Built environment, physical activity, and obesity: what have we learned from reviewing the literature?

Change in Neighborhood Socioeconomic Status and Weight Gain: Dallas Heart Study

INTRODUCTION

Despite a proposed connection between neighborhood environment and obesity, few longitudinal studies have examined the relationship between change in neighborhood socioeconomic deprivation, as defined by moving between neighborhoods, and change in body weight. The purpose of this study is to examine the longitudinal relationship between moving to more socioeconomically deprived neighborhoods and weight gain as a cardiovascular risk factor.

METHODS

Weight (kilograms) was measured in the Dallas Heart Study (DHS), a multiethnic cohort aged 18-65 years, at baseline (2000-2002) and 7-year follow-up (2007-2009, N=1,835). Data were analyzed in 2013-2014. Geocoded addresses were linked to Dallas County, TX, census block groups. A block group-level neighborhood deprivation index (NDI) was created. Multilevel difference-in-difference models with random effects and a Heckman correction factor (HCF) determined weight change relative to NDI change.

RESULTS

Forty-nine percent of the DHS population moved (263 to higher NDI, 586 to lower NDI, 47 within same NDI), with blacks more likely to move than whites or Hispanics (p<0.01), but similar baseline BMI and waist circumference were observed in movers versus non-movers (p>0.05). Adjusting for HCF, sex, race, and time-varying covariates, those who moved to areas of higher NDI gained more weight compared to those remaining in the same or moving to a lower NDI (0.64 kg per 1-unit NDI increase, 95% CI=0.09, 1.19). Impact of NDI change on weight gain increased with time (p=0.03).

CONCLUSIONS

Moving to more-socioeconomically deprived neighborhoods was associated with weight gain among DHS participants.

Mediators effecting moderate-to-vigorous physical activity and inactivity for girls from an intervention program delivered in an organised youth sports setting

OBJECTIVES

The objective of this study was to test whether coaches' physical activity levels, contextual variables, and coaches' behavioural variables mediated the effect of an intervention on female basketball players' moderate-to-vigorous physical activity (MVPA) and inactivity in an organised youth sport (OYS) setting.

DESIGN

Randomised controlled trial

METHODS

Data for the current study were derived from a two-armed, parallel-group randomised controlled trial. This study ran over the course of a 5-day OYS basketball program in 2 sports centres in Sydney, Australia. A convenience sample of 76 female players and 8 coaches were recruited. Coaches allocated to the intervention condition attended 2 coach education sessions, where strategies to increase MVPA and decrease inactivity were taught.

RESULTS

There was a significant effect between changes in coach MVPA and player MVPA (unstandardised regression coefficient [B] = 0.26, 95% CI = 0.14 to 0.38) which coincided with a significant indirect effect (B = 1.80, 95% CI = 0.85 to 2.85). There was also a significant effect between changes in coach inactivity and player inactivity (B = -0.23, 95% CI = -0.14 to -0.31), which coincided with a significant indirect effect (B = -3.20, 95% CI = -0.14 to -0.31). No significant indirect effects were found for lesson context and coaches' behaviours variables.

CONCLUSIONS

Coaches' MVPA and inactivity significantly mediated the effect of the intervention on player MVPA and inactivity, respectively. Consequently, coaches' physical activity levels appear to be important for influencing their players' physical activity levels.

International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries

Background

Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries.

Methods

A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18–66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries.

Results

Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI.

Conclusions

Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.

Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study

BACKGROUND

Few studies to date have explored the relationship between the built environment and physical activity specifically in rural settings. The Ontario Public Health Standards policies mandate that health units in Ontario address the built environment; however, it is unclear how public health practitioners are integrating the built environment into public health interventions aimed at improving physical activity in chronic disease prevention programs.

METHODS

This descriptive qualitative study explored interventions that have or are being implemented which address the built environment specifically related to physical activity in rural Ontario health units, and the impact of these interventions. Data were collected through twelve in-depth semi-structured interviews with rural public health practitioners and managers representing 12 of 13 health units serving rural communities. Key themes were identified using qualitative content analysis.

RESULTS

Themes that emerged regarding the types of interventions that health units are employing included: Engagement with policy work at a municipal level; building and working with community partners, committees and coalitions; gathering and providing evidence; developing and implementing programs; and social marketing and awareness raising. Evaluation of interventions to date has been limited.

CONCLUSIONS

Public health interventions, and their evaluations, are complex. Health units who serve large rural populations in Ontario are engaging in numerous activities to address physical activity levels. There is a need to further evaluate the impact of these interventions on population health.

Advances in physical activity and nutrition environment assessment tools and applications: recommendations

INTRODUCTION

In the past 15 years, researchers, practitioners, and community residents and leaders have become increasingly interested in associations among built environments and physical activity, diet, and obesity. Numerous tools to measure activity and food environments have been developed but vary in quality and usability. Future progress depends on aligning these tools with new communication technology and increasing their utility for planning and policy.

METHODS

The Built Environment Assessment Training Institute Think Thank was held in July 2013. Expert participants discussed priorities, gaps, and promising opportunities to advance the science and practice of measuring obesity-related built environments. Participants proposed and voted on recommended future directions in two categories: "big ideas" and additional recommendations.

RESULTS

Recommendations for the first "big idea" involve developing new, simplified built environment assessment tools and deploying them through online trainings and easily accessible web-based apps. Future iterations of the tools would link to databases of key locations (e.g., parks, food stores); have built-in scoring and analysis; and provide clear, simple feedback to users. A second "big idea" addresses dissemination of results from built environment assessments and translation into policies including land use and food access planning. Additional recommendations include (1) improving multidisciplinary collaborations; (2) engaging stakeholders across sectors; (3) centralized data resource centers; (4) increased use of emerging technologies to communicate findings; and (5) advocating for expanded funding for measurement development, training, and dissemination.

CONCLUSIONS

Implementing these recommendations is likely to improve the quality of built environment measures and expand their use in research and practice.

Food and physical activity environments: an energy balance approach for research and practice

Increases in the prevalence of overweight and obesity are a function of chronic, population-level energy imbalance, whereby energy intakes exceed energy expenditures. Although sometimes viewed in isolation, energy intakes and expenditures in fact exist in a dynamic interplay: energy intakes may influence energy expenditures and vice versa. Obesogenic environments that promote positive energy balance play a central role in the obesity epidemic, and reducing obesity prevalence will require re-engineering environments to promote both healthy eating and physical activity. There may be untapped synergies in addressing both sides of the energy balance equation in environmentally focused obesity interventions, yet food/beverage and physical activity environments are often addressed separately. The field needs design, evaluation, and analytic methods that support this approach. This paper provides a rationale for an energy balance approach and reviews and describes research and practitioner work that has taken this approach to obesity prevention at the environmental and policy levels. Future directions in research, practice, and policy include moving obesity prevention toward a systems approach that brings both nutrition and physical activity into interdisciplinary training, funding mechanisms, and clinical and policy recommendations/guidelines.

Measuring physical neighborhood quality related to health

Although sociodemographic factors are one aspect of understanding the effects of neighborhood environments on health, equating neighborhood quality with socioeconomic status ignores the important role of physical neighborhood attributes. Prior work on neighborhood environments and health has relied primarily on level of socioeconomic disadvantage as the indicator of neighborhood quality without attention to physical neighborhood quality. A small but increasing number of studies have assessed neighborhood physical characteristics. Findings generally indicate that there is an association between living in deprived neighborhoods and poor health outcomes, but rigorous evidence linking specific physical neighborhood attributes to particular health outcomes is lacking. This paper discusses the methodological challenges and limitations of measuring physical neighborhood environments relevant to health and concludes with proposed directions for future work.

