Introduction: Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population. Methods: From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features. Results: Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found. Conclusion: Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.
Plain Language Summary
The most frequently reported associations among Canadian studies on urban form and health outcomes were related to injury and weight status. Not all provinces and territories were represented in this review, with much of the evidence coming from studies in Ontario, Quebec, and Alberta. Objectively-measured aggregate built environment indicators, connectivity and route features, destinations, food environment, population density, and greenspace, parks and recreation features are associated with a range of modifiable health conditions and injury. This scoping review identifies that more Canadian research, with rigorous designs that allow for causal inference, is required to inform policy and practice.
September 22 | 2020
/in Paper of the Week /by Kerolyn ShairsinghDo physical activity and sedentary time mediate the association of the perceived environment with BMI? The IPEN adult study.
Abstract
The study’s main aim was to examine whether adults’ accelerometer-based physical activity and sedentary time mediated the associations of neighbourhood physical environmental perceptions with body mass index (BMI) and weight status across 10 high- and middle-income countries. Data from the IPEN Adult study, an observational multi-country study (n = 5712) were used. Results showed that sedentary time was a non-significant or inconsistent mediator in all models. MVPA mediated the associations of street connectivity, land use mix-diversity, infrastructure/safety for walking and aesthetics with BMI in single models. In the multiple model, MVPA only fully mediated the relation between land use mix-diversity and BMI. This finding was replicated in the models with weight status as outcome. MVPA partially mediated associations of composite environmental variables with weight status. So, although MVPA mediated some associations, future comprehensive studies are needed to determine other mechanisms that could explain the relation between the physical environment and weight outcomes. Food intake, food accessibility and the home environment may be important variables to consider. Based on the consistency of results across study sites, global advocacy for policies supporting more walkable neighbourhoods should seek to optimize land-use-mix when designing and re-designing cities or towns.
September 9 | 2020
/in Paper of the Week /by Kerolyn ShairsinghDo investments in low-income neighborhoods produce objective change in health-related neighborhood conditions?
Stephanie Brooks Holliday, Wendy Troxel, Ann Haas, Madhumita Bonnie Ghosh-Dastidar, Tiffany L Gary-Webb, Rebecca Collins, Robin Beckman, Matthew Baird, Tamara Dubowitz.
Abstract
This study examined the effect of neighborhood investments on neighborhood walkability, presence of incivilities, and crime in two low-income, primarily African American neighborhoods in Pittsburgh, USA. During the study period, one of the neighborhoods (the intervention neighborhood) received substantially more publicly-funded investments than a demographically matched comparison neighborhood. Comparisons between the neighborhoods showed a significant difference-in-difference for all three outcomes. The intervention neighborhood experienced significantly more change related to improved walkability and decreased incivilities. However, the control neighborhood experienced better crime-related outcomes. Analyses that focused on resident proximity to investments found similar results. This highlights the nuances of neighborhood investment, which is important to consider when thinking about public policy.
August 26 | 2020
/in Paper of the Week /by Kerolyn ShairsinghLongitudinal impact of changes in the residential built environment on physical activity: findings from the ENABLE London cohort study.
Christelle Clary, Daniel Lewis, Elizabeth Limb, Claire M Nightingale, Bina Ram, Angie S Page, Ashley R Cooper, Anne Ellaway , Billie Giles-Corti, Peter H Whincup, Alicja R Rudnicka, Derek G Cook, Christopher G Owen, Steven Cummins.
Int J Behav Nutr Phys Act. 2020 Aug 1;17(1):96. doi: 10.1186/s12966-020-01003-9
Abstract
August 10 | 2020
/in Paper of the Week /by Kerolyn ShairsinghHealthcare Service Use for Mood and Anxiety Disorders Following Acute Myocardial Infarction: A Cohort Study of the Role of Neighbourhood Socioenvironmental Characteristics in a Largely Rural Population.
Ismael Foroughi, Neeru Gupta, Dan Lawson Crouse.
Int. J. Environ. Res. Public Health 2020, 17(14), 4939; https://doi.org/10.3390/ijerph17144939
Abstract
August 4 | 2020
/in Paper of the Week /by Kerolyn ShairsinghHealthy built environment: Spatial patterns and relationships of multiple exposures and deprivation in Toronto, Montreal and Vancouver.
Dany Doiron, Eleanor M. Setton, Kerolyn Shairsingh, Michael Brauer, Perry Hystad, Nancy A. Ross, Jeffrey R. Brook.
