Background: The built environment plays a pivotal role in shaping cardiometabolic risk by influencing lifestyle behaviours. The 20-Minute Neighbourhood (20MN) concept, promoting accessible, walkable urban areas, has gained traction as a strategy to improve community health. Objectives: This study examined whether neighbourhood built environment features, operationalised within a 20min, are associated with cardiometabolic risk through indirect behavioural pathways over time, using Bayesian Network Analysis (BNA). Our aim was to investigate causal pathways linking the built environment with cardiometabolic risk. Methods: A Bayesian network model was constructed using longitudinal data from the North-West Adelaide Health Study (NWAHS), spanning three waves over ten years. Built environment indices were developed using expert input, fuzzy logic, and GIS data within a 1600 m street-network buffer of participants' residences. Results: The BNA identified indirect pathways linking built environment variables, particularly the food facilities and public facilities indices, to cardiometabolic risk through modifiable behavioural mediators and downstream biometric change. Specifically, food and public facilities were linked to HbA1c indirectly through fruit and vegetable intake, physical activity, and BMI. The model explained 32.1% of HbA1c variance, with BMI serving as a strong predictor. Centrality measures also identified physical activity and BMI as key bridging nodes within the network. Discussion: These findings show that the contribution of neighbourhood built environment features to cardiometabolic risk may operate primarily through indirect behavioural and biometric pathways rather than through simple direct associations. BNA provided a useful framework for identifying these pathways in a longitudinal, policy-relevant urban health context.

Air pollution may be associated with lesser physical activity (PA), a major risk factor for cardiometabolic disease. Such an analysis has not been conducted for Kuwait, a major petroleum-producing nation with some of the highest rates of diabetes in the world. This study aimed to assess the associations between spatiotemporally expressed ambient air pollutant concentrations and PA in Kuwait. A cross-sectional study was conducted from 2011 to 2014, involving 2529 adults ≥ 18 years. Participants were classified as physically active if they exceeded 600 MET minutes per week. Monthly mean air pollutant concentrations (hydrogen sulphide, nitric oxide, nitrogen dioxide, nitric oxide, nitrogen oxides, ozone, and PM10) were spatially interpolated to local residential areas using data from local monitoring stations. Random effects logistic regression analysis was conducted to assess the associations between PA and air pollutants (an alpha level of 0.05 was used for all statistical tests). Participants were predominantly male (63%) with mean body mass index 29.3 kg/m². 52% were physically active. The overall air pollutant score was inversely associated with PA (adjusted odds ratio: 0.87, 95% CI 0.79–0.95). A  10 mean increase (ppb) in air pollutant concentration was associated with proportionately lower odds of being physically active for hydrogen sulphide (10%), nitric oxide (14%), nitrogen dioxide (16%), and nitrogen oxides (14%). In contrast, a 10 increase (ppb) in ozone concentration was associated with 15% greater odds of being physically active. Our findings highlight for Kuwait a high level of insufficient PA and a previously undocumented negative association between PA and air pollution, particularly nitrogen-based pollutants and hydrogen sulphide. Research is required to evaluate how air pollution may inhibit PA and whether reductions in emissions could increase PA in Kuwait.

Background: Australian children are not meeting recommended daily physical activity and active school travel targets. To increase active wheeled travel to school, the RideScore Active Schools program used gamification to motivate children's participation and smart app technology to provide parents reassurance of children's arrival to and departure from school. Program reach and RideScore's short-term impact on children's active travel from preparatory year to grade six were evaluated. Methods: A quasi-experimental design was utilised with eight school sites allocated to the intervention condition and four schools to the comparison condition, in Queensland, Australia. Bicycle and scooter counts were completed at baseline (T1) and four-months later (T2). The school was the unit of observation and analysis. Program reach and children's participation were assessed through registrations, trip numbers, riding frequency, and distance travelled. Data were analysed using regression analysis with heteroskedasticity-consistent standard errors. Results: From baseline, total bike count increased 38.0 % in intervention schools and decreased 4.3 % in comparison schools. Adjusting for school enrolment, between T1 and T2, intervention relative to comparison schools recorded an average daily increase of 33.6 bikes (p = 0.03), corresponding to an average percentage increase of 55.2 % (p = 0.01). The effect size was moderate (Hedge's g = 0.78). Children travelled a total distance of 88,004 km, corresponding to 12.8 tonnes of CO2 saved. Conditional on assumed travel speeds of 14 km/h and 10 km/hr, commuting contributed 6.5-9.1 min per day to children's physical activity. Conclusion: RideScore increased active wheeled travel and contributed to primary school children's recommended daily physical activity targets.

