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

A tale of many neighborhoods: Latent profile analysis to derive a national neighborhood typology for the US

INTRODUCTION

Neighborhoods are complex and multi-faceted. Analytic strategies used to model neighborhoods should reflect this complexity, with the potential to better understand how neighborhood characteristics together impact health. We used latent profile analysis (LPA) to derive a residential neighborhood typology applicable for census tracts across the US.

METHODS

From tract-level 2015-2019 American Community Survey (ACS) five-year estimates, we selected five indicators that represent four neighborhood domains: demographic composition, commuting, socioeconomic composition, and built environment. We compared model fit statistics for up to eight profiles to identify the optimal number of latent profiles of the selected neighborhood indicators for the entire US. We then examined differences in national tract-level 2019 prevalence estimates of physical and mental health derived from CDC's PLACES dataset between derived profiles using one-way analysis of variance (ANOVA).

RESULTS

The 6-profile LPA model was the optimal categorization of neighborhood profiles based on model fit statistics and interpretability. Neighborhood types were distinguished most by demographic composition, followed by commuting and built environment domains. Neighborhood profiles were associated with meaningful differences in the prevalence of health outcomes. Specifically, tracts characterized as "Less educated non-immigrant racial and ethnic minority active transiters" (n = 3,132, 4%) had the highest poor health prevalence (Mean poor physical health: 18.6 %, SD: 4.30; Mean poor mental health: 19.6 %, SD: 3.85), whereas tracts characterized as "More educated metro/micropolitans" (n = 15, 250, 21%) had the lowest prevalence of poor mental and physical health (Mean poor physical health: 10.6 %, SD: 2.41; Mean poor mental health: 12.4 %, SD: 2.67; p < 0.001).

CONCLUSION

LPA can be used to derive meaningful and standardized profiles of tracts sensitive to the spatial patterning of social and built conditions, with observed differences in mental and physical health by neighborhood type in the US.

The relationship between neighborhood typologies and self-rated health in Maryland: A latent class analysis

Despite widespread evidence that neighborhood conditions impact health, few studies apply theory to clarify the physical and social factors in communities that drive health outcomes. Latent class analysis (LCA) addresses such gaps by identifying distinct neighborhood typologies and the joint influence that neighborhood-level factors play in health promotion. In the current study, we conducted a theory-driven investigation to describe Maryland neighborhood typologies and examined differences in area-level self-rated poor mental and physical health across typologies. We conducted an LCA of Maryland census tracts (n = 1384) using 21 indicators of physical and social characteristics. We estimated differences in tract-level self-rated physical and mental health across neighborhood typologies using global Wald tests and pairwise comparisons. Five neighborhood classes emerged: Suburban Resourced (n = 410, 29.6%), Rural Resourced (n = 313, 22.6%), Urban Underserved (n = 283, 20.4%), Urban Transient (n = 226, 16.3%), Rural Health Shortage (n = 152, 11.0%). Prevalence of self-rated poor physical and mental health varied significantly (p < 0.0001) by neighborhood typology, with the Suburban Resourced neighborhood class demonstrating the lowest prevalence of poor health and the Urban Underserved neighborhoods demonstrating the poorest health. Our results highlight the complexity of defining "healthy" neighborhoods and areas of focus to mitigate community-level health disparities to achieve health equity.

Development and reliability testing of an audit toolbox for the assessment of the physical activity friendliness of urban and rural environments in Germany

Background

According to socio-ecological theories, physical activity behaviors are linked to the physical and social neighborhood environment. Reliable and contextually adapted instruments are needed to assess environmental characteristics related to physical activity. This work aims to develop an audit toolbox adapted to the German context, to urban and rural settings, for different population groups, and different types of physical activity; and to evaluate its inter-rater reliability.

Methods

We conducted a systematic literature search to collect existing audit tools and to identify the latest evidence of environmental factors influencing physical activity in general, as well as in German populations. The results guided the construction of a category system for the toolbox. Items were assigned to the categories based on their relevance to physical activity and to the German context as well as their comprehensibility. We piloted the toolbox in different urban and rural areas (100 street segments, 15 parks, and 21 playgrounds) and calculated inter-rater reliability by Cohen's Kappa.

Results

The audit toolbox comprises a basic streetscape audit with seven categories (land use and destinations, traffic safety, pedestrian infrastructure, cycling infrastructure, attractiveness, social environment, and subjective assessment), as well as supplementary tools for children and adolescents, seniors and people with impaired mobility, parks and public open spaces, playgrounds, and rural areas. 76 % of all included items had moderate, substantial, or almost perfect inter-rater reliability (κ > 0.4).

Conclusions

The audit toolbox is an innovative and reliable instrument for the assessment of the physical activity friendliness of urban and rural environments in Germany.

Uncovering the Heterogeneity in Fitness App Use: A Latent Class Analysis of Chinese Users

This study examines fitness app use patterns and their correlates among Chinese users from the perspectives of uses and gratification theory and self-determination theory. Our sample comprised 632 users of WeRun, the fitness plugin of WeChat, the largest Chinese mobile social networking app; participants completed an online survey and provided self-tracked physical activity data, which were subjected to latent class analysis. Based on the four-class latent class model (which yielded the best model fit and the most interpretable results), 30.5%, 27.5%, 24.7%, and 17.3% of the users were categorized as light users, reward-oriented users, lifestyle-oriented users, and interaction-oriented users, respectively. Moreover, class membership was associated with gender, age, education, income, life satisfaction, autonomy, and platform-based motivations. There is a significant heterogeneity in fitness app use and exercise behaviors. Platform-based motivations and autonomy are important classification factors, as users are looking for specific kinds of gratification from their use of fitness apps. Demographics and individual characteristics are also explanatory factors for class membership. The study findings suggest that fitness app designers should segment users based on motivation and gratification.

Fear of Falling and Environmental Factors: A Scoping Review

Fear of falling is a geriatric condition that must be understood from both a clinical perspective and from the environment in which older adults live. This review aimed to describe the scientific evidence reported in the last 5 years regarding the fear of falling in older adults and its relationship with environmental factors. The relationships between fear of falling and environmental factors are mainly evidenced in the built environment. Older adults with a fear of falling are described as perceiving the built environment as dangerous when they do not meet the requirements of safety, accessibility, and comfort; they also report the importance of living in communities with controlled crime levels and available social support for older adults to improve their insecurity and feelings of vulnerability.

Specific and cumulative lifetime stressors in the aetiology of major depression: A longitudinal community-based population study

AIMS

Early-life stressful circumstances (i.e. childhood maltreatment) coupled with stressful events later in life increase the likelihood of subsequent depression. However, very few studies have been conducted to examine the specific and cumulative effects of these stressors in the development of depression. There is also a paucity of research that simultaneously considers the role of biological factors combined with psychosocial stressors in the aetiology of depression. Guided by the biopsychosocial model proposed by Engel, the present study aims to examine to what extent the experience of stressors across the lifespan is associated with depression while taking into account the role of genetic predispositions.

