The relationship of area-level sociodemographic characteristics, household composition and individual-level socioeconomic status on walking behavior among adults.

Understanding the contextual factors associated with why adults walk is important for those interested in increasing walking as a mode of transportation and leisure. This paper investigates the relationships between neighborhood-level sociodemographic context, individual level sociodemographic characteristics and walking for leisure and transport. Data from two community-based studies of adults (n=550) were used to determine the association between the area-sociodemographic environment (ASDE), calculated from U.S. Census variables, and individual-level SES as potential correlates of walking behavior. Descriptive statistics, mean comparisons and Pearson's correlations coefficients were used to assess bivariate relationships. Generalized estimating equations were used to model the relationship between ASDE, as quartiles, and walking behavior. Adjusted models suggest adults engage in more minutes of walking for transportation and less walking for leisure in the most disadvantaged compared to the least disadvantaged neighborhoods but adding individual level demographics and SES eliminated the significant results. However, when models were stratified for free or reduced cost lunch, of those with children who qualified for free or reduced lunch, those who lived in the wealthiest neighborhoods engaged in 10.7 minutes less of total walking per day compared to those living in the most challenged neighborhoods (p<0.001). Strategies to increase walking for transportation or leisure need to take account of individual level socioeconomic factors in addition to area-level measures.

Creating a replicable, valid cross-platform buffering technique: the sausage network buffer for measuring food and physical activity built environments.

BACKGROUND: Obesity researchers increasingly use geographic information systems to measure exposure and access in neighborhood food and physical activity environments. This paper proposes a network buffering approach, the "sausage" buffer. This method can be consistently and easily replicated across software versions and platforms, avoiding problems with proprietary systems that use different approaches in creating such buffers. METHODS: In this paper, we describe how the sausage buffering approach was developed to be repeatable across platforms and places. We also examine how the sausage buffer compares with existing alternatives in terms of buffer size and shape, measurements of the food and physical activity environments, and associations between environmental features and health-related behaviors. We test the proposed buffering approach using data from EAT 2010 (Eating and Activity in Teens), a study examining multi-level factors associated with eating, physical activity, and weight status in adolescents (n=2,724) in the Minneapolis/St. Paul metropolitan area of Minnesota. RESULTS: Results show that the sausage buffer is comparable in area to the classic ArcView 3.3 network buffer particularly for larger buffer sizes. It obtains similar results to other buffering techniques when measuring variables associated with the food and physical activity environments and when measuring the correlations between such variables and outcomes such as physical activity and food purchases. CONCLUSIONS: Findings from various tests in the current study show that researchers can obtain results using sausage buffers that are similar to results they would obtain by using other buffering techniques. However, unlike proprietary buffering techniques, the sausage buffer approach can be replicated across software programs and versions, allowing more independence of research from specific software.

Built Environment and Self-Rated Health: Comparing Young, Middle-Aged, and Older People in Chengdu, China.

OBJECTIVES: This article explores how the building-scale built environment is associated with self-rated health, examining differences in this association among younger, middle-aged, and older age groups. Features examined included building type, building condition, and sidewalk presence in front of dwellings. BACKGROUND: Understanding how the relationships between built environments and health vary across age groups helps to build a healthy environment for all. However, most studies have concentrated on the neighborhood or indoor environment, rather than whole buildings, and few have compared age groups. METHODS: This study analyzed survey data from 1,019 adults living in 40 neighborhoods in Chengdu, China, recruited through a clustered random sampling approach. It used a Bayesian logistic mixed-effects model with interaction terms between age-group indicators and other variables. RESULTS: Significant differences exist in the relationships of self-rated health with some environmental and other indicators among age groups. For older people, living in multi-floor buildings, having a household smoker, and undertaking fewer hours of weekly exercise were associated with lower odds of reporting good, very good, or excellent health. These relationships were not identified among middle-aged and younger people. More education was associated with higher odds of reporting better health among older and middle-aged groups. CONCLUSIONS: Older people experience more health-related challenges compared to middle-aged and younger people. However, among the examined built environment factors, building type was the only significant factor related to self-rated health among older people. To promote health among older people, this study recommends adding elevators in the multi-floor buildings.

Social Technology: An Interdisciplinary Approach to Improving Care for Older Adults.

