Built Environment Interventions Research Articles

What causes Emergency Medical Services (EMS) delay? Unravel high-risk buildings using citywide ambulance trajectory data

Emergency Medical Services (EMS) delay poses a challenge to public health, especially in ultra-dense cities and aging societies. The potential relationship between the built environment and the ambulance response time (ART) has not been thoroughly investigated at the building-level. This impedes the unraveling of high-risk buildings for EMS delay, and thus the precise optimization of urban EMS systems. Our study develops a quantitative-qualitative approach to construct a building-level ART prediction model and then validated it with ambulance drivers' experiences. A comprehensive theoretical framework is tailored for ART prediction incorporating neglected built environment factors of land use and development intensity. Based on 73,129 ambulance trajectories, a machine learning model is constructed and then employed to predict the ART for each of the 253,475 buildings in central Shanghai under multiple combinations of traffic periods and weather conditions. The results show that the accuracy of high-risk buildings for EMS delay achieves 91%. Moreover, three of the neglected built environment factors, medical POIs density, business POIs density and floor area ratio, rank high in the factor importance. The ambulance drivers’ experiences validate the importance of these built environment factors and emphasize the value of bus priority lanes for ambulance to borrow for swift access. In addition, to illustrate potential applications, we simulated the effects of built environment interventions in case areas predicted to concentrate high-risk buildings. This work provides a new computer-based tool to pinpoint the service blind spots of such urban emergency systems and to develop built environment interventions.

Examining multiscale built environment interventions to mitigate travel-related carbon emissions

While established studies have explored interventions in the built environment (BE) and transportation sector to mitigate travel carbon emissions (TCE), planners still struggle to determine the most effective units of intervention, identify key variables, and determine their optimal values. This study addresses the gap by employing the extreme gradient boosting (XGBoost) model to create a multi-scale comparative framework. This study revealed that the relationship between the built environment and travel-related carbon emissions varies depending on the zoning and scale of the BE measurement unit. The explanatory power of TCE varies across different geographic units, with the 15-min walk distance buffer of residents being the most effective in explaining TCE. Most variables were nonlinearly associated with TCE, and the precise threshold of the association between BE attributes and TCE was quantified. Based on these findings, we provide precise and nuanced insights into BE interventions to reduce TCE.

Should transit-oriented development consider station age effects?

Promoting transit-oriented development (TOD) through the built environment and transport interventions is an essential planning strategy for achieving urban sustainable objectives. Yet, existing studies largely neglect the critical effects of station age on the relationship between the built environment and metro ridership. This study fills this gap by examining how the impact of the built environment on metro ridership varies by station age in Shanghai, China. We apply machine learning methods to identify key determinants of metro ridership and examine nonlinear associations across three station age intervals. The results suggest: (1) the effects of the built environment and metro ridership are not homogeneous among different station ages; (2) the transport-related built environment factors contribute more to metro ridership at the early stage period, while the land use-related built environment variables more profound at latter stages. These insights provide planners with stage-specific guidance on tailoring built environment interventions for TOD.

Imagining and implementing healthy city interventions: Combined results from parallel concept mapping exercises in Montreal with community members and stakeholders.

Built environment interventions provide structural solutions to complex urban challenges. Though community voices are part of municipal decision-making, planners and public health professionals need tools to better integrate their perspectives for desired changes (what) when implementing built environment interventions (how). We present two simultaneous concept mapping exercises conducted in Montréal, Canada, to facilitate the consideration of these dimensions. Community members were prompted about neighbourhood changes that could improve their quality of life; stakeholders were prompted about factors that contribute to successful implementation of interventions. Through each exercise, items were generated, grouped, and rated on importance and feasibility. Concept maps were produced using multidimensional scaling and hierarchical cluster analysis. The clusters identified by community members and stakeholders were combined into a Community × Stakeholder Matrix, which supported discussions on interventions with the research's Advisory Committee. Thirty-two community members generated 41 responses, which resulted in 6 clusters: (1) strengthen public transportation, (2) reduce space dedicated to cars, (3) foster local social connections, (4) develop quality cycling infrastructure, (5) improve pedestrian accessibility, and (6) green the city. Thirty-seven stakeholders generated 40 items, which resulted in 5 clusters: (1) collaboration with stakeholders and citizens, (2) planning and evaluation, (3) common vision for the future, (4) regulatory framework and funding, and (5) context-informed approach. Capturing the collective vision of our urban environments and the processes underlying change through concept mapping can lead to more successful changes. We propose combining understandings of the what and how into a matrix to support evaluation and strategic planning of interventions and better integrate community voices into operational planning.

