Park proximity, quality and recreational physical activity among mid-older aged adults: moderating effects of individual factors and area of residence

Disaggregation of Green Space Access, Walkability, and Behavioral Risk Factor Data for Precise Estimation of Local Population Characteristics

BACKGROUND

Social and Environmental Determinants of Health (SEDH) provide us with a conceptual framework to gain insights into possible associations among different human behaviors and the corresponding health outcomes that take place often in and around complex built environments. Developing better built environments requires an understanding of those aspects of a community that are most likely to have a measurable impact on the target SEDH. Yet data on local characteristics at suitable spatial scales are often unavailable. We aim to address this issue by application of different data disaggregation methods.

METHODS

We applied different approaches to data disaggregation to obtain small area estimates of key behavioral risk factors, as well as geospatial measures of green space access and walkability for each zip code of Allegheny County in southwestern Pennsylvania.

RESULTS

Tables and maps of local characteristics revealed their overall spatial distribution along with disparities therein across the county. While the top ranked zip codes by behavioral estimates generally have higher than the county's median individual income, this does not lead them to have higher than its median green space access or walkability.

CONCLUSION

We demonstrated the utility of data disaggregation for addressing complex questions involving community-specific behavioral attributes and built environments with precision and rigor, which is especially useful for a diverse population. Thus, different types of data, when comparable at a common local scale, can provide key integrative insights for researchers and policymakers.

Modelling count, bounded and skewed continuous outcomes in physical activity research: beyond linear regression models

BACKGROUND

Inference using standard linear regression models (LMs) relies on assumptions that are rarely satisfied in practice. Substantial departures, if not addressed, have serious impacts on any inference and conclusions; potentially rendering them invalid and misleading. Count, bounded and skewed outcomes, common in physical activity research, can substantially violate LM assumptions. A common approach to handle these is to transform the outcome and apply a LM. However, a transformation may not suffice.

METHODS

In this paper, we introduce the generalized linear model (GLM), a generalization of the LM, as an approach for the appropriate modelling of count and non-normally distributed (i.e., bounded and skewed) outcomes. Using data from a study of physical activity among older adults, we demonstrate appropriate methods to analyse count, bounded and skewed outcomes.

RESULTS

We show how fitting an LM when inappropriate, especially for the type of outcomes commonly encountered in physical activity research, substantially impacts the analysis, inference, and conclusions compared to a GLM.

CONCLUSIONS

GLMs which more appropriately model non-normally distributed response variables should be considered as more suitable approaches for managing count, bounded and skewed outcomes rather than simply relying on transformations. We recommend that physical activity researchers add the GLM to their statistical toolboxes and become aware of situations when GLMs are a better method than traditional approaches for modeling count, bounded and skewed outcomes.

Application of theoretical domains framework to explore the enablers and barriers to physical activity among university staff and students: a qualitative study

BACKGROUND

Physical inactivity is one of the major risk factors for developing several chronic illnesses. However, despite strong evidence indicating the health benefits of physical activity, many university staff and students tend to be physically inactive. University settings provide a stable environment where behaviour change interventions can be implemented across multiple levels of change. The aim of this study is to examine the perceived barriers and enablers to physical activity among staff and students in a university setting, using the Theoretical Domains Framework (TDF), a precursor of COM-B behaviour model.

METHODS

This was a qualitative study carried out at a Midlands University in the United Kingdom. Eight group interviews were conducted with the sample (n = 40) consisting of 6 male and 15 female university staff (mean age = 40.5 ± 10.6 years) with different job roles (e.g., academic, administrative, cleaning and catering staff), and 12 male and 7 female students (mean age = 28.6 ± 4.7 years) at different stages of study (e.g., undergraduate, postgraduate, and international students). Interviews were audio recorded, transcribed verbatim and imported into NVivo12 software, responses were mapped using the TDF where theory-driven deductive content analysis was used for data analysis.

RESULTS

Six prominent domains were identified from the group interviews as enablers and/or barriers to physical activity among university staff and students: Environmental context and resources; intentions; social influences; knowledge; beliefs about capabilities; and social/professional role and identity. The themes emerging from the group interviews fit into all 14 domains of the TDF; however, 71% of the themes fit into the six most prominent domains.

CONCLUSIONS

These findings suggest that several enablers and barriers influence university staff and students' capability, opportunity, and motivation to engage in physical activity. This study, therefore, provides a theoretical foundation to inform the development of bespoke interventions to increase physical activity among inactive university staff and students.

Older Adults' Self-Reported Physical Activity and Distance to and Land Use Around Reported Physical Exercise Destinations

Little is known about older adults' physical exercise destinations. We studied associations between physical activity (PA) level and physical exercise destinations (total number and surrounding environment) in community-dwelling 75- to 85-year-old adults living in Central Finland. Participants (N = 901) reported the amount of at least moderate-intensity PA and physical exercise destinations. Distance from home, land use, and locations of sport facilities were defined using a geographic information system. A general linear model showed that older adults with higher PA reported higher numbers of physical exercise destinations and destinations further away from home than those reporting lower PA. Binary logistic regression showed that higher PA increased the odds of reporting a distant destination identified as a sports facility and of reporting destinations located in residential, service, forest, and water body areas, respectively. Physical exercise destinations in different environments may attract older people to go out and be more physically active.

Longitudinal Associations of Physical Activity Patterns and the Environment: An 18-Year Follow-Up to the MESA Study

Introduction: Cross-sectional association between the neighborhood-built environment and physical activity (PA) has been demonstrated previously, indicating the importance of neighborhood perception characteristics such as walkability, safety, and the connectivity of streets on PA levels. Our study aimed to assess the longitudinal data from participants of the Multi-Ethnic Study of Atherosclerosis (MESA) to evaluate the potential relationship between perceived environment and PA patterns. Methods: We analyzed data from a subset of participants (n = 3097) with available PA data who participated in a prospective cohort conducted from 2000 to 2018. The exposure variables were the perceived aspects of the neighborhood environment and the perception of safety, and the outcome was patterns of PA. Patterns were defined as categories reflecting meeting versus not meeting PA guidelines over time. We created the following categories: adopters (individuals who did not meet guidelines at baseline but met guidelines at Exam 6), relapsers (individuals who met guidelines at baseline but did not meet guidelines at Exam 6), maintainers (individuals who met guidelines both at baseline and Exam 6), and insufficiently active (individuals who did not meet guidelines at either baseline or Exam 6). The maintainers' group was considered the reference category. We estimated the relative risk to assess the magnitude effect of the association between environmental perceptions and the outcome. Results: Individuals who reported that lack of parks and playgrounds was "not a problem" in their neighborhood had a 2.3-times higher risk of decreasing their physical activity (i.e., the "relapser" category) compared to maintainers. After full adjustment, perceiving poor sidewalks as "somewhat a serious problem" was associated with a 64% lower risk of becoming an adopter than a maintainer. When compared to those who perceive the neighborhood as "very safe", perception of the neighborhood as "safe" to "not at all safe" (ratings 3, 4, and 5, respectively, on the perceived safety scale) was significantly associated with being classified in the adopter category. Conclusions: As the first longitudinal study of the association of perceived environment and physical activity within the MESA cohort, we conclude that a few aspects are longitudinally associated with being physically active among adults.

