Healthy built environments: A review of the literature

The Healthy Built Environments Program has completed a major scholarly literature review examining the role of the built environment in supporting human health as part of everyday living. The principal aim of the Review is to establish an evidence base that supports the development, prioritisation and implementation of healthy built environment policies and practices. The Review identifies current gaps in the evidence to inform future research directions. It includes an annotated bibliography of key research articles and a glossary of terms to assist practitioners, policy makers and researchers working in this interdisciplinary realm.  The focus of the Review is on the three key built environment domains that support human health: The Built Environment and Getting People Active. The Built Environment and Connecting and Strengthening Communities. The Built Environment and Providing Healthy Food Options. These built environment domains address three of the major risk factors for contemporary chronic disease - physical inactivity, social isolation and obesity. The Literature Review is available for download as the whole document or its individual sections. Whole document (12MB) Cover and Acknowledgements (1.11MB)List of Abbreviations and Contents (2.11MB)The Healthy Built Environments Program Overview (291KB)Executive Summary (295KB)1.0 Introduction (255KB)2.0 Structure of this Review (2.46MB)3.0 Aims and Parameters (2.99MB)4.0 Scope and Methodology (3.20MB)5.0 The Evidence (200KB)5.1 The Built Environment and Getting People Active (653KB)5.2 The Built Environment and Connecting and Strengthening Communities (546KB)5.3 The Built Environment and Providing Healthy Food Options (416KB)6.0 Professional Development (284KB)7.0 Conclusion (114KB)References (490KB)Appendix 1: Diary of Database Searches (202KB)Appendix 2: Glossary (282KB)Appendix 3: Annotated Bibliography (2.57MB

Interpersonal Communication Skills among the Master’s Students in TVET

This study aimed to identify the level of interpersonal communication skills element among final year undergraduate students in in University Tun Hussein Onn Malaysia. In particular, these studies look mastery and interpersonal communication skills in the four elements of verbal communication skills, non-verbal communication skills, listening skills, and feedback skills. Researchers have prepared a questionnaire as an instrument to collect data from respondents. A total of 54 respondents were selected to answer the questionnaire. The study used data on descriptive and inferential statistical analysis. The data collected were analysed using frequency, percentage, mean, according to the order of T test and Pearson correlation. The findings will show that most verbal communication skills high level of proficiency in interpersonal communication. The results will indicated the difference between the sexes in interpersonal skills and no relationship between the levels of interpersonal skills with under graduate educational background of respondents. Several suggestions were made to improve interpersonal communication among students at the university. Keywords: Interpersonal communication skills, Technical and Vocational Educatio

The impact of heat on mortality and morbidity in the Greater Metropolitan Sydney Region: A case crossover analysis

Background: This study examined the association between unusually high temperature and daily mortality (1997-2007) and hospital admissions (1997-2010) in the Sydney Greater Metropolitan Region (GMR) to assist in the development of targeted health program

Exploring the Use of Hospital and Community Mental Health Services among Newly Resettled Refugees

Importance: Resettled refugees in high-income countries represent a vulnerable population. It is known that refugees have high rates of trauma-related mental health issues; however, ad hoc research has generally revealed low rates of health services use among refugees. Such research usually samples a population at a single point in time and is based on targeted surveys. Because refugee populations change over time, such research becomes expensive and time-consuming for agencies interested in routinely publishing statistics of mental health services use among refugees. The linking of large administrative data sets to establish rates of use of mental health services among resettled refugees is a flexible and relatively inexpensive approach. Objective: To use data linkage to establish rates of mental health services use among resettled refugees relative to the general population. Design, Setting, and Participants: This cross-sectional study implemented data linkage from the Refugee Health Nurse Program for 10050 refugees who resettled in Sydney, Australia, from October 23, 2012, to June 8, 2017, with data concerning use of community mental health services and mental health hospitalization from New South Wales Health databases. Data were analyzed between June 1, 2019, and December 31, 2021. Main Outcomes and Measures: Rates of service contacts with community mental health services among the resettled refugees were compared with those of the general population by age, sex, and the most common International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes. Length of community mental health service sessions and rates of mental health hospitalizations were also compared. Results: Among the 255 resettled refugees who had contacts with community mental health care services and were not missing data (median age, 35 [range, 4-80] years; 117 [64%] male and 138 [54%] female), 153 (60%) were born in Iraq and 156 (61%) were Arabic speaking. This population was less likely to use mental health services than the general population and had shorter community mental health consultations. The rate of contacts with community mental health services for depressive disorders among the resettled refugee population was 40% (95% CI, 33%-46%) lower than that among the general population. Rates of same-day hospitalization per 10000 person-years were not significantly different between the refugee population (4 [95% CI, 2-8]) and the general Australian population (7 [95% CI, 7-7]). However, the refugee population was 17% (95% CI, 6%-29%) more likely than the general Australian population to interact with the community mental health system for severe stress- and adjustment disorder-related diagnoses. Conclusions and Relevance: These findings suggest that refugees who have resettled in Australia tend to use fewer mental health services than the general population except for services devoted to stress- and adjustment disorder-related diagnoses. These findings also suggest that it is possible to successfully leverage data linkage to study patterns of mental health services use among resettled refugees.</p

