Attributes of environments supporting walking

Timing and duration of dog walking and dog owner's chronotype in relation to incident depression risk among middle to older-aged female nurses

BACKGROUND

We examined associations between dog ownership, morning dog walking and its timing and duration, and depression risk in female nurses, exploring effect modification by chronotype. We hypothesized that dog ownership and morning walking with the dog are associated with lower odds of depression, and that the latter is particularly beneficial for evening chronotypes by helping them to synchronize their biological clock with the solar system.

METHODS

26,169 depression-free US women aged 53-72 from the Nurses' Health Study 2 (NHS2) were prospectively followed from 2017-2019. We used age- and multivariable-adjusted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for depression according to dog ownership, and morning dog walking, duration, and timing.

RESULTS

Overall, there was no association between owning a dog (ORvs_no_pets = 1.12, 95%CI = 0.91-1.37), morning dog walking (ORvs_not = 0.87, 95%CI = 0.64-1.18), or the duration (OR>30min vs. ≤15mins = 0.68, 95%CI = 0.35-1.29) or timing of morning dog walks (ORafter9am vs. before7am = 1.06, 95%CI = 0.54-2.05) and depression. Chronotype of dog owners appeared to modify these associations. Compared to women of the same chronotype but without pets, dog owners with evening chronotypes had a significantly increased odds of depression (OR = 1.60, 95%CI = 1.12-2.29), whereas morning chronotypes did not (OR = 0.94, 95%CI = 0.71-1.23). Further, our data suggested that evening chronotypes benefited more from walking their dog themselves in the morning (OR = 0.75, 95%CI = 0.46-1.23, Pintx = 0.064;) than morning chronotypes.

CONCLUSIONS

Overall, dog ownership was not associated with depression risk though it was increased among evening chronotypes. Walking their dog in the morning might help evening chronotypes to lower their odds of depression, though more data are needed to confirm this finding.

Distributional environmental justice of residential walking space: The lens of urban ecosystem services supply and demand

Urban ecosystem services (UES), as an important concept in nature-based solutions, can effectively mitigate adverse environmental burdens and have great potential in addressing environmental justice issues. However, few studies linking UES with environmental justice have considered both supply and demand sides of UES, particularly at the spatial scale of residential walking space. Against this backdrop, we investigated the distributional justice of supply and demand for urban cooling, flood mitigation, air purification, and outdoor recreation in residential walking spaces in Shanghai among socially vulnerable groups (i.e., elderly residents, children, females, low-income residents, no-hukou residents, and ethnic minorities). We found that (1) the UES supply of residential walking space was much lower than that of non-residential walking space, while the UES demand was much higher than that of non-residential walking space. (2) Higher proportions of ethnic minorities, no-hukou residents, and females in Shanghai were positively correlated with several UES demands but were not positively correlated with ES supply, indicating a higher possibility of unsatisfied UES demand for these disadvantaged groups. Future urban blue-green space planning should pay more attention to the spatial allocation of blue-green space, especially placing more blue-green space around residential walking spaces with high UES demand and with a high proportion of socially disadvantaged groups.

The Long-Term Influence of Puppy Acquisition on Physical Activity: Results of a 3-Year, Longitudinal, Pilot Study

Dog ownership has been associated with increased levels of physical activity (PA), including increases in total PA and walking time in some but not in all studies. These earlier studies did not consider puppy acquisition, in particular, and were limited to a maximum of 10 months duration. The purpose of the current pilot study was, therefore, to analyze long-term changes in participants' PA behavior after puppy acquisition. Participants who acquired a puppy from one of nine preselected breeds differing in size and energy level were included. PA was assessed at baseline and 6, 12, 24 and 36 months after puppy acquisition using an online questionnaire. Participants, who were initially included, did not differ in their PA at baseline (n = 38). In the group that completed the trial (n = 11) total PA, leisure time walking, total dog-related PA, and total dog walking increased within the first two years and decreased while remaining above baseline values during the last year, coinciding with the COVID-19 pandemic. Non-dog-related PA did not change over time. We conclude that the acquisition of a puppy increases PA and thus, could have a long-lasting positive effect on physical health.

The Determinants of Walking Behavior before and during COVID-19 in Middle-East and North Africa: Evidence from Tabriz, Iran

To support the global strategy to raise public health through walking among adults, we added the evidence on predictors of walking behavior in the Middle East and North Africa (MENA) region by emphasizing the mediator—COVID-19. During the COVID-19 outbreak, public restrictions to encompass the spread of the disease have disrupted normal daily lifestyles, including physical activity and sedentary behavior. It was proposed that tremendous changes have occurred on predictors of physical activity in general and walking behavior in particular for three types of walking, including commute, non-commute, and social walking compared to pre-COVID-19 time. This study aimed to identify the determinants of the walking types mentioned above, including subjective and objective variables before COVID-19, and compare them during the COVID-19 period in a sample from Iran, which has not yet been addressed in previous research. Adults (N = 603) finalized an online survey between June 5 and July 15, 2021. This group reported their individual/socioeconomic locations (e.g., home/work) and perception features before and during COVID-19. The paper developed six Binary Logistic (BL) regression models, with two models for each walking type (commute, non-commute, and social walking). For commute trips before COVID-19, the findings showed that factors including BMI, residential duration, p. (perceived) neighborhood type, p. distance to public transport stations and job/university places, p. sidewalks quality, p. facilities attractiveness, p. existence of shortcut routes, commute distance, building density and distance to public transport were correlated with commute walking. At the same time, such associations were not observed for BMI, p. distance to public transport and job/university places, p. facilities attractiveness, building density, and distance to public transport during COVID-19. The variables include age, possession of a driving license, number of family members, p. neighborhood type, p. distance to grocery, restaurant, parking, and mall, p. existence of sidewalks, land-use mix, and distance to public transport indicated correlations with non-commute before COVID-19. However, p. distance to groceries and malls and the p. existence of sidewalks did not correlate with non-commute walking during COVID-19. Ultimately for social walking, age and income variables, and the considerable proportions of subjective variables (e.g., p. distance to services/land-uses, security, etc.), health status and building density were correlated with social walking before COVID-19. Nevertheless, most of the mentioned variables did not explicitly correlate with social walking during COVID-19. As for the implication of our study, apparently, special actions will be needed by urban authorities to encourage adults to enhance their walkability levels by fully considering both objective and subjective indicators and walking types, which will result in healthier lifestyles.

What moves you? Physical activity strategies in older women

Physical activity improves quality of life and extends independence in older adults. Yet, how to motivate older adults to engage in physical activity is unclear. In the present study, 4108 older women, aged 70-99, reported how they motivated themselves to move when they did not feel like it, and their hours of physical activity and walking each week. Findings indicated that participants who endorsed more strategies had more hours of physical activity and walking. Strategic categories that correlated with more physical activity include focusing on the benefits and utilizing the surrounding environment to help motivate movement.