Environment International, Volume 143, 2020, 106003. Doi.org/10.1016/j.envint.2020.106003.
Abstract
Background:Various aspects of the urban environment and neighbourhood socio-economic status interact with each other to affect health. Few studies to date have quantitatively assessed intersections of multiple urban environmental factors and their distribution across levels of deprivation.
Objectives: To explore the spatial patterns of urban environmental exposures within three large Canadian cities, assess how exposures are distributed across socio-economic deprivation gradients, and identify clusters of favourable or unfavourable environmental characteristics.
Methods: We indexed nationally standardized estimates of active living friendliness (i.e. “walkability”), NO2 air pollution, and greenness to 6-digit postal codes within the cities of Toronto, Montreal and Vancouver. We compared the distribution of within-city exposure tertiles across quintiles of material deprivation. Tertiles of each exposure were then overlaid with each other in order to identify potentially favorable (high walkability, low NO2, high greenness) and unfavorable (low walkability, high NO2, and low greenness) environments.
Results: In all three cities, high walkability was more common in least deprived areas and less prevalent in highly deprived areas. We also generally saw a greater prevalence of postal codes with high vegetation indices and low NO2 in areas with low deprivation, and a lower greenness prevalence and higher NO2 concentrations in highly deprived areas, suggesting environmental inequity is occurring. Our study showed that relatively few postal codes were simultaneously characterized by desirable or undesirable walkability, NO2 and greenness tertiles.
Discussion: Spatial analyses of multiple standardized urban environmental factors such as the ones presented in this manuscript can help refine municipal investments and policy priorities. This study illustrates a methodology to prioritize areas for interventions that increase active living and exposure to urban vegetation, as well as lower air pollution. Our results also highlight the importance of considering the intersections between the built environment and socio-economic status in city planning and urban public health decision-making.
July 20 | 2020
/in Paper of the Week /by Kerolyn ShairsinghHealthcare Service Use for Mood and Anxiety Disorders Following Acute Myocardial Infarction: A Cohort Study of the Role of Neighbourhood Socioenvironmental Characteristics in a Largely Rural Population.
Abstract
Depression and other mood and anxiety disorders are recognized as common complications following cardiac events. Some studies report poorer cardiac outcomes among patients in socioeconomically marginalized neighbourhoods. This study aimed to describe associations between socioeconomic and built environment characteristics of neighbourhood environments and mental health service contacts following an acute myocardial infarction (AMI or heart attack) among adults in the province of New Brunswick, Canada. This province is characterized largely by residents in small towns and rural areas. A cohort of all adults aged 45 and over surviving AMI and without a recent record of mental disorders was identified by linking provincial medical-administrative datasets. Residential histories were tracked over time to assign neighbourhood measures of marginalization, local climate zones, and physical activity friendliness (i.e., walkability). Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of healthcare use for mood and anxiety disorders over the period 2003/04-2015/16 by neighbourhood characteristics. The baseline cohort included 13,330 post-AMI patients, among whom 32.5% were found to have used healthcare services for a diagnosed mood or anxiety disorder at least once during the period of observation. Among men, an increased risk of mental health service use was found among those living in areas characterized by high ethnic concentration (HR: 1.14 (95%CI: 1.03-1.25)). Among women, the risk was significantly higher among those in materially deprived neighbourhoods (HR: 1.16 (95%CI: 1.01-1.33)). We found no convincing evidence of associations between this outcome and the other neighbourhood characteristics considered here. These results suggest that selected features of neighbourhood environments may increase the burden on the healthcare system for mental health comorbidities among adults with cardiovascular disease. Further research is needed to understand the differing needs of socioeconomically marginalized populations to improve mental health outcomes following an acute cardiac event, specifically in the context of smaller and rural communities and of universal healthcare coverage.
July 6 | 2020
/in Paper of the Week /by Kerolyn ShairsinghA scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence.
McCormack GR, Cabaj J, Orpana H, Lukic R, Blackstaffe A, Goopy S, Hagel B, Keough N, Martinson R, Chapman J, Lee C, Tang J, Fabreau G.
Health Promot Chronic Dis Prev Can. 2019 May;39(5):187-200. doi: 10.24095/hpcdp.39.5.03.
Abstract
Plain Language Summary
The most frequently reported associations among Canadian studies on urban form and health outcomes were related to injury and weight status. Not all provinces and territories were represented in this review, with much of the evidence coming from studies in Ontario, Quebec, and Alberta. Objectively-measured aggregate built environment indicators, connectivity and route features, destinations, food environment, population density, and greenspace, parks and recreation features are associated with a range of modifiable health conditions and injury. This scoping review identifies that more Canadian research, with rigorous designs that allow for causal inference, is required to inform policy and practice.
