Ageing in an ultra-dense metropolis: perceived neighbourhood characteristics and utilitarian walking in Hong Kong elders

Objective
The neighbourhood built environment may affect walking behaviour of elders. However, such effects remain underexplored, especially in an Asian context. We examined associations of perceived environmental attributes with overall and neighbourhood-specific walking for transport in a sample of Chinese elders residing in Hong Kong, an ultra-dense Chinese metropolis.

Design
Cross-sectional observational study using a two-stage stratified sampling strategy.

Setting
Hong Kong, China.

Subjects
Chinese-speaking elders (n 484), with no cognitive impairment and able to walk without assistance, residing in thirty-two selected communities stratified by socio-economic status and walkability, were interviewer-administered validated measures of perceived neighbourhood environment and walking for transport.

Results
Much higher levels of transport-related walking (mean 569 (sd 452) min/week) than found in Western samples were reported. The degree of perceived access to shops, crowdedness, presence of sitting facilities and easy access of residential entrance were independently positively related to both frequency of overall and within-neighbourhood walking for transportation. Infrastructure for walking and access to public transport were predictive of higher frequency of transport-related walking irrespective of location, while the perceived degree of land-use mix was predictive of higher levels of within-neighbourhood walking.

Conclusions
The provision of easy access to shops, residential entrances and sitting facilities in the neighbourhood may promote overall transport-related walking, while a good public transport network and pedestrian infrastructure linking destination-poor with destination-rich locations may compensate for the detrimental effects of living in less walkable neighbourhoods. Governmental investment in these micro- and macro-environmental features would help the promotion of an active lifestyle in elders.

Using manipulated photographs to identify features of streetscapes that may encourage older adults to walk for transport

Experimental evidence of environmental features important for physical activity is challenging to procure in real world settings. The current study aimed to investigate the causal effects of environmental modifications on a photographed street's appeal for older adults' walking for transport. Secondly, we examined whether these effects differed according to gender, functional limitations, and current level of walking for transport. Thirdly, we examined whether different environmental modifications interacted with each other. Qualitative responses were also reported to gain deeper insight into the observed quantitative relationships. Two sets of 16 panoramic photographs of a streetscape were created, in which six environmental factors were manipulated (sidewalk evenness, traffic level, general upkeep, vegetation, separation from traffic, and benches). Sixty older adults sorted these photographs on appeal for walking for transport on a 7-point scale and reported qualitative information on the reasons for their rankings. Sidewalk evenness appeared to have the strongest influence on a street's appeal for transport-related walking. The effect of sidewalk evenness was even stronger when the street's overall upkeep was good and when traffic was absent. Absence of traffic, presence of vegetation, and separation from traffic also increased a street's appeal for walking for transport. There were no moderating effects by gender or functional limitations. The presence of benches increased the streetscape's appeal among participants who already walked for transport at least an hour/week. The protocols and methods used in the current study carry the potential to further our understanding of environment-PA relationships. Our findings indicated sidewalk evenness as the most important environmental factor influencing a street's appeal for walking for transport among older adults. However, future research in larger samples and in real-life settings is needed to confirm current findings.

The use of kernel density estimation to examine associations between neighborhood destination intensity and walking and physical activity

