Obesity, physical activity, and the urban environment: public health research needs

Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built environment, physical activity, and overweight. Much of the focus of this research has been on the design and form of suburbs. It suggests that several features of the suburban built environment such as low densities, poor street connectivity and the lack of sidewalks are associated with decreased physical activity and an increased risk of being overweight. But compared to suburban residents, inner city populations have higher rates of obesity and inactivity despite living in neighborhoods that are dense, have excellent street connectivity and who's streets are almost universally lined with sidewalks.     

Mainstreaming social justice: human rights and public health

Our interest in a human rights and health discourse emerges from our efforts as social scientists to bring a meaningful social justice perspective to the realm of public health. In Canada, as in many countries, "health" is still firmly within the domain of the biomedical and the clinical. While considerable effort has been made to include more social, economic, and cultural perspectives, efforts to frame these issues as political phenomena have tended to be polarized into either a rich body of theoretical literature or case studies of interventions which have in varying degrees incorporated a social justice approach. What is still missing is a framework of discourse that allows various concepts of social justice to inform policy, intervention strategies, evaluation and evidence-based measures of effectiveness. This commentary examines the human rights discourse as conceptual space from which to build this framework.     

Associations between the built environment and physical activity in public housing residents

Background  

Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments.     

Mapping the development of research on physical activity and the built environment

Objective

The importance of the built environment for physical activity has been recognized in recent decades, resulting in new research. This study aims to understand the current structure of physical activity and built environment (PABE) research and identify gaps to address as the field continues to rapidly develop.

Methods

Key PABE articles were nominated by top scholars and a snowball sample of 2764 articles was collected in 2013 using citation network links. Article abstracts were examined to determine research focus and network analysis was used to examine the evolution of scholarship.

Results

The network included 318 PABE articles. Of these, 191 were discovery-focused, examining the relationship between physical activity and built environment; 79 were reviews summarizing previous PABE work; 38 focused on theory and methods for studying PABE; six were delivery-focused, examining PABE interventions; and four addressed other topics.

Conclusions

Network composition suggested that PABE is in the discovery phase, although may be transitioning given the large number and central position of review documents that summarize existing literature. The small amount of delivery research was not well integrated into the field. PABE delivery researchers may wish to make explicit connections to the discovery literature in order to better integrate the field.     

Perception of the social and built environment and physical activity among Northeastern Brazil adolescents

Objective

To evaluate the association between levels of physical activity and perception of the social and built environmental in adolescents from Northeastern Brazil.

Methods

The sample comprised 2874 adolescents aged 14 to 19 years (57.8% females) enrolled in private or public secondary schools in the municipality of João Pessoa, Northeastern Brazil. Level of physical activity was measured by questionnaire. Perception of environmental characteristics was measured by means of fifteen questions rated on four-point Likert-type scales ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). The association between physical activity and perception of environmental characteristics was investigated using multivariate binary logistic regression.

Results

Multivariate analysis showed that adolescents living in neighborhoods where other adolescents were physically active (68.7% vs. 60.1%, OR = 1.20; 95%CI: 1.05-1.56, among boys only) or who lived close to places they liked to frequent (71.8% vs. 53.4%, OR = 1.96; 95%CI: 1.40-2.78 among boys; and 42.0% vs. 32.3% OR = 1.33; 95%CI: 1.10-1.74 among girls) were more likely to be physically active.

Conclusions

Adolescents with positive perceptions of certain environmental characteristics were more likely to be physically active. Environmental characteristics may relate differently to levels of physical activity among boys and girls.     

Human rights,transitional justice,public health and social reconstruction

Mass violence, armed conflict, genocide, and complex humanitarian emergencies continue to create major social and public health disasters at the dawn of the 21st Century. Transitional justice, a set of policies designed to address the effects of war on traumatized communities and bring justice, lies at the nexus of public health, conflict, and social reconstruction. Despite the paucity of empirical evidence, advocates of transitional justice have claimed that it can alleviate the effects of trauma, deter future violence, and bring about social reconstruction in war-affected communities. Empirical evidence – including new data and analyses presented in this article – suggests a link between trauma, mental health and attitudes towards and responses to transitional justice programs, but there has been little theoretical discussion about the intersection between public health and transitional justice, and even less empirical research to generate discussion between these two fields. Yet, public health professionals have an important role to play in assessing the impact of transitional justice on communities affected by mass violence. In this paper, we offer a conceptual model for future research that seeks to examine the relationship between transitional justice programs and their potential value to the fields of medicine and public health and discuss the methodological issues and challenges to a comprehensive evaluation of this relationship. To illustrate the discussion, we examine new data and analyses from two cases of contemporary conflicts, eastern Democratic Republic of Congo (DRC) and northern Uganda.     

Creating healthy communities,healthy homes,healthy people: initiating a research agenda on the built environment and public health

Mounting evidence suggests physical and mental health problems relate to the built environment, including human-modified places such as homes, schools, workplaces, parks, industrial areas, farms, roads and highways. The public health relevance of the built environment requires examination. Preliminary research demonstrates the health benefits of sustainable communities. However, the impact of mediating and moderating factors within the built environment on health must be explored further. Given the complexity of the built environment, understanding its influence on human health requires a community-based, multilevel, interdisciplinary research approach. The authors offer recommendations, based upon a recent conference sponsored by the National Institute of Environmental Health Sciences (NIEHS), for research and policy approaches, and suggest interagency research alliances for greater public health impact.     