Population aging is a defining demographic reality of our era. It is associated with an increase in the societal burden of delivering care to older adults with chronic conditions or frailty. How to integrate global population aging and technology development to help address the growing demands for care facing many aging societies is both a challenge and an opportunity for innovation. We propose a social technology approach that promotes use of technologies to assist individuals, families, and communities to cope more effectively with the disabilities of older adults who can no longer live independently due to dementia, serious mental illness, and multiple chronic health problems. The main contributions of the social technology approach include: (1) fostering multidisciplinary collaboration among social scientists, engineers, and healthcare experts; (2) including ethical and humanistic standards in creating and evaluating innovations; (3) improving social systems through working with those who deliver, manage, and design older adult care services; (4) promoting social justice through social policy research and innovation, particularly for disadvantaged groups; (5) fostering social integration by creating age-friendly and intergenerational programs; and (6) seeking global benefit by identifying and generalizing best practices. As an emergent, experimental approach, social technology requires systematic evaluation in an iterative process to refine its relevance and uses in different local settings. By linking technological interventions to the social and cultural systems of older people, we aim to help technological advances become an organic part of the complex social world that supports and sustains care delivery to older adults in need.

Neighbourhood food environments: are they associated with adolescent dietary intake, food purchases and weight status?

OBJECTIVE: To examine neighbourhood food environments, adolescent nutrition and weight status. DESIGN: Cross-sectional, observational study. SETTING: Minneapolis/St. Paul metropolitan region, Minnesota, USA. SUBJECTS: A total of 349 adolescents were recruited to the study. Participants completed 24 h dietary recalls and had their weight and height measured. They also reported demographic information and other diet-related behaviours. Geographic Information Systems were used to examine the availability and proximity of food outlets, particularly those captured within the 800, 1600 and/or 3000 m network buffers around participants' homes and schools. RESULTS: Adjusting for gender, age and socio-economic status, adolescents' sugar-sweetened beverage intake was associated with residential proximity to restaurants (including fast food), convenience stores, grocery stores and other retail facilities within the 800 and/or 1600 m residential buffers (P ≤ 0·01). BMI Z-score and percentage body fat were positively associated with the presence of a convenience store within a 1600 m buffer. Other individual-level factors, such as energy, fruit and vegetable intake, as well as convenience store and fast food purchasing, were not significantly associated with features of the residential neighbourhood food environment in adjusted models. In addition, school neighbourhood environments yielded few associations with adolescent outcomes. CONCLUSIONS: Many factors are likely to have an important role in influencing adolescent dietary intake and weight status. Interventions aimed at increasing neighbourhood access to healthy foods, as well as other approaches, are needed.

Alcohol outlets and youth alcohol use: exposure in suburban areas.

The purpose of this study was to explore how exposure to alcohol outlets (around home and school) influenced alcohol use among 242 high-school students (mean age 16.4, 48.8% male, 93.4% White). Results found no relationship between alcohol outlet exposure, using a measure of both distance to and density around students' homes and schools, and alcohol use. This study suggests that outlet exposure may not influence alcohol use among mostly White, middle-class, and suburban youth. However, the lack of association may also reflect the lower level of alcohol outlets present in low-density residential environments as well as differences in accessibility.

Does the built environment relate to the metabolic syndrome in adolescents?

This article examines the influence of the neighborhood environment on blood profiles, percent body fat, blood pressure, and the metabolic syndrome (MetS) in adolescents. One hundred and eighty-eight adolescents (10-16 yr) agreed to have a fasting blood sample drawn in addition to measures of weight, height, percent fat, and blood pressure. A MetS cluster score was derived by calculating the sum of the sample-specific z-scores from the percent body fat, fasting glucose, high-density lipoprotein cholesterol (negative), triglyceride, and systolic blood pressure. Geographic Information Systems (GIS) technology was used to calculate the distance to and density of built environmental features. Spearman correlation was used to identify significant (p<0.05) relationships between the built environment and the MetS. Statistically significant correlations were added to linear regression models, adjusted for pubertal status, age, and sex. Multivariate linear regression models revealed significant associations between an increased distance to convenience stores and the MetS. The results of this study suggest a role for the built environment in the development of the MetS.

The $64 million question. Invest in good teaching.

University of Minnesota School of Public health, USA.

Relation of modifiable neighborhood attributes to walking.

