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Introduction: The accelerated motorization has brought a series of environmental concerns and damaged public environmental health by causing severe air and noise pollution. The advocate of urban rail transit system such as metro is effective to reduce the private car dependence and alleviate associated environmental outcomes. Meanwhile, the increased metro usage can also benefit public and individual health by facilitating physical activities such as walking or cycling to the metro station. Therefore, promoting metro usage by discovering the nonlinear associations between the built environment and metro ridership is critical for the government to benefit public health, while most studies ignored the non-linear and threshold effects of built environment on weekend metro usage., Method: Using multi-source datasets in Shanghai, this study applies Gradient Boosting Decision Trees (GBDT), a nonlinear machine learning approach to estimate the non-linear and threshold effects of the built environment on weekend metro ridership., Results: Results show that land use mixture, distance to CBD, number of bus line, employment density and rooftop density are top five most important variables by both relative importance analysis and Shapley additive explanations (SHAP) values. Employment density and distance to city center are top five important variables by feature importance. According to the Partial Dependence Plots (PDPs), every built environment variable shows non-linear impacts on weekend metro ridership, while most of them have certain effective ranges to facilitate the metro usage. Maximum weekend ridership occurs when land use mixture entropy index is less than 0.7, number of bus lines reaches 35, rooftop density reaches 0.25, and number of bus stops reaches 10., Implication: Research findings can not only help government the non-linear and threshold effects of the built environment in planning practice, but also benefit public health by providing practical guidance for policymakers to increase weekend metro usage with station-level built environment optimization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Peng, Wang, Zhang and Li.)

This study aimed to systematically review longitudinal studies examining associations between the incidence of type 2 diabetes mellitus (T2DM) and built environmental factors. This review adhered to the 2020 PRISMA guidelines. Longitudinal studies examining associations between T2DM incidence and built environmental features were eligible. Built environment constructs corresponded to the following themes: 1) Walkability - factors such as sidewalks/footpaths, crosswalks, parks, and density of businesses and services; (2) Green/open space - size, greenness, and type of available public outdoor spaces; (3) Food environment - ratio of healthful food outlets (e.g., greengrocers, butchers, supermarkets, and health food shops) to unhealthful food outlets (e.g., fast-food outlets, sweet food retailers, and convenience stores). Five databases (e.g., Medline) were searched from inception until July 2023. Qualitative and quantitative synthesis were used to summarise key findings, including a meta-analysis of adjusted Hazard Ratios (aHR). Of 3,343 articles, 16 longitudinal studies from seven countries, published between 2015 and 2023, involving 13,403,902 baseline participants (median of 83,898), were included. In four of the five studies, unhealthful food environment was significantly associated with higher incident T2DM. Five of seven greenspace studies and two of four walkability studies showed that greater greenery and greater walkability were statistically significantly associated with lesser incident T2DM. In pooled analyses, greater T2DM incidence was associated with unhealthful relative to healthful food environments (pooled HR: 1.21; 95% CI: 1.04, 1.42), and T2DM incidence was inversely associated with green/open space environments (pooled HR: 0.82; 95% CI: 0.74, 0.92). Greater walkability was associated with a slight 2% lesser incidence of T2DM (pooled HR: 0.98; 95% CI: 0.98, 0.99). This review underscores consistency in the nature of associations between built environment features related to T2DM. We observed statistically significant inverse or "protective" associations between T2DM and walkability and healthful food environments. These results support calls for policies and guidelines that promote healthful food environments and walkability., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The City of Toronto adopted a Vision Zero strategy in 2016 that aims to eliminate deaths and serious injuries from vehicular collisions. The strategy includes policies to improve lighting to reduce collision risks, and past research has suggested lighting as a road safety factor. We apply Bayesian spatial analysis (including Poisson log-normal regression modelling, shared component spatial modelling, and Bayesian spatiotemporal modelling) to publicly available data on traffic collisions where persons are killed or seriously injured (KSI) based on Day/Dark conditions. We assess (1) links between KSI risk and socioeconomic and built environment factors, (2) spatial distributions of relative Day & Dark KSI risk, and (3) area-specific trends in space and time for Day-Dark KSI risk change across Toronto neighbourhoods. Our analysis does not find significant associations between socioeconomic/built environment factors and KSI risk, but we uncover neighbourhoods with heightened Dark KSI risk and pronounced Day-Dark KSI changes compared to Toronto's mean area trend. Findings highlight the need for increased policy attention for impacts of lighting on collisions and provide insight for focus regions for improved Vision Zero policy development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Physical health (PH), including muscle strength, endurance, and the ability to perform daily physical tasks, gradually declines with increasing age, leading to disability and an increased disease burden. Both the urban community environment (UCE) and physical activity (PA) were linked to PH., Methods: A total of 625 participants aged 55 years and older from Haidian and Chaoyang Districts in Beijing, China, were included in the study from September to December 2023.PH was assessed by a combined score of four tests, including BMI, chronic disease, depression and self-rated health.The Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A), Center for Epidemiological Survey-Depression Scale (CES-D), Physical Activity Scale for Elderly (PASE) and Social Support Rate Score (SSRS) were collected. The analysis was carried out with SPSS v.20 and Amos 24, and the results were validated via structural equation modeling (SEM)., Results: The urban community environment was positively associated with the health level of older adults. Specifically, the standardized path coefficients indicate that the influence of the built environment (0.72-0.88) was greater than that of the social environment (0.43-0.55) and personal attributes (0.22-0.37) on older adults' health. Physical activity demonstrated both a mediating effect and an indirect effect, highlighting its significant value as a mediating variable., Conclusions: The urban community environment has a positive impact on promoting the physical health of older adults, with the influence of the built environment being greater than that of the social environment and personal attributes on their physical health. Physical activity acts as a mediator between the urban community environment and the physical health of older adults., (© 2024. The Author(s).)

