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Objective: The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics.Design: Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia.Setting: Bogotá, Colombia.Subjects: Pregnant adolescents aged 13-19 years (n 430) and pregnant women aged 20-49 years (n 1272).Results: The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight.Conclusions: Underweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition. [ABSTRACT FROM AUTHOR]

One promising public health intervention for promoting physical activity is the Ciclovía program. The Ciclovía is a regular multisectorial community-based program in which streets are temporarily closed for motorized transport, allowing exclusive access to individuals for recreational activities and physical activity. The objective of this study was to conduct an analysis of the cost-benefit ratios of physical activity of the Ciclovía programs of Bogotá and Medellín in Colombia, Guadalajara in México, and San Francisco in the U.S.A. The data of the four programs were obtained from program directors and local surveys. The annual cost per capita of the programs was: U.S. $6.0 for Bogotá, U.S. $23.4 for Medellín, U.S. $6.5 for Guadalajara, and U.S. $70.5 for San Francisco. The cost-benefit ratio for health benefit from physical activity was 3.23-4.26 for Bogotá, 1.83 for Medellín, 1.02-1.23 for Guadalajara, and 2.32 for San Francisco. For the program of Bogotá, the cost-benefit ratio was more sensitive to the prevalence of physically active bicyclists; for Guadalajara, the cost-benefit ratio was more sensitive to user costs; and for the programs of Medellín and San Francisco, the cost-benefit ratios were more sensitive to operational costs. From a public health perspective for promoting physical activity, these Ciclovía programs are cost beneficial. [ABSTRACT FROM AUTHOR]

Knowledge concerning patterns of health care utilization among Latino-adolescent immigrants is needed to develop culturally-appropriate programs. The objectives of this study were to estimate the annual prevalence of having had a routine physical exam and episodes of adolescents' not seeking health care when they thought they should (forgone health care) among Latino adolescents by immigrant-generational status. Cross-sectional analysis of data from Latino adolescents in Wave I of the National Longitudinal Adolescent Health Study. First-generation immigrants who had lived in the U.S. - 5 years were less likely to receive routine care than third-generation immigrants (39.0% vs. 54.9%). This disparity decreased after adjustment for insurance status, parental education and poverty among Mexican origin adolescents. On average, 16.0% of first-generation immigrants who had lived in the U.S. - 5 years and 22.5% of third-generation immigrants reported forgoing health care. After adjustment for age, insurance status, parental education and routine care, recent arrivals were less likely than third-generation immigrants to forgo health care. Recent arrivals were less likely to receive a routine physical exam and to forgo care than third-generation immigrants. Future studies should explore the effect of acculturation on knowledge, beliefs and perceptions about health, illness and care-seeking behaviors. [ABSTRACT FROM AUTHOR]

PURPOSE: To estimate the prevalence of routine physical examination among in-school adolescents of differing national Latino origins and to assess associations with gender, age, immigrant generational status, language spoken at home, parental education, poverty level, family structure, and insurance status. METHODS: Cross-sectional analysis of Wave I of the National Longitudinal Study of Adolescent Health conducted during 1995. Our sample was limited to adolescents in grades 7 through 12 of Mexican (n = 1657), Cuban (n = 490), Puerto Rican (n = 555), and Central/South American or Dominican (C/S American or DR) (n = 427) origins. We used multivariate logistic regression for survey data to conduct the data analyses. RESULTS: Mexican-origin adolescents were less likely to report a routine physical examination in the previous year, compared with other Latino populations [prevalence (95% confidence interval)]: Mexicans, 47.7% (42.0% -53.6%], Cubans 67.6% (57.4%-76.4%), Puerto Ricans 65.2% (58.4%-71.4%), and C/S American or DR (57.0% [47.3-66.2]). Among Mexican-origin adolescents, having a college-educated parent or insurance was associated with receiving care (adjusted prevalence odds ratio [95% confidence interval]), 2.12 (1.37-3.30) and 1.80 (1.31-2.47), respectively. For Cuban-origin adolescents, first-generation immigrants were less likely to receive care (0.31 [0.14-0.70]), and those living in a single-parent home were more likely to receive care (2.83 [1.52-5.25]). Having a routine physical examination among adolescents of C/S American or DR origins was associated with incomes above the poverty level (2.29 [1.10-4.77] and insurance (2.33 [1.10-4.91]). CONCLUSIONS: Reflecting the heterogeneity of Latino adolescents, the prevalence of routine physical examination and factors associated with it varied by national origin subgroup. These differences should be considered when developing strategies to better address the health needs of Latino youth. [ABSTRACT FROM AUTHOR]

