May 14 | 2018

Environmental noise pollution and risk of preeclampsia.

Auger N, Duplaix M, Bilodeau-Bertrand M, Lo E, Smargiassi A.

Environ Pollut. 2018 Apr 25;239:599-606. Doi. 10.1016/j.envpol.2018.04.060

Abstract

BACKGROUND:

Environmental noise exposure is associated with a greater risk of hypertension, but the link with preeclampsia, a hypertensive disorder of pregnancy, is unclear.

OBJECTIVES:

We sought to determine the relationship between environmental noise pollution and risk of preeclampsia during pregnancy.

METHODS:

We analyzed a population-based cohort comprising 269,263 deliveries on the island of Montreal, Canada between 2000 and 2013. We obtained total environmental noise pollution measurements (LAeq24, Lden, Lnight) from land use regression models, and assigned noise levels to each woman based on the residential postal code. We computed odds ratios (OR) and 95% confidence intervals (CI) for the association of noise with preeclampsia in mixed logistic regression models with participants as a random effect, and adjusted for air pollution, neighbourhood walkability, maternal age, parity, multiple pregnancy, comorbidity, socioeconomic deprivation, and year of delivery. We assessed whether noise exposure was more strongly associated with severe or early onset preeclampsia than mild or late onset preeclampsia.

RESULTS:

Prevalence of preeclampsia was higher for women exposed to elevated environmental noise pollution levels (LAeq24h ≥ 65 dB(A) = 37.9 per 1000 vs. <50 dB(A) = 27.9 per 1000). Compared with 50 dB(A), an LAeq24h of 65.0 dB(A) was not significantly associated the risk of preeclampsia (OR 1.09, 95% CI 0.99-1.20). Associations were however present with severe (OR 1.29, 95% CI 1.09-1.54) and early onset (OR 1.71, 95% CI 1.20-2.43) preeclampsia, with results consistent across all noise indicators. The associations were much weaker or absent for mild and late preeclampsia.

CONCLUSIONS:

Environmental noise pollution may be a novel risk factor for pregnancy-related hypertension, particularly more severe variants of preeclampsia.

April 30 | 2018

Using electronic health record data for environmental and place based population health research: a systematic review.

Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV.

Ann Epidemiol. 2018 Mar 21. pii: S1047-2797(18)30059-0. [Epub ahead of print] DOI:10.1016/j.annepidem.2018.03.008 

Abstract 

PURPOSE:

We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research.

METHODS:

We abstracted information on the environmental and health outcome variables and the methods and data sources used.

RESULTS:

The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas.

CONCLUSIONS:

Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.

April 23 | 2018

Associations between Neighborhood Walkability and Incident and Ongoing Asthma in Children.

Elinor Simons , Sharon D Dell ; Rahim Moineddin , and Teresa To

Ann Am Thorac Soc. 2018 Apr 17. DOI:10.1513/AnnalsATS.201708-693OC

Abstract

RATIONALE:

Childhood asthma has shown variable associations with children’s physical activity. Neighborhood walkability captures community features that promote walking and is protective against some chronic conditions, such as obesity and diabetes.

OBJECTIVES:

We evaluated associations between home neighborhood walkability and incident and ongoing childhood asthma.

METHODS:

This population-based cohort study used prospectively-collected administrative healthcare data for the province of Ontario housed at the Institute for Clinical Evaluative Sciences. We followed an administrative data cohort of 326,383 Toronto children born between 1997 and 2003 until ages 8-15 years. Home neighborhood walkability quintile was measured using a validated Walkability Index with four dimensions: population density, dwelling density, access to retail and services, and street connectivity. Incident asthma was defined by time of entry into the validated Ontario Asthma Surveillance Information System (OASIS) database, which requires two outpatient visits for asthma within two consecutive years or any hospitalization for asthma, and follows children with asthma longitudinally starting at any age. Associations between walkability and incident asthma were examined using Cox proportional hazards models. Associations between ongoing asthma and walkability in each year of life were examined using generalized linear mixed models.

RESULTS:

Twenty-one percent of children (n = 69,628) developed incident asthma and were followed longitudinally in the OASIS asthma database. Low birth home neighborhood walkability was associated with an increased incidence of asthma (HR 1.11, 95% CI, 1.08-1.14). Among children with asthma, low walkability in a given year of a child`s life was associated with greater odds of ongoing asthma in the same year (OR 1.12, 95% CI, 1.09-1.14).

CONCLUSIONS:

Children living in neighborhoods with low walkability were at increased risk of incident and ongoing asthma. Neighborhood walkability improvement, for example by adding pedestrian paths to improve street connectivity, offers potential strategies to contribute to primary asthma prevention.

APRIL 16 | 2018

Roadside vegetation design characteristics that can improve local, near-road air quality.

Baldauf, R., V. Isakov, A. Venkatram, P. Deshmukh, B. Yang, K. Zhang, R. Logan.

Transportation Research Part D: Transport and Environment. Elsevier BV, AMSTERDAM, Netherlands, 52:354-361, (2017) https://doi.org/10.1016/j.trd.2017.03.013

  Abstract

As public health concerns have increased due to the rising number of studies linking adverse health effects with exposures to traffic-related air pollution near large roadways, interest in methods to mitigate these exposures have also increased. Several studies have investigated the use of roadside features in reducing near-road air pollution concentrations since this method is often one of the few short-term options available. Since roadside vegetation has other potential benefits, the impact of this feature has been of particular interest. The literature has been mixed on whether roadside vegetation reduces nearby pollutant concentrations or whether this feature has no effect or even potentially increases downwind air pollutant concentrations. However, these differences in study results highlight key characteristics of the vegetative barrier that can result in pollutant reductions or increase local pollutant levels. This paper describes the characteristics of roadside vegetation that previous research shows can result in improved local air quality, as well as identify characteristics that should be avoided in order to protect from unintended increases in nearby concentrations. These design conditions include height, thickness, coverage, porosity/density, and species characteristics that promote improved air quality. These design considerations can inform highway departments, urban and transportation planners, and developers in understanding how best to preserve existing roadside vegetation or plant vegetative barriers in order to reduce air pollution impacts near transportation facilities. These designs can also be used to mitigate impacts from other air pollution sources where emissions occur near ground-level.

April 9 | 2018

Socio-economic inequalities in exposure to industrial air pollution emissions in Quebec public schools

Emmanuelle Batisse, Sophie Goudreau, Jill Baumgartner, Audrey Smargiassi

Can J Public Health. 2018 Jan 22;108(5-6):e503-e509. http://dx.doi.org/10.17269/cjph.108.6166

Abstract

OBJECTIVES: We aimed to assess the relationships between deprivation at Quebec public schools, their proximity to polluting industries, and their exposure to industrial air emission sources including ambient fine particulate matter (PM2.5), sulphur dioxide (SO2) and nitrogen dioxide (NO2).

METHODS: We obtained four indicators of school deprivation using data from the 2006 Canadian census called the low-income threshold indicator, the neighbourhood SES indicator, and the social and material deprivation indicators of Pampalon. Using proximity spatial tools, we constructed three buffers of 2.5, 5 and 7.5 km around each school and summed up total emissions of PM2.5, SO2and NO2 for each school. Industrial air emissions were estimated using data from the 2006 Canadian National Pollutant Release Inventory. The Pearson correlations and LOESS regressions and natural log-transformed industrial air emissions were evaluated for Quebec public schools within the three buffers.

RESULTS: Of the 2189 public schools in Quebec, 608 (27.8%), 1108 (50.6%) and 1384 (63.2%) schools were located near at least one industry emitting one or more pollutants of interest in buffers of 2.5 km, 5 km and 7.5 km of schools respectively. Weak positive Pearson correlations (r) were found between log-transformed tons of industrial emissions of PM2.5, SO2 and NO2 and both the social deprivation (r = {0.23; 0.33}) and low-income threshold (r = {0.17; 0.29}) indicators in a buffer of 2.5 km. However, we found negative associations between emissions and the neighbourhood SES (r = {0.06; 0.16}) and material deprivation (r = {−0.04; 0.08}) indicators.

CONCLUSION: Our study suggests that schools in Quebec with higher rates of socio-economic deprivation among their students may be more likely to be exposed to higher emissions of industrial air pollutants.

 

April 2 | 2018

Childhood exposure to green space – A novel risk-decreasing mechanism for schizophrenia?

Engemann K, Pedersen CB, Arge L, Tsirogiannis C, Mortensen PB, Svenning JC.

