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This study investigates the factors contributing to bicycle accidents, focusing on four types of bicycle lanes and other exposure and built environment characteristics of census blocks. Using Seoul as a case study, three years of bicycle accident spot data from 2018 to 2020 was collected, resulting in 1,330 bicycle accident spots and a total of 2,072 accidents. The geographically weighted Poisson regression (GWPR) model was used as a methodological approach to investigate the spatially varying relationships between the accident frequency and explanatory variables across the space, as opposed to the Poisson regression model. The results indicated that the GWPR model outperforms the global Poisson regression model in capturing unobserved spatial heterogeneity. For example, the value of deviance that determines the goodness of fit for a model was 0.244 for the Poisson regression model and 0.500 for the far better-fitting GWPR model. Further findings revealed that the factors affecting bicycle accidents have varying impacts depending on the location and distribution of accidents. For example, despite the presence of bicycle lanes, some census blocks, particularly in the northeast part of the city, still pose a risk for bicycle accidents. These findings can provide valuable insights for urban planners and policymakers in developing bicycle safety measures and regulations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Cycling is known to be beneficial for human health. Studies have suggested significant associations of physical activity with macroscale built environments and streetscapes. However, whether good streetscapes can amplify the benefits of a favorable built environment on physical activity remains unknown., Objective: This study examines whether streetscape perceptions can modify the associations between accessibility, land use mix, and bike-sharing use., Methods: This cross-sectional study used data from 18,019,266 bike-sharing orders during weekends in Shanghai, China. A 500 × 500 m grid was selected as the analysis unit to allocate data. Bike-sharing use was defined as the number of bike-sharing origins. Street view images and a human-machine adversarial scoring framework were combined to evaluate lively, safety, and wealthy perceptions. Negative binomial regression was developed to examine the independent effects of the three perceptual factors in both the univariate model and fully adjusted model, controlling for population density, average building height, distance to nearest transit, number of bus stations, number of points of interest, distance to the nearest park, and distance to the central business district. The moderation effect was then investigated through the interaction term between streetscape perception and accessibility and land use mix, based on the fully adjusted model. We also tested whether the findings of streetscape moderation effects are robust when examinations are performed at different geographic scales, using a small-sample statistics approach and different operationalizations of land use mix and accessibility., Results: High levels of lively, safety, and wealthy perceptions were correlated with more bike-sharing activities. There were negative effects for the interactions between the land use Herfindahl-Hirschman index with the lively perception (β=-0.63; P=.01) and safety perception (β=-0.52; P=.001). The interaction between the lively perception and road intersection density was positively associated with the number of bike-sharing uses (β=0.43; P=.08). Among these, the lively perception showed the greatest independent effect (β=1.29; P<.001), followed by the safety perception (β=1.22; P=.001) and wealthy perception (β=0.72; P=.001). The findings were robust in the three sensitivity analyses., Conclusions: A safer and livelier streetscape can enhance the benefits of land use mix in promoting bike-sharing use, with a safer streetscape also intensifying the effect of accessibility. Interventions focused on streetscape perceptions can encourage cycling behavior and enhance the benefits of accessibility and land use mix. This study also contributes to the literature on potential moderators of built environment healthy behavior associations from the perspective of microscale environmental perceptions., (© Huagui Guo, Shuyu Zhang, Xinwei Xie, Jiang Liu, Hung Chak Ho. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion., (© 2024. The Author(s).)

Objectives: We explored the importance of environmental and mobility strategies during early COVID-19 by age and ethnicity and investigated predictors of park visitations considering the COVID-19 impacts., Background: Parks are safe and accessible venues to stay active and reduce social isolation, which is especially important considering COVID-19 and the associated lockdowns., Methods: We analyzed online survey data from 683 residents (collected July 2020) of El Paso, TX, and objective measures of neighborhood park characteristics. Chi-square tests and mixed-effects logistic regression analyses were performed to examine the environmental/mobility strategies, personal and environmental factors, and park visitations, considering the COVID-19 impacts., Results: The percentage of those who visited (1+ times/week) parks or trails/paths in the neighborhood dropped from 41.7% to 19.5% since the start of COVID-19 ( OR = 0.015, p < .001). Before COVID-19, middle-aged and older adults were less likely to visit parks than younger adults, while this difference became insignificant during early COVID-19. Hispanic adults were more likely to visit parks than non-Hispanics both before and during early COVID-19. Positive environmental predictors of park visitations included park availability in the neighborhood, proximity to the closest park, seeing people being physically active in the neighborhood, and neighborhood aesthetics., Conclusions: Proximately located parks, trails, and paths well integrated into residential communities, and high aesthetic quality of the neighborhood are the potential features of pandemic-resilient communities and should be considered an important national priority to maintain and promote the health and well-being of the population, especially during pandemics like COVID-19.

Background: We compared the relation between neighborhood features and moderate to vigorous physical activity (MVPA) using linear regression analysis and the more novel compositional data analysis (CoDA). Compositional data analysis allows us to take the time children allocate to different movement behaviours during a 24-hour time period into account., Methodology: Data from youth participants (n = 409) in the QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) cohort were included. Time spent in MVPA, light physical activity, sedentary behavior, and sleep ("24-hour movement behaviours") was measured using accelerometers. Neighborhood data were collected using a geographic information system and through direct observation. In CoDA models, we used orthogonal logratio coordinates, which allows for the association of neighbourhood walkability with MVPA to be estimated with respect to the average composition of all other behaviours within a 24-hour time frame. In baseline linear regression models, MVPA was regressed cross-sectionally on neighborhood walkability. All models were stratified by sex, and controlled for BMI z-scores, pubertal development, seasonal variation, parental education, and neighbourhood safety., Results: Based on CoDA, girls who lived in more walkable neighborhoods had 10% higher daily MVPA (95% CI: 2%, 19%), taking into account all other movement behaviours. Based on linear regression, girls who resided in more walkable neighborhoods engaged in 4.2 (95% confidence interval [CI]: 1.2, 6.6) more minutes of MVPA per day on average than girls residing in less walkable neighborhoods., Conclusions: Unlike with traditional linear models, all movement behaviours were included in a single model using CoDA, allowing for a more complete picture of the strength and direction of the association between neighbourhood Walkability and MVPA. Application of CoDA to investigate determinants of physical activity provides additional insight into potential mechanisms and the ways in which people allocate their time., (© 2022. The Author(s).)

Background: Cycling for transport provides many health and social benefits - including physical activity and independent access to jobs, education, social opportunities, health care and other services (accessibility). However, some population groups have less opportunity to reach everyday destinations, and public transport stops, by bicycle - owing in part to their greater aversion to riding amongst motor vehicle traffic. Health equity can therefore be improved by providing separated cycleway networks that give more people the opportunity to access places by bicycle using traffic-free routes. The aim of this study was to assess the health equity benefits of two bicycle infrastructure development scenarios - a single cycleway, and a complete network of cycleways - by examining the distributions of physical activity and accessibility benefits across gender, age and income groups., Methods: Travel survey data collected from residents in Sydney (Australia) were used to train a predictive transport mode choice model, which was then used to forecast the impact of the two intervention scenarios on transport mode choice, physical activity and accessibility. The latter was measured using a utility-based measure derived from the mode choice model. The distributions of the forecast physical activity and accessibility benefits were then calculated across gender, age and income groups., Results: The modelled physical activity and accessibility measures improve in both intervention scenarios. However, in the single cycleway scenario, the benefits are greatest for the male, high-income and older age groups. In the complete network scenario, the benefits are more equally distributed. Forecast increases in cycling time are largely offset by decreases in walking time - though the latter is typically low-intensity physical activity, which confers a lesser health benefit than moderate-intensity cycling., Conclusions: Separated cycleway infrastructure can be used to improve health equity by providing greater opportunities for transport cycling in population groups more averse to riding amongst motor vehicle traffic. Disparities in the opportunity to access services and economic/social activities by bicycle - and incorporate more physical activity into everyday travel - could be addressed with connected, traffic-free cycleway networks that cater to people of all genders, ages and incomes., (© 2021. The Author(s).)