BACKGROUND: There is a paucity of research examining associations between walking and environmental attributes that are more modifiable in the short term, such as car parking availability, access to transit, neighborhood traffic, walkways and trails, and sidewalks. METHODS: Adults were recruited between April 2004 and September 2006 in the Minneapolis-St Paul metropolitan area and in Montgomery County, Maryland using similar research designs in the two locations. Self-reported and objective environmental measures were calculated for participants' neighborhoods. Self-reported physical activity was collected through the long form of the International Physical Activity Questionnaire (IPAQ-LF). Generalized estimating equations were used to examine adjusted associations between environmental measures and transport and overall walking. RESULTS: Participants (n=887) averaged 47 years of age (SD=13.65) and reported 67 min/week (SD=121.21) of transport walking and 159 min/week (SD=187.85) of non-occupational walking. Perceived car parking difficulty was positively related to higher levels of transport walking (OR 1.41, 95%CI: 1.18, 1.69) and overall walking (OR 1.18, 95%CI: 1.02, 1.37). Self-reported ease of walking to a transit stop was negatively associated with transport walking (OR 0.86, 95%CI: 0.76, 0.97), but this relationship was moderated by perceived access to destinations. Walking to transit also was related to non-occupational walking (OR 0.85, 95%CI: 0.73, 0.99). CONCLUSIONS: Parking difficulty and perceived ease of access to transit are modifiable neighborhood characteristics associated with self-reported walking.

Housing, the Built Environment, and the Good Life.

At any age, the pursuit of a good life is easier in a physical environment that promotes health, supports activities important to self-fulfillment, and facilitates connections to the larger community. In old age, the home and neighborhood environments are particularly important: they are the locations where older people spend most their time, and they can have a great impact on independence, social connection, feelings of self-worth, and physical and emotional well-being. Within the urban planning field, home and neighborhood characteristics are important dimensions of debates about the measurement of human progress and quality of life, particularly as an alternative to purely economic measures. They are also key issues in public health, particularly as they relate to physical, social, and mental well-being. Here, we focus on how to improve the fit of environments for people as they age.

The effects of neighborhood density and street connectivity on walking behavior: the Twin Cities walking study.

A growing body of health and policy research suggests residential neighborhood density and street connectivity affect walking and total physical activity, both of which are important risk factors for obesity and related chronic diseases. The authors report results from their methodologically novel Twin Cities Walking Study; a multilevel study which examined the relationship between built environments, walking behavior and total physical activity. In order to maximize neighborhood-level variation while maintaining the exchangeability of resident-subjects, investigators sampled 716 adult persons nested in 36 randomly selected neighborhoods across four strata defined on density and street-connectivity - a matched sampling design. Outcome measures include two types of self-reported walking (from surveys and diaries) and so-called objective 7-day accelerometry measures. While crude differences are evident across all outcomes, adjusted effects show increased odds of travel walking in higher-density areas and increased odds of leisure walking in low-connectivity areas, but neither density nor street connectivity are meaningfully related to overall mean miles walked per day or increased total physical activity. Contrary to prior research, the authors conclude that the effects of density and block size on total walking and physical activity are modest to non-existent, if not contrapositive to hypotheses. Divergent findings are attributed to this study's sampling design, which tends to mitigate residual confounding by socioeconomic status.

The Irvine-Minnesota inventory to measure built environments: development.

BACKGROUND: Researchers and policymakers increasingly identify active living-including walking and bicycling for travel and recreation-as a potential strategy to increase rates of physical activity in the United States. Understanding the impact of the built environment on physical activity levels requires reliable methods to measure potentially relevant built environment features. This paper presents an audit tool-the Irvine Minnesota Inventory-that was designed to measure a wide range of built environment features that are potentially linked to active living, especially walking. METHODS: The inventory was created through a literature review, focus group interviews, a panel of experts, and field testing in 27 settings. The inventory was developed in 2003-2004. RESULTS: The Irvine Minnesota Inventory includes 162 items, organized into four domains: accessibility (62 items), pleasurability (56 items), perceived safety from traffic (31 items), and perceived safety from crime (15 items). (Some items are in multiple domains.) The inventory includes both a paper version and a version in Microsoft Access, to allow data to be input directly into the computer. CONCLUSIONS: Limitations of methods used to develop the inventory are discussed. Strategies are offered for using the Irvine Minnesota Inventory to systematically and reliably measure characteristics of the built environment that are potentially linked to active living.

