Characteristics of the built environment in relation to objectively measured physical activity among Mexican adults, 2011

Changes in the Perceptions of the Neighborhood Environment and Physical Activity Patterns Among Mexican Americans on the Texas-Mexico Border

INTRODUCTION

Little research on the association of neighborhood environment with physical activity in resource-poor communities has been done. This study assessed changes in perceptions of the neighborhood environment and the association between those perceptions and physical activity in Mexican Americans on the Texas-Mexico border in an area where there would be community efforts to enhance pedestrian and cycling infrastructure and programming.

METHODS

We analyzed data from a population-based cohort of Mexican American individuals on the Texas-Mexico border. From 2008 to 2018, interviewer-administered questionnaires were used to collect perceptions of neighborhood environment and physical activity at baseline, 5- and 10-year follow-ups, and at other ancillary study visits, with an average of 3 data points per participant. We conducted multivariable longitudinal logistic regression analyses to assess if the changes in odds of positive perceptions of the neighborhood environment over the study years differed by physical activity patterns.

RESULTS

The sample (n = 1036) was mostly female (71%), born in Mexico (70%), and had no health insurance (69%). We saw improvements in the perceptions of several neighborhood environment attributes from 2008 to 2018, though we saw different longitudinal trajectories in these perceptions based on an individual's longitudinal physical activity patterns. By 2014-2018, we saw significantly higher positive perceptions of the neighborhood environment for those who consistently met physical activity guidelines compared with those who did not (adjusted rate ratio = 1.12, P = .049).

DISCUSSION

We found that perceptions of many neighborhood environment attributes improved between 2008 and 2018, and that overall positive perceptions were associated with consistently meeting physical activity guidelines over time.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Friendly Residential Environments That Generate Autonomy in Older Persons

OBJECTIVE

This study aimed to explore the housing and residential environment conditions associated with functional autonomy in older persons.

METHODS

A quantitative cross-sectional study was conducted, including 175 individuals over the age of 60. Participants were non-institutionalized urban residents of Medellín, Colombia, selected by random two-stage sampling (neighborhoods and blocks). Analysis was done according to functional autonomy of action (dependent variable); and demographic conditions, housing, and the physical and social environment suggested by the World Health Organization (WHO) in the strategy of age-friendly cities (independent variables). Univariate, bivariate, and multivariate analyses were performed with these variables, where the odds ratio (OR), association hypothesis test, and confidence intervals were estimated, using logistic regression models.

RESULTS

89.7% of older persons had moderate physical performance. The performance of intergenerational activities (OR = 5.28) and community actions (OR = 11.28) were part of social environments. The adaptations in public transport (OR = 90.33), sanitary services (OR = 4.1), and lighting in parks (OR = 19.9) of the physical environment were the associations found with functional autonomy.

CONCLUSIONS

Exploring how the physical and social environments surrounding housing are associated with the functional performance of older persons can generate useful information to support public health and city infrastructure strategies that improve their physical performance and maintain autonomy.

Objectively measuring the association between the built environment and physical activity: a systematic review and reporting framework

Background

Objective measures of built environment and physical activity provide the opportunity to directly compare their relationship across different populations and spatial contexts. This systematic review synthesises the current body of knowledge and knowledge gaps around the impact of objectively measured built environment metrics on physical activity levels in adults (≥ 18 years). Additionally, this review aims to address the need for improved quality of methodological reporting to evaluate studies and improve inter-study comparability though the creation of a reporting framework.

Methods

A systematic search of the literature was conducted following the PRISMA guidelines. After abstract and full-text screening, 94 studies were included in the final review. Results were synthesised using an association matrix to show overall association between built environment and physical activity variables. Finally, the new PERFORM (’Physical and Environmental Reporting Framework for Objectively Recorded Measures’) checklist was created and applied to the included studies rating them on their reporting quality across four key areas: study design and characteristics, built environment exposures, physical activity metrics, and the association between built environment and physical activity.

Results

Studies came from 21 countries and ranged from two days to six years in duration. Accelerometers and using geographic information system (GIS) to define the spatial extent of exposure around a pre-defined geocoded location were the most popular tools to capture physical activity and built environment respectively. Ethnicity and socio-economic status of participants were generally poorly reported. Moderate-to-vigorous physical activity (MVPA) was the most common metric of physical activity used followed by walking. Commonly investigated elements of the built environment included walkability, access to parks and green space. Areas where there was a strong body of evidence for a positive or negative association between the built environment and physical activity were identified. The new PERFORM checklist was devised and poorly reported areas identified, included poor reporting of built environment data sources and poor justification of method choice.

Conclusions

This systematic review highlights key gaps in studies objectively measuring the built environment and physical activity both in terms of the breadth and quality of reporting. Broadening the variety measures of the built environment and physical activity across different demographic groups and spatial areas will grow the body and quality of evidence around built environment effect on activity behaviour. Whilst following the PERFORM reporting guidance will ensure the high quality, reproducibility, and comparability of future research.

How different are objective operationalizations of walkability for older adults compared to the general population? A systematic review

Background

Walking is an essential activity for everyone and for older adults in particular, given that it is the most accessible form of physical activity and one of the healthiest transportation modes. Understanding how walkability (the potential of the environment to enable and/or encourage walking) has been objectively measured and analyzed for older adults is critical to create more inclusive, healthy, and sustainable environments and to promote healthy aging. Despite the numerous reviews on physical activity among older adults and its relationship with the built environment, the literature still lacks comparison reviews focusing specifically on objective operationalizations of walkability for older adults vs. the general population.

Methods

We conducted a systematic review of 146 empirical studies that measured walkability objectively in relation to walking-related outcomes. We compared studies focused on older adults (n = 24) and the general population (n = 122). Content analysis included the characteristics of the study design, walkability measures, spatial extent, and associations found between walkability and walking-related outcomes.

Results

In both groups of publications, the majority of studies were conducted in the US, Canada, and Europe, and largely in high-income countries. They were mostly published in health-related journals and used cross-sectional designs, operationalized walkability by using indexes, employed self-reported measures for walking-related outcomes, and found positive associations between walkability and walking outcomes. However, we observed some differences among studies focusing on older adults. Compared to studies focusing on the general population, a larger proportion of studies on older adults was conducted in the Middle East and Asia, and they used longitudinal designs, mixed methods to measure walking-related outcomes, variables related with land-use characteristics, safety from traffic and crime, and greenery, and a larger proportion found positive, as well as no associations between walkability and walking-related outcomes.

