The relationship between built environments and physical activity: a systematic review

Intersection of neighborhood dynamics and socioeconomic status in small-area walkability: the Heart Healthy Hoods project

Background

Previous studies found a complex relationship between area-level socioeconomic status (SES) and walkability. These studies did not include neighborhood dynamics. Our aim was to study the association between area-level SES and walkability in the city of Madrid (Spain) evaluating the potential effect modification of neighborhood dynamics.

Methods

All census sections of the city of Madrid (n = 2415) were included. Area-level SES was measured using a composite index of 7 indicators in 4 domains (education, wealth, occupation and living conditions). Two neighborhood dynamics factors were computed: gentrification, proxied by change in education levels in the previous 10 years, and neighborhood age, proxied by median year of construction of housing units in the area. Walkability was measured using a composite index of 4 indicators (Residential Density, Population Density, Retail Destinations and Street Connectivity). We modeled the association using linear mixed models with random intercepts.

Results

Area-level SES and walkability were inversely and significantly associated. Areas with lower SES showed the highest walkability. This pattern did not hold for areas with an increase in education level, where the association was flat (no decrease in walkability with higher SES). Moreover, the association was attenuated in newly built areas: the association was stronger in areas built before 1975, weaker in areas built between 1975 and 1990 and flat in areas built from 1990 on.

Conclusion

Areas with higher neighborhood socioeconomic status had lower walkability in Madrid. This disadvantage in walkability was not present in recently built or gentrified areas.

Electronic supplementary material

The online version of this article (doi:10.1186/s12942-017-0095-7) contains supplementary material, which is available to authorized users.

Quantifying the Modern City: Emerging Technologies and Big Data for Active Living Research

Opportunities and infrastructure for active living are an important aspect of a community's design, livability, and health. Features of the built environment influence active living and population levels of physical activity, but objective study of the built environment influence on active living behaviors is challenging. The use of emerging technologies for active living research affords new and promising means to obtain objective data on physical activity behaviors and improve the precision and accuracy of measurements. This is significant for physical activity promotion because precise measurements can enable detailed examinations of where, when, and how physical activity behaviors actually occur, thus enabling more effective targeting of particular behavior settings and environments. The aim of this focused review is to provide an overview of trends in emerging technologies that can profoundly change our ability to understand environmental determinants of active living. It discusses novel technological approaches and big data applications to measure and track human behaviors that may have broad applications across the fields of urban planning, public health, and spatial epidemiology.

The Influence of Neighbourhoods and the Social Environment on Sedentary Behaviour in Older Adults in Three Prospective Cohorts

Sedentary behaviour is an emerging risk factor for poor health. This study aimed to identify ecological determinants of sedentary behaviour, for which evidence is currently scarce. The study participants were community dwelling adults from, respectively, the Lothian Birth Cohort 1936 (n = 271, mean age 79) and the 1930s (n = 119, mean age 83) and 1950s (n = 310, mean age 64) cohorts of the West of Scotland Twenty-07 study. The outcome measure, percentage of waking time spent sedentary (sedentary time), was measured using an activPAL activity monitor worn continuously for seven days. Potential determinants included objective and subjective neighbourhood measures such as natural space, crime, social cohesion and fear of crime. Other determinants included measures of social participation such as social support, social group membership and providing care. Results from multivariable regression analyses indicated that providing care was associated with reduced sedentary time in retired participants in all cohorts. Fear of crime and perceived absence of services were associated with increased sedentary time for retired 1950s cohort members. Higher crime rates were associated with increased sedentary time in all cohorts but this was not significant after adjustment for socio-demographic characteristics. Most other neighbourhood and social participation measures showed no association with sedentary time.

Public Open Spaces and Leisure-Time Walking in Brazilian Adults

Access to public open space is important to increase leisure-time walking (LTW) in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares) and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey (n = 3145). LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m) from the geographic coordinates of the adults’ residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants’ homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09–2.55). No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.

Kernel Density Estimation as a Measure of Environmental Exposure Related to Insulin Resistance in Breast Cancer Survivors

Background: Environmental factors may influence breast cancer; however, most studies have measured environmental exposure in neighborhoods around home residences (static exposure). We hypothesize that tracking environmental exposures over time and space (dynamic exposure) is key to assessing total exposure. This study compares breast cancer survivors' exposure to walkable and recreation-promoting environments using dynamic Global Positioning System (GPS) and static home-based measures of exposure in relation to insulin resistance.Methods: GPS data from 249 breast cancer survivors living in San Diego County were collected for one week along with fasting blood draw. Exposure to recreation spaces and walkability was measured for each woman's home address within an 800 m buffer (static), and using a kernel density weight of GPS tracks (dynamic). Participants' exposure estimates were related to insulin resistance (using the homeostatic model assessment of insulin resistance, HOMA-IR) controlled by age and body mass index (BMI) in linear regression models.Results: The dynamic measurement method resulted in greater variability in built environment exposure values than did the static method. Regression results showed no association between HOMA-IR and home-based, static measures of walkability and recreation area exposure. GPS-based dynamic measures of both walkability and recreation area were significantly associated with lower HOMA-IR (P < 0.05).Conclusions: Dynamic exposure measurements may provide important evidence for community- and individual-level interventions that can address cancer risk inequities arising from environments wherein breast cancer survivors live and engage.Impact: This is the first study to compare associations of dynamic versus static built environment exposure measures with insulin outcomes in breast cancer survivors. Cancer Epidemiol Biomarkers Prev; 26(7); 1078-84. ©2017 AACR.