Sidewalks are indispensable environmental resources for daily life in that they encourage physical activity. However, the proportion of sidewalk coverage is low even in developed countries. We examined the association between neighborhood sidewalk environment and dementia in Japan. We conducted a 3-year follow-up (2010-2013) among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of community-dwelling older adults. We ascertained the incidence of dementia for 76,053 participants from the public long-term care insurance system. We calculated sidewalk coverage (sidewalk area as a percentage of road area) within 436 residential neighborhood units using geographic information systems. Multilevel survival models were used to estimate hazard ratios for the incidence of dementia. During follow-up, 5,310 dementia cases were found. In urban areas, compared with the lowest quartile of sidewalk coverage, the hazard ratio was 0.42 (95% confidence interval: 0.33, 0.54) for the highest quartile, adjusting for individual covariates. After successive adjustments for other neighborhood factors (land slope; numbers of hospitals, grocery stores, parks, railway stations, and bus stops; educational level; and unemployment rate), the hazard ratio remained statistically significant (hazard ratio = 0.71, 95% confidence interval: 0.54, 0.92). Living in a neighborhood with a high level of sidewalk installation was associated with low dementia incidence in urban areas., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Introduction: Reducing the likelihood of freeway secondary crashes will provide significant safety, operational and environmental benefits. This paper presents a method for assessing the likelihood of freeway secondary crashes with Adaptive Signal Control Systems (ASCS) deployed on alternate routes that are typically used by diverted freeway traffic to avoid any delay or congestion due to a freeway primary crash., Method: The method includes four steps: (1) identification of secondary crashes, (2) verification of alternate routes, (3) assessment of the likelihood of secondary crashes for freeways with ASCS deployed on alternate routes and non-ASCS (i.e. pre-timed, semi- or fully-actuated) alternate routes, and (4) investigation of unobserved heterogeneity of the likelihood of freeway secondary crashes. Four freeway sections (i.e., two with ASCS deployed on alternate routes and two non-ASCS alternate routes) in South Carolina are considered., Results and Conclusions: Findings from the logistic regression modeling reveal significant reduction in the likelihood of secondary crashes for one freeway section (i.e., Charleston I-26 E) with ASCS deployed on alternate route. Other factors such as rear-end crash, dark or limited light, peak period, and annual average daily traffic contribute to the likelihood of freeway secondary crashes. Furthermore, random-parameter logistic regression model results for Charleston I-26 E reveal that unobserved heterogeneity of ASCS effect exists across the observations and ASCS are associated with the reduction of the likelihood of freeway secondary crashes for 84% of the observations (i.e., primary crashes). Location of the primary crash on the freeway is observed to affect the benefit of ASCS toward freeway secondary crash reduction as the primary crash's location determines how many upstream freeway vehicles will be able to take the alternate route. Practical Applications: Based on the findings, it is recommended that the South Carolina Department of Transportation (SCDOT) considers deploying ASCS on alternate routes parallel to freeway sections where high percentages of secondary crashes are found., (Copyright © 2020 National Safety Council and Elsevier Ltd. All rights reserved.)

Socio-economic inequality in the physical activity environment surrounding primary schools may contribute to socio-economic gradients in physical activity and childhood obesity levels. Using a cross-sectional study design, ordinary least squares and logistic regressions were fitted to assess variation in walkability and greenspace within 1 km of primary schools (n = 7133) according to area-level socio-economic position (SEP) and remoteness. Effect modification by school location (major cities or regional/remote) was assessed through stratified analyses. Walkability scores significantly increased from low to high school neighbourhood SEP (p < 0.01) and from remote/very remote to major city locations (p < 0.01). Greenspace area (hectares) in the school neighbourhood was greater in highest compared to lowest SEP areas (β = 18.75, 95%CI 6.63, 30.87) and less in major cities compared to remote/very remote locations (β = - 23.9, 95%CI - 39.7, - 8.1). Schools in highest SEP areas and major cities had higher odds of having any greenspace in their neighbourhood, compared to those in lowest SEP and remote/very remote locations (OR 5.93, (95% CI 4.50, 7.05), OR 20.19, (95% CI 16.05, 25.39) respectively). Stratified results (major cities or regional/remote locations) found the highest SEP school neighbourhoods had higher walkability scores and more greenspace compared to lowest SEP school neighbourhoods in both strata, although overall SEP gradient in walkability and greenspace area only remained in major cities. Walkability and greenspace infrastructure in the school neighbourhood could be improved in areas of lower SEP so that all school children have the opportunity for physical activity.

Introduction: Adaptive Signal Control System (ASCS) can improve both operational and safety benefits at signalized corridors., Methods: This paper develops a series of models accounting for model forms and possible predictors and implements these models in Empirical Bayes (EB) and Fully Bayesian (FB) frameworks for ASCS safety evaluation studies. Different models are validated in terms of the ability to reduce the potential bias and variance of prediction and improve the safety effectiveness estimation accuracy using real-world crash data from non-ASCS sites. This paper then develops the safety effectiveness of ASCS at six different corridors with a total of 65 signalized intersections with the same type of ASCS, in South Carolina., Results: Validation results show that the FB model that accounts for traffic volume, roadway geometric features, year factor, and spatial effects shows the best performance among all models. The study findings reveal that ASCS reduces crash frequencies in the total crash, fatal and injury crash, and angle crash for most of the intersections. The safety effectiveness of ASCS varies with different intersection features (i.e., AADT at major streets, number of legs at an intersection, the number of through lanes on major streets, the number of access points on minor streets, and the speed limit at major streets)., Conclusions: ASCS is associated with crash reductions, and its safety effects vary with different intersection features. Practical Applications: The findings of this research encourage more ASCS deployments and provide insights into selecting ASCS deployment sites for reducing crashes considering the variation of the safety effectiveness of ASCS., (Copyright © 2020. Published by Elsevier Ltd.)

Purpose: The increasing number of deaths due to road traffic accidents (RTAs) has attracted global attention. However, the influence of road types is rarely considered in the study of RTAs. This study evaluates the influence of different road types in RTAs in northern Guizhou to provide a basis for the formulation of evidence-based policies and measures., Methods: We obtained the data from the Zunyi Traffic Management Data Platform for the years 2009-2018. The mortality rates of RTAs were calculated. Descriptive methods and Chi-square tests were used to analyze the characteristics of road traffic collisions on different road types. We also examined the associations between the mortality rate per 10,000 vehicles and the growth of per capital gross domestic product (GDP) with Spearman's rank correlation analysis. According to the passing volume and the infrastructure, we defined different types of roads, like administrative road, functional road, general urban road and urban expressway., Results: In 2012, the traffic mortality rate of administrative roads was 8.9 per 100,000 people, and the mortality rate of functional roads was 7.4 per 100,000 people, which decreased in 2018 to 6.1 deaths per 100,000 people and 5.2 deaths per 100,000 people, respectively. The mortality rate per 10,000 vehicles reached the highest level in 2011 (28.8 per 10,000 vehicles and 22.5 per 10,000 vehicles on administrative and functional roads, respectively). The death rate of county roads was the highest among administrative roads (χ 2  = 17.389, p < 0.05) and that of fourth-class roads was the highest among functional roads (χ 2  = 21.785, p < 0.05). The mortality rate per 10,000 vehicles was negatively correlated with per capital GDP., Conclusion: Although our research shows that RTAs in northern Guizhou have steadily declined in recent years, the range of decline is relatively small. Many measures and sustainable efforts are needed to control road traffic death and accelerate the progress in road traffic safety in northern Guizhou., Competing Interests: Declaration of competing interest There was no conflict of interest declared., (Copyright © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

