Neighbourhood socio-economic disadvantage and loneliness: the contribution of green space quantity and quality.

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48-77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.

Supportive care needs and psychosocial outcomes of rural versus urban women with breast cancer.

OBJECTIVE: To identify whether supportive care needs vary according to remoteness and area-level socio-economic status and to identify the combinations of socio-demographic, area-level and health factors that are associated with poorer quality of life, psychological distress and severity of unmet supportive care needs. METHODS: Cross sectional data was collected from women with a breast cancer diagnosis (n = 2635) in Queensland, Australia, through a telephone survey including socio-demographic, health, psychosocial and supportive care needs measures. Hierarchical regression and cluster analyses were applied to assess the predictors of unmet need and psychosocial outcomes and to identify socio-demographic and health status profiles of women, comparing their level of unmet needs and psychosocial outcomes. RESULTS: Women living in outer regional areas reported the highest severity of unmet need in the patient care domain. Greater unmet need for health systems and information and patient care was also evident for those in moderately and most disadvantaged areas. Three clusters were identified reflecting (1) older women with poorer health and lower education (19%); (2) younger educated women with better health and private insurance (61%); and (3) physically active women with localised cancer who had completed treatment (20%). Poorer outcomes were evident in the first two of these clusters. CONCLUSIONS: This better understanding of the combinations of characteristics associated with poorer psychosocial outcomes and higher unmet need can be used to identify women with higher supportive care needs early and to target interventions.

Individual socioeconomic position, neighbourhood disadvantage and mental well-being: a cross-sectional multilevel analysis of mid-age adults.

BACKGROUND: Socioeconomic disadvantage is associated with mental illness, yet its relationship with mental well-being is unclear. Mental well-being is defined as feeling good and functioning well. Benefits of mental well-being include reduced mortality, improved immune functioning and pain tolerance, and increased physical function, pro-social behaviour, and academic and job performance. This study aims to explore the relationship between individual socioeconomic position (SEP), neighbourhood disadvantage and mental well-being in mid-age adults. METHODS: Multilevel modelling was used to analyse data collected from 7866 participants from the second (2009) wave of HABITAT (How Areas in Brisbane Influence healTh and activiTy), a longitudinal study (2007-2018) of adults aged 40-65 years living in Brisbane, Australia. Mental well-being was measured using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). Exposure measures were education, occupation, household income, and neighbourhood socioeconomic disadvantage. RESULTS: The lowest MWB scores were observed for the least educated (ß = - 1.22, 95%CI = - 1.74, - 0.71), those permanently unable to work (ß = - 5.50, 95%CI = - 6.90, - 4.10), the unemployed (ß = - 2.62, 95%CI = - 4.12, - 1.13), and members of low-income households (ß = - 3.77, 95%CI = - 4.59, - 2.94). Residents of the most disadvantaged neighbourhoods had lower MWB scores than those living in the least disadvantaged neighbourhoods, after adjustment for individual-level SEP (ß = - 0.96, 95%CI = - 1.66, - 0.28). CONCLUSIONS: Both individual-level SEP and neighbourhood disadvantage are associated with mental well-being although the association is stronger for individual-level SEP. This research highlights the need to address individual and neighbourhood-level socioeconomic determinants of mental well-being.

A cross-sectional and longitudinal study of neighbourhood disadvantage and cardiovascular disease and the mediating role of physical activity.

We investigate the prospective association between neighbourhood-level disadvantage and cardiovascular disease (CVD) among mid-to-older aged adults and whether physical activity (PA) mediates this association. The data come from the HABITAT project, a multilevel longitudinal investigation of health and wellbeing in Brisbane. The participants were 11,035 residents of 200 neighbourhoods in 2007, with follow-up data collected in 2009, 2011, 2013 and 2016. Multilevel binomial regression was used for the cross-sectional analysis and mixed-effect parametric survival models were used for the longitudinal analysis. Models were adjusted for age, sex, education, occupation, and household income. Those with pre-existing CVD at baseline were excluded from the longitudinal analyses. The mediated effect of PA on CVD was examined using multilevel generalized structural equation modelling. There was a total of 20,064 person-year observations across the five time-points clustered at three levels. Results indicated that the incidence of CVD was significantly higher in the most disadvantaged neighbourhoods (OR 1.50; HR 1.29) compared with the least disadvantaged. Mediation analysis results revealed that 11.5% of the effect of neighbourhood disadvantage on CVD occurs indirectly through PA in the most disadvantaged neighbourhoods while the corresponding figure is 5.2% in the more advantaged areas. Key findings showed that neighbourhood disadvantage is associated with the incidence of CVD, and PA is a significant mediator of this relationship. Future research should investigate which specific social and built environment features promote or inhibit PA in disadvantaged areas as the basis for policy initiatives to address inequities in CVD.

