A new urban planning code's impact on walking: the residential environments project

A systematic review on the associations between the built environment and adult's physical activity in global tropical and subtropical climate regions

BACKGROUND

Physical inactivity is a major public health concern, exacerbated in countries with a (sub)tropical climate. The built environment can facilitate physical activity; however, current evidence is mainly from North American and European countries with activity-friendly climate conditions. This study explored associations between built environment features and physical activity in global tropical or subtropical dry or desert climate regions.

METHODS

A systematic review of four major databases (Web of Science, Scopus, PubMed, and SportDISCUS) was performed. To be included, studies had to investigate associations between perceived or objective built environment characteristics and adult's physical activity and had to be conducted in a location with (sub)tropical climate. Each investigated association was reported as one case and results were synthesized based upon perceived and objectively assessed environment characteristics as well as Western and non-Western countries. Study quality was evaluated using a tool designed for assessing studies on built environment and physical activity.

RESULTS

Eighty-four articles from 50 studies in 13 countries with a total of 2546 built environment-physical activity associations were included. Design (connectivity, walking/cycling infrastructure), desirability (aesthetics, safety), and destination accessibility were the built environment characteristics most frequently associated with physical activity across the domains active transport, recreational physical activity, total walking and cycling, and moderate-to-vigorous physical activity, particularly if multiple attributes were present at the same time. Very few studies assessed built environment attributes specifically relevant to physical activity in (sub)tropical climates. Most studies were conducted in Western countries, with results being largely comparable with non-Western countries. Findings were largely generalizable across gender and age groups. Results from natural experiments indicated that relocating to an activity-friendly neighborhood impacted sub-groups differently.

CONCLUSIONS

Built environment attributes, including destination accessibility, connectivity, walking and cycling infrastructure, safety, and aesthetics, are positively associated with physical activity in locations with (sub)tropical climate. However, few studies focus on built environment attributes specifically relevant in a hot climate, such as shade or indoor recreation options. Further, there is limited evidence from non-Western countries, where most of the urban population lives in (sub)tropical climates. Policy makers should focus on implementing activity-friendly environment attributes to create sustainable and climate-resilient cities.

Residential relocation to assess impact of changes in the living environment on cardio-respiratory health: A narrative literature review with considerations for exposome research

Residential relocation studies have become increasingly valuable tools for evaluating the effects of changing living environments on human health, but little is known about their application to multiple aspects of the living environment and the most appropriate methodology. This narrative review explores the utility of residential relocation as a natural experiment for studying the impact of changing urban exposures on cardio-metabolic health in high-income settings. It provides a comprehensive overview of the use of residential relocation studies, evaluates their methodological approaches, and synthesizes findings related to health behaviors and cardio-metabolic outcomes. Our search identified 43 relevant studies published between January 1995 and February 2023, from eight countries, predominantly the USA, Canada, and Australia. The majority of eligible studies were published between 2012 and 2021 and examined changes in various domains of the living environment, such as walkability, the built and social environments, but rarely combinations of exposures. Included studies displayed heterogeneity in design and outcomes, 25 involving only movers and 18 considering both movers and non-movers. To mitigate the issue of residential self-selection bias, most studies employed a "change-in-change" design and adjusted for baseline covariates but only a fraction of them accounted for time-varying confounding. Relocation causes simultaneous changes in various features of the living environment, which presents an opportunity for exposome research to establish causal relationships, using large datasets with increased statistical power and a wide range of health outcomes, behaviors and biomarkers. Residential relocation is not a random process. Thus, studies focusing on living environment characteristics need to carefully select time-varying covariates and reference group. Overall, this review informs future research by guiding choices in study design, data requirements, and statistical methodologies. Ultimately, it contributes to the advancement of the urban exposome field and enhances our understanding of the complex relationship between urban environments and human health.

The Built Environment and Population Physical Activity: Methods for Mapping the Relevant Laws

BACKGROUND

The development of policies that promote and enable physical activity (PA) is a global health priority. Laws are an important policy instrument that can enable enduring beneficial outcomes for individuals, organizations, and environments through multiple mechanisms. This article presents a systematic process for mapping laws relevant to PA, which can be used to understand the role of laws as a powerful PA policy lever.

METHODS

Building on methods used in public health law research, we developed a protocol for scientific mapping of laws influencing the built environment for PA in Australia. The MonQcle online legal research platform was used for data coding, analysis, and presentation.

RESULTS

We describe the 10 key stages of legal mapping that we applied to examine state and territory laws that influence walking and cycling in Australia.

CONCLUSIONS

Law is a neglected element of policy research for PA. There is a need for accessible legal data to drive the design, investment, and implementation of legal interventions to improve population PA. Legal mapping is a first step toward evaluation of such laws for PA. This paper provides a practical case study and guidance for the 10 stages in legal mapping of laws that influence the built environment for PA.

The Weight of Place: Built Environment Correlates of Obesity and Diabetes

In recent decades, the prevalence of obesity and diabetes has risen substantially in North America and worldwide. To address these dual epidemics, researchers and policymakers alike have been searching for effective means to promote healthy lifestyles at a population level. As a consequence, there has been a proliferation of research examining how the "built" environment in which we live influences physical activity levels, by promoting active forms of transportation, such as walking and cycling, over passive ones, such as car use. Shifting the transportation choices of local residents may mean that more members of the population can participate in physical activity during their daily routine without structured exercise programs. Increasingly, this line of research has considered the downstream metabolic consequences of the environment in which we live, raising the possibility that "healthier" community designs could help mitigate the rise in obesity and diabetes prevalence. This review discusses the evidence examining the relationship between the built environment, physical activity, and obesity-related diseases. We also consider how other environmental factors may interact with the built environment to influence metabolic health, highlighting challenges in understanding causal relationships in this area of research.

