The sociodemographics of land use planning: relationships to physical activity, accessibility, and equity

Do State Comprehensive Planning Statutes Address Physical Activity?: Implications for Rural Communities

Less than one-quarter of U.S. adults meet physical activity (PA) recommendations, with rural residents less likely to be active than urban residents. The built environment has been identified as a potential facilitator of PA and local comprehensive plans are a foundational tool for guiding the development of the built environment. The purpose of this study was therefore to understand the current landscape of comprehensive planning state statutes related to PA and rural communities. We used primary legal research methods to identify, compile, and evaluate all 50 state comprehensive planning statutes for items related to PA and conditional mandates based on population size of local jurisdictions. The presence of population-conditional planning mandates and the inclusion of PA-related items was analyzed by state-level rurality using Fisher's exact tests. Our analyses demonstrated that (1) broader PA-related items were addressed in state statutes more often than more specific PA-related items; (2) when PA-related items were addressed, they were most likely to be mandated, subsumed elements; (3) several PA-related items were less likely to be addressed in the most rural states and/or conditionally mandated for jurisdictions meeting minimum population requirements; and (4) only two states addressed PA directly and explicitly in their comprehensive planning statutes.

Health Disparities, Transportation Equity and Complete Streets: a Case Study of a Policy Development Process through the Lens of Critical Race Theory

Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.

Prevalence of master plans supportive of active living in US municipalities

Community planning documents can play an important role in promoting the design and maintenance of walkable communities. This study estimates the prevalence among US municipalities of (1) community wide planning documents and (2) inclusion of plan objectives supportive of active living within these documents. Data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS HEAL), a survey of local officials, were analyzed (n = 2005). Prevalence of comprehensive or general plans, 3 specific plan types, and 3 objectives supportive of active living were analyzed using survey weights to create national estimates. Overall, 64% of municipalities had a comprehensive/general plan, 46% had a transportation plan, 48% had a bicycle or pedestrian plan and 76% had a land use plan. Of municipalities with a plan, 78% included at least one of the three objectives measured supportive of active living. Differences in presence of plans and objectives were observed by population size of the municipality, urban status, region, and median education. Helping communities, especially smaller or rural municipalities and those with lower median education levels, create and adopt planning documents supportive of active living may be an important step in creating more walkable communities.

Exploring Neighborhood Environments and Active Commuting in Chennai, India

Few studies assess built environment correlates of active commuting in low-and-middle-income countries (LMICs), but the different context could yield distinct findings. Policies and investments to promote active commuting remain under-developed in LMICs like India, which grapples with traffic congestion, lack of activity-supportive infrastructure, poor enforcement of traffic rules and regulations, air pollution, and overcrowding. This cross-sectional study investigated associations between home neighborhood environment characteristics and active commuting in Chennai, India. Adults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling; n = 56); (2) public transit (n = 52); and (3) private transport (n = 111). Environmental attributes around participants’ homes were assessed using the Neighborhood Environment Walkability Scale for India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modeled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. Consistent with other international studies, participants living in neighborhoods with a mix of land uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (adjusted odds ratio (aOR) = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05), and street connectivity (aOR = 0.2, p = 0.003). Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high-quality epidemiologic studies with greater context specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

Sociocultural perceptions of walkability in Mexican American neighborhoods: Implications for policy and practice

Walking is the most fundamental form of active travel, as well as the most popular form of physical activity. The built and social environment, however, may not adequately support active living, especially in low-income communities. While improving the walking infrastructure is essential, assumptions regarding perceptions of walkability based on a standardized norm may fail to address preferences within specific populations. Particularly in low-income and ethnically diverse urban environments, it is not clear whether objective or perceived measures provide the best assessment of an environments' conduciveness to walkability. This qualitative study of five Mexican American neighborhoods used walk-and-talk focus groups (n=20) and intercept surveys (n=108) to investigate residents' perceptions of their walking environments. Respondents differentiated between physical and social attributes in assessing neighborhood walkability. Physical attributes, such as lack of infrastructure, maintenance and traffic, were more salient to residents when describing what discouraged them from walking. Perceptions of the social environment appeared to be of greater significance than the physical environment in encouraging individuals to walk. While respondents were concerned about personal safety, the overall sociability of the neighborhood, nearby family, familiarity between neighbors, and a sense of social activity all contributed to a positive assessment of walkability and expressed desire to walk, Findings revealed complex interactions between characteristics of the social, built, natural, and policy environments. The emphasis on sociocultural influences on perceptions of walkability underscores the importance of engaging neighborhoods in conversations about their walking environments to reveal strategies that better serve the needs of residents.

