Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations?

Background

There is growing recognition that the urban built environment influences physical activity at the population level, although the effects on disadvantaged groups are less well understood. Using the examples of open/green space and street connectivity, this paper explores whether enhancements to the built environment have potential for addressing physical activity-related health inequalities among Māori, Pacific and low income communities in New Zealand.

Method

A high-level review of the international literature relating open space and street connectivity to physical activity and/or related health outcomes at a population level was completed. Consideration was given to whether these features of the built environment have a disproportionate effect on disadvantaged populations.

Results

Findings from international studies suggest that open space and street connectivity have a beneficial effect on physical activity. Enhancing the built environment may be particularly advantageous for improving physical activity levels among disadvantaged populations.

Conclusion

It is likely that open space and street connectivity have a positive effect on physical activity behaviour; however due to the cross-sectional nature of existing research and the paucity of research among disadvantaged populations definitive conclusions about the effect in these populations cannot be made. Further research is required (e.g. natural experiments or quasi experimental research designs) to determine the effect of changing the environment on physical activity and obesity.

     

Built environment, adiposity, and physical activity in adults aged 50-75

BACKGROUND: Few studies have investigated the built environment and its association with health-especially excess adiposity-and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship. METHODS: This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N=1221; aged 50-75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS-derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI>or=25), three walking activities, and physical activity. Data were collected in 2006-2007 and analyzed in 2007. RESULTS: Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics. CONCLUSIONS: Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population.     

The association between neighborhood characteristics and body size and physical activity in the California teachers study cohort

Objectives. We considered interactions between physical activity and body mass index (BMI) and neighborhood factors.Methods. We used recursive partitioning to identify predictors of low recreational physical activity (< 2.5 hours/week) and overweight and obesity (BMI ≥ 25.0 kg/m²) among 118 315 women in the California Teachers Study. Neighborhood characteristics were based on 2000 US Census data and Reference US business listings.Results. Low physical activity and being overweight or obese were associated with individual sociodemographic characteristics, including race/ethnicity and age. Among White women aged 36 to 75 years, living in neighborhoods with more household crowding was associated with a higher probability of low physical activity (54% vs 45% to 51%). In less crowded neighborhoods where more people worked outside the home, the existence of fewer neighborhood amenities was associated with a higher probability of low physical activity (51% vs 46%). Among non–African American middle-aged women, living in neighborhoods with a lower socioeconomic status was associated with a higher probability of being overweight or obese (46% to 59% vs 38% in high–socioeconomic status neighborhoods).Conclusions. Associations between physical activity, overweight and obesity, and the built environment varied by sociodemographic characteristics in this educated population.The prevalence of overweight and obesity has reached epidemic levels in the United States. The most recent national prevalence data report that 68% of US adults are overweight or obese.¹ This prevalence poses a significant public health problem given that obesity is a risk factor for many chronic conditions and certain cancers.^1–3 Because of the health benefits of physical activity in preventing and treating overweight and obesity, increasing physical activity has become a public health priority.⁴With these high levels of overweight and obesity in the United States,¹ researchers have begun to search for neighborhood factors, including the built environment, that may influence physical activity and overweight or obesity. The built environment comprises the physical attributes of a person''s surroundings, including the existence and condition of sidewalks and walking trails for walking and other types of recreation, the spatial configuration of street networks, the availability of health-promoting resources, and the number of walkable destinations. The research to date suggests that elements of the built environment influence physical activity and levels of overweight or obesity.^5–7 Most studies, however, have focused on relatively specific geographic areas (e.g., a given city or county), have not assessed the influence of the built environment across different sociodemographic groups, and have not considered interactions between individual and neighborhood factors.We aimed to determine the association between measures of the built environment and physical activity levels and body mass index (BMI, defined as weight in kg divided by height in m²) across geographically and sociodemographically diverse neighborhoods. We applied recursive partitioning, a tree-based classification method, to identify both independent associations and interactions between these variables in a large, established cohort of California women.     

