIAL AND METHODS: The index was developed for greater Vancouver, Canada. Greenness presence was derived from remote sensing (NDVI/EVI); forms were extracted from municipal and private databases; and accessibility was based on restrictions such as private ownership. Quality appraisals were conducted for 200 randomly sampled parks using the Public Open Space Desktop Appraisal Tool (POSDAT). Integrating these measures in GIS, exposure was assessed for 60,242 postal codes using 100- to 1,600-m buffers based on hypothesized pathways to mental health. A single index was then derived using principal component analysis (PCA). RESULTS: Comparing NDVI with alternate approaches for assessing natural space resulted in widely divergent results, with quintile rankings shifting for 22-88% of postal codes, depending on the measure. Overall park quality was fairly low (mean of 15 on a scale of 0-45), with no significant difference seen by neighborhood-level household income. The final PCA identified three main sets of variables, with the first two components explaining 68% of the total variance. The first component was dominated by the percentages of public and private greenspace and bluespace and public greenspace within 250m, while the second component was driven by lack of access to bluespace within 1 km. CONCLUSIONS: Many current approaches to modeling natural space may misclassify exposures and have limited specificity. The Natural Space Index represents a novel approach at a regional scale with application to urban planning and policy-making.

Gender differences in the roles for social support in ensuring adequate fruit and vegetable consumption among older adult Canadians.

BACKGROUND: Adequate fruit and vegetable consumption has been linked to reductions in all-cause mortality, stroke, and cancer. Unfortunately, less than half of Canadians aged 65+ meet the standard international guideline for adequate consumption (≥5 servings per day). Among older adults, social isolation and low social support are barriers to proper nutrition, but the effects of specific types of social support on adequate fruit and vegetable consumption are unknown. OBJECTIVE: This study sought to test hypotheses regarding direct and indirect pathways through which tangible and emotional/informational social support may facilitate adequate fruit and vegetable consumption among older adults. METHODS: Analyzing 2008-2009 Canadian Community Health Survey - Healthy Aging component data (n = 14,221), logistic regression models were developed to examine associations between tangible and emotional/informational social support, eating behaviors (eating alone and preparing one's own meals), and meeting the recommended guideline of consuming ≥5 servings of fruit and vegetables per day. RESULTS: In pooled models, emotional/informational support was positively associated with adequate fruit and vegetable consumption (OR = 1.16; 95% CI = 1.07, 1.27). Among men, neither social support form was directly or indirectly associated with adequate consumption; among women, adequate consumption was negatively associated with tangible support but positively associated with higher emotional/informational support. Both of these associations were mediated by not usually cooking one's own meals. CONCLUSIONS: Programs and policies that seek to foster social support for older adults as a means of ensuring proper nutrition should consider the nuanced mechanisms through which different social support forms may operate for men and women.

Examining training and attitudes to basic life support in multi-ethnic communities residing in New South Wales, Australia: A mixed-methods investigation.

BACKGROUND: Bystander response, including cardiopulmonary resuscitation (CPR), is critical to out-of-hospital cardiac arrest (OHCA) survival. Nearly 30% of Australian residents were born overseas, and little is known about their preparedness to perform CPR. In this mixed-methods study, we examined rates of training and willingness and barriers to performing CPR among immigrants in Australia. METHODS: First, we surveyed residents in New South Wales, Australia, using purposeful sampling to enrich immigrant populations. Multivariate logistic regression was used to examine the association between place of birth and willingness to perform CPR. Next, we conducted focus-group discussions with members of the region's largest migrant groups to explore barriers and relevant societal or cultural factors. RESULTS: Of the 1267 survey participants (average age 49.6 years, 52% female), 60% were born outside Australia, most in Asia and 73% had lived in Australia for more than 10 years. Higher rates of previous CPR training were reported among Australian-born participants compared with South Asian-born and East Asian-born (77%, 35%, 48%, respectively, p <0.001). In adjusted models, the odds of willingness to perform CPR on a stranger were significantly lower among migrants than Australian-born (adjusted OR: 0.64; 95% CI 0.49 to 0.83); however, this association was mediated by history of training. Themes emerging from the focus-group discussions included concerns about causing harm, fear of liability, and birthplace-specific social and cultural barriers. CONCLUSIONS: Targeted awareness and training interventions, which address common and culture-specific barriers to response and improved access to training, may improve confidence and willingness to respond to OHCA in multi-ethnic communities.

