Understanding environmental influences on walking; Review and research agenda

BACKGROUND: Understanding how environmental attributes can influence particular physical activity behaviors is a public health research priority. Walking is the most common physical activity behavior of adults; environmental innovations may be able to influence rates of participation. METHOD: Review of studies on relationships of objectively assessed and perceived environmental attributes with walking. Associations with environmental attributes were examined separately for exercise and recreational walking, walking to get to and from places, and total walking. RESULTS: Eighteen studies were identified. Aesthetic attributes, convenience of facilities for walking (sidewalks, trails); accessibility of destinations (stores, park, beach); and perceptions about traffic and busy roads were found to be associated with walking for particular purposes. Attributes associated with walking for exercise were different from those associated with walking to get to and from places. CONCLUSIONS: While few studies have examined specific environment-walking relationships, early evidence is promising. Key elements of the research agenda are developing reliable and valid measures of environmental attributes and walking behaviors, determining whether environment-behavior relationships are causal, and developing theoretical models that account for environmental influences and their interactions with other determinants.     

Associations between perceived neighborhood environmental attributes and adults' sedentary behavior: findings from the U.S.A., Australia and Belgium

Sedentary behaviors are associated with multiple health problems, independently of physical activity. Neighborhood environment attributes might influence sedentary behaviors, but few studies have investigated these relationships. Moreover, all previous studies have been conducted within single countries, limiting environmental variability. We investigated the shape of associations between perceived neighborhood environment attributes and sedentary behavior in three countries; and whether these associations differed by country and gender. Data from U.S.A. (Seattle and Baltimore regions), Australia (Adelaide) and Belgium (Ghent) were pooled. Data collection took place between 2002 and 2008. In total, 6014 adults (20-65 years, 55.7% women) were recruited in high-/low-walkability and high-/low-income neighborhoods. All participants completed the International Physical Activity Questionnaire (domain-specific physical activity, transport-related sitting and overall time spent sitting) and the Neighborhood Environmental Walkability Scale (environmental perceptions). The number of destinations within a 20 min walk from home, perceiving few cul-de-sacs, good walking and cycling facilities, and traffic safety were included in an index of motorized transport correlates. This index was linearly negatively associated with motorized transport time, so the higher the scores on the index (more activity-friendliness), the lower the amount of motorized transport. No gender- or country-differences were identified. Perceived aesthetics and proximity of destinations were included in an index of overall sitting time correlates. A linear negative relationship with overall sitting time was found, but associations were stronger for men and not significant in Belgian adults. In conclusion, consistent and expected correlates were found for motorized transport in the three countries, but results were less clear for overall sitting time. Future studies should include even more countries to maximize environmental variability, but present findings suggest that neighborhoods may be designed to improve health through supporting more active and less sedentary transportation, which can be expected to have health benefits.     

Distinct associations of different sedentary behaviors with health-related attributes among older adults

ObjectiveLeisure-time sedentary behaviors (LTSBs) have been associated adversely with health outcomes. However, limited research has focused on different categories of LTSB. We aimed at identifying categories of LTSBs and examining their separate associations with indices of health among Japanese older adults.MethodsA postal survey collected data on self-reported health, psychological distress, body mass index, moderate-to-vigorous physical activity (MVPA), LTSBs (five behaviors) and socio-demographic characteristics from 1,580 Japanese older adults (67% response rate; 65–74 years) in 2010. Exploratory factor analysis was used to classify LTSBs. Odds ratios (ORs) were calculated for associations of LTSB categories with self-reported health, psychological distress, overweight, and lower MVPA. Data were analyzed in 2013.ResultsTwo categories of LTSB: passive sedentary time (consisting of TV time, listening or talking while sitting, and sitting around) and mentally-active sedentary time (consisting of computer-use and reading books or newspapers) were identified. Higher passive sedentary time was associated with a higher odds of being overweight (OR: 1.39, [95% CI: 1.08–1.80]), and lower MVPA (1.26, [1.02–1.54]). Higher mentally-active sedentary time was associated with lower odds of lower MVPA (0.70, [0.57–0.86]).ConclusionsTwo types of sedentary time—passive and mentally-active—may play different roles in older adults' well-being.     

