Relation between higher physical activity and public transit use

Parental Travel Behaviors and Children's Independent Mobility: A MultiSite Study

PURPOSE

Children who are allowed greater independent mobility (IM) are more physically active. This study investigated associations between parents' current travel mode to work, their own IM and school travel mode as a child, and their child's IM.

METHODS

Children in grades 4 to 6 (n = 1699) were recruited from urban, suburban, and rural schools in Vancouver, Ottawa, and Trois-Rivières. Parents reported their current travel mode to work, IM, and school travel mode as a child. Children self-reported their IM using Hillman's 6 mobility licenses. Multiple imputation was performed to replace missing data. Gender-stratified generalized linear mixed models were adjusted for child age, parent gender, urbanization, and socioeconomic status.

RESULTS

The older a parent was allowed to travel alone as a child, the less IM their child had (boys: β = -0.09, 95% confidence interval [CI], -0.13 to -0.04; girls: β = -0.09, 95% CI, -0.13 to -0.06). Girls whose parents biked to work (β = 0.45, 95% CI, 0.06-0.83) or lived in Trois-Rivières versus other sites (β = 0.82, 95% CI, -0.43 to 1.21) had higher IM. IM increased with each year of age (boys: β = 0.46, CI, 0.34-0.58; girls: β = 0.38, 95% CI, 0.28-0.48).

CONCLUSION

Parents who experienced IM later may be more restrictive of their child's IM. This may help explain the intergenerational decline in children's IM.

Meeting physical activity and resistance exercise guidelines associated with significantly reduced prevalence of diabetes in older adults

BACKGROUND

The global prevalence of diabetes is rising. Lack of physical activity is a known risk factor, and older adults with diabetes face a higher risk of complications compared to other age groups. Additionally, the risk of mortality increases with longer duration of diabetes.

OBJECTIVE

This study aimed to investigate how meeting physical activity guidelines is associated with diabetes prevalence in older adults.

METHODS

We analysed data from 5679 men and women (aged ≥65 years) who participated in the Korea National Health and Nutrition Examination Survey (2016-19). Physical activity levels were measured using the Global Physical Activity Questionnaire, including an assessment of weekly resistance exercise duration. Multivariable adjusted logistic regression analysis was conducted to examine the association between meeting leisure-time physical activity and resistance exercise guidelines with diabetes prevalence.

RESULTS

Meeting either the leisure-time physical activity guideline [odds ratio (OR): 0.72, 95% confidence interval (CI): 0.58-0.88] or the resistance exercise guideline (OR: 0.69, 95% CI: 0.59-0.80) was associated with a lower prevalence of diabetes. Notably, participants who met both guidelines had a 37% lower risk of diabetes (95% CI: 0.47-0.84) compared to those who met none.

CONCLUSIONS

Adherence to physical activity guidelines, especially leisure-time physical activity and resistance exercise, is associated with a reduced prevalence of diabetes in older adults. Meeting both sets of guidelines may significantly lower the risk of diabetes compared to not meeting any. These findings highlight the crucial role of regular physical activity in preventing diabetes amongst older individuals, with the potential for a significant public health impact.

Impacts of zero-fare transit policy on health and social determinants: protocol for a natural experiment study

Population-level efforts are needed to increase levels of physical activity and healthy eating to reduce and manage chronic diseases such as obesity, cardiovascular disease, and type 2 diabetes. Interventions to increase public transit use may be one promising strategy, particularly for low-income communities or populations of color who are disproportionately burdened by health disparities and transportation barriers. This study employs a natural experiment design to evaluate the impacts of a citywide zero-fare transit policy in Kansas City, Missouri, on ridership and health indicators. In Aim 1, comparison to 9 similar cities without zero-fare transit is used to examine differential changes in ridership from 3 years before to 4 years after the adoption of zero-fare. In Aim 2, Kansas City residents are being recruited from a large safety net health system to compare health indicators between zero-fare riders and non- riders. Longitudinal data on BMI, cardiometabolic markers, and economic barriers to health are collected from the electronic health record from 2017 to 2024. Cross-sectional data on healthy eating and device-measured physical activity are collected from a subsample of participants as part of the study procedures (N = 360). Numerous baseline characteristics are collected to account for differences between Kansas City and comparison city bus routes (Aim 1) and between zero-fare riders and non-riders within Kansas City (Aim 2). Evidence on how zero-fare transit shapes population health through mechanisms related to improved economic factors, transportation, physical activity, and healthy eating among low-income groups is expected.

GPS-derived environmental exposures during pregnancy and early postpartum - Evidence from the madres cohort

The built and natural environment factors (e.g., greenspace, walkability) are associated with maternal and infant health during and after pregnancy. Most pregnancy studies assess exposures to environmental factors via static methods (i.e., residential location at a single point in time, usually 3rd trimester). These do not capture dynamic exposures encountered in activity spaces (e.g., locations one visits and paths one travels) and their changes over time. In this study, we aimed to compare daily environmental exposure estimates using residential and global positioning systems (GPS)-measured activity space approaches and evaluated potential for exposure measurement error in the former. To do this, we collected four days of continuous geolocation monitoring during the 1st and 3rd trimesters of pregnancy and at 4-6 months postpartum in sixty-two pregnant Hispanic women enrolled in the MADRES cohort. We applied residential and GPS-based methods to assess daily exposures to greenspace, access to parks and transit, and walkability, respectively. We assessed potential for exposure measurement error in residential vs GPS-based estimates using Pearson correlations for each measure overall and by study period. We found residential and GPS-based estimates of daily exposure to total areas of parks and open spaces were weakly positively correlated (r = 0.31, P < .001) across pregnancy and postpartum periods. Residential estimates of %greenspace (r = 0.52, P < .001) and tree cover (r = 0.55, P < .001) along walkable roads were moderately correlated with GPS-based estimates. Residential and GPS-based estimates of public transit proximity, pedestrian-oriented intersection density, and walkability index score were all highly positively correlated (r > 0.70, P < .001). We also found associations between residential and GPS-based estimates decreased among participants with greater daily mobility. Our findings suggest the popular approach that assessing the built and natural environment exposures using residential methods at one time point may introduce exposure measurement error in pregnancy studies. GPS-based methods, to the extent feasible, are recommended for future studies.

Effects of public transportation use on non-exercise activity thermogenesis and health promotion: a mini-review

PURPOSE

Public transportation (PT) systems significantly shape urban mobility and have garnered attention owing to their potential impact on public health, particularly the promotion of physical activity. Beyond their transportation functions, PT systems also affect daily energy expenditure through non-exercise activity thermogenesis (NEAT). This mini-review surveys the existing literature to explore the effects of PT use on NEAT levels and subsequent health outcomes.

METHODS

A comprehensive literature search was conducted using the electronic databases PubMed, Google Scholar, and Web of Science. Keywords including "public transportation," "non-exercise activity thermogenesis," "physical activity," "health promotion," and related terms were used to identify relevant studies.

RESULTS

This review highlights the multifaceted relationship between PT use and health promotion, emphasizing the potential benefits and challenges of increasing NEAT through public transit utilization. Overall, the findings suggest that PT use contributes positively to NEAT levels, and thus improves health outcomes. However, the extent of this impact may vary depending on individual and contextual factors.

CONCLUSION

Interventions promoting active transportation modes, including public transit, hold promise for addressing sedentary behavior and fostering healthier lifestyles at the population level.

A comprehensive walkability evaluation system for promoting environmental benefits

Pedestrian-oriented urban strategies such as the Paris 15-minute City are needed to respond to the global boiling. Quantitative evaluation of pedestrian-oriented urban objectives is important for various cities, and in this paper, a walkability evaluation system for the advanced model is developed considering the characteristics of a large city. The system calculates the walkability of Seoul. The evaluation system uses the Betweenness index as a weight in the urban network analysis. Considering stations with a high betweenness in urban traffic is essential for evaluating a pedestrian-oriented metropolis. Our findings in this study are that the UNA index in WES is critical for transit-oriented, walkable cities. The large city needs to find the location for mobility hubs or stations to observe the last mile. Installing a mobility hub or station at a high-value location in the city center is functionally important. In a pedestrian-oriented city, citizens can walk and bike the last mile in a busy city center. Walkable cities can encourage active transport and ultimately create more sustainable and environmentally friendly transportation systems. This study offers valuable insights into pedestrian infrastructure, urban systems, and policies that promote green transportation.