Introduction: Long-duration commuting is widely recognized for its significant influence on health. However, while research has traditionally focused on direct impacts, there remains a critical need to explore the nonlinear dynamics of this relationship. This study aims to deepen our understanding of how behavioral preferences and built environments contribute to these complex interactions., Methods: This study was conducted in Jinan, China's most congested city, using data from the "Jinan Residents Commuting Survey" of 1,755 participants aged 19 to 59. We applied Generalized Propensity Score Matching (GPSM) to explore the nonlinear effects of commuting time on self-rated health, adjusting for participants' sociodemographic characteristics. Variables related to active commuting, physical activity, and perceived built environment were also examined for their potential moderating effects., Results: Commuting for less than 21 minutes enhances health, but negative effects intensify and peak at 60 minutes. Heterogeneity analysis reveals that women and older adults, especially those with higher incomes, are more susceptible to long commutes, experiencing a delayed onset of adverse effects. While active commuting offers health benefits, it may exacerbate health issues if prolonged. Conversely, regular physical activity consistently improves health outcomes related to commuting. Additionally, factors like residential greenery and walkability help alleviate commuting-related stress, improving the overall commuting-health dynamic., Discussion: This study clarifies the commuting-health relationship by identifying key time thresholds and the positive effects of active commuting and physical activity on mitigating longer commute impacts. The findings inform healthier commuting behaviors and offer practical guidelines for urban planning and policy-making to enhance commuter well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Qiu, Li, Cui, Du, Xing, Cui and Xinyu.)

Background: The built environment can impact health outcomes. Our purpose was to examine relationships between built environment variables related to physical activity and excess weight in preschoolers. Methods: In this retrospective, population-level study of 4- to 6-year-olds, anthropometric measurements were taken between 2009 and 2017 in Calgary and Edmonton, Alberta, Canada. Based on BMI z-scores (BMIz), children were classified as normal weight (-2 ≤ BMIz <1) or excess weight (BMIz ≥1; overweight and obesity). Physical activity-related built environment variables were calculated (distances to nearest playground, major park, school; street intersection density; number of playgrounds and major parks within an 800 m buffer zone). Binomial logistic regression models estimated associations between physical activity-related built environment variables and excess weight. Results: Our analysis included 140,368 participants (females: n  = 69,454; Calgary: n  = 84,101). For Calgary, adjusted odds ratios (aORs) showed the odds of excess weight increased 1% for every 100-intersection increase [1.010 (1.006-1.015); p  < 0.0001] and 13.6% when there were ≥4 playgrounds (vs. 0 or 1) within an 800 m buffer zone [1.136 (1.037-1.243); p  = 0.0059]. For Edmonton, aORs revealed lower odds of excess weight for every 100 m increase in distances between residences to nearest major park [0.991 (0.986-0.996); p  = 0.0005] and school [0.992 (0.990-0.995); p  < 0.0001]. The odds of excess weight decreased as the number of major parks within the 800 m buffer zone increased from 0 to 1 [0.943 (0.896-0.992); p  = 0.023] and from 0 to ≥3 [0.879 (0.773-0.999); p  = 0.048]. Conclusion: The physical activity-related built environment was associated with excess weight in preschoolers, although relationships varied between cities that differed demographically and geographically.