According to national surveillance studies, participation in leisure-time physical activity remains low among minority women. Furthermore, the correlates of such activity in this group are not well understood. To better understand the environmental, policy, and sociocultural correlates of physical activity among Latina immigrants, six focus groups were conducted in rural North Carolina. Among the 49 participants, median age was 32 years and median education 11 years. Participants were first generation immigrants from Mexico (n = 43), El Salvador (n = 3), Colombia (n = 1), the Dominican Republic (n = 1), and Honduras (n = 1). Environmental and policy barriers to activity were identified, including transportation, lack of facilities, cost, and safety. Sociocultural correlates of activity included gender roles for activity, importance of support from the family and husband, child care issues tied to having few relatives who lived close by, language, and isolation in the community. The women suggested changes and programs that could promote physical activity through multiple channels, especially involving the family. This information can be used to develop culturally appropriate interventions to increase physical activity among Latinas. [ABSTRACT FROM AUTHOR]

Abstract Background Physician-delivered preventive counseling is important for the prevention and management of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a better attitude towards preventive counseling. However, this association and its correlates have not been addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public health priority. This study examines the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia. Methods During 2006, a total of 661 first- and fifth-year medical students completed a culturally adapted Spanish version of the "Healthy Doctor = Healthy Patient" survey (response rate = 78%). Logistic regression analyses were used to assess the association between overall personal practices on physical activity, nutrition, weight control, smoking, alcohol use (main exposure variable) and student attitudes toward preventive counseling on these issues (main outcome variable), stratified by year of training and adjusting by gender and medical training-related factors (basic knowledge, perceived adequacy of training and perception of the school's promotion on each healthy habit). Results The median age and percentage of females for the first- and fifth-year students were 21 years and 59.5% and 25 years and 65%, respectively. After controlling for gender and medical training-related factors, consumption of ≥ 5 daily servings of fruits and/or vegetables, not being a smoker or binge drinker were associated with a positive attitude toward counseling on nutrition (OR = 4.71; CI = 1.6–14.1; p = 0.006 smoking (OR = 2.62; CI = 1.1–5.9; p = 0.022), and alcohol consumption (OR = 2.61; CI = 1.3–5.4; p = 0.009), respectively. Conclusion As for U.S. physician and medical students, a positive association was found between the personal health habits of Colombian medical students and their corresponding attitudes toward preventive counseling, independent of gender and medial training-related factors. Our findings, the first relating to this association in medical students in developing regions, also suggest that within the medical school context, interventions focused on promoting healthy student lifestyles can potentially improve future physician's attitudes toward preventive counseling.

This study examines associations between neighborhood environment attributes and health related quality of life (HRQOL) and self-rated health (SRH) among older adults (60 years and over) in Bogotá, Colombia. Perceived and objective neighborhood environmental characteristics were assessed in a cross sectional multilevel design with 1966 older adults within 50 neighborhoods. Outcome variables included HRQOL (physical and mental dimensions) and SRH measured with the Spanish version of the Short Form 8 (SF-8). Independent variables included perceived and objective neighborhood characteristics as well as self-reported levels of walking. Hierarchical linear and logistic regression models were used for the analysis. Among perceived neighborhood characteristics, safety from traffic was positively associated with both HRQOL dimensions and SRH. Having safe parks was positively associated with the mental dimension of HRQOL and with SRH. Street noise was negatively associated with both HRQOL dimensions. Regarding objective neighborhood characteristics, residing in areas with more than eight percent of land covered by public parks was positively associated with SRH. Objective and perceived neighborhood characteristics could provide insight into potential interventions among older adults from rapidly urbanizing settings in Latin America. [ABSTRACT FROM AUTHOR]

