Urban environment, transport behaviours, and health

Urban environments are very complex systems with a myriad of factors intricately related. Built environment, transport, physical activity and sedentary behaviours, air pollution, and social contacts and feelings of loneliness can have effects on urban population’s health and well-being. Also, some of these determinants can be associated and can interact between them modifying their effects on health. According to the World Health Organisation (WHO), health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Taking into account this comprehensive health definition, this thesis covered different layers of health: general, mental, and physical. With four different studies, the results of the present thesis suggest that it is possible to design urban environments that can increase physical activity levels, mainly through active transport, and that the crime-safety perceptions can have an important role in terms of reinforcing the effects of the built environment on physical activity and sedentary behaviours. Furthermore, active transport, mainly bicycle use, seems to be a source of good mental health and well-being, and a tool to boost social capital production. Increasing physical activity levels also seems to be a good way to improve cardiovascular health through blood pressure levels reduction. The present thesis suggests that urban and transport planning have a great potential to promote healthy behaviours and ensure mental and physical health of city dwellers, mainly through active transport promotion. In order to improve the health promotion through urban environment, more research about aesthetics urban attributes, urban social capital production, effects on mental health and well-being, and effectiveness of urban interventions is needed.Los entornos urbanos son sistemas muy complejos con una miríada de factores intrincadamente relacionados. El entorno construido, el transporte, la actividad física y los comportamientos sedentarios, la contaminación del aire y los contactos sociales y los sentimientos de soledad pueden tener efectos en la salud y el bienestar de la población urbana. Además, algunos de estos determinantes se pueden asociar y pueden interactuar entre ellos modificando sus efectos sobre la salud. Según la Organización Mundial de la Salud (OMS), la salud es "un estado de completo bienestar físico, mental y social y no simplemente la ausencia de enfermedades o dolencias". Teniendo en cuenta esta definición integral de salud, esta tesis cubre diferentes niveles de salud: general, mental y física. Con cuatro estudios diferentes, los resultados de la presente tesis sugieren que es posible diseñar entornos urbanos que puedan aumentar los niveles de actividad física, principalmente a través del transporte activo, y que las percepciones de seguridad con respecto al crimen pueden tener un papel importante en términos de reforzar los efectos del entorno construido sobre la actividad física y los comportamientos sedentarios. Además, el transporte activo, principalmente el uso de bicicletas, parece ser una fuente de buena salud mental y bienestar, y una herramienta para impulsar la producción de capital social. El aumento de los niveles de actividad física también parece ser una buena forma de mejorar la salud cardiovascular a través de la reducción de los niveles de presión arterial. La presente tesis sugiere que la planificación urbana y de transporte tienen un gran potencial para promover comportamientos saludables y garantizar la salud mental y física de los habitantes de las ciudades, principalmente a través de la promoción del transporte activo. Para ir mejorando la promoción de la salud a través del entorno urbano, se necesita más investigación sobre los atributos urbanos estéticos, la producción de capital social urbano, los efectos sobre la salud mental y el bienestar, y la efectividad de las intervenciones urbana

Bicycle use in Latin American cities: changes over time by socio-economic position

IntroductionWe aimed to examine utilitarian bicycle use among adults from 18 large Latin American cities and its association with socio-economic position (education and income) between 2008 and 2018.MethodsData came from yearly cross-sectional surveys collected by the Development Bank of Latin America (CAF). A total of 77,765 survey respondents with complete data were used to estimate multilevel logistic regression models with city as random intercept and year as random slope.ResultsIndividuals with high education and high-income levels had lower odds of using a bicycle compared with participants with lower education and income levels. These associations, however, changed over time with the odds of bicycle use increasing for all groups, especially among individuals with the highest education and income levels.DiscussionOur results confirm the broadening appeal of bicycling across socio-economic positions in several Latin American cities and reinforce the importance of considering policies aimed at supporting and enhancing bicycle travel for all users

Tendencias recientes de la migración interna en Nuevo León, México

El Estado Nuevo León, México, ha sido históricamente un polo de atracción de población en el ámbito nacional, el crecimiento poblacional registrado en este espacio geográfico durante los últimos 50 años es producto en gran parte de los procesos de inmigración, incentivados por el crecimiento económico de un creciente sector industrial, que generó una demanda de mano de obra que sin la llegada de población de otras partes del país no habría sido posible cubrir. En esta investigación se presentan las tendencias recientes de la inmigración en Nuevo León utilizando como fuente primaria de información la Encuesta Intercensal 2015 del Instituto Nacional de Estadística y Geografía (INEGI), de la cual se analizan algunas variables contextuales como el sexo, la edad, condición de habla indígena y la escolaridad. A manera de referencia, se emplean también datos derivados de los censos de 1970, 1990, 2000 y 2010, pues no es posible entender el presente sin comprender el pasado