Associations between supermarket availability and body size in Australia: a cross-sectional observational study comparing state and territory capital cities.

BACKGROUND: Residential environment features such as availability of supermarkets may shape dietary behaviour and thus overweight and obesity. This relationship may not be consistent between cities. This Australian national-level study examined: 1) the relationship between supermarket availability and body size; and 2) whether this relationship varied by capital city. METHODS: This study used 2017-18 Australian National Health Survey data including individual-level socio-demographic information (age, sex, country of birth, education, occupation, household income), and measured body size (height and weight to derive body mass index [BMI], and waist circumference [WC]). Objectively-expressed measures of residential environments included: counts of supermarkets (major chain outlets), counts of amenities (representing walkable destinations including essential services, recreation, and entertainment), and area of public open space - each expressed within road-network buffers at 1000 m and 1500 m; population density (1km2 grid cells); and neighbourhood disadvantage (Index of Relative Socioeconomic Disadvantage) expressed within Statistical Area Level 1 units. Data for adult respondents ≥18 years residing in each of Australia's state and territory capital cities (n = 9649) were used in multilevel models to estimate associations between supermarket availability and body size sequentially accounting for individual and other environment measures. An interaction term estimated city-specific differences in associations between supermarket availability and body size. Models were consequently repeated stratified by city. RESULTS: Body size (BMI and WC) and supermarket availability varied between cities. Initial inverse associations between supermarket availability and body size (BMI and WC) were attenuated to null with inclusion of all covariates, except for BMI in the 1000 m buffer model (beta = - 0.148, 95%CI -0.27, - 0.01, p = 0.025). In stratified analyses, the strengths of associations varied between cities, remaining statistically significant only for some cities (BMI: Melbourne, Brisbane Hobart; WC: Brisbane, Hobart) in fully adjusted models. Different patterns of attenuation of associations with inclusion of covariates were evident for different cities. CONCLUSIONS: For Australian capital cities, greater availability of supermarkets is associated with healthful body size. Marked between-city variations in body size, supermarket availability, and relationships between supermarket availability and body size do not, however, support universal, "one-size-fits-all" solutions to change built environments to support healthful body size.

Mix of destinations and sedentary behavior among Brazilian adults: a cross-sectional study.

BACKGROUND: Sedentary behavior is influenced by contextual, social, and individual factors, including the built environment. However, associations between the built environment and sitting time have not been extensively investigated in countries with economies in transition such as Brazil. The objective of this study is to examine the relationship between sitting-time and access to a mix of destinations for adults from Sao Paulo city, Brazil. METHODS: This study uses data from the Health Survey of Sao Paulo. Sedentary behavior was assessed by a questionnaire using two questions: total sitting time in minutes on a usual weekday; and on a usual weekend day. The mix of destinations was measured by summing the number of facilities (comprising bus stops, train/subway stations, parks, squares, public recreation centres, bike paths, primary health care units, supermarkets, food stores, bakeries, and coffee-shops) within 500 m of each participant's residence. Minutes of sitting time in a typical weekday and weekend day were the outcomes and the mix of destinations score in 500 m buffers was the exposure variable. Associations between the mix of destinations and sitting time were examined using multilevel linear regression: these models accounted for clustering within census tracts and households and adjusted for environmental, sociodemographic, and health-related factors. RESULTS: After adjustment for covariates, the mix of destinations was inversely associated with minutes of sitting time on a weekday (ß=- 8.8, p=0.001) and weekend day (ß=- 6.1, p=0.022). People who lived in areas with a greater mix of destinations had shorter average sitting times. CONCLUSION: Greater mix of destinations within 500 m of peoples' residences was inversely associated with sitting time on a typical weekday and weekend day. In Latin American cities like Sao Paulo built environments more favorable for walking may contribute to reducing sedentary behavior and prevent associated chronic disease.

