Future Policy Research Articles

Sufficiency as a “Strategy of the Enough”: Curbing ecological crises and injustices. A summary of the German Advisory Council on the Environment’s discussion paper

A recent discussion paper Sufficiency as a “Strategy of the Enough”: A Necessary Debate by the German Advisory Council on the Environment (SRU) aims to intensify the debate on sufficiency, a central but neglected element of future-oriented policy. It defines sufficiency as the need to limit the consumption and production of ecologically critical goods and services, mainly by the economically rich, as a basis for reducing distributional injustices and environmental impacts. Rather than proposing specific measures, the paper deliberately aims to explain the need for sufficiency from various scientific disciplines, and invite discussion. Here, the authors of the discussion paper provide a short overview of the analyses and arguments in English.

Altruistic and egoistic motivations to engage with contact-tracing apps: Lessons learned from the Covid-19 pandemic

During the Covid-19 pandemic, contact-tracing apps have offered effective help to bend the contagion curve. Thus, it is of critical importance to understand the factors that influence contact-tracing apps’ adoption among citizens. In particular, the successful adoption and usage of contact-tracing apps strongly relies on individual motives. Therefore, this study draws on the theory of altruistic and egoistic motivation for prosocial behaviours to analyse the underlying motives through which citizens engage in voluntary behaviours aimed at using and promoting the use of contact-tracing apps. The study also examines the mediating role of users’ trust in the app. Data from 221 users of Ireland’s Covid Tracker app was analysed. Structural equation modelling with PLS was used to test the research model. Findings show differences between egoistic and altruistic motivation in promoting app use and sharing. Egoistic motivation significantly promotes voluntary behaviours among citizens and users’ trust in the app mediates this influence. Yet, contrary to predictions, in the context of the pandemic, altruistic motivation does not play a significant role in engaging citizens in these voluntary behaviours, either directly or indirectly. The findings of this study are important for policy makers and may inform future policy decisions regarding the implementation of contact-tracing apps in the case of new pandemics or for other contexts requiring cooperative daily check-in.

Trauma-informed care for unaccompanied children: Lessons learned for practice and policy development.

The number of unaccompanied children (UC) arriving in the United States has increased significantly in recent years. UC often encounter traumatic events in their home country, during their migration journey, and upon resettlement. This article describes a congressionally-funded initiative to provide trauma-informed mental health services to UC and children separated from their parents upon arrival in the United States. It also identifies facilitators and barriers to working with UC and offers lessons learned to help inform future practice and policy development aimed at assisting this vulnerable population. Data were derived from qualitative interviews and a survey administered to grantees. In total, grantees served 1,195 youth and families across 11 states, including UC, asylees, and new immigrants during the period of December 2018 through September 2019. Youth and families served spoke 16 languages and originated from diverse nations. Services provided included direct services to youth and families; training for providers and community members; partnerships and collaborations; and resource/product development or adaptations. Lessons learned and recommendations derived from this initiative can assist others interested in promoting trauma-informed practice and policies for migrant children and their families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessment of Spatiotemporal Distribution of Herbicides in European Agricultural Land Using Agri-Environmental Indices

Short-term estimates are not suitable for monitoring and comparing fluctuating pesticide use in EU agricultural land. A discriminative and comparable (HI) herbicide index was evaluated to elucidate herbicide use in the 21st century. The HI was 0.66 kg of active substances per hectare of conventional agricultural land across the EU. However, the HI varied between the 27 EU Member States. The highest mean values of HI were observed in Belgium, the Netherlands, Cyprus, Germany, France, and Denmark, with the lowest in Romania, Greece, Bulgaria, and Latvia. The results showed that the distribution of the HI variable was independent of the geographical location of each country, such as from North to South or from West to East in the EU. It seems that country-level agri-environmental parameters ultimately influenced the herbicide use. To assess the causes of this variability, 31 agri-environmental parameters (formatted into indices to be comparable) were investigated, emphasizing the structural characteristics of the agricultural sector in each EU Member State. Using only the significant independent variables (13 out of 31), linear discriminant analysis (LDA) was applied to explore the differentiation potential of EU27 by creating a discrimination model. The assessment of each one variable in the HI could contribute to the reduction in environmental impacts and the faultless implementation of the European agricultural policy in the near future.