Exploring Perceived and Objective Measures of the Neighborhood Environment and Associations with Physical Activity among Adults: A Review and a Meta-Analytic Structural Equation Model

There is an urgent need to understand factors that promote physical activities (PA) because it is one of the modifiable risk factors for global mortality. None of the previous reviews considered both perceived and objective characteristics of the same environment. The first aim was to review the literature on studies investigating the relationship between PA behavior of adults and perceived and objective physical environment measures. The second aim was to verify the potential mediational role of the perceived measure in the relationship between the objective measure of the environment and PA using meta-analytic SEM. Only 15 studies reported a relationship between PA and both environmental measures. One of the most studied characteristics of the physical environment is the accessibility to recreational/PA facilities. Both objective and subjective measures of accessibility to PA facilities are associated with PA. Meta-SEM results suggest a significant effect of the objective accessibility to facilities on PA behavior (β = 0.15) and on the perceived measure (β = 0.10), but the indirect effect was not significant. No significant effect was found for the perceived measure on PA, suggesting that individuals' level of awareness about their environments may have played a role. This prompts a need to create awareness campaigns.

Cross-sectional and prospective associations between active living environments and accelerometer-assessed physical activity in the EPIC-Norfolk cohort

The environments in which young and middle-aged adults live may influence their physical activity (PA) behaviours. These associations are less clear among older adults. We estimated cross-sectional and prospective associations of population density, junction density, and land use mix and perceived active living environments with accelerometer-assessed PA in a cohort of older adults. Adults living in more dense and mixed neighbourhoods had less optimal activity profiles at baseline and less optimal changes in activity. Better perceptions were associated with more overall PA at baseline. Interventions for older adults may wish to target individuals living in more dense and mixed neighbourhoods.

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Older adults living in more dense/mixed areas are more sedentary and less active.

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More dense/mixed areas are associated with less optimal changes in activity.

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Adults who perceive living in more activity-friendly accumulate more total activity.

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There was no evidence of associations between perceptions and changes in activity.

Active design of built environments for increasing levels of physical activity in adults: the ENABLE London natural experiment study

Background

Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited.

Objectives

The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined.

Design

The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment.

Setting

East Village, London, UK.

Participants

A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years.

Intervention

The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport.

Main outcome measure

Change in objectively measured daily steps from baseline to follow-up.

Methods

Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village.

Results

A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity.

Conclusions

Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).

Using natural experiments to improve public health evidence: a review of context and utility for obesity prevention

Background

Natural experiments are increasingly valued as a way to assess the health impact of health and non-health interventions when planned controlled experimental research designs may be infeasible or inappropriate to implement. This study sought to investigate the value of natural experiments by exploring how they have been used in practice. The study focused on obesity prevention research as one complex programme area for applying natural experiment studies.

Methods

A literature search sought obesity prevention research from January 1997 to December 2017 and identified 46 population health studies that self-described as a natural experiment.

Results

The majority of studies identified were published in the last 5 years, illustrating a more recent adoption of such opportunities. The majority of studies were evaluations of the impact of policies (n = 19), such as assessing changes to food labelling, food advertising or taxation on diet and obesity outcomes, or were built environment interventions (n = 17), such as the impact of built infrastructure on physical activity or access to healthy food. Research designs included quasi-experimental, pre-experimental and non-experimental methods. Few studies applied rigorous research designs to establish stronger causal inference, such as multiple pre/post measures, time series designs or comparison of change against an unexposed group. In general, researchers employed techniques to enhance the study utility but often were limited in the use of more rigorous study designs by ethical considerations and/or the particular context of the intervention.

Conclusion

Greater recognition of the utility and versatility of natural experiments in generating evidence for complex health issues like obesity prevention is needed. This review suggests that natural experiments may be underutilised as an approach for providing evidence of the effects of interventions, particularly for evaluating health outcomes of interventions when unexpected opportunities to gather evidence arise.

Living liveable? RESIDE's evaluation of the "Liveable Neighborhoods" planning policy on the health supportive behaviors and wellbeing of residents in Perth, Western Australia

BACKGROUND

The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs.

OBJECTIVES

To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations.

METHODS

An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes.

RESULTS

In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant.

CONCLUSIONS

The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health supportive behaviors and wellbeing outcomes including transport and recreation walking, and to create neighborhoods with a stronger sense of community where residents may feel safer.

Methods for accounting for neighbourhood self-selection in physical activity and dietary behaviour research: a systematic review

BACKGROUND

Self-selection into residential neighbourhoods is a widely acknowledged, but under-studied problem in research investigating neighbourhood influences on physical activity and diet. Failure to handle neighbourhood self-selection can lead to biased estimates of the association between the neighbourhood environment and behaviour. This means that effects could be over- or under-estimated, both of which have implications for public health policies related to neighbourhood (re)design. Therefore, it is important that methods to deal with neighbourhood self-selection are identified and reviewed. The aim of this review was to assess how neighbourhood self-selection is conceived and accounted for in the literature.

