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Individual-level analyses have consistently shown associations of travel behaviours with obesity-related measures. However, transport planning policies often target areas rather than individuals. To better inform transport-related policies and initiatives for obesity prevention, area-level relationships need to be investigated. This study linked data from two travel surveys with data from the Australian National Health Survey at the level of Population Health Areas (PHAs) and examined to what extent area-level travel behaviours metrics (prevalence of active travel, mixed travel and sedentary travel, diversity of travel modes) were associated with the rate of high waist circumference. Data from 51,987 travel survey participants were aggregated into 327 PHAs. Bayesian conditional autoregressive models were used to account for spatial autocorrelation. It was found that statistically replacing participants who relied on cars for travel (without walking/cycling) with those engaging in 30+ min/d of walking/cycling (without car use) was associated with a lower rate of high waist circumference. Areas with greater diversity of travel modes (mix of walking/cycling, car use, public transport use) also had lower prevalence of high waist circumference. This data-linkage study suggests that area-level transport planning strategies addressing car dependency, shifting car use to walking/cycling over 30 min/d, may help to reduce obesity.

This study investigates the associations of vigorous-intensity gardening time with cardiometabolic health risk markers. This cross-sectional study (AusDiab) analyzed 2011–2012 data of 3,664 adults (55% women, mean [range], age = 59.3 [34–94] years) in Australia. Multiple linear regression models examined associations of time spent participating in vigorous gardening (0

Australian cities offer potential for public health impact through low-carbon built environment design interventions, given their high per capita carbon footprint and with car use being a large pro...

Objective:Higher neighbourhood walkability would be expected to contribute to better health, but the relevant evidence is inconsistent. This may be because residents’ dietary attributes, which vary with socio-economic status (SES) and influence their health, can be related to walkability. We examined associations of walkability with dietary attributes and potential effect modification by area-level SES.Design:The exposure variable of this cross-sectional study was neighbourhood walkability, calculated using residential density, intersection density and destination density within 1-km street-network buffer around each participant’s residence. The outcome variables were dietary patterns (Western, prudent and mixed) and total dietary energy intake, derived from a FFQ. Main and interaction effects with area-level SES were estimated using two-level linear regression models.Setting:Participants were from all states and territories in Australia.Participants:The analytical sample included 3590 participants (54 % women, age range 34 to 86).Results:Walkability was not associated with dietary attributes in the whole sample. However, we found interaction effects of walkability and area-level SES on Western diet scores (P < 0·001) and total energy intake (P = 0·012). In low SES areas, higher walkability was associated with higher Western dietary patterns (P = 0·062) and higher total energy intake (P = 0·066). In high SES areas, higher walkability was associated with lower Western diet scores (P = 0·021) and lower total energy intake (P = 0·058).Conclusions:Higher walkability may not be necessarily conducive to better health in socio-economically disadvantaged areas. Public health initiatives to enhance neighbourhood walkability need to consider food environments and socio-economic contexts.

Background Urban sprawl – low-density neighbourhood developments at the city’s periphery – is related to risk of overweight/obesity. Our mediation analysis examined the extent to which this relationship may be explained by physically-active and sedentary travel behaviours. Methods We analysed data from 2,465 metropolitan residents in the 2011-12 wave of the Australian Diabetes, Obesity and Lifestyle Study. Urban sprawl measure was geographic information system derived residential proximity to the major city centre. Self-reported weekly frequency of walking for transport (WT) and car driving duration (car use) were used as measures of physically-active and sedentary travel behaviours. Risk of overweight/obesity was calculated using objectively-measured body mass index (> 25 kg/m2). Multi-level regression models and joint-significance mediation tests were used. Results Residing near the city centre was associated with higher levels of WT and lower levels of car use. For instance, compared to those living within 10km from the city centre, those living over 30km away had 57% lower WT frequency (p Conclusions These analyses suggest that travel behaviors can be potential mediators in relationships of urban sprawl with overweight/obesity. Future studies are warranted to assess causality of these relationships. Key messages Urban planning policies need to consider these impacts of the expansion of urban sprawl and promote inner-city high-density development by encouraging more physically-active travel and less time spent sitting in cars to reduce the population burden of overweight/obesity.

