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Roman CG, Chen R, Natarajan L, Conway TL, Patch C, Taylor RB, Cain KL, Roesch S, Adams MA, Saelens BE, King AC, Frank LD, Glanz K, Sallis JF. Crime-related perceptions and walking for recreation inside and outside one's home neighborhood. Health Place 2024; 89:103316. [PMID: 39089217 PMCID: PMC11402571 DOI: 10.1016/j.healthplace.2024.103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/25/2024] [Accepted: 07/05/2024] [Indexed: 08/03/2024]
Abstract
It is widely assumed crime and related concerns, including neighborhood incivilities and fear of crime, are barriers to physical activity (PA). Past studies reveal mixed evidence. Studies of impacts for crime-protective factors are less common but have similarly mixed results. This paper evaluates a comprehensive transdisciplinary conceptual framework of cross-sectional associations between crime-related perceptions and reported minutes/week of recreational walking inside and outside one's home neighborhood. Safe and Fit Environments Study (SAFE) recruited and surveyed 2302 participants from adolescents to older adults from four U.S. metropolitan areas. A zero-inflated model estimated two components of each outcome: whether the respondent walked, and minutes/week walked. Correlates of recreational walking were location-specific, differing based on walking location. Fear of crime, risk evaluation, victimization, and incivilities were not consistently associated with walking for recreation inside one's neighborhood. People with crime concerns about their own neighborhoods, however, more commonly walked for recreation outside their neighborhoods. Protective crime-related perceptions that seldom have been studied in relation to PA, such as street efficacy (i.e., the perceived ability to avoid and manage danger), were strongly associated with recreational walking in both locations, indicating the additional heuristic value of the SAFE conceptual framework. Crime-related perceptions and walking for recreation: Evaluating a conceptual model.
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Affiliation(s)
- Caterina G Roman
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA.
| | - Ruohui Chen
- Feinberg School of Medicine, Department of Preventive Medicine - Biostatistics, Northwestern University, Evanston, Illinois, USA
| | - Loki Natarajan
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, USA
| | - Terry L Conway
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, USA
| | | | - Ralph B Taylor
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Kelli L Cain
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, USA
| | - Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Brian E Saelens
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, University of Washington, Washington, USA
| | - Abby C King
- Stanford Prevention Research Center, Stanford University California, USA
| | - Lawrence D Frank
- Department of Urban Studies and Planning, University of California, San Diego, California, USA
| | - Karen Glanz
- Perelman School of Medicine, University of Pennsylvania, USA and School of Nursing, USA
| | - James F Sallis
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, USA; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Kalu ME, Bello-Haas VD, Griffin M, Boamah S, Harris J, Zaide M, Rayner D, Khattab N, Abrahim S. A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults. Arch Phys Med Rehabil 2023; 104:2147-2168. [PMID: 37119957 DOI: 10.1016/j.apmr.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes. DATA SOURCES PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021. STUDY SECTION Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted. DATA EXTRACTION The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted. DATA SYNTHESIS Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors. CONCLUSIONS Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Salma Abrahim
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
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Lee C, Xu M, Zhu X, Towne SD, Sang H, Lee H, Ory MG. Moving to an Activity-Friendly Community Can Increase Physical Activity. J Phys Act Health 2023; 20:1058-1066. [PMID: 37597842 DOI: 10.1123/jpah.2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Creating activity-friendly communities (AFCs) is an important strategy to increase physical activity (PA). While cross-sectional links between community environments and PA are well documented, their causal relationships remain insufficiently explored. METHODS Using the accelerometer and survey data collected from adults who moved to an AFC (cases) and similar non-AFC-residing adults who did not move (comparisons), this pre-post, case-comparison study examines if moving to an AFC increases PA. Data came from 115 participants (cases = 37, comparisons = 78) from Austin, Texas, who completed 2 waves of 1-weeklong data collection. Difference-in-difference analyses and fixed-effect models were used to test the significance of the pre-post differences in moderate-to-vigorous PA (MVPA) between cases and comparisons, for the full sample and the subsample of 37 pairs matched in key covariates using the Propensity Score Matching method. RESULTS Average treatment effect generated based on Propensity Score Matching and difference-in-difference showed that moving to this AFC led to an average of 10.88 additional minutes of daily MVPA (76.16 weekly minutes, P = .015). Fixed-effect models echoed the result with an increase of 10.39 minutes of daily MVPA after moving to the AFC. We also found that case participants who were less active at baseline and had higher income increased their MVPA more than their counterparts. CONCLUSIONS This study showed that, among our study sample, moving to an AFC increased residents' PA significantly when compared to their premove level and the comparison group. This causal evidence suggests the potential of AFCs as sustainable interventions for PA promotion.
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Affiliation(s)
- Chanam Lee
- Center for Health Systems & Design, Texas A&M University, College Station, TX,USA
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX,USA
| | - Minjie Xu
- Center for Health Systems & Design, Texas A&M University, College Station, TX,USA
- Health and Sustainability Program, Air Quality, Energy, and Health Division, Texas A&M Transportation Institute, Austin, TX,USA
| | - Xuemei Zhu
- Center for Health Systems & Design, Texas A&M University, College Station, TX,USA
- Department of Architecture, Texas A&M University, College Station, TX,USA
| | - Samuel D Towne
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX,USA
- Center for Community Health and Aging, Texas A&M University, College Station, TX,USA
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL,USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL,USA
- Southwest Rural Health Research Center, Texas A&M University, College Station, TX,USA
| | - Huiyan Sang
- Department of Statistics, Texas A&M University, College Station, TX,USA
| | - Hanwool Lee
- Center for Health Systems & Design, Texas A&M University, College Station, TX,USA
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX,USA
| | - Marcia G Ory
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX,USA
- Center for Community Health and Aging, Texas A&M University, College Station, TX,USA
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Rothman L, Hagel BE, Howard AW, Schwartz N, Cloutier MS, Macpherson AK. Is higher school neighbourhood Walk Score associated with greater child pedestrian safety near schools? Inj Prev 2023; 29:363-366. [PMID: 37336630 DOI: 10.1136/ip-2023-044922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Walk Score is a common index used to estimate how suitable the built environment is for walking. Although Walk Score has been extensively validated as a measure of walkability and walking, there are limited studies examining whether commonly used constructs of walkability are associated with traffic safety in children. This study examined the association between Walk Score and child pedestrian injury controlling for observed walking exposure in school zones in Calgary, Toronto and Montreal, Canada. Results indicate that a higher Walk Score was associated with more child pedestrian injuries in all three cities, even after controlling for walking exposure. School travel planning should consider established individual pedestrian collision risk and individual factors rather than assuming a highly walkable environment is also a safe pedestrian environment.