GPS-Based Exposure to Greenness and Walkability and Accelerometry-Based Physical Activity

Background: Physical inactivity is a risk factor for cancer that may be influenced by environmental factors. Indeed, dense and well-connected built environments and environments with natural vegetation may create opportunities for higher routine physical activity. However, studies have focused primarily on residential environments to define exposure and self-reported methods to estimate physical activity. This study explores the momentary association between minute-level global positioning systems (GPS)-based greenness exposure and time-matched objectively measured physical activity.Methods: Adult women were recruited from sites across the United States. Participants wore a GPS device and accelerometer on the hip for 7 days to assess location and physical activity at minute-level epochs. GPS records were linked to 250 m resolution satellite-based vegetation data and Census Block Group-level U.S. Environmental Protection Agency (EPA) Smart Location Database walkability data. Minute-level generalized additive mixed models were conducted to test for associations between GPS measures and accelerometer count data, accounting for repeated measures within participant and allowing for deviations from linearity using splines.Results: Among 360 adult women (mean age of 55.3 ± 10.2 years), we observed positive nonlinear relationships between physical activity and both greenness and walkability. In exploratory analyses, the relationships between environmental factors and physical activity were strongest among those who were white, had higher incomes, and who were middle-aged.Conclusions: Our results indicate that higher levels of physical activity occurred in areas with higher greenness and higher walkability.Impact: Findings suggest that planning and design policies should focus on these environments to optimize opportunities for physical activity. Cancer Epidemiol Biomarkers Prev; 26(4); 525-32. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."

Associations between active living-oriented zoning and no adult leisure-time physical activity in the U.S

Nearly one-third of adults report no leisure-time physical activity (LTPA). Governmental and authoritative bodies recognize the role that community design through zoning code changes can play in enabling LTPA. This study examined the association between zoning and no adult LTPA in the U.S. This study was conducted between 2012 and 2016, with analyses occurring in 2015-2016. Zoning codes effective as of 2010 were compiled for jurisdictions located in the 495 most populous U.S. counties and were evaluated for pedestrian-oriented code reform zoning, 11 active living-oriented provisions (e.g., sidewalks, bike-pedestrian connectivity, mixed use, bike lanes) and a summated zoning scale (max=12). Individual-level LTPA data were obtained from the 2012 CDC Behavioral Risk Factor Surveillance System (BRFSS). County-aggregated, population-weighted zoning variables were constructed for linking to BRFSS. Log-log multivariate regressions (N=147,517 adults), controlling for individual and county characteristics and with robust standard errors clustered on county, were conducted to examine associations between zoning and no LTPA. Relative risks (RR) compared predicted lack of LTPA at 0% and 100% county-level population exposure to each zoning predictor. Zoning code reforms were associated with a 13% lower probability of no LTPA (RR: 0.87, 95% CI: 0.82-0.92). Except for crosswalks, all zoning provisions were associated with an 11-16% lower probability of no LTPA. Having all 12 zoning provisions was associated with a 22% lower probability of no LTPA (RR: 0.78, 95% CI: 0.72-0.83). The results suggest that active living-oriented zoning is a policy lever available to communities seeking to reduce rates of no LTPA.

Built environmental correlates of cycling for transport across Europe

This cross-sectional study aimed to determine which objective built environmental factors, identified using a virtual neighbourhood audit, were associated with cycling for transport in adults living in five urban regions across Europe. The moderating role of age, gender, socio-economic status and country on these associations was also investigated. Overall, results showed that people living in neighbourhoods with a preponderance of speed limits below 30km/h, many bicycle lanes, with less traffic calming devices, more trees, more litter and many parked cars forming an obstacle on the road were more likely to cycle for transport than people living in areas with lower prevalence of these factors. Evidence was only found for seven out of 56 possible moderators of these associations. These results suggest that reducing speed limits for motorized vehicles and the provision of more bicycle lanes may be effective interventions to promote cycling in Europe.

Challenges in conducting natural experiments in parks-lessons from the REVAMP study

Experimental evidence on the role of the built environment for promoting physical activity is important for informing how to create cities that promote active living. Parks provide opportunities for physical activity; however, there is little robust evidence on the impact of park refurbishment. Government agencies often modify parks, providing opportunities for natural experiment studies of these interventions. Such an opportunity was provided by the modification of a large park in Victoria, Australia in 2013 when the Recording and EValuating Activity in a Modified Park (REVAMP) study was established. Based on insights from the REVAMP study, this paper discusses challenges involved in conducting natural experiments in park settings, focussing on issues that may help design more effective future evaluations of the impact of park refurbishment. Natural experiments offer unique opportunities to evaluate the impact of large-scale changes to the built environment. They provide valuable data that might not otherwise be possible to gather, because of the costs associated with modification of the environment. However, factors beyond the control of the study team contribute to the complexity of both organising and conducting natural experiments, with potential flow-on effects to the quality of data. Therefore many extraneous factors need to be considered when designing, costing and conducting natural experiments; studies should identify opportunities to include key partners from the inception of the project, be flexible yet robust, and allow sufficient funding to accommodate unexpected changes in the research protocol.

TRIAL REGISTRATION

Current controlled trial ISRCTN50745547 , registration date 11.1.2014.

Built Environment, Selected Risk Factors and Major Cardiovascular Disease Outcomes: A Systematic Review

INTRODUCTION

Built environment attributes have been linked to cardiovascular disease (CVD) risk. Therefore, identifying built environment attributes that are associated with CVD risk is relevant for facilitating effective public health interventions.

OBJECTIVE

To conduct a systematic review of literature to examine the influence of built environmental attributes on CVD risks.

DATA SOURCE

Multiple database searches including Science direct, CINAHL, Masterfile Premier, EBSCO and manual scan of reference lists were conducted.

INCLUSION CRITERIA

Studies published in English between 2005 and April 2015 were included if they assessed one or more of the neighborhood environmental attributes in relation with any major CVD outcomes and selected risk factors among adults.

DATA EXTRACTION

Author(s), country/city, sex, age, sample size, study design, tool used to measure neighborhood environment, exposure and outcome assessments and associations were extracted from eligible studies.

RESULTS

Eighteen studies met the inclusion criteria. Most studies used both cross-sectional design and Geographic Information System (GIS) to assess the neighborhood environmental attributes. Neighborhood environmental attributes were significantly associated with CVD risk and CVD outcomes in the expected direction. Residential density, safety from traffic, recreation facilities, street connectivity and high walkable environment were associated with physical activity. High walkable environment, fast food restaurants, supermarket/grocery stores were associated with blood pressure, body mass index, diabetes mellitus and metabolic syndrome. High density traffic, road proximity and fast food restaurants were associated with CVDs outcomes.