Schizophr Res. 2018 Mar 21. pii: S0920-9964(18)30178-6. doi:10.1016/j.schres.2018.03.026. [Epub ahead of print] 

https://doi.org/10.1016/j.schres.2018.03.026

Abstract 

Schizophrenia risk has been linked to urbanization, but the underlying mechanism remains unknown. Green space is hypothesized to positively influence mental health and might mediate risk of schizophrenia by mitigating noise and particle pollution exposure, stress relief, or other unknown mechanisms. The objectives for this study were to determine if green space are associated with schizophrenia risk, and if different measures of green space associate differently with risk. We used satellite data from the Landsat program to quantify green space in a new data set for Denmark at 30 × 30 m resolution for the years 1985–2013. The effect of green space at different ages and within different distances from each person’s place of residence on schizophrenia risk was estimated using Cox regression on a very large longitudinal population-based sample of the Danish population (943,027 persons). Living at the lowest amount of green space was associated with a 1.52-fold increased risk of developing schizophrenia compared to persons living at the highest level of green space. This association remained after adjusting for known risk factors for schizophrenia: urbanization, age, sex, and socioeconomic status. The strongest protective association was observed during the earliest childhood years and closest to place of residence. This is the first nationwide population-based study to demonstrate a protective association between green space during childhood and schizophrenia risk; suggesting limited green space as a novel environmental risk factor for schizophrenia. This study supports findings from other studies highlighting positive effects of exposure to natural environments for human health.

March 26| 2018

The Association between Lifelong Greenspace Exposure and 3-Dimensional Brain Magnetic Resonance Imaging in Barcelona Schoolchildren

Payam Dadvand, Jesus Pujol, Dídac Macià, Gerard Martínez-Vilavella, Laura Blanco-Hinojo, Marion Mortamais, Mar Alvarez-Pedrerol, Raquel Fenoll, Mikel Esnaola, Albert Dalmau-Bueno, Mónica López-Vicente, Xavier Basagaña, Michael Jerrett, Mark J. Nieuwenhuijsen, and Jordi Sunyer

Environ Health Perspect; February 2018, Volume 126, Issue 2 https://doi.org/10.1289/EHP1876

ABSTRACT

BACKGROUND:

Proponents of the biophilia hypothesis believe that contact with nature, including green spaces, has a crucial role in brain development in children. Currently, however, we are not aware of evidence linking such exposure with potential effects on brain structure.

OBJECTIVE:

We determined whether lifelong exposure to residential surrounding greenness is associated with regional differences in brain volume based on 3-dimensional magnetic resonance imaging (3D MRI) among children attending primary school.

METHODS:

We performed a series of analyses using data from a subcohort of 253 Barcelona schoolchildren from the Brain Development and Air Pollution Ultrafine Particles in School Children (BREATHE) project. We averaged satellite-based normalized difference vegetation index (NDVI) across 100-m buffers around all residential addresses since birth to estimate each participant’s lifelong exposure to residential surrounding greenness, and we used high-resolution 3D MRIs of brain anatomy to identify regional differences in voxel-wise brain volume associated with greenness exposure. In addition, we performed a supporting substudy to identify regional differences in brain volume associated with measures of working memory (d′ from computerized n-back tests) and inattentiveness (hit reaction time standard error from the Attentional Network Task instrument) that were repeated four times over one year. We also performed a second supporting substudy to determine whether peak voxel tissue volumes in brain regions associated with residential greenness predicted cognitive function test scores.

RESULTS:

Lifelong exposure to greenness was positively associated with gray matter volume in the left and right prefrontal cortex and in the left premotor cortex and with white matter volume in the right prefrontal region, in the left premotor region, and in both cerebellar hemispheres. Some of these regions partly overlapped with regions associated with cognitive test scores (prefrontal cortex and cerebellar and premotor white matter), and peak volumes in these regions predicted better working memory and reduced inattentiveness.

CONCLUSION:

Our findings from a study population of urban schoolchildren in Barcelona require confirmation, but they suggest that being raised in greener neighborhoods may have beneficial effects on brain development and cognitive function.

March 19 | 2018

Associations Between the Built Environment and Objective Measures of Sleep: The Multi-Ethnic Study of Atherosclerosis.

Johnson DA, Hirsch JA, Moore KA, Redline S, Diez Roux AV.

Am J Epidemiol. 2018 Mar 14. doi: 10.1093/aje/kwx302. [Epub ahead of print] https://doi.org/10.1093/aje/kwx302

Abstract

Although dense neighborhood built environments support increased physical activity and lower obesity, these features may also disturb sleep. Therefore, we sought to understand the association between the built environment and objectively measured sleep. From 2010 to 2013, we analyzed data from examination 5 of the Multi-Ethnic Study of Atherosclerosis, a diverse population from 6 US cities. We fit multilevel models that assessed the association between the built environment (Street Smart Walk Score, social engagement destinations, street intersections, and population density) and sleep duration or efficiency from 1-week wrist actigraphy in 1,889 individuals. After adjustment for covariates, a 1-standard-deviation increase in Street Smart Walk Score was associated with 23% higher odds of short sleep duration (≤6 hours; odds ratio = 1.2, 95% confidence interval: 1.0, 1.4), as well as shorter average sleep duration (mean difference = -8.1 minutes, 95% confidence interval: -12.1, -4.2). Results were consistent across other built environment measures. Associations were attenuated after adjustment for survey-based measure of neighborhood noise. Dense neighborhood development may have multiple health consequence. In promoting denser neighborhoods to increase walkability, it is important to also implement strategies that reduce the adverse impacts of this development on sleep, such as noise reductions efforts.

March 12 | 2018

Gene-by-environment interactions in urban populations modulate risk phenotypes

Marie-Julie Favé, Fabien C. Lamaze, David Soave, Alan Hodgkinson, Héloïse Gauvin, Vanessa Bruat, Jean-Christophe Grenier, Elias Gbeha, Kimberly Skead, Audrey Smargiassi, Markey Johnson, Youssef Idaghdour & Philip Awadalla

Nature Communications volume 9, Article number: 827 (2018)  https://www.nature.com/articles/s41467-018-03202-2

 

ABSTRACT

Uncovering the interaction between genomes and the environment is a principal challenge of modern genomics and preventive medicine. While theoretical models are well defined, little is known of the G × E interactions in humans. We used an integrative approach to comprehensively assess the interactions between 1.6 million data points, encompassing a range of environmental exposures, health, and gene expression levels, coupled with whole-genome genetic variation. From ∼1000 individuals of a founder population in Quebec, we reveal a substantial impact of the environment on the transcriptome and clinical endophenotypes, overpowering that of genetic ancestry. Air pollution impacts gene expression and pathways affecting cardio-metabolic and respiratory traits, when controlling for genetic ancestry. Finally, we capture four expression quantitative trait loci that interact with the environment (air pollution). Our findings demonstrate how the local environment directly affects disease risk phenotypes and that genetic variation, including less common variants, can modulate individual’s response to environmental challenges.

March 5 | 2018

Assessing the Exposome with External Measures: Commentary on the State of the Science and Research Recommendations

Michelle C. Turner, Mark Nieuwenhuijsen, Kim Anderson, David Balshaw, Yuxia Cui, Genevieve Dunton, Jane A. Hoppin, Petros Koutrakis, and Michael Jerrett

Annual Review of Public Health Vol. 38:215-239 (Volume publication date March 2017) https://doi.org/10.1146/annurev-publhealth-082516-012802

Abstract

The exposome comprises all environmental exposures that a person experiences from conception throughout the life course. Here we review the state of the science for assessing external exposures within the exposome. This article reviews (a) categories of exposures that can be assessed externally, (b) the current state of the science in external exposure assessment, (c) current tools available for external exposure assessment, and (d) priority research needs. We describe major scientific and technological advances that inform external assessment of the exposome, including geographic information systems; remote sensing; global positioning system and geolocation technologies; portable and personal sensing, including smartphone-based sensors and assessments; and self-reported questionnaire assessments, which increasingly rely on Internet-based platforms. We also discuss priority research needs related to methodological and technological improvement, data analysis and interpretation, data sharing, and other practical considerations, including improved assessment of exposure variability as well as exposure in multiple, critical life stages.

February 27 | 2018

Six research priorities for cities and climate change

Xuemei Bai, Richard J. Dawson, Diana Ürge-Vorsatz, Gian C. Delgado, Aliyu Salisu Barau, Shobhakar Dhakal, David Dodman, Lykke Leonardsen, Valerie Masson-Delmotte, Debra Roberts, Seth Schultz.

Nature 555, 23-25 (2018) doi: 10.1038/d41586-018-02409-z www.nature.com/articles/d41586-018-02409-z

Xuemei Bai and colleagues call for long-term, cross-disciplinary studies to reduce carbon emissions and urban risks from global warming.

