Associations of neighborhood characteristics with active park use: an observational study in two cities in the USA and Belgium

Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease

BACKGROUND

This study sought to identify associations between the Yost Index, a geocoded area neighborhood socioeconomic status (nSES) score, and race/ethnicity with patient refusal of recommended surgery for metastatic bone disease.

METHODS

Patients with metastatic bone disease were extracted from the Surveillance, Epidemiology, and End Results database. The Yost Index was geocoded using factor analysis and categorized into quintiles using census tract-level American Community Service (ACS) 5-year estimates and seven nSES measures. Multivariable logistic regression models calculated odds ratios (ORs) of refusal of recommended surgery and 95% confidence intervals (CIs), adjusting for clinical covariates.

RESULTS

A total of 138,257 patients were included, of which 14,943 (10.8%) were recommended for surgical resection. Patients in the lowest nSES quintile had 57% higher odds of refusing surgical treatment than those in the highest quintile (aOR = 1.57, 95% CI 1.30-1.91, p < 0.001). Patients in the lowest nSES quintile also had a 31.2% higher age-adjusted incidence rate of not being recommended for surgery compared with those in the highest quintile (186.4 vs. 142.1 per 1 million, p < 0.001). Black patients had 34% higher odds of refusing treatment compared with White patients (aOR = 1.34, 95% CI 1.14-1.58, p = 0.003). Advanced age, unmarried status, and patients with aggressive cancer subtypes were associated with higher odds of refusing surgery (p < 0.001).

CONCLUSIONS

nSES and race/ethnicity are independent predictors of a patient refusing surgery for metastatic cancer to bone, even after adjusting for various clinical covariates. Effective strategies for addressing these inequalities and improving the access and quality of care of patients with a lower nSES and minority backgrounds are needed.

Greenspaces and Health: Scoping Review of studies in Europe

Objectives

Access to greenspaces and contact with nature can promote physical activity and have positive effects on physical and mental health. This scoping literature review aims to examine current evidence linking greenspaces and (a) behaviour change, (b) health outcomes and (c) co-benefits.

Methods

This review was conducted in accordance with the PRISMA scoping review guidelines. Searches were conducted through PubMed and EMBASE databases for studies published between 2000 and March 2023 with a focus on Europe.

Results

122 scientific articles and grey literature reports were identified. Access to greenspaces is positively associated with physical and mental health, and reduced risk of all-cause mortality and some non-communicable diseases. Greenspace quality is associated with increased physical activity and reduced risk of obesity. Nature-based therapies or green prescription are effective in improving mental health outcomes and overall health. Importantly, numerous co-benefits of greenspaces are identified.

Conclusion

Increasing access to greenspaces for populations with particular attention to greenspace quality is important for co-benefits. Responsible governance and use of greenspaces are crucial to minimize public health risks and human disturbance of nature.

Change of urban park usage as a response to the COVID-19 global pandemic

Urban parks became critical for maintaining the well-being of urban residents during the COVID-19 global pandemic. To examine the impact of COVID-19 on urban park usage, we selected New York City (NYC) and used SafeGraph mobility data, which was collected from a large sample of mobile phone users, to assess the change in park visits and travel distance to a park based on 1) park type, 2) the income level of the visitor census block group (visitor CBG) and 3) that of the park census block group (park CBG). All analyses were adjusted for the impact of temperature on park visitation, and we focused primarily on visits made by NYC residents. Overall, for the eight most popular park types in NYC, visits dropped by 49.2% from 2019 to 2020. The peak reduction in visits occurred in April 2020. Visits to all park types, excluding Nature Areas, decreased from March to December 2020 as compared to 2019. Parks located in higher-income CBGs tended to have lower reductions in visits, with this pattern being primarily driven by large parks, including Flagship Parks, Community Parks and Nature Areas. All types of parks saw significant decreases in distance traveled to visit them, with the exception of the Jointly Operated Playground, Playground, and Nature Area park types. Visitors originating from lower-income CBGs traveled shorter distances to parks and had less reduction in travel distances compared to those from higher-income CBGs. Furthermore, both before and during the pandemic, people tended to travel a greater distance to parks located in high-income CBGs compared to those in low-income CBGs. Finally, multiple types of parks proved crucial destinations for NYC residents during the pandemic. This included Nature Areas to which the visits remained stable, along with Recreation Field/Courts which had relatively small decreases in visits, especially for lower-income communities. Results from this study can support future park planning by shedding light on the different uses of certain park types before and during a global crisis, when access to these facilities can help alleviate the human well-being consequences of "lockdown" policies.

Neighborhood park access and park characteristics are associated with weight status in youth

This study investigated park access and park quality in the context of childhood obesity. Participants were 20,638 children ages 6-17y from a large primary care health system. Analyses tested associations of park access and park characteristics with children's weight status, and sociodemographic interactions. Both park access and the quality of nearest park were associated with a lower odds of having obesity. Park quality interacted with age, sex, and income. Findings suggest park access is important for supporting a healthy weight in children. Park quality may be most important among 12-14-year-olds, girls, and higher income groups.

Environmental and Mobility Strategies During Early COVID-19: Insights From an Empirical Study Focusing on Park Visitations in El Paso, TX

OBJECTIVES

We explored the importance of environmental and mobility strategies during early COVID-19 by age and ethnicity and investigated predictors of park visitations considering the COVID-19 impacts.

BACKGROUND

Parks are safe and accessible venues to stay active and reduce social isolation, which is especially important considering COVID-19 and the associated lockdowns.

METHODS

We analyzed online survey data from 683 residents (collected July 2020) of El Paso, TX, and objective measures of neighborhood park characteristics. Chi-square tests and mixed-effects logistic regression analyses were performed to examine the environmental/mobility strategies, personal and environmental factors, and park visitations, considering the COVID-19 impacts.

RESULTS

The percentage of those who visited (1+ times/week) parks or trails/paths in the neighborhood dropped from 41.7% to 19.5% since the start of COVID-19 (OR = 0.015, p < .001). Before COVID-19, middle-aged and older adults were less likely to visit parks than younger adults, while this difference became insignificant during early COVID-19. Hispanic adults were more likely to visit parks than non-Hispanics both before and during early COVID-19. Positive environmental predictors of park visitations included park availability in the neighborhood, proximity to the closest park, seeing people being physically active in the neighborhood, and neighborhood aesthetics.

CONCLUSIONS

Proximately located parks, trails, and paths well integrated into residential communities, and high aesthetic quality of the neighborhood are the potential features of pandemic-resilient communities and should be considered an important national priority to maintain and promote the health and well-being of the population, especially during pandemics like COVID-19.

Neighbourhood socio-economic disadvantage and loneliness: the contribution of green space quantity and quality

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48-77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.