CONCLUSION

This study confirms the relationship between neighborhood environment attributes and CVDs and risk factors. Prevention programs should account for neighborhood environmental attributes in the communities where people live.

Are we facing a noncommunicable disease pandemic?

The global boom in premature mortality and morbidity from noncommunicable diseases (NCDs) shares many similarities with pandemics of infectious diseases, yet public health professionals have resisted the adoption of this label. It is increasingly apparent that NCDs are actually communicable conditions, and although the vectors of disease are nontraditional, the pandemic label is apt. Arguing for a change in terminology extends beyond pedantry as the move carries serious implications for the public health community and the general public. Additional resources are unlocked once a disease reaches pandemic proportions and, as a long-neglected and underfunded group of conditions, NCDs desperately require a renewed sense of focus and political attention. This paper provides objections, definitions, and advantages to approaching the leading cause of global death through an alternative lens. A novel framework for managing NCDs is presented with reference to the traditional influenza pandemic response.

The Physical Activity and Redesigned Community Spaces (PARCS) Study: Protocol of a natural experiment to investigate the impact of citywide park redesign and renovation

BACKGROUND

The built environment plays a critical role in promoting physical activity and health. The association between parks, as a key attribute of the built environment, and physical activity, however, remains inconclusive. This project leverages a natural experiment opportunity to assess the impact of the Community Parks Initiative (CPI), a citywide park redesign and renovation effort in New York City, on physical activity, park usage, psychosocial and mental health, and community wellbeing.

METHODS

The project will use a longitudinal design with matched controls. Thirty intervention park neighborhoods are socio-demographically matched to 20 control park neighborhoods. The study will investigate whether improvements in physical activity, park usage, psychosocial and mental health, and community wellbeing are observed from baseline to 3 years post-renovation among residents in intervention vs. control neighborhoods.

DISCUSSION

This study represents a rare opportunity to provide robust evidence to further our understanding of the complex relationship between parks and health. Findings will inform future investments in health-oriented urban design policies and offer evidence for addressing health disparities through built environment strategies.

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

BACKGROUND

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Do the Features, Amenities, and Quality of Physical Activity Resources Differ Between City and County Areas of a Large Rural Region?

The goal of this work was to provide a community-academic partnership with actionable information for physical activity (PA) for a rural health-disparate region. Identified PA outlets were audited and combined with survey data for 813 residents in the region. Less than a third of sampled residents (28%) met PA recommendations, with low perceptions of safety for PA. PA resource outlets in rural areas had higher numbers of incivilities. On the basis of our findings, 4 actionable strategies are recommended: shared-use agreements, reducing incivilities, addressing issues related to safety from traffic, and increasing the number of PA resources in rural areas.

Which environmental factors most strongly influence a street's appeal for bicycle transport among adults? A conjoint study using manipulated photographs

Background

Micro-environmental factors (specific features within a streetscape), instead of macro-environmental factors (urban planning features), are more feasible to modify in existing neighborhoods and thus more practical to target for environmental interventions. Because it is often not possible to change the whole micro-environment at once, the current study aims to determine which micro-environmental factors should get the priority to target in physical environmental interventions increasing bicycle transport. Additionally, interaction effects among micro-environmental factors on the street’s appeal for bicycle transport will be determined.

Methods

In total, 1950 middle-aged adults completed a web-based questionnaire consisting of a set of 12 randomly assigned choice tasks with manipulated photographs. Seven micro-environmental factors (type of cycle path, speed limit, speed bump, vegetation, evenness of the cycle path surface, general upkeep and traffic density) were manipulated in each photograph. Conjoint analysis was used to analyze the data.

Results

Providing streets with a cycle path separated from motorized traffic seems to be the best strategy to increase the street’s appeal for adults’ bicycle transport. If this adjustment is not practically feasible, micro-environmental factors related to safety (i.e. speed limit, traffic density) may be more effective in promoting bicycle transport than micro-environmental factors related to comfort (i.e. evenness of the cycle path surface) or aesthetic (i.e. vegetation, general upkeep). On the other hand, when a more separated cycle path is already provided, micro-environmental factors related to comfort or aesthetic appeared to become more prominent.

Conclusions

Findings obtained from this research could provide advice to physical environmental interventions about which environmental factors should get priority to modify in different environmental situations.

Trial registration

The study was approved by the Ethics Committee of the Ghent University Hospital. Trial registration: B670201318588. Registered at 04/10/2013. http://www.ugent.be/ge/nl/faculteit/raden/ec

Electronic supplementary material

The online version of this article (doi:10.1186/s12942-016-0058-4) contains supplementary material, which is available to authorized users.

The relationship between sports facility accessibility and physical activity among Korean adults

BACKGROUND

The benefits of physical activity on physical and mental health are well known. The accessibility of sports facilities is reported to have considerable association with the amount of physical activity a person participates in. Therefore, we investigated the association between subjectively assessed accessibility of sports facilities and physical activity among Korean adults.

METHODS

We obtained data from the 2012 Community Health Survey. Physical activity was measured based on weekly metabolic equivalent task (MET) hours according to the International Physical Activity Questionnaire (IPAQ). Sociodemographic, economic, and health variables were used as covariates in a logistic regression model.

RESULTS

A total 201,723 participants were included in this study. Participants with easy access to sports facilities participated in physical activity more often than those without easy access (OR = 1.16, 95 % CI 1.13-1.20). More physical activity was generally observed if participants had a history of depression or if participants were among the white-collar or urban subgroups.

CONCLUSION

Our results showed that the accessibility of sports facilities is associated with physical activity. Therefore, it is crucial to consider the accessibility of sports facilities when promoting an environment conducive to physical activity or designing programs for enhancing physical activity.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Differences in environmental preferences towards cycling for transport among adults: a latent class analysis

BACKGROUND

Increasing cycling for transport can contribute to improve public health among adults. Micro-environmental factors (i.e. small-scaled street-setting features) may play an important role in affecting the street's appeal to cycle for transport. Understanding about the interplay between individuals and their physical environment is important to establish tailored environmental interventions. Therefore, the current study aimed to examine whether specific subgroups exist based on similarities in micro-environmental preferences to cycle for transport.

