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Regina Grazuleviciene, Sandra Andrusaityte, Audrius Dedele
Department of Environmental Science, Vytautas Magnus University (LITHUANIA)
There is growing scientific recognition that physical activity and contact with urban green spaces have
the potential to contribute positively to citizens’ health. However, many citizens are not familiar with the
impact of urban environment on health and do not use the green spaces for physical activity or
recreation. The achievement of healthier urban environments and healthy behaviour requires greater
awareness and education of citizens on issues of environment and health. Citizens’ engagement in
the research is an approach that develops and uses new technologies within local communities to
collect and analyse data and to share knowledge. Active participation enables citizens to become
more aware of how they can identify and tackle local ecological issues. In this paper, we report on the
development of the project “Urban Design and Physical Activity: a Kaunas Pilot Study”, which is a part
of the European Commission’s H2020-SwafS-2018 program project Citizen Science for Urban
Environment and Health (CitieS-Health). The research model builds on Participatory Action Research.
The study will be conducted through collaboration between community members, community-based
organisations, public health agencies, and educational institutions with the aim of outlining the citizens’
concerns and placing them at the centre of environmental epidemiology research by developing a kit
that engages the citizens and presents evidence on how the urban design and physical activity affect
citizens health and well-being. This research will enhance the understanding of issues that affect
community health. The participants will benefit from increasing knowledge and the promotion of
changes in health-related behaviour.
Keywords: education and research, international project, citizen science.
Over the last decade, there was a significant increase in the number of projects conducted by citizens.
The majority of citizen science projects engage the participants in research design, data collection,
and analysis of the questions about the neighbourhood environment. However, to date, citizen science
has not relied heavily on the environmental impact on citizens’ health, and there are opportunities to
engage those affected by environment-related health problems, such as respiratory diseases,
allergies, cardiovascular, and other diseases. Epidemiological studies have shown that natural
environment has specific beneficial effects such as improved mental health, reduced risks of
cardiovascular disease, obesity, or diabetes, and lower risks for all-cause mortality [1], [2].
There is growing scientific evidence that both physical activity and contact with urban green spaces
have the potential to contribute positively to citizens’ health [3][5]. Physical activity in green
environment has been indicated as an effective tool to reduce physiological stress [6][8] and to
improve mental health [9], [10]. Nature can also deliver a suite of physical, psychological, and social
well-being benefits [11], [12], including a decreased risk of overweight [9], [12], [13] or cardiovascular
disease [14][16]. The available evidence suggests that physical activity significantly correlates with
the use of parks and residential land [17], and the availability of recreational spaces (such as parks) is
associated with neighbourhood satisfaction, physical activity, a lesser risk of obesity, and better
wellbeing [18]. Among the elderly urban residents, the prevalence of mental health issues such as
stress levels and symptoms of depression generally decreased with an increasing ratio of green
spaces in the residential area [19]. A Spanish study on adults found that increasing physical activity for
2 years after the age of 60 reduced the risk of cardiovascular disease-related mortality by 25%,
whereas in individuals who maintained higher activity throughout this period, that risk was lower by
58% [20]. There is evidence that physical activity in natural environments is associated with a greater
reduction in the risk of poor mental health and cardiovascular health problems than physical activity in
urban street environment is [21], [22]. A recent USA cohort study found that maintaining physical
activity from adolescence into later adulthood reduced the risk for all-cause mortality by 29% to 36%,
while being inactive at a young age but increasing physical activity during midlife reduced such risk by
32% to 35% [23].
Proceedings of EDULEARN19 Conference
1st-3rd July 2019, Palma, Mallorca, Spain
ISBN: 978-84-09-12031-4
The current approach in environmental health research that relies on top-down techniques is
insufficient for generating community-wide impact and inducing the uptake of the results in the society.