February 19 | 2018

Impacts of Bicycle Infrastructure in Mid-Sized Cities (IBIMS): protocol for a natural experiment study in three Canadian cities

Meghan Winters, Michael Branion-Calles, Suzanne Therrien, Daniel Fuller, Lise Gauvin, David G T Whitehurst, and Trisalyn Nelson

BMJ Open. 2018; 8(1): e019130. Published online 2018 Jan 21. doi:  10.1136/bmjopen-2017-019130  PMCID: PMC5781157

Abstract

Introduction

Bicycling is promoted as a transportation and population health strategy globally. Yet bicycling has low uptake in North America (1%–2% of trips) compared with European bicycling cities (15%–40% of trips) and shows marked sex and age trends. Safety concerns due to collisions with motor vehicles are primary barriers.

To attract the broader population to bicycling, many cities are making investments in bicycle infrastructure. These interventions hold promise for improving population health given the potential for increased physical activity and improved safety, but such outcomes have been largely unstudied. In 2016, the City of Victoria, Canada, committed to build a connected network of infrastructure that separates bicycles from motor vehicles, designed to attract people of ‘all ages and abilities’ to bicycling.

This natural experiment study examines the impacts of the City of Victoria’s investment in a bicycle network on active travel and safety outcomes. The specific objectives are to (1) estimate changes in active travel, perceived safety and bicycle safety incidents; (2) analyse spatial inequities in access to bicycle infrastructure and safety incidents; and (3) assess health-related economic benefits.

February 12 | 2018

Effect of air quality alerts on human health: a regression discontinuity analysis in Toronto, Canada

Hong Chen, PhD, Qiongsi Li, MMath, Jay S Kaufman, PhD, Jun Wang, MSc, Ray Copes, MD, Yushan Su, PhD, Tarik Benmarhnia, PhD

The Lancet Planetary Health, Volume 2, No. 1, e19–e26, January 2018  DOI: https://doi.org/10.1016/S2542-5196(17)30185-7

Summary

Background

Ambient air pollution is a major health risk globally. To reduce adverse health effects on days when air pollution is high, government agencies worldwide have implemented air quality alert programmes. Despite their widespread use, little is known about whether these programmes produce any observable public-health benefits. We assessed the effectiveness of such programmes using a quasi-experimental approach.

Methods

We assembled a population-based cohort comprising all individuals who resided in the city of Toronto (Ontario, Canada) from 2003 to 2012 (about 2·6 million people). We ascertained seven health outcomes known to be affected by short-term elevation of air pollution, using provincial health administrative databases. These health outcomes were cardiovascular-related mortality, respiratory-related mortality, and hospital admissions or emergency-department visits for acute myocardial infarction, heart failure, stroke, asthma, and chronic obstructive pulmonary disease (COPD). We applied a regression discontinuity design to assess the effectiveness of an intervention (ie, the air quality alert programme). To quantify the effect of the air quality alert programme, we estimated for each outcome both the absolute rate difference and the rate ratio attributable to programme eligibility (by intention-to-treat analysis) and the alerts themselves (by two-stage regression approach), respectively.

Findings

Between Jan 1, 2003, and Dec 31, 2012, on average between three and 27 daily cardiovascular or respiratory events were reported in Toronto (depending on the outcome). Alert announcements reduced asthma-related emergency-department visits by 4·73 cases per 1 000 000 people per day (95% CI 0·55–9·38), or in relative terms by 25% (95% CI 1–47). Programme eligibility also led to 2·05 (95% CI 0·07–4·00) fewer daily emergency-department visits for asthma. We did not detect a significant reduction in any other health outcome as a result of alert announcements or programme eligibility. However, a non-significant trend was noted towards decreased asthma-related and COPD-related admissions.

Interpretation

In this population-based cohort, the air quality alert programme was related to some reductions in respiratory morbidity, but not any other health outcome examined. This finding suggests that issuing air quality alerts alone has a limited effect on public health and that implementing enforced public actions to reduce air pollution on high pollution days could be warranted. Together with accumulating evidence of substantial burden from long-term air pollution exposure, this study underscores the need for further strengthening of global efforts that can lead to long-term improvement of overall air quality.

Funding

Public Health Ontario, Canadian Institutes for Health Research.

February 5 | 2018

Evaluating street view exposure measures of visible green space for health research.

Larkin AHystad P.

J Expo Sci Environ Epidemiol. 2018 Jan 19. doi: 10.1038/s41370-018-0017-1. [Epub ahead of print]

Abstract

Urban green space, or natural environments, are associated with multiple physical and mental health outcomes. Several proposed pathways of action for these benefits (e.g., stress reduction and attention restoration) require visual perception of green space; however, existing green space exposure measures commonly used in epidemiological studies do not capture street-scale exposures. We downloaded 254 Google Street View (GSV) panorama images from Portland, Oregon and calculated percent of green in each image, called Green View Index (GVI). For these locations we also calculated satellite-based normalized difference vegetation index (NDVI), % tree cover, % green space, % street tree buffering, distance to parks, and several neighborhood socio-economic variables. Correlations between the GVI and other green space measures were low (-0.02 to 0.50), suggesting GSV-based measures captured unique information about green space exposures. We further developed a GVI:NDVI ratio, which was associated with the amount of vertical green space in an image. The GVI and GVI:NDVI ratio were weakly related to neighborhood socioeconomic status and are therefore less susceptible to confounding in health studies compared to other green space measures. GSV measures captured unique characteristics of the green space environment and offer a new approach to examine green space and health associations in epidemiological research.

January 29 | 2018

Human Health Risk Assessment for Gasoline Exhaust

Prepared by: Fuels Assessment Section Water and Air Quality Bureau Healthy Environments and Consumer Safety Branch Health Canada November 2017

http://publications.gc.ca/collections/collection_2017/sc-hc/H144-52-2017-eng.pdf

Excerpt from Executive Summary

Gasoline, or spark ignition, engines are used throughout Canada, representing 92% of on-road vehicles and 87% of off-road engines or equipment. It is reasonable to assume that exposure to gasoline engine exhaust (GE) is nearly ubiquitous, particularly for Canadians living in urban areas or in close proximity to a major roadway: it is estimated that approximately 2 million people live within 50 m of a major road in Canada. GE is a highly variable and complex mixture of particulate and gaseous pollutants, the composition of which depends on numerous factors, including fuel quality, engine and pollution control technologies, vehicle operating conditions and ambient temperature. GE is an important source of criteria air contaminants (CACs) associated with adverse effects on human health, including fine particulate matter (PM2.5), ground-level ozone (O3), nitrogen dioxide (NO2), volatile organic compounds (VOCs) and carbon monoxide (CO). In addition, GE constituents include air toxics that are recognized internationally as carcinogens, such as benzene and polycyclic aromatic hydrocarbons (PAHs).

Gasoline fuel, vehicles and engines are subject to multiple federal regulations that have successfully reduced air pollutant emissions from gasoline mobile sources, representing a major success in the management of air quality in Canada and the protection of human health. However, given the number of vehicles and engines in use, the age structure of the in-use fleets, and the vehicle kilometres travelled by Canadians, gasoline engines remain a key source of air pollution. The adverse health effects of individual pollutants in GE or produced secondarily in the atmosphere from primary GE emissions (e.g. PM2.5, O3, NO2, benzene and PAHs), are well characterized in the scientific literature and include increased risk of cardiorespiratory mortality and morbidity and of cancer, among other outcomes.

This report is a comprehensive review and analysis of the potential adverse health effects associated with gasoline fuel use in Canada. Two distinct approaches are used. Part A provides an evaluation of scientific studies that have examined the health effects associated with exposure to GE as a mixture. Studies on the health effects of individual GE constituents, such as PM2.5 and benzene, were not considered, as these substances have been extensively reviewed by Health Canada elsewhere. Part B provides a quantitative assessment of the contribution of on-road and off-road gasoline mobile source emissions to individual air pollutant concentrations in Canada and the population health impacts associated with that incremental contribution. The health impact analysis in Part B, which is based on well-established quantitative estimates of risk of adverse health impacts associated with incremental changes in air concentrations of individual pollutants, is complementary to the traditional risk assessment approach presented in Part A.

January 15 | 2018

The Canadian Urban Environmental Health Research Consortium – a protocol for building a national environmental exposure data platform for integrated analyses of urban form and health

Jeffrey R. Brook, Eleanor M. Setton, Evan Seed, Mahdi Shooshtari, Dany Doiron and CANUE – The Canadian Urban Environmental Health Research Consortium

BMC Public Health BMC series https://doi.org/10.1186/s12889-017-5001-5 Published: 8 January 2018

Abstract

Background

Multiple external environmental exposures related to residential location and urban form including, air pollutants, noise, greenness, and walkability have been linked to health impacts or benefits. The Canadian Urban Environmental Health Research Consortium (CANUE) was established to facilitate the linkage of extensive geospatial exposure data to existing Canadian cohorts and administrative health data holdings. We hypothesize that this linkage will enable investigators to test a variety of their own hypotheses related to the interdependent associations of built environment features with diverse health outcomes encompassed by the cohorts and administrative data.

