Sharing good NEWS across the world: developing comparable scores across 12 countries for the Neighborhood Environment Walkability Scale (NEWS)

Associations between the urban neighbourhood built and social environment characteristics with physical functioning among mid- and older-aged adults: A systematic review

There is growing recognition of the association between neighbourhood factors and individuals' health. This systematic review examines the associations between urban neighbourhood built and social environment characteristics with different measures of physical functioning among mid- and older-aged adults over 45 years, focusing on cross-sectional and longitudinal study designs. It responds to the increase in publications on this topic following the COVID-19 pandemic. The systematic review included 25 studies written in English from 2018 onwards sourced from 8 databases. Studies were imported into Covidence and reviewed following the 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' (PRISMA) protocols. Findings were assessed according to 13 neighbourhood environment variables: aesthetics, crime safety, greenness and parks, land use mix and destinations, neighbourhood disadvantage, pedestrian/street infrastructure, public transport, residential density, social environment, street connectivity, traffic safety, walkability, and composite variables. Significant associations in the expected direction were found for land use mix and destinations, walkability, crime safety, greenness and parks, social environment, and neighbourhood disadvantage with physical functioning in mid- and older-aged adults. Weaker evidence of expected associations was found for residential density and aesthetics. Future research avenues on this topic include investigating built and social neighbourhood environments in diverse geographies and populations, considering housing status and length of exposure to the neighbourhood environment, using longitudinal surveys over longer time periods and objective measurements.

Exploring the nexus of urban form, transport, environment and health in large-scale urban studies: A state-of-the-art scoping review

BACKGROUND

As the world becomes increasingly urbanised, there is recognition that public and planetary health relies upon a ubiquitous transition to sustainable cities. Disentanglement of the complex pathways of urban design, environmental exposures, and health, and the magnitude of these associations, remains a challenge. A state-of-the-art account of large-scale urban health studies is required to shape future research priorities and equity- and evidence-informed policies.

OBJECTIVES

The purpose of this review was to synthesise evidence from large-scale urban studies focused on the interaction between urban form, transport, environmental exposures, and health. This review sought to determine common methodologies applied, limitations, and future opportunities for improved research practice.

METHODS

Based on a literature search, 2958 articles were reviewed that covered three themes of: urban form; urban environmental health; and urban indicators. Studies were prioritised for inclusion that analysed at least 90 cities to ensure broad geographic representation and generalisability. Of the initially identified studies, following expert consultation and exclusion criteria, 66 were included.

RESULTS

The complexity of the urban ecosystem on health was evidenced from the context dependent effects of urban form variables on environmental exposures and health. Compact city designs were generally advantageous for reducing harmful environmental exposure and promoting health, with some exceptions. Methodological heterogeneity was indicative of key urban research challenges; notable limitations included exposure and health data at varied spatial scales and resolutions, limited availability of local-level sociodemographic data, and the lack of consensus on robust methodologies that encompass best research practice.

CONCLUSION

Future urban environmental health research for evidence-informed urban planning and policies requires a multi-faceted approach. Advances in geospatial and AI-driven techniques and urban indicators offer promising developments; however, there remains a wider call for increased data availability at local-levels, transparent and robust methodologies of large-scale urban studies, and greater exploration of urban health vulnerabilities and inequities.

Short-term effects of a park-based group mobility program on increasing outdoor walking in older adults with difficulty walking outdoors: the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

We estimated the short-term effects of an educational workshop and 10-week outdoor walk group (OWG) compared to the workshop and 10 weekly reminders (WR) on increasing outdoor walking (primary outcome) and walking capacity, health-promoting behavior, and successful aging defined by engagement in meaningful activities and well-being (secondary outcomes) in older adults with difficulty walking outdoors.

METHODS

In a 4-site, parallel-group randomized controlled trial, two cohorts of community-living older adults (≥ 65 years) reporting difficulty walking outdoors participated. Following a 1-day workshop, participants were stratified and randomized to a 10-week OWG in parks or 10 telephone WR reinforcing workshop content. Masked evaluations occurred at 0, 3, and 5.5 months. We modeled minutes walked outdoors (derived from accelerometry and global positioning system data) using zero-inflated negative binomial regression with log link function, imputing for missing observations. We modeled non-imputed composite measures of walking capacity, health-promoting behavior, and successful aging using generalized linear models with general estimating equations based on a normal distribution and an unstructured correlation matrix. Analyses were adjusted for site, participation on own or with a partner, and cohort.

RESULTS

We randomized 190 people to the OWG (n = 98) and WR interventions (n = 92). At 0, 3, and 5.5 months, median outdoor walking minutes was 22.56, 13.04, and 0 in the OWG, and 24.00, 26.07, and 0 in the WR group, respectively. There was no difference between groups in change from baseline in minutes walked outdoors based on incidence rate ratio (IRR) and 95% confidence interval (CI) at 3 months (IRR = 0.74, 95% CI 0.47, 1.14) and 5.5 months (IRR = 0.77, 95% CI 0.44, 1.34). Greater 0 to 3-month change in walking capacity was observed in the OWG compared to the WR group (βz-scored difference = 0.14, 95% CI 0.02, 0.26) driven by significant improvement in walking self-efficacy; other comparisons were not significant.

CONCLUSIONS

A group, park-based OWG was not superior to WR in increasing outdoor walking activity, health-promoting behavior or successful aging in older adults with difficulty walking outdoors; however, the OWG was superior to telephone WR in improving walking capacity through an increase in walking self-efficacy. Community implementation of the OWG is discussed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Visualization analysis of research progress for walkability

The study of walkability is of great significance to the construction of healthy cities. In this paper, taking 1283 articles of walkability, which were included in Web of Science, as the research object. This paper adopts to analysis the research progress by using the method of scientometrics and knowledge networks analysis. Objectively and systematically analyze the research progress of walkability abroad from the aspects of publication overview, knowledge foundation, research direction and hot spots, etc. It is found that foreign researches on walkability mainly include three core directions: walkability and physical activity, walkability evaluation, walkability and urban design. Among them, walkability and physical activity orientation have been studied from various perspectives, such as various groups, various environmental types, different behavioral patterns and various chronic diseases. With the increasingly prominent urbanization problems and the rapid development of new technologies, multiple data, new methods and interdisciplinary cooperation will actively promote the vigorous development of walking suitability research.

Associations of the neighbourhood built and natural environment with cardiometabolic health indicators: A cross-sectional analysis of environmental moderators and behavioural mediators

BACKGROUND

Most studies examining the effects of neighbourhood urban design on cardiometabolic health focused solely on the built or natural environment. Also, they did not consider the roles of neighbourhood socio-economic status (SES) and ambient air pollution in the observed associations, and the extent to which these associations were mediated by physical activity and sedentary behaviours.

METHODS

We used data from the AusDiab3 study (N = 4141), a national cohort study of Australian adults to address the above-mentioned knowledge gaps. Spatial data were used to compute indices of neighbourhood walkability (population density, intersection density, non-commercial land use mix, commercial land use), natural environment (parkland and blue spaces) and air pollution (annual average concentrations of nitrogen dioxide (NO2) and fine particulate matter <2.5 μm in diameter (PM2.5)). Census indices were used to define neighbourhood SES. Clinical assessments collected data on adiposity, blood pressure, blood glucose and blood lipids. Generalised additive mixed models were used to estimate associations.

RESULTS

Neighbourhood walkability showed indirect beneficial associations with most indicators of cardiometabolic health via resistance training, walking and sitting for different purposes; indirect detrimental associations with the same indicators via vigorous gardening; and direct detrimental associations with blood pressure. The neighbourhood natural environment had beneficial indirect associations with most cardiometabolic health indicators via resistance training and leisure-time sitting, and beneficial direct associations with adiposity and blood lipids. Neighbourhood SES and air pollution moderated only a few associations of the neighbourhood environment with physical activity, blood lipids and blood pressure.

CONCLUSIONS

Within a low-density and low-pollution context, denser, walkable neighbourhoods with good access to nature may benefit residents' cardiometabolic health by facilitating the adoption of an active lifestyle. Possible disadvantages of living in denser neighbourhoods for older populations are having limited opportunities for gardening, higher levels of noise and less healthy dietary patterns associated with eating out.

Construct validity of the physical activity neighborhood environment scale-Oman

Aims

This study aims to examine the construct validity of Physical Activity Neighborhoods Environment Scales, Oman (PANES-O), and compare the subjective perceptions with objective measures in Muscat, the capital area of Oman.