METHODS

Responses of 1950 middle-aged adults (45-65 years) on a series of choice tasks depicting potential cycling routes with manipulated photographs yielded three subgroups with different micro-environmental preferences using latent class analysis.

RESULTS

Although latent class analysis revealed three different subgroups in the middle-aged adult population based on their environmental preferences, results indicated that cycle path type (i.e. a good separated cycle path) is the most important environmental factor for all participants and certainly for individuals who did not cycle for transport. Furthermore, only negligible differences were found between the importances of the other micro-environmental factors (i.e. traffic density, evenness of the cycle path, maintenance, vegetation and speed limits) regarding the two at risk subgroups and that providing a speed bump obviously has the least impact on the street's appeal to cycle for transport.

CONCLUSIONS

Results from the current study indicate that only negligible differences were found between the three subgroups. Therefore, it might be suggested that tailored environmental interventions are not required in this research context.

Are People Living in Walkable Areas Healthier and More Satisfied with Life?

Are people who live in more walkable areas healthier and more satisfied with life? This study investigates that question by using the 2005 Behavioral Risk Factors Surveillance System (BRFSS) survey, the largest telephone survey on health in the US (302,841 respondents from 989 metropolitan and micropolitan statistical areas [MSA]; 177,524 respondents from 703 MSAs had complete data). Using multilevel random coefficient modeling, we found that people living in walkable areas reported being generally healthier than people living in less walkable areas. In addition, aside from higher self-reported health, people living in walkable areas also had a lower body mass index (BMI). However, contrary to our prediction, people in more walkable areas were less satisfied with their lives than people in less walkable areas after controlling for various individual-level variables (age, gender, race, education, marital status, income, and unemployment). People who live in walkable areas are healthier but not happier than those living in less walkable areas.

Effects of new motorway infrastructure on active travel in the local population: a retrospective repeat cross-sectional study in Glasgow, Scotland

Background

Promoting active travel is an important part of increasing population physical activity, which has both physical and mental health benefits. A key benefit described by the then Scottish Government of the five-mile M74 motorway extension, which opened during June 2011 in the south of Glasgow, was that the forecast reduction in motor traffic on local streets would make these streets safer for walking and cycling, thus increasing active travel by the local population. The aim of the study was to evaluate the impact of new motorway infrastructure on the proportion of journey stages made actively (cycling or on foot) by individuals travelling in and out of the local area.

Methods

Data for the periods 2009–10 and 2012–13 were extracted from the Scottish Household Survey (SHS) travel diaries, which record each journey stage made during the previous day by a representative sample of the Scottish population aged 16 and over. Each individual journey stage was assigned to one of the following study areas surrounding existing and new transport infrastructure: (1) an area surrounding the new M74 motorway extension (n = 435 (2009–10), 543 (2012–13)), (2) a comparator area surrounding an existing motorway (n = 477 (2009–10), 560 (2012–13)), and (3) a control area containing no comparable motorway infrastructure (n = 541 (2009–10), 593 (2012–13)). Multivariable, multi-level regression analysis was performed to determine any between-area differences in change in active travel over time, which might indicate an intervention effect. Reference populations were defined using two alternative definitions, (1) Glasgow City and (2) Glasgow and surrounding local authorities.

Results

The results showed an increase in the proportion of journey stages using active travel in all study areas compared to both reference populations. However, there were no significant between-area differences to suggest an effect attributable the M74 motorway extension.

Conclusions

There was no clear evidence that the M74 motorway extension either increased or decreased active travel in the local area. The anticipation by policy makers that reduced motorised traffic on local streets might increase journeys walked or cycled appears to have been unfounded.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0403-9) contains supplementary material, which is available to authorized users.

The association between built environment features and physical activity in the Australian context: a synthesis of the literature

BACKGROUND

There is growing evidence indicating that the built environment is a determinant of physical activity. However, despite the well-established health benefits of physical activity this is rarely considered in urban planning. We summarised recent Australian evidence for the association built environment-physical activity among adults. This summary aims to inform policy makers who advocate for the consideration of health in urban planning.

METHODS

A combination of built environment and physical activity terms were used to systematically identify relevant peer reviewed and grey literature.

RESULTS

A total of 23 studies were included, providing 139 tests of associations between specific built environment features and physical activity. Of the total, 84 relationships using objective measures of built environment attributes were evaluated, whereas 55 relationships using self-reported measures were evaluated. Our results indicate that walkable neighbourhoods with a wide range of local destinations to go to, as well as a diverse use of land, encourage physical activity among their residents.

CONCLUSIONS

This research provides a summary of recent Australian evidence on built environments that are most favourable for physical activity. Features of walkability and availability of destinations within walking distance should be accounted for in the development or redevelopment of urban areas. Our findings emphasise the importance of urban planning for health via its impact on population levels of physical activity.

Obtaining Longitudinal Built Environment Data Retrospectively across 25 years in Four US Cities

BACKGROUND

Neighborhood transportation infrastructure and public recreational facilities are theorized to improve the activity, weight, and cardiometabolic profiles of individuals living in close proximity to these resources. However, owing to data limitations, there has not been adequate study of the influence of timing and placement of new infrastructure on health over time.

METHODS

This protocol details methods of the four cities study to perform retrospective field audits in order to capitalize on existing longitudinal health data from the coronary artery risk development in young adults (CARDIA) study. We developed and verified measures of recreation facilities (trails, parks) and transportation infrastructure (bus, light rail, bicycle parking, bicycle paths) in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA (USA). We identify introductions, renovations, and closures between 1985 and 2010 to develop measures of facility and infrastructure change. Ultimately, these data were linked to CARDIA sites' respondents' geographic locations over the 25-year study period to examine associations with health behaviors and outcomes.