Cognability: An Ecological Theory of neighborhoods and cognitive aging

While a growing body of evidence points to potentially modifiable individual risk factors for dementia, the built and social environments in which people develop and navigate cognitive decline are largely overlooked. This paper proposes a new theoretical concept, Cognability, to conceptualize how supportive an area is to cognitive health among aging residents. Cognability incorporates a constellation of both positive and negative neighborhood features related to physical activity, social interaction and cognitive stimulation in later life. We analyzed data from the REasons for Geographic And Racial Differences in Stroke Study, a national sample of older Black and white adults in the United States (n = 21,151; mean age at assessment = 67; data collected 2006-2017). Generalized additive multilevel models examined how cognitive function varied by neighborhood features. Access to civic and social organizations, recreation centers, fast-food and coffee establishments, arts centers, museums, and highways were significantly associated with cognitive function. Race-, gender-, and education-specific models did not yield substantial improvements to the full-model. Our results suggest that the unequal distribution of amenities and hazards across neighborhoods may help account for considerable inequities observed in cognitive health among older adults. Cognability advances ecological theories of aging through an innovative "whole neighborhood" approach. It aims to identify which specific neighborhood features are most protective of cognitive health among aging adults to inform upstream public health initiatives, community interventions, and policy.

Tranquillity in Urban Classical Chinese Gardens and Modern Parks: The Effect of Natural and Contextual Features

Parks and green spaces are an integral part of many urban areas. Such spaces offer a variety of psychological, physical and social benefits promoting a stronger sense of community and allowing people to cope better with everyday stress. These parks are often designed to provide tranquillity for people, and it is now an emerging area of policy in the promotion of quality of life. Tranquillity is considered a natural asset. Although they are vital, tranquil spaces are under threat, and it is, therefore, important to identify and understand such places so that they can be further planned and managed for the benefits that they provide. This study conceptualises the understanding of tranquillity and determines the extent to which a tranquil environment can be achieved. The study identified six parks referred to as “modern parks (MPs)” and “classical Chinese gardens (CCGs)”. Three parks each are located in Hong Kong and Guangzhou. Questionnaires were used to ascertain the importance of tranquil areas and the contribution of park components towards tranquillity. This study investigates the contribution of park elements that include both natural and contextual features. Furthermore, park characteristics and park elements were similarly identified. There were clear differences between natural and contextual features in terms of their potential contribution towards park users’ perceived tranquillity. There is also a striking importance and potential contribution of contextual features within classical Chinese gardens in relation to perceived tranquillity. This study concludes that there is the need to continue to enhance the quality of park spaces with regard to fostering tranquillity in urban areas.

Do we have enough recreational spaces during pandemics? An answer based on the analysis of individual mobility patterns in Switzerland

Densification of cities threatens the provision of public open space for people living in and around cities. The increasing evidence of the many benefits of recreational walking for physical and mental health during the COVID-19 pandemic has highlighted an urgent need for fostering the availability of public open space. In this context, urban planners need information to anticipate recreational needs and propose long-term, resilient solutions that consider the growing demand driven by increasing urban population and intensified in times of crisis such as the recent pandemic. In this paper, we harness the unique large MOBIS:COVID-19 GPS travel diary data on mobility behaviour collected during a normal baseline period and during the first wave of the Covid-19 pandemic in the Canton of Zurich Switzerland. We estimate a sufficiency rate that allows to geolocate locations where the demand for public open space is higher than the available offer. In a second step, we explore if preference patterns for recreational areas have changed during the pandemic. Results indicate that the main cities and important towns in the case study area are saturated by current demand, and that the pandemic has amplified the problem. In particular, urban dwellers look for tranquil areas to recreate. Such information is crucial to guide decision-making processes for planning the cities of the future.

The Effects of Urban Neighborhood Environmental Evaluation and Health Service Facilities on Residents' Self-Rated Physical and Mental Health: A Comparative and Empirical Survey

(1) Background: The neighborhood environment has been shown to be an essential factor affecting residents’ quality of life and health, but the relationship between the characteristics of health service facilities and health levels is rarely known. (2) Methods: This study used a representative sample (n = 591, 303 women; 288 men, age 18–85 years, lived in Chengdu for an extensive time) of residents living in Chengdu City, China, and took spatial point data and empirical research data to construct an ordered logistic regression model. We contrastively analyzed the influence of different variables in the neighborhood environment and health service facilities on self-rated physical health (SRPH) and self-rated mental health (SRMH). (3) Results: The frequency of use and accessibility of multiple facilities in the health service facilities were significantly associated with self-rated health (SRH). Significant differences occurred between residents’ perceived accessibility and actual accessibility of facilities in SRH. Comparing the results of SRPH and SRMH revealed that the influencing factors that affect the two vary. The factors that significantly affect SRMH include neighborhood physical environment evaluation; social environmental evaluation; the frequency of use of the parks and squares, and sports zones; and the accessibility of parks and squares, specialized hospitals, community hospitals, and pharmacies. However, the factors that significantly affect SRPH include the frequency of use of sports venues, general hospitals, and pharmacies and the accessibility of general hospitals. The social environment of the neighborhood is also a non-negligible part, and its interaction with the physical environment of the neighborhood affects the outcome of SRH. (4) Conclusions: Neighborhood environmental characteristics and the layout of health service facilities have significant differential effects on people’s physical and psychological health, and this information is of great value in promoting healthy city development and improving the quality of life of urban populations around the world.