Objectives To implement an overview of reviews that discuss the current state of syntheses (such as systematic reviews) of only observational studies on health risk behaviours (HRBs), including smoking, alcohol intake, poor sleep, poor quality diet, common mental health problems (depression and anxiety), and glycated haemoglobin (HbA1c), while excluding synthesis of clinical trials.Design Overview of reviews or umbrella review following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines.Data sources PubMed, Scopus, Web of Science, PsycINFO-PsychArticles and Epistemonikos, searched from January 2013 to 30 June 2025.Eligibility criteria We included systematic reviews and meta-analyses of observational studies that assessed the relationship between HRBs—including smoking, alcohol intake, poor sleep, poor quality diet, physical activity and common mental health problems such as depression and anxiety—and HbA1c. Reviews of clinical trials were excluded.Data extraction and synthesis We synthesised systematic reviews and meta-analyses on the above topic from five databases following the PRIOR protocol. Two independent reviewers screened titles, abstracts and full texts using standardised methods. Data extracted included study design, exposures, outcomes and population characteristics. Risk of bias was assessed using the AMSTAR-2 tool. Overlap across reviews was evaluated using the corrected covered area metric.Results Eight systematic reviews were included in the final synthesis, encompassing a total sample size of around 307 019 individuals. The study highlights a significant paucity of systematic reviews of observational studies in this area, with no reviews on alcohol and exercise. The existing evidence on poor sleep, poor quality diet and smoking points towards these HRBs leading to worse HbA1c. A bidirectional relationship was found between depression and HbA1c.Conclusions This umbrella review highlights the significant association between HbA1c and key health risk factors underscoring the importance of observational studies, highlighting their ability to capture real-world conditions and complex interactions. While in agreement with existing study designs, this review provides convergent evidence of the critical role of HRBs in managing HbA1c levels.

Cardiometabolic risk (CMR) is a monotonic if not linear continuum where, over time, incremental rises in biological risk can herald large increases in absolute disease risk and thus incident cardiometabolic disease (CMD). The built environment (BE)—green/open space, walkability, and food environment—may influence biological risk. Assessing the biological plausibility and temporal direction of such associations by linking BE features to the progression of biological indicators of CMR is essential for stronger causal inference. This review summarised longitudinal studies assessing BE factors and continuously expressed biological indicators of CMR. Six databases were searched for longitudinal studies examining associations between BE features and continuous CMR factors, including fasting plasma glucose (FPG), triglycerides, lipoproteins, total cholesterol, glycated haemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Four authors screened the titles and abstracts, assessed the full text for inclusion, extracted data, and conducted quality appraisals. Associations were synthesised qualitatively, and a weighted z-score meta-analysis, incorporating study quality and sample size scores, was used to estimate the strength of the pooled evidence. Sixteen longitudinal studies met inclusion criteria, with four studies examining multiple BE features. Green/open space was the most frequently examined feature (n = 9), followed by walkability (n = 8), and food environments (n = 3). Pooled weighted z-score meta-analyses showed that greater availability of green/open space environment was associated with lesser increases over time in SBP (n = 4/5, weighted z = 3.43, p < 0.001) and DBP (n = 3/3, weighted z = 2.89, p < 0.01), but findings were inconsistent for triglycerides (n = 1/2), HDL-C (n = 1/2), and FPG (n = 0/2). There was strong evidence for an association between greater walkability and lesser increases over time in SBP (n = 3/5, weighted z = 2.95, p < 0.01) and HbA1c (n = 2/2), but associations with DBP and FPG were inconsistent. Healthful food sources were associated with lesser increases over time in blood pressure, FPG and HbA1c levels (n = 1/1 for each outcome). This review provides evidence for the role of the built environment in shaping CMR over time, particularly blood pressure and HbA1c, dependent on BE feature. Greater availability of green/open space environment and healthful food environment were reliably associated with a lesser progression of CMR. Evidence for walkability was inconsistent.