Diabetes and the use of primary care provider services in rural, remote and metropolitan Australia

Introduction: Public health agencies around the world are concerned about an ever-increasing burden of type 2 diabetes and related disability. Access to primary care providers (PCPs) can support early diagnosis and management. However, there is limited literature on how frequently older people with diabetes access PCPs, and their levels of access in rural Australia relative to metropolitan areas. Methods: In this research, patterns of PCP use among those with diagnosed diabetes and those without diagnosed diabetes (referred to as ‘healthy' individuals) were compared using a large survey of more than 230 000 people aged 45 years and older from New South Wales, Australia. A published model to study the PCP access patterns of a group of individuals with diabetes risk was used. Results: Annual visits to PCPs among people aged 45 years or more with diabetes in rural areas, while higher than for healthy rural residents, were significantly lower than their metropolitan counterparts, mirroring similar disparities in PCP use across the rural-urban divide in the healthy population. Similar patterns were present in the high-risk population. Nevertheless, people with diabetes visited PCPs around four times a year, which is around the recommended number of annual visits, although some groups (eg those with comorbidities) may need more visits. Conclusion: Patterns of PCP use among rural residents, while significantly less frequent than their metropolitan counterparts, are at the recommended level for people with diabetes

An objective index of walkability for research and planning in the Sydney Metropolitan Region of New South Wales, Australia: an ecological study

Background: Walkability describes the capacity of the built environment to support walking for various purposes. This paper describes the construction and validation of two objective walkability indexes for Sydney, Australia. Methods: Walkability indexes using residential density, intersection density, land use mix, with and without retail floor area ratio were calculated for 5,858 Sydney Census Collection Districts in a geographical information system. Associations between variables were evaluated using Spearman’s rho (ρ). Internal consistency and factor structure of indexes were estimated with Cronbach’s alpha and principal components analysis; convergent and predictive validity were measured using weighted kappa (κw) and by comparison with reported walking to work at the 2006 Australian Census using logistic regression. Spatial variation in walkability was assessed using choropleth maps and Moran’s I. Results: A three-attribute abridged Sydney Walkability Index comprising residential density, intersection density and land use mix was constructed for all Sydney as retail floor area was only available for 5.3% of Census Collection Districts. A four-attribute full index including retail floor area ratio was calculated for 263 Census Collection Districts in the Sydney Central Business District. Abridged and full walkability index scores for these 263 areas were strongly correlated (ρ=0.93) and there was good agreement between walkability quartiles (κw=0.73). Internal consistency ranged from 0.60 to 0.71, and all index variables loaded highly on a single factor. The percentage of employed persons who walked to work increased with increasing walkability: 3.0% in low income-low walkability areas versus 7.9% in low income-high walkability areas; and 2.1% in high income-low walkability areas versus 11% in high income-high walkability areas. The adjusted odds of walking to work were 1.05 (0.96–1.15), 1.58 (1.45–1.71) and 3.02 (2.76–3.30) times higher in medium, high and very high compared to low walkability areas. Associations were similar for full and abridged indexes. Conclusions: The abridged Sydney Walkability Index has predictive validity for utilitarian walking, will inform urban planning in Sydney, and will be used as an objective measure of neighbourhood walkability in a large population cohort. Abridged walkability indexes may be useful in settings where retail floor area data are unavailable

"You can't work with my people if you don't know how to" : enhancing transfer of care from hospital to primary care for Aboriginal Australians with chronic disease

Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital–community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation

Intimate partner violence identified through routine antenatal screening and maternal and perinatal health outcomes