Public transit stop density is associated with walking for exercise among a national sample of older adults

BACKGROUND

Walking is the primary and preferred mode of exercise for older adults. Walking to and from public transit stops may support older adults in achieving exercise goals. This study examined whether density of neighborhood public transit stops was associated with walking for exercise among older adults.

METHODS

2018 National Health and Aging Trends Study (NHATS) data were linked with the 2018 National Neighborhood Data Archive, which reported density of public transit stops (stops/mile2) within participants' neighborhood, defined using census tract boundaries. Walking for exercise in the last month was self-reported. The extent to which self-reported public transit use mediated the relationship between density of neighborhood public transit stops and walking for exercise was examined. Covariates included sociodemographic characteristics, economic status, disability status, and neighborhood attributes. National estimates were calculated using NHATS analytic survey weights.

RESULTS

Among 4,836 respondents with complete data, 39.7% lived in a census tract with at least one neighborhood public transit stop and 8.5% were public transit users. The odds of walking for exercise were 32% higher (OR = 1.32; 95% confidence interval: 1.08, 1.61) among respondents living in a neighborhood with > 10 transit stops per mile compared to living in a neighborhood without any public transit stops documented. Self-reported public transit use mediated 24% of the association between density of neighborhood public transit stops and walking for exercise.

CONCLUSIONS

Density of neighborhood public transit stops was associated with walking for exercise, with a substantial portion of the association mediated by self-reported public transit use. Increasing public transit stop availability within neighborhoods may contribute to active aging among older adults.

A health behaviour pandemic: The COVID-19 pandemic has impacted the physical activity, sleep, and sedentary behaviour of already-struggling Canadians

Objectives

The Canadian 24-Hour Movement Guidelines (24HMG) provide evidence-based recommendations for health behaviours, including light physical activity, moderate-to-vigorous physical activity (MVPA), sedentary behaviour (SB), sleep, and muscle strengthening activities. These behaviours likely changed as a result of public health measures implemented throughout the COVID-19 pandemic. We aimed to understand how Canadians' health behaviours changed during the pandemic.

Methods

We conducted a nationwide survey asking Canadians aged 18-64 to report their health behaviours according to the 24HMG at three timepoints: 1) immediately prior to the pandemic, 2) the most restricted timepoint of the pandemic, and 3) more recently, in March 2022.

Results

We received 494 eligible responses from across Canada. Prior to the pandemic, only 7.7% of respondents were able to meet all 24HMG, which reduced to 3.8% during the most restricted phase of the pandemic (p < 0.01). During this timepoint, self-reported MVPA decreased by -21.9 ± 55.6 weekly minutes, muscle strengthening decreased by -0.34 ± 0.94 weekly sessions, and SB increased by 0.88 ± 2.04 daily hours (p < 0.00001 for all), with nonsignificant increases in nightly sleep. At the more recent March 2022 timepoint, mild recoveries were observed in all health behaviours, however remained significantly lower than baseline levels, with the exception of sleep, which decreased significantly (-0.18 ± 1.42 nightly hours, p = 0.005).

Conclusions

Unfavourable health behaviour changes among Canadians were observed throughout the COVID-19 pandemic, which increases the risk for acute and long-term health conditions. Improved education, infrastructure, and support from public and private sectors can reverse the negative risk factors that arise from these health behaviour changes, and can improve the culture of proactive health behaviours in Canada.

Examining the impacts of public transit on healthy aging through a natural experiment: study protocols and lessons learned from the Active El Paso project

This paper describes protocols and experiences from a seven-year natural-experiment study in El Paso, Texas, a border city of predominantly Latino/Hispanic population. The study focuses on how Bus Rapid Transit (BRT) impacts physical activity and thus plays a role in alleviating obesity and related chronic diseases that impact healthy aging. Our protocols describe a longitudinal and case-comparison study, which compared residents exposed to new BRT stations with those who were not. This paper also introduces lessons and experiences to overcome the following challenges: delays in the BRT opening (the main intervention), the COVID-19 pandemic, methodological challenges, participant recruitment and retention, and predatory survey takers. Our transdisciplinary approach was pivotal in addressing these challenges. We also proposed and tested multi-level intervention strategies to reduce modifiable barriers to transit use. Our most important takeaway for researchers, practitioners, and policy makers is the importance of being flexible and ready to adapt to new circumstances. Future natural-experiment researchers need to become more versatile in an increasingly volatile and uncertain world.

Trading-Off Transit and Non-Transit Physical Activity among Older People: Evidence from Longitudinal Accelerometer Data of a Natural Experiment Study

This study used a natural experiment of a new metro line in Hong Kong to examine trade-offs between transit-related and non-transit-related physical activity (PA) among 104 older people (aged ≥ 65 years) based on longitudinal accelerometer data that distinguished transit-related and non-transit-related PA. Difference-in-difference (DID) analysis compared PA changes between treatment and control groups. We found that new metro stations have trade-off effects between transit and non-transit PA. After opening metro stations, transit-related PA increased by 12 min per day on average, but non-transit-related PA decreased by 18 min per day. In addition, the proportion of time spent in transit-related PA increased by 6%. The results suggested that new metro stations could generate transit-related PA, but it might shift from non-transit-related PA among older people. Our findings revealed trade-off effects of public transit interventions and have significant implications for transport and healthy ageing studies.

Historical development of accelerometry measures and methods for physical activity and sedentary behavior research worldwide: A scoping review of observational studies of adults

This scoping review identified observational studies of adults that utilized accelerometry to assess physical activity and sedentary behavior. Key elements on accelerometry data collection were abstracted to describe current practices and completeness of reporting. We searched three databases (PubMed, Web of Science, and SPORTDiscus) on June 1, 2021 for articles published up to that date. We included studies of non-institutionalized adults with an analytic sample size of at least 500. The search returned 5686 unique records. After reviewing 1027 full-text publications, we identified and abstracted accelerometry characteristics on 155 unique observational studies (154 cross-sectional/cohort studies and 1 case control study). The countries with the highest number of studies included the United States, the United Kingdom, and Japan. Fewer studies were identified from the continent of Africa. Five of these studies were distributed donor studies, where participants connected their devices to an application and voluntarily shared data with researchers. Data collection occurred between 1999 to 2019. Most studies used one accelerometer (94.2%), but 8 studies (5.2%) used 2 accelerometers and 1 study (0.6%) used 4 accelerometers. Accelerometers were more commonly worn on the hip (48.4%) as compared to the wrist (22.3%), thigh (5.4%), other locations (14.9%), or not reported (9.0%). Overall, 12.7% of the accelerometers collected raw accelerations and 44.6% were worn for 24 hours/day throughout the collection period. The review identified 155 observational studies of adults that collected accelerometry, utilizing a wide range of accelerometer data processing methods. Researchers inconsistently reported key aspects of the process from collection to analysis, which needs addressing to support accurate comparisons across studies.

The TROLLEY Study: assessing travel, health, and equity impacts of a new light rail transit investment during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic disrupted life in extraordinary ways impacting health and daily mobility. Public transit provides a strategy to improve individual and population health through increased active travel and reduced vehicle dependency, while ensuring equitable access to jobs, healthcare, education, and mitigating climate change. However, health safety concerns during the COVID-19 pandemic eroded ridership, which could have longstanding negative consequences. Research is needed to understand how mobility and health change as the pandemic recedes and how transit investments impact health and equity outcomes.

METHODS

The TROLLEY (TRansit Opportunities for HeaLth, Livability, Exercise and EquitY) study will prospectively investigate a diverse cohort of university employees after the opening of a new light rail transit (LRT) line and the easing of campus COVID-19 restrictions. Participants are current staff who live either < 1 mile, 1-2 miles, or  > 2 miles from LRT, with equal distribution across economic and racial/ethnic strata. The primary aim is to assess change in physical activity, travel mode, and vehicle miles travelled using accelerometer and GPS devices. Equity outcomes include household transportation and health-related expenditures. Change in health outcomes, including depressive symptoms, stress, quality of life, body mass index and behavior change constructs related to transit use will be assessed via self-report. Pre-pandemic variables will be retrospectively collected. Participants will be measured at 3 times over 2 years of follow up. Longitudinal changes in outcomes will be assessed using multilevel mixed effects models. Analyses will evaluate whether proximity to LRT, sociodemographic, and environmental factors modify change in outcomes over time.

