Health effects of holistic housing renovation in a disadvantaged neighbourhood in the Netherlands: a qualitative exploration among residents and professionals.

BACKGROUND: Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). In a deprived neighbourhood in Utrecht, the Netherlands, this paper examined residents' and professionals' experiences, ideas, and perceptions regarding holistic housing renovation, its health effects, and underlying mechanisms explaining those effects. METHODS: Semi-structured in-depth interviews were conducted with 21 social housing residents exposed to holistic housing renovation, and 12 professionals involved in either the physical renovation or social interventions implemented. Residents were interviewed in various renovation stages (before, during, after renovation). Transcripts were deductively and inductively coded using qualitative software. RESULTS: Residents experienced and professionals acknowledged renovation stress caused by nuisance from construction work (noise, dust), having to move stuff around, and temporary moving; lack of information and control; and perceived violation of privacy. Involvement in design choices was appreciated, and mental health improvement was expected on the long term due to improved housing quality and visual amenity benefits. Social contact between residents increased as the renovation became topic for small talk. Few comments were made regarding physical health effects. The interviews revealed a certain amount of distrust in and dissatisfaction with the housing corporation, construction company, and other authorities. CONCLUSIONS: Renovation stress, aggravated by lack of information and poor accessibility of housing corporation and construction company, negatively affects mental health and sense of control. Potential stress relievers are practical help with packing and moving furniture, and increased predictability by good and targeted communication. Social interventions can best be offered after renovation, when residents live in their renovated apartment and the nuisance and stress from the renovation is behind them. Social partners can use the period leading up to the renovation to show their faces, offer practical help to reduce renovation stress, and increase residents' trust in their organization and authorities in general. This might also contribute to residents' willingness to accept help with problems in the social domain after renovation.

Understanding the mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods: A realist review.

Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). This realist review aimed at understanding underlying mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods. Following systematic and iterative searching, and relevance and quality appraisals, 18 scientific articles and reports were analysed. We identified three pathways via which physical housing improvements affect health, four pathways via which social and socioeconomic interventions affect health, and two pathways via which both reinforce each other in their health effects. Our findings are theoretically novel, relevant for those conducting holistic housing renovations, and point towards gaps in the literature.

The effects of small-scale physical and social environmental interventions on walking behaviour among Dutch older adults living in deprived neighbourhoods: results from the quasi-experimental NEW.ROADS study.

PURPOSE: Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods. METHODS: Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates. RESULTS: Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking. CONCLUSION: Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults.

Hour-by-hour physical activity patterns of adults aged 45-65 years: a cross-sectional study.

Background: Limited information exists on hour-by-hour physical activity (PA) patterns among adults aged 45-65 years. Therefore, this study aimed to distinguish typical hour-by-hour PA patterns, and examined which individuals typically adopt certain PA patterns. Methods: Accelerometers measured light and moderate-vigorous PA. GIS-data provided proportions of land use within an 800 and 1600 m buffer around participant's homes. Latent class analyses were performed to distinguish PA patterns and groups of individuals with similar PA patterns. Results: Four PA patterns were identified: a morning light PA pattern, a mid-day moderate-vigorous PA pattern, an overall inactive pattern and an overall active pattern. Groups of individuals with similar PA patterns differed in ethnicity, dog ownership, and the proportion of roads, sports terrain, larger green and blue space within their residential areas. Conclusions: Four typical hour-by-hour PA patterns, and three groups of individuals with similar patterns were distinguished. It is this combination that can substantially contribute to the development of more tailored policies and interventions. PA patterns were only to a limited extent associated with personal and residential characteristics, suggesting that other factors such as work time regimes, family life and leisure may also have considerable impact on the distribution of PA throughout the day.

How do type and size of natural environments relate to physical activity behavior?

Natural environments (NE) are promoted as places that support physical activity (PA), but evidence on PA distribution across various types and sizes of NE is lacking. Accelerometers and GPS-devices measured PA of Dutch general population adults aged 45-65 years (N=279). Five NE types were distinguished: 'parks', 'recreational area', 'agricultural green', 'forest & moorland', and 'blue space', and four categories of size: 0-3, 3-7, 7-27, and ≥27 ha. Modality (i.e. spatially concentrated PA, walking, jogging, and cycling) and intensity (i.e. sedentary behavior, LPA, and MVPA) of PA varied significantly between NE types. Compared to parks, less sedentary behavior and walking but more spatially concentrated PA was observed in recreational areas and green space. Cycling levels were found to be significantly lower in recreational areas and forest & moorland, but higher in blue space as compared to parks. Larger sized NE (≥7 ha) were associated with higher levels of MVPA, walking, jogging and cycling. Insight in which environments (according to type and size) facilitate PA, contributes to the development of tailored PA promoting interventions with ensuing implications for public health.

Physical and social environmental changes to promote walking among Dutch older adults in deprived neighbourhoods: the NEW.ROADS study.

