Background and Purpose: A growing body of evidence documents multiple ways in which land use and transportation investments influence health. To date, most evidence linking the built environment to health either focuses on behavioral change or environmental exposures. Few studies simultaneously assess how behavior and exposure-based impacts of the built environment interact. This is concerning as increased walkability and transit access can possibly lead to increased exposure to air pollution and injury risk. Method: This paper synthesizes recent research on behavior and exposure-based mechanisms that connect land use and transportation investments with various health outcomes. Exploring the nexus between these pathways provides a framework to identify priority areas for research to inform policies and investments. Results: The most studied pathway articulates how land use and transportation can support healthy behaviors, such as increased physical activity, healthy diet, and social interactions. The second pathway articulates exposure to harmful substances and stressors and potential differential impacts by travel modes. Increased rates of active travel lead to lower generation of vehicle emissions and kilometers traveled; but may actually result in increased exposure which may have adverse effects on sensitive populations such as elderly and youth. Unhealthy exposures have historically concentrated in areas where the most disadvantaged reside-along major transportation corridors where land is cheapest and more affordable housing is located. Highlights • Synthesizes recent evidence on the link between built environment and health • Highlights the need to capture both behavior and exposure-based impacts • Few studies explicitly link built environment factors with clinical end points • Need longitudinal evidence that assesses unique and collective impacts of environmental and biological effects on disease and cost.

The impact of the US EPA-required phase-outs starting in 2000-2001 of residential uses of the organophosphate (OP) pesticides chlorpyrifos (CPF) and diazinon (DZN) on preschool children's pesticide exposures was investigated over 2003-2005, in the Raleigh-Durham-Chapel Hill area of North Carolina. Data were collected from 50 homes, each with a child initially of age 3 years (OCh) and a younger child (YCh). Environmental samples (indoor and outdoor air, dust, soil) and child-specific samples (hand surface residue, urine, diet) were collected annually over 24-h periods at each home. Child time-activity diaries and household pesticide use information were also collected. Analytes included CPF and DZN; pentachlorophenol (PCP); 2,4-dichlorophenoxyacetic acid (2,4-D); the CPF metabolite 3,5,6-trichloro-2-pyridinol (TCP); and the DZN metabolite 2-isopropyl-6-methyl-4-pyrimidinol (IMP). Exposures (ng/day) through the inhalation, dietary ingestion, and indirect ingestion were calculated. Aggregate potential doses in ng/kg body weight per day (ng/kg/day) were obtained by summing the potential doses through the three routes of exposure. Geometric mean aggregate potential doses decreased from 2003 to 2005 for both OCh and YCh, with the exception of 2,4-D. Child-specific longitudinal modeling indicated significant declines across time of the potential doses of CPF, DZN, and PCP for both children; declines of IMP for both children, significant only for OCh; a decline of TCP for OCh but an increase of TCP for YCh; and no significant change of 2,4-D for either child. Age-adjusted modeling indicated significant effects of the child's age for all except CPF, and of time for all except PCP and 2,4-D. Within-home variability was small compared with that between homes; variability was smallest for 2,4-D, both within and between homes. The aggregate potential doses of CPF and DZN were well below published reference dose values. These findings show the success of the US EPA restrictions in reducing young children's pesticide exposures.

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With the mass introduction of shared, dockless electric scooter (e-scooter) programs, many cities are struggling to understand injury implications. This article systematically documents what is known about e-scooter injuries using emergency department (ED) studies; it also provides recommendations to better understand the health and safety risks of this emerging mode. A systematic review was performed for all e-scooter articles through November 2019, retaining injury-related articles. In the case where surveillance data and exposure data were available, injury rates were explored. A total of 18 articles were identified, including: five that used surveillance data methods; seven examining all e-scooter injuries from one to three hospitals; and six examining a medically specific subset of those injured. Variations in the reporting structure of data make pooling difficult, but some trends are emerging. Three surveillance studies report an injury rate of 20–25 ED visits per 100,000 trips. Those injured rarely wear helmets, resulting in a high proportion of head injuries. Extremity injuries, including fractures, are also widespread. The profile of the injured appears to be a 30-year-old male. However, once normalized by exposure data, female, young, and older riders may be at higher risk of injury. Comparisons with other modes remain unclear; this is as much a challenge of the exposure data for the other modes as information on e-scooters. Assumptions about comparisons with bicyclists should be more thoroughly examined. Data harmonization and collaboration between vendors, municipalities, and public health departments would improve the quality of data and resulting knowledge about e-scooter safety risk.