RESULTS

Data available for retrospective audits was inconsistent by city, primarily due to record-keeping differences. We found large increases in bicycle infrastructure, with the exception of Birmingham, AL, USA. Excluding the addition of a new rail line in Minneapolis, MN, USA, few changes occurred in bus service, rail, and parks.

CONCLUSION

Our method represents innovation toward the collection of retrospective neighborhood data for use in longitudinal analyses. The data produced give insight into the way neighborhood infrastructure has changed over time and the potential relationship between these changes and health behaviors.

Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities

BACKGROUND

The majority of people live in cities and urbanization is continuing worldwide. Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also a main source of pollution and disease.

METHODS

We conducted a review around the topic urban and transport planning, environmental exposures and health and describe the findings.

RESULTS

Within cities there is considerable variation in the levels of environmental exposures such as air pollution, noise, temperature and green space. Emerging evidence suggests that urban and transport planning indicators such as road network, distance to major roads, and traffic density, household density, industry and natural and green space explain a large proportion of the variability. Personal behavior including mobility adds further variability to personal exposures, determines variability in green space and UV exposure, and can provide increased levels of physical activity. Air pollution, noise and temperature have been associated with adverse health effects including increased morbidity and premature mortality, UV and green space with both positive and negative health effects and physical activity with many health benefits. In many cities there is still scope for further improvement in environmental quality through targeted policies. Making cities 'green and healthy' goes far beyond simply reducing CO2 emissions. Environmental factors are highly modifiable, and environmental interventions at the community level, such as urban and transport planning, have been shown to be promising and more cost effective than interventions at the individual level. However, the urban environment is a complex interlinked system. Decision-makers need not only better data on the complexity of factors in environmental and developmental processes affecting human health, but also enhanced understanding of the linkages to be able to know at which level to target their actions. New research tools, methods and paradigms such as geographical information systems, smartphones, and other GPS devices, small sensors to measure environmental exposures, remote sensing and the exposome paradigm together with citizens observatories and science and health impact assessment can now provide this information.

CONCLUSION

While in cities there are often silos of urban planning, mobility and transport, parks and green space, environmental department, (public) health department that do not work together well enough, multi-sectorial approaches are needed to tackle the environmental problems. The city of the future needs to be a green city, a social city, an active city, a healthy city.

Street characteristics preferred for transportation walking among older adults: a choice-based conjoint analysis with manipulated photographs

BACKGROUND

Knowledge about the relationships between micro-scale environmental factors and older adults' walking for transport is limited and inconsistent. This is probably due to methodological limitations, such as absence of an accurate neighborhood definition, lack of environmental heterogeneity, environmental co-variation, and recall bias. Furthermore, most previous studies are observational in nature. We aimed to address these limitations by investigating the effects of manipulating photographs on micro-scale environmental factors on the appeal of a street for older adults' transportation walking. Secondly, we used latent class analysis to examine whether subgroups could be identified that have different environmental preferences for transportation walking. Thirdly, we investigated whether these subgroups differed in socio-demographic, functional and psychosocial characteristics, current level of walking and environmental perceptions of their own street.

METHODS

Data were collected among 1131 Flemish older adults through an online (n = 940) or an interview version of the questionnaire (n = 191). This questionnaire included a choice-based conjoint exercise with manipulated photographs of a street. These manipulated photographs originated from one panoramic photograph of an existing street that was manipulated on nine environmental attributes. Participants chose which of two presented streets they would prefer to walk for transport.

RESULTS

In the total sample, sidewalk evenness had by far the greatest appeal for transportation walking. The other environmental attributes were less important. Four subgroups that differed in their environmental preferences for transportation walking were identified. In the two largest subgroups (representing 86% of the sample) sidewalk evenness was the most important environmental attribute. In the two smaller subgroups (each comprising 7% of the sample), traffic volume and speed limit were the most important environmental attributes for one, and the presence of vegetation and a bench were the most important environmental attributes for the other. This latter subgroup included a higher percentage of service flat residents than the other subgroups.

CONCLUSIONS

Our results suggest that the provision of even sidewalks should be considered a priority when developing environmental interventions aiming to stimulate older adults' transportation walking. Natural experiments are needed to confirm whether our findings can be translated to real environments and actual transportation walking behavior.

Perceived environmental correlates of cycling for transport among adults in five regions of Europe

Regular cycling for transport is an important potential contributor to daily physical activity among adults. Characteristics of the physical environment are likely to influence cycling for transport. The current study investigated associations between perceived physical environmental neighbourhood factors and adults' cycling for transport across five urban regions across Europe, and whether such associations were moderated by age, gender, education and urban region. A total of 4,612 adults from five European regions provided information about their transport-related cycling and their neighbourhood physical environmental perceptions in an online survey. Hurdle models adjusted for the clustering within neighbourhoods were performed to estimate associations between perceived physical environmental neighbourhood factors and odds of engaging in cycling for transport and minutes of cycling for transport per week. Inhabitants of neighbourhoods that were perceived to be polluted, having better street connectivity, having lower traffic speed levels and being less pleasant to walk or cycle in had higher levels of cycling for transport. Moderation analyses revealed only one interaction effect by gender. This study indicates that cycling for transport is associated with a number of perceived physical environmental neighbourhood factors across five urban regions across Europe. Our results indicated that the majority of the outcomes identified were valid for all subgroups of age, gender, education and across regions in the countries included in the study.

Local Health Department Engagement in Community Physical Activity Policy

INTRODUCTION

This study assessed correlates of self-reported local health department (LHD) participation in community policy/advocacy activities that support physical activity.

METHODS

In 2014, cross-sectional data from the nationally representative 2013 National Profile of Local Health Departments study administered by the National Association of County and City Health Officials were analyzed. Outcomes were participation in policy/advocacy activities related to urban design/land use, active transportation, and access to recreational facilities. Independent variables included structural characteristics, performance improvement efforts, and collaboration. Multivariate logistic regression models were computed.