Introduction: This study investigated the effects of pavement surface condition and other control factors on casualty crashes at signalized intersections. It involved conducting a before and after study for road surface condition and situational factors. It also included assessing the effects of geometric characteristics on safety performance of signalized intersections post resurfacing to control for the effect of pavement surface condition. Pavement surface condition included roughness, rutting, and skid resistance. The control factors included traffic volume, light and surface moisture condition, and speed limit. The geometric characteristics included approach width, number of lanes, intersection depth, presence of median, presence of shared lane, and presence of bus stop., Method: To account for the repeated observations of the effect of light and surface moisture conditions in four occasions (day-dry, day-wet, night-dry and night-wet) Generalized Estimating Equation (GEE) with Negative Binomial (NB) and log link function was applied. For each signalized intersection in the sample, condition data are collected for the year before and after the year of surface treatment. Crash data, however, are collected for a minimum of three and maximum of five years before and after treatment years., Results: The results show that before treatment, light condition, road surface moisture condition, and skid resistance interaction with traffic volume are the significant contributors to crash occurrence. For after treatment; light condition, road surface moisture condition, their interaction product, and roughness interaction with light condition, surface moisture condition, and traffic volume are the significant contributors. The geometric variables that were found to have significant effects on crash frequency post resurfacing were approach width interactions with presence of shared lane, bus stop, or median., Conclusions: The findings confirm that resurfacing is significant in reducing crash frequency and severity levels. Practical Applications: The study findings would help for better understanding of how geometric characteristics can be improved to reduce crash occurrence., (Copyright © 2021. Published by Elsevier Ltd.)

In urban areas where increased density has caused loss of urban open space (UOS), there is a need for high-quality parks that are inclusive and fit for multiple user groups. To make parks more inclusive, UOS management may need to consider multifunction and the perspectives of various age groups in future development and maintenance activities. Walking interviews were conducted in a park in central Landskrona, Sweden, with children, adolescents, and elderly users, and also with the head park manager of the city. The results revealed different perspectives among the three age groups of users concerning affordances and UOS management. The manager described user-oriented management to support multifunction and inclusion, including user participation. All user groups studied showed an appreciation of liveliness, contact with nature, social places for their own age group, clean and safe parks, and a variety of different atmospheres and activities in the park. Social multifunction can be developed in programmed or non-programmed ways, but some functions interfere with each other. UOS managers can develop parks to suit different age groups, promote user participation within management, and develop social multifunction to create inclusive parks for various age groups.

Selecting an appropriate exposure measure and functional form for Safety Performance Functions (SPFs) is critical in precisely predicting crash counts by different crash types for intersections. This study proposes a new approach, namely Generalized Negative Binomial-P (GNB-P) model, to model the complex relationship between crashes and different exposure measures by crash type for intersections, which helps not only identify the most reliable exposure measure for intersection SPFs, but also explore the most appropriate functional form of the NB models. To this end, three types of SPF functional forms, namely Power function, Hoerl function 1 and Hoerl function 2 with different exposure measures including major road AADT, minor road AADT and total AADT were estimated by crash type for stop-controlled and two types of signalized intersections. The over-dispersion of the SPF models was estimated using the exposure measures to account for crash data variation across different intersections. The SPF estimation results highlighted that the mean-variance structure of NB models is not consistent and varies by crash data. The over-dispersion of SPFs by crash type is not constant and varies across different intersections. The minor road AADT is shown to be positively correlated with the over-dispersion of SPFs in estimating crash counts for Same-Direction Crashes (SDC), Intersecting-Direction Crashes (IDC) and Single-Vehicle Crashes (SVC). Estimating the over-dispersion using exposure measures results in more reliable SPF results. Furthermore, it is found that the Power function with major road and minor road AADT as the exposure measure performs the best in estimating SPFs for Opposite-Direction Crashes (ODC). The Hoerl function 2 with total AADT and the proportion of minor road AADT over the total as the exposure measure performs the best in estimating SVC SPFs for intersections. The Hoerl function 1 with major road and minor road AADT as the exposure measure is more accurate in estimating SPFs for both SDC and IDC., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Walkability continues to attract great attention from urban planners, designers, and engineers as they recognize not only the merits of pedestrian facilities in terms of the health benefits but also their demerits in terms of accident risk to pedestrians. Wide footpaths improve the pedestrian environment and experience, and thereby motivate travelers to walk as much as possible. However, if footpaths are too wide, they may leave a smaller space for the roadway. On the other hand, wide road lanes may lead to higher road vehicle safety but are costly to construct and maintain and also may leave little space for the footpath. Evidently, for a fixed urban space, what is needed is an optimal balance between the vehicle lane and pedestrian path. This problem is encountered routinely in dense cities including Hong Kong where land availability is severely limited., Method: To address the issue, this paper first establishes safety performance functions (SPFs) for the pedestrian space and the road space, using the random-parameter negative binomial regression. The results indicate the extent to which road lane and footpath width changes are associated with changes in in-vehicle occupant and pedestrian casualties. Then the paper uses the SPFs to develop a methodology for optimizing the width allocations to the road lanes and footpaths, duly considering the user (safety) costs and agency (construction) costs associated with each candidate allocation of the widths. Finally, the paper analyzes the sensitivity of the optimal solution to the relative weights of user cost and agency cost., Results: When user and agency costs are considered equally important, the optimal lane width is 5.4 m., Conclusion: It is observed that the road space allocation ratio used by the Hong Kong road agency suggests that the agency places a higher weight to user cost compared to agency cost. Practical Application: The findings can help incorporate design-safety relationships, and the stakeholders (agency and users) perspectives in urban road and footpath design., (Copyright © 2020 National Safety Council and Elsevier Ltd. All rights reserved.)

Introduction: Speeding is a crucial risk factor for pedestrian safety because it shortens reaction time while increasing the impact force in collisions. Various types of traffic calming measures to prevent speeding have been devised. A speed hump-a raised bump installed in the pavement-has been widely used for this purpose., Method: To evaluate the effectiveness of speed humps, the speed profiles of vehicles passing speed humps were analyzed along with pedestrian crash records near speed humps., Results: The speed profiles showed that vehicles gradually diminished their speeds starting 30 m ahead of speed humps and, immediately after passing the humps, accelerated to regain their original speeds within a distance of 30 m. This speed reduction effect is substantial on both local and major roads: 18.4% and 24.0% reduction in speeds, respectively. The analysis of pedestrian crash records revealed that, inside the zones of speed reduction effect near speed humps (i.e., ±30 m from speed humps), fewer pedestrian crashes per roadway distance occurred and pedestrian injuries were less severe, compared with events outside the effect zones. This safety improvement was greater on major roads than local roads. Practical Applications: This work finds that the speed reductions that occurred near speed humps were gradual and influential ±30 m from their locations, suggesting that the hump installations should be close enough to the pedestrian crossings. It is noteworthy that, albeit that speed humps are more prevalent on local roads, the benefits of speed reduction effects from speed humps were more pronounced on major roads than on local roads. Therefore, speed humps on major roads can be considered a more effective measure for pedestrian safety., (Copyright © 2020 National Safety Council and Elsevier Ltd. All rights reserved.)