METHODS

Data analysed were from the Social and Psychiatric Epidemiology Catchment Area of the Southwest of Montreal (ZEPSOM), a large-scale, longitudinal community-based cohort study. A total of 1351 participants with complete information on the lifetime diagnoses of depression over a 10-year follow-up period were included in the study. Stressful events across the lifespan were operationalised as specific, cumulative and latent profiles of stressful experiences. Latent profile analysis (LPA) was used to explore the clustering of studied stressors including childhood maltreatment, poor parent-child relationship, and stressful life events. A polygenetic risk score was calculated for each participant to provide information on genetic liability. Multivariate logistic regression was used to examine the association between specific, cumulative and latent profiles of stressors and subsequent depression.

RESULTS

We found that different subtypes of childhood maltreatment, child-parent bonding and stressful life events predicted subsequent depression. Furthermore, a significant association between combined effects of cumulative stressful experiences and depression was found [odds ratio (OR) = 1.20, 95% confidence interval (CI): 1.12-1.28]. Three latent profiles of lifetime stressors were identified in the present study and named as 'low-level of stress' (75.1%), 'moderate-level of stress' (6.8%) and 'high-level of stress' (18.1%). Individuals with a 'high-level of stress' had a substantially higher risk of depression (OR = 1.80, 95% CI: 1.08-3.00) than the other two profiles after adjusting for genetic predispositions, socio-demographic characteristics, and health-related factors.

CONCLUSIONS

While controlling for genetic predispositions, the present study provides robust evidence to support the independent and cumulative as well as compositional effects of early- and later-on lifetime psychosocial stressors in the subsequent development of depression. Consequently, mental illness prevention and mental health promotion should target the occurrence of stressful events as well as build resilience in people so they can better cope with stress when it inevitably occurs.

Características percebidas da vizinhança e a prática de atividade física entre adolescentes e adultos jovens: um modelo com respostas distais

Os objetivos do estudo foram identificar perfis de vizinhança percebidos por adolescentes e adultos jovens, e estimar sua associação com a realização de atividade física global e de lazer. Utilizaram-se dados de 1.637 indivíduos entre 15 e 24 anos, de um estudo transversal, com amostragem por conglomerados, de uma cidade do Estado da Bahia, Brasil, em 2011. A atividade física foi mensurada pelo International Physical Activity Questionnaire (IPAQ), versão curta, além de questão sobre atividade no lazer. A percepção de características do ambiente físico e social da vizinhança se baseou em escala com 14 questões. Perfis de vizinhança foram definidos por meio de análise de classes latentes (LCA), e a estimação dos seus efeitos na atividade física usou o modelo com respostas distais. A análise de perfil latente resultou em três padrões de vizinhança, descritos como “urbana, sociável e favorável à atividade física - classe 1” (39,6%); “sociável e segura - classe 2” (24,4%); e “insegura, de baixa sociabilidade - classe 3” (36%). Os indivíduos pertencentes à “classe 1” apresentaram maior probabilidade de se exercitar (56,4%), enquanto, para as classes 2 e 3, estes percentuais corresponderam a 46,3% e 42,8%, respectivamente. Associação estatisticamente significante foi identificada apenas na classe “urbana, sociável e favorável à atividade física”, cuja chance de realizar atividade de lazer foi de 72% (OR = 1,72; IC95%: 1,29-2,29). Bairros com atributos favoráveis à prática de atividade física e a existência de elementos de urbanização aumentam a chance do comportamento ativo no lazer entre os adolescentes e adultos jovens. O uso de LCA e do modelo com repostas distais é promissor e inovador na abordagem sobre vizinhança.

Adolescent's movement behaviors and built environment: a latent class analysis

BACKGROUND

Latent class analysis (LCA) is an alternative and innovative approach to verify the relation of the various combinations of the constructed environment and movement behavior (levels of physical activity, sedentary behavior, and sleep) characteristics. This study aimed to identify latent classes based on the characteristics of the neighborhood environment perceived by adolescents and their association with gender, socioeconomic status (SS), body composition and movement behaviors.

METHODS

This cross-sectional study includes 309 Brazilian adolescents (14 to 16 years old, 57% female). The characteristics of the neighborhood environment perceived were analyzed by the Neighborhood Walkability for Youth Scale. Accelerometers were used for a week to evaluate the movement behaviors. Questionnaires assessed the screen times, total sitting time (TST), and sociodemographic characteristics. LCA was used for modeling the "Perceived Enviroment" variable, having been conducted in the poLCA (Polychromous Variable Latent Class Analysis) package of the R statistical software.

RESULTS

Three classes were recognized: class 1, "Best Perceived Environment" with 23.03% of adolescents; class 2, "Moderate Perceived Environment", 63.33%; and class 3, "Worst Perceived Environment", 13.67%. Light physical activity (LPA), TST, and SS were associated with class prevalence. The adolescents with medium and low SS were, respectively, 3.42 (95% CI 1.62-7.21) and 4.18 (95% CI 1.66-10.50) more likely to belong to class 2, and those with low SS were 5.21 (95% CI 1.35-20.13) more likely to belong to class 3. Class 1 adolescents were associated with a lower chance (OR: 0.09, 95% CI 0.02-0.55) of involvement in 'adequate LPA time' compared to class 3. Class 1 adolescents were associated with a lower chance (OR: 0.31, 95% CI 0.12-0.79) of involvement in 'adequate TST' compared to class 2. There was a difference between the LPA and TST classes; class 3 presented a longer time in LPA than class 1; class 1 had higher TST than the other classes.

CONCLUSION

The findings highlight the influence of neighborhood classes on adolescents' LPA and TST.

Neighborhood archetypes and breast cancer survival in California

PURPOSE

Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighborhood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival.

METHODS

Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (socioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included.  The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996-2005 with follow-up through Dec 31, 2017) to evaluate their associations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity.

RESULTS

California neighborhoods were best described by nine archetypal patterns that were differentially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals' race/ethnicity.

CONCLUSIONS

By describing neighborhood archetypes that differentiate survival following breast cancer diagnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace.

Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors

BACKGROUND

Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors.

METHODS

In total, 693 participants aged 66-97 were sampled from two US locales in 2005-2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles.

RESULTS

More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC).

CONCLUSIONS

Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

Residential neighborhood features associated with objectively measured walking near home: Revisiting walkability using the Automatic Context Measurement Tool (ACMT)

Many distinct characteristics of the social, natural, and built neighborhood environment have been included in walkability measures, and it is unclear which measures best describe the features of a place that support walking. We developed the Automatic Context Measurement Tool, which measures neighborhood environment characteristics from public data for any point location in the United States. We explored these characteristics in home neighborhood environments in relation to walking identified from integrated GPS, accelerometer, and travel log data from 681 residents of King Country, WA. Of 146 neighborhood characteristics, 92 (63%) were associated with walking bout counts after adjustment for individual characteristics and correction for false discovery. The strongest built environment predictor of walking bout count was housing unit count. Models using data-driven and a priori defined walkability measures exhibited similar fit statistics. Walkability measures consisting of different neighborhood characteristic measurements may capture the same underlying variation in neighborhood conditions.