BACKGROUND: Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how the distribution of destinations is related to activity. Kernel density estimation is a spatial analysis technique that accounts for the location of features relative to each other. Using kernel density estimation, this study sought to investigate whether individuals who live near destinations (shops and service facilities) that are more intensely distributed rather than dispersed: 1) have higher odds of being sufficiently active; 2) engage in more frequent walking for transport and recreation. METHODS: The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Destinations within these areas were geocoded and kernel density estimates of destination intensity were created using kernels of 400m (meters), 800m and 1200m. Using multilevel logistic regression, the association between destination intensity (classified in quintiles Q1(least)-Q5(most)) and likelihood of: 1) being sufficiently active (compared to insufficiently active); 2) walking≥4/week (at least 4 times per week, compared to walking less), was estimated in models that were adjusted for potential confounders. RESULTS: For all kernel distances, there was a significantly greater likelihood of walking≥4/week, among respondents living in areas of greatest destinations intensity compared to areas with least destination intensity: 400m (Q4 OR 1.41 95%CI 1.02-1.96; Q5 OR 1.49 95%CI 1.06-2.09), 800m (Q4 OR 1.55, 95%CI 1.09-2.21; Q5, OR 1.71, 95%CI 1.18-2.48) and 1200m (Q4, OR 1.7, 95%CI 1.18-2.45; Q5, OR 1.86 95%CI 1.28-2.71). There was also evidence of associations between destination intensity and sufficient physical activity, however these associations were markedly attenuated when walking was included in the models. CONCLUSIONS: This study, conducted within urban Melbourne, found that those who lived in areas of greater destination intensity walked more frequently, and showed higher odds of being sufficiently physically active-an effect that was largely explained by levels of walking. The results suggest that increasing the intensity of destinations in areas where they are more dispersed; and or planning neighborhoods with greater destination intensity, may increase residents' likelihood of being sufficiently active for health.

Neighborhood environmental factors correlated with walking near home: Using SPACES

Purpose: The physical environment plays an important role in influencing participation in physical activity, although the specific factors that are correlated with different patterns of walking remain to be determined We examined correlations between physical environmental factors and self-reported walking for recreation and transport near home. Methods: The local neighborhood environments (defined as a 400-m radius from the respondent's home) of 1678 adults were assessed for their suitability for walking. The environmental data were collected during 2000 using the Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument together with information from other sources. We used logistic regression modeling to examine the relationship between the attributes of the physical environment and the self-reported walking behavior undertaken near home. Results: Functional features were correlated with both walking for recreation (odds ratio (OR) 1.62; 95% confidence interval (Cl): 1.20-2.19) and for transport (OR 1.30; 95% Cl: 0.97-1.73). A well-maintained walking surface was the main functional factor associated with walking for recreation (OR 2.04; 95% Cl: 1.43-2.91) and for transport (OR 2.13; 95% Cl: 1.53-2.96). Destination factors, such as shops and public transport, were significantly correlated with walking for transport (OR 1.80; 95% Cl: 1.33-2.44), but not recreation. Conclusion: The findings suggest that neighborhoods with pedestrian facilities that are attractive and comfortable and where there are local destinations (such as shops and public transport) are associated with walking near home.

Street characteristics preferred for transportation walking among older adults: a choice-based conjoint analysis with manipulated photographs

BACKGROUND: Knowledge about the relationships between micro-scale environmental factors and older adults' walking for transport is limited and inconsistent. This is probably due to methodological limitations, such as absence of an accurate neighborhood definition, lack of environmental heterogeneity, environmental co-variation, and recall bias. Furthermore, most previous studies are observational in nature. We aimed to address these limitations by investigating the effects of manipulating photographs on micro-scale environmental factors on the appeal of a street for older adults' transportation walking. Secondly, we used latent class analysis to examine whether subgroups could be identified that have different environmental preferences for transportation walking. Thirdly, we investigated whether these subgroups differed in socio-demographic, functional and psychosocial characteristics, current level of walking and environmental perceptions of their own street.

METHODS: Data were collected among 1131 Flemish older adults through an online (n = 940) or an interview version of the questionnaire (n = 191). This questionnaire included a choice-based conjoint exercise with manipulated photographs of a street. These manipulated photographs originated from one panoramic photograph of an existing street that was manipulated on nine environmental attributes. Participants chose which of two presented streets they would prefer to walk for transport.

RESULTS: In the total sample, sidewalk evenness had by far the greatest appeal for transportation walking. The other environmental attributes were less important. Four subgroups that differed in their environmental preferences for transportation walking were identified. In the two largest subgroups (representing 86% of the sample) sidewalk evenness was the most important environmental attribute. In the two smaller subgroups (each comprising 7% of the sample), traffic volume and speed limit were the most important environmental attributes for one, and the presence of vegetation and a bench were the most important environmental attributes for the other. This latter subgroup included a higher percentage of service flat residents than the other subgroups.

