Perceptions of neighborhood environment for physical activity: is it "who you are" or "where you live"?

Leveraging the Black Girls Run Web-Based Community as a Supportive Community for Physical Activity Engagement: Mixed Methods Study

BACKGROUND

About 59%-73% of Black women do not meet the recommended targets for physical activity (PA). PA is a key modifiable lifestyle factor that can help mitigate risk for chronic diseases such as obesity, diabetes, and hypertension that disproportionately affect Black women. Web-based communities focused on PA have been emerging in recent years as web-based gathering spaces to provide support for PA in specific populations. One example is Black Girls Run (BGR), which is devoted to promoting PA in Black women.

OBJECTIVE

The purpose of this study was to describe the content shared on the BGR public Facebook page to provide insight into how web-based communities engage Black women in PA and inform the development of web-based PA interventions for Black women.

METHODS

Using Facebook Crowdtangle, we collected posts (n=397) and associated engagement data from the BGR public Facebook page for the 6-month period between June 1, 2021, and December 31, 2021. We pooled data in Dedoose to analyze the qualitative data and conducted a content analysis of qualitative data. We quantified types of posts, post engagement, and compared post types on engagement: "like," "love," "haha," "wow," "care," "sad," "angry," "comments," and "shares."

RESULTS

The content analysis revealed 8 categories of posts: shout-outs to members for achievements (n=122, 31%), goals or motivational (n=65, 16%), announcements (n=63, 16%), sponsored or ads (n=54, 14%), health related (n=47, 11%), the lived Black experience (n=23, 6%), self-care (n=15, 4%), and holidays or greetings (n=8, 2%). The 397 posts attracted a total of 55,354 engagements (reactions, comments, and shares). Associations between the number of engagement and post categories were analyzed using generalized linear models. Shout-out posts (n=22,268) elicited the highest average of total user engagement of 181.7 (SD 116.7), followed by goals or motivational posts (n=11,490) with an average total engagement of 160.1 (SD 125.2) and announcements (n=7962) having an average total engagement of 129.9 (SD 170.7). Significant statistical differences were found among the total engagement of posts (χ72=80.99, P<.001), "like" (χ72=119.37, P<.001), "love" (χ72=63.995, P<.001), "wow" (χ72=23.73, P<.001), "care" (χ72=35.06, P<.001), "comments" (χ72=80.55, P<.001), and "shares" (χ72=71.28, P<.001).

CONCLUSIONS

The majority of content on the BGR Facebook page (n=250, 63%) was focused on celebrating member achievements, motivating members to get active, and announcing and promoting active events. These types of posts attracted 75% of total post engagement. BGR appears to be a rich web-based community that offers social support for PA as well as culturally relevant health and social justice content. Web-based communities may be uniquely positioned to engage minoritized populations in health behavior. Further research should explore how and if web-based communities such as BGR can be interwoven into health interventions and health promotion.

Racial and Ethnic Differences in the Relationship Between Neighborhood Environment and Physical Activity Among Middle-Aged and Older Adults

Objectives:To examine the associations between neighborhood environment-perceived neighborhood social cohesion and perceived neighborhood physical environment-and physical activity (PA) and whether these associations differ by race/ethnicity. Methods: We analyzed data from the Health and Retirement Study, a longitudinal study of US adults aged 50+ from 2006 to 2014 (N = 17,974), using multivariate mixed-effects linear models. PA was repeatedly measured using metabolic equivalent of task estimated values accounting for the vigor and frequency of self-reported PA. Results: In multivariate models, higher levels of PA were positively associated with higher rated neighborhood social cohesion and neighborhood physical environment scores. The effects of social cohesion were stronger among non-Hispanic Whites than among non-Hispanic Black and Hispanic/Latinx participants, while race/ethnicity did not moderate the association between PA and physical environment. Discussion: Intervention strategies that address social and physical barriers of neighborhoods could promote PA in older adults. Key implications for future research are discussed.

The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans

Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.

Urban and rural differences in new onset type 2 diabetes: Comparisons across national and regional samples in the diabetes LEAD network

Introduction

Geographic disparities in diabetes burden exist throughout the United States (US), with many risk factors for diabetes clustering at a community or neighborhood level. We hypothesized that the likelihood of new onset type 2 diabetes (T2D) would differ by community type in three large study samples covering the US.

Research design and methods

We evaluated the likelihood of new onset T2D by a census tract-level measure of community type, a modification of RUCA designations (higher density urban, lower density urban, suburban/small town, and rural) in three longitudinal US study samples (REGARDS [REasons for Geographic and Racial Differences in Stroke] cohort, VADR [Veterans Affairs Diabetes Risk] cohort, Geisinger electronic health records) representing the CDC Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network.

Results

In the REGARDS sample, residing in higher density urban community types was associated with the lowest odds of new onset T2D (OR [95% CI]: 0.80 [0.66, 0.97]) compared to rural community types; in the Geisinger sample, residing in higher density urban community types was associated with the highest odds of new onset T2D (OR [95% CI]: 1.20 [1.06, 1.35]) compared to rural community types. In the VADR sample, suburban/small town community types had the lowest hazard ratios of new onset T2D (HR [95% CI]: 0.99 [0.98, 1.00]). However, in a regional stratified analysis of the VADR sample, the likelihood of new onset T2D was consistent with findings in the REGARDS and Geisinger samples, with highest likelihood of T2D in the rural South and in the higher density urban communities of the Northeast and West regions; likelihood of T2D did not differ by community type in the Midwest.

Conclusions

The likelihood of new onset T2D by community type varied by region of the US. In the South, the likelihood of new onset T2D was higher among those residing in rural communities.

