Cost analysis of the built environment: the case of bike and pedestrian trials in Lincoln, Neb

A Systematic Review Exploring the Economic Valuation of Accessing and Using Green and Blue Spaces to Improve Public Health

Contact with the natural environment in green and blue spaces can have a valuable influence on population physical and mental health and wellbeing. The aim of this study is to explore the economic evidence associated with the public's value for accessing, using and improving local environments to undertake recreational activity and consuming the associated health benefits of green and blue spaces. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Peer-reviewed articles were sought using electronic databases, scrutiny of reference lists, experts and grey literature. All relevant papers meeting the criteria were critically appraised for methodological quality using the Drummond checklist. The review search concluded with 12 papers applying the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach to assess the quality with a narrative analysis conducted under the themes. Results suggest the public value access to green and blue spaces to undertake recreational activities and avoid delay or losing the recreational experience and associated health benefits. The public are willing to pay between £5.72 and £15.64 in 2019 value estimates for not postponing or losing an outdoor experience and for walking in local environments under current and improved environmental conditions, respectively. Valuation estimates indicate the public value green and blue spaces and are willing to pay to improve local environments to gain the health benefits of undertaking leisure activities in green and blue spaces.

Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers

Background

As the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.

Methods/design

The Peer Empowerment Program 4 Physical Activity’ (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit), adoption & penetration (reach), fidelity (quantity & quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.

Discussion

Using a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.

Trial registration

ClinicalTrials.gov, USA (NCT02405325). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set.

Rural Community Leaders' Perceptions of Environmental Health Risks

Qualitative description was used to explore how rural community leaders frame, interpret, and give meaning to environmental health issues affecting their constituents and communities. Six rural community leaders discussed growth, vulnerable families, and the action avoidance strategies they use or see used in lieu of adopting health-promoting behaviors. Findings suggest intervention strategies should be economical, use common sense, be sensitive to regional identity, and use local case studies and “inside leadership.” Occupational health nurses addressing the disparate environmental health risks in rural communities are encouraged to use agenda-neutral, scientifically based risk communication efforts and foster collaborative relationships among nurses, planners, industry, and other community leaders.

What Constitutes an Obesogenic Environment in Rural Communities?

PURPOSE

To identify perceived indicators of the physical environment associated with obesity in rural communities.

DESIGN

Cross-sectional telephone survey.

SETTING

Thirteen communities in rural Missouri, Tennessee, and Arkansas, 2003.

SUBJECTS

A total of 2510 adults completed the survey and 2210 respondents were included in the analysis (74% female, 93% white, and 27% obese).

MEASURES

The 106-item survey measured perceptions of the neighborhood environment (recreational facilities, land use, transportation/safety, aesthetics, and food environment) and health-related behaviors. The primary outcome was obese (body mass index [BMI] > or = 30 kg/mn2) vs. normal weight (BMI = 18.5-24.9 kg/m2).

ANALYSIS

Logistic regression was used to control for age, gender and education.

RESULTS

Several indicators of the perceived neighborhood environment were associated with being obese (adjusted odds ratio [95% confidence interval]), including furthest distance to the nearest recreational facility (1.8 [1.3-2.4]), unpleasant community for physical activity (1.8 [1.3-2.6]), feeling unsafe from crime (2.1 [1.5-2.9]) or traffic (1.7 [1.2-2.3]), and few nonresidential destinations (1.4 [1.0-1.9]). Distance to recreational facilities and crime safety remained significant in the multivariate model, along with dietary-fat intake, sedentary behavior, and moderate/vigorous physical activity.

CONCLUSION

This study adds to a growing evidence base of environmental correlates of obesity and makes a unique contribution regarding rural communities. If causality is established, environmental interventions that target obesogenic neighborhood features may reduce the prevalence of obesity on a population level.

Can the Neighborhood Built Environment Make a Difference in Children's Development? Building the Research Agenda to Create Evidence for Place-Based Children's Policy

Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development. The relatively few studies exploring this relationship support associations between child development and neighborhood destinations, green spaces, interaction with nature, traffic exposure, and housing density. These studies emphasize the need to more deeply understand how child development outcomes might be influenced by the neighborhood built environment. Pursuing this research space is well aligned with the current global movements on livable and child-friendly cities. It has direct public policy impact by informing planning policies across a range of sectors (urban design and planning, transport, public health, and pediatrics) to implement place-based interventions and initiatives that target children's health and development at the community level. We argue for the importance of exploring the effect of the neighborhood built environment on child development as a crucial first step toward informing urban design principles to help reduce developmental vulnerability in children and to set optimal child development trajectories early.