Out-of-hospital cardiac arrests and bystander response by socioeconomic disadvantage in communities of New South Wales, Australia.

BACKGROUND & AIM: Bystander response to out-of-hospital cardiac arrest (OHCA) may relate to area-level factors, including socioeconomic status (SES). We aimed to examine whether OHCA among individuals in more disadvantaged areas are less likely to receive bystander cardiopulmonary resuscitation (CPR) compared to those in more advantaged areas. METHODS: We analysed data on OHCAs in New South Wales, Australia collected prospectively through a statewide, population-based register. We excluded non-medical arrests; arrests witnessed by a paramedic; occurring in a medical centre, nursing home, police station; or airport, and among individuals with a Do-Not-Resuscitate order. Area-level SES for each arrest was defined using the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage and its relationship to likelihood of receiving bystander CPR was examined using hierarchical logistic regression models. RESULTS: Overall, 39% (6622/16,914) of arrests received bystander CPR (71% of bystander-witnessed). The OHCA burden in disadvantaged areas was higher (age-standardised incidence 76-87/100,000/year in more disadvantaged quintiles 1-4 versus 52 per 100,000/year in most advantaged quintile 5). Bystander CPR rates were lower (38%) in the most disadvantaged quintile and highest (42%) in the most advantaged SES quintile. In adjusted models, younger age, being bystander-witnessed, arresting in a public location, and urban location were all associated with greater likelihood of receiving bystander CPR; however, the association between area-level SES and bystander CPR rate was not significant. CONCLUSIONS: There are lower rates of bystander CPR in less advantaged areas, however after accounting for patient and location characteristics, area-level SES was not associated with bystander CPR. Concerted efforts to engage with communities to improve bystander CPR in novel ways could improve OHCA outcomes.

Development of an intervention to facilitate dissemination of community-based training to respond to out-of-hospital cardiac arrest: FirstCPR.

BACKGROUND AND AIM: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue with low survival rates. Prompt bystander action can more than double survival odds. OHCA response training is primarily pursued due to work-related mandates, with few programs targeting communities with lower training levels. The aim of this research was to describe the development process of a targeted multicomponent intervention package designed to enhance confidence and training among laypeople in responding to an OHCA. METHODS: An iterative, three-phase program development process was employed using a mixed methods approach. The initial phase involved establishment of a multidisciplinary panel that informed decisions on key messages, program content, format, and delivery modes. These decisions were based on scientific evidence and guided by behavioural theories. The second phase comprised the development of the intervention package, identifying existing information and developing new material to fill identified gaps. The third phase involved refining and finalising the material via feedback from panel members, stakeholders, and community members. RESULTS: Through this approach, we collaboratively developed a comprehensive evidence-based education and training package consisting of a digital intervention supplemented with free access to in-person education and training. The package was designed to teach community members the specific steps in recognising and responding to a cardiac arrest, while addressing commonly known barriers and fears related to bystander response. The tailored program and delivery format addressed the needs of individuals of diverse ages, cultural backgrounds, and varied training needs and preferences. CONCLUSION: The study highlights the importance of community engagement in intervention development and demonstrates the need of evidence-based and collaborative approaches in creating a comprehensive, localised, relatively low-cost intervention package to improve bystander response to OHCA.

Psychological Impact of COVID-19 on People with Pre-Existing Chronic Disease.

The COVID-19 pandemic has caused an increase in anxiety and depression levels across broad populations. While anyone can be infected by the virus, the presence of certain chronic diseases has been shown to exacerbate the severity of the infection. There is a likelihood that knowledge of this information may lead to negative psychological impacts among people with chronic illness. We hypothesized that the pandemic has resulted in increased levels of anxiety and depression symptoms among people with chronic illness. We recruited 540 participants from the ongoing Prospective Urban and Rural Epidemiology (PURE) study in British Columbia, Canada. Participants were asked to fill out an online survey that included the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression symptoms. We tested our hypothesis using bivariate and multivariable linear regression models. Out of 540 participants, 15% showed symptoms of anxiety and 17% reported symptoms of depression. We found no significant associations between having a pre-existing chronic illness and reporting higher levels of anxiety or depression symptoms during COVID-19. Our results do not support the hypothesis that having a chronic illness is associated with greater anxiety or depression symptoms during the COVID-19 pandemic. Our results were similar to one study but in contrast with other studies that found a positive association between the presence of chronic illness and developing anxiety or depression during this pandemic.