Pedestrian Walkways for Health in Shiraz, Iran, the Contribution of Attitudes, and Perceived Environmental Attributes

Walking is important for improving physical activity and public health. The pedestrian walkways called Walkways for Health in Shiraz, Iran, present a high standard of aesthetic and design features which attract many people for the purpose of recreation. In addition, a significant percentage of Iranians suffer from mental disorders. The contribution of aesthetic and design features toward walking for recreation as well as mental health has been demonstrated in previous studies, which have focused on either one or the other of these aspects. This interdisciplinary research study aims to evaluate both of these aspects simultaneously. A quantitative approach including a survey questionnaire and multiple regression analysis was used to examine the objectives. The contributions of walking attitudes and several perceived environmental attributes to the attractiveness for walking and to general/mental health were determined, which suggested the need for new arrangements of the visual sequences and social setting along these walkways. In addition, the observation that younger people suffer are more affected by mental health disorders was one of the most challenging findings. The policy makers of this city could apply the findings of this study to these pedestrian walkways in order to improve the attractiveness for walking as well as general and mental health.

Study on the Impact of Historic District Built Environment and Its Influence on Residents' Walking Trips: A Case Study of Zhangzhou Ancient City's Historic District

Walking maintains an indisputable advantage as a simple transport mode over short distances. Various situations have shown that when staying in a walk-friendly built environment, people are more likely to walk and interact with their surroundings. Scholars have reported some evidence of the influence of neighbourhood environments on personal walking trips. Most existing studies of the correlation between the built environment and walking, however, have been conducted in the West and are cross-sectional, which leaves a gap in addressing the causality between built environments and walking under the intervention of regeneration measures. This study takes a historic district of a mid-sized city in China as the research area and reports the changes in the traditional residential district's built environment caused by the implementation of urban regeneration. In this paper, we use physical and perceptual indicators to measure the walkability of the built environment. We identify the changed content of the built environment's walkability and the change of residents' walking behaviour through longitudinal and quasi-longitudinal methods. The conclusion shows that the implementation of a regeneration project of the historic district has greatly changed perceived walkability, which has significantly promoted residents' recreational walking trips, especially among the population of middle-aged and elderly people in the district. The conclusion that the built environment's change promotes recreational walking is contrary to the research performed in sprawling Western contexts such as in the US, and it provides a meaningful supplement for research on the topic in an Asian context.

Facilitating barriers: Contextual factors and self-management of type 2 diabetes in urban settings

Urban environments create unique challenges for the management of type 2 diabetes (T2D). City living is associated with unhealthy occupational, nutritional, and physical activity patterns. However, it has also been linked to behaviours that promote health, such as walking and cycling for transportation. Our research is situated at the intersection of these contradictory findings. We ask: What aspects of urban living impact the ability of those living with diabetes to reach optimal health? What contextual and structural factors influence how barriers are experienced in the everyday lives of those living with T2D? We conducted semi-structured interviews with 29 individuals living in Toronto and Vancouver. Interviews were recorded, transcribed, and systematically coded for themes and sub-themes. In addition to affirming readily acknowledged barriers to diabetes management, such as accessing healthy, culturally appropriate food and the cost of management, our findings suggest that the unpredictable nature of urban living creates barriers to routinizing self-management practices. As large, cosmopolitan centres with an abundance of activities on offer, cities pulls people away from home, making adherence to self-management recommendations more difficult. Moreover, our findings challenge commonly held assumptions about the mutually exclusive and static nature of barriers and facilitators. Public transit, a readily acknowledged facilitator of healthy living, can be experienced as a barrier to diabetes management. Participants report intentional non-adherence to their medication regimens for fear of hypoglycemia in subway or traffic delays. While the stimulating nature of cities promotes walkability, it produces barriers as well: participants partake in more restaurant eating than they would if they lived in a rural area and were home to cook their own meals. Understanding how barriers are experienced by people living with diabetes will help mitigate some of the unintended consequences associated with various contextual factors. We recommend that healthcare professionals acknowledge and support people with T2D in routinizing self-management and developing contingency plans for the unpredictability and complexity that urban living entails. We suggest further research be carried out to develop contextually-tailored municipal policies and interventions that will support self-management and improve outcomes for individuals living with T2D in urban settings.

A systematic framework for understanding environmental design influences on physical activity in the elderly population

Purpose

This paper aims to synthesize the published literature regarding the impact of environmental design on the improvement of elderly residents’ physical activity.

Design/methodology/approach

To provide convergent evidence about the association between facility design/management and physical activity of elderly population, searches were conducted in the PubMed and Google Scholar databases, as well as in specific active living design journals such as Applied Gerontology, Aging and Physical Activity, Housing for the Elderly and Sports Sciences. The inclusion criteria for the final list were the articles that were qualitative, quantitative and mixed-methods studies as well as systematic reviews; written in English; related to the built environmental design; wholly or partially focused on physical activity in elderly population; and published in peer-reviewed journals between 1984 and 2019.

Findings

Overall, 30 studies were included in the final list. The results of this review demonstrate that design interventions can raise physical functioning inside and outside of long-term residential facilities. Increasing opportunities for walkable spaces and reducing physical barriers can result in higher levels of physical activity for the elderly population.

Research limitations/implications

This systematic review discloses the design strategies to enhance the level of physical activity by the elderly population based on the findings of the published literature. Overall space layout and accessibility to outdoor walkable spaces were addressed to generally promote the moderate levels of physical activity in elderly population.

Practical implications

Increasing opportunities for walkable spaces and reducing physical barriers result in higher level of activity for the elderly population. Corridor design and interior design ergonomic considerations were highlighted in the literature. Space layout and accessibility to outdoor walkable spaces promote the moderate levels of physical activity.

Social implications

Environmental design considerations are unique aspects of enhancement of activity level in the elderly population.

Originality/value

This systematic review discloses the design strategies to enhance the level of physical activity by the elderly population based on the findings of the published literature. Overall space layout and accessibility to outdoor walkable spaces were addressed to generally promote the moderate levels of physical activity in elderly population.

