Purpose:

Research linking walkability with higher physical activity (PA) has been done in high-income countries with limited environmental and economic heterogeneity leaving it unclear if these findings apply to low- and middle-income countries. This investigation uses cross-sectional data from the Prospective Urban Rural Epidemiologic study to identify the association between walkability and physical activity (PA) in communities throughout the globe.

Methods:

Community-dwelling people between 35 and 70 years were recruited from multiple city-sites in 17 low-, middle- and high-income countries. Within each city, participants were recruited in geographical clusters with representation from rural and urban areas. The International Physical Activity Questionnaire (long-form) was used to quantify total, transportation and recreation PA. Walkability was assessed using the Neighborhood Environment Walkability Scale to generate eight domains and a total score. Due to zero-inflated and highly-skewed data distribution of the PA, we used a two-parts model to assess the association between walkability and PA (logistic regression to model the probability of engaging in PA and log-normal regression to model PA values greater than zero). Models were generated for each walkability domain (and total walkability) and each PA domain; adjusted for age, sex, education, disability, location, country income level and community-level socio-economic status. Significance was set at p<0.001 to account for multiple comparisons.

Results:

Data were available for 73 528 participants (43% male, 51.2 ± 9.8 years, 59% urban residents) from low- (9%), middle- (76%) and high-income (15%) countries. Total, transportation and recreation PA were greater at higher tertiles of total walkability. Greater access to amenities, safety from crime, land use mix, neighbourhood aesthetics and satisfaction, street connectivity, safety from traffic and total walkability, but not infrastructure for walking, were associated with greater total PA (p<0.001 for all). Transport PA was associated with all walkability domains except for safety from crime and traffic (p<0.0001 for all), while recreational PA was associated with all walkability domains except for safety from crime (p<0.001 for all).

Conclusions:

Higher neighbourhood walkability was associated with greater PA in a population from a diverse range of environments and socio-economic levels.

Purpose: Few studies have examined the associations between walkable built environments and older adults’ physical function. Especially, it is less known how built environment attributes may influence physical function in Asian cities. Evidence from Asia has a global relevance and will be of interest to policymakers, population/public health practitioners and researchers, especially those interested in supporting physical function among older adults in dense compact cities. The aim of the study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.

Methods: Cross-sectional data collected in 2013 from 314 older residents (aged 65-84 years) living in Japan were used. This data was obtained from a larger epidemiological study conducted in 2013 at Waseda University that examined social and built environment determinants of Japanese older adults’ health behaviours and outcomes. Physical function was estimated from objectively measured upper and lower body function, mobility, and balance by a trained research team member. A comprehensive list of built environment attributes, including population density, availability of destinations, intersection density, and distance to the nearest public transport station, were objectively calculated. Walk Score as a composite measure of neighbourhood walkability was also obtained. The associations among environmental attributes of walkability (continuously) and objectively assessed physical function measures were examined by multiple linear regression with adjustment for covariates (age, educational attainment, living status, working status, lower body pain, length of residence, depression, and cognitive function) stratified by gender.

Results: Among men, higher population density, availability of destinations, and intersection density were significantly associated with better physical function performance. Higher Walk Score was also marginally associated with better physical function performance. None of the environmental attributes were associated with physical function in elderly women.

Conclusions: Our study provided unique findings in the context of less-studied Asian cities. Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia. Walking-friendly neighbourhoods can not only promote older adults’ active behaviours but can also support their physical function.

Purpose: Evidence on associations between neighbourhood characteristics and weight outcomes remain inconsistent. Weight management interventions may not be successful in permanently modifying weight if the built environment is not supportive of this change. The purpose of this study was to estimate the associations between neighbourhood characteristics and self-reported body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR) among Canadian adults.

Methods: A large, geographically and socially diverse sample was used to examine relationships between multiple neighbourhood characteristics and weight status outcomes. This study included cross-sectional survey data from a longitudinal study (‘Alberta’s Tomorrow Project’ (ATP); n=14,550, urban participants only). Using Geographic Information System, neighbourhood characteristics including 3- and 4-way intersections (connectivity), business destinations (land use), population count (density), and neighbourhood greenness (normalized difference vegetation index; NDVI) within a 400m radius of participant’s homes were objectively estimated. Connectivity, land use, and density (z-scores) were summed to create a combined walkability score. Adjusted logistic regression models (odds ratios: ORs and 95% confidence intervals: CIs) estimated the associations between each neighbourhood characteristics and weight status outcome.