COVID-19: Implications for Physical Activity, Health Disparities, and Health Equity

Physical activity is one of the most efficacious pathways to promoting mental and physical health, preventing disease, and, most important during the COVID-19 pandemic, bolstering a stronger immune system. Efforts to "flatten the curve" have resulted in the temporary closure of exercise facilities and gyms, suspension of sport activities, and advisories to avoid public recreational spaces. All of these changes have made traditional opportunities to be physically active difficult to access. These changes have also exacerbated existing disparities in access to social and environmental supports for physical activity, potentially contributing to a widening gap in physical activity participation among those at greatest risk for COVID-19. Physical activity can play a special role in reducing the inequitable consequences of COVID-19; however, expansion and better targeting of evidence-informed interventions are needed that address the unique barriers present in communities that have been economically and socially marginalized to achieve health equity in COVID-19 outcomes. This review highlights effective and feasible strategies that provide more equitable access to physical activity programs and spaces across the United States. With a renewed investment in physical activity, this behavior can play a crucial role in improving population health and reducing disparities during the COVID-19 pandemic and beyond.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly

Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer's disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.

Assessing Attitudes Toward COVID-19 Prevention: Defining Two Attitudes Crucial for Understanding Systemic and Social Variables Associated with Disparities

This study tested a conceptual model identifying two distinct types of attitudes people may have toward following recommendations to prevent COVID-19. These attitudes were expected to be important for understanding types of systemic and social variables associated with health disparities such as racial discrimination, residential environment, lack of healthcare access, and negative healthcare experiences. The conceptual model was drawn from previous work examining adherence to medical recommendations that identified two distinct and consequential attitudes that influence behavior: perceived benefit (believing recommendations are effective and necessary) and perceived burden (experiencing recommendations as unpleasant or difficult). Approximately equal proportions of Black and White individuals living in the USA (N = 194) were recruited to complete an online survey. A psychometric analysis indicated that perceived benefit and burden attitudes were two distinct and meaningful dimensions that could be assessed with high validity, and scales demonstrated measurement invariance across Black and White groups. In correlation analyses, benefit and burden attitudes were robustly associated with neighborhood violence, healthcare access, and healthcare experiences (but not with experiences of discrimination), and all these associations remained significant after accounting for subjective stress and political affiliation. These findings have implications for increasing compliance to public health recommendations and addressing health disparities.

Quantifying and explaining variation in life expectancy at census tract, county, and state levels in the United States

Studies on geographic inequalities in life expectancy in the United States have exclusively focused on single-level analyses of aggregated data at state or county level. This study develops a multilevel perspective to understanding variation in life expectancy by simultaneously modeling the geographic variation at the levels of census tracts (CTs), counties, and states. We analyzed data from 65,662 CTs, nested within 3,020 counties and 48 states (plus District of Columbia). The dependent variable was age-specific life expectancy observed in each of the CTs. We also considered the following CT-level socioeconomic and demographic characteristics as independent variables: population density; proportions of population who are black, who are single parents, who are below the federal poverty line, and who are aged 25 or older who have a bachelor's degree or higher; and median household income. Of the total geographic variation in life expectancy at birth, 70.4% of the variation was attributed to CTs, followed by 19.0% for states and 10.7% for counties. The relative importance of CTs was greater for life expectancy at older ages (70.4 to 96.8%). The CT-level independent variables explained 5 to 76.6% of between-state variation, 11.1 to 58.6% of between-county variation, and 0.7 to 44.9% of between-CT variation in life expectancy across different age groups. Our findings indicate that population inequalities in longevity in the United States are primarily a local phenomenon. There is a need for greater precision and targeting of local geographies in public policy discourse aimed at reducing health inequalities in the United States.

Associations Between Neighborhood Social Cohesion and Physical Activity in the United States, National Health Interview Survey, 2017

Background

Individual social support is positively related to physical activity participation. However, less is known about how neighborhood-level social structures relate to physical activity participation.

Methods

We analyzed 2017 National Health Interview Survey data for adult participants who completed all questions on physical activity and neighborhood cohesion (N = 23,006). Each cohesion question was binary coded (cohesion or not) and used as a predictor individually and for a composite score measuring total social cohesion. We used linear regression to estimate minutes of moderate aerobic activity, and we used logistic regression to estimate the odds of meeting aerobic guidelines (≥150 min/wk), strength guidelines (≥2 d/wk of muscle strengthening exercises), or both guidelines, predicted by the 5 definitions of cohesion (composite cohesion and the 4 questions separately). Models were adjusted for sex, age, race/ethnicity, family-income-to-poverty ratio, education, nativity, language, and neighborhood tenure.

Results

Respondents who reported having more social cohesion had 45.0 more minutes of aerobic activity and increased odds of meeting aerobic, strength, and combined guidelines (odds ratio [OR] = 1.22, OR = 1.13, and OR = 1.14, respectively; P < .01 for all). Reporting having availability of help when needed, neighbors to count on, trustworthy neighbors, and close-knit neighbors all resulted in increased odds of meeting aerobic guidelines but not increased odds for meeting strength guidelines in the latter 3 components or combined guidelines for the latter 2 components.

Conclusions

Having neighborhood social cohesion or select individual components of neighborhood cohesion are positively related to meeting aerobic, strength, and combined guidelines.

The Effects of GPS-Based Buffer Size on the Association between Travel Modes and Environmental Contexts

To investigate the association between physical activity (including active travel modes) and environmental factors, much research has estimated contextual influences based on zones or areas delineated with buffer analysis. However, few studies to date have examined the effects of different buffer sizes on estimates of individuals’ dynamic exposures along their daily trips recorded as GPS trajectories. Thus, using a 7-day GPS dataset collected in the Chicago Regional Household Travel Inventory (CRHTI) Survey, this study addresses the methodological issue of how the associations between environmental contexts and active travel modes (ATMs) as a subset of physical activity vary with GPS-based buffer size. The results indicate that buffer size influences such associations and the significance levels of the seven environmental factors selected as predictors. Further, the findings on the effects of buffer size on such associations and the significance levels are clearly different between the ATMs of walking and biking. Such evidence of the existence of buffer-size effects for multiple environmental factors not only confirms the importance of the uncertain geographic context problem (UGCoP) but provides a resounding cautionary note to all future research on human mobility involving individuals’ GPS trajectories, including studies on physical activity and travel behaviors, especially on the reliable estimation of individual exposures to environmental factors and their health outcomes.