Obesity and the Built Environment: A Reappraisal

The built environment (BE) has been viewed as an important determinant of health. Numerous studies have linked BE exposure, captured using a variety of methods, to diet quality and to area prevalence of obesity, diabetes, and cardiovascular disease. First-generation studies defined the neighborhood BE as the area around the home. Second-generation studies turned from home-centric to person-centric BE measures, capturing an individual's movements in space and time. Those studies made effective uses of global positioning system tracking devices and mobile phones, sometimes coupled with accelerometers and remote sensors. Activity space metrics explored travel paths, modes, and destinations to assess BE exposure that was both person and context specific. However, as measures of the contextual exposome have become ever more fine-grained and increasingly complex, connections to long-term chronic diseases with complex etiologies, such as obesity, are in danger of being lost. Furthermore, few studies on obesity and the BE have included intermediate energy balance behaviors, such as diet and physical activity, or explored the potential roles of social interactions or psychosocial pathways. Emerging survey-based applications that identify habitual destinations and associated travel patterns may become the third generation of tools to capture health-relevant BE exposures in the long term.

Probabilistic walking models using built environment and sociodemographic predictors

Background

Individual sociodemographic and home neighborhood built environment (BE) factors influence the probability of engaging in health-enhancing levels of walking or moderate-to-vigorous physical activity (MVPA). Methods are needed to parsimoniously model the associations.

Methods

Participants included 2392 adults drawn from a community-based twin registry living in the Seattle region. Objective BE measures from four domains (regional context, neighborhood composition, destinations, transportation) were taken for neighborhood sizes of 833 and 1666 road network meters from home. Hosmer and Lemeshow’s methods served to fit logistic regression models of walking and MVPA outcomes using sociodemographic and BE predictors. Backward elimination identified variables included in final models, and comparison of receiver operating characteristic (ROC) curves determined model fit improvements.

Results

Built environment variables associated with physical activity were reduced from 86 to 5 or fewer. Sociodemographic and BE variables from all four BE domains were associated with activity outcomes but differed by activity type and neighborhood size. For the study population, ROC comparisons indicated that adding BE variables to a base model of sociodemographic factors did not improve the ability to predict walking or MVPA.

Conclusions

Using sociodemographic and built environment factors, the proposed approach can guide the estimation of activity prediction models for different activity types, neighborhood sizes, and discrete BE characteristics. Variables associated with walking and MVPA are population and neighborhood BE-specific.

Electronic supplementary material

The online version of this article (10.1186/s12963-019-0186-8) contains supplementary material, which is available to authorized users.

AwaP-IC—An Open-Source GIS Tool for Measuring Walkable Access

Within the broad field of walkability research, a key area of focus has been the relationship between urban form and capacities for walking. Measures of walkable access can be grouped into two key types: permeability measures that quantify the ease of movement through an urban fabric, and catchment measures, quantifying the potential to reach destinations within walking distance. Of numerous street network measures in use, it has been shown that many are poor proxies of permeability and catchment. Instead, two new measures have been proposed: the area-weighted average perimeter (AwaP) and interface catchment (IC), that, combined, better capture the capacities of urban morphologies to enable and attract pedestrian movement. In this paper, we present the QGIS tool AwaP-IC, developed to overcome the difficulty of computing these measures. Unlike GIS tools based on models that abstract streets to axial lines, by employing new algorithms and spatial computation techniques, AwaP-IC analyses actual urban morphologies, based on cadastral maps delineating public and private land. This can empower a new stream of urban morphological studies with the computational power of GIS. As an open-source tool, it can be further developed for use in urban mapping and to streamline the analysis of large datasets.

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.

Subjective neighborhood assessment and physical inactivity: An examination of neighborhood-level variance

Research suggests a linkage between perceptions of neighborhood quality and the likelihood of engaging in leisure-time physical activity. Often in these studies, intra-neighborhood variance is viewed as something to be controlled for statistically. However, we hypothesized that intra-neighborhood variance in perceptions of neighborhood quality may be contextually relevant. We examined the relationship between intra-neighborhood variance of subjective neighborhood quality and neighborhood-level reported physical inactivity across 48 neighborhoods within a medium-sized city, Texas City, Texas using survey data from 2706 residents collected between 2004 and 2006. Neighborhoods where the aggregated perception of neighborhood quality was poor also had a larger proportion of residents reporting being physically inactive. However, higher degrees of disagreement among residents within neighborhoods about their neighborhood quality was significantly associated with a lower proportion of residents reporting being physically inactive (p=0.001). Our results suggest that intra-neighborhood variability may be contextually relevant in studies seeking to better understand the relationship between neighborhood quality and behaviors sensitive to neighborhood environments, like physical activity.

Differences in Behavior, Time, Location, and Built Environment between Objectively Measured Utilitarian and Recreational Walking

OBJECTIVES

Utilitarian and recreational walking both contribute to physical activity. Yet walking for these two purposes may be different behaviors. We sought to provide operational definitions of utilitarian and recreational walking and to objectively measure their behavioral, spatial, and temporal differences in order to inform transportation and public health policies and interventions.

METHODS

Data were collected 2008-2009 from 651 Seattle-King County residents, wearing an accelerometer and a GPS unit, and filling-in a travel diary for 7 days. Walking activity bouts were classified as utilitarian or recreational based on whether walking had a destination or not. Differences between the two walking purposes were analyzed, adjusting for the nested structure of walking activity within participants.

RESULTS

Of the 4,905 observed walking bouts, 87.4% were utilitarian and 12.6% recreational walking. Utilitarian walking bouts were 45% shorter in duration (-12.1 min) and 9% faster in speed (+0.3km/h) than recreational walking bouts. Recreational walking occurred more frequently in the home neighborhood and was not associated with recreational land uses. Utilitarian walking occurred in areas having higher residential, employment, and street density, lower residential property value, higher area percentage of mixed-use neighborhood destinations, lower percentage of parks/trails, and lower average topographic slope than recreational walking.

CONCLUSION

Utilitarian and recreational walking are substantially different in terms of frequency, speed, duration, location, and related built environment. Policies that promote walking should adopt type-specific strategies. The high occurrence of recreational walking near home highlights the importance of the home neighborhood for this activity.

Geographic variation in the relationship between body mass index and the built environment

Studies examining associations between weight status and neighborhood built environment (BE) have shown inconsistent results and have generally focused on urban settings. However, many Americans do not live in metropolitan areas and BE impacts may be different outside of metropolitan areas. We sought to examine whether the relationship between body mass index (BMI) and neighborhood BE exists and varies by geographic region across small towns in the United States. We conducted telephone surveys with 2156 adults and geographic information systems data in nine towns located within three geographic regions (Northeast, Texas, Washington) in 2011 and 2012. Multiple regression models examined the relationship between individual BMI and BE measures. Most physical activity variables were significantly associated with lower BMI in all geographic regions. We saw variation across geographic region in the relationship between characteristics of the BE variables and BMI. Some perceived and objectively-measured characteristics of the BE were significantly associated with adult BMI, but significant relationships varied by geographic region. For example, in the Northeast, perceived attractiveness of the neighborhood as a reason for why they chose to live there was associated with lower BMI; in Texas, the perceived presence of a fast food restaurant was negatively associated with BMI; in Washington, perceived presence of trees along the streets was associated with lower BMI. Our findings suggest that regional variation plays a role in the relationship between adult BMI and BE characteristics in small towns. Regardless of geographic location, interventions should encourage utilitarian walking and other forms of physical activity.