Associations between neighborhood effects and physical activity, obesity, and diabetes: The Jamaica Health and Lifestyle Survey 2008

OBJECTIVE

To examine the impact of neighborhood disorder, perceived neighborhood safety, and availability of recreational facilities on prevalence of physical activity (PA), obesity, and diabetes mellitus (DM).

STUDY DESIGN AND SETTING

Multilevel analyses were conducted among 2,848 respondents from the 2007-08 Jamaica Health and Lifestyle Survey. Neighborhood effects were based on aggregated interviewer responses to systematic social observation questions. Mixed-effect logistic regression models were created to assess the relationship between neighborhood indicators and DM and the modifiable risk factors PA and overweight/obesity.

RESULTS

There was significant clustering in PA levels of 20 minutes at least once per week (intraclass correlation coefficient [ICC] = 10.7%), low/no PA (ICC = 7.22%), diabetes (ICC = 5.44%), and obesity (ICC = 3.33%) across neighborhoods. Greater levels of neighborhood disorder, home disorder, and counterintuitively recreational space availability were associated with higher levels of low/no PA among women. There was significant interaction by sex between neighborhood infrastructure and overweight/obesity with a significant association in men (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.05, 1.28) but not women (OR = 1.01; 95% CI = 0.95, 1.07).

CONCLUSION

Differences in PA and obesity-related outcomes among Jamaicans may be partially explained by characteristics of the neighborhood environment and differ by sex. Future studies must be conducted to determine the mechanistic pathways through which the neighborhood environment may impact such outcomes to better inform prevention efforts.

Differences in associations between active transportation and built environmental exposures when expressed using different components of individual activity spaces

This study assessed relationships between built environmental exposures measured within components of individual activity spaces (i.e., travel origins, destinations and paths in-between), and use of active transportation in a metropolitan setting. Individuals (n=37,165) were categorised as using active or sedentary transportation based on travel survey data. Generalised Estimating Equations analysis was used to test relationships with active transportation. Strength and significance of relationships between exposures and active transportation varied for different components of the activity space. Associations were strongest when including travel paths in expression of the built environment. Land use mix and greenness were negatively related to active transportation.

Park proximity, quality and recreational physical activity among mid-older aged adults: moderating effects of individual factors and area of residence

Background

The transition from active employment to retirement is a potentially critical period for promoting maintenance or development of recreational physical activity in older age. Park proximity and quality might be important correlates of recreational physical activity in this age group. However, research on park-physical activity relationships among mid-older aged adults is limited and inconclusive. Furthermore, while knowledge of individual moderators of park-physical activity relationships is crucial for tailoring interventions, this knowledge is also limited. We investigated relationships between perceived park proximity, park quality and recreational physical activity among mid-older aged adults. Additionally, we examined the potential moderating effects of gender, education level, retirement status, functional limitations and area of residence on these relationships.

Methods

Self-reported data on demographics, functional limitations, park proximity, park quality, recreational walking and other recreational moderate- to vigorous-intensity physical activity (MVPA) were collected among 2700 Australian adults (57–67 years) in 2012. Objective information on area of residence was collected. To examine associations of park-related variables with recreational walking and other recreational MVPA, zero-inflated negative binomial (ZINB) regression models were used.

Results

Park proximity significantly interacted with retirement status; non-retired participants who reported living near a park were more likely to participate in recreational walking, whereas no relationship was observed in retired participants. Among those who walked for recreation, higher park quality was related to more weekly minutes of recreational walking. No significant relationships with other recreational MVPA and no moderating effects of gender, education level, functional limitations and area of residence were observed.

Conclusions

Parks may stimulate engagement in recreational walking among non-retirees and more walking among those who already walk. Future research should investigate which environmental factors relate to engagement in recreational walking among retirees and examine whether improvements in park quality actually lead to increases in mid-older aged adults’ recreational walking.

Neighborhood environment and children's physical activity and body mass index: evidence from military personnel installation assignments

BACKGROUND

The majority of existing studies use observed, rather than experimental or quasi-experimental, variation in individuals' neighborhood environments to study their influence on body weight and related behaviors.

PURPOSE

This study leverages the periodic relocation of military personnel to examine the relationship between neighborhood environment and children's physical activity (PA) and BMI in military families.

METHODS

This study utilizes data on 12- and 13-year-old children from the Military Teenagers Environments, Exercise, and Nutrition Study (N=903). Multivariate regression models are estimated, separately for families living on- and off-post, to examine the relationship between parents' perceptions of the neighborhood environment, measured using the Neighborhood Environment Walkability Scale-Youth Version (NEWS-Y), and children's self-reported PA and BMI.

RESULTS

Different features of the neighborhood environment were significant for off- versus on-post families. For children living off-post, a 1 standard deviation (SD) increase in the proximity-to-recreational-facilities subscale was associated with 16.5 additional minutes per week (p<0.05) of moderate PA (MPA), but street connectivity had a significant negative association with vigorous activity. For children living on-post, a 1 SD increase on the crime safety subscale was associated with 22.9 additional minutes per week (p<0.05) of MPA. None of the NEWS-Y subscales were associated with children's BMI.

CONCLUSIONS

Efforts to increase children's PA in military families should take into account that different aspects of the neighborhood environment matter for children living on- versus off-post.

Field validation of food outlet databases: the Latino food environment in North Carolina, USA

OBJECTIVE

Obtaining valid, reliable measures of food environments that serve Latino communities is important for understanding barriers to healthy eating in this at-risk population.

DESIGN

The primary aim of the study was to examine agreement between retail food outlet data from two commercial databases, Nielsen TDLinx (TDLinx) for food stores and Dun & Bradstreet (D&B) for food stores and restaurants, relative to field observations of food stores and restaurants in thirty-one census tracts in Durham County, NC, USA. We also examined differences by proportion of Hispanic population (

SETTING

One hundred and seventy-four food stores and 337 restaurants in Durham County, NC, USA.

RESULTS

We found that overall sensitivity of food store listings in TDLinx was higher (64 %) than listings in D&B (55 %). Twenty-five food stores were characterized by auditors as Latino food stores, with 20 % identified in TDLinx, 52 % in D&B and 56 % in both sources. Overall sensitivity of restaurants (68 %) was higher than sensitivity of Latino restaurants (38 %) listed in D&B. Sensitivity did not differ substantially by Hispanic composition of neighbourhoods.

CONCLUSIONS

Our findings suggest that while TDLinx and D&B commercial data sources perform well for total food stores, they perform less well in identifying small and independent food outlets, including many Latino food stores and restaurants.