January 8 | 2018

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study

Rudy Sinharay, MBBS, Jicheng Gong, PhD, Benjamin Barratt, PhD, Pamela Ohman-Strickland, PhD, Sabine Ernst, MD, Prof Frank Kelly, PhD, Prof Junfeng (Jim) Zhang, PhD, Prof Peter Collins, MD, Prof Paul Cullinan, MD, Prof Kian Fan Chung, DSc

Co-first authors contributed equally

The Lancet.  DOI: http://dx.doi.org/10.1016/S0140-6736(17)32643-0 Published: 05 December 2017

Summary

Long-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.

January 1 | 2018

Evaluation of daily time spent in transportation and traffic-influenced microenvironments by urban Canadians

Carlyn J. Matz ,David M. Stieb, Marika Egyed, Orly Brion, Markey Johnson

Air Quality, Atmosphere & Health pp 1–12|  First Online: 30 November 2017 https://doi.org/10.1007/s11869-017-0532-6

Abstract

Exposure to traffic and traffic-related air pollution is associated with a wide array of health effects. Time spent in a vehicle, in active transportation, along roadsides, and in close proximity to traffic can substantially contribute to daily exposure to air pollutants. For this study, we evaluated daily time spent in transportation and traffic-influenced microenvironments by urban Canadians using the Canadian Human Activity Pattern Survey (CHAPS) 2 results. Approximately 4–7% of daily time was spent in on- or near-road locations, mainly associated with being in a vehicle and smaller contributions from active transportation. Indoor microenvironments can be impacted by traffic emissions, especially when located near major roadways. Over 60% of the target population reported living within one block of a roadway with moderate to heavy traffic, which was variable with income level and city, and confirmed based on elevated NO2 exposure estimated using land use regression. Furthermore, over 55% of the target population ≤ 18 years reported attending a school or daycare in close proximity to moderate to heavy traffic, and little variation was observed based on income or city. The results underline the importance of traffic emissions as a major source of exposure in Canadian urban centers, given the time spent in traffic-influenced microenvironments.

December 18 | 2017

The Lancet Commissions

The Lancet Commission on pollution and health

The Lancet Commission on pollution and health Philip J Landrigan, Richard Fuller, Nereus J R Acosta, Olusoji Adeyi, Robert Arnold, Niladri (Nil) Basu, Abdoulaye Bibi Baldé, Roberto Bertollini, Stephan Bose-O’Reilly, Jo Ivey Boufford, Patrick N Breysse, Thomas Chiles, Chulabhorn Mahidol, Awa M Coll-Seck, Maureen L Cropper, Julius Fobil, Valentin Fuster, Michael Greenstone, Andy Haines, David Hanrahan, David Hunter, Mukesh Khare, Alan Krupnick, Bruce Lanphear, Bindu Lohani, Keith Martin, Karen V Mathiasen, Maureen A McTeer, Christopher J L Murray, Johanita D Ndahimananjara, Frederica Perera, Janez Potočnik, Alexander S Preker, Jairam Ramesh, Johan Rockström, Carlos Salinas, Leona D Samson, Karti Sandilya, Peter D Sly, Kirk R Smith, Achim Steiner, Richard B Stewart, William A Suk, Onno C P van Schayck, Gautam N Yadama, Kandeh Yumkella, Ma Zhong

Published: 19 October 2017  DOI: http://dx.doi.org/10.1016/S0140-6736(17)32345-0

Pollution is the largest environmental cause of disease and premature death in the world today. Diseases caused by pollution were responsible for an estimated 9 million premature deaths in 2015—16% of all deaths worldwide—three times more deaths than from AIDS, tuberculosis, and malaria combined and 15 times more than from all wars and other forms of violence. In the most severely affected countries, pollution-related disease is responsible for more than one death in four.

December 11 | 2017

The Chief Public Health Officer’s Report on the State of Public Health in Canada 2017 – Designing Healthy Living

The Chief Public Health Officer’s Report on the State of Public Health in Canada 2017 – Designing Healthy Living

A message from Canada’s Chief Public Health Officer

Without being aware of it, our neighbourhoods and how they are built influence how healthy we are.

I chose designing healthy living as the topic for my first report as Canada’s Chief Public Health Officer because of the tremendous potential that changing our built environment has for helping Canadians live healthier lives.

Chronic diseases like diabetes, cancer and cardiovascular disease are the leading causes of death in Canada. It is alarming that in 2011, almost 2.7 million or 1 in 10 Canadians 20 years and older were living with diabetes. Rising rates of type II diabetes can be considered a red flag for poor health as they are associated with higher rates of other diseases and conditions and linked to an unhealthy diet, low physical activity and higher rates of overweight and obesity. Rates of type II diabetes and other chronic diseases in Canada could be reduced by seamlessly integrating healthy living into our daily lives which can be achieved, in part, by designing and redesigning our communities.

Improving public health and preventing disease through changes to our environment is a well-founded concept. For example, infectious disease rates in the last century were reduced not just through scientific innovation and vaccination, but also through infrastructure planning by improving sanitation and addressing overcrowding in residential neighbourhoods.

This report answers many questions but also raises several others. We need better information if we are to measure the health impacts of community design to incorporate evidence-based strategies into community planning. This report will raise awareness among Canadians about the unique aspects of their communities that they could take advantage of to improve their health. It will also encourage more dialogue across the many disciplines involved in community planning and health promotion so that neighbourhood design considers and promotes physical activity, healthy diets and mental wellness.

Dr. Theresa Tam
Chief Public Health Officer of Canada

https://www.canada.ca/en/public-health/services/publications/chief-public-health-officer-reports-state-public-health-canada/2017-designing-healthy-living.html

December 4 | 2017

Heat and pregnancy-related emergencies: Risk of placental abruption during hot weather.

He S1Kosatsky T2Smargiassi A3Bilodeau-Bertrand M4Auger N5.

Environ Int. 2017 Nov 13. pii: S0160-4120(17)31686-0  DOI:10.1016/j.envint.2017.11.004

Abstract

INTRODUCTION:

Outdoor heat increases the risk of preterm birth and stillbirth, but the association with placental abruption has not been studied. Placental abruption is a medical emergency associated with major morbidity and mortality in pregnancy. We determined the relationship between ambient temperature and risk of placental abruption in warm seasons.

MATERIAL AND METHODS:

We performed a case-crossover analysis of 17,172 women whose pregnancies were complicated by placental abruption in Quebec, Canada from May to October 1989-2012. The main exposure measure was the maximum temperature reached during the week before abruption. We computed odds ratios (OR) and 95% confidence intervals (CI) for the association of temperature with placental abruption, adjusted for humidity and public holidays. We assessed whether associations were stronger preterm or at term, or varied with maternal age, parity, comorbidity and socioeconomic status.

RESULTS:

Compared with 15°C, a maximum weekly temperature of 30°C was associated with 1.07 times the odds of abruption (95% CI 0.99-1.16). When the timing of abruption was examined, the associations were significantly stronger at term (OR 1.12, 95% CI 1.02-1.24) than preterm (OR 0.96, 95% CI 0.83-1.10). Relationships were more prominent at term for women who were younger than 35years old, nulliparous or socioeconomically disadvantaged, but did not vary with comorbidity. Associations were stronger within 1 and 5days of abruption. Temperature was not associated with preterm abruption regardless of maternal characteristics.

CONCLUSIONS:

Elevated temperatures in warm seasons may increase the risk of abruption in women whose pregnancies are near or at term. Pregnant women may be more sensitive to heat and should consider preventive measures such as air conditioning and hydration during hot weather.

Paper of the Week | November 27 | 2017

Noise exposure while commuting in Toronto – a study of personal and public transportation in Toronto

Christopher M.K.L. Yao, Andrew K. Ma, Sharon L. Cushing and Vincent Y.W. Lin.

Journal of Otolaryngology – Head & Neck Surgery201746:62 https://doi.org/10.1186/s40463-017-0239-6 23 November 2017

Abstract

Background

With an increasing proportion of the population living in cities, mass transportation has been rapidly expanding to facilitate the demand, yet there is a concern that mass transit has the potential to result in excessive exposure to noise, and subsequently noise-induced hearing loss.