June 23 | 2020
/in Paper of the Week /by Kerolyn ShairsinghLocal-Area Walkability and Socioeconomic Disparities of Cardiovascular Disease Mortality in Japan.
Koohsari MJ, Nakaya T, Hanibuchi T, Shibata A, Ishii K, Sugiyama T, Owen N, Oka K.
J Am Heart Assoc. 2020 Jun 9:e016152. doi: 10.1161/JAHA.119.016152
Abstract
Background: There are spatial disparities in cardiovascular disease (CVD) mortality related to area-level socioeconomic status (SES) disadvantage, but little is known about the spatial distribution of CVD mortality according to built environment factors. We examined joint associations of neighborhood walkability attributes and SES with CVD mortality rates through linkage of Japanese national data sets.
Methods and Results: National data were used from the 1824 municipalities (of the 1880 potentially eligible municipalities) across Japan. The outcome was mortality from CVD for a 5-year period (2008-2012) for each municipality. A national index of neighborhood deprivation was used as an indicator of municipality-level SES. A national walkability index (based on population density, road density, and access to commercial areas) was calculated. Compared with higher SES municipalities, relative rates for CVD mortality were significantly higher in medium SES municipalities (relative rate, 1.05; 95% CI, 1.02-1.07) and in lower SES municipalities (relative rate, 1.09; 95% CI, 1.07-1.12). There were walkability-related gradients in CVD mortality within the high and medium SES areas, in which lower walkability was associated with higher rates of mortality; however, walkability-related CVD mortality gradients were not apparent in lower SES municipalities.
Conclusions: CVD mortality rates varied not only by area-level SES but also by walkability. Those living in areas of lower walkability were at higher risk of CVD mortality, even if the areas have a higher SES. Our findings provide a novel element of the evidence base needed to inform better allocation of services and resources for CVD prevention.
June 9 | 2020
/in Paper of the Week /by Kerolyn ShairsinghBuilt Environment, Physical Activity, and Obesity: Findings from the International Physical Activity and Environment Network (IPEN) Adult Study.
Sallis JF, Cerin E, Kerr J, Adams MA, Sugiyama T, Christiansen LB, Schipperijn J, Davey R, Salvo D, Frank LD, De Bourdeaudhuij I, Owen N.
Annu Rev Public Health. 2020 Apr 2;41:119-139. doi: 10.1146/annurev-publhealth-040218-043657.
Abstract
Creating more physical activity-supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weight status in 12 countries on 5 continents (n > 14,000). This article presents reanalyzed data from eight primary papers to identify patterns of findings across studies. Neighborhood environment attributes, whether measured objectively or by self-report, were strongly related to all physical activity outcomes (accelerometer-assessed total physical activity, reported walking for transport and leisure) and meaningfully related to overweight/obesity. Multivariable indexes of built environment variables were more strongly related to most outcomes than were single-environment variables. Designing activity-supportive built environments should be a higher international health priority. Results provide evidence in support of global initiatives to increase physical activity and control noncommunicable diseases while achieving sustainable development goals.
Clearing the Air: How electric vehicles and cleaner trucks can reduce pollution, improve health and save lives | July 8th | 2020
/in Events, News, Webinars /by Eleanor SettonJULY 8TH (10am pacific | 1pm eastern)
CANCELLED
A recording of a previous webinar featuring this report is available here.
Understanding the benefits of cleaner air and how we can achieve lower pollution levels is key to effective healthy policy. “Clearing the Air: How electric vehicles and cleaner trucks can reduce pollution, improve health and save lives in the Greater Toronto and Hamilton Area” is being released today to mark Clean Air Day in Canada. This report quantifies the benefits of electrifying cars and buses and shifting to new more efficient trucks, and recommends policy actions governments can take to work towards achieving cleaner air.
Hear about the study highlights and talk with the report authors:
Laura Minet- Transportation Engineering, PhD Candidate, University of Toronto
Sarah Buchanan – Clean Economy Program Manager, Environmental Defence
Helen Doyle – Ontario Public Health Association Environmental Health Working Group
Marianne Hatzopoulou – Transportation and Air Quality Research Group, Associate Professor, University of Toronto
David Stieb- Public Health Physician, Environmental Health Science and Research Bureau, Health Canada