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Potential pathways linking green space quality to prosocial behaviour have not been investigated so far. This study aimed to examine 15 candidate mediators of the association between green space quality and prosocial behaviour across physical activity, social interaction, health-related quality of life (HRQOL), child and caregiver mental health. This study analysed data of 4,969 children aged 4-5 years that were observed for 10 years (2004-2014), retrieved from Longitudinal Study of Australian Children. Caregiver perceptions of the availability of good neighbourhood parks, play spaces, and playgrounds were used to evaluate green space quality. Prosocial behaviour was measured based on caregiver reports of the prosocial subscale from the Strengths and Difficulties Questionnaire. Causal mediation analysis was used to fit each candidate mediator in a single mediation model. Additional analyses were conducted to strengthen the findings by modelling green space quality, candidate mediators with child-reported prosocial behaviour. Findings from this study suggest weak evidence of physical activity mediation, with only physical activity enjoyment displaying moderate mediation consistency. Child social interaction and caregiver mental health showed low mediation consistency. In addition, moderate-to-high and low-to-high mediation consistency was found for child mental health and HRQOL indicators, respectively. Mediation by candidate mediators appeared to manifest more in late childhood. Mediation models using child-reported prosocial behaviour tended to show weaker mediation compared to caregiver-reported prosocial behaviour models. To conclude, green space quality may indirectly influence prosocial behaviour among children via several pathways. Improving the quality of neighbourhood green space may support physical activity enjoyment, social interaction, mental health among children, which may potentially foster the development of prosocial behaviour.
I Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Xiaoqi Feng. Do physical activity, social interaction, and mental health mediate the association between green space quality and child prosocial behaviour? Urban Forestry & Urban Greening 2021, 64, 127264 .
AMA StyleI Gusti Ngurah Edi Putra, Thomas Astell-Burt, Dylan P. Cliff, Stewart A. Vella, Xiaoqi Feng. Do physical activity, social interaction, and mental health mediate the association between green space quality and child prosocial behaviour? Urban Forestry & Urban Greening. 2021; 64 ():127264.
Chicago/Turabian StyleI Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Xiaoqi Feng. 2021. "Do physical activity, social interaction, and mental health mediate the association between green space quality and child prosocial behaviour?" Urban Forestry & Urban Greening 64, no. : 127264.
With rapid urbanization globally, people in cities tend to have fewer opportunities to interact with nature. Some health-promoting green infrastructure may support increased visitation. To investigate associations between green space visitation and a range of health promoting green infrastructure. From November 2019 to January 2020, we conducted a population-based cross-sectional study in Shenzhen, China. Patients diagnosed with hypertension aged 35 years or older managed by community health centers for one year were recruited. A stratified multi-stage cluster random sampling method was applied to select a representative sample of 1 158 participants. A well-structured questionnaire was applied to obtain information. Participants were surveyed face-to-face (response rate 96.4 %; n = 1,116 participants) by trained interviewers. Binary logistic regression model was used to analyze the relationship between green space visitation and a range of health promoting green infrastructure. The rate of visiting green space was 87.5 % (976/1,116). The rate of visiting green space for at least 30 min per week was 85.5 % (954/1,116). The rate of visiting green space for at least 120 min per week was 78.2 % (873/1,116). Green space with walking trails [OR(95 %CI): 2.322(1.501,3.591)], group exercise venue [OR(95 %CI): 1.546(1.034,2.312)] mean higher odds of people with hypertension visiting green space. Green space with fitness area availability was positively associated with cumulative green space visitation of 30 min or more a week [OR(95 %CI): 1.652(1.115,2.447)]. Health knowledge promotion area was associated with greater odds of visiting green space at least 120 min per week [OR(95 %CI): 1.529(1.124,2.079)]. Walking trails, health knowledge promotion areas, fitness areas and group exercise venue are associated with higher levels of green space visitation at health-relevant cumulative durations. Our findings have significance for urban greening strategies that aim to maximize population health.
Jingwen Zhang; Xiaoqi Feng; Wenhui Shi; Jia Cui; Ji Peng; Lin Lei; Juan Zhang; Thomas Astell-Burt; Yu Jiang; Jixiang Ma. Health promoting green infrastructure associated with green space visitation. Urban Forestry & Urban Greening 2021, 64, 127237 .
AMA StyleJingwen Zhang, Xiaoqi Feng, Wenhui Shi, Jia Cui, Ji Peng, Lin Lei, Juan Zhang, Thomas Astell-Burt, Yu Jiang, Jixiang Ma. Health promoting green infrastructure associated with green space visitation. Urban Forestry & Urban Greening. 2021; 64 ():127237.
Chicago/Turabian StyleJingwen Zhang; Xiaoqi Feng; Wenhui Shi; Jia Cui; Ji Peng; Lin Lei; Juan Zhang; Thomas Astell-Burt; Yu Jiang; Jixiang Ma. 2021. "Health promoting green infrastructure associated with green space visitation." Urban Forestry & Urban Greening 64, no. : 127237.