Methods

Noise dosimetry was used to measure time-integrated noise levels in a representative sample of the Toronto Mass Transit system (subway, streetcar, and buses) both aboard moving transit vehicles and on boarding platforms from April – August 2016. 210 measurements were conducted with multiple measurements approximating 2 min on platforms, 4 min within a vehicle in motion, and 10 min while in a car, on a bike or on foot. Descriptive statistics for each type of transportation, and measurement location (platform vs. vehicle) was computed, with measurement locations compared using 1-way analysis of variance.

Results

On average, there are 1.69 million riders per day, who are serviced by 69 subway stations, and 154 streetcar or subway routes. Average noise level was greater in the subway and bus than in the streetcar (79.8 +/− 4.0 dBA, 78.1 +/− 4.9 dBA, vs 71.5 +/−1.8 dBA, p < 0.0001). Furthermore, average noise measured on subway platforms were higher than within vehicles (80.9 +/− 3.9 dBA vs 76.8 +/− 2.6 dBA, p < 0.0001). Peak noise exposures on subway, bus and streetcar routes had an average of 109.8 +/− 4.9 dBA and range of 90.4–123.4 dBA, 112.3 +/− 6.0 dBA and 89.4–128.1 dBA, and 108.6 +/− 8.1 dBA and 103.5–125.2 dBA respectively. Peak noise exposures exceeded 115 dBA on 19.9%, 85.0%, and 20.0% of measurements in the subway, bus and streetcar respectively.

Conclusions

Although the mean average noise levels on the Toronto transit system are within the recommended level of safe noise exposure, cumulative intermittent bursts of impulse noise (peak noise exposures) particularly on bus routes have the potential to place individuals at risk for noise induced hearing

November 20 | 2017

Estimating the health benefits of planned public transit investments in Montreal.

Tétreault LF1, Eluru N2, Hatzopoulou M3, Morency P4, Plante C5, Morency C6, Reynaud F7, Shekarrizfard M3, Shamsunnahar Y2, Faghih Imani A7, Drouin L4, Pelletier A5, Goudreau S5, Tessier F5, Gauvin L8, Smargiassi A9.

Environ Res. 2017 Oct 23;160:412-419. https://doi.org/10.1016/j.envres.2017.10.025

BACKGROUND:

Since public transit infrastructure affects road traffic volumes and influences transportation mode choice, which in turn impacts health, it is important to estimate the alteration of the health burden linked with transit policies.

OBJECTIVE:

We quantified the variation in health benefits and burden between a business as usual (BAU) and a public transit (PT) scenarios in 2031 (with 8 and 19 new subway and train stations) for the greater Montreal region.

METHOD:

Using mode choice and traffic assignment models, we predicted the transportation mode choice and traffic assignment on the road network. Subsequently, we estimated the distance travelled in each municipality by mode, the minutes spent in active transportation, as well as traffic emissions. Thereafter we estimated the health burden attributed to air pollution and road traumas and the gains associated with active transportation for both the BAU and PT scenarios.

RESULTS:

We predicted a slight decrease of overall trips and kilometers travelled by car as well as an increase of active transportation for the PT in 2031 vs the BAU. Our analysis shows that new infrastructure will reduce the overall burden of transportation by 2.5 DALYs per 100,000 persons. This decrease is caused by the reduction of road traumas occurring in the inner suburbs and central Montreal region as well as gains in active transportation in the inner suburbs.

CONCLUSION:

Based on the results of our study, transportation planned public transit projects for Montreal are unlikely to reduce drastically the burden of disease attributable to road vehicles and infrastructures in the Montreal region. The impact of the planned transportation infrastructures seems to be very low and localized mainly in the areas where new public transit stations are planned.

 

November 13 | 2017

The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health

Watts et al

The Lancet, DOI: http://dx.doi.org/10.1016/S0140-6736(17)32464-9

Summary

The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement,1 and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change,2 which concluded that anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be “the greatest global health opportunity of the 21st century”.

November 6 | 2017

The impact of urbanization and climate change on urban temperatures: a systematic review

Sarah Chapman, James E. M. Watson, Alvaro Salazar, Marcus Thatcher, Clive A. McAlpine

Landscape Ecology  October 2017, Volume 32, Issue 10, pp 1921–1935

https://link.springer.com/article/10.1007/s10980-017-0561-4

 

Abstract

Context

Cities have elevated temperatures compared to rural areas, a phenomenon known as the “urban heat island”. Higher temperatures increase the risk of heat-related mortality, which will be exacerbated by climate change.

Objectives

To examine the impact of climate change and urban growth on future urban temperatures and the potential for increased heat stress on urban residents.

Methods

We conducted a systematic review of scientific articles from Jan 2000 to May 2016.

Results

The majority (n = 49, = 86%) of studies examined climate change and the urban heat island in isolation, with few (8) considering their combined effect. Urban growth was found to have a large impact on local temperatures, in some cases by up to 5 °C in North-east USA. In some locations climate change increased the heat island, such as Chicago and Beijing, and in others decreased it, such as Paris and Brussels. When the relative impact of both factors was considered, the temperature increase associated with the urban heat island was always higher. Few studies (9) considered heat stress and its consequences for urban populations. Important contributors to urban temperatures, such as variation in urban density and anthropogenic heat release, were often excluded from studies.

Conclusions

We identify a need for an increased research focus on (1) urban growth impact on the urban heat island in climate change studies; (2) heat stress; and, (3) variation in urban density and its impacts on anthropogenic heat. Focussing on only one factor, climate change or urban growth, risks underestimating future urban temperatures and hampering adaptation.

October 30 | 2017

Healthy Cities of Tomorrow: the Case for Large Scale Built Environment-Health Studies.

Sarkar C , Webster C.

J Urban Health. 2017 Feb;94(1):4-19. DOI: 10.1007/s11524-016-0122-1

EXCERPT FROM INTRODUCTION: New scientific evidence generated over the past decade points to a significant role played by a myriad of attributes of our cities’ built environments (BE) in shaping human behaviour, health and well-being [3456]. This has resulted in a renaissance of interest in an environmentalmodel of public health, comprising interventions specific to physical and social environments [78]. We view this as similar to the wave of public health interest that gave birth to modern town planning in the mid to late twentieth century. Non-clinical environmental interventions in the form of health-specific planning and design of neighbourhoods and cities have been scientifically shown to have significant potential in playing a role in creating healthy cities of tomorrow. In addition to enabling healthier lifestyles, such interventions can produce higher cost effectiveness ratios in health service provision and can thus play a part in reducing future health expenditures [9]. The creation of healthy cities will entail a much closer integration and synergy between the disciplines of public health, epidemiology, transport planning, urban planning and design.

In the recent years several ongoing projects have emerged that aim specifically to measure health-specific components of urban environments at a large scale. The ultimate objective is to eventually link them with existing health cohorts enabling interdisciplinary collaborations and evidence generation towards creation of healthy cities. The Place, Health and Liveability project is one such national-level study aiming to create neighbourhood-level spatial measures of urban liveability across seven domains of employment, food, housing, public open space, social infrastructure, transport and walkability in Australia [10]. Algorithms measuring weighted street distance of individual dwellings to amenities and public transit have been developed to produce composite Walk Scores and Transit Scores in most US cities and some Canadian and Australian cities at the level of individual properties [11]. These are being linked with existing health cohorts to decipher associations with individual’s active travel behaviours [12]. Furthermore, there are many large scale health studies being conducted around the world, including the UK Biobank study (described in the subsequent section), 45 and Up Study in New South Wales, Australia1 (N = 250,000 participants); EpiHealth Study, Sweden2 (N = 300,000); China Kadoorie Biobank, China3 (N = 500,000); Million Death Study, India4 (N = 1,000,000) and Hong Kong FAMILY Cohort5 (N = 46,000) to name just a few. These present us (BE and urban planners and designers, epidemiologists, health economists, public health researchers and policy makers) with a well-timed opportunity to join expertise and resources for an integrated and multi-disciplinary global consortium to model and create national-level BE-health databases that can be turned into fine-tuned professional decision support and guidance systems. In the remaining part of this paper, we shall discuss some of the key issues and challenges in creation of healthy cities and ways to overcome them through interdisciplinary evidence generation on a large scale, planning and forecasting.

October 23 | 2017

A Difference-in-Differences Approach to Assess the Effect of a Heat Action Plan on Heat-Related Mortality, and Differences in Effectiveness According to Sex, Age, and Socioeconomic Status (Montreal, Quebec)

Benmarhnia T, Bailey Z, Kaiser D, Auger N, King N, Kaufman J.

Environ Health Perspect. 2016.  124:1694–1699; http://dx.doi.org/10.1289/EHP203

Abstract

Background: The impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs.

Objectives: We developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP.

Methods: A difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000–2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program.

Results: We found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods.

Conclusion: These findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached.