Background:Insufficient physical activity (PA) is the fourth leading risk factor for cardiometabolic disease. This study assessed in Kuwait adults the spatial clustering of PA; relationships between PA, climatic factors and built environmental (BE) indicators; and ethnic group differences in PA. Methods:A population-based cross-sectional study was conducted from 2011 to 2014 targeting adults in Kuwait ≥18 years old, using the World Health Organisation (WHO) Global Physical Activity Questionnaire (GPAQ) to assess five domains of physical activity. 2530 participants were classified as physically active or not physically active based on accruing at least 600 MET (min/week). Objectively measured residential-area BE indicators were extracted using the street address location of study participants. Climatic variables expressed as monthly aggregates were acquired from Kuwait's climate stations. Random effects logit analysis was used to assess the relationships between PA, climatic and BE variables. Results:The proportion of physically active respondents was 51.9 % (95 % CI: 49.9, 53.8 %). Insufficient PA was greater in women than men. Suburb-level PA ranged from 21.4 % to 81.9 %. Covariate-adjusted analyses of PA revealed a weak positive association between average temperature aOR = 1.03 (95 %CI: 1.00, 1.06), open space sports ground with synthetic grass (300 m) aOR = 1.28 (95 %CI: 0.88, 1.86), and weighted area road density (100 m) aOR = 1.06 (95 %CI: 0.96, 1.17). A lower odds of PA was apparent for respondents who were currently married (vs never married) aOR = 0.68 (95 %CI: 0.46, 0.99), and for women (vs men) aOR = 0.57 (95 %CI: 0.46, 0.72). A greater odds of PA was apparent for the South/Southeast Asian relative to Arab ethnic group aOR = 1.32 (95 %CI: 1.04, 1.67). Conclusion:This study indicates that half the population in Kuwait did not meet the WHO recommended minimum PA level of at least 600 MET (min/week). Efforts to promote PA in Kuwait should consider addressing gender and ethnic disparities, local environmental factors, and demographic influences such as marital status.

OBJECTIVE:To determine the effect of testosterone vs placebo treatment on health-related quality of life (HR-QOL) and psychosocial function in men without pathologic hypogonadism in the context of a lifestyle intervention. DESIGN, SETTING, PARTICIPANTS:Secondary analysis of a 2-year randomized controlled testosterone therapy trial for prevention or reversal of newly diagnosed type 2 diabetes, enrolling men ≥ 50 years at high risk for type 2 diabetes from 6 Australian centers. INTERVENTIONS:Injectable testosterone undecanoate or matching placebo on the background of a community-based lifestyle program. MAIN OUTCOMES:Self-reported measures of HR-QOL/psychosocial function. RESULTS:Of 1007 participants randomized into the Testosterone for Type 2 Diabetes Mellitus (T4DM) trial, 648 (64%) had complete data available for all HR-QOL/psychosocial function assessments at baseline and 2 years. Over 24 months, while most measures were not different between treatment arms, testosterone treatment, compared with placebo, improved subjective social status and sense of coherence. Baseline HR-QOL/psychosocial function measures did not predict the effect of testosterone treatment on glycemic outcomes, primary endpoints of T4DM. Irrespective of treatment allocation, larger decreases in body weight were associated with improved mental quality of life, mastery, and subjective social status. Men with better baseline physical function, greater sense of coherence, and fewer depressive symptoms experienced greater associated decreases in body weight, with similar effects on waist circumference. CONCLUSION:In this diabetes prevention trial, weight loss induced by a lifestyle intervention improved HR-QOL and psychosocial function in more domains than testosterone treatment. The magnitude of weight and waist circumference reduction were predicted by baseline physical function, depressive symptomology, and sense of coherence.

