Accounting for residential and non-residential environments to measure contextual effects on health behavior : the case of recreational walking behavior

Thèse réalisée en cotutelle entre l'Université de Montréal et l'Université Pierre et Marie Curie, Paris 06, Sorbonne Universités.

Accounting for residential and non-residential environments to measure contextual effects on health behavior : the case of recreational walking behavior

Thèse réalisée en cotutelle entre l'Université de Montréal et l'Université Pierre et Marie Curie, Paris 06, Sorbonne Universités.

Development of a reliable measure of walking within and outside the local neighbourhood: RESIDE's neighborhood physical activity questionnarire.

Background: The RESIDential Environment project (RESIDE) is a longitudinal study evaluating the impact of a new residential design code on walking. Objective: To develop a reliable measure of walking – undertaken within and outside the neighborhood – and overall physical activity. Methods: A test–retest reliability study was undertaken (n = 82, mean age 39 years). The instrument was based on the International Physical Activity Questionnaire (IPAQ-short version) and Active Australia Survey. It measured usual frequency and duration of (1) recreational- and transport-related walking within and outside the neighborhood and (2) other vigorous and moderate physical activities. Results: Reliability of recall of whether participants had walked within (k = 0.84) and outside (0.73) the neighborhood was acceptable. Similarly, recall of frequency and duration of transport and recreational-related walking within the neighborhood was excellent (ICC ≥ 0.82), as was recall of transport-related walking trips outside the neighborhood (ICC ≥ 0.84). Reliability for duration of recreational walking outside the neighborhood was fair to good (ICC = 0.55). The reliability of indices of total physical activity based on MET min/week (ICC = 0.82) and MET min/week dichotomized to ‘sufficient’ physical activity for health (kappa = 0.67) were both acceptable. Conclusions:  The Neighborhood Physical Activity Questionnaire (NPAQ) is sufficiently reliable for studies examining environmental correlates of walking within the neighborhood.

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.

Recreational facilities and leisure-time physical activity : an analysis of moderators and self-efficacy as a mediator

Objective: To examine socio-demographic and psychosocial moderators, and self-efficacy as a mediator of the cross-sectional relationships between having access to recreational facilities and leisure-time physical activity (LTPA); to investigate the extent to which the environment-LTPA associations could be explained by self-selection to neighborhoods.

Design: A two-stage stratified sampling design was used to recruit 2,650 adults (aged 20-65) from 32 urban communities varying in walkability and socioeconomic status. Participants reported perceived access to facilities and home equipment for LTPA, weekly minutes of LTPA, self-efficacy for and enjoyment of LTPA, reasons for neighborhood selection, and socio-demographic characteristics.

Main Outcome Measures: Self-reported recreational walking and other forms of moderate-to-vigorous LTPA expressed in MET-minutes.

Results: Specific types of recreational facilities were independently  associated with LTPA. Age, education, being overweight/ obese, reasons for neighborhood selection, enjoyment of, and self-efficacy for LTPA moderated these relationships. Self-efficacy was not a significant mediator of these cross-sectional associations.

Conclusion: These findings have potentially significant implications for the planning of environmental interventions aimed at increasing population-level LTPA particularly in those who are less attitudinally inclined to being physically active.

Associations of neighbourhood greenness with physical and mental health : do walking, social coherence and local social interaction explain the relationships?

Background: Studies have shown associations between health indices and access to “green” environments but the underlying mechanisms of this association are not clear.

Objectives: To examine associations of perceived neighbourhood “greenness” with perceived physical and mental health and to investigate whether walking and social factors account for the relationships.

Methods: A mailed survey collected the following data from adults (n  =  1895) in Adelaide, Australia: physical and mental health scores (12-item short-form health survey); perceived neighbourhood greenness; walking for recreation and for transport; social coherence; local social interaction and sociodemographic variables.

Results: After adjusting for sociodemographic variables, those who perceived their neighbourhood as highly green had 1.37 and 1.60 times higher odds of better physical and mental health, respectively, compared with those who perceived the lowest greenness. Perceived greenness was also correlated with recreational walking and social factors. When walking for recreation and social factors were added to the regression models, recreational walking was a significant predictor of physical health; however, the association between greenness and physical health became non-significant. Recreational walking and social coherence were associated with mental health and the relationship between greenness and mental health remained significant.