RESULTS

Representatives of 490 LHDs participated (79% response rate). Respondents reported similar participation in urban design/land use (25%); active transportation (16%); and recreational facility access (23%) policy/advocacy. LHDs with populations of ≥500,000 were more likely to report urban design/land use (p=0.004) as well as active transportation policy/advocacy participation (p=0.007) compared with those with populations of ≤50,000. LHDs with a community health improvement plan were more likely to participate in urban design/land use policy/advocacy (p=0.001). LHDs who regularly use the Community Guide were more likely to report policy/advocacy activity on active transportation (p=0.007) and expanding access to recreation facilities (p=0.009). LHDs engaged in a land use partnership were more likely to report urban design/land use (p<0.001) and active transportation (p=0.001) policy/advocacy participation.

CONCLUSIONS

Participation in community physical activity policy/advocacy among LHDs was low in this study and varied by LHD characteristics. Intervention opportunities include assisting smaller LHDs and promoting performance improvement efforts and evidence-based practice resources.

Implications of supermarket access, neighbourhood walkability and poverty rates for diabetes risk in an employee population

OBJECTIVE

Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population.

DESIGN

This was a retrospective cross-sectional analysis. Home environment variables were derived using employees' zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk.

SETTING

Data were collected from employee health fairs in a Midwestern health system, 2009-2012.

SUBJECTS

The data set contains 25 227 unique individuals across four years of data. From this group, using an individual's first entry into the database, 15 522 individuals had complete data for analysis.

RESULTS

The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk.

CONCLUSIONS

Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.

Built Environments and Active Living in Rural and Remote Areas: a Review of the Literature

Rural children and adults are more likely to have obesity than their urban counterparts even after adjustment for individual-level behaviors, suggesting that rural environments may promote obesity. The rural built environment may be an important area of research that can help us understand rural-urban disparities in obesity. The purpose of this review is to summarize the rural built environment and active living literature, and to address key issues, gaps, and observations in the field. A literature review was conducted in spring 2015 to identify research published from 2000 to 2015. Our review suggests that limited active living built environments in rural communities and unique rural barriers to physical activity may contribute to a higher prevalence of obesity compared to urban populations. More empirical research is needed to build the evidence-base for the association between rural built environments, active living, and obesity. School- and community-based policies that expand active living opportunities in rural areas should also be closely examined.

Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study

BACKGROUND

The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme.

METHODS

Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese.

RESULTS

Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%)

CONCLUSION

The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.

Neighbourhood walkability, daily steps and utilitarian walking in Canadian adults

OBJECTIVES

To estimate the associations of neighbourhood walkability (based on Geographic Information System (GIS)-derived measures of street connectivity, land use mix, and population density and the Walk Score) with self-reported utilitarian walking and accelerometer-assessed daily steps in Canadian adults.

DESIGN

A cross-sectional analysis of data collected as part of the Canadian Health Measures Survey (2007-2009).

SETTING

Home neighbourhoods (500 m polygonal street network buffers around the centroid of the participant's postal code) located in Atlantic Canada, Québec, Ontario, the Prairies and British Columbia.

PARTICIPANTS

5605 individuals participated in the survey. 3727 adults (≥18 years) completed a computer-assisted interview and attended a mobile clinic assessment. Analyses were based on those who had complete exposure, outcome and covariate data (n=2949).

MAIN EXPOSURE MEASURES

GIS-derived walkability (based on land use mix, street connectivity and population density); Walk Score.

MAIN OUTCOME MEASURES

Self-reported utilitarian walking; accelerometer-assessed daily steps.

RESULTS

No important relationship was observed between neighbourhood walkability and daily steps. Participants who reported more utilitarian walking, however, accumulated more steps (<1 h/week: 6613 steps/day, 95% CI 6251 to 6975; 1 to 5 h/week: 6768 steps/day, 95% CI 6420 to 7117; ≥6 h/week: 7391 steps/day, 95% CI 6972 to 7811). There was a positive graded association between walkability and odds of walking ≥1 h/week for utilitarian purposes (eg, Q4 vs Q1 of GIS-derived walkability: OR=1.66, 95% CI 1.31 to 2.11; Q3 vs Q1: OR=1.41, 95% CI 1.14 to 1.76; Q2 vs Q1: OR=1.13, 95% CI 0.91 to 1.39) independent of age, sex, body mass index, married/common law status, annual household income, having children in the household, immigrant status, mood disorder, perceived health, ever smoker and season.

CONCLUSIONS

Contrary to expectations, living in more walkable Canadian neighbourhoods was not associated with more total walking. Utilitarian walking and daily steps were, however, correlated and walkability demonstrated a positive graded relationship with utilitarian walking.

Public transit generates new physical activity: Evidence from individual GPS and accelerometer data before and after light rail construction in a neighborhood of Salt Lake City, Utah, USA

Poor health outcomes from insufficient physical activity (PA) are a persistent public health issue. Public transit is often promoted for positive influence on PA. Although there is cross-sectional evidence that transit users have higher PA levels, this may be coincidental or shifted from activities such as recreational walking. We use a quasi-experimental design to test if light rail transit (LRT) generated new PA in a neighborhood of Salt Lake City, Utah, USA. Participants (n=536) wore Global Positioning System (GPS) receivers and accelerometers before (2012) and after (2013) LRT construction. We test within-person differences in individuals' PA time based on changes in transit usage pre- versus post-intervention. We map transit-related PA to detect spatial clustering of PA around the new transit stops. We analyze within-person differences in PA time based on daily transit use and estimate the effect of daily transit use on PA time controlling for socio-demographic variables. Results suggest that transit use directly generates new PA that is not shifted from other PA. This supports the public health benefits from new high quality public transit such as LRT.

Obesity-related behaviours and BMI in five urban regions across Europe: sampling design and results from the SPOTLIGHT cross-sectional survey

OBJECTIVES

To describe the design, methods and first results of a survey on obesity-related behaviours and body mass index (BMI) in adults living in neighbourhoods from five urban regions across Europe.

DESIGN

A cross-sectional observational study in the framework of an European Union-funded project on obesogenic environments (SPOTLIGHT).

