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City Planning Policies to Support Health and Sustainability: An International Comparison of Policy Indicators for 25 Cities

Lowe, Melanie; Adlakha, Deepti; Sallis, James F.; Salvo, Deborah; Cerin, Ester; Moudon, Anne Vernez; Higgs, Carl; Hinckson, Erica; Arundel, Jonathan; Boeing, Geoff; Liu, Shiqin; Mansour, Perla; Gebel, Klaus; Puig-ribera, Anna; Mishra, Pinki Bhasin; Bozovic, Tamara; Carson, Jacob; Dygryn, Jan; Florindo, Alex A.; Ho, Thanh Phuong; Hook, Hannah; Hunter, Ruth F.; Lai, Poh-chin; Molina-garcia, Javier; Nitvimol, Kornsupha; Oyeyemi, Adewale L.; Ramos, Carolina D. G.; Resendiz, Eugen; Troelsen, Jens; Witlox, Frank; Giles-corti, Billie. (2022). City Planning Policies to Support Health and Sustainability: An International Comparison of Policy Indicators for 25 Cities. Lancet Global Health, 10(6), E882-E894.

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Abstract

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Keywords

Physical-activity; Population Health; Walkability

Deciphering the Impact of Urban Built Environment Density on Respiratory Health Using a Quasi-cohort Analysis of 5495 Non-smoking Lung Cancer Cases

Wang, Lan; Sun, Wenyao; Moudon, Anne Vernez; Zhu, Yong-guan; Wang, Jinfeng; Bao, Pingping; Zhao, Xiaojing; Yang, Xiaoming; Jia, Yinghui; Zhang, Surong; Wu, Shuang; Cai, Yuxi. (2022). Deciphering the Impact of Urban Built Environment Density on Respiratory Health Using a Quasi-cohort Analysis of 5495 Non-smoking Lung Cancer Cases. Science Of The Total Environment, 850.

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Abstract

Introduction: Lung cancer is a major health concern and is influenced by air pollution, which can be affected by the den-sity of urban built environment. The spatiotemporal impact of urban density on lung cancer incidence remains unclear, especially at the sub-city level. We aimed to determine cumulative effect of community-level density attributes of the built environment on lung cancer incidence in high-density urban areas. Methods: We selected 78 communities in the central city of Shanghai, China as the study site; communities included in the analysis had an averaged population density of 313 residents per hectare. Using data from the city cancer surveil-lance system, an age-period-cohort analysis of lung cancer incidence was performed over a five-year period (2009-2013), with a total of 5495 non-smoking/non-secondhand smoking exposure lung cancer cases. Community -level density measures included the density of road network, facilities, buildings, green spaces, and land use mixture. Results: In multivariate models, built environment density and the exposure time duration had an interactive effect on lung cancer incidence. Lung cancer incidence of birth cohorts was associated with road density and building coverage across communities, with a relative risk of 1middot142 (95 % CI: 1middot056-1middot234, P = 0middot001) and 1middot090 (95 % CI: 1middot053-1middot128, P < 0middot001) at the baseline year (2009), respectively. The relative risk increased exponentially with the exposure timeduration. As for the change in lung cancer incidence over the five-year period, lung cancer incidence of birth cohorts tended to increase faster in communities with a higher road density and building coverage. Conclusion: Urban planning policies that improve road network design and building layout could be important strate-gies to reduce lung cancer incidence in high-density urban areas.

Keywords

Air-quality; Pollutant Dispersion; Risk-factors; Land-use; Mortality; Exposure; Cities; Transport; Compact City; Longitudinal Analysis; Lung Cancer; Urban Planning

Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study

Cruz, Maricela; Drewnowski, Adam; Bobb, Jennifer F.; Hurvitz, Philip M.; Moudon, Anne Vernez; Cook, Andrea; Mooney, Stephen J.; Buszkiewicz, James H.; Lozano, Paula; Rosenberg, Dori E.; Kapos, Flavia; Theis, Mary Kay; Anau, Jane; Arterburn, David. (2022). Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study. Epidemiology, 33(5), 747-755.