Energy demand and air quality in social housing buildings: A novel critical review

Social housing buildings, throughout Europe, represent a consistent share of the existing building stock. Due to the increasing levels of urbanization, the social housing population in the cities has risen and, after the economic crisis following the subprime mortgage crisis and the pandemic, low-income families as well. The greatest part of social dwellings, those built in the previous century, is usually sub-standard from an energy and environmental point of view. This study reviews the existing literature documenting indoor environmental conditions and energy refurbishment interventions or programs to improve the energy efficiency of existing social buildings. By considering the high risk of energy poverty in social contexts, and the socio-economic conditions of tenants, the economic implications deriving from the energy retrofit were also evidenced. Relevant papers published between 2010 and 2024 were reviewed and were divided according to the reference scale, namely the building or the district scale. The review shows the need to improve the energy performances of social dwellings, both to reduce their energy demand and to improve the indoor microclimatic conditions and quality of life of tenants. Through a critical literature review approach, this study provides a contribution to the in-depth understanding of the role of social housing in the contemporary context, providing meaningful insights for formulating more effective and inclusive housing policies for the next future.

Assessing the Relative Progressivity of the Biden Administration's Federal Student Loan Forgiveness Proposal

Abstract We quantify the total stock of balances eligible for the Biden Administration's 2022 student loan forgiveness proposal and examine which groups would have benefited most. Up to $442 billion in loans were eligible. Those who would have benefited most were younger, had lower credit scores, and lived in lower- and middle-income neighborhoods. We also find that Black and Hispanic borrowers would have disproportionately benefited from the proposal. We then compare the distribution of beneficiaries for the proposed policy to several alternative hypothetical forgiveness proposals and three existing tax credits. The additional forgiveness for Pell Grant recipients increased the progressivity of the policy at a cost of $129 billion. Reducing the income eligibility criterion in half from the proposal would have reduced the cost by nearly $100 billion and made the policy more progressive. Compared with existing tax credits, the announced forgiveness policy is less progressive than the Earned Income Tax Credit but more progressive than the 2019 Child Tax Credit and higher education tax credits. We conclude with a discussion of how each policy lever affects the progressivity of loan cancellation to help inform future policy.

Acceptance and Hesitancy of COVID 19 Vaccination Among Medical and Allied Health Students in India - A Pilot Study

Coronavirus disease 2019 (Covid-19) has had a lasting impact globally, resulting in an exponential rise in mortality and morbidity associated with it. In order to counteract this deadly disease, several Covid-19 vaccines were introduced in human trials. In the midst of lot of controversies regarding the efficacy of these vaccines, as well as the potential adverse effects experienced by the vaccinated individuals the questions of acceptance and hesitancy grew stronger. Since the medical and allied health students have access and understanding of evidence based research, their opinions would help in understanding the situation better. Hence, the aim of the present study was to learn about acceptance, hesitancy of Covid vaccination among health care students. A questionnaire-based online survey was conducted in India between 1st May 2021 and 12th July 2021. A total of 212 responses from health care students were obtained from various states. The questionnaire was circulated via social media platforms, which mainly included questions on acceptance, hesitancy, efficacy and adverse effects of vaccines available in India. Responses have been received from Maharashtra, Karnataka, Goa, Haryana, New Delhi, Chhattisgarh, Andhra Pradesh, Tamil Nadu, Kerala, Uttar Pradesh and Punjab. 61.8% of the responders were from the age group of 18-24. The review of this very important aspect is crucial which has been often neglected amidst the pandemic. This study may help in implementation of better public policies in future.

Conceptual model for advancing socioecological and energy transitions through nature-based solutions in territories: Addressing global anthropogenic challenges

The Anthropocene is an epoch characterized by socio-ecological complexity and uncertainty, resulting from human influence on our planet's history. Human actions have triggered planetary threshold crossings, disrupting the planet's self-regulating systems. This prompts the search for alternatives to the ongoing crisis. The COVID-19 pandemic, for example, has highlighted ecological disruptions caused by cumulative human transformations, challenging society's adaptability and allowing biodiversity incursions into previously vacant habitats. This study aims to explore and validate Nature-based Solutions (NbS) as strategic responses to these anthropogenic challenges, focusing on the integration of socio-ecological, geopolitical, economic, and financial elements to foster energy transitions towards a resilient, low-carbon future. The preliminary model integrates these elements within regional strategies, amalgamating insights into ecosystem services, synergies, and commitments. This approach fosters a discourse between science and policy, emphasizing knowledge management, dialogue, and consensus among territorial stakeholders. It aids the transition toward sustainability across varying scales, providing evidence for decision-makers in ecosystem service assessment and valuation. This bolsters integration into economic management policies. In summary, this research emphasizes addressing challenges from a socio-ecological stance, amalgamating knowledge, and propelling discourse between science and policy for a sustainable future. This holistic viewpoint is pivotal in tackling the Anthropocene's socio-ecological quandaries, ensuring a sustainable trajectory for our planet.