Methods

Walkability index scores using GIS maps were calculated for 35 study areas in Muscat based on which five low and 5 high walkable study areas were randomly selected. A community survey was then conducted in November 2020 in each study area using the 16-item PANES-O instrument to measure the participants' perception of neighborhood density, land use mix, infrastructure, safety, aesthetics, and street connectivity. Due to pandemic restrictions, a social media-based purposive sampling strategy was utilized to reach community-based networks and complete digital data collection.

Results

Significant differences between the low and high walkablehigh-walkable neighborhoods were observed for 2 of 3 macroenvironment subscales, density and land use. Respondents in high walkable neighborhoods perceived their areas as having more twin villas (P = 0.001) and apartment buildings (P &lt; 0.001), greater access to destinations (like more shops, and places to go within walking distance; P &lt; 0.001), easy access to public transport (P &lt; 0.001), and more places to be active (P &lt; 0.001); than their counterparts in low walkable neighborhoods. In terms of microenvironmental attributes, respondents in high walkablehigh-walkable neighborhoods perceived their areas to have better infrastructure, better aesthetic qualities, and better social environment than their counterparts in low walkablelow-walkable neighborhoods. Significant differences in perceptions across 12 of the 16-item PANES tool confirmed that 6 of the 7 subscales were significantly sensitive to built environment attributes between the low and high walkable study areas. Respondents in high walkable neighborhoods perceived their areas as having greater access to destinations (like more shops, places to go within walking distance; P ≤ 0.001), easy access to public transport (P ≤ 0.001), more places to be active (P ≤ 0.001), better infrastructure (like more sidewalks, facilities to bicycle; P ≤ 0.001), and better aesthetic qualities (P ≤ 0.001). PANES-O also was able to rate high walkable neighborhoods to be higher in residential density and land-use mix compared to the low walkable neighborhoods demonstrating its sensitivity to the GIS maps' objective measures.

Conclusions and recommendations

These results provide preliminary strong support for the construct validity of PANES-O, suggestingconfirming that it is a promising tool for assessing macroenvironmental perceptions related to physical activity in Oman. Further research using objective measures of microenvironments and device-based physical activity scores is needed to confirm the criterion validity of the 10 micro-environmental attributes of PANES-O using objective measures for the microenvironment. PANES-O could be used to generate and develop the needed evidence on the most appropriate approaches to improving the built environment to promote physical activity and urban planning in Omanthe country.

Do neighbourhood traffic-related air pollution and socio-economic status moderate the associations of the neighbourhood physical environment with cognitive function? Findings from the AusDiab study

Characteristics of the neighbourhood environment, including the built and natural environment, area-level socio-economic status (SES) and air pollution, have been linked to cognitive health. However, most studies have focused on single neighbourhood characteristics and have not considered the extent to which the effects of environmental factors may interact. We examined the associations of measures of the neighbourhood built and natural environment, area-level SES and traffic-related air pollution (TRAP) with two cognitive function domains (memory and processing speed), and the extent to which area-level SES and TRAP moderated the associations. We used cross-sectional data from the AusDiab3 study, an Australian cohort study of adults (mean age: 61 years) in 2011-12 (N = 4141) for which geocoded residential addresses were available. Spatial data were used to create composite indices of built environment complexity (population density, intersection density, non-commercial land use mix, commercial land use) and natural environment (parkland and blue spaces). Area-level SES was obtained from national census indices and TRAP was based on estimates of annual average levels of nitrogen dioxide (NO2). Confounder-adjusted generalised additive mixed models were used to estimate the independent associations of the environmental measures with cognitive function and the moderating effects of area-level SES and TRAP. The positive associations between built environment complexity and memory were stronger in those living in areas with higher SES and lower NO2 concentrations. A positive association between the natural environment and memory was found only in those living in areas with lower NO2 concentrations and average or below-average SES. Built environment complexity and the natural environment were positively related to processing speed. Complex urban environments and access to nature may benefit cognitive health in ageing populations. For higher-order cognitive abilities, such as memory, these positive effects may be stronger in areas with lower levels of TRAP.

Perceived neighborhood environment walkability and health-related quality of life among predominantly Black and Latino adults in New York City

BACKGROUND

Measures of the built environment such as neighborhood walkability have been associated with health behaviors such as physical activity, the lack of which in turn may contribute to the development of diseases such as obesity, diabetes, cardiovascular disease, and cancer. However, limited research has examined these measures in association with health-related quality of life (HR-QoL), particularly in minoritized populations. We examined the relationship between perceived neighborhood environment and HR-QoL in a sample of mostly Black and Latino residents in New York City (NYC).

METHODS

This study utilized the baseline survey data from the Physical Activity and Redesigned Community Spaces (PARCS) Study among 1252 residents [34.6% Black, 54.1% Latino, 80.1% female, mean(±SD) age = 38.8 ± 12.5) in 54 park neighborhoods in NYC. Perceived built environment was measured using Neighborhood Environment and Walkability Survey, and mental and physical HR-QoL was estimated using Short Form (SF)-12. Using factor analysis, we identified two subscales of neighborhood walkability: enablers (e.g., trails, sidewalks, esthetics) vs. barriers (e.g., high crime and traffic). In addition, we included a third subscale on neighborhood satisfaction. Generalized Estimating Equation models adjusted for demographics and BMI and accounted for the clustering effect within neighborhood. Multiple imputation was used to account for missing data.

RESULTS

Mental HR-QoL was associated with barriers of walkability (β ± SE = - 1.63 ± 0.55, p < 0.01) and neighborhood satisfaction (β ± SE = 1.55 ± 0.66, p = 0.02), after adjusting for covariates. Physical HR-QoL was associated with only barriers of walkability (β ± SE = - 1.13 ± 0.57, p < 0.05).

CONCLUSIONS

Among NYC residents living in minoritized neighborhoods, mitigating negative aspects of the neighborhood environment may be more crucial than adding positive features in terms of HR-QoL. Our study points to the need to investigate further the role of the built environment in urban, minoritized communities.

Perceived urban environment attributes and obesity indices in adults: an 8-Nation study from Latin America

This study examines the associations between perceived urban environment attributes and obesity indices by country using data from an eight-nation study from Latin America. The data were collected from 8185 adults. The Neighbourhood Environment Walkability-abbreviated scale was used to assess perceived urban environment attributes. Obesity indices considered were body mass index, waist circumference, neck circumference, a body shape index and waist-to-height ratio. The perception of a more and better land use mix-diversity (β - 0.44; 95% CI - 0.59, - 0.28), traffic safety (- 0.39; - 0.66, - 0.12), and safety from crime (- 0.36; - 0.57, - 0.15) was associated with lower body mass index across the entire sample. Land use mix-diversity (- 1.21; - 1.60, - 0.82), street connectivity (- 0.26; - 0.37, - 0.15), and traffic safety (- 0.79; - 1.47, - 0.12) were negatively associated with waist circumference. Land use mix-diversity (- 0.11; - 0.20, - 0.03), land use mix-access (- 0.23; - 0.34, 0.12), walking/cycling facilities (- 0.22; - 0.37, - 0.08), and safety from crime (- 0.27; - 0.42, - 0.12) were negatively associated with neck circumference. No associations between perceived urban environment attributes and a body shape index were found. Land use mix-diversity (- 0.01; - 0.02, - 0.01), aesthetics (- 0.02; - 0.03, - 0.01), and safety from crime (- 0.02; - 0.04, - 0.01) were associated with waist-to-height ratio. Environmental interventions involving urban environment attributes are associated with obesity indices and, therefore, may help decrease the prevalence of overweight and obesity.

Perceived Neighborhood Safety and Active Transportation in Adults from Eight Latin American Countries

Neighborhood built environment is associated with domain-specific physical activity. However, few studies with representative samples have examined the association between perceived neighborhood safety indicators and domain-specific active transportation in Latin America. This study aimed to examine the associations of perceived neighborhood safety with domain-specific active transportation in adults from eight Latin American countries. Data were obtained from the Latin American Study of Nutrition and Health (n = 8547, aged 18-65). Active transportation (walking and cycling) was assessed using the long form of the International Physical Activity Questionnaire. Specifically, traffic density and speed as well as street lightening, visibility of residents regarding pedestrians and bicyclists, traffic lights and crosswalks, safety of public spaces during the day and at night, crime rate during the day and at night were used to evaluate perceived neighborhood safety. Slow traffic speeds, unsafe public spaces during the day, and crime during the day were associated with ≥10 min/week vs. <10 min/week of walking. Furthermore, drivers exceeding the speed limit and crime rate during the day were associated with reporting ≥10 min/week vs. <10 min/week of cycling. These results indicate a stronger association of the perceived neighborhood safety with walking compared to cycling.