Demand response to improved walking infrastructure: A study into the economics of walking and health behaviour change

Walking is the most common form of moderate-intensity physical activity among adults, is widely accessible and especially appealing to obese people. Most often policy makers are interested in valuing the effect on walking of changes in some characteristics of a neighbourhood, the demand response for walking, of infrastructure changes. A positive demand response to improvements in the walking environment could help meet the public health target of 150 min of at least moderate-intensity physical activity per week. We model walking in an individual's local neighbourhood as a 'weak complement' to the characteristics of the neighbourhood itself. Walking is affected by neighbourhood characteristics, substitutes, and individual's characteristics, including their opportunity cost of time. Using compensating variation, we assess the economic benefits of walking and how walking behaviour is affected by improvements to the neighbourhood. Using a sample of 1209 respondents surveyed over a 12 month period (Feb 2010-Jan 2011) in East Belfast, United Kingdom, we find that a policy that increased walkability and people's perception of access to shops and facilities would lead to an increase in walking of about 36 min/person/week, valued at £13.65/person/week. When focussing on inactive residents, a policy that improved the walkability of the area would lead to guidelines for physical activity being reached by only 12.8% of the population who are currently inactive. Additional interventions would therefore be needed to encourage inactive residents to achieve the recommended levels of physical activity, as it appears that interventions that improve the walkability of an area are particularly effective in increasing walking among already active citizens, and, among the inactive ones, the best response is found among healthier, younger and wealthier citizens.

Cost-Effectiveness of Population-Level Physical Activity Interventions: A Systematic Review

Objective.

This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity.

Data Source.

A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus.

Study Inclusion and Exclusion Criteria.

Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded.

Data Extraction.

Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace.

Data Synthesis.

The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account.

Results.

The most efficient interventions to increase physical activity were community rail-trails ($.006/MET-h), pedometers ($.014/MET-h), and school health education programs ($.056/MET-h).

Conclusion.

Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

A cost analysis of a community health worker program in rural Vermont

Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews. We analyzed personnel and operational costs from October 2010 to September 2011. The estimated total program cost was $420,348, a figure comprised of $281,063 (67%) for personnel and $139,285 (33%) for operations. CHW salaries and office space were the major cost components. Our cost analysis approach may be adapted by others to conduct cost analyses of their CHW program. Our cost estimates can help inform future economic studies of CHW programs and resource allocation decisions.

Mapping the development of research on physical activity and the built environment

OBJECTIVE

The importance of the built environment for physical activity has been recognized in recent decades, resulting in new research. This study aims to understand the current structure of physical activity and built environment (PABE) research and identify gaps to address as the field continues to rapidly develop.

METHODS

Key PABE articles were nominated by top scholars and a snowball sample of 2764 articles was collected in 2013 using citation network links. Article abstracts were examined to determine research focus and network analysis was used to examine the evolution of scholarship.

RESULTS

The network included 318 PABE articles. Of these, 191 were discovery-focused, examining the relationship between physical activity and built environment; 79 were reviews summarizing previous PABE work; 38 focused on theory and methods for studying PABE; six were delivery-focused, examining PABE interventions; and four addressed other topics.

CONCLUSIONS

Network composition suggested that PABE is in the discovery phase, although may be transitioning given the large number and central position of review documents that summarize existing literature. The small amount of delivery research was not well integrated into the field. PABE delivery researchers may wish to make explicit connections to the discovery literature in order to better integrate the field.

Associations among environmental supports, physical activity, and blood pressure in African-American adults in the PATH trial

