Associations between self-reported and objective physical environmental factors and use of a community rail-trail

Validation of the physical activity neighborhood environment scale using geographic information systems among urban men and women in regional China

Aims

To examine the concurrent validity of the Chinese version of Physical Activity Neighborhood Environment Scale (PANES-CHN) among urban adults in regional China.

Methods

With multistage sampling approaches, 801 eligible urban adults aged 35-74 years were recruited from Nanjing municipality of China between July and September of 2019. The neighbourhood built environment features were measured subjectively with PANES-CHN and objectively with geographic information system. The concurrent validity of PANES was assessed using Spearman's correlations (rs).

Results

Among the total 801 participants, the mean age was 54.4 (standard deviation = 11.5), while 48.7 % were men. Overall, of all the five objectively-measurable built environment characteristics, the Spearman correlations were examined significant between subjective and objective measurements for commercial facilities (item 2) (rs = 0.19, 95CI%=0.12, 0.25), recreational facilities (item 6) (rs = 0.10, 95CI%=0.02, 0.16), traffic junctions (item 12) (rs = 0.15, 95CI%=0.07, 0.22), medical/education facilities (item 17) (rs = 0.22, 95CI%=0.15, 0.29), but not for public transport stops. Similar scenarios were observed for participants aged 35-60 years, with sufficient physical activity, men or women. The rs value for medical/education facilities (item 17) was significantly higher in participants aged 35-59 years (0.28 vs. 0.13; p = 0.04) than those aged 60 + years.

Conclusions

PANES-CHN generally has an acceptable validity for assessing built environment characteristics among urban adults in China, which implies that PANES-CHN can be used to measure built environment attributes in health-related population studies.

Visualizing changes in physical activity behavioral patterns after redesigning urban infrastructure

The aim of this study was to explore effects of a major urban reconstruction on physical activity (PA) behavior by comparing PA intensity hotspots before and after the tunneling of a highway with a new infrastructure prioritized for walking and cycling. In total, 126 individuals participated before and after the tunneling. GPS loggers and accelerometers were used to assess location and PA levels. A geographic information system (GIS) was used to perform optimized hotspot analyses on PA data, both on transport and stationary data points. The results showed several changes in PA hotspots on trip data, even if total PA levels did not change. At follow-up, PA intensity hotspots were more connected, with the new infrastructure as a central connection. This was true for higher and lower educated individuals. Therefore, if changes in the built environment do not result in changes on population-level outcomes, this does not imply that they have no impact on behavior.

Exploring Perceived and Objective Measures of the Neighborhood Environment and Associations with Physical Activity among Adults: A Review and a Meta-Analytic Structural Equation Model

There is an urgent need to understand factors that promote physical activities (PA) because it is one of the modifiable risk factors for global mortality. None of the previous reviews considered both perceived and objective characteristics of the same environment. The first aim was to review the literature on studies investigating the relationship between PA behavior of adults and perceived and objective physical environment measures. The second aim was to verify the potential mediational role of the perceived measure in the relationship between the objective measure of the environment and PA using meta-analytic SEM. Only 15 studies reported a relationship between PA and both environmental measures. One of the most studied characteristics of the physical environment is the accessibility to recreational/PA facilities. Both objective and subjective measures of accessibility to PA facilities are associated with PA. Meta-SEM results suggest a significant effect of the objective accessibility to facilities on PA behavior (β = 0.15) and on the perceived measure (β = 0.10), but the indirect effect was not significant. No significant effect was found for the perceived measure on PA, suggesting that individuals’ level of awareness about their environments may have played a role. This prompts a need to create awareness campaigns.

Investigating the Relationship Between Accessibility of Green Space and Adult Obesity Rates: A Secondary Data Analysis in the United States

Objectives:

In spite of the importance of green space for reducing obesity-related problems, there has been little exploration of whether access to green space (e.g., parks and recreational facilities) influences the obesity rate of adults in the United States. The purpose of the study was to investigate the relationships among accessibility of green space, obesity rates, and socioeconomic and demographic variables among adults living in the State of Indiana, United States.

Methods:

We conducted a secondary data analysis to investigate the relationships among accessibility to green space, obesity rates, and socio-demographic variables with employing Geographic Information System in order to measure the accessibility of green space.

Results:

This study found that accessibility of green space served as a strong predictor of reduced obesity rates among adults (β=-2.478; p<0.10). In addition, adults with higher education levels, as well as better access to green space, were found to have even lower obesity rates (β=-0.188; p<0.05). Other control variables such as unemployment rates, food security, and physical inactivity are additional factors that influence obesity rates among adults.

Conclusions:

Accessibility of green space may play an important role in facilitating physical activity participation and reducing obesity rates.

Field Test of a Passive Infrared Camera for Measuring Trail-Based Physical Activity

Introduction: Trails are ubiquitous and far-reaching, but research on the impact trails have on physical activity is limited by the lack of resource-efficient, accurate, and practical systematic observation tools. Commonly used infrared trail sensors count trail use and may broadly differentiate activity (i.e., bicyclist vs. pedestrian), but cannot detect nuances needed for outcomes research such as frequency, intensity, time, and type of activity. Motion-activated passive infrared cameras (PICs), used in ecological research and visitor management in wildlife areas, have potential applicability as a systematic observation data collection tool.

Materials and Methods: We conducted a 7-month field test of a PIC as a systematic observation data collection tool on a hiking trail, using photos to identify each trail user's physical activity type, age, sex, and other characteristics. We also tallied hourly trail use counts from the photos, using Bland–Altman plots, paired t-tests, Concordance Correlation Coefficient, Kendall's Tau-b, and a novel inter-counter reliability measure to test concordance against concurrent hourly counts from an infrared sensor.

Results: The field test proved informative, providing photos of 2,447 human users of the trail over 4,974 h of data collection. Nearly all of the users were walkers (94.0%) and most were male (69.2%). More of the males used the trail alone (44.8%) than did females (29.8%). Concordance was strong between instruments (p < 0.01), though biased (p < 0.01). Inter-counter reliability was 91.1% during the field study, but only 36.2% when excluding the hours with no detectable trail use on either device. Bland–Altman plots highlighted the tendency for the infrared sensor to provide higher counts, especially for the subsample of hours that had counts >0 on either device (14.0%; 694 h).