Factors associated with being diagnosed with high severity of breast cancer: a population-based study in Queensland, Australia.

PURPOSE: This study explores factors that are associated with the severity of breast cancer (BC) at diagnosis. METHODS: Interviews were conducted among women (n = 3326) aged 20-79 diagnosed with BC between 2011 and 2013 in Queensland, Australia. High-severity cancers were defined as either Stage II-IV, Grade 3, or having negative hormone receptors at diagnosis. Logistic regression models were used to estimate odds ratios (ORs) of high severity BC for variables relating to screening, lifestyle, reproductive habits, family history, socioeconomic status, and area disadvantage. RESULTS: Symptom-detected women had greater odds (OR 3.38, 2.86-4.00) of being diagnosed with high-severity cancer than screen-detected women. Women who did not have regular mammograms had greater odds (OR 1.78, 1.40-2.28) of being diagnosed with high-severity cancer than those who had mammograms biennially. This trend was significant in both screen-detected and symptom-detected women. Screen-detected women who were non-smokers (OR 1.77, 1.16-2.71), postmenopausal (OR 2.01, 1.42-2.84), or employed (OR 1.46, 1.15-1.85) had greater odds of being diagnosed with high-severity cancer than those who were current smokers, premenopausal, or unemployed. Symptom-detected women being overweight (OR 1.67, 1.31-2.14), postmenopausal (OR 2.01, 1.43-2.82), had hormone replacement therapy (HRT) < 2 years (OR 1.60, 1.02-2.51) had greater odds of being diagnosed with high-severity cancer than those of healthy weight, premenopausal, had HRT > 10 years. CONCLUSION: Screen-detected women and women who had mammograms biennially had lower odds of being diagnosed with high-severity breast cancer, which highlighted the benefit of regular breast cancer screening. Women in subgroups who are more likely to have more severe cancers should be particularly encouraged to participate in regular mammography screening.

Neighborhood walkability and 12-year changes in cardio-metabolic risk: the mediating role of physical activity.

BACKGROUND: Living in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers. METHODS: The Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999-2000, 2004-05, and 2011-12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants' homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation. RESULTS: There was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P < 0.001), and high-density lipoprotein cholesterol (P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590). CONCLUSIONS: Our mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.

Associations Between Latent Classes of Perceived Neighborhood Destination Accessibility and Walking Behaviors in Older Adults of a Low-Density and a High-Density City.

To examine associations between perceived destination accessibility within different distances from home and self-reported overall amounts of walking for different purposes among older adults (aged ≥ 65 years) in Brisbane, Australia (N = 793) and Hong Kong, China (N = 484). Perceived neighborhood destination accessibility types were derived from latent class analysis using comparable measures of perceived distance to 12 destinations from epidemiological studies in the two cities. Associations of perceived destination accessibility with measures of within-neighborhood walking were also estimated in Hong Kong participants. Better perceived destination accessibility was positively associated with the likelihood of walking in Brisbane participants only. Perceived destination accessibility within a short distance from home (5-min walk) was negatively related to the amount of within-neighborhood walking for transport in Hong Kong residents who walked. Our findings suggest that providing moderate-to-high, but not extreme, levels of destination accessibility may be optimal for the promotion of walking in older community dwellers.

Neighborhood Disadvantage and Body Mass Index: A Study of Residential Relocation.

Natural experiments, such as longitudinal observational studies that follow-up residents as they relocate, provide a strong basis to infer causation between the neighborhood environment and health. In this study, we examined whether changes in the level of neighborhood disadvantage were associated with changes in body mass index (BMI) after residential relocation. This analysis included data from 928 residents who relocated between 2007 and 2013, across 4 waves of the How Areas in Brisbane Influence Health and Activity (HABITAT) study in Brisbane, Australia. Neighborhood disadvantage was measured using a census-derived composite index. For individual-level data, participants self-reported their height, weight, education, occupation, and household income. Data were analyzed using multilevel, hybrid linear models. Women residing in less disadvantaged neighborhoods had a lower BMI, but there was no association among men. Neighborhood disadvantage was not associated with within-individual changes in BMI among men or women when moving to a new neighborhood. Despite a growing body of literature suggesting an association between neighborhood disadvantage and BMI, we found this association may not be causal among middle-aged and older adults. Observing associations between neighborhood socioeconomic disadvantage and BMI over the life course, including the impact of residential relocation at younger ages, remains a priority for future research.