Evidence affirms that green space has health benefits, but ethnic inequities in green space availability are under-researched. Percentages of parkland, tree canopy, and open grass within 1.6 km road network distance from home were linked to 110,233 participants in the Sax Institute’s 45 and Up Study baseline survey living in the cities of Sydney, Newcastle and Wollongong. Participants were dichotomised as having insufficient quantity of each green space variable using 20 % as a cut-point, based upon previous studies indicating evidence of health benefits above this threshold. Adjusted multilevel logistic regressions were used to examine odds of insufficient green space associated with country of birth, years lived in Australia, and whether a language other than English was spoken at home. Compared to participants born in Australia, those born in Italy, Lebanon, Vietnam, or China had higher odds of insufficient parkland. Migrants arriving in Australia after 1966 and those speaking a language other than English also had higher odds of insufficient parkland. In contrast, odds of insufficient tree canopy were lower among participants born in Germany, Italy, Lebanon, the Philippines, China, and India compared to those born in Australia. Odds of insufficient tree canopy were also lower for those who moved to Australia after 1966 or who spoke a non-English language at home. Odds of insufficient open grass were higher for participants born in China, migrants between 1996 and 2008, and those speaking a language other than English at home. In conclusion, different ways of measuring ethnicity and green space influenced the patterns observed. Implications for understanding ethnicity-related contingencies in greenspace-health associations requires study.
Shumirai Mushangwe; Thomas Astell-Burt; David Steel; Xiaoqi Feng. Ethnic inequalities in green space availability: Evidence from Australia. Urban Forestry & Urban Greening 2021, 64, 127235 .
AMA StyleShumirai Mushangwe, Thomas Astell-Burt, David Steel, Xiaoqi Feng. Ethnic inequalities in green space availability: Evidence from Australia. Urban Forestry & Urban Greening. 2021; 64 ():127235.
Chicago/Turabian StyleShumirai Mushangwe; Thomas Astell-Burt; David Steel; Xiaoqi Feng. 2021. "Ethnic inequalities in green space availability: Evidence from Australia." Urban Forestry & Urban Greening 64, no. : 127235.
Background Urban greening may reduce loneliness by offering opportunities for solace, social reconnection and supporting processes such as stress relief. We (i) assessed associations between residential green space and cumulative incidence of, and relief from, loneliness over 4 years; and (ii) explored contingencies by age, sex, disability and cohabitation status. Methods Multilevel logistic regressions of change in loneliness status in 8049 city-dwellers between 2013 (baseline) and 2017 (follow-up) in the Household, Income and Labour Dynamics in Australia study. Associations with objectively measured discrete green-space buffers (e.g. parks) (<400, <800 and <1600 m) were adjusted for age, sex, disability, cohabitation status, children and socio-economic variables. Results were translated into absolute risk reductions in loneliness per 10% increase in urban greening. Results The absolute risk of loneliness rose from 15.9% to 16.9% over the 4 years; however, a 10% increase in urban greening within 1.6 km was associated with lower cumulative incident loneliness [odds ratio (OR) = 0.927, 95% confidence interval (CI) = 0.862 to 0.996; absolute risk reduction = 0.66%]. Stronger association was observed for people living alone (OR = 0.828, 95% CI = 0.725 to 0.944). In comparison to people with <10% green space, the ORs for cumulative incident loneliness were 0.833 (95% CI = 0.695 to 0.997), 0.790 (95% CI = 0.624 to 1.000) and 0.736 (95% CI = 0.549 to 0.986) for 10–20%, 20–30% and >30% green space, respectively. Compared with the <10% green-space reference group with 13.78% incident loneliness over 4 years and conservatively assuming no impact on incident loneliness, associations translated into absolute risk reductions of 1.70%, 2.26% and 2.72% within populations with 10–20%, 20–30% and >30% green space, respectively. These associations were stronger again for people living alone, with 10–20% (OR = 0.608, 95% CI = 0.448 to 0.826), 20–30% (OR = 0.649, 95% CI = 0.436 to 0.966) and >30% (OR = 0.480, 95% CI = 0.278 to 0.829) green space within 1600 m. No age, sex or disability-related contingencies, associations with green space within 400 or 800 m or relief from loneliness reported at baseline were observed. Conclusions A lower cumulative incidence of loneliness was observed among people with more green space within 1600 m of home, especially for people living alone. Potential biopsychosocial mechanisms warrant investigation.
Thomas Astell-Burt; Terry Hartig; Simon Eckermann; Mark Nieuwenhuijsen; Anne McMunn; Howard Frumkin; Xiaoqi Feng. More green, less lonely? A longitudinal cohort study. International Journal Of Epidemiology 2021, 1 .
AMA StyleThomas Astell-Burt, Terry Hartig, Simon Eckermann, Mark Nieuwenhuijsen, Anne McMunn, Howard Frumkin, Xiaoqi Feng. More green, less lonely? A longitudinal cohort study. International Journal Of Epidemiology. 2021; ():1.
Chicago/Turabian StyleThomas Astell-Burt; Terry Hartig; Simon Eckermann; Mark Nieuwenhuijsen; Anne McMunn; Howard Frumkin; Xiaoqi Feng. 2021. "More green, less lonely? A longitudinal cohort study." International Journal Of Epidemiology , no. : 1.
Aims The evidence on the pathways through which the built environment may influence type 2 diabetes (T2D) risk is limited. This study explored whether behavioural, physical and mental health factors mediate the associations between perceived built environment and T2D. Methods Longitudinal data on 36,224 participants aged ≥45 years (The Sax Institute's 45 and Up Study) was analysed. Causal mediation analysis that uses the counterfactual approach to decompose the total effect into direct and indirect effects was performed. Results The results showed that physical activity, recreational walking, and BMI mediated around 6%, 11%, and 30%, respectively, of the association between perceived lack of access to local amenities and T2D incidence. Physical activity (4.8% for day-time crime), recreational walking (2.3% for day-time crime), psychological distress (5.2% for day-time, 3.7% for night-time crime), and BMI (29.6% for day-time crime, 17.4% for night-time crime) also partially mediated the effect of perceived crime. Mediated effects appeared larger at wave 3 than the same wave 2 mediators. Conclusions The findings demonstrate that physical activity, psychological distress, and BMI mediate the pathways between the built environment and T2D. Policies aimed to bring amenities closer to homes, prevent crime, and address mental health may help reduce T2D risk.