Discussion: The study's findings highlight the benefits of using PICs to track trail user characteristics despite the needs to further refine best practices for image coding, camera location, and settings. More widespread field use is limited by the extensive amount of time required to code photos and the need to validate the PICs as a trail use counter. The future potential of PICs as a trail-specific PA research and management tool is discussed.

Measuring Walkability with GIS—Methods Overview and New Approach Proposal

Cities occupy only about 3% of the Earth’s surface area, but half of the global population lives in them. The high population density in urban areas requires special actions to make these areas develop sustainably. One of the greatest challenges of the modern world is to organize urban spaces in a way to make them attractive, safe and friendly to people living in cities. This can be managed with the help of a number of indicators, one of which is walkability. Of course, the most complete analyses are based on spatial data, and the easiest way to implement them is using GIS tools. Therefore, the goal of the paper is to present a new approach for measuring walkability, which is based on density maps of specific urban functions and networks of generally accessible pavements and paths. The method is implemented using open-source data. Density values are interpolated from point data (urban objects featuring specific functions) and polygons (pedestrian infrastructure) using Kernel Density and Line Density tools in GIS. The obtained values allow the calculation of a synthetic indicator taking into account the access by means of pedestrian infrastructure to public transport stops, parks and recreation areas, various attractions, shops and services. The proposed method was applied to calculate the walkability for Kraków (the second largest city in Poland). The greatest value of walkability was obtained for the Main Square (central part of the Old Town). The least accessible to pedestrians are, on the other hand, areas located on the outskirts of the city, which are intended for extensive industrial areas, single-family housing or large green areas.

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review

BACKGROUND

A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence.

METHODS

A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided.

RESULTS

Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified.

CONCLUSIONS

The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.

Effect of an Additional 30 Minutes Spent Outdoors during Summer on Daily Steps and Individually Experienced Heat Index

Spending time outdoors is associated with increased physical activity; however, high ambient temperature/humidity, together with built environment features in urban versus rural environments, may influence physical activity. We conducted an intervention trial with 89 urban and 88 rural participants performing normal activities on Days 1-2 (baseline) and spending an additional 30 min outdoors on Days 3-7 (intervention) in the summer. Participants wore a pedometer with real-time visual feedback to track daily steps taken and a thermometer clipped to their shoe to track temperatures experienced individually. Hygrometer-thermometers were deployed in participants' neighborhoods to collect finer resolution ambient heat indexes in addition to regional weather station measurements. Using linear mixed effects models and adjusting for ambient conditions and individual-level factors, participants on average walked 637 (95%CI (83, 1192)) more steps and had a 0.59 °C (95%CI (0.30, 0.88)) lower daily mean individually experienced heat index during intervention days compared to baseline days. The intervention benefit of increased physical activity was greater in rural residents who were less active at baseline, compared to urban residents. Our results suggest adding a small amount of additional time outdoors may improve physical activity without increasing participants' heat exposure, even during summer in a humid subtropical climate.

The Association of Trail Features With Self-Report Trail Use by Neighborhood Residents

BACKGROUND

Urban trails are a useful resource to promote physical activity. This study identified features of urban trails that correlated with trail use.

METHODS

Multiuse urban trails were selected in Chicago, Dallas, and Los Angeles. An audit of each trail was completed using the Systematic Pedestrian and Cyclist Environmental Scan for Trails instrument, identifying built environmental features. A self-report of trail use was obtained from trailside residents (N = 331) living within 1 mile of each trail. Univariate and multivariate Poisson regressions controlled for trail time from home and motivation for physical activity.

RESULTS

Positive associations with the past month's hours on the trail were observed for the presence of distance signs, vegetation height, vegetation maintenance, and trail crowding, and a negative association was observed for the presence of crossings on the trail. Positive associations with dichotomous trail use were observed for the presence of distance signs, vegetation height, and vegetation maintenance, and a negative association was observed for the presence of crossings on the trail.

CONCLUSIONS

These correlates should be confirmed in other studies and, if supported, should be considered in the promotion and design of urban trails.

Neighborhood Greenery as a Predictor of Outdoor Crimes between Low and High-Income Neighborhoods

Neighborhood greenery contributes to improving mental, emotional, and physical health and may help to promote neighborhood safety. Several studies have reported positive effects of neighborhood greenery on the improvement of outdoor safety, but little is known about whether the relationship between green vegetation and outdoor safety varies with the income status of neighborhoods. The purpose of this study is to examine neighborhood greenery as a predictor of outdoor crime rates between low and high-income neighborhoods while controlling for the sociodemographic conditions of the neighborhoods. This study used 2010 census block group data and objectively measured natural environment data derived from GIS in Austin, Texas. Comparison t-tests and ordinal least square regressions were conducted as statistical analyses. The t-tests showed that low-income neighborhoods were more socioeconomically disadvantaged and had less greenery than high-income neighborhoods. The final regression models showed that neighborhood greenery had a negative relationship with outdoor crimes for low-income neighborhoods but a positive relationship with crimes for high-income neighborhoods. The results suggest that different strategies may be needed in dealing with neighborhood safety according to neighborhood-level income.