Recent trends in internal migration in Nuevo Leon, Mexico

Nuevo León State, Mexico, has historically been a pole of population attraction at the national level, the population growth recorded in this geographic space during the last 50 years is largely a product of immigration processes, stimulated by economic growth of a growing industrial sector, which generated a labor demand that without the arrival of population from other parts of the country would not have been possible to cover. This research presents the recent trends of immigration in Nuevo León using as a primary source of information the Intercensal Survey 2015 of the National Institute of Statistics and Geography (inegi), which analyzes some contextual variables such as sex, age, Indigenous speaking status and schooling. As a reference, data derived from the 1970, 1990, 2000 and 2010 censuses are also used, because it is not possible to understand the present without understanding the past

Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project

Introduction: Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. Methods and analysis: PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14 000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. Ethics and dissemination: Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL. Document type: Articl

Physical activity through sustainable transport approaches (PASTA): protocol for a multi-centre, longitudinal study

BACKGROUND: Physical inactivity is one of the leading risk factors for non-communicable diseases, yet many are not sufficiently active. The Physical Activity through Sustainable Transport Approaches (PASTA) study aims to better understand active mobility (walking and cycling for transport solely or in combination with public transport) as an innovative approach to integrate physical activity into individuals' everyday lives. The PASTA study will collect data of multiple cities in a longitudinal cohort design to study correlates of active mobility, its effect on overall physical activity, crash risk and exposure to traffic-related air pollution. METHODS/DESIGN: A set of online questionnaires incorporating gold standard approaches from the physical activity and transport fields have been developed, piloted and are now being deployed in a longitudinal study in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich). In total, 14000 adults are being recruited (2000 in each city). A first questionnaire collects baseline information; follow-up questionnaires sent every 13 days collect prospective data on travel behaviour, levels of physical activity and traffic safety incidents. Self-reported data will be validated with objective data in subsamples using conventional and novel methods. Accelerometers, GPS and tracking apps record routes and activity. Air pollution and physical activity are measured to study their combined effects on health biomarkers. Exposure-adjusted crash risks will be calculated for active modes, and crash location audits are performed to study the role of the built environment. Ethics committees in all seven cities have given independent approval for the study. DISCUSSION: The PASTA study collects a wealth of subjective and objective data on active mobility and physical activity. This will allow the investigation of numerous correlates of active mobility and physical activity using a data set that advances previous efforts in its richness, geographical coverage and comprehensiveness. Results will inform new health impact assessment models and support efforts to promote and facilitate active mobility in cities

Transport mode choice and body mass index: Cross-sectional and longitudinal evidence from a European-wide study.

BACKGROUND: In the fight against rising overweight and obesity levels, and unhealthy urban environments, the renaissance of active mobility (cycling and walking as a transport mode) is encouraging. Transport mode has been shown to be associated to body mass index (BMI), yet there is limited longitudinal evidence demonstrating causality. We aimed to associate transport mode and BMI cross-sectionally, but also prospectively in the first ever European-wide longitudinal study on transport and health. METHODS: Data were from the PASTA project that recruited adults in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich) to complete a series of questionnaires on travel behavior, physical activity levels, and BMI. To assess the association between transport mode and BMI as well as change in BMI we performed crude and adjusted linear mixed-effects modeling for cross-sectional (n = 7380) and longitudinal (n = 2316) data, respectively. RESULTS: Cross-sectionally, BMI was 0.027 kg/m2 (95%CI 0.015 to 0.040) higher per additional day of car use per month. Inversely, BMI was -0.010 kg/m2 (95%CI -0.020 to -0.0002) lower per additional day of cycling per month. Changes in BMI were smaller in the longitudinal within-person assessment, however still statistically significant. BMI decreased in occasional (less than once per week) and non-cyclists who increased cycling (-0.303 kg/m2, 95%CI -0.530 to -0.077), while frequent (at least once per week) cyclists who stopped cycling increased their BMI (0.417 kg/m2, 95%CI 0.033 to 0.802). CONCLUSIONS: Our analyses showed that people lower their BMI when starting or increasing cycling, demonstrating the health benefits of active mobility

Walking for transportation in large Latin American cities: walking-only trips and total walking events and their sociodemographic correlates.

Walking for transportation is a common and accessible means of achieving recommended physical activity levels, while providing important social and environmental co-benefits. Even though walking in rapidly growing urban areas has become especially challenging given the increasing dependence on motorised transportation, walking remains a major mode of transportation in Latin American cities. In this paper we aimed to quantify self-reported walking for transportation in Mexico City, Bogota, Santiago de Chile, Sao Paulo, and Buenos Aires, by identifying both walking trips that are conducted entirely on foot and walking events involved in trips mainly conducted on other means of transportation (e.g. private vehicle, public transit) among individuals ≥5-years old. We show how walking-only trips account for approximately 30% trips in the analysed cities, and we evidence how the pedestrian dimension of mobility is largely underestimated if walking that is incidental to other transportation modes is not accounted for: when considering all walking events, we observed an increase between 73% and 217% in daily walking time. As a result, we estimated that between 19% and 25% of residents in these cities meet the WHO physical activity guidelines solely from walking for transportation. The results of the study also suggest that the promotion of public transportation in large Latin American cities can especially help certain population groups achieve the daily recommended levels of physical activity, while among low-income groups accessibility and safety seem to be the key challenges to be addressed

Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities.

BACKGROUND: Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES: We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS: In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS: A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION: Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870