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Affiliation(s)
- Linda Rothman
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brent E Hagel
- Department of Paediatrics, Univ of Calgary, Calgary, Alberta, Canada
| | | | - Naomi Schwartz
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Marie Soleil Cloutier
- Centre Urbanisation Culture Société, Institut national de la recherche scientifique, Quebec City, Quebec, Canada
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Tang F, Li K, Rauktis ME, Chi I, Dong X. A Social-Ecological Approach to Understanding Activity Engagement Patterns Among Older Chinese Immigrants. Int J Aging Hum Dev 2023; 96:219-233. [PMID: 35291843 PMCID: PMC9896126 DOI: 10.1177/00914150221084648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Few studies have focused on activity engagement among older immigrants. We aim to map the patterns of activity engagement and examine the associations with social-ecological factors in a sample of older Chinese immigrants. Participants were from the Population Study of Chinese Elderly in Chicago (PINE). Four patterns of activity engagement were identified through latent class analysis: restricted, diverse, informal social, and community-based social. Intrapersonal, interpersonal, cultural, and environmental factors distinguished latent classes of activity engagement. In particular, acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment such as social network size, positive social support, and neighborhood cohesion were associated with the likelihood of categorization in the diverse, informal social, and community-based social groups relative to the restricted group. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Ke Li
- School of Social Work, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Rauktis
- School of Social Work, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Iris Chi
- Suzanne Dwork-Peck School of Social Work, 5116University of Southern California, Los Angeles, CA, USA
| | - XinQi Dong
- 242612Rutgers University, The State University of New Jersey, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
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6
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Kim EJ, Jin S. Walk Score and Neighborhood Walkability: A Case Study of Daegu, South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4246. [PMID: 36901257 PMCID: PMC10001684 DOI: 10.3390/ijerph20054246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/25/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Walking is a popular physical activity that helps prevent obesity and cardiovascular diseases. The Walk Score, which measures neighborhood walkability, considers access to nine amenities using a geographic information system but does not deal with pedestrian perception. This study aims to (1) examine the correlation between access to each amenity, an individual component of the Walk Score, and perceived neighborhood walkability and (2) investigate the correlation with the perceived neighborhood walkability by adding variables of pedestrian perception to the existing Walk Score components. This study conducted a survey with 371 respondents in Daegu, South Korea, between 12 October and 8 November 2022. A multiple regression model was used to examine the correlations. The results showed no association between perceived neighborhood walkability and the individual component of the Walk Score. As variables of environmental perception, the fewer hills or stairs, the more alternative walking routes, the better separation between road and pedestrians, and the richer the green space, the more people perceived their neighborhood as walkable. This study found that the perception of the built environment had a more substantial influence on perceived neighborhood walkability than the accessibility to amenities. It proved that the Walk Score should include pedestrian perception and quantitative measurement.
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7
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Cheng GJ, Nicklett EJ. Racial and Ethnic Differences in the Relationship Between Neighborhood Environment and Physical Activity Among Middle-Aged and Older Adults. J Aging Health 2022; 34:1163-1177. [PMID: 35603774 PMCID: PMC10790400 DOI: 10.1177/08982643221103359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Objectives:To examine the associations between neighborhood environment-perceived neighborhood social cohesion and perceived neighborhood physical environment-and physical activity (PA) and whether these associations differ by race/ethnicity. Methods: We analyzed data from the Health and Retirement Study, a longitudinal study of US adults aged 50+ from 2006 to 2014 (N = 17,974), using multivariate mixed-effects linear models. PA was repeatedly measured using metabolic equivalent of task estimated values accounting for the vigor and frequency of self-reported PA. Results: In multivariate models, higher levels of PA were positively associated with higher rated neighborhood social cohesion and neighborhood physical environment scores. The effects of social cohesion were stronger among non-Hispanic Whites than among non-Hispanic Black and Hispanic/Latinx participants, while race/ethnicity did not moderate the association between PA and physical environment. Discussion: Intervention strategies that address social and physical barriers of neighborhoods could promote PA in older adults. Key implications for future research are discussed.
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Affiliation(s)
- Greta Jianjia Cheng
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Emily J. Nicklett
- Department of Social Work, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, US
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8
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Towne SD, Xu M, Zhu X, Ory MG, Lee S, Lee C. Differential Effects of a Global Public Health Crisis on Physical Activity: Evidence From a Statewide Survey From the United States. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:63-80. [PMID: 35746822 PMCID: PMC9951772 DOI: 10.1177/19375867221107087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM We aimed to identify how the COVID-19 lockdown affected changes, including the potential for longer term sustained changes, in physical activity, as compared to immediately prior to the pandemic. BACKGROUND Physical activity's significant role in overall health is known to be influenced by the surrounding environment, such as one's neighborhood, prompting this study of physical activity and its relationship with individual-level and neighborhood-level factors within the pandemic timeline. METHODS A statewide online survey assessed adults' self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA) comparing a typical week immediately prior to the pandemic and during the pandemic (prewidespread vaccination) using negative binomial models. RESULTS Overall, MVPA decreased during the pandemic, though the decrease was driven largely by the reduction in MVPA outside one's neighborhood. In contrast, MVPA done within one's neighborhood increased over time. This change in MVPA done within one's neighborhood was not uniform across several characteristics including income level favoring those with the highest income (p < .05) and race/ethnicity favoring those self-reporting as non-Hispanic White (p < .05). While several factors, including higher Walk Scores, were associated with higher levels of MVPA without evidence of change over time, evidence of a differential effect over time was seen for other key indicators of social and structural determinants of health including income and race/ethnicity. CONCLUSIONS This study can add to the existing literature surrounding not only COVID-19 but also neighborhood built environmental research seeking to identify factors associated with changes in MVPA, a known indicator of overall health and health-related outcomes.
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Affiliation(s)
- Samuel D. Towne
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA,Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA,Southwest Rural Health Research Center, Texas A&M University, College Station, TX, USA,Center for Population Health and Aging, Texas A&M University, College Station, TX, USA
| | - Minjie Xu
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
| | - Xuemei Zhu
- Department of Architecture, Texas A&M University, College Station, TX, USA
| | - Marcia G. Ory
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA,Center for Population Health and Aging, Texas A&M University, College Station, TX, USA
| | - Sungmin Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
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Akinci ZS, Delclòs-Alió X, Vich G, Salvo D, Ibarluzea J, Miralles-Guasch C. How different are objective operationalizations of walkability for older adults compared to the general population? A systematic review. BMC Geriatr 2022; 22:673. [PMID: 35971086 PMCID: PMC9377138 DOI: 10.1186/s12877-022-03233-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/09/2022] [Indexed: 01/10/2023] Open
Abstract
Background Walking is an essential activity for everyone and for older adults in particular, given that it is the most accessible form of physical activity and one of the healthiest transportation modes. Understanding how walkability (the potential of the environment to enable and/or encourage walking) has been objectively measured and analyzed for older adults is critical to create more inclusive, healthy, and sustainable environments and to promote healthy aging. Despite the numerous reviews on physical activity among older adults and its relationship with the built environment, the literature still lacks comparison reviews focusing specifically on objective operationalizations of walkability for older adults vs. the general population. Methods We conducted a systematic review of 146 empirical studies that measured walkability objectively in relation to walking-related outcomes. We compared studies focused on older adults (n = 24) and the general population (n = 122). Content analysis included the characteristics of the study design, walkability measures, spatial extent, and associations found between walkability and walking-related outcomes. Results In both groups of publications, the majority of studies were conducted in the US, Canada, and Europe, and largely in high-income countries. They were mostly published in health-related journals and used cross-sectional designs, operationalized walkability by using indexes, employed self-reported measures for walking-related outcomes, and found positive associations between walkability and walking outcomes. However, we observed some differences among studies focusing on older adults. Compared to studies focusing on the general population, a larger proportion of studies on older adults was conducted in the Middle East and Asia, and they used longitudinal designs, mixed methods to measure walking-related outcomes, variables related with land-use characteristics, safety from traffic and crime, and greenery, and a larger proportion found positive, as well as no associations between walkability and walking-related outcomes. Conclusion Although there is a promising increase in interest in older adults-focused walkability studies in the last decade, there is still a need for more studies focusing on different settings, using wider spatial extents, longitudinal designs, objective or mixed methods to collect outcome data, and specific variables and/or specially created indexes for older adults and for settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03233-x.