CONCLUSIONS: Our results suggest that the provision of even sidewalks should be considered a priority when developing environmental interventions aiming to stimulate older adults' transportation walking. Natural experiments are needed to confirm whether our findings can be translated to real environments and actual transportation walking behavior.

Identifying the beliefs which predict environmentally friendly behaviour in the Brisbane area : a foundation for informed interventions

A move to more sustainable living can provide immediate and long term health and environmental benefits. The Green Living Study consisted of a mail survey of 1186 South East Queensland residents and an online survey of a further 451 individuals, primarily from South East Queensland, and explored the predictors of environmentally friendly behaviour. This paper explores the underlying beliefs that were found to predict specific environmentally friendly behaviours, such as walking for transport, switching off lights when not in use, switching off unused appliances at the wall and shopping with reusable bags. Beliefs explored included social norms, advantages and disadvantages of performing the behaviours, and issues of control over ones behaviour. The findings showed that people’s environmentally friendly behaviours may be influenced by convenience, saving money and saving face; i.e. is it easy to do, will I be better off, and will I be seen as ‘different’? Understanding the beliefs which directly predict behaviour can help inform public policy and educational initiatives. A number of models for transferring this knowledge into policy and practice will be discussed.

‘The health-location connection’: using GIS and social media on smartphones to track engagement with the Local urban environment for work, recreation, and physical activity

A technologically innovative study was undertaken across two suburbs in Brisbane, Australia, to assess socioeconomic differences in women's use of the local environment for work, recreation, and physical activity. Mothers from high and low socioeconomic suburbs were instructed to continue with usual daily routines, and to use mobile phone applications (Facebook Places, Twitter, and Foursquare) on their mobile phones to ‘check-in’ at each location and destination they reached during a one-week period. These smartphone applications are able to track travel logistics via built-in geographical information systems (GIS), which record participants’ points of latitude and longitude at each destination they reach. Location data were downloaded to Google Earth and excel for analysis. Women provided additional qualitative data via text regarding the reasons and social contexts of their travel. We analysed 2183 ‘check-ins’ for 54 women in this pilot study to gain quantitative, qualitative, and spatial data on human-environment interactions. Data was gathered on distances travelled, mode of transport, reason for travel, social context of travel, and categorised in terms of physical activity type – walking, running, sports, gym, cycling, or playing in the park. We found that the women in both suburbs had similar daily routines with the exception of physical activity. We identified 15% of ‘check-ins’ in the lower socioeconomic group as qualifying for the physical activity category, compared with 23% in the higher socioeconomic group. This was explained by more daily walking for transport (1.7kms to 0.2kms) and less car travel each week (28.km to 48.4kms) in the higher socioeconomic suburb. We ascertained insights regarding the socio-cultural influences on these differences via additional qualitative data. We discuss the benefits and limitations of using new technologies and Google Earth with implications for informing future physical and social aspects of urban design, and health promotion in socioeconomically diverse cities.

A cross-discipline and collaborative approach to identifying the predictors of environmentally friendly and health protective behaviour