Biking practices and preferences in a lower income, primarily minority neighborhood: Learning what residents want

This paper examines if, in a lower-income minority neighborhood, bicycling practices and bicycle-environment preferences of Blacks and Hispanics were different from Whites. During the summer of 2014, surveys were mailed to 1537 households near a proposed cycle track on Malcolm X Boulevard in Roxbury, MA. On the Boulevard, intercept surveys were distributed to cyclists and observations noted about passing cyclist's characteristics. Data were analyzed from 252 returned-mailed surveys, 120 intercept surveys, and 709 bicyclists. White (100%), Hispanic (79%), and Black (76%) bicyclists shown pictures of 6 bicycle facility types in intercept surveys perceived the cycle track as safest. More White mailed-survey respondents thought bikes would not be stolen which may explain why more Hispanics (52%) and Blacks (47%) preferred to park their bikes inside their home compared with Whites (28%), with H/W B/W differences statistically significant (p < 0.05). More Hispanic (81%) and Black (54%) mailed-survey respondents thought they would bicycle more if they could bicycle with family and friends compared with Whites (40%). Bicyclists observed commuting morning and evening included Blacks (55%), Whites (36%) and Hispanics (9%). More Whites (68%) wore helmets compared with Hispanics (21%) and Blacks (17%) (p < 0.001). More Blacks (94%) and Hispanics (94%) rode a mountain bike compared with Whites (75%). Minority populations are biking on roads but prefer cycle tracks. They also prefer to park bikes inside their homes and bicycle with family and friends. Wide cycle tracks (bicycling with family/friends) and home bike parking should be targeted as capital investments in lower-income minority neighborhoods.

How much are built environments changing, and where?: Patterns of change by neighborhood sociodemographic characteristics across seven U.S. metropolitan areas

Investments in neighborhood built environments could increase physical activity and overall health. Disproportionate distribution of these changes in advantaged neighborhoods could inflate health disparities. Little information exists on where changes are occurring. This paper aims to 1) identify changes in the built environment in neighborhoods and 2) investigate associations between high levels of change and sociodemographic characteristics. Using Geographic Information Systems, neighborhood land-use, local destinations (for walking, social engagement, and physical activity), and sociodemographics were characterized in 2000 and 2010 for seven U.S. cities. Linear and change on change models estimated associations of built environment changes with baseline (2000) and change (2010-2000) in sociodemographics. Spatial patterns were assessed using Global Moran's I to measure overall clustering of change and Local Moran's I to identify statistically significant clusters of high increases surrounded by high increases (HH). Sociodemographic characteristics were compared between HH cluster and other tracts using Analysis of Variance (ANOVA). We observed small land-use changes but increases in the destination types. Greater increases in destinations were associated with higher percentage non-Hispanic whites, percentage households with no vehicle, and median household income. Associations were present for both baseline sociodemographics and changes over time. Greater increases in destinations were associated with lower baseline percentage over 65 but higher increases in percentage over 65 between 2000 and 2010. Global Moran's indicated changes were spatially clustered. HH cluster tracts started with a higher percentage non-Hispanic whites and higher percentage of households without vehicles. Between 2000 and 2010, HH cluster tracts experienced increases in percent non-Hispanic white, greater increases in median household income, and larger decreases in percent of households without a vehicle. Changes in the built environment are occurring in neighborhoods across a diverse set of U.S. metropolitan areas, but are patterned such that they may lead to increased health disparities over time.

Urban Park Development and Pediatric Obesity Rates: A Quasi-Experiment Using Electronic Health Record Data

INTRODUCTION

Childhood obesity affects ~20% of children in the United States. Environmental influences, such as parks, are linked with increased physical activity (PA).

OBJECTIVE

To examine whether changes in Body Mass Index (BMI) z-score were associated with construction of a new park.

METHODS

A quasi-experimental design was used to determine whether living in proximity of a park was associated with a reduction in BMI z-score. Children were selected from health clinics within an 11 mile radius of the park. A repeated-measure ANOVA was employed for analysis of the relationship between exposure (new park) and BMI z-score.

RESULTS

Participants were 1443 (median age 10.3 range (2-17.9 years), BMI: z-score 0.84 ± 1.09) African American (77.4%) adolescents. Change in BMI z-score was not statistically different for children living at different distances from the park after controlling for age, gender, race, ethnicity, or payer type (p = 0.4482). We did observe a small 0.03 increase in BMI z-score from pre- to post-park (p = 0.0007). There was a significant positive association between child's baseline age and BMI z-score (p < 0.001).

CONCLUSIONS

This study found proximity to a park was not associated with reductions in BMI z-score. Additional efforts to understand the complex relationship between park proximity, access, and PA are warranted.