There is a need for stimulating public participation and increasing awareness about such issues as the
impact of physical activity on health and the connections between the quality of the surrounding urban
environment, well-being, and chronic disease. The community-based participatory action research is a
foundational method to engage those affected by environment-related health problems, and wider
attention, education, and involvement of citizens in population health science are required. Citizen
engagement in research is an approach that develops and uses new technologies within local
communities to collect and analyse data and to share knowledge. Such research project-based
learning involves the incorporation of a different role of both the citizen and the researcher within the
learning-by-doing process. Active participation enables citizens to become more aware of how they
can identify and tackle local ecological issues because their action provides them with “real-life”
experience. Active citizens will acquire knowledge on participant engagement in the citizen science
research, environment quality measurements and characterisation, project development and planning,
progress tracking, and communication. Such project-based learning offers ways to transfer the
acquisition of foundational and practical knowledge into “real projects for real citizens”. A recent citizen
engagement projects review concluded that the visions, methods, and experiences concerning
community participation show that a participative approach may contribute to better, context-specific
knowledge and health promotion, as knowledge stimulates health-related behaviour and suggestions
for policy changes [24].
In this paper, we report on the development of the project “Urban Design and Physical Activity: a
Kaunas Pilot Study”, which is a part of the European Commission’s H2020-SwafS-2018 program
project Citizen Science for Urban Environment and Health (CitieS-Health). The research model is built
on participatory action research [25], [26]. The study will be conducted through collaboration between
community members, community-based organisations, public health agencies, and educational
institutions with the aim of outlining the citizens’ concerns and placing them at the centre of
environmental epidemiology research by developing a kit that engages the citizens and presents
evidence on how the urban design and physical activity affect citizenshealth and well-being.
Design of the Citizen Science Pilot Study. The current concept used in this citizen science study has
evolved over the past two decades [26]. The growing public involvement in the research significantly
increases the need for innovative tools in database management, scientific analysis, and educational
research. The model for developing this pilot study comprises 7 steps: choosing a scientific question;
forming a team of scientists-educators; developing protocols, data forms, and educational support
materials; engagement and training of the participants; data collection, coding, and display; data
analysis and interpretation; and dissemination of the results and measurement of the outcomes. The
main scientific objective of this pilot study is to assess how the urban design and physical activity
affect citizenshealth and well-being. Specific objectives are the following: 1) Placing citizens’
concerns at the centre of environmental epidemiology research by developing a kit that engages the
participants, gives answers to citizens’ questions, and provides them with personalised information. 2)
Developing methods, tools, and maps that allow for easy scaling-up and replication of the citizen
science project that lies at the intersection of epidemiology and citizen sensing, thus opening science
to people from all backgrounds. 3) Evaluating the developed model and its impact on the society’s
well-being and health. 4) Raising public awareness about the effects of urban planning and physical
activity on health by translating scientific knowledge gained throughout the process into useful and
practical knowledge for the society. This study engages adult permanent residents of Kaunas city of
different age and social status, participants of previous studies and citizens in collaboration with
neighbourhood associations, activist groups, and people concerned with the city’s environment and
health problems. We engage the volunteers from communities through the Kaunas NGO Association
that consists of more than 50 citizen entities in Kaunas, including the Civil Community Centre Dainava,
Community Centre Aleksotas, Community Centre Marvele, and Kaunas City Municipality Public Health
Bureau, which are interested in collaboration in this study. Particular attention will be given to
engaging people of different ages and socioeconomic status (students, employed, jobless, retired, and
older people) to increase participation in citizen science of those people who are usually less
represented in environmental epidemiological studies.
Data collection and databases. This CitieS-Health pilot study will use the available databases of
previous environmental epidemiological studies for the characterisation of exposures at Kaunas city
level, and will also employ basic personal-level data collection. The tools that are going to be used
range from complex technical equipment to simple sensors. This pilot study concentrates on a tight
connection between the organisation of local citizens to suggest environment and health questions
and research employing lightweight technologies in the development of new knowledge and behaviour
changes in environmental health. In this citizens-scientists collaborative study, the participants will
suggest relevant topics for their own research in collaboration with the scientists. The potential areas
of the study could be to identify Kaunas citizens’ major anxieties related to environmental problems,
active mobility, city traffic, ambient air quality, greenness and other issues, and to reveal their
expectations and needs for health support, which will give rise to social and policy implications. To
collect new data, the questions suggested by the participants will be formalised by the scientists in the
questionnaires, and tools will be suggested for the estimation of different environmental exposure (i.e.
