Built Environment Interventions Research Articles

The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments.

BackgroundEvidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity.MethodsEligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI).ResultsTwelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen’s centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result.ConclusionsThe present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0433-3) contains supplementary material, which is available to authorized users.

Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study.

BackgroundStudies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking.MethodsUsing data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years.ResultsInstalling and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness.ConclusionsIn low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).

Behaviour change towards active mobility influenced by policy interventions in East London.

INTRODUCTION In order to increase the levels of physical activity in urban population, it is essential to know how a behavioural change towards active mobility can be produced and what factors influence people in their choice to walk and cycle. There is evidence to support that changing the built environment has the potential to influence walking and cycling behaviour. METHODS / RESULTS A framework to assess the process of behaviour change towards active travel modes (walking and cycling) and understand its determinants has been designed and will be tested with preliminary results in a case-study area. A longitudinal survey with the goal of 2,000 participants in 7 European cities will provide the core data for the preliminary analysis (the survey will still be open until the end of 2016). The conceptual framework used for this assessment is based on the Transtheoretical Model of Behaviour Change, which describes five stages of change. The questionnaires feature specific questions for the stage of change diagnosis of the participants and other attitudinal and behavioural questions. This provides the opportunity to assess the potential impacts of policy interventions in the relatively short term before the population can actually act upon change. The framework includes spatial analysis, which will be presented for the case-study of the post-Olympic regeneration plans in East London. Different levels of intensity of exposure to built environment interventions will be defined in a unique dose-response model in regards to the distance, number and quality of interventions that every group will be exposed to. Conclusions Understanding the relative importance of the factors influencing mobility behaviour will help to determine the most promising policy avenues for the change towards walking and cycling. This on-going study puts together a unique mix of theories and methods in order to explore the bridges between behavioural change science and policy making.

A built environment response to the rising costs of dementia

Purpose This paper aims to identify costs related to dementia care provision and explore how purpose-built environment investments can help control these costs and improve quality of life and clinical outcomes. Design/methodology/approach This research adopts a multi-method approach where the findings of a literature review drove the analysis of data obtained from the 115 pilot projects funded by the Department of Health England’s National Dementia Capital Investment Programme. Findings Under the UK Government’s new productivity challenge, it is fundamental to identify actions that provide value for money to prioritise policy and practice. This paper identifies healthcare spaces (e.g. bathroom) where the impact of the built environment on healthcare costs are most evident and building elements (e.g. lighting) to which these costs can be directly associated. The paper advocates the development of evidence and decision support tools capable of: linking built environment interventions to the healthcare costs; and helping the healthcare and social care sectors to develop effective and efficient capital investment strategies. Research Limitations/implications Further work needs to develop more systematic ways of rationalising proactive and timely built environment interventions capable of mitigating dementia (and older people) care cost escalation. Originality/value This research takes an innovative view on capital investment for care environments and suggests that appropriate built environment interventions can have a profound impact on costs associated with dementia care provision.

Walkability and cardiometabolic risk factors: Cross-sectional and longitudinal associations from the Multi-Ethnic Study of Atherosclerosis

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004–2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health.

Built environment and mode choice relationship for commute travel in the city of Rajkot, India

Metropolitan areas around the world are looking for sustainable strategies to reduce use of private automobiles, energy consumption and emissions, often achieved by built environment interventions that encourage use of sustainable modes of transport. This study contributes by providing the empirical evidence on the relation between built environment and mode choice in context of Indian city of Rajkot. Using personal interview data and data available from Rajkot Municipal Corporation it is observed that there is a strong tendency among Rajkot residents to preselect their residential location to suit their modal preferences. This is especially true for non-motorized transport users. Among the built environment variables, access to destination and land use related indicators also have significant influence on mode choice. The study Infers that the land use policy should focus on accessibility and mixing of diverse uses, and transport supply will have to be location based to support non-motorized and public transport travel.