Correlates of Physical Activity in Urban African American Adults and Older Adults: Testing the Social Cognitive Theory

Background

Older adults, especially ethnic minorities continue to be the least active segment of the U.S. population. Health disparities are evident in that African Americans participate in less physical activity (PA) and are less likely to meet PA guidelines compared with non-Hispanic Caucasians.

Purpose

Using the social cognitive theory (SCT), this study examined the individual, social, and physical environmental correlates of PA behavior.

Methods

Participants (N = 110, females = 96, mean age = 64.8 ± 5.7 years) were urban, community-dwelling African American adults and older adults who completed demographics and psychosocial questionnaires assessing (SCT) constructs of self-efficacy, outcome expectations, social support, and perceptions of the physical environment. A latent factor PA construct represented self-report (Godin Leisure-time Exercise Questionnaire, Physical Activity Scale for the Elderly) and objective (accelerometer worn for 7 days) PA.

Results

The direct and indirect effects of SCT constructs on PA were tested using structural equation modeling, and the overall model fit was adequate (comparative fit index = 0.94, root mean square error of approximation = 0.04, standardized root mean square residual = 0.05, chi square = 67.03, p = .17). Results indicated that: (a) self-efficacy was the strongest direct predictor of PA (β = 0.79) and also influenced outcome expectations (β = 0.457, p < .001); and (b) outcome expectations directly (β = 0.36) predicted PA. Among demographic moderators, only age was inversely associated with outcome expectations (β = -0.28). Social support or physical environment did not influence PA.

Conclusions

Our findings suggest that self-efficacy and outcome expectations are important correlates of PA for African American adults and older adults. Future studies should examine the direct and indirect impact of PA interventions targeting self-efficacy and outcomes expectations to promote behavior change.

Neighborhood Recreation Facilities and Facility Membership Are Jointly Associated with Objectively Measured Physical Activity

Efforts to increase physical activity have traditionally included either individual-level interventions (e.g., educational campaigns) or neighborhood-level interventions (e.g., additional recreational facilities). Little work has addressed the interaction between spatial proximity and individual characteristics related to facility use. We aimed to better understand the synergistic impact of both physical activity environments and recreational facility membership on objectively measured physical activity. Using the New York City Physical Activity and Transit (PAT) survey (n = 644), we evaluated associations between counts of commercial physical activity facilities within 1 km of participants' home addresses with both facility membership and accelerometry-measured physical activity. Individuals living near more facilities were more likely to report membership (adjusted odds ratio for top versus bottom quartile of facility count: 3.77 (95% CI 1.54-9.20). Additionally, while amount of facilities within a neighborhood was associated with more physical activity, this association was stronger for individuals reporting gym membership. Interventions aiming to increase physical activity should consider both neighborhood amenities and potential barriers, including the financial and social barriers of membership. Evaluation of neighborhood opportunities must expand beyond physical presence to consider multiple dimensions of accessibility.

"If they focus on giving us a chance in life we can actually do something in this world": Poverty, inequality, and youths' critical consciousness

Critical consciousness (CC) has emerged as a framework for understanding how low-income and racial/ethnic minority youth recognize, interpret, and work to change the experiences and systems of oppression that they face in their daily lives. Despite this, relatively little is known about how youths' experiences with economic hardship and structural oppression shape how they "read their world" and motivate participation in critical action behaviors. We explore this issue using a mixed-methods design and present our findings in two studies. In Study 1 we examine the types of issues that a sample of low-income and predominantly racial/ethnic minority youth (ages 13-17) living in the Chicago area discuss when asked to reflect on issues that are important to them. The most commonly mentioned themes were community violence (59%), prejudice and intolerance (31%), world issues (25%), and economic disparities (18%). In Study 2 we examine youths' quantitative reports of engaging in critical action behavior; more than 65% had participated in at least one activity targeting social change in the previous 6 months. We then examined relationships between youths' experiences with poverty within their households and neighborhoods, neighborhood income inequality, and exposure to violence and youths' likelihood of participating in critical action behaviors. Greater exposure to violence and neighborhood income inequality were related to an increased likelihood of engaging in critical action behaviors. This work highlights the diverse ways that low-income and racial/ethnic minority youth reflect on societal inequality and their commitment to effecting change through sociopolitical participation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Racial Discrimination and Low Household Education Predict Higher Body Mass Index in African American Youth

OBJECTIVE

The purpose of this study was to examine the relationships between environmental factors, including household education, community violence exposure, racial discrimination, and cultural identity, and BMI in African American adolescents.

METHODS

A community-based sample of 198 African American youth (120 girls, 78 boys; ages 11-19 years) from Washtenaw County, Michigan, were included in this analysis. Violence exposure was assessed by using the Survey of Children's Exposure to Community Violence; racial discrimination by using the Adolescent Discrimination Distress Index; cultural identity by using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents; and household education by using a seven-category variable. Measured height and body weight were used to calculate BMI.

RESULTS

Racial discrimination was positively associated with BMI, whereas household education was inversely associated with BMI in African American adolescents (discrimination: β = 0.11 ± 0.04, p = 0.01; education: β = -1.13 ± 0.47, p = 0.02). These relationships were significant when accounting for the confounding effects of stress, activity, diet, and pubertal development. Significant gender interactions were observed with racial discrimination and low household education associated with BMI in girls only (discrimination: β = 0.16 ± 0.05, p = 0.003; education: β = -1.12 ± 0.55, p = 0.045). There were no significant relationships between culture, community violence exposure, and BMI (all p's > 0.05).

CONCLUSION

Environmental factors, including racial discrimination and low household education, predicted higher BMI in African American adolescents, particularly among girls. Longitudinal studies are needed to better understand the mechanisms by which these environmental factors increase obesity risk in African American youth.

Racial Differences in Neighborhood Perceptions and their Influences on Physical Activity among Urban Older Women

Background

Proper levels of physical activity (PA) are important to healthy aging. Little is known about racial differences in influences of neighborhood perceptions (NP) on PA and use of neighborhood resources among community-dwelling older women.