Low physical activity is associated with adverse health outcome and higher costs in Indonesia: A national panel study

Aims

To assess the association between low physical activity, cardiovascular disease (CVD) and risk factors, health service utilization, risk of catastrophic health expenditure, and work productivity in Indonesia.

Methods

In this population-based, panel data analysis, we used data from two waves of the Indonesian Family Life Survey (IFLS) for 2007/2008 and 2014/2015. Respondents aged 40-80 years who participated in both waves were included in this study (n = 5,936). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-SF). Multinomial logistic regression model was used to examine factors associated with physical activity levels (low, moderate, and high). We applied a series of multilevel mixed-effect panel regression to examine the associations between physical activity and outcome variables.

Results

The prevalence of low physical activity increased from 18.2% in 2007 to 39.6% in 2014. Compared with those with high physical activity, respondents with low physical activity were more likely to have a 10-year high CVD risk (AOR: 2.11, 95% CI: 1.51-2.95), use outpatient care (AOR: 1.26, 95% CI: 1.07-1.96) and inpatient care (AOR 1.45, 95% CI: 1.07-1.96), experience catastrophic health expenditure of 10% of total household expenditure (AOR: 1.66, 95% CI: 1.21-2.28), and have lower labor participation (AOR: 0.24, 95% 0.20-0.28).

Conclusions

Low physical activity is associated with adverse health outcomes and considerable costs to the health system and wider society. Accelerated implementation of public health policies to reduce physical inactivity is likely to result in substantial population health and economic benefits.

Physical activity during recess in elementary schoolchildren in Belgium and Ecuador: The role of the physical environment at school

To increase physical activity levels in children, knowledge on how school playgrounds can be optimally designed is important. Until now, the contribution of playground variety and greening to children's physical activity level during recess remains unclear. This study examined the associations of school playground variety and greening with energy expenditure (EE) in elementary school children in Ecuador and Belgium. Additionally, moderating effects of study site and gender were studied. Observational data were collected using SOPLAY in ten schools in East Flanders (Belgium) and Cuenca (Ecuador). Data were analysed with linear mixed-effects model analyses. Results showed that independent of study site, EE was higher in playground areas with less green elements, and a higher level of total variety. Primary surface was only associated with EE in boys, they were more active when an artificial surface was present. Implementation of loose equipment was somewhat more strongly positively associated with EE in Ecuadorian than in Belgian children. Because of the well-known restorative effects of green elements, we do not wish to suggest that less greening should be implemented at schools. However, ideally green spaces should be designed in a way that active play is stimulated by combining green elements with other improvements.

Associations of park features with park use and park-based physical activity in an urban environment in Asia: A cross-sectional study

Park use is associated with health, yet our understanding of park features related to their use is limited. Singapore's parks were audited for 30 micro-features, then geospatial analysis characterized micro-features scores for parks nearest to participants' homes. Adults (3,435) reported their park use and park-based physical activity. Using linear regression models, we found living near a park with higher micro-features scores was associated with more time in parks and park-based physical activity. Specific micro-features were associated with more park time (wildlife areas, water features, forested areas, unpaved trails (2-2.6 h/month, p < 0.05)) and with physical activity in parks (water features, forested areas, large playground, open green spaces (1.8-2.2 h/month, p < 0.05)). These findings could inform parks planning to support population-health.

To Create a Safe and Healthy Place for Children: The Associations of Green Open Space Characteristics With Children's Use

Green open space (GOS) is an important outdoor resource for the well-being of children by providing places for physical activity (PA), especially in the highly urbanized environment. The COVID-19 lockdowns have made children have more sedentary time than before due to less access to public places. This article aims to examine the associations of GOS characteristics (environmental and surrounding) and children's use (visitation and PA pattern) to provide evidence for promoting their PA during the pandemic. This study employed the method of GPS positioner, accelerometer, and survey to measure the children's actual use in GOS. A total of 179 children participated in the study and 10 GOSs were selected. The children were provided with the accelerometers and GPS positioners to track their walking steps, duration, and locations. The environmental characteristics and 1 km buffer of the selected GOSs were explored as extended study area. Results showed that 49.16% of children reported more visitations than before the pandemic, and 48.60% of them preferred to go on weekdays during the pandemic. Both environmental and surrounding characteristics could affect the visitation pattern. The size (p < 0.000), residential ratio (p < 0.000), and intersection density (p < 0.000) were found as the factors significantly associated with visitation pattern. The children's PA pattern was mainly associated with the environmental characteristics of size (p < 0.000), sports, and playground proportion (p < 0.000). The locations of children's PA were mainly around square, playground, sheltered place, and waterside areas. COVID-19 has transformed the children's use of GOS, as well as their relationship with GOS. The large GOS was more likely to promote PA and its use by the children. The environmental and surrounding characteristics of GOS could affect their use pattern, whereas their PA pattern was mainly associated with the environmental characteristics. The findings suggest that GOS characteristics could be an effective solution to respond the challenge from the pandemic, and promote their visitation and PA.

Park environment and moderate-to-vigorous physical activity in parks among adolescents in a high-density city: the moderating role of neighbourhood income

Background

Urban parks are critical environmental resources in which adolescents engage in physical activity (PA). Evidence on the associations between park environmental characteristics and park-based PA in adolescents is mixed, particularly for high-density cities. Evidence is also lacking concerning the moderating role of neighbourhood socioeconomic status on the park-PA relationships. The current study aimed to examine the associations between park environmental characteristics and moderate-to-vigorous physical activity (MVPA) in parks among adolescents in Hong Kong and the moderating effect of neighbourhood income on these associations.

Methods

A cross-sectional study involving direct observations of adolescents was conducted in 32 randomly selected urban parks in Hong Kong. Park environmental characteristics were measured using the Community Park Audit Tool. Park-based MVPA among adolescents was measured using the System for Observation Play and Recreation in Communities. Neighbourhood income was extracted from the 2011 Hong Kong Population Census data on median household income.

Results

There was a significant positive association between the quality of amenities and park-based MVPA (metabolic equivalents per observation) in adolescents. However, the associations between the diversity of active facilities, greenness and adolescents’ park-based MVPA were not significant. Neighbourhood income moderated the association between adolescents’ park-based MVPA and park safety, where the relationship between park safety and park-based MVPA was significantly positive in low-income neighbourhoods but not significant in high-income neighbourhoods. An income-by-environment interaction was also observed concerning park aesthetics, with a negative relationship between park aesthetics and park-based MVPA in high-income neighbourhoods but not in low-income neighbourhoods.

Conclusion

Our findings provide evidence regarding how park environment and neighbourhood income impact adolescents’ park-based MVPA in Hong Kong. These findings can inform urban planning and policymakers who seek to improve urban park development in high-density cities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-021-00289-7.

Did Playground Renovations Equitably Benefit Neighborhoods in Chicago?