The Irvine-Minnesota inventory to measure built environments: reliability tests.

BACKGROUND: Inter-rater reliability is an important element of environmental audit tools. This paper presents results of reliability tests of the Irvine-Minnesota Inventory, an extensive audit tool aimed at measuring a broad range of built environment features that may be linked to active living. METHODS: Inter-rater reliability was measured by percentage agreement between observers. Reliability was tested on a broad range of sites in both California and Minnesota. RESULTS: For the variables that remained in the inventory, in tests conducted at the University of California-Irvine, 76.8% of the variables had >80% agreement among the three raters. In tests conducted at the University of Minnesota, 99.2% of the variables had >80% agreement among the two raters. CONCLUSIONS: Reliability was high for most items. The inventory was modified to eliminate items with low reliability. Differences in the use of the inventory and the goals of the research led to generally higher reliability in Minnesota. Those differences, limitations, and directions for future research are discussed.

Perceived and Police-Reported Neighborhood Crime: Linkages to Adolescent Activity Behaviors and Weight Status.

PURPOSE: Inadequate physical activity and obesity during adolescence are areas of public health concern. Questions exist about the role of neighborhoods in the etiology of these problems. This research addressed the relationships of perceived and objective reports of neighborhood crime to adolescent physical activity, screen media use, and body mass index (BMI). METHODS: Socioeconomically and racially/ethnically diverse adolescents (N = 2,455, 53.4% female) from 20 urban, public middle and high schools in Minneapolis/St. Paul, Minnesota responded to a classroom survey in the Eating and Activity in Teens 2010 study. BMI was measured by research staff. Participants' mean age was 14.6 (standard deviation = 2.0); 82.7% represented racial/ethnic groups other than non-Hispanic white. Linear regressions examined associations between crime perceived by adolescents and crime reported to police and the outcomes of interest (BMI z-scores, physical activity, and screen time). Models were stratified by gender and adjusted for age, race/ethnicity, socioeconomic status, and school. RESULTS: BMI was positively associated with perceived crime among girls and boys and with reported crime in girls. For girls, there was an association between higher perceived crime and increased screen time; for boys, between higher reported property crime and reduced physical activity. Perceived crime was associated with reported crime, both property and personal, in both genders. CONCLUSIONS: Few prior studies of adolescents have studied the association between both perceived and reported crime and BMI. Community-based programs for youth should consider addressing adolescents' safety concerns along with other perceived barriers to physical activity. Interventions targeting actual crime rates are also important.

Youth dietary intake and weight status: healthful neighborhood food environments enhance the protective role of supportive family home environments.

The aim of this study is to investigate individual and joint associations of the home environment and the neighborhood built environment with adolescent dietary patterns and body mass index (BMI) z-score. Racially/ethnically and socioeconomically diverse adolescents (n=2682; 53.2% girls; mean age14.4 years) participating in the EAT 2010 (Eating and Activity in Teens) study completed height and weight measurements and surveys in Minnesota middle and high schools. Neighborhood variables were measured using Geographic Information Systems data. Multiple regressions of BMI z-score, fruit and vegetable intake, and fast food consumption were fit including home and neighborhood environmental variables as predictors and also including their interactions to test for effect modification. Supportive family environments (i.e., higher family functioning, frequent family meals, and parent modeling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Associations between the built environment and adolescent outcomes were fewer. Interaction results, although not all consistent, indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighborhood was supportive of healthful behavior. Public health interventions that simultaneously improve both the home environment and the neighborhood environment of adolescents may have a greater impact on adolescent obesity prevention than interventions that address one of these environments alone.

Effect of street connectivity and density on adult BMI: results from the Twin Cities Walking Study.

BACKGROUND: The prevalence of overweight and obesity in the US population has risen dramatically in recent years. To try to explain this, some studies have examined the association between the built environment and obesity (measured using the body mass index (BMI)). Most of these studies have not sought to identify causal effects, but rather correlations. METHODS: Data from the Twin Cities Walking Study were used to examine the effect of population density and block size on BMI. Although the Twin Cities Walking Study is a cross-sectional observational study, the matched-sampling design is novel in that it maximises environmental variance while minimising person variance to enhance exchangeability of subjects and more closely mimic an experimental study. RESULTS: Contrary to expectations, the hypothesised most walkable neighbourhood (high density, small block stratum) had the greatest mean and median BMI. After adjusting for demographic covariates, physical activity and clustering due to neighbourhood, no conclusive effect of population density by block size on BMI was found (ß=-1.024, 95% CI -2.408 to 0.359). CONCLUSION: There is no evidence of an effect of population density by block size on BMI.

