Melody Smith

Systematic literature review of built environment effects on physical activity and active transport – an update and new findings on health equity

BackgroundEvidence is mounting to suggest a causal relationship between the built environment and people’s physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status.MethodsA systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted.ResultsTwenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost.ConclusionsImproving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.

Accelerometer data treatment for adolescents: Fitting a piece of the puzzle.

This study aimed to assess the differences in participant retention and associations between physical activity and key variables when a range of accelerometer data inclusion criteria are employed. Data were drawn from 204 adolescents of Pacific Island heritage (survey, body composition, 7-day accelerometry) and their parents (date of birth, socioeconomic status) between October 2014 and February 2016 in Auckland, New Zealand. Data wear time criteria for inclusion were as follows: A) > = 10 h/weekday or > = 8 h weekend day, > = 5 days (at least one weekend day); B) > = 10 h/weekday or > = 8 h weekend day, > = 4 days; C) > = 7 h/day, > = 3 days; D) > = 10 h/day, > = 1 day. Overall, 49%, 62%, 88%, and 96% of participants met the criteria, respectively. Adjusted odds of meeting each criterion were examined using a multivariable logistic regression model. Almost 50% of participants were excluded by the most stringent inclusion criteria. Increased body fat percentage and proportion of time in moderate-to-vigorous activity were associated with decreased odds of meeting Criterions A and B. This research contributes to a growing understanding of the impact of differing accelerometer reduction approaches to sample retention and bias in adolescent physical activity research.

Associations of the perceived and objective neighborhood environment with physical activity and sedentary time in New Zealand adolescents

BackgroundThere is accumulating evidence supporting the association between neighborhood built environments and adults’ physical activity (PA) and sedentary time (ST); however, few studies have investigated these associations in adolescents. A better understanding of the features of the built environment that encourage PA or ST is therefore of critical importance to promote health and wellbeing in adolescents. The aim of this study was to estimate the associations of GIS-determined and perceived walkability components in individual residential buffer zones with accelerometer-assessed moderate-to-vigorous physical activity (MVPA) and ST in adolescents.MethodsThe Built Environment in Adolescent New Zealanders (BEANZ) study was conducted in two cities (Auckland and Wellington) during the 2013-2014 academic school years. The exposure measures were subjective and objective environmental indices of activity-friendliness using four residential buffers. Road network buffers were calculated around participant’s residential addresses using the sausage buffer approach at 250xa0m, 500xa0m, 1xa0km, and 2xa0km scales. A 25xa0m radius was used for the buffers. Data were analysed using Generalized Additive Mixed Models in R.ResultsData were analysed from 524 participants (15.78xa0±xa01.62xa0years; 45% male). Participants accumulated ~114xa0min/day of moderate-to-vigorous PA (MVPA) and ~354xa0min/day of ST during accelerometer wear-time (~828xa0min/day). The estimated difference in MVPA between participants with the 1st and 3rd quartiles observed values on the composite subjective environmental index of activity-friendliness (perceived land use mix - diversity, street connectivity and aesthetics) was equivalent to ~8xa0min/day (~56 MVPA min/week) and for the objective environmental index of activity-friendliness (gross residential density and number of parks within 2xa0km distance from home) was ~6xa0min of MVPA/day (~45 MVPA min/week). When both indices were entered in a main-effect model, both indices remained significantly correlated with MVPA with sex as a moderator. The predicted difference in sedentary time between those with the minimum and maximum observed values on the subjective index of non-sedentariness was ~20xa0min/day.ConclusionsThe combined assessment of the main effects of subjective and objective indices of activity-friendliness on NZ adolescents’ PA and ST showed positive relationships with MVPA for the subjective index only. The subjective index was a significant correlate of PA in both girls and boys, while the objective index was significant only in boys when sex was entered as a moderator. Further research is warranted to understand the relationships of ST with the built environment.

Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design

BackgroundAchieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neighbourhoods. Previous studies of the effects of street changes have generally relied on natural experiments, have included few outcomes, and have seldom attempted to understand the equity impacts of such interventions.MethodsIn this paper we describe the design of Te Ara Mua – Future Streets, a mixed-methods, controlled before-after intervention study to assess the effect of retrofitting street changes at the suburb scale on multiple health, social and environmental outcomes. The study has a particular focus on identifying factors that improve walking and cycling to local destinations in low-income neighbourhoods and on reducing social and health inequities experienced by Māori (Indigenous New Zealanders) and Pacific people. Qualitative system dynamics modelling was used to develop a causal theory for the relationships between active travel, and walking and cycling infrastructure. On this basis we selected outcomes of interest. Together with the transport funder, we triangulated best evidence from the literature, transport policy makers, urban design professionals and community knowledge to develop interventions that were contextually and culturally appropriate. Using a combination of direct observation and random sample face to face surveys, we are measuring outcomes in these domains of wellbeing: road-user behaviour, changes to travel mode for short trips, physical activity, air quality, road traffic injuries, greenhouse gas emissions, and perceptions of neighbourhood social connection, safety, and walking and cycling infrastructure .DiscussionWhile building on previous natural experiments, Te Ara Mua - Future Streets is unique in testing an intervention designed by the research team, community and transport investors together; including a wide range of objective outcome measures; and having an equity focus. When undertaking integrated intervention studies of this kind, a careful balance is needed between epidemiological imperatives, the constraints of transport funding and implementation and community priorities, while retaining the ability to contribute new evidence for healthy, equitable transport policy.The study was retrospectively registered as a clinical trial on 21 June 2018 in the ISCRTN registry: ISRCTN89845334 http://www.isrctn.com/ISRCTN89845334

What are the associations between neighbourhood walkability and sedentary time in New Zealand adults? The URBAN cross-sectional study

Objectives We estimated associations between objectively determined neighbourhood ‘walkability’ attributes and accelerometer-derived sedentary time (ST) by sex, city or type of day. Design A cross-sectional study. Setting The URBAN (Understanding the Relationship between Activity and Neighbourhoods) study was conducted in 48 neighbourhoods across four cities in New Zealand (August 2008 to October 2010). Participants The response rate was 41% (2029 recruited participants/5007 eligible households approached). In total, 1762 participants (aged 41.4±12.1, mean±SD) met the data inclusion criteria and were included in analyses. Primary and secondary outcome measures The exposure variables were geographical information system (GIS) measures of neighbourhood walkability (ie, street connectivity, residential density, land-use mix, retail footprint area ratio) for street network buffers of 500u2009m and 1000u2009m around residential addresses. Participants wore an accelerometer for 7u2009days. The outcome measure was average daily minutes of ST. Results Data were available from 1762 participants (aged 41.4±12.1 years; 58% women). No significant main effects of GIS-based neighbourhood walkability measures were found with ST. Retail footprint area ratio was negatively associated with sedentary time in women, significant only for 500u2009m residential buffers. An increase of 1 decile in street connectivity was significantly associated with a decrease of over 5u2009min of ST per day in Christchurch residents for both residential buffers. Conclusion Neighbourhoods with proximal retail and higher street connectivity seem to be associated with less ST. These effects were sex and city specific.

Health literacy of Pacific mothers in New Zealand is associated with sociodemographic and non-communicable disease risk factors: surveys, focus groups and interviews.

Introduction: Pacific people living in New Zealand, suffer from inequitably high rates of noncommunicable diseases and their associated risk factors. This disease burden may be compounded by low health literacy levels. The objectives of this research were: (1) measure relationships between health literacy, socio-demographic factors and non-communicable disease risk factors in a large sample of Pacific mothers living in New Zealand and (2) gain in-depth understanding of social and cultural factors contributing to these relationships. Methods: Logistic regression was employed to investigate health literacy and: acculturation, socioeconomic status, physical activity, education, smoking status, health status, and alcohol consumption. Semi-structured focus groups were conducted with Pacific mothers and interviews with Pacific health professionals adopting the culturally appropriate talanoa, and kakala methods, within the Fonofale framework. Findings: Associations between low health literacy and age, ethnicity, acculturation, employment, education, smoking status, and alcohol status were shown. Novel findings from the focus groups were: the use and comprehension of health information and what constitutes preferred information and health service delivery modes. Conclusions: Findings suggest current health related information is not being used to its fullest extent by Pacific mothers. This may be due to underlying socio-demographic factors. This is the first study to examine the factors related to health literacy among Pacific mothers in NZ. Findings should be used to inform future interventions and delivery of public health nutrition messages.