SETTING

60 urban neighbourhoods (12 per country) were randomly selected in large urban zones in Belgium, France, Hungary, the Netherlands and the UK, based on high or low values for median household income (socioeconomic status, SES) and residential area density.

PARTICIPANTS

A total of 6037 adults (mean age 52 years, 56% female) participated in the online survey.

OUTCOME MEASURES

Self-reported physical activity, sedentary behaviours, dietary habits and BMI. Other measures included general health; barriers and motivations for a healthy lifestyle, perceived social and physical environmental characteristics; the availability of transport modes and their use to specific destinations; self-defined neighbourhood boundaries and items related to residential selection.

RESULTS

Across five countries, residents from low-SES neighbourhoods ate less fruit and vegetables, drank more sugary drinks and had a consistently higher BMI. SES differences in sedentary behaviours were observed in France, with residents from higher SES neighbourhoods reporting to sit more. Residents from low-density neighbourhoods were less physically active than those from high-density neighbourhoods; during leisure time and (most pronounced) for transport (except for Belgium). BMI differences by residential density were inconsistent across all countries.

CONCLUSIONS

The SPOTLIGHT survey provides an original approach for investigating relations between environmental characteristics, obesity-related behaviours and obesity in Europe. First descriptive results indicate considerable differences in health behaviours and BMI between countries and neighbourhood types.

Perceived and Objective Measures of Neighborhood Walkability and Physical Activity among Adults in Japan: A Multilevel Analysis of a Nationally Representative Sample

Although associations between a person’s neighborhood and their health have been studied internationally, most studies have been limited to a few cities or towns. Therefore, we used a nationally representative sample to explore whether perceived and objective neighborhood walkability was associated with the physical activity of residents. Data were analyzed from the Japanese General Social Surveys of 2010 (n = 2395; 1114 men and 1281 women). Perceived walkability was scored using factor analysis for the respondents’ perceptions of neighborhood conditions, while objective walkability was measured using the geographic information system approach. Finally, multilevel logistic regression analysis was performed to examine whether neighborhood walkability was associated with the frequency of leisure-time physical activity (LTPA) among respondents. We found that perceived walkability was positively associated with the frequency of LTPA (odds ratio of the highest quartile was 1.53 (1.14–2.05) compared with the lowest quartile); however, objective walkability showed no association. When stratified by gender, an association between perceived walkability and LTPA was observed among women, but only a marginally significant association was present between objective walkability and LTPA among men. We conclude that the association between neighborhood walkability and LTPA can be partially generalized across Japan.

Physical Activity Measures in the Healthy Communities Study

The risk of obesity is reduced when youth engage in recommended levels of physical activity (PA). For that reason, public health organizations in the U.S. have encouraged communities to implement programs and policies designed to increase PA in youth, and many communities have taken on that challenge. However, the long-term effects of those programs and policies on obesity are largely unknown. The Healthy Communities Study is a large-scale observational study of U.S. communities that is examining the characteristics of programs and policies designed to promote healthy behaviors (e.g., increase PA and improve diet) and determining their association with obesity-related outcomes. The purpose of this paper is to describe the methods used to measure PA in children and the personal and community factors that may influence it. The study used both self-reported and objective measures of PA, and measured personal, family, and home influences on PA via three constructs: (1) PA self-schema; (2) parental support; and (3) parental rules regarding PA. Neighborhood and community factors related to PA were assessed using three measures: (1) child perceptions of the neighborhood environment; (2) availability of PA equipment; and (3) attributes of the child's street segment via direct observation. School influences on children's PA were assessed via three constructs: (1) school PA policies; (2) child perceptions of the school PA environment; and (3) school outdoor PA environment. These measures will enable examination of the associations between characteristics of community PA programs and policies and obesity-related outcomes in children and youth.

Does the Effect of Micro-Environmental Factors on a Street's Appeal for Adults' Bicycle Transport Vary across Different Macro-Environments? An Experimental Study

BACKGROUND

Characteristics of the physical environment can be classified into two broad categories: macro- ("raw" urban planning features influenced on a regional level) and micro- (features specifically within a streetscape influenced on a neighborhood level) environmental factors. In urban planning applications, it is more feasible to modify conditions at the neighborhood level than at the regional level. Yet for the promotion of bicycle transport we need to know whether relationships between micro-environmental factors and bicycle transport depend on different types of macro-environments. This study aimed to identify whether the effect of three micro-environmental factors (i.e., evenness of the cycle path surface, speed limits and type of separation between cycle path and motorized traffic) on the street's appeal for adults' bicycle transport varied across three different macro-environments (i.e., low, medium and high residential density street).

METHODS

In total, 389 middle-aged adults completed a web-based questionnaire consisting of socio-demographic characteristics and a series of choice tasks with manipulated photographs, depicting two possible routes to cycle along. Conjoint analysis was used to analyze the data.

RESULTS

Although the magnitude of the overall effects differed, in each macro-environment (i.e., low, medium and high residential density), middle-aged adults preferred a speed limit of 30 km/h, an even cycle path surface and a hedge as separation between motorized traffic and the cycle path compared to a speed limit of 50 or 70 km/h, a slightly uneven or uneven cycle path surface and a curb as separation or no separation between motorized traffic and the cycle path.

CONCLUSIONS

Our results suggest that irrespective of the macro-environment, the same micro-environmental factors are preferred in middle-aged adults concerning the street's appeal for bicycle transport. The controlled environment simulations in the experimental choice task have the potential to inform real life environmental interventions and suggest that micro-environmental changes can have similar results in different macro-environments.

Value of urban green spaces in promoting healthy living and wellbeing: prospects for planning

There has been considerable work done in recent years exploring the value of urban green space for health and wellbeing. Urban green spaces provide environmental benefits through their effects on negating urban heat, offsetting greenhouse gas emissions, and attenuating storm water. They also have direct health benefits by providing urban residents spaces for physical activity and social interaction, and allowing psychological restoration to take place. Consequently, there is a real need to understand the mechanisms by which these benefits accrue. Previously, much of the focus has been on the characteristics of the urban green space that are likely to influence its use, such as its accessibility, quality, facilities, attractiveness, and security. This assumes a causal relationship, when in reality the relationship is more complex and multifactorial. It is more likely that it is the functionality of the green space, be it for exercise or sociocultural activities, rather than its character, which translates to the reported benefits. Challenges exist, such as competing urban planning priorities, economic considerations, and market forces. There is thus a need for urban planning to match the health benefits sought with the needs of the community and the functionality that the urban green space will serve.