Utilitarian and Recreational Walking Among Spanish- and English-Speaking Latino Adults in Micropolitan US Towns

BACKGROUND

Walking among Latinos in US Micropolitan towns may vary by language spoken.

METHODS

In 2011-2012, we collected telephone survey and built environment (BE) data from adults in six towns located within micropolitan counties from two states with sizable Latino populations. We performed mixed-effects logistic regression modeling to examine relationships between ethnicity-language group [Spanish-speaking Latinos (SSLs); English-speaking Latinos (ESLs); and English-speaking non-Latinos (ENLs)] and utilitarian walking and recreational walking, accounting for socio-demographic, lifestyle and BE characteristics.

RESULTS

Low-income SSLs reported higher amounts of utilitarian walking than ENLs (p = 0.007), but utilitarian walking in this group decreased as income increased. SSLs reported lower amounts of recreational walking than ENLs (p = 0.004). ESL-ENL differences were not significant. We identified no statistically significant interactions between ethnicity-language group and BE characteristics.

DISCUSSION

Approaches to increase walking in micropolitan towns with sizable SSL populations may need to account for this group's differences in walking behaviors.

Pedestrian-oriented zoning is associated with reduced income and poverty disparities in adult active travel to work, United States

Active travel to work can provide additional minutes of daily physical activity. While the literature points to the relationship between zoning, equity and socioeconomic status, and physical activity, no study has quantitatively explored these connections. This study examined whether zoning may help to moderate any income and poverty inequities in active travel and taking public transit to work. Research was conducted between May 2012 and June 2015. Zoning data were compiled for 3914 jurisdictions covering 45.45% of the U.S. population located in 471 of the most populous U.S. counties and 2 consolidated cities located in 48 states and the District of Columbia. (Sensitivity analyses also captured unincorporated areas which, with the municipalities, collectively covered ~72% of the U.S.

POPULATION

) Zoning codes were obtained and evaluated to assess the pedestrian-orientation of the zoning codes. Public transit use, active travel to work, median household income, and poverty data were obtained for all study jurisdictions from the 2010-2014 American Community Survey estimates. Associations were examined through multivariate regression models, controlling for community sociodemographics, clustered on county, with robust standard errors. We found that certain pedestrian-oriented zoning provisions (e.g., crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, and more zoning provisions) were associated with reduced income and/or poverty disparities in rates of public transit use and active travel to work. Findings from this study can help to inform cross-sectoral collaborations between the public health, planning, and transportation fields regarding zoning for pedestrian-orientation and active travel.

Secondary GIS built environment data for health research: guidance for data development

Built environment (BE) data in geographic information system (GIS) format are increasingly available from public agencies and private providers. These data can provide objective, low-cost BE data over large regions and are often used in public health research and surveillance. Yet challenges exist in repurposing GIS data for health research. The GIS data do not always capture desired constructs; the data can be of varying quality and completeness; and the data definitions, structures, and spatial representations are often inconsistent across sources. Using the Small Town Walkability study as an illustration, we describe (a) the range of BE characteristics measurable in a GIS that may be associated with active living, (b) the availability of these data across nine U.S. small towns, (c) inconsistencies in the GIS BE data that were available, and (d) strategies for developing accurate, complete, and consistent GIS BE data appropriate for research. Based on a conceptual framework and existing literature, objectively measurable characteristics of the BE potentially related to active living were classified under nine domains: generalized land uses, morphology, density, destinations, transportation system, traffic conditions, neighborhood behavioral conditions, economic environment, and regional location. At least some secondary GIS data were available across all nine towns for seven of the nine BE domains. Data representing high-resolution or behavioral aspects of the BE were often not available. Available GIS BE data - especially tax parcel data - often contained varying attributes and levels of detail across sources. When GIS BE data were available from multiple sources, the accuracy, completeness, and consistency of the data could be reasonable ensured for use in research. But this required careful attention to the definition and spatial representation of the BE characteristic of interest. Manipulation of the secondary source data was often required, which was facilitated through protocols.

Communities on the Move: Pedestrian-Oriented Zoning as a Facilitator of Adult Active Travel to Work in the United States

BACKGROUND

Communities across the United States have been reforming their zoning codes to create pedestrian-friendly neighborhoods with increased street connectivity, mixed use and higher density, open space, transportation infrastructure, and a traditional neighborhood structure. Zoning code reforms include new urbanist zoning such as the SmartCode, form-based codes, transects, transportation and pedestrian-oriented developments, and traditional neighborhood developments.

PURPOSE

To examine the relationship of zoning code reforms and more active living--oriented zoning provisions with adult active travel to work via walking, biking, or by using public transit.

METHODS

Zoning codes effective as of 2010 were compiled for 3,914 municipal-level jurisdictions located in 471 counties and 2 consolidated cities in 48 states and the District of Columbia, and that collectively covered 72.9% of the U.S. population. Zoning codes were evaluated for the presence of code reform zoning and nine pedestrian-oriented zoning provisions (1 = yes): sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, bike-pedestrian trails/paths, mixed-use development, and other walkability/pedestrian orientation. A zoning scale reflected the number of provisions addressed (out of 10). Five continuous outcome measures were constructed using 2010-2014 American Community Survey municipal-level 5-year estimates to assess the percentage of workers: walking, biking, walking or biking, or taking public transit to work OR engaged in any active travel to work. Regression models controlled for municipal-level socioeconomic characteristics and a GIS-constructed walkability scale and were clustered on county with robust standard errors.

RESULTS

Adjusted models indicated that several pedestrian-oriented zoning provisions were statistically associated (p < 0.05 or lower) with increased rates of walking, biking, or engaging in any active travel (walking, biking, or any active travel) to work: code reform zoning, bike parking (street furniture), bike lanes, bike-pedestrian trails/paths, other walkability, mixed-use zoning, and a higher score on the zoning scale. Public transit use was associated with code reform zoning and a number of zoning measures in Southern jurisdictions but not in non-Southern jurisdictions.

CONCLUSION

As jurisdictions revisit their zoning and land use policies, they may want to evaluate the pedestrian-orientation of their zoning codes so that they can plan for pedestrian improvements that will help to encourage active travel to work.