Environmental and lifestyle factors associated with overweight and obesity in Perth,Australia

PURPOSE: To examine associations between environmental and lifestyle factors and overweight or obesity. DESIGN: A cross-sectional survey and an environmental scan of recreational facilities. SETTING: Metropolitan Perth, Western Australia. SUBJECTS: Healthy sedentary workers and homemakers aged 18 to 59 years (n = 1803) living in areas within the top and bottom quintiles of social disadvantage. MEASURES: Four lifestyle factors, one social environmental factor, and five physical environment factors (three objectively measured). RESULTS: After adjustment for demographic factors and other variables in the model, overweight was associated with living on a highway (odds ratio [OR], 4.24; 95% confidence interval [CI], 1.62-11.09) or streets with no sidewalks or sidewalks on one side only (OR, 1.35; 95% CI, 1.03-1.78) and perceiving no paths within walking distance (OR, 1.42; 95% CI, 1.08-1.86). Poor access to four or more recreational facilities (OR, 1.68; 95% CI, 1.11-2.55) and sidewalks (OR, 1.62; 95% CI, .98-2.68) and perceiving no shop within walking distance (OR, 1.84; 95% CI, 1.01-3.36) were associated with obesity. Conversely, access to a motor vehicle all the time was negatively associated with obesity (OR, .56; 95% CI, .32-.99). Watching 3 or more hours of television daily (ORs, 1.92 and 1.85, respectively) and rating oneself as less active than others (ORs, 1.66 and 4.05, respectively) were associated with both overweight and obesity. After adjustment for individual demographic factors and all other variables in the model, socioeconomic status of area of residence and leisure-time physical activity were not associated with overweight or obesity. CONCLUSION: Factors that influence overweight and obesity appear to differ, but aspects of the physical environment may be important. Objectively measured neighborhood environment factors warrant further investigation.     

Combating childhood obesity: a survey of laws affecting the built environments of low-income and minority children

Childhood overweight and obesity have reached epidemic proportions, with nearly one of every three children in the USA being affected. That factors in the built environment are closely correlated to childhood obesity has become increasingly evident. Negative built environment factors disproportionately affect poor and minority children. This paper examines the current research on the state of childhood overweight and obesity and surveys the built environment factors that have been linked to the problem. Analyzing the built environment from a legal perspective, this paper identifies how zoning, legislation, public/private partnerships, and contracts are being used at the local, state, and federal levels to combat the epidemic of childhood obesity. Using these tools, local, state, and federal government agencies are increasing access to healthy food, decreasing the density of unhealthy food sources, and increasing physical activity resources for children. Whereas some of the programs are geared toward minority and low-income children, many apply to children across the socioeconomic and demographic spectrum.     

Exploring Associations between Physical Activity and Perceived and Objective Measures of the Built Environment

The built environment may be responsible for making nonmotorized transportation inconvenient, resulting in declines in physical activity. However, few studies have assessed both the perceived and objectively measured environment in association with physical activity outcomes. The purpose of this study was to describe the associations between perceptions and objective measures of the built environment and their associations with leisure, walking, and transportation activity. Perception of the environment was assessed from responses to 1,270 telephone surveys conducted in Forsyth County, NC and Jackson, MS from January to July 2003. Participants were asked if high-speed cars, heavy traffic, and lack of crosswalks or sidewalks were problems in their neighborhood or barriers to physical activity. They were also asked if there are places to walk to instead of driving in their neighborhood. Speed, volume, and street connectivity were assessed using Geographic Information Systems (GIS) for both study areas. Locations of crashes were measured using GIS for the NC study area as well. Objective and perceived measures of the built environment were in poor agreement as calculated by kappa coefficients. Few associations were found between any of the physical activity outcomes and perception of speed, volume, or presence of sidewalks as problems in the neighborhood or as barriers to physical activity in regression analyses. Associations between perceptions of having places to walk to and presence of crosswalks differed between study sites. Several associations were found between objective measures of traffic volume, traffic speed, and crashes with leisure, walking, and transportation activity in Forsyth County, NC; however, in Jackson, MS, only traffic volume was associated with any of the physical activity outcomes. When both objective and perceived measures of the built environment were combined into the same model, we observed independent associations with physical activity; thus, we feel that evaluating both objective and perceived measures of the built environment may be necessary when examining the relationship between the built environment and physical activity. McGinn is with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Evenson and Huston are with the Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA; Herring is with the Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA; Rodriguez is with the Department of City and Regional Planning, University of North Carolina, Chapel Hill, NC, USA.     