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Abstract

Background: Neighborhoods may play an important role in shaping long-term weight trajectory and obesity risk. Studying the impact of moving to another neighborhood may be the most efficient way to determine the impact of the built environment on health. We explored whether residential moves were associated with changes in body weight. Methods: Kaiser Permanente Washington electronic health records were used to identify 21,502 members aged 18-64 who moved within King County, WA between 2005 and 2017. We linked body weight measures to environment measures, including population, residential, and street intersection densities (800 m and 1,600 m Euclidian buffers) and access to supermarkets and fast foods (1,600 m and 5,000 m network distances). We used linear mixed models to estimate associations between postmove changes in environment and changes in body weight. Results: In general, moving from high-density to moderate- or low-density neighborhoods was associated with greater weight gain postmove. For example, those moving from high to low residential density neighborhoods (within 1,600 m) gained an average of 4.5 (95% confidence interval [CI] = 3.0, 5.9) lbs 3 years after moving, whereas those moving from low to high-density neighborhoods gained an average of 1.3 (95% CI = -0.2, 2.9) lbs. Also, those moving from neighborhoods without fast-food access (within 1600m) to other neighborhoods without fast-food access gained less weight (average 1.6 lbs [95% CI = 0.9, 2.4]) than those moving from and to neighborhoods with fast-food access (average 2.8 lbs [95% CI = 2.5, 3.2]). Conclusions: Moving to higher-density neighborhoods may be associated with reductions in adult weight gain.

Keywords

Body-mass Index; Neighborhood Socioeconomic-status; New-york-city; Built Environment; Physical-activity; Food Environment; Urban Sprawl; Risk-factors; Obesity; Walking; Electronic Medical Records; Fast Foods; Population Density; Residential Density; Residential Moves; Supermarkets

Using Open Data and Open-source Software to Develop Spatial Indicators of Urban Design and Transport Features for Achieving Healthy and Sustainable Cities

Boeing, Geoff; Higgs, Carl; Liu, Shiqin; Giles-corti, Billie; Sallis, James F.; Cerin, Ester; Lowe, Melanie; Adlakha, Deepti; Hinckson, Erica; Moudon, Anne Vernez; Salvo, Deborah; Adams, Marc A.; Barrozo, Ligia, V; Bozovic, Tamara; Delclos-alio, Xavier; Dygryn, Jan; Ferguson, Sara; Gebel, Klaus; Thanh Phuong Ho; Lai, Poh-chin; Martori, Joan C.; Nitvimol, Kornsupha; Queralt, Ana; Roberts, Jennifer D.; Sambo, Garba H.; Schipperijn, Jasper; Vale, David; Van De Weghe, Nico; Vich, Guillem; Arundel, Jonathan. (2022). Using Open Data and Open-source Software to Develop Spatial Indicators of Urban Design and Transport Features for Achieving Healthy and Sustainable Cities. Lancet Global Health, 10(6), E907-E918.

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Abstract

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

Keywords

Systems; Access; Care

What Next? Expanding Our View of City Planning and Global Health, and Implementing and Monitoring Evidence-informed Policy

Giles-corti, Billie; Moudon, Anne Vernez; Lowe, Melanie; Cerin, Ester; Boeing, Geoff; Frumkin, Howard; Salvo, Deborah; Foster, Sarah; Kleeman, Alexandra; Bekessy, Sarah; De Sa, Thiago Herick; Nieuwenhuijsen, Mark; Higgs, Carl; Hinckson, Erica; Adlakha, Deepti; Arundel, Jonathan; Liu, Shiqin; Oyeyemi, Adewale L.; Nitvimol, Kornsupha; Sallis, James F. (2022). What Next? Expanding Our View of City Planning and Global Health, and Implementing and Monitoring Evidence-informed Policy. Lancet Global Health, 10(6), E919-E926.

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Abstract

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.