METHODS

Articles from a systematic search undertaken in 2017 were included if they examined associations between neighbourhood environment exposures and adult physical activity or dietary behaviour. Exposures could include any objective measurement of the built (e.g., supermarkets), natural (e.g., parks) or social (e.g., crime) environment. Articles had to explicitly state that a given method was used to account for neighbourhood self-selection. The systematic review was registered with the PROSPERO International Prospective Register of Systematic Reviews (number CRD42018083593) and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

Of 31 eligible articles, almost all considered physical activity (30/31); few examined diet (2/31). Methods used to address neighbourhood self-selection varied. Most studies (23/31) accounted for items relating to participants' neighbourhood preferences or reasons for moving to the neighbourhood using multi-variable adjustment in regression models (20/23) or propensity scores (3/23). Of 11 longitudinal studies, three controlled for neighbourhood self-selection as an unmeasured confounder using fixed effects regression.

CONCLUSIONS

Most studies accounted for neighbourhood self-selection by adjusting for measured attributes of neighbourhood preference. However, commonly the impact of adjustment could not be assessed. Future studies using adjustment should provide estimates of associations with and without adjustment for self-selection; consider temporality in the measurement of self-selection variables relative to the timing of the environmental exposure and outcome behaviours; and consider the theoretical plausibility of presumed pathways in cross-sectional research where causal direction is impossible to establish.

A Spatial Distribution Equilibrium Evaluation of Health Service Resources at Community Grid Scale in Yichang, China

Whether the supplies of health services and related facilities meet the demand is a critical issue when developing healthy cities. The importance of health services and related facilities in public health promotion has been adequately proved. However, since the community population and resource data are usually available at the scale of an administrative region; it is very difficult to perform further fine-scaled spatial distribution equilibrium evaluation studies. Such kinds of activities are highly expected for precise urban planning and management. Yichang is located in Hubei province, the central part of China, along the Yangzi River. It is leading both of China’s smart cities demonstration project and China’s healthy cities pilot project. Yichang has defined 1271 community grids for urban management and service, where each grid consists of 200 households generally with its population distribution data routinely updated. The research set the 15-min walking distances of the residents as impedance factors, and the numbers and the types of health service resources as attractiveness factors for accessibility evaluation. The resource ratio, richness and per capita number of various health service resources that can be reached within 15 min from the community grid building is used as spatial distribution equilibrium evaluation indicators. The entropy weight method is used to assign the indicator weight value. The obtained fine-scale evaluation results were analyzed. In this way, a community grid-scale spatial distribution equilibrium evaluation of health service resources in Yichang was performed. The proposed research could be of value for rapid and precise evaluation of spatial distribution equilibrium evaluation of a variety of healthy city resources, to support healthy city planning and management.

Correlates of Walking for Travel in Seven European Cities: The PASTA Project

BACKGROUND

Although walking for travel can help in reaching the daily recommended levels of physical activity, we know relatively little about the correlates of walking for travel in the European context.

OBJECTIVE

Within the framework of the European Physical Activity through Sustainable Transport Approaches (PASTA) project, we aimed to explore the correlates of walking for travel in European cities.

METHODS

The same protocol was applied in seven European cities. Using a web-based questionnaire, we collected information on total minutes of walking per week, individual characteristics, mobility behavior, and attitude (N=7,875). Characteristics of the built environment (the home and the work/study addresses) were determined with geographic information system (GIS)-based techniques. We conducted negative binomial regression analyses, including city as a random effect. Factor and principal component analyses were also conducted to define profiles of the different variables of interest.

RESULTS

Living in high-density residential areas with richness of facilities and density of public transport stations was associated with increased walking for travel, whereas the same characteristics at the work/study area were less strongly associated with the outcome when the residential and work/study environments were entered in the model jointly. A walk-friendly social environment was associated with walking for travel. All three factors describing different opinions about walking (ranging from good to bad) were associated with increased minutes of walking per week, although the importance given to certain criteria to choose a mode of transport provided different results according to the criteria.

DISCUSSION

The present study supports findings from previous research regarding the role of the built environment in the promotion of walking for travel and provides new findings to help in achieving sustainable, healthy, livable, and walkable cities. https://doi.org/10.1289/EHP4603.

The effect of moving to East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village, on physical activity and adiposity (ENABLE London): a cohort study

BACKGROUND

The built environment can affect health behaviours, but longitudinal evidence is limited. We aimed to examine the effect of moving into East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village that was repurposed on active design principles, on adult physical activity and adiposity.

METHODS

In this cohort study, we recruited adults seeking new accommodation in East Village and compared physical activity and built environment measures with these data in control participants who had not moved to East Village. At baseline and after 2 years, we objectively measured physical activity with accelerometry and adiposity with body-mass index and bioimpedance, and we assessed objective measures of and participants' perceptions of change in their built environment. We examined the change in physical activity and adiposity between the East Village and control groups, after adjusting for sex, age group, ethnicity, housing tenure, and household (as a random effect).

FINDINGS

We recruited participants for baseline assessment between Jan 24, 2013, and Jan 7, 2016, and we followed up the cohort after 2 years, between Feb 24, 2015, and Oct 24, 2017. At baseline, 1819 households (one adult per household) consented to initial contact by the study team. 1278 adults (16 years and older) from 1006 (55%) households participated at baseline; of these participants, 877 (69%) adults from 710 (71%) households were assessed after 2 years, of whom 441 (50%) participants from 343 (48%) households had moved to East Village. We found no effect associated with moving to East Village on daily steps, the time spent doing moderate-to-vigorous physical activity (either in total or in 10-min bouts or more), daily sedentary time, body-mass index, or fat mass percentage between participants who had moved to East Village and those in the control group, despite sizeable improvements in walkability and neighbourhood perceptions of crime and quality among the East Village group relative to their original neighbourhood at baseline.

