Women's Perceptions of Neighborhood Resources and Hazards Related to Diet, Physical Activity, and Smoking: Focus Group Results from Economically Distinct Neighborhoods in a Mid-Sized U.S. City

Neighborhood Walking and Social Connectedness

Neighborhood social ties matter crucially, especially during stressful life events like a global pandemic, for they represent vital sources of wellbeing and community capacity. Activities that enable community members to engage in incidental sociability and acts of “neighboring”—that is, authentic social interactions with their neighbors—warrant attention from sport and active living researchers because of their potential to bolster the social fabric of our neighborhoods and facilitate neighbors' access to important resources, such as information, material resources, and social support. Though perhaps dismissed as trivial, neighborhood walking represents a valuable and underappreciated everyday activity that fits this description, especially in an age characterized by an epidemic of social isolation and loneliness. Despite its vast potential to address the quasi-anonymity of urban life, neighborhood walking remains surprisingly underexamined as a facilitator for fostering social connectedness, the sense of connection and social bond people feel toward others. The goal of this manuscript, therefore, is to establish the conceptual grounding for how neighborhood walking strengthens social ties among neighbors to facilitate access to important coping resources. In doing so, it aims to advance a research agenda on walking that moves beyond the benefits of physical activity.

Using Social Media Mining and PLS-SEM to Examine the Causal Relationship between Public Environmental Concerns and Adaptation Strategies

With growing scientific evidence showing the harmful impact of air pollution on the environment and individuals’ health in modern societies, public concern about air pollution has become a central focus of the development of air pollution prevention policy. Past research has shown that social media is a useful tool for collecting data about public opinion and conducting analysis of air pollution. In contrast to statistical sampling based on survey approaches, data retrieved from social media can provide direct information about behavior and capture long-term data being generated by the public. However, there is a lack of studies on how to mine social media to gain valuable insights into the public’s pro-environmental behavior. Therefore, research is needed to integrate information retrieved from social media sites into an established theoretical framework on environmental behaviors. Thus, the aim of this paper is to construct a theoretical model by integrating social media mining into a value-belief-norm model of public concerns about air pollution. We propose a hybrid method that integrates text mining, topic modeling, hierarchical cluster analysis, and partial least squares structural equation modelling (PLS-SEM). We retrieved data regarding public concerns about air pollution from social media sites. We classified the topics using hierarchical cluster analysis and interpreted the results in terms of the value-belief-norm theoretical framework, which encompasses egoistic concerns, altruistic concerns, biospheric concerns, and adaptation strategies regarding air pollution. Then, we used PLS-SEM to confirm the causal relationships and the effects of mediation. An empirical study based on the concerns of Taiwanese social media users about air pollution was used to demonstrate the feasibility of the proposed framework in general and to examine gender differences in particular. Based on the results of the empirical studies, we confirmed the robust effects of egoistic, altruistic, and biospheric concerns of public impact on adaptation strategies. Additionally, we found that gender differences can moderate the causal relationship between egoistic concerns, altruistic concerns, and adaptation strategies. These results demonstrate the effectiveness of enhancing perceptions of air pollution and environmental sustainability by the public. The results of the analysis can serve as a basis for environmental policy and environmental education strategies.

Gender Differences in Physical Activity Associated with Urban Neighborhood Parks: Findings from the National Study of Neighborhood Parks

INTRODUCTION

Urban neighborhood parks are designed to provide easy access to recreation and physical activity. We analyzed data from the first National Study of Neighborhood Parks, which assessed the characteristics and use of a representative sample of U.S. urban neighborhood parks. This article compares factors associated with active commuting (e.g., walking) to parks among men and women and park characteristics associated with observed moderate-to-vigorous physical activity (MVPA) within neighborhood parks.

METHODS

We used systematic direct observation to quantify parks visitors of all ages in 162 U.S. neighborhood parks in 25 cities in 2016 and surveyed a sample of adult visitors (877 women and 793 men). We used descriptive statistics to identify park facilities, amenities, and park management practices associated with park use. We also conducted multivariate regressions to identify factors most closely associated with observed park-based MVPA among all age groups and with self-reported levels of active commuting to parks among adults.