Examining the relationship between car ownership, car use, and exercise: Role of the built environment

Although owning a car allows people to access distant fitness centers and may promote exercise, car use may encourage sedentary behavior and reduce exercise. There is no empirical evidence on the relationship between car ownership, car use, and exercise, and whether improving the built environment is useful to encourage exercise by affecting car ownership and usage. Through a survey of 1049 respondents in Shanghai and subsequent path analysis, we investigate the relationship between the built environment around residences and workplaces, car ownership, car usage for work and non-work trips, and the duration of exercise weekly. While car ownership directly fosters exercise, it indirectly reduces exercise due to increased car usage for work and non-work trips, and the negative effects outweigh the positive. Moreover, the built environment around residences and workplaces affects exercise through car ownership and usage. People living in dense and downtown neighborhoods conduct more exercise because of the fewer likelihood of owning and/or using cars. More intersections and transit stops around residences and mixed land use around workplaces reduce exercise by increasing car ownership and/or car usage. We conclude that reducing car ownership and usage can promote exercise, and built environment interventions are effective in enhancing public health outcomes.

Acceptability of built environment interventions to support active travel in 17 Canadian metropolitan areas: findings from the THEPA study

Acceptability of built environment interventions to support active travel in 17 Canadian metropolitan areas: findings from the THEPA study

Acceptability of built environment interventions to improve healthy eating and physical activity among city dwellers in Saskatchewan, Canada: THEPA findings from a local context

ABSTRACT Obesity and related chronic conditions present significant challenges in both national and global public health. Modifying the built environment stands as a population-level strategy to foster healthier behaviours and alleviate the burden of chronic diseases. The success of such interventions, however, hinges on their public acceptability, an aspect often overlooked. This study aimed to evaluate the level of public acceptability concerning diverse built environment interventions promoting healthy eating and physical activity within two major Canadian cities. We conducted an analysis of data gathered from 2,133 participants through a pan-Canadian survey, employing multilevel logistic regression. Interventions were categorized using the Nuffield Council on Bioethics’ ‘intervention ladder’, graded by their level of intrusiveness. Overall, individuals were more agreeable to implementing the least intrusive interventions in both food and physical activity domains. However, public support varied based on the type of intervention within and across different levels of intrusiveness. Notably, individuals self-identifying as women, Indigenous, or born outside of Canada demonstrated a higher likelihood of accepting interventions across all levels. The connection between neighborhood attributes and acceptability remained inconclusive. These locally pertinent findings carry practical implications for selecting, designing and implementing built environment interventions.

Using mobile phone big data and street view images to explore the mismatch between walkability and walking behavior

Stimulating more citizens to walk plays an essential role in building a healthy city. This paper explores the mismatch between walkability and walking behavior, using mobile phone data, street view images, and various sources of open data. Using Shenzhen as our case study, we identified walking trips of 6 months in 2021 from cellular mobile data, taking the rule-based heuristics approach. We collected ground truth GPS data to validate the walking trip extraction method. Open data and deep learning enabled quantifying walkability from the perspective of four pedestrian needs: safety, convenience, continuity, and attractiveness. We employed geospatial techniques to identify the mismatch areas between walkability and walking behavior in the city. We also explored the spatially varying effects of walkability on walking behavior. Our results showed that the mismatch areas with high-level walking trips but low-level walkability mainly occurred in the fringe areas of the central business district (CBD) and subcenters that require prioritizing more interventions. Moreover, walkability showed strong effects on walking trips in the inner suburbs. For the four aspects of our walkability framework, safety and convenience had greater positive effects on walking trips in suburbs than in urban areas. Continuity promotes walking trips mainly in the city’s western sector. The positive effect of attractiveness on walking trips clustered in the central and western parts of the city. Based on the findings, we provide prioritized and contextualized built-environment intervention strategies and policy recommendations for urban designers and transportation planners.

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions.