INTERPRETATION

Despite large improvements in neighbourhood perceptions and walkability, we found no clear evidence that moving to East Village was associated with increased physical activity. Improving the built environment on its own might be insufficient to increase physical activity.

FUNDING

National Institute for Health Research and National Prevention Research Initiative.

Restructuring the built environment to change adult health behaviors: a scoping review integrated with behavior change frameworks

Built environment restructuring can improve public health through increased opportunity for healthy behaviors. Behavioral science targets individual health behaviors within place, suggesting the potential to integrate these approaches. This scoping review was one of the first to summarise the impact built environment restructuring has on health outcomes and behaviors and integrate these findings with the Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework of behavior change. Potential studies were identified from 12 academic databases in urban design, psychology and public health. Search parameters involved 50 environment types, for example green space or healthy cities, combined with both an intervention (e.g. green infrastructure, active transport) and a measurable health outcome (e.g. exercise, wellbeing). Searches were limited to North America, Europe, or Australia/New Zealand. Of 536 potential studies reviewed against defined inclusion/exclusion criteria, 23 contributed to the findings. Evidence supported the positive influence of restructuring on varied health outcomes, many of which were drivers and domains of health behavior. Most studies indicated a clear contribution to increased physical activity. Recommendations include the need for explicit communication of theories guiding restructuring project design, consideration of health outcomes beyond physical activity, and better investigation of unanticipated barriers to health behaviors arising from built environment restructuring projects.

Extending the paradigm: a policy framework for healthy and equitable eating (HE2)

OBJECTIVE

The current short communication aimed to provide a new conceptualisation of the policy drivers of inequities in healthy eating and to make a call to action to begin populating this framework with evidence of actions that can be taken to reduce the inequities in healthy eating.

DESIGN

The Healthy and Equitable Eating (HE2) Framework derives from a systems-based analytical approach involving expert workshops.

SETTING

Australia.

SUBJECTS

Academics, government officials and non-government organisations in Australia.

RESULTS

The HE2 Framework extends previous conceptualisations of policy responses to healthy eating to include the social determinants of healthy eating and its social distribution, encompassing policy areas including housing, social protection, employment, education, transport, urban planning, plus the food system and environment.

CONCLUSIONS

As the burden of non-communicable diseases continues to grow globally, it is important that governments, practitioners and researchers focus attention on the development and implementation of policies beyond the food system and environment that can address the social determinants of inequities in healthy eating.

Local Food Environments, Suburban Development, and BMI: A Mixed Methods Study

More than half the world’s population now live in urban settlements. Worldwide, cities are expanding at their fringe to accommodate population growth. Low-density residential development, urban sprawl, and car dependency are common, contributing to physical inactivity and obesity. However, urban design and planning can modify urban form and enhance health by improving access to healthy food, public transport, and services. This study used a sequential mixed methods approach to investigate associations between food outlet access and body mass index (BMI) across urban-growth and established areas of Melbourne, Australia, and identify factors that influence local food environments. Population survey data for 3141 adults were analyzed to examine associations, and 27 interviews with government, non-government, and private sector stakeholders were conducted to contextualize results. Fast food density was positively associated with BMI in established areas and negatively associated in urban-growth areas. Interrelated challenges of car dependency, poor public transport, and low-density development hampered healthy food access. This study showed how patterns of suburban development influence local food environments and health outcomes in an urbanized city context and provides insights for other rapidly growing cities. More nuanced understandings of the differential effect of food environments within cities have potential to guide intra-city planning for improving health and reducing inequities.

Moving to an active lifestyle? A systematic review of the effects of residential relocation on walking, physical activity and travel behaviour

OBJECTIVE

To synthesise the literature on the effects of neighbourhood environmental change through residential relocation on physical activity, walking and travel behaviour.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42017077681).

DATA SOURCES

Electronic databases for peer-reviewed and grey literature were systematically searched to March 2017, followed by forward and backward citation tracking.

ELIGIBILITY CRITERIA

A study was eligible for inclusion if it (1) measured changes in neighbourhood built environment attributes as a result of residential relocation (either prospectively or retrospectively); (2) included a measure of physical activity, walking, cycling or travel modal change as an outcome; (3) was quantitative and (4) included an English abstract or summary.

RESULTS

A total of 23 studies was included in the review. Among the eight retrospective longitudinal studies, there was good evidence for the relationship between relocation and walking (consistency score (CS)>90%). For the 15 prospective longitudinal studies, the evidence for the effects of environmental change/relocation on physical activity or walking was weak to moderate (CS mostly <45%), even weaker for effects on other outcomes, including physical activity, cycling, public transport use and driving. Results from risk of bias analyses support the robustness of the findings.

CONCLUSION

The results are encouraging for the retrospective longitudinal relocation studies, but weaker evidence exists for the methodologically stronger prospective longitudinal relocation studies. The evidence base is currently limited, and continued longitudinal research should extend the plethora of cross-sectional studies to build higher-quality evidence.

Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History

Background: Although fear of falling (FOF) has been studied since FOF has negative consequences for the elderly, there is limited information about the risk factors of FOF, including the environment. The purpose of this study was to describe individual and environmental factors of FOF between those with and without a fall history from an ecological aspect and to examine whether individual and environmental factors differently affect the FOF according to the state of fall history in community-dwelling older adults in Korea. Methods: Data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Adults were used. Participants were 7730 older adults. Hierarchical logistic regression analysis was conducted to examine the predictors of FOF. Results: According to the ecological model, female and discomfort with the neighborhood environment were significantly associated with greater odds of reporting FOF in both older adults with fall history and those without. A significant interaction was not observed between any variable of FOF in participants with and without a fall history. Conclusions: An ecological model including individual and environmental factors should be considered when conducting research and designing programs and decision policies related to FOF for older adults with and without a history of falling.