RESULTS

Reasons to visit parks varied by gender, with women more likely than men to bring children (59% vs 42% for men; p < .001), and men more likely than women to go to parks to relax (38% vs 29%; p = .01). Bringing children to parks was associated with more motorized transport among women, but not among men. Active commuting to parks was associated with living closer to parks (β = -0.92; p < .0001), a greater frequency of park use (β = 0.99; p < .0001), and the park having a working drinking fountain (β = 0.62; p = .01), with no significant differences between men and women. Men and boys used park facilities very differently than women and girls. Men and boys engaged in the most MVPA in soccer fields, gyms, and skate parks, whereas for women and girls the top three sites were pools, playgrounds, and walking paths.

CONCLUSIONS

Significant gender differences in why men and women visit parks and how parks are used likely reflect cultural determinants of gender roles. Our findings suggest that park management practices should be adjusted to mitigate the lower use of parks and lower levels of park-based MVPA among women and girls compared with men and boys.

Physical Activity among Adults with Low Socioeconomic Status Living in Industrialized Countries: A Meta-Ethnographic Approach to Understanding Socioecological Complexities

Method

Using MeSH keywords, we searched major electronic databases including Medline, EMBASE, CINAHL, and PsycINFO in order to identify relevant publications published between January 2000 and October 2018. We included 19 qualitative studies which met inclusion criteria and were focused on physical activity determinants among adults.

Results

Determinants emerging from these studies were grouped into six themes: (i) urban environment, (ii) financial constraints, (iii) work-life integration, (iv) community engagement, (v) social support, and (vi) psychosocial factors. After conceptualising these six themes into a social ecological model, we identified potential research gaps for physical activity among adults with low socioeconomic status living in industrialized countries.

Conclusion

Our major insight was that, in industrialized countries, physical activity overlooks potential strengths to maintain health and well-being of those people with low socioeconomic status. A more complex understanding of contradictions between positive and deficit frames would lead to more critical insights of research gaps of physical activity in adult population with low socioeconomic status.

Park Use and Park-Based Physical Activity in Low-Income Neighborhoods

Routine physical activity is important for everyone, and most urban areas have an infrastructure of neighborhood parks that are intended to serve as a setting for recreation and leisure. However, parks are not used proportionally by all age groups, genders, and socioeconomic groups. This paper explores factors associated with park use by different age and gender groups in low-income neighborhoods in Los Angeles, CA. We found that women's visits to parks generally centered around children, whereas men's visits were more likely to be associated with their own physical activity. Barriers for seniors are associated with limited facilities and programming that meet their needs. Park managers should consider park renovations that include social meeting places, comfortable sitting areas, and walking paths to better serve women and seniors.

A Mixed Methods Study on the Barriers and Facilitators of Physical Activity Associated with Residential Relocation

Despite evidence suggesting that neighbourhood characteristics are associated with physical activity, very few mixed methods studies investigate how relocating neighbourhood, and subsequent changes in the built environment, influences physical activity. This sequential mixed methods study estimates associations between changes in overall physical activity and transportation walking and cycling and changes in objectively assessed neighbourhood walkability (quantitative phase) and describes perceived barriers and facilitators to physical activity following residential relocation (qualitative phase). During the quantitative phase, self-reported changes in transportation walking, transportation cycling, and overall physical activity following residential relocation were measured using a 5-point scale: (1) a lot less now, (2) a little less now, (3) about the same, (4) a little more now, and (5) a lot more now. Walkability improvers reported a slight increase in transportation walking (mean = 3.29, standard deviation (SD) = 0.87), while walkability decliners reported little or no perceived change in their transportation walking after relocation (mean = 2.96, SD = 1.12). This difference approached statistical significance (p=0.053). Furthermore, walkability decliners reported a slight decrease in transportation cycling (mean = 2.69, SD = 0.96), while walkability improvers reported little or no perceived change in their transportation cycling after relocation (mean = 3.02, SD = 0.84). This difference was statistically significant (p < 0.05). Change in walkability resulting from relocation was not significantly associated with perceived change in overall physical activity. Our qualitative findings suggest that moving to a neighbourhood with safe paths connecting to nearby destinations can facilitate transportation walking and cycling. Some participants describe adjusting their leisure physical activity to compensate for changes in transportation walking and cycling. Strong contributors to neighbourhood leisure physical activity included the presence of aesthetic features and availability of recreational opportunities that allow for the creation of social connections with community and family.