Longitudinal Association of Built Environment Pattern with Physical Activity in a Community-Based Cohort of Elderly Hong Kong Chinese: A Latent Profile Analysis

A large number of studies have focused on the associations between single built environment (BE) characteristics and physical activity (PA). Combinations of BE characteristics offer a more comprehensive approach to identify the BE–PA associations. We aimed to examine the BE–PA associations in a cohort of elderly Hong Kong Chinese. Between 2001 and 2003, 3944 participants (65–98 years of age) were recruited and followed for a mean of 7.8 years. BE characteristics were assessed via geographic information system. PA levels were obtained using the Physical Activity Scale for the Elderly questionnaire at baseline and three follow-ups. Latent profile analysis was first conducted to classify the BE characteristics, and linear mixed-effects models were then used to explore the longitudinal associations between the BE classes and changes in the PA levels. Three classes of BE were identified. Class 3 (characterized by greater green space and sky view factor) demonstrated a significant decline in household PA (β = −1.26, 95% confidence interval: −2.20, −0.33) during the study period, and a slower decline in walking PA (1.19 (0.42, 1.95)) compared with Class 2 (characterized by a greater proportion of residential land use). Our results indicate that BE patterns characterized by high green space and a sky view factor may help promote the walking PA level.

Associations Between Latent Classes of Perceived Neighborhood Destination Accessibility and Walking Behaviors in Older Adults of a Low-Density and a High-Density City

To examine associations between perceived destination accessibility within different distances from home and self-reported overall amounts of walking for different purposes among older adults (aged ≥ 65 years) in Brisbane, Australia (N = 793) and Hong Kong, China (N = 484). Perceived neighborhood destination accessibility types were derived from latent class analysis using comparable measures of perceived distance to 12 destinations from epidemiological studies in the two cities. Associations of perceived destination accessibility with measures of within-neighborhood walking were also estimated in Hong Kong participants. Better perceived destination accessibility was positively associated with the likelihood of walking in Brisbane participants only. Perceived destination accessibility within a short distance from home (5-min walk) was negatively related to the amount of within-neighborhood walking for transport in Hong Kong residents who walked. Our findings suggest that providing moderate-to-high, but not extreme, levels of destination accessibility may be optimal for the promotion of walking in older community dwellers.

Do Party Schools Report Higher Rates of Violence Against Women in Their Clery Data? A Latent Class Analysis

The current study examined violent crimes against women among 1,384 four-year private and public college campuses using Clery Act data from 2014-2016 (i.e., rape, domestic and dating violence, stalking, and fondling). Latent class analysis (LCA) was used to identify five types of campuses: smaller (22%), liberal arts (25%), satellite (16%), private (19%), and party schools (18%). Smaller schools reported the lowest rates of violence against women (VAW), whereas private schools had significantly higher reported rapes. These findings have important implications for the types of campuses seem to be abiding by Clery law and reporting crimes that involve VAW.

A systematic review of the clinical application of data-driven population segmentation analysis

BACKGROUND

Data-driven population segmentation analysis utilizes data analytics to divide a heterogeneous population into parsimonious and relatively homogenous groups with similar healthcare characteristics. It is a promising patient-centric analysis that enables effective integrated healthcare interventions specific for each segment. Although widely applied, there is no systematic review on the clinical application of data-driven population segmentation analysis.

METHODS

We carried out a systematic literature search using PubMed, Embase and Web of Science following PRISMA criteria. We included English peer-reviewed articles that applied data-driven population segmentation analysis on empirical health data. We summarized the clinical settings in which segmentation analysis was applied, compared and contrasted strengths, limitations, and practical considerations of different segmentation methods, and assessed the segmentation outcome of all included studies. The studies were assessed by two independent reviewers.

RESULTS

We retrieved 14,514 articles and included 216 articles. Data-driven population segmentation analysis was widely used in different clinical contexts. 163 studies examined the general population while 53 focused on specific population with certain diseases or conditions, including psychological, oncological, respiratory, cardiovascular, and gastrointestinal conditions. Variables used for segmentation in the studies are heterogeneous. Most studies (n = 170) utilized secondary data in community settings (n = 185). The most common segmentation method was latent class/profile/transition/growth analysis (n = 96) followed by K-means cluster analysis (n = 60) and hierarchical analysis (n = 50), each having its advantages, disadvantages, and practical considerations. We also identified key criteria to evaluate a segmentation framework: internal validity, external validity, identifiability/interpretability, substantiality, stability, actionability/accessibility, and parsimony.

CONCLUSIONS

Data-driven population segmentation has been widely applied and holds great potential in managing population health. The evaluations of segmentation outcome require the interplay of data analytics and subject matter expertise. The optimal framework for segmentation requires further research.

Capturing exposure in environmental health research: challenges and opportunities of different activity space models

Background

The built environment health promotion has attracted notable attention across a wide spectrum of health-related research over the past decade. However, the results about the contextual effects on health and PA are highly heterogeneous. The discrepancies between the results can potentially be partly explained by the diverse use of different spatial units of analysis in assessing individuals’ exposure to various environment characteristics. This study investigated whether different residential and activity space units of analysis yield distinct results regarding the association between the built environment and health. In addition, this study examines the challenges and opportunities of the different spatial units of analysis for environmental health-related research.

Methods

Two common residential units of analysis and two novel activity space models were used to examine older adults’ wellbeing in relation to the built environment features in the Helsinki Metropolitan Area, Finland. An administrative unit, 500 m residential buffer, home range model and individualized residential exposure model were used to assess the associations between the built environment and wellbeing of respondent’s (n = 844).

Results

All four different spatial units of analysis yield distinct results regarding the associations between the built environment characteristics and wellbeing. A positive association between green space and health was found only when exposure was assessed with individualized residential exposure model. Walkability index and the length of pedestrian and bicycle roads were found to positively correlate with perceived wellbeing measures only with a home range model. Additionally, all units of analysis differed from each other in terms of size, shape, and how they capture different contextual measures.

Conclusions

The results show that different spatial units of analysis result in considerably different measurements of built environment. In turn, the differences derived from the use of different spatial units seem to considerably affect the associations between environment characteristics and wellbeing measures. Although it is not easy to argue about the correctness of these measurements, what is evident is that they can reveal different wellbeing outcomes. While some methods are especially usable to determine the availability of environmental opportunities that promote active travel and the related health outcomes, others can provide us with insight into the mechanisms how the actual exposure to green structure can enhance wellbeing.