low-cost portable sensors and mobile apps). The scientists will familiarise the citizens with possible
data collection techniques, means, tools, processing, and storage of new data that may be generated
within the project. We will clarify which sources of environmental and health-related data best
contribute to the expected outcomes of the study suggested by the citizens, and what data are
available in Kaunas city from previous epidemiological studies. For this study, environmental exposure
databases created in the EC FP7 ESCAPE and PHENOTYPE projects will be available. The already
available environmental data sources include Kaunas city strategic noise maps; geographic
information systems (GIS) databases with information on living surrounding, green space, street
maps, air pollution, and others. Using the selected digital tools and data obtained from questionnaires
and through sensors and remote monitoring, citizens and scientists will develop the final study design,
and active participants will have the possibility to collect new data on environmental exposures and
health effects during their everyday walking routes. In addition, with the help of digital tools, citizens
will be able to study the risk factors of their chronic diseases and to learn from the aggregated data
reports. From the beginning of the project, the participants will be involved in discussions to identify
and prioritise environmental and health issues, and therefore we hope to obtain information about the
full spectrum of problems and expectations that they might identify. Citizens will participate in all
stages of the development of the pilot study: formulation of the research questions, designing and
implementation of the study, and analysis, interpretation, and communication of the results.
Work plan for the creation of the toolkit. The study starts from the identification of citizens’ health and
environmental concerns. Suggested questions for discussions: Does air pollution in your place of
residence cause problems? Does noise interfere with your sleep, work, or rest at home? Can citizens
easily walk and cycle around using good quality routes? How might the urban structures and the
possibility for physical activity provided by them influence health-related quality of life and well-being?
How may citizens’ behaviour and mode of mobility influence health and well-being? Does your
physical activity reach the Public Health Guidelines for Physical Activity (150 min/week of moderate
intensity activity, or 75 min/week of vigorous intensity activity)? How do you describe the current state
of your health, mood, and physical activity? What related changes in urban design, or political
decisions for healthy living and moving can we suggest? To assess active mobility in different
environments, we will use GIS, maps, and sensors. In order to enhance the understanding of how
urban design might affect physical activity (selection of walking and/or cycling routes), the participants
will be familiarised with epidemiological research findings. After learning such methods as
neighbourhood asset and risk mapping, the participants will acquire scientific skills to investigate the
association between physical activity levels and self-rated health status. Active participants who will
agree to wear FitBit Alta watch-pedometer will have a possibility to participate in tool development. We
will create databases and tools based on health effects of physical activity in green environment and
urban street environment. The databases and tools are planned to be used for formal and informal
scientific education. We will evaluate the effectiveness of the created toolkit for the involvement of
citizens in the research study and the measurement of environmental impact on health.
Measurements. For environmental exposure assessment, we suggest using the available Kaunas city
traffic-related noise maps (Fig. 1), air pollution maps (Fig. 2), information on the quantity of greenness
in the residential setting (i.e., the Normalised Difference Vegetation Index NDVI, Fig. 3), the residence
distance to a Kaunas city parks (Fig. 4), and the frequency and duration of mobility in green and urban
areas (a self-reported questionnaire). To assess citizens’ mobility, we seek to estimate the number of
Kaunas citizens whose physical activity reaches the Public Health Guidelines for Physical Activity.
National guidelines for aerobic physical activity recommend that adults should participate in at least
150 minutes of moderate intensity aerobic activity per week or 75 minutes of vigorous intensity activity
per week, or an equivalent combination of both [27], [28]. Physical activity will be measured using the
General Practice Physical Activity Questionnaire, physical activity sensors, and a smart watch. We will
use a self-reported health questionnaire and questions to obtain citizensopinion on the quality of the
residential place and on the participantshealth. We will use geospatial analysis and statistical
analysis software packages to assess the associations between environmental quality, exposures,
physical activity, and the participants’ health and well-being.
