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Results for “Built Environment”

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PubMed1994

Poisoned landscapes: the epidemiology of environmental lead exposure in Massachusetts children 1990-1991.

This research models the geographic variation in lead poisoning among children living in Massachusetts between 1990 and 1991. Elevated levels of blood lead, which reduce educational performance, arise because children are exposed to unnaturally concentrated sources of lead in the built environment. A Poisson regression model indicates that a large number of children with lead poisoning may be detected in towns with a high proportion of older housing, female headed households, African-Americans, and an industrial heritage. Our results suggest links between the processes of urbanization and industrialization in Massachusetts and today's lead poisoned landscapes.

Child, Preschool↗

PubMed2005

The public health roots of zoning: in search of active living's legal genealogy.

BACKGROUND: Improvements in the built environment and changes in land-use policy are promising approaches to increasing physical activity among a largely sedentary population. Opportunities for walking and cycling as part of daily life are important to increasing physical activity and improving health. Yet, local zoning codes and related land-use regulations have made it difficult to create vibrant, mixed-use neighborhoods with well-connected streets and more compact development-the infrastructure necessary to support healthier rates of walking and cycling for transportation. METHODS: To better understand the dynamic nature of land-use law and policy, and how policymakers might accomplish zoning reform to encourage more physically active environments, this paper traces the public health roots of zoning through a family tree of land-use legal doctrines. RESULTS: Zoning and public health laws evolved from the same legal ancestors-the common law of public nuisance and the expansion of state police powers, both premised on protection of the public's health. When the U.S. Supreme Court approved zoning in the 1926 case of Ambler Realty v. Village of Euclid, it nominally recognized the health basis of zoning. But it went on to craft a new legal rationale focused more on protection of property rights and residential neighborhoods. Since Euclid, court decisions have given little consideration to the public health roots of zoning. Given an emerging body of research demonstrating the importance of walking-friendly environments and the deference shown by the courts to the passage of zoning laws, the courts are likely to support policymakers as they move to change zoning systems conceived long ago. CONCLUSIONS: Legal, historical, and policy rationales support the modernization of zoning and land use policies that allow sensible mixes of land uses. Mixed land uses make walking an attractive alternative to driving and support a more physically active and healthy citizenry.

City Planning↗

PubMed2005

Developing a reliable Senior Walking Environmental Assessment Tool.

BACKGROUND: Research of the effects of the built environment on physical activity often excludes certain segments of the population. The senior population, one segment perhaps most influenced by the physical features of an environment, has been understudied. Developing reliable measures of the environment is important to increase our understanding of the environmental effects on physical activity among seniors. METHODS: A review of urban planning and health literature helped identify important concepts and theories that were used to inform the development of the Senior Walking Environmental Assessment Tool (SWEAT). Urban planning and health research professionals were consulted and provided feedback on the tool. A total of 355 neighborhood segments were assessed using SWEAT. Thirty-six neighborhood segments were assessed for inter-rater reliability. RESULTS: Overall, raters exhibited good-to-excellent agreement on most items included in SWEAT. Items assessing buildings and destinations were less reliable than other categories. CONCLUSIONS: The development of a reliable senior-specific environmental measurement of detailed street level environmental features that may influence walking among seniors is important to advance this research and engage communities to consider simple environmental changes that encourage walking among seniors.

Aged↗

PubMed2006

Relationship between urban sprawl and weight of United States youth.