Redesign, Field-Testing, and Validation of the Physical Activity Campus Environmental Supports (PACES) Audit

This paper describes the redesign, field-testing, and convergent validity of a practical tool-Physical Activity Campus Environmental Supports (PACES) audit. Methods. The audit includes two parts: (1) PACES-Programs, which is comprised of questions regarding populations served, fees, programs (recreation/fitness classes and intramurals), proximity, adequacy of facilities, and marketing, and (2) PACES-Facilities, which is comprised of questions regarding built environment (aesthetics, bike racks, stairs, and universal design), recreation equipment, staff, amenities, and access. Each item criterion is specifically scored using a five-point, semantic-differential scale ranging from limited to extensive environmental support. A few questions utilize select all that apply for a summed score. PACES training, interrater reliability, and data collection are all accessible via an online portal. PACES was tested on 76 college campuses. Convergent validity was examined by comparing the PACES-Programs questions to Healthy Campus Initiatives-Programs questions (HCI-Programs) and comparing the PACES-Facilities questions to questions contained in the Physical Activity Resource Assessment (PARA) Instrument. Statistical analyses included Cronbach's alpha, ANOVA, latent profile analysis, and Spearman correlations. Results. The PACES-Programs audit includes 10 items for a potential total of 73 points (α = 0.72) and PACES-Facilities audit includes 15 items for a potential total of 77 points (α = 0.837). Most (77.8%) of the 153 facilities assessed scored in the most healthful range (20-42), which was mainly due to the extensiveness of the aerobic equipment/amenities and the competence/accessibility of staff. Significant differences in PACES-Total and PACES-Programs scores were associated with campus size and PACES-Facilities across regions. For the paired validation assessments, correlations were significant between PACES-Programs and HCI-Programs ((n=41) r=0.498, p < 0.001) and PACES-Facilities and PARA (n=29) for both features (r=0.417, p=0.024) and amenities (r=0.612, p < 0.001), indicating moderate convergent validity. Conclusion. The PACES audit is a valid, reliable tool for assessing the quality of recreation facilities and programs in a variety of college campus environments.

EXCESSO DE PESO, AMBIENTE PERCEBIDO E PRIVAÇÃO SOCIAL: UM ESTUDO DA PERCEPÇÃO DE PAIS OU RESPONSÁVEIS

Objective:

To investigate parents’ or guardians’ perception of their residential proximity to food retailers, leisure areas, and spaces for physical activity according to neighborhood social deprivation, and test associations between the perceived environment and their children’s overweight.

Methods:

Cross-sectional study conducted with 408 children and adolescents (6- to 15-year-olds) attending public schools in a medium-sized Brazilian city. Data were collected from 2011 to 2014. A telephone interview using a structured research tool determined the presence of overweight and the walking time between the participants’ home and the places evaluated. The indicator of social deprivation adopted was the Health Vulnerability Index. Logistic regression models were constructed to predict the perception of proximity (social deprivation as an explanatory variable) and evaluate perceived environmental factors (explanatory variables) associated with overweight (outcome).

Results:

Residents of areas with higher social vulnerability showed a probability of perceived proximity 50 to 71% lower to supermarkets, street/produce markets, parks, recreation areas/community centers, and gyms compared to residents of less vulnerable areas. The perceived proximity to parks reduced the chance of overweight in children and adolescents in 73%, with an odds ratio (OR) of 0.27 (95%CI 0.07-0.95; p<0.05).

Conclusions:

The perceived environment of the residential area infrastructure might be related to neighborhood social deprivation and the presence of overweight in children and adolescents.

Protected Natural Areas: In Sickness and in Health

Numerous studies show the benefits that contact with the natural environment have for human health, but there are few studies on the role of Protected Natural Areas (PNAs), either from the preventive point of view or on their potential benefits, on individuals with health problems. A study was made of the relationship between the visitation of Montseny Natural Park and Biosphere Reserve and health, from the perspective of a population group with different diseases. A total of 250 patients resident in the areas near the park were surveyed, recording their beliefs about the benefits of nature, as well as the reasons for visiting and the activities associated with health that they carried out in the park. The pure air is the most valued benefit (27.2%), particularly for those with allergies. The majority (57%) visit the park for health reasons. High levels (82%) of exercise are recorded, especially by patients with heart diseases (85%), and 65% exercised in the park. More physical activity is mentioned among those that visit the park most often, particularly among those that carried it out for health reasons. Plants were collected for medicinal use by 39.6%. The study confirmed the significant role of the Montseny Natural Park and Biosphere Reserve as a health resource for individuals with diseases that live near it. It also corroborates the beneficial effects that the PNA provide in human health.

Cycling for Transportation in Sao Paulo City: Associations with Bike Paths, Train and Subway Stations

Cities that support cycling for transportation reap many public health benefits. However, the prevalence of this mode of transportation is low in Latin American countries and the association with facilities such as bike paths and train/subway stations have not been clarified. We conducted a cross-sectional analysis of the relationship between bike paths, train/subway stations and cycling for transportation in adults from the city of Sao Paulo. We used data from the Sao Paulo Health Survey (n = 3145). Cycling for transportation was evaluated by a questionnaire and bike paths and train/subway stations were geocoded using the geographic coordinates of the adults' residential addresses in 1500-m buffers. We used multilevel logistic regression, taking account of clustering by census tract and households. The prevalence of cycling for transportation was low (5.1%), and was more prevalent in males, singles, those active in leisure time, and in people with bicycle ownership in their family. Cycling for transportation was associated with bike paths up to a distance of 500 m from residences (OR (Odds Ratio) = 2.54, 95% CI (Confidence interval) 1.16-5.54) and with the presence of train/subway stations for distances >500 m from residences (OR = 2.07, 95% CI 1.10-3.86). These results are important to support policies to improve cycling for transportation in megacities such as Sao Paulo.

Rural Active Living: A Call to Action

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.

Trail Characteristics as Correlates of Urban Trail Use

Purpose.

The purpose of this study was to identify the environmental correlates of urban trail use.

Design.

Three multiuse urban trails at least 15 miles in length were selected. Trails were divided into one-half-mile segments (N = 102 total segments) and marked in the field. An audit of each trail was completed identifying built environmental features. A cross-sectional count of trail users was completed at each segment estimating the type of use, age, gender.

Setting.

Data collection occurred on urban trails in Chicago, Dallas, and Los Angeles.

Subjects.

Trained observers counted 17,338 users across the three trails.

Measures.

The SPACES for Trails instrument was used, and a trail count data collection sheet was developed.

Analysis.

Univariate and multivariate Poisson regressions controlling for location of trail and density of the population within 1 mile of the trail.

Results.

Positive associations with trail use were observed for mixed views (β = .33, p < .0001), streetlights (β = .30, p < .0001), good trail condition (β = .28, p < .0001), and the presence of cafés (β = .38, p < .0001) and other trailside facilities (β = .08, p < .0001). Negative associations were observed for litter (β = −.22, p < .0001), noise (β = −.41, p < .0001), higher vegetation density (β = −.10, p > .001), drainage features (β = −.67, p < .0003), natural areas adjacent to the trail (β = −.39, p < .0001), and tunnel present (β = −.20, p < .04).