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Key Words

• Latino

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MESH Headings

• Databases, Factual
• Diet/economics
• Diet/ethnology
• Food Supply/economics
• Hispanic or Latino
• Humans
• Language
• North Carolina
• Residence Characteristics
• Restaurants

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Grants

• R01-HL 114091 NHLBI NIH HHS
• T32 HD07168-33 NICHD NIH HHS
• N01-HC-48050 NHLBI NIH HHS
• DK56350 NIDDK NIH HHS
• HHSN268201300027C NHLBI NIH HHS
• N01HC95095 NHLBI NIH HHS
• N01-HC-48049 NHLBI NIH HHS
• R01 HL114091 NHLBI NIH HHS
• N01HC48048 NHLBI NIH HHS
• R01 HL104580 NHLBI NIH HHS
• HHSN268201300026C NHLBI NIH HHS
• P30 ES010126 NIEHS NIH HHS
• N01-HC-48047 NHLBI NIH HHS
• N01HC48049 NHLBI NIH HHS
• N01-HC-95095 NHLBI NIH HHS
• HHSN268201300025C NHLBI NIH HHS
• HHSN268200900041C NHLBI NIH HHS
• HHSN268201300028C NHLBI NIH HHS
• T32 DK007686 NIDDK NIH HHS
• N01HC48050 NHLBI NIH HHS
• N01HC48047 NHLBI NIH HHS
• T32 HD007168 NICHD NIH HHS
• P30 DK056350 NIDDK NIH HHS
• N01-HC-48048 NHLBI NIH HHS
• R24 HD050924 NICHD NIH HHS
• HHSN268201300029C NHLBI NIH HHS
• R01-HL104580 NHLBI NIH HHS
• P2C HD050924 NICHD NIH HHS

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Affiliation(s)

Pasquale E Rummo University of North Carolina at Chapel Hill, Carolina Population Center, CB# 8120, University Square, 123 West Franklin Street, Chapel Hill, NC 27516-2524, USA
Penny Gordon-Larsen University of North Carolina at Chapel Hill, Carolina Population Center, CB# 8120, University Square, 123 West Franklin Street, Chapel Hill, NC 27516-2524, USA Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Sandra S Albrecht University of North Carolina at Chapel Hill, Carolina Population Center, CB# 8120, University Square, 123 West Franklin Street, Chapel Hill, NC 27516-2524, USA Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

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Identifying risk profiles for childhood obesity using recursive partitioning based on individual, familial, and neighborhood environment factors

BACKGROUND

Few studies consider how risk factors within multiple levels of influence operate synergistically to determine childhood obesity. We used recursive partitioning analysis to identify unique combinations of individual, familial, and neighborhood factors that best predict obesity in children, and tested whether these predict 2-year changes in body mass index (BMI).

METHODS

Data were collected in 2005-2008 and in 2008-2011 for 512 Quebec youth (8-10 years at baseline) with a history of parental obesity (QUALITY study). CDC age- and sex-specific BMI percentiles were computed and children were considered obese if their BMI was ≥95th percentile. Individual (physical activity and sugar-sweetened beverage intake), familial (household socioeconomic status and measures of parental obesity including both BMI and waist circumference), and neighborhood (disadvantage, prestige, and presence of parks, convenience stores, and fast food restaurants) factors were examined. Recursive partitioning, a method that generates a classification tree predicting obesity based on combined exposure to a series of variables, was used. Associations between resulting varying risk group membership and BMI percentile at baseline and 2-year follow up were examined using linear regression.

RESULTS

Recursive partitioning yielded 7 subgroups with a prevalence of obesity equal to 8%, 11%, 26%, 28%, 41%, 60%, and 63%, respectively. The 2 highest risk subgroups comprised i) children not meeting physical activity guidelines, with at least one BMI-defined obese parent and 2 abdominally obese parents, living in disadvantaged neighborhoods without parks and, ii) children with these characteristics, except with access to ≥1 park and with access to ≥1 convenience store. Group membership was strongly associated with BMI at baseline, but did not systematically predict change in BMI.

CONCLUSION

Findings support the notion that obesity is predicted by multiple factors in different settings and provide some indications of potentially obesogenic environments. Alternate group definitions as well as longer duration of follow up should be investigated to predict change in obesity.

Residential instability and obesity over time: the role of the social and built environment

This research uses the National Longitudinal Study of Adult Health's Obesity and Neighborhood Environment (ONE) to examine the relationship between residential instability and change in obesity in the United States. Mobility is thought to be related to obesity because it conditions what kinds of amenities are present in the areas where people live and what level of motivation individuals have to take advantage of these amenities. Thus, this research uses spatial measures as potential confounders for the mobility-health relationship. Results suggest that mobility is a protective factor against weight gain over time. However, the effect of mobility is completely explained by the environmental characteristics. After adjusting for changes in physical activity resources and the crime rate, adolescents who move and adolescents who do not move have precisely the same risk of being obese. Mobility is thus a function of the change in environmental characteristics. Implications for developing the built environment are discussed.

Built Environment Associations with Adiposity Parameters among Overweight and Obese Hispanic Youth

Objective

The purpose of this cross-sectional study was to establish neighborhood built environment correlates of adiposity as measured by dual X-ray absorptiometry. The utility and methodological gains of using this measure for built environment research were further investigated by comparing model fit across parallel models on body mass index z-scores and waist circumference.

Methods

Pre-existing data collected from 2001 to 2011 on 576 overweight and obese Hispanic youth were compiled with built environment data, and 2000 census data for analyses conducted in 2012. Walking-distance buffers were built around participants' residential locations. Variables for park space, food access, walkability, and neighborhood socio-cultural aspects were entered into a multivariate regression model predicting percent body fat. Parallel models were built for body mass index z-score, and waist circumference.

Results

Significant associations were found between percent body fat and supermarket access for boys, and percent body fat and increased park space and decreased neighborhood linguistic isolation for girls. Neighborhood socio-cultural characteristics accounted for more variance in obesity compared to body mass index z-score or waist circumference.

Conclusion

Park access, food environment, and neighborhood socio-cultural characteristics are independent contributors to body fat in children, and the contribution of these risks differs by gender. There are incremental gains to using a more accurate measure of body fat in built environment obesity studies.

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A study of obese/overweight Hispanic youth using dual X-ray absorptiometry

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Percent body fat (%BF) was modeled on neighborhood environment characteristics.

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Food access, walkability, parks, and socio-cultural aspects were related to %BF.

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The final model for %BF was used to predict BMI z-score and waist circumference.

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Using DXA to measure body fat has incremental gains in built environment research.

The Dynamic Family Home: a qualitative exploration of physical environmental influences on children's sedentary behaviour and physical activity within the home space

Background

Recent changes in home physical environments, such as decreasing outdoor space and increasing electronic media, may negatively affect health by facilitating sedentariness and reducing physical activity. As children spend much of their time at home they are particularly vulnerable. This study qualitatively explored family perceptions of physical environmental influences on sedentary behaviour and physical activity within the home space.

Methods

Home based interviews were conducted with 28 families with children aged 9–13 years (total n = 74 individuals), living in Perth, Australia. Families were stratified by socioeconomic status and selected to provide variation in housing. Qualitative methods included a family interview, observation and home tour where families guided the researcher through their home, enabling discussion while in the physical home space. Audio recordings were transcribed verbatim and thematically analysed.

Results

Emergent themes related to children’s sedentariness and physical activity included overall size, space and design of the home; allocation of home space; equipment within the home space; perceived safety of the home space; and the changing nature of the home space. Families reported that children’s activity options were limited when houses and yards were small. In larger homes, multiple indoor living rooms usually housed additional sedentary entertainment options, although parents reported that open plan home layouts could facilitate monitoring of children’s electronic media use. Most families reported changing the allocation and contents of their home space in response to changing priorities and circumstances.