High blood pressure disproportionately affects African-American adults and is a leading cause of stroke and heart attack. Engaging in recommended levels of physical activity reduces blood pressure, and social and physical environmental supports for physical activity may increase engagement in physical activity. Based on social cognitive theory within a bioecological framework, the present study tested hypotheses that perceived peer social support for physical activity and neighborhood walkability would be positively associated with physical activity, and that physical activity would mediate their relation with blood pressure. Baseline data were collected with 434 African-American adults in underserved communities (low income, high crime) participating in the Positive Action for Today's Health (PATH) trial. Perceived peer social support for physical activity and neighborhood walkability were measured with validated surveys. Physical activity was assessed with 7-day accelerometry (moderate-to-vigorous physical activity, min/day) and with a 4-week recall of walking. Three blood pressure assessments were taken by trained staff using standard protocols, with values from the second and third assessments averaged. The sample was predominantly female (63%), overweight (mean body mass index = 30.9, SD = 8.4), and had slightly elevated blood pressures with a mean systolic blood pressure of 132.4 (SD = 17.9) and a mean diastolic blood pressure of 81.4 (SD = 11.0). Results demonstrated that peer social support for physical activity (B = 2.43, p = .02) and neighborhood walkability (B = 2.40, p = .046) were significantly related to average daily moderate-to-vigorous physical activity. Neighborhood walkability was also significantly associated with self-reported average daily walking (B = 8.86, p = .02). Physical activity did not mediate their relation with blood pressure and no significant direct effects of these variables on blood pressure were found. The positive influence of social and physical environmental supports on physical activity in underserved African-American communities may guide intervention efforts and contribute to our understanding of physical activity and related health outcomes.

Evidence-based intervention in physical activity: lessons from around the world

Promotion of physical activity is a priority for health agencies. We searched for reviews of physical activity interventions, published between 2000 and 2011, and identified effective, promising, or emerging interventions from around the world. The informational approaches of community-wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended. Behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school-based strategies that encompass physical education, classroom activities, after-school sports, and active transport. Recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community-scale and street-scale urban design and land use, active transport policy and practices, and community-wide policies and planning. Thus, many approaches lead to acceptable increases in physical activity among people of various ages, and from different social groups, countries, and communities.

The relationship between cluster-analysis derived walkability and local recreational and transportation walking among Canadian adults

We investigated the association between objectively-assessed neighborhood walkability and local walking among adults. Two independent random cross-sectional samples of Calgary (Canada) residents were recruited. Neighborhood-based walking, attitude towards walking, neighborhood self-selection, and socio-demographic characteristics were captured. Built environmental attributes underwent a two-staged cluster analysis which identified three neighborhood types (HW: high walkable; MW: medium walkable; LW: low walkable). Adjusting for all other characteristics, MW (OR 1.40, p < 0.05) and HW (OR 1.34, approached p < 0.05) neighborhood residents were more likely than LW neighborhood residents to participate in neighborhood-based transportation walking. HW neighborhood residents spent 30-min/wk more on neighborhood-based transportation walking than both LW and MW neighborhood residents. MW neighborhood residents spent 14-min/wk more on neighborhood-based recreational walking than LW neighborhood residents. Neighborhoods with a highly connected pedestrian network, large mix of businesses, high population density, high access to sidewalks and pathways, and many bus stops support local walking.

Should we invest in environmental interventions to encourage physical activity in England? An economic appraisal

BACKGROUND

The Department of Health in England asked the National Institute for Health and Clinical Excellence (NICE) to develop guidance on environmental interventions that promote physical activity. The economic appraisals summarized in this study informed the development of that guidance. In view of the difficulties inherent in applying conventional health economic evaluation techniques to public health interventions, the economic appraisal employed a multi-faceted approach.

METHODS

The analyses comprised of three components. Two cost-utility analyses; the first used a life-time disease progression model which sought to take into account the long-term benefits of physical activity on health outcomes, whereas the second used data from a regression analysis which captured some of the short-term, process benefits of physical activity which might manifest themselves in terms of improved mental health and wellbeing. The third approach was a cost-benefit analysis that took into account benefits beyond healthcare.

RESULTS

The cost-utility approaches generated cost-effectiveness estimates ranging between £100 and £10 000 per QALY depending on the level of effectiveness of the intervention and the proportion of the intervention cost that was deemed to be attributable to health. The standardized cost-benefit ratio was 11:1.

CONCLUSION

The findings present a consistent case to support environmental interventions that promote increased physical activity in the sedentary adult population. However, some degree of caution should be taken in interpreting the findings due to the limitations of the evidence upon which they are based. Further consideration should also be given to the relative merits of alternative approaches to assessing the value of changes to the built environment that might also benefit health as a positive externality.