Conclusions.

These correlates should be confirmed in other studies and if supported should be considered in the promotion and design of urban trails.

Walking and Bicycling: An Evaluation of Environmental Audit Instruments

Purpose.

This paper reviews existing environmental audit instruments used to capture the walkability and bikability of environments. The review inventories and evaluates individual measures of environmental factors used in these instruments. It synthesizes the current state of knowledge in quantifying the built environment. The paper provides health promotion professionals an understanding of the essential aspects of environments influencing walking and bicycling for both recreational and transportation purposes. It serves as a basis to develop valid and efficient tools to create activity-friendly communities.

Data Sources.

Keyword searches identified journal articles from the computer-based Academic Citation Databases, including the National Transportation Library, the Web of Science Citation Database, and MEDLINE. Governmental publications and conference proceedings were also searched.

Study Inclusion and Exclusion Criteria.

All instruments to audit physical environments have been included in this review, considering both recreation- and transportation-related walking and bicycling. Excluded are general methods devised to estimate walking and cycling trips, those used in empirical studies on land use and transportation, and research on walking inside buildings.

Data Extraction Methods.

Data have been extracted from each instrument using a template of key items developed for this review. The data were examined for quality assurance among three experienced researchers.

Data Synthesis.

A behavioral model of the built environment guides the synthesis according to three components: the origin and destination of the walk or bike trip, the characteristics of the road traveled, and the characteristics of the areas surrounding the trip's origin and destination. These components, combined with the characteristics of the instruments themselves, lead to a classification of the instruments into the four categories of inventory, route quality assessment, area quality assessment, and approaches to estimating latent demand for walking and bicycling. Furthermore, individual variables used in each instrument to measure the environment are grouped into four classes: spatiophysical, spatiobehavioral, spatiopsychosocial, and policy-based.

Major Conclusions.

Individually, existing instruments rely on selective classes of variables and therefore assess only parts of built environments that affect walking and bicycling. Most of the instruments and individual measures have not been rigorously tested because of a lack of available data on walking and bicycling and because of limited research budgets. Future instrument development will depend on the acquisition of empirical data on walking and bicycling, on inclusion of all three components of the behavioral model, and on consideration of all classes of variables identified.

Neighborhood Environment, Access to Places for Activity, and Leisure-Time Physical Activity in a Diverse North Carolina Population

Purpose.

To examine associations between perceived neighborhood characteristics, access to places for activity, and leisure-time physical activity.

Design.

Cross-sectional telephone survey.

Setting.

Cabarrus, Henderson, Pitt, Robeson, Surry, and Wake counties in North Carolina.

Subjects.

Population-based sample of 1796 adults at least 18 years of age residing in the six counties.

Measures.

The 133-item questionnaire assessed self-reported leisure-time physical activity and perceptions of neighborhood characteristics (sidewalks, trails, heavy traffic, streetlights, unattended dogs, and safety from crime) and general access to places for physical activity.

Results.

Trails, streetlights, and access to places were positively associated with engaging in any leisure activity: unadjusted odds ratio (OR) (95% confidence interval [CI]); 1.62 (1.09–2.41), 1.57 (1.14–2.17), and 2.94 (1.91–4.52), respectively. Trails and access to places were positively associated with engaging in the recommended amount of leisure activity: 1.49 (1.00–2.22), and 2.28 (1.30–4.00), respectively). In multivariable logistic regression modeling including environmental factors and demographics, access to places was associated with any activity (2.23 [1.44–3.44]) and recommended activity (2.15 [1.23–3.77]), and trails were associated with recommended activity (1.51 [1.00–2.28]).

Conclusion.

Certain neighborhood characteristics, particularly trails, and access to places for physical activity may be associated with leisure activity levels. In this study, perceived neighborhood environmental factors and access to places for physical activity were strongly associated with race, education, and income.

The Relationship between Convenience of Destinations and Walking Levels in Older Women

Purpose.

To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood “walkability” rating.

Design.

Cross-sectional analysis of data obtained in 1999.

Setting.

Community in southwest Pennsylvania.

Subjects.

Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%.

Measures.

Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer.

Results.

Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings ( p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire ( p < .01). There was also a positive trend between participants' neighborhood “walkability” rating and activity levels measured by pedometer and questionnaire ( p < .01).

Conclusion.

These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.

Linking Perceptions of the Community to Behavior: Are Protective Social Factors Associated with Physical Activity?

Although the relationship of psychosocial factors to physical activity has been explored, there is increased interest in how perceptions of the community environment influence behavior.However, few methodological studies have incorporated perceptions of the social and community environment (protective social factors) or addressed key measurement issues.Computer-assisted telephone interviews were administered to a national sample of 1, 818 U.S.adults.Unadjusted and multivariate-adjusted odds ratios were calculated to compare active and inactive participants by Protective Social Factors (PSF) scores and selected sociodemographics. Confirmatory factor analysis and reliability analysis suggested strong PSF scale psychometric properties (• =. 92). After adjustment for potential confounders, a 10-point rise in the PSF score resulted in a 12% increased likelihood of meeting Centers for Disease Control and Prevention/American College of Sports Medicine recommendations. Additional analyses indicated that greater perceived PSFs were associated with meeting these recommendations among Whites but not among African Americans.

Environmental Perceptions Related to Physical Activity in High- and Low-Risk Counties

To identify whether perceptions about the physical activity environment were related to the prevalence of sedentary lifestyle, residents from high-risk (n = 153) or low-risk (n = 100) counties were interviewed. County risk status was determined by the prevalence of cardiovascular mortality, overweight, and sedentary lifestyle. Key public officials in the same counties were also interviewed. Residents in the low-risk county were more likely to report having sidewalks in their community and that these sidewalks were safe and well lit than residents living in the high-risk counties. Low-risk county residents also reported more indoor recreation facilities being available than the residents in the high-risk counties. Residents supported allocating tax dollars toward improving sidewalks, lighting, and so on. Thus a more conducive environment for physical activity was found in the low-risk county. Improving physical environments and individual perceptions could help increase physical activity behavior.