Conclusions

The physical home environment can enhance or limit opportunities for children’s sedentary behaviour and physical activity. However, the home space is a dynamic ecological setting that is amenable to change and is largely shaped by the family living within it, thus differentiating it from other settings. While size and space were considered important, how families prioritise the use of their home space and overcome the challenges posed by the physical environment may be of equal or greater importance in establishing supportive home environments. Further research is required to tease out how physical, social and individual factors interact within the family home space to influence children’s sedentary behaviour and physical activity at home.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-014-0157-1) contains supplementary material, which is available to authorized users.

The effects of community environmental factors on obesity among Korean adults: a multilevel analysis

OBJECTIVES:

This study explored multidimensional factors related to obesity by dividing them into individual and environmental factors, and performed multilevel analysis to investigate community environmental effects.

METHODS:

Data from the 2011 and 2012 Community Health Surveys were used for the analysis. Community-level variables, constructed from various regional statistics, were included in the model as environmental factors. Respondents with body mass index (BMI)≥25 were defined as obese, and a multilevel logistic regression analysis was conducted to analyze individual and environmental factors related to obesity. Moreover, a stratified analysis was conducted to compare factors related to obesity between men and women.

RESULTS:

Of 337,136 samples, 82,887 (24.6%) were obese, with BMI≥25. Sociodemographic characteristics at the individual level were mostly significantly related to obesity; however, while there were more obese men subjects among those with high socioeconomic status, there were more obese women among those with low socioeconomic status. There were fewer obese respondents among those who regularly walked and more obese respondents among those who reported short sleep duration or were highly stressed. At the community level, people living in areas with high socioeconomic status, high satisfaction with safety and public transportation, and high accessibility to sports facilities in their community had lower obesity risks.

CONCLUSIONS:

Community-level environmental factors affected obesity, especially perceived community environment, more significant than physical environment. Thus, it is necessary to develop effective obesity prevention and management strategies by considering potential community environmental factors that affect obesity.

Bicycling policy indirectly associated with overweight/obesity

BACKGROUND

Policies to enhance bicycling are correlated with health outcomes. Research has yet to provide an adequate, empirically derived explanation for this finding.

PURPOSE

To examine a comprehensive model of a pathway potentially linking bicycle policies to overweight/obesity.

METHODS

Data representing multiple years between 2006 and 2012 from CDC, U.S. Census Bureau, U.S. Department of Transportation, and the Alliance for Biking and Walking were subjected to bivariate and multivariate analyses in 2013. A path model was created to explain the relationship between bicycle policies and overweight/obesity in the 48 largest U.S. cities.

RESULTS

Zero-order correlations were significant between the number of bicycle policies and the percentage of workers bicycling to work and rates of overweight/obesity. These relationships did not remain statistically significant in the multivariate analysis. However, more bicycle policies were associated with a greater number of bicycle infrastructure components (p<0.005). In turn, bicycling infrastructure components were positively related to the percentage of workers bicycling to work (p<0.001), which was inversely associated with overweight/obesity rates (p<0.05).

CONCLUSIONS

The results of this study suggest that large cities with more policies aimed at promoting bicycling have fewer overweight/obese residents, partially because the policies are related to supportive bicycling infrastructures that promote bicycling to work.

"It is about being outside": Canadian youth's perspectives of good health and the environment

Drawing on qualitative data generated from an ethnographic study exploring Canadian youth's understanding of health, this paper examines youth's perspectives of the relationships between health and environment. Seventy-one youth (12 to 19 years of age) took part in individual and focus group interviews, as well as in photovoice interviews. Although initial discourse about health mainly focused on healthy eating and exercise, youth were more enthused and able to share their thoughts and feelings about the relationships between health and environment during the photovoice interviews. For these youth, good health was defined and visualized as "being outside" in a safe, clean, green, and livable space. Youth talked about conditions contributing to healthy environments and how healthy environments contributed to a strong sense of place. Overall, the conversations about the environment evoked many feelings in the youth. Results are discussed in the context of current research and in relation to youth, but also more broadly in relation to research on health and environment.

A retrospective study on changes in residents' physical activities, social interactions, and neighborhood cohesion after moving to a walkable community

OBJECTIVE

This study is to examine changes in residents' physical activities, social interactions, and neighborhood cohesion after they moved to a walkable community in Austin, Texas.

METHODS

Retrospective surveys (N=449) were administered in 2013-2014 to collect pre- and post-move data about the outcome variables and relevant personal, social, and physical environmental factors. Walkability of each resident's pre-move community was measured using the Walk Score. T tests were used to examine the pre-post move differences in the outcomes in the whole sample and across sub-groups with different physical activity levels, neighborhood conditions, and neighborhood preferences before the move.

RESULTS

After the move, total physical activity increased significantly in the whole sample and all sub-groups except those who were previously sufficiently active; lived in communities with high walkability, social interactions, or neighborhood cohesion; or had moderate preference for walkable neighborhoods. Walking in the community increased in the whole sample and all subgroups except those who were previously sufficiently active, moved from high-walkability communities, or had little to no preference for walkable neighborhoods. Social interactions and neighborhood cohesion increased significantly after the move in the whole sample and all sub-groups.

CONCLUSION

This study explored potential health benefits of a walkable community in promoting physically and socially active lifestyles, especially for populations at higher risk of obesity. The initial result is promising, suggesting the need for more work to further examine the relationships between health and community design using pre-post assessments.

Variations in active transport behavior among different neighborhoods and across adult lifestages

OBJECTIVE

Built environment characteristics are closely related to transport behavior, but observed variations could be due to residents own choice of neighborhood called residential self-selection. The aim of this study was to investigate differences in neighborhood walkability and residential self-selection across life stages in relation to active transport behavior.

METHODS

The IPEN walkability index, which consists of four built environment characteristics, was used to define 16 high and low walkable neighborhoods in Aarhus, Denmark (250.000 inhabitants). Transport behavior was assessed using the IPAQ questionnaire. Life stages were categorized in three groups according to age and parental status. A factor analysis was conducted to investigate patterns of self-selection. Multivariable logistic regression analyses were carried out to evaluate the association between walkability and transport behavior i.e. walking, cycling and motorized transport adjusted for residential self-selection and life stages.

RESULTS

A total of 642 adults aged 20-65 years completed the questionnaire. The highest rated self-selection preference across all groups was a safe and secure neighborhood followed by getting around easily on foot and by bicycle. Three self-selection factors were detected, and varied across the life stages. In the multivariable models high neighborhood walkability was associated with less motorized transport (OR 0.33 95%CI 0.18-0.58), more walking (OR 1.65 95%CI 1.03-2.65) and cycling (OR 1.50 95% CI 1.01-2.23). Self-selection and life stage were also associated with transport behavior, and attenuated the association with walkability.

CONCLUSION

This study supports the hypothesis that some variation in transport behavior can be explained by life stages and self-selection, but the association between living in a more walkable neighborhood and active transport is still significant after adjusting for these factors. Life stage significantly moderated the association between neighborhood walkability and cycling for transport, and household income significantly moderated the association between neighborhood walkability and walking for transport. Getting around easily by bicycle and on foot was the highest rated self-selection factor second only to perceived neighborhood safety.

For debate: a new wave in public health improvement

The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved.

