Mohammad Javad Koohsari

Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention

The time that children and adults spend sedentary–put simply, doing too much sitting as distinct from doing too little physical activity—has recently been proposed as a population-wide, ubiquitous influence on health outcomes. It has been argued that sedentary time is likely to be additional to the risks associated with insufficient moderate-to-vigorous physical activity. New evidence identifies relationships of too much sitting with overweight and obesity, type 2 diabetes, cardiovascular disease, some cancers and other adverse health outcomes. There is a need for a broader base of evidence on the likely health benefits of changing the relevant sedentary behaviours, particularly gathering evidence on underlying mechanisms and dose–response relationships. However, as remains the case for physical activity, there is a research agenda to be pursued in order to identify the potentially modifiable environmental and social determinants of sedentary behaviour. Such evidence is required so as to understand what might need to be changed in order to influence sedentary behaviours and to work towards population-wide impacts on prolonged sitting time. In this context, the research agenda needs to focus particularly on what can inform broad, evidence-based environmental and policy initiatives. We consider what has been learned from research on relationships of environmental and social attributes and physical activity; provide an overview of recent-emerging evidence on relationships of environmental attributes with sedentary behaviour; argue for the importance of conducting international comparative studies and addressing life-stage issues and socioeconomic inequalities and we propose a conceptual model within which this research agenda may be addressed.

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.

Public Open Space and Walking: The Role of Proximity, Perceptual Qualities of the Surrounding Built Environment, and Street Configuration

This study examined how proximity and attractiveness of public open spaces (POSs), perceptions of the surrounding built environment, and street configuration were associated with walking to and within POSs. Residents from three neighborhoods in Melbourne (N = 335) completed a questionnaire about walking and perceptions of their neighborhood, and geographic information systems and space syntax measures were used to assess proximity of POSs and street configuration. Proximity and attractiveness of POSs were not associated with POS-related walking. However, several perceptual qualities of the built environment, including safety from crime and traffic and aesthetics, were associated with greater walking. As well, persons living in areas with the most integrated street configurations reported less POS-related walking. Neighborhood perceptions and street configuration are key urban design issues to consider in promoting residents’ use of POS for walking.

Adverse associations of car time with markers of cardio-metabolic risk

Objective To examine associations of time spent sitting in cars with markers of cardio-metabolic risk in Australian adults. Method Data were from 2800 participants (age range: 34–65) in the 2011–12 Australian Diabetes, Obesity and Lifestyle Study. Self-reported time spent in cars was categorized into four groups: ≤ 15 min/day; > 15 to ≤ 30 min/day; > 30 to ≤ 60 min/day; and > 60 min/day. Markers of cardio-metabolic risk were body mass index (BMI), waist circumference, systolic and diastolic blood pressure, triglycerides, HDL (high-density lipoprotein)-cholesterol, fasting plasma glucose, 2-h plasma glucose, a clustered cardio-metabolic risk score, and having the metabolic syndrome or not. Multilevel linear and logistic regression analyses examined associations of car time with each cardio-metabolic risk outcome, adjusting for socio-demographic and behavioral variables and medication use for blood pressure and cholesterol/triglycerides. Results Compared to spending 15 min/day or less in cars, spending more than 1 h/day in cars was significantly associated with higher BMI, waist circumference, fasting plasma glucose, and clustered cardio-metabolic risk, after adjusting for socio-demographic attributes and potentially relevant behaviors including leisure-time physical activity and dietary intake. Gender interactions showed car time to be associated with higher BMI in men only. Conclusions Prolonged time spent sitting in cars, in particular over 1 h/day, was associated with higher total and central adiposity and a more-adverse cardio-metabolic risk profile. Further studies, ideally using objective measures of sitting time in cars and prospective designs, are needed to confirm the impact of car use on cardio-metabolic disease risk.

Mismatch between perceived and objectively measured land use mix and street connectivity: associations with neighborhood walking.

Studies on the mismatch between objective and perceived measures of walkability and walking provide insights into targeting interventions. These studies focused on those living in more walkable environments, but perceiving them as less walkable. However, it is equally important to understand how the other mismatch (living in less walkable areas, but perceiving them as walkable) is related to walking. This study examined how the mismatch between perceived and objective walkability measures (i.e., living in less walkable areas, but perceiving them as walkable, and living in more walkable areas, but perceiving them as less walkable) was associated with walking. Baseline data from adult participants (n = 1466) of the RESIDential Environment Project (Perth, Australia in 2004-06) collected self-report neighborhood walking for recreation and transport in a usual week and participants’ perceptions of street connectivity and land use mix in their neighborhood. The exposure was the mismatch between objective and perceived measures of these. Multilevel logistic regression examined associations of walking with the mismatch between perceived and objective walkability measures. Perceiving high walkable attributes as low walkable was associated with lower levels of walking, while perceiving a low walkable attribute as walkable was associated with higher levels of walking. Walking interventions must create more pedestrian-friendly environments as well as target residents’ perceptions.