City planning and population health: a global challenge.

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Neighborhood socioeconomic disadvantage and body mass index among residentially stable mid-older aged adults: Findings from the HABITAT multilevel longitudinal study.

Despite a body of evidence on the relationship between neighborhood socioeconomic disadvantage and body mass index (BMI), few studies have examined this relationship over time among ageing populations. This study examined associations between level of neighborhood socioeconomic disadvantage and the rate of change in BMI over time. The sample included 11,035 participants aged between 40 and 65years at baseline from the HABITAT study, residing in 200 neighborhoods in Brisbane, Australia. Data were collected biennially over four waves from 2007 to 2013. Self-reported height and weight were used to calculate BMI, while neighborhood disadvantage was measured using a census-based composite index. All models were adjusted for age, education, occupation, and household income. Analyses were conducted using multilevel linear regression models. BMI increased over time at a rate of 0.08kg/m2 (95% CI 0.02, 0.13) and 0.17kg/m2 (95% CI 0.11, 0.29) per wave for men and women respectively. Both men and women residing in the most disadvantaged neighborhoods had a higher average BMI than their counterparts living in the least disadvantaged neighborhoods. There were no evident differences in the rate of BMI change over time by level of neighborhood disadvantage. The findings suggest that by mid-older age, the influence of neighborhood socioeconomic conditions over time on BMI may have already played out. Future research should endeavor to identify the genesis of neighborhood socioeconomic inequalities in BMI, the determinants of these inequalities, and then suitable approaches to intervening.

Associations between physical activity and the neighbourhood social environment: baseline results from the HABITAT multilevel study.

Limitations have arisen when measuring associations between the neighbourhood social environment and physical activity, including same-source bias, and the reliability of aggregated neighbourhood-level social environment measures. This study examines cross-sectional associations between the neighbourhood social environment (perceptions of incivilities, crime, and social cohesion) and self-reported physical activity, while accounting for same-source bias and reliability of neighbourhood-level exposure measures, using data from a large population-based clustered sample. This investigation included 11,035 residents aged 40-65years from 200 neighbourhoods in Brisbane, Australia, in 2007. Respondents self-reported their physical activity and perceptions of the social environment (neighbourhood incivilities, crime and safety, and social cohesion). Models were adjusted for individual-level education, occupation, and household income, and neighbourhood disadvantage. Exposure measures were generated via split clusters and an empirical Bayes estimation procedure. Data were analysed in 2016 using multilevel multinomial logistic regression. Residents of neighbourhoods with the highest incivilities and crime, and lowest social cohesion were reference categories. Individuals were more likely to be in the higher physical activity categories if they were in neighbourhoods with the lowest incivilities and the lowest crime. No associations were found between social cohesion and physical activity. This study provides a basis from which to gain a clearer understanding of the relationship between the neighbourhood social environment and individual physical activity. Further work is required to explore the pathways between perceptions of the neighbourhood social environment and physical activity.

Neighborhood disadvantage, individual-level socioeconomic position and physical function: A cross-sectional multilevel analysis.