This study aimed to systematically review longitudinal studies examining associations between the incidence of type 2 diabetes mellitus (T2DM) and built environmental factors. This review adhered to the 2020 PRISMA guidelines. Longitudinal studies examining associations between T2DM incidence and built environmental features were eligible. Built environment constructs corresponded to the following themes: 1) Walkability - factors such as sidewalks/footpaths, crosswalks, parks, and density of businesses and services; (2) Green/open space - size, greenness, and type of available public outdoor spaces; (3) Food environment - ratio of healthful food outlets (e.g., greengrocers, butchers, supermarkets, and health food shops) to unhealthful food outlets (e.g., fast-food outlets, sweet food retailers, and convenience stores). Five databases (e.g., Medline) were searched from inception until July 2023. Qualitative and quantitative synthesis were used to summarise key findings, including a meta-analysis of adjusted Hazard Ratios (aHR). Of 3,343 articles, 16 longitudinal studies from seven countries, published between 2015 and 2023, involving 13,403,902 baseline participants (median of 83,898), were included. In four of the five studies, unhealthful food environment was significantly associated with higher incident T2DM. Five of seven greenspace studies and two of four walkability studies showed that greater greenery and greater walkability were statistically significantly associated with lesser incident T2DM. In pooled analyses, greater T2DM incidence was associated with unhealthful relative to healthful food environments (pooled HR: 1.21; 95% CI: 1.04, 1.42), and T2DM incidence was inversely associated with green/open space environments (pooled HR: 0.82; 95% CI: 0.74, 0.92). Greater walkability was associated with a slight 2% lesser incidence of T2DM (pooled HR: 0.98; 95% CI: 0.98, 0.99). This review underscores consistency in the nature of associations between built environment features related to T2DM. We observed statistically significant inverse or "protective" associations between T2DM and walkability and healthful food environments. These results support calls for policies and guidelines that promote healthful food environments and walkability.

Background: The objective effects of testosterone treatment on health-related quality of life (HR-QOL) and psychosocial function in men without pathologic hypogonadism are unknown. Methods: Secondary analysis of a 2-year, randomised controlled, testosterone therapy trial for prevention, or reversal of newly diagnosed, type 2 diabetes, enrolling men>50 years at high risk for type 2 diabetes from six Australian centres. Men received injectable testosterone undecanoate or matching placebo on the background of a community-based lifestyle program. Main outcomes were self-reported measures of HR-QOL/psychosocial function. Findings: Of 1007 participants randomised into T4DM, 648 (64%) had complete data available for all HR-QOL/psychosocial function assessments at baseline and two years. Over 24 months, testosterone treatment, compared with placebo, improved subjective social status and sense of coherence. Baseline HR-QOL/psychosocial function measures did not predict the effect of testosterone treatment on glycemic outcomes, primary endpoints of T4DM. Irrespective of treatment allocation, larger decreases in body weight were associated with improved mental quality of life, mastery, and subjective social status. Men with better baseline physical function, greater sense of coherence, and less depressive symptoms experienced greater associated decreases in body weight, with similar effects on waist circumference. Interpretation: In this diabetes prevention trial, weight loss induced by a lifestyle intervention improved HR-QOL and psychosocial function in more domains than testosterone treatment. The magnitude of weight and waist circumference reduction were predicted by baseline physical function, depressive symptomology, and sense of coherence.Trial Registration: This study was registered on the Australia and New Zealand Clinical Trials Registry (ACTRN12612000287831). Funding: The T4DM study was supported by grants from the National Health and Medical Research Council (NHMRC) Project Grant #1030123, Bayer, Lilly, and the University of Adelaide with in-kind support from Weight Watchers and Sonic Healthcare. Declaration of Interest: MG has received research funding from Bayer, Otzuka, and speaker’s honoraria from Besins Health Care and Novartis. DJH has served as an expert witness in antidoping and professional standards tribunals and for testosterone litigation. BGAS has received speaker fees (Besins, Astellas). BBY has received speaker honoraria and conference support from Bayer, Lilly and Besins Healthcare, and research support from Bayer, Lilly and Lawley Pharmaceuticals, and has held advisory roles with Lilly, Besins Healthcare, Ferring and Lawley Pharmaceuticals. GAW has received research funding for testosterone pharmacology studies (Lawley, Bayer, Lilly), speakers (Besins, Bayer) and consultancy (Elsevier) fees. JDZ has received speaker fees from Besins. CA has received speaker honoraria (Besins) and had advisory roles (Besins, Ferring). MD, MNTF, KB, WJI, KPR and DJ have nothing to disclose. Ethical Approval: The study received ethics committee approval to be conducted at each site.