October 16 | 2017

Urban greenness and mortality in Canada’s largest cities: a national cohort study

Dan L Crouse, Lauren Pinault, Adele Balram, Perry Hystad, Paul A Peters, Hong Chen, Aaron van Donkelaar, Randall V Martin, Richard Ménard, Alain Robichaud, Paul J Villeneuve

The Lancet Planetary Health Volume 1, Issue 7, October 2017, Pages e289-e29  DOI: http://dx.doi.org/10.1016/S2542-5196(17)30118-3

Summary

Background

Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality.

Methods

We used data from a large cohort study (the 2001 Canadian Census Health and Environment Cohort [2001 CanCHEC]), which consisted of approximately 1·3 million adult (aged ≥19 years), non-immigrant, urban Canadians in 30 cities who responded to the mandatory 2001 Statistics Canada long-form census. The cohort has been linked by Statistics Canada to the Canadian mortality database and to annual income tax filings through 2011. We measured greenness with images from the moderate-resolution imaging spectroradiometer from NASA’s Aqua satellite. We assigned estimates of exposure to greenness derived from remotely sensed Normalized Difference Vegetation Index (NDVI) within both 250 m and 500 m of participants’ residences for each year during 11 years of follow-up (between 2001 and 2011). We used Cox proportional hazards models to estimate associations between residential greenness (as a continuous variable) and mortality. We estimated hazard ratios (HRs) and corresponding 95% CIs per IQR (0·15) increase in NDVI adjusted for personal (eg, education and income) and contextual covariates, including exposures to fine particulate matter, ozone, and nitrogen dioxide. We also considered effect modification by selected personal covariates (age, sex, household income adequacy quintiles, highest level of education, and marital status).

Findings

Our cohort consisted of approximately 1 265 000 individuals at baseline who contributed 11 523 770 person-years. We showed significant decreased risks of mortality in the range of 8–12% from all causes of death examined with increased greenness around participants’ residence. In the fully adjusted analyses, the risk was significantly decreased for all causes of death (non-accidental HR 0·915, 95% CI 0·905–0·924; cardiovascular plus diabetes 0·911, 0·895–0·928; cardiovascular 0·911, 0·894–0·928; ischaemic heart disease 0·904, 0·882–0·927; cerebrovascular 0·942, 0·902–0·983; and respiratory 0·899, 0·869–0·930). Greenness associations were more protective among men than women (HR 0·880, 95% CI 0·868–0·893 vs 0·955, 0·941–0·969), and among individuals with higher incomes (highest quintile 0·812, 0·791–0·834 vs lowest quintile 0·991, 0·972–1·011) and more education (degree or more 0·816, 0·791–0·842 vs did not complete high school 0·964, 0·950–0·978).

Interpretation

Increased amounts of residential greenness were associated with reduced risks of dying from several common causes of death among urban Canadians. We identified evidence of inequalities, both in terms of exposures to greenness and mortality risks, by personal socioeconomic status among individuals living in generally similar environments, and with reasonably similar access to health care and other social services. The findings support the development of policies related to creating greener and healthier cities.

October 10 | 2017

BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe’s blue spaces.

Grellier J, White MP, Albin M, Bell S, Elliott LR, Gascón M, Gualdi S, Mancini L, Nieuwenhuijsen MJ, Sarigiannis DA, van den Bosch M, Wolf T, Wuijts S, Fleming LE.

BMJ Open. 2017 Jun 14;7(6)   http://dx.doi.org/10.1136/bmjopen-2017-016188

 

Abstract

INTRODUCTION:

Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe’s coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with ‘blue space’ (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood.

AIMS AND METHODS:

The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas.

ETHICS AND DISSEMINATION:

Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.

October 2 | 2017

Association of Long-Term Exposure to Transportation Noise and Traffic-Related Air Pollution with the Incidence of Diabetes: A Prospective Cohort Study.

Clark C, Sbihi H, Tamburic L2, Brauer M, Frank LD, Davies HW.

Environ Health Perspect. 2017 Aug 31;125(8):087025.  https://doi.org/10.1289/EHP1279

Abstract

BACKGROUND:

Evidence for an association between transportation noise and cardiovascular disease has increased; however, few studies have examined metabolic outcomes such as diabetes or accounted for environmental coexposures such as air pollution, greenness, or walkability.

OBJECTIVES:

Because diabetes prevalence is increasing and may be on the causal pathway between noise and cardiovascular disease, we examined the influence of long-term residential transportation noise exposure and traffic-related air pollution on the incidence of diabetes using a population-based cohort in British Columbia, Canada.

METHODS:

We examined the influence of transportation noise exposure over a 5-y period (1994-1998) on incident diabetes cases in a population-based prospective cohort study (n=380,738) of metropolitan Vancouver (BC) residents who were 45-85 y old, with 4-y of follow-up (1999-2002). Annual average transportation noise (Lden), air pollution [black carbon, particulate matter with aerodynamic diameter <2.5μm (PM2.5), nitrogen oxides], greenness [Normalized Difference Vegetation Index (NDVI)], and neighborhood walkability at each participant’s residence were modeled. Incident diabetes cases were identified using administrative health records.

RESULTS:

Transportation noise was associated with the incidence of diabetes [interquartile range (IQR) increase, 6.8 A-weighted decibels (dBA); OR=1.08 (95% CI: 1.05, 1.10)]. This association remained after adjustment for environmental coexposures including traffic-related air pollutants, greenness, and neighborhood walkability. After adjustment for coexposure to noise, traffic-related air pollutants were not associated with the incidence of diabetes, whereas greenness was protective.

CONCLUSION:

We found a positive association between residential transportation noise and diabetes, adding to the growing body of evidence that noise pollution exposure may be independently linked to metabolic health and should be considered when developing public health interventions.

September 25 | 2017

Exposure to ambient air pollution and the incidence of dementia: A population-based cohort study.

Chen H, Kwong JC, Copes R, Hystad P, van Donkelaar A, Tu K, Brook JR, Goldberg MS, Martin RV, Murray BJ, Wilton AS, Kopp A, Burnett RT.

Environ Int. 2017 Sep 13; 108: 271-277. https://doi.org/10.1016/j.envint.2017.08.020

Abstract

INTRODUCTION:

Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.

METHODS:

The study population comprised all Ontario residents who, on 1 April 2001, were 55-85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects’ historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.

RESULTS:

We identified 257,816 incident cases of dementia in 2001-2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03-1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08-1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.

DISCUSSION:

In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.

September 18 | 2017

Estimated Changes in Life Expectancy and Adult Mortality Resulting from Declining PM2.5 Exposures in the Contiguous United States: 1980–2010

Neal Fann, Sun-Young Kim, Casey Olives, and Lianne Sheppard.

Environ Health Perspect. 2017; Vol 125, Issue 9.  https://doi.org/10.1289/EHP507

ABSTRACT

Background: PM2.5 precursor emissions have declined over the course of several decades, following the implementation of local, state, and federal air quality policies. Estimating the corresponding change in population exposure and PM2.5-attributable risk of death prior to the year 2000 is made difficult by the lack of PM2.5 monitoring data.

Objectives: We used a new technique to estimate historical PM2.5 concentrations, and estimated the effects of changes in PM2.5 population exposures on mortality in adults (age ≥30 y), and on life expectancy at birth, in the contiguous United States during 1980–2010.

Methods: We estimated annual mean county-level PM2.5 concentrations in 1980, 1990, 2000, and 2010 using universal kriging incorporating geographic variables. County-level death rates and national life tables for each year were obtained from the U.S. Census and Centers for Disease Control and Prevention. We used log-linear and nonlinear concentration–response coefficients from previous studies to estimate changes in the numbers of deaths and in life years and life expectancy at birth, attributable to changes in PM2.5.

Results: Between 1980 and 2010, population-weighted PM2.5 exposures fell by about half, and the estimated number of excess deaths declined by about a third. The States of California, Virginia, New Jersey, and Georgia had some of the largest estimated reductions in PM2.5-attributable deaths. Relative to a counterfactual population with exposures held constant at 1980 levels, we estimated that people born in 2050 would experience an ∼1-y increase in life expectancy at birth, and that there would be a cumulative gain of 4.4 million life years among adults ≥30 y of age.

Conclusions: Our estimates suggest that declines in PM2.5 exposures between 1980 and 2010 have benefitted public health.

September 11 | 2017

Beyond the Normalized Difference Vegetation Index (NDVI): Developing a Natural Space Index for population-level health research.

Rugel EJ, Henderson SB, Carpiano RM, Brauer M.

Environ Res. 2017 Aug 29; 159:474-483. doi:  10.1016/j.envres.2017.08.033

Abstract

BACKGROUND:

Natural spaces can provide psychological benefits to individuals, but population-level epidemiologic studies have produced conflicting results. Refining current exposure-assessment methods is necessary to advance our understanding of population health and to guide the design of health-promoting urban forms.