Heterogeneous effects of neighborhood type on commute mode choice: An exploration of residential dissonance in the Twin Cities

Many studies have measured residential and travel preferences to address residential self-selection and they often focused on the average or independent effect of the built environment on travel behavior. However, individuals' behavioral responses to built environment interventions may vary by their different tastes. Using the 2011 data from the Minneapolis–St. Paul metropolitan area, this study examines the influences of neighborhood type, travel attitudes, and their interaction terms on commute mode choice. The interactions between neighborhood type and travel attitudes have no significant impact on driving commute frequency whereas the effects of neighborhood type on the propensity for transit commute differ by transit preference. Specifically, urban consonants (including those in LRT neighborhoods) have the highest propensity for transit commute, followed by suburban dissonants, urban dissonants, and then suburban consonants. Therefore, individuals' heterogeneous responses to built environment elements should be taken into account in future research and in the design of land use and transportation policies aiming to shape urban travel.

Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study.

BackgroundFew studies to date have explored the relationship between the built environment and physical activity specifically in rural settings. The Ontario Public Health Standards policies mandate that health units in Ontario address the built environment; however, it is unclear how public health practitioners are integrating the built environment into public health interventions aimed at improving physical activity in chronic disease prevention programs.MethodsThis descriptive qualitative study explored interventions that have or are being implemented which address the built environment specifically related to physical activity in rural Ontario health units, and the impact of these interventions. Data were collected through twelve in-depth semi-structured interviews with rural public health practitioners and managers representing 12 of 13 health units serving rural communities. Key themes were identified using qualitative content analysis.ResultsThemes that emerged regarding the types of interventions that health units are employing included: Engagement with policy work at a municipal level; building and working with community partners, committees and coalitions; gathering and providing evidence; developing and implementing programs; and social marketing and awareness raising. Evaluation of interventions to date has been limited.ConclusionsPublic health interventions, and their evaluations, are complex. Health units who serve large rural populations in Ontario are engaging in numerous activities to address physical activity levels. There is a need to further evaluate the impact of these interventions on population health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1786-2) contains supplementary material, which is available to authorized users.

The Built Environment and Actual Causes of Death

This article reviews empirical scholarship on preventable actual causes of death—namely, physical activity, food, and traffic-induced injury–related built environment interventions that lead to health improvements. A systems perspective built on the ecological health model is offered that addresses social determinants of health- and place-based contexts. In doing so, this article offers examples of upstream approaches to address the actual causes of death and ends with guidance on planning practice, research, and teaching organized around the research divisions of the Association of Collegiate Schools of Planning.

Effective use of the built environment to manage behavioural and psychological symptoms of dementia: a systematic review.

ObjectiveTo determine the effectiveness of built environment interventions in managing behavioural and psychological symptoms of dementia (BPSD) among residents in long-term care settings.MethodsSystematic review of literature published from 1995–2013. Studies were included if they: were randomized controlled trials, quasi-experimental trials, or comparative cohort studies; were in long-term or specialized dementia care; included residents with dementia and BPSD; and examined effectiveness of a built environment intervention on frequency and/or severity of BPSD. Quality of included studies was assessed using the Downs and Black Checklist. Study design, patient population, intervention, and outcomes were extracted and narratively synthesized.ResultsFive low to moderate quality studies were included. Three categories of interventions were identified: change/redesign of existing physical space, addition of physical objects to environment, and type of living environment. One of the two studies that examined change/redesign of physical spaces reported improvements in BPSD. The addition of physical objects to an existing environment (n = 1) resulted in no difference in BPSD between treatment and control groups. The two studies that examined relocation to a novel living environment reported decreased or no difference in the severity and/or frequency of BPSD post-intervention. No studies reported worsening of BPSD following a built environment intervention.ConclusionsThe range of built environment interventions is broad, as is the complex and multi-dimensional nature of BPSD. There is inconclusive evidence to suggest a built environment intervention which is clinically superior in long-term care settings. Further high-quality methodological and experimental studies are required to demonstrate the feasibility and effectiveness of such interventions.

Moving toward implementation: The potential for accountable care organizations and private–public partnerships to advance active neighborhood design

The 2010 Affordable Care Act's (ACA) aims of lowering costs and improving quality of care will renew focus on preventive health strategies. This coincides with a trend in medicine to reconsider population health approaches as part of the standard curriculum. This intersection of new policy and educational climates presents a unique opportunity to reconsider traditional healthcare structures. This paper introduces and advances an alignment that few have considered. We propose that accountable care organizations (ACOs), which are expected to proliferate under the ACA, present the best opportunity to establish partnerships between healthcare, public health, and community-based organizations to achieve the legislation's goals. One example is encouraging daily physical activity via built environment interventions and programs, which is recommended by numerous groups. We highlight how nonprofit organizations in Sacramento, California have been able to leverage influence, capital, and policy to encourage design for active living, and how their work is coordinating with public health and healthcare initiatives. In conclusion, we critically examine potential barriers to the success of partnerships between ACOs and community organizations and encourage further exploration and evaluation.