The 20-min neighbourhood (20MN) concept aims to enable residents to meet daily needs using resources within a 20-min trip from home noting that there is no single definition of what services and amenities are required for daily needs nor what modes of transport constitute a 20 min trip. Whether 20MNs promote better health and whether associations differ by socio-economic status (SES) is unknown. Using cross-sectional data from adults randomly sampled in 2018-19 from Melbourne or Adelaide, Australia, we examined whether associations between neighbourhood type (20MN/non-20MN) and diet, physical activity or self-rated health vary according to individual- or area-level SES. We found no consistent patterns of interactions. The results do not consistently support the often assumed belief that 20MNs support more healthful behaviour and that these relationships vary by SES.

The health of Indigenous Australians is far poorer than non-Indigenous Australians, including an excess burden of infectious diseases. The health effect of built environmental (BE) features on Indigenous communities receives little attention. This study's objective was to determine associations between BE features and infectious disease incidence rates in remote Indigenous communities in the Northern Territory (NT), Australia. Remote Indigenous communities (n = 110) were spatially joined to 93 Indigenous Locations (ILOC). Outcomes data were extracted (NT Notifiable Diseases System) and expressed as ILOC-specific incidence rates. Counts of buildings were extracted from community asset maps and grouped by function. Age-adjusted infectious disease rates were dichotomised, and bivariate binomial regression used to determine the relationships between BE variables and infectious disease. Infrastructure Shelter BE features were universally associated with significantly elevated disease outcomes (relative risk 1.67 to 2.03). Significant associations were observed for Services, Arena, Community, Childcare, Oval, and Sports and recreation BE features. BE groupings associated with disease outcomes were those with communal and/or social design intent or use. Comparable BE groupings without this intent or use did not associate with disease outcomes. While discouraging use of communal BE features during infectious disease outbreaks is a conceptually valid countermeasure, communal activities have additional health benefits themselves, and infectious disease transmission could instead be reduced through repairs to infrastructure, and more infrastructure. This is the first study to examine these associations simultaneously in more than a handful of remote Indigenous communities to illustrate community-level rather than aggregated population-level associations.

Indigenous Australians experience poorer health than non-Indigenous Australians, with cardiometabolic diseases (CMD) being the leading causes of morbidity and mortality. Built environmental (BE) features are known to shape cardiometabolic health in urban contexts, yet little research has assessed such relationships for remote-dwelling Indigenous Australians. This study assessed associations between BE features and CMD-related morbidity and mortality in a large sample of remote Indigenous Australian communities in the Northern Territory (NT). CMD-related morbidity and mortality data were extracted from NT government health databases for 120 remote Indigenous Australian communities for the period 1 January 2010 to 31 December 2015. BE features were extracted from Serviced Land Availability Programme (SLAP) maps. Associations were estimated using negative binomial regression analysis. Univariable analysis revealed protective effects on all-cause mortality for the BE features of Education, Health, Disused Buildings, and Oval, and on CMD-related emergency department admissions for the BE feature Accommodation. Incidence rate ratios (IRR’s) were greater, however, for the BE features Infrastructure Transport and Infrastructure Shelter. Geographic Isolation was associated with elevated mortality-related IRR’s. Multivariable regression did not yield consistent associations between BE features and CMD outcomes, other than negative relationships for Indigenous Location-level median age and Geographic Isolation. This study indicates that relationships between BE features and health outcomes in urban populations do not extend to remote Indigenous Australian communities. This may reflect an overwhelming impact of broader social inequity, limited correspondence of BE measures with remote-dwelling Indigenous contexts, or a ‘tipping point’ of collective BE influences affecting health more than singular BE features.