Active Transport to Work in Australia: Is it all downhill from here?

Physical inactivity is increasing in Australia and active forms of transportation may be one way to increase the working population's daily physical activity. We used travel-to-work data from employed persons aged 15 years and over participating in the 1996 (n = 7,636,319) and 2001 (n = 8,298,606) Australian censuses to determine prevalence and trends in walking and cycling to work by state and gender, and differences in prevalence by age. In 2001, 3.8% of Australians walked to work and < 1% cycled. Over 64% travelled to work by car. There have been small declines in walking (men and women) and cycling (men) over the 5-years from 1996 to 2001. People were more likely to walk or cycle to work if they lived in the Northern Territory, if they were male or if they were aged 15 to 24 years. They were more likely to travel by car if they lived in the Australian Capital Territory, if they were male, or if they were aged 45-54 years. Few people walk or cycle to work in Australia. Efforts to encourage active transportation are urgently needed.

Barriers to Walking: An Investigation of Adults in Hamilton (Ontario, Canada)

This study investigates perceived barriers to walking using data collected from 179 randomly-selected adults between the ages of 18 and 92 in Hamilton, Ontario, Canada. A survey (Hamilton Active Living Study) asked questions about socio-demographics, walking, and barriers to walking. A series of binary logit models are estimated for twenty potential barriers to walking. The results demonstrate that different barriers are associated with different sub-groups of the population. Females, senior citizens, and those with a higher body mass index identify the most barriers to walking, while young adults, parents, driver's license owners, and bus pass owners identify the fewest barriers. Understanding who is affected by perceived barriers can help policy makers and health promotion agencies target sub-groups of the population in an effort to increase walking.

A Comparison of Objective Physical Activity, Muscle Strength, and Depression among Community-dwelling Older Women Living in Sloped Versus Non-sloped Environments

OBJECTIVE

To examine the relationship between the living location and outcomes of physical activity level and physical and psychological functioning in older women. The specific aim was to understand the association between living in a sloped versus non-sloped environment and these outcomes.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

108 older women aged 65 years or older who resided in Nagasaki prefecture participated.

MEASUREMENTS

Physical activity, lung function, muscle strength (hand grip and quadriceps force) and depressive symptoms were assessed objectively.

RESULTS

In logistic regression, activity counts per day (OR 0.779, 95%CI 0.715-0.841, p<0.01), activity times per day (OR 0.821, 95%CI 0.801-0.913, p<0.01), hand grip force (OR 0.666, 95%CI 0.558-0.796, p<0.001), and depressed (Center for Epidemiological Studies Depression Scale score ≥16) (OR 1.093, 95%CI 1.019-1.427, p<0.05) showed statistically significant inverse associations with living in a sloped ground.

CONCLUSIONS

Since dwelling on sloped ground was associated with negative (lower physical activity levels, lower grip strength, and more depression) outcomes, a comprehensive geriatric assessment, related to all aspects of older women, is recommended. Planning of home exercise programs for the elderly should take such environmental factors into consideration.

Does territoriality modify the relationship between perceived neighborhood challenges and physical activity? A multilevel analysis

PURPOSE

Individuals who perceive more neighborhood challenges are less physically active. Territoriality, an observable positive marker of social presence and defensible space in the neighborhood, may influence the association between neighborhood challenges and physical activity (PA). We hypothesized that greater territoriality would reduce the negative effects of neighborhood challenges on PA levels.

METHODS

Data were collected by the Healthy Environments Partnership in an urban Midwestern city. Multilevel regressions were used to test associations in a sample of 696 white, black, and Hispanic adults older than 25 years.

RESULTS

Territoriality moderated associations between residents' perceptions of neighborhood challenges and PA. Contrary to our hypothesis, individuals who perceived more neighborhood challenges and lived in areas with more territoriality markers (e.g., buildings with decorations, buildings with security signage, and neighborhood watch signs) were less physically active than other respondents (b = -2.41, standard error = 0.84, P < .01).

CONCLUSIONS

Our findings suggest that associations between perceived neighborhood challenges and PA are shaped by the context in which the individual lives. Our study provides empirical evidence that individual perceptions and observed neighborhood characteristics are joint contributors to PA and suggest the need for continued research to characterize the complexity of individual and contextual factors that contribute to PA.

Vital places: Facilitators of behavioral and social health mechanisms in low-income neighborhoods

Starkly unequal built and social environments among urban neighborhoods are part of the explanation for health disparities in the United States. This study is a qualitative investigation of the ways that residents of a low-income neighborhood in Madison, WI, use and interpret nearby neighborhood places. Specifically, I ask how and why certain places may facilitate beneficial behavioral and social mechanisms that impact health. I develop the organizing concept of "vital places": nearby destinations that are important to and frequently-used by neighborhood residents, and that have theoretical relevance to health. I argue that conceiving of certain places as vital integrates our understanding of the essential components of places that are beneficial to health, while also allowing policy-makers to be creative about the ways they intervene to improve the life chances of residents in disadvantaged neighborhoods. I synthesize the findings into the characteristics of three types of vital places. First, I find that a convenient, comprehensive, and affordable food source can facilitate a healthy diet. An attractive, accessible, and safe recreational facility can support greater physical and social activity. Finally, shared, casual, focused social spaces provide opportunities to create and sustain supportive social ties. This study adds depth and complexity to the ways we conceptualize health-relevant community assets and provides insight into revitalization strategies for distressed low-income housing.

How design of places promotes or inhibits mobility of older adults: realist synthesis of 20 years of research

OBJECTIVE

The objective of this study was to determine the environmental features that best support aging in place.

METHOD

We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991-2011) that attempts to explain how place may influence older adults' decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory.

RESULTS

Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors.

DISCUSSION

Safety considerations are one of the most prominent influences of older adults' decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults.

Efforts of a Kansas foundation to increase physical activity and improve health by funding community trails, 2012

INTRODUCTION

Trails are associated with increased physical activity; however, little is known about the process of building trails by various types of organizations. From 2005 through 2012 the Sunflower Foundation: Health Care for Kansans (Sunflower) funded multiple organizations to construct 70 trails of varying lengths and surfaces in municipalities, schools, and communities across Kansas. The purpose of this study was to assess the process of developing and implementing community trail projects across Kansas with funding from a public foundation.