Tashi Dendup; Xiaoqi Feng; Pauline O'Shaughnessy; Thomas Astell-Burt. Perceived built environment and type 2 diabetes incidence: Exploring potential mediating pathways through physical and mental health, and behavioural factors in a longitudinal study. Diabetes Research and Clinical Practice 2021, 176, 108841 .
AMA StyleTashi Dendup, Xiaoqi Feng, Pauline O'Shaughnessy, Thomas Astell-Burt. Perceived built environment and type 2 diabetes incidence: Exploring potential mediating pathways through physical and mental health, and behavioural factors in a longitudinal study. Diabetes Research and Clinical Practice. 2021; 176 ():108841.
Chicago/Turabian StyleTashi Dendup; Xiaoqi Feng; Pauline O'Shaughnessy; Thomas Astell-Burt. 2021. "Perceived built environment and type 2 diabetes incidence: Exploring potential mediating pathways through physical and mental health, and behavioural factors in a longitudinal study." Diabetes Research and Clinical Practice 176, no. : 108841.
The choice of a green space metric may affect what relationship is found with health outcomes. In this research, we investigated the relationship between percent green space area, a novel metric developed by us (based on the average contiguous green space area a spatial buffer has contact with), in three different types of buffers and type 2 diabetes (T2D). We obtained information about diagnosed T2D and relevant covariates at the individual level from the large and representative 45 and Up Study. Average contiguous green space and the percentage of green space within 500 m, 1 km, and 2 km of circular buffer, line-based road network (LBRN) buffers, and polygon-based road network (PBRN) buffers around participants’ residences were used as proxies for geographic access to green space. Generalized estimating equation regression models were used to determine associations between access to green space and T2D status of individuals. It was found that 30%–40% green space within 500 m LBRN or PBRN buffers, and 2 km PBRN buffers, but not within circular buffers, significantly reduced the risk of T2D. The novel average green space area metric did not appear to be particularly effective at measuring reductions in T2D. This study complements an existing research body on optimal buffers for green space measurement.
Soumya Mazumdar; Shanley Chong; Thomas Astell-Burt; Xiaoqi Feng; Geoffrey Morgan; Bin Jalaludin. Which Green Space Metric Best Predicts a Lowered Odds of Type 2 Diabetes? International Journal of Environmental Research and Public Health 2021, 18, 4088 .
AMA StyleSoumya Mazumdar, Shanley Chong, Thomas Astell-Burt, Xiaoqi Feng, Geoffrey Morgan, Bin Jalaludin. Which Green Space Metric Best Predicts a Lowered Odds of Type 2 Diabetes? International Journal of Environmental Research and Public Health. 2021; 18 (8):4088.
Chicago/Turabian StyleSoumya Mazumdar; Shanley Chong; Thomas Astell-Burt; Xiaoqi Feng; Geoffrey Morgan; Bin Jalaludin. 2021. "Which Green Space Metric Best Predicts a Lowered Odds of Type 2 Diabetes?" International Journal of Environmental Research and Public Health 18, no. 8: 4088.
Thomas Astell-Burt; Michael A Navakatikyan; Ramya Walsan; Walt Davis; Gemma Figtree; Leonard Arnolda; Xiaoqi Feng. Green space and cardiovascular health in people with type 2 diabetes. 2021, 69, 102554 .
AMA StyleThomas Astell-Burt, Michael A Navakatikyan, Ramya Walsan, Walt Davis, Gemma Figtree, Leonard Arnolda, Xiaoqi Feng. Green space and cardiovascular health in people with type 2 diabetes. . 2021; 69 ():102554.
Chicago/Turabian StyleThomas Astell-Burt; Michael A Navakatikyan; Ramya Walsan; Walt Davis; Gemma Figtree; Leonard Arnolda; Xiaoqi Feng. 2021. "Green space and cardiovascular health in people with type 2 diabetes." 69, no. : 102554.
Associations between green space type and 9-year risk of incident cardiovascular disease (CVD) hospitalisations and deaths were analysed in 4166 people with type 2 diabetes in the Sax Institute's 45 and Up Study. Incidence of all-cause mortality, cardiovascular mortality, fatal or non-fatal CVD events and acute myocardial infarctions (AMI) were 14.67%, 7.23%, 47.36%, and 4.51%, respectively. After full adjustment, more tree canopy was associated with lower CVD mortality, lower fatal or non-fatal CVD events, and lower AMI risk. More open grass was associated with lower all-cause mortality, lower CVD mortality and lower fatal or non-fatal CVD events, but higher AMI risk.
Thomas Astell-Burt; Michael A. Navakatikyan; Ramya Walsan; Walt Davis; Gemma Figtree; Leonard Arnolda; Xiaoqi Feng. Green space and cardiovascular health in people with type 2 diabetes. Health & Place 2021, 69, 102554 .
AMA StyleThomas Astell-Burt, Michael A. Navakatikyan, Ramya Walsan, Walt Davis, Gemma Figtree, Leonard Arnolda, Xiaoqi Feng. Green space and cardiovascular health in people with type 2 diabetes. Health & Place. 2021; 69 ():102554.
Chicago/Turabian StyleThomas Astell-Burt; Michael A. Navakatikyan; Ramya Walsan; Walt Davis; Gemma Figtree; Leonard Arnolda; Xiaoqi Feng. 2021. "Green space and cardiovascular health in people with type 2 diabetes." Health & Place 69, no. : 102554.