Conclusions: Perceived neighbourhood greenness was more strongly associated with mental health than it was with physical health. Recreational walking seemed to explain the link between greenness and physical health, whereas the relationship between greenness and mental health was only partly accounted for by recreational walking and social coherence. The restorative effects of natural environments may be involved in the residual association of this latter relationship.

Perceived neighborhood environment and park use as mediators of the effect of area socio-economic status on walking behaviors

Background: Access to local parks can affect walking levels. Neighborhood environment and park use may influence relationships between neighborhood socioeconomic status (SES) and walking.

Methods: Self-report data on perceived park features, neighborhood environment, park use, neighborhood walking and sociodemographics
were obtained from a sample of Australian adults, living in high/low SES areas. Surveys were mailed to 250 randomly selected households within 500m of 12 matched parks. Mediating effects of perceived environment attributes and park use on relationships between area-SES and walking were examined.

Results: Mean frequency of local park use was higher for high-SES residents (4.36 vs 3.16 times/wk, P < .01), who also reported higher levels of park safety, maintenance, attractiveness, opportunities for socialization, and neighborhood crime safety, aesthetics, and traffic safety. Safety and opportunity for socialization were independently positively related to monthly frequency of visits to a local park which, in turn, was positively associated with walking for recreation and total walking. Residents of higher SES areas reported an average 22% (95% CI: 5%, 37%) more weekly minutes of recreational walking than their low SES counterparts.

Conclusion: Residents of high-SES areas live in environments that promote park use, which positively contributes to their weekly amounts of overall and recreational walking.

Walking for recreation and perceptions of the neighbourhood environment in older chinese urban dwellers

Engagement in walking for recreation can contribute to healthy aging. Although there is growing evidence that the neighborhood environment can influence walking for recreation, the amount of such evidence in relation to older adults is scarce and limited to Western low-density urban locations. Asian urban environments are typified by distinctive environmental and cultural characteristics that may yield different patterns to those observed in Western countries. Therefore, the main aim of this study was to examine associations of perceived environmental attributes with overall and within-neighborhood walking for recreation in Chinese elders (65+ years) residing in Hong Kong, an ultradense Asian metropolis. A sample of 484 elders was recruited from 32 neighborhoods stratified by socio-economic status and walkability (dwelling and intersection densities). Validated questionnaires measuring perceived neighborhood environment and weekly minutes of overall and within-neighborhood walking for recreation were interviewer administered. Results showed that the level of recreational walking was twice to four times higher than that reported in Western adults and elders. While overall walking for recreation showed a general lack of associations with perceived environmental attributes, within-neighborhood recreational walking was positively related with proximity of recreational facilities, infrastructure for walking, indoor places for walking, and presence of bridge/overpasses connecting to services. Age and educational attainment moderated the associations with several perceived environmental attributes with older and less-educated participants showing stronger associations. Traditional cultural views on the benefits of physical activity and the high accessibility of facilities and pedestrian infrastructure of Hong Kong may explain the high levels of walking. Although specific neighborhood attributes, or their perception, may influence recreational walking within the neighborhood, the compactness and public transport affordability of ultradense metropolises such as Hong Kong may make it easy for elders to compensate for the lack of favorable neighborhood attributes by walking outside the neighborhood.

Effects of built environment on walking among Hong Kong older adults

 Key Messages
1. Reliable and valid intervieweradministered questionnaires were developed to investigate associations of perceived neighbourhood attributes of Hong Kong older adults with their walking for transportation and recreation.
2. Access to and availability of different types of services and destinations, provision of
facilities for resting/sitting in the neighbourhood, and easy access to/from residential
buildings may help maintain an active lifestyle by facilitating walking for transport in the neighbourhood.
3. Access to services, indoor places for walking, environmental aesthetics, low traffic, and absence of physical barriers may promote recreational walking.

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 front 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. (C) 2004 American Journal of Preventive Medicine.