Between 2013 and 2016, the Chicago Park District renovated 327 playgrounds in need of repair across Chicago through a $44 million investment. This study evaluated whether short-term and longer-term impacts of renovations on park use and park-based moderate-to-vigorous physical activity (MVPA) differed by neighborhood income level and neighborhood concentration of Black residents. A total of 39 parks with renovated playgrounds and 39 matched comparison parks with playgrounds that needed repair but not selected for renovation in year 1 were studied. Three waves of observational data were collected at each park: baseline, 12 months post-renovation, and 24 months post-renovation. Difference-in-differences mixed-effects Poisson regression models estimated renovation effects. The effects of renovations differed by the income level and concentration of Black residents in the neighborhoods where parks were located. In low-income neighborhoods, renovations were associated with reductions in park use and park-based MVPA over the longer term. In contrast, renovations were associated with short- and longer-term increases in park use and park-based MVPA in medium-income neighborhoods and with longer-term increases in MVPA in high-income neighborhoods. Renovations were generally not associated with any changes in park use or park-based MVPA in high-percent Black neighborhoods, but they were associated with increased park use and park-based MVPA in low-percent Black neighborhoods. This study suggests playground renovations in Chicago may have had unintended consequences, increasing neighborhood income and racial disparities in park use and park-based MVPA. Future playground renovation efforts may need to allocate more resources for renovating the broader park where in disrepair, more intensely involve neighborhood residents, and employ complementary strategies such as additional park programming to ensure renovations benefit all neighborhoods.

Park use, perceived park proximity, and neighborhood characteristics: Evidence from 11 cities in Latin America

This study examines how park use may be associated with perceived park proximity, neighborhood-built environment and perceived social disorder in Latin American cities. The study uses self-reported data from the 2016 CAF survey, including 7,970 urban residents from 11 cities across Latin America. Results show positive graded associations between perceived park proximity and use, holding all others constant. Additional factors that were found to be associated with park use are neighborhood formality and related built-environment characteristics, including paved streets and sidewalks. Park use was mostly unrelated to perceived social disorder, with the exception of indigence, with which it is was positively associated. Stronger associations between park proximity and use were observed among those who reported higher prevalence of indigence or begging in their household block. These findings stress the importance of perceived park proximity in enhancing their use in urban Latin America, and challenge the role of social disorder and crime as a barrier for park use.

Residential green space and child intelligence and behavior across urban, suburban, and rural areas in Belgium: A longitudinal birth cohort study of twins

BACKGROUND

Exposure to green space has beneficial effects on several cognitive and behavioral aspects. However, to our knowledge, no study addressed intelligence as outcome. We investigated whether the level of urbanicity can modify the association of residential green space with intelligence and behavior in children.

METHODS AND FINDINGS

This study includes 620 children and is part of the East Flanders Prospective Twin Survey (EFPTS), a registry of multiple births in the province of East Flanders, Belgium. Intelligence was assessed with the Wechsler Intelligence Scale for Children-Revised (WISC-R) in 620 children (310 twin pairs) between 7 and 15 years old. From a subset of 442 children, behavior was determined based on the Achenbach Child Behavior Checklist (CBCL). Prenatal and childhood residential addresses were geocoded and used to assign green space indicators. Mixed modeling was performed to investigate green space in association with intelligence and behavior while adjusting for potential confounding factors including sex, age, parental education, neighborhood household income, year of assessment, and zygosity and chorionicity. We found that residential green space in association with both intelligence and behavior in children was modified by the degree of urbanicity (p < 0.001). In children living in an urban environment, multivariable adjusted mixed modeling analysis revealed that an IQR increment of residential green space (3,000-m radius) was associated with a 2.6 points (95% CI 1.4-3.9; p < 0.001) higher total intelligence quotient (IQ) and 2.0 points (95% CI -3.5 to -0.4; p = 0.017) lower externalizing behavioral score. In children residing in a rural or suburban environment, no association was found. A limitation of this study is that no information was available on school location and the potential for unmeasured confounding (e.g., time spend outdoors).

CONCLUSIONS

Our results indicate that residential green space may be beneficial for the intellectual and the behavioral development of children living in urban areas. These findings are relevant for policy makers and urban planners to create an optimal environment for children to develop their full potential.

Placement of Outdoor Exercise Equipment and Physical Activity: A Quasi-Experimental Study in Two Parks in Southern California

To reduce the burden of chronic disease, the Centers for Disease Control and Prevention (CDC) funded the Orange County Partnerships to Improve Health (OC-PICH) project in Orange County, California. One of the strategies included adding outdoor exercise equipment (OEE) in two parks in Garden Grove and Anaheim. Using a quasi-experimental pre-post design, we evaluated park users’ physical activity levels before and after OEE installation using the System for Observing Play and Recreation in Communities (SOPARC). The OEE was installed along a walking path in Edison Park (Anaheim) and grouped within a single area (a “fitness zone”) in Garden Grove Park. In both parks, there were significantly greater odds of high-intensity physical activity overall after the installation—19% higher odds in Anaheim, and 23% higher odds in Garden Grove. However, the fitness zone area in Garden Grove had substantially higher odds of increased physical activity post-intervention (OR = 5.29, CI: 3.76–7.44, p < 0.001). While the increases in physical activity levels are consistent with past studies that link OEE to higher levels of physical activity among park users, our findings also suggest that the location and placement of equipment within a park may be an important factor to consider when improving park amenities for physical activity.

Improved Street Walkability, Incivilities, and Esthetics Are Associated with Greater Park Use in Two Low-Income Neighborhoods

Parks may provide opportunities for people to increase their physical activity and improve health. Yet, parks are generally less plentiful and underutilized in low-income urban neighborhoods compared with more advantaged neighborhoods. Renovations within and around parks may improve park utilization but the empirical evidence supporting this relationship is scarce. This study assessed the impact of greenspace, housing, and commercial investments on street characteristics (walkability, amenities, incivilities/poor esthetics) and park use by examining park use over time in two low-income neighborhoods in Pittsburgh, PA (n = 17 parks), before and after neighborhood-based renovations that were primarily centered in one neighborhood. We used systematic observation of parks, park use, and street blocks surrounding parks to examine the impact of neighborhood changes on park use. We used difference-in-differences to test whether park use and street characteristics surrounding the parks improved more in the intervention neighborhood than in the comparison neighborhood. We also used zero-inflated negative binomial regression with interactions by time to test whether changes in street characteristics were associated with changes in park use over time. We found that improved walkability, incivilities, and esthetics surrounding parks in socioeconomically disadvantaged neighborhoods were associated with greater park use and may help increase visits to underutilized parks.