Urbanization, a major force driving changes in neighborhood environments, may affect residents’ health by influencing their daily activity levels. We examined associations of population density changes in urban areas with adults’ physical activity changes over 12 years using data from the Australian Diabetes, Obesity and Lifestyle Study (1999–2012). The analytical sample contained 2,354 participants who remained at the same residential address throughout the study period in metropolitan cities and regional cities (42 study areas). Census-based population density measures were calculated for 1-km–radius buffers around their homes. Population density change was estimated using linear growth models. Two-level linear regression models were used to assess associations between changes in population density and changes in self-reported walking and physical activity durations. The average change in population density was 0.8% per year (range, −4.1 to 7.8) relative to baseline density. After adjustment for confounders, each 1% annual increase in population density was associated with 8.5-minutes/week (95% confidence interval: 0.6, 16.4) and 19.0-minutes/week (95% confidence interval: 3.7, 34.4) increases in walking and physical activity, respectively, over the 12-year study period. Increasing population density through urban planning policies of accommodating population growth within the existing urban boundary, rather than expanding city boundaries, could assist in promoting physical activity at the population level.

Background Living in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers. Methods The Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999–2000, 2004–05, and 2011–12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants’ homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation. Results There was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590). Conclusions Our mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.

Social-ecological justice is an emerging field that argues for nature’s agency, social-ecological awareness, recognition of nature’s capabilities, and participation in decision-making processes. A social-ecological justice perspective lifts the analysis out of a distribution of environmental impacts to humans, to a recognition of social-ecological complexities. However, bringing this perspective to urban planning requires a suite of methods and tools in coordination with existing planning methods that do not address issues of social-ecological justice, or, justice for nature. Drawing from existing methods and tools, this paper presents a novel methodology to define, identify, and map social-ecological injustices in urban landscapes. Three dimensions of social-ecological justice (distribution, recognition, and participation) are operationalised into a set of indicators, which are added to create a Social-Ecological Injustices Index that identifies place hotspots. A fourth dimension, capabilities, is discussed, but not operationalised in the paper. The urban region of Melbourne, which has been undergoing intense urbanisation processes, is used as a case study to test the applicability of this index. The geospatial analysis reveals various degrees of social-ecological injustices across the Melbourne Metropolitan region and unveils the location of the most deprived areas. This methodology can be applied as a systematic and effective way for urban planners and decision-makers to identify and target social-ecological injustice hotspots as areas of prioritisation for urban regeneration with nature-based solutions.

Introduction Time spent sitting in cars is a prevalent form of sedentary behaviour. Overall time spent sitting and specific sedentary behaviours such as TV viewing have been shown to be associated with cardiovascular disease – a major contributor to premature death. A previous review found that motor vehicle use (including public transport) was associated with obesity. We update the relevant evidence base, focusing specifically on car use as the risk exposure, and expanding the outcomes to relevant indices of cardiovascular disease risk including obesity. Methods The initial search using four databases (Web of Science, Scopus, Medline, and Transport Research International Documentation) produced 3481 hits. After screening and excluding articles included in the previous review, nine articles were found eligible for review. Of these, five examined cross-sectional associations, three examined longitudinal associations, and one examined both. Results One study found longer car use to be related to higher risk of cardiovascular disease as a cause of death. Six out of six cases examining relationships of car use duration with obesity-related outcomes reported significant detrimental associations. However, car use frequency was associated with obesity outcomes in only one out of four cases. Findings were mixed or null for other cardiovascular disease risk markers (blood glucose, blood lipids, blood pressure and composite risk indices. Studies examining effect modification by gender and age found associations of car use with obesity to be more pronounced in men and working-age adults, relative to women and older adults. Conclusion This review found strong evidence supporting detrimental associations of prolonged car use with obesity. However, none of the studies used device-measured time spent sitting in cars. Robust evidence of health risk associated with car use can inform initiatives to lower high levels of car dependency, which is an important goal of the transport and health sectors.

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.