Introduction: Left-turning vehicles pose considerable safety risks to pedestrians at intersections. Left-turn traffic-calming treatments are designed to slow left-turn traffic. This study examined the effects of one type of left-turn calming, the hardened-centerline treatment, on the numbers of conflicts between left-turning vehicles and pedestrians and left-turn speeds in Washington, DC., Method: Numbers of conflicts between left-turning vehicles and pedestrians, as well as left-turn speeds, were collected at selected intersections in Washington, DC, where the hardened centerline was installed, as well as at control intersections in the city where no treatment was installed, before and after installation. Poisson regression evaluated the change in numbers of conflicts associated with the hardened-centerline treatment. The effect of the treatment on left-turn speeds was estimated by a log-linear regression model, and the effect on the odds of left-turning vehicles exceeding 15 mph was estimated by a logistic regression model., Results: The treatment was associated with a 70.5% reduction in conflicts between left-turning vehicles and pedestrians, a 9.8% reduction in mean left-turn speeds, and a 67.1% reduction in the odds of left-turning vehicles exceeding 15 mph. All the reductions were statistically significant., Conclusions: The study demonstrates that the hardened-centerline treatment can reduce conflicts between left-turning vehicles and pedestrians, and slow down left-turn traffic at intersections. Practical applications: The treatment should be added to the toolbox for communities looking to improve pedestrian safety at intersections., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Neighborhood factors have gained increasing attention, while the association between the neighborhood's characteristics and multimorbidity has not been clarified. In this study, we aim to depict variations in the number of non-communicable chronic diseases (NCDs) as a function of urban vs. rural settings and road types., Methods: The present cross-sectional study derived data from the China Health and Retirement Longitudinal Study 2011 National Baseline Survey. Negative binomial regression with clustered robust standard errors was performed to analyze variations in the number of NCDs among 13,414 Chinese middle-aged and older adults. Logistic regression models were employed to investigate the association between neighborhood-level characteristics and each NCD, respectively., Results: First, over 65% of subjects had at least one NCDs, and over 35% had multimorbidity. Arthritis (33.08%), hypertension (24.54%), and digestive disease (21.98%) were the most prevalent NCDs. Urban vs. rural differences in multimorbidity were fully explained by neighborhood clustering variations (IRR = 1.02, 95% CI, 0.95-1.10). Living with paved roads was associated with a smaller number of NCDs relative to living with unpaved roads (IRR = 0.86, 95% CI, 0.78-0.95). Results from subgroup analyses suggested that in comparison with those living with unpaved roads, individuals living with paved roads respectively had lower odds of chronic lung disease (OR = 0.76, 95% CI, 0.63-0.93), chronic liver disease (OR = 0.74, 95% CI, 0.55-0.99), chronic kidney disease (OR = 0.68, 95% CI, 0.51-0.89), digestive disease (OR = 0.82, 95% CI, 0.69-0.97), arthritis or rheumatism (OR = 0.69, 95% CI, 0.55-0.87), and asthma (OR = 0.67, 95% CI, 0.51-0.88)., Conclusions: Urban vs. rural disparities in multimorbidity appeared to result from within-neighborhoods characteristics. The improvement in neighborhood-level characteristics, such as road pavement, holds promise to alleviate the increasing disease burden of chronic diseases.

Highway horizontal curves (H-curves) provide a smooth transition between two tangent sections of roadways. They allow vehicles to adjust their travel directions gradually. However, the geometry changes of the highway sections with H-curves often raise safety concerns. In order to deploy effective safety countermeasures, a critical task is to understand the risk factors associated with H-curves. Existing studies have made efforts to probe the safety issues associated with H-curves, whereas they were limited to relatively small-scale examinations because of the challenges in identifying H-curves from large road networks. In addition, due to the lack of well-archived traffic and roadway information, gathering other data associated with the H-curves is also difficult. Regarding to these gaps, this study aims to leverage open-source data to analyze the crash risk of highway sections with H-curves. In particular, the present study highlights itself from two main aspects: (i) a H-curve extraction tool was developed to facilitate large-scale curve data collection through the analytics of different open source data; and (ii) a crash modeling framework was developed to quantify H-curve crash risk. A case study based on a statewide road network was performed to test the developed crash risk models with the collected curve data. The results show the opportunities of using the developed tool for large-scale data collection and analyze the safety impacts of H-curve geometric properties, elevation change, traffic exposure, among others. Findings of this study provide insights into the improvement of H-curve data collection and safety evaluation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The study was aimed at assessing the association of all components of safety (crime, traffic, social, and physical) and general safety with walking for leisure and transportation among Iranian adults. In this regard, sociodemographic factors as potential effect modifiers on walking behavior and the association of neighborhood safety with the level of walking were explored., Method: A total of 1300 questionnaires were distributed among respondents residing in 8 neighborhoods in Bandar Abbas city, among which 1132 qualified for use in further analysis. Using a binary logistic regression method, differences in walking behavior and perceived safety to walk were evaluated across sociodemographic characteristics., Results: The results showed that the walking rate is higher among older adults, married people, and adults with lower education and a higher length of residency. An increase in neighborhood safety from crime, traffic, social disorders, and overall safety associates with increased leisure walking among all populations. Further, overall neighborhood safety and safety from crime and traffic positively correlate with the level of transportation walking among all respondents. For both types of walking, this association varies in sociodemographic groups., Conclusion: The study suggests that an increase in the safety of a neighborhood contributes to a higher level of leisure and transportation walking; however, it varies in different subgroups. This study provides the knowledge needed to consider all aspects of neighborhood safety to measure walking behavior level.

Background: Long-haul truck drivers (LHTDs) suffer from long work hours often resulting in fatigue. Although several studies have reported that fatigue can contribute to crashes, no study has identified the location and patterns of fatigue-related crashes and solicited truck driver feedback on potential mitigation strategies. The purpose of this study is 1) to map the location of fatigue-related crashes and 2) examine the perceptions of truck drivers concerning fatigue-related crashes., Methods: Using databases from the Saskatchewan Government Insurance, information on LHTD demographics, crashes and their causes, as well as crash location was analyzed. All fatigue-related crashes were then documented and mapped. Additionally, we interviewed 67 LHTDs (mean age = 53.0 ± 12.9; range 23-89; 95% were men) asking questions about fatigue, access to truck stops/rest areas, and provided recommendations for improvement. All interviews were subsequently analyzed using thematic analyses., Results: On average, there were 20 fatigue-related crashes per year over the 10-year period. Fatigue-related crashes were common across Saskatchewan, however, there was a concentration of crashes along major roadways between major cities. There was a significant association between crashes with age and experience. Despite many LHTDs being fatigued, there was a lack of truck stops/rest areas along highway routes. LHTDs suggested having access to truck stops/rest areas 250-400 km apart with running water and washrooms available., Conclusions: Additional truck stops and rest areas are needed in Saskatchewan to ensure LHTDs have more opportunities for rest to reduce fatigue in general, as well as to reduce the risk of fatigue-related crashes.

Background: Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies., Methods: A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts. Health determinants, dimensions and indicators researched in the selected studies were synthetized, and associations analyzed. An independent assessment of quality of the studies was performed. Key conclusions and policy recommendations were extracted to build a framework to analyze environment related population health and policies in urban settings., Results: Ninety four studies of varied methodological approaches and quality met the inclusion criteria. The review identified positive associations between all environmental determinants -socioeconomic, built environment, natural environment, healthcare, behaviors, and health outcomes - overall mortality and morbidity, in urban settings. Improvements in income, education, air quality, occupation status, mobility and smoking habits indicators have positive impact in overall mortality and chronic diseases morbidity indicators. Initiatives to improve population health in which policymakers can be more evidence-informed include socioeconomic, natural environment and built environment determinants., Conclusions: There is scope and need to further explore which environmental determinants and dimensions most contribute to population health to create a series of robust evidence-based measures to better inform urban planning policies.

Background: Investments in traffic calming infrastructure and other street design features can enhance pedestrian safety as well as contribute to the 'walkability' of neighbourhoods. Pedestrian-motor vehicle collisions (PMVCs) in urban areas, however, remain common and occur more frequently in lower income neighbourhoods. While risk and protective features of roadways related to PMVC have been identified, little research exists examining the distribution of roadway environment features. This study examined the relationship between roadway environment features related to child pedestrian safety and census tract income status in Toronto., Methods: Spatial cluster detection based on 2006 census tract data identified low-income and high-income census tract clusters in Toronto. Police-reported PMVC data involving children between the ages of 5 and 14 years were mapped using geographical information system. Also mapped were roadway environment features (densities of speed humps, crossing guards, local roads, one-way streets and missing sidewalks). Multivariate logistic regression was used to examine the relationship between roadway environment features (independent variables) and cluster income status (dependent variable), controlling for child census tract population., Results: There were significantly fewer speed humps and local roads in low-income versus high-income clusters. Child PMVC rates were 5.4 times higher in low-income versus high-income clusters., Conclusion: Socioeconomic inequities in the distribution of roadway environment features related to child pedestrian safety have policy and process implications related to the safety of child pedestrians in urban neighbourhoods., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

In this commentary, we propose using laws in implementing the Healthy Prisons Agenda. We evaluate the efficacy of laws in tackling health inequalities in prisons, provide recommendations on how states can uphold their international commitments that safeguard prisoners' right to healthcare, and frame prisons as health-promoting settings. We also assess the challenges that can thwart this proposal, such as the non-binding nature of international obligations, global prison overcrowding and the dependency on prison governors and staff for implementation of the Agenda. The commentary concludes by recommending further evaluation of our proposal and testing its potential generalisability to other health-promotion agendas.