Neighbourhood typologies and associations with body mass index and obesity: A cross-sectional study

Little research has investigated associations between a combined measure of the food and physical activity (PA) environment, BMI (body-mass-index) and obesity. Cross-sectional data (n=22,889, age 18-86years) from the Yorkshire Health Study were used [2010-2013]. BMI was calculated using self-reported height and weight; obesity=BMI≥30. Neighbourhood was defined as a 2km radial buffer. Food outlets and PA facilities were sourced from Ordnance Survey Points of Interest (PoI) and categorised into 'fast-food', 'large supermarkets', 'convenience and other food retail outlets' and 'physical activity facilities'. Parks were sourced from Open Street Map. Latent class analysis was conducted on these five environmental variables and availability was defined by quartiles of exposure. Linear and logistic regressions were then conducted for BMI and obesity respectively for different neighbourhood types. Models adjusted for age, gender, ethnicity, area-level deprivation, and rural/urban classification. A five-class solution demonstrated best fit and was interpretable. Neighbourhood typologies were defined as; 'low availability', 'moderate availability', 'moderate PA, limited food', 'saturated' and 'moderate PA, ample food'. Compared to low availability, one typology demonstrated lower BMI (saturated, b=-0.50, [95% CI=-0.76, -0.23]), while three showed higher BMI (moderate availability, b=0.49 [0.27, 0.72]; moderate PA, limited food, b=0.30 [0.01, 0.59]; moderate PA, ample food, b=0.32 [0.08, 0.57]). Furthermore, compared to the low availability, saturated neighbourhoods showed lower odds of obesity (OR=0.86 [0.75, 0.99]) while moderate availability showed greater odds of obesity (OR=1.18 [1.05, 1.32]). This study supports population-level approaches to tackling obesity however neighbourhoods contained features that were health-promoting and -constraining.

Environments favorable to healthy lifestyles: A systematic review of initiatives in Canada

BACKGROUND

In recent years, a number of initiatives aimed at promoting healthy lifestyles in health-friendly environments have been implemented. The purpose of this review is to synthesize initiatives conducted in Canada and documented in publications for the period 1995-2015 in order to gain a better understanding of their objectives and impacts.

METHODS

A systematic review of Canadian initiatives published over the past 20 years was conducted from multiple databases (i.e., Scopus, SPORTDiscus, PubMed, Academic search complete, Reseausante.com, Cairn, and Erudit). In total, 264 publications were identified and retained for the final analysis based on 5 criteria: (1) publication between 1995 and 2015, (2) online availability, (3) research conducted in Canada, (4) main topic related to environments favorable to healthy lifestyles (EFHL), and (5) publication in French or English.

RESULTS

A sharp increase in the number of studies on EFHL was observed between 2010 and 2015 (57%). Two major lifestyle components-physical activity and nutrition-and 2 environmental aspects-neighborhood and built environment-were the elements most frequently examined regarding adults (48%), young people (34%), and seniors (9%), using quantitative (60%) and qualitative (18%) methods. Furthermore, the analysis reveals a greater focus on the municipal (53%) than the national or provincial levels (31%).

CONCLUSION

This work is a first map of Canadian studies related to EFHL. It clarifies the definition of EFHL and classifies its components. As well, it documents the issues raised, the research methods employed, and the role of stakeholders, while outlining a new research agenda that includes dimensions of EFHL formerly neglected by researchers, namely, political and sociocultural spheres of action.

Physical Environment Correlates of Physical Activity in Developing Countries: A Review

BACKGROUND

Noncommunicable diseases and obesity are considered problems of wealthy, developed countries. These conditions are rising dramatically in developing countries. Most existing research on the role of the physical environment to support physical activity examines developed countries only.

OBJECTIVES

This review identifies physical environment factors that are associated with physical activity in developing countries.

METHODS

This review is modeled on a highly cited review by Saelens and Handy in 2008. The current review analyzes findings from 159 empirical studies in the 138 developing countries.

RESULTS

Results discuss the association of physical environment features and physical activity for all developing countries and identify the patterns within regions. The review supports the association of traffic safety with physical activity for transportation. Rural (vs urban) residence, distance to nonresidential land uses, and "composite" features of the physical environment are associated with general physical activity. Rural (vs urban) residence is associated with physical activity for work.

CONCLUSIONS

More research is needed on associations between the physical environment and physical activity in developing countries. Research should identify specific physical environment features in urban areas that are associated with higher activity levels.

The Interplay between Genes and Psychosocial Home Environment on Physical Activity

INTRODUCTION

Genetic factors contribute to individual differences in physical activity, but it remains uncertain whether the magnitude of the genetic effects is modified by variations in home environments. We aimed to examine to what extent the psychosocial home environment in childhood and adolescence modifies the genetic influences on leisure time physical activity in young adulthood.

METHODS

Participants were Finnish twins (N = 3305) who reported their leisure time physical activity at age 24 yr. The psychosocial home environment was assessed by twins at ages 12, 14, and 17 yr, as well as by their parents when the twins were age 12 yr. Gene-environment interaction modeling was performed with OpenMx software.

RESULTS

Parental ratings of positive home atmosphere as well as the twins' ratings of both positive home atmosphere at age 14 yr and lower relational tensions at ages 12 and 14 yr predicted higher leisure time physical activity levels in young adulthood (regression coefficients = 0.33-0.64). Parental perceptions as well as the twins' perceptions of positive home atmosphere at ages 14 and 17 yr increased the additive genetic variation (moderation effects: 0.55, 95% confidence interval [CI] = 0.29-0.80; 0.60, 95% CI = 0.26-1.05; and 0.52, 95% CI = 0.19-0.87, respectively). The twins' ratings of positive home atmosphere at age 12 yr and lower relational tensions at ages 12 and 14 yr increased the unique environmental variation of their subsequent physical activity (moderation effects: 0.46, 95% CI = 0.19-0.60; 0.48, 95% CI = 0.29-0.64; and 0.85, 95% CI = 0.12-0.95, respectively).

CONCLUSIONS

A psychosocial home environment that is warm and supportive in childhood and adolescence not only increases the mean level of subsequent leisure time physical activity in young adulthood but also modifies the genetic and environmental variances in leisure time physical activity.

Patterns of food and physical activity environments related to children's food and activity behaviors: A latent class analysis

Relationships between food and physical activity (PA) environments and children's related behaviors are complex. Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections. Regression analyses examined whether derived classes were related to food consumption, PA, and overweight among 404 low-income children. Compared to children living in Low PA-Low Food environments, children in High Intersection&Parks-Moderate Density&Food, and High Density-Low Parks-High Food environments, had significantly greater sugar-sweetened beverage consumption (ps<0.01) and overweight/obesity (ps<0.001). Children in the High Density-Low Parks-High Food environments were more likely to walk to destinations (p = 0.01) Recognizing and leveraging beneficial aspects of neighborhood patterns may be more effective at positively influencing children's eating and PA behaviors compared to isolating individual aspects of the built environment.

Perceived environmental barriers to outdoor mobility and changes in sense of autonomy in participation outdoors among older people: a prospective two-year cohort study

OBJECTIVE

The aim was to study whether perceived environmental barriers to outdoor mobility affect changes in sense of autonomy in participation outdoors among community-dwelling older people over a two-year period.