Experiencing Public Spaces in Southern Chile: Analysing the Effects of the Built Environment on Walking Perceptions

In Latin American cities, the built environment is facing crucial challenges in the 21st century, not only in terms of the redesign of the physical environment, but also how to remodel public spaces as healthier places for walking and social interaction. The objective of this article is to evaluate the effects of the built environment on walking perceptions in a central neighbourhood in the intermediate city of Valdivia, Chile. The methodology integrates quantitative and qualitative methods to explore which elements of the physical built environment ease and hinder walkability. Depthmap software and Simpson's Diversity Index are used to evaluate connectivity and diversity of land uses at street level. Additionally, the People Following method and 26 walking interviews are conducted using the Natural Go-Along technique to analyse pedestrians' perceptions about their mobility environment. The results show that the factors that promote walkability mainly include streets with high connectivity values, wide pavements, diversity of greening, and facade characteristics of buildings with architectural heritage causing tranquillity, longing, and happiness. On the contrary, factors that inhibit walkability are related to poor-quality and narrow sidewalks, cars parked on sidewalks, dirty streets, and motorized traffic and vehicular noise causing negative emotions in walking perceptions such as tiredness, anger, disgust, discomfort, and insecurity, with negative effects on the well-being of residents that vary according to age and gender. Finally, recommendations are oriented to improve public spaces in central areas in southern Chile, to address moving towards more liveable and inclusive environments and support well-being through urban design in these types of context.

The neighbourhood environment and profiles of the metabolic syndrome

BACKGROUND

There is a dearth of studies on how neighbourhood environmental attributes relate to the metabolic syndrome (MetS) and profiles of MetS components. We examined the associations of interrelated aspects of the neighbourhood environment, including air pollution, with MetS status and profiles of MetS components.

METHODS

We used socio-demographic and MetS-related data from 3681 urban adults who participated in the 3rd wave of the Australian Diabetes, Obesity and Lifestyle Study. Neighbourhood environmental attributes included area socio-economic status (SES), population density, street intersection density, non-commercial land use mix, percentages of commercial land, parkland and blue space. Annual average concentrations of NO₂ and PM_2.5 were estimated using satellite-based land-use regression models. Latent class analysis (LCA) identified homogenous groups (latent classes) of participants based on MetS components data. Participants were then classified into five metabolic profiles according to their MetS-components latent class and MetS status. Generalised additive mixed models were used to estimate relationships of environmental attributes with MetS status and metabolic profiles.

RESULTS

LCA yielded three latent classes, one including only participants without MetS ("Lower probability of MetS components" profile). The other two classes/profiles, consisting of participants with and without MetS, were "Medium-to-high probability of high fasting blood glucose, waist circumference and blood pressure" and "Higher probability of MetS components". Area SES was the only significant predictor of MetS status: participants from high SES areas were less likely to have MetS. Area SES, percentage of commercial land and NO₂ were associated with the odds of membership to healthier metabolic profiles without MetS, while annual average concentration of PM_2.5 was associated with unhealthier metabolic profiles with MetS.

CONCLUSIONS

This study supports the utility of operationalising MetS as a combination of latent classes of MetS components and MetS status in studies of environmental correlates. Higher socio-economic advantage, good access to commercial services and low air pollution levels appear to independently contribute to different facets of metabolic health. Future research needs to consider conducting longitudinal studies using fine-grained environmental measures that more accurately characterise the neighbourhood environment in relation to behaviours or other mechanisms related to MetS and its components.

The relationship between perceived built environment and cycling or e-biking for transport among older adults–a cross-sectional study

The built environment plays a key role in promoting active mobility for healthy aging. Encouraging active mobility among older adults, however, can be especially challenging in more rural areas where distances tend to be longer and infrastructure is favoring car traffic. The association of older adults’ perception of attributes of the built environment with cycling and e-biking for transport was investigated. The potential moderating effects of age, sex, and mobility impairments were explored. A cross-sectional survey was conducted in towns and communities of <100,000 inhabitants, including 2,144 participants (mean age: 74; 53% men). Three different cycling outcomes (any cycling/e-biking, frequency (≥3 days/week) and amount (minutes/week)) were analyzed among all cyclists and e-bike users separately, resulting in six dependent variables. The impact of ten environmental attributes on these outcomes was analyzed in separate models. Overall, street connectivity, and the proximity and number of destinations were most important. Only street connectivity and traffic safety were related to minutes cycling or e-biking per week. Cycling amount was higher overall for e-biking but fewer environmental attributes showed an association compared to any cycling, regardless of bicycle type. Traffic safety was not associated with four out of the six cycling outcomes and was inversely associated with minutes cycling or e-biking. Density was not related to any of the variables investigated. Several interaction effects of sex, age, and mobility impairments were found. Further research is needed on environmental attributes influencing e-bike use, the most important types of destinations, and a more differentiated assessment of perceived traffic safety in older adults.

Perceived Urban Environment Attributes and Device-Measured Physical Activity in Latin America: An 8-Nation Study

INTRODUCTION

Attributes of the neighborhood-built environment are associated with self-reported physical activity, but only a few studies have concentrated on device-measured physical activity in Latin America. This study examines the associations of perceived neighborhood-built environment attributes, device-measured sedentary time, and light-intensity and moderate-to-vigorous physical activity in adults from 8 Latin American countries.

METHODS

Data from Estudio Latinoamericano de Nutrición y Salud adult study, an observational multicountry study (N=2,478), were analyzed in 2020. Data were collected between 2014 and 2015. Perceived neighborhood-built environment attributes were measured using the Neighbourhood Environment Walkability Survey. Sedentary time, light-intensity physical activity, and moderate-to-vigorous physical activity data were collected using accelerometers.

RESULTS

No associations between perceived neighborhood-built environment attributes and sedentary time were found. Positive perceptions of walking/cycling facilities (β=6.50, 95% CI=2.12, 10.39) were associated with more light-intensity physical activity. Perceptions of better aesthetics (Argentina) and better walking/cycling facilities (Brazil and Ecuador) were positively associated with light-intensity physical activity. Land use mix-diversity (β=0.14, 95% CI=0.03, 0.25), walking/cycling facilities (β=0.16, 95% CI=0.05, 0.27), aesthetics (β=0.16, 95% CI=0.02, 0.30), and safety from traffic (β=0.18, 95% CI=0.05, 0.24) were positively associated with moderate-to-vigorous physical activity. Land use mix-diversity, street connectivity, and safety from traffic were positively associated with moderate-to-vigorous physical activity in Venezuela.

CONCLUSIONS

These findings have implications for policy recommendations, which can guide policies to promote physical activity in the region. Land use mix-diversity, walking/cycling facilities, aesthetics, and safety from traffic can maintain or increase the levels of light-intensity and moderate-to-vigorous physical activity among Latin American adults.

Destinations fostering older adults' walking for transport: a cross-sectional study from Germany

Background

Having destinations within walking distance can encourage older people to walk. Yet, not all destinations may be equally important. Little is known about the types of destinations fostering older adults’ walking for transport in small and medium-sized towns and rural communities. The aim of this study was to explore the associations between the availability of different destinations and walking for transport among older adults living in communities with less than 100,000 inhabitants.

Methods

Between May and September 2019, self-reported data from 2242 older adults (≥ 65 years) living in the Metropolitan Region Northwest (Germany) were collected within the project AFOOT – Securing urban mobility of an aging population. Data from 2137 study participants were eligible for this analysis. Logistic regression models were used to investigate the relationship between the perceived destination availability of 19 different destinations within a 20-min or 10-min walk from home, respectively, and the engagement in walking for transport. Crude and adjusted models were run separately for each destination and distance category. Exploratory subgroup analyses examined the associations between the availability of destinations within a 20-min walk from home and walking for transport stratified by gender, use of a walking aid, and car availability.