Interpersonal Correlates of Active Transportation

Abstract Influenced by sociocultural norms, parents act as gatekeepers to childrens active transportation and independent mobility. Commonly, this is expressed through parental licence and convenience. This chapter presents a summary of these concepts as well as the forces underlying many of the day-to-day decisions that parents make regarding their childs active transportation and independent mobility, specifically working parents, neighbourhood safety concerns, community connections and social surveillance. A diagram is presented to illustrate the connectivity and cyclic nature of these factors and how they impact childrens active transportation. Future research is needed to understand the role that the millennial generation may play in breaking this cycle.

Health experiences of children and young people who migrate – Opportunities for health education:

Research on migration and health is gaining significant ground, with a focus on the adverse physical and mental health outcomes experienced by migrants. The health-related experiences of children and young people who migrate, however, are relatively absent, with children’s migration and health status often conflated with that of their parents. The omission of children’s own perspectives limits knowledge about how health is understood and experienced by child migrants, including the identification of best ways to support their health. Drawing on the empirical literature on child migrants and health from the World Health Organization’s (WHO) Western Pacific Region, we adopt a critical perspective to examine how the research to date supports a particular way of understanding and investigating the health of children and young people who migrate. Specifically, we highlight how a dominant focus on parents’ migration status, (negative) health outcomes and patterns of risk behaviours limits, rather than aids, the understanding of migrant children’s health. In doing so, we illustrate how much of the evidence base upholds Westernised biomedical notions of health and privileges the use of particular methodologies to assess health outcomes and reduce health risks. These preferences, in turn, shape the subsequent range of ‘appropriate’ forms of health education for, rather than with, children. We conclude by drawing on some exceptions and consider the opportunities these provide for developing health education in line with children’s own understandings of health – crucially underscoring the importance migrant children and young people attach to the more social aspects of their health and migration experiences.

Associations of children's active school travel with perceptions of the physical environment and characteristics of the social environment: A systematic review

&NA; This systematic review summarised and evaluated the evidence for associations between school travel modes in children aged 5–13 years and perceived physical environments as well as social and sociodemographic characteristics. A computerised electronic search was performed for English articles published between January 2000 and July 2017. Data were extracted, study quality was assessed, and findings were analysed using a vote‐counting technique. Thirty‐seven studies met the inclusion criteria and were reviewed. Active school travel was associated positively with safety, walkability and neighbourhood social interactions, and negatively with travel distance and car ownership. Risk of bias, poor sampling methods and lack of external validity were common study limitations. Generally insufficient findings were reported for social characteristics. HighlightsReview of descriptive associations of active school travel with environments.Traffic and route safety is positively associated with active school travel.Neighbourhood social interactions may promote active school travel.Methodological limitations reduce study quality and robustness of the synthesis.Heterogeneity in measurement obstructs comparability and certainty of findings.

Viewing obesogenic advertising in children's neighbourhoods using Google Street View: Obesogenic advertising in Google Street View

The advertising of unhealthy food and beverages forms an important component of obesogenic environments. Such marketing to children is a key health determinant because of its impact on dietary preference and food purchasing behaviour. The location of outdoor advertising is important in exploring obesogenic environments and childrens neighbourhoods. The aim of this study is to explore issues involved in the use of Google Street View to examine outdoor food and beverage advertising. The implications for using Google Street View in the context of neighbourhood built environment research and grass-roots advocacy are discussed. The study was conducted within walkable distances from 19 primary and intermediate schools in Auckland, New Zealand, where walkable was defined as limited by 800xa0m road network boundaries, which are equivalent to school buffer boundaries. Google Street View allows for centrality of data collection, coding, and storage. However, challenges exist with the method because 727 (29.4%) of a total of 2,474 outdoor advertisements that were identified were not able to be categorised because images were unclear, not in English, blocked, or at angles where detail cannot be deciphered. Specific to outdoor advertising for food and beverages, the results presented here show that children are exposed to a significantly greater number of unhealthy advertising than other advertising, P=0.001, eta-squared statistic (0.45) indicates a large effect size. Overall, the results show promise for the use of Google Street View in the study of obesogenic environments.