Background: This study investigated the association between intimate partner violence (IPV) identified on routine prenatal screening and perinatal outcomes for mother and infant. Methods: Routinely collected perinatal data for a cohort of all women and their infants born in public health facilities in Sydney (Australia) over the period 2014-2016 (N = 52,509) were analysed to investigate the risk of adverse maternal and perinatal outcomes associated with a history of IPV. The association between an affirmative response on prenatal IPV screening and low birth weight (LBW) < 2.5 kg, preterm birth < 37 weeks, breastfeeding indicators and postnatal depressive symptoms (PND) was investigated in a series of logistic regression models. Results: IPV was associated with an increased risk of PND (OR = 2.53, 95% CI 1.76-3.63), not breastfeeding at birth (OR = 1.65, 95% CI 1.30-2.09), non-exclusive breastfeeding at discharge (OR = 1.66, 95% CI 1.33-2.07) and first post-natal visit (OR = 1.54, 95% CI 1.24-1.91). Self-reported fear of a partner was strongly associated with an increased risk of PND (OR = 3.53, 95% CI 2.50-5.00), and also LBW (OR = 1.58, 95% CI 1.12-2.22), preterm birth (OR = 1.38, 95% CI 1.08-1.76), lack of early initiation of breastfeeding (OR = 1.67, 95% CI 1.28-2.17), non-exclusive breastfeeding at discharge from hospital (OR = 1.60, 95% CI 1.24-2.06) and at the first post-natal visit (OR = 1.27, 95% CI 0.99-3.04). Conclusions: IPV reported at the time of pregnancy was associated with adverse infant and maternal health outcomes. Although women may be disinclined to report IPV during pregnancy, universal, routine antenatal assessment for IPV is essential for early identification and appropriate management to improve maternal and newborn health

Neighbourhood walkability, road density and socio-economic status in Sydney, Australia

Background Planning and transport agencies play a vital role in influencing the design of townscapes, travel modes and travel behaviors, which in turn impact on the walkability of neighbourhoods and residents\u27 physical activity opportunities. Optimising neighbourhood walkability is desirable in built environments, however, the population health benefits of walkability may be offset by increased exposure to traffic related air pollution. This paper describes the spatial distribution of neighbourhood walkability and weighted road density, a marker for traffic related air pollution, in Sydney, Australia. As exposure to air pollution is related to socio-economic status in some cities, this paper also examines the spatial distribution of weighted road density and walkability by socio-economic status (SES). Methods We calculated walkability, weighted road density (as a measure of traffic related air pollution) and SES, using predefined and validated measures, for 5858 Sydney neighbourhoods, representing 3.6 million population. We overlaid tertiles of walkability and weighted road density to define sweet-spots (high walkability-low weighted road density), and sour- spots (low walkability-high weighted road density) neighbourhoods. We also examined the distribution of walkability and weighted road density by SES quintiles. Results Walkability and weighted road density showed a clear east-west gradient across the region. Our study found that only 4 % of Sydney\u27s population lived in sweet-spot neighbourhoods with high walkability and low weighted road density (desirable), and these tended to be located closer to the city centre. A greater proportion of neighbourhoods had health limiting attributes of high weighted road density or low walkability (about 20 % each), and over 5 % of the population lived in sour-spot neighbourhoods with low walkability and high weighted road density (least desirable). These neighbourhoods were more distant from the city centre and scattered more widely. There were no linear trends between walkability/weighted road density and neighbourhood SES. Conclusions Our walkability and weighted road density maps and associated analyses by SES can help identify neighbourhoods with inequalities in health-promoting or health-limiting environments. Planning agencies should seek out opportunities for increased neighbourhood walkability through improved urban development and transport planning, which simultaneously minimizes exposure to traffic related air pollution

Associations of the neighbourhood built and natural environment with cardiometabolic health indicators : A cross-sectional analysis of environmental moderators and behavioural mediators

Background: Most studies examining the effects of neighbourhood urban design on cardiometabolic health focused solely on the built or natural environment. Also, they did not consider the roles of neighbourhood socioeconomic status (SES) and ambient air pollution in the observed associations, and the extent to which these associations were mediated by physical activity and sedentary behaviours. Methods: We used data from the AusDiab3 study (N = 4141), a national cohort study of Australian adults to address the above-mentioned knowledge gaps. Spatial data were used to compute indices of neighbourhood walkability (population density, intersection density, non-commercial land use mix, commercial land use), natural environment (parkland and blue spaces) and air pollution (annual average concentrations of nitrogen dioxide (NO2) and fine particulate matter <2.5 μm in diameter (PM2.5)). Census indices were used to define neighbourhood SES. Clinical assessments collected data on adiposity, blood pressure, blood glucose and blood lipids. Generalised additive mixed models were used to estimate associations. Results: Neighbourhood walkability showed indirect beneficial associations with most indicators of cardiometabolic health via resistance training, walking and sitting for different purposes; indirect detrimental associations with the same indicators via vigorous gardening; and direct detrimental associations with blood pressure. The neighbourhood natural environment had beneficial indirect associations with most cardiometabolic health indicators via resistance training and leisure-time sitting, and beneficial direct associations with adiposity and blood lipids. Neighbourhood SES and air pollution moderated only a few associations of the neighbourhood environment with physical activity, blood lipids and blood pressure. Conclusions: Within a low-density and low-pollution context, denser, walkable neighbourhoods with good access to nature may benefit residents’ cardiometabolic health by facilitating the adoption of an active lifestyle. Possible disadvantages of living in denser neighbourhoods for older populations are having limited opportunities for gardening, higher levels of noise and less healthy dietary patterns associated with eating out