Results

The availability of each of the investigated destinations within a 20-min walk and of nearly all of these destinations within a 10-min walk from home was significantly positively associated with walking for transport in crude models. Most associations remained significant after adjustment for covariates. The strongest associations were found for the availability of small stores, pharmacy, and bakery. The availability of a bus stop showed the weakest associations and was not significantly associated with walking for transport after adjustment for covariates.

Conclusions

The provision of local amenities within walking distance may be a promising approach to foster older adults’ walking for transport in smaller communities with less than 100,000 inhabitants and to enable active and healthy aging in place. Further quantitative and qualitative research is needed to validate these findings and to better understand older adults’ walking behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02896-w.

Examining multilevel neighborhood socioeconomic characteristics associated with colorectal cancer screening in Vietnamese Americans residing in Philadelphia County

Colorectal cancer (CRC) is one of the most predominant cancers in the USA and ranks third among all cancers in incidence and mortality. Vietnamese Americans exhibit persistently lower screening rates compared to the general U.S. population, due to cultural, economic, and environmental barriers. The impact of environmental factors in particular is not well known, and lack of geographical access may be a significant barrier to accessing screening. This study aims to elucidate build and neighborhood environmental factors affecting CRC screening rates among Vietnamese Americans. A total of 517 Vietnamese Americans 50 years and older residing in Philadelphia County were included in the study. Surveys were collected to determine CRC screening behavior and sociodemographic characteristics. Individual neighborhood characteristics, which included the Walk Score, was obtained based on the participant's address. Neighborhood characteristics were calculated using census-tract level data for the social deprivation index, ethnic composition, and presence of hospitals or federally qualified health centers (FQHC). The generalized linear mixed model revealed that residing in an ethnically dense neighborhood was negatively associated with CRC screening (β = -0.67, SE = 0.29, p = .01), while social deprivation (β = 0.30, SE = 0.27, p = .27) and presence of FQHCs or hospitals (β = 0.16, SE = 0.30, p = .58) were not. Individual neighborhood characteristics including the Walk Score (β = 0.21, SE = 0.26, p = .43) was not associated with CRC screening behavior. Neighborhood characteristics, specifically ethnic density is associated with lower uptake of screening in this population. Future interventions should aim to target specific Vietnamese American and other Asian ethnic neighborhoods that may experience disparities in screening.

From urban neighbourhood environments to cognitive health: a cross-sectional analysis of the role of physical activity and sedentary behaviours

BACKGROUND

There is a dearth of studies on the effects of the neighbourhood environment on adults' cognitive function. We examined how interrelated aspects of the built and natural neighbourhood environment, including air pollution, correlate with adults' cognitive function, and the roles of physical activity and sedentary behaviours in these associations.

METHODS

We used data from 4,141 adult urban dwellers who participated in the Australian Diabetes, Obesity and Lifestyle 3 study on socio-demographic characteristics, neighbourhood self-selection, physical activity and sedentary behaviours, and cognitive function. Neighbourhood environmental characteristics included population density, intersection density, non-commercial land use mix, and percentages of commercial land, parkland and blue space, all within 1 km residential buffers. We also calculated annual mean concentrations of NO2 and PM2.5. Generalised additive mixed models informed by directed acyclic graphs were used to estimate the total, direct and indirect effects of environmental attributes on cognitive functions and the joint-significance test was used to examine indirect effects via behaviours.

RESULTS

In the total effects models, population density and percentage of parkland were positively associated with cognitive function. A positive association of PM2.5 with memory was also observed. All neighbourhood environmental attributes were directly and/or indirectly related to cognitive functions via other environmental attributes and/or physical activity but not sedentary behaviours. Engagement in transportation walking and gardening frequency partially mediated the positive effects of the neighbourhood environment on cognitive function, while frequency of transportation walking mediated the negative effects.

CONCLUSIONS

In the context of a low-density country like Australia, denser urban environments with access to parkland may benefit residents' cognitive health by providing opportunities for participation in a diversity of activities. A more fine-grained characterisation of the neighbourhood environment may be necessary to tease out the negative and positive impacts of inter-related characteristics of urban neighbourhood environments on cognitive function.

Adaptation of the Physical Activity Neighborhood Environment Scale in Oman

OBJECTIVES

This study aimed to adapt the Physical Activity Neighborhood Environment Scale (PANES), which is a 17-item tool for assessing environmental factors relevant for walking and bicycling in the community, to the Omani context.

METHODS

The adaptation process was conducted in three steps: (1) revision by local experts, (2) Arabic translation and cognitive testing and (3) test-retest reliability testing with a sample of 33 Omani women and men, between September 2016 and August 2017.

RESULTS

Four of the 17 items of the PANES were modified and one was removed, resulting in a 16-item PANES, Oman (PANES-O) questionnaire. The test-retest reliability scores ranged from 0.436-1.000; scores for more than half (n = 9) were almost perfect (0.8-1.0), demonstrating a good level of consistency and good psychometric performance similar to other studies.

CONCLUSION

The PANES-O demonstrated good test-retest reliability and appears to be a promising tool for assessing environmental perceptions related to physical activity in Oman. However, construct validity should be confirmed before wider use.

Adolescent's movement behaviors and built environment: a latent class analysis

BACKGROUND

Latent class analysis (LCA) is an alternative and innovative approach to verify the relation of the various combinations of the constructed environment and movement behavior (levels of physical activity, sedentary behavior, and sleep) characteristics. This study aimed to identify latent classes based on the characteristics of the neighborhood environment perceived by adolescents and their association with gender, socioeconomic status (SS), body composition and movement behaviors.

METHODS

This cross-sectional study includes 309 Brazilian adolescents (14 to 16 years old, 57% female). The characteristics of the neighborhood environment perceived were analyzed by the Neighborhood Walkability for Youth Scale. Accelerometers were used for a week to evaluate the movement behaviors. Questionnaires assessed the screen times, total sitting time (TST), and sociodemographic characteristics. LCA was used for modeling the "Perceived Enviroment" variable, having been conducted in the poLCA (Polychromous Variable Latent Class Analysis) package of the R statistical software.

RESULTS

Three classes were recognized: class 1, "Best Perceived Environment" with 23.03% of adolescents; class 2, "Moderate Perceived Environment", 63.33%; and class 3, "Worst Perceived Environment", 13.67%. Light physical activity (LPA), TST, and SS were associated with class prevalence. The adolescents with medium and low SS were, respectively, 3.42 (95% CI 1.62-7.21) and 4.18 (95% CI 1.66-10.50) more likely to belong to class 2, and those with low SS were 5.21 (95% CI 1.35-20.13) more likely to belong to class 3. Class 1 adolescents were associated with a lower chance (OR: 0.09, 95% CI 0.02-0.55) of involvement in 'adequate LPA time' compared to class 3. Class 1 adolescents were associated with a lower chance (OR: 0.31, 95% CI 0.12-0.79) of involvement in 'adequate TST' compared to class 2. There was a difference between the LPA and TST classes; class 3 presented a longer time in LPA than class 1; class 1 had higher TST than the other classes.

CONCLUSION

The findings highlight the influence of neighborhood classes on adolescents' LPA and TST.

Development of Measures of Perceived Neighborhood Environmental Attributes Influencing, and Perceived Barriers to Engagement in, Healthy Behaviors for Older Chinese Immigrants to Australia

Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants to Australia and similar Western countries. Older Chinese immigrants living in Melbourne (Australia) were recruited from neighborhoods varying in walkability and percentage of Chinese residents. Versions of the Neighborhood Environment for Healthy Aging–Chinese Immigrants to Australia (NEHA-CIA) questionnaire (20 subscales) and the Perceived Barriers to Health-Enhancing Behaviors questionnaire (four subscales) were developed from extant validated scales and information collected in formative qualitative research. Thirty-one participants took part in cognitive interviews aimed to pilot-test and refine the questionnaires. The modified questionnaires were administered to 52 participants twice, two weeks apart. Test-retest reliability (intraclass correlation coefficients), internal consistency (Cronbach’s α), and construct validity (associations with theoretically-relevant constructs) were examined. Most items and subscales of both questionnaires had good test-retest reliability and internal consistency, while the NEHA-CIA also showed good construct validity. Future studies need to further examine the construct validity of the questionnaire of perceived barriers and determine the factorial validity of both measures on large representative samples.

