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

Understanding the independent and joint associations of the home and workplace built environments on cardiorespiratory fitness and body mass index

This observational study examined the associations of built environment features around the home and workplace with cardiorespiratory fitness (CRF) based on a treadmill test and body mass index (BMI) (weight (kg)/height (m)(2)). The study included 8,857 adults aged 20-88 years who completed a preventive medical examination in 2000-2007 while living in 12 Texas counties. Analyses examining workplace neighborhood characteristics included a subset of 4,734 participants. Built environment variables were derived around addresses by using geographic information systems. Models were adjusted for individual-level and census block group-level demographics and socioeconomic status, smoking, BMI (in CRF models), and all other home or workplace built environment variables. CRF was associated with higher intersection density, higher number of private exercise facilities around the home and workplace, larger area of vegetation around the home, and shorter distance to the closest city center. Aside from vegetation, these same built environment features around the home were also associated with BMI. Participants who lived and worked in neighborhoods in the lowest tertiles for intersection density and the number of private exercise facilities had lower CRF and higher BMI values than participants who lived and worked in higher tertiles for these variables. This study contributes new evidence to suggest that built environment features around homes and workplaces may affect health.

Neighborhood environment and physical activity among older adults: do the relationships differ by driving status?

Some attributes of neighborhood environments are associated with physical activity among older adults. This study examined whether the associations were moderated by driving status. Older adults from neighborhoods differing in walkability and income completed written surveys and wore accelerometers (N = 880, mean age = 75 years, 56% women). Neighborhood environments were measured by geographic information systems and validated questionnaires. Driving status was defined on the basis of a driver's license, car ownership, and feeling comfortable to drive. Outcome variables included accelerometer-based physical activity and self-reported transport and leisure walking. Multilevel generalized linear regression was used. There was no significant Neighborhood Attribute × Driving Status interaction with objective physical activity or reported transport walking. For leisure walking, almost all environmental attributes were positive and significant among driving older adults but not among nondriving older adults (five significant interactions at p < .05). The findings suggest that driving status is likely to moderate the association between neighborhood environments and older adults' leisure walking.

How ‘age-friendly’ are rural communities and what community characteristics are related to age-friendliness? The case of rural Manitoba, Canada

Since the World Health Organization introduced the concept of ‘age-friendly’ communities in 2006, there has been rapidly growing interest in making communities more age-friendly on the part of policy makers world-wide. There is a paucity of research to date, however, that has examined age-friendliness in diverse communities, particularly in rural communities. The main objective of the study reported in this paper was to examine whether age-friendliness varies across community characteristics, such as a population size. The study was based on surveys administered in 56 communities throughout Manitoba, a mid-Western Canadian province, in the context of a needs assessment process for communities that are part of the Age-Friendly Manitoba Initiative. A total of 1,373 individuals completed a survey developed to measure age-friendliness. Domains included the physical environment; housing options; the social environment; opportunities for participation; community supports and health-care services; transportation options; and communication and information. Community characteristics were derived from census data. Multi-level regression analysis indicated that the higher the percentage of residents aged 65 or older, the higher the ratings of age-friendliness overall and, specifically, ratings of the social environment, opportunities for participation, and communication and information. Moreover, small communities located within a census metropolitan area and remote communities in the far north of the province emerged as having the lowest age-friendliness ratings. These findings suggest that communities are generally responsive to the needs of their older residents. That different results were obtained for the various age-friendly domains underscores the importance of considering age-friendliness in a holistic way and measuring it in terms of a range of community features. Our study further highlights the importance of differentiating between degrees of rurality, as different patterns emerged for communities of different sizes and proximity to a larger urban centre.

Physical activity in deprived communities in London: examining individual and neighbourhood-level factors

Introduction

The objectives of this study were to examine relationships between neighbourhood-level and individual-level characteristics and physical activity in deprived London neighbourhoods.

Methods

In 40 of the most deprived neighbourhoods in London (ranked in top 11% in London by Index of Multiple Deprivation) a cross-sectional survey (n = 4107 adults aged > = 16 years), neighbourhood audit tool, GIS measures and routine data measured neighbourhood and individual-level characteristics.

The binary outcome was meeting the minimum recommended (CMO, UK) 5×30 mins moderate physical activity per week. Multilevel modelling was used to examine associations between physical activity and individual and neighbourhood-level characteristics.

Results

Respondents living more than 300 m away from accessible greenspace had lower odds of achieving recommended physical activity levels than those who lived within 300 m; from 301–600 m (OR = 0.7; 95% CI 0.5–0.9) and from 601–900 m (OR = 0.6; 95% CI 0.4–0.8). There was substantial residual between-neighbourhood variance in physical activity (median odds ratio = 1.7). Other objectively measured neighbourhood-level characteristics were not associated with physical activity levels.