This study investigates the factors contributing to bicycle accidents, focusing on four types of bicycle lanes and other exposure and built environment characteristics of census blocks. Using Seoul as a case study, three years of bicycle accident spot data from 2018 to 2020 was collected, resulting in 1,330 bicycle accident spots and a total of 2,072 accidents. The geographically weighted Poisson regression (GWPR) model was used as a methodological approach to investigate the spatially varying relationships between the accident frequency and explanatory variables across the space, as opposed to the Poisson regression model. The results indicated that the GWPR model outperforms the global Poisson regression model in capturing unobserved spatial heterogeneity. For example, the value of deviance that determines the goodness of fit for a model was 0.244 for the Poisson regression model and 0.500 for the far better-fitting GWPR model. Further findings revealed that the factors affecting bicycle accidents have varying impacts depending on the location and distribution of accidents. For example, despite the presence of bicycle lanes, some census blocks, particularly in the northeast part of the city, still pose a risk for bicycle accidents. These findings can provide valuable insights for urban planners and policymakers in developing bicycle safety measures and regulations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Research on the relationship between microscale built environments and physical activity among older adults in densely populated old urban areas with high aging rates is scarce. Particularly, the relationship between urban block land-use pattern and older adults' walking activities have not yet been completely understood., Methods: This study examined the daily walking habits and socioeconomic attributes of older adults in 17 blocks with different built environment characteristics in Nanjing City, China. A multi-layer linear model was used to quantitatively analyse the mechanism underlying the effects of various factors on the health of older adults., Results: The result shows significant positive correlation between neighborhood walkability and the enhancement of walking frequency and activity. For every 10% increase in pedestrian road connectivity and land use, the walking activity volume increased by 22.4 and 12%, and the BMI increased by 9.1 and 7.3% toward the standard range, respectively. For every 10% increase in distance between residence and plaza and park, the walking activity volume decreased by 5.4 and 3.2%, and BMI decreased by 9.9 and 6.3%, respectively., Discussion: For every 10.4% increase in land mixed-use rate and per capita green area, BMI increased by 19.4%. Furthermore, higher household income and number of family members have significant correlation with walking activities and health effects. Moreover, the block-scale built environment and walking activities jointly affected health, with a cross-functional relationship between multiple factors., Competing Interests: BC was employed by Nanjing Gardening-Landscaping Economic Development Limited Liability Company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chen, Cao, Xu, Zhong and Chen.)

Introduction: The rapid development of urbanization has brought about changes in residents' living environment and behavior, leading to health challenges such as hypertension. An improvement in the built-up environment in the community could contribute to the construction of a healthy city, promote the active life of the residents, and prevent and relieve hypertension. However, there is little research on the relationship between the built environment of the community and hypertension. This cross-sectional study aims to evaluate the relationship between communities' built environment, health behavior, and hypertension grade of residents in Yuhui District of Bengbu City., Methods: This study is based on data from the 2022 Health Survey of Residents in 21 communities. To investigate the impact of the community's built environment on residents' hypertension and the underlying mechanisms, regression and structural equation modeling were employed., Results and Discussion: The results show that the built environment of urban communities has a significant impact on the residents' hypertension. The presence of high densities of supermarkets, convenience stores, parks and plazas, but low densities of clinics and hospitals, has been identified as a significant risk factor for the development of high blood pressure among the residents. Nevertheless, the adoption of healthy behaviors, including regular walking, physical activity, and a diet rich in fruit and vegetables, can play an important role in reducing the risk of hypertension. The findings of this study show that enhancements to the built environment in urban neighborhoods could contribute to a reduction in the prevalence of hypertension among residents. Furthermore, the implementation of efficacious health interventions in urban settings would facilitate the alteration of residents' health behaviors and enhance their overall health status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gu, Jing, Tang, Jia, Zhang and Wang.)