In urban health studies where spatial and temporal changes are of importance, spatio-temporal variations are usually neglected. For the Heinz Nixdorf Recall Study, we investigate spatio-temporal variation in analyses of effects of urban greenness on depression by including spatio-temporal random effect terms in a Poisson model on district level. Our results show negative associations between greenness and depression. The findings suggest strong temporal autocorrelation and weak spatial effects. Even if the weak spatial effects are suggestive of neglecting them, as in our case, spatio-temporal random effects should be taken into account to provide reliable inference in urban health studies., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Traffic events are one of the five leading causes of mortality in Mexico. Pedestrians are one of the main road users involved in such incidents and have the highest mortality rate, which is regularly analysed in relation to vehicles and pedestrians, but not the built environment. The purpose of this study was to analyse the elements of the road system organisation that influences the mortality rate of pedestrians hit by motor vehicles in the Guadalajara Metropolitan Area., Method: We designed a case and control study in which the cases were sites where a pedestrian died during 2012. The controls were sites close to where the death occurred, as well as those with road infrastructure characteristics similar to those where the events took place. We obtained the pedestrian data from the death certificates and assessed some of the environmental elements of the road sites. A logistic regression analysis was used to estimate OR; 95% CI., Results: Road system factors related with pedestrian mortality in close locations were: the presence of bus stops on intersections in one street or both, and road system features, such as the presence of traffic islands, vehicle flow and pedestrian flow., Conclusions: According to the urban network theory and multiple theory, the final elements resulted as risk factors due to a fault in connectivity between the nodes. A temporal analysis of urban features will help urban planners make decisions regarding the safety of pedestrians and other road users., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Previous studies reported positive associations between perceived neighborhood greenness and mental health. There has been a focus on perceived neighborhood greenness at people's home environment or in general, but data are lacking on greenness at working places or other locations where they actually spend most of their time during their day., Methods: This study investigated the perceived greenness of college students' home and study environments and its relation to mental health. An online survey collected data from 601 participants with a mean age of 24 years, living in or around and studying in the city of Graz, Austria. The perceived greenness at home and at university was assessed using questions on quality of and access to green space; mental health was measured with the WHO-5 well-being index. Uni- and multivariate regression analyses were used to analyze the data., Results: The analyses revealed positive associations between perceived greenness at home and mental health as well as perceived greenness at university and mental health. This adds more evidence to the existing literature that perceiving the environment as green is positively related to better mental health., Conclusions: Future research will have to incorporate objective greenness measures as a means of controlling for the reliability of the measurements and investigate the effects of different environments people are exposed to over the course of a day.

Background: Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes., Methods: The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models., Discussion: Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods., Study Registration: Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.

As active commuting levels continue to decline among primary schoolchildren, evidence about which built environmental characteristics influence walking or cycling to school remains inconclusive and is strongly context-dependent. This study aimed to identify the objective built environmental drivers of, and barriers to, active commuting to school for a multi-ethnic sample of 1,889 healthy primary schoolchildren (aged 5-11) in London, UK. Using cross-sectional multilevel ordered logistic regression modelling, supported by the spatial exploration of built environmental characteristics through cartography, the objective built environment was shown to be strongly implicated in children's commuting behaviour. In line with earlier research, proximity to school emerged as the prime variable associated with the choice for active commuting. However, other elements of the urban form were also significantly associated with children's use of active or passive modes of transport. High levels of accidents, crime and air pollution along the route to school were independently correlated with a lower likelihood of children walking or cycling to school. Higher average and minimum walkability and higher average densities of convenience stores along the way were independently linked to higher odds of active commuting. The significance of the relations for crime, air pollution and walkability disappeared in the fully-adjusted model including all built environmental variables. In contrast, relationships with proximity, traffic danger and the food environment were maintained in this comprehensive model. Black children, pupils with obesity, younger participants and those from high socioeconomic families were less likely to actively commute to school. There is thus a particular need to ensure that roads with high volumes of actively commuting children are kept safe and clean, and children's exposure to unhealthy food options along the way is limited. Moreover, as short commuting distances are strongly correlated with walking or cycling, providing high-quality education near residential areas might incite active transport to school., Competing Interests: The authors have declared that no competing interests exist.

Aims: To develop, validate and test a ward environment assessment tool (WEAT) for post-occupancy evaluation of hospital wards from the perspectives of ward nurses, using Person-Environment fit theory., Background: It is argued that as the needs and expectations of various user groups of healthcare facilities would vary, so would the tools to measure the suitability of the architectural design features of these healing environments for different groups of users. However, a review of relevant literature revealed that there is a dearth of assessment tools to appraise the adequacy of healthcare facilities for nursing staff., Methods: Extant literature was reviewed to construct WEAT. Twenty ward nurses were interviewed to obtain user perspectives on the ward environment. Post-occupancy evaluation of three hospital wards was undertaken to validate and test WEAT., Results: WEAT: A new post-occupancy evaluation tool was created., Conclusions: WEAT measures the impacts of ward environment on nurses in four personal constructs; namely physical, cognitive, sensory and universal., Implications for Nursing Management: WEAT is an innovative management decision-making tool for ward managers, who may use its results to argue for workspace redesign with facilities managers, explore job readjustments with occupational health nurses and review job description with human resource managers., (© 2020 John Wiley & Sons Ltd.)

Parks may provide opportunities for people to increase their physical activity and improve health. Yet, parks are generally less plentiful and underutilized in low-income urban neighborhoods compared with more advantaged neighborhoods. Renovations within and around parks may improve park utilization but the empirical evidence supporting this relationship is scarce. This study assessed the impact of greenspace, housing, and commercial investments on street characteristics (walkability, amenities, incivilities/poor esthetics) and park use by examining park use over time in two low-income neighborhoods in Pittsburgh, PA (n = 17 parks), before and after neighborhood-based renovations that were primarily centered in one neighborhood. We used systematic observation of parks, park use, and street blocks surrounding parks to examine the impact of neighborhood changes on park use. We used difference-in-differences to test whether park use and street characteristics surrounding the parks improved more in the intervention neighborhood than in the comparison neighborhood. We also used zero-inflated negative binomial regression with interactions by time to test whether changes in street characteristics were associated with changes in park use over time. We found that improved walkability, incivilities, and esthetics surrounding parks in socioeconomically disadvantaged neighborhoods were associated with greater park use and may help increase visits to underutilized parks.