Optimization Strategy for Parks and Green Spaces in Shenyang City: Improving the Supply Quality and Accessibility

In this study, we evaluated the supply quality of parks and green spaces within the Third Ring Road area in Shenyang city by combining a landscape pattern index analysis with a principal component analysis. Moreover, a network analysis based on the ArcGIS platform was used to measure the accessibility of parks and green spaces. The research results showed that the overall supply quality of parks and green spaces (−9.55) must be improved. The supply quality levels of the four analyzed park types could be ranked as follows: garden parks (118.00) > community parks (73.67) > comprehensive parks (−16.64) > specific parks (−32.17). Among the analyzed recreation parks, the accessibility of daily recreation parks was poor, while the overall service efficiency of weekly recreation parks was better, except in a few regions. These research results can provide suggestions for future green space planning in Shenyang city. In addition, from the perspective of landscape patterns, studying the service quality of parks and green spaces can provide new ideas for further research on accessibility.

Assessing the Impact of a New Urban Greenway Using Mobile, Wearable Technology-Elicited Walk- and Bike-Along Interviews

Physical inactivity is the fourth leading risk factor for global mortality, causing an estimated 3.3 million deaths worldwide. Characteristics of the built environment, including buildings, public spaces, pedestrian and cycling infrastructure, transportation networks, parks, trails and green spaces can facilitate or constrain physical activity. However, objective study of built environment interventions on physical activity remains challenging due to methodological limitations and research gaps. Existing methods such as direct observations or surveys are time and labour intensive, and only provide a static, cross-sectional view of physical activity at a specific point in time. The aim of this study was to develop a novel method for objectively and inexpensively assessing how built environment changes may influence physical activity. We used a novel, unobtrusive method to capture real-time, in situ data from a convenience sample of 25 adults along a newly constructed urban greenway in an area of high deprivation in Belfast, UK. Walk/bike-along interviews were conducted with participants using a body-worn or bicycle-mounted portable digital video camera (GoPro HERO 3+ camera) to record their self-determined journeys along the greenway. This is the first study to demonstrate the feasibility of using wearable sensors to capture participants’ responses to the built environment in real-time during their walking and cycling journeys. These findings contribute to our understanding of the impact of real-world environmental interventions on physical activity and the importance of precise, accurate and objective measurements of environments where the activity occurs.

Street view greenness is associated with lower risk of obesity in adults: Findings from the 33 Chinese community health study

BACKGROUND

Urban greenness may protect against obesity, but very few studies have assessed 'street view' (SV) greenness metrics, which may better capture people's actual exposure to greenness compared to commonly-used satellite-derived metrics. We aimed to investigate these associations further in a Chinese adult study.

METHODS

Our analysis included 24,845 adults in the 33 Chinese Community Health Study in 2009. SV images from Tencent Map, segmented by machine learning algorithms, were used to determine the average proportion of green vegetation in SV images at community level in 800m road network buffer. Sensitivity analyses were performed with an alternative buffer size. Overall greenness was assessed as normalized difference vegetation index (NDVI) in 800 m buffer. We used predicted PM_2.5 and monitored NO₂ as proxies of air pollution. Body mass index (BMI), waist circumference (WC) and hip circumference (HC) were regressed on SV greenness by generalized linear mixed models, with adjustment for covariates. Mediation analyses were performed to assess the mediation effects of air pollution.

RESULTS

Each interquartile range (IQR = 3.6%) increase in street view greenness was associated with a 0.15 kg/m² (95% CI: -0.22, -0.09) decrease in BMI and 0.23 cm (95% CI: -0.35, -0.11) reduction in HC, and was associated with 7% lower odds of overweight (OR = 0.93, 95% CI:0.90, 0.96) and 18% lower odds of obesity (OR = 0.82, 95% CI:0.76, 0.89). Similar effect estimation was observed compared with commonly-used NDVI measures. PM_2.5 and NO₂ mediated 15.5% and 6.1% of the effects of SV greenness with BMI, respectively.

CONCLUSIONS

Our findings suggest beneficial associations between community-level SV greenness and lower body weight in Chinese adults. The effects were observed in women but not in men. Air pollution may partially mediate the association. These findings may have implications to support efforts to promote greening in urban areas.

Neighborhood active aging infrastructure and cognitive function: A mixed-methods study of older Americans

Physical exercise benefits cognitive functioning and can protect against neurodegeneration. Neighborhood environments may be pivotal to physically active aging, and thus help shape older adults' cognitive function. This mixed-methods study investigated where older adults exercised outside the home, and whether availability of these neighborhood sites was associated with cognitive function. We thematically analyzed qualitative data from semi-structured interviews in 2015 with 125 older adults (mean age = 71) in the Minneapolis (MN) metropolitan area. Results identified nearby public parks, fitness/sports amenities, and walkable destinations as motivators for recreational exercise and active transit among participants. These findings informed quantitative analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national sample of older Black and white Americans (n = 21,151; mean age at assessment = 67; data collected 2006-2017). We used generalized additive multilevel models to examine whether neighborhood features that qualitative participants identified as encouraging physical activity were associated with elevated levels of cognitive function. Results indicated that residing in neighborhoods with greater availability of local parks, access to recreational amenities, and business density was associated with higher levels of cognitive function. We found no evidence to suggest a significant association between availability of these neighborhood resources and rate of cognitive decline. This study identifies specific neighborhood active aging infrastructure that may support cognitive function among older adults aging in place.

Investigating the WHAT and WHY on older adults' use of neighborhood open spaces following an environmental intervention

Using neighborhood open spaces (NOS) may be an easy way for older adults to maintain healthy aging through physical activity and social interaction. Little is known about older adults' use of NOS, their preferences, and barriers to using them. This paper presents older adults' use of NOS in a deprived neighborhood before and after an intervention and factors promoting or inhibiting their use using convergent mixed methods design. Participatory research was employed involving older adults in the intervention. The System for Observing Play and Recreation in Communities was used to observe older adults' use of 13 NOS in spring 2017 (baseline) and spring 2018 (follow-up). Ten interviews were conducted in 2018 to identify barriers and facilitators for using NOS. Two NOS had a pavilion built and, in one NOS, benches were renovated, including building raised flower beds and small tables. At baseline, 209 older adults were observed, whereas 329 were observed at follow-up. More (44%) older adults were observed at follow-up in the NOS with the renovated benches. No use of the two pavilions was observed. The interviews identified six factors important for older adults' use of NOS: weather, support for social caretakers, support for resourceful volunteers, organized activities, social interaction, and sense of ownership. Organizational resources, such as social caretakers and volunteers, are important to promote older adults' use of NOS. Social interaction is a key factor for older adults' use of NOS and should be prioritized by health promoters.