Cross Sectional Association between Spatially Measured Walking Bouts and Neighborhood Walkability

Walking is the most popular choice of aerobic physical activity to improve health among U.S. adults. Physical characteristics of the home neighborhood can facilitate or hinder walking. The purpose of this study was to quantify neighborhood walking, using objective methods and to examine the association between counts of walking bouts in the home neighborhood and neighborhood walkability. This was a cross-sectional study of 106 adults who wore accelerometers and GPS devices for two weeks. Walking was quantified within 1, 2, and 3 km Euclidean (straight-line) and network buffers around the geocoded home location. Walkability was estimated using a commercially available index. Walking bout counts increased with buffer size and were associated with walkability, regardless of buffer type or size (p < 0.001). Quantification of walking bouts within (and outside) of pre-defined neighborhood buffers of different sizes and types allowed for the specification of walking locations to better describe and elucidate walking behaviors. These data support the concept that neighborhood characteristics can influence walking among adults.

Neighborhood characteristics and depressive symptoms in an older population

OBJECTIVES

We explored relationships between depressive symptoms and neighborhood environment measures including traffic safety, crime, social capital, and density of businesses in community-dwelling older adults from four different regions of the United States.

METHOD

The Healthy Aging Research Network walking study is a cross-sectional study of 884 adults aged 65+, which included a 10-item Center for Epidemiologic Studies Depression scale of depressive symptoms, demographics, self-reported neighborhood perceptions, and objective neighborhood data.

RESULTS

After adjusting for individual covariates, reports of neighborhood crime, unsafe traffic, and unwillingness of neighbors to help each other were significantly positively associated with depressive symptoms among participants.

CONCLUSION

This research suggests an association between self-reported depressive symptoms and the social and built environment; examining causal association requires additional longitudinal research in diverse populations of older adults.

Urban Natural Environments, Obesity, and Health-Related Quality of Life among Hispanic Children Living in Inner-City Neighborhoods

Although a substantial body of literature has provided evidence supporting the positive effects of natural environments on well-being, little has been known about the specific spatial patterns of urban nature in promoting health-related quality of life (HRQOL) among children. This study assessed the association that the urban natural environment measured by landscape spatial patterns may have with obesity and HRQOL among Hispanic children. Ninety-two 4th and 5th grade students were recruited from Houston, Texas, and the Pediatric Quality of Life Inventory (PedsQL) was used to capture the children's HRQOL. The quality of urban natural environments was assessed by quantifying the landscape spatial patterns, using landscape indices generated by Geographic Information Systems and remote sensing. From the bivariate analyses, children's body mass index showed a significantly negative association with their HRQOL. After controlling for socio-demographic factors, the results revealed that larger and more tree areas were positively correlated with children's HRQOL. In addition, those children living in areas with tree patches further apart from each other showed higher HRQOL. This research adds to the current multi-disciplinary area of research on environment-health relationships by investigating the roles of urban greeneries and linking their spatial structures with children's HRQOL.

Do Neighborhood Physical Activity Resources and Land Use Influence Physical Activity among African American Public Housing Residents?

Few studies have examined neighborhood influences on physical activity (PA) among low-income African Americans living in public housing. This study measured the associations of PA resources and land use with PA among 216 African Americans living in 12 low-income housing developments in Houston, Texas. Neighborhood measures included both detailed information from in-person audits and geographic information systems (GIS) data. Hierarchical linear regression models tested the associations of neighborhood PA resource availability and quality and land use density and diversity with individual-level, self-reported PA. Land use diversity was positively associated with walking among men after controlling for other neighborhood characteristics. Policies that promote land use diversity or improve the pedestrian environment in areas with diverse destinations may encourage PA among public housing residents.

Behavioral and Environmental Modification of the Genetic Influence on Body Mass Index: A Twin Study

Body mass index (BMI) has a strong genetic basis, with a heritability around 0.75, but is also influenced by numerous behavioral and environmental factors. Aspects of the built environment (e.g., environmental walkability) are hypothesized to influence obesity by directly affecting BMI, by facilitating or inhibiting behaviors such as physical activity that are related to BMI, or by suppressing genetic tendencies toward higher BMI. The present study investigated relative influences of physical activity and walkability on variance in BMI using 5079 same-sex adult twin pairs (70 % monozygotic, 65 % female). High activity and walkability levels independently suppressed genetic variance in BMI. Estimating their effects simultaneously, however, suggested that the walkability effect was mediated by activity. The suppressive effect of activity on variance in BMI was present even with a tendency for low-BMI individuals to select into environments that require higher activity levels. Overall, our results point to community- or macro-level interventions that facilitate individual-level behaviors as a plausible approach to addressing the obesity epidemic among US adults.

Quasi-causal associations of physical activity and neighborhood walkability with body mass index: a twin study

OBJECTIVE

Physical activity, neighborhood walkability, and body mass index (BMI, kg/m(2)) associations were tested using quasi-experimental twin methods. We hypothesized that physical activity and walkability were independently associated with BMI within twin pairs, controlling for genetic and environmental background shared between them.

METHODS

Data were from 6376 (64% female; 58% identical) same-sex pairs, University of Washington Twin Registry, 2008-2013. Neighborhood walking, moderate-to-vigorous physical activity (MVPA), and BMI were self-reported. Residential address was used to calculate walkability. Phenotypic (non-genetically informed) and biometric (genetically informed) regression was employed, controlling for age, sex, and race.

RESULTS

Walking and MVPA were associated with BMI in phenotypic analyses; associations were attenuated but significant in biometric analyses (Ps<0.05). Walkability was not associated with BMI, however, was associated with walking (but not MVPA) in both phenotypic and biometric analyses (Ps<0.05), with no attenuation accounting for shared genetic and environmental background.

CONCLUSIONS

The association between activity and BMI is largely due to shared genetic and environmental factors, but a significant causal relationship remains accounting for shared background. Although walkability is not associated with BMI, it is associated with neighborhood walking (but not MVPA) accounting for shared background, suggesting a causal relationship between them.

A disadvantaged advantage in walkability: findings from socioeconomic and geographical analysis of national built environment data in the United States

Urban form-the structure of the built environment-can influence physical activity, yet little is known about how walkable design differs according to neighborhood sociodemographic composition. We studied how walkable urban form varies by neighborhood sociodemographic composition, region, and urbanicity across the United States. Using linear regression models and 2000-2001 US Census data, we investigated the relationship between 5 neighborhood census characteristics (income, education, racial/ethnic composition, age distribution, and sex) and 5 walkability indicators in almost 65,000 census tracts in 48 states and the District of Columbia. Data on the built environment were obtained from the RAND Corporation's (Santa Monica, California) Center for Population Health and Health Disparities (median block length, street segment, and node density) and the US Geological Survey's National Land Cover Database (proportion open space and proportion highly developed). Disadvantaged neighborhoods and those with more educated residents were more walkable (i.e., shorter block length, greater street node density, more developed land use, and higher density of street segments). However, tracts with a higher proportion of children and older adults were less walkable (fewer street nodes and lower density of street segments), after adjustment for region and level of urbanicity. Research and policy on the walkability-health link should give nuanced attention to the gap between persons living in walkable areas and those for whom walkability has the most to offer.