Researchers have linked neighborhood food availability to the overall frequency of using food outlets without noting if those outlets were within or outside of participants' neighborhoods. We aimed to examine the association of neighborhood restaurant and food store availability with frequency of use of neighborhood food outlets, and whether such an association was modified by neighborhood street connectivity using a large and diverse population-based cohort of middle-aged U.S. adults. We used self-reported frequency of use of fast food restaurants, sit-down restaurants, and grocery stores in respondents' home neighborhoods using data from the Coronary Artery Risk Development in Young Adults study Year 20 exam in 2005-2006 (n = 2860; Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) and geographically matched GIS-measured neighborhood-level food resource, street, and U.S. Census data. We used mixed-effects logistic regression to examine the associations of the GIS-measured count of neighborhood fast food restaurants, sit-down restaurants, and grocery stores with self-reported frequency of using neighborhood restaurants and food stores and whether such associations differed by GIS-measured neighborhood street connectivity among those who perceived at least one such food outlet. In multivariate analyses, we observed a positive association between the GIS-measured count of neighborhood sit-down restaurants (OR = 1.02, 95% CI 1.00-1.04) and the self-reported frequency of using neighborhood sit-down restaurants. We observed no statistically significant association between GIS-measured count of neighborhood fast food restaurants and self-reported frequency of using neighborhood fast food restaurants, nor did we observe a statistically significant association between GIS-measured count of neighborhood grocery stores and self-reported frequency of using neighborhood grocery stores. We observed inverse associations between GIS-measured neighborhood street connectivity and the self-reported frequencies of using neighborhood fast food restaurants (OR = 0.42, 95% CI 0.26-0.68) and grocery stores (OR = - 2.26, 95% CI - 4.52 to - 0.01). Neighborhood street connectivity did not modify the association between GIS-measured neighborhood restaurant and food store count and the self-reported frequency of using neighborhood restaurants and food stores. Our findings suggest that, for those who perceived at least one sit-down restaurant in their neighborhood, individuals who have more GIS-measured sit-down restaurants in their neighborhoods reported more frequent use of sit-down restaurants than those whose neighborhoods contain fewer such restaurants. Our results also suggest that, for those who perceived at least one fast food restaurant in their neighborhood, individuals who live in neighborhoods with greater GIS-measured street connectivity reported less use of neighborhood fast food restaurants than those who live in neighborhoods with less street connectivity. The count of neighborhood sit-down restaurants and the connectivity of neighborhood street networks appear important in understanding the use of neighborhood food resources.

Background: Identification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features., Methods: This cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child's home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features., Results: After adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability., Conclusions: The neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

School neighbourhood built environments (SN-BE) can influence adolescents' active transport to school habits. Typically, SN-BE assessment has involved micro-scale (i.e., environmental audits) or macro-scale (Geographic Information Systems (GIS)) assessment tools. However, existing environmental audits are time/resource-intensive and not specific to school neighbourhoods, while GIS databases are not generally purposed to include micro-scale data. This study evaluated the inter-rater reliability and feasibility of using a modified audit tool and protocol (Microscale Audit of Pedestrian Streetscapes Global-School Neighbourhood (MAPS Global-SN)) to assess the SN-BE of twelve secondary schools in Dunedin, New Zealand. Correlations between MAPS Global-SN and GIS measures of the SN-BE were also examined. Specifically, MAPS Global-SN audit and GIS spatial analysis (intersection density, residential density, land use mix, walkability) was conducted within a 0.5 km street-network buffer-zone around all twelve schools. Based on investigator and expert consultation, MAPS Global-SN included eight modifications to both auditing processes and items. Inter-rater reliability data was collected from two independent auditors across two schools. The feasibility of a condensed audit protocol (auditing one side of each street segment in the neighbourhood, compared to both sides) was also assessed. Results indicated the modified MAPS Global-SN tool had good to excellent inter-rater reliability and the condensed MAPS Global-SN audit protocol appeared to sufficiently represent the micro-scale SN-BE. Results also highlighted the complementary nature of micro- and macro-scale assessments. Further recommendations for SN-BE assessment are discussed., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Insufficient physical activity (PA) is the fourth major risk factor for many non-communicable diseases and premature mortality worldwide. Features of the built environment (BE) play a considerable role in determining population PA behaviors. The majority of evidence for PA-BE relationships comes from high-income countries and may not be generalizable to low- and middle-income countries (LMICs). We aim to systematically review the literature and assess the associations between perceived and/or objective BE characteristics and PA domains in LMICs. This review adopted a systematic search strategy for English language articles published between January 2000 and June 2019 from four electronic databases-Medline, Embase, Web of Science and PubMed-adhering to the PRISMA guidelines. Studies addressing the associations between self-reported and/or objective BE and PA were only included if they were conducted in LMICs, according to the World Bank classification list. Articles investigating PA-BE relationships across any age groups were included, and all study designs were eligible, except for qualitative studies and reviews. Thirty-three studies were included for evidence synthesis. Cross-sectional studies were the most prevailing study design (97%), revealing a notable gap in longitudinal PA-BE research in LMICs. A majority of the BE factors were not associated with different PA domains while others (e.g., density, proximity to services, aesthetics) exhibited an inconsistent association. Land-use mix diversity was positively associated with transport PA and the presence of recreation facilities resulted in an increase in PA during leisure-time. Increased safety from crime at night consistently increased total PA and walking levels. Research exploring the associations between BE attributes and PA behaviors in LMICs appears to be limited and is primarily cross-sectional. Longitudinal research studies with objective measures are needed for inferring well-grounded PA-BE causal relationships and informing the design of evidence-based environmental interventions for increasing PA levels in LMICs., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The goals of this research are to: (i) investigate whether the driver's physiological performance has a significant impact on driving speed choice, considering the visibility level under fog conditions and the horizontal and vertical alignment of a rural road; (ii) quantify the relationships among these variables; (iii) calculate the maximum acceptable speed that meets the driver's physiological tolerance threshold. Methods: A driving simulator study was conducted. A total of 30 participants were recruited, and each completed 5 driving simulator trials under varying visibility levels, radii of curvature and vertical grades. A multiple linear regression model was established to measure the association between normalized heart rate, driving speed, visibility, radius of curvature and gradient. Results: The results indicated that driving speed, visibility, radius of curvature and gradient all significantly affected the normalized heart rate. For instance, an increase in driving speed and vertical grade and a reduction in the radius of curvature are related to an increase in normalized heart rate. Moreover, an acceptable speed model that considered the driver's normalized heart rate was constructed, given the visibility level and horizontal and vertical alignment. Conclusions: The study shows a significant correlation between the drivers' physiological performance and his or her driving speed choice under the influence of visibility in fog. Given visibility conditions and road alignment parameters, we can calculate the maximum acceptable speed that meets the driver's physiological requirements. Such findings should be indicative of real-time traffic management that could reduce the crash risk under inadequate visibility conditions in fog.

Objective: This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes., Methods: A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school students were used. BMI z scores were calculated, student obesity or obesity/overweight was determined using Centers for Disease Control and Prevention growth charts, and these data were combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examined using neighborhood (census tract) fixed effects., Results: Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types., Conclusions: Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity., (© 2019 The Obesity Society.)

Objective: There is little research simultaneously examining both teen drivers' characteristics and the driving environment. This study aimed to investigate how traffic engineering factors (road designs, traffic operations, and surface conditions) contribute to risks of teen driver's fatality. Understanding the role of traffic engineering factors can further improve efforts to reduce teen diving-related fatal crashes. Methods: This study used the Fatality Analysis Reporting System and General Estimate System for years 2014 to 2015. We explored numerous engineering variables: horizontal/vertical alignment, intersections types, interchange areas, traffic ways types, posted speed limit, work zone areas, types of traffic control devices and road surface conditions. Traditional variables considered in this study included sex, age, presence of passengers in relation to age group, time of day, lighting condition, season, vehicle model year, vehicle type, seatbelt use, crash type and movement prior to a crash. We ran cross-tabulations and unadjusted analyses to report unadjusted odds ratios of teen driver's fatality. A multiple logistic regression model was used to identify which variables related to road design and traffic operations remained significant after being adjusted by other variables. Results: For traditional factors, results corroborated prior findings. All the engineering factors, except work zone area, were significant in the unadjusted analyses; four variables - horizontal alignments, posted speed limit, traffic control device type, and traffic way type - remained statistically significant in the final model. The adjusted odds ratio (AOR) of curved high-speed segment was nearly seven times (6.94; 95% CI = 3.58, 13.46) that of a straight segment with a low posted speed limit (reference group). The AOR of no traffic control was four times (4.17; 95% CI = 2.95, 5.88) that of roads with traffic controls. The AOR of a two-way undivided road was almost three times (2.75, 95% CI = 1.43, 5.29) that of a two-way median barrier road (reference group). Conclusions: This study suggests teen driver education programs consider addressing road design characteristics. For example, incorporating focused lessons on traffic signs and traffic control types may better prepare young people for their driving experiences. Additionally, more supervised driving time is needed on various road types, especially those that present greater risks (e.g., roads with grades/curves, intersections with no traffic signal, undivided roads, and unpaved roads).