BACKGROUND: Among United States youth there is an obesity epidemic with potential life-long health implications. To date, relationships between the built environment and body mass index (BMI) have not been evaluated for youth, and have not been evaluated longitudinally. OBJECTIVES: To determine if urban sprawl is associated with BMI for U.S. youth. METHODS: Using data from the 1997 National Longitudinal Survey of Youth (NLSY97), both cross-sectional and longitudinal analyses were conducted. Hierarchical modeling was used to relate characteristics of individuals, households, and places to BMI. Individual and household data were extracted from the NLSY97. The independent variable of interest was the county sprawl index, which was derived with principal components analyses from census and other data. RESULTS: In a cross-sectional analysis, the likelihood of U.S. adolescents (aged 12-17 years) being overweight or at risk of overweight (> or =85th percentile relative to the Centers for Disease Control growth charts) was associated with county sprawl (p=0.022). In another cross-sectional analysis, after controlling for sociodemographic and behavioral covariates, the likelihood of young adults (aged 18-23 years) being obese was also associated with county sprawl (p=0.048). By contrast, in longitudinal analyses, BMI growth curves for individual youth over the 7 years of NLSY97, and BMI changes for individual youth who moved between counties, were not related to county sprawl (although coefficient signs were as expected). CONCLUSIONS: Cross-sectional analyses suggest that urban form is associated with being overweight among U.S. youth. The strength of these relationships proved comparable to those previously reported for adults. Longitudinal analyses show no such relationship. It is unclear why these approaches give different results, but sample sizes, latent effects, and confounders may contribute.

Adolescent↗

PubMed2007

Task demands and human capabilities in door use.

Doors are ubiquitous in the built environment, bur despite their frequent use by people and their involvement in over 300,000 injuries per year (USA), they are little studied from a human factors perspective. This paper provides a classification scheme for doors based on human/door interaction and a prototypical task analysis of door use. Two observational studies were performed on a particular type of door. The first observed 1600 human/door interactions and found that people's use of force-enhancing strategies increased for larger doors, particularly for people of smaller stature. The second observed 800 interactions with push doors and found that the pont where force is exerted is higher for taller individuals and closer to the center of the door than is typically assumed for placing handles. Th second study was partly corroborated by measuring the position of wear patterns on doors. As is expected in human factors, the was people used doors was a function of both task demands and human capabilities. These results suggests that those specifying doors for building s use a restoring torque below 30 Nm and site the handle or push plate 250-350 mm from the door edge and 1000-1500 mm above the floor.

Analysis of Variance↗

PubMed2006

The value of Seasonal Correction Factors in assessing the health risk from domestic radon: a case study in Northamptonshire, UK.

Following an intensive survey of domestic radon levels in the United Kingdom (UK), the former National Radiological Protection Board (NRPB), now the Radiation Protection Division of the Health Protection Agency (HPA-RPD), established a measurement protocol and promulgated Seasonal Correction Factors applicable to the country as a whole. Radon levels in the domestic built environment are assumed to vary systematically and repeatably during the year, being generally higher in winter. The Seasonal Correction Factors therefore comprise a series of numerical multipliers, which convert a 1-month or 3-month radon concentration measurement, commencing in any month of the year, to an effective annual mean radon concentration. In a recent project undertaken to assess the utility of short-term exposures in quantifying domestic radon levels, a comparative assessment of a number of integrating detector types was undertaken, with radon levels in 34 houses on common geology monitored over a 12-month period using dose-integrating track-etch detectors exposed in pairs (one upstairs, one downstairs) at 1-month and 3-month resolution. Seasonal variability of radon concentrations departed significantly from that expected on the basis of the HPA-RPD Seasonal Correction Factor set, with year-end discontinuities at both 1-month and 3-month measurement resolutions. Following this study, monitoring with electrets was continued in four properties, with weekly radon concentration data now available for a total duration in excess of three and a half years. Analysis of this data has permitted the derivation of reliable local Seasonal Correction Factors. Overall, these are significantly lower than those recommended by HPA-RPD, but are comparable with other results from the UK and from abroad, particularly those that recognise geological diversity and are consequently prepared on a regional rather than a national basis. This finding calls into question the validity of using nationally aggregated Seasonal Correction Factors, especially for shorter exposures, and the universal applicability of these corrections is discussed in detail.

Air Pollution, Indoor↗

PubMed2006

Workshop summary: connecting social and environmental factors to measure and track environmental health disparities.