Latin American cities have evolved via exclusionary historical processes, resulting in hasty and unplanned urbanization, insufficient infrastructure, and extreme levels of violence. These issues have well-documented health implications. In urban settings, gender may lead to unequal access to opportunities and services, however, its consideration into policies, interventions, and research remains insufficient, potentially exacerbating urban inequities. Drawing inspiration from feminist urbanism and urban health research, we propose a structured tool for Latin American cities to develop gender-sensitive urban policies, interventions, and urban health research. The study encompassed: (1) a narrative literature review of feminist urbanism frameworks and the Delphi method to select the most appropriate dimensions; (2) a thorough examination of data availability and indicators in three studies of urban transformation interventions in Brazil, Colombia, and Chile to evaluate data availability and local interest; and (3) an urban health dialogue with the relevant indicators. We identified three key dimensions: "proximity", "autonomy", and "representativeness". Neighborhood was considered the most meaningful level for analyses. The indicators were organized into subdimensions, considering existing literature on their implications for gender and health. The proposed tool is comprehensive and adaptable, thus, it can be used in diverse Latin American urban contexts. It is a valuable resource for incorporating a gender-sensitive perspective into urban policymaking, interventions, and health-related research.

Competing Interests: Competing interests: The authors declare no competing interests.

Despite the relevance of cities and city policies for health, there has been limited examination of large numbers of cities aimed at characterizing urban health determinants and identifying effective policies. The relatively few comparative studies that exist include few cities in lower and middle income countries. The Salud Urbana en America Latina study (SALURBAL) was launched in 2017 to address this gap. The study has four aims: (1) to investigate social and physical environment factors associated with health differences across and within cities; (2) to document the health impact of urban policies and interventions; (3) to use systems approaches to better understand dynamics and identify opportunities for intervention and (4) to create a new dialogue about the drivers of health in cities and their policy implications and support action. Beyond these aims SALURBAL, has an overarching goal of supporting collaborative policy relevant research and capacity -building that engages individuals and institutions from across Latin America. In this review we provide an update on the SALURBAL data resource and collaborative approach and summarize key findings from the first aim of the study. We also describe key elements of our approach, challenges we have faced and how we have overcome them, and identify key opportunities to support policy relevant evidence generation in urban health for the future., (© 2024. The Author(s).)

The Care Block of Bogotá, Colombia, is an urban program that offers services for low-income unpaid caregivers. This study aimed to (i) characterize unpaid caregivers' subjective well-being, mental health symptoms, physical activity levels, and use of public spaces linked to the Care Block; (ii) identify caregivers' perceived built and social environment facilitators and barriers to accessing the Care Block facility; and (iii) document the community-led advocacy process to improve the Care Block program. The quantitative component included a subjective well-being and mental health symptoms survey, and the System for Observing Play and Recreation in Communities (SOPARC) instrument. The qualitative component included the Our Voice citizen science method augmented with portable virtual reality equipment to engage participants in advocacy for changes. Participants (median age of 53 years) dedicated a median of 13.8 h a day to unpaid caregiving, had an average subjective well-being score of 7.0, and 19.1% and 23.8% reported having depression and generalized anxiety symptoms respectively. Caregivers reported that the program fosters their perception of purpose, enjoyment, resilience, and cognitive and emotional awareness. SOPARC evaluation showed that most women engaged in moderate to vigorous physical activity. The caregivers highlighted education, physical activity services, and integration of facilities as facilitators to accessing the Care Block program. Poor quality and lack of sidewalks and roads, limited personal safety, and the risk of pedestrian-vehicle collisions were identified as barriers. Virtual Reality sparked compelling dialogue between participants and stakeholders, allowing stakeholders to reflect on an urban program facilitating unpaid care work., Competing Interests: Declarations. Ethics Statement: All phases of the study were reviewed and approved by the ethics committee of the Universidad de Los Andes (Acta No. 806–2017; Acta No. 1565–2022; 1571–2022, 1588–2022)., (© 2024. The Author(s).)

