Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas' PA. We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA. Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women. Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas' PA.
An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km2, 100 intersections per km2, and 25 public transport stops per km2 were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.
Background Physical inactivity is a global pandemic responsible for over 5 million deaths annually through its effects on multiple non-communicable diseases. We aimed to document how objectively measured attributes of the urban environment are related to objectively measured physical activity, in an international sample of adults. Methods We based our analyses on the International Physical activity and Environment Network (IPEN) adult study, which was a coordinated, international, cross-sectional study. Participants were sampled from neighbourhoods with varied levels of walkability and socioeconomic status. The present analyses of data from the IPEN adult study included 6822 adults aged 18–66 years from 14 cities in ten countries on five continents. Indicators of walkability, public transport access, and park access were assessed in 1·0 km and 0·5 km street network buffers around each participant's residential address with geographic information systems. Mean daily minutes of moderate-to-vigorous-intensity physical activity were measured with 4–7 days of accelerometer monitoring. Associations between environmental attributes and physical activity were estimated using generalised additive mixed models with gamma variance and logarithmic link functions. Results Four of six environmental attributes were significantly, positively, and linearly related to physical activity in the single variable models: net residential density (exp[b] 1·006 [95% CI 1·003–1·009]; p=0·001), intersection density (1·069 [1·011–1·130]; p=0·019), public transport density (1·037 [1·018–1·056]; p=0·0007), and number of parks (1·146 [1·033–1·272]; p=0·010). Mixed land use and distance to nearest public transport point were not related to physical activity. The difference in physical activity between participants living in the most and least activity-friendly neighbourhoods ranged from 68 min/week to 89 min/week, which represents 45–59% of the 150 min/week recommended by guidelines. Interpretation Design of urban environments has the potential to contribute substantially to physical activity. Similarity of findings across cities suggests the promise of engaging urban planning, transportation, and parks sectors in efforts to reduce the health burden of the global physical inactivity pandemic. Funding Funding for coordination of the IPEN adult study, including the present analysis, was provided by the National Cancer Institute of National Institutes of Health (CA127296) with studies in each country funded by different sources.
In their Correspondence, Jennifer Kent and colleagues have concerns about the sentiment “what gets measured, gets done” expressed through the title of the lead Comment in the Lancet Global Health Series on urban design, transport, and health1Giles-Corti B Moudon AV Lowe M et al.Creating healthy and sustainable cities: what gets measured, gets done.Lancet Glob Health. 2022; 10: e782-e785Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar “promotes measurement alone as a legitimate pathway to decision making”. We agree that measurement alone is insufficient to bring about change. However, creating surveillance systems to guide and evaluate evidence-informed goal setting, action, advocacy, and accountability is an essential public health function. The primary aim of this Series was to develop a set of health-related policy and spatial indicators that could be used in a global surveillance system to benchmark and monitor progress towards creating healthy and sustainable cities. We have helped to enable this goal by creating open-source tools facilitating indicators to be replicated. The importance of incorporating public health concerns into city planning policies is clear. Hence, all our indicators are policy-relevant and associated with health outcomes. The indicators also align with the UN Sustainable Development Goal indicator framework2UN General AssemblyResolution adopted by the General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development A/RES/70/1. United Nations, New York, NY2015Google Scholar and WHO's3WHOUN HabitatHidden cities: unmasking and overcoming health inequities in urban settings. World Health Organization, Geneva2010Google Scholar call to unmask the hidden city by identifying inequities and integrating health in all policies. On our collective watch, unhealthy and unsustainable cities continue to be built. Given rapid urbanisation, global health challenges, and climate change, the time to act is now. The Series found that despite urban policies expressing an ambition to be healthy, sustainable, and liveable, most cities did not have measurable standards and targets to achieve this vision.4Lowe M Adlakha D Sallis JF et al.City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities.Lancet Glob Health. 2022; 10: e882-e894Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar Consequently, there is inequitable access to health-supportive environments,5Boeing G Higgs C Liu S et al.Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities.Lancet Glob Health. 