Obesity is a public health crisis in Kuwait. However, not all obese individuals are metabolically unhealthy (MuHO) given the link between obesity and future cardiovascular events. We assessed the prevalence of the metabolically healthy obese (MHO) phenotype and its relationship with high sensitivity C-reactive protein (hs-CRP), serum alanine aminotransferase (ALT), and insulin resistance (HOMA-IR) in Arab and South Asian ethnic groups in Kuwait. The national cross-sectional survey of diabetes and obesity in Kuwait adults aged 18–60 years were analysed. The harmonised definition of metabolic syndrome was used to classify metabolic health. Multinomial logistic regression analysis was used to model the relationship between the MHO and MuHO phenotypes and hs-CRP, ALT and HOMA-IR levels. Overall, the prevalence of MHO for body mass index (BMI)- and waist circumference (WC)-defined obesity was 30.8% and 56.0%, respectively; it was greater in women (60.4% and 61.8%, respectively) than men (39.6% and 38.2%, respectively). Prevalence rates were also lower for South Asians than for Arabs. The MHO phenotype had hs-CRP values above 3 µg/mL for each age group category. Men compared to women, and South Asians compared to Arabs had a lower relative risk for the MHO group relative to the MuHO group. This study shows there is high prevalence of MHO in Kuwait.

Safe Routes to School (SR2S) interventions have been implemented in many economically developed countries to improve children’s engagement in Active School Travel (AST). Evaluations have highlighted inconsistencies in SR2S intervention outcomes, raising questions as to how, why, and under what contextual conditions these interventions work. This review used a Rapid Realist Review (RRR) methodology to build, test, and refine an overarching program theory that unpicks the contextual factors and underlying mechanisms influencing children’s engagement in AST. From the 45 included documents, 16 refined Context–Mechanism–Outcome Configurations (CMOCs) were developed and clustered into three partial program theories (i.e., implementor/implementation, child, and parent), with the associated mechanisms of: (1) School Reliance; (2) School Priority; (3) Fun; (4) Pride; (5) Perceived Safety; (6) Distrust; (7) Convenience; (8) Perceived Capabilities; and (9) Reassurance. The overarching program theory delineates the pathways between intervention implementation, children’s motivation, parental decision-making, and children’s engagement in AST. The findings suggest SR2S interventions can motivate children to engage in AST, but whether this motivation is translated into engagement is determined by parental decision-making. This review is novel for highlighting that many of the factors influencing parental decision-making are contextually driven and appear to be unaddressed by the current suite of SR2S intervention strategies. The review additionally highlights the complexity of parental perceptions of safety, with the traffic and the road environment shaping only part of this multidimensional mechanism. Practitioners and policymakers need to tailor SR2S interventions to local contexts to better influence parental decision-making for children’s engagement in AST.