Objective To test relatively simple and complex models for examining model fit, higher‐level variation in, and correlates of, GP consultations, where known nonhierarchical data structures are present. Setting New South Wales (NSW), Australia. Design Association between socioeconomic circumstances and geographic remoteness with GP consultation frequencies per participant was assessed using single‐level, hierarchical, and multiple membership cross‐classified (MMCC) models. Models were adjusted for age, gender, and a range of socioeconomic and demographic confounds. Data Collection/Extraction Methods A total of 261,930 participants in the Sax Institute's 45 and Up Study were linked to all GP consultation records (Medicare Benefits Schedule; Department of Human Services) within 12 months of baseline (2006‐2009). Principal Findings Deviance information criterion values indicated the MMCC negative binomial regression was the best fitting model, relative to an MMCC Poisson equivalent and simpler hierarchical and single‐level models. Between‐area variances were relatively consistent across models, even when between GP variation was estimated. Lower rates of GP consultation outside of major cities were only observed once between‐GP variation was assessed simultaneously with between‐area variation in the MMCC models. Conclusions Application of the MMCC model is necessary for estimation of variances and effect sizes in sources of big data on primary care in which complex nonhierarchical clustering by geographical area and GP is present.
Thomas Astell‐Burt; Michael A. Navakatikyan; Leonard F. Arnolda; Xiaoqi Feng. Multilevel modeling of geographic variation in general practice consultations. Health Services Research 2021, 1 .
AMA StyleThomas Astell‐Burt, Michael A. Navakatikyan, Leonard F. Arnolda, Xiaoqi Feng. Multilevel modeling of geographic variation in general practice consultations. Health Services Research. 2021; ():1.
Chicago/Turabian StyleThomas Astell‐Burt; Michael A. Navakatikyan; Leonard F. Arnolda; Xiaoqi Feng. 2021. "Multilevel modeling of geographic variation in general practice consultations." Health Services Research , no. : 1.
We hypothesized that visits to green and blue spaces may have enabled respite, connection and exercise during the COVID-19 pandemic, but such benefits might have been inequitably distributed due to differences in financial difficulties, opportunities to work from home, and localized restrictions in spatial mobility generated by ‘lockdowns’. A nationally representative online and telephone survey conducted in 12–26 October on the Social Research Centre’s Life in AustraliaTM panel (aged ≥ 18 y, 78.8% response, N = 3043) asked about access, visitation, and felt benefits from green and/or blue spaces. Increasing financial difficulty was associated with less time in and fewer visits to green and/or blue spaces, as well as fewer different types visited. Financial difficulty was also associated with feelings that visits to green and/or blue space had less benefit for maintaining social connection. Working from home was associated with more frequent and longer visitation to green and/or blue spaces, as well as discovery of ones previously unvisited. Working from home was also associated with increased levels of exercise and respite resulting from visits to green and/or blue spaces. Residents of Melbourne, a city of 4.9 million who were in ‘lockdown’ at the time of the survey, appeared more likely to benefit from visits to green and/or blue spaces than residents of Sydney, Australia’s largest city at 5.2 million, who were not in lockdown. Residents of Melbourne compared with Sydney reported consistently increased visitation of, discovery of, and greater levels of various felt benefits derived from green and/or blue spaces, including more respite, connection, and exercise. Comparatively shorter distances to preferred green and/or blue spaces and closure of alternative settings at the time of the survey completion in Melbourne compared with Sydney may provide partial explanation, though more acute responses to experiencing green and/or blue spaces within highly cognitively demanding antecedent conditions posed by lockdown are also plausible and warrant further investigation with other health indicators. These results were robust to adjustment for a range of covariates including preferences for natural settings, which were consistently associated with greater levels of green and/or blue space visitation and felt benefits. Collectively, these results indicate that parallel efforts to generate (or renew) felt connection to natural settings, to increase working from home opportunities, and to mitigate financial difficulties may be important to help maximize the population health benefits of urban planning strategies intended to improve the availability of, and to reduce inequities in access to, green and blue spaces. Benefits felt more commonly by people living through lockdown underlines the role previous investments in green and blue space have played in enabling coping during the COVID-19 pandemic.
Thomas Astell-Burt; Xiaoqi Feng. Time for ‘Green’ during COVID-19? Inequities in Green and Blue Space Access, Visitation and Felt Benefits. International Journal of Environmental Research and Public Health 2021, 18, 2757 .
AMA StyleThomas Astell-Burt, Xiaoqi Feng. Time for ‘Green’ during COVID-19? Inequities in Green and Blue Space Access, Visitation and Felt Benefits. International Journal of Environmental Research and Public Health. 2021; 18 (5):2757.
Chicago/Turabian StyleThomas Astell-Burt; Xiaoqi Feng. 2021. "Time for ‘Green’ during COVID-19? Inequities in Green and Blue Space Access, Visitation and Felt Benefits." International Journal of Environmental Research and Public Health 18, no. 5: 2757.