Worksite neighborhood and obesogenic behaviors: findings among employees in the Promoting Activity and Changes in Eating (PACE) trial

BACKGROUND

Understanding mechanisms linking neighborhood context to health behaviors may provide targets for increasing lifestyle intervention effectiveness. Although associations between home neighborhood and obesogenic behaviors have been studied, less is known about the role of worksite neighborhood.

PURPOSE

To evaluate associations between worksite neighborhood context at baseline (2006) and change in obesogenic behaviors of adult employees at follow-up (2007-2009) in a worksite randomized trial to prevent weight gain.

METHODS

Worksite property values were used as an indicator of worksite neighborhood SES (NSES). Worksite neighborhood built environment attributes associated with walkability were evaluated as explanatory factors in relationships among worksite NSES, diet, and physical activity behaviors of employees. Behavioral data were collected at baseline (2005-2007) and follow-up (2007-2009). Multilevel linear and logistic models were constructed adjusting for covariates and accounting for clustering within worksites. Product-of-coefficients methods were used to assess mediation. Analyses were performed after study completion (2011-2012).

RESULTS

Higher worksite NSES was associated with more walking (OR=1.16, 95% CI=1.03, 1.30, p=0.01). Higher density of residential units surrounding worksites was associated with more walking and eating five or more daily servings of fruits and vegetables, independent of worksite NSES. Residential density partially explained relationships among worksite NSES, fruit and vegetable consumption, and walking.

CONCLUSIONS

Worksite neighborhood context may influence employees' obesogenic behaviors. Furthermore, residential density around worksites could be an indicator of access to dietary and physical activity-related infrastructure in urban areas. This may be important given the popularity of worksites as venues for obesity prevention efforts.

How design of places promotes or inhibits mobility of older adults: realist synthesis of 20 years of research

OBJECTIVE

The objective of this study was to determine the environmental features that best support aging in place.

METHOD

We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991-2011) that attempts to explain how place may influence older adults' decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory.

RESULTS

Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors.

DISCUSSION

Safety considerations are one of the most prominent influences of older adults' decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults.

The built environment and utilitarian walking in small U.S. towns

OBJECTIVES

The role of the built environment on walking in rural United States (U.S.) locations is not well characterized. We examined self-reported and measured built environment correlates of walking for utilitarian purposes among adult residents of small rural towns.

METHODS

In 2011-12, we collected telephone survey and geographic data from 2152 adults in 9 small towns from three U.S. regions. We performed mixed-effects logistic regression modeling to examine relationships between built environment measures and utilitarian walking ("any" versus "none"; "high" [≥150min per week] versus "low" [<150min per week]) to retail, employment and public transit destinations.

RESULTS

Walking levels were lower than those reported for populations living in larger metropolitan areas. Environmental factors significantly (p<0.05) associated with higher odds of utilitarian walking in both models included self-reported presence of crosswalks and pedestrian signals and availability of park/natural recreational areas in the neighborhood, and also objectively measured manufacturing land use.

CONCLUSIONS

Environmental factors associated with utilitarian walking in cities and suburbs were important in small rural towns. Moreover, manufacturing land use was associated with utilitarian walking. Modifying the built environment of small towns could lead to increased walking in a sizeable segment of the U.S. population.

The benefit of pets and animal-assisted therapy to the health of older individuals

Many studies utilizing dogs, cats, birds, fish, and robotic simulations of animals have tried to ascertain the health benefits of pet ownership or animal-assisted therapy in the elderly. Several small unblinded investigations outlined improvements in behavior in demented persons given treatment in the presence of animals. Studies piloting the use of animals in the treatment of depression and schizophrenia have yielded mixed results. Animals may provide intangible benefits to the mental health of older persons, such as relief social isolation and boredom, but these have not been formally studied. Several investigations of the effect of pets on physical health suggest animals can lower blood pressure, and dog walkers partake in more physical activity. Dog walking, in epidemiological studies and few preliminary trials, is associated with lower complication risk among patients with cardiovascular disease. Pets may also have harms: they may be expensive to care for, and their owners are more likely to fall. Theoretically, zoonotic infections and bites can occur, but how often this occurs in the context of pet ownership or animal-assisted therapy is unknown. Despite the poor methodological quality of pet research after decades of study, pet ownership and animal-assisted therapy are likely to continue due to positive subjective feelings many people have toward animals.

The spatial clustering of obesity: does the built environment matter?

BACKGROUND

Obesity rates in the USA show distinct geographical patterns. The present study used spatial cluster detection methods and individual-level data to locate obesity clusters and to analyse them in relation to the neighbourhood built environment.

METHODS

The 2008-2009 Seattle Obesity Study provided data on the self-reported height, weight, and sociodemographic characteristics of 1602 King County adults. Home addresses were geocoded. Clusters of high or low body mass index were identified using Anselin's Local Moran's I and a spatial scan statistic with regression models that searched for unmeasured neighbourhood-level factors from residuals, adjusting for measured individual-level covariates. Spatially continuous values of objectively measured features of the local neighbourhood built environment (SmartMaps) were constructed for seven variables obtained from tax rolls and commercial databases.

RESULTS

Both the Local Moran's I and a spatial scan statistic identified similar spatial concentrations of obesity. High and low obesity clusters were attenuated after adjusting for age, gender, race, education and income, and they disappeared once neighbourhood residential property values and residential density were included in the model.

CONCLUSIONS

Using individual-level data to detect obesity clusters with two cluster detection methods, the present study showed that the spatial concentration of obesity was wholly explained by neighbourhood composition and socioeconomic characteristics. These characteristics may serve to more precisely locate obesity prevention and intervention programmes.

Dog walking is associated with more outdoor play and independent mobility for children

OBJECTIVE

Dog ownership is positively associated with children's physical activity. It is plausible that dog-facilitated activity rather than dog ownership per se encourages children's physical activity behaviors. We examined relationships between dog walking and children's physical activity, and outdoor play and independent mobility.

METHOD

Cross-sectional survey data from the 2007 Perth (Western Australia) TRavel, Environment, and Kids (TREK) project were analyzed for 727 10-12 year olds with a family dog. Weekly minutes of overall physical activity and walking, local walking and outdoor play were collected from children and parents. Children's weekly pedometer steps were measured. Independent mobility was determined by active independent travel to 15 local destinations.