DISCUSSION

The TROLLEY study will utilize rigorous methods to advance our understanding of health, well-being, and equity-oriented outcomes of new LRT infrastructure through the COVID-19 recovery period, in a sample of demographically diverse adult workers whose employment location is accessed by new transit. Results will inform land use, transportation and health investments, and workplace interventions. Findings have the potential to elevate LRT as a public health priority and provide insight on how to ensure public transit meets the needs of vulnerable users and is more resilient in the face of future health pandemics.

TRIAL REGISTRATION

The TROLLEY study was registered at ClinicalTrials.gov ( NCT04940481 ) June 17, 2021, and OSF Registries ( https://doi.org/10.17605/OSF.IO/PGEHU ) June 24, 2021, prior to participant enrollment.

Neighborhood built environments and Hispanic/Latino adults' physical activity in the U.S.: The Hispanic community health study/study of Latinos community and surrounding areas study

Despite experiencing health inequities, less is known about neighborhood environments and physical activity among Hispanic/Latino adults compared to other populations. We investigated this topic in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanic/Latino adults in the San Diego, California area of the U.S. completed measures of overall moderate-to-vigorous physical activity (MVPA) via accelerometry and domain-specific MVPA via questionnaire at Visits 1 (2008-2011; n = 4086) and 2 (2014-2017; n = 1776), ~6 years apart. 800-m home neighborhood buffers were used to create objective measures of residential, intersection, and retail density, bus/trolley stops, greenness, parks, and recreation area at Visit 1. Regression models tested the association of each neighborhood feature with MVPA at Visit 1 and over 6 years, adjusting for individual characteristics and neighborhood socioeconomic deprivation. At Visit 1, those in neighborhoods with higher vs. lower retail density or recreation area (+1 vs. -1 standard deviation from the mean) engaged in 10% more overall MVPA and 12-22% more active transportation. Those in neighborhoods with higher vs. lower residential density engaged in 22% more active transportation. Those in neighborhoods with higher vs. lower greenness and park count engaged in 14-16% more recreational MVPA. Neighborhood features were unassociated with changes in MVPA over 6 years. Although changes in MVPA over time were similar across neighborhoods, Hispanic/Latino adults living in neighborhoods with design features supportive of walking and recreational activity (e.g., greater residential and retail density, more parks and recreation facilities) were consistently more active. Improving neighborhood environments appears important for supporting physical activity among Hispanic/Latino adults.

Walking for transportation in large Latin American cities: walking-only trips and total walking events and their sociodemographic correlates

Walking for transportation is a common and accessible means of achieving recommended physical activity levels, while providing important social and environmental co-benefits. Even though walking in rapidly growing urban areas has become especially challenging given the increasing dependence on motorised transportation, walking remains a major mode of transportation in Latin American cities. In this paper we aimed to quantify self-reported walking for transportation in Mexico City, Bogota, Santiago de Chile, Sao Paulo, and Buenos Aires, by identifying both walking trips that are conducted entirely on foot and walking events involved in trips mainly conducted on other means of transportation (e.g. private vehicle, public transit) among individuals ≥5-years old. We show how walking-only trips account for approximately 30% trips in the analysed cities, and we evidence how the pedestrian dimension of mobility is largely underestimated if walking that is incidental to other transportation modes is not accounted for: when considering all walking events, we observed an increase between 73% and 217% in daily walking time. As a result, we estimated that between 19% and 25% of residents in these cities meet the WHO physical activity guidelines solely from walking for transportation. The results of the study also suggest that the promotion of public transportation in large Latin American cities can especially help certain population groups achieve the daily recommended levels of physical activity, while among low-income groups accessibility and safety seem to be the key challenges to be addressed.

Transit Use and Health Care Costs: A Cross-sectional Analysis

INTRODUCTION

Greater transit use is associated with higher levels of physical activity, which is associated with lower health risks and better health outcomes. However, there is scant evidence about whether health care costs differ based on level of transit ridership.

METHODS

A sample (n=947) of members of Kaiser Permanente in the Portland, Oregon area were surveyed in 2015 about their typical use of various modes of travel including transit. Electronic medical record-derived health care costs were obtained among these members for the prior three years. Analysis examined proportional costs between High transit users (3+ days/week), Low transit users (1-2 days/week), and Non-users adjusting for age and sex, and then individually (base models) and together for demographic and health status variables.

RESULTS

In separate base models across individual covariates, High transit users had lower total health care costs (59-69% of Non-user's costs) and medication costs (31-37% of Non-users' costs) than Non-users. Low transit users also had lower total health care (69%-76% of Non-users' costs) and medication costs (43-57% transit of Non-user's costs) than Non-users. High transit users' outpatient costs were also lower (77-82% of Non-users). In fully-adjusted models, total health care and medication costs were lower among High transit users' (67% and 39%) and Low transit users' (75% and 48%) compared to Non-users, but outpatient costs did not differ by transit use.

CONCLUSIONS

Findings have implications for the potential cost benefit of encouraging and supporting more transit use, although controlled longitudinal and experimental evidence is needed to confirm findings and understand mechanisms.

Causal evaluation of the health effects of light rail line: A Natural Experiment

BACKGROUND AND OBJECTIVE

No research to date has causally linked built environment data with health care costs derived from clinically assessed health outcomes within the framework of longitudinal intervention design. This study examined the impact of light rail transit (LRT) line intervention on health care costs after controlling for mode-specific objectively assessed moderateto-vigorous physical activity (MVPA), participant-level neighborhood environmental measures, demographics, attitudinal predispositions, and residential choices.

DATA AND METHODS

Based on a natural experiment related to a new LRT line in Portland - 282 individuals divided into treatment and control groups were prospectively followed during the pre- and post-intervention periods. For each individual, we harness high-resolution data on Electronic Medical Record (EMR) based health care costs, mode-specific MVPA, survey-based travel behavior, attitudinal/perception information, and objectively assessed built environment measures. Simulation-assisted longitudinal grouped random parameter models are developed to gain more accurate insights into the effects of LRT line intervention.

RESULTS

Regarding the "average effect" of the LRT line intervention, no statistically significant reductions in health care costs were observed for the treated individuals over time. However, substantial heterogeneity was observed not only in the magnitude of effects but its direction as well after controlling for the within- and between-individual variations. For a subgroup of treated individuals, the LRT line opening decreased health care costs over time relative to the control group. Further comparative analysis based on the findings of heterogeneity-based models revealed that the effect of LRT intervention for the treated individuals differed by individual characteristics, attitudes/perceptions, and neighborhood level environmental features.

CONCLUSIONS

The study revealed the presence of significant effect modifiers and distinct subgroup structures in the data related to the effects of LRT line intervention on health care costs. Severe implications of ignoring unobserved heterogeneity are highlighted. Limitations and potential avenues for future research are discussed.

Proposal of a Comprehensive and Multi-Component Approach to Promote Physical Activity among Japanese Office Workers: A Qualitative Focus Group Interview Study

Office workers spend up to two-thirds of their working hours sitting and are less physically active than other occupational groups. It is necessary to develop an effective approach to promote physical activity among office workers. We conducted a focus group interview with seven Japanese office workers to investigate the current status (topic 1) of, and their opinions on (topic 2), physical activity promotion programs in their workplace. Data were analyzed using qualitative data analysis. We classified the data from topic 1 into individual, socio-cultural, physical, and organizational environments. Most participants indicated that they spent a lot of time sitting and needed programs for a wide range of corresponding employee demands. We classified the data from topic 2 into capability, opportunity, and motivation. Most participants indicated that they wanted evidence-based information, a standing desk, and a conducive workplace environment to enhance physical activity. Thus, we proposed a comprehensive and multi-component approach comprising individual (information delivery), socio-cultural environment (team building, supportive atmosphere), physical environment (standing desk, use of poster), and organizational (incentive, encouraging message from an executive, workplace policy) strategies. Future studies should evaluate the effectiveness of this proposal.