Neighbourhood Built Environment Influences on Physical Activity among Adults: A Systematized Review of Qualitative Evidence

Qualitative studies can provide important information about how and why the built environment impacts physical activity decision-making—information that is important for informing local urban policies. We undertook a systematized literature review to synthesize findings from qualitative studies exploring how the built environment influences physical activity in adults. Our review included 36 peer-reviewed qualitative studies published from 1998 onwards. Our findings complemented existing quantitative evidence and provided additional insight into how functional, aesthetic, destination, and safety built characteristics influence physical activity decision-making. Sociodemographic characteristics (age, sex, ethnicity, and socioeconomic status) also impacted the BE’s influence on physical activity. Our review findings reinforce the need for synergy between transportation planning, urban design, landscape architecture, road engineering, parks and recreation, bylaw enforcement, and public health to be involved in creating neighbourhood environments that support physical activity. Our findings support a need for local neighbourhood citizens and associations with representation from individuals and groups with different sociodemographic backgrounds to have input into neighbourhood environment planning process.

"It makes us really look inferior to outsiders": Coping with psychosocial experiences associated with the lack of access to safe water and sanitation

OBJECTIVE

This paper explores daily experiences and coping resources related to the lack of access to safe water and adequate sanitation in Usoma, a lakeshore community in Western Kenya.

METHODS

A qualitative approach that involved 10 focus group discussions and 9 key informant interviews with community leaders, volunteers and professionals was used to explore the research objectives. Data were collected from June to August 2013.

RESULTS

Daily practices and experiences around water and sanitation, such as water collection, open defecation and shared toilets, were a major concern to residents. In the absence of safe water, residents used social networks and support, financial resources and the nearby Lake Victoria as coping resources.

CONCLUSION AND IMPLICATION FOR PRACTICE

Findings from this study are important for mobilizing resources in vulnerable settings as a first step towards designing community-based interventions. For public health practice, practitioners must work with - and collaborate across - sectors to enhance and strengthen social networks and cohesion, and protect the natural environment while working toward addressing water-related challenges in deprived settings.

Difficulty and independence in shopping among older Americans: more than just leaving the house

BACKGROUND

The built, social and economic environments are associated with disability, but knowledge of how these environmental characteristics simultaneously influence older adults' ability to shop independently is limited.

OBJECTIVE

We investigated cross-sectional associations between the outdoor home, local neighborhood and macrosocioeconomic levels of the environment and shopping difficulty and interactions between environmental factors and shopping difficulty.

METHODS

Using nationally representative data from a study of Medicare-eligible adults, we conducted a cross-sectional secondary data analysis to examine associations between the environment and difficulty shopping (N = 5504).

RESULTS

Sidewalk conditions, broken steps, neighborhood social cohesion and neighborhood socioeconomic disadvantage were associated with more difficulty shopping, although health factors partially accounted for associations between broken steps and disadvantage and shopping difficulty. The association between social cohesion and shopping difficulty also depended on the degree of socioeconomic disadvantage in the neighborhood.

CONCLUSIONS

Overall, results suggest that factors in the outdoor and local neighborhood environment influence the ability to shop independently for older adults, but that it also may depend on the socioeconomic context of the neighborhood. Interventions aimed at improving the built environment directly outside of older adults' homes and helping increase social cohesion among neighbors, has the potential to reduce difficulty in carrying out this important activity. Implications for rehabilitation Built features of the outdoor home environment including sidewalks and broken steps influence whether older adults are able to safely leave their home to conduct daily activities such as shopping, so it is important that clinicians and rehabilitation professionals are aware of these challenges when helping their patients resume daily activities such as shopping. The physical condition and safety of the immediate outdoor home and neighborhood environment is critical for maintaining independence and well-being for older adults, which is critical for physical rehabilitation as well as maintenance of essential activities such as shopping. Living in more socially cohesive neighborhoods may aid in physical rehabilitation efforts by helping older adults feel more comfortable and able to shop independently in neighborhoods with social and economic disadvantages.

