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Few studies examining the effects of neighborhood exposures have accounted for longitudinal residential history. This study examined associations of body mass index (BMI, kg/m

Evidence connecting health care expenditures with physical activity and built environment is rare. We examined how detailed urban form relates to mode specific moderate-to-vigorous physical activity (MVPA) and health care costs—controlling for transit access, residential choices/preferences, sociodemographic factors. We harness high resolution data for 476 participants in the Rails and Health study on health care costs, mode specific MVPA, parcel-level built environment, and neighborhood perception surveys. To account for dependencies among outcomes, structural equation modeling framework is used. A 1% increase in bike, walk, and transit-related MVPA was associated with lower health care costs by −0.28%, −0.09%, and −0.27% respectively. A one-unit increase in neighborhood walkability index correlates with a 6.48% reduction in health care costs. Indirect associations between residential choices, attitudes, and health outcomes through MVPA were also observed. The results suggest the potential to alter behaviors and lower health care costs through retrofitting neighborhoods.

The Neighbourhood Environments in Waterloo: Patterns of Active Transportation and Health (NEWPATH) study examined built environment influences on travel, physical activity, food consumption, and health. This collaboration between researchers and practitioners in health and transportation planning is the first, to our knowledge, to integrate food purchasing, diet, travel, and objectively measured physical activity into a trip-destination protocol. This study simultaneously examines diet and physical activity relationships with BMI and waist circumference (WC).Individual diet and travel diary data were linked to objective built-environment measures of walkability and retail food environments. BMI and WC were self-reported (n = 1,160). Some respondents wore accelerometers to objectively measure physical activity (n = 549). Pathways from the built environment through behavior (walking and eating) to BMI and WC were assessed using path analysis.Walkability was associated with lower BMI and WC through physical activity and active travel. Healthy retail food environments were associated with healthy eating and lower BMI and WC, whereas walkability and healthy retail food environments were insignificant (p0.05). Walkable neighborhoods had less healthy food environments, but active travel was not associated with healthy eating or caloric intake.Findings highlight the importance of neighborhood walkability and food environments in shaping physical activity, diet, and obesity.

As evidence of the health impacts of transportation investments has grown, planners have increasingly used health impact assessments (HIAs) to evaluate transportation plans, projects, and policies. Most HIAs to date, however, have been limited in their ability to quantify health impacts due to a lack of validated methods and tools, scarcity of disaggregate and locally-relevant data, and cost. This paper presents the development and application of a quantitative HIA tool designed to address these and other common limitations of existing HIAs. Developed through a grant from the San Diego Association of Governments and the San Diego County Health and Human Services, the tool is based on detailed modeled regression analyses associating the built environment with physical activity, safety, diabetes, hypertension, and asthma in a large sample of California Health Interview Survey participants. The tool allows users to enter built environment characteristics for baseline and future development scenarios and estimate corresponding health impacts. This paper describes the development of this tool and its application to the Palomar Gateway District rail transit station area in San Diego County. The results suggest that plan-endorsed projected build-out is associated with increased physical activity from walking for transportation, park visitation, and reductions in type 2 diabetes and high blood pressure. Potential for increased exposure to air pollution among children and teens may, however, attenuate some of these benefits. Quantifying both the positive and the negative health outcomes of transportation investments can inform proposals and reduce health risks. This study demonstrates how the application of an evidence-based software tool can support the HIA process and create empirical evidence useable within transportation decisions and planning practice.

Background A better understanding of the extent to which psychosocial and environmental correlates of physical activity are specific to locations would inform intervention optimization. Purpose To investigate cross-sectional associations of location-general and location-specific variables with physical activity and sedentary time in three common locations adolescents spend time. Methods Adolescents (N = 472,Mage = 14.1,SD = 1.5) wore an accelerometer and global positioning systems (GPS) tracker and self-reported on psychosocial (e.g., self-efficacy) and environmental (e.g., equipment) factors relevant to physical activity and sedentary time. We categorized each survey item based on whether it was specific to a location to generate psychosocial and environmental indices that were location-general or specific to either school, non-school, or home location. Physical activity (MVPA) and sedentary time were based on time/location match to home, school, or all “other” locations. Mixed-effects models investigated the relation of each index with location-specific activity. Results The location-general and non-school physical activity psychosocial indices were related to greater MVPA at school and “other” locations. The school physical activity environment index was related to greater MVPA and less sedentary time at school. The home activity environment index was related to greater MVPA at home. The non-school sedentary psychosocial index was related to less sedentary time at home. Interactions among indices revealed adolescents with low support on one index benefited (i.e., exhibited more optimal behavior) from high support on another index (e.g., higher scores on the location-general PA psychosocial index moderated lower scores on the home PA environment index). Concurrent high support on two indices did not provide additional benefit. Conclusions No psychosocial or environment indices, including location-general indices, were related to activity in all locations. Most of the location-specific indices were associated with activity in the matching location(s). These findings provide preliminary evidence that psychosocial and environmental correlates of activity are location specific. Future studies should further develop location-specific measures and evaluate these constructs and whether interventions may be optimized by targeting location-specific psychosocial and environmental variables across multiple locations.