In highly urbanized and unequal Latin America, urban health and health equity research are essential to effective policymaking. To ensure the application of relevant and context-specific evidence to efforts to reduce urban health inequities, urban health research in Latin America must incorporate strategic research translation efforts. Beginning in 2017, the Urban Health in Latin America (SALURBAL) project implemented policy-relevant research and engaged policymakers and the public to support the translation of research findings. Over 6 years, more than 200 researchers across eight countries contributed to SALURBAL's interdisciplinary network. This network allowed SALURBAL to adapt research and engagement activities to local contexts and priorities, thereby maximizing the policy relevance of research findings and their application to promote policy action, inform urban interventions, and drive societal change. SALURBAL achieved significant visibility and credibility among academic and nonacademic urban health stakeholders, resulting in the development of evidence and tools to support urban policymakers, planners, and policy development processes across the region. These efforts and their outcomes reveal important lessons regarding maintaining flexibility and accounting for local context in research, ensuring that resources are dedicated to policy engagement and dissemination activities, and recognizing that assessing policy impact requires a nuanced understanding of complex policymaking processes. These reflections are relevant for promoting urban health and health equity research translation across the global south and worldwide. This paper presents SALURBAL's strategy for dissemination and policy translation, highlights innovative initiatives and their outcomes, discusses lessons learned, and shares recommendations for future efforts to promote effective translation of research findings., (© 2024. The Author(s).)

Purpose: This paper aims to enrich understanding of the obesity transition among socioeconomic status (SES) strata by gender and age in cities of Colombia and Mexico. The study uses harmonized data from the Salud Urbana en América Latina (SALURBAL) study., Methods: A population-level system dynamics model was developed using 2010 and 2015 data from Colombia and 2012 and 2016 data from Mexico (national health surveys). The model simulates the prevalence of different BMI categories (i.e., not overweight, overweight, obese) stratified by gender, age, and SES, in the SALURBAL cities (aggregated to the country level) of Colombia and Mexico from 2010 to 2050. Sample sizes for Colombia in 2010 and Mexico in 2012 were 7420 and 5785 children (<5 years), 21601 and 14413 children and adolescents (5-17 years), and 46597 and 20464 adults (18-64 years), respectively. Sample sizes for Colombia in 2015 and Mexico in 2016 were 4450 and 907 children, 12468 and 2350 children and adolescents, and 90430 and 3413 adults, respectively., Results: For men in Colombia and Mexico, the burden of obesity is projected to increase among lower SES adults over time. Colombian women show similar patterns observed in men but the burden of obesity was already greater in the lower SES groups as early as 2012. In Mexican women, the burden of obesity in 2012 is higher in the lower SES population; however, the prevalence of obesity is projected to increase at a faster rate in the higher SES population. Patterns for children aged 0-14 years differed by gender and country., Conclusions: The model suggests that the prevalence of obesity among SES strata by age and gender in SALURBAL cities of Colombia and Mexico are likely to change over time, and predicts their possible evolution through the different stages of the obesity transition., Competing Interests: 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., (© 2024 The Authors.)

We present findings from the Our Voice in Barú project, examining adolescent engagement in citizen science to address environmental and social factors affecting well-being in a semi-rural Afro-descendant community in Latin America. The project aimed to identify barriers and enablers of well-being, informing adolescent-led actions for sustainable environmental changes relevant to adolescent health. Utilizing the Our Voice citizen science method, which involved technology-enabled walks, participatory cartography workshops and community meetings, we engaged adolescents and other community members. Complex systems framework was employed to analyze results and assess the promotion of collective action and local change. Local enablers of well-being included availability of quality sports and recreational venues as safe spaces, educational settings and cultural aspects, fostering safety, community pride, and personal growth. Conversely, barriers included environmental contamination, deteriorated sports venues and drug addiction, indicating the community's limited access to services and exposure to harmful substances. Adolescent citizen scientists, in partnership with the research team and relevant community decision-makers, successfully achieved changes aimed at identified barriers, including infrastructural enhancements like the repair of pumps to remove stagnant water, improvements in the quality and safety of recreational venues, and the implementation of community-led initiatives to address substance abuse and promote healthier behaviors. The Our Voice in Barú project empowered adolescents to advocate for change and promoted collective action to tackle barriers identified as significant to their well-being., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings., Method: A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11-15 years). The Theoretical Domains Framework guided a content analysis of the data., Results: We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape., Conclusion: These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping., (© 2023. The Author(s).)