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Affiliation(s)
- Zeynep S Akinci
- Grup d'Estudis en Mobilitat, Transport i Territori (GEMOTT), Departament de Geografia, Universitat Autònoma de Barcelona, Edifici B, Campus de Bellaterra, 08193, Cerdanyola del Vallès, Barcelona, Spain.
| | - Xavier Delclòs-Alió
- Grup de Recerca en Anàlisi Territorial i Estudis Turístics (GRATET), Departament de Geografia, Universitat Rovira i Virgili, Vila-seca, Spain
| | - Guillem Vich
- Grup d'Estudis en Mobilitat, Transport i Territori (GEMOTT), Departament de Geografia, Universitat Autònoma de Barcelona, Edifici B, Campus de Bellaterra, 08193, Cerdanyola del Vallès, Barcelona, Spain.,ISGlobal (Barcelona Institute for Global Health), Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Deborah Salvo
- People, Health and Place Unit; Prevention Research Center in St. Louis; Brown School; Washington University in St Louis , St. Louis, Missouri, USA
| | - Jesús Ibarluzea
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastian, Spain.,Faculty of Psychology of the University of the Basque Country, 20018, San Sebastian, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain.,Biodonostia Health Research Institute, Environmental Epidemiology and Child Development Group, 20014, San Sebastian, Spain
| | - Carme Miralles-Guasch
- Grup d'Estudis en Mobilitat, Transport i Territori (GEMOTT), Departament de Geografia, Universitat Autònoma de Barcelona, Edifici B, Campus de Bellaterra, 08193, Cerdanyola del Vallès, Barcelona, Spain.,Institut de Ciència i Tecnologia Ambientals (ICTA), Universitat Autònoma de Barcelona - Edifici ICTA-ICP, Campus de Bellaterra, 08193, Cerdanyola del Vallès, Barcelona, Spain
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10
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The relationship between walk score® and perceived walkability in ultrahigh density areas. Prev Med Rep 2021; 23:101393. [PMID: 34123713 PMCID: PMC8173305 DOI: 10.1016/j.pmedr.2021.101393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/04/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Walk Score® was positively correlated with several perceived walkable environmental attributes. There was a large correlation between Walk Score® and access to shops. There was a medium correlation between Walk Score® and overall perceived walkability.
Walk Score® is a free web-based tool that provides a walkability score for any given location. A limited number of North American studies have found associations between Walk Score® and perceived built environment attributes, yet it remains unknown whether similar associations exist in Asian countries. The study’s objective is to examine the covariate-adjusted correlations between the Walk Score® metric and measures of the perceived built environment in ultrahigh density areas of Japan. Cross-sectional data were obtained from a randomly selected sample of adult residents living in two Japanese urban localities. There was a large correlation between Walk Score® and access to shops (0.58; p < 0.001). There were medium correlations between Walk Score® and population density (0.38; p < 0.001), access to public transport (0.34; p < 0.001), presence of sidewalks (0.41; p < 0.001), and access to recreational facilities (0.37; p < 0.001), and there was a small correlation between Walk Score® and presence of bike lanes (0.16; p < 0.001). There was a small negative correlation between Walk Score® and traffic safety (-0.13; p < 0.001). There was a medium correlation between Walk Score® and overall perceived walkability (0.48; p < 0.001). This study's findings highlight that Walk Score® was correlated with several perceived walkable environment attributes in the context of ultrahigh density areas in Asia.
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11
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Zanwar P, Kim J, Kim J, Manser M, Ham Y, Chaspari T, Ahn CR. Use of Connected Technologies to Assess Barriers and Stressors for Age and Disability-Friendly Communities. Front Public Health 2021; 9:578832. [PMID: 33777874 PMCID: PMC7991298 DOI: 10.3389/fpubh.2021.578832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The benefits of engaging in outdoor physical activity are numerous for older adults. However, previous work on outdoor monitoring of physical activities did not sufficiently identify how older adults characterize and respond to diverse elements of urban built environments, including structural characteristics, safety attributes, and aesthetics. Objective: To synthesize emerging multidisciplinary trends on the use of connected technologies to assess environmental barriers and stressors among older adults and for persons with disability. Methods: A multidisciplinary overview and literature synthesis. Results: First, we review measurement and monitoring of outdoor physical activity in community environments and during transport using wearable sensing technologies, their contextualization and using smartphone-based applications. We describe physiological responses (e.g., gait patterns, electrodermal activity, brain activity, and heart rate), stressors and physical barriers during outdoor physical activity. Second, we review the use of visual data (e.g., Google street images, Street score) and machine learning algorithms to assess physical (e.g., walkability) and emotional stressors (e.g., stress) in community environments and their impact on human perception. Third, we synthesize the challenges and limitations of using real-time smartphone-based data on driving behavior, incompatibility with software data platforms, and the potential for such data to be confounded by environmental signals in older adults. Lastly, we summarize alternative modes of transport for older adults and for persons with disability. Conclusion: Environmental design for connected technologies, interventions to promote independence and mobility, and to reduce barriers and stressors, likely requires smart connected age and disability-friendly communities and cities.
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Affiliation(s)
- Preeti Zanwar
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, United States.,Center for Health Systems and Design, Colleges of Architecture and Medicine, Texas A&M University, College Station, TX, United States.,Network on Life Course and Health Dynamics and Disparities, University of Southern California, Los Angeles, CA, United States
| | - Jinwoo Kim
- Department of Multidisciplinary Engineering, College of Engineering, Texas A&M University, College Station, TX, United States
| | - Jaeyoon Kim
- Department of Construction Science, College of Architecture, Texas A&M University, College Station, TX, United States
| | - Michael Manser
- Texas A&M Transportation Institute, Texas A&M University System, College Station, TX, United States
| | - Youngjib Ham
- Department of Construction Science, College of Architecture, Texas A&M University, College Station, TX, United States
| | - Theodora Chaspari
- Department of Computer Science and Engineering, College of Engineering, Texas A&M University, College Station, TX, United States
| | - Changbum Ryan Ahn
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, United States.,Department of Construction Science, College of Architecture, Texas A&M University, College Station, TX, United States
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12
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Zhong S, Lee C, Lee H. Community Environments That Promote Intergenerational Interactions vs. Walking Among Older Adults. Front Public Health 2020; 8:587363. [PMID: 33344399 PMCID: PMC7744414 DOI: 10.3389/fpubh.2020.587363] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Intergenerational interactions and walking are two of the most beneficial forms of activities for older adults. As older adults spend most of their time at or near home, the characteristics of the proximate residential environments are particularly important for supporting those activities. This study aims to (1) explore places used for various social interactions older adults engage in, (2) examine specific neighborhood environmental features associated with intergenerational interactions, and (3) compare similarities and differences in environmental correlates of intergenerational interactions vs. walking. Methods: This cross-sectional study analyzed self-reported survey data from 455 community-dwelling adults aged 65+ from Austin, Texas, as well as Geographic Information System (GIS) measures capturing the neighborhood environment around each participant's home. Descriptive statistics were used for Aim 1. Multivariable binary logistic models were used for Aims 2 and 3, to identify environmental variables predicting the odds of participating in intergenerational interactions (with children 1+ times/week, and with children, teenagers, or adults 1+ times/week) in one's neighborhood, as well as walking 1+ times/week for transportation or recreation purposes. Results: Participants had a mean age of 73 years, and were primarily female (72.1%) and non-Hispanic white (72.8%). Older adults interacted frequently with adults (79.2%, 1+ times/week) and other older adults (66.9%) in their neighborhood, while less frequently with children (28.0%) and teenagers (21.9%). Recreational walking (73.3%, 1+ times/week) was more popular for older adults than transportation walking (43.8%). Multivariable analyses showed that neighborhood perceptions, transportation infrastructure, land uses, land covers, population densities, development activities, and composite scores were significant predictors of intergenerational activities. Both similarities and differences were found in terms of the neighborhood environmental factors associated with intergenerational interactions vs. walking although differences were more evident in the domains of land covers, development activities, and composite scores. Conclusions: Given the significant health benefits, promoting intergenerational interactions and walking among older adults should be a national/global responsibility. Further work is needed to improve our understanding of the specific social and physical environmental facilitators as well as barriers to creating intergenerational communities that can support healthy living of all generations.