On May 24-25, 2005 in Ann Arbor, Michigan, the US Environmental Protection Agency, the National Institute of Environmental Health Sciences, and the University of Michigan sponsored a technical workshop on the topic of connecting social and environmental factors to measure and track environmental health disparities. The workshop was designed to develop a transdisciplinary scientific foundation for exploring the conceptual issues, data needs, and policy applications associated with social and environmental factors used to measure and track racial, ethnic, and class disparities in environmental health. Papers, presentations, and discussions focused on the use of multilevel analysis to study environmental health disparities, the development of an organizing framework for evaluating health disparities, the development of indicators, and the generation of community-based participatory approaches for indicator development and use. Group exercises were conducted to identify preliminary lists of priority health outcomes and potential indicators and to discuss policy implications and next steps. Three critical issues that stem from the workshop were: (a) stronger funding support is needed for community-based participatory research in environmental health disparities, (b) race/ethnicity and socioeconomic position need to be included in environmental health surveillance and research, and (c) models to elucidate the interrelations between social, physical, and built environments should continue to be developed and empirically tested.

Education↗

PubMed2006

National environmental health measures for minority and low-income populations: tracking social disparities in environmental health.

Healthy People 2010 [US Department of Health and Human Services, 2004. Healthy People 2010. Available: http://www.healthypeople.gov/Publications/ [accessed May 22, 2004]] has established as a top priority the elimination of health disparities. Current research suggests that characteristics of the social, physical and built environment contribute to these disparities. In order to track progress and to assess the potential contributions of the various components of the "environment," tools specific to environmental health disparities are required. In this paper, we discuss one potential tool, a set of candidate measures that may be used to track disparities in outcomes, as well as measures that may be used analytically to assess potential causal pathways. Several other reports on health and environmental measures have been produced, including the Environmental Protection Agency's (EPA) America's Children and the Environment. However, there has not been a comprehensive discussion about environmental measures that focus on racial, ethnic and socioeconomic disparities in health. Therefore, we focus on measures specific to historically disadvantaged populations. Based on a conceptual framework that views health disparities as partially driven by differential access to resources and exposures to hazards, we group the measures into four categories: social processes, environmental contaminants/exposures, bodyburdens of environmental contaminants, and health outcomes. We provide a few examples to illustrate each category, including residential segregation, PM(2.5) exposures, blood mercury concentrations, and asthma morbidity and mortality. These measures and categories are derived from a review of environmental health disparities from several disciplines. As a next step in a long-term effort to better understand the relationship between social disadvantage, environment, and health disparities, we hope that the proposed measures and literature review serve as a foundation for future monitoring of environmental health disparities. These efforts may aid community organizations, local agencies, scientists and policy makers in allocating resources and developing interventions.

Asthma↗

PubMedDate not supplied

Health professionals' perspectives of providing care to people with dementia in the acute setting: Toward better practice.

This article reports an interpretative research project about the care of patients with dementia admitted to the acute setting with a non-dementia-related illness. Open-ended interviews were conducted with 25 medical, nursing, and other health care professionals drawn from 3 metropolitan teaching hospitals in Australia. Qualitative data analysis generated 5 major themes relating to the built environment and organizational "system" as determinants of practice, the influence of key players, current dementia care management, and ideal dementia care management. Results showed acute care hospitals are not the best place for people with dementia and can negatively influence health outcomes such as functional independence and quality of life. Participants reported attempts to provide best practice but experienced major constraints stemming largely from environmental, sociocultural, and economic issues. Recommendations include the delivery of acute services in tandem with dementia services and a whole organization shift in thinking away from what conveniently suits the institution to thinking that is person-centered and dementia-friendly. With support from executive-level management, nurses can play a leading role in the implementation of practice change.

Activities of Daily Living↗

PubMed2006

Walkability of local communities: using geographic information systems to objectively assess relevant environmental attributes.