Physical Activity and Cognitive Function in African American Older Adults Living With HIV

The purpose of the current study was to investigate the association between self-reported physical activity (minutes/week) and cognitive functioning in a sample of African American older adults living with HIV. A secondary analysis of baseline data collected from clinically stable African American older adults living with HIV (aged >50 years; N = 124) enrolled in the Rush Center of Excellence on Disparities in HIV and Aging study was conducted. Participants completed a battery of 19 cognitive function tests that were used to create summary scores of global cognition and five cognitive domains. Physical activity was measured using a modified self-report questionnaire derived from a national health survey. Average self-reported number of weekly minutes spent in light physical activity was 290.6 minutes and for moderate/vigorous physical activity was 314.67 minutes. Number of weekly minutes of light physical activity was significantly positively associated with visuospatial ability; however, no associations were found between moderate/vigorous physical activity and any cognitive domain. Contrary to expectations, our findings do not support a relationship between moderate/vigorous physical activity and cognitive function in African American older adults living with HIV. [Journal of Gerontological Nursing, 47(12), 27-34.].

Walkability measures to predict the likelihood of walking in a place: A classification and regression tree analysis

Walkability is a popular and ubiquitous term at the intersection of urban planning and public health. As the number of potential walkability measures grows in the literature, there is a need to compare their relative importance for specific research objectives. This study demonstrates a classification and regression tree (CART) model to compare five familiar measures of walkability from the literature for their relative ability to predict whether or not walking occurs in a dataset of objectively measured locations. When analyzed together, the measures had moderate-to-high accuracy (87.8% agreement: 65.6% of true walking GPS-measured points classified as walking and 93.4% of non-walking points as non-walking). On its own, the most well-known composite measure, Walk Score, performed only slightly better than measures of the built environment composed of a single variable (transit ridership, employment density, and residential density).Thus there may be contexts where transparent and longitudinally available measures of urban form are worth a marginal tradeoff in prediction accuracy. This comparison of walkability measures using CART highlights the importance for public health and urban design researchers to think carefully about how and why particular walkability measures are used.

The factors related to a sedentary lifestyle: A meta-analysis review

AIMS

To compare factors associated with the sedentary lifestyle described in the literature with the factors listed in NANDA International.

DESIGN

Systematic review with meta-analysis of factors associated with a sedentary lifestyle in adolescents, adults and older people.

DATA SOURCES

An electronic search of PubMed, Scopus, CINAHL and Latin America and the Caribbean Literature on Health and Science databases conducted in May 2016.

REVIEW METHODS

Descriptive data were extracted according to a standardized form. The odds ratios for each etiological factor associated with a sedentary lifestyle were extracted directly from the articles or calculated from the data described therein. The meta-analysis was conducted for factors that were investigated in more than one study.

RESULTS

Thirty-five articles were included. The statistically significant factors were: lack of social support, of physical space, of time, of motivation, of sports skills and of interest in physical activity, intolerance to activity, being retired, living in a low-income country, laziness, not having a job/studying, low socioeconomic status and level of knowledge about physical activity, female gender, living in an urban area, negative self-perception of health, using public transportation, being in the oldest age group in the study and perceived physical disability.

CONCLUSION

The new factors associated with a sedentary lifestyle and those already included in the NANDA International classification will lead to better clinical guidance for nurses.

IMPACT

Knowledge about these factors can contribute directly to public health policies.

Transit environments for physical activity: Relationship between micro-scale built environment features surrounding light rail stations and ridership in Houston, Texas

INTRODUCTION

Health professionals promote transport-related physical activity because travelers oftentimes walk or bike to and from transit stops or stations. Although previous studies have examined the associations between macro-scale built environment features surrounding light rail transit (LRT) stations (e.g., density) and LRT ridership, this study examined the associations between numerous micro-scale features (e.g., street-level noise pollution) and ridership.

METHODS

This analysis originated from the Houston Travel-Related Activity in Neighborhoods (TRAIN) Study, a project evaluating how an LRT extension impacted adult physical activity in Houston, Texas. In 2014, researchers used the Analytic Audit Tool to quantify 58 micro-scale built environment features within six categories: Land Use Environment, Transportation Environment, Facilities, Aesthetics, Signage, and Social Environment. Feature data were obtained from 590 street segments within 0.25 miles of 22 LRT stations. For each station, separate composite indices were created per category by averaging the computed feature scores (1-7) within each category, with higher scores signifying more physical activity-promoting features. Station-level LRT ridership data were obtained from monthly ridership reports for the 12 months following station opening. Linear mixed models were constructed to examine the associations of the six built environment categories with ridership, adjusting for season, weekday vs. weekend day, and station as a random intercept.

RESULTS

Holding all other variables constant, every one-unit increase in composite index scores for Transportation Environment and Social Environment was associated with an increase in daily ridership by 425 and 488 riders, respectively (p < 0.05). Every one-unit increase in composite index score for Signage was associated with a decrease of 722 riders daily (p < 0.05). The relations of Land Use Environment, Facilities, and Aesthetics with ridership were statistically null (p > 0.05).

CONCLUSIONS

Enhancements to the Transportation Environment and Social Environment may slightly increase overall LRT ridership, and consequently, utilitarian physical activity.

National and metropolitan trends in public transit use, transit-related walking, and ridesharing between 2009 and 2017

Introduction

Walking is a common form of physical activity and is the most frequent way to access public transit. On-going changes in the US transportation system are occurring, notably increases in smartphone application-based ridesharing. The goal of this research is to assess whether increasing use of ridesharing was associated with a change in transit-related walking. This is important to both public health and transportation, as it can inform changes in active transportation which promotes both physical activity and transit use.

Methods

We examined the association between change in transit use, transit-related walking, and ridesharing nationally and for selected metropolitan areas using the 2009 and 2017 National Household Travel Survey (≥18 years; n = 263,572 and n = 230,592, respectively). Analyses were conducted in 2019. Covariates included sex, age, race/ethnicity, education, employment, work from home, household size, number of vehicles, population density, Census region, metro area size and heavy rail transit category and season.

Results

The national prevalence of transit use in the past month in 2009 was 16.9% (95% CI: 16.4%-17.4%) and in 2017 was 16.1% (15.6%-16.6%), a significant decrease (p < 0.02). The prevalence of daily transit-related walking in 2009 was 4.2% (4.0%-4.4%) and in 2017 was 4.4% (4.2%-4.6%; p = 0.22). The prevalence of daily taxi use in 2009 was 0.5% (0.4%-0.6%) and taxi/rideshare in 2017 was 1.1% (1.0%-1.2%), a significant increase (p < 0.0001). The relationships remained after covariate adjustment. Finally, there was not a significant change in transit-related walking or interaction between year and taxi/rideshare use after additional adjustment for taxi/rideshare. Changes in transit-related walking in metros were largely not significant, whereas increases in taxi/rideshare were largely significant.

Conclusions

Results suggest that increased use of ridesharing may not be linked with changes in transit-related walking. Continued surveillance of travel mode prevalence is required to track potential reductions in population-level physical activity with technology-related changes in travel.

A systematic review of the evolution of GPS use in active living research: A state of the evidence for research, policy, and practice

This is the first systematic review to comprehensively capture Global Positioning Systems' (GPS) utilization in active living research by investigating the influence of physical contexts and social environment on all intensities of physical activity and sedentary behavior among all age groups. An extensive search of peer-reviewed literature was conducted using six databases. Out of 2026 articles identified, 129 studies met the inclusion criteria. After describing the evolution of GPS use across four themes (study designs and methods, physical contexts and social environment, active transportation, and behaviors), evidence-based recommendations for active living research, policy, and practice were generated.

Increasing physical activity in the community setting

Physical activity (PA) is beneficial for both mental and physical health, yet many individuals do not meet PA recommendations. There are a multitude of approaches to increase levels of PA and the role of the community is one area of growing interest. This review discusses the community environment as well as programs within the community and their influence on PA levels. Despite some research limitations, there are clear factors associated with community-based PA. Strategies that improve the built environment along with community-based programs have shown success, although differences between the characteristics of communities can mean strategies to promote PA are not universally effective. Additional research is needed on effective strategies that can be tailored to the characteristics of the community to increase PA. Further, public health interventions and policies should consider the role of the community when aiming to increase PA levels.