Evaluating causal relationships between urban built environment characteristics and obesity: a methodological review of observational studies

Background

Existing reviews identify numerous studies of the relationship between urban built environment characteristics and obesity. These reviews do not generally distinguish between cross-sectional observational studies using single equation analytical techniques and other studies that may support more robust causal inferences. More advanced analytical techniques, including the use of instrumental variables and regression discontinuity designs, can help mitigate biases that arise from differences in observable and unobservable characteristics between intervention and control groups, and may represent a realistic alternative to scarcely-used randomised experiments. This review sought first to identify, and second to compare the results of analyses from, studies using more advanced analytical techniques or study designs.

Methods

In March 2013, studies of the relationship between urban built environment characteristics and obesity were identified that incorporated (i) more advanced analytical techniques specified in recent UK Medical Research Council guidance on evaluating natural experiments, or (ii) other relevant methodological approaches including randomised experiments, structural equation modelling or fixed effects panel data analysis.

Results

Two randomised experimental studies and twelve observational studies were identified. Within-study comparisons of results, where authors had undertaken at least two analyses using different techniques, indicated that effect sizes were often critically affected by the method employed, and did not support the commonly held view that cross-sectional, single equation analyses systematically overestimate the strength of association.

Conclusions

Overall, the use of more advanced methods of analysis does not appear necessarily to undermine the observed strength of association between urban built environment characteristics and obesity when compared to more commonly-used cross-sectional, single equation analyses. Given observed differences in the results of studies using different techniques, further consideration should be given to how evidence gathered from studies using different analytical approaches is appraised, compared and aggregated in evidence synthesis.

Municipal Officials' Participation in Built Environment Policy Development in the United States

PURPOSE

This study examined municipal officials' participation in built environment policy initiatives focused on land use design, transportation, and parks and recreation.

DESIGN

Web-based cross-sectional survey.

SETTING

Eighty-three municipalities with 50,000 or more residents in eight states.

SUBJECTS

Four hundred fifty-three elected and appointed municipal officials.

MEASURES

Outcomes included self-reported participation in land use design, transportation, and parks and recreation policy to increase physical activity. Independent variables included respondent position; perceptions of importance, barriers, and beliefs regarding physical activity and community design and layout; and physical activity partnership participation.

ANALYSIS

Multivariable logistic regression models.

RESULTS

Compared to other positions, public health officials had lower participation in land use design (78.3% vs. 29.0%), transportation (78.1% vs. 42.1%), and parks and recreation (67.1% vs. 26.3%) policy. Perceived limited staff was negatively associated with participation in each policy initiative. Perceptions of the extent to which physical activity was considered in community design and physical activity partnership participation were positively associated with participation in each. Perceived lack of collaboration was associated with less land use design and transportation policy participation, and awareness that community design affects physical activity was associated with more participation. Perceived lack of political will was associated with less parks and recreation policy participation.

CONCLUSION

Public health officials are underrepresented in built environment policy initiatives. Improving collaborations may improve municipal officials' policy participation.

Built environment change and change in BMI and waist circumference: Multi-ethnic Study of Atherosclerosis

OBJECTIVE

To examine longitudinal associations of the neighborhood built environment with objectively measured body mass index (BMI) and waist circumference (WC) in a geographically and racial/ethnically diverse group of adults.

METHODS

This study used data from 5,506 adult participants in the Multi-Ethnic Study of Atherosclerosis, aged 45-84 years in 2000 (baseline). BMI and WC were assessed at baseline and four follow-up visits (median follow-up 9.1 years). Time-varying built environment measures (population density, land-use, destinations, bus access, and street characteristics) were created using Geographic Information Systems. Principal components analysis was used to derive composite scores for three built environment factors. Fixed-effects models, tightly controlling for all time-invariant characteristics, estimated associations between change in the built environment, and change in BMI and WC.

RESULTS

Increases in the intensity of development (higher density of walking destinations and population density, and lower percent residential) were associated with less pronounced increases or decreases over time in BMI and WC. Changes in connected retail centers (higher percent retail, higher street connectivity) and public transportation (distance to bus) were not associated with changes in BMI or WC.

CONCLUSIONS

Longitudinal changes in the built environment, particularly increased density, are associated with decreases in BMI and WC.

International variation in neighborhood walkability, transit, and recreation environments using geographic information systems: the IPEN adult study

Background

The World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions.

Methods

The International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant’s residential address using 1-km and 500-m street network buffers.

Results

Eleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability.

Conclusions

Results show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals’ physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose–response relationships from projected changes to the built environment that would otherwise be impossible.

Electronic supplementary material

The online version of this article (doi:10.1186/1476-072X-13-43) contains supplementary material, which is available to authorized users.

Critical environmental factors for transportation cycling in children: a qualitative study using bike-along interviews

BACKGROUND

Environmental factors are found to influence transport-related physical activity, but have rarely been studied in relation with cycling for transport to various destinations in 10-12 yr old children. The current qualitative study used 'bike-along interviews' with children and parents to allow discussion of detailed environmental factors that may influence children's cycling for transport, while cycling in the participant's neighborhood.

METHODS

Purposeful convenience sampling was used to recruit 35 children and one of their parents residing in (semi-) urban areas. Bike-along interviews were conducted to and from a randomly chosen destination (e.g. library) within a 15 minutes' cycle trip in the participant's neighborhood. Participants wore a GoPro camera to objectively assess environmental elements, which were subsequently discussed with participants. Content analysis and arising themes were derived using a grounded theory approach.

RESULTS

The discussed environmental factors were categorized under traffic, urban design, cycling facilities, road design, facilities at destination, aesthetics, topography, weather, social control, stranger danger and familiar environment. Across these categories many environmental factors were (in)directly linked to road safety. This was illustrated by detailed discussions of the children's visibility, familiarity with specific traffic situations, and degree of separation, width and legibility of cycle facilities.

CONCLUSION

Road safety is of major concern in this 10-12 yr old study population. Bike-along interviews were able to identify new, detailed and context-specific physical environmental factors which could inform policy makers to promote children's cycling for transport. However, future studies should investigate whether hypothetical changes to such micro environmental features influence perceptions of safety and if this in turn could lead to changes in children's cycling for transport.

Healthy Canada by Design CLASP: Lessons learned from the first phase of an intersectoral, cross-provincial, built environment initiative

OBJECTIVES

The Healthy Canada by Design (HCBD) CLASP (Coalitions Linking Action and Science for Prevention) Initiative promotes the building of communities that support health by 1) facilitating the integration of health evidence into built environment decision-making; 2) developing new, cross-sector collaboration models and tools; and 3) fostering a national community of practice.

PARTICIPANTS

A coalition of public health professionals, researchers, professional planners and non-governmental organization (NGO) staff from across Canada developed, implemented and participated in the Initiative.

SETTINGS

In the first phase, HCBD interventions took place for the most part in large urban and suburban settings in Quebec, Ontario and British Columbia. National knowledge transfer and exchange (KTE) activities were delivered both locally and nationally.

INTERVENTION

Project participants developed tools or processes for collaboration between the health and the community planning sectors. These were designed to increase the capacity of the health sector to influence decisions about land use and transportation planning. Tool or process development was accompanied by pilot testing, evaluation, and dissemination of findings and lessons learned. On a parallel track, NGOs involved with HCBD led national KTE interventions.

OUTCOMES

The first phase of HCBD demonstrated the potential for public health organizations to influence the built environment determinants of cancer and chronic diseases. Public health authorities forged relationships with several organizations with a stake in built environment decisions, including municipal and regional planning departments, provincial governments, federal government agencies, researchers, community groups and NGOs. The Initiative accomplished the following: 1) created new relationships across sectors and across health authorities; 2) improved the knowledge and skills for influencing land use planning processes among public health professionals; 3) increased awareness of health evidence and intent to change practice among built environment decision-makers; and 4) facilitated inclusion of health considerations in local plans, policies and decisions.