Neighborhood walkability, physical activity and changes in glycemic markers in people with type 2 diabetes: The Hoorn Diabetes Care System cohort

Studies investigating neighborhood walkability and physical activity in people with type 2 diabetes (T2D) mainly used self-report measures, and only few studies assessed the association with glycemic control. This study assessed the associations between objectively measured (i.e. GIS based) and subjectively measured (i.e. questionnaire-based) neighborhood walkability and changes in glycemic markers in people with T2D, and whether this association was mediated by device-measured physical activity (PA), in the Diabetes Care System Cohort (n = 1230). Neither objective or subjectively measured walkability was associated with glycemic control. In mediation analyses we observed no overall mediation by PA.

Adaptation and evaluation of the neighborhood environment walkability scale for youth for Chinese children (NEWS-CC)

Background

The physical activity-environment relationship has been infrequently investigated in Chinese children. Reliable and valid environmental measures specific to the age group and the local context are crucial for better understanding this relationship. The purposes of this study were to adapt the Neighborhood Environment Walkability Scale for youth (NEWS-Y) for Chinese children (termed NEWS-CC), and to examine the reliability and factorial validity of the NEWS-CC.

Methods

The development of the NEWS-CC involved the translation of the NEWS-Y to Chinese and the addition of nine new items capturing Hong Kong specific environmental attributes which were generated in our previous study. A total of 953 Hong Kong children aged 9–14 years volunteered to complete the NEWS-CC twice with 7–14 days apart. Confirmatory factor analysis (CFA) was performed to examine the factorial validity of the NEWS-CC. Test-retest reliability of subscales and individual items in the NEWS-CC was examined by intraclass correlation coefficients (ICCs).

Results

The CFA identified a 7-factor measurement model for the NEWS-CC which fitted the data well, with an additional “pollution” factor not included in the original NEWS-Y. The final NEWS-CC consisted of 67 items in 10 subscales. The test-retest reliability of subscales (range of ICC = 0.47–0.86) and individual items (range of ICC = 0.41–0.79) in the final NEWS-CC was moderate to good.

Conclusion

The results of this study support the psychometric properties of the NEWS-CC. The NEWS-CC can be used to assess physical activity-related neighborhood environment among children in Hong Kong, as well as cities that share similar urban forms with Hong Kong.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10530-4.

Perceived Neighborhood Crime Safety Moderates the Association Between Racial Discrimination Stress and Chronic Health Conditions Among Hispanic/Latino Adults

Background: Little is known about the link between perceived neighborhood walkability and prevalence of chronic disease. Even less is known regarding this association among Hispanic/Latino adults, despite exhibiting high rates of chronic diseases. Stress due to racial discrimination is a harmful social determinant of health in Hispanics/Latinos. Having both low perceived neighborhood walkability and high racial discrimination stress may exacerbate the chronic disease status of Hispanics/Latinos. Among a U.S. national sample of Hispanic/Latino adults, this cross-sectional study aims to examine (1) the associations among overall perceived neighborhood walkability, racial discrimination stress, and having a chronic health condition; and (2) whether overall perceived neighborhood walkability moderates the hypothesized association between racial discrimination stress and having a chronic health condition. Methods: In January 2018, 798 Hispanic/Latino adults (M age = 39.7 years, SD = 15.1; 58.6% female; 70.0% U.S. born; 52.0% Mexican/Mexican American) responded to a survey via Qualtrics Panels. Surveys included the Neighborhood Environment Walkability Scale-Abbreviated, Hispanic Stress Inventory-2, and self-reported presence/absence of chronic health conditions (e.g., hypertension, heart disease). A logistic regression was conducted testing for the moderation of the main effect of racial discrimination stress on the presence of a chronic health condition by overall perceived neighborhood walkability. Results: After controlling for age, body mass index, and income, racial discrimination stress was inversely associated with overall perceived neighborhood walkability (b = -0.18, p < 0.001) and positively associated with having a chronic health condition (OR = 1.02; 95% CI [1.00, 1.03]). While overall perceived neighborhood walkability was not associated with having a chronic health condition, perceived crime safety was inversely associated with having a chronic health condition (OR = 0.94; 95% CI [0.89, 0.99]). Perceived crime safety moderated the positive association between discrimination stress and having a chronic health condition, such that the association was only significant among those who perceived their neighborhood to be less safe (β = -0.004, 95% CI [-0.01, -0.00]). Conclusions: Overall perceived neighborhood walkability was inversely associated with racial discrimination stress, but not associated with having a chronic health condition. Perceived neighborhood crime safety, but not infrastructure or aesthetics, matters when it comes to the link between racial discrimination stress and having a chronic health condition among Hispanics/Latinos.

Why Do Students Walk or Cycle for Transportation? Perceived Study Environment and Psychological Determinants as Predictors of Active Transportation by University Students

University students are particularly at risk to suffer from physical and psychological complaints and for not fulfilling health-oriented physical activity (PA) recommendations. Since PA is linked with various benefits for health and educational outcomes, the group of students is of particular interest for PA promotion. Although active commuting has been identified as a relevant domain of PA in order to gain the various benefits of PA, little knowledge is available with respect to university students. This study tested conditions in the study environment, as well as personal motivators and barriers, as determinants for the active transportation of university students. Using a cross-sectional convenience sample of a university in the southwest of Germany (n = 997), we applied factor analyses to bundle relevant information on environmental and psychological determinants (adapted NEWS-G; adapted transport-related items from an Australian university survey) and blockwise hierarchical regressions. The objective was to analyze associations between the bundled determinants and self-reports on PA for transport-related walking and cycling (measured by the EHIS-PAQ). Results revealed associations between transport-related cycling and the perceived study environment (e.g., high automobile traffic) as well as certain personal motivators and barriers (e.g., time effort or weather conditions). The study contributes to the knowledge about determinants that are important for the development and improvement of public health interventions for students in a university setting.

Time Distances to Residential Food Amenities and Daily Walking Duration: A Cross-Sectional Study in Two Low Tier Chinese Cities

Recent studies indicate the accepted concept of using land-use mix (LUM) to promote physical activity is ineffective and even counteractive in the Chinese context. Before considering LUM as a whole, different amenity types need to be respectively analyzed in relation to various functions and demands. This study aims to examine the specific associations between food-related amenities and perceived daily walking duration (WD) in small Chinese cities. Two interviewer-administered questionnaire surveys (n = 354) were conducted in Yuncheng and Suihua between 2017 and 2018. Logistic regression models were used to examine the associations of WD with seven different categories of food outlet at three levels of walking distance. The associations were further explored by food environment diversity and through two age groups. With the exception of café/tea house, the other six food outlets were positively associated with WD. After adjusting for socioeconomic variables, the associations of grocery store and supermarket weakened. Higher levels of food environment diversity were associated with a longer WD. Among the age groups, food outlets were more associated with older adults’ WD. This novel quantitative study suggests that increasing the number and heterogeneity of food-related amenities (including mobile street vendors) within a neighborhood can enhance physical activity in small Chinese cities.

Walking for Transport among Older Adults: A Cross-Sectional Study on the Role of the Built Environment in Less Densely Populated Areas in Northern Germany

In the last decades, there has been rising interest in public health research in the importance of the built environment for a healthy and active life in old age, but little attention has been paid to less densely populated areas. This study aimed to explore the impact of the built environment on walking for transport in the context of an older population living in communities of <100,000 inhabitants. Within the project AFOOT–Securing urban mobility of an aging population, a cross-sectional postal survey was carried out from May to September 2019 in older adults (≥65 years) in the Metropolitan Region Northwest, Germany. Self-reported data from 2189 study participants were analyzed. Logistic and linear regression models were used to examine the associations between the built environment and walking for transport. Any walking and frequent walking were positively associated with nearly all built environment attributes, even after adjustment for demographic and health covariates. The amount of walking in minutes per week was associated only with residential density. Moderating effects of gender, age, and use of walking aids were identified. Improving the built environment appears to be a promising opportunity to motivate and enable older adults to walk for transport.

Objective and subjective measures of the neighbourhood environment: Associations with frailty levels

OBJECTIVES

The aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults.

METHODS

A cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents' perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty.

RESULTS

Frail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables.

DISCUSSION

Neighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.