Associations of Leisure-Time Sitting in Cars With Neighborhood Walkability

BACKGROUND Too much sitting, including time spent sitting in cars, is associated with poor health outcomes. Identifying the built-environment attributes that may reduce vehicular sitting time can inform future initiatives linking the public health, urban design, and transportation sectors. METHODS Data collected in 2003-2004 from adult residents (n = 2521) of Adelaide, Australia were used. Logistic regression analyses examined associations of prolonged time spent sitting in cars during leisure time (30 min/day or more) with neighborhood walkability and its components (dwelling density; intersection density; land use mix; net retail area ratio). RESULTS Lower overall walkability was significantly associated with a higher odds (OR = 1.43, 95% CI: 1.21-1.70) of spending prolonged time in cars. For analyses with walkability components, lower net retail area ratio, lower residential density, and lower intersection density were significantly associated with prolonged sitting in cars. CONCLUSION This study found that residents of high walkable neighborhoods tended to spend less time sitting in cars. In particular, higher net retail area ratio, an indicator of tightly spaced commercial areas, was strongly associated with less time in cars. Policy and planning initiatives to reduce car use require further evidence, particularly on the influence of neighborhood retail areas.

Street network measures and adults' walking for transport: Application of space syntax.

The street network underpins the walkability of local neighborhoods. We examined whether two street network measures (intersection density and street integration from space syntax) were independently associated with walking for transport (WT); and, to what extent the relationship of street integration with WT may be explained by the presence of destinations. In 2003-2004, adults living in Adelaide, Australia (n=2544) reported their past-week WT frequency and perceived distances to 16 destination types. Marginal models via generalized estimating equations tested mediation effects. Both intersection density and street integration were significantly associated with WT, after adjusting for each other. Perceived destination availability explained 42% of the association of street integration with WT; this may be because of an association between street integration and local destination availability - an important element of neighborhood walkability. The use of space syntax concepts and methods has the potential to provide novel insights into built-environment influences on walking.

Activity-Friendly Built Environment Attributes and Adult Adiposity

Physically-active and sedentary behaviors are determinants of adult weight gain and are associated with built-environment attributes. We reviewed recent evidence on built-environment attributes with adult adiposity. Of 41 relevant papers identified, 34 reported cross-sectional, six recorded prospective findings, and one included both cross-sectional and prospective designs. In 15 cross-sectional examinations of composite built environment indices (walkability; composite other), seven identified significant positive relationships in the expected direction; of 42 instances examining particular walkability elements (density, connectivity, land use mix), 13 were positive. Of 44 instances examining proximity of utilitarian and recreational destinations, there were 13 positive associations; and, of 41 instances examining pedestrian-environment attributes, 12 were positive. In the seven prospective studies, 20 sets of relationships were identified – nine were significant and in the expected direction. Evidence on built environment/adiposity relationships remains modest and could be strengthened through improvements in measurement methods and with further evidence from prospective studies.

A systematic review of physical activity and sedentary behaviour research in the oil-producing countries of the Arabian Peninsula

BackgroundThe dramatic rise in Noncommunicable Diseases (NCD) in the oil-producing countries of the Arabian Peninsula is driven in part by insufficient physical activity, one of the five main contributors to health risk in the region. The aim of this paper is to review the available evidence on physical activity and sedentary behaviour for this region. Based on the findings, we prioritize an agenda for research that could inform policy initiatives with regional relevance.MethodsWe reviewed regional evidence on physical activity and sedentary behaviour to identify the needs for prevention and policy-related research. A literature search of peer-reviewed publications in the English language was conducted in May 2016 using PubMed, Web of Science and Google Scholar. 100 studies were identified and classified using the Behavioural Epidemiology Framework.ResultsReview findings demonstrate that research relevant to NCD prevention is underdeveloped in the region. A majority of the studies were epidemiological in approach with few being large-scale population-based studies using standardised measures. Correlates demonstrated expected associations with health outcomes, low levels of physical activity (particularly among young people), high levels of sedentary behaviour (particularly among men and young people) and expected associations of known correlates (e.g. gender, age, education, time, self-motivation, social support, and access). Very few studies offered recommendations for translating research findings into practice.ConclusionsFurther research on the determinants of physical activity and sedentary behaviour in the Arabian Peninsula using standard assessment tools is urgently needed. Priority research includes examining these behaviours across the four domains (household, work, transport and leisure). Intervention research focusing on the sectors of education, health and sports sectors is recommended. Furthermore, adapting and testing international examples to the local context would help identify culturally relevant policy and programmatic interventions for the region.

Area-Level Disparities of Public Open Space: A Geographic Information Systems Analysis in Metropolitan Melbourne

This article examines differences in proximity to, and size of, four types of public open space for different levels of socio-economic disadvantage in metropolitan Melbourne. Since the provision of public open space in Melbourne is guided by the Victoria Planning Provisions (VPP), this article also demonstrates the use of Geographic Information Systems (GIS) as a tool to compare the current distribution of public open space with policy. Measures of distance to, and size of, the closest public open space were derived using GIS and analysed according to area-level socio-economic disadvantage. A novel method of estimating public open space access points is introduced. Over one-third of dwellings in metropolitan Melbourne were located in areas that did not align with the VPP public open space proximity standard; however, we found no evidence of a socio-economic gradient in terms of compliance. There were statistically significant differences between disadvantaged and advantaged areas with respect to proximity to, and size of, public open space. However, while the differences were statistically significant the magnitudes of the differences were small. Future research needs to investigate how different measures (e.g. quality, size) can be included in planning regulations to support equitable provision of public open space.