Land use, residential density, and walking. The multi-ethnic study of atherosclerosis

The relationships between the campus built environment and walking activity

Despite the gradual development of students' sedentary habits and associated health problems, only a few studies have extensively and systematically measured campus built environments (CBE) and their impact on street walking activity. This study explores the association between CBEs and pedestrian volume (PV). Comprehensive questionnaires, field audits, and GIS were used to measure the CBE variables and PV of 892 street segments on eight Chinese campuses in Tianjin. We used negative binomial regression models without spatial autocorrelations to investigate the relationship between the CBEs and PV. The findings indicated that campus Walk Score, facility and residential land ratio, campus design qualities, sidewalk conditions, street amenities, and other streetscape features were positively associated with PV. This study presents implications for campus research and planning practices in designing a pedestrian-friendly, sustainable, and healthy campus.

Depleted Housing Elicits Cardiopulmonary Dysfunction After a Single Flaming Eucalyptus Wildfire Smoke Exposure in a Sex-Specific Manner in ApoE Knockout Mice

Although it is well established that wildfire smoke exposure can increase cardiovascular morbidity and mortality, the combined effects of non-chemical stressors and wildfire smoke remains understudied. Housing is a non-chemical stressor that is a major determinant of cardiovascular health, however, disparities in neighborhood and social status have exacerbated the cardiovascular health gaps within the United States. Further, pre-existing cardiovascular morbidities, such as atherosclerosis, can worsen the response to wildfire smoke exposures. This represents a potentially hazardous interaction between inadequate housing and stress, cardiovascular morbidities, and worsened responses to wildfire smoke exposures. The purpose of this study was to examine the effects of enriched (EH) versus depleted (DH) housing on pulmonary and cardiovascular responses to a single flaming eucalyptus wildfire smoke (WS) exposure in male and female apolipoprotein E (ApoE) knockout mice, which develop an atherosclerosis-like phenotype. The results of this study show that cardiopulmonary responses to WS exposure occur in a sex-specific manner. EH blunts adverse WS-induced ventilatory responses, specifically an increase in tidal volume (TV), expiratory time (Te), and relaxation time (RT) after a WS exposure, but only in females. EH also blunted an increase in isovolumic relaxation time (IVRT) and the myocardial performance index (MPI) 1-week after exposures, also only in females. Our results suggest that housing alters the cardiovascular response to a single WS exposure, and that DH might cause increased susceptibility to environmental exposures that manifest in altered ventilation patterns and diastolic dysfunction in a sex-specific manner.

Association between Young People's Neighbourhoods' Characteristics and Health Risk Factors in Saudi Arabia

INTRODUCTION

A neighbourhood's environmental characteristics can positively or negatively influence health and well-being. To date, no studies have examined this concept in the context of Saudi Arabian youth. Therefore, this study aimed to evaluate the association between a neighbourhood's environmental characteristics and health risk factors among Saudi Arabian youth.

METHODS

A total of 335 secondary-school students (175 males, 160 females), aged 15-19 years old, participated. Body mass index (BMI) and waist circumference measurements were taken, and physical activity (steps) was measured via pedometer. The perceived neighbourhood environment was assessed using the International Physical Activity Questionnaire Environment Module (IPAQ-E).

RESULTS

Significant differences were found between the youths from urban, rural farm, and rural desert locations in terms of BMI, waist circumference, daily steps, accessibility, infrastructure, social environment, household vehicles, safety, and access to facilities (p < 0.001). Rural desert youths were less active, and males (26.43 + 8.13) and females (24.68 + 5.03) had higher BMIs compared to the youths from other areas. Chi-square analysis revealed a significant difference (χ21 = 12.664, p < 0.001) between the genders as to social-environment perceptions. Males perceived their neighbourhood as a social environment more than was reported by females (68.39% and 50.28%, respectively). Pearson's correlation revealed negative significant relationships between steps and both safety of neighbourhood (r = -0.235, p < 0.001) and crime rate (r = -0.281, p < 0.001).

DISCUSSION

Geographical location, cultural attitudes, lack of facilities, and accessibility impact youth physical-activity engagement and weight status; this includes environmental variables such as residential density, neighbourhood safety, household motor vehicles, and social environment.

CONCLUSIONS

This is the first study examining associations with neighbourhood environments in the youths of the Kingdom of Saudi Arabia. Significant associations and geographical differences were found. More research and policy interventions to address neighbourhoods' environmental characteristics and health risk factors relative to Saudi Arabian youth are warranted.

Depleted housing elicits cardiopulmonary dysfunction after a single flaming eucalyptus wildfire smoke exposure in a sex-specific manner in ApoE knockout mice

Although it is well established that wildfire smoke exposure can increase cardiovascular morbidity and mortality, the combined effects of non-chemical stressors and wildfire smoke remains understudied. Housing is a non-chemical stressor that is a major determinant of cardiovascular health, however, disparities in neighborhood and social status have exacerbated the cardiovascular health gaps within the United States. Further, pre-existing cardiovascular morbidities, such as atherosclerosis, can worsen the response to wildfire smoke exposures. This represents a potentially hazardous interaction between inadequate housing and stress, cardiovascular morbidities, and worsened responses to wildfire smoke exposures. The purpose of this study was to examine the effects of enriched (EH) versus depleted (DH) housing on pulmonary and cardiovascular responses to a single flaming eucalyptus wildfire smoke (WS) exposure in male and female apolipoprotein E (ApoE) knockout mice, which develop an atherosclerosis-like phenotype. The results of this study show that cardiopulmonary responses to WS exposure occur in a sex-specific manner. EH blunts adverse WS-induced ventilatory responses, specifically an increase in tidal volume (TV), expiratory time (Te), and relaxation time (RT) after a WS exposure, but only in females. EH also blunted a WS-induced increase in isovolumic relaxation time (IVRT) and the myocardial performance index (MPI) 1-wk after exposures, also only in females. Our results suggest that housing alters the cardiovascular response to a single WS exposure, and that DH might cause increased susceptibility to environmental exposures that manifest in altered ventilation patterns and diastolic dysfunction in a sex-specific manner.

Effect of built environment on BMI of older adults in regions of different socio-economic statuses

Background

Numerous studies have ignored the influence of underdeveloped urban surroundings on the physical health of China's ageing population. Lanzhou is a typical representative of a less developed city in China.

Methods

This study investigated the relationship between body mass index (BMI) and built environment amongst older adults in regions of different socio-economic statuses (SES) using data from medical examinations of older adults in Lanzhou, as well as calculating community built environment indicators for regions of different SES based on multiple linear regression models.

Results

Results showed that age and underlying disease were negatively associated with overall older adult BMI in the study buffer zone. Land use mix, number of parks and streetscape greenery were positively associated with older adult BMI. Street design and distance to bus stops were negatively connected in low SES regions, but population density and street design were negatively correlated in high SES areas.