Studies investigating the potential role of neighbourhood green space quality on the development of prosocial behaviour among children are sparse. This study aimed to investigate the longitudinal association between caregiver perceived green space quality and child prosocial behaviour, and identify potential effect modifiers of the association. This was a longitudinal study using data from the Longitudinal Study of Australian Children, involving 4,969 children aged 4–5 years that were biannually followed-up from 2004 to 2014. Prosocial behaviour was assessed using a prosocial scale from Goodman's Strengths and Difficulties Questionnaire. Green space quality was measured based on caregiver perception of the availability of neighbourhood parks, playgrounds, and play spaces of good quality. Latent class analysis was used to partition children into groups denoting different levels of caregiver perceptions of green space quality accumulated over 10 years. Multinomial logistic regression was used to examine the likelihood of being in groups with favourable perception of green space quality. Multilevel linear regression was used to examine associations between trajectory groups and prosocial behaviour. Separate multivariate models were developed to assess the potential role of quality green space in reducing prosocial behaviour related inequalities. Furthermore, two-way interaction terms were added into the models to identify potential effect moderation. There were six trajectory classes of green space quality perceived by caregivers. The likelihood of being in groups with better green space quality varied by neighbourhood circumstances. Children with consistently very good quality green space had higher prosocial behaviour (β = 0.35; 95%CI = 0.23, 0.47) than those with low quality green space. Better prosocial behaviour was also observed among children whose caregiver perception of green space quality trended from good to very good (β = 0.23; 95%CI = 0.11, 0.35) and from very good to good (β = 0.31; 95%CI = 0.20, 0.42) compared to children with consistently low quality green space. Very good quality green space perceived by caregivers over time potentially reduces socioeconomic inequalities in prosocial behaviour. Green space quality-prosocial behaviour association was stronger among boys, children speaking only English at home, those living in more affluent areas, and remote areas. Trajectory of caregiver perceived green space quality was positively associated with child prosocial behaviour. The findings suggest that improving the quality of green space to be very good quality, particularly in deprived and less accessible areas may help improve prosocial behaviour in children.
I Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Xiaoqi Feng. Association between caregiver perceived green space quality and the development of prosocial behaviour from childhood to adolescence: Latent class trajectory and multilevel longitudinal analyses of Australian children over 10 years. Journal of Environmental Psychology 2021, 74, 101579 .
AMA StyleI Gusti Ngurah Edi Putra, Thomas Astell-Burt, Dylan P. Cliff, Stewart A. Vella, Xiaoqi Feng. Association between caregiver perceived green space quality and the development of prosocial behaviour from childhood to adolescence: Latent class trajectory and multilevel longitudinal analyses of Australian children over 10 years. Journal of Environmental Psychology. 2021; 74 ():101579.
Chicago/Turabian StyleI Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Xiaoqi Feng. 2021. "Association between caregiver perceived green space quality and the development of prosocial behaviour from childhood to adolescence: Latent class trajectory and multilevel longitudinal analyses of Australian children over 10 years." Journal of Environmental Psychology 74, no. : 101579.
Growing body of research recognizes the importance of green spaces on the perinatal outcomes however, further evidence from different geographies are warranted. We aimed to investigate association between, and differential responses to, maternal exposure to green space and birthweight. Birth records (n = 82,221) were extracted from the Perinatal Data Collection (PDC) in Sydney’s metropolitan area between January 2016 and December 2017. Association between green space quantity and birthweight, term birthweight, low birthweight, term low birthweight and preterm were assessed using linear and logistic regressions. Potential modification by area-level socioeconomic status and maternal country of birth were tested using interaction terms. Difference in birth weight for the ≥40% versus <20% green space within SA2s was 59.0 g (95%CI: 42.9, 75.3) in unadjusted models which dropped to 25.6 g (95%CI: 13.0, 38.2) in adjusted models. Stratified analysis suggested stronger associations for babies of mothers from affluent neighbourhoods, while statistically significant association was not observed in deprived areas. Furthermore, the association was more pronounced among babies to mothers who were born overseas. Associations were consistent for term births. Higher levels of green space were associated with lower odds of preterm birth in adjusted models. However, we did not identify statistically significant association between green space quantity and the risk of low birthweight (LBW). Our study suggests that green space may support healthier birth outcomes and help to reduce the birthweight gap between newborns of mothers born in Australia and overseas. However, disproportionate benefits among women in affluent neighbourhoods may widen socioeconomic inequities in birthweight.
Selin Akaraci; Xiaoqi Feng; Thomas Suesse; Bin Jalaludin; Thomas Astell-Burt. Greener neighbourhoods, healthier birth outcomes? Evidence from Australia. Environmental Pollution 2021, 278, 116814 .
AMA StyleSelin Akaraci, Xiaoqi Feng, Thomas Suesse, Bin Jalaludin, Thomas Astell-Burt. Greener neighbourhoods, healthier birth outcomes? Evidence from Australia. Environmental Pollution. 2021; 278 ():116814.
Chicago/Turabian StyleSelin Akaraci; Xiaoqi Feng; Thomas Suesse; Bin Jalaludin; Thomas Astell-Burt. 2021. "Greener neighbourhoods, healthier birth outcomes? Evidence from Australia." Environmental Pollution 278, no. : 116814.
Recent meta-analysis reported higher dementia risks associated with lower body mass index (BMI) and decreasing BMI. We examined to what extent these associations were attenuated by changes in behaviours and local environment. Multilevel discrete time-to-event models examined associations between baseline and change in BMI with dementia detected through prescription medications (source: Department of Human Services), hospitalisations and death certificates among 144,456 participants in the Sax Institute's 45 and Up Study. Models were adjusted for socioeconomic factors and measures of change in adherence to published guidelines for moderate to vigorous physical activity, sleep duration, alcohol, and fruit and vegetable consumption, as well as incidence of cardiometabolic diseases, and indicators of area-level disadvantage and rurality. Data was analysed in 2020. Higher dementia risks (albeit with imprecision) were found among participants who were underweight (Incidence Hazard Ratio (IHR) 1.30, 95%CI=0.86–1.86) and lower risks among those who were overweight (IHR=0.78, 95%CI=0.70–0.86) or obese (IHR=0.72, 95%CI=0.62–0.83) compared with ‘normal’ BMI. A ≥0.8 kg/m2 reduction in BMI associated with IHR=1.81 (95%CI=1.64–2.01) higher dementia risk relative to those with stable BMI. Higher dementia risk with decreasing BMI was fairly consistent relative to baseline BMI category. Adherence to physical activity and sleep duration guidelines were associated with reduced dementia risk, but neither these, nor adjustment for other behaviours and local factors, explained the BMI-dementia association. In conclusion, we replicated the BMI-dementia findings from a recent meta-analysis and provide further support to preventive strategies focussed on increasing physical activity and improving sleep duration. Other potential environmental risk factors outside of socioeconomic and urban/rural circumstances warrant investigation.