Reaiming RE-AIM: using the model to plan, implement, and evaluate the effects of environmental change approaches to enhancing population health

The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, which provides a practical means of evaluating health interventions, has primarily been used in studies focused on changing individual behaviors. Given the importance of the built environment in promoting health, using RE-AIM to evaluate environmental approaches is logical. We discussed the benefits and challenges of applying RE-AIM to evaluate built environment strategies and recommended modest adaptations to the model. We then applied the revised model to 2 prototypical built environment strategies aimed at promoting healthful eating and active living. We offered recommendations for using RE-AIM to plan and implement strategies that maximize reach and sustainability, and provided summary measures that public health professionals, communities, and researchers can use in evaluating built environment interventions.

A systematic review of built environment and health

The built environment can be considered a foundation for health and wellness. This structure, whether it be neighborhood layout or safe walking trails, impacts decisions relating to individual and community health outcomes. This review compiled the published research that examined the relationship between built environment and health. Findings from the 23 articles reviewed indicate that neighborhoods that are characterized as more walkable, either leisure-oriented or destination-driven, are associated with increased physical activity, increased social capital, lower overweight, lower reports of depression, and less reported alcohol abuse.

The built environment, climate change, and health: opportunities for co-benefits

The earth's climate is changing, due largely to greenhouse gas emissions resulting from human activity. These human-generated gases derive in part from aspects of the built environment such as transportation systems and infrastructure, building construction and operation, and land-use planning. Transportation, the largest end-use consumer of energy, affects human health directly through air pollution and subsequent respiratory effects, as well as indirectly through physical activity behavior. Buildings contribute to climate change, influence transportation, and affect health through the materials utilized, decisions about sites, electricity and water usage, and landscape surroundings. Land use, forestry, and agriculture also contribute to climate change and affect health by increasing atmospheric levels of carbon dioxide, shaping the infrastructures for both transportation and buildings, and affecting access to green spaces. Vulnerable populations are disproportionately affected with regard to transportation, buildings, and land use, and are most at risk for experiencing the effects of climate change. Working across sectors to incorporate a health promotion approach in the design and development of built environment components may mitigate climate change, promote adaptation, and improve public health.

If You Build It, They Will Come: Lessons From Developing Walking Trails in Rural Missouri

Given the high rates of sedentary behaviors, attempts to increase physical activity have incorporated individual and, more recently, policy and environmental approaches for promotion of activity. This article presents a summary of the approaches being used by the Ozark Heart Health Coalitions in developing walking trails in rural Missouri. In summarizing these approaches the authors describe 10 lessons with the aim of articulating the process and, thereby, increasing interest and capacity in development of walking trails. Qualitative and quantitative data were used to show burden and priorities and build support with numerous stakeholders. Stakeholders were engaged to identify common objectives, obtain land and funding, and determine trail size, materials, and time needed for construction. Implementation activities focused on trail maintenance and addition of amenities (e.g., playgrounds, benches). In the area of evaluation, they collect data via interviews with walkers on trails and community telephone surveys.

Living near a trail is associated with increased odds of walking among patients using community clinics

We tested the hypothesis that living near a walking or cycling trail was associated with greater odds of walking. This has been previously studied in healthy and unselected populations, but to our knowledge has not been studied in patients attending community clinics. A cross-sectional survey was completed by 1211 persons in five community clinics that serve poor populations. We performed univariate analysis and developed a multivariate logistic regression model for walking adjusting for 12 independent variables including self-rated health, frequent mental distress, lifestyle and demographic variables, and environmental characteristics of the neighborhood including perceived proximity to a walking or cycling trail. Compared to those who reported not living close to a trail, persons who reported living near a trail were more likely to meet recommended levels of walking of at least 30 minutes fives times per week (unadjusted odds ratio = 1.49, 95% confidence intervals = 1.04-2.13). In the multivariate model, male gender (unadjusted odds ratio = 1.63, 95% confidence intervals = 1.15-2.30), having three or more convenient destinations (unadjusted odds ratio = 1.78, 95% confidence intervals = 1.37-2.32), and living near a trail (unadjusted odds ratio = 1.45, 95% confidence intervals = 1.01-2.09) were positively associated with walking at statistically significant levels. The odds of walking were lower in non-Hispanic blacks (odds ratio = 0.59, 95% confidence intervals = 0.40-0.87) and current smokers (odds ratio = 0.66, 95% confidence intervals = 0.57-0.76). For patients attending community clinics, environmental strategies to encourage walking may include mixed-land-use neighborhoods and construction of trails.

Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases

Given the growing attention on how environmental and policy interventions can affect chronic disease burden, our objectives are to describe (a) effective and promising interventions to address tobacco use, physical activity, and healthy eating and (b) lessons learned from the literature and practice experience in applying environmental and policy approaches. A total of 17 interventions were reviewed, organized across 3 domains affecting the physical environment/access, economic environment, and communication environment. Many of these interventions are effective. Several lessons are important to consider, such as the need to start with environmental and policy approaches, intervene comprehensively and across multiple levels, make use of economic evaluations, make better use of existing analytic tools, understand the politics and local context, address health disparities, and conduct sound policy research.

Rural community leaders' perceptions of environmental health risks: improving community health

Qualitative description was used to explore how rural community leaders frame, interpret, and give meaning to environmental health issues affecting their constituents and communities. Six rural community leaders discussed growth, vulnerable families, and the action avoidance strategies they use or see used in lieu of adopting health-promoting behaviors. Findings suggest intervention strategies should be economical, use common sense, be sensitive to regional identity, and use local case studies and "inside leadership." Occupational health nurses addressing the disparate environmental health risks in rural communities are encouraged to use agenda-neutral, scientifically based risk communication efforts and foster collaborative relationships among nurses, planners, industry, and other community leaders.

A multilevel ecological approach to promoting walking in rural communities

BACKGROUND

Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This study's purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking.

METHODS

A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003-2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week.

RESULTS

At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking.

CONCLUSIONS

Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.

Where does walkability matter the most? An environmental justice interpretation of New Jersey data

Physical inactivity contributes to a growing proportion of premature mortality and morbidity in the United States, and the last decade has been the focus of calls for action. Analysis of 340 residents of New Jersey found that 15%-20% reported multiple problems with using their immediate neighborhoods for physical activity. These respondents were disproportionately African Americans living in neighborhoods that they regard as only of fair or poor quality. Neighborhood walkability is a second-wave environmental justice issue meriting carefully designed research and ameliorative actions in concert with other neighborhood-level redevelopment activities.

Walkability and self-rated health in primary care patients

Background

The objective of this study was to investigate the relationship between perceived walkability and overall self-rated health among patients who use community-based clinics.

Methods

A cross-sectional survey was distributed to a convenience sample in three community clinics. Forms were completed by 793 clinic patients. Multiple logistic regression analysis was to control for the effects of demographic variables and lifestyles.

Results

Perceiving the availability of places to walk was related to better self-rated health. The most important places were work (OR = 3.2), community center (OR = 3.12), park (OR = 2.45) and day care (OR = 2.05). Respondents who said they had zero (OR = .27) or one (OR = .49) place to walk were significantly less healthy than persons who said they had five or more places to walk.

Conclusion

Persons who perceived that they had no place to walk were significantly less healthy than persons who thought they had at least one place to walk (OR = .39). Support for walkable neighborhoods and education of patients about options for walking may be in the best interests of community medicine patients.

Use of a community trail among new and habitual exercisers: a preliminary assessment

INTRODUCTION

We evaluated physical activity patterns and trail use among new and habitually active exercisers using onsite trail interviews.

METHODS

Using a cross-sectional study design, 414 adults who accessed two new trails that bisect a rural community of 26,809 residents were interviewed during the first summer of the trails' official operation (2001). The trails comprise 12 miles of level and paved surface and run parallel to adjacent water sheds, businesses, and neighborhoods. Recent trail activity patterns were obtained, including the following: frequency of use, mode of activity, duration, distance traveled on trail, access points, time of day used, use of exercise companions, and distance traveled to get to trail. Perceived enablers and barriers related to trail use were also obtained. Data were compared between newly adopted exercisers (new exercisers) and individuals active prior to development of the trails (habitually active exercisers).

RESULTS

Twenty-three percent of the trail users were new exercisers. New exercisers were more dependent on the trails as a primary outlet for physical activity than were habitually active exercisers (P < .001). New exercisers traveled shorter distances to access the trails and rated convenience as a primary reason for using them. Both safety and terrain issues emerged as enablers for trail use, and unsafe conditions emerged as a concern among new exercisers.

CONCLUSION

A community trail may be an important vehicle for promoting physically active lifestyles. However, new exercisers must overcome issues of proximal and safe access from residential areas in addition to other safety concerns to achieve regular physical activity.