METHODS

Community-dwelling people aged 75-90 years (n = 848) in central Finland were interviewed on two occasions, face-to-face at baseline and over the telephone two years later. Perceived environmental barriers to outdoor mobility were assessed using a 15-item structured questionnaire, and the sum scores categorized into tertiles (0, 1 and 2 or more barriers). Autonomy in participation outdoors was assessed with the 'Impact on Participation and Autonomy' (IPA) questionnaire using the autonomy outdoors subscale (score range 0-20, higher scores indicating more restricted autonomy).

RESULTS

Scores for autonomy in participation outdoors were available for 848 participants at baseline (mean 6.2, SD = 3.8) and for 748 participants at the two-year follow-up (mean 6.7, SD = 3.9). At baseline, those reporting multiple environmental barriers had the most restricted autonomy, while those reporting no environmental barriers had the least restricted autonomy (p < .001). Over the follow-up, autonomy in participation outdoors declined more among those reporting multiple environmental barriers compared to those reporting none (age- and sex-adjusted group*time β = .629, s.e. = .277, p = .023). Adjustment for cognitive functioning, education, number of chronic conditions and change in walking difficulty did not influence the association.

CONCLUSION

Perceived environmental barriers to outdoor mobility accelerate the decline in autonomy in participation outdoors among older community-dwelling people. Understanding factors affecting autonomy can help in finding ways to support the sense of autonomy as people age.

Neighborhood Typologies Associated with Alcohol Use among Adults in Their 30s: a Finite Mixture Modeling Approach

There has been increasing interest in how neighborhood context may be associated with alcohol use. This study uses finite mixture modeling to empirically identify distinct neighborhood subtypes according to patterns of clustering of multiple neighborhood characteristics and examine whether these subtypes are associated with alcohol use. Neighborhoods were 303 census block groups in the greater Seattle, WA, area where 531 adults participating in an ongoing longitudinal study were residing in 2008. Neighborhood characteristics used to identify neighborhood subtypes included concentration of poverty, racial composition, neighborhood disorganization, and availability of on-premise alcohol outlets and off-premise hard liquor stores. Finite mixture models were used to identify latent neighborhood subtypes, and regression models with cluster robust standard errors examined associations between neighborhood subtypes and individual-level typical weekly drinking and number of past-year binge drinking episodes. Five neighborhood subtypes were identified. These subtypes could be primarily characterized as (1) high socioeconomic disadvantage, (2) moderate disadvantage, (3) low disadvantage, (4) low poverty and high disorganization, and (5) high alcohol availability. Adjusted for covariates, adults living in neighborhoods characterized by high disadvantage reported the highest levels of typical drinking and binge drinking compared to those from other neighborhood subtypes. Neighborhood subtypes derived from finite mixture models may represent meaningful categories that can help identify residential areas at elevated risk for alcohol misuse.

Neighborhood Design, Physical Activity, and Wellbeing: Applying the Walkability Model

Neighborhood design affects lifestyle physical activity, and ultimately human wellbeing. There are, however, a limited number of studies that examine neighborhood design types. In this research, we examine four types of neighborhood designs: traditional development, suburban development, enclosed community, and cluster housing development, and assess their level of walkability and their effects on physical activity and wellbeing. We examine significant associations through a questionnaire (n = 486) distributed in Tucson, Arizona using the Walkability Model. Among the tested neighborhood design types, traditional development showed significant associations and the highest value for walkability, as well as for each of the two types of walking (recreation and transportation) representing physical activity. Suburban development showed significant associations and the highest mean values for mental health and wellbeing. Cluster housing showed significant associations and the highest mean value for social interactions with neighbors and for perceived safety from crime. Enclosed community did not obtain the highest means for any wellbeing benefit. The Walkability Model proved useful in identifying the walkability categories associated with physical activity and perceived crime. For example, the experience category was strongly and inversely associated with perceived crime. This study provides empirical evidence of the importance of including vegetation, particularly trees, throughout neighborhoods in order to increase physical activity and wellbeing. Likewise, the results suggest that regular maintenance is an important strategy to improve mental health and overall wellbeing in cities.

Obesogenic environments: current evidence of the built and food environments

Aims:

Obesity is one of the most significant global health and social problems, with rates rising dramatically over the past few decades. While the basic drivers of obesity are obvious (more energy consumed than expended), the causes are multifactorial and complex. A decade ago, it was suggested that exploring the ways in which the built environment influenced physical activity and dietary behaviours might provide fertile ground for investigation. This article overviews current evidence and, in particular, emergent themes that are of significance for the United Kingdom.

Methods:

This article is based on literature extracted from keyword searching of electronic databases. A timeframe of 2006–2016 was used.

Results:

In the past decade, the research base has grown significantly; while frustratingly some results are still inconclusive or contradictory, it might be argued enough evidence exists to act upon. Themes such as the importance of the journey to school for young people and the multiple environments in which people spend their time are examples of where real progress has been made in the evidence base.

Conclusion:

Progress towards real change in policy and practice may seem slow; however, the opportunities afforded for health and planning professionals to work together provide a step towards the whole systems approaches to tackle obesity that are desperately needed.

Change in Neighborhood Characteristics and Change in Coronary Artery Calcium: A Longitudinal Investigation in the MESA (Multi-Ethnic Study of Atherosclerosis) Cohort

BACKGROUND

Although some evidence shows that neighborhood deprivation is associated with greater subclinical atherosclerosis, prior studies have not identified what aspects of deprived neighborhoods were driving the association.

METHODS

We investigated whether social and physical neighborhood characteristics are related to the progression of subclinical atherosclerosis in 5950 adult participants of the MESA (Multi-Ethnic Study of Atherosclerosis) during a 12-year follow-up period. We assessed subclinical disease using coronary artery calcium (CAC). Neighborhood features examined included density of recreational facilities, density of healthy food stores, and survey-based measures of availability of healthy foods, walking environment, and social environment. We used econometric fixed-effects models to investigate how change in a given neighborhood exposure is related to simultaneous change in subclinical atherosclerosis.

RESULTS

Increases in density of neighborhood healthy food stores were associated with decreases in CAC (mean changes in CAC Agatston units per 1-SD increase in neighborhood exposures, -19.99; 95% confidence interval, -35.21 to -4.78) after adjustment for time-varying demographic confounders and computed tomography scanner type. This association remained similar in magnitude after additional adjustment for time-varying behavioral risk factors and depression. The addition of time-varying biomedical factors attenuated associations with CAC slightly (mean changes in CAC per 1-SD increase in neighborhood exposures, -17.60; 95% confidence interval, -32.71 to -2.49). Changes across time in other neighborhood measures were not significantly associated with within-person change in CAC.

CONCLUSIONS

Results from this longitudinal study provide suggestive evidence that greater access to neighborhood healthy food resources may slow the development of coronary atherosclerosis in middle-aged and older adults.