RESULTS

Overall, 55% of children walked their dog. After adjustment, more dog walkers than non-dog walkers walked in the neighborhood (75% vs. 47%), played in the street (60% vs. 45%) and played in the yard (91% vs. 84%) (all p ≤ 0.05). Dog walkers were more independently mobile than non-dog walkers (p ≤ 0.001). Dog walking status was not associated with overall physical activity, walking, or pedometer steps (p>0.05).

CONCLUSIONS

Dog-facilitated play and physical activity can be an effective strategy for increasing children's physical activity. Dog walking may provide a readily accessible and safe option for improving levels of independent mobility.

Active commuting to school, weight status, and cardiometabolic risk in children from rural areas: the Cuenca study

PURPOSE

The aim of this study was to examine (a) whether distance from home to school is a determinant of active commuting to school (ACS), (b) the relationship between distance from home to heavily used facilities (school, green spaces, and sports facilities) and the weight status and cardiometabolic risk categories, and (c) whether ACS has a positive impact on schoolchildren's health.

METHOD

A cross-sectional study was conducted with 956 schoolchildren aged 10 to 12 years from the province of Cuenca, Spain. Height, weight, fat mass, waist circumference, blood pressure, fasting plasma lipid profile, insulin, fitness, physical activity, and ACS were measured. Distances from home to facilities were measured by a geographic information system, and a validated metabolic syndrome index was used.

FINDINGS

Children living closer to school (less than 600 m) commuted actively to school more frequently than children living further away (more than 800 m). Normoweight boys lived further away from sports facilities than overweight/obese peers, and children presenting higher cardiometabolic risk levels lived closer to school than those who did not. No differences were found between children who daily walked/cycled to school and those commuting actively to school less frequently in body mass index, metabolic syndrome index, fitness, and physical activity.

CONCLUSIONS

ACS had no positive impact on schoolchildren's health. Distance to school is an indicator of active commuting. However, it seems that not enough physical activity is done to prevent obesity and cardiometabolic risk factors in rural areas.

A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies

OBJECTIVES

The application of GIS in health science has increased over the last decade and new innovative application areas have emerged. This study reviews the literature and builds a framework to provide a conceptual overview of the domain, and to promote strategic planning for further research of GIS in health.

METHOD

The framework is based on literature from the library databases Scopus and Web of Science. The articles were identified based on keywords and initially selected for further study based on titles and abstracts. A grounded theory-inspired method was applied to categorize the selected articles in main focus areas. Subsequent frequency analysis was performed on the identified articles in areas of infectious and non-infectious diseases and continent of origin.

RESULTS

A total of 865 articles were included. Four conceptual domains within GIS in health sciences comprise the framework: spatial analysis of disease, spatial analysis of health service planning, public health, health technologies and tools. Frequency analysis by disease status and location show that malaria and schistosomiasis are the most commonly analyzed infectious diseases where cancer and asthma are the most frequently analyzed non-infectious diseases. Across categories, articles from North America predominate, and in the category of spatial analysis of diseases an equal number of studies concern Asia.

CONCLUSION

Spatial analysis of diseases and health service planning are well-established research areas. The development of future technologies and new application areas for GIS and data-gathering technologies such as GPS, smartphones, remote sensing etc. will be nudging the research in GIS and health.

Compliance potential mapping: a tool to assess potential contributions of walking towards physical activity guidelines

BACKGROUND

Walking for transport is increasingly considered an important component for meeting physical activity guidelines. This is true for individuals of all ages, and particularly important for seniors, for whom other physical activities may not be recommended. In order to evaluate the potential contributions of walking to physical activity, in this paper the concept of Compliance Potential Mapping is introduced. The concept is illustrated using seniors as a case study.

METHODS

Based on estimates of walking trip distance and frequency, estimates of expected total daily walking distance are obtained. These estimates are converted to weekly walking minutes, which are in turn compared to recommended physical activity guidelines for seniors. Once estimates of travel behavior are available, the approach is straightforward and based on relatively simple map algebra operations.

RESULTS

Compliance Potential Mapping as a tool to assess the potential contributions of walking towards physical activity is demonstrated using data from Montreal's 2008 travel survey. The results indicate that the central parts of Montreal Island display higher potential for compliance with physical activity guidelines, but with variations according to age, income, occupation, possession of driver's license and vehicle, and neighborhood and accessibility parameters.

CONCLUSIONS

Compliance Potential Maps offer valuable information for public health and transportation planning and policy analysis.

Emerging technologies for assessing physical activity behaviors in space and time

Precise measurement of physical activity is important for health research, providing a better understanding of activity location, type, duration, and intensity. This article describes a novel suite of tools to measure and analyze physical activity behaviors in spatial epidemiology research. We use individual-level, high-resolution, objective data collected in a space-time framework to investigate built and social environment influences on activity. First, we collect data with accelerometers, global positioning system units, and smartphone-based digital travel and photo diaries to overcome many limitations inherent in self-reported data. Behaviors are measured continuously over the full spectrum of environmental exposures in daily life, instead of focusing exclusively on the home neighborhood. Second, data streams are integrated using common timestamps into a single data structure, the "LifeLog." A graphic interface tool, "LifeLog View," enables simultaneous visualization of all LifeLog data streams. Finally, we use geographic information system SmartMap rasters to measure spatially continuous environmental variables to capture exposures at the same spatial and temporal scale as in the LifeLog. These technologies enable precise measurement of behaviors in their spatial and temporal settings but also generate very large datasets; we discuss current limitations and promising methods for processing and analyzing such large datasets. Finally, we provide applications of these methods in spatially oriented research, including a natural experiment to evaluate the effects of new transportation infrastructure on activity levels, and a study of neighborhood environmental effects on activity using twins as quasi-causal controls to overcome self-selection and reverse causation problems. In summary, the integrative characteristics of large datasets contained in LifeLogs and SmartMaps hold great promise for advancing spatial epidemiologic research to promote healthy behaviors.

Understanding the relationship between dog ownership and children's physical activity and sedentary behaviour

BACKGROUND

Dog ownership is a catalyst for physical activity in adults. Given 50-70% of Australian households with children have a dog, dog-facilitated physical activity may be an effective way to increase physical activity and decrease child obesity.

OBJECTIVE

We hypothesized that children with a family dog walk more, are more physically active and are more likely to achieve recommended levels of weekly physical activity compared with children who do not have a dog.

METHOD

Cross-sectional data from the Western Australian TRravel, Environment, and Kids project (TREK) were analyzed for 1218 children aged 10-12 years. Individual and environment factors, child physical activity, walking, screen use, sedentary behaviour and dog ownership status was collected from child and parent questionnaires. Children's height and weight were measured.