Case-comparison study protocol for gauging effects of neighbourhood trends and sickness: examining the perceptions of transit-Induced gentrification in Prince George's County

INTRODUCTION

Impoverished neighbourhoods and communities of colour often bear the brunt of unintended transit-oriented development (TOD) impacts. These impacts have been known to come in the form of transit-induced gentrification (TIG), a socioeconomic by-product of TOD defined as a phenomenon that occurs when the provision of transit service, particularly light rail transit (LRT), 'up-scales' nearby neighbourhood(s) and displaces existing residents. Consequently, TIG or even the perception of TIG can impact health outcomes (eg, anxiety) and social determinants of health (SDOH) (eg, crime).

METHODS/ANALYSIS

In 2022, the purple line (PL), a 16.2 mile LRT line, is opening in Prince George's County, Maryland, a suburb of Washington, DC, comprised of over 80% African American and Hispanic residents. By taking advantage of this natural experiment, we are proposing the GENTS (Gauging Effects of Neighborhood Trends and Sickness: Examining the Perceptions of Transit-Induced Gentrification in Prince George's County) Study in order to evaluate perceived TIG and associated health outcome and SDOH changes, at two points in time, among Prince George's County adults in a prospective case-comparison design during the pre-PL LRT period. Descriptive analysis and latent growth curve modelling will be used to examine these changes over time.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the University of Maryland Institutional Review Board. The GENTS Study will identify temporal changes in perceived TIG, health outcomes and SDOH among case and comparison residents before the completion and operation of the PL LRT, an under researched period of TOD. The dissemination of GENTS Study findings will be able to address research questions and policy issues that are specifically tailored to PG County while also providing more effective procedural solutions for other regions undergoing TOD and TIG risks.

Keeping kids safe for active travel to school: A mixed method examination of school policies and practices and children's school travel behaviour

Active school travel contributes to children's physical, mental and social wellbeing. The prevalence of children's active school travel, however, has been declining in many developed countries. Gaining insights into school culture and environments in relation to school travel behaviour is crucial to inform interventions. Using a multiphase mixed methods approach, this study aimed to provide a comprehensive understanding of how school policies and practices supported or inhibited school travel behaviour in Auckland, New Zealand. Data were drawn from Neighbourhoods for Active Kids, a cross-sectional study of 1085 children aged 8-13 years between February 2015 and December 2016. School representatives were interviewed regarding their policies and practices related to school travel behaviour and traffic around school, and the data were analysed thematically. An overarching theme, sub-themes and categories were contextualised for quantitative modelling using objectively measured school variables (school socioeconomic status, active school travel programme, built environments around school). Mixed effects multinomial logistic regression models were employed to determine associations between school travel mode and objectively measured child (sociodemographic characteristics, traffic safety perceptions) and school variables. Safety was the core concept of school travel policies, procedures and programmes. Significant differences in child variables, school socioeconomic status, and cycle lanes and traffic lights around school were found between children who actively travelled or used public transport to school and those driven to school. Overall, this study demonstrated the important role of school policy and procedures and the potential application of an intersectoral approach for interventions to support changes in school travel behaviour.

Monitoring State-Level Changes in Walking, Biking, and Taking Public Transit to Work - American Community Survey, 2006 and 2017

Introduction

Active commuting to work is one way people can be physically active and can be influenced by state-level initiatives. The American Community Survey (ACS) is a potential data source to evaluate changes in active commuting at the state level, but state-level changes have not been well documented. We examined state-level changes in estimates of walking, biking, and taking transit to work (combined and separately) among employed persons between 2006 and 2017.

Methods

Data were from the ACS, a nationally representative annual household survey from the US Census Bureau. We estimated state-level prevalence of walking, bicycling, or taking transit to work (separately and in combination) in 2006 and 2017 and tested differences by year.

Results

The prevalence of active commuting to work varied widely among states (2017 range: 1.7% in Alabama and Mississippi to 35.0% in New York). Changes from 2006 to 2017 also varied, with 8 states exhibiting a significant increase (Massachusetts [2.7 percentage points], New York [2.2], Hawaii [1.6], Illinois [1.3], Washington [1.3], New Jersey [1.2], Virginia [0.9], and Michigan [0.4]), and 12 exhibiting a significant decrease (South Dakota [−1.9], Idaho [−1.3], New Hampshire [−1.3], Wisconsin [−1.1], Maryland [−1.0], Nevada [−0.9], Ohio [−0.8], Mississippi [−0.6], Texas [−0.6], Florida [−0.5], Georgia [−0.4], and Indiana [−0.4]). The contributions of walking, bicycling, and taking transit also varied by state.

Conclusion

Active commuting remains relatively rare across states. States pursuing initiatives to support active transportation may consider using ACS to monitor and evaluate changes in active commuting.

Creating Built Environments That Expand Active Transportation and Active Living Across the United States: A Policy Statement From the American Heart Association

Physical activity is vital for the health and well-being of youth and adults, although the prevalence of physical activity continues to be low. Promoting active transportation or human-powered transportation through policy, systems, and environmental change is one of the leading evidence-based strategies to increase physical activity regardless of age, income, racial/ethnic background, ability, or disability. Initiatives often require coordination across federal, state, and local agencies. To maximize the effectiveness of all types of interventions, it is imperative to establish strong and broad partnerships across professional disciplines, community members, and advocacy groups. Health organizations can play important roles in facilitating these partnerships. This policy statement provides recommendations and resources that can improve transportation systems, enhance land use design, and provide education to support policies and environments to promote active travel. The American Heart Association supports safe, equitable active transportation policies in communities across the country that incorporate consistent implementation evaluation. Ultimately, to promote large increases in active transportation, policies need to be created, enforced, and funded across multiple sectors in a coordinated and equitable fashion. Active transportation policies should operate at 3 levels: the macroscale of land use, the mesoscale of pedestrian and bicycle networks and infrastructure such as Complete Streets policies and Safe Routes to School initiatives, and the microscale of design interventions and placemaking such as building orientation and access, street furnishings, and safety and traffic calming measures. Health professionals and organizations are encouraged to become involved in advocating for active transportation policies at all levels of government.

Measuring objective and subjective well-being: dimensions and data sources

Well-being is an important value for people’s lives, and it could be considered as an index of societal progress. Researchers have suggested two main approaches for the overall measurement of well-being, the objective and the subjective well-being. Both approaches, as well as their relevant dimensions, have been traditionally captured with surveys. During the last decades, new data sources have been suggested as an alternative or complement to traditional data. This paper aims to present the theoretical background of well-being, by distinguishing between objective and subjective approaches, their relevant dimensions, the new data sources used for their measurement and relevant studies. We also intend to shed light on still barely unexplored dimensions and data sources that could potentially contribute as a key for public policing and social development.

Physical activity accrued as part of public transport use in England

BACKGROUND

Walking and cycling for transport (active travel) is an important source of physical activity with established health benefits. However, levels of physical activity accrued during public transport journeys in England are unknown.

METHODS

Using the English National Travel Survey 2010-14 we quantified active travel as part of public transport journeys. Linear regression models compared levels of physical activity across public transport modes, and logistic regression models compared the odds of undertaking 30 min a day of physical activity.

RESULTS

Public transport users accumulated 20.5 min (95% confidence interval=19.8, 21.2) a day of physical activity as part of public transport journeys. Train users accumulated 28.1 min (26.3, 30.0) with bus users 16.0 min (15.3, 16.8). Overall, 34% (32%, 36%) of public transport users achieved 30 min a day of physical activity in the course of their journeys; 21% (19%, 24%) of bus users and 52% (47%, 56%) of train users.

CONCLUSION

Public transport use is an effective way to incorporate physical activity into daily life. One in three public transport users meet physical activity guidelines suggesting that shifts from sedentary travel modes to public transport could dramatically raise the proportion of populations achieving recommended levels of physical activity.

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.