Green Infrastructure, Ecosystem Services, and Human Health

Contemporary ecological models of health prominently feature the natural environment as fundamental to the ecosystem services that support human life, health, and well-being. The natural environment encompasses and permeates all other spheres of influence on health. Reviews of the natural environment and health literature have tended, at times intentionally, to focus on a limited subset of ecosystem services as well as health benefits stemming from the presence, and access and exposure to, green infrastructure. The sweeping influence of green infrastructure on the myriad ecosystem services essential to health has therefore often been underrepresented. This survey of the literature aims to provide a more comprehensive picture—in the form of a primer—of the many simultaneously acting health co-benefits of green infrastructure. It is hoped that a more accurately exhaustive list of benefits will not only instigate further research into the health co-benefits of green infrastructure but also promote consilience in the many fields, including public health, that must be involved in the landscape conservation necessary to protect and improve health and well-being.

Associations between neighbourhood walkability and daily steps in adults: a systematic review and meta-analysis

Background

Higher street connectivity, land use mix and residential density (collectively referred to as neighbourhood walkability) have been linked to higher levels of walking. The objective of our study was to summarize the current body of knowledge on the association between neighbourhood walkability and biosensor-assessed daily steps in adults.

Methods

We conducted a systematic search of PubMed, SCOPUS, and Embase (Ovid) for articles published prior to May 2014 on the association between walkability (based on Geographic Information Systems-derived street connectivity, land use mix, and/or residential density) and daily steps (pedometer or accelerometer-assessed) in adults. The mean differences in daily steps between adults living in high versus low walkable neighbourhoods were pooled across studies using a Bayesian hierarchical model.

Results

The search strategy yielded 8,744 unique abstracts. Thirty of these underwent full article review of which six met the inclusion criteria. Four of these studies were conducted in Europe and two were conducted in Asia. A meta-analysis of four of these six studies indicates that participants living in high compared to low walkable neighbourhoods accumulate 766 more steps per day (95 % credible interval 250, 1271). This accounts for approximately 8 % of recommended daily steps.

Conclusions

The results of European and Asian studies support the hypothesis that higher neighbourhood walkability is associated with higher levels of biosensor-assessed walking in adults. More studies on this association are needed in North America.

Improving current practice in reviews of the built environment and physical activity

Over the last decade, there has been a marked increase in studies about built environments and physical activity. As the number of publications is growing rapidly, literature reviews play an important role in identifying primary studies and in synthesizing their findings. However, many of the reviews of effectiveness in this field demonstrate methodological limitations that might lead to inaccurate portrayals of the evidence. Some literature reviews a priori excluded intervention studies even though they provide the strongest level of evidence. The label 'systematic review' has mostly been used inappropriately. One of the major criteria of a systematic review that is hardly ever met is that the quality of the primary studies needs to be assessed and this should be reflected in the synthesis, presentation and interpretation of results. With few exceptions, 'systematic' reviews about environments and physical activity did not refer to or follow the QUORUM or PRISMA statements. This commentary points out the usefulness of the PRISMA statement to standardize the reporting of methodology of reviews and provides additional guidance to limit sources of bias in them. The findings and recommendations from this article can help in moving forward the synthesis of evidence of effectiveness not only in built environments and physical activity, but also more broadly in exercise science and public health.

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014

Introduction

A community’s built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement.

Methods

Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change.

Results

Twenty-four adults (mean age, 69.4 y [standard deviation, 13.2 y]), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use.

Conclusion

An electronic tablet–based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

Transit Use, Physical Activity, and Body Mass Index Changes: Objective Measures Associated With Complete Street Light-Rail Construction

OBJECTIVES

We assessed effects on physical activity (PA) and weight among participants in a complete street intervention that extended a light-rail line in Salt Lake City, Utah.

METHODS

Participants in the Moving Across Places Study resided within 2 kilometers of the new line. They wore accelerometers and global positioning system (GPS) loggers for 1 week before and after rail construction. Regression analyses compared change scores of participants who never rode transit with continuing, former, and new riders, after adjustment for control variables (total n = 537).

RESULTS

New riders had significantly more accelerometer-measured counts per minute than never-riders (P < .01), and former riders had significantly fewer (P < .01). New riders lost (P < .05) and former riders gained (P < .01) weight. Former riders lost 6.4 minutes of moderate-to-vigorous PA (MVPA) per 10 hours of accelerometer wear (P < .01) and gained 16.4 minutes of sedentary time (P < .01). New riders gained 4.2 MVPA minutes (P < .05) and lost 12.8 (P < .05) sedentary minutes per 10 hours accelerometer wear.

CONCLUSIONS

In light of the health benefits of transit ridership in the complete street area, research should address how to encourage more sustained ridership.

Built environment and obesity by urbanicity in the U.S

Based on the data from the Behavioral Risk Factor Surveillance System 2012, this study examines the association of neighborhood built environments with individual physical inactivity and obesity in the U.S. Multilevel modeling is used to control for the effects of individual socio-demographic characteristics. Neighborhood variables include built environment, poverty level and urbanicity at the county level. Among the built environment variables, a poorer street connectivity and a more prominent presence of fast-food restaurants are associated with a higher obesity risk (especially for areas of certain urbanicity levels). Analysis of data subsets divided by areas of different urbanicity levels and by gender reveals the variability of effects of independent variables, more so for the neighborhood variables than individual variables. This implies that some obesity risk factors are geographically specific and vary between men and women. The results lend support to the role of built environment in influencing people's health behavior and outcome, and promote public policies that need to be geographically adaptable and sensitive to the diversity of demographic groups.