Pedestrian injuries from falls are an understudied cause of morbidity. Here, we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions. Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identified in the 2019 National Emergency Medical Services Information System database. In total, 118,520 injurious pedestrian falls and 33,915 pedestrians-motor vehicle collisions were identified, with 89% of the incidents occurring in urban areas. Thirty-two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 19% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.1 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was 3.9 for individuals 50years and older and 6.1 for those 65years and older. In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is significantly greater and justifies an increased focus on outdoor falls prevention, in addition to urban design, policy, and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the USA.

Ineffective built environment interventions: How to reduce driving in American suburbs?

Designing effective built environment policies to reduce auto use is key to promoting sustainable transportation in suburban areas. However, most studies on the association between the built environment and auto use focus on the entire region rather than suburban areas. In addition, previous studies often ignore the possible nonlinear association between them. Applying Gradient Boosting Decision Trees to the data in the Twin Cities, USA, this study explores the nonlinear relationships between built environment attributes and driving distance in suburban areas and illustrates how the relationships differ from those in urban areas. The results show that suburban residents are less sensitive to the built environment than urban residents. More importantly, built environment policies that work in urban areas might be infertile in suburban areas. Although many studies have advocated population densification and mixed-use development for driving mitigation, this study suggests that these policies are ineffective in suburban areas. Instead, promoting job accessibility and densifying intersection density are promising to reduce auto use in suburban areas. Densifying transit stops has a small but nontrivial contribution to mitigating auto use.

The vitality of native grassland plants in current urban climatic conditions in Gauteng, South Africa

Plants are essential components of urban microclimates, as they can help mitigate some of the adverse effects of urbanisation, enhance environmental quality, and thus contribute to overall species well-being and the sustainability of cities. Urban planners and policymakers often incorporate green infrastructure and urban greening into their strategies to create healthier and more livable urban environments. Plants are primary producers, serving as a baseline for the attraction and habitat of other species; they also provide vital ecosystem services, such as climate amelioration. Landscape designers and horticulturalists can influence plant selection through built environment interventions, increasing urban ecosystem services and benefits. Based on the evidence of native plant preferences by insects and people and their natural adaptation to regional climatic extremes, we tested, through an experimental study, the potential of native grassland plants to survive in assemblages in current urban environments. The study specifically monitored the tolerance of nine native grassland plant species to urban environments over six months in Gauteng, South Africa. A stratified random sampling was done by monitoring permanent quadrats in two purposefully engineered urban native gardens. Plant vitality was evaluated using chlorophyll a fluorescence. General climate data were obtained from a local weather station. Microclimatic temperature and humidity data were collected at each site and quadrat using Hygrochron High-Resolution Temperature and Humidity data loggers. The results indicated that all nine native plant species functioned with good photosynthetic health and can be recommended as resilient species that tolerate current urban conditions. Correlation studies indicated that two forb species, Haplocarpha lyrata and Scabiosa columbaria, showed great tolerance to current urban conditions. This vitality is likely contributed to their winter dormancy morphologically based on below-ground biomass, and their physiological adaptation to tolerate both wet and dry habitat conditions. This points to the potential of grassland forb species for urban use and the potential for climate adaptation in grassland areas.

The nonlinear relationship between the active travel behavior of older adults and built environments: A comparison between an inner-city area and a suburban area

The nonlinear relationship between the built environment and active travel among older adults within the inner-city context has been widely researched. However, limited attempts have been made to explore the demographic and spatial heterogeneity of the built environment's effects in dense urban or peripheral urban contexts. With the outward urban expansion brought about by rapid suburban growth in Chinese cities, there have been dynamic built environment, service, and socioeconomic composition changes in the suburbs. Using data from Xiamen, China, this study employs a BO-LightGBM method to fill this gap among different cohorts of the aging population (different personal statuses and family relationships) within two contexts, and the SHAP method is adopted to interpret the models with distinctive spatial patterns of built environment differentiation. Our results show that differentiation in the threshold values and gradients exists between built environment associations and the elderly's active travel in Inner Xiamen and Outer Xiamen. The contribution of built environment variables to impact older adult's active travel is related to the regional context as well as demographic characteristics. These results offer nuanced and contextualized built environment interventions for building age-friendly cities.