Objective: Driving errors contribute to traffic crashes and thus the causal factors associated with driving errors are of great interest to the road safety researchers. The present study attempts to identify and quantify the effects of various risk factors that are likely to influence driving error with the application of structural equation modeling (SEM). These risk factors include blood alcohol concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%), different driving environments (rural, urban), and driver attributes (such as age, gender, education). Method: Eighty-two licensed drivers participated in a driving simulator experiment. They completed driving under the influence of 4 BAC levels in the driving environments within the framework of a full-factorial within-subjects design. Driving error was modeled as an unobserved latent variable based on several driving simulator indicators. An SEM approach was utilized to examine the influence of BAC level, driving environment, and driver attributes on the latent variable pertaining to driving error. Results: The findings suggest the suitability of an SEM approach in the investigation of driving error. The results revealed that all 3 positive BACs (0.03%, 0.05%, and 0.08%) had a significant positive influence on driving error compared to 0% BAC, and the tendency toward driving error increased with increasing BAC (factor loadings for 0.03%, 0.05%, and 0.08% BAC were 0.22, 0.31, and 0.37, respectively). Moreover, driving in an urban environment led to more driving errors compared to a rural environment, including sober drivers. Among the driver attributes, gender and awareness about drink and drive laws were the only factors influencing driving error. Conclusion: This study highlights a novel approach to investigate driving error by modeling it as a latent variable instead of modeling individual performance measures. The successful execution of SEM in alcohol impairment research may serve as a significant step in the human factors field moving from piecemeal analysis to a combined analysis where interrelationships among numerous risk factors and driving error can be established. The study outcomes may serve as a reference while developing strategies to enhance road traffic safety where special emphasis can be given to the critical risk factors influencing driving error identified in the study.

Objective: The primary objective of this study is to explore the effects of the lighting level on nighttime safety of signalized intersections based on conflict models under traffic conditions varying in cycles. Method: Nighttime data were collected from a field study at six signalized intersections in Nanjing, Jiangsu Province in China. Nighttime rear-end conflict models were developed by adopting the generalized linear model (GLM) approach to relate the frequency of rear-end traffic conflicts to lighting level, traffic volume and platoon ratio at the signal cycle level. Results: The final model consisting of all explanatory variables, including lighting level, traffic volume, and platoon ratio demonstrates a better performance of safety evaluation when compared to the model considering traffic volume only and the model with traffic volume and an additional variable of lighting or traffic conditions. Nighttime safety of signalized intersections is expected to improve with larger platoon ratios and higher lighting levels. A potential application of the final model was further explored by benefit-cost analyses. The analyses provided a hypothetical recommended lighting level under various traffic volumes and platoon ratios when safety benefit equals lighting system cost. Conclusions: Nighttime safety can be evaluated using the developed rear-end conflict models, which relate the number of rear-end conflicts to traffic and lighting variables. The number of rear-end conflicts can be calculated by the final conflict model with lighting level, traffic volume, and platoon ratio. The developed model can be potentially applied to provide further insights on the lighting management for intersection safety optimization with traffic conditions varying in signal cycles via vehicle-to-infrastructure (V2I) communications.

Objective: Researchers have linked geographic disparities in obesity to community-level characteristics, yet many prior observational studies have ignored temporality and potential for bias., Methods: Repeated cross-sectional data were used from the Behavioral Risk Factor Surveillance System (BRFSS) (2003-2012) to examine the influence of county-level characteristics (active commuting, unemployment, percentage of limited-service restaurants and convenience stores) on BMI. Each exposure was calculated using mean values over the 5-year period prior to BMI measurement; values were standardized; and then variables were decomposed into (1) county means from 2003 to 2012 and (2) county-mean-centered values for each year. Cross-sectional (between-county) and longitudinal (within-county) associations were estimated using a random-effects within-between model, adjusting for individual characteristics, survey method, and year, with nested random intercepts for county-years within counties within states., Results: A negative between-county association for active commuting (β = -0.19; 95% CI: -0.23 to -0.16) and positive associations for unemployment (β = 0.17; 95% CI: 0.14 to 0.19) and limited-service restaurants (β = 0.13; 95% CI: 0.11 to 0.14) were observed. An SD increase in active commuting within counties was associated with a 0.51-kg/m 2 (95% CI: -0.72 to -0.31) decrease in BMI over time., Conclusions: These results suggest that community-level characteristics play an important role in shaping geographic disparities in BMI between and within communities over time., (© 2019 The Obesity Society.)

Objective: The aim of this study was to examine the association of county-level food access, recreational opportunities, and natural amenities with participant engagement in a weight management program., Methods: In this cohort study, participants in the Veterans Health Administration MOVE! weight management program between October 1, 2007, and September 30, 2013, were observed for 12 months after enrollment. Engagement was measured as the number of program visits per year at 12 months. Cross-sectional analysis and spatial regression were used to examine county characteristics associated with greater participant engagement at 12 months., Results: A total of 321,624 participants in 2,708 counties were included. Greater engagement was associated with older age, female sex, white race, being married, and being retired. After accounting for similarities between nearby communities, engagement at 12 months was 3.1 visits higher for each additional farmers' market per 1,000 population (P = 0.01). Engagement was highest for participants living in counties with the most natural amenities (P < 0.001). Recreational opportunities had only a small effect on engagement in the program (β = 0.02 visits at 12 months; P = 0.002)., Conclusions: Consideration of a participant's county characteristics in addition to other known demographics and program factors may help to explain variation in engagement in weight management programs., (© 2019 The Obesity Society (TOS). This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Previous studies reported contradictory evidence for associations between perceived greenness and obesity mediated by physical activity, focusing on people's homes or general greenness. Data are lacking in other environments. We studied the association of perceived greenness at home and at university with BMI and physical activity. An online survey collected data from 601 participants, living and studying in and around the city of Graz, Austria; mean age of 24 years. Greenness was assessed using questions on quality of and access to green space; Body mass index (BMI) was derived from self-reported measures; physical activity and sedentariness were measured using the IPAQ questionnaire (short version). On average, BMI was 22.6 (SD = 3.7), physical activity was 63.3 (SD = 51.7) METh/week, and participants spent 5.8 (SD = 4.0) h/day sitting. Regression analyses revealed no associations between perceived greenness and BMI and physical activity for all environments, but a negative association for sedentariness and perceived greenness at home, but not at university. The results indicate a relation between perceived greenness and sedentariness, which differs for the home-and study environment.

Because of high population density and rapid urbanization, different human life stages have distinct growth experiences, leading to different lifestyles and age-spatial separation in the same neighborhood environment, particularly in smaller Chinese cities. The relationship of environment to physical activity may differ from western or larger Chinese cities. This study examined the associations of walking duration to the neighborhood environment and other factors, and explored the nuances of walking behavior for different life stages of adults in a smaller Chinese city, Yuncheng. An interviewer-administered questionnaire survey ( n = 173) and face-to-face interviews ( n = 19) were conducted in August 2017. Descriptive analysis and multiple linear regression were performed to describe walking motivations, sociodemographic characteristics, neighborhood environments, and their impacts on walking duration across three life stages. The quantitative findings were followed by interviews to validate and interpret them. Our results showed no positive associations of land-use mix (LUM) and residential density on walking duration, and even inverse associations of LUM-recreation and LUM-education for specific life stages were identified. Younger people's walking behavior was more related to consumption amenities distinct from those of older people. Our findings suggest that using walkable neighborhood policies (e.g., high residential density and land-use mix) to increase physical activity might be ineffective in smaller Chinese cities.