INTRODUCTION: Understanding associations between physical function and neighborhood disadvantage may provide insights into which interventions might best contribute to reducing socioeconomic inequalities in health. This study examines associations between neighborhood-disadvantage, individual-level socioeconomic position (SEP) and physical function from a multilevel perspective. METHODS: Data were obtained from the HABITAT multilevel longitudinal (2007-13) study of middle-aged adults, using data from the fourth wave (2013). This investigation included 6004 residents (age 46-71years) of 535 neighborhoods in Brisbane, Australia. Physical function was measured using the PF-10 (0-100), with higher scores indicating better function. The data were analyzed using multilevel linear regression and were extended to test for cross-level interactions by including interaction terms for different combinations of SEP (education, occupation, household income) and neighborhood disadvantage on physical function. RESULTS: Residents of the most disadvantaged neighborhoods reported significantly lower physical function (men: ß -11.36 95% CI -13.74, -8.99; women: ß -11.41 95% CI -13.60, -9.22). These associations remained after adjustment for individual-level SEP. Individuals with no post-school education, those permanently unable to work, and members of the lowest household income had significantly poorer physical function. Cross-level interactions suggested that the relationship between household income and physical function is different across levels of neighborhood disadvantage for men; and for education and occupation for women. CONCLUSION: Living in a disadvantaged neighborhood was negatively associated with physical function after adjustment for individual-level SEP. These results may assist in the development of policy-relevant targeted interventions to delay the rate of physical function decline at a community-level.

The Family Life Course and Health: Partnership, Fertility Histories, and Later-Life Physical Health Trajectories in Australia.

Life course perspectives suggest that later-life health reflects long-term social patterns over an individual's life: in particular, the occurrence and timing of key roles and transitions. Such social patterns have been demonstrated empirically for multiple aspects of fertility and partnership histories, including timing of births and marriage, parity, and the presence and timing of a marital disruption. Most previous studies have, however, addressed particular aspects of fertility or partnership histories singly. We build on this research by examining how a holistic classification of family life course trajectories from ages 18 to 50, incorporating both fertility and partnership histories, is linked to later-life physical health for a sample of Australian residents. Our results indicate that long-term family life course trajectories are strongly linked to later-life health for men but only minimally for women. For men, family trajectories characterized by early family formation, no family formation, an early marital disruption, or high fertility are associated with poorer physical health. Among women, only those who experienced both a disrupted marital history and a high level of fertility were found to be in poorer health.

Ethnic differences in overweight and obesity and the influence of acculturation on immigrant bodyweight: evidence from a national sample of Australian adults.

BACKGROUND: Despite growing international migration and documented ethnic differences in overweight and obesity in developed countries, no research has described the epidemiology of immigrant overweight and obesity at a national level in Australia, a country where immigrants comprise 28.1 % of the population. The aim of this study was to examine ethnic differences in body mass index (BMI) and overweight/obesity in Australia and the influence of acculturation on bodyweight among Australian immigrants. METHODS: Data from the national Household Income and Labour Dynamics in Australia (HILDA) survey were used to examine mean BMI and odds of overweight/obesity comparing immigrants (n = 2 997) with Australian born (n = 13 047). Among immigrants, acculturation differences were examined by length of residence in Australia and age at migration. Data were modelled in a staged approach using multilevel linear and logistic regression, controlling for demographic and socioeconomic variables. RESULTS: Relative to Australian born, men from North Africa/Middle East and Oceania regions had significantly higher BMIs, and men from North West Europe, North East Asia and Southern and Central Asia had significantly lower BMIs. Among women, the majority of foreign born groups had significantly lower BMIs compared with Australian born. Male and female immigrants living in Australia for 15 years or more had significantly higher BMIs and increased odds of being overweight/obese respectively, compared with immigrants living in Australia for less than 5 years. Male immigrants arriving as adolescents were twice more likely to be overweight/obese and had significantly higher BMIs than immigrants who arrived as adults. Male and female immigrants who arrived as children (≤11 years) had significantly higher odds of adult overweight/obesity and BMIs. CONCLUSIONS: This study provides evidence of ethnic differences in overweight and obesity in Australia with male immigrants from North Africa/Middle East and Oceania regions being particularly vulnerable. In addition, this study suggests that greater acculturation may negatively impact immigrant bodyweight and recently arrived immigrants as well as those who arrive as children or adolescents may benefit from obesity prevention intervention. Public health policy targeted at and tailored to these immigrant cohorts will assist in the multi-pronged approach required to address the obesity epidemic.

A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight.

We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento-structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento-structural type interventions, remains crucial.

Change in walking for transport: a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults.

BACKGROUND: Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples' engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 - 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned? METHODS: The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression. RESULTS: The odds of being defined as a 'never walker' were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households. CONCLUSIONS: Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.