METHODS

In 2012, we stratified funded organizations by type and conducted proportional random sampling to select 20 key informants from those organizations to participate in structured telephone interviews. Interviews were recorded and transcribed verbatim. Two researchers coded interview transcripts according to issues identified by participants.

RESULTS

Issues associated with trail-building identified as important were collaboration among groups, unexpected construction costs, champions for the project, and level of difficulty of construction. Participants indicated that trails facilitated physical activity. Trails were integrated into communities through events such as walking events and other promotional efforts; these efforts were thought to increase trail use. The perceived outcomes of building the trails included providing the community with a physical activity resource, inspiring the community to start additional trail projects, and increasing the physical activity of local residents.

CONCLUSION

Sunflower's funding was instrumental in developing trail projects to provide new physical activity resources across Kansas. Public health practitioners seeking to increase physical activity should seek funding from foundations that focus on health.

Associations between perceived and observational physical environmental factors and the use of walking paths: a cross-sectional study

Background

How to promote physical activity is an important public health problem that is attracting increasing attention. Although the application of environmental approaches is believed to promote resident walking, there remains insufficient evidence of the effectiveness of these interventions.

Methods

This study employed direct observation and questionnaires. Observations were performed on each Tuesday, Thursday, Saturday, and Sunday from April 13th to May 16th. Fourteen trained observers observed six community walking paths, and an additional walking path in a park. The trained observers filled out 2388 observation forms in the field, including 228 forms rating the permanent environment, and 1080 forms assessing the current environment and counting the number of walkers. A total of 1800 questionnaireswere administered to community residents.

Results

The results of both observation and questionnaires showed good association regarding the characteristics of walking path users (for observation, female = 54.4%; for questionnaire interviews, female, OR = 1.441), and the environmental features associated with walking path utilization (for observation, positive associations were observed between the utilization index and observational environmental variables; for questionnaire interviews, roads and aesthetics were important, OR = 1.044). There were positive associations between path use and time, a preference for brisk walking, and the observed current and permanent environmental variables. Female participants were more likely to use walking paths than males (OR = 1.441, 95% confidence interval [CI] 1.126–1.846). BMI and traffic hazard safety were significantly negatively associated with walking path use (OR = 0.948, 95% CI 0.915–0.981, and OR = 0.933, 95% CI 0.887–0.981, respectively). Roads, aesthetics, and knowledge of physical activity were significantly positively correlated with use of walking paths (OR = 1.044, 95% CI 1.017–1.072, and OR = 1.175, 95% CI 1.043–1.323). Participants that resided further than 1 km from the park were less likely to use walking paths (OR = 0.703, 95% CI 0.530–0.933). Gender-specific associations were also found.

Conclusions

Both perceived and objective environmental factors were associated with walking path use. Data suggested that the permanent and current conditions of the paths might influence walking path utilization, and that gender-specific promotion strategies should be considered.

Development and validation of a tool to assess the physical and social environment associated with physical activity among adults in Sri Lanka

BACKGROUND

Environmental characteristics are known to be associated with patterns of physical activity (PA). Although several validated tools exist, to measure the environment characteristics, these instruments are not necessarily suitable for application in all settings especially in a developing country. This study was carried out to develop and validate an instrument named the "Physical And Social Environment Scale--PASES" to assess the physical and social environmental factors associated with PA. This will enable identification of various physical and social environmental factors affecting PA in Sri Lanka, which will help in the development of more tailored intervention strategies for promoting higher PA levels in Sri Lanka.

METHODS

The PASES was developed using a scientific approach of defining the construct, item generation, analysis of content of items and item reduction. Both qualitative and quantitative methods of key informant interviews, in-depth interviews and rating of the items generated by experts were conducted. A cross sectional survey among 180 adults was carried out to assess the factor structure through principal component analysis. Another cross sectional survey among a different group of 180 adults was carried out to assess the construct validity through confirmatory factor analysis. Reliability was assessed with test re-test reliability and internal consistency using Spearman r and Cronbach's alpha respectively.

RESULTS

Thirty six items were selected after the expert ratings and were developed into interviewer administered questions. Exploration of factor structure of the 34 items which were factorable through principal component analysis with Quartimax rotation extracted 8 factors. The 34 item instrument was assessed for construct validity with confirmatory factor analysis which confirmed an 8 factor model (x2 = 339.9, GFI = 0.90). The identified factors were infrastructure for walking, aesthetics and facilities for cycling, vehicular traffic safety, access and connectivity, recreational facilities for PA, safety, social cohesion and social acceptance of PA with the two non-factorable factors, residential density and land use mix. The PASES also showed good test re-test reliability and a moderate level of internal consistency.

CONCLUSIONS

The PASES is a valid and reliable tool which could be used to assess the physical and social environment associated with PA in Sri Lanka.

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.

People living in hilly residential areas in metropolitan Perth have less diabetes: spurious association or important environmental determinant?

Background

Variations in ‘slope’ (how steep or flat the ground is) may be good for health. As walking up hills is a physiologically vigorous physical activity and can contribute to weight control, greater neighbourhood slopes may provide a protective barrier to weight gain, and help prevent Type 2 diabetes onset. We explored whether living in ‘hilly’ neighbourhoods was associated with diabetes prevalence among the Australian adult population.

Methods

Participants (≥25 years; n = 11,406) who completed the Western Australian Health and Wellbeing Surveillance System Survey (2003–2009) were asked whether or not they had medically-diagnosed diabetes. Geographic Information Systems (GIS) software was used to calculate a neighbourhood mean slope score, and other built environment measures at 1600 m around each participant’s home. Logistic regression models were used to predict the odds of self-reported diabetes after progressive adjustment for individual measures (i.e., age, sex), socioeconomic status (i.e., education, income), built environment, destinations, nutrition, and amount of walking.