OBJECTIVES:

The aim of this study was to develop a comprehensive Natural Space Index that robustly models potential exposure based on the presence, form, accessibility, and quality of multiple forms of greenspace (e.g., parks and street trees) and bluespace (e.g., oceans and lakes).

MATERIAL AND METHODS:

The index was developed for greater Vancouver, Canada. Greenness presence was derived from remote sensing (NDVI/EVI); forms were extracted from municipal and private databases; and accessibility was based on restrictions such as private ownership. Quality appraisals were conducted for 200 randomly sampled parks using the Public Open Space Desktop Appraisal Tool (POSDAT). Integrating these measures in GIS, exposure was assessed for 60,242 postal codes using 100- to 1,600-m buffers based on hypothesized pathways to mental health. A single index was then derived using principal component analysis (PCA).

RESULTS:

Comparing NDVI with alternate approaches for assessing natural space resulted in widely divergent results, with quintile rankings shifting for 22-88% of postal codes, depending on the measure. Overall park quality was fairly low (mean of 15 on a scale of 0-45), with no significant difference seen by neighborhood-level household income. The final PCA identified three main sets of variables, with the first two components explaining 68% of the total variance. The first component was dominated by the percentages of public and private greenspace and bluespace and public greenspace within 250m, while the second component was driven by lack of access to bluespace within 1 km.

CONCLUSIONS:

Many current approaches to modeling natural space may misclassify exposures and have limited specificity. The Natural Space Index represents a novel approach at a regional scale with application to urban planning and policy-making.

September 5 | 2017

Associations of Pregnancy Outcomes and PM2.5 in a National Canadian Study

Stieb DM, Chen L, Beckerman BS, Jerrett M, Crouse DL, Omariba DW, Peters PA, van Donkelaar A, Martin RV, Burnett RT, Gilbert NL, Tjepkema M, Liu S, Dugandzic  RM.

Environ Health Perspect. 2016 Feb;124(2):243-9. doi:  10.1289/ehp.1408995

ABSTRACT

Background

Numerous studies have examined associations between air pollution and pregnancy outcomes, but most have been restricted to urban populations living near monitors.

Objectives

We examined the association between pregnancy outcomes and fine particulate matter in a large national study including urban and rural areas.

Methods

Analyses were based on approximately 3 million singleton live births in Canada between 1999 and 2008. Exposures to PM2.5(particles of median aerodynamic diameter ≤ 2.5 μm) were assigned by mapping the mother’s postal code to a monthly surface based on a national land use regression model that incorporated observations from fixed-site monitoring stations and satellite-derived estimates of PM2.5. Generalized estimating equations were used to examine the association between PM2.5 and preterm birth (gestational age < 37 weeks), term low birth weight (< 2,500 g), small for gestational age (SGA; < 10th percentile of birth weight for gestational age), and term birth weight, adjusting for individual covariates and neighborhood socioeconomic status (SES).

Results

In fully adjusted models, a 10-μg/m3 increase in PM2.5 over the entire pregnancy was associated with SGA (odds ratio = 1.04; 95% CI 1.01, 1.07) and reduced term birth weight (–20.5 g; 95% CI –24.7, –16.4). Associations varied across subgroups based on maternal place of birth and period (1999–2003 vs. 2004–2008).

Conclusions

This study, based on approximately 3 million births across Canada and employing PM2.5 estimates from a national spatiotemporal model, provides further evidence linking PM2.5 and pregnancy outcomes.

August 28 | 2017

Outdoor Light at Night and Breast Cancer Incidence in the Nurses’ Health Study II

Peter James, Kimberly A. Bertrand,  Jaime E. Hart, Eva S. Schernhammer, Rulla M. Tamimi, and Francine Laden

Environmental Health Perspectives, August 2017, Volume 125 Issue 8, https://doi.org/10.1289/EHP935

BACKGROUND:

Animal and epidemiologic studies suggest that exposure to light at night (LAN) may disrupt circadian patterns and decrease nocturnal secretion of melatonin, which may disturb estrogen regulation, leading to increased breast cancer risk.

OBJECTIVES:

We examined the association between residential outdoor LAN and breast cancer incidence using data from the nationwide U.S.-based Nurses’ Health Study II cohort.

METHODS:

We followed 109,672 women from 1989 through 2013. Cumulative LAN exposure was estimated using time-varying satellite data for a composite of persistent nighttime illumination at ∼1 km2 scale for each residence during follow-up. Incident invasive breast cancer cases were confirmed by medical record review. We used Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for anthropometric, reproductive, lifestyle, and socioeconomic risk factors.

RESULTS:

Over 2,187,425 person-years, we identified 3,549 incident breast cancer cases. Based on a fully adjusted model, the estimated HR for incident breast cancer with an interquartile range (IQR) (31.6 nW/cm2/sr) increase in cumulative average outdoor LAN was 1.05 (95% CI: 1.00, 1.11). An association between LAN and breast cancer appeared to be limited to women who were premenopausal at the time of a case [HR=1.07 (95% CI: 1.01, 1.14) based on 1,973 cases vs. HR=1.00 (95% CI: 0.91, 1.09) based on 1,172 cases in postmenopausal women; p-interaction=0.08]. The LAN–breast cancer association was observed only in past and current smokers at the end of follow-up [HR=1.00 (95% CI: 0.94, 1.07) based on 2,215 cases in never smokers; HR=1.10 (95% CI: 1.01, 1.19) based on 1,034 cases in past smokers vs. HR=1.21 (95% CI: 1.07, 1.37) for 300 cases in current smokers; p-interaction=0.08].

CONCLUSIONS:

Although further work is required to confirm our results and to clarify potential mechanisms, our findings suggest that exposure to residential outdoor light at night may contribute to invasive breast cancer risk.

 

August 21 | 2017

Residential greenness and birth outcomes: evaluating the influence of spatially correlated built-environment factors.

Hystad P1, Davies HW, Frank L, Van Loon J, Gehring U, Tamburic L, Brauer M. 

Environ Health Perspect. 2014 Oct;122(10):1095-102.

doi: 10.1289/ehp.1308049   Epub 2014 Jul 11.

Abstract

BACKGROUND:

Half the world’s population lives in urban areas. It is therefore important to identify characteristics of the built environment that are beneficial to human health. Urban greenness has been associated with improvements in a diverse range of health conditions, including birth outcomes; however, few studies have attempted to distinguish potential effects of greenness from those of other spatially correlated exposures related to the built environment.

OBJECTIVES:

We aimed to investigate associations between residential greenness and birth outcomes and evaluate the influence of spatially correlated built environment factors on these associations.

METHODS:

We examined associations between residential greenness [measured using satellite-derived Normalized Difference Vegetation Index (NDVI) within 100 m of study participants’ homes] and birth outcomes in a cohort of 64,705 singleton births (from 1999-2002) in Vancouver, British Columbia, Canada. We also evaluated associations after adjusting for spatially correlated built environmental factors that may influence birth outcomes, including exposure to air pollution and noise, neighborhood walkability, and distance to the nearest park.

RESULTS:

An interquartile increase in greenness (0.1 in residential NDVI) was associated with higher term birth weight (20.6 g; 95% CI: 16.5, 24.7) and decreases in the likelihood of small for gestational age, very preterm (< 30 weeks), and moderately preterm (30-36 weeks) birth. Associations were robust to adjustment for air pollution and noise exposures, neighborhood walkability, and park proximity.

CONCLUSIONS:

Increased residential greenness was associated with beneficial birth outcomes in this population-based cohort. These associations did not change after adjusting for other spatially correlated built environment factors, suggesting that alternative pathways (e.g., psychosocial and psychological mechanisms) may underlie associations between residential greenness and birth outcomes.

 

August 14 | 2017

Within- and between-city contrasts in nitrogen dioxide and mortality in 10 Canadian cities; a subset of the Canadian Census Health and Environment Cohort (CanCHEC).