Assessment and counseling by healthcare providers can successfully increase physical activity; however, a valid instrument to effectively measure physical activity is needed. This study examines the validity of the Exercise Vital Sign tool by comparing Exercise Vital Sign data collected at Kaiser Permanente Northwest with accelerometry data.Participants (n=521) completed accelerometer monitoring and had ≥1 Exercise Vital Sign measurement in their electronic medical record. Using accelerometry as the gold standard, the association between moderate-to-vigorous physical activity minutes per week estimated through Exercise Vital Sign and that estimated through accelerometry was examined using the Spearman correlation coefficient. Comparability of moderate-to-vigorous physical activity categories (inactive, lowly active, moderately active, sufficiently active) was assessed using simple and weighted κ statistics. Sensitivity, specificity, and positive and negative predictive values were calculated. The study was conducted in 2012-2015, with analysis in 2019-2020.Average accelerometry-based moderate-to-vigorous physical activity was 212 minutes per week, and 57% of the participants were considered sufficiently active. Exercise Vital Sign‒based moderate-to-vigorous physical activity averaged 170 minutes per week, and 53% of the participants were active. There was a positive correlation between the moderate-to-vigorous physical activity minutes per week reported through Exercise Vital Sign and that reported through accelerometry (r =0.38, p0.0001). A fair agreement was observed between Exercise Vital Sign‒ and accelerometry-based moderate-to-vigorous physical activity categories (weighted κ=0.29), with the highest agreement occurring for those with physical activity level ≥150 minutes per week. The positive correlation increased when moderate-to-vigorous physical activity was examined dichotomously (150 or ≥150 minutes per week, κ=0.34). The sensitivity, specificity, positive predictive value, and negative predictive value for Exercise Vital Sign (when compared with those of accelerometry) were 67%, 68%, 61%, and 73%, respectively.The Exercise Vital Sign is a useful physical activity assessment tool that correctly identifies the majority of adults who do and do not meet physical activity guidelines.

This study evaluated changes in cycling trips before and after the construction of an urban greenway in Vancouver, Canada. Urban cycling has gained in popularity as a healthy and environmentally friendly mode of transport. Carsharing is also on the rise globally, and it has the potential to disrupt urban mobility, including cycling and public transit. In this study, we hypothesized that cycling trips will increase after the opening of the greenway for residents living within 300 meters of the greenway compared to those living further away. We also posited that carsharing membership would have a positive impact on cycling uptake. Data were drawn from a three-year natural experiment study (2012–2015) of the Comox-Helmcken Greenway (“Comox Greenway”) in Vancouver. An experimental-and-control design was employed to compare pre-post differences in cycling trips for residents within 300 m of the greenway (experimental group, n = 239) and those further away (control group, n = 285). The opening of the greenway resulted in a 251% increase in cycling trips for the experimental group compared to the control group. Ethnically white subjects reported 130% more cycling trips than non-white subjects, and those aged 65 and older reported 79% fewer cycling trips than younger age cohorts. Carshare membership reduced the number of cycling trips after the greenway opening. Results suggest that greenways could be an effective strategy to boost urban cycling, and that carsharing programs may have a countervailing effect on cycling. The findings support recent initiatives to reappropriate road space in urban areas for cycling and walking due to the COVID-19 pandemic.

