Background
Rural-residing adults in the United States (U.S.) walk less than their urban counterparts. Yet micropolitan statistical areas – small towns geographically isolated from metropolitan areas – are home to 10% of the U.S. population and are centers of residential and employment land uses that may support walking. Little is known about the walking behaviors or built environments of small town residents and how they compare with better-studied urban populations.

Objectives
This study is the first to compare objectively measured walking behaviors and home neighborhood built environments in a sample of small town and urban area residents. It also summarizes prior research that separately assessed the association between the built environment and utilitarian walking in these two different locations.

Methods
Parcel-based sampling was used to randomly select adults living in the urbanized Seattle metropolitan area and in nine small towns across 3 regions in the U.S. In the Seattle sample, 699 participants completed a demographic, behavioral and attitudinal survey. They then wore an accelerometer, GPS device, and completed a travel diary for one week. In the nine small towns, 2,152 participants completed a demographic, behavioral and attitudinal survey. A sub-sample of 299 participants enrolled in a follow-up study and wore an accelerometer, GPS device, and completed a travel diary for one week. In both study populations, the accelerometer, GPS, and travel diary data were used to measure objective physical activity, which was further classified as walking for recreational or utilitarian purposes or non-walking (Kang et al. 2013). In both samples, home locations were geocoded and neighborhood built environments were measured within a 1-km network buffer using GIS techniques. First, this study summarizes differences in survey measures of socio-demographics, GIS measures of neighborhood built environment, and objective measures of walking between the urban Seattle participants and the small town sub-sample of participants that provided objective activity data. Second, this study summarizes previous research that assessed the association between GIS measures of home neighborhood built environment and survey measures of neighborhood walking in the full small town sample population (Doescher et al., under review). These results are compared to previous research that has assessed the association between GIS measures of home neighborhood built environment and objective measures of walking in the Seattle population (Kang 2013).

Results
Compared to the urban Seattle population, the small town population had lower household income, had a greater proportion of overweight or obese,  were older, were more likely to be married, were less educated, had more vehicles in the household and were more likely to live in a single family home. Small town residents also had lower home neighborhood residential density, fewer neighborhood destinations (including restaurants, food stores, schools, and parks), a lower neighborhood street intersection density, and a smaller area of steep slopes in their home neighborhood. The small town participants walked for utilitarian purposes an average of 38.6 minutes per week and for recreational purposes 50.0 minutes per week. The urban Seattle participants walked an average of 142.9 minutes per week for utilitarian purposes and 37.2 minutes per week for recreational purposes. Previous research found that in the small town population, after adjusting for socio-demographics and neighborhood perceptions, manufacturing land use and the presence of a post office within 1 km were positively associated with self-report utilitarian walking ≥150 minutes per week. In the urban population, after adjusting for socio-demographics and neighborhood perceptions, home neighborhood residential and employment density were positively associated with utilitarian walking minutes per week. For both populations, perception of neighborhood support for PA and walkability were associated with more walking.

Conclusions
This study found that the small town sample population was of lower socio-economic status and had less walkable objectively measured home neighborhoods than the urban Seattle population. These differences may explain why the small town population walked for utilitarian purposes much less than the urban population. However, the small town population walked for recreational purposes more than the urban population, suggesting that small town built environments can support walking, but may either not have the agglomeration of destinations to support utilitarian walking, or driving for short utilitarian purposes in small towns is easier than walking. Prior research found different home neighborhood built environment features associated with utilitarian walking in urban versus small towns, suggesting that different environmental interventions may be necessary to support utilitarian walking in small towns versus urban areas.

Implications
The differences noted between the urban and the small town populations in both walking levels and environmental influences on walking suggest different approaches to using the built environment to support more physical activity through walking. While in urban areas modifying the neighborhood environment can positively affect utilitarian walking, in small towns, environmental supports that relate to recreational walking might be more effective.

References

1. Doescher M, Lee C, Berke EM, Adachi-Mejia AM, Lee C-K, Stewart O, et al. The Built Environment and Utilitarian Walking in Small U.S. Towns. Preventive Medicine under review.
2. Kang B, Moudon AV, Hurvitz PM, Reichley L, Saelens BE. Walking objectively measured: classifying accelerometer data with GPS and travel diaries. Med Sci Sports Exerc 2013;45(7):1419-28.
3. Kang B. Chapter 4 Utilitarian and Recreational Walking in Objectively Measured Walking: Temporal, Spatial, and Built Environmental Characteristics (doctoral dissertation). 2013.

Support / Funding Source
This study was funded by the National Institute of Health grants R01HL091881 and 1R01HL103478-01A1 Note to reviewers: We are in the process of running analyses that pool the urban and the small town populations to assess differences in BE influences on walking for transport and for recreation, adjusting for socio-demographic and neighborhood perception. While, unfortunately, the results of these analyses are not available at this time, we intend to present them at the conference. To our knowledge, this would be the first analyses comparing these two populations based on objective measures of both walking and the built environment.