Examining the state, quality and strength of the evidence in the research on built environments and physical activity among adults: An overview of reviews from high income countries.

BACKGROUND: Built environments have been implicated in the development of chronic disease, with physical activity (PA) considered one of the critical mechanisms for this relationship. Substantial growth in research on built environments and PA makes navigating the available evidence challenging. OBJECTIVE: To examine and describe the current state, strength and quality of research investigating the associations between built environments and PA domains of active living (i.e., leisure, transportation, occupational) and total PA among adults (≥18 years) from high-income OECD countries. METHODS: We conducted an overview of systematic reviews. A systematic search of six bibliographic databases and grey literature from January 2000 to May 2020. Review quality was assessed with the AMSTAR2. Results by age group were synthesized narratively and direction of association displayed using harvest plots. Certainty of the evidence was assessed using a modified GRADE approach. RESULTS: The overview included 116 systematic reviews. Most evidence was cross-sectional and of low-to-very low quality. Moderate-to-high certainty of evidence supported positive associations between environments that support active transportation (e.g., walkability, walking infrastructure, street connectivity, land-use mix) and transportation PA among adults/working-aged adults. Across all age groups, there was very low-to-moderate certainty for consistent positive associations between point of decision prompts (e.g., signs in stairwells and along paths) and all PA. Evidence from older adults was of very low certainty and largely equivocal. There was little-to-no evidence for young and middle-aged adults and occupational PA. DISCUSSION: While there has been an increase in evidence from observational and natural experiment studies, most has been related to active transportation infrastructure and point of decision prompts. There remains a need for these studies to evaluate built environments for leisure and occupational PA and among younger and older adults, and for high quality reviews to summarize this evidence. Interventions that target changes to the built environment show promise for promoting PA among adults, providing an important means to combat the global physical inactivity crisis.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries.

BACKGROUND: Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews. OBJECTIVE: Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years). METHODS: We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach. RESULTS: This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit. DISCUSSION: There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

Tracking changes in national BCG vaccination policies and practices using the BCG World Atlas.

The BCG vaccine is a widely given vaccine against tuberculosis (TB), yet studies on effectiveness have shown considerable heterogeneity; as a result, BCG vaccine policies vary greatly across the globe and change across geography, and with time and disease burden. The recently updated third BCG World Atlas (www.bcgatlas.org) is a publicly available online database with information on BCG practices across 194 countries. This helpful resource has been used for over 10 years to support clinicians, TB researchers and TB vaccine development worldwide. Here, we summarise main findings from the third BCG Atlas' most recent update which included additional data collected around BCG strain type, vaccine stockouts and associated changes. Longitudinal analysis enables evaluation of changes in TB incidence over time, a method becoming more common in legislation interventions. A large number of countries in the BCG Atlas (156/194 countries) maintain universal neonatal BCG vaccination, of which 51 are considered low TB burden countries. We demonstrate the majority of countries who changed their national policy moved to targeted vaccination for high-risk groups, were in Europe and also had significant decreases in TB incidence both before and after policy change. Globally, the most common BCG strain continues to be the Danish strain, despite its worldwide manufacturing interruption in 2015. Substantial variation and disproportionality exists in which regions were most affected by stockouts between 2009 and 2019. Tracking and understanding the reasoning behind changes to national BCG practices and their impact on TB burden is critical for decision makers as they contemplate how to include BCG vaccination in future immunisation guidelines in low and high TB burden countries.

Physical distancing messages targeting youth on the social media accounts of Canadian public health entities and the use of behavioral change techniques.

INTRODUCTION: Physical distancing (PD) is an important public health strategy to reduce the transmission of COVID-19 and has been promoted by public health authorities through social media. Although youth have a tendency to engage in high-risk behaviors that could facilitate COVID-19 transmission, there is limited research on the characteristics of PD messaging targeting this population on social media platforms with which youth frequently engage. This study examined social media posts created by Canadian public health entities (PHEs) with PD messaging aimed at youth and young adults aged 16-29 years and reported behavioral change techniques (BCTs) used in these posts. METHODS: A content analysis of all social media posts of Canadian PHEs from Facebook, Twitter, Instagram and YouTube were conducted from April 1st to May 31st, 2020. Posts were classified as either implicitly or explicitly targeting youth and young adults. BCTs in social media posts were identified and classified based on Behavior Change Technique Taxonomy version 1 (BCTTv1). Frequency counts and proportions were used to describe the data. RESULTS: In total, 319 youth-targeted PD posts were identified. Over 43% of the posts originated from Ontario Regional public health units, and 36.4 and 32.6% of them were extracted from Twitter and Facebook, respectively. Only 5.3% of the total posts explicitly targeted youth. Explicit posts were most frequent from federal PHEs and posted on YouTube. Implicit posts elicited more interactions than explicit posts regardless of jurisdiction level or social media format. Three-quarters of the posts contained at least one BCT, with a greater portion of BCTs found within implicit posts (75%) than explicit posts (52.9%). The most common BCTs from explicit posts were instructions on how to perform a behavior (25.0%) and restructuring the social environment (18.8%). CONCLUSIONS: There is a need for more PD messaging that explicitly targets youth. BCTs should be used when designing posts to deliver public health messages and social media platforms should be selected depending on the target population.