Using Geographic Information Systems (GIS) to assess the role of the built environment in influencing obesity: a glossary

Features of the built environment are increasingly being recognised as potentially important determinants of obesity. This has come about, in part, because of advances in methodological tools such as Geographic Information Systems (GIS). GIS has made the procurement of data related to the built environment easier and given researchers the flexibility to create a new generation of environmental exposure measures such as the travel time to the nearest supermarket or calculations of the amount of neighbourhood greenspace. Given the rapid advances in the availability of GIS data and the relative ease of use of GIS software, a glossary on the use of GIS to assess the built environment is timely. As a case study, we draw on aspects the food and physical activity environments as they might apply to obesity, to define key GIS terms related to data collection, concepts, and the measurement of environmental features

Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations?

Background: There is growing recognition that the urban built environment influences physical activity at the population level, although the effects on disadvantaged groups are less well understood. Using the examples of open/green space and street connectivity, this paper explores whether enhancements to the built environment have potential for addressing physical activity-related health inequalities among Mori, Pacific and low income communities in New Zealand. Method: A high-level review of the international literature relating open space and street connectivity to physical activity and/or related health outcomes at a population level was completed. Consideration was given to whether these features of the built environment have a disproportionate effect on disadvantaged populations. Results: Findings from international studies suggest that open space and street connectivity have a beneficial effect on physical activity. Enhancing the built environment may be particularly advantageous for improving physical activity levels among disadvantaged populations. Conclusion: It is likely that open space and street connectivity have a positive effect on physical activity behaviour; however due to the cross-sectional nature of existing research and the paucity of research among disadvantaged populations definitive conclusions about the effect in these populations cannot be made. Further research is required (e.g. natural experiments or quasi experimental research designs) to determine the effect of changing the environment on physical activity and obesity

Does the choice of neighbourhood supermarket access measure influence associations with individual-level fruit and vegetable consumption? A case study from Glasgow

BackgroundPrevious studies have provided mixed evidence with regards to associations between food store access and dietary outcomes. This study examines the most commonly applied measures of locational access to assess whether associations between supermarket access and fruit and vegetable consumption are affected by the choice of access measure and scale.MethodSupermarket location data from Glasgow, UK (n = 119), and fruit and vegetable intake data from the \u27Health and Well-Being\u27 Survey (n = 1041) were used to compare various measures of locational access. These exposure variables included proximity estimates (with different points-of-origin used to vary levels of aggregation) and density measures using three approaches (Euclidean and road network buffers and Kernel density estimation) at distances ranging from 0.4 km to 5 km. Further analysis was conducted to assess the impact of using smaller buffer sizes for individuals who did not own a car. Associations between these multiple access measures and fruit and vegetable consumption were estimated using linear regression models.ResultsLevels of spatial aggregation did not impact on the proximity estimates. Counts of supermarkets within Euclidean buffers were associated with fruit and vegetable consumption at 1 km, 2 km and 3 km, and for our road network buffers at 2 km, 3 km, and 4 km. Kernel density estimates provided the strongest associations and were significant at a distance of 2 km, 3 km, 4 km and 5 km. Presence of a supermarket within 0.4 km of road network distance from where people lived was positively associated with fruit consumption amongst those without a car (coef. 0.657; s.e. 0.247; p0.008).ConclusionsThe associations between locational access to supermarkets and individual-level dietary behaviour are sensitive to the method by which the food environment variable is captured. Care needs to be taken to ensure robust and conceptually appropriate measures of access are used and these should be grounded in a clear a priori reasoning

Particulate air pollution and health inequalities: a Europe-wide ecological analysis

<p>Background: Environmental disparities may underlie the unequal distribution of health across socioeconomic groups. However, this assertion has not been tested across a range of countries: an important knowledge gap for a transboundary health issue such as air pollution. We consider whether populations of low-income European regions were a) exposed to disproportionately high levels of particulate air pollution (PM10) and/or b) disproportionately susceptible to pollution-related mortality effects.</p> <p>Methods: Europe-wide gridded PM10 and population distribution data were used to calculate population-weighted average PM10 concentrations for 268 sub-national regions (NUTS level 2 regions) for the period 2004–2008. The data were mapped, and patterning by mean household income was assessed statistically. Ordinary least squares regression was used to model the association between PM10 and cause-specific mortality, after adjusting for regional-level household income and smoking rates.</p> <p>Results: Air quality improved for most regions between 2004 and 2008, although large differences between Eastern and Western regions persisted. Across Europe, PM10 was correlated with low household income but this association primarily reflected East–West inequalities and was not found when Eastern or Western Europe regions were considered separately. Notably, some of the most polluted regions in Western Europe were also among the richest. PM10 was more strongly associated with plausibly-related mortality outcomes in Eastern than Western Europe, presumably because of higher ambient concentrations. Populations of lower-income regions appeared more susceptible to the effects of PM10, but only for circulatory disease mortality in Eastern Europe and male respiratory mortality in Western Europe. </p> <p>Conclusions: Income-related inequalities in exposure to ambient PM10 may contribute to Europe-wide mortality inequalities, and to those in Eastern but not Western European regions. We found some evidence that lower-income regions were more susceptible to the health effects of PM10.</p&gt

Sociodemographic factors associated with healthy eating and food security in socio-economically disadvantaged groups in the UK and Victoria, Australia