Background. As a society, our interaction with the environment is having a negative impact on human health. For example, an increase in car use for short trips, over walking or cycling, has contributed to an increase in obesity, diabetes and poor heart health and also contributes to pollution, which is associated with asthma and other respiratory diseases. In order to change the nature of that interaction, to be more positive and healthy, it is recommended that individuals adopt a range of environmentally friendly behaviours (such as walking for transport and reducing the use of plastics). Effective interventions aimed at increasing such behaviours will need to be evidence based and there is a need for the rapid communication of information from the point of research, into policy and practice. Further, a number of health disciplines, including psychology and public health, share a common mission to promote health and well-being. Therefore, the objective of this project is to take a cross-discipline and collaborative approach to reveal psychological mechanisms driving environmentally friendly behaviour. This objective is further divided into three broad aims, the first of which is to take a cross-discipline and collaborative approach to research. The second aim is to explore and identify the salient beliefs which most strongly predict environmentally friendly behaviour. The third aim is to build an augmented model to explain environmentally friendly behaviour. The thesis builds on the understanding that an interdisciplinary collaborative approach will facilitate the rapid transfer of knowledge to inform behaviour change interventions. Methods. The application of this approach involved two surveys which explored the psycho-social predictors of environmentally friendly behaviour. Following a qualitative pilot study, and in collaboration with an expert panel comprising academics, industry professionals and government representatives, a self-administered, Theory of Planned Behaviour (TPB) based, mail survey was distributed to a random sample of 3000 residents of Brisbane and Moreton Bay Region (Queensland, Australia). This survey explored specific beliefs including attitudes, norms, perceived control, intention and behaviour, as well as environmental altruism and green identity, in relation to walking for transport and switching off lights when not in use. Following analysis of the mail survey data and based on feedback from participants and key stakeholders, an internet survey was employed (N=451) to explore two additional behaviours, switching off appliances at the wall when not in use, and shopping with reusable bags. This work is presented as a series of interrelated publications which address each of the research aims. Presentation of Findings. Chapter five of this thesis consists of a published paper which addresses the first aim of the research and outlines the collaborative and multidisciplinary approach employed in the mail survey. The paper argued that forging alliances with those who are in a position to immediately utilise the findings of research has the potential to improve the quality and timely communication of research. Illustrating this timely communication, Chapter six comprises a report presented to Moreton Bay Regional Council (MBRC). This report addresses aim's one and two. The report contains a summary of participation in a range of environmentally friendly behaviours and identifies the beliefs which most strongly predicted walking for transport and switching off lights (from the mail survey). These salient beliefs were then recommended as targets for interventions and included: participants believing that they might save money; that their neighbours also switch off lights; that it would be inconvenient to walk for transport and that their closest friend also walks for transport. Chapter seven also addresses the second aim and presents a published conference paper in which the salient beliefs predicting the four specified behaviours (from both surveys) are identified and potential applications for intervention are discussed. Again, a range of TPB based beliefs, including descriptive normative beliefs, were predictive of environmentally friendly behaviour. This paper was also provided to MBRC, along with recommendations for applying the findings. For example, as descriptive normative beliefs were consistently correlated with environmentally friendly behaviour, local councils could engage in marketing and interventions (workshops, letter box drops, internet promotions) which encourage parents and friends to model, rather than simply encourage, environmentally friendly behaviour. The final two papers, presented in Chapters eight and nine, addresses the third aim of the project. These papers each present two behaviours together to inform a TPB based theoretical model with which to predict environmentally friendly behaviour. A generalised model is presented, which is found to predict the four specific behaviours under investigation. The role of demographics was explored across each of the behaviour specific models. It was found that some behaviour's differ by age, gender, income or education. In particular, adjusted models predicted more of the variance in walking for transport amongst younger participants and females. Adjusted models predicted more variance in switching off lights amongst those with a bachelor degree or higher and predicted more variance in switching off appliances amongst those on a higher income. Adjusted models predicted more variance in shopping with reusable bags for males, people 40 years or older, those on a higher income and those with a bachelor degree or higher. However, model structure and general predictability was relatively consistent overall. The models provide a general theoretical framework from which to better understand the motives and predictors of environmentally friendly behaviour. Conclusion. This research has provided an example of the benefits of a collaborative interdisciplinary approach. It has identified a number of salient beliefs which can be targeted for social marketing campaigns and educational initiatives; and these findings, along with recommendations, have been passed on to a local council to be used as part of their ongoing community engagement programs. Finally, the research has informed a practical model, as well as behaviour specific models, for predicting sustainable living behaviours. Such models can highlight important core constructs from which targeted interventions can be designed. Therefore, this research represents an important step in undertaking collaborative approaches to improving population health through human-environment interactions.