Conclusion

These findings indicate that the built environment of SES regions has varying impacts on the BMI of older persons and that planners may establish strategies to lower the incidence of obesity amongst older adults in different SES locations.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Neighborhood built environments and cognition in later life

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults' cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population.Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition.Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80.Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

The Correlation of Built Environment on Hypertension, and Weight Status amongst Adolescence in Saudi Arabia

The prevalence of hypertension is becoming more common in children and adolescents than ever before. Thus, the aim of this study was to evaluate the associations between the built environment on physical activity, sedentary behaviour, waist circumference, and health amongst adolescents in Saudi Arabia. A systolic and diastolic blood pressure, resting heart rate and waist circumference of 380 boys and girls aged between 15-19 years old (male = 199 and females = 181) were measured. The International physical activity Questionnaire Short Form was used to assess the physical activity levels and time spent sitting. The statistical analysis conducted were means and standard deviation, 2-way and 3-way of variance (ANOVA), Bonferroni post hoc tests, Chi-squared distribution and Pearson's correlations. Among males, 16.75% were classified as hypertensive, 12.69% as pre-hypertensive, and 70.56% as normal whereas, females, 23.20% were classified as hypertensive, 12.15% as pre-hypertensive and 64.64% as normal. There were significant differences (F_1,379 = 16.50, p < 0.001) between males and females waist circumference. Pearson's correlation also revealed significant positive relationships in sedentary time (r = 0.123, p < 0.016), WC (r = 0.104, p < 0.043), and systolic blood pressure (r = 0.110, p < 0.032). The results revealed that systolic and diastolic blood pressure are significantly related to multiple measures of weight status, and sedentary behaviour. The results also highlight that active youth had lower resting heart rate compared to inactive peers. The present findings provide a foundation of knowledge for future research and highlight the major need for research and policy interventions, to address the concerning health habits of Al-Ahsa youth and broader Kingdom of Saudi Arabia.

Longitudinal neighbourhood determinants with cognitive health and dementia disparities: protocol of the Multi-Ethnic Study of Atherosclerosis Neighborhoods and Aging prospective cohort study

INTRODUCTION

The burden of Alzheimer's disease (AD) and AD-related dementias (ADRD) is increasing nationally and globally, with disproportionate impacts on lower-income, lower education and systematically marginalised older adults. Presence of inequalities in neighbourhood factors (eg, social context, physical and built environments) may affect risk of cognitive decline and be key for intervening on AD/ADRD disparities at the population level. However, existing studies are limited by a dearth of longitudinal, detailed neighbourhood measures linked to rich, prospective cohort data. Our main objective is to identify patterns of neighbourhood change related to prevalence of-and disparities in-cognitive decline and dementia.

METHODS AND ANALYSES

We describe the process of collecting, processing and linking extensive neighbourhood data to the Multi-Ethnic Study of Atherosclerosis (MESA), creating a 25+ years dataset. Within the MESA parent study, the MESA Neighborhoods and Aging cohort study will characterise dynamic, longitudinal neighbourhood social and built environment variables relevant to cognition for residential addresses of MESA participants. This includes administering new surveys, expanding residential address histories, calculating new measures derived from spatial data and implementing novel deep learning algorithms on street-level imagery. Applying novel statistical techniques, we will examine associations of neighbourhood environmental characteristics with cognition and clinically relevant AD/ADRD outcomes. We will investigate determinants of disparities in outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighbourhood environments to these disparities. This project will provide new evidence about pathways between neighbourhood environments and cognitive outcomes, with implications for policies to support healthy ageing.

ETHICS AND DISSEMINATION

This project was approved by the University of Washington and Drexel University Institutional Review Boards (protocols #00009029 and #00014523, and #180900605). Data will be distributed through the MESA Coordinating Center. Findings will be disseminated in peer-reviewed scientific journals, briefs, presentations and on the participant website.

Comparing effects of Euclidean buffers and network buffers on associations between built environment and transport walking: the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Transport walking has drawn growing interest due to its potential to increase levels of physical activities and reduce reliance on vehicles. While existing studies have compared built environment-health associations between Euclidean buffers and network buffers, no studies have systematically quantified the extent of bias in health effect estimates when exposures are measured in different buffers. Further, prior studies have done the comparisons focusing on only one or two geographic regions, limiting generalizability and restricting ability to test whether direction or magnitude of bias are different by context. This study aimed to quantify the degree of bias in associations between built environment exposures and transport walking when exposures were operationalized using Euclidean buffers rather than network buffers in diverse contexts.

METHODS

We performed a simulations study to systematically evaluate the degree of bias in associations between built environment exposures in Euclidean buffers and network buffers and transport walking, assuming network buffers more accurately captured true exposures. Additionally, we used empirical data from a multi-ethnic, multi-site cohort to compare associations between built environment amenities and walking for transport where built environment exposures were derived using Euclidean buffers versus network buffers.

RESULTS

Simulation results found that the bias induced by using Euclidean buffer models was consistently negative across the six study sites (ranging from -80% to -20%), suggesting built environment exposures measured using Euclidean buffers underestimate health effects on transport walking. Percent bias was uniformly smaller for the larger 5 km scale than the 1 km and 0.25 km spatial scales, independent of site or built environment categories. Empirical findings aligned with the simulation results: built environment-health associations were stronger for built environment exposures operationalized using network buffers than using Euclidean buffers.

CONCLUSION

This study is the first to quantify the extent of bias in the magnitude of the associations between built environment exposures and transport walking when the former are measured in Euclidean buffers vs. network buffers, informing future research to carefully conceptualize appropriate distance-based buffer metrics in order to better approximate real geographic contexts. It also helps contextualize existing research in the field that used Euclidean buffers when that were the only option. Further, this study provides an example of the uncertain geographic context problem.

Analysis of Urban Built Environment Impacts on Outdoor Physical Activities-A Case Study in China

Outdoor physical activities can promote public health and they are largely influenced by the built environment in different urban settings. Understanding the association between outdoor physical activities and the built environment is important for promoting a high quality of life. Existing studies typically focus on one type of outdoor activity using interview-based small samples and are often lack of systematic understanding of the activities' intensity and frequency. In this study, we intend to gain deeper insight into how the built environment influences physical activities using the data extracted from individual's wearables and other open data sources for integrated analysis. Multi-linear regression with logarithm transformation is applied to perform the analysis using the data from Changsha, China. We found that built environment impacts on outdoor physical activities in Changsha are not always consistent with similar studies' results in other cities. The most effective measures to promote outdoor physical activities are the provision of good arterial and secondary road networks, community parks, among others in Changsha. The results shed light on future urban planning practices in terms of promoting public health.