Moving Toward Active Lifestyles: The Change of Transit-Related Walking to Work From 2009 to 2017

BACKGROUND

This study explored the percentage change of walking to/from public transit to work from 2009 to 2017 in general and for specific sociodemographic characteristics. Furthermore, this study also examined the sociodemographic characteristics of those who walked to/from transit to work and those who walked 30 minutes or more per day to/from transit to work and compared the difference between 2009 and 2017.

METHODS

2009 and 2017 National Household Travel Survey were used. This study used weighted logistic regressions to explore the sociodemographic characteristics of those who walked to/from transit to work and those who walked 30 minutes or more per day to/from transit to work in both 2009 and 2017.

RESULTS

The percentage of trips achieving the recommended level of physical activity (30 min or more per day) by walking to/from transit work solely has a slightly increase from 9 in 2009 to 9.5 in 2017. However, the weighted percentages of walking to/from transit to work decreased for low-education, low-income, and minority populations. High population density areas were related to more transit-related walking trips to work in both 2009 and 2017.

CONCLUSIONS

Policymakers in terms of transit location and service should consider low-education, low-income, and minority populations to address potential equity issues.

Autonomous Vehicles and Public Health

Autonomous vehicles (AVs) have the potential to shape urban life and significantly modify travel behaviors. "Autonomous technology" means technology that can drive a vehicle without active physical control or monitoring by a human operator. The first AV fleets are already in service in US cities. AVs offer a variety of automation, vehicle ownership, and vehicle use options. AVs could increase some health risks (such as air pollution, noise, and sedentarism); however, if proper regulated, AVs will likely reduce morbidity and mortality from motor vehicle crashes and may help reshape cities to promote healthy urban environments. Healthy models of AV use include fully electric vehicles in a system of ridesharing and ridesplitting. Public health will benefit if proper policies and regulatory frameworks are implemented before the complete introduction of AVs into the market.

Associations between neighborhood built environment and cognition vary by apolipoprotein E genotype: Multi-Ethnic Study of Atherosclerosis

We examined whether neighborhood built environment (BE) and cognition associations in older adults vary by apolipoprotein E (APOE) genotype, a genetic risk factor for Alzheimer's disease (AD). We conducted a cross-sectional analysis of 4091 participants. Neighborhood characteristics included social and walking destination density (SDD, WDD), intersection density, and proportion of land dedicated to retail. Individuals were categorized as APOE ε2 (lower AD risk), APOE ε4 (higher AD risk), or APOE ε3 carriers. Among APOE ε2 carriers, greater proportion of land dedicated to retail was associated with better global cognition, and greater SDD, WDD, intersection density, and proportion of land dedicated to retail was associated with better processing speed. These associations were not observed in APOE ε3 or ε4 carriers. APOE ε2 carriers may be more susceptible to the potentially beneficial effects of denser neighborhood BEs on cognition; however, longitudinal studies are needed.

Combining sensor tracking with a GPS-based mobility survey to better measure physical activity in trips: public transport generates walking

Background

Policymakers need accurate data to develop efficient interventions to promote transport physical activity. Given the imprecise assessment of physical activity in trips, our aim was to illustrate novel advances in the measurement of walking in trips, including in trips incorporating non-walking modes.

Methods

We used data of 285 participants (RECORD MultiSensor Study, 2013–2015, Paris region) who carried GPS receivers and accelerometers over 7 days and underwent a phone-administered web mobility survey on the basis of algorithm-processed GPS data. With this mobility survey, we decomposed trips into unimodal trip stages with their start/end times, validated information on travel modes, and manually complemented and cleaned GPS tracks. This strategy enabled to quantify walking in trips with different modes with two alternative metrics: distance walked and accelerometry-derived number of steps taken.

Results

Compared with GPS-based mobility survey data, algorithm-only processed GPS data indicated that the median distance covered by participants per day was 25.3 km (rather than 23.4 km); correctly identified transport time vs. time at visited places in 72.7% of time; and correctly identified the transport mode in 67% of time (and only in 55% of time for public transport). The 285 participants provided data for 8983 trips (21,163 segments of observation). Participants spent a median of 7.0% of their total time in trips. The median distance walked per trip was 0.40 km for entirely walked trips and 0.85 km for public transport trips (the median number of accelerometer steps were 425 and 1352 in the corresponding trips). Overall, 33.8% of the total distance walked in trips and 37.3% of the accelerometer steps in trips were accumulated during public transport trips. Residents of the far suburbs cumulated a 1.7 times lower distance walked per day and a 1.6 times lower number of steps during trips per 8 h of wear time than residents of the Paris core city.

Conclusions

Our approach complementing GPS and accelerometer tracking with a GPS-based mobility survey substantially improved transport mode detection. Our findings suggest that promoting public transport use should be one of the cornerstones of policies to promote physical activity.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0841-2) contains supplementary material, which is available to authorized users.

Intention to use light-rail transit in Houston, Texas, United States: Findings from the Travel-Related Activity in Neighborhoods study

Using data from the Houston Travel-Related Activity in Neighborhoods (TRAIN) study, this study examined how various factors affect whether individuals intend to use newly opened light-rail transit (LRT) lines in Houston. The Houston TRAIN study is a natural experiment on the effect of new LRT lines on both transit use and physical activity. A mixed binary logit model was developed based on a dichotomous dependent variable and rich set of variables, including sociodemographic factors, health status, travel behavior and technology, and attitudes and perceptions. The mixed model also allowed accounting for the unobserved heterogeneity across individuals in their sensitivity to observed variables. The results indicated the important role of various factors influencing the decision on intent to use the new LRT lines. In general, demographics mattered but to a lower extent than psychological or personality-related variables. For example, attitudes and perceptions toward the public transit system and consciousness of physical activities derived by using public transit were important factors. Personal health constraints negatively influenced intention to use, while experience with the public transport system was among the positive indicators. The findings show the potential of future interventions in this community to promote use of the new system, such as educational campaigns that improve perceptions of public transit use and clarify the benefits of being active. While providing growing evidence that cognitive variables are important in measuring intention to use public transit, the results emphasize the positive role of efforts integrating transportation and health to develop effective and sustainable solutions.

The measurement of interpersonal interactions with continuous spatiotemporal data: Application to a study of the effects of resource competition on racial group interactions

We describe a sequential qualitative ➔ quantitative mixed-method procedure used to construct conceptually grounded quantitative metrics of interpersonal behavior from continuous spatiotemporal data. Metrics were developed from data collected during an experiment in which racially diverse participants interacted with self-resembling avatars at social events hosted in the virtual world Second Life. In the qualitative stage, the researchers conceptualized four distinct patterns of movement from overhead video recreations of participants interacting during the social events. In the quantitative stage, these patterns of movement were operationalized into metrics to reflect each type of observed interpersonal behavior. The metrics were normalized through a series of transformations, and construct validity was assessed through correlations with self-report measures of intergroup behavior. Finally, the metrics were applied to an analysis of the virtual-world study examining the influence of resource competition on racial group interactions. The findings contribute to our understanding of the influence of resource competition on Blacks', Asians', and Whites' group dynamics. Applications of these metrics for the future of the psychological study of interpersonal behavior are discussed.

Daily Walking among Commuters: A Cross-Sectional Study of Associations with Residential, Work, and Regional Accessibility in Melbourne, Australia (2012-2014)

BACKGROUND

Most research on walking for transport has focused on the walkability of residential neighborhoods, overlooking the contribution of places of work/study and the ease with which destinations outside the immediate neighborhood can be accessed, referred to as regional accessibility.

OBJECTIVES

We aimed to examine if local accessibility/walkability around place of work/study and regional accessibility are independently and interactively associated with walking.

METHODS

A sample of 4,913 adult commuters was derived from a household travel survey in Melbourne, Australia (2012-2014). Local accessibility was measured as the availability of destinations within an 800-m pedestrian network from homes and places of work/education using a local living index [LLI; 0-3 (low), 4-6, 7-9, and 10-12 (high) destinations]. Regional accessibility was estimated using employment opportunity, commute travel time by mode, and public transport accessibility. Every individual's potential minutes of walking for each level of exposure (observed and counter to fact) were predicted using multivariable regression models including confounders and interaction terms. For each contrast of exposure levels of interest, the corresponding within-individual differences in predicted walking were averaged across individuals to estimate marginal effects.