There is mounting evidence linking land development and transportation investments to physical activity with resulting implications for chronic disease prevention. Links between the physical environment and health have traditionally focused on harmful exposures such as air pollution, noise, and traffic injury. Given limited funds and competition for how and where investments are made, there is a need to prioritize and target resources to maximize health benefits that can include activity related chronic disease prevention. The ability to apply this evidence to decision making has been limited by the complexity and inconsistency of research methods, and lack of a direct connection with the planning contexts in which decisions are made. Scenario planning tools provide a method to apply evidence with spatial planning decisions at a range of geographic scales. The US Environmental Protection Agency commissioned the development of a National Public Health Assessment Model (N-PHAM). This project utilized built and natural environment data at the block-group level and large population surveys to model the relationships of the environment with several health outcomes for a range of age and income groups. N-PHAM is the first health assessment tool that can connect to multiple existing scenario planning platforms utilizing nationally available data and can be consistently applied nationally. Such tools can empower communities to choose investments that have the greatest potential to improve public health and quality of life, reduce health care costs, and address environmental justice related disparities.

Background Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors. Methods In total, 693 participants aged 66–97 were sampled from two US locales in 2005–2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles. Results More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC). Conclusions Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km 2, 100 intersections per km 2, and 25 public transport stops per km 2 were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.

Objectives The use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency in responses between local in-field observers and non-local remote online observers and (2) the reliability between in-country online observers and non-local remote online observers using the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features along streets in five countries. Methods Consistency and inter-rater reliability were analyzed between local and non-local observers on a pooled database of 200 routes in five study regions (Melbourne, Australia; Ghent, Belgium; Curitiba, Brazil; Hong Kong, China; and Valencia, Spain) for microscale environmental feature subscales and item-level variables using the intraclass correlation coefficient (ICC). Results A local in-field versus remote online comparison had an ICC of 0.75 (95 % CI: 0.68–0.80) for the grand total score. An ICC of 0.91 (95 % CI: 0.88–0.93) was found for the local online versus remote online comparison. Positive subscales yielded stronger results in comparison to negative subscales, except for the similarly poor-performing positive aesthetics/social characteristics. Conclusions This study demonstrated remote audits of microscale built environments using online imagery had good reliability with local in-field audits and excellent reliability with local online audits. Results generally supported remote online environmental audits as comparable to local online audits. This identification of low-cost and efficient data acquisition methods is important for expanding research on microscale built environments and physical activity globally.

Studies of the built environment and physical activity (PA) have primarily been cross-sectional. Evidence on the causal impacts of transportation improvements on PA and sedentary behavior (SB) is lacking. This study assessed the effect of retrofitting an urban greenway on PA and SB in Vancouver, Canada. A sample of 524 participants (median age of 44; 57% female) were divided into experimental and control groups, and the effect of exposure to the greenway was examined by using different distance thresholds. Self-report measures of moderate-to-vigorous PA (MVPA) and SB were collected using the International Physical Activity Questionnaire (IPAQ-SF) before (baseline; 2012–2013) and after (follow-up; 2014–2015) construction of the Comox-Helmcken Greenway in 2013. Mixed-effects models estimated the impacts of greenway on MVPA and SB. For participants living near the greenway (≤300 m), the odds of achieving an average of 20 min of daily MVPA doubled (OR = 2.00; 95% CI = 1.00, 3.98) after the greenway's opening. The odds of being sedentary for >9 h declined by 54% (OR = 0.46; 95% CI = 0.25, 0.85) after opening. PA benefits from the greenway declined with distance from 100 m to 500 m. Reduction in SB was lowest at 100 m and greatest at 300 m. Retrofitting an urban residential neighborhood through greenway interventions can be successful in promoting physical activity while reducing sedentary behavior. Recommendations for future longitudinal research include the use of objective PA measures, studying different neighborhood contexts, collecting more representative samples, and minimizing attrition.

Background and purpose A growing body of evidence documents multiple ways in which land use and transportation investments influence health. To date, most evidence linking the built environment to health either focuses on behavioral change or environmental exposures. Few studies simultaneously assess how behavior and exposure-based impacts of the built environment interact. This is concerning as increased walkability and transit access can possibly lead to increased exposure to air pollution and injury risk. Method This paper synthesizes recent research on behavior and exposure-based mechanisms that connect land use and transportation investments with various health outcomes. Exploring the nexus between these pathways provides a framework to identify priority areas for research to inform policies and investments. Results The most studied pathway articulates how land use and transportation can support healthy behaviors, such as increased physical activity, healthy diet, and social interactions. The second pathway articulates exposure to harmful substances and stressors and potential differential impacts by travel modes. Increased rates of active travel lead to lower generation of vehicle emissions and kilometers traveled; but may actually result in increased exposure which may have adverse effects on sensitive populations such as elderly and youth. Unhealthy exposures have historically concentrated in areas where the most disadvantaged reside – along major transportation corridors where land is cheapest and more affordable housing is located. Implications A high priority for future research is to examine mechanisms that spatially link built environment and chronic disease. More longitudinal evidence is required inclusive of biomarker data within clinical trials to isolate independent and interactive effects of biological and neurological mechanisms from behavioral and exposure related impacts of the environment. Downstream impacts of the built environment on healthcare utilization and costs and workforce productivity is needed for policy makers to justify the major investments required to plan or retrofit communities.