GIS-measured walkability, transit, and recreation environments in relation to older Adults' physical activity: A latent profile analysis

An infrequently studied question is how diverse combinations of built environment (BE) features relate to physical activity (PA) for older adults. We derived patterns of geographic information systems- (GIS) measured BE features and explored how they accounted for differences in objective and self-reported PA, sedentary time, and BMI in a sample of older adults. Senior Neighborhood Quality of Life Study participants (N=714, aged 66-97years, 52.1% women, 29.7% racial/ethnic minority) were sampled in 2005-2008 from the Seattle-King County, WA and Baltimore, MD-Washington, DC regions. Participants' home addresses were geocoded, and net residential density, land use mix, retail floor area ratio, intersection density, public transit density, and public park and private recreation facility density measures for 1-km network buffers were derived. Latent profile analyses (LPAs) were estimated from these GIS-based measures. In multilevel regression models, profiles were compared on accelerometer-measured moderate-to-vigorous PA (MVPA) and sedentary time and self-reported PA, adjusting for covariates and clustering. Analyses were conducted in 2014-2015. LPAs yielded three profiles: low walkability/transit/recreation (L-L-L); mean walkability/transit/recreation (M-M-M); and high walkability/transit/recreation (H-H-H). Three PA outcomes were more favorable in the HHH than the LLL profile group (difference of 7.2min/day for MVPA, 97.8min/week for walking for errands, and 79.2min/week for walking for exercise; all ps<0.02). The most and least activity-supportive BE profiles showed greater differences in older adults' PA than did groupings based solely on a 4-component walkability index, suggesting that diverse BE features are important for healthy aging.

Path Analysis of Campus Walkability/Bikeability and College Students' Physical Activity Attitudes, Behaviors, and Body Mass Index

PURPOSE

The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students' body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators.

DESIGN

Cross-sectional.

SETTING

Thirteen university campuses.

PARTICIPANTS

A total of 1384 student participants.

MEASURES

Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA.

ANALYSIS

Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation.

RESULTS

The overall model fit was good with χ² of 171.388 ( df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (β = -.085) and positive association between personal barriers and BMI (β = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (β = .010). Self-regulation was positively associated with moderate-intensity PA (β = .213), which, in turn, was negatively associated with BMI (β = -.057).

CONCLUSIONS

The ease of walking and biking on a campus was related to college students' walking behavior and their BMI. Students' PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Validity and reliability of HOP-Up: a questionnaire to evaluate physical activity environments in homes with preschool-aged children

BACKGROUND

Early identification of physical activity (PA) opportunities in the home and neighborhood environment may help obesity prevention efforts in households with young children. This cross-sectional study's purpose was to develop a brief, easy-to-use, self-report inventory called Home Opportunities for Physical activity check-Up (HOP-Up), to evaluate the availability and accessibility of PA space and equipment in and near homes with preschool children, and establish its validity and reliability.

METHODS

The HOP-Up was field tested by two trained researchers and parents of preschool-aged children (n = 50; 71% white). To establish criterion validity, researchers were the 'gold standard' and visited participants' homes to assess their PA environments using the HOP-Up, while participants separately completed their HOP-Up. Two weeks later, parents completed the HOP-Up online for test-retest reliability. After minor survey refinements, exploratory and confirmatory factor analysis using a split-half cross validation procedure was conducted in a larger sample of participants (n = 655, 60% white) who completed the HOP-Up online to examine its factor structure. To establish convergent validity, correlations were conducted to compare HOP-Up scales from the factor solution generated with PA behavior and cognitions, and reported screen time.

RESULTS

Intra-class correlations (ICCs) examining HOP-Up item agreement between researcher and parents revealed slight to substantial agreement (range 0.22 to 0.81) for all items. ICCs for all HOP-Up items ranged from fair to substantial agreement between parent responses at both time points (range 0.42 to 0.95). Exploratory factor analysis revealed a five factor solution (18 items), supported eigen values, scree plots, review for contextual sense, and confirmatory factor analysis. Additionally, there were significant (p < 0.05) positive correlations among nearly all five HOP-Up scales with parent and child physical activity levels (range 0.08 to 0.35), and values parents placed on PA for self and child (range 0.16 to 0.35), and negative correlations of Neighborhood Space & Supports for PA scale with parent and child reported screen time (r = -0.11, r = -0.13, respectively).

CONCLUSIONS

Findings support the psychometric properties of this brief, easy-to-use, HOP-Up questionnaire, which may help parents, prevention researchers, residential planners, and practitioners increase their understanding of how the home environment-inside, outside, and the neighborhood- impacts preschool children's physical activity levels.

Exploring the mediating roles of physical activity and television time on the relationship between the neighbourhood environment and childhood obesity

OBJECTIVE

Understanding the mechanisms by which neighbourhood environments influence childhood obesity is needed to facilitate the development of prevention strategies. The objective of this cross-sectional study was to identify the distinct types of neighbourhoods in which Canadian children reside and examine the extent to which physical activity and sedentary behaviour mediate the relationship between neighbourhood type and childhood obesity.

METHODS

Baseline data from the National Longitudinal Survey of Children and Youth (1994/1995) were used for this study. Latent class analysis was used to group children (age 0-11; N = 22,831) into neighbourhood types based on perceived and census-derived measures of neighbourhood attributes. A path analysis was used to determine the extent to which levels of physical activity and sedentary behaviour mediated the relationship between the resulting neighbourhood types and obesity.

RESULTS

Five neighbourhood types were identified. Children living in the high safety-low deprivation neighbourhood type, which had the most supportive attributes with regard to physical activity, were significanlty less likely to be obese than children living in the other neighbourhood types. Relative to the high safety-low deprivation neighbourhood, the relationship between neighbourhood type and obesity was partially mediated by physical activity and sedentary behaviour (7%-12% of total effect) among the other urban neighbourhoods, and no mediating effect was found in the rural neighbourhood.

CONCLUSIONS

Intervention strategies attempting to address the increased risk of obesity associated with neighbourhood environments should be tailored according to urban and rural setting and should consider taking a comprehensive approach aimed at improving a range of obesity-related behaviours.

Effect of inspiratory muscle training with load compared with sham training on blood pressure in individuals with hypertension: study protocol of a double-blind randomized clinical trial

Background

Hypertension is a complex chronic condition characterized by elevated arterial blood pressure. Management of hypertension includes non-pharmacologic strategies, which may include techniques that effectively reduce autonomic sympathetic activity. Respiratory exercises improve autonomic control over cardiovascular system and attenuate muscle metaboreflex. Because of these effects, respiratory exercises may be useful to lower blood pressure in subjects with hypertension.

Methods/design

This randomized, double-blind clinical trial will test the efficacy of inspiratory muscle training in reducing blood pressure in adults with essential hypertension. Subjects are randomly allocated to intervention or control groups. Intervention consists of inspiratory muscle training loaded with 40 % of maximum inspiratory pressure, readjusted weekly. Control sham intervention consists of unloaded exercises. Systolic and diastolic blood pressures are co-primary endpoint measures assessed with 24 h ambulatory blood pressure monitoring. Secondary outcome measures include cardiovascular autonomic control, inspiratory muscle metaboreflex, cardiopulmonary capacity, and inspiratory muscle strength and endurance.