CONCLUSIONS

The first phase of HCBD engaged built environment stakeholders, including public health professionals, planners, researchers, community groups and NGOs, in ways that would be expected to influence health risk factors and population health outcomes in the long term.

A longitudinal analysis of the influence of the neighborhood built environment on walking for transportation: the RESIDE study

The purpose of the present analysis was to use longitudinal data collected over 7 years (from 4 surveys) in the Residential Environments (RESIDE) Study (Perth, Australia, 2003-2012) to more carefully examine the relationship of neighborhood walkability and destination accessibility with walking for transportation that has been seen in many cross-sectional studies. We compared effect estimates from 3 types of logistic regression models: 2 that utilize all available data (a population marginal model and a subject-level mixed model) and a third subject-level conditional model that exclusively uses within-person longitudinal evidence. The results support the evidence that neighborhood walkability (especially land-use mix and street connectivity), local access to public transit stops, and variety in the types of local destinations are important determinants of walking for transportation. The similarity of subject-level effect estimates from logistic mixed models and those from conditional logistic models indicates that there is little or no bias from uncontrolled time-constant residential preference (self-selection) factors; however, confounding by uncontrolled time-varying factors, such as health status, remains a possibility. These findings provide policy makers and urban planners with further evidence that certain features of the built environment may be important in the design of neighborhoods to increase walking for transportation and meet the health needs of residents.

Anti-Obesity Agents and the US Food and Drug Administration

Despite the growing market for obesity care, the US Food and Drug Administration (FDA) has approved only two new pharmaceutical agents-lorcaserin and combination phentermine/topiramate-for weight reduction since 2000, while removing three agents from the market in the same time period. This article explores the FDA's history and role in the approval of anti-obesity medications within the context of a public health model of obesity. Through the review of obesity literature and FDA approval documents, we identified two major barriers preventing fair evaluation of anti-obesity agents including: (1) methodological pitfalls in clinical trials and (2) misaligned values in the assessment of anti-obesity agents. Specific recommendations include the use of adaptive (Bayesian) design protocols, value-based analyses of risks and benefits, and regulatory guidance based on a comprehensive, multi-platform obesity disease model. Positively addressing barriers in the FDA approval process of anti-obesity agents may have many beneficial effects within an obesity disease model.

Does walkable neighbourhood design influence the association between objective crime and walking?

Background

Few studies have investigated associations between objectively measured crime and walking, and findings are mixed. One explanation for null or counterintuitive findings emerges from criminology studies, which indicate that the permeable street layouts and non-residential land uses that underpin walkable neighbourhoods are also associated with more crime. This study examined associations between objective crime and walking, controlling for the characteristics of walkable neighbourhoods.

Methods

A population representative sample of adults (25–65 years) (n = 3,487) completed the Western Australian Health and Wellbeing Survey (2006–2008) demographic and walking frequency items. Objective environmental measures were generated for each participant’s 400 m and 1600 m neighbourhood areas, including burglary, personal crime (i.e., crimes committed against people) in public space, residential density, street connectivity and local destinations. Log-linear negative binomial regression models were used to examine associations between crime and walking frequency/week, with progressive adjustment for residential density, street connectivity and local destinations.

Results

Burglary and personal crime occurring within a participant’s 400 m and 1600 m neighbourhoods were positively and significantly associated with walking frequency. For example, for every additional 10 crimes against the person/year within 400 m of a participant’s home, walking frequency increased by 8% (relative change = 1.077, p = 0.017). Associations remained constant after controlling for residential density and street connectivity, but attenuated after adjusting for local destinations (e.g., for personal crime in 400 m: relative change = 1.054, p = 0.104). This pattern of attenuation was evident across both crime categories and both neighbourhood sizes.

Conclusions

The observed positive associations between objective crime and walking appear to be a function of living in a more walkable environment, as the presence of destinations has the capacity to both promote walking and attract crime. This study provides a plausible explanation for some mixed findings emerging from studies examining crime as a barrier to walking. In some settings, the hypothesised deterrent effect of crime on walking may be insufficient to outweigh the positive impacts of living in a more walkable environment.

A call for caution and transparency in the calculation of land use mix: measurement bias in the estimation of associations between land use mix and physical activity

There is evidence that land use mix based on the Shannon (1948) entropy formula may be misspecified in some studies. The aim of this study was to quantify the bias arising from this misspecification. Spatial coordinates were obtained from Statistics Canada for 9348 unique point locations. Five hundred-metre polygon-based network buffers were drawn around each coordinate (ArcGIS 10.1). Land use mix was calculated for each buffer using the true and misspecified land use mix formulas. Linear regression models were used to estimate the associations between a simulated dataset of daily steps and the true and misspecified measures. Misspecification of the land use mix formula resulted in a systematic underestimation of the true association by 26.4% (95% CI 25.8-27.0%). To minimize measurement bias in future studies, researchers are encouraged to use a constant definition of N in the denominator of the Shannon entropy formula.

Neighborhood context and immigrant children's physical activity

Physical activity is an important determinant of obesity and overall health for children, but significant race/ethnic and nativity disparities exist in the amount of physical activity that children receive, with immigrant children particularly at risk for low levels of physical activity. In this paper, we examine and compare patterns in physical activity levels for young children of U.S.-born and immigrant mothers from seven race/ethnic and nativity groups, and test whether physical activity is associated with subjective (parent-reported) and objective (U.S. Census) neighborhood measures. The neighborhood measures include parental-reported perceptions of safety and physical and social disorder and objectively defined neighborhood socioeconomic disadvantage and immigrant concentration. Using restricted, geo-coded Early Childhood Longitudinal Study-Kindergarten (ECLS-K) data (N = 17,510) from 1998 to 1999 linked with U.S. Census 2000 data for the children's neighborhoods, we utilize zero-inflated Poisson (ZIP) models to predict the odds of physical inactivity and expected days of physical activity for kindergarten-aged children. Across both outcomes, foreign-born children have lower levels of physical activity compared to U.S.-born white children. This disparity is not attenuated by a child's socioeconomic, family, or neighborhood characteristics. Physical and social disorder is associated with higher odds of physical inactivity, while perceptions of neighborhood safety are associated with increased expected days of physical activity, but not with inactivity. Immigrant concentration is negatively associated with both physical activity outcomes, but its impact on the probability of physical inactivity differs by the child's race/ethnic and nativity group, such that it is particularly detrimental for U.S.-born white children's physical activity. Research interested in improving the physical activity patterns of minority and second-generation immigrant children should consider how neighborhood context differentially impacts the health and physical activity of children from various racial, ethnic and nativity backgrounds.

The built environment predicts observed physical activity

BACKGROUND

In order to improve our understanding of the relationship between the built environment and physical activity, it is important to identify associations between specific geographic characteristics and physical activity behaviors.

PURPOSE

Examine relationships between observed physical activity behavior and measures of the built environment collected on 291 street segments in Indianapolis and St. Louis.