RESULTS

Approximately 60% of children had a family dog. Dog ownership was associated with, on average, 29 more minutes of walking and 142 more minutes of physical activity per week (P ≤ 0.01). After adjustment, children with a dog were 49% more likely to achieve the recommended level of weekly physical activity (420 min) and 32% more likely to have walked in their neighbourhood in the last week, compared with non-dog owners (P ≤ 0.05). These relationships varied by gender. Dog ownership was not associated with screen use or weight status.

CONCLUSIONS

Dog ownership was associated with walking and physical activity, but not screen use or weight status. Within dog-owning families, the promotion of walking and active play with a dog may be a strategy to increase children's physical activity.

Testing the results of municipal mixed-use zoning ordinances: a novel methodological approach

Municipal mixed-use zoning (MUZ) is one public health strategy to create more walkable neighborhoods by reducing the separation of daily activities. This study uses a novel data-gathering methodology to evaluate municipal zoning ordinances in twenty-two California cities in conjunction with the walkability potential of resulting mixed-use zones, to explore the extent to which variations in uses mandated by MUZ ordinances are correlated with variations in walking opportunities. We find that, after controlling for population, socioeconomic status, and zone size, significant relationships exist between the range and precision of uses mandated by MUZ ordinances and the mixture and breadth of walking destinations in these zones. The study also demonstrates that analysis of municipal zoning codes and a novel data-gathering methodology yield valid data. The analysis of MUZ ordinances is a significant complement to other approaches to measuring walkability and can be used across cities.

Does neighborhood walkability moderate the effects of intrapersonal characteristics on amount of walking in post-menopausal women?

This study identifies factors associated with walking among postmenopausal women and tests whether neighborhood walkability moderates the influence of intrapersonal factors on walking. We used data from the Women's Health Initiative Seattle Center and linear regression models to estimate associations and interactions. Being white and healthy, having a high school education or beyond and greater non-walking exercise were significantly associated with more walking. Neighborhood walkability was not independently associated with greater walking, nor did it moderate influence of intrapersonal factors on walking. Specifying types of walking (e.g., for transportation) can elucidate the relationships among intrapersonal factors, the built environment, and walking.

Barriers, facilitators and preferences for the physical activity of school children. Rationale and methods of a mixed study

Background

Physical activity interventions in schools environment seem to have shown some effectiveness in the control of the current obesity epidemic in children. However the complexity of behaviors and the diversity of influences related to this problem suggest that we urgently need new lines of insight about how to support comprehensive population strategies of intervention. The aim of this study was to know the perceptions of the children from Cuenca, about their environmental barriers, facilitators and preferences for physical activity.

Methods/Design

We used a mixed-method design by combining two qualitative methods (analysis of individual drawings and focus groups) together with the quantitative measurement of physical activity through accelerometers, in a theoretical sample of 121 children aged 9 and 11 years of schools in the province of Cuenca, Spain.

Conclusions

Mixed-method study is an appropriate strategy to know the perceptions of children about barriers and facilitators for physical activity, using both qualitative methods for a deeply understanding of their points of view, and quantitative methods for triangulate the discourse of participants with empirical data. We consider that this is an innovative approach that could provide knowledges for the development of more effective interventions to prevent childhood overweight.

Examining aspects of the built environment: an evaluation of a community walking map project

OBJECTIVE

Interventions that address the built environment present an opportunity to affect behaviours such as physical activity. The purpose of this study was to evaluate a community walking map developed for eight neighbourhoods in the City of Edmonton (COE).

METHOD

A walking map developed in partnership with the COE's Walkable Initiative was distributed to 11,994 households across eight neighbourhoods in July 2010. In total, 149 respondents completed an online follow-up survey that assessed the effectiveness of the walking maps in influencing physical activity.

RESULTS

Of the 149 respondents, 89 (59.7%) reported that they had received a copy of the map, and 60 (40.2%) reported that they had not. Of those who had a copy, 76.4% (n=68) indicated that the routes and destinations on the map encouraged them to walk more in the community, 64.0% (n=57) stated they would walk more often to get to destinations, and 55.1% (n=49) indicated they would walk more often for physical activity or exercise as a result of having a copy of the map. Finally, 91.0% (n=81) stated that they found the map to be useful, as it provided walking routes (60/81, 74.1%,) and places to go in the community (57/81, 70.4%). Of those who did not receive a copy, 95.0% (n=57) indicated that they would use a community walking map.

CONCLUSION

This evaluation demonstrated that a community walking map was a valuable tool for not only encouraging walking for physical activity but also motivating individuals to explore their communities and visit local community destinations.

Mixed land use and obesity: an empirical comparison of alternative land use measures and geographic scales

Obesity is a growing epidemic in the United States. Walkable neighborhoods, characterized as having the 3Ds of walkability (population Density, land use Diversity, and pedestrian-friendly Design), have been identified as a potentially promising factor to prevent obesity for their residents. Past studies examining the relationship between obesity and walkability vary in geographic scales of neighborhood definitions and methods of measuring the 3Ds. To better understand potential influences of these sometimes arbitrary choices, we test how four types of alternative measures of land use diversity measured at three geographic scales relate to body mass index for 4960 Salt Lake County adults. Generalized estimation equation models demonstrate that optimal diversity measures differed by gender and geographic scale and that integrating walkability measures at different scales improved the overall performance of models.

Home versus nonhome neighborhood: quantifying differences in exposure to the built environment

BACKGROUND

Built environment and health research have focused on characteristics of home neighborhoods, whereas overall environmental exposures occur over larger spatial ranges.

PURPOSE

Differences in built environment characteristics were analyzed for home and nonhome locations using GPS data.

METHODS

GPS data collected in 2007-2008 were analyzed for 41 subjects in the Seattle area in 2010. Environmental characteristics for 3.8 million locations were measured using novel GIS data sets called SmartMaps, representing spatially continuous values of local built environment variables in the domains of neighborhood composition, utilitarian destinations, transportation infrastructure, and traffic conditions. Using bootstrap sampling, CIs were estimated for differences in built environment values for home (<833 m of home address) and nonhome (>1666 m) GPS locations.

RESULTS

Home and nonhome built environment values were significantly different for more than 90% of variables across subjects (p<0.001). Only 51% of subjects had higher counts of supermarkets near than away from home. Different measures of neighborhood parks yielded varying results.

CONCLUSIONS

SmartMaps helped measure local built environment characteristics for a large set of GPS locations. Most subjects had significantly different home and nonhome built environment exposures. Considering the full range of individuals' environmental exposures may improve understanding of effects of the built environment on behavior and health outcomes.