Healthy Cities

elevated AMI fatality risk. These findings may help guide the allocation of health resources.

Background

With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor–human health outcome pairs.

Method

On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard.

Results

Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads.

Conclusions

This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.

Objectives: To assess overall and gender-specific associations between marital status and out-of-hospital coronary death (OHCD) compared with patients surviving to hospital admission.

Design: A cross-sectional study based on linkage of administrative health databases.

Setting: Beijing, China.

Participants: From 2007 to 2019, 378 883 patients with acute coronary event were identified in the Beijing Monitoring System for Cardiovascular Diseases, a validated city-wide registration system based on individual linkage of vital registration and hospital discharge data.

Outcome measures: OHCD was defined as coronary death occurring before admission. Multilevel modified Poisson regression models were used to calculate the prevalence ratios (PR) and 95% CIs.

Results: Among 378 883 acute coronary events, OHCD accounted for 33.8%, with a higher proportion in women compared with men (41.5% vs 28.7%, p<0.001). Not being married was associated with a higher proportion of OHCD in both genders, with a stronger association in women (PR 2.18, 95% CI 2.10 to 2.26) than in men (PR 1.97, 95% CI 1.91 to 2.02; p for interaction <0.001). The associations of OHCD with never being married (PR 1.98, 95% CI 1.88 to 2.08) and being divorced (PR 2.54, 95% CI 2.42 to 2.67) were stronger in men than in women (never married: PR 0.98, 95% CI 0.82 to 1.16; divorced: PR 1.47, 95% CI 1.34 to 1.61) (p for interaction <0.001 for both). Being widowed was associated with a higher proportion of OHCD in both genders, with a stronger association in women (PR 2.26, 95% CI 2.17 to 2.35) compared with men (PR 1.89, 95% CI 1.84 to 1.95) (p for interaction <0.001).

Conclusions: Not being married was independently associated with a higher proportion of OHCD and the associations differed by gender. Our study may aid the development of gender-specific public health interventions in high-risk populations characterised by marital status to reduce OHCD burden.

Background: Chinese people on average consume almost twice as much salt as recommended by the World Health Organization. In recent years, dining out and ordering food online are increasingly popular, especially for urban residents. The aim of this study is to evaluate the effectiveness of different settings on a digital food delivery App in nudging consumers towards reduced salt options through a randomized controlled trial in China.

Methods and Analysis: This is a randomized controlled trial with matched restaurants randomized to five parallel intervention groups plus a control group. Participating restaurants are recruited via open invitation and targeted invitation on a voluntary basis and are free to withdraw from the study at anytime. Each enrolled restaurant can select 1-3 of their most popular dishes to participate in this study. The recruitment ends at the end of June 2021. As of June 30, 285 restaurants enrolled for intervention groups and successfully completed interface set-up requirements. The primary outcome of this study is to investigate the differences in customer ordering behaviors regarding salt preference that result from changing the default settings and/or in combination with health messages before placing the order. The primary outcome will be measured by the difference between the number of regular salt orders and the number of reduced salt orders amongst the five intervention groups, and between each intervention group and the control group. We will collect order data at the end of the 2-month study period from the food delivery App. The secondary outcome is to measure if reduced the salt version of the participating dishes has less salt content than the regular version. The secondary outcome will be measured by lab testing salt content of randomly sampled dishes during the study period. In addition, we will also conduct pre- and post- intervention surveys with participating restaurants to assess their knowledge, attitude, and practice regarding salt reduction, and their perceptions on how such intervention affects their business, if at all. We will not include findings from the pre- and post-intervention interviews as an outcome but will use them to inform future restaurantbased salt reduction promotions.

Discussion: The study will test whether changing in the choice architecture on the digital food ordering platform will promote healthier ordering behavior among consumers. Results on whether user interface modifications can promote purchases of reduced salt dishes may provide evidence to inform future sodium reduction strategies and health promotion interventions on online food ordering platforms, with the potential to apply to offline dining settings. The results may also inform current government efforts to roll out national guidelines on promoting nutrition labeling by restaurants. Despite these strengths in study design, securing the agreement of the food delivery App, recruiting individual restaurants and maintaining compliance to the interface set up through the period of the study proved to be and remains challenging.

Neighborhoods are places where people spend the most time in their lives. Neighborhoods have a decisive impact on the residents' health. With several important tasks, including the transformation of old neighborhoods, the maintenance of existing neighborhoods, and the construction of new neighborhoods in the future, a scientific and reasonable evaluation standard is urgently needed to guide the development of healthy neighborhoods. To build the evaluation system, this paper first clarifies the principles for selecting evaluation indicators, which include: 1) the indicators are selected from a humanistic perspective; 2) the pathways between neighborhoods environment and health outcomes are deeply considered; 3) the indicators are selected from multiple scales. Secondly, based on the combined perspectives of urban planning and public health, it identifies the indicators that affect the residents' health in neighborhoods and searches the literature through the quality assessment to provide evidence to support the accuracy and effectiveness of the indicators. Finally, it proposes prospect to the evaluation, including 1) it is urgent to improve and utilize the healthy neighborhoods based on the Chinese condition; 2) advanced technologies need to be widely applied in neighborhoods in the future; 3) the transitions in cities should be considered in the future development of neighborhoods. It hopes that relevant researchers and government leaders to realize the importance and urgency of healthy neighborhoods to build more healthy neighborhoods in China.

Details are available HERE. 

As the increased attention to human settlements and healthy environment from all over the world, ‘healthy cities’ has become one of the most indispensable topics for urban development. Under such circumstance and the concept of “Health China” proposed in 2016, there has been an increasingly concern on the policy of urban tobacco and smoking control. In 2018, the World Health Organization started to focus on “smoking in cities” problem. In this study, WHO China cooperated with the Baidu Big Data department and Tsinghua University to conduct the spatial analysis and statistics research on the situation of urban smokers and the effects of tobacco control policy in China.

We evaluated people’s change of attention for tobacco-related information by using the massive and spatiotemporal query data and user profile data related to smoking problem in 2013 and 2017 offered by Baidu Big Data department. The data covered 2869 urban districts in China. Besides, we assessed the effects of tobacco control policies in Chinese cities based on the tobacco control policies of various cities. The results showed that there has been an increase in people’s awareness and discussion on the legislative content of smoke-free and the areas with high overall smoking attention were concentrated in the Yangtze River Basin. Meanwhile, the significant increase of people’s attention to e-cigarettes and tobacco tax policy was also found. As for the smoker groups, the proportion of smokers under 24 years old, female smokers and smokers with lower education level increased. We further compared the difference between cities with different levels of tobacco control policies and the results revealed the increase in overall attention on smoking in cities with strict smoking restrict policies. In addition, the attention of smoke-free and cessation increased in cities with smoking restrict policies and especially in those with strict smoking restrict policies. Furthermore, as the area with increasing smoke-free attention were obviously scattered around cities with strict smoking restrict policies, we found the policy may exert influence to surrounding area.

Tsinghua University:

Ying Long, Zhaoxi Zhang (Presenter), Jue Ma, Yuyang Zhang

Baidu Big Data Department:

Jidong Peng, Peng Liu, Shengwen Yang, Lu Meng, Xin Mao, Huadong Li

We thank Gauden GALEA, Xiaopeng JIANG, Kelvin Khow Chuan HENG, Paige SNIDER, Jiani SUN and Xi YIN (in the alphabetic order) from WHO China for their regular inputs and technical discussions.