BACKGROUND:The 20-min neighbourhood (20 MN) concept aims to provide people the ability to meet their daily needs within a 20-min non-motorised trip from home. Evidence as to whether the 20 MN encourages more walking for transport or recreation is currently absent. METHODS:This cross-sectional study used self-reported data from the Places and Locations for Activity and Nutrition study (ProjectPLAN) targeting adults (n = 843) residing in Melbourne or Adelaide, Australia. Multiple services and amenities were used to represent access to five service domains (healthy food, community resources, recreational resources, public open space, public transport). Address points meeting the access criteria for each of the five domains were defined as having a 20 MN. Non-20 MNs were defined as having five or fewer individual services and amenities. This study examined if those residing in a 20 MN compared with a non-20MN undertook more walking for transport or for recreation. The analysis considered separately each of the cities to support the estimation of effects specific to each local context. RESULTS:Respondents residing in a 20 MN relative to a non-20MN had higher odds of walking for transport in Melbourne (OR = 4.24, 95% CI = 2.38, 7.56), whilst in Adelaide there was no evidence of a difference (OR = 1.31, 95% CI = 0.80, 2.13). In Melbourne, the mean time spent walking for transport was greater for 20 MNs (82.5 min/week, 95% CI = 65.3, 99.7) compared to non-20MNs (41.2 min/week, 95% CI = 32.7, 49.7). Whilst minutes spent walking for recreation was higher than minutes spent walking for transport, no differences were found between neighbourhood types and walking for recreation in either city. CONCLUSION:20 MNs appeared to promote walking for transport in the higher density setting of Melbourne, but no association was observed in the lower density city of Adelaide. Further investigation is required to determine other factors beyond service provision that can promote walking for transport in Adelaide (e.g. pedestrian safety). Recreational walking did not differ across neighbourhood types highlighting that service provision and thus the 20 MN is not related to walking for exercise/recreation purposes.

Background Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia’s second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia). Methods Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs. Results In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide’s 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne. Conclusions The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept.

Beliefs that neighbourhood environments influence body mass index (BMI) assume people residing proximally have similar outcomes. However, spatial relationships are rarely examined. We considered spatial autocorrelation when estimating associations between neighbourhood environments and BMI in two Australian cities. Using cross-sectional data from 1329 participants (Melbourne = 637, Adelaide = 692), spatial autocorrelation in BMI was examined for different spatial weights definitions. Spatial and ordinary least squares regression were compared to assess how accounting for spatial autocorrelation influenced model findings. Geocoded household addresses were used to generate matrices based on distances between addresses. We found low positive spatial autocorrelation in BMI; magnitudes differed by matrix choice, highlighting the need for careful consideration of appropriate spatial weighting. Results indicated statistical evidence of spatial autocorrelation in Adelaide but not Melbourne. Model findings were comparable, with no residual spatial autocorrelation after adjustment for confounders. Future neighbourhoods and BMI research should examine spatial autocorrelation, accounting for this where necessary.

The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the "community infrastructure" domain within the built environment, and the "community capacity" domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.

Introduction: Active School Travel (AST) programs, such as Safe Routes to School (SR2S), have been predominantly evaluated using self-reported methods that are susceptible to bias (e.g., social desirability). Objective methods, such as observational route counts, are underutilised in AST program evaluations, and existing studies have not assessed instrument inter-rater reliability. This study aimed to strengthen the evidence base supporting the use of objective measurements to estimate school children's AST behaviour by adapting an existing observational route counting instrument to align with the route-level aims of SR2S programs and assessing its inter-rater reliability. Methods: The ROute Observation for Travelling to School (ROOTS) instrument was adapted from Crawford and Gerrard's Ride2School instrument. Reliability data were collected across four days from three purposively selected public primary schools (one school per day with one school repeated due to rain). Four pairs of trained observers were assigned to different routes at observation points approximately 100-200m away from the same school on the same day. Without conferring, the observational pairs recorded all active travel behaviour (i.e., children walking, cycling, scootering, skating to school), for four 15-minute intervals between 8:15am and 9:15am. Intraclass Correlation Coefficients (ICC) were computed to assess the inter-rater reliability of each observational pair. Results: The total number of observations made by the four observational pairs was 353.0 (M = 88.3, SD = 27.1). ICCs for observational pairs ranged between 0.841 (95% CI: 0.758, 0.897) and 1.000, reflecting good to excellent inter-rater reliability. Conclusion: The ROOTS instrument had good to excellent inter-rater reliability, which supports the use of observational route counts to provide AST evaluations with an objective, reliable alternative to self-reported methods. The ROOTS instrument may be particularly useful for researchers and practitioners evaluating route-level AST behaviour in SR2S programs to tailor these programs to the route-level needs of children and parents.