The Economic Value of Walkable Neighborhoods

Sohn, Dong Wook; Moudon, Anne Vernez; Lee, Jeasun. (2012). The Economic Value of Walkable Neighborhoods. Urban Design International, 17(2), 115 – 128.

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Abstract

This study investigated how the benefits of a walkable neighborhood were reflected in the American real estate market by examining the economic values of urban environmental factors supporting walking activities. Property values were used as a proxy measure for economic value and analyzed in relation to land use characteristics that have been known to correlate with walking at the neighborhood scale. Four aspects of the built environment supporting walking were included in the analyses: development density, land use mix, public open space and pedestrian infrastructure. Hedonic models were employed where the property value was regressed on the measures of the four sets of correlates of walking in a neighborhood. Models were estimated for four land use types - single-family residential, rental multi-family residential, commercial and office. The findings did not support previous arguments that increasing density weakens the quality of a neighborhood. To the contrary, the positive association of higher development density with the value of single-family residential properties detected in King County suggested that high development density might increase surrounding property values. The pedestrian infrastructure and land use mix significantly contributed to increases in rental multi-family residential property values. Higher development density with higher street and sidewalk coverage were also favored by retail service uses. In relation to land use mix, mixing retail service uses and rental multi-family residential uses helped make rental housings more attractive. URBAN DESIGN International (2012) 17, 115-128. doi:10.1057/udi.2012.1; published online 4 April 2012

Keywords

Land-use; Physical-activity; Travel Behavior; Smart Growth; Mode Choice; Urban Form; Walking; Gis; Transportation; Accessibility; Mixed Land Use; Neighborhood; Urban Design

Worksite Neighborhood and Obesogenic Behaviors: Findings among Employees in the Promoting Activity and Changes in Eating (PACE) Trial

Barrington, Wendy E.; Beresford, Shirley A. A.; Koepsell, Thomas D.; Duncan, Glen E.; Moudon, Anne Vernez. (2015). Worksite Neighborhood and Obesogenic Behaviors: Findings among Employees in the Promoting Activity and Changes in Eating (PACE) Trial. American Journal Of Preventive Medicine, 48(1), 31 – 41.

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Abstract

Background: Understanding mechanisms linking neighborhood context to health behaviors may provide targets for increasing lifestyle intervention effectiveness. Although associations between home neighborhood and obesogenic behaviors have been studied, less is known about the role of worksite neighborhood. Purpose: To evaluate associations between worksite neighborhood context at baseline (2006) and change in obesogenic behaviors of adult employees at follow-up (2007-2009) in a worksite randomized trial to prevent weight gain. Methods: Worksite property values were used as an indicator of worksite neighborhood SES (NSES). Worksite neighborhood built environment attributes associated with walkability were evaluated as explanatory factors in relationships among worksite NSES, diet, and physical activity behaviors of employees. Behavioral data were collected at baseline (2005-2007) and follow-up (2007-2009). Multilevel linear and logistic models were constructed adjusting for covariates and accounting for clustering within worksites. Product-of-coefficients methods were used to assess mediation. Analyses were performed after study completion (2011-2012). Results: Higher worksite NSES was associated with more walking (OR = 1.16, 95% CI = 1.03, 1.30, p = 0.01). Higher density of residential units surrounding worksites was associated with more walking and eating five or more daily servings of fruits and vegetables, independent of worksite NSES. Residential density partially explained relationships among worksite NSES, fruit and vegetable consumption, and walking. Conclusions: Worksite neighborhood context may influence employees' obesogenic behaviors. Furthermore, residential density around worksites could be an indicator of access to dietary and physical activity-related infrastructure in urban areas. This may be important given the popularity of worksites as venues for obesity prevention efforts. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords

Health Behavior; Food Habits; Lifestyles & Health; Prevention Of Obesity; Employee Health Promotion; Follow-up Studies (medicine); Local Food Environment; Dietary Energy Density; Body-mass Index; Socioeconomic-status; Physical-activity; Built Environment; Longitudinal-associations; Walking Behavior; Restaurant Use; Weight-gain

Utilitarian and Recreational Walking Among Spanish- and English-Speaking Latino Adults in Micropolitan US Towns

Doescher, Mark P.; Lee, Chanam; Saelens, Brian E.; Lee, Chunkuen; Berke, Ethan M.; Adachi-mejia, Anna M.; Patterson, Davis G.; Moudon, Anne Vernez. (2017). Utilitarian and Recreational Walking Among Spanish- and English-Speaking Latino Adults in Micropolitan US Towns. Journal Of Immigrant & Minority Health, 19(2), 237 – 245.