Do physical activity and sedentary time mediate the association of the perceived environment with BMI? The IPEN adult study

The study's main aim was to examine whether adults' accelerometer-based physical activity and sedentary time mediated the associations of neighbourhood physical environmental perceptions with body mass index (BMI) and weight status across 10 high- and middle-income countries. Data from the IPEN Adult study, an observational multi-country study (n = 5712) were used. Results showed that sedentary time was a non-significant or inconsistent mediator in all models. MVPA mediated the associations of street connectivity, land use mix-diversity, infrastructure/safety for walking and aesthetics with BMI in single models. In the multiple model, MVPA only fully mediated the relation between land use mix-diversity and BMI. This finding was replicated in the models with weight status as outcome. MVPA partially mediated associations of composite environmental variables with weight status. So, although MVPA mediated some associations, future comprehensive studies are needed to determine other mechanisms that could explain the relation between the physical environment and weight outcomes. Food intake, food accessibility and the home environment may be important variables to consider. Based on the consistency of results across study sites, global advocacy for policies supporting more walkable neighbourhoods should seek to optimize land-use-mix when designing and re-designing cities or towns.

Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial

BACKGROUND

Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking.

OBJECTIVE

The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA).

METHODS

For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months.

RESULTS

No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day.

CONCLUSIONS

No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-018-5658-4.

Built Environment, Physical Activity, and Obesity: Findings from the International Physical Activity and Environment Network (IPEN) Adult Study

Creating more physical activity-supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weight status in 12 countries on 5 continents (n > 14,000). This article presents reanalyzed data from eight primary papers to identify patterns of findings across studies. Neighborhood environment attributes, whether measured objectively or by self-report, were strongly related to all physical activity outcomes (accelerometer-assessed total physical activity, reported walking for transport and leisure) and meaningfully related to overweight/obesity. Multivariable indexes of built environment variables were more strongly related to most outcomes than were single-environment variables. Designing activity-supportive built environments should be a higher international health priority. Results provide evidence in support of global initiatives to increase physical activity and control noncommunicable diseases while achieving sustainable development goals.

International Mind, Activities and Urban Places (iMAP) study: methods of a cohort study on environmental and lifestyle influences on brain and cognitive health

INTRODUCTION

Numerous studies have found associations between characteristics of urban environments and risk factors for dementia and cognitive decline, such as physical inactivity and obesity. However, the contribution of urban environments to brain and cognitive health has been seldom examined directly. This cohort study investigates the extent to which and how a wide range of characteristics of urban environments influence brain and cognitive health via lifestyle behaviours in mid-aged and older adults in three cities across three continents.

METHODS AND ANALYSIS

Participants aged 50-79 years and living in preselected areas stratified by walkability, air pollution and socioeconomic status are being recruited in Melbourne (Australia), Barcelona (Spain) and Hong Kong (China) (n=1800 total; 600 per site). Two assessments taken 24 months apart will capture changes in brain and cognitive health. Cognitive function is gauged with a battery of eight standardised tests. Brain health is assessed using MRI scans in a subset of participants. Information on participants' visited locations is collected via an interactive web-based mapping application and smartphone geolocation data. Environmental characteristics of visited locations, including the built and natural environments and their by-products (e.g., air pollution), are assessed using geographical information systems, online environmental audits and self-reports. Data on travel and lifestyle behaviours (e.g., physical and social activities) and participants' characteristics (e.g., sociodemographics) are collected using objective and/or self-report measures.

ETHICS AND DISSEMINATION

The study has been approved by the Human Research Ethics Committee of the Australian Catholic University, the Institutional Review Board of the University of Hong Kong and the Parc de Salut Mar Clinical Research Ethics Committee of the Government of Catalonia. Results will be communicated through standard scientific channels. Methods will be made freely available via a study-dedicated website.

TRIAL REGISTRATION NUMBER

ACTRN12619000817145.

Development and validation of the neighborhood environment walkability scale for youth across six continents

BACKGROUND

The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents' physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability.

METHODS

Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status.

RESULTS

Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity.

CONCLUSIONS

A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Neighbourhood built environment and physical function among mid-to-older aged adults: A systematic review

This systematic review included 23 quantitative studies that estimated associations between aspects of the neighbourhood built environment and physical function among adults aged ≥45 years. Findings were analysed according to nine aspects of the neighbourhood built environment: walkability, residential density, street connectivity, land use mix, public transport, pedestrian infrastructure, aesthetics, safety and traffic. Evidence was found for a positive association of pedestrian infrastructure and aesthetics with physical function, while weaker evidence was found for land use mix, and safety from crime and traffic. There was an insufficient number of studies for walkability, residential density, street connectivity and access to public transport.

Test-Retest Reliability and Walk Score® Neighbourhood Walkability Comparison of an Online Perceived Neighbourhood-Specific Adaptation of the International Physical Activity Questionnaire (IPAQ)

There is a growing public health interest in the contributions of the built environment in enabling and supporting physical activity. However, few tools measuring neighbourhood-specific physical activity exist. This study assessed the reliability of an established physical activity tool (International Physical Activity Questionnaire: IPAQ) adapted to capture perceived neighbourhood-specific physical activity (N-IPAQ) administered via the internet and compared N-IPAQ outcomes to differences in neighbourhood Walk Score^®. A sample of n = 261 adults completed an online questionnaire on two occasions at least seven days apart. Questionnaire items captured walking, cycling, moderate-intensity, and vigorous-intensity physical activity, undertaken inside the participant's perceived neighbourhood in the past week. Intraclass correlations, Spearman's rank correlation, and Cohen's Kappa coefficients estimated item test-retest reliability. Regression estimated the associations between self-reported perceived neighbourhood-specific physical activity and Walk Score^®. With the exception of moderate physical activity duration, participation and duration for all physical activities demonstrated moderate reliability. Transportation walking participation and duration was higher (p < 0.05) in more walkable neighbourhoods. The N-IPAQ administered online found differences in neighbourhoods that vary in their walkability. Future studies investigating built environments and self-reported physical activity may consider using the online version of the N-IPAQ.

A theory-based, task-oriented, outdoor walking programme for older adults with difficulty walking outdoors: protocol for the Getting Older Adults Outdoors (GO-OUT) randomised controlled trial

INTRODUCTION

A theory-based, task-oriented, community walking programme can increase outdoor walking activity among older adults to optimise functional independence, social participation and well-being. The study objective is to determine if there is a difference in the change in outdoor walking activity from baseline to 10 weeks, 5.5 months and 12 months after receiving a 1-day interactive workshop and outdoor walking programme (Getting Older Adults Outdoors (GO-OUT)) compared with the workshop and weekly reminders (WR) in older adults with difficulty walking outdoors.

METHODS AND ANALYSIS

A randomised controlled trial is being conducted in four urban Canadian communities. We will stratify 240 individuals by site and participant type (ie, individual vs spousal/friend pair) and randomise to either the GO-OUT or WR intervention. The GO-OUT intervention involves a 1-day workshop, where participants complete eight interactive stations to build knowledge and skills to walk outside, followed by a 10-week group outdoor walking programme (two 1-hour sessions/week) led by a physiotherapist or kinesiologist in parks. The WR intervention consists of the same workshop and 10 weekly telephone reminders to facilitate outdoor walking. The primary outcome measure is mean outdoor walking time in minutes/week derived from accelerometry and global positioning system data. GO-OUT is powered to detect an effect size of 0.4, given α=0.05, β=0.20, equal number of participants/group and a 20% attrition rate. Secondary outcomes include physical activity, lifespace mobility, participation, health-related quality of life, balance, leg strength, walking self-efficacy, walking speed, walking distance/endurance and mood.

ETHICS AND DISSEMINATION

GO-OUT has received ethics approval at all sites. A Data Safety Monitoring Board will monitor adverse events. We will disseminate findings through lay summaries, conference presentations and journal articles.

TRIAL REGISTRATION NUMBER

NCT03292510 (Pre-results).