Conclusion

Although there is a promising increase in interest in older adults-focused walkability studies in the last decade, there is still a need for more studies focusing on different settings, using wider spatial extents, longitudinal designs, objective or mixed methods to collect outcome data, and specific variables and/or specially created indexes for older adults and for settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03233-x.

Development and Validation of the Mexican Public Open Spaces Tool (MexPOS)

Public open spaces (POS) are "publicly owned spaces such as parks, green areas, squares, marketplaces, streets and highways which are of public access". Some attributes could increase or decrease participants' attendance. Thus, reliable and valid audit tools are needed in order to measure these attributes. This study aimed to develop and validate a tool to assess POS features within the Mexico City context. The Mexican Public Open Spaces Tool (MexPOS) was developed based on (1) two validated POS audit tools, (2) several visits to the POS, (3) pilot testing, and (4) multiple work sessions with a group of specialists. The original tool included 181 items divided into nine sections. Trained personnel visited and evaluated 944 POS in Mexico City. An exploratory factor analysis was performed to examine the construct validity of the items and the relationship between the subscales. The final model resulted in seven factors: (1) Food and Wellness Environment (α = 0.15), (2) Maintenance (α = 0.81), (3) Amenities (α = 0.72), (4) Legibility (α = 0.59), (5) Security (α = 0.48), (6) Perceived Environment (α = 0.65), and (7) Urban Environment (α = 0.58). Our study highlights the relevance of using a validated tool to measure POS characteristics related to participants' attendance to help assess infrastructure improvements and identify priority areas for changing socio-urban environments for physical activity.

Determining thresholds for spatial urban design and transport features that support walking to create healthy and sustainable cities: findings from the IPEN Adult study

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km², 100 intersections per km², and 25 public transport stops per km² were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.

City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

How the Built Environment Promotes Residents' Physical Activity: The Importance of a Holistic People-Centered Perspective

Promoting adequate physical activity (PA) such as walking and cycling is essential to cope with the global health challenge of non-communicable diseases (NCDs). Much research has been conducted to analyze how the built environment can promote PA, but the results are not consistent. Some scholars found that certain built environments such as green spaces generated positive impacts on PA, while some other studies showed no correlations. We suspected that the built environment should be measured in a deeply holistic nuanced way in order to properly reflect its impact on PA. Therefore, our research adopted an integral urban-analysis comparing three typical neighborhoods in Beijing, China. Our data show that the highest PA occurs in the neighborhood with the lowest density, amount of green space and street connectivity, apparently compensated by its low-rise housing type and high appreciation of the quality of sidewalks and street safety. This indicates that dimensions impacting PA have to be considered in context, and the peoples’ perception of the built environment matters.

Mapping food and physical activity environments in low- and middle-income countries: A systematised review

This systematised literature review synthesised evidence on approaches to mapping food and physical activity (PA) environments in low- and middle-income countries (LMICs). Of the 60 articles included, 25 and 35 mapped food and PA environments respectively. All studies were cross-sectional with researcher-led data collection. Three types of mapping tools were identified - maps (n = 18), GPS (n = 10), and GIS (n = 37). Our findings point to a paucity of research mapping food and PA environments, overall and particularly subjective domains. We highlight a need for future studies that utilise innovative, inexpensive and participatory research methods to understand dynamic exposures to obesogenic environment features in resource-constrained contexts undergoing rapid urbanisation.

Perceived Urban Environment Attributes and Device-Measured Physical Activity in Latin America: An 8-Nation Study

INTRODUCTION

Attributes of the neighborhood-built environment are associated with self-reported physical activity, but only a few studies have concentrated on device-measured physical activity in Latin America. This study examines the associations of perceived neighborhood-built environment attributes, device-measured sedentary time, and light-intensity and moderate-to-vigorous physical activity in adults from 8 Latin American countries.

METHODS

Data from Estudio Latinoamericano de Nutrición y Salud adult study, an observational multicountry study (N=2,478), were analyzed in 2020. Data were collected between 2014 and 2015. Perceived neighborhood-built environment attributes were measured using the Neighbourhood Environment Walkability Survey. Sedentary time, light-intensity physical activity, and moderate-to-vigorous physical activity data were collected using accelerometers.

RESULTS

No associations between perceived neighborhood-built environment attributes and sedentary time were found. Positive perceptions of walking/cycling facilities (β=6.50, 95% CI=2.12, 10.39) were associated with more light-intensity physical activity. Perceptions of better aesthetics (Argentina) and better walking/cycling facilities (Brazil and Ecuador) were positively associated with light-intensity physical activity. Land use mix-diversity (β=0.14, 95% CI=0.03, 0.25), walking/cycling facilities (β=0.16, 95% CI=0.05, 0.27), aesthetics (β=0.16, 95% CI=0.02, 0.30), and safety from traffic (β=0.18, 95% CI=0.05, 0.24) were positively associated with moderate-to-vigorous physical activity. Land use mix-diversity, street connectivity, and safety from traffic were positively associated with moderate-to-vigorous physical activity in Venezuela.

CONCLUSIONS

These findings have implications for policy recommendations, which can guide policies to promote physical activity in the region. Land use mix-diversity, walking/cycling facilities, aesthetics, and safety from traffic can maintain or increase the levels of light-intensity and moderate-to-vigorous physical activity among Latin American adults.

Association between built environment and physical activity in Latin American countries: a multicentre cross-sectional study

OBJECTIVE

To assess the association between the physical activity level and the built environment by accessibility, microinfrastructure and security in Latin America (LA).

DESIGN

We conducted a multicentre cross-sectional study to collect physical activity and built environment data. The levels of physical activity were calculated through the International Physical Activity Questionnaire survey. Using the Neighbourhood Environment Walkability Scale-Abbreviated, characteristics of the built environment were measured through three domains: accessibility, microinfrastructure and security. To estimate the association of the built environment and physical activity, we used mixed effects logistic regression analysis. In addition, likelihood ratio test to account for clustered effect within countries and/or cities was used.

SETTING

Eight countries in LA.