Hydrogen technologies and policies for sustainable future: a review

Hydrogen technologies and policies for sustainable future: a review

Abstract 799: Area-level socioeconomic deprivation is associated with inadequate access to quality preoperative care and increased readmission after surgery for early-stage lung cancer

Abstract Objective: Socioeconomic deprivation (SED) has been associated with higher lung cancer risk and mortality. However, the effects of SED on lung cancer outcomes in an integrated, single-payer healthcare system, such as the Veterans Health Administration (VHA), remains unknown. We sought to examine the impact of area-level SED on access to care and outcomes in veterans with early-stage non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective cohort study of patients with clinical stage I NSCLC receiving definitive surgical treatment in the VHA from 2006-2016. Patients were assigned an area deprivation index (ADI) score, a ZIP code-level measure of SED incorporating multiple poverty, education, housing, and employment indicators from the United States Census. Using multivariable analysis, we evaluated the relationship between ADI and guideline-concordant quality metrics (QMs) that stage I NSCLC patients should routinely meet in the preoperative (positron emission tomography [PET] imaging, smoking cessation support [SCS], pulmonary function testing [PFT], and timely surgery) and postoperative (cancer surveillance imaging, SCS, and appropriate oncology referral) periods. We also assessed the association between ADI and various cancer-specific outcomes including overall survival (OS). Results: The study included 9,704 patients. High ADI was associated with lower likelihood of receiving PET imaging (ADI ≥76 vs. ≤50: adjusted odds ratio [aOR] 0.592, 95% CI 0.502-0.698) and PFT (ADI ≥76 vs. ≤50: aOR 0.816, 95% CI 0.694-0.959) before surgery. High ADI was also associated with delayed surgery (>12 weeks after diagnosis; ADI ≥76 vs. ≤50: aOR 1.202, 95% CI 1.058-1.366). ADI was associated with 30-day readmission after surgery (ADI ≥76 vs. ≤50: aOR 1.380, 95% CI 1.103-1.726) but not with 30-day mortality (ADI ≥76 vs. ≤50: aOR 1.221, 95% CI 0.816-1.826), major complications (ADI ≥76 vs. ≤50: aOR 0.927, 95% CI 0.780-1.101), prolonged hospital length of stay (≥14 days; ADI ≥76 vs. ≤50: aOR 0.893, 95% CI 0.755-1.056), or 90-day mortality (ADI ≥76 vs. ≤50: aOR 0.876, 95% CI 0.645-1.190). ADI was not associated with adherence to postoperative QMs (ADI ≥76 vs. ≤50: aOR 0.888, 95% CI 0.764-1.032), OS (ADI ≥76 vs. ≤50: aOR 0.984, 95% CI 0.911-1.062), or cumulative incidence of cancer recurrence (ADI ≥76 vs. ≤50: aOR 1.047, 95% CI 0.930-1.179). Conclusions: Area-level SED is associated with inadequate adherence to preoperative QMs and increased readmission after surgery for stage I NSCLC. Our data suggests that veterans with high SED experience inadequate access to quality preoperative care for early-stage NSCLC but do not have inferior long-term outcomes after resection. Future VHA policies should focus on providing more equitable guideline-concordant preoperative care and preventing postoperative readmission for stage I NSCLC. Citation Format: Steven Tohmasi, Daniel B. Eaton, Brendan T. Heiden, Nikki E. Rossetti, Martin W. Schoen, Su-Hsin Chang, Yan Yan, Mayank R. Patel, Bryan F. Meyers, Benjamin D. Kozower, Varun Puri. Area-level socioeconomic deprivation is associated with inadequate access to quality preoperative care and increased readmission after surgery for early-stage lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 799.