Results

After full adjustment, the odds of self-reported diabetes was 0.72 (95% CI 0.55-0.95) and 0.52 (95% CI 0.39-0.69) for adults living in neighbourhoods with moderate and higher levels of slope, respectively, compared with adults living in neighbourhoods with the lowest levels of slope. The odds of having diabetes was 13% lower (odds ratio 0.87; 95% CI 0.80-0.94) for each increase of one percent in mean slope.

Conclusions

Living in a hilly neighbourhood may be protective of diabetes onset or this finding is spurious. Nevertheless, the results are promising and have implications for future research and the practice of flattening land in new housing developments.

Associations of neighborhood characteristics with active park use: an observational study in two cities in the USA and Belgium

BACKGROUND

Public parks can be an important setting for physical activity promotion, but to increase park use and the activity levels of park users, the crucial attributes related to active park use need to be defined. Not only user characteristics and structural park attributes, but also characteristics of the surrounding neighborhood are important to examine. Furthermore, internationally comparable studies are needed, to find out if similar intervention strategies might be effective worldwide. The main aim of this study was to examine whether the overall number of park visitors and their activity levels depend on study site, neighborhood walkability and neighborhood income.

METHODS

Data were collected in 20 parks in Ghent, Belgium and San Diego, USA. Two trained observers systematically coded park characteristics using the Environmental Assessment of Public Recreation Spaces (EAPRS) tool, and park user characteristics using the System for Observing Play and recreation in Communities (SOPARC) tool. Multilevel multiple regression models were conducted in MLwiN 2.25.

RESULTS

In San Diego parks, activity levels of park visitors and number of vigorously active visitors were higher than in Ghent, while the number of visitors walking and the overall number of park visitors were lower. Neighborhood walkability was positively associated with the overall number of visitors, the number of visitors walking, number of sedentary visitors and mean activity levels of visitors. Neighborhood income was positively associated with the overall number of visitors, but negatively with the number of visitors being vigorously active.

CONCLUSIONS

Neighborhood characteristics are important to explain park use. Neighborhood walkability-related attributes should be taken into account when promoting the use of existing parks or creating new parks. Because no strong differences were found between parks in high- and low-income neighborhoods, it seems that promoting park use might be a promising strategy to increase physical activity in low-income populations, known to be at higher risk for overweight and obesity.

Perceived environment and public open space use: a study with adults from Curitiba, Brazil

BACKGROUND

The aim of this study was to investigate the association between the perceived environment and the use of public open spaces (POS).

METHODS

A cross-sectional study with household surveys was conducted in 1,461 adults from Curitiba, Brazil interviewed in person. The perceived environment was evaluated with the Neighborhood Environment Walkability Scale, and the POS use was evaluated using the ordinal scale (increased use).

RESULTS

The presence of interesting objects, heavy traffic, and the number of positive attributes of the environment was positively associated with POS use among men, and the presence of trees was associated with the use among women.

CONCLUSIONS

Managers should invest in the architectural attractiveness of neighborhoods and should plant and conserve trees to encourage POS use.

Travel to, and use of, twenty-one Michigan trails

OBJECTIVE AND METHODS

This study examined trail use among 857 trail users on 21 trails in Michigan from 2008 to 2011 using a valid and reliable intercept survey.

RESULTS

Most of the 857 participants traveled to the trail from their home (92.6%), lived within 15 min of the trails (74.8%), and used active transport to travel to the trails 69.7%. The odds of active transport to the trails were greater among those who had not graduated high school (OR=3.49; 95% CI=1.02, 11.99) and high school graduates (OR=7.432; 95% CI=2.02, 27.30) compared to college graduates. Whites and adults also had greater odds of active transport than non-Whites (OR=3.160, 95% CI: 1.65, 6.05), and older adults (OR=1.75; 95% CI: 1.20, 2.54). The majority of respondents (89.7%) reported using trails for recreational purposes. A significantly greater proportion of females (73.3%) compared to males (64.7%) reported using the trail with others.

CONCLUSIONS

The findings from this study might enable health and parks and recreation professionals to better promote physical activity on trails.

Association between residents' perception of the neighborhood's environments and walking time in objectively different regions

OBJECTIVE

The purpose of this study is to delineate the association between residents' perception of the neighborhood's environments and walking time in objectively different regions in Japan.

METHODS

Two regions were selected as high and low walkable regions on the basis of differences in their residential density, mixed land use and street connectivity. The subjects in this study were participants in a health promotion program focused on walking sponsored by local governments. A questionnaire was sent to the participants asking about how their perception of the neighborhood's environment related to walking, and the time spent walking per week. There were 237 residents from the high walkable region and 195 from the low walkable region who completed the study survey.

RESULTS

The high walkable region had a larger residential density, a high mixed land use and a higher street connectivity than the low walkable region. Walking time, and the scores of the perception of the neighborhood's environment for the high walkable region residents were significantly higher than those for the low walkable region residents. Thus, residents' perception of the neighborhood's environment generally reflected the actual physical environmental characteristics. Residents in the high walkable region whose scores for accessibility and aesthetics were high, spent significantly more walking time. Residents in the low walkable region whose scores for accessibility, safety, convenience and aesthetics were high, spent significantly more walking time.

CONCLUSION

The study results suggested that the neighborhood's environment may influence daily walking time. The perceptions of the neighborhood's environmental factors that correlate with walking times differ between the different regional physical environments. Therefore, to promote physical activity, the consideration of environmental factors unique to residents' neighborhood's environments is needed.

Rationale and development of the Move More North Carolina: Recommended Standards for After-School Physical Activity

The purpose of this article is to describe the rationale and procedure employed in developing the Move More North Carolina: Recommended Standards for After-School Physical Activity, which was publicly released statewide in April 2009. The Standards outline evidenced-based best practices for after-school programs to implement in order to increase amount and quality of physical activity (PA) among program participants. The Standards can be applied in any after-school program and were developed to benefit the approximately 152,000 school-aged children who are served by NC after-school programs each year. These programs often serve children at high risk for physical inactivity, including children from racial/ethnic minorities, impoverished areas, with disabilities, and/or living in neighborhoods with limited PA opportunities. The rationale for developing standards for PA in after-school programs is threefold: (1) such programs can provide enjoyable, safe, and age-appropriate PA; (2) they can facilitate family involvement, community partnership, and increase access to PA resources; and (3) they serve children at risk for inactivity. Recommended best practices are included for the following categories: time/intensity, qualified staff/training, curriculum, program size, facilities, equipment, and evaluation. Methods used to inform The Standards included a planning team, on-line surveys, focus groups, a systematic literature review, a consensus panel, and external expert review. The impact of The Standards is yet to be seen, but the collaborative process used in their creation can serve as a model for the development of similar PA standards in other states.