BACKGROUND: Physical activity is important for healthy ageing, and daily walking is seen as a feasible way to be active at older ages. Yet, many older persons, particularly in lower socioeconomic groups and residing in deprived neighbourhoods, are insufficiently active. Creating a physical and social neighbourhood environment that is more supportive for walking has the potential to improve walking behaviour. Current evidence of the impact of changes to the physical and/or social environmental on walking behaviour is scarce. The aim of the NEW.ROADS study is to design, implement and evaluate changes to the physical and social environment for the purpose of increasing walking behaviour among older residents of deprived neighbourhoods. METHODS: Physical and social environmental interventions were developed by matching scientific evidence on environmental determinants of walking, with input from the target population and stakeholders, and ongoing neighbourhood activities. Specifically, a neighbourhood walking route was designed and marked, and neighbourhood walking groups were organised. These environmental interventions were evaluated in a four-armed experimental study. In addition, the design of the study to evaluate the effect of these environmental changes on walking behaviour is described. DISCUSSION: Designing and implementing environmental interventions is a complex endeavour, challenged by limited available theory and evidence. Input from the target population and professional stakeholders is essential, but may also put constraints on the evaluation. TRIAL REGISTRATION: NTR3800 (registered 9/1/2013).

How many walking and cycling trips made by elderly are beyond commonly used buffer sizes: results from a GPS study.

In choosing appropriate buffer sizes to study environmental influences on physical activity, studies are hampered by insufficient insight into the distance elderly travel actively. This study aims at getting insight into the number of trips walked and cycled within various buffer sizes using GPS measures. Data were obtained from the Elderly And their Neighborhood study (Spijkenisse, the Netherlands (2011-2012)). Trip length and mode of transport were derived from the GPS data (N=120; total number of trips=337). Distance decay functions were fitted to estimate the percentage of trips to grocery stores within commonly used buffer sizes. Fifty percent of the trips walked had a distance of at least 729m; for trips cycled this was 1665m. Elderly aged under 75 years and those with functional limitations walked and cycled shorter distances than those over 75 years and those without functional limitations. Males cycled shorter distances than females. Distance decay functions may aid the selection of appropriate buffer sizes, which may be tailored to individual characteristics.

Household and food shopping environments: do they play a role in socioeconomic inequalities in fruit and vegetable consumption? A multilevel study among Dutch adults.

BACKGROUND: Fruit and vegetables are protective of a number of chronic diseases; however, their intakes have been shown to vary by socioeconomic position (SEP). Household and food shopping environmental factors are thought to contribute to these differences. To determine whether household and food shopping environmental factors are associated with fruit and vegetable (FV) intakes, and contribute to socioeconomic inequalities in FV consumption. METHODS: Cross-sectional data were obtained by a postal questionnaire among 4333 adults (23-85 years) living in 168 neighbourhoods in the south-eastern Netherlands. Participants agreed/disagreed with a number of statements about the characteristics of their household and food shopping environments, including access, prices and quality. Education was used to characterise socioeconomic position (SEP). Main outcome measures were whether or not participants consumed fruit or vegetables on a daily basis. Multilevel logistic regression models examined between-area variance in FV consumption and associations between characteristics of the household and food shopping environments and FV consumption. RESULTS: Only a few household and food shopping environmental factors were significantly associated with fruit and vegetable consumption, and their prevalence was low. Participants who perceived FV to be expensive were more likely to consume them. There were significant socioeconomic inequalities in fruit and vegetable consumption (ORs of not consuming fruit and vegetables were 4.26 and 5.47 among the lowest-educated groups for fruit and vegetables, respectively); however, these were not explained by any household or food shopping environmental factors. CONCLUSIONS: Improving access to FV in the household and food shopping environments will only make a small contribution to improving population consumption levels, and may only have a limited effect in reducing socioeconomic inequalities in their consumption.

Area variation in recreational cycling in Melbourne: a compositional or contextual effect?

OBJECTIVE: To examine whether compositional and/or contextual area characteristics are associated with area socioeconomic inequalities and between-area differences in recreational cycling. SETTING: The city of Melbourne, Australia. PARTICIPANTS: 2349 men and women residing in 50 areas (58.7% response rate). MAIN OUTCOME MEASURE: Cycling for recreational purposes (at least once a month vs never). DESIGN: In a cross-sectional survey participants reported their frequency of recreational cycling. Objective area characteristics were collected for their residential area by environmental audits or calculated with Geographic Information Systems software. Multilevel logistic regression models were performed to examine associations between recreational cycling, area socioeconomic level, compositional characteristics (age, sex, education, occupation) and area characteristics (design, safety, destinations or aesthetics). RESULTS: After adjustment for compositional characteristics, residents of deprived areas were less likely to cycle for recreation (OR 0.66; 95% CI 0.43 to 1.00), and significant between-area differences in recreational cycling were found (median odds ratio 1.48 (95% credibility interval 1.24 to 1.78). Aesthetic characteristics tended to be worse in deprived areas and were the only group of area characteristics that explained some of the area deprivation differences. Safety characteristics explained the largest proportion of between-area variation in recreational cycling. CONCLUSION: Creating supportive environments with respect to safety and aesthetic area characteristics may decrease between-area differences and area deprivation inequalities in recreational cycling, respectively.