Despite considerable increases in road freight traffic and associated crashes over the past decade, our understanding of their spatial distribution remains limited. This is concerning because freight vehicle crashes often lead to fatal and severe injuries. This study focuses on Seoul, South Korea and contributes to the literature by investigating the patterns and sources of spatial inequity in freight crashes. Specifically, it examines whether socioeconomically disadvantaged neighborhoods experience a higher concentration of freight crashes. Using the Gelbach's decomposition technique, this study also aims to identify the factors contributing to differences in freight crashes between disadvantaged and less-disadvantaged neighborhoods and quantify their relative contributions. The regression results show that severe freight crashes are more prevalent in disadvantaged neighborhoods before adjusting for other factors-a pattern not observed in non-severe crashes. The decomposition analysis reveals that the observed disparities in severe freight crashes between disadvantaged and less-disadvantaged neighborhoods are fully explained by differences in several neighborhood characteristics, including local road density, truck traffic volume density, proximity to logistics terminals, and off-road bicycle lane density, between neighborhood types. Interestingly, differences in built environment characteristics between neighborhood types not only fail to explain but instead counteract the disparities in severe freight crashes. The findings of this study suggest detailed policy implications for mitigating freight crash occurrences and addressing related spatial inequities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The built environment, as a critical factor influencing residents' cardiovascular health, has a significant potential impact on the incidence of cardiovascular diseases (CVDs)., Methods: Taking Xixiangtang District in Nanning City, Guangxi Zhuang Autonomous Region of China as a case study, we utilized the geographic location information of CVD patients, detailed road network data, and urban points of interest (POI) data. Kernel density estimation (KDE) and spatial autocorrelation analysis were specifically employed to identify the spatial distribution patterns, spatial clustering, and spatial correlations of built environment elements and diseases. The GeoDetector method (GDM) was used to assess the impact of environmental factors on diseases, and geographically weighted regression (GWR) analysis was adopted to reveal the spatial heterogeneity effect of environmental factors on CVD risk., Results: The results indicate that the built environment elements and CVDs samples exhibit significant clustering characteristics in their spatial distribution, with a positive correlation between the distribution density of environmental elements and the incidence of CVDs (Moran's I > 0, p < 0.01). Further factor detection revealed that the distribution of healthcare facilities had the most significant impact on CVDs (q = 0.532, p < 0.01), followed by shopping and consumption (q = 0.493, p < 0.01), dining (q = 0.433, p < 0.01), and transportation facilities (q = 0.423, p < 0.01), while the impact of parks and squares (q = 0.174, p < 0.01) and road networks (q = 0.159, p < 0.01) was relatively smaller. Additionally, the interaction between different built environment elements exhibited a bi-factor enhancement effect on CVDs. In the local analysis, the spatial heterogeneity of different built environment elements on CVDs further revealed the regional differences and complexities., Conclusions: The spatial distribution of built environment elements is significantly correlated with CVDs to varying degrees and impacts differently across regions, underscoring the importance of the built environment on cardiovascular health. When planning and improving urban environments, elements and areas that have a more significant impact on CVDs should be given priority consideration., (© 2024. The Author(s).)

Introduction: The importance of improving older adults' mental health is increasing worldwide with the rapid development of the aging process. Green space is an important part of the urban built environment, demonstrates a deep connection with the mental health of older adults, and its internal mechanisms have been widely studied. This study analyzed the influence of urban green spaces on the mental health of older adults via three factors: relative deprivation, physical activity, and social trust., Methods: Based on the 2018 China Labor Dynamics Survey, a multi-level structural equation model was used to explore the mediating roles of relative deprivation, physical activity, social trust in urban green spaces, and the mental health of older adults., Results: Urban green space was positively correlated with the mental health of older adults. Relative deprivation and physical activities played a mediating role between urban green space and the mental health of older adults., Discussion: An increase in urban green spaces can help increase the number of older adults obtaining green space resources, and help them maintain good mental health. Secondly, older adults with a relatively homogeneous environment have more equal opportunities to obtain urban green space resources, which helps to reduce the comparison of older adults in access to green space resources and reduce the adverse impact of relative deprivation on their mental health. Additionally, increasing urban green spaces can encourage older adults to engage in physical activities and improve their mental health. Finally, we suggest improving the accessibility, fairness, and quality of green spaces, paying attention to the psychological needs of older adults, encouraging older adults to engage in physical activities in green spaces, and taking various measures to enhance the positive role of green space on the mental health of older adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zuo, Cheng, Feng and Zhuang.)

The association between built environment and physical activity has been recognized. However, how and to what extent microscale streetscapes are related to running activity remains underexplored, partly due to the lack of running data in large urban areas. Moreover, few studies have examined the interactive effects of macroscale built environment and microscale streetscapes. This study examines the main and interactive effects of the two-level environments on running intensity, using 9.73 million fitness tracker data from Keep in Shanghai, China. Results of spatial error model showed that: 1) the explanatory power of microscale streetscapes was higher than that of macroscale built environment with R 2 of 0.245 and 0.240, respectively, which is different from the prior finding that R 2 is greater for macroscale built environment than for microscale streetscape; 2) sky and green view indexes were positively associated with running intensity, whereas visual crowdedness had a negative effect; 3) there were negative interactions of land use Herfindahl-Hirschman index with sky and green view indexes, while a positive interaction was observed for visual crowdedness. To conclude, greener, more open and less visually crowded streetscapes, can promote running behavior and enhance the benefits of land use mix as well. The findings highlight the importance of streetscapes in promoting running behavior, instead of a supplement to macroscale built environment., (© 2024. The Author(s).)