Perceptions of social capital and the built environment and mental health

There has been much speculation about a possible association between the social and built environment and health, but the empirical evidence is still elusive. The social and built environments are best seen as contextual concepts but they are usually estimated as an aggregation of individual compositional measures, such as perceptions on trust or the desirability to live in an area. If these aggregated compositional measures were valid measures, one would expect that they would evince correlations at higher levels of data collection (e.g., neighbourhood). The aims of this paper are: (1) to investigate the factor structure of a self-administered questionnaire measuring individual perceptions of trust, social participation, social cohesion, social control, and the built environment; (2) to investigate variation in these factors at higher than the individual level (households and postcodes) in order to assess if these constructs reflect some contextual effect; and (3) to study the association between mental health, as measured by the General Health Questionnaire-12 (GHQ-12), and these derived factors. A cross-sectional household survey was undertaken during May-August 2001 in a district of South Wales with a population of 140,000. We found that factor analysis grouped our questions in factors similar to the theoretical ones we had previously envisaged. We also found that approximately one-third of the variance for neighbourhood quality and 10% for social control was explained at postcode (neighbourhood) level after adjusting for individual variables, thus suggesting that some of our compositional measures capture contextual characteristics of the built and social environment. After adjusting for individual variables, trust and social cohesion, two key social capital components were the only factors to show statistically significant associations with GHQ-12 scores. However, these factors also showed little variation at postcode levels, suggesting a stronger individual determination. We conclude that our results provide some evidence in support of an association between mental health (GHQ-12 scores) and perceptions of social capital, but less support for the contextual nature of social capital.     

Methodologies for assessing contextual exposure to the built environment in physical activity studies: A systematic review

Growing research has integrated Global Positioning Systems (GPS), Geographic Information Systems (GIS), and accelerometry in studying effects of built environment on physical activity outcomes. This systematic review aimed to summarize current geospatial methods of assessing contextual exposure to the built environment in these studies. Based on reviewing 79 eligible articles, methods were identified and grouped into three main categories based on similarities in their approaches as follows: domain-based (67% of studies), buffer-based (22%), and activity space-based (11%). Additionally, technical barriers and potential sources of uncertainties in each category were discussed and recommendations on methodological improvements were made.     

The built environment and recreational physical activity among adults in Curitiba, Brazil

Objective

To examine the relationship between objective measures of the built environment (BE) and recreational physical activity (PA) in adults from Curitiba, Brazil.

Method

A phone survey was carried among a random sample of 1206 people. Walking during leisure time (WLT) and moderate and vigorous recreational PA (MVPA) was measured using IPAQ. Characteristics of the BE were determined in an area of 500 m surrounding respondent's homes. Multivariate logistic regression analysis was used to estimate the associations between recreational PA and BE.

Results

After adjusting for confounders, WLT was associated with area income level US$971.45-3341.64 vs. US$167.05-461.06 (25.7% vs. 11.1% POR = 2.5; 95% CI = 1.5-4.4), having ≥ 2 gyms vs. none (26.1% vs. 12.7%, POR = 1.9; 95% CI = 1.2-3.0) and distance to recreation centers, 1769.1-2835.5 km vs. 2835.6-10,212.3 km (22.1% vs. 11.0%, POR = 2.3; 95% CI = (1.0-2.5). MVPA was associated with neighborhood income US$971.45-3341.64 vs. US$167.05-461.06 (47.6% vs. 22.0% POR = 3.0; 95% CI = 1.5-5.9) and having ≥ 2 gyms vs. none (41.7% vs. 26.0%, POR = 1.5; 95% CI = 1.11-2.1).

Conclusion

The presence of some recreational facilities for PA was associated with recommended levels of PA during leisure time in Curitiba, Brazil.     

Adolescent physical activity and the built environment: a latent class analysis approach

This study used latent class analysis to classify adolescent home neighborhoods (n=344) according to built environment characteristics, and tested how adolescent physical activity, sedentary behavior, and screen time differ by neighborhood type/class. Four distinct neighborhood classes emerged: (1) low-density retail/transit, low walkability index (WI), further from recreation; (2) high-density retail/transit, high WI, closer to recreation; (3) moderate-high-density retail/transit, moderate WI, further from recreation; and (4) moderate-low-density retail/transit, low WI, closer to recreation. We found no difference in adolescent activity by neighborhood class. These results highlight the difficulty of disentangling the potential effects of the built environment on adolescent physical activity.     

Bed bugs, public health, and social justice: Part 2, An opinion survey

Bed bug infestations have resurged globally, nationally, and locally, yet the public health community in the U.S. has yet to mount a coordinated response to the escalating bed bug problem. Surveys of attendees at the 2009 National Environmental Health Association Annual Educational Conference & Exhibition, 2009 Ohio Association of Health Commissioners Fall Conference, 2009 Central Ohio Bed Bug Summit, and 2010 Hamilton County Council on Aging Annual Conference were conducted to gauge opinions about bed bugs. Survey results revealed that 90% of all respondents considered bed bugs to be a public health concern, and 73% indicated that bed bugs pose an environmental justice concern. These findings, which indicate that bed bugs are an inescapable public health mandate with environmental justice undertones, should rally public health agencies at federal, state, and local levels to respond with authority of agency to the escalating bed bug problem.