Independent and Joint Associations between Multiple Measures of the Built and Social Environment and Physical Activity in a Multi-Ethnic Urban Community

Physical activity is associated with reduced risk of a number of health outcomes, yet fewer than half of adults in the United States report recommended levels of physical activity. Analyses of structural characteristics of the built environment as correlates of physical activity have yielded mixed results. We examine associations between multiple aspects of urban neighborhood environments and physical activity in order to understand their independent and joint effects, with a focus on the extent to which the condition of the built environment and indicators of the social environment modify associations between structural characteristics and physical activity. We use data from a stratified, multi-stage proportional probability sample of 919 non-Hispanic Black, non-Hispanic White, and Hispanic adults in an urban community, observational data from their residential neighborhoods, and census data to examine independent and joint associations of structural characteristics (e.g., street network connectivity), their condition (e.g., sidewalk condition), and social environments (e.g., territoriality) with physical activity. Our findings suggest that sidewalk condition is associated with physical activity, above and beyond structural characteristics of the built environment. Associations between some structural characteristics of the built environment and physical activity were conditional upon street condition, physical deterioration, and the proportion of parks and playgrounds in good condition. We found modest support for the hypothesis that associations between structural characteristics and physical activity are modified by aspects of the social environment. Results presented here point to the value of and need for understanding and addressing the complexity of factors that contribute to the relationships between the built and social environments and physical activity, and in turn, obesity and co-morbidities. Bringing together urban planners, public health practitioners and policy makers to understand and address aspects of urban environment associated with health outcomes is critical to promoting health and health equity.     

Observing physical activity in suburbs

This study examined the reliability of the block walk method (BWM) for observing physical activity on suburban sidewalks/streets. Trained observers simultaneously walked 40 sidewalk/street segments each 1525 m in length at a pace of 30.5 m/min while recording the number of individuals walking/bicycling/jogging and the address where the activity occurred. An activity was observed at 2.9% of the 1020 addresses walked passed. In all 41 individuals were seen walking, 4 jogging, and 3 bicycling during 400 observation minutes. Agreements were 80%, 90%, and 86.7% for address, activity type, and number of individuals. The BWM is reliable for assessing activity on suburban sidewalks/streets.     

Neighborhood-based differences in physical activity: an environment scale evaluation

OBJECTIVES: This study evaluated a neighborhood environment survey and compared the physical activity and weight status of the residents in 2 neighborhoods. METHODS: On 2 occasions, 107 adults from neighborhoods with differing "walkability" were selected to complete a survey on their neighborhood environment. Physical activity was assessed by self-report and by accelerometer; height and weight were assessed by self-report. RESULTS: Neighborhood environment characteristics had moderate to high test-retest reliabilities. Residents of high-walkability neighborhoods reported higher residential density, land use mix, street connectivity, aesthetics, and safety. They had more than 70 more minutes of physical activity and had lower obesity prevalence (adjusted for individual demographics) than did residents of low-walkability neighborhoods. CONCLUSIONS: The reliability and validity of self-reported neighborhood environment subscales were supported. Neighborhood environment was associated with physical activity and overweight prevalence.     

