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Studies increasingly use geographic information systems (GISs) to assess the impact of built environments on health in childhood. The extensive range of GIS measures and operational definitions of the built environment determinants, as well as definitions of the geographic areas of exposure, entail methodological challenges that need to be addressed. We aimed to identify, systematize and evaluate (1) operational definitions of GIS-derived built environment measures and (2) the geographic areas of exposure applied in studies examining the impact of built environments on mental health and activity participation among children and adolescents. A systematic literature review was conducted. We searched for peer-reviewed articles using Web of Science, PubMed, Medline, PsychINFO and SweMed+. The material was systematized using descriptive statistics and a synthesis approach. Numerous operational definitions were identified, which we grouped into the following categories of measures: population, built form, land-use, road/street environment, facility and amenity, neighborhood green and open space and composite measures. There was a large variability in the measures applied, and some studies lacked precise operational definitions. Most studies used ego-centered definitions, based on circular and/or network buffers with distances that ranged from 50 to 8050 m, to define the areas of exposure. This review elucidated that consistency in operational definitions is urgently needed. We suggest that the identified categories of measures represent an initial step towards establishing consensus about which determinants are important to measure. This could provide a basis for refining operational definitions, which eventually can ensure targeted use and consistency in measures applied across future studies.

The aim of the present study was to investigate the relationship between green areas and adolescents' body mass index (BMI). This is based on the notion that nature environment is known to have beneficial effects on human health, and that some of the explanation for this is that green areas are especially motivating or suitable as arenas for physical activity. We included 10,527 participants from the Norwegian Youth Study, which was conducted between 2001 and 2004. The participants reported body weight, height, and important potential confounding variables about lifestyle, family situation, and neighbourhood characteristics. Green area was assessed from land cover maps and we calculated the percentage of green areas within 1 km and 5 km buffers around the adolescents' schools. We found that the percentage of overweight and obese adolescents increased significantly when the percentage of green areas in the participants' surrounding increased (p, Highlights • Prevalence of overweight among Norwegian adolescents varies dependent on greenness. • The prevalence is highest in most green areas and lowest in less green areas. • Physical activity and active transportation are independent explanatory factors. • Health promoting activities should be understood better in rural areas in Norway.

Commuting is an important aspect of daily life for many employees, but there is little knowledge of how this affects individual commuters' health and well-being. The authors investigated the relationship between commuting and subjective health complaints, using data from a web-based questionnaire. In a sample of 2126 railway employees, 644 (30.3%) had long commute times. A 29-item inventory was used to measure the number and degree of the subjective health complaints. Those who commuted 60 min or more each way were characterized by significantly higher numbers and degrees of subjective health complaints compared with their peers with short commutes. The mean number of complaints was 7.5 among the former group and 6.4 for the latter group (p = 0.009). In a regression model, in which the authors controlled for age, gender, education, self-rated health, and coping, the employees with long commutes reported more complaints than those with short commutes. Significant associations were found between those with long commutes and the number and degree of incidences of self-reported musculoskeletal pain, pseudo-neurologic complaints, and gastrointestinal problems. Commuters who had had long commutes for more than 10 years reported more gastrointestinal and musculoskeletal complaints than those with long commutes for less than 2 years. Also, commuters with long commutes spent less time with their families and leisure activities compared with those with short commutes. The authors conclude that the association between long commute times and higher levels of subjective health complaints should attract the attention of transport planners, employers, and public health policymaker., Highlights • Long commuters reported more subjective health symptoms than short commuters. • Musculoskeletal, gastrointestinal and pseudo neurological complaints were most frequent. • Long commuters spent less time with their families and on leisure activities than short commuters.