2022; 10: e907-e918Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar which is crucial to address in all cities. We agree with Kent and colleagues that academic evidence alone is insufficient to stimulate policy improvements. Hence, we developed local scorecards and reports distributed online, encouraged collaborators to discuss local findings with policy makers, and are currently working with local advocates championing policy reform (eg, Bicycle Mayors in Chennai and Mexico City). The Series also called on civil society to advocate for evidence-informed city planning. Although measurement alone will not change urban policies, as Sharon Friel argues: “no evidence, no problem, no action” (Friel S, Australian National University, personal communication). Our cities are causing harm to human, ecosystem, and planetary health. All tools available—science, advocacy, politics, policies, standards, and regulations—must be used to reduce these harms. Our indicators are designed to benchmark and monitor progress, to support evidence-informed decision making, and to help advocates hold governments accountable for achieving healthy and sustainable cities for all. We believe they are worth measuring. BG-C is currently supported by a National Health and Medical Research Council Partnership Grant (GNT9100003) and an Royal Melbourne Institute of Technology Vice Chancellor's Professorial Fellowship. JFS has received travel support from the Rails to Trails Conservancy; and has participated in an Advisory Board for a National Institute of Health Grant for InSPACE and American Association of Retired Persons Liveability Index. DP is on the Steering Committee of the Low-and-Middle Income Country Council of the International Society for Physical Activity and Health. All other authors declare. Creating healthy and sustainable cities: what gets measured, gets doneSince the first Lancet Series on urban design, transport, and health (Series 1) was published in 2016, the urgency to make the transition to healthy and sustainable cities worldwide has intensified. That year, the UN's Sustainable Development Goals1 for promoting prosperity while protecting the planet and ensuring equity came into force. WHO also released its Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development. At WHO Global Conference on non-communicable diseases (NCDs) in 2017, heads of states reiterated their commitment to reduce premature mortality from NCDs by a third by 2030. Full-Text PDF Open AccessCity planning policies to support health and sustainability: an international comparison of policy indicators for 25 citiesCity planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Full-Text PDF Open AccessWhat gets measured does not always get doneWe commend the authors of the Lancet Global Health Series on urban design, transport, and health on the delivery of a comprehensive set of recommendations, which are relevant and useful. We have the greatest respect for their work in measuring the health impacts of urban form in various international contexts. Full-Text PDF Open Access
Tumor promoters were originally defined as agents that promote the neoplastic transformation of cells pretreated with a subcarcinogenic dose of an initiating carcinogen. From a large body of studies using the mouse skin model, it appears that initiating carcinogens act by inducing genetic alterations of the nuclear genome (i.e. mutations) that lead to activation of protooncogenes such as c-Ha-ras. 1 The activation of a single proto-oncogene is, however, insufficient to induce the malignant phenotype, but subsequent exposure of the initiated cells to a tumor promoter does lead to neoplastic transformation. 2 Some of the most potent tumor promoters are natural plant products that belong to the phorbol ester class, such as 12-O-tetradecanoylphorbol-13-acetate (TPA). The mechanism by which tumor promoters act, as opposed to the mechanism of initiation, has remained elusive for many years. However, several recent key observations have given us some very important clues to the possible mechanism of tumor promotion.
Methods of effective cardiovascular risk reduction that are suitable for use in clinical settings are needed. Several behavioral interventions were designed to be compatible with office-based medical practice, to be delivered by paraprofessional counselors, and to be of low intensity and low cost. Eighty-three hypercholesterolemic volunteers were assigned to one of three experimental conditions (face-to-face counseling, mail and telephone counseling, initial session only). Twenty-six nonrandomized subjects served as a no-contact group and were followed for 1 year. Participants in the first three groups received risk factor education, behavioral recommendations, and a packet of materials, while those in the face-to-face and mail/telephone counseling groups were contacted for five brief follow-up sessions over a 4-month period. At the 1-year follow-up evaluation, subjects in the face-to-face and mail/telephone counseling conditions showed decreases in plasma cholesterol of 6.2 and 4.6%, respectively (P < 0.01), while the other two groups evidenced small increases. There were no differences by condition for plasma triglycerides, systolic or diastolic blood pressure, or weight. Low-intensity, low-cost behavioral interventions delivered by paraprofessionals can produce long-term decreases in a major cardiovascular risk factor. Physicians are encouraged to incorporate similar interventions into their practices.
The nuclear factor-κB (NF-κB) transcription factor family has been considered the central mediator of the inflammatory process and a key participant in innate and adaptive immune responses. Coincident with the molecular cloning of NF-κB/RelA and identification of its kinship to the v-Rel oncogene, it was anticipated that NF-κB itself would be involved in cancer development. Oncogenic activating mutations in NF-κB genes are rare and have been identified only in some lymphoid malignancies, while most NF-κB activating mutations in lymphoid malignancies occur in upstream signaling components that feed into NF-κB. NF-κB activation is also prevalent in carcinomas, in which NF-κB activation is mainly driven by inflammatory cytokines within the tumor microenvironment. Importantly, however, in all malignancies, NF-κB acts in a cell type-specific manner: activating survival genes within cancer cells and inflammation-promoting genes in components of the tumor microenvironment. Yet, the complex biological functions of NF-κB have made its therapeutic targeting a challenge.