Thomas Astell-Burt; Michael A. Navakatikyan; Xiaoqi Feng. Behavioural change, weight loss and risk of dementia: A longitudinal study. Preventive Medicine 2020, 145, 106386 .
AMA StyleThomas Astell-Burt, Michael A. Navakatikyan, Xiaoqi Feng. Behavioural change, weight loss and risk of dementia: A longitudinal study. Preventive Medicine. 2020; 145 ():106386.
Chicago/Turabian StyleThomas Astell-Burt; Michael A. Navakatikyan; Xiaoqi Feng. 2020. "Behavioural change, weight loss and risk of dementia: A longitudinal study." Preventive Medicine 145, no. : 106386.
Current evidence from studies on green space and child prosocial behaviour suggests a paucity of studies investigating the plausible role of green space quality in shaping the development of prosocial behaviour. This study aimed to examine longitudinal association between green space quality and prosocial behaviour among children. We analysed 10-year longitudinal data (2004-2014) from the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Prosocial behaviour that covers positive behaviours (e.g. sharing, helping) was measured using a prosocial scale from Goodman’s Strengths and Difficulties Questionnaire (SDQ). Parents’ perceptions on the availability of “good” parks, playgrounds, and play space in the neighbourhood assessed green space quality. Multilevel linear regression models were used to examine potential changes in prosocial behaviour across childhood in relation to green space quality. A two-way interaction term between green space and age was fitted to assess potential differences in the effect of green space quality by age. Sensitivity analyses by child’s sex and history of residential movement were also performed. From the analysis of 24,418 observations nested in 4,969 children, prosocial behaviour was relatively high (mean=8.13 out of 10; SD=1.79) and about balanced proportions between girls (48.74%) and boys (51.26%) were included. Prosocial behaviour was higher among children whose parents agreed (β=0.10; 95%CI=0.04, 0.16) and strongly agreed (β=0.20; 95%CI=0.13, 0.27) to having quality green space in their neighbourhood. The benefit of exposure to favourable green space on prosocial behaviour was relatively same among both children who changed and did not change neighbourhood, but reported higher among boys than girls. Young compared to older children or adolescents tended to benefit more by the presence of quality green space. Green space quality was positively associated with child prosocial behaviour. Boys and young children benefited more by quality green space. The findings suggest to improve the quality of green space and also identify characteristics of green space appealing for girls and suitable for older children.
I Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Xiaoqi Feng. Association between green space quality and prosocial behaviour: A 10-year multilevel longitudinal analysis of Australian children. Environmental Research 2020, 196, 110334 .
AMA StyleI Gusti Ngurah Edi Putra, Thomas Astell-Burt, Dylan P. Cliff, Stewart A. Vella, Xiaoqi Feng. Association between green space quality and prosocial behaviour: A 10-year multilevel longitudinal analysis of Australian children. Environmental Research. 2020; 196 ():110334.
Chicago/Turabian StyleI Gusti Ngurah Edi Putra; Thomas Astell-Burt; Dylan P. Cliff; Stewart A. Vella; Xiaoqi Feng. 2020. "Association between green space quality and prosocial behaviour: A 10-year multilevel longitudinal analysis of Australian children." Environmental Research 196, no. : 110334.
Background Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have significant issues with sustained use, with up to 98% of people only using the app for a short time before dropping out and/or dropping use down to the point where the app is no longer effective at helping to manage disease. Objective Our objectives are to systematically appraise and perform a meta-analysis on dropout rates in apps for chronic disease and to qualitatively synthesize possible reasons for these dropout rates that could be addressed in future interventions. Methods MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, Cochrane CENTRAL (Central Register of Controlled Trials), and Embase were searched from 2003 to the present to look at mobile health (mHealth) and attrition or dropout. Studies, either randomized controlled trials (RCTs) or observational trials, looking at chronic disease with measures of dropout were included. Meta-analysis of attrition rates was conducted in Stata, version 15.1 (StataCorp LLC). Included studies were also qualitatively synthesized to examine reasons for dropout and avenues for future research. Results Of 833 studies identified in the literature search, 17 were included in the review and meta-analysis. Out of 17 studies, 9 (53%) were RCTs and 8 (47%) were observational trials, with both types covering a range of chronic diseases. The pooled dropout rate was 43% (95% CI 29-57), with observational studies having a higher dropout rate (49%, 95% CI 27-70) than RCTs in more controlled scenarios, which only had a 40% dropout rate (95% CI 16-63). The studies were extremely varied, which is represented statistically in the high degree of heterogeneity (I2>99%). Qualitative synthesis revealed a range of reasons relating to attrition from app-based interventions, including social, demographic, and behavioral factors that could be addressed. Conclusions Dropout rates in mHealth interventions are high, but possible areas to minimize attrition exist. Reducing dropout rates will make these apps more effective for disease management in the long term. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019128737; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128737
Gideon Meyerowitz-Katz; Sumathy Ravi; Leonard Arnolda; Xiaoqi Feng; Glen Maberly; Thomas Astell-Burt. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. Journal of Medical Internet Research 2020, 22, e20283 .
AMA StyleGideon Meyerowitz-Katz, Sumathy Ravi, Leonard Arnolda, Xiaoqi Feng, Glen Maberly, Thomas Astell-Burt. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. Journal of Medical Internet Research. 2020; 22 (9):e20283.