<em>Ex ante</em> analysis of circular built environment policy coherence

As European governments adopt new circular built environment policies to cope with the socio-ecological crisis, the need for evaluating such policies gains in urgency. Ex post evaluation is, however, difficult as these policies have not been in place long enough to have had significant effects. Nonetheless, ex ante policy evaluation may be possible by assessing policy coherence or the alignment and synergies of policy goals, instruments and implementation practices. This paper proposes a framework to analyse circular built environment policies. This framework is based on a combination of two existing analytical frameworks: circular city development and policy coherence analysis. The framework is tested for the case of a circular built environment in campus development at Delft University of Technology in the Netherlands, which is regarded as an urban development proxy. Policy documents and semi-structured interviews were analysed and coded. Results confirm previous findings about a prevailing focus on looping actions and indicates limited policy instrumentalisation across governance levels. Identified multilevel (in)coherence in circular city policy is pointed out as consequence of siloed-led and supply chain-based thinking and underdeveloped circular policy frameworks. Finally, the analytical benefits of circular city development and policy coherence frameworks are discussed. Policy relevance Circular economy policies are conceptually limited in delivering a more circular city and built environment. By proposing and testing a circular city policy coherence framework, this article reveals the limited effect of circular economy policies in coping with unsustainable urbanisation. Policymaking and implementation for circularity in the built environment require frameworks that embrace urban complexities instead of reductionist approaches seeing the built environment as a mere agglomeration of supply-chains. Policymakers may use the proposed circular city policy coherence framework as a tool for ex ante policy evaluation in diverse areas of urban development, and specifically for built environment interventions. The combination of both content- and process-based frameworks enables the identification of possible (in)coherence in current and future policy goals, instruments and implementation practices. This can improve policy in early stages of implementation and create more effective policy outputs and outcomes in the long term.

The gap in capacity building on climate, health, and equity in built environment postsecondary education: a mixed-methods study.

Institutions of higher education are feeling increasing pressure from both students and the international climate community to offer more courses and joint degrees on the role of the built environment in advancing climate action, population health, and social equity. The built environment plays a leading role in this new, transdisciplinary approach. Thoughtfully designed buildings, neighborhoods, and communities can simultaneously lower per capita greenhouse gas emissions, reduce population exposure to dangerous climate-sensitive extreme weather events, reduce disparities in climate-related health outcomes, and advance social equity goals. This mixed-methods study explored the extent to which post-secondary courses and joint degree programs teach students the research methods and technical skills they will need to design and implement built environment interventions addressing the effects of climate change on population health and social equity. The study found that the number of universities offering courses addressing climate, health, and equity in the built environment grew from 2018 to 2022. The number of joint planning/public health degree programs rose from four in 2005 to 15 in 2022. No joint architecture/public health degree programs were identified. A detailed review of 99 course descriptions from three universities found that 17 courses (roughly 1/5 of the total) covered population health, built environment, and climate change; and, 2/3 of the set (n = 60) covered two out of the three topics. Schools of public health were more likely to offer courses covering all three topics, whereas schools of architecture were more likely to include the building scale in relevant courses. Exposure pathways and social equity/vulnerable populations were the most common methods included in relevant courses. Professors and administrators at institutions identified by the study as "transdisciplinary-ready" reported that accreditation requirements and university rules governing the allocation of student tuition had slowed efforts to offer cross-listed courses. However, faculty in these institutions regularly collaborate informally with their peers - both on transdisciplinary research and by offering guest lectures in each other's courses. The results of this study show that, while universities have made great strides over the past 18 years in beginning to support transdisciplinary research and pedagogy, institutional barriers and gaps in key content areas remain.

Built environment interventions for emission mitigation: A machine learning analysis of travel-related CO2 in a developing city

The transport sector accounts for more than one-fifth of global CO2 emissions. Reducing fossil fuel consumption and travel-related CO2 emissions (TCE) is a major approach to mitigating global climate change. Urban planners worldwide propose to promote low-carbon travel by changing the built environment. Therefore, understanding the relationships between built environment variables and TCE is key to the development of land use and transportation policies. Using 2019 regional household travel data from Zhongshan, a polycentric urban area in China, this study developed a gradient boosting decision trees model to estimate the relative importance of built environment variables in predicting TCE and their nonlinear associations with TCE. Built environment variables collectively contribute nearly half of the predictive power to predicting TCE, suggesting the potential of built environment interventions. Among them, location accessibility to city-level and township-level centers and population density are the top-three important features in predicting TCE. Furthermore, most built environment variables show threshold relationships with TCE. The results suggest that polycentric development, intensification of town centers, and densification of street networks are conducive to TCE mitigation. These findings inform planners of effective ranges of built environment variables to promote low-carbon travel.