Understanding Aging in Place: Home and Community Features, Perceived Age-Friendliness of Community, and Intention Toward Aging in Place

BACKGROUND AND OBJECTIVES

Promoting age-friendliness of communities and supporting aging in place (AIP) are of great importance. Based on processes of belonging and agency, which suggest that person-environment interactions influence residents' evaluations and behaviors related to the environment, this study aims to examine the interrelationship between the availability of age-friendly features, perceived age-friendliness of community, and intention toward AIP.

RESEARCH DESIGN AND METHODS

This study used the 2015 AARP Age-Friendly Community Survey, which includes 66 home and neighborhood features under the eight domains specified by the WHO's Age-Friendly Cities Guidelines. A series of regression and mediational analyses were conducted to test hypotheses.

RESULTS

Overall, a greater availability of age-friendly features was positively associated with perceived age-friendliness of community and AIP intention. The relationship between age-friendly features and AIP intention was mediated by perceived age-friendliness of community (50.3% to 96% of the total effects). When perceived age-friendliness of community was introduced to models, the direct effects of housing, outdoor spaces and buildings, and transportation domains remained significant.

DISCUSSION AND IMPLICATIONS

Findings suggest that a greater availability of age-friendly features influences older adults' perception on their community, leading to the development of a desire to age-in-place, supporting processes of belonging and agency. Domains of housing, outdoor spaces and buildings, and transportation may be the most important features in promoting age-friendliness of community and the key determinants of aging in place. Policy makers and practitioners may need to prioritize promoting age-friendly built environment before social environment in building age-friendly communities.

Psychosocial and Social Environmental Factors as Moderators in the Relation between the Objective Environment and Older Adults' Active Transport

In order to develop tailored interventions aiming to encourage active transport among older adults, it is important to gain insights into the modifiable moderators affecting active transport behavior considering the neighborhood in which one lives. Therefore, this study aimed to determine which objective physical environmental factors have an impact on the active transport behavior of Belgian older adults (≥65 years old) and which psychosocial and social environmental moderators influence those relationships. Data from 503 independent living older adults who participated the Belgian Environmental Physical Activity Study in Seniors were included. Multilevel negative binominal regression models (participants nested in neighborhoods) with log link function were fitted for the analyses. Our resulted indicated that older adults living in an environment with higher residential density, higher park density, lower public transport density, and more entropy index had higher active transport levels. Furthermore, different types of neighborhood in which older adults live can lead to different moderators that are decisive for increasing older adults’ active transport behavior. Therefore, based on our results some recommendations towards tailored interventions could be given to increase older adults’ active transport behavior depending on the environment in which one lives.

Are park availability and satisfaction with neighbourhood parks associated with physical activity and time spent outdoors?

BACKGROUND

There is substantial scope for enhancing population health through increased park visits and active use of parks; however, a better understanding of factors that influence park visitation is needed. This cross-sectional study examined how parent-reported satisfaction and perceived availability of parks were associated with adults' physical activity and children's physical activity and time spent outdoors, and whether these associations were mediated by park visitation.

METHODS

Self-reported surveys were completed by adults living within 5 km of two parks located in Melbourne, Australia. Participants reported their satisfaction with neighbourhood park quality, walking duration from home to the nearest park, and park visitation in the past 7 days. Participants with a child aged 2-15 years also answered similar questions in relation to their child. The primary outcome variable for adults was leisure-time physical activity (LTPA) and for children was proxy-reported time spent outside. The secondary outcome for adults was combined transportation and LTPA and for children (5-15 years) was the number of days physical activity recommendations were met in the past 7 days.

RESULTS

Significant positive associations between park availability and park visitation in the past 7 days, and between park visitation and the outcome variables were observed among both adults (n = 1085, M_age = 48.9, SD 13.4) and children (n = 753, M_age = 8.8, SD = 3.7). The association between park satisfaction and park visitation was only significant among adults. Park visitation mediated associations between park availability and park satisfaction and the outcome variables among both adults and children.

CONCLUSIONS

Improving park availability and users' satisfaction with parks may increase visitation and consequently increase physical activity and time spent outdoors.

Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%; age > 60 years; fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults' use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.

Mental Health and Recreation Opportunities

The environment has direct and indirect effects on mental health. Previous studies acknowledge that the poor design of communities and social environments leads to increased psychological distress, but methodological issues make it difficult to draw clear conclusions. Recent public health, leisure and recreation studies have tried to determine the relationship between recreation opportunities and mental health. However, previous studies have heavily focused on individual contexts rather than national or regional levels; this is a major limitation. It is difficult to reflect the characteristics of community environments effectively with such limited studies, because social environments and infrastructure should be analyzed using a spatial perspective that goes beyond an individual’s behavioral patterns. Other limitations include lack of socioeconomic context and appropriate data to represent the characteristics of a local community and its environment. To date, very few studies have tested the spatial relationships between mental health and recreation opportunities on a national level, while controlling for a variety of competing explanations (e.g., the social determinants of mental health). To address these gaps, this study used multi-level spatial data combined with various sources to: (1) identify variables that contribute to spatial disparities of mental health; (2) examine how selected variables influence spatial mental health disparities using a generalized linear model (GLM); (3) specify the spatial variation of the relationships between recreation opportunities and mental health in the continental U.S. using geographically weighted regression (GWR). The findings suggest that multiple factors associated with poor mental health days, particularly walkable access to local parks, showed the strongest explanatory power in both the GLM and GWR models. In addition, negative relationships were found with educational attainment, racial/ethnic dynamics, and lower levels of urbanization, while positive relationships were found with poverty rate and unemployment in the GLM. Finally, the GWR model detected differences in the strength and direction of associations for 3109 counties. These results may address the gaps in previous studies that focused on individual-level scales and did not include a spatial context.