Uncovering How Urban Regeneration Programs May Stimulate Leisure-time Walking Among Adults in Deprived Areas: A Realist Review

Evidence suggests that urban regeneration programs can stimulate leisure-time walking (LTW) in deprived areas. However, underlying pathways remain unclear. This study explored how urban regeneration might stimulate LTW among adults in deprived areas. We conducted a realist review, a theory-driven approach to evidence synthesis that focuses on mechanisms. We searched three electronic databases for peer-reviewed literature that describes how the neighborhood environment or urban regeneration influences LTW among adults in deprived areas. Evidence from 13 qualitative studies was synthesized. All studies indicated that safety problems and poor physical neighborhood design make adults fearful of walking. Seven studies indicated that poor aesthetics makes walking less relaxing and stress releasing. Seven studies indicated that poor infrastructure makes it inconvenient for adults to walk. A limited number of studies indicated that a lack of LTW facilities creates a shortage of settings for walking and that low levels of social capital constrain social support for walking and social interaction while walking. Evidence from this study suggests that urban regeneration might stimulate LTW among adults in deprived areas by creating a neighborhood that is less frightening, more relaxing, and more convenient to walk in.

Exploring the influence of local food environments on food behaviours: a systematic review of qualitative literature

Objective

Systematic reviews investigating associations between objective measures of the food environment and dietary behaviours or health outcomes have not established a consistent evidence base. The present paper aims to synthesise qualitative evidence regarding the influence of local food environments on food and purchasing behaviours.

Design

A systematic review in the form of a qualitative thematic synthesis.

Setting

Urban localities.

Subjects

Adults.

Results

Four analytic themes were identified from the review including community and consumer nutrition environments, other environmental factors and individual coping strategies for shopping and purchasing decisions. Availability, accessibility and affordability were consistently identified as key determinants of store choice and purchasing behaviours that often result in less healthy food choices within community nutrition environments. Food availability, quality and food store characteristics within consumer nutrition environments also greatly influenced in-store purchases. Individuals used a range of coping strategies in both the community and consumer nutrition environments to make optimal purchasing decisions, often within the context of financial constraints.

Conclusions

Findings from the current review add depth and scope to quantitative literature and can guide ongoing theory, interventions and policy development in food environment research. There is a need to investigate contextual influences within food environments as well as individual and household socio-economic characteristics that contribute to the differing use of and views towards local food environments. Greater emphasis on how individual and environmental factors interact in the food environment field will be key to developing stronger understanding of how environments can support and promote healthier food choices.

Geospatial Approaches to Cancer Control and Population Sciences

Cancer incidence and mortality display strong geographic patterns worldwide and in the United States (1, 2). The environment where individuals live, work, and play is increasingly being recognized as important across the cancer control continuum, including the risk of cancer development, detection, diagnosis, treatment, mortality, and survivorship (3-5). At the same time, emergent technological capacity in geographic information systems (GIS) and mapping, along with increasing sophistication in applied spatial methods, has resulted in a growing research community developing and applying geospatial approaches in health research (5). Through collaborative, transdisciplinary efforts, and continued data collection efforts, there is great potential to apply these emerging geospatial approaches to various aspects of cancer prevention and control to inform etiology and target interventions and implementation of efficacious risk-reducing strategies. Cancer Epidemiol Biomarkers Prev; 26(4); 472-5. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."