Perceived neighborhood environmental attributes associated with adults' transport-related walking and cycling: Findings from the USA, Australia and Belgium

ABSTRACT: BACKGROUND: Active transportation has the potential to contribute considerably to overall physical activity levels in adults and is likely to be influenced by neighborhood-related built environment characteristics. Previous studies that examined the associations between built environment attributes and active transportation, focused mainly on transport-related walking and were conducted within single countries, limiting environmental variability. We investigated the direction and shape of relationships of perceived neighborhood attributes with transport-related cycling and walking in three countries; and examined whether these associations differed by country and gender. METHODS: Data from the USA (Baltimore and Seattle), Australia (Adelaide) and Belgium (Ghent) were pooled. In total, 6,014 adults (20-65 years, 55.7% women) were recruited in high-/low-walkable and high-/low-income neighborhoods. All participants completed the Neighborhood Environmental Walkability Scale and the International Physical Activity Questionnaire. Generalized additive mixed models were used to estimate the strength and shape of the associations. RESULTS: Proximity to destinations, good walking and cycling facilities, perceiving difficulties in parking near local shopping areas, and perceived aesthetics were included in a 'cyclability' index. This index was linearly positively related to transport-related cycling and no gender- or country-differences were observed. The 'walkability' index consisted of perceived residential density, land use mix access, proximity of destinations and aesthetics. A non-linear positive relationship with transport-related walking was found. This association was stronger in women than in men, and country-specific associations were identified: the strongest association was observed in Seattle, the weakest in Adelaide. In Ghent, the association weakened at higher levels of walkability. CONCLUSIONS: For cycling, consistent correlates were found in the three countries, but associations were less straightforward for transport-related walking. Moreover, the identified neighborhood environmental correlates were different for walking compared to cycling. In order to further clarify the shape of these associations and reach more specific international guidelines for developing walkable and bikeable neighborhoods, future studies should include even more countries to maximize environmental variability.     

Toward a global agenda for research in environmental epidemiology

The global environment is in critical decline. Whether one's concern about environmental epidemiology stems from the perspectives of environmental health, climate change, ecological collapse, or growing inequity, clear problems exist. Natural capital resources are being depleted; disregard for the integrity of ecosystems is entrenched in current business practices. Indeed, despite increasing rhetoric to the contrary, the disregard displayed by those who hold power globally toward long-term sustainability and, thus, the health and well-being of future generations, could be described as wanton. Six years ago, the Millennium Development Goals were announced by the United Nations as a rallying point for action to achieve a sustainable future, particularly by reducing the gap between the "have mores" and "have nots." The attainment of these Goals is now endangered, as is, apparently, the spirit of optimism and idealism that inspired them at the Millennium Summit. We call for a reinvigoration of both concern about-and action on-sustainability. In particular, we appeal to those engaged in the field of environmental epidemiology (and other specialties with whom they engage) to consider how they might help by incorporating sustainability issues (including global ecological integrity and global environmental justice) into their own research programs. This incorporation would make a vital contribution to protect both present and future generations and to reduce resource and health gaps between North and South. Simply put, we propose that sustainability becomes integral to advancing the science of environmental epidemiology and related environmental disciplines.     

Associations of public open space attributes with active and sedentary behaviors in dense urban areas: A systematic review of observational studies

In the context of rapid urbanization, public open spaces in dense urban areas are critical built environment elements to support active lifestyles. Several reviews have explored the associations of public open space attributes with physically active and sedentary behavior. However, few reviews have included studies from Asia, and no studies have focused on dense urban areas. This systematic review analyzed 18 observational studies investigating associations between public open space attributes with physical activity and sedentary behavior in dense urban areas of East Asian countries, including Japan, Taiwan, China, and Hong Kong. We found that closer distance to and a greater number of public open spaces and features within them were positively associated with leisure-time physical activity. Places near water features and corridors within public open spaces were associated with more sedentary behavior. These findings inform landscape and urban design guidelines for (re)designing public open spaces to support active lifestyles in high dense urban areas.     