Nine in 10 road traffic deaths occur in low- and middle-income countries (LMICs). Despite this disproportionate burden, few studies have examined built environment correlates of road traffic injury in these settings, including in Latin America. We examined road traffic collisions in Bogotá, Colombia, occurring between 2015 and 2019, and assessed the association between neighborhood-level built environment features and pedestrian injury and death. We used descriptive statistics to characterize all police-reported road traffic collisions that occurred in Bogotá between 2015 and 2019. Cluster detection was used to identify spatial clustering of pedestrian collisions. Adjusted multivariate Poisson regression models were fit to examine associations between several neighborhood-built environment features and rate of pedestrian road traffic injury and death. A total of 173,443 police-reported traffic collisions occurred in Bogotá between 2015 and 2019. Pedestrians made up about 25% of road traffic injuries and 50% of road traffic deaths in Bogotá between 2015 and 2019. Pedestrian collisions were spatially clustered in the southwestern region of Bogotá. Neighborhoods with more street trees (RR, 0.90; 95% CI, 0.82-0.98), traffic signals (0.89, 0.81-0.99), and bus stops (0.89, 0.82-0.97) were associated with lower pedestrian road traffic deaths. Neighborhoods with greater density of large roads were associated with higher pedestrian injury. Our findings highlight the potential for pedestrian-friendly infrastructure to promote safer interactions between pedestrians and motorists in Bogotá and in similar urban contexts globally., (© 2024. The New York Academy of Medicine.)

Introduction: Global surveillance of physical activity (PA) of children and adolescents with questionnaires is limited by the use of instruments developed in high-income countries (HICs) lacking sociocultural adaptation, especially in low- and middle-income countries (LMICs); under-representation of some PA domains; and omission of active play, an important source of PA. Addressing these limitations would help improve international comparisons, and facilitate the cross-fertilisation of ideas to promote PA. We aim to develop and assess the reliability and validity of the app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) among 8-17 years old in 14 LMICs and HICs representing all continents; and generate the 'first available data' on active play in most participating countries., Methods and Analysis: Our study involves eight stages: (1) systematic review of psychometric properties of existing PA questionnaires for children and adolescents; (2) development of the GAC-PAQ (first version); (3) content validity assessment with global experts; (4) cognitive interviews with children/adolescents and parents in all 14 countries; (5) development of a revised GAC-PAQ; (6) development and adaptation of the questionnaire app (application); (7) pilot-test of the app-based GAC-PAQ; and, (8) main study with a stratified, sex-balanced and urban/rural-balanced sample of 500 children/adolescents and one of their parents/guardians per country. Participants will complete the GAC-PAQ twice to assess 1-week test-retest reliability and wear an ActiGraph wGT3X-BT accelerometer for 9 days to test concurrent validity. To assess convergent validity, subsamples (50 adolescents/country) will simultaneously complete the PA module from existing international surveys., Ethics and Dissemination: Approvals from research ethics boards and relevant organisations will be obtained in all participating countries. We anticipate that the GAC-PAQ will facilitate global surveillance of PA in children/adolescents. Our project includes a robust knowledge translation strategy sensitive to social determinants of health to inform inclusive surveillance and PA interventions globally., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Research trends concerning hearing loss within teen rural populations are limited and current evidence suggests that extended high-frequency audiometry can be a sensitive tool to detect subclinical hearing loss. Moreover, current research emphasises the importance of representing different ethnic populations in science. This study aimed to determine the prevalence of acquired hearing loss through conventional pure-tone (0.25-8 kHz) and extended high frequency (EHF) (9-20 kHz) audiometry in Afro-Colombian adolescents from a rural area in Colombia., Design: Observational, cross-sectional study., Participants: 230 Afro-Colombian adolescents aged 13-17 years who attended high school in a rural population from Cartagena, Colombia., Interventions: Otoscopic examination, conventional (0.25-8 kHz) and EHF (9-20 kHz) audiometry tests were performed during February-March 2021. Sociodemographic and associated factor questionnaires were also applied to assess probable factors associated with EHF hearing loss., Main Outcome Measures: Prevalence of acquired hearing loss using conventional and EHF audiometry, and factors associated with hearing loss., Results: Of 230 adolescents who met the eligibility criteria, 133 (57.82%) were female. The mean age was 15.22 years (SD: 1.62). The prevalence of hearing loss in at least one ear assessed with conventional audiometry was 21.30% and with EHF audiometry 14.78%. The main abnormal otoscopic findings included: neotympanum (1.30%), myringosclerosis (0.87%) and monomeric scars (0.43%). Factors associated with a higher probability of EHF hearing loss found through logistic regression were older age (prevalence ratio (PR): 1.45; 95% CI 1.16 to 1.80), attending the 'Picó' four or more times a month (PR: 6.63; 95% CI 2.16 to 20.30), attending bars more than three times a month (PR: 1.14; 95% CI 1.03 to 1.59) and self-reported hearing difficulties (PR: 1.24; 95% CI 1.22 to 4.05)., Conclusions: Our results suggest that acquired hearing loss is already widespread among this young rural population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Climate change is expected to greatly increase exposure to flooding, particularly in urban populations in low- and middle-income countries. We examined within-city social disparities in exposure to flooding in 276 Latin American cities and associated features of the neighborhood urban environment., Methods: We used a spatially granular dataset of historical flood events from 2000 to 2018 to describe neighborhood flooding within cities across eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, and Panama). We estimated the percentage of the population living in flooded neighborhoods, described social disparities in flooding based on neighborhood educational attainment, and compared the magnitude of disparities across and within cities. We used multilevel models to examine how city- and neighborhood-level factors are related to neighborhood flooding., Results: We examined 44,698 neighborhoods in 276 cities from eight countries with a total of 223 million residents and 117 distinct flood events from 2000-2018. One in four residents in neighborhoods in the lowest education quintile lived in neighborhoods with flooding, compared to one in 20 residents of the highest neighborhood education quintile. Greater neighborhood flooding was associated with lower neighborhood-level educational attainment and with neighborhoods that were coastal, less dense (population or intersection), further from the city center, greener, and had steeper slopes. There was no association between city-level educational attainment and flooding., Conclusion: There are large social disparities in neighborhood flooding within Latin American cities. Residents of areas with lower education attainment face substantially higher risks of flooding. Policymakers must prioritize flood adaptation and recovery efforts in neighborhoods with lower socioeconomic position.