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S

We conducted secondary data analyses of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting. Data were collected at the prescribing visit (baseline) and at one and three months of follow up from 78 families. Family characteristics were identified at baseline; regression models were used to explore changes during follow up in associations of park use with knowledge, attitudes and perceived access to parks. At baseline, park users differed from non-users in demographics, knowledge of park locations, attitudes about the value of park visits, but not affinity for nature. Park users were also more likely than non-users to feel that their neighborhood was safe for children to play in. Changes in knowledge of park locations, nature affinity, and perceived access to parks were each significantly associated with increased park use by families at one and three months after the park prescription. Adjusting for age, gender, race, poverty, and US birth, increases in knowing the location of parks were associated with an increase of 0.27 weekly park visits (95% CI 0.05, 0.49; p = 0.016); increases in feeling a caregiver had money to visit parks were associated with 0.48 more weekly park visits (95% CI 0.28, 0.69; p < 0.001); increases in perceived money for park outings were associated with 0.24 increased park visits per week (95% CI 0.05, 0.42; p = 0.01); each unit increase in nature affinity was associated with 0.34 more weekly park visits (95% CI 0.09, 0.59; p = 0.007). In other words, knowing where to go, valuing nature, and having time, and money contributed to increased likelihood of visiting a park. We discuss in terms of health behavior theory how demographics, knowledge, attitudes and perceived barriers to park use can inform park prescription interventions.

Association of psychosocial and perceived environmental factors with park-based physical activity among elderly in two cities in China and Germany

Background

Urban parks play an important role in promoting physical activity (PA) among adults and especially among older city residents. According to the socioecological approach the association of physical environments and psychosocial factors in the context of park-based PA of elderly have not been systematically examined until now, let alone the relevance of the city (urban area) on a cross-cultural level. This study investigated selected aspects of (1) the association of psychosocial and park environmental factors with park-based physical activity (PBPA) of older people; and (2) the moderating effect of city on the association of these factors with PBPA.

Methods

A face-to-face survey was conducted of a mixed-culture sample from different urban surroundings in Hong Kong (HK) and Leipzig (L). In six parks of each city physically active elderly (> = 60 years; HK: n = 306; L: n = 311) were recruited. Multiple linear regressions were used to analyse the association between psychosocial factors and perceived environmental factors with PBPA and the moderating effect of city.

Results

Controlled for demographic variables, all other psychosocial factors were significantly related to PBPA, except social support. In terms of environmental factors, PBPA was positively associated with safety, attractiveness, features and negatively associated with park time distance. Controlled for demographic variables, psychosocial and environmental factors, the moderating effect of city on the associations of park features and park time distance with PBPA was not significant in HK. In contrast, there was a significant positive relationship for park features and a negative relationship for park time distance with PBPA in L.

Conclusions

Psychosocial and perceived environmental factors significantly influence PBPA of older people. City moderates the associations of these factors and independently contributes to park-based PA of the elderly. The different interactions of environmental factors and urban area for PBPA of elderly can support policy makers on the municipal level in choosing adequate strategies for promoting PA of older people in parks.

Physical activity and health-related fitness in Asian adolescents: The Asia-fit study

Purpose: The present study aimed to investigate and compare physical activity (PA) and health-related fitness in Asian adolescents, and to examine the associations between meeting PA guidelines and attaining fitness standards. Methods: A sample of 12,590 adolescents (M_age = 13.63 years, SD = 1.01) from eight Asian metropolitan cities completed measurements of PA, five field-based fitness tests, and covariates. The fitness test scores were further classified into Healthy Fitness Zone (HFZ) or Needs Improvement Zone (NIZ). Results: Findings showed that adolescents' levels of PA and fitness components differed by cities. City differences were also found in proportions of meeting PA guidelines and achieving the HFZs of aerobic capacity, muscular fitness, and body composition. After controlling covariates, meeting PA guidelines positively associated with being in the HFZs of aerobic and muscular fitness, but the association was not significant with being in the body composition HFZ. Conclusion: There was a large variation in PA and health-related fitness in adolescents across the eight Asian cities. Asian adolescents achieving PA guidelines were more likely to be in the HFZ of aerobic and muscular fitness. Prospective follow-up studies are warranted to gain better insights into the relationships between objectively-measured PA and fitness.

Loneliness and Life Satisfaction Explained by Public-Space Use and Mobility Patterns

Previous research has shown that personal, neighborhood, and mobility characteristics could influence life satisfaction and loneliness of people and that exposure to public spaces, such as green spaces, may also affect the extent to which people feel lonely or satisfied with life. However, previous studies mainly focused on one of these effects, resulting in a lack of knowledge about the simultaneous effects of these characteristics on loneliness and life satisfaction. This study therefore aims to gain insights into how public-space use mediates the relations between personal, neighborhood, and mobility characteristics on the one hand and loneliness and life satisfaction on the other hand. Relationships were analyzed using a path analysis approach, based on a sample of 200 residents of three neighborhoods of the Dutch city ‘s-Hertogenbosch. The results showed that the influence of frequency of public-space use on life satisfaction and loneliness is limited. The effects of personal, neighborhood, and mobility characteristics on frequency of use of public space and on loneliness and life satisfaction were found to be significant. Age and activities of daily living (ADL) are significantly related to each other, and ADL was found to influence recreational and passive space use and loneliness and life satisfaction. Policymakers should, therefore, mainly focus on creating neighborhoods that are highly walkable and accessible, where green spaces and public-transport facilities are present, to promote physical activity among all residents.

Associations between the physical environment and park-based physical activity: A systematic review

BACKGROUND

With an increase in the evidence for the associations between park-based physical activity (PA) and physical environments (especially park and neighborhood environments), researchers face an important challenge in interpreting and summarizing the evidence to develop environmental change interventions. An updated review is needed to better inform policymaking and environmental interventions. The current study aimed to systematically review the research on the associations of park-based PA with park and neighborhood environmental characteristics.

METHODS

We targeted English peer-reviewed articles from 5 electronic databases using keywords related to park-based PA, park environments, and neighborhood environments. Of the 4071 identified papers, 25 studies published between 2008 and 2016 met all the eligibility criteria and were included in this review.

RESULTS

The characteristics of physical environment that received consistent support included paths/trails, lighting, and incivilities (e.g., broken glasses and litter). Mixed findings were revealed for 6 park environmental factors (unspecified active facilities, playgrounds and skating areas, fitness stations, picnic areas, greenness, and park size) and 2 neighborhood environmental factors (park density and park proximity).

CONCLUSION

It can be concluded that paths/trails, lighting, and incivilities are 3 key physical environmental attributes of park-based PA. Given the inconsistent findings on park and neighborhood environmental factors, more robust designs such as prospective investigation are required.

Socioecological Correlates of Park-based Physical Activity in Older Adults: A Comparison of Hong Kong and Leipzig Parks

AIMS

The present study aimed to examine and compare the socioecological correlates of park-based physical activity (PA) among Hong Kong and Leipzig older adults in terms of types of activity areas, perceived park environment, psychosocial factors, and the interactions between the perceived park environmental and psychosocial factors.