PARTICIPANTS

Adults aged 15-65 years (n=9218) living in urban areas and consented to participate of the Latin American Study of Nutrition and Health.

RESULTS

Most of the population in LA had access to a grocery store (97.2%), public transport stop (91.5%) and children's playground (81.6%). Metropolitan parks were more accessible in Ecuador (59.8%) and Colombia (59.2%) than in Venezuela (33.5%). Individuals located within 20 min of walking from sport facilities or children's playground areas were more likely to perform moderate-to-high physical activity OR 1.20 (95% CI 1.06 to 1.36) and OR 1.25 (95% CI 1.02 to 1.53), respectively. Only 14.5% of the population from the region considered that their neighbourhood had an adequate design for walking or cycling. Likewise, among adults living in LA, only 39.75% had the perception of living in a safe neighbourhood.

CONCLUSIONS

This multicentre study shows that currently, LA built environment does not promote physical activity in the region. Our findings provide the rationale to push forward, at regional and national levels, policies and interventions that will help to achieve a safe, healthy and friendly built environment to encourage participation in active recreation and sports in leisure time.

TRIAL REGISTRATION NUMBER

NCT02226627.

Public spaces and physical activity in adults: insights from a mixed-methods study

Public spaces could promote health equity by providing a place for people to engage in physical activity. Whereas most studies show a positive association between public spaces and physical activity, there are still mixed results, especially in low- and middle-income countries. The objectives of this mixed-methods study were: (i) to assess the quantitative association between access to public spaces and physical activity; (ii) to assess the modification of the association by public spaces quality, area-level walkability, and social stratifiers; (iii) to explain the quantitative results using qualitative data. Quantitative data were obtained with a household survey in two arid-climate Mexican cities in 2017-2018. physical activity was measured with the Global Physical Activity Questionnaire. Access to public spaces was measured in buffers centered on survey blocks, walkability with area-level indicators, and public spaces quality with the Physical Activity Resources Assessment. Qualitative data were obtained with semi-structured interviews and neighborhood observation. No quantitative association between access to public spaces and physical activity was found, as well as no interactions between access to public spaces and other variables. Walkability was positively associated with physical activity. Qualitative analysis showed that local public spaces were rarely used by adults because they were perceived as small, unequipped, unattractive, and unsafe. The results shed light on the relationship between public spaces and physical activity, highlighting the improvements in design and upkeep of public spaces that are necessary to achieve their potential health benefit.

Time Distances to Residential Food Amenities and Daily Walking Duration: A Cross-Sectional Study in Two Low Tier Chinese Cities

Recent studies indicate the accepted concept of using land-use mix (LUM) to promote physical activity is ineffective and even counteractive in the Chinese context. Before considering LUM as a whole, different amenity types need to be respectively analyzed in relation to various functions and demands. This study aims to examine the specific associations between food-related amenities and perceived daily walking duration (WD) in small Chinese cities. Two interviewer-administered questionnaire surveys (n = 354) were conducted in Yuncheng and Suihua between 2017 and 2018. Logistic regression models were used to examine the associations of WD with seven different categories of food outlet at three levels of walking distance. The associations were further explored by food environment diversity and through two age groups. With the exception of café/tea house, the other six food outlets were positively associated with WD. After adjusting for socioeconomic variables, the associations of grocery store and supermarket weakened. Higher levels of food environment diversity were associated with a longer WD. Among the age groups, food outlets were more associated with older adults’ WD. This novel quantitative study suggests that increasing the number and heterogeneity of food-related amenities (including mobile street vendors) within a neighborhood can enhance physical activity in small Chinese cities.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study

Background

Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries.

Methods

This study examined data from 8185 adults (aged 18–65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix–diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data.

Results

Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA.

Conclusions

Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA.

Trial registration

ClinicalTrials. Gov NCT02226627. Retrospectively registered on August 27, 2014.

Association between Perceived Neighborhood Built Environment and Walking and Cycling for Transport among Inhabitants from Latin America: The ELANS Study

Purpose: This study aimed to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in inhabitants from Latin American countries. Methods: This cross-sectional study involved 9218 participants (15–65 years) from the Latin American Study of Nutrition and Health, which included a nationally representative sample of eight countries. All participants completed the International Physical Activity Questionnaire-Long Form for measure walking and cycling for transport and the Neighborhood Environment Walkability Scale-Abbreviated. Furthermore, perceived proximity from home to public open spaces and shopping centers was assessed. Results: Perceived land use mix-access (OR: 1.32; 95%CI: 1.16,1.50) and the existence of many alternative routes in the neighbourhood (1.09 1.01,1.17) were associated with higher odds of reporting any walking for transport (≥10 min/week). Perceived slow speed of traffic (1.88 1.82,1.93) and few drivers exceeding the speed limits (1.92; 1.86,1.98) were also related to higher odds of reporting any walking for transport. The odds of reporting any cycling for transport (≥10 min/week) were higher in participants perceiving more walking/cycling facilities (1.87 1.76,1.99), and better aesthetics (1.22 1.09,1.38). Conclusions: Dissimilar perceived neighborhood built environment characteristics were associated with walking and cycling for transport among inhabitants from Latin America.

Eye-Level Street Greenery and Walking Behaviors of Older Adults

Evidence suggests that built environment characteristics affect older adults' travel activity behaviors, e.g., walking and cycling, which have well-established health benefits. However, the relationship between urban greenery and walking behaviors remains unclear, partly due to methodological limitation. Previous studies often measured urban greenery from a bird's eye perspective, which may mismatch with the pedestrian's perception from the street. In this study, we measured greenery view index from eye-level streetscape photos retrieved from Baidu Street View, an online mapping service provider. Walking behaviors of 180 older adults in six neighborhoods were collected from questionnaires. We also measured land use diversity, pedestrian-oriented design (street connectivity), and population density-the three Ds of the built environment. Results show that street greenery view index contributes to walking time of older adults, suggesting street greenery should be taken into design consideration to promote walking behaviors of older adults.

