Hannah Badland

City planning and population health: a global challenge

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Applying GPS to enhance understanding of transport-related physical activity☆

The purpose of the paper is to review the utility of the global positioning system (GPS) in the study of health-related physical activity. The paper draws from existing literature to outline the current work performed using GPS to examine transport-related physical activity, with a focus on the relative utility of the approach when combined with geographic information system (GIS) and other data sources including accelerometers. The paper argues that GPS, especially when used in combination with GIS and accelerometery, offers great promise in objectively measuring and studying the relationship of numerous environmental attributes to human behaviour in terms of physical activity and transport-related activity. Limitations to the use of GPS for the purpose of monitoring health-related physical activity are presented, and recommendations for future avenues of research are discussed.

Associations of children's independent mobility and active travel with physical activity, sedentary behaviour and weight status: A systematic review

UNLABELLED Health benefits from childrens independent mobility and active travel beyond school travel are largely unexplored. OBJECTIVES This review synthesized the evidence for associations of independent mobility and active travel to various destinations with physical activity, sedentary behaviour and weight status. DESIGN Systematic review. METHODS A systematic search in six databases (PubMed, Scopus, CINAHL, SportDiscus, PsychInfo, TRIS) for papers published between January 1990 and March 2012 was undertaken, focussing on children aged 3-18 years. Study inclusion and methodological quality were independently assessed by two reviewers. RESULTS 52 studies were included. Most studies focussed solely on active travel to and/or from school, and showed significant positive associations with physical activity. The same relationship was detected for active travel to leisure-related places and independent mobility with physical activity. An inverse relationship between active travel to school and weight status was evident but findings were inconsistent. Few studies examined correlations between active travel to school and self-reported screen-time or objectively measured sedentary behaviour, and findings were unclear. CONCLUSIONS Studies on independent mobility suggested that children who have the freedom to play outdoors and travel actively without adult supervision accumulate more physical activity than those who do not. Further investigation of childrens active travel to leisure-related destinations, measurement of diverse sedentary behaviour beyond simply screen-based activities, and consistent thresholds for objectively measured sedentary behaviour in children will clarify the inconsistent evidence base on associations of active travel with sedentary behaviour and weight status.

An Ethical Framework for Automated, Wearable Cameras in Health Behavior Research

Technologic advances mean automated, wearable cameras are now feasible for investigating health behaviors in a public health context. This paper attempts to identify and discuss the ethical implications of such research, in relation to existing guidelines for ethical research in traditional visual methodologies. Research using automated, wearable cameras can be very intrusive, generating unprecedented levels of image data, some of it potentially unflattering or unwanted. Participants and third parties they encounter may feel uncomfortable or that their privacy has been affected negatively. This paper attempts to formalize the protection of all according to best ethical principles through the development of an ethical framework. Respect for autonomy, through appropriate approaches to informed consent and adequate privacy and confidentiality controls, allows for ethical research, which has the potential to confer substantial benefits on the field of health behavior research.

Using the SenseCam to Improve Classifications of Sedentary Behavior in Free-Living Settings

BACKGROUND Studies have shown relationships between important health outcomes and sedentary behavior, independent of physical activity. There are known errors in tools employed to assess sedentary behavior. Studies of accelerometers have been limited to laboratory environments. PURPOSE To assess a broad range of sedentary behaviors in free-living adults using accelerometers and a Microsoft SenseCam that can provide an objective observation of sedentary behaviors through first person-view images. METHODS Participants were 40 university employees who wore a SenseCam and Actigraph accelerometer for 3-5 days. Images were coded for sitting and standing posture and 12 activity types. Data were merged and aggregated to a 60-second epoch. Accelerometer counts per minute (cpm) of <100 were compared with coded behaviors. Sensitivity and specificity analyses were performed. Data were collected in June and July 2011 and analyzed in April 2012. RESULTS TV viewing, other screen use, and administrative activities were correctly classified by the 100-cpm cutpoint. However, standing behaviors also fell under this threshold, and driving behaviors exceeded it. Multiple behaviors occurred simultaneously. A nearly 30-minute per day difference was found in sedentary behavior estimates based on the accelerometer versus the SenseCam. CONCLUSIONS Researchers should be aware of the strengths and weaknesses of the 100-cpm accelerometer cutpoint for identifying sedentary behavior. The SenseCam may be a useful tool in free-living conditions to better understand health behaviors such as sitting.

Neighborhood built environment and transport and leisure physical activity: findings using objective exposure and outcome measures in New Zealand.

Background: Evidence of associations between neighborhood built environments and transport-related physical activity (PA) is accumulating, but few studies have investigated associations with leisure-time PA. Objective: We investigated associations of five objectively measured characteristics of the neighborhood built environment—destination access, street connectivity, dwelling density, land-use mix and streetscape quality—with residents’ self-reported PA (transport, leisure, and walking) and accelerometer-derived measures of PA. Methods: Using a multicity stratified cluster sampling design, we conducted a cross-sectional survey of 2,033 adults who lived in 48 New Zealand neighborhoods. Multilevel regression modeling, which was adjusted for individual-level (sociodemographic and neighborhood preference) and neighborhood-level (deprivation) confounders, was used to estimate associations of built environment with PA. Results: We found that 1-SD increases in destination access, street connectivity, and dwelling density were associated with any versus no self-reported transport, leisure, or walking PA, with increased odds ranging from 21% [street connectivity with leisure PA, 95% confidence interval (CI): 0%, 47%] to 44% (destination accessibility with walking, 95% CI: 17%, 79%). Among participants who self-reported some PA, a 1-SD increase in street connectivity was associated with a 13% increase in leisure PA (95% CI: 0, 28%). SD increases in destination access, street connectivity, and dwelling density were each associated with 7% increases in accelerometer counts. Conclusions: Associations of neighborhood destination access, street connectivity, and dwelling density with self-reported and objectively measured PA were moderately strong, indicating the potential to increase PA through changes in neighborhood characteristics.

Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study: research design and methodology

BackgroundBuilt environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study.Methods and designThe URBAN Study is a multi-centered, stratified, cross-sectional research design, collecting data across four New Zealand cities. Within each city, 12 neighborhoods were identified and selected for investigation based on higher or lower walkability and Māori demographic attributes. Neighborhoods were selected to ensure equal representation of these characteristics. Within each selected neighborhood, 42 households are being randomly selected and an adult and child (where possible) recruited into the study. Data collection includes: objective and self-reported PA engagement, neighborhood perceptions, demographics, and body size measures. The study was designed to recruit approximately 2,000 adults and 250 children into the project. Other aspects of the study include photovoice, which is a qualitative assessment of built environment features associated with PA engagement, an audit of the neighborhood streetscape environment, and an individualized neighborhood walkability profile centered on each participants residential address. Multilevel modeling will be used to examine the individual-level and neighborhood-level relationships with PA engagement and body size.DiscussionThe URBAN Study is applying a novel scientifically robust research design to provide urgently needed epidemiological information regarding the associations between the built environment and health outcomes. The findings will contribute to a larger, international initiative in which similar neighborhood selection and PA measurement procedures are utilized across eight countries. Accordingly, this study directly addresses the international priority issues of increasing PA engagement and decreasing obesity levels.

Public open space, physical activity, urban design and public health: Concepts, methods and research agenda

Public open spaces such as parks and green spaces are key built environment elements within neighbourhoods for encouraging a variety of physical activity behaviours. Over the past decade, there has been a burgeoning number of active living research studies examining the influence of public open space on physical activity. However, the evidence shows mixed associations between different aspects of public open space (e.g., proximity, size, quality) and physical activity. These inconsistencies hinder the development of specific evidence-based guidelines for urban designers and policy-makers for (re)designing public open space to encourage physical activity. This paper aims to move this research agenda forward, by identifying key conceptual and methodological issues that may contribute to inconsistencies in research examining relations between public open space and physical activity.

Perceived Neighborhood Environmental Attributes Associated with Walking and Cycling for Transport among Adult Residents of 17 Cities in 12 Countries: The IPEN Study.

Introduction Prevalence of walking and cycling for transport is low and varies greatly across countries. Few studies have examined neighborhood perceptions related to walking and cycling for transport in different countries. Therefore, it is challenging to prioritize appropriate built-environment interventions. Objectives The aim of this study was to examine the strength and shape of the relationship between adults’ neighborhood perceptions and walking and cycling for transport across diverse environments. Methods As part of the International Physical activity and Environment Network (IPEN) adult project, self-reported data were taken from 13,745 adults (18–65 years) living in physically and socially diverse neighborhoods in 17 cities across 12 countries. Neighborhood perceptions were measured using the Neighborhood Environment Walkability Scale, and walking and cycling for transport were measured using the International Physical Activity Questionnaire–Long Form. Generalized additive mixed models were used to model walking or cycling for transport during the last seven days with neighborhood perceptions. Interactions by city were explored. Results Walking-for-transport outcomes were significantly associated with perceived residential density, land use mix–access, street connectivity, aesthetics, and safety. Any cycling for transport was significantly related to perceived land use mix–access, street connectivity, infrastructure, aesthetics, safety, and perceived distance to destinations. Between-city differences existed for some attributes in relation to walking or cycling for transport. Conclusions Many perceived environmental attributes supported both cycling and walking; however, highly walkable environments may not support cycling for transport. People appear to walk for transport despite safety concerns. These findings can guide the implementation of global health strategies. Citation Kerr J, Emond JA, Badland H, Reis R, Sarmiento O, Carlson J, Sallis JF, Cerin E, Cain K, Conway T, Schofield G, Macfarlane DJ, Christiansen LB, Van Dyck D, Davey R, Aguinaga-Ontoso I, Salvo D, Sugiyama T, Owen N, Mitáš J, Natarajan L. 2016. Perceived neighborhood environmental attributes associated with walking and cycling for transport among adult residents of 17 cities in 12 countries: the IPEN study. Environ Health Perspect 124:290–298; http://dx.doi.org/10.1289/ehp.1409466

A Longitudinal Analysis of the Influence of the Neighborhood Built Environment on Walking for Transportation The RESIDE Study

The purpose of the present analysis was to use longitudinal data collected over 7 years (from 4 surveys) in the Residential Environments (RESIDE) Study (Perth, Australia, 2003-2012) to more carefully examine the relationship of neighborhood walkability and destination accessibility with walking for transportation that has been seen in many cross-sectional studies. We compared effect estimates from 3 types of logistic regression models: 2 that utilize all available data (a population marginal model and a subject-level mixed model) and a third subject-level conditional model that exclusively uses within-person longitudinal evidence. The results support the evidence that neighborhood walkability (especially land-use mix and street connectivity), local access to public transit stops, and variety in the types of local destinations are important determinants of walking for transportation. The similarity of subject-level effect estimates from logistic mixed models and those from conditional logistic models indicates that there is little or no bias from uncontrolled time-constant residential preference (self-selection) factors; however, confounding by uncontrolled time-varying factors, such as health status, remains a possibility. These findings provide policy makers and urban planners with further evidence that certain features of the built environment may be important in the design of neighborhoods to increase walking for transportation and meet the health needs of residents.