Exploring the spatial scale effects of built environments on transport walking: Multi-Ethnic Study of Atherosclerosis

We employed a longitudinal distributed lag modeling approach to systematically estimate how associations between built environment features and transport walking decayed with the increase of distance from home to built environment destinations. Data came from a cohort recruited from six U.S. cities (follow-up 2000-2010, N = 3913, baseline mean age 60). Built environment features included all walkable destinations, consisting of common and popular destinations for daily life. We also included two subsets frequent social destinations and food stores to examine if the spatial scale effects differed by varying density for different types of built environment destinations. Adjusted results found that increases in transport walking diminished when built environment destinations were farther, although distance thresholds varied across different types of built environment destinations. Higher availability of walking destinations within 2-km and frequent social destinations within 1.6-km were associated with transport walking. Food stores were not associated with transport walking. This new information will help policymakers and urban designers understand at what distances each type of built environment destinations influences transport walking, in turn informing the development of interventions and/or the placement of amenities within neighborhoods to promote transport walking. The findings that spatial scales depend on specific built environment features also highlight the need for methods that can more flexibly estimate associations between outcomes and different built environment features across varying contexts, in order to improve our understanding of the spatial mechanisms involved in said associations.

Urban Densification and Physical Activity Change: A 12-Year Longitudinal Study of Australian Adults

Urbanization, a major force driving changes in neighborhood environments, may affect residents' health by influencing their daily activity levels. We examined associations of population density changes in urban areas with adults' physical activity changes over 12 years using data from the Australian Diabetes, Obesity and Lifestyle Study (1999-2012). The analytical sample contained 2,354 participants who remained at the same residential address throughout the study period in metropolitan cities and regional cities (42 study areas). Census-based population density measures were calculated for 1-km-radius buffers around their homes. Population density change was estimated using linear growth models. Two-level linear regression models were used to assess associations between changes in population density and changes in self-reported walking and physical activity durations. The average change in population density was 0.8% per year (range, -4.1 to 7.8) relative to baseline density. After adjustment for confounders, each 1% annual increase in population density was associated with 8.5-minutes/week (95% confidence interval: 0.6, 16.4) and 19.0-minutes/week (95% confidence interval: 3.7, 34.4) increases in walking and physical activity, respectively, over the 12-year study period. Increasing population density through urban planning policies of accommodating population growth within the existing urban boundary, rather than expanding city boundaries, could assist in promoting physical activity at the population level.

Non-Linear Effects of the Built Environment and Social Environment on Bus Use among Older Adults in China: An Application of the XGBoost Model

Global aging has raised increasing concerns on the health and well-being of older adults. Public transport is a viable option to improve the mobility and quality of life among older adults. However, policies that promote the public transport use among older adults are rare. This study utilizes the eXtreme Gradient Boosting (XGBoost) decision tree to explore the non-linear associations of the built and social environment with bus use among older adults in China. The bus use of older adults was obtained from the Zhongshan Household Travel Survey (ZHTS) in 2012. Results show that non-linear relationships exist among all built environment and social environment characteristics. Within certain thresholds, the percentage of green space land use, land use mixture, bus-stop density, and dwelling unit density are positively related to bus use among older adults. Likewise, one social environment variable, the proportion of older adults in a neighborhood, is the key social environment variable. Furthermore, the dwelling unit density and proportion of older adults appear to have an inverse U-shaped relationship. Additionally, age, ownership of motorcycles, and distance from home to the nearest bus stop also show non-linearity. The findings presented in this paper facilitate effective planning interventions to promote bus use among older adults.

Longitudinal Associations between the Neighborhood Built Environment and Cognition in US Older Adults: The Multi-Ethnic Study of Atherosclerosis

Few studies have examined associations between neighborhood built environments (BE) and longitudinally measured cognition. We examined whether four BE characteristics were associated with six-year change in global cognition and processing speed. We obtained data on 1816 participants without dementia from the Multi-Ethnic Study of Atherosclerosis. BE measures included social destination density, walking destination density, proportion of land dedicated to retail, and network ratio (street connectivity). Global cognition was measured with the Cognitive Abilities Screening Instrument (CASI) and processing speed with the Digit Symbol Coding test (DSC). Multivariable random intercept logistic models tested associations between neighborhood BE at 2010-2012 and maintained/improved cognition (versus decline) from 2010-2018, and mediation by minutes of physical activity (PA)/week. The sample was an average of 67 years old (standard deviation = 8.2) (first cognitive measurement) and racially/ethnically diverse (29% African American, 11% Chinese, 17% Hispanic, 44% White). Compared to individuals with no walking destinations in the 1-mile surrounding their residence, those with 716 walking destinations (maximum observed) were 1.24 times more likely to have maintain/improved DSC score (Odds ratio: 1.24; 95% confidence interval: 1.03-1.45). No other associations were observed between BE and cognition, and PA minutes/week did not mediate the association between walking destination density and DSC change. This study provides limited evidence for an association between greater neighborhood walking destinations and maintained/improved processing speed in older age and no evidence for associations between the other BE characteristics and cognition. Future studies with finer grained BE and cognitive measures and longer-term follow up may be required.

GPS-based built environment measures associated with adult physical activity

Studies often rely on home locations to access built environment (BE) influences on physical activity (PA). We use GPS and accelerometer data collected for 288 individuals over a two-week period to examine eight GPS-derived BE characteristics and moderate-to-vigorous PA (MVPA) and light-to-moderate-vigorous PA (LMVPA). NDVI, parks, blue space, pedestrian-orientated intersections, and population density were associated with increased odds of LMVPA and MVPA, while traffic air pollution and noise were associated with decreased odds of LMVPA and MVPA. Associations varied by population density and when accounting for multiple BE measures. These findings provide further information on where individuals choose to be physically active.

Children's Active School Travel: Examining the Combined Perceived and Objective Built-Environment Factors from Space Syntax

Increasing active school travel (AST) among children may provide the required level of daily physical activity and reduce the prevalence of obesity. Despite efforts to promote this mode, recent evidence shows that AST rates continue to decrease in suburban and urban areas alike. The aim of this research study, therefore, is to facilitate our understanding of how objective and perceived factors near the home influence children's AST in an understudied city, İstanbul, Turkey. Using data from a cross-sectional sample of students aged 12-14 from 20 elementary schools (n = 1802) and consenting parents (n = 843), we applied a nominal logistic regression model to highlight important predictors of AST. The findings showed that street network connectivity (as measured by two novel space syntax measures, metric reach and directional reach) was the main deciding factor for active commuting to school, while parents' perceptions of condition of sidewalks and shade-casting street trees were moderately significant factors associated with AST. Overall, this study demonstrated the significance of spatial structure of street network around the homes in the potential for encouraging AST, and more importantly, the need to consider objective and perceived environmental attributes when strategizing means to increase this mode choice and reduce ill-health among children.