Deciphering the stroke-built environment nexus in transitional cities: Conceptual framework, empirical evidence, and implications for proactive planning intervention

Adverse lifestyle-associated health outcomes, and stroke in particular, have been aggravated in transitional countries under high-speed urbanisation. Against this backdrop, deciphering the nexus between built environments (BEs) and lifestyle-associated health outcomes is of importance for crafting proactive interventions. The existing literature on this topic, however, fails to sufficiently capture the multiplicity of health-related BEs and, in turn, the complexity of such a nexus, largely challenging the applicability of established frameworks and the reliability of relevant findings. Looking at the case of stroke in Wuhan, China, this research aims to flesh out the understanding of the nexus between multidimensional BEs and lifestyle-associated health outcomes in transitional cities, with regards to conceptual framework and empirical evidence. To this end, we clarified stroke-related BE elements and integrated them into one conceptual framework. We then visualised stroke risk and examined its BE determinants using the Bayesian conditional autoregressive model. The visualisation results showed that stroke risks exhibited significant clustering in the high-density urban core. The statistical analysis found that, after the data were controlled for sociodemographic characteristics, net population density and building density were positively associated with stroke risk. In contrast, an abundance of public parks and institutional land use and access to medical care facilities have presented negative correlations with stroke risk, regardless of urban density. Our research reveals that compact urban developments might not be a silver bullet for health promotion in transitional cities, calling for an urgent need to scrutinise their applicability. To offset the adverse effects of increasingly dense urban environments, more efforts should also be made to provide better access to the identified salubrious resources. Furthermore, we argue that the establishment of comprehensive conceptual frameworks that connect BEs and lifestyle-associated health outcomes deserves to be highlighted in further research, planning intervention schemes, and health impact assessment projects.

The Association of Built Environment and Physical Activity in Older Adults: Using a Citywide Public Housing Scheme to Reduce Residential Self-Selection Bias

Previous studies have documented numerous health benefits of conducting regular physical activity among older adults. The built environment is believed to be a key factor that can hinder or facilitate daily physical activity, such as walking and exercising. However, most empirical studies focusing on environment-physical activity associations exhibited residential self-selection bias with cross-sectional research design, engendering doubts about the impact of built environment on physical activity. To reduce this bias, we assessed physical activity behaviors of 720 Hong Kong older adults (≥65 years) residing in 24 public housing estates. The Hong Kong public housing scheme currently provides affordable rental flats for 2.1 million people or approximate 30% of total population. The applicants were allocated to one of 179 housing estates largely by family size and flat availability. Built environment characteristics were measured following the ‘5Ds’ principle: (street network) design, (land-use) diversity, density, distance to transit, and destination accessibility. Multilevel mixed models were used to explore the associations between the built environment and the different domains of physical activity (transportation walking, recreational walking, and recreational moderate-to-vigorous physical activity (MVPA) while controlling for potential estate-level socioeconomic and individual confounders. We found that transportation walking was positively associated with the number of bus stops and the presence of Mass Transit Railway (MTR) stations. Recreational MVPA was positively related to the number of recreational facilities. However, land-use mix was negatively related to transportation walking, recreational walking, and recreational MVPA. The findings of this study support a threshold effect in the environment-physical activity associations. Furthermore, large-scale public housing schemes involving random or semi-random residence assignment in many cities may provide opportunities to explore built environments and physical activity behavior, with the potential to overcome residential self-selection bias.

The Association of Urban Greenness and Walking Behavior: Using Google Street View and Deep Learning Techniques to Estimate Residents' Exposure to Urban Greenness

Many studies have established that urban greenness is associated with better health outcomes. Yet most studies assess urban greenness with overhead-view measures, such as park area or tree count, which often differs from the amount of greenness perceived by a person at eye-level on the ground. Furthermore, those studies are often criticized for the limitation of residential self-selection bias. In this study, urban greenness was extracted and assessed from profile view of streetscape images by Google Street View (GSV), in conjunction with deep learning techniques. We also explored a unique research opportunity arising in a citywide residential reallocation scheme of Hong Kong to reduce residential self-selection bias. Two multilevel regression analyses were conducted to examine the relationships between urban greenness and (1) the odds of walking for 24,773 public housing residents in Hong Kong, (2) total walking time of 1994 residents, while controlling for potential confounders. The results suggested that eye-level greenness was significantly related to higher odds of walking and longer walking time in both 400 m and 800 m buffers. Distance to the closest Mass Transit Rail (MTR) station was also associated with higher odds of walking. Number of shops was related to higher odds of walking in the 800 m buffer, but not in 400 m. Eye-level greenness, assessed by GSV images and deep learning techniques, can effectively estimate residents’ daily exposure to urban greenness, which is in turn associated with their walking behavior. Our findings apply to the entire public housing residents in Hong Kong, because of the large sample size.

The relationship between objectively-measured attributes of the built environment and selected cardiovascular risk factors in a South African urban setting

BACKGROUND

Evidence concerning the relationship between objectively-measured attributes of the built environment with cardio-metabolic risk in populations from lower- and middle-income countries is lacking. In this paper, we describe the association between the objectively-measured built environment with body mass index, blood pressure and physical activity in adult South Africans.

METHODS

This cross-sectional study included 341 adults aged ≥35 years drawn from the Cape Town arm of the Prospective Urban Rural Epidemiology (PURE) cohort study. All Cape Town PURE participants were invited to take part in the study. Actigraph GT3X accelerometer and Geographic Information Systems were used to measure physical activity and built environment attributes (community center, shopping center and taxi rank).

RESULTS

In age and sex adjusted models (reference 500 m), access to community centers (1000 m) was positively related to body mass index [beta 4.70 (95%CI: 2.06 to 7.34)] and diastolic blood pressure [4.97 (0.00 to 9.95)]. Distance from a community center (1600 m) was positively related to diastolic blood pressure [6.58 (1.57 to 11.58)] and inversely with moderate-to-vigorous physical activity [- 69.30 (- 134.92 to - 3.70)]. Distance to a shopping center (1600 m) was positively related to body mass index [4.78 (1.11 to 8.45)] and shopping center (1000 m) was positively related to systolic blood pressure respectively [76.99 (0.03 to 83.95)].

CONCLUSION

Distance to community and shopping centers were significantly associated with BMI, systolic, diastolic blood pressure and moderate-to-vigorous physical activity. Future research should include multiple aspects of built environment variables in order to provide for a broader understanding of their effect on cardiovascular risk profile of African populations.