Geographic Information Systems (GIS) can be used to objectively measure features of the built environment that may influence adults' physical activity, which is an important determinant of chronic disease. We describe how a previously developed index of walkability was operationalised in an Australian context, using available spatial data. The index was used to generate a stratified sampling frame for the selection of households from 32 communities for the PLACE (Physical Activity in Localities and Community Environments) study. GIS data have the potential to be used to construct measures of environmental attributes and to develop indices of walkability for cities, regions or local communities.

Adult↗

PubMed2006

Are self-reported physical activity levels associated with perceived desirability of activity-friendly communities?

People living in activity-friendly communities (AFCs) are more active but the self-selection influence is unknown. From 4856 respondents we explored mediating variables with expressed desire to live in AFCs. Association with desire to live in AFCs included ages 18-24 years (odds ratio [OR]=1.9), African American (OR=1.9) or Hispanic (OR=1.5), and believing AFCs would support activity-based transportation (OR=2.4). Regular physical activity (PA) was marginally associated with desire to live in AFCs (OR=1.3). These findings suggest that PA may be a significant factor in communities of this style. Strategies for social marketing along with changes to the built environment to increase PA levels are discussed.

Adolescent↗

PubMed2005

Gait dynamics on an inclined walkway.

OBJECTIVE: This paper documents research that quantifies and describes the biomechanics of normal gait on inclined surfaces. DESIGN: Experimental, investigative. BACKGROUND: It is necessary to walk on inclined surfaces to negotiate the natural and built environments. Little research has been conducted on the biomechanics of normal gait on inclined surfaces. METHODS: The gait of 11 healthy male volunteers was measured using a Vicon system 370 on an inclinable walkway. Gait was measured at 0 degrees , 5 degrees , 8 degrees and 10 degrees of incline. Passive optical markers were placed on each subject and they walked at a self-selected speed up and down the walkway. Ground reaction forces and EMG were measured. Gait data were analysed in Vicon Clinical Manager. RESULTS: Changes in the dynamics of the lower limbs with respect to incline angles are described. Between subject and between condition differences in biomechanical parameters were significant. Hip flexion increased at heel strike with inclines from -10 degrees to +10 degrees . Knee flexion and ankle dorsiflexion at heel strike increased with increasing angle walking up, but not down. Changes in joint moments and powers due to change in the angle of incline or direction of walking were observed. CONCLUSIONS: The mechanisms by which the body enables walking up and downhill, specifically raising and lowering the centre of mass, and preventing slipping, can be seen in the alteration in the dynamics of the lower limbs. Increases in range of motion and muscle strength requirements need to be considered in the design of lower limb prostheses and in orthopaedic and neurological rehabilitation. RELEVANCE: Gait, prosthetics, rehabilitation, balance and falls.

Adult↗

PubMed2002

Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects.

We undertook a month-long intensive pilot study of a sample of adult wheelchair-users in Boston, Massachusetts and Durham, North Carolina, USA. The study had four objectives; to: (1) measure experiences of reaching and failing to reach specific destinations; (2) measure encounters with environmental facilitators and barriers, including both those overcome and not overcome; (3) determine the frequencies of destinations, facilitators, and barriers, and (4) test for consistency between daily reports and retrospective reports. Full participation entailed baseline and exit telephone interviews, and 28 daily telephone contacts. Participants reported reaching a wide range of destinations, most notably, banks, stores and shops, friends' and relatives' homes and health professionals' offices. There was a smaller range of destinations that they could not reach, despite trying; most notably, religious buildings, friends' and relatives' homes and work-places. They encountered an array of barriers, some of which they were able to overcome and others they could not overcome. Reported barriers included personal, interpersonal, and environmental barriers. The 25 subjects completing the study reported a wide range of human, environmental, and technologic support. In general, the consistency among daily, baseline, and exit interviews was high. This study has both substantive and methodologic implications. It suggests that efforts to facilitate social participation by wheelchair-users should focus not only on the built environment, but also on interventions in personal assistance and assistive technology, health promotion and fitness, and programs that improve civility. Methodologically, the data suggest that it is possible to make reliable measures of environmental encounters without the administrative and respondent burden associated with daily interviews.