Contribution of the neighborhood environment and obesity to breast cancer survival: the California Breast Cancer Survivorship Consortium

Little is known about neighborhood attributes that may influence opportunities for healthy eating and physical activity in relation to breast cancer mortality. We used data from the California Breast Cancer Survivorship Consortium and the California Neighborhoods Data System (CNDS) to examine the neighborhood environment, body mass index, and mortality after breast cancer. We studied 8,995 African American, Asian American, Latina, and non-Latina white women with breast cancer. Residential addresses were linked to the CNDS to characterize neighborhoods. We used multinomial logistic regression to evaluate the associations between neighborhood factors and obesity and Cox proportional hazards regression to examine associations between neighborhood factors and mortality. For Latinas, obesity was associated with more neighborhood crowding [quartile 4 (Q4) vs. Q1: OR, 3.24; 95% confidence interval (CI), 1.50-7.00]; breast cancer-specific mortality was inversely associated with neighborhood businesses (Q4 vs. Q1: HR, 0.46; 95% CI, 0.25-0.85) and positively associated with multifamily housing (Q3 vs. Q1: HR, 1.98; 95% CI, 1.20-3.26). For non-Latina whites, lower neighborhood socioeconomic status (SES) was associated with obesity [quintile 1 (Q1) vs. Q5: OR, 2.52; 95% CI, 1.31-4.84], breast cancer-specific (Q1 vs. Q5: HR, 2.75; 95% CI, 1.47-5.12), and all-cause (Q1 vs. Q5: HR, 1.75; 95% CI, 1.17-2.62) mortality. For Asian Americans, no associations were seen. For African Americans, lower neighborhood SES was associated with lower mortality in a nonlinear fashion. Attributes of the neighborhood environment were associated with obesity and mortality following breast cancer diagnosis, but these associations differed across racial/ethnic groups.

The impact of neighborhood social and built environment factors across the cancer continuum: Current research, methodological considerations, and future directions

Neighborhood social and built environments have been recognized as important contexts in which health is shaped. The authors reviewed the extent to which these neighborhood factors have been addressed in population-level cancer research by scanning the literature for research focused on specific social and/or built environment characteristics and their association with outcomes across the cancer continuum, including incidence, diagnosis, treatment, survivorship, and survival. The commonalities and differences in methodologies across studies, the current challenges in research methodology, and future directions in this research also were addressed. The assessment of social and built environment factors in relation to cancer is a relatively new field, with 82% of the 34 reviewed articles published since 2010. Across the wide range of social and built environment exposures and cancer outcomes considered by the studies, numerous associations were reported. However, the directions and magnitudes of associations varied, in large part because of the variation in cancer sites and outcomes studied, but also likely because of differences in study populations, geographic regions, and, importantly, choice of neighborhood measures and geographic scales. The authors recommend that future studies consider the life-course implications of cancer incidence and survival, integrate secondary and self-report data, consider work neighborhood environments, and further develop analytical and statistical approaches appropriate to the geospatial and multilevel nature of the data. Incorporating social and built environment factors into research on cancer etiology and outcomes can provide insights into disease processes, identify vulnerable populations, and generate results with translational impact of relevance for interventionists and policy makers.

What shape is your neighbourhood? Investigating the micro geographies of physical activity

Being physically active has demonstrated health benefits, and more walkable neighbourhoods can potentially increase physical activity. Yet not all neighbourhoods provide opportunities for active lifestyles. This paper examines the social context of being active in local and non-local places. We use a social practice theoretical framework to examine how residents talk about and make sense of physical activity and places, contrasting individual and neighbourhood factors. In 2010, fourteen focus groups were held in four neighbourhoods varying by walkability and area-level deprivation (two Auckland and two Wellington, New Zealand), and with participants grouped by gender, ethnicity, and employment. Focus groups elicited discussion on where local residents go for physical activity, and the opportunities and barriers to physical activity in their local area and beyond. Thematic analyses compared across all groups for contrasts and similarities in the issues discussed. Neighbourhood walkability factors appeared to shape where residents engage with public places, with residents seeking out good places. Individual factors (e.g. employment status) also influenced how residents engage with their local neighbourhoods. All groups referred to being active in places both close by and further afield, but residents in less walkable neighbourhoods with fewer local destinations drew attention to the need to go elsewhere, notably for exercise, being social, and to be in pleasant, restorative environments. Being physically active in public settings was valued for social connection and mental restoration, over and above specifically 'health' reasons. Residents talk about being active in local and non-local places revealed agency in how they managed the limitations and opportunities within their immediate residential setting. That is, factors of place and people contributed to the 'shape' of everyday residential environments, at least with regard to physical activity.