Results/findings: Among participants, based on BMI, 65% were overweight, of which 26% were obese. Based on waist circumference, 70% of participants were obese. Based on WHR, 61% of the participants were classified as high risk. Four-way intersections (overweight/obese vs. healthyweight: OR 0.94 (CI 0.89, 0.99)) and walkability (overweight/obese vs. healthyweight: OR 0.98 (CI 0.96, 0.99); obese vs. non-obese: OR 0.98 (CI 0.96, 0.99)) were negatively associated with BMI. NDVI was negatively associated with WHR (high risk vs. low risk: OR 0.93 (CI 0.89, 0.96)). Some unexpected (though novel) findings were the positive associations of population count (high risk vs. low risk: OR 1.01 (CI 1.005, 1.012)), and walkability (high risk vs. low risk: OR 1.02 (CI 1.001, 1.04)) with WHR.

Conclusions: Neighbourhood characteristics are associated with weight status outcomes. Public health interventions promoting healthy weight need to incorporate strategies that take into consideration the local built environment. Moreover, modifying the built environment, a population-level intervention, could improve health by promoting healthy weight. 

Purpose: Adolescents have the potential to be active in multiple places across weekdays and weekends. However, most studies of the built environment and physical activity focus exclusively on residential neighborhoods. This study aims to examine cross-sectional associations of objective built environments around home and school with accelerometer-assessed moderate-to-vigorous physical activity (MVPA) across the week. 

Methods: Data were collected from 417 adolescents (12-20 years) in Melbourne, Australia as part of the NEighbourhood Activity in Youth study. MVPA outside school hours on weekdays and weekend were assessed by accelerometer. Built environment features around home and school (500m, 1km and 2km street network buffers), including recreation facilities, park count, park size, trails, and walkability and its components, were assessed using Geographic Information Systems. Sociodemographic information were self-reported by adolescents. Multilevel linear regression models were used to estimate associations.

Results: On weekdays, three features of the built environment (park count, park size and trails) around school (mostly within 500m-1km street network buffers) and one feature of the built environment (recreation facilities) within 2km from home were positively associated with MVPA. On weekend days, seven of eight of the selected built environment features (all except trails) around home across the three buffer sizes were positively associated with MVPA. Only park count within 500m from school was also positively associated with weekend MVPA. 

Conclusion: Selected built environment features around home appear to be more important for weekend MVPA and features around school more important for weekday MVPA among adolescents. Understanding the contribution of built environment features around both home and school could serve as a basis for policy recommendations and public health interventions to be developed for each setting. 

Purpose: Identify neighbourhood features parents perceived as being important for their child’s active play, their own active recreation, and their coactivity (physical activity performed together).  

Methods: A cross-sectional study design was used. During May to September 2019, a convenience sample of 145 parents (Mage = 36.21 years) with preschoolers (Mage = 3.90 years) living in Edmonton, Canada were recruited online, through existing lab databases, and in-person from various destinations throughout the city. To achieve a representation of Edmonton, at least 10 families were recruited from each of its 12 electoral wards. Participating parents completed a 20-minute survey (electronic or paper) where they rated the importance of several neighbourhood features (destinations, design, social, safety, aesthetics) for their child’s active play, their own active recreation, and their coactivity via 6-item Likert scales (1 = not at all important, 2 = unimportant, 3 = neutral, 4 = important, 5 = most important, 6 = not applicable). Responses “important” and “most important” were collapsed into one group “important”. Descriptive statistics were used to summarize categorical and continuous variables.

Results: Over 75% of parents perceived several neighbourhood features (17/32) as important for their child’s active play, their own active recreation, and their coactivity. Of these, there were 2/9 destinations (parks, playgrounds), 3/6 design features (quiet streets, trails, sidewalks), 4/6 social features (friends/family, child’s friends, knowing neighbours, trusting neighbours), 6/6 safety features (street lighting, crime, traffic, daylight, sidewalk maintenance, crosswalks), and 2/5 aesthetic features (cleanliness, natural features). Neighbourhood features considered important by over 90% of parents for their child’s active play, their own active recreation, and coactivity were parks (97.9%, 97.9%, 97.2%), playgrounds (99.3%, 95.9%, 97.2%), sidewalks (90.9%, 97.9%, 90.3 %), low crime (92.3%, 93.1%, 92.4%), and cleanliness (98.6%, 99.3%, 95.9%).