Materials and methods

In 2014 and 2015, 49 white and 44 black women of age 65 and older living in Washington, DC were queried about their PA, NP, use of neighborhood resources and sociodemographic characteristics. They wore an accelerometer and a Global Positioning System device concurrently for 7 consecutive days. Data were analyzed by race.

Results

Compared to Whites, Blacks had lower NP scores (71% positive vs. 77%, p = 0.01), lower mean daily step counts (mean (SD): 3256 (1918) vs. 5457 (2989), p < 0.001), and lower frequencies of all exercise activities combined (19.7 (8.7) vs. 25.2 (11.8) per week, p = 0.01). For both Whites and Blacks, better NPs were associated with more frequent PA both at (p = 0.05) and away from home (p = 0.01). However, better NPs were associated with higher frequencies of exercise activities, moderate-to-high intensity activities, and utilitarian walking for Whites but not Blacks (p < 0.05 for race-perception interaction terms).

Conclusions

In an urban setting, older Black women were more likely than older White women to have poor NPs, less PA, and weaker or no association of positive NPs with higher levels of certain PAs. Such substantial racial differences warrant further investigation and consideration in health promotion programs.

Area racism and birth outcomes among Blacks in the United States

There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditionally used survey methods. In this study, we circumvent some of these limitations by examining a previously developed Internet query-based proxy of area racism (Stephens-Davidowitz, 2014) in relation to preterm birth and low birthweight among Blacks. Area racism was measured in 196 designated market areas as the proportion of total Google searches conducted between 2004 and 2007 containing the "n-word." This measure was linked to county-level birth data among Blacks between 2005 and 2008, which were compiled by the National Center for Health Statistics; preterm birth and low birthweight were defined as <37 weeks gestation and <2500 g, respectively. After adjustment for maternal age, Census region, and county-level measures of urbanicity, percent of the Black population, education, and poverty, we found that each standard deviation increase in area racism was associated with relative increases of 5% in the prevalence of preterm birth and 5% in the prevalence of low birthweight among Blacks. Our study provides evidence for the utility of an Internet query-based measure as a proxy for racism at the area-level in epidemiologic studies, and is also suggestive of the role of racism in contributing to poor birth outcomes among Blacks.

The Impact of Symptoms of Depression and Walking on Gestational Age at Birth in African American Women

BACKGROUND

Symptoms of depression have been related to lower gestational age and preterm birth (<37 completed weeks gestation). Leisure time physical activity may have protective effects on preterm birth; however, less has been published with regard to other domains of physical activity such as walking for a purpose (e.g., for transportation) or the pathways by which symptoms of depression impact gestational age at birth.

METHODS

This was a secondary analysis of available data of African American women. Women were interviewed within 3 days after birth. We proposed a model in which walking for a purpose during pregnancy mediated the effects of symptoms of depression (measured by the 20-item Center for Epidemiologic Studies-Depression [CES-D] scale) on gestational age at birth in a sample of 1,382 African American women.

RESULTS

Using structural equation modeling, we found that the direct effect of CES-D scores of 23 or greater, which have been correlated with major depression diagnosis, on gestational age at birth was -4.23 (p < .001). These results indicate that symptoms of depression were associated with a decrease in gestational age at birth of 4.23 days. Walking for a purpose mediated the effect of CES-D scores of 23 or greater on gestational age at birth.

CONCLUSIONS

Compared with African American women without symptoms of depression, African American women who had symptoms of depression walked less for a purpose during their pregnancy and delivered infants with lower gestational age at birth. If not medically contraindicated, clinicians should incorporate walking as part of prenatal care recommendations and reassure women about safety of walking during pregnancy.

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.

Relations of Neighborhood Environment Influences, Physical Activity, and Active Transportation to/from School across African American, Latino American, and White Girls in the United States

BACKGROUND

Neighborhood environment influences may be particularly important for understanding physical activity (PA) patterns across ethnic subgroups of early adolescent girls.

PURPOSE

This study examined relationships between neighborhood variables, moderate to vigorous physical activity (MVPA), and active transportation to/from school across African American, Latino American, and White early adolescent girls living in an urban/suburban community in the northwestern U.S.A. Relations between the neighborhood variables across ethnic groups also were examined.

METHOD

The sample comprised 372 African American, Latino American, and White girls living in the U.S.A. (mean age = 12.06 years; SD = 1.69).

RESULTS

Data were analyzed using multiple-sample structural equation modeling. Results showed that girls' MVPA was positively related to physical activity facility accessibility and negatively related to age. Active transport was positively related to physical activity facility accessibility, neighborhood walkability, and age, and negatively related to distance to the nearest school and household income.

CONCLUSIONS

Findings highlight the importance of both perceived and objective neighborhood influences on girls' MVPA and active transport. Consistencies in findings across African American, Latino American, and White girls suggest that neighborhood-level PA promotion has the potential for broad impact across all three ethnic groups.

Police-Recorded Crime and Perceived Stress among Patients with Type 2 Diabetes: the Diabetes Study of Northern California (DISTANCE)

While stress has been linked to poor health outcomes, little is known about the impact of objective measures of neighborhood crime on stress in patients with chronic disease. Using the Kaiser Permanente Diabetes Study of Northern California (DISTANCE), we examined associations between police-recorded crime (2005-2007) and stress (Perceived Stress Scale-4) in four large Northern California cities (Oakland, Sacramento, San Francisco, and San Jose). We performed stratified analysis by gender and race/ethnicity using generalized linear regression models. In our study sample (n = 3188, mean age 59, range 30-77), 10 % reported high stress. In adjusted analyses, higher neighborhood all crimes rate was associated with modest increase in high stress for African-American (OR = 1.10; 95 % CI 1.02-1.22) and Latina women (OR = 1.36; 95 % CI 1.10-1.67) and property crime showed similar associations with stress for these groups of women. Visible crime was associated with stress only for Latina women (OR = 1.43; 95 % CI 1.14-1.78). We found no association between crime and stress among men or other racial/ethnic groups of women. High crime levels may disproportionately impact health among certain subpopulations. Studies using additional measures of stress are necessary to differentiate the health impact of crime-related stress from other forms of stressors among individuals living with diabetes.