Purpose: To investigate the association between the neighborhood built environment and trajectories of body mass index (BMI) in youth., Methods: Data were collected in a prospective study of 1293 adolescents in Montreal. Built environment variables were obtained from public databases for road networks, land use, and the Canadian Census. Anthropometric data were collected when participants were ages 12.5, 15 and 17 years. We undertook hierarchical cluster analysis to identify contrasting neighborhood types based on features of the built environment (e.g., vegetation, population density, walkability). Associations between neighborhood type and trajectories of BMI z-score (BMIz) were estimated using multivariable linear mixed regression analyses, stratified by sex., Results: We identified three neighborhood types: Urban, Suburban, and Village. In contrast to the Urban type, the Suburban type was characterized by more vegetation, few services and low population density. Village and Suburban types were similar, but the former had greater land use diversity, population density with more parks and a denser food environment. Among girls, living in Urban types was associated with decreasing BMIz trajectories. Living in Village types was associated with increasing BMIz trajectories. No associations were observed among boys., Conclusions: Neighborhoods characterized by greater opportunities for active living appear to be less obesogenic, particularly among girls., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Food insecurity is pervasive in Allegheny County, as one in five residents experiences food insecurity. Food insecurity is linked to chronic health conditions like heart disease and hypertension and disproportionately affects women in the United States, particularly women who are head of household. There are multiple dimensions used to measure regional disparities in food accessibility. Prior research has examined the linkages between food access and food insecurity, and this study aims to explore further the relationship between equitable access to sustainable and affordable food sources. This study examines food outlets in Allegheny County to determine if there is a significant relationship between food outlet availability and food insecurity. Both the presence and accessibility of these food outlets were examined. To measure accessibility, the walking distance to the nearest public transportation stop was calculated for each public transportation stop. The minimum distance to each food outlet was compared to food insecurity rates on a census tract level. Results showed that communities without grocery stores had lower access to healthy and affordable food sources. Also, communities with a higher proportion of female-headed households experienced greater food insecurity, regardless of access to food outlets. There was no statistically significant relationship between the distance from public transportation stops to grocery stores and rates of food insecurity overall and in low-income communities. However, communities with inaccessible grocery stores, either absent in the census tract or without close public transport stops, did have even greater average rates of food insecurity if there was an above-average proportion of female-headed households. Based on these findings, it is evident there exist structural elements of the built environment that correspond with disproportionate rates of food insecurity experienced by communities with households that are predominately female headed. In addition to resource support for these marginalized groups, we suggest that sole reliance on distance as an indicator of food insecurity can be misleading. There should be a greater focus on walkability aggregated on a household or individual level within the community instead of physical distance alone at a general scale.