Figure 1 Kaunas city traffic-related noise map
Figure 2 Kaunas city air pollution map
Figure 3 Kaunas city Normalized Difference
Vegetation Index (NDVI)
Figure 4 Kaunas city parks layer
This CitieS-Health pilot study will bridge the gap between the citizen science and epidemiological
studies in environmental health and will provide a means through which people may be engaged in the
process of undertaking population health science research.
The cooperation between scientists and the society and the use the technology-based tools for
citizens’ participation as active citizen scientists in their own health studies can allow for personal data
collection at a larger scale than traditional population studies would. We expect the study topics to
include the participants anxieties relating city planning and environmental problems, their
expectations and needs for health support and physical activity, their exposure to traffic flow
emissions, and the effects of green spaces in neighbourhoods on health. We expect to measure the
effects of walking on active participants health status. This study will fill the gap in the evaluation of
the effects of traffic-related exposures on the well-being of citizens in different age and social status
groups and will generate important new knowledge leading to area-specific estimation of health risk
due to traffic-related exposure in the urban environment. The project will raise awareness about the
effects of the quality of the surrounding environment on health and will increase the amount of
scientific evidence on health benefits of physical activity in green environment. Potential new data
generated in the course of the project and the benefits of the project include: i) Data on real-time
physical activity in different environments and health-related data collected using low-cost portable
sensors; ii) Data on environmental health problems in residential settings; iii) Increased public
awareness of the effects of urban planning and physical activity; gained practical knowledge for the
society; and iv) The acquired knowledge and data might provide citizens and stakeholders with
evidence of health benefits associated with green city planning and physical activity.
Urban planning and green spaces are crucial for citizens’ well-being and physical activity. The
achievement of healthier urban environments and healthy behaviour requires greater awareness and
education of citizens on issues of environment and health. The presented pilot study is an example of
the use of citizen science in order to engage the public in environmental issues and education and to
provide sound evidence for decision-making. The potential benefits of citizen science for population
health science include understanding the complexity of the local public health problems, public
awareness of and respect for well-being, and suggestions of health and policy interventions. This
participatory approach of the CitieS-Health pilot study has a potential for a greater engagement of the
society in knowledge production and use, the elucidation of the local environmental problems, tackling
local ecological issues, and sharing knowledge. The collaborative research enhances the
understanding of issues that affect the community’s health; the participants will benefit from increasing
knowledge and the promotion of changes in health-related behaviour. This study will help the citizens
acquire research skills, new knowledge, experience collaborating with scientists, and knowledge about
healthy behaviour. The created toolkit on urban design and citizens’ physical activity will provide
opportunities for new local and international collaborative research and policy recommendations.
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ResearchGate has not been able to resolve any citations for this publication.
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Importance Although the benefits of leisure-time physical activity (LTPA) in middle age are established, the health effects of long-term participation and changes in LTPA between adolescence and middle age have not been documented. Objective To determine whether an association exists between LTPA life course patterns and mortality. Design, Setting, and Participants This prospective cohort study used data from the National Institutes of Health–AARP (formerly American Association of Retired Persons) Diet and Health Study established in 1995 to 1996. Data analysis was conducted from March 2017 through February 2018. Data were analyzed for 315 059 adult AARP members living in 6 states, namely, California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania, or 2 metropolitan areas, Atlanta, Georgia, or Detroit, Michigan. Exposures Self-reported LTPA (hours per week) at the baseline interview for ages grouped as 15 to 18, 19 to 29, 35 to 39, and 40 to 61 years. Main Outcomes and Measures All-cause, cardiovascular disease (CVD)–related, and cancer-related mortality records available through December 31, 2011. Results Of 315 059 participants, 183 451 (58.2%) were men, and the participants were 50 to 71 years of age at enrollment. Ten LTPA trajectories (categorized as maintaining, increasing, and decreasing LTPA across time) were identified, and 71 377 deaths due to all causes, 22 219 deaths due to CVD, and 16 388 deaths due to cancer occurred. Compared with participants who were consistently inactive throughout adulthood, participants who maintained the highest amount of LTPA in each age period were at lower risks for all-cause, CVD-related, and cancer-related mortality. For example, compared with participants who were consistently inactive, maintaining higher amounts of LTPA was associated with lower all-cause (hazard ratio [HR], 0.64; 95% CI, 0.60-0.68), CVD-related (HR, 0.58; 95% CI, 0.53-0.64), and cancer-related (HR, 0.86; 95% CI, 0.77-0.97) mortality. Adults who were less active throughout most of the adult life course but increased LTPA in later adulthood (40-61 years of age) also had lower risk for all-cause (HR, 0.65; 95% CI, 0.62-0.68), CVD-related (HR, 0.57; 95% CI, 0.53-0.61), and cancer-related (HR, 0.84; 95% CI, 0.77-0.92) mortality. Conclusions and Relevance Maintaining higher LTPA levels and increasing LTPA in later adulthood were associated with comparable low risk of mortality, suggesting that midlife is not too late to start physical activity. Inactive adults may be encouraged to be more active, whereas young adults who are already active may strive to maintain their activity level as they get older.