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Affiliation(s)
- Sinan Zhong
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, United States
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, United States
| | - Hanwool Lee
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, United States
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13
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Christman ZJ, Wilson-Genderson M, Heid A, Pruchno R. The Effects of Neighborhood Built Environment on Walking for Leisure and for Purpose Among Older People. THE GERONTOLOGIST 2020; 60:651-660. [PMID: 31513712 DOI: 10.1093/geront/gnz093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Characteristics of a neighborhood's built environment affect the walking behavior of older people, yet studies typically rely on small nonrepresentative samples that use either subjective reports or aggregate indicators from administrative sources to represent neighborhood characteristics. Our analyses examine the usefulness of a novel method for observing neighborhoods-virtual observations-and assess the extent to which virtual-based observations predict walking among older adults. RESEARCH DESIGN AND METHODS Using Google Street View, we observed the neighborhoods of 2,224 older people and examined how characteristics of the neighborhood built environments are associated with the amount of time older people spend walking for leisure and purpose. RESULTS Multilevel model analyses revealed that sidewalk characteristics had significant associations with both walking for purpose and leisure. Land use, including the presence of multifamily dwellings, commercial businesses, and parking lots were positively associated with walking for purpose and single-family detached homes were negatively associated with walking for purpose, but none of these characteristics were associated with leisure walking. Gardens/flowers were associated with walking for leisure but not purpose. Garbage/litter was not associated with either type of walking behavior. DISCUSSION AND IMPLICATIONS Virtual observations are a useful method that provides meaningful information about neighborhoods. Findings demonstrate how neighborhood characteristics assessed virtually differentially impact walking for leisure and purpose among older adults and are interpreted within a social-ecological model.
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Affiliation(s)
- Zachary J Christman
- Department of Geography, Planning, and Sustainability, Rowan University, Glassboro, New Jersey
| | | | - Allison Heid
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
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14
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Peters M, Muellmann S, Christianson L, Stalling I, Bammann K, Drell C, Forberger S. Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review. Int J Health Geogr 2020; 19:47. [PMID: 33168094 PMCID: PMC7654613 DOI: 10.1186/s12942-020-00243-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/30/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence. METHODS A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided. RESULTS Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified. CONCLUSIONS The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.
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Affiliation(s)
- Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
| | - Imke Stalling
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Karin Bammann
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Carina Drell
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
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15
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Li Y, Yatsuya H, Hanibuchi T, Ota A, Naito H, Otsuka R, Murata C, Hirakawa Y, Chiang C, Uemura M, Tamakoshi K, Aoyama A. Positive Association of Physical Activity with Both Objective and Perceived Measures of the Neighborhood Environment among Older Adults: The Aichi Workers' Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217971. [PMID: 33138333 PMCID: PMC7663542 DOI: 10.3390/ijerph17217971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
We examined the association between objective and perceived neighborhood characteristics and self-reported leisure-time physical activity (PA) in older Japanese residents living in areas ranging from metropolitan to rural in 2016. Objective measures used were walkability and the numbers of parks/green spaces and sports facilities within 500 or 1000 m of subjects’ homes, calculated using geographic information systems. Subjective measures were the subjects’ perceptions of their neighborhoods, assessed using a structured questionnaire. All variables were divided into three groups, and the lowest tertile was used as the reference. We assessed the location and frequency of strolling or brisk walking, moderate-intensity PA, and vigorous-intensity PA (sports) using a self-reported questionnaire and defined as performing a certain type of PA 3–4 times/week as a habit. Living in a neighborhood in the highest tertile for walkability and number of parks/green spaces as well as perception of having good access to recreational facilities, observing others exercising and the presence of walkable sidewalks was associated with walking and sports habits (multivariable odds ratios (ORs): 1.33–2.46, all p < 0.05). Interestingly, objective measures of PA-friendly environmental features were inversely associated with moderate-intensity PA habits, potentially because moderate-intensity PA consisted predominantly of gardening. In conclusion, living in an environment supportive of PA, whether objectively or subjectively measured, is related to leisure-time PA habits among older Japanese adults.
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Affiliation(s)
- Yuanying Li
- Department of Public Health, Fujita Health University School of Medicine, Aichi 470-1192, Japan; (H.Y.); (A.O.); (H.N.)
- Correspondence: ; Tel.: +81-562-93-2476
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Aichi 470-1192, Japan; (H.Y.); (A.O.); (H.N.)
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi 466-8550, Japan; (Y.H.); (C.C.); (M.U.); (A.A.)
| | - Tomoya Hanibuchi
- Graduate School of Environmental Studies, Tohoku University, Sendai 980-8572, Japan;
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Aichi 470-1192, Japan; (H.Y.); (A.O.); (H.N.)
| | - Hisao Naito
- Department of Public Health, Fujita Health University School of Medicine, Aichi 470-1192, Japan; (H.Y.); (A.O.); (H.N.)
| | - Rei Otsuka
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan;
| | - Chiyoe Murata
- Department of Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan;
- Department of Nutrition, Tokai Gakuen University, Aichi 468-8514, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi 466-8550, Japan; (Y.H.); (C.C.); (M.U.); (A.A.)
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi 466-8550, Japan; (Y.H.); (C.C.); (M.U.); (A.A.)
| | - Mayu Uemura
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi 466-8550, Japan; (Y.H.); (C.C.); (M.U.); (A.A.)
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University School of Health Science, Aichi 461-8673, Japan;
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi 466-8550, Japan; (Y.H.); (C.C.); (M.U.); (A.A.)
- Nagoya University of Arts and Sciences, Aichi 481-8503, Japan
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16
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Planning and Design Support Tools for Walkability: A Guide for Urban Analysts. SUSTAINABILITY 2020. [DOI: 10.3390/su12114405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a survey of operational methods for walkability analysis and evaluation, which we hold show promise as decision-support tools for sustainability-oriented planning and urban design. An initial overview of the literature revealed a subdivision of walkability studies into three main lines of research: transport and land use, urban health, and livable cities. A further selection of articles from the Scopus and Web of Science databases focused on scientific papers that deal with walkability evaluation methods and their suitability as planning and decision-support tools. This led to the definition of a taxonomy to systematize and compare the methods with regard to factors of walkability, scale of analysis, attention on profiling, aggregation methods, spatialization and sources of data used for calibration and validation. The proposed systematization aspires to offer to non-specialist but competent urban analysts a guide and an orienteering, to help them integrate walkability analysis and evaluation into their research and practice.