Associations of objectively measured built-environment attributes with youth moderate-vigorous physical activity: a systematic review and meta-analysis

BACKGROUND

Understanding attributes of the built environment that influence children's and adolescents' habitual physical activity can inform urban design.

OBJECTIVE

To conduct a systematic review and meta-analysis of studies linking aspects of the built environment with youth moderate-vigorous activity, including walking.

DATA SOURCES

The PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using relevant key words for articles published between January 2000 and March 2013.

STUDY SELECTION

The included articles reported associations between children's or adolescents' objectively measured physical activity and residential neighbourhoods or activity settings defined with geographical information systems (GIS), street audits or global positioning systems (GPS). Excluded articles did not delineate neighbourhoods by residential address or were not written in English. Of 320 potentially relevant articles, 31 met the inclusion criteria, but only 23 (with a total of 6,175 participants, aged 8-17 years) provided sufficient data to derive effects (associations) of built-environment features on child or adolescent habitual moderate-vigorous activity.

STUDY APPRAISAL AND SYNTHESIS METHODS

Ten criteria were used to appraise the inclusion of studies. The effects were analysed as the difference in mean minutes of daily moderate-vigorous activity either between two levels of a dichotomous variable (e.g., neighbourhood park available or not within 800 m) or between predicted means corresponding to a difference of two standard deviations of a simple linear numeric variable (e.g., housing density per square kilometre). The magnitude of the difference in means was evaluated via standardization. The meta-analysis was performed with the 14 studies using GIS or street audits to relate a total of 58 specific built-environment features to daily activity. Each feature was categorized with two dichotomous variables to indicate whether the feature promoted playing and/or walking, and these variables were included in the meta-analytic model as moderators interacting with age and proportion of males in the study as linear numeric covariates.

RESULTS

The meta-analysed effects of built-environment features that encourage play (including sports and fitness) and/or walking on youth moderate-vigorous activity ranged between trivial and small. There was a moderate effect of age (15 versus 9 years) whereby play facilities, parks, playgrounds and features that facilitate walking had negative effects on children's activity but positive effects on adolescents' activity. In studies that located youth physical activity with GPS, walking to school produced small increases in activity compared with transport by car or bus, greater proportions of activity took place in streets and urban venues (40-80%) than in green spaces (20-50%), and more than half of children's outdoor activity occurred with a parent nearby.

LIMITATIONS

The meta-analysis cannot quantify the additive effect when several built-environment features are provided in a given neighbourhood.

CONCLUSIONS

Children do not benefit to the same extent as adolescents from built-environment features that encourage walking and those designed or used for neighbourhood play.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

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

OBJECTIVES

We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates.

METHODS

We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study.

RESULTS

Of 169 included articles, 89.2% reported beneficial relationships-but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (-14.2%), those examining direct measures of obesity (-6.2%), or those with an academic first author (-3.4%) were less likely to find a beneficial relationship.

CONCLUSIONS

Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.

The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example

BACKGROUND

It is rare that decisions about investing in public health interventions in a city, town or other location can be informed by research generated in that specific place. It is therefore necessary to base decisions on evidence generated elsewhere and to make inferences about the extent to which this evidence is generalisable to the place of interest. In this paper we discuss the issues involved in making such inferences, using physical activity as an example. We discuss the ways in which elements of the structural, physical, social and/or cultural environment (environmental factors [EFs]) can shape physical activity (PA) and also how EFs may influence the effectiveness of interventions that aim to promote PA. We then highlight the ways in which EFs may impact on the generalisability of different types of evidence.

DISCUSSION

We present a framework for thinking about the influence of EFs when assessing the generalisability of evidence from the location in which the evidence was generated (place A) to the location to which the evidence is to be applied (place B). The framework relates to similarities and differences between place A and place B with respect to: a) the distributions of EFs; b) the causal pathways through which EFs or interventions are thought to exert their effect on PA and c) the ways in which EFs interact with each other. We suggest, using examples, how this scheme can be used by public health professionals who are designing, executing, reporting and synthesising research on PA; or designing/implementing interventions.

SUMMARY

Our analysis and scheme, although developed for physical activity, may potentially be adapted and applied to other evidence and interventions which are likely to be sensitive to influence by elements of the structural, physical, social and/or cultural environment such as the epidemiology of obesity and healthy weight promotion.

Inequitable walking conditions among older people: examining the interrelationship of neighbourhood socio-economic status and urban form using a comparative case study

BACKGROUND

Supportive neighbourhood walking conditions are particularly important for older people as they age and who, as a group, prefer walking as a form of physical activity. Urban form and socio-economic status (SES) can influence neighbourhood walking behaviour. The objectives of this study were: a) to examine how urban form and neighbourhood SES inter-relate to affect the experiences of older people who walk in their neighbourhoods; b) to examine differences among neighbourhood stakeholder key informant perspectives on socio-political processes that shape the walkability of neighbourhood environments.