A Qualitative Exploration of Factors Associated With Walking and Physical Activity in Community-Dwelling Older Latino Adults

BACKGROUND

Ethnic/racial minorities often live in neighborhoods that are not conducive to physical activity (PA) participation. We examined perceived factors related to walking/PA among Spanish- and English-speaking older Latinos in a low-income, multi-ethnic neighborhood.

METHOD

Exploratory focus group study was conducted with Latinos stratified by preferred language and gender: English-speaking women (n = 7, M age = 74.6); English-speaking men (n = 3, M age = 69.3); Spanish-speaking women (n = 5, M age = 66.4); Spanish-speaking men (n = 5, M age = 74.0). Focus group audio files were transcribed, and qualitative research software was used to code and analyze documents.

RESULTS

At the individual level, reasons for exercising (improved health) and positive health outcome expectancies (weight loss and decreased knee pain) were discussed. Neighborhood/environmental factors of safety (fear of crime), neighborhood changes (lack of jobs and decreased social networks), weather, and destination walking were discussed.

DISCUSSION

Individual and environmental factors influence PA of older, urban Latinos, and should be taken into consideration in health promotion efforts.

Qualitative environmental health research: an analysis of the literature, 1991-2008

Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. In this analysis, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. A primary search for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. This analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.

"Food is directed to the area": African Americans' perceptions of the neighborhood nutrition environment in Pittsburgh

Studies have shown racial disparities in neighborhood access to healthy food in the United States. We used a mixed methods approach employing geographic information systems, focus groups, and a survey to examine African Americans' perceptions of the neighborhood nutrition environment in Pittsburgh. We found that African Americans perceive that supermarkets serving their community offer produce and meats of poorer quality than branches of the same supermarket serving White neighborhoods (p<0.001). Unofficial taxis or jitneys, on which many African Americans are reliant, provide access from only certain stores; people are therefore forced to patronize these stores even though they are perceived to be of poorer quality. Community-generated ideas to tackle the situation include ongoing monitoring of supermarkets serving the Black community. We conclude that stores should make every effort to be responsive to the perceptions and needs of their clients and provide an environment that enables healthy eating.

Qualitative environmental health research: an analysis of the literature, 1991-2008

BACKGROUND

Recent articles have advocated for the use of qualitative methods in environmental health research. Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena.

OBJECTIVE

In this analysis of the literature, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health.

DATA SOURCES

A primary search on ISI Web of Knowledge/Web of Science for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Inclusion and exclusion criteria are described.

DATA EXTRACTION

Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health.

DATA SYNTHESIS

Ninety-one articles met inclusion criteria. These articles were published in 58 different journals, with a maximum of eight for a single journal. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health, with most studies relying on one-on-one interviews. Details of the analyses were absent from a large number of studies. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures.

DISCUSSION AND CONCLUSIONS

Qualitative data are published in traditionally quantitative environmental health studies to a limited extent. However, this analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.

Characteristics of urban parks associated with park use and physical activity: a review of qualitative research

Given that recent literature reviews on physical activity in urban parks deliberately excluded qualitative findings, we reviewed qualitative research on this topic informed by a published classification scheme based on quantitative research. Twenty-one studies met our inclusion criteria. These studies relied mainly on semi-structured interviews with individuals or in focus groups; only five studies involved in situ observation. Our synthesis aligns with previous quantitative research showing that attributes including safety, aesthetics, amenities, maintenance, and proximity are important for encouraging park use. Furthermore, our synthesis of qualitative research suggests that perceptions of the social environment entwine inextricably with perceptions of the physical environment. If so, physical attributes of parks as well as perceptions of these attributes (formed in relation to broader social contexts) may influence physical activity patterns. Both qualitative and quantitative methods provide useful information for interpreting such patterns, and in particular, when designing and assessing interventions intended to improve the amount and intensity of physical activity.