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17
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Kim EJ, Kim J, Kim H. Neighborhood Walkability and Active Transportation: A Correlation Study in Leisure and Shopping Purposes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072178. [PMID: 32218233 PMCID: PMC7177876 DOI: 10.3390/ijerph17072178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022]
Abstract
A walkable environment is a crucial factor for promoting active transportation. The purpose of this study is to examine the association between neighborhood walkability and active transportation for noncommuting purposes (leisure and shopping) in Seoul, Korea. The Walkability Score is used as a measure of walkability, and a multilevel logistic regression model is employed to measure the odds of active transportation (i.e., walking and cycling; nonmotorized trips) at two levels: individual (level 1) and neighborhood (level 2). The results of the study showed that the Walkability Score was significantly correlated with higher odds of active transportation in shopping models. Specifically, every one-point increase in the Walkability Score was associated with 1.5%–1.8% higher odds of active transportation in shopping models. However, there was no significant correlation between the two in leisure models. Meanwhile, individual characteristics associated with the odds of active transportation differed in the leisure and shopping models. Older age was positively correlated with the odds of active transportation in the leisure model, while females showed a positive correlation in the shopping model. Based on the study, urban and transportation planners can recommend urban policies to promote active transportation in an urban setting.
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Affiliation(s)
- Eun Jung Kim
- Department of Urban Planning, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea; (E.J.K.); (J.K.)
| | - Jiyeong Kim
- Department of Urban Planning, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea; (E.J.K.); (J.K.)
| | - Hyunjung Kim
- Department of Civil and Environmental Engineering, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea
- Correspondence: ; Tel.: +82-2-880-8903
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18
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Rejeski WJ, Fanning J. Models and theories of health behavior and clinical interventions in aging: a contemporary, integrative approach. Clin Interv Aging 2019; 14:1007-1019. [PMID: 31213787 PMCID: PMC6549388 DOI: 10.2147/cia.s206974] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/04/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Historically, influential models and theories of health behavior employed in aging research view human behavior as determined by conscious processes that involve intentional motives and beliefs. We examine the evolution, strengths, and weaknesses of this approach; then offer a contemporary definition of the mind, provide support for it, and discuss the implications it has for the design of behavioral interventions in research on aging. Methods: A narrative review was conducted. Results: Traditionally, models and theories used to either predict or change health behaviors in aging have not viewed the mind as encompassing embodied and relational processes nor have they given adequate attention to multi-level, in-the-moment determinants of health behavior. Discussion: Future theory and research in aging would benefit from a broader integrative model of health behavior. The effects of adverse life experience and changes in biological systems with aging and chronic disease on health behavior warrant increased attention.
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Affiliation(s)
- W Jack Rejeski
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Jason Fanning
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
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19
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Towne SD, Lopez ML, Li Y, Smith ML, Warren JL, Evans AE, Ory MG. Examining the Role of Income Inequality and Neighborhood Walkability on Obesity and Physical Activity among Low-Income Hispanic Adults. J Immigr Minor Health 2019; 20:854-864. [PMID: 28735455 DOI: 10.1007/s10903-017-0625-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Obesity is a major public health issue affecting rising medical costs and contributing to morbidity and premature mortality. We aimed to identify factors that may play a role in obesity and physical activity at the individual and environmental/neighborhood levels. We analyzed data from an adult sample who were parents of students enrolled in a school-based health and wellness program. The sample was restricted to those who were Hispanic and whose children were on free/reduced lunch (n = 377). Dependent variables: body mass index (BMI); neighborhood walkability. Walk Score® was used to assess neighborhood walkability. Overall, 46% of participants were obese and 31% were overweight. The median age of respondents was 34 years, and the majority were female (88%) and married (59%). Participants who resided in a census tract with a higher relative income inequality (high, OR 2.54, 90% CI 1.154-5.601; moderate-high OR 2.527, 90% CI 1.324-4.821) and those who were unmarried (OR 1.807, 90% CI 1.119-2.917) were more likely to be obese versus normal weight. Overweight individuals that resided in areas that were walkable versus car-dependent averaged more days engaging in walking for at least 30-min (p <.05). Identifying individual and neighborhood factors associated with obesity can inform more targeted approaches to combat obesity at multiple ecological levels. The importance of understanding how neighborhood characteristics influence health-related and behavioral outcomes is further reinforced with the current findings. Identifying effective strategies to engage communities and organizations in creating, implementing, adopting, evaluating, and sustaining policy and/or environmental interventions will be needed to combat the obesity epidemic.
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Affiliation(s)
- Samuel D Towne
- Texas A&M School of Public Health, 1266 TAMU, College Station, TX, 77843-1266, USA.
| | - Michael L Lopez
- Texas A&M AgriLife Extension, Texas A&M University, College Station, TX, 77843, USA
| | - Yajuan Li
- Department of Agricultural Economics, Texas A&M University, College Station, TX, 77843, USA
| | - Matthew Lee Smith
- Texas A&M School of Public Health, 1266 TAMU, College Station, TX, 77843-1266, USA.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, 30602, USA
| | - Judith L Warren
- Texas A&M AgriLife Extension, Texas A&M University, College Station, TX, 77843, USA
| | - Alexandra E Evans
- Michael & Susan Dell Center for Healthy Living Division of Health Promotion and Behavioral Science School of Public Health, University of Texas, Austin, TX, 78701, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M School of Public Health, 1266 TAMU, College Station, TX, 77843-1266, USA
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20
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Lee S, Lee C, Ory MG, Won J, Towne SD, Wang S, Forjuoh SN. Fear of Outdoor Falling Among Community-Dwelling Middle-Aged and Older Adults: The Role of Neighborhood Environments. THE GERONTOLOGIST 2019; 58:1065-1074. [PMID: 28958081 DOI: 10.1093/geront/gnx123] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighborhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults. Research Design and Methods A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighborhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighborhood environmental variables associated with fear of outdoor falling. Results Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247-7.094), be female (OR = 4.423, 95% CI = 1.830-10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124-6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472-15.137). Among the neighborhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188-0.935), drainage ditches (OR = 2.383, 95% CI = 1.136-5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742-8.288) were associated with the odds of having a fear of outdoor falling. Discussion and Implications In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.