Associations of neighborhood socioeconomic and racial/ethnic characteristics with changes in survey-based neighborhood quality, 2000-2011

We investigated the relationships between neighborhood socio-demographic characteristics (socioeconomic status [SES], percentage of Black residents, and percentage of Hispanic residents) and survey-based measures of the social environment (social cohesion, safety) and the physical environment (healthy food environment, walking environment) in six sites from 2000 through 2011. Neighborhood environments were patterned by area SES and racial/ethnic composition, such that higher SES and lower percentage minority neighborhoods had better physical and social environments. Increasing disparities over time were observed for some neighborhood environments. Further research should explore the role of neighborhood environments in maintaining or increasing social disparities in health.

How important is perception of safety to park use? A four-city survey

PURPOSE

To determine individual- and park-related characteristics associated with adults visiting their closest neighborhood park and involvement in sports, walking, and sedentary activities.

DESIGN

Cross-sectional study.

SETTING

Neighborhoods surrounding 24 parks in four United States metropolitan areas.

SUBJECTS

Adults (N = 3,815) (25% African American, 12% Hispanic, and 56% Non-Hispanic White) living within .5 mile of one of 24 public parks.

MEASURES

Anonymous surveys and park observations.

ANALYSIS

Chi-square statistics and logistic regression including individual and park characteristics.

RESULTS

Thirty-seven percent reported never having visited their park; 16% reported using it for regular exercise. Respondents who perceived the parks as safe or very safe had 4.6 times the odds of visiting the parks. Active sports participation was associated with being male, ages 18 to 24, and of African American heritage. Walking was associated with being female, age 47+, and reporting fair or poor health. Females, Hispanics, and those reporting fair/poor health were more likely to report sedentary activities. Park characteristics associated with park use included fewer physical incivilities, closer proximity to homes, more facilities, and organized activities.

CONCLUSIONS

Perceptions of park safety were strongly associated with ever having visited a respective park, while park characteristics appeared to influence the types of activities performed. Increasing the number of organized activities and offering a variety of different facilities may encourage park use.

Association between perceived neighbourhood characteristics, physical activity and diet quality: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND

The study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results.

METHODS

We conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the "Walking Environment" and "Availability of Healthy Foods" scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression.

RESULTS

Perceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57-1.83) and 1.39 (1.28-1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31-1.66) of eating fruits, and 1.47 greater (1.30-1.66) of eating vegetables, more than once per day.

CONCLUSIONS

Perceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.

Neighborhood Walkability and Walking for Transport Among South Asians in the MASALA Study

BACKGROUND

The neighborhood built environment can have a strong influence on physical activity levels, particularly walking for transport. In examining racial/ethnic differences in physical activity, one important and understudied group is South Asians. This study aims to describe the association between neighborhood walkability and walking for transport among South Asian men and women in the United States in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.

METHODS

A cross-sectional study was conducted in 2014 using the baseline dataset of the MASALA study (N = 906). Mean age was 55 years old and 54% of the sample was male. Weekly minutes spent walking for transport was assessed using a questionnaire adapted from the Cross-Cultural Activity Participation Study. Neighborhood walkability was measured using Walk Score, a composite index of walkability.

RESULTS

After adjusting for covariates, with each 10-point increase in Walk Score, South Asian American men engaged in 13 additional minutes per week of walking for transport (P = .008). No association was observed between walkability and walking for transport in South Asian American women.

CONCLUSIONS

Results provide new evidence for how the effects of environmental influences on walking for transport may vary between South Asian men and women.

Associations of perceived neighborhood safety and crime with cardiometabolic risk factors among a population with type 2 diabetes

Little is known about how neighborhood crime may relate to health in diabetes patients. We examined associations between individuals' perceptions of neighborhood safety or violent crime and stress, physical activity, body mass index (BMI) or hemoglobin A1c (HbA1c) in a sample (n=721) of adults (mean age:63) with diabetes. Self-reported neighborhood safety, violent crime, physical activity, and stress were collected and linked to clinical measures of BMI and HbA1c. Approximately 54% and 15% of patients reported neighborhood safety concerns and violent crimes, respectively. Any neighborhood safety concerns (β=1.14, 95% C.I. 0.04-2.24) and violent crime (β=2.04, 95% C.I. 0.34-3.73) were associated with BMI in adjusted analysis. Any violent crime was associated with class II-III obesity (BMI≥35) (OR=1.34, 95% C.I.: 1.02, 1.75). There were no significant associations between neighborhood safety concerns or violent crime with stress, physical activity, or HbA1c. Neighborhood safety is associated with BMI and obesity. Further studies, including longitudinal designs, are needed to study how people with diabetes may be influenced by a sense of poor personal safety in their neighborhoods.

Racial differences in parental perceptions of the neighborhood as predictors of children's physical activity and sedentary behavior

Objective

Most U.S. children engage in insufficient physical activity (PA) and spend too much time in sedentary behaviors (SBs), leading to increased risk of obesity and chronic disease. Evidence remains inconsistent on relationships between parental perceptions of the neighborhood and children's PA and SB. This study examines parental neighborhood perceptions, stratified by race, as predictors of children's PA and SB.

Methods

Relationships were tested with regressions stratified by parental race. The sample included 196 parents, residing in St. Louis, Missouri with a child at home. Participants responded to a mailed survey in 2012. Parental neighborhood perceptions were examined by mean composite scores and individual items.

Results

For parents of all races, perceived barriers negatively predicted the number of days in a week children engaged in ≥ 60 min of PA. Examining parental neighborhood perceptions by individual item, the perception that drivers exceed neighborhood speed limits was a positive predictor of their children's SB only among white parents. Only among minority-race parents was perceived neighborhood crime rate a positive predictor of their children's SB.