METHODS

Based on the SOPARC, systematic observations were conducted in six randomly selected urban parks in each city. A total of 317 Hong Kong (Mage = 69.96; SD = 6.81) and 311 Leipzig (Mage = 72.06; SD = 6.78) older adults from these six parks completed an interviewer-delivered survey measuring their perceived park environment, psychosocial variables, and park-based PA.

RESULTS

In both cities, the types of activity areas were positively associated with the number of older adults observed being active in parks. Psychosocial factors, especially self-efficacy and perceived barriers, had larger associations with park-based PA compared with the perceived park environment. The interaction between perceived park features and self-efficacy in the association with park-based PA was found in Leipzig, but not in Hong Kong.

CONCLUSION

Findings of the current study contribute to the cross-cultural understanding of the socioecological correlates of park-based PA among older adults.

Use of a public park for physical activity in the Caribbean: evidence from a mixed methods study in Jamaica

BACKGROUND

Small island Caribbean countries such as Jamaica are now facing an epidemic of obesity and decreased physical activity (PA) levels. Public parks have been shown to be important resources for PA that also provide psychological and social benefits associated with increased PA. There are no studies that document PA in parks in the Caribbean.

METHODS

This study utilized a mixed method approach by using the System for Observing Play and Recreation in Communities (SOPARC) to obtain baseline data on park usage patterns in Emancipation Park, a large urban public park in Jamaica. In addition, in-depth interviews were conducted to gain additional insights on the park's use for PA.

RESULTS

The park was used mostly by females, in the evenings and by persons 18-64 years old. Females had significantly lower mean energy expenditure (EE) than males (0.078 versus 0.080 kcal/kg/min, p < 0.05). In-depth interviews revealed that safety, a central location within a business district, aesthetic appeal, a walking track and individual health benefits were key reasons for persons engaging in PA at the park.

CONCLUSIONS

This is the first study to describe the usage of a public park for PA in Jamaica. The study elicited aspects of park use for PA in a major urban park in Jamaica from different vantage points by using direct systematic observation augmented with a qualitative approach. It revealed important differential park use for PA by sex, age group and EE levels, and provided insights into factors that motivate and hinder park usage for PA. This can be used by policymakers in Jamaica to inform PA interventions to reduce obesity, provide baseline data for comparisons with other parks in developing countries and to advocate for well-designed public parks.

Association Between Neighborhood Income, Patterns of Use, and Physical Activity Levels in Fitness Zones of Curitiba, Brazil

Background: Socioeconomic characteristics of locations where physical activity equipment is installed may affect the activity level of users. The purpose of this study was to verify patterns of use and physical activity levels in fitness zones installed in low- and high-income neighborhoods in the city of Curitiba, Brazil. Methods: Over 1200 observations were conducted in 20 fitness zones in the city of Curitiba, Brazil. Data were collected during the months of November and December 2012, in 4 periods of the day (8 AM, 11 AM, 2 PM, and 5 PM), on 2 weekdays and 2 weekend days. Results: A total of 2232 people were observed in the fitness zones. Age group, level of physical activity in the area, use of fitness zones during weekend days, and occupation of spaces were significantly associated with neighborhood income. Moreover, users of fitness zones located in high-income neighborhoods showed higher odds ratio (OR = 1.74; 95% confidence interval, 1.46-2.07) of moderate to vigorous physical activity than light or sedentary activities, regardless of gender or day of the week. Conclusions: The sole presence of equipment does not seem to favor the use of fitness zones in low-income neighborhoods. Future studies should investigate intrinsic factors for the use of fitness zones for physical activity.

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

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

The Association Between Park Facilities and Duration of Physical Activity During Active Park Visits

Public parks provide places for urban residents to obtain physical activity (PA), which is associated with numerous health benefits. Adding facilities to existing parks could be a cost-effective approach to increase the duration of PA that occurs during park visits. Using objectively measured PA and comprehensively measured park visit data among an urban community-dwelling sample of adults, we tested the association between the variety of park facilities that directly support PA and the duration of PA during park visits where any PA occurred. Cross-classified multilevel models were used to account for the clustering of park visits (n = 1553) within individuals (n = 372) and parks (n = 233). Each additional different PA facility at a park was independently associated with a 6.8% longer duration of PA bouts that included light-intensity activity, and an 8.7% longer duration of moderate to vigorous PA time. Findings from this study are consistent with the hypothesis that more PA facilities increase the amount of PA that visitors obtain while already active at a park.

How Do Racial/Ethnic Groups Differ in Their Use of Neighborhood Parks? Findings from the National Study of Neighborhood Parks

The current study examined racial/ethnic differences in use of parks and park facilities and features and self-reported park use and perceptions. We conducted observations in a nationally representative sample of 193 neighborhood parks in 27 US cities over a 1-week period between April and August of 2016 using the System of Observing Play and Recreation in Communities (SOPARC). To determine the propensity of different racial/ethnic groups to use parks relative to expectation based on their representation in the surrounding neighborhood, we calculated the percentages of park users of each race/ethnicity and compared these to the percentages of racial/ethnic groups residing in the neighborhood within a 1-mile radius of the park based on 2010 U.S. Census data. In the same parks, we administered an intercept survey to assess park users' self-reported use and perceptions of the park (N = 1872). We examined racial/ethnic differences in self-reported use and perceptions of parks using GEE models that adjusted for several individual- and park-level covariates. Hispanics comprised a disproportionate percentage of observed park users. Racial/ethnic groups generally did not differ in their self-reported park use and perceptions, except for the social context of park visits. In adjusted models, Hispanics had significantly higher odds of visiting with a child family member (OR = 1.44) and lower odds of visiting alone than non-Hispanic whites (OR = .55). Findings highlight Hispanics' greater propensity to use parks and indicate that parks may serve a communal purpose for Hispanics that they do not serve for other racial/ethnic groups.

Changes in Physical Activity After Installation of a Fitness Zone in a Community Park

Introduction

Increases in physical activity can lead to decreases in the prevalence of chronic diseases. Parks provide an ideal setting for physical activity. We investigated the effect of a fitness equipment installation on the intensity of park users’ physical activity at a community park.

Methods

We used the System for Observing Play and Recreation in a Community to record physical activity in Eastgate Park in Garden Grove, California, in August 2015 (preintervention [n = 1,650 person-periods]) and in February 2016 (postintervention [n = 1,776 person-periods]). We quantified physical activity in target areas of the park during 15-minute observation periods in 2 ways: 1) we categorized each user’s activity level during the period (sedentary, walking, vigorous), and 2) we converted activity levels to numeric metabolic equivalent task (MET) scores and calculated the period-average score across users. We used mixed-effects regression models to assess 1) the proportional odds of higher activity level at postintervention and 2) the association between intervention status (pre vs post) and mean period-average MET scores.