Maximising students' use of purpose-built shade in secondary schools: Quantitative and qualitative results of a built-environment intervention

A trial installing shade sails at secondary schools found increased students' use of newly shaded areas, but relatively low use overall. We examined site features and weather related to use of these shaded areas. Tables with seats and temperatures ≥27°C increased student use of shaded areas, presence of grass decreased use. Focus groups at eight schools suggest students were unaware of changes to their habitual use of favoured locations. Results infer careful selection of locations for built-shade and provision of tables with seats will assist in maximising student use and investments in shade sails.

Connecting and strengthening communities in places for health and well-being

A healthy built environment is one which connects citizens together to create a sense of community. These are influential determinants of good mental and physical health. This paper presents an overview of key research on how the built environment supports the development of community as part of creating and sustaining places for health and well-being. Formal public places such as town squares, plazas, parks and gardens cultivate community in numerous ways. Informal public places such as those in between buildings, on the street, at the train station and bus stop are also important for social encounters and interaction. Careful design of open space, neighbourhood streets and buildings can encourage human interaction as part of community creation. Evidence is presented here as a ‘Places Framework’ to illuminate the ways in which place strengthens community. The paper concludes by discussing and critically evaluating policy implications for urban planners and designers. Major gaps in the research are identified and suggestions made for future investigative work to strengthen the evidence for building healthy communities through built environment interventions.

Built environment interventions for increasing physical activity in adults and children

Built environment interventions for increasing physical activity in adults and children

Planning Health-Promoting Development: Creation and Assessment of an Evidence-Based Index in the Region of Peel, Canada

There is mounting evidence of relationships between the built environment, health behaviours, and chronic disease. Collaborative intervention efforts aimed at improving sustainability and environmental planning are underway in many jurisdictions, but relatively few have focused on the rationale and evidence for health-promoting development. Given current rates of chronic diseases, such as diabetes, a collaborative effort between planning departments, public health professionals, and researchers was undertaken to create an evidence-based healthy development index aimed at encouraging health-promoting development in the municipality of the Region of Peel, ON, Canada. In this paper we present the review process used to establish prerequisite elements and measures in the index, and the spatial analytical methodology developed to assess these measures within existing neighbourhoods in our setting. The assessment process and results offer important insight into barriers in existing design standards, official plan policies, zoning by-laws, and technical requirements that limit health-promoting development and have hindered implementation of the index as a tool for planning policy. Our discussion highlights challenges that those seeking to undertake similar interventions in other rapidly developing suburban jurisdictions may encounter. Despite barriers to implementation of the index in the form originally intended, a variety of positive policy contributions have been made in municipal and provincial jurisdictions as a result of this work. Further study is needed to identify and address detailed barriers to policy implementation, and to document the longitudinal health impacts associated with this built environment intervention

Built environment interventions to stimulate leisure-time physical activity–evaluating the planning and implementation process in 3 Danish municipalities

Built environment interventions to stimulate leisure-time physical activity–evaluating the planning and implementation process in 3 Danish municipalities

There's no such thing as bad weather, just the wrong clothing: climate, weather and active school transportation in Toronto, Canada.

Climatic conditions may enable or deter active school transportation in many North American cities, but the topic remains largely overlooked in the existing literature. This study explores the effect of seasonal climate (i.e., fall versus winter) and weekly weather conditions (i.e., temperature, precipitation) on active travelling to school across different built and policy environments. Home-to-school trips by 11-12-year-old children in the City of Toronto were examined using data from the 2006 Transportation Tomorrow Survey. Binomial logistic regressions were estimated to explore the correlates of the choice of active (i.e., walking) versus non-active (i.e., private automobile, transit and school bus) mode for school trips. Climate and weather-related variables were not associated with choice of school travel mode. Children living within the sidewalk snow-plough zone (i.e., in the inner-suburban neighbourhoods) were less likely to walk to school than children living outside of the zone (i.e., in the inner-city neighbourhoods). Given that seasonality and short-term weather conditions appear not to limit active school transportation in general, built environment interventions designed to facilitate active travel could have benefits that spill over across the entire year rather than being limited to a particular season. Educational campaigns with strategies for making the trip fun and ensuring that the appropriate clothing choices are made are also warranted in complementing built environment modifications.