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Abstract

Walking among Latinos in US Micropolitan towns may vary by language spoken. In 2011-2012, we collected telephone survey and built environment (BE) data from adults in six towns located within micropolitan counties from two states with sizable Latino populations. We performed mixed-effects logistic regression modeling to examine relationships between ethnicity-language group [Spanish-speaking Latinos (SSLs); English-speaking Latinos (ESLs); and English-speaking non-Latinos (ENLs)] and utilitarian walking and recreational walking, accounting for socio-demographic, lifestyle and BE characteristics. Low-income SSLs reported higher amounts of utilitarian walking than ENLs (p = 0.007), but utilitarian walking in this group decreased as income increased. SSLs reported lower amounts of recreational walking than ENLs (p = 0.004). ESL-ENL differences were not significant. We identified no statistically significant interactions between ethnicity-language group and BE characteristics. Approaches to increase walking in micropolitan towns with sizable SSL populations may need to account for this group's differences in walking behaviors.

Keywords

Walking; Confidence Intervals; Ecology; Ethnic Groups; Hispanic Americans; Income; Language & Languages; Metropolitan Areas; Population; Public Health; Recreation; Rural Conditions; White People; Logistic Regression Analysis; Socioeconomic Factors; Social Context; Body Mass Index; Acquisition Of Data; Physical Activity; Data Analysis Software; Odds Ratio; United States; Environment Design; Ethnicity; Rural Populations; Physical-activity; Built Environment; United-states; Postmenopausal Women; Acculturation; Risk; Transportation; Mortality; Health; Associations; Studies; Demographic Aspects; Telephone Surveys; Minority & Ethnic Groups; Physical Fitness; Low Income Groups; Urban Environments; Demographics; Language; Accounting; Statistical Analysis; Urban Areas; Towns; Populations; Adults; Lifestyles; Latin American Cultural Groups; Sociodemographics; Landscape Architecture; Population Growth; Pediatrics; Leisure; Health Care; Noncitizens; Preventive Medicine; United States--us

Framing the Question: Is Shrinking Good or Bad?

Moudon, Anne Vernez. (2019). Framing the Question: Is Shrinking Good or Bad? Journal Of Urban Design, 24(1), 66 – 68.

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Keywords

Urban Planning; Unemployment; Cost Of Living; Balance Of Trade; Medical Care; Economic Development; Demography; Decision Making; Framing

Common Ground: Eight Factors that Influence Walking and Biking to School

Stewart, Orion; Moudon, Anne Vernez; Claybrooke, Charlotte. (2012). Common Ground: Eight Factors that Influence Walking and Biking to School. Transport Policy, 24, 240 – 248.

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Abstract

The primary goals of Safe Routes to School (SRTS) programs are to increase the number and safety of children walking, biking or using other forms of active travel to school (ATS). This study reviewed quantitative and qualitative research and identified eight common factors that influenced the choice of ATS: distance to school, parental fear of traffic and crime, family schedule constraints and values, neighborhood and family resources and culture, weather, and school characteristics. Suggestions were made as to how these barriers and facilitators of ATS could be integrated into the decision to fund local SRTS programs and to improve their effectiveness. Published by Elsevier Ltd.

Keywords

Commuting; Transportation Of School Children; Transportation Safety Measures; Qualitative Research; Cycling; Walking; Bike; Child; Pedestrian; Safe Routes To School; Safety; Walk; Active Transportation; Physical-activity; Urban Form; Elementary-schools; Safe Routes; Travel Mode; Children; Prevalence; Trip; Environment