Reliability testing of the Pedestrian and Bicycling Survey (PABS) method.

BACKGROUND: The Pedestrian and Bicycling Survey (PABS) is a questionnaire designed to be economical and straightforward to administer so that it can be used by local governments interested in measuring the amount and purposes of walking and cycling in their communities. In addition, it captures key sociodemographic characteristics of those participating in these activities. METHODS: In 2009 and 2010 results from the 4-page mail-out/mail-back PABS were tested for reliability across 2 administrations (test-retest reliability). Two versions--early and refined--were tested separately with 2 independent groups of university students from 4 universities (N = 100 in group 1; N = 87 in group 2). Administrations were 7 to 9 days apart. RESULTS: Almost all survey questions achieved adequate to excellent reliability. CONCLUSIONS: Transportation surveys have not typically been tested for reliability making the PABS questionnaire an important new option for improving information collection about travel behavior, particularly walking and cycling.

Adolescent physical activity and the built environment: a latent class analysis approach.

This study used latent class analysis to classify adolescent home neighborhoods (n=344) according to built environment characteristics, and tested how adolescent physical activity, sedentary behavior, and screen time differ by neighborhood type/class. Four distinct neighborhood classes emerged: (1) low-density retail/transit, low walkability index (WI), further from recreation; (2) high-density retail/transit, high WI, closer to recreation; (3) moderate-high-density retail/transit, moderate WI, further from recreation; and (4) moderate-low-density retail/transit, low WI, closer to recreation. We found no difference in adolescent activity by neighborhood class. These results highlight the difficulty of disentangling the potential effects of the built environment on adolescent physical activity.

Do adolescents who live or go to school near fast-food restaurants eat more frequently from fast-food restaurants?

This population-based study examined whether residential or school neighborhood access to fast food restaurants is related to adolescents' eating frequency of fast food. A classroom-based survey of racially/ethnically diverse adolescents (n=2724) in 20 secondary schools in Minneapolis/St. Paul, Minnesota was used to assess eating frequency at five types of fast food restaurants. Black, Hispanic, and Native American adolescents lived near more fast food restaurants than white and Asian adolescents and also ate at fast food restaurants more often. After controlling for individual-level socio-demographics, adolescent males living near high numbers fast food restaurants ate more frequently from these venues compared to their peers.

Patterns of obesogenic neighborhood features and adolescent weight: a comparison of statistical approaches.

BACKGROUND: Few studies have addressed the potential influence of neighborhood characteristics on adolescent obesity risk, and findings have been inconsistent. PURPOSE: Identify patterns among neighborhood food, physical activity, street/transportation, and socioeconomic characteristics and examine their associations with adolescent weight status using three statistical approaches. METHODS: Anthropometric measures were taken on 2682 adolescents (53% female, mean age=14.5 years) from 20 Minneapolis/St. Paul MN schools in 2009-2010. Neighborhood environmental variables were measured using GIS data and by survey. Gender-stratified regressions related to BMI z-scores and obesity to (1) separate neighborhood variables; (2) composites formed using factor analysis; and (3) clusters identified using spatial latent class analysis in 2012. RESULTS: Regressions on separate neighborhood variables found a low percentage of parks/recreation, and low perceived safety were associated with higher BMI z-scores in boys and girls. Factor analysis found five factors: away-from-home food and recreation accessibility, community disadvantage, green space, retail/transit density, and supermarket accessibility. The first two factors were associated with BMI z-score in girls but not in boys. Spatial latent class analysis identified six clusters with complex combinations of both positive and negative environmental influences. In boys, the cluster with highest obesity (29.8%) included low SES, parks/recreation, and safety; high restaurant and convenience store density; and nearby access to gyms, supermarkets, and many transit stops. CONCLUSIONS: The mix of neighborhood-level barriers and facilitators of weight-related health behaviors leads to difficulties disentangling their associations with adolescent obesity; however, statistical approaches including factor and latent class analysis may provide useful means for addressing this complexity.