Access to public spaces and physical activity for Mexican adult women

The aim of this article was to explore the association between access to public spaces and physical activity for adult women, controlling and testing interactions with sociodemographic and public spaces characteristics. We combined sociodemographic data from a survey with the adult (18-65 years of age) women population of Tijuana, Mexico, conducted in 2014 (N = 2,345); with data from a 2013 study on public spaces in the same city. We evaluated access to public spaces by the presence and total area of public spaces in buffers of 400, 800, 1,000 and 1,600m around the participants’ homes. We measured physical activity with the short version of the International Physical Activity Questionnaire (IPAQ-short). We employed multinomial logistic models to evaluate the association between access to public spaces and physical activity, and tested for interactions between access to public spaces and public spaces quality and sociodemographic characteristics. We observed no interaction between access to public spaces and public spaces quality in their effect on physical activity. There was an association between the presence of public spaces in the 400m buffer, and higher odds of being in the low physical activity level (as opposed to being in the moderate level) (coefficient: 0.50; 95%CI: 0.13; 0.87). Participants who used public transport were less likely to be in the low physical activity level (coefficient: -0.57; 95%CI: -0.97; -0.17). We suggest that, in this population, the access to public spaces might be less relevant for physical activity than other elements of the urban environment and sociodemographic characteristics.

Physical Environment Correlates of Physical Activity in Developing Countries: A Review

BACKGROUND

Noncommunicable diseases and obesity are considered problems of wealthy, developed countries. These conditions are rising dramatically in developing countries. Most existing research on the role of the physical environment to support physical activity examines developed countries only.

OBJECTIVES

This review identifies physical environment factors that are associated with physical activity in developing countries.

METHODS

This review is modeled on a highly cited review by Saelens and Handy in 2008. The current review analyzes findings from 159 empirical studies in the 138 developing countries.

RESULTS

Results discuss the association of physical environment features and physical activity for all developing countries and identify the patterns within regions. The review supports the association of traffic safety with physical activity for transportation. Rural (vs urban) residence, distance to nonresidential land uses, and "composite" features of the physical environment are associated with general physical activity. Rural (vs urban) residence is associated with physical activity for work.

CONCLUSIONS

More research is needed on associations between the physical environment and physical activity in developing countries. Research should identify specific physical environment features in urban areas that are associated with higher activity levels.

Assessing the effect of physical activity classes in public spaces on leisure-time physical activity: "Al Ritmo de las Comunidades" A natural experiment in Bogota, Colombia

The Recreovia program provides free physical activity (PA) classes in public spaces in Bogota, Colombia. The purpose of this study was to assess the effectiveness of the Recreovia program in increasing PA among users of nine parks in Bogota. This study was a natural experiment conducted between 2013 and 2015 in Bogota. Community members and park users living nearby three groups of parks were compared: Group 1 were parks implementing new Recreovias (n=3), Group 2 were control parks (n=3) without Recreovias, and Group 3 were parks with existing Recreovías. Individuals in the "intervention" group were exposed to newly implemented Recreovia programs in parks near their homes. Measurements were collected at baseline and 6-8months after the intervention started. A total of 1533 participants were enrolled in the study: 501 for the existing Recreovias (included in a cross-sectional assessment) and 1032 participants (from the new Recreovias and control parks) included in the cross-sectional and pre-post study. Most participants were low income females. Twenty-three percent of the intervention group started participating in the program. Users of existing Recreovias were significantly more active and less likely to be overweight/obese compared to new Recreovia users at baseline. No changes on PA were found when comparing the intervention and control groups. Recreovias may have potential for increasing PA at the population level in urban areas given their rapid scalability, the higher levels of PA observed among program users, and its potential to reach women, low-income, less educated populations, and the overweight and obese.

Access to parks and physical activity: an eight country comparison

Several systematic reviews have reported mixed associations between access to parks and physical activity, and suggest that this is due to inconsistencies in the study methods or differences across countries. An international study using consistent methods is needed to investigate the association between access to parks and physical activity. The International Physical Activity and Environment Network (IPEN) Adult Study is a multi-country cross-sectional study using a common design and consistent methods. Accelerometer, survey and Geographic Information Systems (GIS) data for 6,181 participants from 12 cities in 8 countries (Belgium, Brazil, Czech Republic, Denmark, Mexico, New Zealand, UK, USA) were used to estimate the strength and shape of associations of 11 measures of park access (1 perceived and 10 GIS-based measures) with accelerometer-based moderate-to-vigorous physical activity (MVPA) and four types of self-reported leisure-time physical activity. Associations were estimated using generalized additive mixed models. More parks within 1 km from participants' homes were associated with greater leisure-time physical activity and accelerometer-measured MVPA. Respondents who lived in the neighborhoods with the most parks did on average 24 minutes more MVPA per week than those living in the neighborhoods with the lowest number of parks. Perceived proximity to a park was positively associated with multiple leisure-time physical activity outcomes. Associations were homogeneous across all cities studied. Living in neighborhoods with many parks could contribute with up to 1/6 of the recommended weekly Having multiple parks nearby was the strongest positive correlate of PA. To increase comparability and validity of park access measures, we recommend that researchers, planners and policy makers use the number of parks within 1 km travel distance of homes as an objective indicator for park access in relation to physical activity.

Where Latin Americans are physically active, and why does it matter? Findings from the IPEN-adult study in Bogota, Colombia; Cuernavaca, Mexico; and Curitiba, Brazil

Latin America (LA) has a unique structural, political, cultural and social environment. This study aimed to identify the places where Latin American adults are physically active; and to determine the association of using public- and restricted-access places with physical activity (PA). We used data from the International PA Environment Network study in Bogota, Colombia (n=1000, accelerometry=249); Cuernavaca, Mexico (n=677, accelerometry=652); and Curitiba, Brazil (n=697, accelerometry=331) (2010-2011). Walking and moderate-to-vigorous PA for leisure were measured with the International Physical Activity Questionnaire. Overall PA and PA within 10-minute bouts were measured with accelerometers. Participants reported use of public- and restricted-access places for PA. Mixed-effects regression models were used to determine the association of using public- and restricted-access places with PA. The streets were the most frequently-reported place for PA, and walking was the most common PA in the studied places. 'Informal', non-exercise-or-sports places (e.g., shopping malls) ranked high for use for PA in Bogota and Cuernavaca. In Curitiba, use of 'formal' places for sports/exercise (e.g., gyms) was more prevalent. Using public-access places was directly related to walking for leisure in all cities, and to additional PA outcomes in Bogota and Cuernavaca. In Cuernavaca and Curitiba, using restricted-access places was also associated with PA. Our study highlights the importance of public-access places for PA in LA. In some contexts, places for social interaction may be as important for PA as places for exercise/sport. Strategies increasing the availability, accessibility and quality of these places may effectively promote PA in LA.