METHODS

Street segments were selected using a stratified geographic sampling design to ensure representation of neighborhoods with different land use and socioeconomic characteristics. Characteristics of the built environment on-street segments were audited using two methods: in-person field audits and audits based on interpretation of Google Street View imagery with each method blinded to results from the other. Segments were dichotomized as having a particular characteristic (e.g., sidewalk present or not) based on the two auditing methods separately. Counts of individuals engaged in different forms of physical activity on each segment were assessed using direct observation. Non-parametric statistics were used to compare counts of physically active individuals on each segment with built environment characteristic.

RESULTS

Counts of individuals engaged in physical activity were significantly higher on segments with mixed land use or all non-residential land use, and on segments with pedestrian infrastructure (e.g., crosswalks and sidewalks) and public transit.

CONCLUSION

Several micro-level built environment characteristics were associated with physical activity. These data provide support for theories that suggest changing the built environment and related policies may encourage more physical activity.

The next step in health behavior research: the need for ecological moderation analyses - an application to diet and physical activity at childcare

BACKGROUND

The ecological perspective holds that human behavior depends on the interaction of different environmental factors and personal characteristics, but it lacks validation and operationalization. In the current paper, an ecological view was adopted to examine the interactive impact of several ecological systems on children's dietary intake and physical activity at childcare or similar facilities. The ecological view was operationalized into three types of interaction: 1) interaction between types of childcare environment (physical, social, political, economic); 2) interaction between micro-systems (the childcare and home environment) in meso-systems; and 3) interaction between childcare environment and child characteristics. The predictive value of each of these interactions was tested based on a systematic review of the literature.

DISCUSSION

Several studies support the hypothesis that the influence of the childcare environment on children's physical activity and diet is moderated by child characteristics (age, gender), but interaction between environmental types as well as between micro-systems is hardly examined in the field of behavioral nutrition and physical activity. Qualitative studies and general child development research provide some valuable insights, but we advocate quantitative research adopting an ecological perspective on environmental influences.

SUMMARY

Empirical studies operationalizing a true ecological view on diet and physical activity are scarce. Theorizing and assessment of interaction is advocated to become common practice rather than an exception in behavioral nutrition and physical activity research, in order to move the field forward.

Perceived neighbourhood environmental attributes associated with adults׳ recreational walking: IPEN Adult study in 12 countries

This study examined the strength and shape of associations between perceived environmental attributes and adults' recreational walking, using data collected from 13,745 adult participants in 12 countries. Perceived residential density, land use mix, street connectivity, aesthetics, safety from crime, and proximity to parks were linearly associated with recreational walking, while curvilinear associations were found for residential density, land use mix, and aesthetics. The observed associations were consistent across countries, except for aesthetics. Using data collected from environmentally diverse countries, this study confirmed findings from prior single-country studies. Present findings suggest that similar environmental attributes are associated with recreational walking internationally.

Obesogenic environments: a systematic review of the association between the physical environment and adult weight status, the SPOTLIGHT project

Background

Understanding which physical environmental factors affect adult obesity, and how best to influence them, is important for public health and urban planning. Previous attempts to summarise the literature have not systematically assessed the methodological quality of included studies, or accounted for environmental differences between continents or the ways in which environmental characteristics were measured.

Methods

We have conducted an updated review of the scientific literature on associations of physical environmental factors with adult weight status, stratified by continent and mode of measurement, accompanied by a detailed risk-of-bias assessment. Five databases were systematically searched for studies published between 1995 and 2013.

Results

Two factors, urban sprawl and land use mix, were found consistently associated with weight status, although only in North America.

Conclusions

With the exception of urban sprawl and land use mix in the US the results of the current review confirm that the available research does not allow robust identification of ways in which that physical environment influences adult weight status, even after taking into account methodological quality.

Longitudinal associations between neighborhood recreational facilities and change in recreational physical activity in the multi-ethnic study of atherosclerosis, 2000-2007

Many cross-sectional studies have investigated the relationship between neighborhood physical environment and physical activity. However, few studies have examined this relationship longitudinally, and no study has examined the association between change in objective measurements of physical activity resources and change in physical activity in adults. We used longitudinal data from the Multi-Ethnic Study of Atherosclerosis (2000-2007) of 6,814 adults who were aged 45-84 years at baseline. Physical activity was assessed via a semiquantitative questionnaire at baseline and at 2 follow-up visits (approximately 1.6 and 3.2 years later). We measured the density of recreational facilities within 1 mile of each participant's home address and used linear mixed-effects models to estimate the association between change in recreational facility density and change in physical activity. After adjusting for potential confounders, we found that a greater increase in recreational density was associated with a less pronounced decline in physical activity (mean difference in annual change in physical activity for each 1-unit increase in recreational density over time = 10.3 (95% confidence interval: 0.7, 19.9)). This association was stronger in older adults. Better access to recreational facilities may benefit middle-aged and older adults by enabling them to maintain activity levels as they age.

Adolescent self-defined neighborhoods and activity spaces: spatial overlap and relations to physical activity and obesity

Defining the proper geographic scale for built environment exposures continues to present challenges. In this study, size attributes and exposure calculations from two commonly used neighborhood boundaries were compared to those from neighborhoods that were self-defined by a sample of 145 urban minority adolescents living in subsidized housing estates. Associations between five built environment exposures and physical activity, overweight and obesity were also examined across the three neighborhood definitions. Limited spatial overlap was observed across the various neighborhood definitions. Further, many places where adolescents were active were not within the participants׳ neighborhoods. No statistically significant associations were found between counts of facilities and the outcomes based on exposure calculations using the self-defined boundaries; however, a few associations were evident for exposures using the 0.75mile network buffer and census tract boundaries. Future investigation of the relationship between the built environment, physical activity and obesity will require practical and theoretically-based methods for capturing salient environmental exposures.

An objective index of walkability for research and planning in the Sydney metropolitan region of New South Wales, Australia: an ecological study

BACKGROUND

Walkability describes the capacity of the built environment to support walking for various purposes. This paper describes the construction and validation of two objective walkability indexes for Sydney, Australia.

METHODS

Walkability indexes using residential density, intersection density, land use mix, with and without retail floor area ratio were calculated for 5,858 Sydney Census Collection Districts in a geographical information system. Associations between variables were evaluated using Spearman's rho (ρ). Internal consistency and factor structure of indexes were estimated with Cronbach's alpha and principal components analysis; convergent and predictive validity were measured using weighted kappa (κw) and by comparison with reported walking to work at the 2006 Australian Census using logistic regression. Spatial variation in walkability was assessed using choropleth maps and Moran's I.

RESULTS

A three-attribute abridged Sydney Walkability Index comprising residential density, intersection density and land use mix was constructed for all Sydney as retail floor area was only available for 5.3% of Census Collection Districts. A four-attribute full index including retail floor area ratio was calculated for 263 Census Collection Districts in the Sydney Central Business District. Abridged and full walkability index scores for these 263 areas were strongly correlated (ρ=0.93) and there was good agreement between walkability quartiles (κw=0.73). Internal consistency ranged from 0.60 to 0.71, and all index variables loaded highly on a single factor. The percentage of employed persons who walked to work increased with increasing walkability: 3.0% in low income-low walkability areas versus 7.9% in low income-high walkability areas; and 2.1% in high income-low walkability areas versus 11% in high income-high walkability areas. The adjusted odds of walking to work were 1.05 (0.96-1.15), 1.58 (1.45-1.71) and 3.02 (2.76-3.30) times higher in medium, high and very high compared to low walkability areas. Associations were similar for full and abridged indexes.