Activities of Daily Living↗

PubMed2004

Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia.

A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied 'pride of place'. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of 'public' and 'private'. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised 'health care' space. This space is neither private nor public but a reflection of the economic, political and social processes underlying this transformation.

Australia↗

PubMed2003

Challenging aging stereotypes: strategies for creating a more active society.

BACKGROUND: The myths of aging provide a partial explanation for why older people have not been primary targets for health promotion and disease-prevention programs. Accelerated population aging signals an urgent need for increased attention to health promotion and disease-prevention interventions across the entire life course. OBJECTIVE: The purpose of this article is to review what is known about: (1). the prevalence and nature of ageist stereotypes; (2). the varied ways in which ageist stereotypes are harmful to health, functioning, and well-being; and (3). strategies for effective communication with older adults around lifestyle issues, with particular emphasis on physical activity. RESULTS: This article reviews literature on current myths and reality of aging in the context of designing health promotion programs for older adults. Strategies for combating ageist stereotypes are based on a multilevel view of determinants of health and aging. CONCLUSIONS: Ageist stereotypes are pervasive in U.S. society and harmful to older adults' psychological well-being, physical and cognitive functioning, and survival. Concrete strategies for communicating with older adults can increase the effectiveness of health promotion programs. Strategies for combating ageism and creating a healthier society must address all segments of society, and include educational and media campaigns, an expansion of current research foci, greater sensitivity from care providers, more opportunities for intergenerational linkages, the design of productive roles for older adults, a retrofit of the built environment, and intensified and collaborative action from both the public and private sectors.

Aged↗

PubMed2003

Promoting physical activity among older adults: from ecology to the individual.

The promotion of physical activity in older populations holds the promise of promoting health and reducing the risk of disablement. Individual- and community-based programs are often presented as being distinct and, in some cases, antithetical. The objective of this paper is to illustrate, through the use of an ecologic model, that individual- and community-based programs are complementary. The following topics are discussed: (1). the development of transdisciplinary theories; (2). the establishment of better measures to address the linkages across individual behavior, group behavior, the built environment, and the temporal sequence of biological, behavioral, and environmental factors; (3). the translation of research into practice and policies; and (4). the training of a new generation of scholars and practitioners to develop and execute research, practice, and policy agendas in this area. An ecologic model fosters a comprehensive agenda based on biological, behavioral, and environmental factors. The study of the interaction of the individual with the environment is challenging but potentially more important than the study of the role of the individual or the environment alone in the promotion of physical activity.

Aged↗

PubMed1997

Consumerist ideology and the symbolic landscapes of private medicine.

The consumption of health care has generally been examined by geographers in terms of patterns of service utilization by patients. The sites of service provision have been viewed as locations rather than as contributors to, and constituents of, urban landscapes. In this paper we argue that perspectives of the so-called "new" cultural geography can assist in interpreting the urban landscapes of health care. The case of accident and medical clinics in New Zealand is examined and used to argue that the underlying ideologies of private provision and consumerism is reflected in the symbols used in both the built environment and in advertising.

Advertising↗

PubMed1997

Addressing barriers: disabled rights and the implications for nursing of the social construct of disability.

Drawing upon the writings of disabled people, this paper explores some of the issues which nurses working with disabled people are trying to address, in particular the barriers model of disability. Traditionally disability has been regarded as a personal tragedy afflicting the individual, hence the response to disability has been via the charity, health and welfare systems. Disabled people over the past two decades have substantially challenged this view of disability and the responses it prompts, arguing that disability is created by social barriers and barriers in the built environment. This requires a different response. Nurses working with disabled people, such as learning disability nurses, have struggled to develop more appropriate responses to disability, for example by developing working alliances with people with learning difficulties in order to both promote health and address disabling barriers. The issues these nurses face and some of the lessons disabled people have taught them are relevant to the nursing profession's wider struggle to shed its medical and dependency image.

Attitude of Health Personnel↗