Conclusions

Distance to nearest greenspace is associated with meeting recommended physical activity levels in deprived London neighbourhoods. Despite residual variance in physical activity levels between neighbourhoods, we found little evidence for the influence of other measured neighbourhood-level characteristics.

Correlates of walking and cycling for transport and recreation: factor structure, reliability and behavioural associations of the perceptions of the environment in the neighbourhood scale (PENS)

Background

Emerging evidence suggests that walking and cycling for different purposes such as transport or recreation may be associated with different attributes of the physical environment. Few studies to date have examined these behaviour-specific associations, particularly in the UK. This paper reports on the development, factor structure and test-retest reliability of a new scale assessing perceptions of the environment in the neighbourhood (PENS) and the associations between perceptions of the environment and walking and cycling for transport and recreation.

Methods

A new 13-item scale was developed for assessing adults’ perceptions of the environment in the neighbourhood (PENS). Three sets of analyses were conducted using data from two sources. Exploratory and confirmatory factor analyses were used to identify a set of summary environmental variables using data from the iConnect baseline survey (n = 3494); test-retest reliability of the individual and summary environmental items was established using data collected in a separate reliability study (n = 166); and multivariable logistic regression was used to determine the associations of the environmental variables with walking for transport, walking for recreation, cycling for transport and cycling for recreation, using iConnect baseline survey data (n = 2937).

Results

Four summary environmental variables (traffic safety, supportive infrastructure, availability of local amenities and social order), one individual environmental item (street connectivity) and a variable encapsulating general environment quality were identified for use in further analyses. Intraclass correlations of these environmental variables ranged from 0.44 to 0.77 and were comparable to those seen in other similar scales. After adjustment for demographic and other environmental factors, walking for transport was associated with supportive infrastructure, availability of local amenities and general environment quality; walking for recreation was associated with supportive infrastructure; and cycling for transport was associated only with street connectivity. There was limited evidence of any associations between environmental attributes and cycling for recreation.

Conclusion

PENS is acceptable as a short instrument for assessing perceptions of the urban environment. Previous findings that different attributes of the environment may be associated with different behaviours are confirmed. Policy action to create supportive environments may require a combination of environmental improvements to promote walking and cycling for different purposes.

Perceived neighborhood environment and physical activity in 11 countries: do associations differ by country?

BACKGROUND

Increasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country.

METHODS

Population representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported.

RESULTS

Significant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries.

CONCLUSION

There is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

Systematic review on measurement properties of questionnaires assessing the neighbourhood environment in the context of youth physical activity behaviour

BACKGROUND

High-quality measurement instruments for assessing the neighbourhood environment are a prerequisite for identifying associations between the neighbourhood environment and a person's physical activity. The aim of this systematic review was to identify reliable and valid questionnaires assessing neighbourhood environmental attributes in the context of physical activity behaviours in children and adolescents. In addition, current gaps and best practice models in instrumentation and their evaluation are discussed.

METHODS

We conducted a systematic literature search using six databases (Web of Science, Medline, TRID, SportDISCUS, PsycARTICLES and PsycINFO). Two independent reviewers screened the identified English-language peer-reviewed journal articles. Only studies examining the measurement properties of self- or proxy-report questionnaires on any aspects of the neighbourhood environment in children and adolescents aged 3 to 18 years were included. The methodological quality of the included studies was assessed using the COSMIN checklists.

RESULTS

We identified 13 questionnaires on attributes of the neighbourhood environment. Most of these studies were conducted in the United States (n = 7). Eight studies evaluated self-report measures, two studies evaluated parent-report measures and three studies included both administration types. While eight studies had poor methodological quality, we identified three questionnaires with substantial test-retest reliability and two questionnaires with acceptable convergent validity based on sufficient evidential basis.

CONCLUSIONS

Based on the results of this review, we recommend that cross-culturally adapted questionnaires should be used and that existing questionnaires should be evaluated especially in diverse samples and in countries other than the United States. Further, high-quality studies on measurement properties should be promoted and measurement models (formative vs. reflexive) should be specified to ensure that appropriate methods for psychometric testing are applied in future studies.

Interactive effects of built environment and psychosocial attributes on physical activity: a test of ecological models

BACKGROUND

The principle of cross-level interactions of influence on behavior in ecological models is seldom studied.

PURPOSE

To examine built environment × psychosocial interactive effects on physical activity.

METHODS

Multi-level mixed regression analyses used data from the Neighborhood Quality of Life Study conducted in neighborhoods in two US regions (n = 2,199 adults). Outcomes were (1) objectively measured moderate-to-vigorous physical activity, (2) reported transport walking, and (3) leisure-walking. Conceptually matched built environment variables were analyzed for domain-specific outcomes.