Conclusion: Parents perceived several neighbourhood features as important for all three physical activity behaviours. These findings may be helpful in guiding future research examining neighbourhood correlates of physical activity among preschoolers and their parents. Further, neighbourhood planners may find this information useful for developing neighbourhoods conducive for active living in young families. 

Purpose

Natural experiment interventions are gaining increased importance when looking to understand health behaviours. Twenty mile per hour (20mph) (30 kilometre per hour) speed limits are one such intervention purported to increase walking and cycling, through creating more supportive environments for these travel modes. To date there has been little evidence to show if, and how, such 20mph speed limits influence these activities. In 2018, the City of Edinburgh Council implemented a citywide 20mph speed limit – the first Scottish city to do so. This study aimed to understand how, and why this intervention may, or may not have influenced walking and cycling.

Methods

Fifteen focus groups were conducted involving 100 participants who lived and/or worked in Edinburgh. Participants represented a range of socio-demographic and travel-related characteristics, including pedestrians, cyclists, parents of young children, and professional drivers. The topic guide was informed by a programme theory, and investigated attitudes towards the speed limit, how the limit influenced participants’ personal walking and cycling experiences and behaviours, and their perceptions of others’ walking and cycling. Qualitative data were analysed using NVivo 11. Key themes were developed using thematic analysis.

Results

Views on how the 20mph speed limit impacted walking and cycling were mixed. Participants identified a reduced speed differential between cyclists and motorists resulting from the speed limit. This was perceived both positively as it reduced intimidation experienced by cyclists, and negatively, as it meant bicycles spent more time in close proximity to passing or following cars. Parents discussed being more comfortable with their children walking and cycling on 20mph streets, as the impact of any potential collision would be lessened. An almost unanimous finding was the importance of segregated cycling infrastructure, and that without this in place a 20mph limit could only ever have a limited impact on cycling behaviour.

Conclusions

Whilst positive perceptions of a speed limit reduction on walking and cycling were highlighted, the implementation of such interventions in isolation is likely to have a modest impact on these behaviours. These limits should be one of several measures to support these behaviours, where segregated infrastructure is prioritised.

Purpose

The co-existence of high levels of physical inactivity, obesity, and diabetes is often observed in ethnic/racial minority and/or low-income communities. These heath disparities may be related to the built environment. In particular, the quality of local neighborhood parks (features and amenities) may be related to visits by people for physical activity (PA). Furthermore, ethnic/racial minority and/or low-income individuals may perceive their local neighborhood parks to be lacking park features and amenities that are conducive to health-enhancing PA. The purpose of this qualitative study is to explore the socio-cultural influences in the perceptions of park quality among ethnic/racial and/or low-income individuals in a metropolitan area in Southeast United States.

Methods

We employed a cross-sectional study design and purposive sampling to recruit participants for five focus groups with ethnic/racial minority and/or low-income individuals from a city in the Southeast United States. ​A semi-structured focus group guide was used to elicit participants’ perceptions of local neighborhood parks, including barriers and facilitators to park use. Focus groups were audio-recorded and transcribed verbatim. Transcripts were analyzed using descriptive and interpretive coding to identify themes. Demographic information was also collected.

Results

Participants were primarily female (n=48, with nine male participants), Black (63%), and on average 50 years old. Participants perceived their local neighborhood parks to be in disrepair (e.g., broken playground equipment, damaged athletic courts), and lacking amenities (e.g., water fountains, restrooms, benches, and shaded areas). Although participants perceived poor park quality, participants also believed local neighborhood parks to be sources of community unity because parks were named for historical figures, cultural events held at parks, and the contributions of community groups. Nevertheless, Black participants believed they have been displaced from local neighborhood parks by emerging immigrant groups.

Conclusions

Our findings indicate that disparities in health-enhancing PA among racial/ethnic minority and/or low-income individuals from a city in Southeast United States may be related to perceived park quality. Strategies for increasing park use and PA among racial/ethnic minority and/or low-income individuals should address socio-cultural factors such as community pride, neighborhood input, and shared experiences to ignite park activation.