RESULTS

High LLI at home and work/education was associated with more minutes walking than low LLI by 3.9 [95% confidence interval (CI): 2.3, 5.5] and 8.3 (95% CI: 7.3, 9.3) min, respectively, in mutually adjusted models. Across regional accessibility measures, an independent association with walking and an interactive association with LLI at work/education was observed. To take one example, the regional accessibility measure of "Jobs within 30 min by public transport" was associated with 4.3 (95% CI: 2.9, 5.7) more mins walking for high (≥30,000 jobs) compared with low (<4,000 jobs) accessibility in adjusted models. The estimated difference for high vs. low LLI (work/education) (among those with low regional accessibility) was 3.6 min (95% CI: 2.3, 4.8), while the difference for high vs. low regional accessibility (among those with low LLI) was negligible (-0.01; 95% CI: -1.2, 1.2). However, the combined effect estimate for high LLI and high regional accessibility, compared with low on both, was 12.8 min (95% CI: 11.1, 14.5), or 9.3 (95% CI: 6.7, 11.8) min/d walking more than expected based on the separate effect estimates.

CONCLUSIONS

High local living (work/education) and regional accessibility, regardless of the regional accessibility measure used, are positively associated with physical activity. High exposure to both is associated with greater benefit than exposure to one or the other alone. https://doi.org/10.1289/EHP3395.

Differences in social and physical dimensions of perceived walkability in Mexican American and non-hispanic white walking environments in Tucson, Arizona

INTRODUCTION

Physical activity patterns within the U.S. vary greatly across ethnicity, with data generally indicating lower rates among Hispanic/Latino adults. At the same time, Hispanic/Latino pedestrians face higher rates of injury and fatalities. Despite the importance of supportive physical activity environments on both health and safety outcomes, limited attention has been paid to ethnic or cultural differences in perceptions of supportive environments for walking. To fill this gap, we explore differences in physical and social environment contributors to perceived walkability between pedestrians in predominantly (> 70%) Mexican American and predominantly non-Hispanic white areas in Tucson, Arizona.

METHODS

In early 2017 the research team conducted brief on-street intercept interviews with pedestrians (N = 190) to learn about the environmental attributes associated with pedestrian perceptions of walkability. Study locations were matched for similar physical walkability metrics, income, and poverty rates. Consensus-based thematic coding identified 14 attributes of the built and social environment that contributed, positively and negatively, to perceptions of walkability.

RESULTS

Attributes of the social environment, both positive (i.e., social interaction, social cohesion, and community identity) and negative (i.e., crime/security), were more frequently expressed as components of walkability in Mexican American study areas while physical environment attributes (i.e., infrastructure, street crossings, and aesthetics) were more frequently mentioned in non-Hispanic white areas.

CONCLUSIONS

Contributors to perceived walkability in non-Hispanic white study areas were largely consistent with existing built environment-focused walkability metrics. Differences seen in Mexican American areas suggest a need to better understand differences across populations, expand the construct of walkability to consider social environment attributes, and account for interactions between social and physical environments. Results highlight the need for collaboration between public health and planning professionals, to evaluate walkability using culturally relevant measures that account for the social environment, particularly in Mexican American and other communities of color.

Beyond the bus stop: where transit users walk

OBJECTIVES

Extending the health benefits of public transit requires understanding how transit use affects pedestrian activity, including pedestrian activity not directly temporally or spatially related to transit use. In this study, we identified where transit users walked on transit days compared with non-transit days within and beyond 400m and 800m buffers surrounding their home and work addresses.

METHODS

We used data collected from 2008-2013 in King County, Washington, from 221 non-physically-disabled adult transit users, who were equipped with an accelerometer, global positioning system (GPS), and travel diary. We assigned walking activity to the following buffer locations: less than and at least 400m or 800m from home, work, or home/work (the home and work buffers comprised the latter buffer). We used Poisson generalized estimating equations to estimate differences in minutes per day of total walking and minutes per day of non-transit-related walking on transit days compared with non-transit days in each location.

RESULTS

We found that durations of total walking and non-transit-related walking were greater on transit days than on non-transit days in all locations studied. When considering the home neighborhood in isolation, most of the greater duration of walking occurred beyond the home neighborhood at both 400m and 800m; results were similar when considering the work neighborhood in isolation. When considering the neighborhoods jointly (i.e., by using the home/work buffer), at 400m, most of the greater duration of walking occurred beyond the home/work neighborhood. However, at 800m, most of the greater duration of walking occurred within the home/work neighborhood.

CONCLUSIONS

Transit days were associated with greater durations of total walking and non-transit related walking within and beyond the home and work neighborhoods. Accordingly, research, design, and policy strategies focused on transit use and pedestrian activity should consider locations outside the home and work neighborhoods, in addition to locations within them.

Towards a comprehensive set of GPS-based indicators reflecting the multidimensional nature of daily mobility for applications in health and aging research

BACKGROUND

GPS tracking is increasingly used in health and aging research to objectively and unobtrusively assess individuals' daily-life mobility. However, mobility is a complex concept and its thorough description based on GPS-derived mobility indicators remains challenging.

METHODS

With the aim of reflecting the breadth of aspects incorporated in daily mobility, we propose a conceptual framework to classify GPS-derived mobility indicators based on their characteristic and analytical properties for application in health and aging research. In order to demonstrate how the classification framework can be applied, existing mobility indicators as used in existing studies are classified according to the proposed framework. Then, we propose and compute a set of selected mobility indicators based on real-life GPS data of 95 older adults that reflects diverse aspects of individuals' daily mobility. To explore latent dimensions that underlie the mobility indicators, we conduct a factor analysis.

RESULTS

The proposed framework enables a conceptual classification of mobility indicators based on the characteristic and analytical aspects they reflect. Characteristic aspects inform about the content of the mobility indicator and comprise categories related to space, time, movement scope, and attribute. Analytical aspects inform how a mobility indicator is aggregated with respect to temporal scale and statistical property. The proposed categories complement existing studies that often underrepresent mobility indicators involving timing, temporal distributions, and stop-move segmentations of movements. The factor analysis uncovers the following six dimensions required to obtain a comprehensive view of an older adult's daily mobility: extent of life space, quantity of out-of-home activities, time spent in active transport modes, stability of life space, elongation of life space, and timing of mobility.

CONCLUSION

This research advocates incorporating GPS-based mobility indicators that reflect the multi-dimensional nature of individuals' daily mobility in future health- and aging-related research. This will foster a better understanding of what aspects of mobility are key to healthy aging.

Mobile Sensing in Environmental Health and Neighborhood Research

Public health research has witnessed a rapid development in the use of location, environmental, behavioral, and biophysical sensors that provide high-resolution objective time-stamped data. This burgeoning field is stimulated by the development of novel multisensor devices that collect data for an increasing number of channels and algorithms that predict relevant dimensions from one or several data channels. Global positioning system (GPS) tracking, which enables geographic momentary assessment, permits researchers to assess multiplace personal exposure areas and the algorithm-based identification of trips and places visited, eventually validated and complemented using a GPS-based mobility survey. These methods open a new space-time perspective that considers the full dynamic of residential and nonresidential momentary exposures; spatially and temporally disaggregates the behavioral and health outcomes, thus replacing them in their immediate environmental context; investigates complex time sequences; explores the interplay among individual, environmental, and situational predictors; performs life-segment analyses considering infraindividual statistical units using case-crossover models; and derives recommendations for just-in-time interventions.

Assessment of direct and indirect associations between children active school travel and environmental, household and child factors using structural equation modelling

BACKGROUND

Active school travel (AST) is influenced by multiple factors including built and social environments, households and individual variables. A holistic theory such as Mitra's Behavioural Model of School Transportation (BMST) is vital to comprehensively understand these complex interrelationships. This study aimed to assess direct and indirect associations between children's AST and environmental, household and child factors based on the BMST using structural equation modelling (SEM).