Perceived neighborhood environmental attributes associated with leisure-time and transport physical activity in Mexican adults

Environmental factors have been associated with specific physical activity domains, including leisure-time and transport physical activity, in some high income countries. Few studies have examined the environmental correlates for domain-specific physical activity in low-and middle-income countries, and results are inconsistent. We aimed to estimate the associations between perceived environment and self-reported leisure-time walking, moderate-to-vigorous leisure-time physical activity and transport physical activity among adults living in Cuernavaca, Mexico. A population-based study of adults 20 to 64years old was conducted in Cuernavaca, Mexico in 2011 (n=677). Leisure and transport physical activity was measured using the International Physical Activity Questionnaire - Long Form. Perceptions of neighborhood environment were obtained by questionnaire. Hurdle regression models estimated the association between environmental perceptions and participation and time spent in each physical activity domain. High perceived aesthetics were positively correlated with participation and time spent in leisure-time walking and moderate-to-vigorous physical activity. SES differences existed for aesthetics in relation to participation in leisure-time walking. Participation in transport physical activity was positively associated with easy access to large parks, while closer distance to large parks was a negative correlate for participation and time-spent in this physical activity domain. Results suggest that perceived environmental characteristics related with physical activity are domain specific. High perceived aesthetics were an important correlate for leisure-time activities among Mexican adults, suggesting that policy strategies aimed at improving this environmental perception may be warranted. Patterns of associations between environmental correlates and transport physical activity differed from those reported in commonly studied high income countries.

Urban density, diversity and design: Is more always better for walking? A study from Hong Kong

Many cities in China have undergone rapid urbanization and are experiencing a decline in residents' physical activity levels. Previous studies have reported inconsistent findings on the association between 3D's (density, diversity, design) and walking behavior, and few studies have been conducted in China. The aim of this study was to identify the association between objectively measured 3D's and different domains of walking (transport vs. leisure) in Hong Kong, China. A survey was conducted in 2014 to collect walking data and relevant individual data from 1078 participants aged 18-65. The participants were randomly selected from 36 Hong Kong housing estates with different built environment and neighborhood socioeconomic status (SES). Built environment factors-population design, land-use mix and street intersection density-were assessed using a geographic information system. Multi-level regression was used to explore the associations between walking behavior and built environment factors, while adjusting for covariates. Two out the three D's-land-use mix and street connectivity-are not significantly related to any domains of walking. Furthermore, the third D, population density, is only positively related to walking for transport and walking for leisure in the lower range of density, while is negatively related to walking for leisure in the higher range of density. The findings suggest that the association between original 3D's and walking may vary in different urban contexts. The policy or planning strategy-using three D's to promote physical activity-may be ineffective or even counterproductive in large and already dense cities in China.

Individual and environmental correlates of objectively measured physical activity and sedentary time in adults from Curitiba, Brazil

OBJECTIVES

This study assessed the association of individual and neighborhood environment characteristics and objectively measured physical activity (PA) and sedentary time (ST) in adults from Curitiba, Brazil.

METHODS

A population-based cross-sectional study was conducted through face-to-face household interviews in 2010. The analytic sample included 305 adults aged 20-65 years recruited from 32 census tracts selected according to neighborhood walkability and socioeconomic status. Individual and environmental PA correlates were evaluated through standardized and valid self-reported measures, including the Neighborhood Environment Walkability Scale. Minutes per week of PA and ST were assessed through accelerometry. Multi-level regression models were used in the analyses.

RESULTS

After adjusting for confounders the strongest individual and environmental correlates associated with ST was residential density (B = 0.14; p = 0.008), light-intensity PA was being a father/mother (B = 35.71; p = 0.025) and moderate-to-vigorous PA was sex (B = 0.91; p < 0.001) and number of cars (one car, B = -1.05; two cars, B = -1.14; p < 0.001).

CONCLUSIONS

The associations found with individual and environmental correlates varied accordingly across all outcomes. Future changes in policies and infrastructure should consider the social context of the community and improvements to promote a safer environment in the neighborhood.

Nutrition status of children in Latin America

The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.

Within What Distance Does "Greenness" Best Predict Physical Health? A Systematic Review of Articles with GIS Buffer Analyses across the Lifespan

Is the amount of "greenness" within a 250-m, 500-m, 1000-m or a 2000-m buffer surrounding a person's home a good predictor of their physical health? The evidence is inconclusive. We reviewed Web of Science articles that used geographic information system buffer analyses to identify trends between physical health, greenness, and distance within which greenness is measured. Our inclusion criteria were: (1) use of buffers to estimate residential greenness; (2) statistical analyses that calculated significance of the greenness-physical health relationship; and (3) peer-reviewed articles published in English between 2007 and 2017. To capture multiple findings from a single article, we selected our unit of inquiry as the analysis, not the article. Our final sample included 260 analyses in 47 articles. All aspects of the review were in accordance with PRISMA guidelines. Analyses were independently judged as more, less, or least likely to be biased based on the inclusion of objective health measures and income/education controls. We found evidence that larger buffer sizes, up to 2000 m, better predicted physical health than smaller ones. We recommend that future analyses use nested rather than overlapping buffers to evaluate to what extent greenness not immediately around a person's home (i.e., within 1000-2000 m) predicts physical health.

Do associations between objectively-assessed physical activity and neighbourhood environment attributes vary by time of the day and day of the week? IPEN adult study

BACKGROUND

To more accurately quantify the potential impact of the neighbourhood environment on adults' physical activity (PA), it is important to compare environment-PA associations between periods of the day or week when adults are more versus less likely to be in their neighbourhood and utilise its PA resources. We examined whether, among adults from 10 countries, associations between objectively-assessed neighbourhood environment attributes and moderate-to-vigorous physical activity (MVPA) varied by time of the day and day of the week. The secondary aim was to examine whether such associations varied by employment status, gender and city.