Neighborhood characteristics and transport walking: Exploring multiple pathways of influence using a structural equation modeling approach

In studies of neighborhood effects on transport walking, residential preferences along with other personal characteristics (walking attitude, factors that affect decision to walk for transport) are important factors to consider. However, few studies have examined relationships between neighborhood characteristics and transport walking accounting for a complex suite of personal factors. This study employed a structural equation modeling approach to examine associations between neighborhood characteristics and transport walking behaviors by accounting for residential preferences, self-assessed factors that affect decision to walk for transportation, and socio-demographics; and to examine whether neighborhood effects were modified by walking attitude and residential preferences. Based on a cross-sectional phone and mail survey of 2,848 residents of New York City, Baltimore, Chicago, Los Angeles, St. Paul, and Winston Salem in 2011-12, we found neighborhood characteristics had significant independent associations with transport walking, even after adjusting for residential preferences and other personal factors. Neighborhood effects on transport walking did not differ significantly by walking attitude or residential preferences. Our findings highlight the importance of neighborhood effects in promoting transport walking, and suggest that while residential preferences are important factors, they do not obviate the neighborhood effects on transport walking.

Neighborhood Walkability and Active Transportation: A Correlation Study in Leisure and Shopping Purposes

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.

[Walkability and healthy aging: an analytical proposal for small and medium-sized Brazilian cities]

Evidence has shown that urban environments that discourage walking contribute to functional incapacity in the elderly. Various indices have been proposed to describe an area's walkability, combining different aspects of the built environment that promote (or inhibit) walking. However, due to problems with the quality and availability of data in Brazil, there is no walkability index to date applies to all cities of the country and that has been properly tested in the population. The current study aimed to propose a walkability index based on geographic information systems for a medium-sized city, with open-access data, and to test its association with functional incapacity in the elderly. The study used data from the urban area of a medium-sized Brazilian city to select a parsimonious set of variables through factor analysis. The resulting index was tested for its association with the capacity to perform activities of daily living that require more movement, in 499 elderly, using generalized estimating equations. The resulting walkability index consists of residential density, commercial density, street connectivity, presence of sidewalks, and public lighting. These variables comprised the first factor in the factor analysis, excluding only arborization which was retained in the second factor. The worst walkability score was associated with the highest functional incapacity score. Based on the results and their validation, the study suggests an easily applicable walkability index with great potential for use in action plans to adapt environments.

Does Environmental Walkability Matter? The Role of Walkable Environment in Active Commuting

Since walkability plays an important role in active commuting, several cities are actively promoting its integration into urban and environmental planning policies. This study examined the association between walkability and active commuting in Seoul, Korea. A multilevel logistic regression model was used to examine the correlation between Walkability Score and the probability of active commuting after controlling for individual variables. The analysis used 129,044 individual samples nested within 424 administrative districts (dongs). In this study, three models were tested: Model 1 contained only individual variables, Model 2 contained individual variables and Walkability Score, and Model 3 included neighborhood-level variables in addition to the variables of Model 2. The results showed that the Walkability Score was significantly correlated with the odds of active commuting. Specifically, every additional one-point increase in Walkability Score was associated with 0.3% higher odds of active commuting (Model 2: odds ratio (OR) = 1.003, 95% confidence interval (CI) = 1.001-1.005; Model 3: OR = 1.003, 95% CI = 1.001-1.006). Additionally, public transportation density was also positively correlated with the odds of active commuting. The odds of active commuting were positively correlated with younger age, female, lower-income, and having no car. Based on the findings, policy recommendations in urban planning and design, transport engineering, and environmental planning are provided.

How Does Walkability Change Behavior? A Comparison between Different Age Groups in the Netherlands

Empirical research provides evidence that, in neighborhoods with higher walkability, individuals make more walking trips. However, it is not clear what the exact nature is of the relationships between neighborhood walkability and walking trips, since a higher walking frequency can be explained in different ways. This study examined whether the extra walking trips in better walkable neighborhoods are related primarily to trip generation, destination choice, or transport mode choice and whether this is the same for different age groups. A neighborhood fixed effects regression analysis was conducted in a first step to obtain a walkability measure for each neighborhood in the Netherlands including systematic as well as unobserved effects. Subsequently, the estimated fixed effects were used as walkability data for a path analysis based on a causal model to test the hypotheses stated. The results of the path analysis show direct relationships of neighborhood walkability with trip generation, destination choice, and transport mode choice, after controlling for the mutual relationships between the activity and trip variables. Comparing different age groups (i.e., children, adults, and elderly), the differences found mostly concerned the relationship between neighborhood walkability and trip generation. We concluded therefore that conditions for walkability are not the same for all age groups.

How Does Walkability Change Behavior? A Comparison between Different Age Groups in the Netherlands

Empirical research provides evidence that, in neighborhoods with higher walkability, individuals make more walking trips. However, it is not clear what the exact nature is of the relationships between neighborhood walkability and walking trips, since a higher walking frequency can be explained in different ways. This study examined whether the extra walking trips in better walkable neighborhoods are related primarily to trip generation, destination choice, or transport mode choice and whether this is the same for different age groups. A neighborhood fixed effects regression analysis was conducted in a first step to obtain a walkability measure for each neighborhood in the Netherlands including systematic as well as unobserved effects. Subsequently, the estimated fixed effects were used as walkability data for a path analysis based on a causal model to test the hypotheses stated. The results of the path analysis show direct relationships of neighborhood walkability with trip generation, destination choice, and transport mode choice, after controlling for the mutual relationships between the activity and trip variables. Comparing different age groups (i.e., children, adults, and elderly), the differences found mostly concerned the relationship between neighborhood walkability and trip generation. We concluded therefore that conditions for walkability are not the same for all age groups.

Relation between residential density and walking time among urban adults in Nanjing, China

OBJECTIVES

The interest in built environment attributes on physical activity has been rapidly increasing over recent decades. This study aimed to investigate the associations between residential density (RD) and walking time (WT), a common mode of physical activity, among urban adults in China.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Locally registered adults aged 35-74 years were randomly selected from eight urban neighbourhoods in Nanjing, China, in 2017. The outcome variable was self-reported WT (dichotomised), whereas RD (in tertiles) was the independent variable. Mixed-effects regression models were introduced to examine the RD-WT association via computing odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Of 1568 eligible participants, 98.9% completed the survey, with a mean age (standard deviation) of 54.7 (11.1) years, in which 46% were men. After adjustment for potential confounders, a negative gradient RD-WT association was seen across RD tertiles among the participants (OR = 2.88 [95% CI = 1.79, 4.64] and 2.10 [95% CI = 1.35, 3.26] for lower and middle tertiles, respectively, compared with the upper RD tertile). The negative RD-WT association was observed for both men and women.

CONCLUSIONS

RD was negatively associated with the WT of urban adults in China. These results have public health implications for improving community-level physical activity through development of walking-friendly built environment.

Neighborhood Walkability and BMI Change: A National Study of Veterans in Large Urban Areas

OBJECTIVE

Improving neighborhood walkability has been proposed as a policy intervention to reduce obesity. The objective of this study was to evaluate longitudinal relationships between neighborhood walkability and body weight among adults living in large urban areas.