Policies, Politics, and Paradigms: Healthy Planning in Australian Local Government

Local government in Australia is critically positioned to provide built environment initiatives that respond to the increasing prevalence of non-communicable diseases (NCD), climate change, and various other human and ecological health considerations. However, action on the ground has not been as widespread as might be expected, particularly in improving community health. This research explores the barriers to and enablers of the implementation of healthy planning and active living initiatives through in-depth interviews with healthy planning and active living advocates. Advocates are seen to promote healthy planning in relatively weak policy settings, where politicised, largely reactive decisions by individual politicians or practitioners are the main determinants of project success. The most important factor affecting project uptake and implementation is how the ‘problem’ of healthy planning, or what might be considered a healthy planning paradigm, is presented. Such a paradigm includes a strong reliance on the co-benefits of projects; it is also subject to the way that healthy planning is communicated and framed. Potential problems around such a setting are subsequently examined, identifying the potential reasons for the slow delivery of healthy planning.

Kids in Communities Study (KiCS) study protocol: a cross-sectional mixed-methods approach to measuring community-level factors influencing early child development in Australia

INTRODUCTION

Healthy childhood development in the early years is critical for later adult health and well-being. Early childhood development (ECD) research has focused primarily on individual, family and school factors, but largely ignored community factors. The Kids in Communities Study (KiCS) will test and investigate community-level influences on child development across Australia.

METHODS AND ANALYSIS

Cross-sectional mixed-methods study exploring community-level effects in 25 Australian local communities; selection based on community socioeconomic status (SES) and ECD using the Australian Early Development Census (AEDC), a population measure of child development, to create a local community 'diagonality type', that is, those performing better or worse (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their SES. Data collection includes stakeholder interviews, parent and service provider focus groups, and surveys with general community residents and service providers, mapping of neighbourhood design and local amenities and services, analysis of policy documents, and the use of existing sociodemographic and early childhood education and care data. Quantitative data will be used to test associations between local community diagonality type, and ECD based on AEDC scores. Qualitative data will provide complementary and deeper exploration of these same associations.

ETHICS AND DISSEMINATION

The Royal Children's Hospital Human Research Ethics Committee approved the study protocol (#30016). Further ethics approvals were obtained from State Education and Health departments and Catholic archdioceses where required. ECD community-level indicators will eventually be derived and made publically available. Findings will be published in peer-reviewed journals, community reports, websites and policy briefs to disseminate results to researchers, and key stakeholders including policymakers, practitioners and (most importantly) the communities involved.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments

BACKGROUND

Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity.

METHODS

Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI).

RESULTS

Twelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen's centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result.

CONCLUSIONS

The present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved.

Walkability and cardiometabolic risk factors: Cross-sectional and longitudinal associations from the Multi-Ethnic Study of Atherosclerosis

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004-2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health.

Safe RESIDential Environments? A longitudinal analysis of the influence of crime-related safety on walking

BACKGROUND

Numerous cross-sectional studies have investigated the premise that the perception of crime will cause residents to constrain their walking; however the findings to date are inconclusive. In contrast, few longitudinal or prospective studies have examined the impact of crime-related safety on residents walking behaviours. This study used longitudinal data to test whether there is a causal relationship between crime-related safety and walking in the local neighbourhood.

METHODS

Participants in the RESIDential Environments Project (RESIDE) in Perth, Australia, completed a questionnaire before moving to their new neighbourhood (n = 1813) and again approximately one (n = 1467), three (n = 1230) and seven years (n = 531) after relocating. Self-report measures included neighbourhood perceptions (modified NEWS items) and walking inside the neighbourhood (min/week). Objective built environmental measures were generated for each participant's 1600 m neighbourhood at each time-point, and the count of crimes reported to police were generated at the suburb-level for the first three time-points only. The impact of crime-related safety on walking was examined in SAS using the Proc Mixed procedure (marginal repeated measures model with unrestricted variance pattern). Initial models controlled for demographics, time and self-selection, and subsequent models progressively adjusted for other built and social environment factors based on a social ecological model.

RESULTS

For every increase of one level on a five-point Likert scale in perceived safety from crime, total walking within the local neighbourhood increased by 18.0 min/week (p = 0.000). This relationship attenuated to an increase of 10.5 min/week after accounting for other built and social environment factors, but remained significant (p = 0.008). Further analyses examined transport and recreational walking separately. In the fully adjusted models, each increase in safety from crime was associated with a 7.0 min/week increase in recreational walking (p = 0.009), however findings for transport walking were non-significant. All associations between suburb-level crime and walking were non-significant.

CONCLUSIONS

This study provides longitudinal evidence of a potential causal relationship between residents' perceptions of safety from crime and recreational walking. Safety perceptions appeared to influence recreational walking, rather than transport-related walking. Given the popularity of recreational walking and the need to increase levels of physical activity, community social and physical environmental interventions that foster residents' feelings of safety are likely to increase recreational walking and produce public health gains.

Neighbourhood environment and physical activity in older adults

RATIONALE

The neighbourhood socio-physical environment has effects on health in later life including health behaviours, chronic illnesses, mental health and mortality. Few studies have examined the relationship of both physical environmental features and social aspects of neighbourhood with older adults' physical activity.