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.

Measuring availability of healthy foods: agreement between directly measured and self-reported data

A major challenge in studies of the impact of the local food environment is the accuracy of measures of healthy food access. The authors assessed agreement between self-reported and directly measured availability of healthful choices within neighborhood food stores and examined the validity of reported availability using directly measured availability as a "gold standard." Reported availability was measured via a phone survey of 1,170 adults in Baltimore, Maryland, in 2004. Directly measured availability was assessed in 226 food stores in 2006 using a modified Nutrition Environment Measures Survey in Stores (NEMS-S). Whites, college-educated individuals, and higher income households (≥$50,000) had significantly higher reported and directly measured availability than did blacks, those with less education, and lower income households. Persons in areas with above average directly measured availability reported above average availability 70%-80% of the time (sensitivity = 79.6% for all stores within 1 mile (1.6 km) of participants' homes and 69.6% for the store with the highest availability within 1 mile). Those with below average directly measured availability reported low availability only half the time. With revisions to improve specificity, self-reported measures can be reasonable indicators of healthy food availability and provide feasible proxy measures of directly assessed availability.

Evaluation of personal and built environment attributes to physical activity: a multilevel analysis on multiple population-based data sources

Background. Studies have documented that built environment factors potentially promote or impede leisure time physical activity (LTPA). This study explored the relationship between multiple built environment factors and individual characteristics on LTPA. Methods. Multiple data sources were utilized including individual level data for health behaviors and health status from the Nevada Behavioral Risk Factor Surveillance System (BRFSS) and community level data from different data sources including indicators for recreation facilities, safety, air quality, commute time, urbanization, population density, and land mix level. Mixed model logistic regression and geographic information system (GIS) spatial analysis were conducted. Results. Among 6,311 respondents, 24.4% reported no LTPA engagement during the past 30 days. No engagement in LTPA was significantly associated with (1) individual factors: older age, less education, lower income, being obesity, and low life satisfaction and (2) community factors: more commute time, higher crime rate, urban residence, higher population density, but not for density and distance to recreation facilities, air quality, and land mix. Conclusions. Multiple data systems including complex population survey and spatial analysis are valuable tools on health and built environment studies.

A photovoice documentation of the role of neighborhood physical and social environments in older adults' physical activity in two metropolitan areas in North America

A substantial body of evidence indicates that regular engagement in moderate-intensity physical activity on most days of the week is sufficient for older adults to achieve positive health outcomes. Although there is a growing body of literature that examines the affect of neighborhood environment on physical activity in older adults, the research tends to overlook social aspects that potentially shape the relationship between physical environment and physical activity. This article presents qualitative themes related to the role of the physical and social environments in influencing physical activity among older adults as identified through the photovoice method with sixty-six older adults in eight neighborhoods in metropolitan Vancouver, British Columbia, Canada and Greater Portland, Oregon, USA. The photovoice data generated seven themes: being safe and feeling secure, getting there, comfort in movement, diversity of destinations, community-based programs, peer support and intergenerational/volunteer activities. Although the majority of these themes have explicit or implicit physical and social aspects, certain themes are primarily based on physical environmental aspects (e.g., safe and feeling secure, comfort in movement), while a few themes are more oriented to social context (e.g., peer support, intergenerational activity/volunteering). The themes are discussed with a focus on how the neighborhood physical and social environmental aspects interplay to foster or hinder older adults in staying active in both everyday activities and intentional physical activities. Policy implications of the findings are discussed.

Role of built environments in physical activity, obesity, and cardiovascular disease

In industrialized nations like the United States and Sweden, the vast majority of adults do not meet the physical activity guidelines of 150 minutes per week.1 Inactive lifestyles put most adults at risk of cardiovascular diseases (CVD), diabetes, obesity, some cancers, osteoporosis, and psychological disorders.2 Physical activity can be effective at all phases of chronic disease management, from primordial prevention (prevention of risk factors) through treatment and rehabilitation.2 There is particular interest in the potential for physical activity to prevent chronic diseases, thereby improving quality of life and reducing health care costs.3 In the past decade, limitations of prevention approaches that target mainly individuals with educational and motivational programs have been recognized, triggering a trend to consider influences on behavior that are outside the person, such as the built environment.4 ,5 The purposes of the present paper are to describe multilevel ecological models of behavior as they apply to physical activity, describe key concepts, summarize evidence on the relation of built environment attributes to physical activity and obesity, and provide recommendations for built environment changes that could increase physical activity. The intent of this non-systematic review is to present conclusions from previous reviews then illustrate results by highlighting selected studies.

The influence of neighborhood residential density, physical and social environments on older adults' physical activity: An exploratory study in two metropolitan areas

This study explored the influence of neighborhood residential density, physical and social environments on physical activity of older adults in Metro Vancouver, British Columbia and Metro Portland, Oregon. Eight neighborhoods in the two metropolitan regions were selected based on varying population density and income levels. Photovoice method was used with sixty-six older adult participants across the neighborhoods. Data were analyzed to explore any possible differences in the physical or social environmental aspects perceived as barriers or facilitators to physical activity between the higher and lower density neighborhoods. Four themes emerged based on a systematic analysis of the participant-taken photographs, participants' descriptions of photographs and group discussions. These themes were: safety and security, accessibility, comfort of movement, and peer support. Although a few themes were common across the eight neighborhoods, there were also differences between neighborhoods of varying residential density and across the two metro areas. More negative issues were reported concerning traffic hazards and personal safety in the higher density neighborhoods compared to the lower density neighborhoods. Also, a more positive outlook on public transportation was noted in the higher density neighborhoods. Across the two regions, differences were noted regarding private transportation, intergenerational activities and volunteering.