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Affiliation(s)
- Sungmin Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Chanam Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Marcia G Ory
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station
| | - Jaewoong Won
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Samuel D Towne
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station
| | - Suojin Wang
- Department of Statistics, College of Science, Texas A&M University, College Station
| | - Samuel N Forjuoh
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station.,Department of Family & Community Medicine, Baylor Scott & White Health, College of Medicine, Texas A&M Health Science Center, Temple
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21
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Lo BK, Graham ML, Folta SC, Paul LC, Strogatz D, Nelson ME, Parry SA, Carfagno ME, Wing D, Higgins M, Seguin RA. Examining the Associations between Walk Score, Perceived Built Environment, and Physical Activity Behaviors among Women Participating in a Community-Randomized Lifestyle Change Intervention Trial: Strong Hearts, Healthy Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E849. [PMID: 30857189 PMCID: PMC6427661 DOI: 10.3390/ijerph16050849] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
Little is known about the relationship between perceived and objective measures of the built environment and physical activity behavior among rural populations. Within the context of a lifestyle-change intervention trial for rural women, Strong Hearts, Healthy Communities (SHHC), we examined: (1) if Walk Score (WS), an objective built environment measure, was associated with perceived built environment (PBE); (2) if WS and PBE were associated with moderate-to-vigorous physical activity (MVPA); and (3) if MVPA changes were modified by WS and/or PBE. Accelerometers and questionnaires were used to collect MVPA and PBE. Bivariate analyses and linear mixed models were used for statistical analyses. We found that WS was positively associated with perceived proximity to destinations (p < 0.001) and street shoulder availability (p = 0.001). MVPA was generally not associated with WS or PBE. Compared to controls, intervention group participants increased MVPA if they lived in communities with the lowest WS (WS = 0), fewer perceived walkable destinations, or extremely safe perceived traffic (all p < 0.05). Findings suggest that WS appears to be a relevant indicator of walkable amenities in rural towns; results also suggest that the SHHC intervention likely helped rural women with the greatest dearth of built environment assets to improve MVPA.
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Affiliation(s)
- Brian K Lo
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Lynn C Paul
- College of Education, Health and Human Development, Montana State University, Bozeman, MT 59717, USA.
| | | | | | - Stephen A Parry
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - Michelle E Carfagno
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - David Wing
- Exercise and Physical Activity Resource Center, University of California, San Diego, CA 92093, USA.
| | - Michael Higgins
- Exercise and Physical Activity Resource Center, University of California, San Diego, CA 92093, USA.
| | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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22
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Abstract
With support and demand for walkable urban spaces on the rise, there has been growing concern among academics and practitioners of increasing exclusivity, particularly in amenity-rich areas. This study examines equity in neighborhood walkability from the perspective of housing affordability, asking whether more walkable urban neighborhoods have less affordable housing from the viewpoint of both neighborhood residents and households within the encompassing metropolitan region. While considering additional factors that may affect housing affordability, including coastal proximity, crime, rail access, housing age, housing size, and employment accessibility, the results indicate lower housing affordability primarily for renter households already living in walkable neighborhoods, but not for those looking to move to a more walkable neighborhood from within the same metropolitan area. Case studies of three large U.S. urban areas, Charlotte, NC, Pittsburgh, PA, and Portland, OR, highlight local variations in the walkability–housing affordability nexus.
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23
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Van Cauwenberg J, Nathan A, Barnett A, Barnett DW, Cerin E. Relationships Between Neighbourhood Physical Environmental Attributes and Older Adults' Leisure-Time Physical Activity: A Systematic Review and Meta-Analysis. Sports Med 2019; 48:1635-1660. [PMID: 29721838 DOI: 10.1007/s40279-018-0917-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Activity-friendly neighbourhood physical environments with access to recreational facilities are hypothesised to facilitate leisure-time physical activity (LTPA) among older adults (≥ 65 years old). The aim of the current study was to systematically review and quantitatively summarise study findings on the relationships between physical environmental attributes and LTPA among older adults. METHODS An extensive search of literature, including grey literature, yielded 72 articles eligible for inclusion. The reported associations between seven categories of environmental attributes and six LTPA outcomes were extracted, weighted by sample size and study quality, and quantitatively summarised. Reported moderating effects of individual and environmental characteristics and neighbourhood definition were also examined. RESULTS We observed positive associations for walkability (p = 0.01), land-use mix-access (p = 0.02) and aesthetically pleasing scenery (p < 0.001) with leisure-time walking. For leisure-time walking within the neighbourhood, evidence was found for positive associations with land-use mix-access (p = 0.03) and access to public transit (p = 0.05), and a negative association with barriers to walking/cycling (p = 0.03). Evidence for positive relationships between overall LTPA and access to recreational facilities (p = 0.01) and parks/open space (p = 0.04) was found. Several environmental attribute-LTPA outcome combinations were insufficiently studied to draw conclusions. No consistent moderating effects were observed for individual and environmental characteristics and neighbourhood definition. CONCLUSIONS The observed significant relationships can be used to inform policy makers and planners on how to (re-)design neighbourhoods that promote LTPA among older adults. Many environmental attribute-LTPA outcome relationships have been studied insufficiently and several methodological issues remain to be addressed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2016:CRD42016051180.
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Affiliation(s)
- Jelle Van Cauwenberg
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium.
| | - Andrea Nathan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - David W Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.,School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China.,Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
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Towne SD, Li Y, Lee S, Smith ML, Han G, Quinn C, Du Y, Benden M, Ory MG. Physical activity and associated medical cost savings among at-risk older adults participating a community-based health & wellness program. PLoS One 2018; 13:e0198239. [PMID: 29894478 PMCID: PMC5997342 DOI: 10.1371/journal.pone.0198239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/16/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Physical activity declines are seen with increasing age; however, the US CDC recommends most older adults (age 65 and older) engage in the same levels of physical activity as those 18–64 to lessen risks of injuries (e.g., falls) and slow deteriorating health. We aimed to identify whether older adults participating in a short (approx. 90-minute sessions) 20 session (approximately 10-weeks) health and wellness program delivered in a community setting saw improvements in physical activity and whether these were sustained over time. Methods Employing a non-equivalent group design, community-dwelling older adults were purposely recruited into either an intervention or comparison group. The intervention was a multicomponent lifestyle enhancement intervention focused on healthy eating and physical activity, including structured physical activity exercises within the class sessions. Two groups were included: intervention (survey group: n = 65; accelerometer subgroup: n = 38) and the comparison group (survey group: n = 102; accelerometer subgroup: n = 55). Measurements were made at baseline and approximately three months later to reflect immediate post-treatment period (survey, accelerometer) with long-term follow-up 6 months after baseline (survey). Adults not meeting the physical activity guidelines (i.e., 150/75 minutes of moderate-to-vigorous physical activity or MVPA) were targeted for subgroup analyses. Paired t-tests were used for bivariate comparisons, while repeated measures random coefficient models (adjusting for propensity scores using inverse probability of treatment weighted (IPTW) estimation) were used for multivariate models. Estimated medical costs associated with gains in physical activity were also measured among survey respondents in the intervention group. Results The accelerometer group contained 38 participants in the intervention group with 71% insufficiently active at baseline and 55 participants in the comparison group with 76% insufficiently active at baseline (<150 weekly MVPA minutes). The survey group contained 65 participants in the intervention group with 73.85% insufficiently active at baseline and 102 participants in the comparison group with 76.47% insufficiently active at baseline. In paired t-tests with the accelerometer group, a moderate effect size (-0.4727, p = 0.0210) indicating higher MVPA was found for intervention participants with <150 weekly MVPA at baseline. In fully adjusted analyses using propensity score matching, among the subjectively measured physical activity (survey) group, there was a differential impact from baseline to 6-month post among the intervention group with an improvement of 160 minutes among all study participants (p < .0001) versus no difference among the comparison group. For those insufficiently active at baseline, there was an improvement of 103 minutes among intervention (p < .0001) and 55 minutes among the comparison (p < .0001) with the improvement of the intervention significantly greater than that among the comparison (p = 0.0224). Further, among those insufficiently active at baseline there was a relative cost savings from baseline to 6-months over and above the estimated cost of the intervention estimated between $143 and $164 per participant. Discussion This intervention was able to reach and retain older adults and showed significant MVPA gains and estimated medical cost savings among more at-risk individuals (baseline <150 MVPA). This intervention can be used in practice as a strategy to improve MVPA among the growing population of older community-dwelling adults.