Residential context, walking and obesity: two African-American neighborhoods compared

We compare walking and obesity rates in two African-American neighborhoods that are similar in urban form but different in level of neighborhood disadvantage. We find higher rates of utilitarian walking in the neighborhood with higher density and disadvantage and more destinations within walking distance. However levels of leisure walking and physical activity were not higher, and rates of obesity were not lower in the non-poor neighborhood with better maintenance, more sidewalks and recreational facilities. Different types of barriers to physical activity reported in the two neighborhoods and the high rates of overweight and obesity in both may explain the findings.     

Accessibility and connectivity in physical activity studies: the impact of missing pedestrian data

OBJECTIVE: One important characteristic in physical activity research into the built environment is network connectivity, usually calculated using street networks. However, a true pedestrian network may have very different connectivity than a street network. This study, conducted in 2004, examines the difference in walkability analyses when street networks versus pedestrian networks are used for four metropolitan suburbs in Perth, Western Australia. METHODS: A street network of Perth was used to represent the current standard of data for walkability analyses. Aerial photography from 2003 was used to create a pedestrian network, which incorporated pedestrian footpaths into the street network. The street and pedestrian networks were compared using three measures of connectivity: Pedsheds, link node ratio and pedestrian route directness. RESULTS: A comparison of the results using street versus pedestrian networks showed very different outcomes for conventional neighbourhood designs. Connectivity measures for conventional neighbourhoods improved up to 120% with the addition of pedestrian networks, although traditional neighbourhoods still had slightly better connectivity values overall. CONCLUSION: The true pedestrian network increases the connectivity of a neighbourhood and may have significant impact on these measures, especially in neighbourhoods with conventional street designs. It is critical that future studies incorporate pedestrian networks into their analyses.     

Complexity in Built Environment,Health, and Destination Walking: A Neighborhood-Scale Analysis

This study investigates the relationships between the built environment, the physical attributes of the neighborhood, and the residents’ perceptions of those attributes. It focuses on destination walking and self-reported health, and does so at the neighborhood scale. The built environment, in particular sidewalks, road connectivity, and proximity of local destinations, correlates with destination walking, and similarly destination walking correlates with physical health. It was found, however, that the built environment and health metrics may not be simply, directly correlated but rather may be correlated through a series of feedback loops that may regulate risk in different ways in different contexts. In particular, evidence for a feedback loop between physical health and destination walking is observed, as well as separate feedback loops between destination walking and objective metrics of the built environment, and destination walking and perception of the built environment. These feedback loops affect the ability to observe how the built environment correlates with residents’ physical health. Previous studies have investigated pieces of these associations, but are potentially missing the more complex relationships present. This study proposes a conceptual model describing complex feedback relationships between destination walking and public health, with the built environment expected to increase or decrease the strength of the feedback loop. Evidence supporting these feedback relationships is presented.     

The Built Environment and Obesity

Obesity results from a complex interaction between diet, physicalactivity, and the environment. The built environment encompassesa range of physical and social elements that make up the structureof a community and may influence obesity. This review summarizesexisting empirical research relating the built environment toobesity. The Medline, PsychInfo, and Web of Science databaseswere searched using the keywords "obesity" or "overweight" and"neighborhood" or "built environment" or "environment." Thesearch was restricted to English-language articles conductedin human populations between 1966 and 2007. To meet inclusioncriteria, articles had to 1) have a direct measure of body weightand 2) have an objective measure of the built environment. Atotal of 1,506 abstracts were obtained, and 20 articles metthe inclusion criteria. Most articles (84%) reported a statisticallysignificant positive association between some aspect of thebuilt environment and obesity. Several methodological issueswere of concern, including the inconsistency of measurementsof the built environment across studies, the cross-sectionaldesign of most investigations, and the focus on aspects of eitherdiet or physical activity but not both. Given the importanceof the physical and social contexts of individual behavior andthe limited success of individual-based interventions in long-termobesity prevention, more research on the impact of the builtenvironment on obesity is needed. environment design • obesity • residence characteristics • social environment     

Built environment and obesity by urbanicity in the U.S.