Background The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outcomes and associated costs, especially within a causal framework. Health related fiscal impacts of transit investment should be a key consideration in major transit investment decisions. Methods The Rails & Health study is a natural experiment evaluating changes in clinical measures, health care utilization and health care costs among Kaiser Permanente Northwest (KPNW) members following the opening of a new light rail transit (LRT) line in Portland, Oregon. The study is prospectively following 3036 adults exposed to the new LRT line and a similar cohort of 4386 adults who do not live close to the new line. Individual-level outcomes and covariates are extracted from the electronic medical record at KPNW, including member demographics and comorbidities, blood pressure, body mass index, lipids, glycosylated hemoglobin, and health care utilization and costs. In addition, participants are surveyed about additional demographics, travel patterns, physical activity (PA), and perceived neighborhood walkability. In a subsample of the study population, we are collecting direct measures of travel-related behavior—physical activity (accelerometry), global positioning system (GPS) tracking, and travel diaries—to document mechanisms responsible for observed changes in health outcomes and cost. Comprehensive measures of the built environment at baseline and after rail construction are also collected. Statistical analyses will (1) examine the effects of opening a new LRT line on chronic disease indicators, health care utilization, and health care costs and (2) evaluate the degree to which observed effects of the LRT line on health measures and costs are mediated by changes in total and transportation-associated PA. Discussion The results of the Rails & Health study will provide urban planners, transportation engineers, health practitioners, developers, and decision makers with critical information needed to document how transit investments impact population health and related costs.

Impacts of coronavirus disease 2019 (COVID-19) on the transport sector and the corresponding policy measures are becoming widely investigated. Considering the various uncertainties and unknowns about this virus and its impacts (especially long-term impacts), it is critical to understand opinions and suggestions from experts within the transport sector and related planning fields. To date, however, there is no study that fills this gap in a comprehensive way. This paper is an executive summary of the findings of the WCTRS COVID-19 Taskforce expert survey conducted worldwide between the end of April and late May 2020, obtaining 284 valid answers. The experts include those in the field of transport and other relevant disciplines, keeping good balances between geographic regions, types of workplaces, and working durations. Based on extensive analyses of the survey results, this paper first reveals the realities of lockdowns, restrictions of out-of-home activities and other physical distancing requirements, as well as modal shifts. Experts' agreements and disagreements to the structural questions about changes in lifestyles and society are then discussed. Analysis results revealed that our human society was not well prepared for the current pandemic, reaffirming the importance of risk communication. Geographical differences of modal shifts are further identified, especially related to active transport and car dependence. Improved sustainability and resilience are expected in the future but should be supported by effective behavioral intervention measures. Finally, policy implications of the findings are discussed, together with important future research issues.

IntroductionOnly international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese).Methods and analysisThe IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11–19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status.Ethics and disseminationEthical approval was received from each study site’s Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

INTRODUCTION: Greater transit use is associated with higher levels of physical activity, which is associated with lower health risks and better health outcomes. However, there is scant evidence about whether health care costs differ based on level of transit ridership. METHODS: A sample (n=947) of members of Kaiser Permanente in the Portland, Oregon area were surveyed in 2015 about their typical use of various modes of travel including transit. Electronic medical record-derived health care costs were obtained among these members for the prior three years. Analysis examined proportional costs between High transit users (3+ days/week), Low transit users (1–2 days/week), and Non-users adjusting for age and sex, and then individually (base models) and together for demographic and health status variables. RESULTS: In separate base models across individual covariates, High transit users had lower total health care costs (59–69% of Non-user’s costs) and medication costs (31–37% of Non-users’ costs) than Non-users. Low transit users also had lower total health care (69%−76% of Non-users’ costs) and medication costs (43–57% transit of Non-user’s costs) than Non-users. High transit users’ outpatient costs were also lower (77–82% of Non-users). In fully-adjusted models, total health care and medication costs were lower among High transit users’ (67% and 39%) and Low transit users’ (75% and 48%) compared to Non-users, but outpatient costs did not differ by transit use. CONCLUSIONS: Findings have implications for the potential cost benefit of encouraging and supporting more transit use, although controlled longitudinal and experimental evidence is needed to confirm findings and understand mechanisms.