METHODS

This cross-sectional study included 6,712 adults from 14 cities across 10 countries with ≥1 day of valid accelerometer-assessed MVPA and complete information on socio-demographic and objectively-assessed environmental characteristics within 0.5 and 1 km street-network buffers around the home. Accelerometer measures (MVPA min/h) were created for six time periods from early morning until late evening/night, for weekdays and weekend days separately. Associations were estimated using generalized additive mixed models.

RESULTS

Time of the day, day of week, gender and employment status were significant moderators of environment-MVPA associations. Land use mix was positively associated with MVPA in women who were employed and in men irrespective of their employment status. The positive associations between MVPA and net residential density, intersection density and land use mix were stronger in the mornings of weekdays and the afternoon/evening periods of both weekdays and weekend days. Associations between number of parks and MVPA were stronger in the mornings and afternoon/evenings irrespective of day of the week. Public transport density showed consistent positive associations with MVPA during weekends, while stronger effects on weekdays were observed in the morning and early evenings.

CONCLUSIONS

This study suggests that space and time constraints in adults' daily activities are important factors that determine the impact of neighbourhood attributes on PA. Consideration of time-specific associations is important to better characterise the magnitude of the effects of the neighbourhood environment on PA. Future research will need to examine the contribution of built environment characteristics of areas surrounding other types of daily life centres (e.g., workplaces) to explaining adults' PA at specific times of the day.

International comparisons of the associations between objective measures of the built environment and transport-related walking and cycling: IPEN Adult Study

INTRODUCTION

Mounting evidence documents the importance of urban form for active travel, but international studies could strengthen the evidence. The aim of the study was to document the strength, shape, and generalizability of relations of objectively measured built environment variables with transport-related walking and cycling.

METHODS

This cross-sectional study maximized variation of environments and demographics by including multiple countries and by selecting adult participants living in neighborhoods based on higher and lower classifications of objectively measured walkability and socioeconomic status. Analyses were conducted on 12,181 adults aged 18-66 years, drawn from 14 cities across 10 countries worldwide. Frequency of transport-related walking and cycling over the last seven days was assessed by questionnaire and four objectively measured built environment variables were calculated. Associations of built environment variables with transport-related walking and cycling variables were estimated using generalized additive mixed models, and were tested for curvilinearity and study site moderation.

RESULTS

We found positive associations of walking for transport with all the environmental attributes, but also found that the relationships was only linear for land use mix, but not for residential density, intersection density, and the number of parks. Our findings suggest that there may be optimum values in these attributes, beyond which higher densities or number of parks could have minor or even negative impact. Cycling for transport was associated linearly with residential density, intersection density (only for any cycling), and land use mix, but not with the number of parks.

CONCLUSION

Across 14 diverse cities and countries, living in more densely populated areas, having a well-connected street network, more diverse land uses, and having more parks were positively associated with transport-related walking and/or cycling. Except for land-use-mix, all built environment variables had curvilinear relationships with walking, with a plateau in the relationship at higher levels of the scales.

Harnessing Technology and Citizen Science to Support Neighborhoods that Promote Active Living in Mexico

Middle- and low-income countries bear 80 % of the global chronic disease burden. Population-level, multi-sectoral approaches to promoting healthful lifestyles that take into local physical, socioeconomic, and sociocultural characteristics of both the environment and the population are needed. The "Nuestra Voz (Our Voice)" is one such approach that involves neighborhood residents acting as "citizen scientists" to systematically gather information on the barriers and facilitators of physical activity in their neighborhoods and then use their data to collectively advocate for local environmental- and policy-level changes to support active living. We pilot tested this approach in Cuernavaca, Mexico with adults and adolescents. This community-engaged and participatory approach is driven by residents, who utilize a GPS-enabled electronic tablet-based application with simple audio-based instructions to take photographs and record audio narratives of facets of their neighborhood that promote or hinder active living. After collecting these data, the citizen scientists come together in a community meeting and use their data to prioritize realistic, multi-level changes for promoting active living in their neighborhoods. A survey assessed participants' acceptability of the approach. Participating citizen scientists included 32 adults and 9 adolescents. The citizen scientists rated the acceptability of five of the nine acceptability survey items with an average of 4.0 or higher out of 5.0, indicating they thought it was "fun," were comfortable carrying the tablet, were likely to use it again, and would recommend it to friends and family. Items with average scores of less than 4 were all related to safety concerns. The most common barriers reported by citizen scientists using the tablet were poor sidewalk quality, presence of trash, negative characteristics of the streets, unpleasant aesthetics (e.g., graffiti), and presence of parks and recreational facilities. The Our Voice citizen scientist approach using the Discovery Tool has high potential for assisting communities in diverse settings to begin to identify both local barriers to active living as well as potentially useful strategies for promoting physical activity in culturally congruent ways that are appropriate and feasible in the local context.

Perceived Neighborhood Environment and Physical Activity: The International Physical Activity and Environment Network Adult Study in Mexico

INTRODUCTION

There is compelling evidence linking physical activity with environmental characteristics in high-income countries, but evidence among low- and middle-income countries is scarce and results are inconsistent. This study assessed associations between perceived measures of the built environment and objectively measured physical activity among Mexican adults.

METHODS

A population-based study of adults aged 20-65 years was conducted in Cuernavaca, Mexico, in 2011 (N=629). Participants wore an accelerometer for 7 days. Perceived environment data were obtained by questionnaire. In 2014, multiple regression models estimated the association between perceived environmental variables and total moderate to vigorous physical activity (MVPA); MVPA within 10-minute bouts was analyzed using a two-part model.

RESULTS

Easy access to neighborhood parks and close proximity to metropolitan parks were positively associated with total MVPA. Proximity to metropolitan parks was also positively related to any MVPA within bouts among women. High perceived aesthetics among those of low SES and high perceived safety from crime among men were positively associated with total MVPA and MVPA within bouts. Having few cul-de-sacs within the neighborhood and proximity to transit stops were inversely related to total MVPA.

CONCLUSIONS

Access to parks, aesthetics, and safety from crime are important correlates of physical activity among Mexican adults. Yet, this study finds no association for other environmental features usually thought to be important for increasing activity levels. These findings highlight the importance of conducting more studies in low- and middle-income countries that examine the relationship between physical activity and the built environment.