OBJECTIVE

This study examined the relationship of neighbourhood physical and social environment with physical activity among older adults.

METHODS

A cross-sectional telephone survey was conducted with 434 older adults in eight neighbourhoods in greater Vancouver, Canada and Portland, United States. Data included participants' perceptions of their neighbourhood built and social environment factors and levels of physical activity. A logistic regression analysis was conducted to understand the relationship between these factors.

RESULTS

Participants engaged in physical activity most frequently at home (87.1%) or in close proximity of home (76.5%). Neighbourhood walkability, presence of amenities and accessibility were not significantly associated with meeting physical activity requirements. Participation in a recreational program with friends was associated with increased likelihood of physical activity.

CONCLUSION

The home and its immediate physical environmental context has potentially important relevance in supporting physical activity in older adults. Also, neighbourhood social aspects have a positive influence on activity levels.

Can the Neighborhood Built Environment Make a Difference in Children's Development? Building the Research Agenda to Create Evidence for Place-Based Children's Policy

Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development. The relatively few studies exploring this relationship support associations between child development and neighborhood destinations, green spaces, interaction with nature, traffic exposure, and housing density. These studies emphasize the need to more deeply understand how child development outcomes might be influenced by the neighborhood built environment. Pursuing this research space is well aligned with the current global movements on livable and child-friendly cities. It has direct public policy impact by informing planning policies across a range of sectors (urban design and planning, transport, public health, and pediatrics) to implement place-based interventions and initiatives that target children's health and development at the community level. We argue for the importance of exploring the effect of the neighborhood built environment on child development as a crucial first step toward informing urban design principles to help reduce developmental vulnerability in children and to set optimal child development trajectories early.

Health impacts of the Cambridgeshire Guided Busway: a natural experimental study

Background

Improving transport infrastructure to support walking and cycling on the journey to and from work – active commuting – could help to promote physical activity and improve population health.

Aims

To assess whether or not investment in new high-quality transport infrastructure was associated with an increase in active commuting; wider health impacts of changes in travel behaviour; determinants of the use and uptake of active commuting; and how changes in travel behaviour were distributed in the population and related to the wider social context.

Design

The Commuting and Health in Cambridge study, comprising a quasi-experimental cohort study combined with both nested and supplementary in-depth quantitative and qualitative studies.

Setting

Cambridgeshire, UK.

Participants

A cohort of 1143 adults living within 30 km of Cambridge, working in the city and recruited in 2009; and a separate sample of 1710 users intercepted on the Cambridgeshire Guided Busway in 2012.

Intervention

The Cambridgeshire Guided Busway, comprising a new bus network using 22 km of guideway (segregated bus track) accompanied by a traffic-free path for pedestrians and cyclists, opened in 2011.

Main outcome measure

Change in time spent in active commuting from 2009 to 2012, using a self-reported measure validated using georeferenced combined heart rate and movement sensor data.

Methods

A delay from 2009 to 2011 in completing the intervention entailed some changes to the original design and attrition of the cohort. A period of methodological and observational research on active commuting preceded the evaluation, which was based on a quasi-experimental cohort analysis together with the intercept and qualitative data. A graded measure of each participant’s exposure to the intervention, based on the proximity of the busway to his or her home, served as the basis for controlled comparisons.

Results

Commuting practices were complex and shaped by various changeable social and environmental factors. Walking and cycling were often incorporated into longer commuting journeys made predominantly by car or public transport. In multivariable multinomial regression analyses, exposure to the intervention was associated with a greater likelihood of a large increase in the proportion of commuting trips involving any active travel [adjusted relative risk ratio (RRR) 1.80, 95% confidence interval (CI) 1.27 to 2.55], of a large decrease in the proportion of trips made entirely by car (RRR 2.09, 95% CI 1.35 to 3.21), and of an increase in weekly cycle commuting time (RRR 1.34, 95% CI 1.03 to 1.76). There was a mixed pattern of effects at the individual level, with the intervention providing a more supportive environment for active commuting for some and not for others. There was some evidence that the effect was most pronounced among those who reported no active commuting at baseline, and observational evidence suggesting a relationship between active commuting, greater overall physical activity, and improved well-being and weight status.

Conclusions

These findings provide new empirical support and direction for reconfiguring transport systems to improve population health and reduce health inequalities. They should be combined with evidence from research evaluating related environmental changes in other settings, preferably using longer periods of observation and controlled comparisons, to support more generalisable causal inference.

Funding

The National Institute for Health Research Public Health Research programme.

Changes in mode of travel to work: a natural experimental study of new transport infrastructure

BACKGROUND

New transport infrastructure may promote a shift towards active travel, thereby improving population health. The purpose of this study was to determine the effect of a major transport infrastructure project on commuters' mode of travel, trip frequency and distance travelled to work.

METHODS

Quasi-experimental analysis nested within a cohort study of 470 adults working in Cambridge, UK. The intervention consisted of the opening of a guided busway with a path for walking and cycling in 2011. Exposure to the intervention was defined as the negative of the square root of the shortest distance from home to busway. The outcome measures were changes in commute mode share and number of commute trips - both based on a seven-day travel-to-work record collected before (2009) and after (2012) the intervention - and change in objective commute distance. The mode share outcomes were changes in the proportions of trips (i) involving any active travel, (ii) involving any public transport, and (iii) made entirely by car. Separate multinomial regression models were estimated adjusting for commute and sociodemographic characteristics, residential settlement size and life events.