Results

In the immediate zone around the fitness equipment, the odds ratio for a higher activity level was 1.58 (95% confidence interval [CI], 1.14–2.18; P = .006) and the mean period-average MET score was 0.33 (95% CI, −0.07 to 0.74; P = .11) units higher at postintervention. Across the park as a whole, the odds ratio for a higher activity level was 1.41 (95% CI, 1.21–1.63; P < .001), and the mean period-average MET score was 0.34 (95% CI, 0.12–0.56; P = .003) units higher at postintervention.

Conclusion

Installing fitness zones appears to be an effective intervention for increasing physical activity of park users. Further studies need to be conducted to understand the sustained impact of fitness zones over time.

Park Use in Low-Income Urban Neighborhoods: Who Uses the Parks and Why?

We examined individual and environmental influences on park use among residents of two low-income predominantly African American neighborhoods to identify determinants of park use in lower-income urban neighborhoods. We analyzed data from interviews of 1003 individuals randomly selected from the neighborhoods, systematic observations of neighborhood parks, and police-recorded crime incidence within a .5-mi buffer around each park. Most participants (82.4%) had previously visited a neighborhood park, and nearly half (46.2%) had visited one in the past month. However, only 8.5% of participants were aware of their closest park. Compared with the parks closest to home, parks that participants reported visiting most were larger and had more amenities and features and fewer incivilities and reported crimes of a serious nature. Park use among residents of lower-income neighborhoods may be increased by offering more amenities and features and ensuring the presence of a well-appointed park within easy walking distance of residents' homes.

Daily Patterns of Preschoolers' Objectively Measured Step Counts in Six European Countries: Cross-Sectional Results from the ToyBox-Study

This study is part of the ToyBox-study, which is conducted in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain), aiming to develop a cost-effective kindergarten-based, family-involved intervention to prevent overweight and obesity in four- to six-year-old preschool children. In the current study, we aimed to examine and compare preschoolers’ step count patterns, across the six European countries. A sample of 3578 preschoolers (mean age: 4.8 ± 0.4) was included. Multilevel analyses were performed to take clustering of measurements into account. Based on the average hourly steps, step count patterns for the six European countries were created for weekdays and weekend days. The step count patterns during weekdays were related to the daily kindergarten schedules. Step count patterns during weekdays showed several significant peaks and troughs (p < 0.01) and clearly reflected the kindergartens’ daily schedules, except for Germany. For example, low numbers of steps were observed during afternoon naptimes and high numbers of steps during recess. In Germany, step count patterns did not show clear peaks and troughs, which can be explained by a less structured kindergarten schedule. On weekend days, differences in step count patterns were observed in the absolute number of steps in the afternoon trough and the period in which the evening peak occurred. Differences in step count patterns across the countries can be explained by differences in (school) policy, lifestyle habits, and culture. Therefore, it might be important to respond to these step count patterns and more specifically to tackle the inactive periods during interventions to promote physical activity in preschoolers.

Socioeconomic Inequalities in Green Space Quality and Accessibility-Evidence from a Southern European City

Background: The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods: Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall’s tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results: Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions: Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health.

Schools, Air Pollution, and Active Transportation: An Exploratory Spatial Analysis of Calgary, Canada

An exploratory spatial analysis investigates the location of schools in Calgary (Canada) in relation to air pollution and active transportation options. Air pollution exhibits marked spatial variation throughout the city, along with distinct spatial patterns in summer and winter; however, all school locations lie within low to moderate pollution levels. Conversely, the study shows that almost half of the schools lie in low walkability locations; likewise, transitability is low for 60% of schools, and only bikability is widespread, with 93% of schools in very bikable locations. School locations are subsequently categorized by pollution exposure and active transportation options. This analysis identifies and maps schools according to two levels of concern: schools in car-dependent locations and relatively high pollution; and schools in locations conducive of active transportation, yet exposed to relatively high pollution. The findings can be mapped and effectively communicated to the public, health practitioners, and school boards. The study contributes with an explicitly spatial approach to the intra-urban public health literature. Developed for a moderately polluted city, the methods can be extended to more severely polluted environments, to assist in developing spatial public health policies to improve respiratory outcomes, neurodevelopment, and metabolic and attention disorders in school-aged children.

Neighborhood Influences and BMI in Urban Older Adults

OBJECTIVE

Increases in body weight and declining physical activity that may accompany aging are linked to a range of problems affecting daily life (i.e., decreased mobility and overall quality of life). This study investigates the actual and perceived neighborhood environment on overweight and obese urban older adults.

METHOD

We selected 217 individuals aged 65+ who answered questions about their neighborhood on the 2009 Speak to Your Health survey. Using multinomial regression models and geospatial models, we examined relationships between neighborhood environment and BMI.

RESULTS

We found that obese older adults were 63% less likely to have a park within their neighborhood ( p = .04). Our results also show that older adults who perceive their neighborhood crime as very high are 12 times more likely to be overweight ( p = .04).

DISCUSSION

Findings suggest that parks may affect BMI in older adults; however, neighborhood perceptions play a greater role.

Active Use of Parks in Flanders (Belgium): An Exploratory Observational Study

Parks have the potential to increase physical activity at the community level by providing opportunities to be active. In order to inform interventions to promote physical activity in parks, insight is needed concerning park user characteristics, the activity level of park users, the types of activities performed and associations between park areas and temporal variables with observed physical activity levels. Park user characteristics (sex, age, ethnicity and activity level) were recorded within pre-defined park areas in two parks in Ghent (Belgium) using the System for Observing Play and Recreation in Communities (SOPARC). Most park users were male, adult, and engaged in vigorous-intensity physical activity (48%). Most popular activities were biking (38%), sitting (23%) and walking (15%); accordingly, trails were used most and had the highest levels of physical activity compared to other park areas. Parks were used least frequently in the morning, during the weekend and by seniors. Therefore, active park use during morning periods, on weekend days and by seniors should be promoted and urban planners should consider that different park areas can possibly elicit varying activity levels among park users.

Walking in Two French Neighborhoods: A Study of How Park Numbers and Locations Relate to Everyday Walking

Research indicates that people are drawn to green spaces with attractive amenities. This study extends that finding by comparing walking patterns in two neighborhoods with different numbers of parks; parks did not differ in rated attractiveness nor did neighborhoods differ substantially in rated walkability. Adults, aged 32-86 years (n = 90), drew their 3 most recent walking routes on maps of their neighborhood. Analyses showed that participants' round trips were longer by 265.5 meters (.16 mile) in the neighborhood with a single, large, centrally located park (p < .02). However, participants in the neighborhood with multiple, small, more distributed parks, visited more streets, p < .001, more streets with green spaces, p < .038, and used more varied routes, p < .012. Results suggest there are potential benefits to both layouts. Large centralized parks may invite longer walks; smaller, well-distributed parks may invite more varied routes suggestive of appropriation and motivation processes. Both layouts might be combined in a single neighborhood to attract more walkers.