Background: Aedes aegypti-borne diseases are becoming major public health problems in tropical and sub-tropical regions. While socioeconomic status has been associated with larval mosquito abundance, the drivers or possible factors mediating this association, such as environmental factors, are yet to be identified. We examined possible associations between proximity to houses and roads and immature mosquito abundance, and assessed whether these factors and mosquito prevention measures mediated any association between household environmental factors and immature mosquito abundance., Methods: We conducted two cross-sectional household container surveys in February-March and November-December, 2017, in urban and rural areas of Quetzaltenango, Guatemala. We used principal components analysis to identify factors from 12 variables to represent the household environment. One factor which included number of rooms in house, electricity, running water, garbage service, cable, television, telephone, latrine, well, and sewer system, was termed "environmental capital." Environmental capital scores ranged from 0 to 5.5. Risk factors analyzed included environmental capital, and distance from nearest house/structure, paved road, and highway. We used Poisson regression to determine associations between distance to nearest house/structure, roads, and highways, and measures of immature mosquito abundance (total larvae, total pupae, and positive containers). Using cubic spline generalized additive models, we assessed non-linear associations between environmental capital and immature mosquito abundance. We then examined whether fumigation, cleaning containers, and distance from the nearest house, road, and highway mediated the relationship between environmental capital and larvae and pupae abundance., Results: We completed 508 household surveys in February-March, and we revisited 469 households in November-December. Proximity to paved roads and other houses/structures was positively associated with larvae and pupae abundance and mediated the associations between environmental capital and total numbers of larvae/pupae (p ≤ 0.01). Distance to highways was not associated with larval/pupal abundance (p ≥ 0.48). Households with the lowest and highest environmental capital had fewer larvae/pupae than households in the middle range (p < 0.01)., Conclusions: We found evidence that proximity to other houses and paved roads was associated with greater abundance of larvae and pupae. Understanding risk factors such as these can allow for improved targeting of surveillance and vector control measures in areas considered at higher risk for arbovirus transmission.

Purpose: Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods., Methods: Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates., Results: Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking., Conclusion: Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults.

Background: Attributes of the built environment, such as neighborhood walkability, have been linked to increased physical activity and reduced obesity risk. This relationship, however, has primarily been documented in adults; less is known about neighborhood walkability and youth obesity, as limited prior research has produced mixed findings. The purpose of this study was to examine the association between neighborhood walkability and youth obesity, including differences by urbanicity. Methods: Data were collected in 2013 from youth aged 7-14 years ( n  = 13,469) in a Southeastern county school district. Height and weight were objectively measured and utilized to calculate body mass index (BMI) z -scores. Youth demographic characteristics and addresses were obtained, and a Walk Score ® was gathered for each youth's home address. Multilevel linear regression analysis, accounting for nesting within census block groups, was conducted to examine the association between Walk Score and BMI z -score and to test for the moderating effect of urbanicity. Separate multilevel analyses examined Walk Score and BMI z -score among urban, urban-rural mixed, and rural youth subsamples. Results: Overall, as Walk Score increased, youth BMI z -score decreased. Walk Score was positively associated with BMI z -score among urban youth and negatively associated with BMI z -score among rural youth; no relationship was observed between Walk Score and youth in urban-rural mixed areas. Conclusions: Neighborhood walkability may impact youth differently across geographic areas. Further study is warranted about how youth utilize a walkable environment and mechanisms through which walkability influences youth physical activity and obesity risk.

Background: Exposure to natural outdoor environments (NOE) has been shown to be beneficial to older adults' health and functioning, yet this assertion has rarely been tested in China. We investigated the relationships between exposure to NOE and older adults' self-rated health in Shanghai, China and examined whether these relationships varied by sex, age, education and hukou status., Method: This cross-sectional study used micro-data sample of the 2010 Shanghai population census, including 7962 older adults nested within 3345 neighbourhoods. Self-rated health was the outcome variable. Four NOE exposure indicators were calculated for each neighbourhood: the amount of surrounding greenness/blueness and proximity to large green/blue spaces. Multilevel logistic regression was employed to explore the association between natural outdoor environment exposure and self-rated health, adjusting for individual-level and neighbourhood-level covariates. Stratified analyses were used to examine variations by sex, age, education and hukou status., Results: Older adults living in neighbourhoods with higher surrounding greenness and higher proximity to both green spaces and blue spaces were more likely to report good health. Residential surrounding blueness was not significantly related to self-rated health. Females, those aged 60-69 years, those who had elementary school or junior high school education and those with non-local hukou benefit more from residential surrounding greenness, and those aged 70-79 years and who had elementary school or junior high school education benefit more from residential proximity to blue spaces., Conclusions: Higher residential greenness and proximity to both green spaces and blue spaces were associated with better self-rated health, particularly for females, younger older adults, the low educated and non-local hukou holders. Our findings suggest that urban green spaces and urban blue spaces have different effects on health among Chinese older adults and that the assessment of exposure matters to the investigation of NOE-health relationships.

Background: Everyday activities, such as walking or cycling, may be a feasible and practical way to integrate physical activity into everyday life. Walking and cycling for transport or recreation in the area local to a person's home may have additional benefits. However, urban planning tends to prioritise car use over active modes. We explored the cross-sectional association between living near an urban motorway and local walking and cycling., Methods: In 2013, residents living in an area (a) near a new urban motorway (M74), (b) near a longstanding urban motorway (M8), or (c) without a motorway, in Glasgow, Scotland, were invited to complete postal surveys assessing local walking and cycling journeys and socio-demographic characteristics. Using adjusted regression models, we assessed the association between motorway proximity and self-reported local walking and cycling, as well as the count of types of destination accessed. We stratified our analyses according to study area., Results: One thousand three hundred forty-three residents (57% female; mean age: 54 years; SD: 16 years) returned questionnaires. There was no overall association between living near an urban motorway and the likelihood of local walking or cycling, or the number of types of local destination accessed by foot or bicycle. In stratified analyses, for those living in the area around the new M74 motorway, increasing residential proximity to the motorway was associated with lower likelihood of local recreational walking and cycling (OR 0.63, 95% CI: 0.39 to 1.00) a pattern not found in the area with the longstanding M8 motorway. In the area near the M8 motorway residential proximity was statistically significantly (p = 0.014) associated with a 12% decrease in the number of types of destination accessed, a pattern not found in the M74 study area., Conclusions: Our findings suggest that associations between living near a motorway and local walking and cycling behaviour may vary by the characteristics of the motorway, and by whether the behaviour is for travel or recreation. The lack of associations seen in the study area with no motorway suggests a threshold effect whereby beyond a certain distance from a motorway, additional distance makes no difference.

Background: A rapidly growing body of research suggests that qualities of the built environment can promote active living among children and youth. Nevertheless, shortcomings in the current evidence for understanding which built environment characteristics provide opportunities for taking part in activities in childhood remain. This study aimed to examine whether population density, green spaces, and facilities/amenities are associated with participation in leisure-time physical activity (PA), organized activities, and social activities with friends and peers in Norwegian 8-year-olds., Methods: Data from a sample of 23,043 children from the Norwegian Mother and Child Cohort Study (MoBa) were linked with geospatial data about the built environment. The questionnaire data reported by mothers provided information on the children's leisure activities. We computed exposure to neighborhood population density and access to green spaces and facilities/amenities within 800- and 5000-m radii of the participants' home addresses using geographic information systems. Associations were estimated using logistic regression models., Results: We found beneficial associations between having a park within 800-m and more leisure-time PA during the summer. Furthermore, children living in neighborhoods with higher proportions of green space participated in more PA during the winter. More densely populated areas and access to facilities were associated with participation in organized and social activities. Specifically, we observed that more playgrounds/sport fields in the neighborhood were the strongest and most consistent correlate of activity participation in Norwegian 8-year-olds by being related to more socialization with friends and peers., Conclusion: This population-based study underscores the importance of access to a variety of venues and opportunities for different activities in the immediate neighborhood surroundings and in the greater community to support participation in physical activity and organized and social activities in childhood.