Questionnaire survey of municipalities on policies to promote physical activity among residents: An examination by administrative sector and population size

Objectives National policies to promote physical activity and exercise have been formulated by several ministries and agencies in Japan. This study aimed to examine the formulation and implementation of such policies in municipalities by administrative sector and population size.Methods After stratifying all municipalities in Japan at the population level, we randomly selected 272 municipalities. We collected 1,632 cases in six sectors (health, sports, education, urban planning, transportation, and environment) within these municipalities. A questionnaire survey on the status of policy formulation, implementation, and coordination among departments was conducted as a cross-sectional study. Differences between groups of municipalities were statistically analyzed using Fisher's exact test. The survey period was from September 2018 to March 2019.Results A total of 616 responses were collected (response rate 37.7%). The response rates for health and education were lower than those for the other sectors. The rate of policy formulation to promote physical activity was extremely high in the health and sports sectors, and there was slight variation by population size. In contrast, formulation rates were generally low in the urban planning, transportation, and environment sectors, especially in smaller municipalities. In the sectors mentioned above, physical activity promotion projects mainly involved the development of exercise and sports infrastructures. Health, sports, and education were the primary sectors that used those environments. Regarding interdepartmental coordination in policy implementation, a cooperative relationship existed among the health, sports, and education sectors and between the urban planning and transportation sectors. However, smaller municipalities were found to have fewer opportunities for such collaboration and tended to implement policies independently.Conclusion This study clarifies the policy formulation and implementation for promoting physical activity in municipalities at the national level in Japan. In addition, their characteristics were identified based on different administrative sectors and population size. These results are expected to be used in future local government policies.

MOBILE HEALTH (MHEALTH) INNOVATIONS FOR PUBLIC HEALTH FEEDBACK: A GLOBAL PERSPECTIVE

In recent years, Mobile Health (mHealth) innovations have emerged as a transformative force in the realm of public health, revolutionizing the way healthcare is delivered and monitored worldwide. This review presents a comprehensive overview of the latest advancements in mHealth technologies, focusing particularly on their role in soliciting and utilizing public health feedback on a global scale. The proliferation of smartphones and mobile applications has paved the way for novel approaches to healthcare delivery, monitoring, and data collection. Through leveraging the ubiquity and connectivity of mobile devices, mHealth initiatives have facilitated enhanced communication between healthcare providers and patients, enabling real-time monitoring of health metrics, adherence to treatment regimens, and timely interventions. One of the key aspects of mHealth innovations is their capacity to engage diverse populations and solicit feedback regarding various aspects of public health, ranging from disease outbreaks to healthcare service quality. Through interactive platforms and user-friendly interfaces, individuals can provide valuable insights, report symptoms, and participate in surveys, thereby contributing to the generation of actionable data for public health interventions. Furthermore, mHealth solutions have demonstrated significant promise in overcoming barriers to healthcare access, particularly in underserved and remote communities. By delivering health information, diagnostic tools, and remote consultations via mobile platforms, these innovations have expanded the reach of essential healthcare services, thereby bridging gaps in healthcare delivery and improving health outcomes on a global scale. However, challenges such as privacy concerns, technological literacy, and disparities in digital access persist, underscoring the importance of equitable deployment and user-centered design in mHealth initiatives. Moreover, the integration of mHealth solutions into existing healthcare infrastructure requires careful coordination among stakeholders, including policymakers, healthcare providers, and technology developers. Mobile Health (mHealth) innovations hold immense potential to revolutionize public health feedback mechanisms on a global scale. By harnessing the power of mobile technologies, these initiatives can empower individuals, enhance healthcare delivery, and inform evidence-based public health policies for a healthier future.
 Keywords: Mobile Health, mHealth, Public Health, Healthcare, Innovation, Review.

Comparison and Implementation of Environmental Law Policies in Handling Climate Change in ASEAN Countries: A Comparative Study of Indonesia, Malaysia, and Thailand

Addressing climate change is a global issue that requires collaborative efforts and effective policies. In the ASEAN region, countries such as Indonesia, Malaysia and Thailand have similar challenges in dealing with the impacts of climate change and promoting environmental sustainability. In this context, this study aims to compare the environmental law policies implemented by the three countries. This study uses a comparative method to analyze the differences and similarities of environmental law policies in addressing climate change in Indonesia, Malaysia, and Thailand. First, the national legal framework governing environmental protection and climate change will be analyzed. Next, specific policies that have been implemented to reduce greenhouse gas emissions, encourage renewable energy, and promote adaptation to climate change will be explored. Through this approach, this study is expected to provide a better understanding of the effectiveness of environmental law policies in addressing climate change in ASEAN countries. The results of this comparative analysis will provide insights into the successes and challenges faced by each country, as well as recommendations for future policy improvements. The findings of this research are expected to provide valuable inputs for policy makers, legal practitioners, and other relevant stakeholders in developing more effective strategies in addressing climate change at the national and regional levels. With a better understanding of comparative environmental law policies, ASEAN countries can learn from each other and work together to achieve common goals in facing the challenges of climate change.