RESULTS

With leisure walking as the outcome, built environment × psychosocial interactions were significant in 7 of 20 models tested. Directions of interactions were consistent, indicating a stronger built environment-leisure walking association in adults with less favorable psychosocial status. Little evidence supported such interactions with objectively measured moderate-to-vigorous physical activity or transport walking as outcomes.

CONCLUSION

The results imply that the built environment may exert stronger influence on adults who are not psychologically predisposed to be active.

Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis

BACKGROUND

Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA.

METHODS

A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country.

RESULTS

A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e.g., U.S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA.

CONCLUSIONS

Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Street connectivity and obesity in Glasgow, Scotland: impact of age, sex and socioeconomic position

This study investigated associations of street connectivity with body mass index (BMI), and whether these associations varied by sex, age and socioeconomic position, amongst adults in Glasgow, Scotland. Data on socio-demographic variables, height and weight were collected from 1062 participants in the Greater Glasgow Health and Well-being Study, and linked with neighbourhood-level census and geo-referenced data on area level deprivation and street connectivity. Results of multilevel models showed that, after adjustment for individual level covariates, street connectivity was not significantly associated with either BMI or BMI category; nor were there any significant interactions between age, sex or socioeconomic position and street connectivity.

Walkability parameters, active transportation and objective physical activity: moderating and mediating effects of motor vehicle ownership in a cross-sectional study

BACKGROUND

Neighborhood walkability has been associated with physical activity in several studies. However, as environmental correlates of physical activity may be context specific, walkability parameters need to be investigated separately in various countries and contexts. Furthermore, the mechanisms by which walkability affects physical activity have been less investigated. Based on previous research, we hypothesized that vehicle ownership is a potential mediator. We investigated the associations between walkability parameters and physical activity, and the mediating and moderating effects of vehicle ownership on these associations in a large sample of Swedish adults.

METHODS

Residential density, street connectivity and land use mix were assessed within polygon-based network buffers (using Geographic Information Systems) for 2,178 men and women. Time spent in moderate to vigorous physical activity was assessed by accelerometers, and walking and cycling for transportation were assessed by the International Physical Activity Questionnaire. Associations were examined by linear regression and adjusted for socio-demographic characteristics. The product of coefficients approach was used to investigate the mediating effect of vehicle ownership.

RESULTS

Residential density and land use mix, but not street connectivity, were significantly associated with time spent in moderate to vigorous physical activity and walking for transportation. Cycling for transportation was not associated with any of the walkability parameters. Vehicle ownership mediated a significant proportion of the association between the walkability parameters and physical activity outcomes. For residential density, vehicle ownership mediated 25% of the association with moderate to vigorous physical activity and 20% of the association with the amount of walking for transportation. For land use mix, the corresponding proportions were 34% and 14%. Vehicle ownership did not moderate any of the associations between the walkability parameters and physical activity outcomes.

CONCLUSIONS

Residential density and land use mix were associated with time spent in moderate to vigorous physical activity and walking for transportation. Vehicle ownership was a mediator but not a moderator of these associations. The present findings may be useful for policy makers and city planners when designing neighborhoods that promote physical activity.

Contribution of individual and environmental factors to physical activity level among Spanish adults

Background

Lack of physical activity (PA) is a major risk for chronic disease and obesity. The main aims of the present study were to identify individual and environmental factors independently associated with PA and examine the relative contribution of these factors to PA level in Spanish adults.

Methodology/Principal Findings

A population-based cross-sectional sample of 3,000 adults (18–75 years old) from Gran Canaria (Spain) was selected using a multistage stratified random sampling method. The participants were interviewed at home using a validated questionnaire to assess PA as well as individual and environmental factors. The data were analyzed using bivariate and multivariate logistic regression. One demographic variable (education), two cognitive (self-efficacy and perceived barriers), and one social environmental (organized format) were independently associated with PA in both genders. Odds ratios ranged between 1.76–2.07 in men and 1.35–2.50 in women (both p<0.05). Individual and environmental factors explained about one-third of the variance in PA level.

Conclusions/Significance

Self-efficacy and perceived barriers were the most significant factors to meet an adequate level of PA. The risk of insufficient PA was twofold greater in men with primary or lesser studies and who are employed. In women, living in rural environments increased the risk of insufficient PA. The promotion of organized PA may be an efficient way to increase the level of PA in the general population. Improvement in the access to sport facilities and places for PA is a prerequisite that may be insufficient and should be combined with strategies to improve self-efficacy and overcome perceived barriers in adulthood.