Perceived and Objective Measures of Neighborhood Environment for Physical Activity Among Mexican Adults, 2011

INTRODUCTION

Environmental supports for physical activity may help residents to be physically active. However, such supports might not help if residents' perceptions of the built environment do not correspond with objective measures. We assessed the associations between objective and perceived measures of the built environment among adults in Cuernavaca, Mexico, and examined whether certain variables modified this relationship.

METHODS

We conducted a population-based (n = 645) study in 2011 that used objective (based on geographic information systems) and perceived (by questionnaire) measures of the following features of the built environment: residential density, mixed-land use, intersection density, and proximity to parks and transit stops. We used linear regression to assess the adjusted associations between these measures and to identify variables modifying these relationships.

RESULTS

Adjusted associations were significant for all features (P < .05) except intersection density and proximity to transit stops. Significantly stronger associations between perceived and objective measures were observed among participants with low socioeconomic status, participants who did not own a motor vehicle or did not meet physical activity recommendations, and participants perceiving parks as safe.

CONCLUSION

Perceived measures of residential density, mixed-land use, and proximity to parks are associated with objective environmental measures related to physical activity. However, in Mexico, it should not be assumed that perceived measures of intersection density and proximity to transit stops are the same as objective measures. Our results are consistent with those from high-income countries in that associations between perceived and objective measures are modified by individual sociodemographic and psychosocial factors.

Statistical Validation of a Web-Based GIS Application and Its Applicability to Cardiovascular-Related Studies

PURPOSE

There is abundant evidence that neighborhood characteristics are significantly linked to the health of the inhabitants of a given space within a given time frame. This study is to statistically validate a web-based GIS application designed to support cardiovascular-related research developed by the NIH funded Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) Data Coordinating Center (DCC) and discuss its applicability to cardiovascular studies.

METHODS

Geo-referencing, geocoding and geospatial analyses were conducted for 500 randomly selected home addresses in a U.S. southeastern Metropolitan area. The correlation coefficient, factor analysis and Cronbach's alpha (α) were estimated to quantify measures of the internal consistency, reliability and construct/criterion/discriminant validity of the cardiovascular-related geospatial variables (walk score, number of hospitals, fast food restaurants, parks and sidewalks).

RESULTS

Cronbach's α for CVD GEOSPATIAL variables was 95.5%, implying successful internal consistency. Walk scores were significantly correlated with number of hospitals (r = 0.715; p < 0.0001), fast food restaurants (r = 0.729; p < 0.0001), parks (r = 0.773; p < 0.0001) and sidewalks (r = 0.648; p < 0.0001) within a mile from homes. It was also significantly associated with diversity index (r = 0.138, p = 0.0023), median household incomes (r = -0.181; p < 0.0001), and owner occupied rates (r = -0.440; p < 0.0001). However, its non-significant correlation was found with median age, vulnerability, unemployment rate, labor force, and population growth rate.

CONCLUSION

Our data demonstrates that geospatial data generated by the web-based application were internally consistent and demonstrated satisfactory validity. Therefore, the GIS application may be useful to apply to cardiovascular-related studies aimed to investigate potential impact of geospatial factors on diseases and/or the long-term effect of clinical trials.

Accelerometer-based physical activity levels among Mexican adults and their relation with sociodemographic characteristics and BMI: a cross-sectional study

Background

The objectives of this study were to describe the accelerometer based total and bout-specific PA levels for a representative sample of adults from Cuernavaca, Mexico, and to examine the relationships with sociodemographic characteristics and BMI status.

Methods

Cross sectional study of adults from Cuernavaca, Mexico (2011, n = 677). Participants wore Actigraph GT3X accelerometers for seven days and sociodemographic data was collected through a survey. Weight and height were objectively measured. Total minutes/week of moderate-to-vigorous PA (MVPA) and of MVPA occurring within bouts of at least ten minutes were obtained. Intensity-specific (moderate and vigorous) total PA and bouted-PA was also obtained. The relation of each PA variable with sex, age, socioeconomic status, education, marital status and BMI status was assessed using unadjusted and adjusted linear models.

Results

The mean total MVPA among adults from Cuernavaca was 221.3 ± 10.0 (median = 178.3 min/week). Average MVPA within bouts was 65.8 ± 4.7 min/week (median = 30.0 min/week). 9.7 % of total MVPA occurred within bouts. Significant associations were found for total and bout-specific MVPA with being male (positive) and owning a motor vehicle (negative). Additional associations were found for intensity-specific PA outcomes. Mexican adults were more active during weekdays than weekends, suggesting that PA may be more strongly driven by necessity (transport) than by choice (leisure).

Conclusions

This is the first study to objectively measure PA for a representative sample of Mexican adults in an urban setting. The sociodemographic correlates vary from those known from high income countries, stressing the need for more correlate studies from lower-to-middle income countries.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0243-z) contains supplementary material, which is available to authorized users.

Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America

OBJECTIVE

There is evidence linking the built environment (BE) with physical activity (PA), but few studies have been conducted in Latin America (LA). State-of-the-art methods and protocols have been designed in and applied in high-income countries (HIC). In this paper, we identify key challenges and potential solutions to conducting high-quality PA and BE research in LA.

METHODS

The experience of implementing the IPEN data collection protocol (IPEN: International Physical Activity Environment Network) in Curitiba, Brazil; Bogotá, Colombia; and Cuernavaca, Mexico (2010-2011); is described to identify challenges for conducting PA and BE research in LA.

RESULTS

Five challenges were identified: lack of academic capacity (implemented solutions (IS): building a strong international collaborative network); limited data availability, access and quality (IS: partnering with influential local institutions, and crafting creative solutions to use the best-available data); socio-political, socio-cultural and socio-economic context (IS: in-person recruitment and data collection, alternative incentives); safety (IS: strict rules for data collection procedures, and specific measures to increase trust); and appropriateness of instruments and measures (IS: survey adaptation, use of standardized additional survey components, and employing a context-based approach to understanding the relationship between PA and the BE). Advantages of conducting PA and BE research in LA were also identified.

CONCLUSIONS

Conducting high-quality PA and BE research in LA is challenging but feasible. Networks of institutions and researchers from both HIC and LMIC play a key role. The lessons learned from the IPEN LA study may be applicable to other LMIC.