Associations of socio-demographic, perceived environmental, social and psychological factors with active travel in Hong Kong adolescents: the iHealt(H) cross-sectional study

Adolescent active travel (AT) can contribute to health-enhancing physical activity, sense of community, social interactions, spatial and navigational skills and is a sustainable form of transport. Data analysed were from surveys with validated scales, translated and adapted for Chinese speaking Hong Kong adolescents and their parents, and administered to 1,299 adolescent/parent dyads. Using hierarchical modelling, this study examined independent associations of socio-demographic, perceived environmental, social and psychological factors (in that order) with adolescent AT to/from school (ATS) and AT to other destinations in Hong Kong. Moderation by gender and age on perceived environmental and social factors and number of household vehicles on proximity to destinations with AT were also estimated. The adolescents participating in ATS (58%), averaged 7.93 trips and 139.79 min per week. Adolescents averaged 7.68 trips/week to destinations other than school. Perceived proximity of school to home and social support for PA from peers were independently associated with higher odds of engaging in ATS. Social support for PA from household adults was associated with lower odds of engaging in ATS, especially in older adolescents. Trip frequency in those who engaged in ATS was positively associated with perceived proximity of school, access to services and parental transport-related PA. Perceived proximity of school was negatively associated with weekly minutes of ATS. Gender modified the association between social support for PA from peers and ATS frequency, and that of perceived proximity to public transport from home with weekly minutes of ATS. Perceived environmental, social and psychological factors were independently associated with AT to destinations other than school. In conclusion, Hong Kong adolescents appear to have high frequencies of ATS and AT to other destinations than reported elsewhere. Social support from peers, parental AT and having schools and other destinations within walking distance from home may independently contribute to adolescents' AT.

Factorial Invariance of the Abbreviated Neighborhood Environment Walkability Scale among Senior Women in the Nurses' Health Study Cohort

The purpose of this study was to examine the factorial invariance of the Abbreviated Neighborhood Environment Walkability Scale (NEWS-A) across subgroups based on demographic, health-related, behavioral, and environmental characteristics among Nurses' Health Study participants (N = 2,919; age M = 73.0, SD = 6.9 years) living in California, Massachusetts, and Pennsylvania. A series of multi-group confirmatory factor analyses were conducted to evaluate increasingly restrictive hypotheses of factorial invariance. Factorial invariance was supported across age, walking limitations, and neighborhood walking. Only partial scalar invariance was supported across state residence and neighborhood population density. This evidence provides support for using the NEWS-A with older women of different ages, who have different degrees of walking limitations, and who engage in different amounts of neighborhood walking. Partial scalar invariance suggests that researchers should be cautious when using the NEWS-A to compare older adults living in different states and neighborhoods with different levels of population density.

Associations of neighborhood environmental attributes with adults' objectively-assessed sedentary time: IPEN adult multi-country study

Neighborhood environmental attributes have been found to be associated with residents' time spent walking and in physical activity, in studies from single countries and in multiple-country investigations. There are, however, mixed findings on such environmental relationships with sedentary (sitting) time, which primarily have used evidence derived from single-country investigations with self-reported behavioral outcome measures. We examined potential relationships of neighborhood environmental attributes with objectively-assessed sedentary time using data from 5712 adults recruited from higher and lower socio-economic status neighborhoods in 12 sites in 10 countries, between 2002 and 2011. Ten perceived neighborhood attributes, derived from an internationally-validated scale, were assessed by questionnaire. Sedentary time was derived from hip-worn accelerometer data. Associations of individual environmental attributes and a composite environmental index with sedentary time were estimated using generalized additive mixed models. In fully adjusted models, higher street connectivity was significantly related to lower sedentary time. Residential density, pedestrian infrastructure and safety, and lack of barriers to walking were related to higher sedentary time. Aesthetics and safety from crime were related to less sedentary time in women only. The predicted difference in sedentary time between those with the minimum versus maximum composite environmental index values was 71 min/day. Overall, certain built environment attributes, including street connectivity, land use mix and aesthetics were found to be related to sedentary behavior in both expected and unexpected directions. Further research using context-specific measures of sedentary time is required to improve understanding of the potential role of built environment characteristics as influences on adults' sedentary behavior.

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.

The Smart City Active Mobile Phone Intervention (SCAMPI) study to promote physical activity through active transportation in healthy adults: a study protocol for a randomised controlled trial

Background

The global pandemic of physical inactivity represents a considerable public health challenge. Active transportation (i.e., walking or cycling for transport) can contribute to greater total physical activity levels. Mobile phone-based programs can promote behaviour change, but no study has evaluated whether such a program can promote active transportation in adults. This study protocol presents the design and methodology of The Smart City Active Mobile Phone Intervention (SCAMPI), a randomised controlled trial to promote active transportation via a smartphone application (app) with the aim to increase physical activity.

Methods/design

A two-arm parallel randomised controlled trial will be conducted in Stockholm County, Sweden. Two hundred fifty adults aged 20–65 years will be randomised to either monitoring of active transport via the TRavelVU app (control), or to a 3-month evidence-based behaviour change program to promote active transport and monitoring of active travel via the TRavelVU Plus app (intervention). The primary outcome is moderate-to-vigorous intensity physical activity (MVPA in minutes/day) (ActiGraph wGT3x-BT) measured post intervention. Secondary outcomes include: time spent in active transportation measured via the TRavelVU app, perceptions about active transportation (the Transport and Physical Activity Questionnaire (TPAQ)) and health related quality of life (RAND-36). Assessments are conducted at baseline, after the completed intervention (after 3 months) and 6 months post randomisation.

Discussion

SCAMPI will determine the effectiveness of a smartphone app to promote active transportation and physical activity in an adult population. If effective, the app has potential to be a low-cost intervention that can be delivered at scale.

Trial registration

ClinicalTrials.gov NCT03086837; 22 March, 2017.

Objectively-assessed neighbourhood destination accessibility and physical activity in adults from 10 countries: An analysis of moderators and perceptions as mediators

RATIONALE

Residents of neighbourhoods with high destination accessibility (higher population density, more-interconnected streets, and better access to services, public transport and parks) are more physically active. Evidence on the factors that underlie these associations is sparse and inconsistent.

OBJECTIVE

We examined (1) five socio-demographic and four non-destination perceived neighbourhood attributes as moderators of the relationship between objectively-assessed destination accessibility and moderate-to-vigorous physical activity (MVPA); (2) perceived indicators of destination accessibility as mediators of those relationships; and, (3) the generalizability of findings across 14 cities.

METHODS

Data were from the International Physical Activity and Environment Network (IPEN) Adult study (N = 6822), which provided comparable objective and perceived environmental variables and accelerometer-based MVPA from 14 cities across 10 countries. Mediation and mediation moderation analyses were performed.

RESULTS

Objective net residential density, public transport density, and number of parks in the neighbourhood were consistently associated with MVPA across all examined socio-demographic groups and non-destination perceived neighbourhood characteristics. However, only the association between number of parks and MVPA was mediated by its conceptually-comparable perceived indicator. While the associations of objective intersection density and land use mix with MVPA were moderated by both gender and perceived pedestrian infrastructure/safety, only the latter moderating effects were mediated by the conceptually-comparable perceived indicators. Perceived neighbourhood safety and/or aesthetics moderated the associations of objective ratio of retail/civic land to total area and distance to nearest transport stop with MVPA. These associations were not mediated by the conceptually-comparable perceived indicators.

CONCLUSION

Densely populated neighbourhoods with access to public transport and parks have the potential to significantly and equitably contribute to adults' MVPA on a global scale. Perceived neighbourhood aesthetics, pedestrian-friendliness and safety can magnify the positive effects of mixed-use neighbourhoods on residents' MVPA by interacting with the perceived ease of access to a variety of destinations.

Associations of the perceived and objective neighborhood environment with physical activity and sedentary time in New Zealand adolescents

Background

There is accumulating evidence supporting the association between neighborhood built environments and adults’ physical activity (PA) and sedentary time (ST); however, few studies have investigated these associations in adolescents. A better understanding of the features of the built environment that encourage PA or ST is therefore of critical importance to promote health and wellbeing in adolescents. The aim of this study was to estimate the associations of GIS-determined and perceived walkability components in individual residential buffer zones with accelerometer-assessed moderate-to-vigorous physical activity (MVPA) and ST in adolescents.

Methods

The Built Environment in Adolescent New Zealanders (BEANZ) study was conducted in two cities (Auckland and Wellington) during the 2013-2014 academic school years. The exposure measures were subjective and objective environmental indices of activity-friendliness using four residential buffers. Road network buffers were calculated around participant’s residential addresses using the sausage buffer approach at 250 m, 500 m, 1 km, and 2 km scales. A 25 m radius was used for the buffers. Data were analysed using Generalized Additive Mixed Models in R.

