THE INFLUENCE OF PUBLIC OPEN SPACES ON SEDENTARY BEHAVIOR AND HEALTHCARE COSTS OF ADULTS TREATED IN PRIMARY CARE

• Grant number: 25/02142-4
• Support Opportunities: Scholarships in Brazil - Doctorate
• Start date: October 01, 2025
• End date: November 30, 2028
• Field of knowledge: Health Sciences - Collective Health - Public Health
• Principal Investigator: Jamile Sanches Codogno
• Grantee: Maria Carolina Castanho Saes Norberto
• Host Institution: Faculdade de Ciências e Tecnologia (FCT). Universidade Estadual Paulista (UNESP). Campus de Presidente Prudente. Presidente Prudente , SP, Brazil

Abstract

Population aging and the increasing prevalence of chronic noncommunicable diseases (NCDs) have had significant impacts on health systems. Sedentary behavior stands out among the behavioral factors associated with NCDs. Studies indicate that unfavorable urban environments can discourage the practice of physical activities, while open, accessible and well-planned public spaces, such as squares and parks, favor the adoption of more active lifestyles. The objective of this study is to analyze the mediating role of sedentary behavior in the relationship between the built environment and health expenditures in primary care. The sample will consist of adults, of both sexes, aged 40 or over, recruited from primary health care (PHC) clinics in the city of Presidente Prudente.Direct healthcare costs will be estimated based on the analysis of medical records, considering consultations, exams, medications and operational costs of the service. The built environment will be assessed subjectively (adapted NEWS questionnaire) and objectively (georeferenced via GIS). Data on sedentary behavior, physical activity, sociodemographic characteristics and presence of NCDs will be assessed through questionnaires. Data will be analyzed using descriptive statistics (means, standard deviations, frequencies and 95% CI). Regression models will be used to test the mediating role of sedentary behavior between the built environment and healthcare costs, adjusting for confounding variables. The counterfactual mediation approach will be adopted, with estimates obtained via bootstrap. The quality of the models will be assessed by fit indicators and statistical significance will be considered for p<0.05. The analyses will be conducted using Stata 16.0 software.