Background: Cycling is known to be beneficial for human health. Studies have suggested significant associations of physical activity with macroscale built environments and streetscapes. However, whether good streetscapes can amplify the benefits of a favorable built environment on physical activity remains unknown., Objective: This study examines whether streetscape perceptions can modify the associations between accessibility, land use mix, and bike-sharing use., Methods: This cross-sectional study used data from 18,019,266 bike-sharing orders during weekends in Shanghai, China. A 500 × 500 m grid was selected as the analysis unit to allocate data. Bike-sharing use was defined as the number of bike-sharing origins. Street view images and a human-machine adversarial scoring framework were combined to evaluate lively, safety, and wealthy perceptions. Negative binomial regression was developed to examine the independent effects of the three perceptual factors in both the univariate model and fully adjusted model, controlling for population density, average building height, distance to nearest transit, number of bus stations, number of points of interest, distance to the nearest park, and distance to the central business district. The moderation effect was then investigated through the interaction term between streetscape perception and accessibility and land use mix, based on the fully adjusted model. We also tested whether the findings of streetscape moderation effects are robust when examinations are performed at different geographic scales, using a small-sample statistics approach and different operationalizations of land use mix and accessibility., Results: High levels of lively, safety, and wealthy perceptions were correlated with more bike-sharing activities. There were negative effects for the interactions between the land use Herfindahl-Hirschman index with the lively perception (β=-0.63; P=.01) and safety perception (β=-0.52; P=.001). The interaction between the lively perception and road intersection density was positively associated with the number of bike-sharing uses (β=0.43; P=.08). Among these, the lively perception showed the greatest independent effect (β=1.29; P<.001), followed by the safety perception (β=1.22; P=.001) and wealthy perception (β=0.72; P=.001). The findings were robust in the three sensitivity analyses., Conclusions: A safer and livelier streetscape can enhance the benefits of land use mix in promoting bike-sharing use, with a safer streetscape also intensifying the effect of accessibility. Interventions focused on streetscape perceptions can encourage cycling behavior and enhance the benefits of accessibility and land use mix. This study also contributes to the literature on potential moderators of built environment healthy behavior associations from the perspective of microscale environmental perceptions., (© Huagui Guo, Shuyu Zhang, Xinwei Xie, Jiang Liu, Hung Chak Ho. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Context: Built environment interventions (pedestrian/bicycle infrastructure and enhanced access) mitigate barriers to physical activity by making the healthy choice the default choice. Demonstration projects (eg, temporary pedestrian lanes or sidewalks marked with tape) are used to test these interventions before making permanent changes. However, it is unknown whether demonstration projects lead to desired built environment changes., Objective: To systematically review the literature to determine outcomes and overall public health impacts of demonstration projects and whether they lead to permanent changes to the built environment., Design: Systematic review, conducted from March to September 2022 by searching PubMed and EBSCOhost for peer-reviewed literature and Google for gray (non-peer-reviewed) literature. Inclusion criteria were policy, systems, or environmental interventions; temporary implementation; and presence of evaluation data. Exclusion criteria were individual/interpersonal-level interventions, permanent implementation, and absence of evaluation data. Two authors coded for inclusion/exclusion and resolved discrepancies, coded a portion of included sources and resolved discrepancies, refined coding guide definitions, and coded remaining sources., Main Outcome Measures: Data were extracted based on the expanded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, which incorporates constructs of the Implementation Outcomes Framework (acceptability, appropriateness, feasibility)., Results: Gray (N = 23) and peer-reviewed (N = 1) sources describing unique demonstration projects (N = 31) met inclusion criteria. Projects tested built environment interventions including traffic calming measures, crosswalks, bike lanes, intersection design, and trails. Sources primarily reported effectiveness (typically improved safety), maintenance, acceptability, and appropriateness. Most sources did not report projects leading to permanent changes to the built environment., Conclusions: Based on inconsistent reporting of key outcomes (number of community members reached, changes to physical activity levels), overall impacts are unknown. Most demonstration projects captured community members' feedback, which was typically positive, but it is unknown whether feedback led to long-term changes. We recommend providing improved demonstration project guidance for practitioners to facilitate robust data collection, including suggested evaluation methods and tools., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Social and Environmental Determinants of Health (SEDH) provide us with a conceptual framework to gain insights into possible associations among different human behaviors and the corresponding health outcomes that take place often in and around complex built environments. Developing better built environments requires an understanding of those aspects of a community that are most likely to have a measurable impact on the target SEDH. Yet data on local characteristics at suitable spatial scales are often unavailable. We aim to address this issue by application of different data disaggregation methods., Methods: We applied different approaches to data disaggregation to obtain small area estimates of key behavioral risk factors, as well as geospatial measures of green space access and walkability for each zip code of Allegheny County in southwestern Pennsylvania., Results: Tables and maps of local characteristics revealed their overall spatial distribution along with disparities therein across the county. While the top ranked zip codes by behavioral estimates generally have higher than the county's median individual income, this does not lead them to have higher than its median green space access or walkability., Conclusion: We demonstrated the utility of data disaggregation for addressing complex questions involving community-specific behavioral attributes and built environments with precision and rigor, which is especially useful for a diverse population. Thus, different types of data, when comparable at a common local scale, can provide key integrative insights for researchers and policymakers.

Background: Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases., Methods: The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized., Results: The chronic diseases were positively associated with male sex ( p  < 0.001), married ( p  < 0.001), and higher age ( p  < 0.001). The chronic diseases were negatively associated with larger family size ( p  < 0.05), higher SES ( p  < 0.001), and higher diet quality index (DQI) ( p  < 0.001). No significant relationship was found between chronic disease and physical activity., Conclusion: Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Irankhah, Asadimehr, Kiani, Jamali, Rezvani and Sobhani.)

Background: Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China)., Methods: The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes., Results: Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants., Conclusion: Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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 health 1,2 . Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities 3 . Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories 4 . 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., (© 2024. The Author(s).)

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.