METHODS

In this retrospective longitudinal study of United States military veterans using Department of Veterans Affairs health care, Veterans Affairs clinical and administrative data (2007-2014) were linked to environmental measures constructed from public (2006-2014) and proprietary (2008-2014) sources, and linear regression models with person fixed effects were used to estimate associations between walkability and BMI among 758,434 men and 70,319 women aged 20 to 80 years in 2009 to 2014.

RESULTS

Neighborhood walkability was associated with small reductions in BMI. Effects were most pronounced among men aged 30 to 49 and 50 to 64. For women, differences were largest in the two youngest age groups, 20 to 29 and 30 to 49, though only estimates for all women combined were statistically significant. For women aged 30 to 49, effect sizes grew when the sample was limited to those who remained in the same neighborhood during the entire follow-up period.

CONCLUSIONS

Investments in the built environment to improve walkability may be a useful strategy for weight control in some segments of the adult population.

Residential greenness and increased physical activity in patients after coronary artery bypass graft surgery

Aims

Physical activity is a fundamental component of rehabilitation following coronary artery bypass (CABG) surgery. Proximity to neighbourhood green spaces may encourage physical activity. We investigated the association between residential greenness and exercise-related physical activity post-CABG surgery.

Methods

Participants in a prospective cohort study of 846 patients (78% men) who underwent CABG surgery at seven cardiothoracic units during the time period 2004–2007 were interviewed regarding their physical activity habits one day before and one year after surgery. Exposure to residential neighbourhood greenness (within a 300 m buffer around their place of residence) was measured using the Normalized Difference Vegetative Index. Participation in exercise-related physical activity (yes/no), weekly duration of exercise-related physical activity and the change in exercise-related physical activity between baseline and follow-up were examined for associations with residential greenness, adjusting for socio-demographic factors, propensity score adjusted participation in cardiac rehabilitation and health-related covariates after multiple imputation for missing variables.

Results

Living in a higher quartile of residential greenness was associated with a 52% greater odds of being physically active (OR 1.52, 95% CI 1.22–1.90). This association persisted only (OR 1.75, 95% CI 1.35–2.27) among patients who did not participate in cardiac rehabilitation following surgery and was stronger in women (OR 2.38, 95% CI 1.40–4.07) than in men (OR 1.37, 95% CI 1.07–1.75). Participants who lived in greener areas were more likely to increase their post-surgical physical activity than those who lived in less green areas (OR 1.59, 95% CI 1.25–2.01).

Conclusions

Residential greenness appears to be beneficial in increasing exercise-related physical activity in cardiac patients, especially those not particpating in cardiac rehabilitation after CABG surgery.

Beyond the bus stop: where transit users walk

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of the Built Environment and Bicycling Psychological Factors on the Acceptable Bicycling Distance of Rural Residents

The ability to understand bicycling behavior in China’s rural areas is critical in constructing an improved, sustainable, countryside amid the rapid urbanization in the country. This study analyzes the influence of individual bicycling psychology, objective, and perceived built environment on the acceptable bicycling distance of rural residents. This research is conducted by controlling for the socio-demographic characteristics of the residents on the bases of a face-to-face questionnaire survey and an on-site measurement. Exploratory factor analysis shows three attitudinal common factors on bicycling infrastructure, namely, bicycling ancillary facilities, bicycle lane conditions, and safety, and two bicycling motivation factors, namely, convenience and other motivations. Multiple linear regression was estimated and results of the models were consistent. Individual bicycling psychology and built environment factors significantly influence the acceptable bicycling distance of rural residents. The socio-demographic variables insignificantly influence the acceptable bicycling distance, which is inconsistent with the existing literature. The research results provide a broad empirical base for the complex relationships among individual bicycling psychological factors, objective and perceived built environment, and bicycling behavior. This study presents the first research on bicycling in Chinese rural areas and provides guidance for the development of effective countermeasures in constructing ecovillages.

Impact of Neighborhood Built Environments on Shopping Travel Modes in Shanghai, China

Walking is one of the most widely used means of transport. Neighborhood built environments have a direct influence on individuals' daily commuting, recreational travel patterns, and shopping travel behavior. In Chinese cities, shopping activities are among the most frequent reasons for daily travel. Yet, research on the impact of neighborhood built environments on people's shopping travel activities in high-density cities is limited. To fill this research gap, this study investigates how neighborhood built environments might affect pedestrians' shopping travel activities in Shanghai, China. The data, which includes shopping travel patterns, perceived environmental characteristics, and individual socioeconomic status, were collected from a survey of 21 randomly selected neighborhoods in Shanghai in 2011. In total, data from 2,838 samples (participants) were collected. Multinomial logistic regression was used to investigate how neighborhood built environments affect residents' choice of travel mode for shopping, that is, the likelihood of taking transit, driving, or biking vs. walking. Results showed that nearly half of people surveyed (43.3%) used walking as their primary shopping mode. Road network density, presence of primary schools, and average sidewalk width were positively correlated with the likelihood of using walking as the primary shopping mode. Gender, age, and car ownership were also significant in the model.

Identifying neighborhood characteristics associated with diabetes and hypertension control in an urban African-American population using geo-linked electronic health records

For health care providers, information on community-level social determinants of health is most valuable when it is specific to the populations and health outcomes for which they are responsible. Diabetes and hypertension are highly prevalent conditions whose management requires an interplay of clinical treatment and behavioral modifications that may be sensitive to community conditions. We used geo-linked electronic health records from 2016 of African American patients of a network of federally qualified health centers in Philadelphia, PA to examine cross-sectional associations between characteristics of patients' residential neighborhoods and hypertension and diabetes control (n = 1061 and n = 2633, respectively). Hypertension and diabetes control were defined to align with the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) reporting requirements for HRSA-funded health centers. We examined associations with nine measures of neighborhood socioeconomic status (poverty, education, deprivation index), social environment (violent crime, perceived safety and social capital, racial segregation), and built environment (land-use mix, intersection density). In demographics-adjusted log-binomial regression models accounting for neighborhood-level clustering, poor diabetes and hypertension control were more common in highly segregated neighborhoods (i.e., high proportion of African American residents relative to the mean for Philadelphia; prevalence ratio = 1.27 [1.02-1.57] for diabetes, 1.22 [1.12-1.33] for hypertension) and less common in more walkable neighborhoods (i.e., higher retail land use). Neighborhood deprivation was also weakly associated with poor hypertension control. An important consideration in making geographic information actionable for providers is understanding how specific community-level determinants affect the patient population beyond individual-level determinants.

Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis

Introduction

The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults.

Methods

PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome.

Results

After screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively).

Conclusions

Total and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas.

Prospero registration number

CRD42016043226.