Chicago/Turabian StyleGideon Meyerowitz-Katz; Sumathy Ravi; Leonard Arnolda; Xiaoqi Feng; Glen Maberly; Thomas Astell-Burt. 2020. "Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis." Journal of Medical Internet Research 22, no. 9: e20283.
Urban greening is a climate change-related policy with considerable health benefits. But do these benefits extend to prevention of dementia and, if so, which types of green space matter? Multilevel discrete time-to-event cohort study of incident Alzheimer’s disease over 11 years among a baseline recruited between January 1, 2006 and December 31, 2009 (the Sax Institute’s 45 and Up Study). Sampled participants for this study (N=109,688) were aged 45 years or older with no record of dementia up to 6 years before baseline, living in the cities of Sydney, Wollongong and Newcastle, Australia. Exposures were percentage total green space, tree canopy and open grass within 1.6-km road network distance buffers at baseline. Outcomes were time-to-first anti-dementia medication prescription (Department of Human Services) or dementia detected during hospitalisation or death up to 31 December 2016 (up to 11 years follow-up). Outcomes were analysed in parallel to triangulate on associations with green space, while testing for bias due to potential under-prescribing of anti-dementia medications. Models were adjusted for baseline person-level factors and area-level socioeconomic disadvantage. Dementia detection varied by case ascertainment method. 1.55% (1,703/109,688) persons were detected using prescribed anti-dementia medications. 3.32% (3,639/109,688) persons were detected during hospitalisation or death via ICD-10 codes. Dementia incidence irrespective of outcome measurement was lower among females, younger participants, those living in couples, with higher qualifications and higher incomes. Dementia risk was lower with more tree canopy when the outcome was measured using hospital and death records (≥30% vs <10% tree canopy incidence hazard ratio (IHR) = 0.86, 95%CI 0.75, 0.99), after adjusting for person-level factors. The opposite association was observed when anti-dementia medications were used to detect dementia (≥30% vs <10% tree canopy IHR = 1.33, 95%CI 1.07, 1.66). Anti-dementia medication-based detection also indicated lower dementia risk with more open grass (≥20% vs <5% IHR = 0.83, 95%CI 0.67, 1.03). Anti-dementia medication prescribing was lower in the highest vs. lowest area-level disadvantage tertile (29.8% vs. 43.7%) among people diagnosed with dementia, indicating potential bias from geographic differences in prescribing practices. Adjusting for area-level disadvantage explained associations between tree canopy, open grass and dementia when detected by anti-dementia medication, but had negligible impact on negative (i.e. potentially protective) association between tree canopy and dementia detected by hospital and death records (≥30% vs <10% tree canopy hazard ratio 0.84, 95%CI 0.72, 0.99). Increasing urban tree canopy cover may help to reduce the risk of dementia. Replication in contrasting contexts and mediation studies to assess pathways are warranted.
Thomas Astell-Burt; Michael A. Navakatikyan; Xiaoqi Feng. Urban green space, tree canopy and 11-year risk of dementia in a cohort of 109,688 Australians. Environment International 2020, 145, 106102 .
AMA StyleThomas Astell-Burt, Michael A. Navakatikyan, Xiaoqi Feng. Urban green space, tree canopy and 11-year risk of dementia in a cohort of 109,688 Australians. Environment International. 2020; 145 ():106102.
Chicago/Turabian StyleThomas Astell-Burt; Michael A. Navakatikyan; Xiaoqi Feng. 2020. "Urban green space, tree canopy and 11-year risk of dementia in a cohort of 109,688 Australians." Environment International 145, no. : 106102.
Urban green space may help slow cognitive decline. We extend the investigation towards subjective memory and green space type using latent class analysis and multilevel models of 45,644 individuals in the Sax Institute's 45 and Up Study. Participants with more tree canopy relative to open grass within 1.6 km, compared to similar quantities of both types, tended to have more favourable odds of subjective memory complaints and self-rated excellent memory at baseline. Higher quantities of open grass relative to tree canopy did not afford similar levels of benefit. Socioeconomic factors explained associations between green space and cumulative incidence of memory-related outcomes.
Thomas Astell-Burt; Xiaoqi Feng. Greener neighbourhoods, better memory? A longitudinal study. Health & Place 2020, 65, 102393 .
AMA StyleThomas Astell-Burt, Xiaoqi Feng. Greener neighbourhoods, better memory? A longitudinal study. Health & Place. 2020; 65 ():102393.
Chicago/Turabian StyleThomas Astell-Burt; Xiaoqi Feng. 2020. "Greener neighbourhoods, better memory? A longitudinal study." Health & Place 65, no. : 102393.
Increasing evidence suggests adults living in greener areas tend to have more favourable sleep-related outcomes, but children and adolescents are under-researched. We hypothesised that children and adolescents living in greener areas would have better quality and more sufficient levels of sleep on average, especially within the context of high traffic noise exposure. These hypotheses were tested using multilevel logistic regressions fitted on samples from the nationally representative Longitudinal Study of Australian Children (10–11 years old, n = 3469, and 14–15 years old, n = 2814) and the GINIplus and LISA cohorts (10 years old, n = 1461, and 15 years old, n = 4172) from the Munich, Wesel, and Leipzig areas of Germany. Questionnaire-based binary indicators of sleep sufficiency and sleep quality in each cohort were assessed with respect to objectively measured green space exposures adjusting for age, sex, and maternal education. Models were augmented with proxy measures of traffic noise and two-way interaction terms to test for effect modification. Cross-tabulations illustrated little convincing evidence of association between green space and insufficient sleep or poor sleep quality in either sample, except for insufficient sleep among 10 year old participants in Germany. These null findings were replicated in adjusted models. The proxy for traffic noise was associated with poor quality sleep in 15 year old participants in Germany, but no convincing evidence of modified association with green space was observed.