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

BACKGROUND

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

METHODS

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

DISCUSSION

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

Observational Park-based physical activity studies: A systematic review of the literature

This article reports the outcomes of a systematic review of observational park-based physical activity (PA) studies. Five electronic databases and the Active Living Research website were searched in July 2015 to identify relevant articles. Studies were included if they: a) reported observational data collected at outdoor park-based settings during free living conditions, b) reported results of a park audit, c) included PA as an outcome measure of the park audit, and d) were published after 1990 in English-language peer-review journals. Thirty-two articles, reporting outcomes of 26 unique studies, met inclusion criteria for review. Most studies (n=20, 87%) had cross-sectional or non-interventional study designs, while 6 (23%) employed quasi-experimental designs. Studies were predominately conducted in the U.S. (n=19, 76%). The median number of park users across studies was 4558 (Range=815 to 76,632). Approximately half (51%) of all park users were female. Eighty-one percent of studies (n=21) reported PA outcomes for individuals of all ages, while 4 studies (15%) reported PA outcomes for children only and 1 study (4%) for adults only. Moderate-to-vigorous physical activity (MVPA) of park users ranged from 31% to 85% (Median=55.0%). Studies conducted in the U.S. reported a slightly higher median number of park-users engaging in MVPA than those outside the U.S. (60.5% vs. 52.8%). Fifteen studies examined gender differences in MVPA. Among these, 12 (87%) reported more males engaging in MVPA than females. Results of this review highlight the need for innovative strategies to promote MVPA among park users and to increase park use among children.

Park characteristics, use, and physical activity: A review of studies using SOPARC (System for Observing Play and Recreation in Communities)

The System for Observing Play and Recreation in Communities (SOPARC) can obtain information on park users and their physical activity using momentary time sampling. We conducted a literature review of studies using the SOPARC tool to describe the observational methods of each study, and to extract public park use overall and by demographics and physical activity levels. We searched PubMed, Embase, and SPORTDiscus for full-length observational studies published in English in peer-reviewed journals through 2014. Twenty-four studies from 34 articles were included. The number of parks observed per study ranged from 3 to 50. Most studies observed parks during one season. The number of days parks were observed ranged from 1 to 16, with 16 studies observing 5 or more days. All studies included at least one weekday and all but two included at least one weekend day. Parks were observed from 1 to 14times/day, with most studies observing at least 4 times/day. All studies included both morning and afternoon observations, with one exception. There was a wide range of park users (mean 1.0 to 152.6 people/park/observation period), with typically more males than females visiting parks and older adults less than other age groups. Park user physical activity levels varied greatly across studies, with youths generally more active than adults and younger children more active than adolescents. SOPARC was adapted to numerous settings and these review results can be used to improve future studies using the tool, demonstrate ways to compare park data, and inform park promotions and programming.

Insights from an observational assessment of park-based physical activity in Nanchang, China

Internationally, parks have been shown to be an important community asset for physical activity (PA), but little is known about the relationship between park usage and physical activity in China. The purpose of this study was to determine the association between park user characteristics and PA in Nanchang, China. In June 2014, 75,678 people were observed in eight parks over 12 days using SOPARC, a validated systematic observation tool. A logistic regression analysis was used to determine the association between PA and park user characteristics. Most park users were older adults (53.5%) or adults (34.6%). Overall, 55% of park users engaged in moderate-to-vigorous physical activity (MVPA). Fewer women were observed in parks than men, but were 66% more likely to be engaged in MVPA than men. Park users were more likely to be observed in MVPA between 6–9 am and when the temperature was below 30 °C. Chinese park users were more active (55%) than US studies in Tampa (30%), Chicago (49%), and Los Angeles (34%). More research is necessary to identify features of parks that are associated with greater PA so that effective interventions can be developed to promote active park use in Chinese citizens.

•

Park use and physical activity were assessed in 8 parks in Nanchang, China.

•

Children and teenagers were seldom observed in parks.

•

About half of park users were physically active.

•

Temperature but not air quality was related to park use.

Local Spatial Analysis and Dynamic Simulation of Childhood Obesity and Neighbourhood Walkability in a Major Canadian City

Body weight is an important indicator of current and future health and it is even more critical in children, who are tomorrow's adults. This paper analyzes the relationship between childhood obesity and neighbourhood walkability in Calgary, Canada. A multivariate analytical framework recognizes that childhood obesity is also associated with many factors, including socioeconomic status, foodscapes, and environmental factors, as well as less measurable factors, such as individual preferences, that could not be included in this analysis. In contrast with more conventional global analysis, this research employs localized analysis and assesses need-based interventions. The one-size-fit-all strategy may not effectively control obesity rates, since each neighbourhood has unique characteristics that need to be addressed individually. This paper presents an innovative framework combining local analysis with simulation modeling to analyze childhood obesity. Spatial models generally do not deal with simulation over time, making it cumbersome for health planners and policy makers to effectively design and implement interventions and to quantify their impact over time. This research fills this gap by integrating geographically weighted regression (GWR), which identifies vulnerable neighbourhoods and critical factors for childhood obesity, with simulation modeling, which evaluates the impact of the suggested interventions on the targeted neighbourhoods. Neighbourhood walkability was chosen as a potential target for localized interventions, owing to the crucial role of walking in developing a healthy lifestyle, as well as because increasing walkability is relatively more feasible and less expensive then modifying other factors, such as income. Simulation results suggest that local walkability interventions can achieve measurable declines in childhood obesity rates. The results are encouraging, as improvements are likely to compound over time. The results demonstrate that the integration of GWR and simulation modeling is effective, and the proposed framework can assist in designing local interventions to control and prevent childhood obesity.

How active are people in metropolitan parks? An observational study of park visitation in Australia

Background

Parks are generally an under-utilized resource in the community with great potential to enhance levels of physical activity. If parks are to attract more visitors across a broad cross-section of the population and facilitate increased physical activity, research is needed to better understand park visitor characteristics and how visitors spend their time in parks. The Recording and EValuating Activity in a Modified Park (REVAMP) study is a natural experiment monitoring a park upgrade in a low socioeconomic status (SES) neighborhood. This study described the observed baseline characteristics of park visitors (age, sex) and characteristics of visitation (weekday or weekend day, period of the day) and explored how these characteristics were associated with observed park-based physical activity in two metropolitan parks located Melbourne, Australia.

