The built environment plays a key role in promoting active mobility for healthy aging. Encouraging active mobility among older adults, however, can be especially challenging in more rural areas where distances tend to be longer and infrastructure is favoring car traffic. The association of older adults’ perception of attributes of the built environment with cycling and e-biking for transport was investigated. The potential moderating effects of age, sex, and mobility impairments were explored. A cross-sectional survey was conducted in towns and communities of <100,000 inhabitants, including 2,144 participants (mean age: 74; 53% men). Three different cycling outcomes (any cycling/e-biking, frequency (≥3 days/week) and amount (minutes/week)) were analyzed among all cyclists and e-bike users separately, resulting in six dependent variables. The impact of ten environmental attributes on these outcomes was analyzed in separate models. Overall, street connectivity, and the proximity and number of destinations were most important. Only street connectivity and traffic safety were related to minutes cycling or e-biking per week. Cycling amount was higher overall for e-biking but fewer environmental attributes showed an association compared to any cycling, regardless of bicycle type. Traffic safety was not associated with four out of the six cycling outcomes and was inversely associated with minutes cycling or e-biking. Density was not related to any of the variables investigated. Several interaction effects of sex, age, and mobility impairments were found. Further research is needed on environmental attributes influencing e-bike use, the most important types of destinations, and a more differentiated assessment of perceived traffic safety in older adults.

Abstract Background Having destinations within walking distance can encourage older people to walk. Yet, not all destinations may be equally important. Little is known about the types of destinations fostering older adults’ walking for transport in small and medium-sized towns and rural communities. The aim of this study was to explore the associations between the availability of different destinations and walking for transport among older adults living in communities with less than 100,000 inhabitants. Methods Between May and September 2019, self-reported data from 2242 older adults (≥ 65 years) living in the Metropolitan Region Northwest (Germany) were collected within the project AFOOT – Securing urban mobility of an aging population. Data from 2137 study participants were eligible for this analysis. Logistic regression models were used to investigate the relationship between the perceived destination availability of 19 different destinations within a 20-min or 10-min walk from home, respectively, and the engagement in walking for transport. Crude and adjusted models were run separately for each destination and distance category. Exploratory subgroup analyses examined the associations between the availability of destinations within a 20-min walk from home and walking for transport stratified by gender, use of a walking aid, and car availability. Results The availability of each of the investigated destinations within a 20-min walk and of nearly all of these destinations within a 10-min walk from home was significantly positively associated with walking for transport in crude models. Most associations remained significant after adjustment for covariates. The strongest associations were found for the availability of small stores, pharmacy, and bakery. The availability of a bus stop showed the weakest associations and was not significantly associated with walking for transport after adjustment for covariates. Conclusions The provision of local amenities within walking distance may be a promising approach to foster older adults’ walking for transport in smaller communities with less than 100,000 inhabitants and to enable active and healthy aging in place. Further quantitative and qualitative research is needed to validate these findings and to better understand older adults’ walking behavior.

The promotion of walking and cycling to stay active and mobile offers great potential for healthy aging. Intersectoral collaboration for age-friendly urban planning is required in local government to realize this potential. Semi-structured interviews were conducted with the heads of planning and public health departments in city and district administrations of a Metropolitan Region in Germany to identify factors influencing action on the cross-cutting issue of active mobility for healthy aging. Although some administrations are working on the promotion of active mobility, they consider neither the needs of older people nor health effects. A lack of human resources and expertise, mainly due to the low priority placed on the issue, are described as the main barriers for further strategic collaboration. Furthermore, the public health sector often focuses on pathogens as the cause of morbidity and mortality, reducing their acceptance of responsibility for the topic. Facilitating factors include the establishment of new administrative structures, projects with rapid results that create awareness and credibility among citizens and politicians, additional staff with expertise in health promotion, and political commitment. In the future, new administrative structures for intersectoral collaboration are needed in order to consider various perspectives in complex developments, such as healthy aging, and to benefit from synergies.

Urban planning that recognizes and integrates the needs of older adults in urban design provides an environment that allows these people to stay in their homes longer. The aim of the current study was to describe the preferences of a variety of urban design features among older adults living in less densely populated areas and to explore differences by groups of people that are often underrepresented in participatory processes. We conducted a survey of 1,836 older adults (age 65+) in cities and municipalities with <100,000 inhabitants in northwest Germany. Urban design features were analysed separately by individual and contextual factors. The urban design features rated as most important were safety concerns and urban design quality features. Crime safety was most often rated as important. The greatest difference in design preferences was observed for women, the oldest old, people with low education and actively mobile people. Increasing preference for lighting, crossings and separated cycle and footpath was observed by community size. The different emphasis put on urban design features by some groups highlight the importance of a diversity of representation in age-friendly development. Cooperation of different sectors is recommended to assess concerns and fears of the residents to help increase perceived safety.