Discussion

Previously published work suggests that inspiratory muscle training reduces blood pressure in persons with hypertension, but the effectiveness of this intervention is yet to be established. We propose an adequately sized randomized clinical trial to test this hypothesis rigorously. If an effect is found, this study will allow for the investigation of putative mechanisms to mediate this effect, including autonomic cardiovascular control and metaboreflex.

Trial registration

ClinicalTrials.gov NCT02275377. Registered on 30 September 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1514-y) contains supplementary material, which is available to authorized users.

Differential Effects of Neighborhood Type on Adolescent Alcohol Use in New Zealand

Identifying neighborhood typologies associated with adolescent alcohol use can inform the development of harm reduction strategies. Utilizing data from a nationally representative youth survey (n = 4267) in New Zealand, latent class analysis was used to categorize neighborhood types (defined by 10 demographic, social and environmental indicators) to investigate their association with alcohol consumption and related harm. Three neighborhood types were distinguished: (1) "high outlet density and economic deprivation" (30 % of all neighborhoods); (2) "high deprivation, social disorganization, and unsafe" (38 %); and (3) "higher income, safe, and socially organized" (32 %). Significant ethnic variation was evident between neighborhood types. There was an age-group interaction in the main effects with significant associations between neighborhood type and drinking measures and harm most apparent among younger adolescents (<16 years), as described next. Compared to students residing in "higher income, safe, and socially organized" neighborhoods, the frequency of binge drinking and high typical consumption was significantly higher in students residing in "high outlet density and economic deprivation" and "high deprivation, social disorganization, and unsafe", with students residing in "high outlet density and economic deprivation" also experiencing higher levels of alcohol-related harm. The findings that neighborhoods characterized by high deprivation and alcohol outlet density and low social organization and perceptions of safety were associated with risky drinking patterns and harm, specifically among young adolescents, underscores the importance of adopting a developmental approach to the study of contextual effects on adolescents.

Perceived insecurity, mental health and urbanization: Results from a multicentric study

AIMS

This article aims to (1) explore the levels of perceived insecurity in a sample of patients with mood or anxiety disorders and (2) assess whether living in 'big cities' can influence the levels of patients' perceived insecurity and social contacts compared to living in a non-urbanized context.

METHODS

A total of 24 Italian mental health centers (MHCs) have been invited to participate. Twenty patients consecutively accessing the MHC have been recruited. All patients have been assessed using validated assessment tools.

RESULTS

The sample consisted of 426 patients, mostly female, with a mean age of 45 years. Globally, 52.2% of patients had a diagnosis of mood disorders, and 37.8% had anxiety disorders. Half of the sample declared that the main feeling toward life is uncertainty; higher levels of pessimistic views toward life have been detected in patients living in urban areas. A positive association between negative attitudes toward life and higher levels of depressive and anxiety symptoms, poor social functioning and higher levels of perceived psychological distress has been found.

CONCLUSION

Our findings confirm the presence of a common sense of perceived uncertainty among our sample. Such attitude toward life can have a detrimental impact on patients' psychological and physical well-being, contributing to high levels of distress.

Built environmental correlates of physical activity in China: A review

Objective

China faces growing levels of physical inactivity and obesity, associated with increasing urbanization and changing lifestyles in recent years. China is expanding its cities to accommodate a growing urban population. This paper identifies built environment factors that are associated with physical activity in China. Findings can inform urban design and development in China to support increased physical activity.

Methods

This paper is modeled on a review of built environment correlates of walking by Saelens and Handy (2008). Saelens and Handy reviewed research in developed countries. The present paper reviews 42 empirical studies that were conducted in China and were published between 2006 and 2014.

Results

Results discuss the association of built environment features and physical activity for transportation, recreation and work. Studies focus on adults and on major cities. Data on the built environment is typically self-reported. Strongest evidence was found for the positive association of physical activity with proximal non-residential locations, pedestrian infrastructure, aesthetics, and non-park physical activity facilities, and for the negative association of physical activity with urban residence. In terms of physical activity for transportation, evidence is strongest for associations between physical activity for transportation and proximal non-residential locations.

Conclusion

More research is needed on the built environment and physical activity, especially including research on significant features of Chinese cities, such as air pollution, high density levels, traffic safety, and others. Research on associations between built environment features and physical activity should consider the specific social and built environment contexts of Chinese cities.

•

Research on the environment and physical activity is increasing in China.

•

Physical activity is linked to mixed land use, sidewalks, aesthetics, and facilities.

•

Future research should address environments and issues specific to China.

Neighbourhood typology based on virtual audit of environmental obesogenic characteristics

Virtual audit (using tools such as Google Street View) can help assess multiple characteristics of the physical environment. This exposure assessment can then be associated with health outcomes such as obesity. Strengths of virtual audit include collection of large amount of data, from various geographical contexts, following standard protocols. Using data from a virtual audit of obesity-related features carried out in five urban European regions, the current study aimed to (i) describe this international virtual audit dataset and (ii) identify neighbourhood patterns that can synthesize the complexity of such data and compare patterns across regions. Data were obtained from 4,486 street segments across urban regions in Belgium, France, Hungary, the Netherlands and the UK. We used multiple factor analysis and hierarchical clustering on principal components to build a typology of neighbourhoods and to identify similar/dissimilar neighbourhoods, regardless of region. Four neighbourhood clusters emerged, which differed in terms of food environment, recreational facilities and active mobility features, i.e. the three indicators derived from factor analysis. Clusters were unequally distributed across urban regions. Neighbourhoods mostly characterized by a high level of outdoor recreational facilities were predominantly located in Greater London, whereas neighbourhoods characterized by high urban density and large amounts of food outlets were mostly located in Paris. Neighbourhoods in the Randstad conurbation, Ghent and Budapest appeared to be very similar, characterized by relatively lower residential densities, greener areas and a very low percentage of streets offering food and recreational facility items. These results provide multidimensional constructs of obesogenic characteristics that may help target at-risk neighbourhoods more effectively than isolated features.

Assessing opportunities for physical activity in the built environment of children: interrelation between kernel density and neighborhood scale

BACKGROUND

Built environment studies provide broad evidence that urban characteristics influence physical activity (PA). However, findings are still difficult to compare, due to inconsistent measures assessing urban point characteristics and varying definitions of spatial scale. Both were found to influence the strength of the association between the built environment and PA.

METHODS

We simultaneously evaluated the effect of kernel approaches and network-distances to investigate the association between urban characteristics and physical activity depending on spatial scale and intensity measure. We assessed urban measures of point characteristics such as intersections, public transit stations, and public open spaces in ego-centered network-dependent neighborhoods based on geographical data of one German study region of the IDEFICS study. We calculated point intensities using the simple intensity and kernel approaches based on fixed bandwidths, cross-validated bandwidths including isotropic and anisotropic kernel functions and considering adaptive bandwidths that adjust for residential density. We distinguished six network-distances from 500 m up to 2 km to calculate each intensity measure. A log-gamma regression model was used to investigate the effect of each urban measure on moderate-to-vigorous physical activity (MVPA) of 400 2- to 9.9-year old children who participated in the IDEFICS study. Models were stratified by sex and age groups, i.e. pre-school children (2 to <6 years) and school children (6-9.9 years), and were adjusted for age, body mass index (BMI), education and safety concerns of parents, season and valid weartime of accelerometers.