Xiaoqi Feng; Claudia Flexeder; Iana Markevych; Marie Standl; Joachim Heinrich; Tamara Schikowski; Sibylle Koletzko; Gunda Herberth; Carl-Peter Bauer; Andrea Von Berg; Dietrich Berdel; Thomas Astell-Burt. Impact of Residential Green Space on Sleep Quality and Sufficiency in Children and Adolescents Residing in Australia and Germany. International Journal of Environmental Research and Public Health 2020, 17, 4894 .
AMA StyleXiaoqi Feng, Claudia Flexeder, Iana Markevych, Marie Standl, Joachim Heinrich, Tamara Schikowski, Sibylle Koletzko, Gunda Herberth, Carl-Peter Bauer, Andrea Von Berg, Dietrich Berdel, Thomas Astell-Burt. Impact of Residential Green Space on Sleep Quality and Sufficiency in Children and Adolescents Residing in Australia and Germany. International Journal of Environmental Research and Public Health. 2020; 17 (13):4894.
Chicago/Turabian StyleXiaoqi Feng; Claudia Flexeder; Iana Markevych; Marie Standl; Joachim Heinrich; Tamara Schikowski; Sibylle Koletzko; Gunda Herberth; Carl-Peter Bauer; Andrea Von Berg; Dietrich Berdel; Thomas Astell-Burt. 2020. "Impact of Residential Green Space on Sleep Quality and Sufficiency in Children and Adolescents Residing in Australia and Germany." International Journal of Environmental Research and Public Health 17, no. 13: 4894.
Association between urban green space quality and older adult outdoor recreation may vary across contrasting community contexts, but few international comparisons have been made. Data on older adult outdoor recreation and the quality of thirty-two (32) green spaces were collected using established tools (Systematic Observation of Play and Recreations in the Community and the Community Park Audit Tool) adapted for the cities of Sydney, Singapore and Dhaka between February to May 2017. Descriptive statistics and Poisson regressions were used to analyse the association between older adult recreation and measures of green space quality in each city. Higher quality green space was associated with more sedentary activity (β = 0.02, p < 0.005) and walking (β = 0.034, p < 0.005) after adjusting for differences between cities. Further tests suggested both sedentary activity and walking were higher in parks scoring more favourably on safety. Vigorous recreational activities were more common in parks scoring more favourably on accessibility, safety and landscape quality. Differences in associations between older adult recreation with each quality indicator were observed between cities. Interestingly, the expected association between quality and recreational activity could be different where high-quality urban green spaces are abundant (e.g. Singapore).
Faysal Kabir Shuvo; Xiaoqi Feng; Thomas Astell-Burt. Urban green space quality and older adult recreation: an international comparison. Cities & Health 2020, 1 -21.
AMA StyleFaysal Kabir Shuvo, Xiaoqi Feng, Thomas Astell-Burt. Urban green space quality and older adult recreation: an international comparison. Cities & Health. 2020; ():1-21.
Chicago/Turabian StyleFaysal Kabir Shuvo; Xiaoqi Feng; Thomas Astell-Burt. 2020. "Urban green space quality and older adult recreation: an international comparison." Cities & Health , no. : 1-21.
Background: Management of diabetes and chronic disease is a challenge, making mHealth an increasingly attractive option. There is evidence that these apps may be effective, with systematic reviews demonstrating improvements in HbA1c and other measures of diabetes control. However, dropout can be a major issue in apps. Recent research has indicated that rates of attrition in mHealth interventions may be as high as 98%. Knowledge of mHealth dropout rates is critical to assessing their efficacy. Methods: Medline, Pubmed, Cochrane CENTRAL, and Embase were searched from 2003 to the present, looking at mHealth and attrition or dropout. Studies looking at chronic disease with measures of dropout were included. Results: Of 830 studies identified in the literature search, 16 were included in the review and meta-analysis (results presented below). Chronic disease management apps had an overall dropout rate of 47%. Apps targeting metabolic disease had a lower rate of 32%. The studies were varied, with high heterogeneity (I2>99%). Conclusion: Dropout rates in mHealth interventions are high, but lower in apps targeting metabolic disease. Reducing dropout rates will make these apps more effective for disease management in the long term. Disclosure G. Meyerowitz-Katz: None. T. Astell-Burt: None. S. Ravi: None. L.F. Arnolda: None. X. Feng: None.
Gideon Meyerowitz-Katz; Thomas Astell-Burt; Sumathy Ravi; Leonard F. Arnolda; Xiaoqi Feng. 775-P: Mobile Self-Management Apps to Manage Diabetes and Chronic Disease: A Systematic Review and Meta-analysis into Dropout and Attrition Rates. Diabetes 2020, 69, 775 .
AMA StyleGideon Meyerowitz-Katz, Thomas Astell-Burt, Sumathy Ravi, Leonard F. Arnolda, Xiaoqi Feng. 775-P: Mobile Self-Management Apps to Manage Diabetes and Chronic Disease: A Systematic Review and Meta-analysis into Dropout and Attrition Rates. Diabetes. 2020; 69 (Supplement):775.
Chicago/Turabian StyleGideon Meyerowitz-Katz; Thomas Astell-Burt; Sumathy Ravi; Leonard F. Arnolda; Xiaoqi Feng. 2020. "775-P: Mobile Self-Management Apps to Manage Diabetes and Chronic Disease: A Systematic Review and Meta-analysis into Dropout and Attrition Rates." Diabetes 69, no. Supplement: 775.