The association between park facilities and the occurrence of physical activity during park visits

Prior research has found a positive relationship between the variety of park facilities and park-based physical activity (PA), but has not provided an estimate of the effect that additional different PA facilities have on whether an individual is active during a park visit. Using objective measures of park visits and PA from an urban sample of 225 adults in King County, Washington, we compared the variety of PA facilities in parks visited where an individual was active to PA facilities in parks where the same individual was sedentary. Each additional different PA facility at a park was associated with a 6% increased probability of being active during a visit. Adding additional different PA facilities to a park appears to have a moderate effect on whether an individual is active during a park visit, which could translate into large community health impacts when scaled up to multiple park visitors.

Land use proportion and walking: Application of isometric substitution analysis

Entropy measures of land use mix are a commonly used component of walkability. However, they present methodological challenges, and studies on their associations with walking have produced mixed findings. This study examined associations of the proportion of discrete land uses with walking, using isometric substitution models that take the complementary nature of land use proportions into account. Analysis of data collected from middle-aged adults living in Brisbane, Australia (n = 10,794) found that replacing residential or other land with commercial land was associated with higher levels of walking. The isometric substitution approach may explain the potential impact of land use changes on residents' walking.

The Association of Built Environment and Physical Activity in Older Adults: Using a Citywide Public Housing Scheme to Reduce Residential Self-Selection Bias

Previous studies have documented numerous health benefits of conducting regular physical activity among older adults. The built environment is believed to be a key factor that can hinder or facilitate daily physical activity, such as walking and exercising. However, most empirical studies focusing on environment-physical activity associations exhibited residential self-selection bias with cross-sectional research design, engendering doubts about the impact of built environment on physical activity. To reduce this bias, we assessed physical activity behaviors of 720 Hong Kong older adults (≥65 years) residing in 24 public housing estates. The Hong Kong public housing scheme currently provides affordable rental flats for 2.1 million people or approximate 30% of total population. The applicants were allocated to one of 179 housing estates largely by family size and flat availability. Built environment characteristics were measured following the ‘5Ds’ principle: (street network) design, (land-use) diversity, density, distance to transit, and destination accessibility. Multilevel mixed models were used to explore the associations between the built environment and the different domains of physical activity (transportation walking, recreational walking, and recreational moderate-to-vigorous physical activity (MVPA) while controlling for potential estate-level socioeconomic and individual confounders. We found that transportation walking was positively associated with the number of bus stops and the presence of Mass Transit Railway (MTR) stations. Recreational MVPA was positively related to the number of recreational facilities. However, land-use mix was negatively related to transportation walking, recreational walking, and recreational MVPA. The findings of this study support a threshold effect in the environment-physical activity associations. Furthermore, large-scale public housing schemes involving random or semi-random residence assignment in many cities may provide opportunities to explore built environments and physical activity behavior, with the potential to overcome residential self-selection bias.

Associations of Residential Socioeconomic, Food, and Built Environments With Glycemic Control in Persons With Diabetes in New York City From 2007-2013

In the present study, we examined the longitudinal associations between residential environmental factors and glycemic control in 182,756 adults with diabetes in New York City from 2007 to 2013. Glycemic control was defined as a hemoglobin A1c (HbA1c) level less than 7%. We constructed residential-level measures and performed principle component analysis to formulate a residential composite score. On the basis of this score, we divided residential areas into quintiles, with the lowest and highest quintiles reflecting the least and most advantaged residential environments, respectively. Several residential-level environmental characteristics, including more advantaged socioeconomic conditions, greater ratio of healthy food outlets to unhealthy food outlets, and residential walkability were associated with increased glycemic control. Individuals who lived continuously in the most advantaged residential areas took less time to achieve glycemic control compared with the individuals who lived continuously in the least advantaged residential areas (9.9 vs. 11.5 months). Moving from less advantaged residential areas to more advantaged residential areas was related to improved diabetes control (decrease in HbA1c = 0.40%, 95% confidence interval: 0.22, 0.55), whereas moving from more advantaged residential areas to less advantaged residential areas was related to worsening diabetes control (increase in HbA1c = 0.33%, 95% confidence interval: 0.24, 0.44). These results show that residential areas with greater resources to support healthy food and residential walkability are associated with improved glycemic control in persons with diabetes.

Neighborhood built environment and cognition in non-demented older adults: The Multi-Ethnic Study of Atherosclerosis

Preliminary studies suggest that neighborhood social and built environment (BE) characteristics may affect cognition in older adults. Older adults are particularly vulnerable to the neighborhood environment due to a decreasing range of routine travel with increasing age. We examined if multiple neighborhood BE characteristics are cross-sectionally associated with cognition in a diverse sample of older adults, and if the BE-cognition associations vary by individual-level demographics. The sample included 4539 participants from the Multi-Ethnic Study of Atherosclerosis. Multivariable linear regression was used to examine the associations between five BE measures and four cognitive measures, and effect modification by individual-level education and race/ethnicity. In the overall sample, increasing social destination density, walking destination density, and intersection density were associated with worse overall cognition, whereas increasing proportion of land dedicated to retail was associated with better processing speed. Effect modification results suggest that the association between urban density and worse cognition may be limited to or strongest in those of non-white race/ethnicity. Although an increase in neighborhood retail destinations was associated with better cognition in the overall sample, these results suggest that certain BE characteristics in dense urban environments may have a disproportionately negative association with cognition in vulnerable populations. However, our findings must be replicated in longitudinal studies and other regional samples.

Walkable neighborhoods and obesity: Evaluating effects with a propensity score approach

Background

Research investigating the connection between neighborhood walkability and obesity often overlooks the issue of nonrandom residential selection.

Methods

We use propensity score methods to adjust for the nonrandom selection into residential neighborhoods in this cross-sectional, observational study. The sample includes 103,912 women residing in Salt Lake County, Utah age 20 or older. We measured percentage living in neighborhoods with more walkability, area level measures of neighborhood characteristics, and obesity (body mass index (BMI) > 30).

Results

Our findings confirm previous work that observes an association between living in more walkable neighborhoods and lower obesity. After adjusting for nonrandom selection, the odds of being obese when living in a less walkable neighborhood increase. Specifically, the odds ratio for being obese without the propensity score correction is 1.12. After adjusting for nonrandom selection, the odds ratio for being obese is 1.19, an increase of six percent.

Conclusion

Results demonstrate that residential selection bias inherent in cross-sectional analysis slightly attenuates the true association between neighborhood walkability and obesity. Results lend support to the growing body of research suggesting that more walkable neighborhoods have residents with a lower prevalence of obesity. Absent propensity score controls, the causal relationship between environment and obesity would be underestimated by 6%. Our analysis suggests there is an association between neighborhood walkability and obesity.