Associations between neighborhood park space and cognition in older adults vary by US location: The Multi-Ethnic Study of Atherosclerosis

We used cross-sectional Multi-Ethnic Study of Atherosclerosis data from six US cities/counties and adjusted multilevel linear regression to examine park space-cognition associations among non-demented older adults (n = 4084). We found that greater neighborhood park space 1-mile around the residence (measured continuously) was associated with better processing speed in the overall sample (estimate: 0.48; 95% CI: 0.03, 0.92). However, greater neighborhood park space (½-mile around residence) was associated with worse global cognition in Los Angeles, California (estimate: -2.66; 95% CI: -4.70, -0.62) and worse processing speed in Forsyth County, North Carolina (estimate: -0.72; 95% CI: -1.37, -0.08). Dichotomizing at the mean, having ≥6% park space (½-mile around residence) was associated with better global cognition in Saint Paul, Minnesota (estimate: 0.21; 95% CI: 0.05, 0.38), and better processing speed in New York City (estimate: 0.19; 95% CI: 0.04, 0.35). Park space-cognition associations varied by city/county, suggesting problems with pooling multiple sites without accounting for geographic context or regionally-varying park characteristics (e.g., quality).

Age-Friendly Features in Home and Community and the Self-Reported Health and Functional Limitation of Older Adults: the Role of Supportive Environments

This study aims to identify age-friendly community features that are associated with better health for older adults. This cross-sectional study utilized the 2015 AARP Age-Friendly Communities (AFC) Survey, which includes 66 home and community features that fall within the eight domains specified by the World Health Organization (WHO)'s age-friendly cities guidelines. Two measures of health (self-rated health and functional limitations) were examined using multi-level linear and logistic regressions. Both a greater perceived availability of age-friendly features in communities and a good person-environment fit were associated with better self-rated health and a lower likelihood of reporting functional limitations. The domains of outdoor spaces and buildings, transportation, and social participation and inclusion were consistently associated with these outcomes. Promoting age-friendliness in outdoor spaces and buildings, transportation, and social participation and inclusion domains by providing green spaces, neighborhood safety programs, transportation options, and social opportunities may be the most effective way to support healthy and active aging.

Environmental Mismatch: Do Associations between the Built Environment and Physical Activity among Youth Depend on Concordance with Perceptions?

Without accurate awareness of features within the built environment, the availability of a supportive built environment alone may not be sufficient to influence physical activity levels. We examined the moderating effects of concordance/discordance between selected objective and perceived built environment features in the relationship between objective built environment features and physical activity. Cross-sectional data from 465 youth aged 12–20 years from 18 schools in Melbourne, Australia were used. The relationship between trails and physical activity differed by concordance/discordance. There were positive relationships among those with concordant perceptions, but no significant differences for those with discordant perceptions. At least for trails, environmental interventions designed to enhance physical activity may be less effective if efforts are not made to enhance individuals’ awareness of their environment.

Is the availability of open public spaces associated with leisure-time physical activity in Brazilian adults?

This study aims to analyse the association between perceived presence of public spaces near residences and practice of physical activity during leisure time by adults in the state capitals of Brazil, based on sociodemographic characteristics. Participants were individuals aged ≥18 years living in the 27 state capitals of Brazil (n = 52 929, 53.9% female) who responded to a national survey called VIGITEL in 2013. Physical activity during leisure time (≥1 time/week), perception of space, population and sociodemographic variables (sex, age, years of study and geographic region) were self-reported. The adjusted binary logistic regression analysis was used. Among adults, the prevalence of physical activity during leisure was 45.1% (95% CI [44.2; 46.0]), and 71.1% (95% CI [70.2, 71.8]) perceived public space near their residence. A direct association between perceiving public space and physical activity ([OR] = 1.43; 95% CI [1.32; 1.55]) was observed. No significant difference was observed in the population groups (men and women, younger and older adults, and those with more and fewer years of study). Thus, even with the possible regional differences in Brazilian state capitals, the presence of public spaces increases the practice of physical activity during leisure time, independent of sociodemographic variables.

Neighborhood Walkability and Housing Prices: A Correlation Study

This study aims to examine the relationship between the level of walkability and housing prices in Seoul, Korea. The average transaction price per square meter for each apartment complex was set as a dependent variable and the walkability score was used as an independent variable. This study divided a total of 5986 apartment complexes into areas with high and low housing prices for analysis. Based on the strong spatial autocorrelations of housing prices, this study employed spatial regression models in addition to the Ordinary Least Squares (OLS) model. Results showed that housing prices positively correlated with the walkability score in areas with low housing prices, whereas no significant association was observed in areas with high housing prices. Additional findings showed that housing prices were associated with building age (−), number of households in the complex (+), slope (−), and greenness (+) in both subsamples. Results also showed that high school quality had a different association with housing prices depending on the subsample (e.g., the sign was positive in areas with high housing prices and no significance in areas with low housing prices). The results herein support public policy proposals relevant to urban planning, environmental design, and housing policies.

Older Adults' Outdoor Walking and Inequalities in Neighbourhood Green Spaces Characteristics

Outdoor walking has considerable benefits for healthy ageing and older adults are recommended to walk regularly. However, older adults living in high-deprivation areas walk less than those living in low-deprivation areas. Previous research has shown that the characteristics of neighbourhood green spaces (i.e., proximity, attractiveness, size, and number) may influence outdoor walking. This study examines spatial inequalities in the characteristics of neighbourhood green spaces in high- versus low-deprivation areas and their possible influences on disparities in older adults’ outdoor walking levels. For this purpose, it included a sample of 173 participants (≥65 years) and used secondary data and a geographic information system (GIS) to objectively measure neighbourhood green spaces characteristics. Geographic positioning system (GPS) technology was used to objectively measure outdoor walking levels. Data on participants’ personal characteristics were collected by questionnaire. The results indicate that one characteristic of neighbourhood green spaces (i.e., size) is positively related to outdoor walking levels. They show that inequalities in neighbourhood green spaces’ size in high- versus low-deprivation areas may influence disparities in older adults’ outdoor walking levels. Despite inequalities in other neighbourhood green space characteristics (e.g., proximity, attractiveness, and number) in high- versus low-deprivation areas, no relationship was found between these neighbourhood green space characteristics and participants’ outdoor walking levels. Enhancing the distribution or creation of large neighbourhood green spaces (e.g., through creating green space networks) may enhance outdoor walking among older residents, especially in high-deprivation areas.

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.