Using GPS technology to (re)-examine operational definitions of 'neighbourhood' in place-based health research

BACKGROUND Inconsistencies in research findings on the impact of the built environment on walking across the life course may be methodologically driven. Commonly used methods to define 'neighbourhood', from which built environment variables are measured, may not accurately represent the spatial extent to which the behaviour in question occurs. This paper aims to provide new methods for spatially defining 'neighbourhood' based on how people use their surrounding environment. RESULTS Informed by Global Positioning Systems (GPS) tracking data, several alternative neighbourhood delineation techniques were examined (i.e., variable width, convex hull and standard deviation buffers). Compared with traditionally used buffers (i.e., circular and polygon network), differences were found in built environment characteristics within the newly created 'neighbourhoods'. Model fit statistics indicated that exposure measures derived from alternative buffering techniques provided a better fit when examining the relationship between land-use and walking for transport or leisure. CONCLUSIONS This research identifies how changes in the spatial extent from which built environment measures are derived may influence walking behaviour. Buffer size and orientation influences the relationship between built environment measures and walking for leisure in older adults. The use of GPS data proved suitable for re-examining operational definitions of neighbourhood.

Objectively assessing "Walkability" of local communities: using GIS to identify the relevant environmental attributes.

Geographic Information Systems (GIS) may be used to measure objectively, those features of the built environment that may influence walking. Public health research on environmental determinants of physical activity in adults shows that different factors can influence walking for recreation, compared to walking for transport. Most studies have used perceived (self-report) rather than objective measures of potentially relevant environmental attributes. We describe how a previously-developed index of ‘walkability’ was operationalized in an Australian context, using available spatial data.               Attributes believed to be of relevance to walking for transport, that are measurable using GIS, are: Dwelling density (higher-density neighborhoods support greater retail and service variety, resulting in shorter, walkable distances between facilities; driving and parking are more difficult and time consuming). Connectivity (higher intersection densities provide people with a greater variety of potential routes, easier access to major roads where public transport is available and shorter times to get to destinations). Land use mix (the more varied the land use mix and built form, then the more conducive it is to walk to various destinations). Net retail area (there are more options for destinations where goods and services may be purchased and more local employment opportunities that can be reached by walking). The associations of these attributes with walking behaviors can be  examined separately, or in combination. Such GIS data are very helpful in fundamental studies of the environmental determinants of behavior, and also in applied policy research for cities, regions or local communities, to
address public health and environmental issues.

Residential proximity to school and the active travel choices of parents

Issue addressed: Walking for transport can contribute significantly to health-enhancing physical activity. We examined the prevalence and duration of walking to and from school, together with perceived influences on doing so, among parents of primary school children. Methods: Questionnaires were completed by parents from four primary schools (one government and three private) located in south-east Queensland (n=559; 40% response rate). Results: Eighteen per cent of parents reported walking for at least 10 minutes during journeys to school. Significantly greater proportions of parents with only one car in their household, with a child who attended a government school, with no driver’s licence, who had less than 11 years of education, and lived within two kilometres of the school walked for at least 10 minutes during the school journey. Factors perceived by parents most strongly to influence walking to school were: being physically active; safety concerns for the child walking alone; not having to park; walking being the child’s preferred option; too much motor vehicle traffic; and their child’s age and level of road sense. Conclusions: Despite the overall low prevalence of walking to school by parents, health-enhancing benefits may be achieved even when other modes of transport are used in conjunction with walking.