RESULTS

Proximity to the busway predicted an increased likelihood of a large (>30 %) increase in the share of commute trips involving any active travel (relative risk ratio [RRR] 1.80, 95 % CI 1.27, 2.55) and a large decrease in the share of trips made entirely by car (RRR 2.09, 95 % CI 1.35, 3.21), as well as a lower likelihood of a small (<30 %) reduction in the share of trips involving any active travel (RRR 0.47, 95 % CI 0.28, 0.81). It was not associated with changes in the share of commute trips involving any public transport, the number of commute trips, or commute distance.

CONCLUSIONS

The new infrastructure promoted an increase in the share of commuting trips involving active travel and a decrease in the share made entirely by car. Further analysis will show the extent to which the changes in commute mode share were translated into an increase in time spent in active commuting and consequent health gain.

Are liveable neighbourhoods safer neighbourhoods? Testing the rhetoric on new urbanism and safety from crime in Perth, Western Australia

New urbanism advocates for the design of the compact, pedestrian-friendly, mixed-use developments thought to promote walking. New urbanist proponents also claim their developments incur other social and wellbeing benefits, including enhanced safety from crime; however there is limited empirical evidence supporting this. We tested the premise that new urbanism inhibits crime by examining the relationship between compliance with a planning policy based on new urbanism and: (1) residents' reports of victimisation; and (2) objective crime measures. RESIDE Participants (n = 603) who had lived in their new developments for 36 months completed a questionnaire that included items on their experiences of victimisation. Detailed measures quantifying the degree to which these developments (n = 36) complied with the policy requirements were generated in Geographic Information Systems. Logistic regression examined the associations between policy compliance and self-report victimisation, and negative binomial log-linear models examined area-level associations between compliance and objective crime. For each 10% increase in overall policy compliance, the odds of being a victim reduced by 40% (OR = 0.60, CI = 0.53-0.67, p = 0.000). Findings for the individual policy 'elements' were consistent with this: for each 10% increment in compliance with the community design, movement network, lot layout and public parkland elements, the odds of victimisation reduced by approximately 6% (p = 0.264), 51% (p = 0.001), 15% (p = 0.000) and 22% (p = 0.001) respectively. However, while policy compliance correlated with lower odds of self-report victimisation among residents, the associations between compliance and development-wide (objective) crime were positive but non-significant. The results indicate that planning policies based on new urbanism may indeed deliver other social and wellbeing benefits for residents, however they also hint that the design of an 'objectively' safe place may differ from the design of a 'subjectively' safe space.

Is change in availability of sports facilities associated with change in physical activity? A prospective cohort study

OBJECTIVE

We examined whether change in distance to or number of sports facilities is related to change in metabolic equivalent task (MET) hours/week.

METHOD

25,834 Finnish Public Sector study cohort participants reported their weekly physical activity in 2000 and 2008. Distances from each participant's home to the nearest facility and number of facilities within 500m from home were calculated from geographic coordinates. We assessed changes in weekly MET hours of physical activity between the baseline and the follow-up in relation to change in distance to the nearest facility (remained close, decreased, remained distant, increased) and number of facilities <500m from home (remained high, increased, remained low, decreased).

RESULTS

The average decrease in MET hours was greater for those whose distance to a sports facility increased (-1.4 (95% CI -3.8--0.96)) (vs. remained close). The same was observed for those for whom the number of facilities near home decreased (-2.35 (95% CI -4.84-0.14)) (vs. remained high). Increase in availability was not related to increase in MET hours.

CONCLUSIONS

An increase in distance to and decrease in number of sports facilities were associated with a decrease in physical activity suggesting that changes in availability of facilities may affect physical activity levels.

The influence of the neighborhood physical environment on early child health and development: A review and call for research

This review examines evidence of the association between the neighborhood built environment, green spaces and outdoor home area, and early (0-7 years) child health and development. There was evidence that the presence of child relevant neighborhood destinations and services were positively associated with early child development domains of physical health and wellbeing and social competence. Parents׳ perceptions of neighborhood safety were positively associated with children׳s social-emotional development and general health. Population representative studies using objective measures of the built environment and valid measures of early child development are warranted to understand the impact of the built environment on early child health and development.

A longitudinal analysis of the influence of the neighborhood built environment on walking for transportation: the RESIDE study

The purpose of the present analysis was to use longitudinal data collected over 7 years (from 4 surveys) in the Residential Environments (RESIDE) Study (Perth, Australia, 2003-2012) to more carefully examine the relationship of neighborhood walkability and destination accessibility with walking for transportation that has been seen in many cross-sectional studies. We compared effect estimates from 3 types of logistic regression models: 2 that utilize all available data (a population marginal model and a subject-level mixed model) and a third subject-level conditional model that exclusively uses within-person longitudinal evidence. The results support the evidence that neighborhood walkability (especially land-use mix and street connectivity), local access to public transit stops, and variety in the types of local destinations are important determinants of walking for transportation. The similarity of subject-level effect estimates from logistic mixed models and those from conditional logistic models indicates that there is little or no bias from uncontrolled time-constant residential preference (self-selection) factors; however, confounding by uncontrolled time-varying factors, such as health status, remains a possibility. These findings provide policy makers and urban planners with further evidence that certain features of the built environment may be important in the design of neighborhoods to increase walking for transportation and meet the health needs of residents.