The Moving to Health (M2H) approach to natural experiment research: A paradigm shift for studies on built environment and health

Improving the built environment (BE) is viewed as one strategy to improve community diets and health. The present goal is to review the literature on the effects of BE on health, highlight its limitations, and explore the growing use of natural experiments in BE research, such as the advent of new supermarkets, revitalized parks, or new transportation systems. Based on recent studies on movers, a paradigm shift in built-environment health research may be imminent. Following the classic Moving to Opportunity study in the US, the present Moving to Health (M2H) strategy takes advantage of the fact that changing residential location can entail overnight changes in multiple BE variables. The necessary conditions for applying the M2H strategy to Geographic Information Systems (GIS) databases and to large longitudinal cohorts are outlined below. Also outlined are significant limitations of this approach, including the use of electronic medical records in lieu of survey data. The key research question is whether documented changes in BE exposure can be linked to changes in health outcomes in a causal manner. The use of geo-localized clinical information from regional health care systems should permit new insights into the social and environmental determinants of health.

Perceived urban neighborhood environment for physical activity of older adults in Seoul, Korea: A multimethod qualitative study

This study assessed the attributes of a perceived urban neighborhood environment for the physical activity (PA) of older adults by applying a qualitative multimethod approach to collect both descriptive and spatial information. Conducted in a northern community of Seoul, Korea, from April 2014 to November 2015, data collection methods included 90 walking tours by researchers, 46 face-to-face, semi-structured interviews combined with qualitative mapping with senior residents aged 65+, 19 guided tours with the interviewees, and 3 focus groups with 12 community service providers. Thematic analysis and pattern finding were performed on the data. Walking was the main type of PA of the older adults. Nine attributes of perceived neighborhood environment for PA were identified under three themes: daily living (everyday life activities, mobility, social opportunities, diverse destinations); the multidimensionality of accessibility (physical, economic, psychosocial), and attractiveness and pleasantness (maintenance, aesthetics). The subcategories of the attributes included proximity, access to public transportation, walkability, cost-worthiness, low or no cost, familiarity, sense of welcoming, sociocultural appropriateness, fair access, order and upkeep, safety, openness, cleanliness, and interestingness. Strategies to generate more movement and activities in the everyday routine of the elderly should be a core task for health promotion and neighborhood design. A strategic application of multiple qualitative methods can create an opportunity to build contextual understanding and to generate ideas in interactions with the community.

Socio-environmental correlates of physical activity in patients with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Study of the causes of the reduced levels of physical activity in patients with COPD has been scarce and limited to biological factors.

AIM

To assess the relationship between novel socio-environmental factors, namely dog walking, grandparenting, neighbourhood deprivation, residential surrounding greenness and residential proximity to green or blue spaces, and amount and intensity of physical activity in COPD patients.

METHODS

This cross-sectional study recruited 410 COPD patients from five Catalan municipalities. Dog walking and grandparenting were assessed by questionnaire. Neighbourhood deprivation was assessed using the census Urban Vulnerability Index, residential surrounding greenness by the satellite-derived Normalized Difference Vegetation Index, and residential proximity to green or blue spaces as living within 300 m of such a space. Physical activity was measured during 1 week by accelerometer to assess time spent on moderate-to-vigorous physical activity (MVPA) and vector magnitude units (VMU) per minute.

FINDINGS

Patients were 85% male, had a mean (SD) age of 69 (9) years, and post-bronchodilator FEV1 of 56 (17) %pred. After adjusting for age, sex, socio-economic status, dyspnoea, exercise capacity and anxiety in a linear regression model, both dog walking and grandparenting were significantly associated with an increase both in time in MVPA (18 min/day (p<0.01) and 9 min/day (p<0.05), respectively) and in physical activity intensity (76 VMU/min (p=0.05) and 59 VMUs/min (p<0.05), respectively). Neighbourhood deprivation, surrounding greenness and proximity to green or blue spaces were not associated with physical activity.

CONCLUSIONS

Dog walking and grandparenting are associated with a higher amount and intensity of physical activity in COPD patients.

TRIAL REGISTRATION NUMBER

Pre-results, NCT01897298.

Access and quality of parks and associations with obesity: A cross-sectional study

Public health is increasingly engaging with multi-faceted obesity prevention efforts. Although parks represent key community assets for broader public health, they may not be distributed equitably and associations with obesity are equivocal. We investigated park access and quality relative to deprivation and obesity with individual-level data from the Yorkshire Health Study. Compared to the least deprived areas, the moderately and most deprived areas had a greater park access and park quality in terms of features and amenities. However, parks in the moderately and most deprived areas also had the most safety concerns and incivilities. Although deprivation was associated with obesity, contrary to current policy guidance, both park access and quality appear less important for understanding variations in obesity within this study. Although sub-group analyses by deprivation tertile revealed that low quality park amenities in highly and moderately deprived areas may be important for understanding obesity prevalence, all other associations were non-significant.

Park availability and major depression in individuals with chronic conditions: Is there an association in urban India?

Green space exposure has been positively correlated with better mental-health indicators in several high income countries, but has not been examined in low- and middle-income countries undergoing rapid urbanization. Building on a study of mental health in adults with a pre-existing chronic condition, we examined the association between park availability and major depression among 1208 adults surveyed in Delhi, India. Major depression was measured using the Mini International Neuropsychiatric Interview. The ArcGIS platform was used to quantify park availability indexed as (i) park distance from households, (ii) area of the nearest park; and within one km buffer area around households - the (iii) number and (iv) total area of all parks. Mixed-effects logistic regression models adjusted for socio-demographic characteristics indicated that relative to residents exposed to the largest nearest park areas (tertile 3), the odds [95% confidence interval] of major depression was 3.1 [1.4-7.0] times higher among residents exposed to the smallest nearest park areas (tertile 1) and 2.1 [0.9-4.8] times higher in residents with mid-level exposure (tertile 2). There was no statistically significant association between other park variables tested and major depression. We hypothesized that physical activity in the form of walking, perceived stress levels and satisfaction with the neighborhood environment may have mediating effects on the association between nearest park area and major depression. We found no significant mediation effects for any of our hypothesized variables. In conclusion, our results provide preliminary and novel evidence from India that availability of large parks in the immediate neighborhood positively impacts mental well-being of individuals with pre-existing chronic conditions, at the opportune time when India is embarking on the development of sustainable cities that aim to promote health through smart urban design - one of the key elements of which is the inclusion of urban green spaces.