Neighborhood context and youth cardiovascular health behaviors

OBJECTIVES: This study sought to determine the relationships between race/ethnicity, socioeconomic status (SES), and cardiovascular health behaviors among youths and whether neighborhood characteristics are associated with such behaviors independently of individual characteristics. METHODS: Linear models determined the effects of individual and neighborhood characteristics (SES, social disorganization, racial/ethnic minority concentration, urbanization) on dietary habits, physical activity, and smoking among 8165 youths aged 12 to 21 years. RESULTS: Low SES was associated with poorer dietary habits, less physical activity, and higher odds of smoking. After adjustment for SES, Black race was associated with poorer dietary habits and lower odds of smoking. Hispanic ethnicity was associated with healthier dietary habits, lower levels of physical activity, and lower odds of smoking than non-Hispanic ethnicity. Low neighborhood SES and high neighborhood social disorganization were independently associated with poorer dietary habits, while high neighborhood Hispanic concentration and urbanicity were associated with healthier dietary habits. Neighborhood characteristics were not associated with physical activity or smoking. CONCLUSIONS: Changes in neighborhood social structures and policies that reduce social inequalities may enhance cardiovascular health behaviors.     

Neighborhood built environment associations with adolescents' location-specific sedentary and screen time

Less is known about how neighborhood environments relate to sedentary time as compared to physical activity. This study examined relations of perceived and objective neighborhood environments with TV time, total screen time, total sedentary time, sedentary time at home, sedentary time in the home neighborhood, and time spent at home, in 524 12–16 year olds. Better perceived aesthetics and a perceived neighborhood environment index were related to less TV and screen time, and greater cul-de-sac density was related to less total and home sedentary time. Greater street connectivity, mixed land use, and an objective neighborhood environmental index were related to more total sedentary time. Findings suggest that some neighborhood environment attributes may not have the same potential influences on limiting sedentary time as they do for supporting physical activity.     

Associations of device-measured sedentary time,mentally-passive and mentally-active sedentary behaviors with self-concept in adolescents

BackgroundThe purpose of this study was to analyze the associations of device-measured total sedentary time, self-reported mentally-active, and passive sedentary time with self-concept among adolescents.MethodsA cross-sectional study was conducted with 669 adolescents, aged 10–14 years, from the sixth grade of elementary school, in Londrina/PR, Brazil. The device-based sedentary time was measured using accelerometers (GT3X and GT3X+; ActiGraph), and 370 participants presented valid data. The self-reported sedentary time in different activities was summed and divided into mentally-active (playing electronic games, studying, and reading) and mentally-passive (watching TV, watching DVD, using computer for leisure) sedentary time. Self-concept was assessed using the Piers-Harris II Inventory. Body mass index, socioeconomic status, loneliness, sleep quality, sex, and age were included as confounders.ResultsMentally-passive sedentary time (β = −0.211, 95%CI:-0.402;-0.020) and device-based sedentary time (β = −0.103, 95%CI:-0.191;-0.015) were associated with lower self-concept. Mentally-active sedentary time was not associated with self-concept.ConclusionTotal device-based sedentary time and time in mentally-passive sedentary behaviors were associated with lower self-concept among adolescents, while mentally-active sedentary time was not associated with self-concept. Potential interventions on self-concept should focus on reducing mentally-passive sedentary time.     