Neighborhood environment in studies of health of older adults: a systematic review

CONTEXT

Epidemiologists and public health researchers are studying neighborhood's effect on individual health. The health of older adults may be more influenced by their neighborhoods as a result of decreased mobility. However, research on neighborhood's influence on older adults' health, specifically, is limited.

EVIDENCE ACQUISITION

Recent studies on neighborhood and health for older adults were identified. Studies were identified through searches of databases including PsycINFO, CINAHL, PubMed, Academic Search Premier, Ageline, Social Science Citation Index, and Health Source. Criteria for inclusion were as follows: human studies; English language; study sample included adults aged > or =55 years; health outcomes, including mental health, health behaviors, morbidity, and mortality; neighborhood as the primary exposure variable of interest; empirical research; and studies that included > or =10 neighborhoods. Air pollution studies were excluded. Five hundred thirty-eight relevant articles were published during 1997-2007; a total of 33 of these articles met inclusion criteria.

EVIDENCE SYNTHESIS

The measures of objective and perceived aspects of neighborhood were summarized. Neighborhood was primarily operationalized using census-defined boundaries. Measures of neighborhood were principally derived from objective sources of data; eight studies assessed perceived neighborhood alone or in combination with objective measures. Six categories of neighborhood characteristics were socioeconomic composition, racial composition, demographics, perceived resources and/or problems, physical environment, and social environment. The studies are primarily cross-sectional and use administrative data to characterize neighborhood.

CONCLUSIONS

These studies suggest that neighborhood environment is important for older adults' health and functioning.

Environments for healthy ageing: a critical review

Population health outcomes are shaped by complex interactions between individuals and the environments in which they live, work and play. Environments encompass streets and buildings (physical environment), attitudes, supports and relationships with others (social environment), as well as social and political systems and policies. The impact of environments on the physical, mental health and functioning of individuals has emerged as a growing body of research in population health and health disparities. Yet, the majority of studies in this area do not focus on older adults even though older adults are particularly susceptible to the characteristics of their local environments. In this paper we review the current state of the health literature on physical environments for healthy ageing, using the International Classification of Functioning Disability and Health as a framework. Collectively, the literature emphasizes the role of supportive, barrier-free environments particularly for older adults who are at greater risk for disability and poor health. As part of our review we identify conceptual as well as methodological limitations in the current literature, including (i) a theoretical and empirical neglect of the underlying mechanisms behind the person-environment relationship; (ii) a lack of studies using nationally representative samples; (iii) over-reliance on cross-sectional data; and (iv) a need for better definition and measurement of person-centered environments. We conclude by offering some suggestions and directions for future research in this area.

Targeting the taqueria: implementing healthy food options at Mexican American restaurants

As part of a 5-year community-based intervention in Salinas, California, the Steps to a Healthier Salinas team developed a taqueria intervention addressing obesity and diabetes among Mexican Americans. The authors present: (a) a comparison of service/entrée options for Salinas taquerias (n = 35) and fast-food restaurants ( n = 38) at baseline, (b) a case study of one taqueria, (c) a description of a healthy nutrition tool kit tailored to taquerias, and (d) an evaluation of the intervention at Year 3. It was found that traditional Mexican American-style menu offerings at taquerias tended to be healthier than American-style fast-food restaurant offerings. In addition, the initial response to the intervention has shown positive changes, which include the taqueria owners promoting available healthy menu items and modifying other menu offerings to reduce fats and increase fruit and vegetable availability. This, in turn, has led to a transition of the owners' perceptions of themselves as gatekeepers for a healthy community.

Community-based perceptions of neighborhood health in urban neighborhoods

This community-based study explored perceptions of neighborhood health and neighborhood health characteristics to inform a new urban health neighborhood outreach program utilizing nurse and community health worker teams. Neighborhood residents and representatives from community agencies described their perceptions of personal health and neighborhood health through questionnaires and focus groups called community conversations. Respondents were more likely to report themselves as healthy and less likely to report their neighborhoods as healthy. Community conversations' common themes included respect, partnerships and relationships. Results provide guidance for planners of urban neighborhood health initiatives.