The contribution of media analysis to the evaluation of environmental interventions: the commuting and health in Cambridge study

Background

Media content can increase awareness of, and shape interactions with, public health interventions. As part of a natural experimental evaluation of the travel, physical activity and health impacts of the Cambridgeshire Guided Busway, we analysed print and social media discourse and interview data to understand the nature of new transport infrastructure and how it was experienced.

Methods

Newspaper articles were systematically retrieved from the LexisNexis database and tweets were identified from an online archive. Interviews were conducted as part of the larger evaluation study with 38 adults. Inductive thematic analysis was performed and comparisons were drawn between datasets.

Results

The findings are discussed in relation to five themes. First, an understanding of the intervention context and how the intervention was experienced was developed through accounts of events occurring pre and post the busway’s opening. Second, the media captured the dynamic nature of the intervention. Third, the media constructed idealised portrayals of the anticipated busway which in some cases were contradicted by the impact of the busway on the existing context and people’s lived experiences. Fourth, differential media coverage of the intervention components suggested that a lesser value was placed on promoting active travel compared with public transport. Lastly, interview data provided support for the hypothesis that the media increased awareness of the busway and served as a frame of reference for constructing expectations and comparing experiences.

Conclusions

This analysis has contributed to the wider evaluation of the busway, helping to understand its nature and implementation and informing hypotheses about how the local population interact with the infrastructure by attending to the significance of representations in the media.

Do changes in residents' fear of crime impact their walking? Longitudinal results from RESIDE

OBJECTIVE

To examine the influence of fear of crime on walking for participants in a longitudinal study of residents in new suburbs.

METHODS

Participants (n=485) in Perth, Australia, completed a questionnaire about three years after moving to their neighbourhood (2007-2008), and again four years later (2011-2012). Measures included fear of crime, neighbourhood perceptions and walking (min/week). Objective environmental measures were generated for each participant's neighbourhood, defined as the 1600 m road network distance from home, at each time-point. Linear regression models examined the impact of changes in fear of crime on changes in walking, with progressive adjustment for other changes in the built environment, neighbourhood perceptions and demographics.

RESULTS

An increase in fear of crime was associated with a decrease in residents' walking inside the local neighbourhood. For each increase in fear of crime (i.e., one level on a five-point Likert scale) total walking decreased by 22 min/week (p=0.002), recreational walking by 13 min/week (p=0.031) and transport walking by 7 min/week (p=0.064).

CONCLUSION

This study provides longitudinal evidence that changes in residents' fear of crime influence their walking behaviours. Interventions that reduce fear of crime are likely to increase walking and produce public health gains.

Change in walking and body mass index following residential relocation: the multi-ethnic study of atherosclerosis

OBJECTIVES

We investigated whether moving to neighborhoods with closer proximity of destinations and greater street connectivity was associated with more walking, a greater probability of meeting the "Every Body Walk!" campaign goals (≥ 150 minutes/week of walking), and reductions in body mass index (BMI).

METHODS

We linked longitudinal data from 701 participants, who moved between 2 waves of the Multi-Ethnic Study of Atherosclerosis (2004-2012), to a neighborhood walkability measure (Street Smart Walk Score) for each residential location. We used fixed-effects models to estimate if changes in walkability resulting from relocation were associated with simultaneous changes in walking behaviors and BMI.

RESULTS

Moving to a location with a 10-point higher Walk Score was associated with a 16.04 minutes per week (95% confidence interval [CI] = 5.13, 29.96) increase in transport walking, 11% higher odds of meeting Every Body Walk! goals through transport walking (adjusted odds ratio = 1.11; 95% CI = 1.02, 1.21), and a 0.06 kilogram per meters squared (95% CI = -0.12, -0.01) reduction in BMI. Change in walkability was not associated with change in leisure walking.

CONCLUSIONS

Our findings illustrated the potential for neighborhood infrastructure to support health-enhancing behaviors and overall health of people in the United States.

Evaluating the Implementation and Active Living Impacts of a State Government Planning Policy Designed to Create Walkable Neighborhoods in Perth, Western Australia

Purpose.

Evaluate the implementation of a government planning policy (Liveable Neighbourhoods Guidelines) and its impacts on residents' walking behaviors.

Design.

Cross-sectional study of participants from the RESIDential Environments project (RESIDE).

Setting.

Nineteen “liveable” and 17 “conventionally designed” housing developments across Perth, Western Australia.

Subjects.

Five hundred ninety-four participants from RESIDE who resided in 36 housing developments.

Measures.

Developed in geographic information systems to assess the on-ground implementation of 43 policy requirements. Policy compliance was defined as the degree to which construction of the developments adhered to the standards outlined. Walking behaviors were measured using the Neighborhood Physical Activity Questionnaire. K-means cluster analyses identified groups of homogeneous developments with respect to policy implementation.

Analysis.

Logistic regression with generalized estimating equations estimated the odds ratios (ORs) and 95% confidence intervals (95% CIs) for the likelihood of undertaking any and ≥ 60 minutes of transport and recreational walking associated with (1) policy compliance and (2) different clusters of developments.

Results.

There were few significant differences in on-ground outcomes between the two development types. Despite incomplete implementation, the odds of walking for transport increased with overall levels of policy compliance (OR= 1.53, 95% CI 1.13–2.08) and compliance with the community design (OR = 1.3, 95% CI 1.13–1.42), movement network (OR = 2.49, 95% CI 1.38–4.50), and lot layout elements (OR = 1.26, 95% CI 1.06–1.50).

Conclusion.

Consistent with the aims of the policy, residents in walkable (i.e., liveable) neighborhoods may be more physically active.