Conclusions

While predictors of children's PA did not differ widely, several distinct predictors of children's SB by parental race lend support toward further examination of this topic.

•

We examine parental neighborhood perceptions by race and children's behaviors.

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For all parents, perceived barriers negatively predict children's activity.

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For white parents, speeding cars positively predict children's sedentary behavior.

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For minority-race parents, crime positively predicts children's sedentary behavior.

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Results could inform tailored strategies for reducing children's sedentary behavior.

Why the Neighborhood Social Environment Is Critical in Obesity Prevention

The continuing obesity epidemic in the USA calls for the examination of antecedents to the well-known risk factors of physical activity and diet. The neighborhood built environment has been extensively studied in relation to obesity noting an increased risk of development and prevalence of obesity in relation to numerous built environment characteristics (lack of green spaces, higher number of fast food restaurants, low walkability indices). The neighborhood social environment, however, has been less extensively studied but is perhaps an equally important component of the neighborhood environment. The neighborhood social environment, particularly constructs of social capital, collective efficacy, and crime, is associated with obesity among both adults and children. Several studies have identified physical activity as a potential pathway of the neighborhood social environment and obesity association. Further work on social networks and norms and residential segregation, as well as the examination of dietary behaviors and mental health as potential mediating pathways, is necessary. Given the existing evidence, intervening on the neighborhood social environment may prove to be an effective target for the prevention on obesity. Intervention studies that promote healthy behaviors and prevent obesity while addressing aspects of the neighborhood social environment are necessary to better identify targets for obesity prevention.

The Paradox of Parks in Low-Income Areas: Park Use and Perceived Threats

Concerns about safety and perceived threats have been considered responsible for lower use of parks in high poverty neighborhoods. To quantify the role of perceived threats on park use we systematically observed 48 parks and surveyed park users and household residents in low-income neighborhoods in the City of Los Angeles. Across all parks, the majority of both park users and local residents perceive parks as safe or very safe. We noted apparently homeless individuals during nearly half of all observations, but very few instances of fighting, intimidating groups, smoking and intoxication. The presence of homeless individuals was associated with higher numbers of park users, while the presence of intoxicated persons was associated with lower numbers. Overall the strongest predictors of increased park use were the presence of organized and supervised activities. Therefore, to increase park use, focusing resources on programming may be more fruitful than targeting perceived threats.

An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter?

BACKGROUND

Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability.

METHODS

The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence.

RESULTS

Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4%) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4%) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis.

CONCLUSIONS

The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier =  NCT01072500.

Support for physical activity policies and perceptions of work and neighborhood environments: variance by BMI and activity status at the county and individual levels

PURPOSE

To examine support for local policies encouraging physical activity and perceived neighborhood environment characteristics by physical activity and weight status of respondents across U.S. counties.

DESIGN

We used a random-digit-dial, computer-assisted telephone interview (CATI) to conduct a cross-sectional telephone questionnaire in selected U.S. counties in 2011.

SETTING

Counties with high prevalences of obesity and sedentary behavior (HH; n = 884) and counties with low prevalences of obesity and sedentary behavior (LL; n = 171) were selected nationally.

SUBJECTS

Adult respondents from HH (n = 642) and LL (n = 566) counties.

MEASURES

Questions were asked of respondents, pertaining to support for physical activity policies in various settings, neighborhood features, time spent in physical activity and sedentary behaviors, self-reported weight and height, and personal demographic information.

ANALYSIS

Means and frequencies were calculated; bivariable and multivariable linear and logistic regression models, developed. Models were adjusted for individual characteristics and county HH/LL status.

RESULTS

Respondents in LL counties perceived their neighborhood and work environments to be more supportive of healthy behaviors and were more supportive of local physical activity policies than respondents in HH counties (p < .001 for all). Positive neighborhood environment perceptions were related to reduced body mass index, increased physical activity, and decreased sedentary behavior.

CONCLUSION

Policy support and neighborhood environments are associated with behaviors. Results can inform targeting policy agendas to facilitate the improvement of environments (community, work, and school) to be more supportive of physical activity.

The relative contribution of layers of the Social Ecological Model to childhood obesity

OBJECTIVE

The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children's weight status.

DESIGN

Cross-sectional survey of randomly selected households with children living in low-income diverse communities.

SETTING

A telephone survey conducted in 2009-2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child's residence to food and physical activity outlets.

SUBJECTS

Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights.

RESULTS

Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children's weight status.

CONCLUSIONS

The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.

Features of the built environment related to physical activity friendliness and children's obesity and other risk factors

OBJECTIVES

We investigated the relationships among environmental features of physical activity friendliness, socioeconomic indicators, and prevalence of obesity (BMI status), central adiposity (waist circumference, waist-height ratio), and hypertension.

DESIGN AND SAMPLE

The design was cross-sectional; the study was correlational. The sample was 911 kindergarteners through sixth graders from three schools in an urban school district residing in 13 designated neighborhoods.

MEASURES

Data from walking environmental community audits, census data for socioeconomic indicators, body mass index, waist circumference, waist-height ratio, and blood pressure were analyzed. A modified Alfonzo's Hierarchy of Walking Needs model was the conceptual framework for environmental features (i.e., accessibility, safety, comfort, and pleasurability) related to physical activity.

RESULTS

Accessibility was significantly and negatively correlated with prevalence of obesity and with prevalence of a waist-height ratio >0.50. When neighborhood education was controlled, and when both neighborhood education and poverty were controlled with partial correlational analysis, comfort features of a walking environment were significantly and positively related to prevalence of obesity. When poverty was controlled with partial correlation, accessibility was significantly and negatively correlated with prevalence of waist-height ratio >0.50.

CONCLUSIONS

The built environment merits further research to promote physical activity and stem the obesity epidemic in children. Our approach can be a useful framework for future research.