Background The Norwegian population has among the highest hip fracture rates in the world. The incidence varies geographically, also within Norway. Calcium in drinking water has been found to be beneficially associated with bone health in some studies, but not in all. In most previous studies, other minerals in water have not been taken into account. Trace minerals, for which drinking water can be an important source and even fulfill the daily nutritional requirement, could act as effect-modifiers in the association between calcium and hip fracture risk. The aim of the present study was to investigate the association between calcium in drinking water and hip fracture, and whether other water minerals modified this association. Materials and methods A survey of trace metals in 429 waterworks, supplying 64% of the population in Norway, was linked geographically to the home addresses of patients with incident hip fractures (1994–2000). Drinking water mineral concentrations were divided into “low” (below and equal waterworks average) and “high” (above waterworks average). Poisson regression models were fitted, and all incidence rate ratios (IRRs) were adjusted for age, geographic region, urbanization degree, type of water source, and pH of the water. Effect modifications were examined by stratification, and interactions between calcium and magnesium, copper, zinc, iron and manganese were tested both on the multiplicative and the additive scale. Analyses were stratified on gender. Results Among those supplied from the 429 waterworks (2,110,916 person-years in men and 2,397,217 person-years in women), 5433 men and 13,493 women aged 50–85 years suffered a hip fracture during 1994–2000. Compared to low calcium in drinking water, a high level was associated with a 15% lower hip fracture risk in men (IRR = 0.85, 95% CI: 0.78, 0.91) but no significant difference was found in women (IRR = 0.98, 95%CI: 0.93–1.02). There was interaction between calcium and copper on hip fracture risk in men (p = 0.051); the association between calcium and hip fracture risk was stronger when the copper concentration in water was high (IRR = 0.52, 95% CI: 0.35, 0.78) as opposed to when it was low (IRR = 0.88, 95% CI: 0.81, 0.94). This pattern persisted also after including potential confounding factors and other minerals in the model. No similar variation in risk was found in women. Conclusion In this large, prospective population study covering two thirds of the Norwegian population and comprising 19,000 hip fractures, we found an inverse association between calcium in drinking water and hip fracture risk in men. The association was stronger when the copper concentration in the water was high.

Aims and background: To assess the contribution of genetic and environmental influences on the development of inflammatory bowel disease (IBD) by comparing the population relative risk for concordant disease in Norwegian monozygotic (MZ) and dizygotic (DZ) twins to the risk of concordant disease among ordinary siblings of patients with IBD. Furthermore, clinical characteristics of IBD were evaluated. We also wanted to explore whether perinatal factors modify the risk for development of IBD among twins. Methods: Patients with IBD who were enrolled in an incidence study from 1990 to 1994 (IBSEN) and the twins were identified through the Norwegian national birth registry, which was established in 1967. A postal questionnaire was sent to 12700 Norwegian twins in 1998, born between 1967 and 1979. The IBD diagnosis in the twins was confirmed by phone interview and hospital records. Results: Twenty four twin pairs, 8 monozygotic and 16 dizygotic pairs, in which at least one claimed to have IBD, were recruited and compared to 85 patients with Crohn's disease (CD) and 86 with ulcerative colitis (UC) from the incidence study. Based on the population prevalence of CD (262/100 000) and UC (505/100 000), the relative risks for concordant disease in MZ pairs were estimated to 92.4 (95 % CI: 73.3, 114.6) and 49.5 (95 % CI: 35.7, 63.3) in CD and UC, respectively. The corresponding risks in DZ pairs were 42.4 (95 % CI: 29.6, 55.2) and 0.0. Among ordinary siblings of CD and UC the risks for concordance were 20.9 (95 % CI: 2.7, 39.3) and 4.6 (95 % CI: 0.0, 11.25), respectively. When comparing clinical characteristics between twins and incidence patients with IBD, only the prevalence of stricturing disease was significantly greater among twins with CD. The first-born twin in pairs discordant for disease, 12 out of 19 (63.2 %), tended to be affected by IBD (p = 0.10). Conclusion: Our study confirmed the importance of genetic influences on the development of CD. The risk among DZ twins for concordant disease was twice as high as among ordinary siblings, which might underscore the importance of shared environmental factors in uteri or later in life. Perinatal factors like bacterial colonization of the gut may seem to influence the development of IBD.