Creating neighbourhood groupings based on built environment features to facilitate health promotion activities.

Detailed assessments of the built environment often resist data reduction and summarization. This project sought to develop a method of reducing built environment data to an extent that they can be effectively communicated to researchers and community stakeholders. We aim to help in an understanding of how these data can be used to create neighbourhood groupings based on built environment characteristics and how the process of discussing these neighbourhoods with community stakeholders can result in the development of community-informed health promotion interventions. We used the Irvine Minnesota Inventory (IMI) to assess 296 segments of a semi-rural community in Alberta. Expert raters "created" neighbourhoods by examining the data. Then, a consensus grouping was developed using cluster analysis, and the number of IMI variables to characterize the neighbourhoods was reduced by multiple discriminant function analysis. The 296 segments were reduced to a consensus set of 10 neighbourhoods, which could be separated from each other by 9 functions constructed from 24 IMI variables. Biplots of these functions were an effective means of summarizing and presenting the results of the community assessment, and stimulated community action. It is possible to use principled quantitative methods to reduce large amounts of information about the built environment into meaningful summaries. These summaries, or built environment neighbourhoods, were useful in catalyzing action with community stakeholders and led to the development of health-promoting built environment interventions.

Creating Neighbourhood Groupings Based on Built Environment Features to Facilitate Health Promotion Activities

Detailed assessments of the built environment often resist data reduction and summarization. This project sought to develop a method of reducing built environment data to an extent that they can be effectively communicated to researchers and community stakeholders. We aim to help in an understanding of how these data can be used to create neighbourhood groupings based on built environment characteristics and how the process of discussing these neighbourhoods with community stakeholders can result in the development of community-informed health promotion interventions.We used the Irvine Minnesota Inventory (IMI) to assess 296 segments of a semi-rural community in Alberta. Expert raters "created" neighbourhoods by examining the data. Then, a consensus grouping was developed using cluster analysis, and the number of IMI variables to characterize the neighbourhoods was reduced by multiple discriminant function analysis.The 296 segments were reduced to a consensus set of 10 neighbourhoods, which could be separated from each other by 9 functions constructed from 24 IMI variables. Biplots of these functions were an effective means of summarizing and presenting the results of the community assessment, and stimulated community action.It is possible to use principled quantitative methods to reduce large amounts of information about the built environment into meaningful summaries. These summaries, or built environment neighbourhoods, were useful in catalyzing action with community stakeholders and led to the development of health-promoting built environment interventions.

There’s No Such Thing as Bad Weather, Just the Wrong Clothing: Climate, Weather and Active School Transportation in Toronto, Canada

Climatic conditions may enable or deter active school transportation in many North American cities, but the topic remains largely overlooked in the existing literature. This study explores the effect of seasonal climate (i.e., fall versus winter) and weekly weather conditions (i.e., temperature, precipitation) on active travelling to school across different built and policy environments.Home-to-school trips by 11-12-year-old children in the City of Toronto were examined using data from the 2006 Transportation Tomorrow Survey. Binomial logistic regressions were estimated to explore the correlates of the choice of active (i.e., walking) versus non-active (i.e., private automobile, transit and school bus) mode for school trips.Climate and weather-related variables were not associated with choice of school travel mode. Children living within the sidewalk snow-plough zone (i.e., in the inner-suburban neighbourhoods) were less likely to walk to school than children living outside of the zone (i.e., in the inner-city neighbourhoods).Given that seasonality and short-term weather conditions appear not to limit active school transportation in general, built environment interventions designed to facilitate active travel could have benefits that spill over across the entire year rather than being limited to a particular season. Educational campaigns with strategies for making the trip fun and ensuring that the appropriate clothing choices are made are also warranted in complementing built environment modifications.