Active Living Research

BACKGROUND: With funding support from the Robert Wood Johnson Foundation, the Active Living Partnership of Columbia, Missouri, sought to make routine physical activity more commonplace in the community through behavioral and environmental change strategies. INTERVENTION: The Active Living by Design 5P model (partnerships, promotions, programs, policy changes, and physical projects) was modified to create two mutually reinforcing components. Programs and promotions (e.g., Walking School Bus) were implemented to influence individual behaviors and generate public policy advocates. Policy changes, such as activity-friendly street design standards, created safe and attractive places for physical activity programs. A strong, diverse community partnership supported all efforts. RESULTS: Key project successes were a citywide social marketing program; the Walking School Bus program, which grew rapidly; and policy campaigns resulting in improved street design standards and a voter-approved $3.5 million sales tax for sidewalks around schools. Notable challenges included programs targeting teenagers and efforts to increase physical activity through self-reported activity logging. LESSONS LEARNED: The most important lesson was to implement multiple strategies because programs can leverage policy successes, and new policies often lead to more funding for infrastructure. Other lessons learned were to build early successes by reaching first for the "low-hanging fruit" (e.g., elementary-age children rather than teenagers) and to have a flexible plan to take advantage of unexpected opportunities (e.g., a new, influential partner with a specific interest). CONCLUSIONS: A modified 5P model was tested and found to be an effective framework for achieving behavioral and environmental changes that promote healthy, active lifestyles in the community.

BACKGROUND: African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women. METHODS: Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included. RESULTS: Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks. CONCLUSIONS: Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.

This chapter describes the development of an urban tree canopy cover assessment and restoration project designed to inform community stakeholders and to guide tree planting efforts in disadvantaged neighborhoods surrounding the Indianapolis, Indiana central business district. The primary goals of the project were to create estimates of tree canopy cover and distribution within the study region, and to identify neighborhoods in which to focus tree planting efforts. Estimates derived from high resolution satellite imagery and aerial photography indicate approximately 17% of the studying region was covered by tree canopy. A site selection model identified eight residential neighborhoods that exhibited social and environmental characteristics prioritized for tree planting. These neighborhoods contained significantly less tree cover than other residential communities. The results of this study were used to inform a tree planting campaign, the Indianapolis NeighborWoods initiative, with a goal of planting 100,000 trees in the study region.

Stair climbing can be a low-cost and relatively accessible way to add everyday physical activity, but many building stairwells are inaccessible or unpleasant and elevators are far more convenient. This study explores the use of and attitude toward stairs in an innovative office building where the main elevators for able-bodied users stop only at every third floor ("skip-stop" elevators). These users are expected to walk up or down nearby stairs that have been made open and appealing ("skip-stop" stairs). The study takes advantage of a natural experiment. Some workers' offices were clustered around the skip-stop elevator and the stairs, whereas others had access to a traditional elevator core, that is, an elevator that stopped at each floor with nearby fire exit stairs. Stair use on the open skip-stop stairs and enclosed fire stairs was measured using infrared monitors and card-reader activity logs. An online survey of employees (N=299, a 17.4% response rate) gathered information on stair use and attitudes and behaviors toward physical activity; interviews with key personnel identified major implementation issues. The skip-stop stair was used 33 times more than the enclosed stair of the traditional elevator core, with 72% of survey participants reporting daily stair use. Although implementation issues related to organizational objectives, costs, security, barrier-free accessibility, and building codes exist, the skip-stop feature offers a successful strategy for increasing stair use in workplaces.

This research examines neighborhood-scale physical and social environmental conditions that are associated with active living among seniors in Greendale, Wisconsin. The town's demographics reflect a naturally occurring retirement community. From survey responses of over 700 seniors, findings show that far more seniors reported walking for health and exercise reasons than for instrumental reasons or for social interaction. Senior Greendalers rarely reported deterrents to walking because of poor safety. Most residents feel safe being out in their neighborhood at night, and show a strong sense of belongingness to one's neighborhood. The latter may be linked to one's feeling of safety, and NORC qualities themselves may elicit these perceptions. Proximity to amenities in one's neighborhood seems to be a key factor in reports of walking behavior, regardless of the specific amenity itself. Retrofitting communities may be necessary to promote healthier environments in which adults age and remain vital.