Positive Action for Today's Health (PATH): Sex differences in walking and perceptions of the physical and social environment

Research indicates that people from low socioeconomic and ethnic minority backgrounds disproportionately fail to meet the weekly national recommendations for physical activity. Perceptions of environmental factors may be significant barriers to walking in communities experiencing high rates of crime and poverty and may impact women and men differently. The present study investigated sex differences in the impact of perceptions of the environment and overall neighborhood quality on walking in an underserved population. Participants were 195 African American women and 95 African American men. Baseline data indicated that women reported greater concerns about safety, poorer perceptions of aesthetics, and lower neighborhood satisfaction than men. Regression analyses showed that perceptions of access to places for walking significantly predicted walking for both women and men and that sex moderated the effect of neighborhood satisfaction. These results suggest that interventions focused on building accessibility to places for walking while also addressing social environmental concerns are needed in high crime communities.

Nonresident African-American fathers' influence on sons' exercise intentions in the fathers and sons program

PURPOSE

To test the effects of a family-centered intervention for enhancing intentions to exercise among African-American boys with nonresident fathers.

DESIGN

Quasi-experimental, intervention study.

SETTING

Two Midwestern cities.

SUBJECTS

A total of 287 nonresident African-American fathers and their 8- to 12-year-old sons (n = 158 intervention dyads; n = 129 comparison dyads).

INTERVENTION

The Fathers and Sons Program is a 15-session family-based intervention focused on promoting the health of African-American boys by enhancing the parenting attitudes and behaviors of their nonresident fathers and positively influencing parent-child interactions.

MEASURES

Demographic information and intervention outcomes were assessed at baseline and follow-up via self-report.

ANALYSIS

Descriptive statistics, logistic regression, and structural equation modeling.

RESULTS

The intervention was successful in improving the exercise intentions of boys (B = .246; p = .005; B = .210; p = .012). The effect was not direct; increasing contact between fathers and sons (B = .154; p = .001), enhancing the quality of their relationship (B = .366; p < .001), and improving fathers' own intentions to exercise (B = .265; p = .001) were mediating factors.

CONCLUSION

Interventions aimed at improving exercise intentions among African-American boys with nonresident fathers should focus on relational factors.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Neighborhood perceptions and active school commuting in low-income cities

BACKGROUND

Few children accumulate the recommended ≥60 minutes of physical activity each day. Active travel to and from school (ATS) is a potential source of increased activity for children, accounting for 22% of total trips and time spent traveling by school-aged children.

PURPOSE

This study identifies the association of parents' perceptions of the neighborhood, geospatial variables, and demographic characteristics with ATS among students in four low-income, densely populated urban communities with predominantly minority populations.

METHODS

Data were collected in 2009-2010 from households with school-attending children in four low-income New Jersey cities. Multivariate logistic regression analyses (n=765) identified predictors of ATS. Analyses were conducted in 2012.

RESULTS

In all, 54% of students actively commuted to school. Students whose parents perceived the neighborhood as very unpleasant for activity were less likely (OR=0.39) to actively commute, as were students living farther from school, with a 6% reduction in ATS for every 0.10 mile increase in distance to school. Perceptions of crime, traffic, and sidewalk conditions were not predictors of ATS.

CONCLUSIONS

Parents' perceptions of the pleasantness of the neighborhood, independent of the effects of distance from school, may outweigh concerns about crime, traffic, or conditions of sidewalks in predicting active commuting to school in the low-income urban communities studied. Efforts such as cleaning up graffiti, taking care of abandoned buildings, and providing shade trees to improve neighborhood environments are likely to increase ATS, as are efforts that encourage locating schools closer to the populations they serve.

Associations between neighborhood characteristics and physical activity among youth within rural-urban commuting areas in the US

The association among rural-urban communities, neighborhood characteristics, and youth physical activity is inconsistent in the literature. We used data from the 2007 National Survey of Children's Health, for youth aged 10-17 years (n = 45,392), to examine the association between physical activity and neighborhood characteristics, after adjusting for known confounders. We also examined the association between physical activity and neighborhood characteristics within seven levels of Rural-Urban Commuting Areas (RUCAs) that depict a continuum from isolated rural to dense urban communities. Attainment of a minimum physical activity level differed by RUCA (P = 0.0004). In adjusted, RUCA-specific models, the presence of parks was associated with attaining a minimum physical activity level in only one of the seven RUCAs (adjusted odds ratio: 3.49; 95 % confidence interval: 1.55, 7.84). This analysis identified no association between youths' minimum physical activity attainment and neighborhood characteristics in unstratified models; and, RUCA-specific models showed little heterogeneity by rural-urban community type. Although this analysis found little association between youth physical activity and neighborhood characteristics, the findings could reflect the crude categorization of the neighborhood amenities (sidewalks, parks, recreation centers) and detracting elements (litter, dilapidated housing, vandalism) and suggests that simple measurement of the presence of an amenity or detracting element is insufficient for determining potential associations with reaching minimum levels of physical activity. By exploring neighborhood characteristics and features of neighborhood amenities within the context of well-defined community types, like RUCAs, we can better understand how and why these factors contribute to different levels of youth physical activity.

Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study

BACKGROUND

As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations.

METHODS

This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final.

RESULTS

In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final.

CONCLUSION

These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.

The influence of community and the built environment on physical activity

OBJECTIVE

To examine associations between the built environment and leisure-time physical activity (LTPA) among African Americans and Whites.

METHOD

Independent and control variables were produced from the literature and theory to represent key components of built environment, sense of community, sociodemographic, and health status characteristics. Logistic regression analysis and descriptive statistics were used to measures correlative relationships with physical activity.

RESULTS

Built environment elements, especially homeownership, were associated with LTPA, particularly among older African American rural residents.

DISCUSSION

Recommendations include transferring the concept of community ownership to residents living in areas where rates of physical activity are low.

Design for health: the relationship between design and noncommunicable diseases

The authors explore the relationship between design and noncommunicable diseases, first by highlighting how design knowledge and practice can have a direct and indirect effect on these diseases. They then review the literature on the link between the physical environment (e.g., dwellings, the neighborhood, cities) and noncommunicable diseases. Last, they illustrate the links between design and noncommunicable diseases by exploring in greater detail how designers and the design of the urban environment can play a positive role in the reduction of noncommunicable diseases.