Based on the data from the Behavioral Risk Factor Surveillance System 2012, this study examines the association of neighborhood built environments with individual physical inactivity and obesity in the U.S. Multilevel modeling is used to control for the effects of individual socio-demographic characteristics. Neighborhood variables include built environment, poverty level and urbanicity at the county level. Among the built environment variables, a poorer street connectivity and a more prominent presence of fast-food restaurants are associated with a higher obesity risk (especially for areas of certain urbanicity levels). Analysis of data subsets divided by areas of different urbanicity levels and by gender reveals the variability of effects of independent variables, more so for the neighborhood variables than individual variables. This implies that some obesity risk factors are geographically specific and vary between men and women. The results lend support to the role of built environment in influencing people׳s health behavior and outcome, and promote public policies that need to be geographically adaptable and sensitive to the diversity of demographic groups.     

Impact of Urban Sprawl on Overweight,Obesity, and Physical Activity in Sydney,Australia

Obesity and inadequate physical activity are major risk factors for many diseases. The built environment plays an important role in influencing participation in physical activity. We aimed to determine whether urban sprawl in Sydney, Australia is associated with overweight/obesity and levels of physical activity. We used a cross-sectional multilevel study design to relate urban sprawl (based on population density) measured at an area level to overweight/obesity and levels of physical activity measured at an individual level whilst controlling for individual and area level covariates in metropolitan Sydney. Individual level data were obtained from the 2002 and 2003 New South Wales Population Health Survey. We had information on 7,290 respondents. The mean population density was 2,168 persons per square kilometer (standard deviation = 1,741, range = 218–7,045). After controlling for individual and area level covariates, for an inter-quartile increase in sprawl, the odds of being overweight was 1.26 (95% CI = 1.10–1.44), the odds of being obese was 1.47 (95% CI = 1.24–1.75), the odds of inadequate physical activity was 1.38 (95% CI = 1.21–1.57), and the odds of not spending any time walking during the past week was 1.58 (95% CI = 1.28–1.93). Living in more sprawling suburbs increases the risk of overweight/obesity and inadequate physical activity despite the relatively low levels of urban sprawl in metropolitan Sydney. Modifications to the urban environment to increase physical activity may be worthwhile.     

Physical Activity Resource Attributes and Obesity in Low-Income African Americans

More than two thirds of Americans are overweight or obese, and African Americans are particularly vulnerable to obesity when compared to Caucasians. Ecological models of health suggest that lower individual and environmental socioeconomic status and the built environment may be related to health attitudes and behaviors that contribute to obesity. This cross-sectional study measured the direct associations of neighborhood physical activity resource attributes with body mass index (BMI) and body fat among low-income 216 African Americans (Mean (M) age = 43.5 years, 63.9% female) residing in 12 public housing developments. The Physical Activity Resource Assessment instrument measured accessibility, incivilities, and the quality of features and amenities of each physical activity resource within an 800-m radius around each housing development. Sidewalk connectivity was measured using the Pedestrian Environment Data Scan instrument. Ecological multivariate regression models analyzed the associations between the built environment attributes and resident BMI and body fat at the neighborhood level. Sidewalk connectivity was associated with BMI (M = 31.3 kg/m²; p < 0.05). Sidewalk connectivity and resource accessibility were associated with body fat percentage (M = 34.8%, p < 0.05). Physical activity resource attributes and neighborhood sidewalk connectivity were related to BMI and body fat among low-income African Americans living in housing developments. This research was funded by the Robert Wood Johnson Foundation’s Active Living Research program.     

