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Background: Several recent studies have identified a relationship between the natural environment and improved health outcomes. However, for practical reasons, most have been observational, cross-sectional studies. Purpose: A natural experiment, which provides stronger evidence of causality, was used to test whether a major change to the natural environment—the loss of 100 million trees to the emerald ash borer, an invasive forest pest— has influenced mortality related to cardiovascular and lower- respiratory diseases. Methods: Two fixed-effects regression models were used to estimate the relationship between emerald ash borer presence and county-level mortality from 1990 to 2007 in 15 U.S. states, while controlling for a wide range of demographic covariates. Data were collected from 1990 to 2007, and the analyses were conducted in 2011 and 2012. Results: There was an increase in mortality related to cardiovascular and lower-respiratory-tract illness in counties infested with the emerald ash borer. The magnitude of this effect was greater as infestation progressed and in counties with above-average median household income. Across the 15 states in the study area, the borer was associated with an additional 6113 deaths related to illness of the lower respiratory system, and 15,080 cardiovascular-related deaths. Conclusions: Results suggest that loss of trees to the emerald ash borer increased mortality related to cardiovascular and lower-respiratory-tract illness. This finding adds to the growing evidence that

Context Epidemiologists and public health researchers are studying neighborhood's effect on individual health. The health of older adults may be more influenced by their neighborhoods as a result of decreased mobility. However, research on neighborhood's influence on older adults' health, specifically, is limited. Evidence acquisition Recent studies on neighborhood and health for older adults were identified. Studies were identified through searches of databases including PsycINFO, CINAHL, PubMed, Academic Search Premier, Ageline, Social Science Citation Index, and Health Source. Criteria for inclusion were as follows: human studies; English language; study sample included adults aged ≥55 years; health outcomes, including mental health, health behaviors, morbidity, and mortality; neighborhood as the primary exposure variable of interest; empirical research; and studies that included ≥10 neighborhoods. Air pollution studies were excluded. Five hundred thirty-eight relevant articles were published during 1997–2007; a total of 33 of these articles met inclusion criteria. Evidence synthesis The measures of objective and perceived aspects of neighborhood were summarized. Neighborhood was primarily operationalized using census-defined boundaries. Measures of neighborhood were principally derived from objective sources of data; eight studies assessed perceived neighborhood alone or in combination with objective measures. Six categories of neighborhood characteristics were socioeconomic composition, racial composition, demographics, perceived resources and/or problems, physical environment, and social environment. The studies are primarily cross-sectional and use administrative data to characterize neighborhood. Conclusions These studies suggest that neighborhood environment is important for older adults' health and functioning.

Several recent studies have identified a relationship between the natural environment and improved health outcomes. However, for practical reasons, most have been observational, cross-sectional studies.A natural experiment, which provides stronger evidence of causality, was used to test whether a major change to the natural environment-the loss of 100 million trees to the emerald ash borer, an invasive forest pest-has influenced mortality related to cardiovascular and lower-respiratory diseases.Two fixed-effects regression models were used to estimate the relationship between emerald ash borer presence and county-level mortality from 1990 to 2007 in 15 U.S. states, while controlling for a wide range of demographic covariates. Data were collected from 1990 to 2007, and the analyses were conducted in 2011 and 2012.There was an increase in mortality related to cardiovascular and lower-respiratory-tract illness in counties infested with the emerald ash borer. The magnitude of this effect was greater as infestation progressed and in counties with above-average median household income. Across the 15 states in the study area, the borer was associated with an additional 6113 deaths related to illness of the lower respiratory system, and 15,080 cardiovascular-related deaths.Results suggest that loss of trees to the emerald ash borer increased mortality related to cardiovascular and lower-respiratory-tract illness. This finding adds to the growing evidence that the natural environment provides major public health benefits.

Background Research of the effects of the built environment on physical activity often excludes certain segments of the population. The senior population, one segment perhaps most influenced by the physical features of an environment, has been understudied. Developing reliable measures of the environment is important to increase our understanding of the environmental effects on physical activity among seniors. Methods A review of urban planning and health literature helped identify important concepts and theories that were used to inform the development of the Senior Walking Environmental Assessment Tool (SWEAT). Urban planning and health research professionals were consulted and provided feedback on the tool. A total of 355 neighborhood segments were assessed using SWEAT. Thirty-six neighborhood segments were assessed for inter-rater reliability. Results Overall, raters exhibited good-to-excellent agreement on most items included in SWEAT. Items assessing buildings and destinations were less reliable than other categories. Conclusions The development of a reliable senior-specific environmental measurement of detailed street level environmental features that may influence walking among seniors is important to advance this research and engage communities to consider simple environmental changes that encourage walking among seniors.