Background: Transportation policies can impact health outcomes while simultaneously promoting social equity and environmental sustainability. We developed an agent-based model (ABM) to simulate the impacts of fare subsidies and congestion taxes on commuter decision-making and travel patterns. We report effects on mode share, travel time and transport-related physical activity (PA), including the variability of effects by socioeconomic strata (SES), and the trade-offs that may need to be considered in the implementation of these policies in a context with high levels of necessity-based physical activity., Methods: The ABM design was informed by local stakeholder engagement. The demographic and spatial characteristics of the in-silico city, and its residents, were informed by local surveys and empirical studies. We used ridership and travel time data from the 2019 Bogotá Household Travel Survey to calibrate and validate the model by SES. We then explored the impacts of fare subsidy and congestion tax policy scenarios., Results: Our model reproduced commuting patterns observed in Bogotá, including substantial necessity-based walking for transportation. At the city-level, congestion taxes fractionally reduced car use, including among mid-to-high SES groups but not among low SES commuters. Neither travel times nor physical activity levels were impacted at the city level or by SES. Comparatively, fare subsidies promoted city-level public transportation (PT) ridership, particularly under a 'free-fare' scenario, largely through reductions in walking trips. 'Free fare' policies also led to a large reduction in very long walking times and an overall reduction in the commuting-based attainment of physical activity guidelines. Differential effects were observed by SES, with free fares promoting PT ridership primarily among low-and-middle SES groups. These shifts to PT reduced median walking times among all SES groups, particularly low-SES groups. Moreover, the proportion of low-to-mid SES commuters meeting weekly physical activity recommendations decreased under the 'freefare' policy, with no change observed among high-SES groups., Conclusions: Transport policies can differentially impact SES-level disparities in necessity-based walking and travel times. Understanding these impacts is critical in shaping transportation policies that balance the dual aims of reducing SES-level disparities in travel time (and time poverty) and the promotion of choice-based physical activity., (© 2024. The Author(s).)