Results

Data were analysed from 524 participants (15.78 ± 1.62 years; 45% male). Participants accumulated ~114 min/day of moderate-to-vigorous PA (MVPA) and ~354 min/day of ST during accelerometer wear-time (~828 min/day). The estimated difference in MVPA between participants with the 1st and 3rd quartiles observed values on the composite subjective environmental index of activity-friendliness (perceived land use mix - diversity, street connectivity and aesthetics) was equivalent to ~8 min/day (~56 MVPA min/week) and for the objective environmental index of activity-friendliness (gross residential density and number of parks within 2 km distance from home) was ~6 min of MVPA/day (~45 MVPA min/week). When both indices were entered in a main-effect model, both indices remained significantly correlated with MVPA with sex as a moderator. The predicted difference in sedentary time between those with the minimum and maximum observed values on the subjective index of non-sedentariness was ~20 min/day.

Conclusions

The combined assessment of the main effects of subjective and objective indices of activity-friendliness on NZ adolescents’ PA and ST showed positive relationships with MVPA for the subjective index only. The subjective index was a significant correlate of PA in both girls and boys, while the objective index was significant only in boys when sex was entered as a moderator. Further research is warranted to understand the relationships of ST with the built environment.

Perceived neighborhood environmental attributes associated with leisure-time and transport physical activity in Mexican adults

Environmental factors have been associated with specific physical activity domains, including leisure-time and transport physical activity, in some high income countries. Few studies have examined the environmental correlates for domain-specific physical activity in low-and middle-income countries, and results are inconsistent. We aimed to estimate the associations between perceived environment and self-reported leisure-time walking, moderate-to-vigorous leisure-time physical activity and transport physical activity among adults living in Cuernavaca, Mexico. A population-based study of adults 20 to 64years old was conducted in Cuernavaca, Mexico in 2011 (n=677). Leisure and transport physical activity was measured using the International Physical Activity Questionnaire - Long Form. Perceptions of neighborhood environment were obtained by questionnaire. Hurdle regression models estimated the association between environmental perceptions and participation and time spent in each physical activity domain. High perceived aesthetics were positively correlated with participation and time spent in leisure-time walking and moderate-to-vigorous physical activity. SES differences existed for aesthetics in relation to participation in leisure-time walking. Participation in transport physical activity was positively associated with easy access to large parks, while closer distance to large parks was a negative correlate for participation and time-spent in this physical activity domain. Results suggest that perceived environmental characteristics related with physical activity are domain specific. High perceived aesthetics were an important correlate for leisure-time activities among Mexican adults, suggesting that policy strategies aimed at improving this environmental perception may be warranted. Patterns of associations between environmental correlates and transport physical activity differed from those reported in commonly studied high income countries.

"Can we walk?" Environmental supports for physical activity in India

India is currently facing a non-communicable disease epidemic. Physical activity (PA) is a preventative factor for non-communicable diseases. Understanding the role of the built environment (BE) to facilitate or constrain PA is essential for public health interventions to increase population PA. The objective of this study was to understand BEs associations with PA occurring in two major life domains or life areas-travel and leisure-in urban India. Between December 2014 and April 2015, in-person surveys were conducted with participants (N=370; female=47.2%) in Chennai, India. Perceived BE characteristics regarding residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking and bicycling, aesthetics, traffic safety, and safety from crime were measured using the adapted Neighborhood Environment Walkability Scale-India (NEWS-India). Self-reported PA was measured the International Physical Activity Questionnaire. High residential density was associated with greater odds of travel PA (aOR=1.9, 95% CI=1.2, 3.2). Land use mix-diversity was positively related to travel PA (aOR=2.1, 95%CI=1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score predicted a two-fold increase in odds of travel PA (aOR=1.9, 95% CI=1.1, 3.1) and a 40% decrease in odds of leisure PA (aOR=0.6, 95% CI=0.4, 1.0). However, the association of the aggregated score with leisure PA was not significant. Results suggest that relationships between BE and PA in low-and-middle income countries may be context-specific, and may differ markedly from higher income countries. Findings have public health implications for India suggesting that caution should be taken when translating evidence across countries.

Reliability of self-report measures of correlates of obesity-related behaviours in Hong Kong adolescents for the iHealt(H) and IPEN adolescent studies

BACKGROUND

This study examined the reliability of measures of correlates of dietary behaviours (DBs), physical activity (PA) and sedentary behaviour (SB) for Hong Kong adolescents.

METHOD

Individual, social and environmental correlates of obesity-related behaviours were assessed twice, 15-27 days apart (average 20 days), via self-administered questionnaires. These questionnaire included measures of decisional balance, self-efficacy, enjoyment and social support related to intake of fruits, vegetables, high-fat foods and sugar-sweetened beverages, PA behaviour and SB. They also included measures of perceived barriers to PA, parental rules related to PA and SB, and environmental correlates of DB, PA and SB. The questionnaires were self-completed outside school hours. A sample of 119 12-17 year old Chinese-speaking secondary school students (60 girls; 59 boys) were recruited from four Hong Kong schools located in areas stratified by walkability and socio-economic status.

RESULTS

The test-retest reliability of the examined measures ranged from poor to excellent (ICC: 0.30-0.99). All measures of correlates of PA and SB had excellent or substantial test-retest reliability, with the exception of self-efficacy for reducing SB (ICC: 0.59). Four of 18 measures of DBs showed moderate, and two poor (ICC < 0.41), test-retest reliability. Evidence of unidimensionality (Cronbach's α ≥ 0.70) was found for 10 of 28 multi-item scales. The evidence for the remaining 18 was either questionable or poor.

CONCLUSIONS

Most of the self-report measures of correlates of obesity-related behaviours used in the iHealt(H) study have acceptable test-retest reliability in Hong Kong adolescents. The factorial structure of several scales needs to be investigated in a larger sample.

Individual and environmental correlates of objectively measured physical activity and sedentary time in adults from Curitiba, Brazil

OBJECTIVES

This study assessed the association of individual and neighborhood environment characteristics and objectively measured physical activity (PA) and sedentary time (ST) in adults from Curitiba, Brazil.

METHODS

A population-based cross-sectional study was conducted through face-to-face household interviews in 2010. The analytic sample included 305 adults aged 20-65 years recruited from 32 census tracts selected according to neighborhood walkability and socioeconomic status. Individual and environmental PA correlates were evaluated through standardized and valid self-reported measures, including the Neighborhood Environment Walkability Scale. Minutes per week of PA and ST were assessed through accelerometry. Multi-level regression models were used in the analyses.

RESULTS

After adjusting for confounders the strongest individual and environmental correlates associated with ST was residential density (B = 0.14; p = 0.008), light-intensity PA was being a father/mother (B = 35.71; p = 0.025) and moderate-to-vigorous PA was sex (B = 0.91; p < 0.001) and number of cars (one car, B = -1.05; two cars, B = -1.14; p < 0.001).

CONCLUSIONS

The associations found with individual and environmental correlates varied accordingly across all outcomes. Future changes in policies and infrastructure should consider the social context of the community and improvements to promote a safer environment in the neighborhood.

Neighborhood environment walkability and health-related quality of life among older adults in Hong Kong

This study examined the associations between walkability related environmental attributes (WREA) and health-related quality of life (HRQoL) among older adults in Hong Kong. A cross-sectional study was conducted among 340 participants (women = 233; mean age = 74.4 years) living in urban communities. Independent variables included residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking, aesthetics, traffic hazards, crime, access to parking, lack of cul-de-sacs, hilliness, and physical barriers. Physical and mental dimensions of HRQoL were the dependent variables. Results revealed significant associations between WREA and HRQoL and demonstrated that aesthetics and physical barriers were significant determinants of physical health after adjusting age and sex, and crime and physical barriers were significant determinants of mental health after adjusting sex. This study provided empirical evidence that environmental walkability was associated with HRQoL among older adults in Hong Kong.

Construct Validity of the Neighborhood Environment Walkability Scale for Africa

PURPOSE

The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity-related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries.

METHODS

NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18-85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire.

RESULTS

The overall "walkability" index had a positive relationship with both walking for transportation (η = 0.020, P = 0.005) and recreation (η = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η = 0.020, P = 0.006 and η = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η = 0.016, P = 0.015), road/path connectivity (η = 0.025, P = 0.002), path infrastructure (η = 0.021, P = 0.005), and overall places for walking and cycling (η = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda.

CONCLUSIONS

Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis

BACKGROUND

Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations.

METHODS

Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic).

RESULTS

Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified.

CONCLUSIONS

Results support strong links between the neighbourhood physical environment and older adults' AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.