METHODS

Data were drawn from Neighbourhoods for Active Kids (NfAK), a cross-sectional study of 1102 children aged 8-13 years (school years 5-8) and their parents from nine intermediate and 10 primary schools in Auckland, New Zealand between February 2015 and December 2016. Data were collected using an online participatory mapping survey (softGIS) with children, a computer-assisted telephone interviewing survey (CATI) with parents, and ArcGIS for built environment attributes. Based on the BMST a conceptual model of children's school travel behaviour was specified for SEM analyses ('hypothesised SEM'), and model modification was made to improve the model ('modified SEM'). SEM analyses using Mplus were performed to test the hypothesised/modified SEM and to assess direct and indirect relationships among variables.

RESULTS

The overall fit of the modified SEM was acceptable (N = 542; Root mean square error of approximation = 0.04, Comparative fit index = 0.94, Tucker-Lewis index = 0.92). AST was positively associated with child independent mobility, child-perceived neighbourhood safety, and parent-perceived importance of social interaction and neighbourhood social environment. Distance to school, and parental perceptions of convenience and concerns about traffic safety were negatively associated with AST. Parental fears of stranger danger were indirectly related to AST through those of traffic safety. Distance to school and child independent mobility mediated relationships between AST and child school year and sex.

CONCLUSIONS

Increasing children's AST requires action on multiple fronts including communities that support independent mobility by providing child friendly social and built environments, safety from traffic, and policies that promote local schools and safe vehicle-free zones around school.

Associations of Public Transportation Use With Cardiometabolic Health: A Systematic Review and Meta-Analysis

Public transportation provides an opportunity to incorporate physical activity into journeys, but potential health impacts have not been systematically examined. We searched the literature for articles on public transportation and health published through December 2017 using Google (Google Inc., Mountain View, California), 5 medical databases, and 1 transportation-related database. We identified longitudinal studies which examined associations between public transportation and cardiometabolic health (including adiposity, type 2 diabetes mellitus, and cardiovascular disease). We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and performed meta-analyses where possible. Ten studies were identified, 7 investigating use of public transportation and 3 examining proximity to public transportation. Seven studies used individual-level data on changes in body mass index (BMI; weight (kg)/height (m)²), with objective outcomes being measured in 6 studies. Study follow-up ranged from 1 year to 10 years, and 3 studies adjusted for nontransportation physical activity. We found a consistent association between use of public transportation and lower BMI. Meta-analysis of data from 5 comparable studies found that switching from automobile use to public transportation was associated with lower BMI (−0.30 units, 95% confidence interval: −0.47, −0.14). Few studies have investigated associations between public transportation use and nonadiposity outcomes. These findings suggest that sustainable urban design which promotes public transportation use may produce modest reductions in population BMI.

Building Healthy Community Environments: A Public Health Approach

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today's environmental challenges.

Higher residential and employment densities are associated with more objectively measured walking in the home neighborhood

Understanding where people walk and how the built environment influences walking is a priority in active living research. Most previous studies were limited by self-reported data on walking. In the present study, walking bouts were determined by integrating one week of accelerometry, GPS, and a travel log data among 675 adult participants in the baseline sample of the Travel Assessment and Community study. Home neighborhood was defined as being within 0.5 mi of each participants' residence (a 10-minute walk), with home neighborhood walking defined as walking bout lines with at least one GPS point within the home neighborhood. Home neighborhood walkability was constructed with seven built environment variables derived from spatially continuous objective values (SmartMaps). A Zero Inflated Negative Binomial (ZINB) served to estimate associations between home neighborhood environment characteristics and home neighborhood walking frequency. Higher residential density and job density were the two neighborhood walkability measures related to higher likelihood and more time walking in the home neighborhood, highest tertile residential density (22.44 - 62.63 unit/acre) (coefficient=1.434; 95th CI of 1.003, 2.049) and highest tertile job density (12.4 - 272.3 jobs/acre) (coefficient=1.616; 95th CI of 1.102, 2.370). The large proportion of walking that takes place in the home neighborhood highlights the importance of continuing to examine the impact of the home neighborhood environment on walking. Potential interventions to increase walking behavior may benefit from increasing residential and employment density within residential areas.

Foot-based audit of streets adjacent to new light rail stations in Houston, Texas: measurement of health-related characteristics of the built environment for physical activity research

Background

Active travel to and from a transit station may provide significant amounts of physical activity and improve health. The ease with which people can traverse the distance to the transit station may impede or support active travel. Therefore, transit stations that have features that are supportive of utilitarian physical activity would be desirable. This study aimed to characterize the built environment surrounding new light rail transit (LRT) stations in the City of Houston, Texas.

Methods

In 2014, we used a series of systematic protocols and a standardized environmental audit instrument, the Analytic Audit Tool, to collect data on segments (streets) that surround 22 LRT stations that were being newly built. Using Geographic Information System (GIS), we assembled all the segments that intersect a 0.25-mile circular buffer around each station for the audit exercise. Several 3- to 4-member teams of trained auditors completed the audit exercise on a subset of these identified segments. Our analysis were descriptive in nature. We provided the frequency distributions of audited features across the study area. We also followed an original algorithm to produce several composite index scores for our study area. The composite index score is indicative of the prevalence of physical activity friendly/unfriendly features in the study area.

Results

In all, we audited a total of 590 segments covering a total of 218 US Census blocks, and eight City of Houston super neighborhoods. Findings suggest the environment around the new LRT stations may not be supportive of physical activity. In general, the audited segments lacked land use integration; had abandoned buildings, had uneven sidewalks; were not bike-friendly, had minimal presence of public-recreational facilities that would support physical activity; and had significant physical disorder. Notably, certain attractive and comfort features were frequently to usually available.

Conclusions

Current findings, which will be compared to follow-up audit data, can be useful for future researchers and practitioners interested in the built environment around LRT stations.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6560-4) contains supplementary material, which is available to authorized users.

A Test of How Australian Adults Allocate Time for Physical Activity

The most common reported barrier to physical activity is a lack of sufficient time. Just like most resources in economics are finite, so too is time within a day. We utilized a time-utility model to better understand how people are allocating time for physical activity. Additionally, we tested whether the allocation of physical activity time impacts people's perception of "lack of time" as a barrier for physical activity or their likelihood of being sufficiently physical active. Australian adults (N = 725 participants, 54% men) reported their time use throughout their day, perceived lack of time as a barrier to activity, and physical activity. Cluster analysis and χ²-tests were used to test the study research questions. People tended to either be entirely inactive (29%) or active while doing either leisure (18%), occupation (18%), transport (14%), or household (22%) activities. Those who were active during their leisure or transport time were most likely to be sufficiently active. There were no significant differences among clusters in how much people perceived that lack of time was a physical activity barrier. The commonly reported barrier of not having enough time to be active might be a fallacy. Although a lack of time is a commonly reported barrier of physical activity, these findings bring to light that increasing physical activity behavior is not as simple as adding more time to the day.

A Meta-analysis of the Literature on the Association of the Social and Built Environment With Obesity: Identifying Factors in Need of More In-Depth Research

Objective:

This study aims to identify groups of the social and built environment factors that have been studied substantially along with factors that need further attention, to guide the research, designing, and planning of the social and built environment for reducing obesity prevalence.

Data Source:

A systematic search of literature was undertaken from PubMed, Google Scholar, and Web of Knowledge.

Study Inclusion and Exclusion Criteria:

Keyword combination of “built environment,” “social environment,” and “obesity” were used to expand the search scope. Exclusion criteria included (1) any article with less than 50 citations from 2005 to 2010, and those with less than 25 citations from 2011 to 2015. In this way we included the most prominent peer-reviewed studies published in recent years while excluding less influential publications; (2) any article published in a language other than English; (3) literature review articles; (4) any article studying health outcomes not obesity related. We included research on eating behaviors since the studies contributed profoundly to food environment research.

Data Synthesis:

A meta-analysis of 153 empirical studies, selected from 2005 to 2015 based on a series of criteria, was conducted using factor analysis. The exploratory factor analysis was undertaken to group the prevalence and use of the social and built environment factors associated with obesity.

Results:

The findings suggested that the research community has gained a substantial understanding of the D variables of the built environment, including density, diversity, design, distance to transit, and destination access. Factors concerning different age groups, minority populations, groups with low socioeconomic status, food environment, and street-level urban design features have been less examined.

Conclusions:

The findings are important to guide future research directions, giving more attention to the factors in need of more in-depth research.