The Relationship between the Neighborhood Built Environment and Active Transportation among Adults: A Systematic Literature Review

Active transportation (AT) has aroused great interest in recent years as it may benefit public health and reduce the dependency on cars. This article aims to summarize recent findings on the relationship between the objectively measured built environment and AT among adults, to examine if different study designs may generate different results, and to provide directions for future research. A systematic literature review of journal articles from different databases was conducted. Fifty-one articles published between 2005 and 2017 were identified, and twelve built environment factors were extracted. The results showed that residential density, land use mix, street connectivity, retail land use, walkability, sidewalk, and access to destinations had a convincing positive relationship with walking for transport. Regarding cycling for transport, while street connectivity and bike lane showed a convincing positive relationship, neighborhood aesthetics and access to destinations showed a convincing negative relationship. Studies that use different analyzed geographic units and different measurements of AT may generate different results, so choosing suitable geographic units and measurement of AT is necessary to reduce the mismatch in the relationships. In addition, we need more longitudinal studies, more studies on cycling for transport, and more studies in countries outside North America and Australasia.

Do Inequalities in Neighborhood Walkability Drive Disparities in Older Adults' Outdoor Walking?

Older residents of high-deprivation areas walk less than those of low-deprivation areas. Previous research has shown that neighborhood built environment may support and encourage outdoor walking. The extent to which the built environment supports and encourages walking is called “walkability”. This study examines inequalities in neighborhood walkability in high- versus low-deprivation areas and their possible influences on disparities in older adults’ outdoor walking levels. For this purpose, it focuses on specific neighborhood built environment attributes (residential density, land-use mix and intensity, street connectivity, and retail density) relevant to neighborhood walkability. It applied a mixed-method approach, included 173 participants (≥65 years), and used a Geographic Information System (GIS) and walking interviews (with a sub-sample) to objectively and subjectively measure neighborhood built environment attributes. Outdoor walking levels were measured by using the Geographic Positioning System (GPS) technology. Data on personal characteristics was collected by completing a questionnaire. The results show that inequalities in certain land-use intensity (i.e., green spaces, recreation centers, schools and industries) in high- versus low-deprivation areas may influence disparities in older adults’ outdoor walking levels. Modifying neighborhood land use intensity may help to encourage outdoor walking in high-deprivation areas.

Snow and Rain Modify Neighbourhood Walkability for Older Adults

The literature has documented a positive relationship between walkable built environments and outdoor mobility in older adults. Yet, surprisingly absent is any consideration of how weather conditions modify the impact of neighbourhood walkability. Using archived weather data linked to survey data collected from a sample of older adults in Vancouver, Canada, we found that car-dependent neighbourhoods (featuring longer block lengths, fewer intersections, and greater distance to amenities) became inaccessible in snow. Even older adults who lived in very walkable neighbourhoods walked to 25 per cent fewer destinations in snow. It is crucial to consider the impact of weather in the relationship between neighbourhood walkability and older adult mobility.

Direct and Indirect Associations Between the Built Environment and Leisure and Utilitarian Walking in Older Women

BACKGROUND

The built environment predicts walking in older adults, but the degree to which associations between the objective built environment and walking for different purposes are mediated by environmental perceptions is unknown.

PURPOSE

We examined associations between the neighborhood built environment and leisure and utilitarian walking and mediation by the perceived environment among older women.

METHODS

Women (N = 2732, M age = 72.8 ± 6.8 years) from Massachusetts, Pennsylvania, and California completed a neighborhood built environment and walking survey. Objective population and intersection density and density of stores and services variables were created within residential buffers. Perceived built environment variables included measures of land use mix, street connectivity, infrastructure for walking, esthetics, traffic safety, and personal safety. Regression and bootstrapping were used to test associations and indirect effects.

RESULTS

Objective population, stores/services, and intersection density indirectly predicted leisure and utilitarian walking via perceived land use mix (odds ratios (ORs) = 1.01-1.08, 95 % bias corrected and accelerated confidence intervals do not include 1). Objective density of stores/services directly predicted ≥150 min utilitarian walking (OR = 1.11; 95% CI = 1.02, 1.22). Perceived land use mix (ORs = 1.16-1.44) and esthetics (ORs = 1.24-1.61) significantly predicted leisure and utilitarian walking, CONCLUSIONS: Perceived built environment mediated associations between objective built environment variables and walking for leisure and utilitarian purposes. Interventions for older adults should take into account how objective built environment characteristics may influence environmental perceptions and walking.

Changes in walking, body mass index, and cardiometabolic risk factors following residential relocation: Longitudinal results from the CARDIA study

BACKGROUND

While many studies have found the built environment to be associated with walking, most have used cross-sectional research designs and few have examined more distal cardiometabolic outcomes. This study contributes longitudinal evidence based on changes in walking, body mass index (BMI), and cardiometabolic risk following residential relocation.

METHODS

We examined 1,079 participants in the CARDIA study who moved residential locations between 2000 and 2006 (ages 32-46 in 2000, 49% white/51% black, 55% female). We created a walkability index from measures of population density, street connectivity, and food and physical activity resources, measured at participants' pre- and post-move residential locations. Outcomes measured before and after the move included walking, BMI, waist circumference, blood pressure, insulin resistance, triglycerides, cholesterol, atherogenic dyslipidemia, and C-reactive protein. Fixed effects (FE) models were used to estimate associations between within-person change in walkability and within-person change in each outcome. These estimates were compared to those from random effects (RE) models to assess the implications of unmeasured confounding.

RESULTS

In FE models, a one-SD increase in walkability was associated with a 0.81 mmHg decrease in systolic blood pressure [95% CI: (-1.55, -0.07)] and a 7.36 percent increase in C-reactive protein [95% CI: (0.60, 14.57)]. Although several significant associations were observed in the RE models, Hausman tests suggested that these estimates were biased for most outcomes. RE estimates were most commonly biased away from the null or in the opposite direction of effect as the FE estimates.

CONCLUSIONS

Greater walkability was associated with lower blood pressure and higher C-reactive protein in FE models, potentially reflecting competing health risks and benefits in dense, walkable environments. RE models tended to overstate or otherwise misrepresent the relationship between walkability and health. Approaches that base estimates on variation between individuals may be subject to bias from unmeasured confounding, such as residential self-selection.

Secondary GIS built environment data for health research: guidance for data development

Built environment (BE) data in geographic information system (GIS) format are increasingly available from public agencies and private providers. These data can provide objective, low-cost BE data over large regions and are often used in public health research and surveillance. Yet challenges exist in repurposing GIS data for health research. The GIS data do not always capture desired constructs; the data can be of varying quality and completeness; and the data definitions, structures, and spatial representations are often inconsistent across sources. Using the Small Town Walkability study as an illustration, we describe (a) the range of BE characteristics measurable in a GIS that may be associated with active living, (b) the availability of these data across nine U.S. small towns, (c) inconsistencies in the GIS BE data that were available, and (d) strategies for developing accurate, complete, and consistent GIS BE data appropriate for research. Based on a conceptual framework and existing literature, objectively measurable characteristics of the BE potentially related to active living were classified under nine domains: generalized land uses, morphology, density, destinations, transportation system, traffic conditions, neighborhood behavioral conditions, economic environment, and regional location. At least some secondary GIS data were available across all nine towns for seven of the nine BE domains. Data representing high-resolution or behavioral aspects of the BE were often not available. Available GIS BE data - especially tax parcel data - often contained varying attributes and levels of detail across sources. When GIS BE data were available from multiple sources, the accuracy, completeness, and consistency of the data could be reasonable ensured for use in research. But this required careful attention to the definition and spatial representation of the BE characteristic of interest. Manipulation of the secondary source data was often required, which was facilitated through protocols.