Objectives: Individuals living in group homes during the COVID-19 pandemic faced unique challenges and health risks related to living in shared spaces. This study aimed to assess the experiences of living and working in a group home during the pandemic and to explore the role of the built environment., Study Design and Methods: We conducted longitudinal working groups with group home residents with intellectual and developmental disabilities and serious mental illness, group home staff, and families/caregivers of residents from December 2020 through December 2022. Common themes highlighting ways in which group home residents, staff, and caregivers perceived the built environment to impact living in a group home during the COVID-19 pandemic were identified., Results: Resonant themes centered around increased risk of COVID-19 infection, ad hoc spatial adaptations for infection control, space-related challenges due to isolation and quarantine requirements, and limited access to public spaces., Conclusion: Group home residents and staff experienced multiple health and wellness challenges during the COVID-19 pandemic related to their surrounding built environment. Mechanisms to engage group home residents in modifications of their built environment may improve the effectiveness of infection control policies while acknowledging individual autonomy., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

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., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

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., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

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., (© 2021. The Author(s).)

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., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

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 (β = 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 (β = -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., Competing Interests: The authors have declared that no competing interests exist.

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.

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.

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., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Riitta Pyky et al.)

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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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.

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.

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.

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

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 (β = 0.122, t =  2.999, p  = 0.003) and access to physical activity facilities (β = 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.

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.

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.

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.

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., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Recently, the importance of light physical activity (LPA) for health has been emphasized, and residential greenness has been positively linked to the level of LPA and a variety of positive health outcomes. However, people spend less time in green environments because of urbanization and modern sedentary leisure activities., Aims: In this population-based study, we investigated the association between objectively measured residential greenness and accelerometry measured physical activity (PA), with a special interest in LPA and gender differences., Methods: The study was based on the Northern Finland Birth Cohort 1966 (5433 members). Participants filled in a postal questionnaire and underwent clinical examinations and wore a continuous measurement of PA with wrist-worn Polar Active Activity Monitor accelerometers for two weeks. The volume of PA (metabolic equivalent of task or MET) was used to describe the participant's total daily activity (light: 2-3.49 MET; moderate: 3.5-4.99 MET; vigorous: 5-7.99 MET; very vigorous: ≥8 MET). A geographic information system (GIS) was used to assess the features of each individual's residential environment. The normalized difference vegetation index (NDVI) was used for the objective quantification of residential greenness. Multiple linear regression and a generalized additive model (GAM) were used to analyze the association between residential greenness and the amount of PA at different intensity levels., Results: Residential greenness (NDVI) was independently associated with LPA (unadjusted β = 174; CI = 140, 209) and moderate physical activity (MPA) (unadjusted β = 75; CI = 48, 101). In the adjusted model, residential greenness was positively and significantly associated with LPA (adjusted β = 70; CI = 26, 114). In men, residential greenness was positively and significantly associated with LPA (unadjusted β = 224; CI = 173, 275), MPA (unadjusted β = 75; CI = 48, 101), and moderate to vigorous physical activity (MVPA) (unadjusted β = 89; CI = 25, 152). In women, residential greenness was positively related to LPA (unadjusted β = 142; CI = 96, 188) and inversely associated with MPA (unadjusted β = -22; CI = -36, -8), vigorous/very vigorous physical activity (VPA/VVPA) (unadjusted β = -49; CI = -84, -14), and MVPA (unadjusted β = -71; CI = -113, -29). In the final adjusted models, residential greenness was significantly associated only with the amount of LPA in men (adjusted β = 140; CI = 75, 204)., Conclusions: Residential greenness was positively associated with LPA in both genders, but the association remained significant after adjustments only in men. Residential greenness may provide a supportive environment for promoting LPA.

The school neighbourhood built environment (BE) can facilitate active transport to school (ATS) in adolescents. Most previous studies examining ATS were conducted in large urban centres and focused on BE of home neighbourhoods. This study examined correlations between school-level ATS rates among adolescents, objectively measured school neighbourhood BE features, and adolescents' perceptions of the school route across different urbanisation settings. Adolescents (n = 1260; 15.2 ± 1.4 years; 43.6% male) were recruited from 23 high schools located in large, medium, and small urban areas, and rural settings in Otago, New Zealand. Adolescents completed an online survey. School neighbourhood BE features were analysed using Geographic Information Systems. School neighbourhood intersection density, residential density and walkability index were higher in large urban areas compared to other urbanisation settings. School-level ATS rates (mean 38.1%; range: 27.8%-43.9%) were negatively correlated with school neighbourhood intersection density (r = -0.58), residential density (r = -0.60), and walkability index (r = -0.64; all p < 0.01). School-level ATS rates were also negatively associated with adolescents' perceived safety concerns for walking (r = -0.76) and cycling (r = -0.78) to school, high traffic volume (r = -0.82), and presence of dangerous intersections (r = -0.75; all p < 0.01). Future initiatives to encourage ATS should focus on school neighbourhood BE features and minimise adolescents' traffic safety related concerns.

Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.