Association between built environment and moderate to vigorous physical activity in Korean adults: a multilevel analysis

Background

Research on the association between the built environment and moderate and vigorous physical activities (MVPA) is still evolving. Therefore, more evidence is needed. This study examines the relationship between built environment and MVPA in Korean adults.

Methods

A large sample of 204 324 adults from the 2012 Korean Community Health Survey (KCHS) was analyzed. MVPA was assessed by the International Physical Activity Questionnaire. Individual correlates from the KCHS and community built environment data from the Korean government were collected. A multilevel logistic regression was performed using the GLIMMIX procedure.

Results

Residents in cities (OR = 0.75, 95% CI 0.60-0.93) and districts (OR = 0.70, 95% CI 0.52-0.94) were less likely to engage in MVPA than residents in counties. While residents in communities with the least amount of physical equipment were less likely to participate in MVPA (OR = 0.72, 95% CI 0.57-0.90), residents in communities with the second smallest area of open space for PA were more likely to be active (OR = 1.37, 95% CI 1.07-1.77). The effect of built environment on MVPA was significant but relatively weak in comparison to the influence of individual correlates.

Conclusions

To improve MVPA in adults, a community built environment should be considered along with individual correlates.

Gender differences in walking (for leisure, transport and in total) across adult life: a systematic review

BACKGROUND

The aim of this systematic review was to examine gender differences in walking for leisure, transport and in total in adults living in high-income countries, and to assess whether gender differences in walking practices change across the life-course.

METHODS

A systematic literature search was conducted of publications dated 1995 to 2015. Papers providing quantitative data on participation in walking of both men and women aged at least 18 years in a high-income country were screened for the quality of the data on gender differences in walking. Data were extracted and results were synthesised using forest plots and narrative summary.

RESULTS

Thirty-six studies were included in the review: 18 reported on walking for leisure, 16 on walking for transport (in total, or for particular purposes), and 14 on total walking. Most (33) studies provided data comparing the proportion of men and women who walked (at all or for a minimum duration) over a defined period, usually one week. There was consistent evidence that more women than men walk for leisure, although effect sizes were small. However, this effect varies by age: more younger women than younger men walk for leisure, but the gender difference diminishes with age and appears to reverse in the oldest age groups. Taking all ages together, there was no consistent gender difference in walking for transport or in total walking, although the small number of studies reporting on walking to undertake errands suggested that more women than men walk for this purpose.

CONCLUSIONS

While there is little evidence that levels of total walking consistently vary by gender, our findings suggest that there are consistent gender differences in participation in walking for some purposes, including for leisure, and that there are gender differences in the impact of age on walking. We conclude that more research is needed to improve our understanding of how walking fits into the lives of women and men across the life-course, especially in relation to gender differences in the impact of aging on walking.

PROSPERO REGISTRATION

PROSPERO registration number: CRD42015025961 .

Is the Association between Park Proximity and Recreational Physical Activity among Mid-Older Aged Adults Moderated by Park Quality and Neighborhood Conditions?

Previous studies have reported mixed findings on the relationship between park proximity and recreational physical activity (PA), which could be explained by park quality and the surrounding neighborhood environment. We examined whether park quality and perceptions of the neighborhood physical and social environment moderated associations between park proximity and recreational PA among mid-older aged adults. Cross-sectional self-reported data on park proximity, park quality, neighborhood physical and social environmental factors, recreational walking and other moderate- to vigorous-intensity recreational physical activity (MVPA) were collected among 2700 Australian adults (57–69 years) in 2012. Main effects between park proximity and measures of recreational PA were non-significant. Park proximity was positively related to engagement in recreational walking among participants who reported average and high social trust and cohesion, but not among those reporting low social trust and cohesion. No other moderating effects were observed. Current findings suggest synergistic relationships between park proximity and social trust and cohesion with mid-older aged adults’ recreational walking. More research is needed to unravel the complex relationship between parks, recreational PA and the social context of neighborhoods.

One size doesn't fit all: cross-sectional associations between neighborhood walkability, crime and physical activity depends on age and sex of residents

BACKGROUND

Low-income African American adults are disproportionately affected by obesity and are also least likely to engage in recommended levels of physical activity (Flegal et al. JAMA 303(3):235-41, 2010; Tucker et al. Am J Prev Med 40(4):454-61, 2011). Moderate-to-vigorous physical activity (MVPA) is an important factor for weight management and control, as well as for reducing disease risk (Andersen et al. Lancet 368(9532):299-304, 2006; Boreham and Riddoch J Sports Sci 19(12):915-29, 2001; Carson et al. PLoS One 8(8):e71417, 2013). While neighborhood greenspace and walkability have been associated with increased MVPA, evidence also suggests that living in areas with high rates of crime limits MVPA. Few studies have examined to what extent the confluence of neighborhood greenspace, walkability and crime might impact MVPA in low-income African American adults nor how associations may vary by age and sex.

METHODS

In 2013 we collected self-reported data on demographics, functional limitations, objective measures of MVPA (accelerometry), neighborhood greenspace (geographic information system), and walkability (street audit) in 791 predominantly African-American adults (mean age 56 years) living in two United States (U.S.) low-income neighborhoods. We also acquired data from the City of Pittsburgh on all crime events within both neighborhoods.

EXPOSURE

To examine cross-sectional associations of neighborhood-related variables (i.e., neighborhood greenspace, walkability and crime) with MVPA, we used zero-inflated negative binomial regression models. Additionally, we examined potential interactions by age (over 65 years) and sex on relationships between neighborhood variables and MVPA.

RESULTS

Overall, residents engaged in very little to no MVPA regardless of where they lived. However, for women, but not men, under the age of 65 years, living in more walkable neighborhoods was associated with more time engaged in MVPA in (β = 0.55, p = 0.007) as compared to their counterparts living in less walkable areas. Women and men age 65 years and over spent very little time participating in MVPA regardless of neighborhood walkability. Neither greenspace nor crime was associated with MVPA in age-sex subgroups.

CONCLUSIONS

Neighborhood walkability may play a stronger role on MVPA than accessible greenspace or crime in low-income urban communities. Walkability may differentially impact residents depending on their age and sex, which suggests tailoring public health policy design and implementation according to neighborhood demographics to improve activity for all.

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.

