Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study

Background The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 c...

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Published in:LANCET GLOBAL HEALTH
Main Authors: Corsi, Daniel J.; Marschner, Simone; Lear, Scott; Hystad, Perry; Rosengren, Annika; Ismail, Rosnah; Yeates, Karen; Swaminathan, Sumathi; Puoane, Thandi; Wang, Chuangshi; Li, Yang; Rangarajan, Sumathy; Chifamba, Jephat; Kumar, K. Vidhu; Mohan, Indu; Davletov, Kairat; Artamonov, Galina; Palileo-Villanueva, Lia M.; Mat-Nasir, Nafi za; Zatonska, Katarzyna; Oguz, Aytekin; Bahonar, Ahmad; Alhabib, Khalid F.; Yusufali, Afzalhussein; Lopez-Jaramillo, Patricio; Lanas, Fernando; Galatte, Agustina; Avezum, Alvaro; Mckee, Martin; Yusuf, Salim; Chow, Clara K.
Format: Article
Language:English
Published: ELSEVIER SCI LTD 2024
Subjects:
Online Access:https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-record/WOS:001343346500001
author Corsi
Daniel J.; Marschner
Simone; Lear
Scott; Hystad
Perry; Rosengren
Annika; Ismail
Rosnah; Yeates
Karen; Swaminathan
Sumathi; Puoane
Thandi; Wang
Chuangshi; Li
Yang; Rangarajan
Sumathy; Chifamba
Jephat; Kumar
K. Vidhu; Mohan
Indu; Davletov
Kairat; Artamonov
Galina; Palileo-Villanueva
Lia M.; Mat-Nasir
Nafi za; Zatonska
Katarzyna; Oguz
Aytekin; Bahonar
Ahmad; Alhabib
Khalid F.; Yusufali
Afzalhussein; Lopez-Jaramillo
Patricio; Lanas
Fernando; Galatte
Agustina; Avezum
Alvaro; Mckee
Martin; Yusuf
Salim; Chow
Clara K.
spellingShingle Corsi
Daniel J.; Marschner
Simone; Lear
Scott; Hystad
Perry; Rosengren
Annika; Ismail
Rosnah; Yeates
Karen; Swaminathan
Sumathi; Puoane
Thandi; Wang
Chuangshi; Li
Yang; Rangarajan
Sumathy; Chifamba
Jephat; Kumar
K. Vidhu; Mohan
Indu; Davletov
Kairat; Artamonov
Galina; Palileo-Villanueva
Lia M.; Mat-Nasir
Nafi za; Zatonska
Katarzyna; Oguz
Aytekin; Bahonar
Ahmad; Alhabib
Khalid F.; Yusufali
Afzalhussein; Lopez-Jaramillo
Patricio; Lanas
Fernando; Galatte
Agustina; Avezum
Alvaro; Mckee
Martin; Yusuf
Salim; Chow
Clara K.
Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
Public, Environmental & Occupational Health
author_facet Corsi
Daniel J.; Marschner
Simone; Lear
Scott; Hystad
Perry; Rosengren
Annika; Ismail
Rosnah; Yeates
Karen; Swaminathan
Sumathi; Puoane
Thandi; Wang
Chuangshi; Li
Yang; Rangarajan
Sumathy; Chifamba
Jephat; Kumar
K. Vidhu; Mohan
Indu; Davletov
Kairat; Artamonov
Galina; Palileo-Villanueva
Lia M.; Mat-Nasir
Nafi za; Zatonska
Katarzyna; Oguz
Aytekin; Bahonar
Ahmad; Alhabib
Khalid F.; Yusufali
Afzalhussein; Lopez-Jaramillo
Patricio; Lanas
Fernando; Galatte
Agustina; Avezum
Alvaro; Mckee
Martin; Yusuf
Salim; Chow
Clara K.
author_sort Corsi
spelling Corsi, Daniel J.; Marschner, Simone; Lear, Scott; Hystad, Perry; Rosengren, Annika; Ismail, Rosnah; Yeates, Karen; Swaminathan, Sumathi; Puoane, Thandi; Wang, Chuangshi; Li, Yang; Rangarajan, Sumathy; Chifamba, Jephat; Kumar, K. Vidhu; Mohan, Indu; Davletov, Kairat; Artamonov, Galina; Palileo-Villanueva, Lia M.; Mat-Nasir, Nafi za; Zatonska, Katarzyna; Oguz, Aytekin; Bahonar, Ahmad; Alhabib, Khalid F.; Yusufali, Afzalhussein; Lopez-Jaramillo, Patricio; Lanas, Fernando; Galatte, Agustina; Avezum, Alvaro; Mckee, Martin; Yusuf, Salim; Chow, Clara K.
Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
LANCET GLOBAL HEALTH
English
Article
Background The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. Methods Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m(2)) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. Findings Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (133, SD 28) compared with other regions (101, 25) and urban communities (112, 30). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 058, 95% CI 035-093; p=0025) for high compared with low scores and for increasing trend (085, 078-091; p<00001). The trends were statistically significant in urban (085, 077-093; p=00007) and rural (087, 078-097; p=0015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 075 (95% CI 061-092; p=00066); bike lanes RR 058 (045-073; p<00001); pedestrian safety RR 075 (062-090; p=00018); and traffic signals RR 068 (052-089; p=00055). Community disorder was associated with a higher prevalence of obesity (RR 148, 95% CI 117-186; p=00010). Interpretation Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health.
ELSEVIER SCI LTD
2214-109X

2024
12
11
10.1016/S2214-109X(24)00287-0
Public, Environmental & Occupational Health

WOS:001343346500001
https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-record/WOS:001343346500001
title Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
title_short Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
title_full Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
title_fullStr Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
title_full_unstemmed Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
title_sort Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study
container_title LANCET GLOBAL HEALTH
language English
format Article
description Background The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. Methods Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m(2)) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. Findings Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (133, SD 28) compared with other regions (101, 25) and urban communities (112, 30). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 058, 95% CI 035-093; p=0025) for high compared with low scores and for increasing trend (085, 078-091; p<00001). The trends were statistically significant in urban (085, 077-093; p=00007) and rural (087, 078-097; p=0015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 075 (95% CI 061-092; p=00066); bike lanes RR 058 (045-073; p<00001); pedestrian safety RR 075 (062-090; p=00018); and traffic signals RR 068 (052-089; p=00055). Community disorder was associated with a higher prevalence of obesity (RR 148, 95% CI 117-186; p=00010). Interpretation Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health.
publisher ELSEVIER SCI LTD
issn 2214-109X

publishDate 2024
container_volume 12
container_issue 11
doi_str_mv 10.1016/S2214-109X(24)00287-0
topic Public, Environmental & Occupational Health
topic_facet Public, Environmental & Occupational Health
accesstype
id WOS:001343346500001
url https://www-webofscience-com.uitm.idm.oclc.org/wos/woscc/full-record/WOS:001343346500001
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