METHODS

An embedded comparative case study examined differences among four Ottawa neighbourhoods that were purposefully selected to provide contrasts on urban form (inner-urban versus suburban) and SES (higher versus lower). Qualitative data collected from 75 older walkers and 19 neighbourhood key informants, as well as quantitative indicators were compared on the two axes of urban form and SES among the four neighbourhoods.

RESULTS AND DISCUSSION

Examining the inter-relationship of neighbourhood SES and urban form characteristics on older people's walking experiences indicated that urban form differences were accentuated positively in higher SES neighbourhoods and negatively in lower SES neighbourhoods. Older people in lower SES neighbourhoods were more affected by traffic hazards and more reliant on public transit compared to their higher SES counterparts. In higher SES neighbourhoods the disadvantages of traffic in the inner-urban neighbourhood and lack of commercial destinations in the suburban neighbourhood were partially offset by other factors including neighbourhood aesthetics. Key informant descriptions of the socio-political process highlighted how lower SES neighbourhoods may face greater challenges in creating walkable places. These differences pertained to the size of neighbourhood associations, relationships with political representatives, accessing information and salient neighbourhood association issues. Findings provide evidence of inequitable walking environments.

CONCLUSION

Future research on walking must consider urban form-SES inter-relationships and further examine the equitable distribution of walking conditions as well as the socio-political processes driving these conditions. There is a need for municipal governments to monitor differences in walking conditions among higher and lower SES neighbourhoods, to be receptive to the needs of lower SES neighbourhood and to ensure that policy decisions are taken to address inequitable walking conditions.

Perceived characteristics of the neighborhood and its association with physical activity behavior and self-rated health

The aim of our study was to identify perceptions of the residential environment and their association with physical activity for specific purposes and with self-rated health in an urban context. A representative survey of inhabitants of Graz (a mid-sized Austrian city) aged 15-60 years (n=997) was conducted. We found a perceived high social-environmental quality of the residential environment to be associated with higher levels of self-rated health and leisure time physical activity. Both leisure time physical activity and satisfaction with environmental quality were independently linked with self-rated health. Furthermore, a high level of satisfaction with the individual's local infrastructure may support the residents to engage in higher levels of physical activity for transportation, whereas the preferred mode of transportation may be gender-specific: men tend to use the bicycle while women walk. Our results suggest that local infrastructure facilities should be designed so as to ensure accessibility by both walking and cycling.

Addressing pedestrian safety: a content analysis of pedestrian master plans in North Carolina

OBJECTIVE

To systematically examine the content of pedestrian master plans in North Carolina in order to assess whether and how these plans were designed to improve pedestrian safety.

METHODS

All current pedestrian master plans in North Carolina through 2008 were gathered and examined using content analysis. A safety quality index was developed to assess the thoroughness with which a plan addressed safety issues in four categories: (1) goal statement, (2) analysis of current conditions, (3) policy proposals, and (4) program proposals. Plans were also compared according to the implementation guidelines included and on the recent pedestrian accident history of the municipalities in which they were developed.

RESULTS

Forty-six plans were developed in North Carolina through 2008, either at the municipal or regional level. Almost all pedestrian master plans in North Carolina described improving safety as one of their goals. The majority attempted to do so by improving the built environment through engineering projects, including building new sidewalks, trails, or greenways and by upgrading existing facilities. Regional plans tended to propose fewer policies and programs, as well as less specific proposals, than did municipal plans. Although most plans contained multiple proposals to address pedestrian safety, few plans identified a group accountable for implementation, a timeline of implementation actions, or the resources necessary to make implementation possible. Municipalities with a recent history of pedestrian injuries were more likely to develop plans than those with fewer pedestrian injuries. Plans developed by municipalities with a recent history of pedestrian fatalities tended to more thoroughly addressed safety.

CONCLUSION

Safety was a major component of nearly every pedestrian master plan in North Carolina. Most plans contained multiple proposals to address pedestrian safety. These findings lay the foundation for future research evaluating both the implementation and the impact of these planning documents on the safety of pedestrians.

Accessibility and Urban Development: A Grid-Based Comparative Statistical Analysis of Dutch Cities

Accessibility has become a key issue in modern urban planning. This paper aims to identify the impact of differences in spatial accessibility on the development of the built environment in cities. Using a few simple accessibility indicators, it tries to map out in a quantitative way the detailed implications of accessibility conditions for built-up areas, on the basis of a 25 m × 25 m grid cell approach. The statistical tool used here is logistic regression, followed by a GIS representation of the empirical results for four Dutch cities: Amsterdam, The Hague, Rotterdam, and Utrecht.