Obesity, diet quality, physical activity, and the built environment: the need for behavioral pathways

BACKGROUND

The built environment (BE) is said to influence local obesity rates. Few studies have explored causal pathways between home-neighborhood BE variables and health outcomes such as obesity. Such pathways are likely to involve both physical activity and diet.

METHODS

The Seattle Obesity Study (SOS II) was a longitudinal cohort of 440 adult residents of King Co, WA. Home addresses were geocoded. Home-neighborhood BE measures were framed as counts and densities of food sources and physical activity locations. Tax parcel property values were obtained from County tax assessor. Healthy Eating Index (HEI 2010) scores were constructed using data from food frequency questionnaires. Physical activity (PA) was obtained by self-report. Weights and heights were measured at baseline and following 12 months' exposure. Multivariable regressions examined the associations among BE measures at baseline, health behaviors (HEI-2010 and physical activity) at baseline, and health outcome both cross-sectionally and longitudinally.

RESULTS

None of the conventional neighborhood BE metrics were associated either with diet quality, or with meeting PA guidelines. Only higher property values did predict better diets and more physical activity. Better diets and more physical activity were associated with lower obesity prevalence at baseline and 12 mo, but did not predict weight change.

CONCLUSION

Any links between the BE and health outcomes critically depend on establishing appropriate behavioral pathways. In this study, home-centric BE measures, were not related to physical activity or to diet. Further studies will need to consider a broader range of BE attributes that may be related to diets and health.

ParkIndex: Development of a standardized metric of park access for research and planning

OBJECTIVE

A lack of comprehensive and standardized metrics for measuring park exposure limits park-related research and health promotion efforts. This study aimed to develop and demonstrate an empirically-derived and spatially-represented index of park access (ParkIndex) that would allow researchers, planners, and citizens to evaluate the potential for park use for a given area.

METHODS

Data used for developing ParkIndex were collected in 2010 in Kansas City, Missouri (KCMO). Adult study participants (n=891) reported whether they used a park within the past month, and all parks in KCMO were mapped and audited using ArcGIS 9.3 and the Community Park Audit Tool. Four park summary variables - distance to nearest park, and the number of parks, amount of park space, and average park quality index within 1mile were analyzed in relation to park use using logistic regression. Coefficients for significant park summary variables were used to create a raster surface (ParkIndex) representing the probability of park use for all 100m×100m cells in KCMO.

RESULTS

Two park summary variables were positively associated with park use - the number of parks and the average park quality index within 1 mile. The ParkIndex probability of park use across all cells in KCMO ranged from 17 to 77 out of 100.

CONCLUSION

ParkIndex represents a standardized metric of park access that combines elements of both park availability and quality, which was developed empirically and can be represented spatially. This tool has both practical and conceptual significance for researchers and professionals in diverse disciplines.

A cross-sectional study examining predictors of visit frequency to local green space and the impact this has on physical activity levels

BACKGROUND

Lack of physical activity (PA) is a growing public health concern. There is a growing body of literature that suggests a positive relationship may exist between the amount of local green space near one's home and PA levels. For instance, park proximity has been shown to predict PA levels amongst certain populations. However, there is little evidence for the role of relatedness towards nature and perceptions of local green space on this relationship. The aim of this study was to examine, in a National UK sample, whether subjective indices associated with local green space were better predictors of visit frequency to local green space and PA levels compared to objectively measured quantity of local green space.

METHODS

A cross-sectional survey was designed. From a random sample, 2079 working age adults responded to an online survey in September 2011. Demographics, self-reported PA, objective measures of the local environment (including local green space, road coverage, and environmental deprivation), were assessed in conjunction with perceptions of local green space and nature relatedness. Quantity of local green space was assessed by cross-referencing respondents' home postcodes with general land use databases. Regression models were conducted to assess which of our independent variables best predicted visit frequency to local green space and/or meeting PA guidelines. In addition, an ordinal regression was run to examine the relationship between visit frequency to local green space and the likelihood of meeting national PA guidelines.

RESULTS

Nature relatedness was the strongest predictor for both visit frequency to local green space and meeting PA guidelines. Results show that perceived quality is a better predictor of visit frequency to local green space than objective quantity of local green space. The odds of achieving the recommended amount of PA was over four times greater for people who visited local green space once per week compared to never going (OR 4.151; 95 % CI, 2.40 to 7.17).

CONCLUSIONS

These results suggest that perceptions of local green space and nature relatedness play an important role in the relationship between local green space and PA. Considering the known health benefits of PA, our results are potentially important for public health interventions, policy making and environmental planning.

Neighbourhood environment, physical activity, quality of life and depressive symptoms in Hong Kong older adults: a protocol for an observational study

INTRODUCTION

The neighbourhood environment can assist the adoption and maintenance of an active lifestyle and affect the physical and mental well-being of older adults. The psychosocial and behavioural mechanisms through which the environment may affect physical and mental well-being are currently poorly understood.

AIM

This observational study aims to examine associations between the physical and social neighbourhood environments, physical activity, quality of life and depressive symptoms in Chinese Hong Kong older adults.

METHODS AND ANALYSES

An observational study of the associations of measures of the physical and social neighbourhood environment, and psychosocial factors, with physical activity, quality of life and depressive symptoms in 900 Hong Kong older adults aged 65+ years is being conducted in 2012-2016. The study involves two assessments taken 6 months apart. Neighbourhood walkability and access to destinations are objectively measured using Geographic Information Systems and environmental audits. Demographics, socioeconomic status, walking for different purposes, perceived neighbourhood and home environments, psychosocial factors, health status, social networks, depressive symptoms and quality of life are being assessed using validated interviewer-administered self-report measures and medical records. Physical functionality is being assessed using the Short Physical Performance Battery. Physical activity and sedentary behaviours are also being objectively measured in approximately 45% of participants using accelerometers over a week. Physical activity, sedentary behaviours, quality of life and depressive symptoms are being assessed twice (6 months apart) to examine seasonality effects on behaviours and their associations with quality of life and depressive symptoms.

ETHICS AND DISSEMINATION

The study received ethical approval from the University of Hong Kong Human Research Ethics Committee for Non-Clinical Faculties (EA270211) and the Department of Health (Hong Kong SAR). Data are stored in a password-protected secure database for 10 years, accessible only to the named researchers. Findings will be submitted for publication in peer-reviewed journals.