Counseling African Americans in Cardiac Rehabilitation: Implications for Comprehensive Lifestyle Modification

African Americans are more likely to die of a myocardial infarction than any other racial group and have higher rates of sudden cardiac death, and in comparison to whites, these deaths are likely to occur at a younger age. Because secondary prevention interventions have been reported to reduce overall mortality, it is important that health care providers understand and respond with sensitivity to the needs and preferences that African Americans bring to cardiac rehabilitation. Providing culturally appropriate cardiac rehabilitation services to African Americans has the potential to improve access to care, quality of care, and health outcomes. This article reviews the historical legacy and general values and beliefs that African Americans bring to their participation in cardiac rehabilitation and examines values and beliefs about diet, weight, body image, exercise, rest, and preferences for depression treatment that should be considered when counseling African Americans. Social-ecological factors that influence the ability to commit to and maintain cardiovascular risk—reducing behaviors are also discussed. Strategies for responding to the health-related beliefs and cultural values of African Americans are examined.

Effects of the built environment on physical activity of adults living in rural settings

OBJECTIVE

To conduct a systematic review of the literature to examine the influence of the built environment (BE) on the physical activity (PA) of adults in rural settings.

DATA SOURCE

Key word searches of Academic Search Premier, PubMed, CINAHL, Web of Science, and Sport Discus were conducted.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies published prior to June 2008 were included if they assessed one or more elements of the BE, examined relationships between the BE and PA, and focused on rural locales. Studies only reporting descriptive statistics or assessing the reliability of measures were excluded.

DATA EXTRACTION

Objective(s), sample size, sampling technique, geographic location, and definition of rural were extracted from each study. Methods of assessment and outcomes were extracted from the quantitative literature, and overarching themes were identified from the qualitative literature.

DATA SYNTHESIS

Key characteristics and findings from the data are summarized in Tables 1 through 3.

RESULTS

Twenty studies met inclusion and exclusion criteria. Positive associations were found among pleasant aesthetics, trails, safety/crime, parks, and walkable destinations.

CONCLUSIONS

Research in this area is limited. Associations among elements of the BE and PA among adults appear to differ between rural and urban areas. Considerations for future studies include identifying parameters used to define rural, longitudinal research, and more diverse geographic sampling. Development and refinement of BE assessment tools specific to rural locations are also warranted.

"Do you see what I see?" - correlates of multidimensional measures of neighborhood types and perceived physical activity-related neighborhood barriers and facilitators for urban youth

OBJECTIVES

To classify types of neighborhood environment and to examine the gender-specific cross-sectional associations between these neighborhood types and adolescents' perceptions of physical activity-related neighborhood barriers and facilitators.

METHODS

This cross-sectional study was conducted with a sample of 350 high school students in Baltimore, Maryland, in 2006. Participants completed the Neighborhood Environment Walkability Scale (NEWS). Objectively GIS-measured attributes of urban form came from various sources. Classification of built environment/neighborhood types was achieved by factor analysis and cluster analysis.

RESULTS

Four neighborhood types were identified: (1) arterial development; (2) inner-city area; (3) suburban residential; and (4) central business district. Girls who lived in suburban residential areas were less likely than their central business district counterparts to perceive the protective effects of crosswalks and pedestrian traffic signals. Girls living in inner-city neighborhoods were more likely than their central business district counterparts to perceive the traffic as being slow. Boys' perceptions of their neighborhood did not vary by neighborhood pattern.

CONCLUSIONS

Girls appear to be more sensitive to their environment and perceive more physical activity-related built environment barriers compared to boys. Efforts to overcome physical activity barriers salient for adolescent girls should be tailored to the type of neighborhood.

Perceptions of Neighborhood Disorder: The Role of Individual and Neighborhood Characteristics

OBJECTIVES: The study of neighborhood effects on health and wellbeing has regained prominence in recent years. Most authors have relied on Census data and other administrative data sources to assess neighborhood characteristics. Less commonly employed, but gaining in popularity, are measures from surveys which ask neighborhood residents about various aspects of their neighborhood environment. Such surveys are a potentially attractive alternative or augmentation to administrative data sources. METHODS: Using data from a study of neighborhood effects on pregnancy outcomes among low income, inner city women in Philadelphia, PA (N=3,988), we examined psychometric and ecometric properties of scales used to assess perceptions of crime and safety, physical disorder and social disorder, and estimated effects of individual and neighborhood level predictors on perceptions. RESULTS: The three perceived neighborhood disorder scales had high internal consistency and good neighborhood level reliability. Several individual attributes of the women predicted perceptions of neighborhood disorder controlling for neighborhood level characteristics (within census tract, fixed-effect estimates). In addition, our objective indicators of neighborhood crime, physical and social disorder were highly significant predictors of women's perceptions, explaining over 70% of the between neighborhood variation in perceptions. CONCLUSIONS: When data on objective neighborhood characteristics are unavailable the inclusion of questions about residents' perceptions of neighborhood conditions in surveys of inner city residents provides a useful alternative to characterize neighborhood conditions.

Disparities in physical activity and sedentary behaviors among US children and adolescents: prevalence, correlates, and intervention implications

Regular physical activity is important for health benefits among youth, but disparities exist. This paper describes disparities in physical activity participation and sedentary behaviors among youth in the United States, provides intervention implications, and offers recommendations for future research focused on reducing disparities related to levels of physical activity. Secondary analysis of national accelerometer data showed that achievement of recommended levels of physical activity ranged across subgroups from 2% to 61%. Mean hours per day spent in sedentary behavior ranged from 5.5 to 8.5. The largest disparities were by gender and age. An improved understanding of correlates may inform the design of interventions to increase physical activity in targeted subgroups. Additional theoretically based research is needed to elucidate which factors contributing to physical activity disparities are amenable to change via intervention. To eliminate health disparities, changes in policies that have an impact on physical activity may be necessary to promote physical activity among high-risk youth.