CONCLUSIONS

The abridged Sydney Walkability Index has predictive validity for utilitarian walking, will inform urban planning in Sydney, and will be used as an objective measure of neighbourhood walkability in a large population cohort. Abridged walkability indexes may be useful in settings where retail floor area data are unavailable.

Methodological approaches in conducting overviews: current state in HTA agencies

OBJECTIVES

Overviews search for reviews rather than for primary studies. They might have the potential to support decision making within a shorter time frame by reducing production time. We aimed to summarize available instructions for authors intending to conduct overviews as well as the currently applied methodology of overviews in international Health Technology Assessment (HTA) agencies.

METHODS

We identified 127 HTA agencies and scanned their websites for methodological handbooks as well as published overviews as HTA reports. Additionally, we contacted HTA agencies by e-mail to retrieve possible unidentified handbooks or other related sources.

RESULTS

In total, eight HTA agencies providing methodological support were found. Thirteen HTA agencies were found to have produced overviews since 2007, but only six of them published more than four overviews. Overviews were mostly employed in HTA products related to rapid assessment. Additional searches for primary studies published after the last review are often mentioned in order to update results.

CONCLUSIONS

Although the interest in overviews is rising, little methodological guidance for the conduct of overviews is provided by HTA agencies. Overviews are of special interest in the context of rapid assessments to support policy-making within a short time frame. Therefore, empirical work on overviews needs to be extended. National strategies and experience should be disclosed and discussed.

Does change in the neighborhood environment prevent obesity in older women?

Neighborhood environment is consistently associated with obesity; changes to modifiable aspects of the neighborhood environment may curb the growth of obesity in the US and other developed nations. However, currently the majority of studies are cross-sectional and thus not appropriate for evaluating causality. The goal of this study was to evaluate the effect of a neighborhood-changing intervention on changes in obesity among older women. Over the past 30 years the Portland, Oregon metropolitan region has made significant investments in plans, regulatory structures, and public facilities to reduce sprawl and increase compact growth centers, transit-oriented development approaches, and green space. We used geocoded residential addresses to link data on land-use mix, public transit access, street connectivity, and access to green space from four time points between 1986 and 2004, with longitudinal data on body mass index (BMI) from a cohort of 2003 community-dwelling women aged 66 years and older. Height and weight were measured at clinic visits. Women self-reported demographics, health habits, and chronic conditions, and self-rated their health. Neighborhood socioeconomic status was assessed from census data. Neighborhood walkability and access to green space improved over the 18-year study period. On average there was a non-significant mean weight loss in the cohort between baseline (mean age 72.6 years) and the study's end (mean age 85.0 years). We observed no association between neighborhood built environment or change in built environment and BMI. Greater neighborhood socioeconomic status at baseline was independently associated with a healthier BMI at baseline, and protected against an age-related decline in BMI over time. BMI decreases with age reflect increased frailty, especially among older adults with complex morbidities. Future research should consider the influence of the neighborhood environment on additional relevant health outcomes and should include measures of the social environment in conjunction with built environment measures.

PACES: a Physical Activity Campus Environmental Supports Audit on university campuses

PURPOSE

This study evaluated the policy and built and recreation environmental supports for physical activity on 13 university campuses.

DESIGN

Environmental audit survey.

SETTING

Thirteen U.S. universities, 2009. Subjects. University policies, recreation programs and facilities, and at least five additional buildings per campus.

MEASURES

The Physical Activity Campus Environmental Supports Audit was developed for this study.

ANALYSIS

Analysis of variance with post hoc Tukey's B and χ(2) assessed differences by institution and building type.

RESULTS

The mean obesogenic policy score was significantly lower than the desired score, ≥7 (p = .002), with only one campus scoring 10. The mean built environment audit score (5.4 ± 1.7) was low, with significant differences between institutions (p < .001) and only three campuses scoring above the desired score, ≥7. Although generally stairwells were clean and well lighted, there was a lack of signage to encourage stair use (p < .001). Overall, recreation programs (7.1 ± .7) and facilities (7.1 ± 1.2) scored well, but amenities scores were lower for satellite (2.8 ± 1.6) versus main (4.1 ± 1.8) recreation facilities (p = .04).

CONCLUSION

On these 13 university campuses, recreation programs and facilities were supportive of healthful lifestyles for obesity prevention, but policies and the built environment were not. This physical activity environmental audit survey requires testing in a wider sample of postsecondary institutions to corroborate its utility and provide evidence to support initiatives to improve campus environments for physical activity.

Crime, physical activity and outdoor recreation among Latino adolescents in Chicago

PURPOSE

The purpose was to examine how fear of crime, crime victimization, and perceived level of community incivilities are related to physical activity participation and outdoor recreation among Latino adolescents.

METHOD

The study utilized a mixed methods approach that included 25 qualitative interviews and 390 school-based surveys collected from youth across three schools in Little Village, Chicago, Illinois.

RESULTS

Results showed that Latino adolescents who expressed greater fear of crime also engaged in less physical activity and outdoor recreation. There was no association between crime victimization and physical activity and outdoor recreation. Those who perceived greater levels of community incivilities also engaged in less outdoor recreation, but perception of incivilities had no significant association with physical activity levels. Interview data revealed most of the children believed crime was a serious problem in their neighborhood and it impacted their ability to be physically active and play outside.

CONCLUSIONS

Fear of crime was related to lower physical activity and outdoor recreation. It is imperative that communities provide safe environments for children to be active. Increasing police and adult presence in parks and school grounds is recommended. Moreover, efforts must be made to reduce the gang problems in Latino communities.

Associations between observed neighborhood characteristics and physical activity: findings from a multiethnic urban community

BACKGROUND

There is growing interest in the contributions of characteristics of the neighborhood environment to inequalities in physical activity. However, few studies have examined the relationship between observed neighborhood environmental characteristics and physical activity in a multiethnic urban area.

PURPOSE

The purpose of this study was to assess relationships between neighborhood environments and physical activity and the extent to which these associations varied by demographic characteristics or perceptions of the physical and social environment.

METHODS

Cross-sectional analyses drew upon data collected from a stratified proportional probability sample of non-Hispanic Black, Hispanic and non-Hispanic White (NHW) adults (n = 919) in low-to-moderate income neighborhoods in Detroit, Michigan. Physical activity was assessed as self-reported duration and frequency of vigorous and moderate physical activity. Observed physical environment was assessed through systematic social observation by trained observers on blocks adjacent to survey respondents' residences.

RESULTS

We find a positive association of sidewalk condition with physical activity, with stronger effects for younger compared with older residents. In addition, physical disorder was more negatively associated with physical activity among NHW and older residents.

CONCLUSIONS

These findings suggest that sidewalk improvements and reductions in physical disorder in urban communities may promote greater equity in physical activity.

Associations between neighborhood characteristics and self-rated health: a cross-sectional investigation in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort

Quantifying the effects of specific neighborhood features on self-reported health is important in understanding the global health impact of neighborhood context. We investigated associations of neighborhood poverty, sociability and walkability with self-rated physical and mental health in the Multi-Ethnic Study of Atherosclerosis (MESA). In separate models, each neighborhood variable was associated with physical health but associations with sociability and walkability were stronger than those for poverty. Only walkability remained significant after adjusting for the other neighborhood variables. There was no evidence that self-rated mental health as assessed by the SF12 was associated with neighborhood poverty, walkability or sociability. This study provides information on how neighborhood context is associated with global health in diverse midlife and older persons.