Background Investigation of physical activity and dietary behaviors across locations can inform “setting-specific” health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents. Methods Participants were adolescents aged 12–16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h dietary recalls to assess dietary behaviors and eating locations. Spatial analyses were performed to classify daily physical activity, sedentary time patterns, and dietary behaviors by location, categorized as home, school, and “other” locations. Results Adolescents were least physically active at home (2.5 min/hour of wear time) and school (2.9 min/hour of wear time) compared to “other” locations (5.9 min/hour of wear time). Participants spent a slightly greater proportion of wear time in sedentary time when at school (41 min/hour of wear time) than at home (39 min/hour of wear time), and time in bouts lasting ≥30 min (10 min/hour of wear time) and mean sedentary bout duration (5 min) were highest at school. About 61% of daily energy intake occurred at home, 25% at school, and 14% at “other” locations. Proportionately to energy intake, daily added sugar intake (5 g/100 kcal), fruits and vegetables (0.16 servings/100 kcal), high calorie beverages (0.09 beverages/100 kcal), whole grains (0.04 servings/100 kcal), grams of fiber (0.65 g/100 kcal), and calories of fat (33 kcal/100 kcal) and saturated fat (12 kcal/100 kcal) consumed were nutritionally least favorable at “other” locations. Daily sweet and savory snacks consumed was highest at school (0.14 snacks/100 kcal). Conclusions Adolescents’ health behaviors differed based on the location/environment they were in. Although dietary behaviors were generally more favorable in the home and school locations, physical activity was generally low and sedentary time was higher in these locations. Health behavior interventions that address the multiple locations in which adolescents spend time and use location-specific behavior change strategies should be explored to optimize health behaviors in each location.

Background Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects. Methods We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility. Results Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible. Conclusion Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.

Creating more physical activity–supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weight status in 12 countries on 5 continents ( n > 14,000). This article presents reanalyzed data from eight primary papers to identify patterns of findings across studies. Neighborhood environment attributes, whether measured objectively or by self-report, were strongly related to all physical activity outcomes (accelerometer-assessed total physical activity, reported walking for transport and leisure) and meaningfully related to overweight/obesity. Multivariable indexes of built environment variables were more strongly related to most outcomes than were single-environment variables. Designing activity-supportive built environments should be a higher international health priority. Results provide evidence in support of global initiatives to increase physical activity and control noncommunicable diseases while achieving sustainable development goals.

Objective The aim of this study was to examine 2-year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments. Methods A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Children 6 to 12 years old and a parent or caregiver completed Time 1 (n = 681) and Time 2 (n = 618) assessments. Children lived in neighborhoods characterized as "high/favorable" or "low/unfavorable" in nutrition and activity environments, respectively (four neighborhood types). Child BMI z score and overweight or obesity status were primary outcomes, with diet and activity behaviors as behavioral outcomes. Results After adjusting for sociodemographics and Time 1 values, children living in two of the three less environmentally supportive neighborhoods had significantly less favorable BMI z score changes (+0.11, 95% CI: 0.01-0.21; + 0.12, 95% CI: 0.03-0.21), and all three less supportive neighborhoods had higher overweight or obesity (relative risks, 1.41-1.49; 95% CI: 1.13-1.80) compared with children in the most environmentally supportive neighborhoods. Changes in daily energy intake and sedentary behavior by neighborhood type were consistent with observed weight status changes, with unexpected findings for physical activity. Conclusions More walkable and recreation-supportive environments with better nutrition access were associated with better child weight outcomes and related behavior changes.