Measuring the walkability of local communities using geographic information systems data

Researchers are working to identify and promote environment and policy initiatives to encourage more active and healthy communities. Measuring environmental attributes through objective means can verify which physical environment factors are most important. We describe how Geographic Information Systems (GIS) may be used to measure objectively, the features of the built environment that may influence walking. We show how four key attributes currently believed to be of most relevance to walking for transport may be used to create a ‘walkability’ index. These are dwelling density (higher-density neighbourhoods support greater retail and service variety, resulting in shorter, walkable distances between facilities; driving and parking are more difficult); street connectivity (higher intersection density provides people with a greater choice of potential routes, easier access to major roads where public transport is available and shorter times to get to destinations); land use mix (the more varied the land use mix and built form, the more conducive it is to walk to various destinations); and net retail area (people who live near multiple and diverse retail opportunities are able to make more frequent and shorter shopping trips by walking and can walk to more local employment opportunities). The potential relationships between each of the objective environmental-attribute measures and walking behaviours is discussed, together with suggestions as to how such measures might be used to guide community infrastructure planning. GIS mapping can assist decision makers in where to focus transportation investments and where to guide future growth. Readily accessible GIS data can be used to guide and support urban planning and infrastructure investment decisions in both the private and public sectors, to increase walking in communities.

An Australian version of the neighborhood environment walkability scale : validity evidence

This study examined validity evidence for the Australian version of the Neighborhood Environment Walkability Scale (NEWS-AU). A stratified two-stage cluster sampling design was used to recruit 2,650 adults from Adelaide (Australia). The sample was drawn from residential addresses within eight high-walkable and eight low-walkable suburbs matched for socio-economic status (SES). Neighborhood walkability was measured using Geographic Information Systems data on dwelling density, intersection density, net retail area, and land-use mix. Participants completed the NEWS-AU and reported weekly minutes of walking for transport and recreation (International Physical Activity Questionnaire [IPAQ]). Multilevel confirmatory factor analysis (MCFA) was used to define the individual- and Census Collection District (CCD)-level measurement model of the NEWS-AU. Seven individual-level and five CCD-level factors were identified. These measurement models were somewhat similar to those of the original Neighborhood Environment Walkability Scale (NEWS). Patterns of associations between the NEWS-AU factors/scales and the walking measures provided some validity evidence for the instrument.

Motivational readiness for active commuting by university students : incentives and barriers

Issue addressed: Walking for transport can contribute significantly to health enhancing physical activity. We examined the associations of stages of motivational readiness for active transport with perceived barriers and incentives to walking to and from university among students. Methods: Mail-back surveys were completed by 781 students in a regional university in southeast Queensland. They identified one of eight options on motivational readiness for active commuting, which were then classified as: pre-contemplation; contemplation-preparation; or, action-maintenance. Open-ended questions were used to identify relevant barriers and incentives. Logistic regressions were used to examine the barriers and incentives that distinguished between those at different stages of motivational readiness. Results: Barriers most frequently reported were long travel distances, inconvenience and time constraints. Incentives most frequently reported were shorter travel distance, having more time, supportive infrastructure and better security. Those not considering active commuting (pre-contemplation) were significantly more likely to report shorter travel distance as an incentive compared to those in contemplation-preparation. Those in contemplation-preparation were significantly more likely to report lack of motivation, inadequate infrastructure, shorter travel distance and inconvenience as barriers; and, having more time, supportive infrastructure, social support and incentive programs as encouragement. Conclusions: Different barriers and incentives to walking to or from university exist for students in the different stages of motivational readiness for active commuting. Interventions targeted specifically to stage of motivational readiness may be potentially helpful in increasing activity levels, through active transport.

Walkable area within which destinations matter : differences between Australian and Japanese cities

Adults’ walking for transport is important for health benefits and can be associated with availability of destinations such as shops and services within a walking distance of 10 to 15 minutes from home. However, relevant evidence is mostly from Western countries. This study examined associations of destinations with walking for transport in Australian and Japanese cities. Data were collected from Adelaide, Australia (n = 2508), and 4 Japanese cities (n = 1285). Logistic regressions examined associations of self-reported walking for transport with the number of destination types within walk-distance categories. Walking was significantly associated with the number of destination types within a 10-minute walk from home for Australia and with the number of destination types within a 6- to 20-minute walk for Japan. Further research is needed on why walking by residents of Japanese cities can be influenced by more distant local destinations than in Australia to inform physical activity–related environmental and policy initiatives.