Psychometric properties of the modified RESIDE physical activity questionnaire among low-income overweight women

Objectives This study explored the criterion-related validity and test-retest reliability of the modified RESIDential Environment physical activity questionnaire and whether the instrument's validity varied by body mass index, education, race/ethnicity, or employment status. Design Validation study using baseline data collected for randomized trial of a weight loss intervention. Methods Participants recruited from health departments wore an ActiGraph accelerometer and self-reported non-occupational walking, moderate and vigorous physical activity on the modified RESIDential Environment questionnaire. We assessed validity (n = 152) using Spearman correlation coefficients, and reliability (n = 57) using intraclass correlation coefficients. Results When compared to steps, moderate physical activity, and bouts of moderate/vigorous physical activity measured by accelerometer, these questionnaire measures showed fair evidence for validity: recreational walking (Spearman correlation coefficients 0.23–0.36), total walking (Spearman correlation coefficients 0.24–0.37), and total moderate physical activity (Spearman correlation coefficients 0.18–0.36). Correlations for self-reported walking and moderate physical activity were higher among unemployed participants and women with lower body mass indices. Generally no other variability in the validity of the instrument was found. Evidence for reliability of RESIDential Environment measures of recreational walking, total walking, and total moderate physical activity was substantial (intraclass correlation coefficients 0.56–0.68). Conclusions Evidence for questionnaire validity and reliability varied by activity domain and was strongest for walking measures. The questionnaire may capture physical activity less accurately among women with higher body mass indices and employed participants. Capturing occupational activity, specifically walking at work, may improve questionnaire validity.

How socio-economic status contributes to participation in leisure-time physical activity

The aim of this cross-sectional study was to identify individual, social, and environmental contributors (mediators) to individual- and area-level differences in leisure-time physical activity across socio-economic groups. A two-stage stratified sampling design was used to recruit 20–65 year old adults (N = 2194) living in 154 census collection districts of Adelaide, Australia (overall response rate: 12%). Participants completed two surveys six months apart (response rate on the second survey: 83%). Individual-level socio-economic status (SES) was assessed using self-report measures on educational attainment, household income, and household size. Area-level SES was assessed using census data on median household income and household size for each selected census district. Bootstrap generalized linear models were used to examine associations between SES, potential mediators, and leisure-time physical activity. The product-of-coefficient test was used to estimate mediating effects. All SES measures were independently associated with potential individual and social mediators of the SES-activity relationships. Individual- and area-level income was also associated with perceived neighborhood attributes. Self-efficacy and social support for physical activity explained virtually all of the differences in physical activity across educational attainment groups. Physical barriers to walking and access to public open space contributed in part to the explanation of differences in recreational walking across income groups. Yet, self-efficacy and social support were the key mediators of the observed relationships between individual- and area-level income and physical activity. This study suggests that in order to increase physical activity participation in the more disadvantaged segments of the population, comprehensive, multilevel interventions targeting activity-related attitudes and skills as well as social and physical environments are needed.

Has the development of a New Urbanist community affected the physical activity levels of residents in surrounding neighborhoods?

Study Aims. The neighborhood environment has been shown to influence physical activity levels, but little is known about how far-reaching these effects are. This study sought to determine whether or not the development of a New Urbanist community in Austin, Texas affected the physical activity levels of residents in surrounding neighborhoods. The results were stratified by demographic characteristics, residential distance from the New Urbanist community, and type of physical activity to determine if any observed changes varied by these factors.^ Methods. Self-report questionnaires were mailed to a random sample of households located within one mile of the New Urbanist development. The questionnaire included questions about physical activity behaviors before and after the community was constructed in 2006. Changes in reported levels of physical activity between the two time points were examined.^ Results. The prevalence and average minutes per week of total physical activity did not change. Significant increases in the frequency and quantity of moderate-intensity leisure-time physical activity were observed. The amount of time spent walking and biking for recreation outside of the neighborhood increased significantly among those living close to Mueller. The weekly time spent in vigorous-intensity activity increased significantly, especially among those living closer to Mueller. There were significant decreases in the prevalence of and time spent walking for transport. The use of Mueller parks and trails was highest among participants living close to Mueller.^ Conclusions. The nearby Mueller development does not appear to have encouraged sedentary members of the surrounding population to become physically active, but might be associated with increased weekly physical activity among those who were already active. The increase in vigorous-intensity physical activity and recreational walking/biking outside of the neighborhood among those subjects living closer to Mueller may be attributed to the use of Mueller parks and trails, which was also considerably higher among this group. People may be substituting the time they spent walking for transport before the Mueller development with moderate-intensity leisure-time physical activity. Future research should seek to identify barriers that may be preventing more nearby residents from using Mueller facilities for physical activity. ^