Consumer involvement in health research: a review and research agenda

The involvement of consumers in health research is now Department of Health policy within the UK. Despite the existence of policy directives, there is a dearth of knowledge on the effects of such involvement. This paper critically reviews the state of our knowledge on this issue, and maps out a research agenda with the aim of stimulating systematic, empirical inquiry into consumer involvement in health research. The paper discusses definitions of 'the consumer'; considers why consumer involvement is believed to be important to health research; traces the development of the policy; analyses the epistemological and methodological implications of the policy; discusses the various levels of consumer involvement in research; and outlines the objections to the policy that have been put forward by clinicians and researchers. Four questions were identified during the review as being in need of theoretical and empirical attention: (1) how can consumer involvement in health research be further conceptualised? (2) how and why does consumer involvement influence health research? (3) how can the influence of consumers in health research be measured and evaluated? and (4) what factors are associated with 'successful' consumer involvement in health research?     

Clinical evaluation units: a research agenda

A new model for evaluating quality rests on the tripod of outcomes research, practice pattern analysis, and the tenets of continuous quality improvement. The hospital-based locus for this tripod could be clinical evaluation units. This article describes the conceptual framework, study design, and research challenges associated with an ongoing project whose purpose is to assess the current status of these clinical evaluation units in academic medical centers nationwide.     

Associations between depressive symptoms and sedentary behaviors in dyads: Longitudinal crossover effects

ObjectiveEvidence-based models linking depressive symptoms and sedentary behaviors suggest that they may both exacerbate each other, leading to a vicious cycle. While existing theory and research focus on within-individual associations between sedentary behaviors and depressive symptoms, this study investigated crossover effects (i.e., from one person to another) of sedentary behaviors of one person in the dyad on depressive symptoms in their partners. Second, we tested the crossover effects of depressive symptoms of one person in the dyad on sedentary behaviors in their partners.MethodsData from 320 dyads were analyzed using cross-lagged path models. Dyads included a person attempting to become more physically active (the focus person) and their partners, supporting behavior change of focus persons. Participants were 18–90 years old. Depressive symptoms were assessed with the Patient Health Questionnaire-9 and sedentary time was measured with GT3X-BT accelerometers at Time 1 (T1; baseline), Time 2 (T2; 8-month follow-up), and Time 3 (T3; 14-month follow-up).ResultsSignificant time-lagged crossover effects were found: focus persons' depressive symptoms (T1) predicted partners' sedentary time (T2); partners' sedentary time (T1) predicted focus persons' depressive symptoms (T2); and focus persons' depressive symptoms (T2) predicted partners’ sedentary time (T3). A significant indirect effect indicated that longer sedentary time among partners (T1) predicted more depressive symptoms among focus persons (T2), which in turn were associated with longer sedentary time among partners (T3).ConclusionsThe study provides preliminary support for a dyadic vicious cycle of sedentary behaviors and depressive symptoms.     

Next steps: envisioning a research agenda

The topic of diagnostic error is a relatively new one in the academic arena and lacks an organized research agenda. Participants at “Diagnostic Error in Medicine— 2008” formally considered this issue and provided initial suggestions. Recommendations were made to standardize taxonomies and definitions, especially in regard to what constitutes a delay in diagnosis. Error discovery needs emphasis, especially with autopsies becoming a rarity. Developing standardized tools to study diagnostic error in laboratory-like conditions was viewed as a top priority. Many issues were reviewed in regard to error generation (what conditions are error-prone, what is the role of the clinicians expertise, etc.), and error reduction. These included both system-level and cognitive interventions, with specific suggestions for each dimension.     

Compliance and intimacy: young adults' attempts to motivate health-promoting behaviors by romantic partners

Benefits of relational intimacy on health may derive from its influence on the success of verbal attempts to motivate romantic partners' compliance with suggested protective behaviors. The intimacy levels of 209 participants' romantic relationships were assessed, as were motivations to change 4 health behaviors in response to 8 appeal strategies. Intimacy had significant impacts on the estimated effectiveness of several appeals. Also, as intimacy increased, caring replaced the provision of health information as the most efficacious strategy for motivating dietary modification. Overall, appeals seeking safer sex and those employing liking, caring, and threat strategies were rated as generally most effective.