The interaction between physical activity and obesity gene variants in association with BMI: Does the obesogenic environment matter?

Little is known about how obesity susceptibility single nucleotide polymorphisms (SNPs) interact with moderate to vigorous physical activity (MVPA) in relation to BMI during adolescence, once obesogenic neighborhood factors are accounted for. In race stratified models, including European (EA; N=4977), African (AA; N=1726), and Hispanic Americans (HA; N=1270) from the National Longitudinal Study of Adolescent to Adult Health (1996; ages 12-21), we assessed the evidence for a SNPxMVPA interaction with BMI-for-age Z score, once accounting for obesogenic neighborhood factors including physical activity amenities, transportation and recreation infrastructure, poverty and crime. Eight SNPxMVPA interactions with suggestive significance (p<0.10; three in each EA, and AA, two in HA) were observed showing attenuation on BMI-for-age Z score in adolescents with ≥5 versus <5 bouts/week MVPA, except for rs10146997 (near NRXN3). Findings were robust to the inclusion of neighborhood-level variables as covariates. These findings suggest that any attenuation from MVPA on a genetic susceptibility to obesity during adolescence is likely not operating through obesogenic neighborhood factors.

The Impact of Neighborhoods on CV Risk

Cardiovascular disease (CVD) continues to be the leading cause of death and a major source of health disparities in the Unites States and globally. Efforts to reduce CVD risk and eliminate cardiovascular health disparities have increasingly emphasized the importance of the social determinants of health. Neighborhood environments have emerged as a possible target for prevention and policy efforts. Hence there is a need to better understand the role of neighborhood environments in shaping cardiovascular risk. The MESA (Multi-Ethnic Study of Atherosclerosis) Neighborhood Study provided a unique opportunity to build a comprehensive place-based resource for investigations of associations between specific features of neighborhood physical and social environments and cardiovascular risk factors and outcomes. This review summarizes the approaches used to characterize residential neighborhood environments in the MESA cohort, provides an overview of key findings to date, and discusses challenges and opportunities in neighborhood health effects research. Results to date suggest that neighborhood physical and social environments are related to behavioral and biomedical risk factors for CVD and that cardiovascular prevention efforts may benefit from taking neighborhood context into account.

Neighborhood Walking Environment and Activity Level Are Associated With OSA: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

There has been growing interest in understanding how neighborhoods may be related to cardiovascular risk. Neighborhood effects on sleep apnea could be one contributing mechanism. We investigated whether neighborhood walking environment and personal activity levels are related to OSA.

METHODS

Data were analyzed from a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA), including subjects who participated in both the MESA Sleep and Neighborhood studies (N = 1,896). Perceived neighborhood walking environment and subjects' objective activity were evaluated in multivariate, multilevel models to determine any association with sleep apnea severity as defined by using the apnea-hypopnea index. Sex, race/ethnicity, and obesity were examined as moderators.

RESULTS

Residing in the lowest quartile walking environment neighborhoods (score < 3.75) was associated with more severe sleep apnea (mean, 2.7 events/h greater AHI [95% CI, 0.7 to 4.6]), after adjusting for demographic characteristics, BMI, comorbidities, health behaviors, neighborhood socioeconomic status, and site. Associations were stronger among obese and male individuals. Approximately 1 SD greater objective activity in men was associated with a lower AHI (mean, -2.4 events/h [95% CI, -3.5 to -1.3]). This association was partially mediated by BMI (P < .001).

CONCLUSIONS

Living in neighborhoods with a low walking environment score is associated with greater severity of sleep apnea, especially in male and obese individuals. In men, greater activity level is associated with less severe sleep apnea, independent of BMI, comorbidities, and socioeconomic status. Neighborhood-level interventions that increase walkability and enable increased physical activity may potentially reduce the severity of sleep apnea.

Factors influencing time-location patterns and their impact on estimates of exposure: the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air)

We assessed time-location patterns and the role of individual- and residential-level characteristics on these patterns within the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) cohort and also investigated the impact of individual-level time-location patterns on individual-level estimates of exposure to outdoor air pollution. Reported time-location patterns varied significantly by demographic factors such as age, gender, race/ethnicity, income, education, and employment status. On average, Chinese participants reported spending significantly more time indoors and less time outdoors and in transit than White, Black, or Hispanic participants. Using a tiered linear regression approach, we predicted time indoors at home and total time indoors. Our model, developed using forward-selection procedures, explained 43% of the variability in time spent indoors at home, and incorporated demographic, health, lifestyle, and built environment factors. Time-weighted air pollution predictions calculated using recommended time indoors from USEPA overestimated exposures as compared with predictions made with MESA Air participant-specific information. These data fill an important gap in the literature by describing the impact of individual and residential characteristics on time-location patterns and by demonstrating the impact of population-specific data on exposure estimates.

Environmental, behavioral, and psychological predictors of transit ridership: Evidence from a community intervention

Understanding who takes advantage of new transit (public transportation) interventions is important for personal and environmental health. We examine transit ridership for residents living near a new light rail construction as part of "complete street," pedestrian-friendly improvements. Adult residents (n=536) completed surveys and wore accelerometer and GPS units that tracked ridership before and after new transit service started. Transit riders were more physically active. Those from environments rated as more walkable were likely to be continuing transit riders. Place attachment, but not perceived physical incivilities on the path to transit, was associated with those who continued to ride or became new riders of transit. This effect was mediated through pro-city attitudes, which emphasize how the new service makes residents eager to explore areas around transit. Thus, place attachment, along with physical and health conditions, may be important predictors and promoters of transit use.

Do Neighborhood Physical Activity Resources and Land Use Influence Physical Activity among African American Public Housing Residents?

Few studies have examined neighborhood influences on physical activity (PA) among low-income African Americans living in public housing. This study measured the associations of PA resources and land use with PA among 216 African Americans living in 12 low-income housing developments in Houston, Texas. Neighborhood measures included both detailed information from in-person audits and geographic information systems (GIS) data. Hierarchical linear regression models tested the associations of neighborhood PA resource availability and quality and land use density and diversity with individual-level, self-reported PA. Land use diversity was positively associated with walking among men after controlling for other neighborhood characteristics. Policies that promote land use diversity or improve the pedestrian environment in areas with diverse destinations may encourage PA among public housing residents.

Neighbourhood walkability, daily steps and utilitarian walking in Canadian adults

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

MAIN EXPOSURE MEASURES

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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