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The mounting mental health issues faced by elderly urban residents increase the social and economic costs to society associated with dementia and depression. Therefore, it is necessary to identify the characteristics of elderly urban residents suffering from mental health issues, to address these issues more effectively. We used 2015 Community Health Survey data from the Korea Centers for Disease Control and Prevention to identify the demographic and social characteristics of 11,408 elderly urban residents in relation to stress levels and symptoms of depression in seven metropolitan areas in Korea, and to calculate the odds ratio for urban green space. We found that the prevalence of these mental health issues generally decreased in relation to the ratio of green space of an area. These findings suggest identifying elderly people who are vulnerable to certain mental health issues based on demographic and social characteristics and demonstrate that the ratio of urban green space within a community is an important component in improving mental health outcomes for elderly urban residents. These findings have policy implications for assisting elderly people vulnerable to certain mental health issues and for establishing a green welfare policy targeting this population.
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Background: Several single-exposure studies have documented possible effects of environmental factors on lung function, but none has relied on an exposome approach. We aimed to evaluate the association between a broad range of prenatal and postnatal lifestyle and environmental exposures and lung function in children. Methods: In this analysis, we used data from 1033 mother-child pairs from the European Human Early-Life Exposome (HELIX) cohort (consisting of six existing longitudinal birth cohorts in France, Greece, Lithuania, Norway, Spain, and the UK of children born between 2003 and 2009) for whom a valid spirometry test was recorded for the child. 85 prenatal and 125 postnatal exposures relating to outdoor, indoor, chemical, and lifestyle factors were assessed, and lung function was measured by spirometry in children at age 6-12 years. Two agnostic linear regression methods, a deletion-substitution-addition (DSA) algorithm considering all exposures simultaneously, and an exposome-wide association study (ExWAS) considering exposures independently, were applied to test the association with forced expiratory volume in 1 s percent predicted values (FEV1%). We tested for two-way interaction between exposures and corrected for confounding by co-exposures. Findings: In the 1033 children (median age 8·1 years, IQR 6·5-9·0), mean FEV1% was 98·8% (SD 13·2). In the ExWAS, prenatal perfluorononanoate (p=0·034) and perfluorooctanoate (p=0·030) exposures were associated with lower FEV1%, and inverse distance to nearest road during pregnancy (p=0·030) was associated with higher FEV1%. Nine postnatal exposures were associated with lower FEV1%: copper (p=0·041), ethyl-paraben (p=0·029), five phthalate metabolites (mono-2-ethyl 5-carboxypentyl phthalate [p=0·016], mono-2-ethyl-5-hydroxyhexyl phthalate [p=0·023], mono-2-ethyl-5-oxohexyl phthalate [p=0·0085], mono-4-methyl-7-oxooctyl phthalate [p=0·040], and the sum of di-ethylhexyl phthalate metabolites [p=0·014]), house crowding (p=0·015), and facility density around schools (p=0·027). However, no exposure passed the significance threshold when corrected for multiple testing in ExWAS, and none was selected with the DSA algorithm, including when testing for exposure interactions. Interpretation: Our systematic exposome approach identified several environmental exposures, mainly chemicals, that might be associated with lung function. Reducing exposure to these ubiquitous chemicals could help to prevent the development of chronic respiratory disease. Funding: European Community's Seventh Framework Programme (HELIX project).