Pre-service ECEC teachers’ conceptions of climate change: a community funds of knowledge and identity approach

ABSTRACT Climate change is one of the greatest threats to humanity and the biosphere. Early childhood education and care has been proposed as a key strategy to enable individuals to gain climate change literacy and enact behaviour change. Well-designed pre-service teacher training programmes in the science of climate change are required to implement effective climate change education programmes starting in the early years. Yet how pre-service early childhood teachers conceptualise climate change based on their community funds of knowledge and identity is largely unknown. This qualitative case study shows how seven Maltese pre-service teachers have some basic understanding of climate change but they also hold misconceptions, and their (mis)understandings are influenced by their community funds of knowledge and identity. Based on these findings, suggestions for teacher training programmes in relation to climate change education are proposed, and the implications of the findings for future research, policy and practice are noted.

Recent updates on treatment patterns in patients with treated attention-deficit/hyperactivity disorders from a nationwide real-world database in South Korea.

The prevalence of attention-deficit/hyperactivity disorder (ADHD) is steadily increasing across Korea. We analyzed ADHD patients with ADHD medications (Rx) characteristics and treatment patterns compared to patients without Rx and identified the differences between pediatric-/adult- and active-/transient-patients with Rx. Using a nationwide claims dataset from 2020 to 2021, we conducted a prevalence-based cross-sectional study and analyzed the recent patients' characteristics and patterns among ADHD patients. Among 132 017 ADHD patients with Rx, differences from 20 312 without Rx across all characteristics except sex. We found significant differences in characteristics and treatment patterns between pediatric-/adult- and active-/transient-patients with Rx. Age-specific sex ratios notably diverged in pediatric patients (61.2%), but remained similar in adults, revealing significant psychiatric comorbidities differences. Active-patients peaked at 6-11 years (41.4%), while transient-patients at 18-30 years (36.1%). Predominantly, methylphenidate (89.7%), atomoxetine (27.8%), and clonidine (2.8%) were prescribed, with 85% experiencing treatment changes within methylphenidate formulations. In pediatric patients, extended-release methylphenidate was preferred (56.1%), adults favored oral delivery system methylphenidate (71.5%), and active-patients had higher treatment rates than transient-patients across all patterns, with low monotherapy rates. This study provides epidemiologic insights into recent characteristics and treatment patterns of ADHD patients with Rx in Korea, providing valuable evidence for identifying those actively receiving ADHD treatment in future healthcare policy decisions.

Trends in air toxics cancer risk in Southern California, 1998-2018

Air toxics are an important category of air pollutants that are known to cause adverse health effects, including increased cancer risk. Regulatory efforts at federal, state, and local levels have aimed to decrease air toxics emissions over the past several decades. This study evaluated trends in air toxics cancer risks in Southern California using data from 1998 to 2018. We estimated air toxics cancer risk for each of four iterations of the South Coast Air Quality Management District’s Multiple Air Toxics Exposure Study, which included at least one year of measurements at 10 stations and air toxics modeling for each iteration. Cancer risks were calculated using the measured and modeled air toxics concentrations averaged over a one to two year period and multiplied by the corresponding cancer potency factor and combined exposure factor that accounted for multiple exposure pathways and children’s increased sensitivity to the health effects of air pollution. We examined temporal trends in overall air toxics cancer risks and evaluated changes in the air toxics species that contributed most to cancer risk in the region. Both measurement and modeling results show that air toxics cancer risk in Southern California decreased by more than 80% between 1998 and 2018, including a decrease of about 50% from 2012 to 2018. Diesel particulate matter was the main risk driver, followed by benzene, 1,3-butadiene, and formaldehyde. We found that more densely populated communities showed larger decreases than sparsely populated areas. The substantial decrease in air toxics levels over this 20-year period points to the success of air pollution policies aimed at addressing air toxics emissions and can inform future policy efforts to further reduce air toxics health impacts.