Methods

Direct observations of park visitors were conducted using a modified version of SOPARC (the System for Observing Play and Recreation in Communities) on four weekdays and four weekend days. During weekdays, observations were conducted every hour from 7:30 am-4:30 pm and on weekend days from 8:30 am-4:30 pm. This equated to a total of 1460 scans across the two parks. Chi-square tests examined bivariate associations between park-based physical activity, and socio-demographic and park visitation characteristics. Logistic regression models examined the odds of being observed engaging in moderate- to vigorous-intensity physical activity relative to lying/sitting/standing according to socio-demographic and park visitation characteristics.

Results

In total, 4756 park visitors were observed with the majority visiting on weekend days (87 %) and in the afternoon (41 %). Most visitors (62 %) were lying, sitting or standing, with only 29 % observed engaging in moderate-intensity and 9 % in vigorous-intensity physical activity. Park use differed by time of day, sex, age group, and neighborhood SES. Physical activity was lower for women than men (OR 0.76) and higher among visitors in the high SES area (OR 1.52).

Conclusions

Parks offer substantial opportunities for people of all ages to engage in physical activity; however, this study showed that a large proportion of the park visitors observed were engaged in sedentary pursuits. Further research on how park design, amenities and programming can optimize park visitation and park-based physical activity is needed.

Trial Registration

Current controlled trial ISRCTN50745547, registration date 11.1.2014

International variation in neighborhood walkability, transit, and recreation environments using geographic information systems: the IPEN adult study

Background

The World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions.

Methods

The International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant’s residential address using 1-km and 500-m street network buffers.

Results

Eleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability.

Conclusions

Results show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals’ physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose–response relationships from projected changes to the built environment that would otherwise be impossible.

Electronic supplementary material

The online version of this article (doi:10.1186/1476-072X-13-43) contains supplementary material, which is available to authorized users.

Catchments of general practice in different countries--a literature review

The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus.

Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area.

This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK.

Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the allocation of resources so that opportunities for good health outcomes for all groups within society, especially those who have been systematically denied equitable access, are maximised.

Public open spaces and walking for recreation: moderation by attributes of pedestrian environments

OBJECTIVE

This study examined whether attributes of pedestrian environments moderate the relationships between access to public open spaces (POS) and adults' recreational walking.

METHODS

Data were collected from participants of the North West Adelaide Health Study in 2007. Recreational walking was determined using self-reported walking frequency. Measures of POS access (presence, count, and distance to the nearest POS) were assessed using a Geographic Information System. Pedestrian environmental attributes included aesthetics, walking infrastructure, barrier/traffic, crime concern, intersection density, and access to walking trails. Regression analyses examined whether associations between POS access and recreational walking were moderated by pedestrian environmental attributes.

RESULTS

The sample included 1574 participants (45% men, mean age: 55). POS access measures were not associated with recreational walking. However, aesthetics, walking infrastructure, and access to walking trail were found to moderate the POS-walking relationships. The presence of POS was associated with walking among participants with aesthetically pleasing pedestrian environments. Counter-intuitively, better access to POS was associated with recreational walking for those with poorer walking infrastructure or no access to walking trails.

CONCLUSION

Local pedestrian environments moderate the relationships between access to POS and recreational walking. Our findings suggest the presence of complex relationships between POS availability and pedestrian environments.

Structural diversity: a multi-dimensional approach to assess recreational services in urban parks

Urban green spaces provide important recreational services for urban residents. In general, when park visitors enjoy "the green," they are in actuality appreciating a mix of biotic, abiotic, and man-made park infrastructure elements and qualities. We argue that these three dimensions of structural diversity have an influence on how people use and value urban parks. We present a straightforward approach for assessing urban parks that combines multi-dimensional landscape mapping and questionnaire surveys. We discuss the method as well the results from its application to differently sized parks in Berlin and Salzburg.

The associations between park environments and park use in southern US communities

PURPOSE

To document park use and park and neighborhood environment characteristics in rural communities, and to examine the relationship between park characteristics and park use.

METHODS

The System for Observing Play and Recreation in Communities measured use in 42 target areas across 6 community parks in May 2010 and October 2010. Direct observation instruments were used to assess park and neighborhood environment characteristics. Logistic regression was used to determine the relationship between the condition, number of amenities, and number of incivilities in a target area with target area use.

FINDINGS

Ninety-seven people were observed across all parks during May 2010 data collection and 116 people during October 2010 data collection. Low park quality index scores and unfavorable neighborhood environment characteristics were observed. There was a significant positive association between number of incivilities in a target area and target area use (OR = 1.91; 95% CI: 1.09-3.38; P = .03).

CONCLUSIONS

The number of people observed using the parks in this study was low, and it was considerably less than the number observed in other studies. The objective park and neighborhood environment characteristics documented in this study provide a more comprehensive understanding of parks than other studies. Further examining the complex relationship between park and neighborhood environment characteristics and park use is important, as it can inform park administrators and city planners of characteristics that are best able to attract visitors.

Proximity to urban parks and mental health

BACKGROUND

Urban parks have received attention in recent years as a possible environmental factor that could encourage physical activity, prevent obesity, and reduce the incidence of chronic conditions. Despite long hypothesized benefits of parks for mental health, few park studies incorporate mental health measures.

AIMS OF THE STUDY

To test the association between proximity to urban parks and psychological distress.

METHODS

Cross-sectional analysis of individual health survey responses. Data were collected for a study of capital improvements of neighborhood parks in Los Angeles. A survey was fielded on a sample of residential addresses, stratified by distance from the park (within 400m, 800m, 1.6 km, and 3.2km; N=1070). We used multiple regression to estimate the relationship between the psychological distress as measured by the MHI-5 (outcome variable) and distance to parks (main explanatory variable), controlling for observed individual characteristics.

RESULTS

Mental health is significantly related to residential distance from parks, with the highest MHI-5 scores among residents within short walking distance from the park (400m) and decreasing significantly over the next distances. The number of visits and physical activity minutes are significantly and independently related to distance, although controlling for them does not reduce the association between distance and mental health.

DISCUSSION AND LIMITATIONS

This paper provides a new data point for an arguably very old question, but for which empirical data are sparse for the US. A nearby urban park is associated with the same mental health benefits as decreasing local unemployment rates by 2 percentage points, suggesting at least the potential of environmental interventions to improve mental health. The analysis is cross-sectional, making it impossible to control for important confounders, including residential selection.

IMPLICATIONS FOR HEALTH POLICY

Mental health policy has traditionally focused on individual-centered interventions. Just as health policy for preventable chronic illnesses has shifted attention to modifiable environmental determinants, population mental health may benefit substantially from environmental interventions.

IMPLICATIONS FOR FUTURE RESEARCH

Policy evaluations should incorporate mental health measures when assessing neighborhood improvement programs and physical environments. Many recent and ongoing studies have excluded mental health measure in the belief that they are too burdensome for respondents or irrelevant. If a causal relationship is confirmed, then ameliorating neighborhood conditions and physical environments could represent a scalable way to improve mental health issues for large populations.