Full-text available
Currently, the engagement of local communities in Health Impact Assessment is becoming more and more important. A scoping review was performed to take stock of visions, methods and experiences in this field.
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Exercise in natural environments (“green exercise”) confers numerous health benefits, but little is known about why people engage in green exercise. This study examined the importance of nature experiences as a motive for physical activity and the motivational profile of people who engage in green exercise compared to gym- and sports-based exercise. Physical activity motives and typical times spent in different domains of physical activity were reported by 2168 Norwegian adults in a survey. Experiencing nature was generally rated as the second-most important physical activity motive, exceeded only by convenience motives, and it was especially important for older adults and those who engage in greater amounts of instrumental physical activity. Green exercisers reported stronger motives concerning convenience and experiencing nature, whereas gym- or sports-based exercisers reported stronger motives for physical health and sociability. The motives associated with different leisure-time exercise domains may assist in understanding optimal promotion of green exercise.
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Unlabelled: The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD) patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients' stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP) in the park group was evident on the seventh day before the walk (-4 mm Hg, p = 0.031) and 60 min after the walk (-6.00 mm Hg, p = 0.002). The cortisol slope was negatively associated with the DBP changes (r = -0.514, p < 0.05). Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients' stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.
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Research increasingly suggests that moderate to vigorous physical activity (MVPA) is essential to children's health. However, little is known about the extent to which and when different urban environments influence the extent to which children engage in MVPA. To this end, this study explores the relationship between children's MVPA and urban land use and land cover (LULC) for several temporal subdivisions of children's weekly routines (before school, after school and weekends). In particular, the location and corresponding level of physical activity of 4th grade students (n=134) was recorded using paired global positioning system (GPS) receivers and accelerometers over 33days for each student. GPS locations were temporally related to accelerometry records and then geographically related to 13 categories of LULC. Mixed linear models were fitted to evaluate the extent to which duration spent in each LULC category can explain individuals' time in MVPA before school, after school, and during the weekends. Geographic cluster analysis was also applied to assess whether any significant spatial relationships between observations of MVPA may exist. Duration of exposure to vegetated parks/open spaces, built residential, and built institutional LULC was found to significantly increase children's time spent in MVPA. Further, most observations of MVPA were found to exhibit significant geographic clustering and were predominately associated with built residential areas (particularly those near schools), indicating the importance of neighborhoods and areas in close proximity to children's households on their level of physical activity.
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Urbanisation has a profound effect on both people and the environment, as levels of physical activity decline and many natural ecosystems become lost or degraded. Here we draw on emerging research to examine the role of green spaces in providing a venue for outdoor physical activity, and in enhancing the benefit of a given amount of physical activity for urban residents. We identify critical knowledge gaps, including (1) whether (and for whom) levels of physical activity increase as new green spaces are introduced or old spaces reinvigorated; (2) which characteristics of nature promote physical activity; (3) the extent to which barriers to outdoor physical activity are environmental or social; and (4) whether the benefits of physical activity and experiences of nature accrue separately or synergistically. A clear understanding of these issues will help guide effective investment in green space provision, ecological enhancement and green exercise promotion.
Conference Paper
Citizen sensing is an approach that develops and uses lightweight technologies with local communities to collect, share and act upon data. In doing so it enables them to become more aware of how they can tackle local issues. We report here on the development and uptake of the 'City- Commons Framework for Citizen Sensing', a conceptual model that builds on Participatory Action Research with the aim of playing an integrating role: outlining the processes and mechanisms for ensuring sensing technologies are co-designed by citizens to address their concerns. At the heart of the framework is the idea of a city commons: a pool of community-managed resources. We discuss how the framework was used by communities in Bristol to measure and monitor the problem of damp housing.