In the last decades, there has been rising interest in public health research in the importance of the built environment for a healthy and active life in old age, but little attention has been paid to less densely populated areas. This study aimed to explore the impact of the built environment on walking for transport in the context of an older population living in communities of <100,000 inhabitants. Within the project AFOOT–Securing urban mobility of an aging population, a cross-sectional postal survey was carried out from May to September 2019 in older adults (≥65 years) in the Metropolitan Region Northwest, Germany. Self-reported data from 2189 study participants were analyzed. Logistic and linear regression models were used to examine the associations between the built environment and walking for transport. Any walking and frequent walking were positively associated with nearly all built environment attributes, even after adjustment for demographic and health covariates. The amount of walking in minutes per week was associated only with residential density. Moderating effects of gender, age, and use of walking aids were identified. Improving the built environment appears to be a promising opportunity to motivate and enable older adults to walk for transport.

Reducing social inequalities in health and health determinants, including physical activity (PA), is a major challenge for public health. PA-promoting interventions are increasingly implemented. Little is known, however, about the impact of these interventions on social inequalities. For prioritizing interventions most likely to be effective in reducing inequalities, studies of PA interventions need to conduct equity impact assessments. The aim of this article is to describe the development of a logic model framework for equity impact assessments of interventions to promote PA. The framework was developed within the prevention research network AEQUIPA—Physical activity and health equity: primary prevention for healthy ageing, informed by an equity-focused systematic review, expert interviews, exploratory literature searches, and joint discussions within the network. The framework comprises a general equity-focused logic model to be adapted to specific interventions. The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation, compliance with and acceptance of interventions, as well as the efficacy of interventions. Future work within AEQUIPA will reveal which key elements are most critical for the interventions’ equity impacts. Equity impact assessments are beneficial for prioritizing interventions most likely to be effective in reducing health inequalities.

Abstract Maintenance of physical activity and mobility is a crucial factor for healthy ageing and ageing in place. The built environment can either promote or hinder active transportation, and also affect social participation and independence. Although public health researchers have been examining this relationship for years, in Germany it is neither a commonly addressed topic of public health authorities nor explicitly in the focus of urban planning departments. The AFOOT project pursues an inter- and transdisciplinary approach to identify entry points for health and equity assessment in urban planning procedures, with a particular focus on small- and medium-sized towns. The final goal is to develop a guide for intersectoral policy action. The project methodology includes document analysis, interviewing of experts, workshops and the simulation of implementation by role-playing games with local stakeholders. Against the background of the ‘Health in All Policies’ strategy, encouragement of a transdisciplinary dialogue within planning processes, with a special focus on walkability and active living of an ageing population, will contribute to the improvement of population health and health equity. This study protocol describes nature of, and rationale for the approach.

Hintergrund: Sozial-ökologische Modelle nehmen an, dass das Bewegungsverhalten durch die Interaktion mit der Umwelt auf verschiedenen Ebenen beeinflusst wird. Gerade im Alter, wenn der Aktionsradius ab- und körperliche Einschränkungen zunehmen und die Menschen sich hauptsächlich in ihrem gewohnten näheren Umfeld aufhalten, sind kontextuelle Faktoren von besonderer Bedeutung. Kurze Entfernungen zu wichtigen Dienstleistern, verkehrssichere Wege ohne Stolperquellen und vernetzte Straßenzüge können die Mobilität fördern und so zu Gesundheit, Selbstständigkeit und Lebensqualität beitragen. Der Öffentliche Gesundheitsdienst (ÖGD) in Bremen und Niedersachsen hat seit 2001 bzw. 2007 die gesetzliche Aufgabe der kommunalen Gesundheitsförderung, die Gestaltung der Wohnumwelt obliegt allerdings dem Stadtplanungssektor. Aspekte menschlicher Gesundheit sind bislang überwiegend nur implizit in den Zielen lokaler Planungskonzepte enthalten. Ziel sollte es daher sein, zukünftig durch integriertes Verwaltungshandeln zwischen Stadtplanungs- und Gesundheitsämtern Gesundheitsbelange einschließlich der Gesundheitsförderung nachhaltig in lokalen Stadtentwicklungsstrategien zu implementieren.

Introduction In the German lung cancer screening trial LUSI, smoking cessation counseling (SCC) was offered to all participants at time of randomization, and smoking habits were asked for within annual questionnaire inquiries. We analyzed the smoking habits of the participants within the first 2 years of follow-up and especially the potential effect of the SCC on these habits. Materials and methods We used the smoking data of the initial inquiry on which the decision on invitation to the study was based, the socio-economic data of the questionnaire filled-in at time of randomization, the psycho-social data obtained during the SCC, and the annual questionnaire data of the first two annual follow-up screening rounds. Results Smoking prevalence decreased in the entire cohort significantly by 4 %, whereby the decrease was with 4.5 % statistically not significantly higher in the control arm than in the screening arm with 3.4 %. The decline was much stronger in the subgroup of attendees to stop-smoking counseling and mounted up therein to 10 %. In some participants, an increase of readiness to quit smoking was observed during the counseling hour, but did not show effects on smoking status 2 years later. Discussion We did not see a tendency to increased smoking among participants of the intervention arm or the entire study. The decline of smoking prevalence among the attendees of the counseling might be due to self-selection. Since the issue of effectiveness of smoking cessation counseling is important, further research with randomization into offering counseling or no intervention should be taken into consideration.