Neighborhood design and walking. A quasi-experimental longitudinal study

BACKGROUND: Few studies have employed longitudinal data to examine associations between the physical environment and walking. METHODS: Using cross-sectional (n=70) and longitudinal (n=32) data (collected 2003-2006), associations of neighborhood design and demographics with walking were examined. Participants were low-income, primarily African-American women in the southeastern U.S. Through a natural experiment, some women relocated to neo-traditional communities (experimental group) and others moved to conventional suburban neighborhoods (control group). RESULTS: Post-move cross-sectional comparisons indicated that women in neo-traditional neighborhoods did not, on average, walk more than women in suburban neighborhoods. Race and household size were significant predictors of physical activity. Additionally, using longitudinal data, this study controlled for the effects of pre-move walking and demographics. Analyses examined the effects of environmental factors (e.g., density, land-use mix, street-network patterns) on post-move walking. Women who moved to places with fewer culs-de-sac, on average, walked more. Unexpectedly, increases in land-use mix were associated with less walking. CONCLUSIONS: Results suggest that neo-traditional neighborhood features alone (e.g., sidewalks, front porches, small set-back distances) may not be enough to affect walking; however, changes in street patterns may play a role.     

Environmental and policy factors associated with overweight among adults in Missouri

PURPOSE: To measure the association between environmental and policy factors (i.e., community perceptions, community infrastructure, and worksite infrastructure) and being overweight. DESIGN: Cross-sectional data from the Missouri Cardiovascular Disease Survey, a one-time random-digit-dialed telephone interview of noninstitutionalized adults. SETTING: Missouri, 1999 to 2000. SUBJECTS: The response rate was 69.6%. A total of 2821 adults completed the interview. The sample was weighted to represent the population of Missouri: 52% female, 71% white, and 59% overweight. MEASURES: The survey comprised 92 closed-ended multiple-choice items. Overweight was defined as a body mass index greater than or equal to 25 kg/m2 on the basis of self-reported height and weight. RESULTS: After adjustment for demographic and behavioral factors, environmental variables associated with being overweight included negative (i.e., unsafe and unpleasant) community perceptions (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and the absence of outdoor exercise facilities (OR = 1.2; CI = 1.0, 1.5). Worksite policy variables were not related to the outcome; however, negative community perceptions (OR = 2.8; CI = 1.5, 5.2) and the absence of sidewalks and shoulders (OR = 1.7; CI = 1.3, 2.4) were associated with overweight among employed persons. CONCLUSIONS: An ecological perspective, focusing on the physical and social environment, was adopted to address the subject of overweight and obesity. Results of this study show that negative perceptions of the physical environment and the absence of enabling infrastructure are modestly associated with overweight, in comparison with other known risk factors. Environmental and policy interventions that promote healthier lifestyles by encouraging physical activity and healthy eating may have an effect on reducing the prevalence of overweight and obesity.     

Regional differences in walking frequency and BMI: What role does the built environment play for Blacks and Whites?

Studies have found that urban sprawl explains many regional differences in BMI and walking behavior. Yet, African Americans, who often live in dense, urban neighborhoods with exemplar street connectivity, suffer disproportionately from obesity. This study analyzed walking and BMI among 1124 Whites and 691 Blacks in Los Angeles County and southern Louisiana in relation to neighborhood safety, street connectivity, and walking destinations. While the built environment partly explains regional differences in walking and BMI among Whites, the magnitude of effect was modest. There were no regional differences in outcomes for African Americans; individual rather than neighborhood characteristics served as the best predictors.     

Neighbourhood built environment and physical function among mid-to-older aged adults: A systematic review

This systematic review included 23 quantitative studies that estimated associations between aspects of the neighbourhood built environment and physical function among adults aged ≥45 years. Findings were analysed according to nine aspects of the neighbourhood built environment: walkability, residential density, street connectivity, land use mix, public transport, pedestrian infrastructure, aesthetics, safety and traffic. Evidence was found for a positive association of pedestrian infrastructure and aesthetics with physical function, while weaker evidence was found for land use mix, and safety from crime and traffic. There was an insufficient number of studies for walkability, residential density, street connectivity and access to public transport.