Heat vs. Health: Home Office under a Changing Climate

Stressors are especially widespread in urban agglomerations. Common themes of built environment interventions that support health and well-being are blue and green infrastructure, indoor and outdoor air quality, thermal comfort, access to natural lighting, and acoustics. Given the current megatrends of increasing summer temperatures and the high popularity of home offices, we aimed at modeling thermal comfort changes of people working at home in three Austrian cities (Vienna, Innsbruck, and Graz) during the next decades until 2090. We present findings based on (I) an inter-disciplinary literature search and (II) indoor and outdoor climate simulations for actual and future climate scenarios. Based on the results, we discuss the potential impacts for work and human health and well-being, and we suggest a framework for the home office in “post-COVID-19 Austria” that integrates social, ecological, and economic aspects. The results of our study indicate that, in future climate scenarios, overheating of the interior can no longer be prevented without active cooling measures and nature-based solutions. Recommendations on the adjustment of behavior under climate change, including greening, adequate ventilation, and cooling techniques, are thus urgently needed for employees who are working from home in order to maintain physical and mental health and wellbeing.

Association of tobacco use with the tobacco-related built environment: an ecological study from urban slums of Bhopal, India

IntroductionTobacco is one of the biggest public health problems and a major risk factor for various non-communicable diseases (NCDs). An important aspect of tobacco control strategy could include modifications in the tobacco-related built environment. This study investigated the association between tobacco shop density and tobacco use prevalence in the urban slums of Bhopal city, India.MethodsWe conducted a cross-sectional survey to obtain the distribution of tobacco-related built environment (tobacco shops) in the neighbourhood (400-m service area) of 32 urban slum clusters of Bhopal. We plotted this distribution using the 'network service area analysis' in ArcMap 10.7.1 software. Then, we used an ecological design to determine the association between tobacco shop density and tobacco use prevalence in these 32 clusters (N = 6214 adult inhabitants). We used multiple linear regression analysis to estimate the regression coefficient (adjusted for socio-demographic variables) between tobacco use and tobacco shop density at the cluster level.ResultsThe prevalence of tobacco use among all 32 slum clusters ranged from 22.1 to 59.6% (median 40.9% with IQR 31.8–44.2). There were 194 tobacco shops situated in the neighbourhood of all clusters. The median density of tobacco shops was 59.40/km2 (IQR 39.9–108.1/km2) in the neighbourhoods of slum clusters. Tobacco use prevalence was significantly associated with tobacco shop density (estimate or B = 0.071, p value = 0.002) after adjusting for age, literacy, wealth index, and gender ratio.ConclusionsTobacco use prevalence is significantly associated with tobacco shop density in the slums of Bhopal city in central India. We need to develop appropriate built environment interventions to control rampant tobacco use.

Natural experiments in healthy cities research: how can urban planning and design knowledge reinforce the causal inference?

Healthy cities researchers often ask questions about cause and effect: the causes are built environment interventions via urban planning and design practices, such as park renovation, a new bus line or a housing redevelopment programme; effects are individual and public health outcomes. The growing interest in natural experiments for causal inference in healthy cities research comes mainly from the public health fields. Planning and design knowledge of how the interventions were produced should have a central role in research design but is rarely discussed. This is evident from our analysis of three well-documented natural experiment research projects. This also motivates us to build a conceptual model, with the legal assignment of treatment and control groups and random distribution of confounders (LARD principle) to demonstrate how urban planning and design knowledge can help discover strong natural experiments to reinforce the causal inference in healthy cities research.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Wave 1 results of the INTerventions, Research, and Action in Cities Team (INTERACT) cohort study: Examining spatio-temporal measures for urban environments and health.

Built environment interventions have the potential to improve population health and reduce health inequities. The objective of this paper is to present the first wave of the INTErventions, Research, and Action in Cities Team (INTERACT) cohort studies in Victoria, Vancouver, Saskatoon, and Montreal, Canada. We examine how our cohorts compared to Canadian census data and present summary data for our outcomes of interest (physical activity, well-being, and social connectedness). We also compare location data and activity spaces from survey data, research-grade GPS and accelerometer devices, and a smartphone app, and compile measures of proximity to select built environment interventions.