Introduction: Many U.S. cities have adopted the Vision Zero strategy with the specific goal of eliminating traffic-related deaths and injuries. To achieve this ambitious goal, safety professionals have increasingly called for the development of a safe systems approach to traffic safety. This approach calls for examining the macrolevel risk factors that may lead road users to engage in errors that result in crashes. This study explores the relationship between built environment variables and crash frequency, paying specific attention to the environmental mediating factors, such as traffic exposure, traffic conflicts, and network-level speed characteristics., Methods: Three years (2011-2013) of crash data from Mecklenburg County, North Carolina, were used to model crash frequency on surface streets as a function of built environment variables at the census block group level. Separate models were developed for total and KAB crashes (i.e., crashes resulting in fatalities (K), incapacitating injuries (A), or non-incapacitating injuries (B)) using the conditional autoregressive modeling approach to account for unobserved heterogeneity and spatial autocorrelation present in data., Results: Built environment variables that are found to have positive associations with both total and KAB crash frequencies include population, vehicle miles traveled, big box stores, intersections, and bus stops. On the other hand, the number of total and KAB crashes tend to be lower in census block groups with a higher proportion of two-lane roads and a higher proportion of roads with posted speed limits of 35 mph or less., Conclusions: This study demonstrates the plausible mechanism of how the built environment influences traffic safety. The variables found to be significant are all policy-relevant variables that can be manipulated to improve traffic safety. Practical Applications: The study findings will shape transportation planning and policy level decisions in designing the built environment for safer travels., (Published by Elsevier Ltd.)

Pedestrian safety plays an important role in the transportation system. Intersections are dangerous locations for pedestrians with mixed traffic. This paper aims to predict the near-accident events between pedestrians and vehicles at signalized intersections using PET (Post Encroachment Time) and TTC (Time to Collision). With automated computer vision techniques, mobility features of pedestrians and vehicles are generated. Extreme Value Theory (EVT) is used to model PET and minimum TTC values to select the most appropriate threshold values to label pedestrians' near-accident events. A Gated Recurrent Unit (GRU) neural network is further used to predict these events. The established model reaches an AUC (Area Under the Curve) value of 0.865 on the test data set. Moreover, the proposed model can also be applied to develop collision warning systems under the Connected Vehicle environment., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This study aims to acquire a better understanding of the quantitative relationship between environmental impact factors and heating energy consumption of buildings in severe cold regions. We analyze the effects of five urban morphological parameters (building density, aspect ratio, building height, floor area ratio, and shape factor) and three climatic parameters (temperature, wind speed, and relative humidity) on the heating energy use intensity (EUI) of commercial and residential buildings in a severe cold region. We develop regression models using empirical data to quantitatively evaluate the impact of each parameter. A stepwise approach is used to ensure that all the independent variables are significant and to eliminate the effects of multicollinearity. Finally, a spatial cluster analysis is performed to identify the distribution characteristics of heating EUI. The results indicate that the building height, shape factor, temperature, and wind speed have a significant impact on heating EUI, and their effects vary with the type of building. The cluster analysis indicated that the areas in the north, east, and along the river exhibited high heating EUI. The findings obtained herein can be used to evaluate building energy efficiency for urban planners and heating companies and departments based on the surrounding environmental conditions.

Background: The association between neighborhood environment and health may be biased due to confounding by residential self-selection. The displacement of disaster victims can act as a natural experiment that exposes residents to neighborhood environments they did not select, allowing for the study of neighborhood effects on health., Methods: We leveraged data from a cohort of older adults 65 years of age or older living in Iwanuma, Japan, located 80 km west of the 2011 Great East Japan Earthquake and Tsunami. Surveys were conducted 7 months before the disaster, as well as 2.5 and 5.5 years afterward, and linked with medical records. We classified each individual's type of exposure to neighborhood environment based on proximity to local food and recreation destinations and walkability., Results: Fixed-effect models indicated that change in the exposure type from low to high urban density was associated with increased body mass index (0.46 kg/m; 95% confidence interval [CI] = 0.20, 0.73), waist circumference (1.8 cm; 95% CI = 0.56, 3.0), low-density lipoprotein cholesterol (11 mg/dl; 95% CI = 5.0, 17), and decreased high-density lipoprotein cholesterol (-3.1 mg/dl; 95% CI = -5.0, -1.3). We observed similar trends when we analyzed only the individuals who experienced postdisaster relocation to temporary homes., Conclusions: Increased proximity to food outlets was simultaneously correlated with greater walkability and accessibility to recreational destinations; however, any protective association of physical activity-promoting built environment appeared to be offset by proximity to unhealthy food outlets, especially fast-food restaurants and bars.