New rapid transit investments have been motivated by environmental, economic, and health benefits. Given transit's potential to increase active travel, recent research leverages transit changes for natural experiment studies to examine physical activity outcomes. We aimed to quantify the association size, critically examine existing literature, and make recommendations for future studies to advance research and policies on active travel, transportation, and physical activity. Studies of physical activity impacts following transit interventions were systematically reviewed using seven health and transport databases (May–July 2017). Two investigators extracted data on sample size, intervention, pre- and post-intervention physical activity, and relevant measurement information. Inconsistency of results and estimated overall mean physical activity change post-intervention were assessed. Forest plots were created from physical activity change in each study using a general variance-based random effects model. Of 18 peer-reviewed articles examining health behaviors, 15 addressed physical activity and five were natural experiment studies with pre- and post- intervention measurements. Studies varied by intervention, duration, outcome measurement, sampling location, and spatial method. Q (201) and I2 (98%) indicated high study heterogeneity. Among these five studies, after transit interventions, total physical activity decreased (combined mean - 80.4 min/week, 95% CI - 157.9, −2.9), but transport-related physical activity increased (mean 6.7 min/week, 95% CI - 10.1, 23.5). Following new transit infrastructure, total physical activity may decline but transport-related physical activity may increase. Positive transit benefits were location, sociodemographic, or activity-specific. Future studies should address context, ensure adequate follow-up, utilize controls, and consider non-residential environments or participants. Keywords: Transportation, Physical activity, Meta-analysis, Longitudinal studies, Walking, Active travel

Objectives:This study investigated the resilience of single-family housing values in walkable versus unwalkable neighborhoods during the economic downturn from 2008 to 2012 in Dallas, Texas.Methods:Using propensity score matching and difference in differences methods, this study established a natural experimental design to compare before-and-after value changes of single-family (SF) homes in walkable neighborhoods with unwalkable neighborhoods during the Great Recession. Two thousand seven hundred ninety-nine SF homes within 18 Tax Increment Financing (TIF) districts were categorized into walkable (Walk Score ≥50) and unwalkable (Results:On average, the SF homes in walkable neighborhoods held $4566 (2.08%) more value than their how walkable counterparts.Conclusions:This study aims to help planners and decision-makers by documenting the unmet demand for walkable communities and their sustained economic benefit. Increased awareness of the sustained value of walkable communities can be used by lenders who finance and by policy makers who regulate placemaking. Results from this study can be integrated with research that demonstrates health-care cost savings of walkable environments to create an even more comprehensive set of evidence-based interventions to increase their supply.

Background: Relationships between several built environment factors and physical activity and walking behavior are well established, but internationally-comparable built environment measures are lacking. The Microscale Audit of Pedestrian Streetscapes (MAPS)-Global is an observational measure of detailed streetscape features relevant to physical activity that was developed for international use. This study examined the inter-observer reliability of the instrument in five countries. Methods: MAPS-Global was developed by compiling concepts and items from eight environmental measures relevant to walking and bicycling. Inter-rater reliability data were collected in neighborhoods selected to vary on geographic information system (GIS)-derived macro-level walkability in five countries (Australia, Belgium, Brazil, Hong Kong-China, and Spain). MAPS-Global assessments (n = 325) were completed in person along a = 0.25 mile route from a residence toward a non-residential destination, and a commercial block was also rated for each residence (n = 82). Two raters in each country rated each route independently. A tiered scoring system was created that summarized items at multiple levels of aggregation, and positive and negative valence scores were created based on the expected effect on physical activity. The intraclass correlation coefficient (ICC) was computed for scales and selected items using one-way random models. Results: Overall, 86.6% of individual items and single item indicators showed excellent agreement (ICC >= 0.75), and 13.4% showed good agreement (ICC = 0.60-0.74). All subscales and overall summary scores showed excellent agreement. Six of 123 items were too rare to compute the ICC. The median ICC for items and scales was 0.92 with a range of 0.50-1.0. Aesthetics and social characteristics showed lower ICCs than other sub-scales, but reliabilities were still in the excellent range (ICC >= 0.75). Conclusion: Evaluation of inter-observer reliability of MAPS-Global across five countries indicated all items and scales had "good" or "excellent" reliability. The results demonstrate that trained observers from multiple countries were able to reliably conduct observations of both residential and commercial areas with the new MAPS-Global instrument. Next steps are to evaluate construct validity in relation to physical activity in multiple countries and gain experience with using MAPS-Global for research and practice applications.

Background There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels. Objectives To examine how features of the built and natural environments relate to hypertension and the mediating role of transportation and leisure walking and body mass index in this relationship. Methods We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors that may contribute to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available. Results Our analysis of two population-based Canadian cohorts consistently found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively. Discussion We suggest an integrated population health approach that considers multimorbidity as a result of exposure to car-dependent areas and the lack of green spaces. Longitudinal research is needed to document causal effects of built and natural environments on hypertension.