RESULTS

Association between intensity measures and MVPA strongly differed by network-distance, with stronger effects found for larger network-distances. Simple intensity revealed smaller effect estimates and smaller goodness-of-fit compared to kernel approaches. Smallest variation in effect estimates over network-distances was found for kernel intensity measures based on isotropic and anisotropic cross-validated bandwidth selection.

CONCLUSION

We found a strong variation in the association between the built environment and PA of children based on the choice of intensity measure and network-distance. Kernel intensity measures provided stable results over various scales and improved the assessment compared to the simple intensity measure. Considering different spatial scales and kernel intensity methods might reduce methodological limitations in assessing opportunities for PA in the built environment.

Patterns of Walkability, Transit, and Recreation Environment for Physical Activity

INTRODUCTION

Diverse combinations of built environment (BE) features for physical activity (PA) are understudied. This study explored whether patterns of GIS-derived BE features explained objective and self-reported PA, sedentary behavior, and BMI.

METHODS

Neighborhood Quality of Life Study participants (N=2,199, aged 20-65 years, 48.2% female, 26% ethnic minority) were sampled in 2001-2005 from Seattle / King County WA and Baltimore MD / Washington DC regions. Their addresses were geocoded to compute net residential density, land use mix, retail floor area ratio, intersection density, public transit, and public park and private recreation facility densities using a 1-km network buffer. Latent profile analyses (LPAs) were estimated from these variables. Multilevel regression models compared profiles on accelerometer-measured moderate to vigorous PA (MVPA) and self-reported PA, adjusting for covariates and clustering. Analyses were conducted in 2013-2014.

RESULTS

Seattle region LPAs yielded four profiles, including low walkability/transit/recreation (L-L-L); mean walkability/transit/recreation (M-M-M); moderately high walkability/transit/recreation (MH-MH-MH); and high walkability/transit/recreation (H-HH). All measures were higher in the HHH than the LLL profile (difference of 17.1 minutes/day for MVPA, 146.5 minutes/week for walking for transportation, 58.2 minutes/week for leisure-time PA, and 2.2 BMI points; all p<0.05). Baltimore region LPAs yielded four profiles, including L-L-L; M-M-M; high land use mix, transit, and recreation (HLU-HT-HRA); and high intersection density, high retail floor area ratio (HID-HRFAR). HLU-HT-HRA and L-L-L differed by 12.3 MVPA minutes/day; HID-HRFAR and L-L-L differed by 157.4 minutes/week for walking for transportation (all p<0.05).

CONCLUSIONS

Patterns of environmental features explain greater differences in adults' PA than the four-component walkability index.

Exploring the forest instead of the trees: An innovative method for defining obesogenic and obesoprotective environments

Past research has assessed the association of single community characteristics with obesity, ignoring the spatial co-occurrence of multiple community-level risk factors. We used conditional random forests (CRF), a non-parametric machine learning approach to identify the combination of community features that are most important for the prediction of obesogenic and obesoprotective environments for children. After examining 44 community characteristics, we identified 13 features of the social, food, and physical activity environment that in combination correctly classified 67% of communities as obesoprotective or obesogenic using mean BMI-z as a surrogate. Social environment characteristics emerged as most important classifiers and might provide leverage for intervention. CRF allows consideration of the neighborhood as a system of risk factors.

Patterns of neighborhood environment attributes in relation to children's physical activity

Characterizing neighborhood environments in relation to physical activity is complex. Latent profiles of parents' perceptions of neighborhood characteristics were examined in relation to accelerometer-measured moderate-to-vigorous physical activity (MVPA) among 678 children (ages 6-12) in two US regions. Neighborhood environment profiles derived from walkability, transit access, aesthetics, crime and traffic safety, pedestrian infrastructure, and recreation/park access were created for each region. The San Diego County profile lowest on walkability and recreation/park access was associated with an average of 13 fewer min/day of children's out-of-school MVPA compared to profiles higher on walkability and recreation/park access. Seattle/King County profiles did not differ on children's MVPA. Neighborhood environment profiles were associated with children's MVPA in one region, but results were inconsistent across regions.

Neighborhood social environment and patterns of adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus

This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage, compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multilevel contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements.

Urban environment interventions linked to the promotion of physical activity: a mixed methods study applied to the urban context of Latin America

This study summarizes the evidence from quantitative systematic reviews that assessed the association between urban environment attributes and physical activity. It also documents sociopolitical barriers and facilitators involved in urban interventions linked with active living in the ten most populated urban settings of Latin America. The synthesis of evidence indicates that several attributes of urban environments are associated with physical activity, including land-use mix and cycling infrastructure. The documentary analysis indicated that despite the benefits and opportunities provided by the programs and existing infrastructure in the examined cities, an overall concern is the rising inequality in the coverage and distribution of the initiatives in the region. If these programs and initiatives are to achieve a real population level effect that helps to reduce health disparities, they need to examine their social and spatial distribution within the cities so they can reach underserved populations and develop to their full potential.

Home and workplace built environment supports for physical activity

BACKGROUND

Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA.

PURPOSE

To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel).

METHODS

Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA.

RESULTS

In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction.

CONCLUSIONS

This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.

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

Background

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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

The Association between walking and perceived environment in Chinese community residents: a cross-sectional study

Background

The neighborhood environment, as a determinant of walking, has been assessed in several developed countries. However, few studies have investigated these associations in Chinese populations.

Objective

To examine the association between the perceived neighborhood environment and walking for recreation or transportation purposes among Chinese community residents.

Methods

We used a multi-stage stratified random sampling design to conduct a cross-sectional study of 1528 Chinese adults in Shanghai. Environmental and walking variables were assessed using a revised Abbreviated Neighborhood Environment Walkability Scale for Chinese subjects and a long version of International Physical Activity Questionnaire. Self-reported demographic variables including gender, age, employment status, and location of community were also collected. Multiple logistic regression analysis was applied to examine the association between the neighborhood environment and walking.

Results

Based on the results of IPAQ, 13.7% of the overall subjects were physical inactive, which was considered to be lowly active. For all participants, accessibility to services was significantly associated with walking for both recreation and transportation (odds ratio = 1.062, 95% confidence interval: 1.016, 1.110; odds ratio = 1.053; 95% confidence interval: 1.008, 1.100, respectively). In males, accessibility to services was significantly associated both with walking for recreation and walking for transportation. However, a significantly negative association was found between the neighborhood surroundings and walking for recreation. In contrast, females who perceived good traffic safety tended to walk for recreation. Data also revealed a difference between working and retired individuals. Among working participants, perceived environmental variables were not significantly associated with walking for recreation and transportation.

Conclusions

The association between neighborhood environment and walking varied depending on the reason for walking and the characteristics of the participants. Our findings suggest that interventions to promote walking in community residents should include improving the neighborhood environment, particularly accessibility to services such as building more stores, parks, and public transit facilities.