Objective To investigate the associations between sociodemographic factors and both diet indicators and food security among socio-economically disadvantaged populations in two different (national) contextual settings.Design Logistic regression was used to determine cross-sectional associations between nationality, marital status, presence of children in the household, education, employment status and household income (four low income categories) with daily fruit and vegetable consumption, low-fat milk consumption and food security.Setting Socio-economically disadvantaged neighbourhoods in the UK and Australia.Subjects Two samples of low-income women from disadvantaged neighbourhoods: (i) in the UK, the 2003–05 Low Income Diet and Nutrition Survey (LIDNS; n 643); and (ii) in Australia, the 2007–08 Resilience for Eating and Activity Despite Inequality (READI; n 1340).Results The influence of nationality, marital status and children in the household on the dietary outcomes varied between the two nations. Obtaining greater education qualifications was the most telling factor associated with healthier dietary behaviours. Being employed was positively associated with low-fat milk consumption in both nations and with fruit consumption in the UK, while income was not associated with dietary behaviours in either nation. In Australia, the likelihood of being food secure was higher among those who were born outside Australia, married, employed or had a greater income, while higher income was the only significant factor in the UK.Conclusions The identification of factors that differently influence dietary behaviours and food security in socio-economically disadvantaged populations in the UK and Australia suggests continued efforts need to be made to ensure that interventions and policy responses are informed by the best available local evidence

“Availability is the poor cousin of marketing and pricing”: qualitative study of stakeholders’ views on policy priorities around tobacco and alcohol availability

Background: Reducing alcohol and tobacco availability is one potential way to reduce harm from these unhealthy commodities. This study explores key stakeholders’ views in relation to policy priorities and considerations for both alcohol and tobacco availability. Methods: We conducted semi-structured interviews with 14 stakeholders from alcohol and/or tobacco third sector organizations, government, public health and licensing in Scotland. Interviews explored their views on alcohol/tobacco availability, including its place in the policy landscape and experiences in gaining support for policies. Data were analyzed using thematic analysis. Results: Stakeholders believed that alcohol and tobacco availability have not received as much policy attention as pricing and marketing. Stakeholders highlighted the importance of public support and having sufficient evidence to inform policy. Key considerations for future policies include: drawing on lessons from tobacco control policies to address alcohol availability, considering different aspects of availability (especially online availability), ensuring policies reflect their local context, considering the impact of policies on children, and managing retailers’ involvement in the policy process. Conclusion: This study highlights key considerations for policies to address alcohol and tobacco availability. There is a need for more research to consider retailers’ views and provide greater detail on specific policy suggestions.</p

The association between green space and cause-specific mortality in urban New Zealand: an ecological analysis of green space utility

&lt;b&gt;Background:&lt;/b&gt; There is mounting international evidence that exposure to green environments is associated with health benefits, including lower mortality rates. Consequently, it has been suggested that the uneven distribution of such environments may contribute to health inequalities. Possible causative mechanisms behind the green space and health relationship include the provision of physical activity opportunities, facilitation of social contact and the restorative effects of nature. In the New Zealand context we investigated whether there was a socioeconomic gradient in green space exposure and whether green space exposure was associated with cause-specific mortality (cardiovascular disease and lung cancer). We subsequently asked what is the mechanism(s) by which green space availability may influence mortality outcomes, by contrasting health associations for different types of green space. &lt;b&gt;Methods:&lt;/b&gt; This was an observational study on a population of 1,546,405 living in 1009 small urban areas in New Zealand. A neighbourhood-level classification was developed to distinguish between usable (i.e., visitable) and non-usable green space (i.e., visible but not visitable) in the urban areas. Negative binomial regression models were fitted to examine the association between quartiles of area-level green space availability and risk of mortality from cardiovascular disease (n = 9,484; 1996 - 2005) and from lung cancer (n = 2,603; 1996 - 2005), after control for age, sex, socio-economic deprivation, smoking, air pollution and population density. &lt;b&gt;Results:&lt;/b&gt; Deprived neighbourhoods were relatively disadvantaged in total green space availability (11% less total green space for a one standard deviation increase in NZDep2001 deprivation score, p &#60; 0.001), but had marginally more usable green space (2% more for a one standard deviation increase in deprivation score, p = 0.002). No significant associations between usable or total green space and mortality were observed after adjustment for confounders. &lt;b&gt;Conclusion&lt;/b&gt; Contrary to expectations we found no evidence that green space influenced cardiovascular disease mortality in New Zealand, suggesting that green space and health relationships may vary according to national, societal or environmental context. Hence we were unable to infer the mechanism in the relationship. Our inability to adjust for individual-level factors with a significant influence on cardiovascular disease and lung cancer mortality risk (e.g., diet and alcohol consumption) will have limited the ability of the analyses to detect green space effects, if present. Additionally, green space variation may have lesser relevance for health in New Zealand because green space is generally more abundant and there is less social and spatial variation in its availability than found in other contexts

Which urban land covers/uses are associated with residents’ mortality? A cross-sectional, ecological, pan-European study of 233 cities

Objectives: The study aim was to determine whether the range and distribution of all, and proportions of specific, land covers/uses within European cities are associated with city-specific mortality rates. ​Setting: 233 European cities within 24 countries. ​Participants: Aggregated city-level all-cause and age-group standardised mortality ratio for males and females separately and Western or Eastern European Region. ​Results: The proportion of specific land covers/uses within a city was related to mortality, displaying differences by macroregion and sex. The land covers/uses associated with lower standardised mortality ratio (SMR) for both Western and Eastern European cities were those characterised by ‘natural’ green space, such as forests and semi-natural areas (Western Female coefficient: −18.3, 95% CI −29.8 to −6.9). Dense housing was related to a higher SMR, most prominently in Western European cities (Western Female coefficient: 17.4, 95% CI 9.6 to 25.2). ​Conclusions: There is pressure to build on urban natural spaces, both for economic gain and because compact cities are regarded as more sustainable, yet here we offer evidence that doing so may detract from residents’ health. Our study suggests that urban planners and developers need to regard retaining more wild and unstructured green space as important for healthy city systems