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Affiliation(s)
- Samuel D. Towne
- Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, United States of America
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Southwest Rural Health Research Center, Texas A&M University, College Station, Texas, United States of America
- * E-mail:
| | - Yajuan Li
- Department of Agricultural Economics, Texas A&M University, College Station, Texas, United States of America
| | - Shinduk Lee
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, United States of America
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, Georgia, United States of America
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Cindy Quinn
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, United States of America
| | - Yuxian Du
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Health Policy and Management, School of Public Health, Texas A&M University Health Science Center, College Station, Texas, United States of America
| | - Mark Benden
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Marcia G. Ory
- Center for Population Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
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Effectiveness of a Lifestyle Intervention on Social Support, Self-Efficacy, and Physical Activity among Older Adults: Evaluation of Texercise Select. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020234. [PMID: 29385779 PMCID: PMC5858303 DOI: 10.3390/ijerph15020234] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/09/2018] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
Despite the well-recognized benefits of physical activity across the life course, older adults are more inactive than other age groups. The current study examines the effects of Texercise Select participation on self-reported sedentary, light, moderate, and vigorous physical activity. Secondarily, this study examined intervention effects on two potential facilitators of physical activity: (1) self-efficacy for being more physically active and (2) social support received for physical activity. This study used a non-equivalent group design with self-reported surveys administered at baseline, three-month (immediate post for cases) and six-month follow-ups for the intervention (n = 163) and a comparison group (n = 267). Multivariable mixed model analyses were conducted controlling for age, sex, race, ethnicity, education, comorbid conditions, and site. Among the intervention group, the program had significant immediate effects on most primary outcomes (p < 0.05) at three months. Furthermore, significant improvements were observed for all physical activity intensity levels at six months (p < 0.05). The reduction in sedentary behavior and increases in all physical activity intensity levels were significantly greater from baseline to three-month and baseline to six-month follow-ups among intervention group participants relative to those in the comparison group. This study confirms the effectiveness of Texercise Select to reduce sedentary behavior and improve physicality, supporting the intervention’s robustness as a scalable and sustainable evidence-based program. It also counters negative stereotypes that older adults are not interested in attending multi-modal lifestyle intervention programs nor able to make health behavior changes that can improve health and overall functioning.
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Meek KP, Bergeron CD, Towne SD, Ahn S, Ory MG, Smith ML. Restricted Social Engagement among Adults Living with Chronic Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E158. [PMID: 29351193 PMCID: PMC5800257 DOI: 10.3390/ijerph15010158] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/06/2018] [Accepted: 01/15/2018] [Indexed: 01/15/2023]
Abstract
Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions. Methods: Cross-sectional representative data from the National Council on Aging Chronic Care Survey were examined for relationships between social engagement restrictions and chronic conditions, health status, support, quality of life implications, self-care barriers, caregiving, and demographics. Associations were tested using bivariate analyses and binary logistic regression. Results: Participants were 793 middle-aged (age 44-64) and older adults (age 65+) with one or more chronic conditions. Factors associated with social engagement restrictions included having higher education, receiving care, having more physician visits and hospitalizations, being disabled, being unemployed, and having higher Emotional and Physical Problems Scale scores. Conclusions: Findings reveal the prevalence of social engagement restrictions among middle-aged and older adults with chronic conditions. Results highlight the importance of promoting research, assessments, and interventions to increase social engagement among this aging population.
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Affiliation(s)
- Kayla P Meek
- College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | - Caroline D Bergeron
- Bexar County Community Health Collaborative, San Antonio, TX 78212, USA.
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
| | - Samuel D Towne
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
- School of Public Health, Texas A&M University, College Station, TX 77843, USA.
- Southwest Rural Health Research Center, Texas A&M University, College Station, TX 77843, USA.
| | - SangNam Ahn
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
- School of Public Health, The University of Memphis, Memphis, TN 38152, USA.
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
- School of Public Health, Texas A&M University, College Station, TX 77843, USA.
| | - Matthew Lee Smith
- College of Public Health, The University of Georgia, Athens, GA 30602, USA.
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
- School of Public Health, Texas A&M University, College Station, TX 77843, USA.
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Barnett DW, Barnett A, Nathan A, Van Cauwenberg J, Cerin E. Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2017; 14:103. [PMID: 28784183 PMCID: PMC5547528 DOI: 10.1186/s12966-017-0558-z] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/31/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement. METHODS One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined. RESULTS Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found. CONCLUSIONS Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.
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Affiliation(s)
- David W. Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - Anthony Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - Jelle Van Cauwenberg
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
| | - Ester Cerin
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region China
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004 Australia
| | - on behalf of the Council on Environment and Physical Activity (CEPA) – Older Adults working group
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC 3000 Australia
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region China
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004 Australia
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Barnett DW, Barnett A, Nathan A, Van Cauwenberg J, Cerin E. Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2017. [PMID: 28784183 DOI: 10.1186/sl2966-017-0558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement. METHODS One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined. RESULTS Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found. CONCLUSIONS Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.
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Affiliation(s)
- David W Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Anthony Barnett
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Jelle Van Cauwenberg
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium
| | - Ester Cerin
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, VIC, 3000, Australia.
- School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region, China.
- Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
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Mier N, Ory MG, Towne SD, Smith ML. Relative Association of Multi-Level Supportive Environments on Poor Health among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040387. [PMID: 28383513 PMCID: PMC5409588 DOI: 10.3390/ijerph14040387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 12/14/2022]
Abstract
Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods: This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results: Two personal characteristics (number of chronic conditions and educational level) were consistently related (p < 0.05) to health outcomes. Supportive family, home, financial, neighborhood, and health care environmental factors were shown to be related (p < 0.05) to various aspects of physical or mental health outcomes. Conclusions: Multidimensional factors including personal characteristics and protective environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health.
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Affiliation(s)
- Nelda Mier
- Department of Public Health Studies, Texas A&M School of Public Health, McAllen Campus, McAllen, TX 78503, USA.
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
| | - Samuel D Towne
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
| | - Matthew Lee Smith
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA.