Background: Health-focused research funders increasingly support multi-country research partnerships that study health, urban development and equity in global settings. To develop new knowledge that benefits society, these grants require researchers to integrate diverse knowledges and data, and to manage research-related aspects of coloniality, such as power imbalances and epistemic injustices. We conducted research to develop a transdisciplinary study proposal with partners in multiple middle and high income countries, aiming to embed equity into the methodology and funding model., Methods: Parallel to literature review, we used participatory and social research methods to identify case study cities for our primary study and to inform our study design. We conducted semi-structured interviews with informed and consented sustainable urban development experts in the USA (n=23). We co-developed our research approach with our global advisory group (n=14) and conducted a participatory workshop (n=30) to identify case study sites, also informed by conversations with international academic experts in sustainable development (n=27)., Results: Through literature review we found that there is a need to study the contextual pre-conditions of urban transformation, the influence of coloniality on understandings of how cities can change and the failure of standard development practices to meet the needs of all residents and the planet. Through expert input and literature we found that decolonial and storytelling methods may help us show the complexities behind stories of urban transformation, particularly the role of marginalized populations in creating long-term change., Conclusions: There are multiple benefits of conducting research to develop an equitably designed multi-country research collaboration. We built new partnerships and co-developed our research approach, creating new understanding of diverse collaborators' disciplinary perspectives and institutional requirements. By investigating the informational needs of U.S. sustainable development actors and designing our study to meet these needs, we have increased the likelihood that our research will create impact., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Pineo H et al.)

Objectives: The objective was to investigate the benefits of the 'weekend warrior' physical activity pattern in Latin America, where many people take part in high levels of non-exercise physical activity., Methods: Participants in the Mexico City Prospective Study were surveyed from 1998 to 2004 and resurveyed from 2015 to 2019. Those who exercised up to once or twice per week were termed weekend warriors. Those who exercised more often were termed regularly active. Analyses were adjusted for potential confounders., Results: The main analysis included 26 006 deaths in 154 882 adults (67% female) aged 52±13 years followed for 18±4 years (mean±SD). Compared with those who reported no exercise, the HR (95% CI) was 0.88 (0.83 to 0.93) in the weekend warriors and 0.88 (0.84 to 0.91) in the regularly active. Similar results were observed for cardiovascular disease and cancer mortality, but associations were weaker. Stratified analyses showed that substantial reductions in all-cause mortality risk only occurred when the duration of exercise sessions was at least 30-60 min. The repeated-measures analysis included 843 deaths in 10 023 adults followed for 20±2 years. Compared with being inactive or becoming inactive, the HR was 0.86 (95% CI 0.65 to 1.12) when being a weekend warrior or becoming a weekend warrior and 0.85 (95% CI 0.70 to 1.03) when being regularly active or becoming regularly active., Conclusions: This is the first prospective study to investigate the benefits of the weekend warrior physical activity pattern in Latin America. The results suggest that even busy adults could benefit from taking part in one or two sessions of exercise per week., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Norm-based accounts of social behavior in economics typically reflect tradeoffs between maximization of own consumption utility and conformity to social norms. Theories of norm-following tend to assume that there exists a single, stable, commonly known injunctive social norm for a given choice setting and that each person has a stable propensity to follow social norms. We collect panel data on 1468 participants aged 11-15 years in Belfast, Northern Ireland and Bogotá, Colombia in which we measure norms for the dictator game and norm-following propensity twice at 10 weeks apart. We test these basic assumptions and find that norm-following propensity is stable, on average, but reported norms show evidence of change. We find that individual-level variation in reported norms between people and within people across time has interpretable structure using a series of latent transition analyses (LTA) which extend latent class models to a panel setting. The best fitting model includes five latent classes corresponding to five sets of normative beliefs that can be interpreted in terms of what respondents view as "appropriate" (e.g. equality vs. generosity) and how they view deviations (e.g. deontological vs. consequentialist). We also show that a major predictor of changing latent classes over time comes from dissimilarity to others in one's network. Our application of LTA demonstrates how researchers can engage with heterogeneity in normative perceptions by identifying latent classes of beliefs and deepening understanding of the extent to which norms are shared, stable, and can be predicted to change. Finally, we contribute to the nascent experimental literature on the economic behavior of children and adolescents., Supplementary Information: The online version contains supplementary material available at 10.1007/s10683-024-09821-5., (© The Author(s) 2024.)