Crouse DL1, Peters PA2, Villeneuve PJ3, Proux MO4, Shin HH1, Goldberg MS5, Johnson M6, Wheeler AJ6, Allen RW7, Atari DO8, Jerrett M9, Brauer M10, Brook JR11, Cakmak S1, Burnett RT1

J Expo Sci Environ Epidemiol. 2015 Sep-Oct;25(5):482-9. Epub 2015 Jan 21.

doi: 10.1038/jes.2014.89

 

Abstract:

The independent and joint effects of within- and between-city contrasts in air pollution on mortality have been investigated rarely. To examine the differential effects of between- versus within-city contrasts in pollution exposure, we used both ambient measurements and land use regression models to assess associations with mortality and exposure to nitrogen dioxide (NO2) among ~735,600 adults in 10 of the largest Canadian cities. We estimated exposure contrasts partitioned into within- and between-city contrasts, and the sum of these as overall exposures, for every year from 1984 to 2006. Residential histories allowed us to follow subjects annually during the study period. We calculated hazard ratios (HRs) adjusted for many personal and contextual variables. In fully-adjusted, random-effects models, we found positive associations between overall NO2 exposures and mortality from non-accidental causes (HR per 5 p.p.b.: 1.05; 95% confidence interval (CI): 1.03-1.07), cardiovascular disease (HR per 5 p.p.b.: 1.04; 95% CI: 1.01-1.06), ischaemic heart disease (HR per 5 p.p.b.: 1.05; 95% CI: 1.02-1.08) and respiratory disease (HR per 5 p.p.b.: 1.04; 95% CI: 0.99-1.08), but not from cerebrovascular disease (HR per 5 p.p.b.: 1.01; 95% CI: 0.96-1.06). We found that most of these associations were determined by within-city contrasts, as opposed to by between-city contrasts in NO2. Our results suggest that variation in NO2 concentrations within a city may represent a more toxic mixture of pollution than variation between cities.

 

August 7 | 2017

Spatial Transferability of a Microresidential Mobility Model in the Integrated Land Use, Transportation, and Environment Modeling System

Fatmi, M.R. and Habib, M.A. (2015)

Transportation Research Record: Journal of the Transportation Research Board No. 2496, pp. 29-36

https://doi.org/10.3141/2494-04

Abstract

This paper presents the spatial transferability analysis of a microbehavioral model from the residential mobility component of the integrated land use, transportation, and environment (ILUTE) modeling system developed and implemented in the Greater Toronto and Hamilton Area, Ontario, Canada. The study examined whether ILUTE could be spatially transferred with the current model components to a different geographic area: Halifax, Nova Scotia, Canada. The residential mobility component within ILUTE is a continuous-time, hazard-based duration model, developed with retrospective survey data from the Residential Mobility Survey 2 in the Greater Toronto and Hamilton Area. This study developed a similar continuous-time, hazard-based duration model for the residential mobility decisions of households in Halifax on the basis of retrospective survey data from a household mobility and travel survey. The model results suggested that households in Halifax and the Greater Toronto and Hamilton Area exhibited profound differences in residential mobility decisions. Sociodemographic, dwelling, and neighborhood characteristics significantly affected residential mobility decisions in the Greater Toronto and Hamilton Area. The effects of land use and accessibility measures were noteworthy for Halifax. For instance, home-to-work distances in Halifax affected the decision to move; however, such an effect could not be confirmed in the Greater Toronto and Hamilton Area. Households’ first periods of residence after household formation in a residential location were shorter in Halifax than in the Greater Toronto and Hamilton Area. It was concluded that the direct transfer of micromodels from one spatial context to another could be difficult.

 

July 31 | 2017

Statistical modeling of the spatial variability of environmental noise levels in Montreal, Canada, using noise measurements and land use characteristics.

Martina S RagettliSophie GoudreauCéline PlanteMichel FournierMarianne HatzopoulouStéphane Perron and Audrey Smargiassi

Expo Sci Environ Epidemiol. 2016 Nov;26(6):597-605. doi: 10.1038/jes.2015.82. Epub 2016 Jan 6

10.1038/jes.2015.82

ABSTRACT: The availability of noise maps to assess exposure to noise is often limited, especially in North American cities. We developed land use regression (LUR) models for LAeq24h, Lnight, and Lden to assess the long-term spatial variability of environmental noise levels in Montreal, Canada, considering various transportation noise sources (road, rail, and air). To explore the effects of sampling duration, we compared our LAeq24h levels that were computed over at least five complete contiguous days of measurements to shorter sampling periods (20 min and 24 h). LUR models were built with General Additive Models using continuous 2-min noise measurements from 204 sites. Model performance (adjusted R2) was 0.68, 0.59, and 0.69 for LAeq24h, Lnight, and Lden, respectively. Main predictors of measured noise levels were road-traffic and vegetation variables. Twenty-minute non-rush hour measurements corresponded well with LAeq24h levels computed over 5 days at road-traffic sites (bias: -0.7 dB(A)), but not at rail (-2.1 dB(A)) nor at air (-2.2 dB(A)) sites. Our study provides important insights into the spatial variation of environmental noise levels in a Canadian city. To assess long-term noise levels, sampling strategies should be stratified by noise sources and preferably should include 1 week of measurements at locations exposed to rail and aircraft noise.

 

July 24 | 2017

Regional Climate Projections of Extreme Heat Events in Nine Pilot Canadian Communities for Public Health Planning

Casati, B., Yagouti, A., Chaumont, D. (2013), JAMC, vol. 52, 2669:2698

https://doi.org/10.1175/JAMC-D-12-0341.1

ABSTRACT: Public health planning needs the support of evidence-based information on current and future climate, which could be used by health professionals and decision makers to better understand and respond to the health impacts of extreme heat. Climate models provide information regarding the expected increase in temperatures and extreme heat events with climate change and can help predict the severity of future health impacts, which can be used in the public health sector for the development of adaptation strategies to reduce heat-related morbidity and mortality. This study analyzes the evolution of extreme temperature indices specifically defined to characterize heat events associated with health risks, in the context of a changing climate. The analysis is performed by using temperature projections from the Canadian Regional Climate Model.

 

July 17 | 2017

Large-scale physical activity data reveal worldwide activity inequality

Tim Althoff, Rok Sosič, Jennifer L. Hicks, Abby C. King, Scott L. Delp & Jure Leskovec., 2017.  Nature, Published online 10 July 2017.

https://www.nature.com/nature/journal/vaop/ncurrent/full/nature23018.htmldoi:10.1038/nature23018

Using data captured from smartphones, researchers have amassed a dataset consisting of 68 million days of physical activity for 717,527 people to study activity across the globe.

As described in the abstract: “Aspects of the built environment, such as the walkability of a city, are associated with a smaller gender gap in activity and lower activity inequality. In more walkable cities, activity is greater throughout the day and throughout the week, across age, gender, and body mass index (BMI) groups, with the greatest increases in activity found for females. Our findings have implications for global public health policy and urban planning and highlight the role of activity inequality and the built environment in improving physical activity and health.”

 

 

 

July 10 | 2017

Exploring pathways linking greenspace to health: Theoretical and methodological guidance

Markevych, I., Schoierer, J., Hartig, T., Chudnovsky, A., Hystad, P., Dzhambov, A.M., de Vries, S., Triguero-Mas, M., Brauer, M., Nieuwenhuijsen, M.J. and Lupp, G., 2017. Environmental Research, 158, pp.301-317.

https://doi.org/10.1016/j.envres.2017.06.028

During an Expert Workshop held in September 2016, the evidence linking greenspace and health was reviewed from a transdisciplinary standpoint, with a particular focus on potential underlying biopsychosocial pathways and how these can be explored and organized to support policy-relevant population health research.

This Report provides guidance for further epidemiological research with the goal of creating new evidence upon which to develop policy recommendations.

 

 

July 3 | 2017

For your reading enjoyment! Watch for our new “Paper of the Week” posts. We will be highlighting papers authored by CANUE members as well as new articles of interest. If you would like to have your own paper featured, or suggest a paper that you find especially interesting, please send us a note at info@canue.ca.

Our inaugural selection is The Lancet’s series on Urban design, transport and health. Check out the three commentaries and the three papers that make up the series, and illustrate the importance and timeliness of CANUE and the memberships’ efforts to advance research on urban form and health.

Urban design: an important future force for health and wellbeing
Sabine Kleinert, Richard Horton

Healthier neighbourhoods through healthier parks
Bill de Blasio

Urban design and transport to promote healthy lives
Shifalika Goenka, Lars Bo Andersen

City planning and population health: a global challenge
Billie Giles-Corti, Anne Vernez-Moudon, Rodrigo Reis, Gavin Turrell, Andrew L Dannenberg, Hannah Badland, Sarah Foster, Melanie Lowe, James F Sallis, Mark Stevenson, Neville Owen

Land use, transport, and population health: estimating the health benefits of compact cities
Mark Stevenson, Jason Thompson, Thiago Hérick de Sá, Reid Ewing, Dinesh Mohan, Rod McClure, Ian Roberts, Geetam Tiwari, Billie Giles-Corti, Xiaoduan Sun, Mark Wallace, James Woodcock

Use of science to guide city planning policy and practice: how to achieve healthy and sustainable future cities
James F Sallis, Fiona Bull, Ricky Burdett, Lawrence D Frank, Peter Griffiths, Billie Giles-Corti, Mark Stevenson