Do rural migrant parents intend to settle in cities? Impacts of childcare strategies, split households, migration duration, and distance

IntroductionThe current transnational and internal migration involve more and more circular and temporary residences in the host communities. However, few studies have examined the settlement intention of circular and temporary migrant parents with children under 18 years old, which has made inclusive planning for these migrants' needs difficult. This paper aimed to examine whether rural migrant parents intended to settle in cities, with specific discussion about the impacts of childcare strategies, split households, and migration duration and distance.MethodsThis was a cross-sectional study design. The data was sourced from the China Migrants Dynamic Survey.ResultsThrough analysis of a sample of 4,247 rural migrant parents in the Pearl River Delta, this study found that 56% of rural migrant parents intended to become urban settlers. Higher levels of education and income and longer migration durations yielded the parents' increased intention to become urban settlers. The birthplaces and primary caregivers of migrants' children were also significant factors. Moreover, split households, especially households in which the youngest child did not live with the parents in cities, decreased parents' intention to settle permanently. Instead of geographic distance, administrative provincial boundaries were found to be a critical factor in inter-provincial migrant parents' decreased intention to settle in cities.DiscussionThis study provides insights into understanding urbanization in China and contributes to future policy studies regarding internal migration, social integration and population growth, especially in a low fertility and rapid aging contest.

Data stewardship in FTLD research: Investigator and research participant views.

Federal policies and guidelines have expanded the return of individual results to participants and expectations for data sharing between investigators and through repositories. Here, we report investigators' and study participants' views and experiences with data stewardship practices within frontotemporal lobal degeneration (FTLD) research, which reveal unique ethical challenges. Semi-structured interviews with (1) investigators conducting FTLD research that includes genetic data collection and/or analysis and (2) participants enrolled in a single site longitudinal FTLD study. Analysis of the interviews identified three meta themes: perspectives on data sharing, experiences with enrollment and participation, and data management and security as mechanisms for participant protections. This study identified a set of preliminary gaps and needs regarding data stewardship within FTLD research. The results offer initial insights on ethical challenges to data stewardship aimed at informing future guidelines and policies.

Relationship between Sociodemographic and Health-Related Factors and Sedentary Time in Middle-Aged and Older Adults in Taiwan.

Background and Objectives: This study aimed to investigate the associations between sociodemographic and health-related factors and sedentary time in middle-aged and older Taiwanese adults. Materials and Methods: A total of 1031 participants (460 men, 571 women; mean age 65.0 years ± 7.8 years; range 55 to 93 years) were randomly recruited from the National Computer Assessment Telephone Interview, Taiwan, in 2013. Sedentary time, TV viewing, physical activity, and sociodemographic factors were assessed through questionnaires. Body mass index was self-reported and calculated to evaluate obesity. In 2023, the associations between sedentary time and sociodemographic and health-related factors were analyzed using Pearson's correlation, cross tabulation, and logistic regression and were stratified by gender. Results: Over 47% of participants reported spending more than 2 h watching TV, and more than 33% reported engaging in over 6 h of total sedentary activities. Men and women with insufficient physical activity had a higher probability of prolonged sedentary time than their physically active counterparts (p = 0.032 for men, p = 0.024 for women). Both men and women who spent more than 2 h watching TV daily were more likely to have high sedentary time compared to those with shorter TV viewing durations (both p < 0.001). Highly educated and unmarried women exhibited a higher likelihood of prolonged sedentary time than their less educated and married counterparts (p = 0.021 and p = 0.01, respectively). Conclusions: Sedentary time showed significant and positive associations with both insufficient physical activity and prolonged TV viewing in both genders. Additionally, significant associations were observed between sedentary time and high education and unmarried status in women. These findings emphasize the importance of implementing gender-specific approaches in future interventions and policy initiatives aimed at reducing sedentary behavior among middle-aged and older adults.

Integrating Perceptions, Physical Features and the Quality of the Walking Route into an Existing Accessibility Tool: The Perceived Environment Walking Index (PEWI)

Perceptions of the environment shape individual mobility decisions and represent the ‘lived reality’ of accessibility and walkability. Yet recent common walkability analyses and instruments try to include perceptions of different population groups without integrating them into practical tools. However, there is a need for a holistic tool as a basis for transport planners and researchers to integrate the various aspects of walkability into one instrument. This paper investigates multiple relations between different walkability concept parameters and presents the development of the Perceived Environment Walking Index (PEWI). To achieve this, we used a multi-method study design and developed and tested the PEWI in two urban neighbourhoods in Hamburg in three steps. First, we calculated the objective walking accessibility using GIS based on the well-known Walk Score®. Second, we integrated 18 indicators representing physical features and the quality of the walking route, alongside subjective perceptions of walking accessibility broken down into the categories of functionality, safety and security as well as pleasantness and attractiveness. Key results imply that integrating these indicators into an existing accessibility tool is a promising, nuanced method for an improved picture of walkability and accessibility whereas indices focusing only on distances or travel times are not sufficient to represent the lived reality. The implications of our results are discussed with regard to future research gaps and policy.