- Institute of Gerontology, Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
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Forjuoh SN, Ory MG, Won J, Towne SD, Wang S, Lee C. Determinants of Walking among Middle-Aged and Older Overweight and Obese Adults: Sociodemographic, Health, and Built Environmental Factors. J Obes 2017; 2017:9565430. [PMID: 28744375 PMCID: PMC5514329 DOI: 10.1155/2017/9565430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/31/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study examined the association between selected sociodemographic, health, and built environmental factors and walking behaviors of middle-aged and older overweight/obese adults. METHODS Subjective data were obtained from surveys administered to community-dwelling overweight/obese adults aged ≥50 years residing in four Texas cities from October 2013 to June 2014, along with objective data on neighborhood walkability (Walk Score™). Multivariate logistic regression identified factors predicting the odds of walking the recommended ≥150 minutes per week for any purpose. RESULTS Of 253 participants, the majority were non-Hispanic white (81.8%), married (74.5%), and male (53.4%) and reported an annual income of ≥$50,000 (65.5%). Approximately, half were employed (49.6%) or had at least a college degree (51.6%). Walking the recommended ≥150 minutes per week for any purpose (n = 57, 22.5%) was significantly associated with having at least a college degree (OR = 5.55, 95% CI = 1.79-17.25), having no difficulty walking a quarter of a mile (OR = 5.18, 95% CI = 1.30-20.83), and being unemployed (OR = 3.25, 95% CI = 1.18-8.93) as well as perceived presence of sidewalks/protected walkways (OR = 3.56, 95% CI = 1.10-11.50) and perceived absence of distracted drivers in the neighborhood (OR = 4.08, 95% CI = 1.47-11.36). CONCLUSION Addressing neighborhood conditions related to distracted drivers and pedestrian infrastructure may promote walking among middle-aged and older overweight/obese individuals.
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Affiliation(s)
- Samuel N. Forjuoh
- Department of Family & Community Medicine, Baylor Scott & White Health, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
- *Samuel N. Forjuoh:
| | - Marcia G. Ory
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Jaewoong Won
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA
| | - Samuel D. Towne
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Suojin Wang
- Department of Statistics, College of Science, Texas A&M University, College Station, TX, USA
| | - Chanam Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA
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Ory MG, Towne SD, Won J, Forjuoh SN, Lee C. Social and environmental predictors of walking among older adults. BMC Geriatr 2016; 16:155. [PMID: 27553668 PMCID: PMC4995768 DOI: 10.1186/s12877-016-0327-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/13/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Regular physical activity (PA) is a major factor in maintaining health in aging populations. This study examines the influences of sociodemographic, health, and environmental characteristics on older adults' walking behaviors, and the role physicians can play in promoting physical activity. METHODS Online and paper surveys (n = 272) were distributed to community-dwelling older (age ≥ 60) adults from a large integrated healthcare system in two counties in Central Texas. Descriptive statistics were utilized to characterize participant's walking behaviors and places. Multivariate logistic regression was employed to predict being: 1) a frequent walker (i.e., walking at least three times a week); and 2) meeting the Centers for Disease Control and Prevention (CDC) PA recommendation through walking (i.e., walking ≥150 min per week), while considering sociodemographic, health, and environmental factors. RESULTS Individuals had a median age of 69 years, were of both genders (50.37 % female), and were primarily non-Hispanic White (84.87 %). While the majority (59.55 %) walked at least three times a week, only 27.86 % walked ≥150 min a week. Factors associated with a lower likelihood of being frequent walkers included experiencing poor mental health in the past month (OR = 0.345, 95 % CI = 0.185-0.645) and residing in areas with low or moderate (versus high) perceived neighborhood cohesion (OR = 0.471, 95 % CI = 0.228-0.974), while those in Census Tracts reflecting populations with a lower median age were more likely to report frequent walking behavior (OR = 1.799, 95 % CI = 1.034-3.131). Factors associated with a lower likelihood of meeting the CDC PA recommendation included being 60-69 years (versus 70 years or older) (OR = 0.538, 95 % CI = 0.290-0.997), experiencing poor mental health in the past month (OR = 0.432, 95 % CI = 0.198-0.944), and lacking social support for walking (OR = 0.383, 95 % CI = 0.154-0.957). CONCLUSION Given the health benefits, PA promotion must be seen as a national responsibility. In particular, physicians have a major role to play in communicating the importance of PA to their older patients and making discussions about strategies for overcoming barriers to walking an integral part of their clinical encounter with these patients.
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Affiliation(s)
- Marcia G. Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, Texas, 77843 USA
| | - Samuel D. Towne
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, Texas, 77843 USA
| | - Jaewoong Won
- Department of Landscape Architecture and Urban Planning, Texas A&M, College Station, Texas, USA
| | - Samuel N. Forjuoh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health, College Station, Texas, 77843 USA
- Department of Family & Community Medicine, Texas A&M Health Science Center, College Station, Texas, USA
- Baylor Scott & White Health, Temple, Texas, USA
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M, College Station, Texas, USA
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Duncan DT, Méline J, Kestens Y, Day K, Elbel B, Trasande L, Chaix B. Walk Score, Transportation Mode Choice, and Walking Among French Adults: A GPS, Accelerometer, and Mobility Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060611. [PMID: 27331818 PMCID: PMC4924068 DOI: 10.3390/ijerph13060611] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 11/22/2022]
Abstract
Background: Few studies have used GPS data to analyze the relationship between Walk Score, transportation choice and walking. Additionally, the influence of Walk Score is understudied using trips rather than individuals as statistical units. The purpose of this study is to examine associations at the trip level between Walk Score, transportation mode choice, and walking among Paris adults who were tracked with GPS receivers and accelerometers in the RECORD GPS Study. Methods: In the RECORD GPS Study, 227 participants were tracked during seven days with GPS receivers and accelerometers. Participants were also surveyed with a GPS-based web mapping application on their activities and transportation modes for all trips (6969 trips). Walk Score, which calculates neighborhood walkability, was assessed for each origin and destination of every trip. Multilevel logistic and linear regression analyses were conducted to estimate associations between Walk Score and walking in the trip or accelerometry-assessed number of steps for each trip, after adjustment for individual/neighborhood characteristics. Results: The mean overall Walk Scores for trip origins were 87.1 (SD = 14.4) and for trip destinations 87.1 (SD = 14.5). In adjusted trip-level associations between Walk Score and walking only in the trip, we found that a walkable neighborhood in the trip origin and trip destination was associated with increased odds of walking in the trip assessed in the survey. The odds of only walking in the trip were 3.48 (95% CI: 2.73 to 4.44) times higher when the Walk Score for the trip origin was “Walker’s Paradise” compared to less walkable neighborhoods (Very/Car-Dependent or Somewhat Walkable), with an identical independent effect of trip destination Walk Score on walking. The number of steps per 10 min (as assessed with accelerometry) was cumulatively higher for trips both originating and ending in walkable neighborhoods (i.e., “Very Walkable”). Conclusions: Walkable neighborhoods were associated with increases in walking among adults in Paris, as documented at the trip level. Creating walkable neighborhoods (through neighborhood design increased commercial activity) may increase walking trips and, therefore, could be a relevant health promotion strategy to increase physical activity.
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Affiliation(s)
- Dustin T Duncan
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
- College of Global Public Health, New York University, New York, NY 10016, USA.
- Population Center, New York University, New York, NY 10016, USA.
- Center for Data Science, New York University, New York, NY 10016, USA.
| | - Julie Méline
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris 75012, France.
- Sorbonne Universités, UPMC Unv Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris 75012, France.
| | - Yan Kestens
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal, Montreal, Montréal, QC H3N 1X9, Canada.
| | - Kristen Day
- Department of Technology, Culture and Society, New York University Tandon School of Engineering, New York, NY 11201, USA.
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
- Wagner School of Public Service, New York University, New York, NY 10012, USA.
| | - Leonardo Trasande
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA.
- College of Global Public Health, New York University, New York, NY 10016, USA.
- Departments of Pediatrics and Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA.
| | - Basile Chaix
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris 75012, France.
- Sorbonne Universités, UPMC Unv Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris 75012, France.
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