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Purpose. Evaluate the implementation of a government planning policy (Liveable Neighbourhoods Guidelines) and its impacts on residents' walking behaviors. Design. Cross-sectional study of participants from the RESIDential Environments project (RESIDE). Setting. Nineteen "liveable" and 17 "conventionally designed" housing developments across Perth, Western Australia. Subjects. Five hundred ninety-four participants from RESIDE who resided in 36 housing developments. Measures. Developed in geographic information systems to assess the on-ground implementation of 43 policy requirements. Policy compliance was defined as the degree to which construction of the developments adhered to the standards outlined. Walking behaviors were measured using the Neighborhood Physical Activity Questionnaire. K-means cluster analyses identified groups of homogeneous developments with respect to policy implementation. Analysis. Logistic regression with generalized estimating equations estimated the odds ratios (ORs) and 95% confidence intervals (95% CIs) for the likelihood of undertaking any and ≥ 60 minutes of transport and recreational walking associated with (1) policy compliance and (2) different clusters of developments. Results. There were few significant differences in on-ground outcomes between the two development types. Despite incomplete implementation, the odds of walking for transport increased with overall levels of policy compliance (OR= 1.53, 95% CI 1.13–2.08) and compliance with the community design (OR = 1.3, 95% CI 1.13–1.42), movement network (OR = 2.49, 95% CI 1.38–4.50), and lot layout elements (OR = 1.26, 95% CI 1.06–1.50). Conclusion. Consistent with the aims of the policy, residents in walkable (i.e., liveable) neighborhoods may be more physically active.

Few studies have specifically investigated fear of crime as a deterrent to walking. This study tested the hypothesis that fear would inhibit residents from walking in their local neighborhoods. Homeowners ( n = 1,044) in Perth, Western Australia, reported their fear of crime, neighborhood problems and walking, and objective environmental measures were generated for each participant's neighborhood. Multivariate logistic regression models examined the association between fear and walking, with progressive adjustment for other correlates. Fear was associated with lower odds of transport walking (OR = 0.79, p = .034); however, car access was ubiquitous so fearful participants could avoid walking. A similar association between fear and recreational walking attenuated after controlling for other neighborhood factors. Findings suggest that the capacity for fear to deter recreational walkers is not fixed, and that a supportive environment can lessen its impact. Community initiatives that encourage social interaction between residents and improve neighborhood aesthetics may increase levels of recreational walking.

There is growing concern that the built forms resulting from conventional suburban design may be adversely affecting the social well-being, sense of community, and psychological health of its residents. This study tested the premise that suburban neighborhood developments ( n = 36) designed in accordance with a New Urbanist inspired planning policy in Perth, Western Australia, improved residents' ( n = 644) sense of community and mental health. Findings revealed that with each 10% increase in policy compliance, residents odds of experiencing high sense of community increased by 21% ( OR = 1.21, 95% CI = [1.04, 1.41]) and low psychological distress increased by 14% ( OR = 1.14, 95% CI = [1.01, 1.28]). These results add empirical input to the debate surrounding the rhetoric and purported social goals and benefits of the New Urbanism, indicating that implementation of its neo-traditionalist neighborhood design principles may help create the conditions for positive neighborhood sense of community and mental health.

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care.

The neighborhood influences on walking are well recognized, yet less is known about how the environment impacts sedentary behaviors. This study used a social-ecological model to examine the correlates of sitting time, independent of walking behavior. Objective built environment measures and self-reported community participation were examined for associations with sitting time for 1,179 residents in Perth, Western Australia. Neighborhood built environment and social factors were significantly associated with women's sitting time only. In particular, the presence of community infrastructure was negatively associated with women's weekday sitting (relative reduction = 0.951; p = .037), but statistical significance weakened after accounting for community participation (relative reduction = 0.951; p = .057). Community participation was independently associated with both women's weekday and weekend sitting (both p < .001). More walkable neighborhoods may help limit women's sitting time by providing better access to community infrastructure, as local venues may afford additional opportunities for social interaction and participation.

With not much to do in their neighborhood, youth may spend more time in the home engaged in screen-based activities. Screen time data from 2,790 youth in the Western Australian Health and Wellbeing Survey were linked to objectively measured count of types of neighborhood "services," "convenience goods," "public open space," and "youth-related" destinations. On average, youth accrued 801 mean min/week screen time and had access to seven different types of neighborhood destinations. A larger number of different types of neighborhood "youth-related," "service," and "total" destinations were associated with less screen time (all p ≤ .05). A significant gender interaction was observed. Girls with access to ≥12 youth-related destinations had 109 fewer mean min/week screen time, compared with girls with 0 to 3 youth-related destinations. Providing alternatives to screen use by ensuring access to a variety of neighborhood places for structured and unstructured activities may be an important strategy for decreasing youth screen time.

IntroductionMedication adherence is associated with a reduction of adverse outcomes in heart failure (HF). However, this association is complex to estimate accurately because adherence (exposure) can vary during the follow-up period. Adherence can be estimated as a fixed exposure to predict outcomes, and this is known as a landmark analysis. In contrast, adherence can also be estimated as a dynamic exposure which varies over time in the follow-up period. This is known as a time-varying analysis and is expected to be the more precise method.
Objectives and ApproachWe compared these two methods in a HF cohort. We identified a population-based cohort of 3619 heart failure patients, aged 65-84 years hospitalised in Western Australia from 2003-2007 and who survived to 1-year post-discharge (landmark date). Adherence to renin-angiotensin system inhibitors (RASI) and β-blockers was calculated using proportion of days covered (PDC) expressed either as a fixed time exposure (in landmark analysis) or a varying exposure (in time-dependent analysis). The latter was updated every 30 days after the landmark date. Cox regression models were used to investigate the association between adherence and all-cause death at 1- and 3-years post-landmark date.
ResultsFor 1-year outcomes, hazard ratios (HR) for every 10% increase in PDC were similar between models from landmark analyses (RASI adherence: 0.93, 0.90-0.97; β-blocker adherence: 0.96, 0.92-1.0) and time-dependent analyses (RASI adherence: 0.94, 0.91-0.97; β-blockers adherence: 0.95, 0.92 -0.99). However, 95% confidence intervals estimated from time-dependent models were narrower than those from landmark analyses. HRs were slightly closer to the null when estimated from time-dependent models. A similar pattern was seen with 3-year outcomes.
Conclusion / ImplicationsTime-dependent analysis of adherence-outcome associations results in more precise estimates of hazard ratios. Estimates of HRs from landmark analysis models were similar but usually lower than those from time-dependent models.

Background The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs. Objectives To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations. Methods An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes. Results In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant. Conclusions The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health supportive behaviors and wellbeing outcomes including transport and recreation walking, and to create neighborhoods with a stronger sense of community where residents may feel safer.

BACKGROUND: The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs. OBJECTIVES: To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations. METHODS: An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes. RESULTS: In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant. CONCLUSIONS: The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health supportive behaviors and wellbeing outcomes ...

BACKGROUND: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. METHODS: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies. FINDINGS: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. INTERPRETATION: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.