BACKGROUND: Inter-relationships among built and socioeconomic environmental characteristics may result in confounding of associations between environment exposure measures and health behaviors or outcomes, but traditional multivariate adjustment can be inappropriate due to collinearity. METHODS: We used principal factor analysis to describe inter-relationships between a large set of Geographic Information System-derived built and socioeconomic environment measures for adolescents in the National Longitudinal Study of Adolescent Health (Wave I, 1995-96, n = 17,294). Using resulting factors in sex-stratified multivariate negative binomial regression models, we tested for confounding of associations between built and socioeconomic environment characteristics and moderate to vigorous physical activity (MVPA). Finally, we used knowledge gained from factor analysis to construct replicable environmental measures that account for inter-relationships and avoid collinearity. RESULTS: Using factor analysis, we identified three built environment constructs [(1) homogenous landscape; 2) development intensity with high pay facility count; 3) development intensity with high public facility count] and two socioeconomic environment constructs [1) advantageous economic environment, 2) disadvantageous social environment]. In regression analysis, confounding of built environment-MVPA associations by socioeconomic environment factors was stronger than among built environment factors. In fully adjusted models, MVPA was negatively associated with the highest (versus lowest) quartile of homogenous land cover in males [exp(coeff) (95% CI): 0.91 (0.86, 0.96)] and intensity (pay facilities) [exp(coeff) (95% CI): 0.92 (0.85, 0.99)] in females. Single proxy measures (Simpson's diversity index, count of pay facilities, count of public facilities, median household income, and crime rate) representing each environmental construct replicated associations with MVPA. CONCLUSIONS: Environmental characteristics are inter-related. Both built and SES environments should be incorporated into analysis in order to minimize confounding. Single environmental measures may be useful proxies for environmental constructs in longitudinal analysis and replication in external populations, but more research is needed to better understand mechanisms of action, and ultimately identify policy-relevant environmental determinants of physical activity.

BACKGROUND: Built environment research is dominated by cross-sectional designs, which are particularly vulnerable to residential self-selection bias resulting from health-related attitudes, neighborhood preferences, or other unmeasured characteristics related to both neighborhood choice and health-related outcomes. METHODS: We used cohort data from the National Longitudinal Study of Adolescent Health (United States; Wave I, 1994-95; Wave III, 2001-02; n = 12,701) and a time-varying geographic information system. Longitudinal relationships between moderate to vigorous physical activity (MVPA) bouts and built and socioeconomic environment measures (landcover diversity, pay and public physical activity facilities per 10,000 population, street connectivity, median household income, and crime rate) from adolescence to young adulthood were estimated using random effects models (biased by unmeasured confounders) and fixed effects models (within-person estimator, which adjusts for unmeasured confounders that are stable over time). RESULTS: Random effects models yielded null associations except for negative crime-MVPA associations [coefficient (95% CI): -0.056 (-0.083, -0.029) in males, -0.061 (-0.090, -0.033) in females]. After controlling for measured and time invariant unmeasured characteristics using within-person estimators, MVPA was higher with greater physical activity pay facilities in males [coefficient (95% CI): 0.024 (0.006, 0.042)], and lower with higher crime rates in males [coefficient (95% CI): -0.107 (-0.140, -0.075)] and females [coefficient (95% CI): -0.046 (-0.083, -0.009)]. Other associations were null or in the counter-intuitive direction. CONCLUSIONS: Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self-selection can bias associations toward the null, as opposed to its typical characterization as a positive confounder. Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias. The authors discuss complexities of adjusting for residential self-selection and residential relocation, particularly during the adolescent to young adult transition.

In research investigating built environment (BE) influences on physical activity (PA), inconsistent neighborhood definitions may contribute to inconsistent findings. Using data from the National Longitudinal Study of Adolescent Health (Wave I; 1994-95), we compared associations between moderate-vigorous PA (MVPA) and PA facility counts and street connectivity measures (intersection density and link:node ratio) within 1, 3, 5, and 8.05 kilometers (km) from each respondent's residence (Euclidean neighborhood buffers). BE-MVPA associations varied by BE characteristic, urbanicity, and sex. PA facilities within 3 km buffers and intersection density within 1k buffers exhibited the most consistent associations with MVPA. Policy recommendations and corresponding research should address potential differences in relevant neighborhood areas across environment feature and population subgroup.

We completed a systematic search of the epidemiologic literature on built environment and obesity and identified 63 relevant papers, which were then evaluated for the quality of between-study evidence. We were able to classify studies into one of two primary approaches for defining place and corresponding geographic areas of influence: those based on contextual effects derived from shared pre-determined administrative units and those based on individually unique geographic buffers. The 22 contextual papers evaluated 80 relations, 38 of which did not achieve statistical significance. The 15 buffer papers evaluated 40 relations, 24 of which did not achieve statistical significance. There was very little between-study similarity in methods in both types of approaches, which prevented estimation of pooled effects. The great heterogeneity across studies limits what can be learned from this body of evidence.

Reduced physical activity is particularly pronounced among lower income individuals and racial/ethnic minorities, and may be related to unsupportive neighborhood environments for physical activity. The purpose of this research was to conduct focus groups with low-income urban Black and Latino adolescents to identify whether these adolescents were physically active, in what settings, and what features of the settings were important for encouraging their physical activity. Results suggest potential gender differences, but little difference across race/ethnicity. Results can inform the development of a park/physical activity setting characteristics survey to help improve conditions of parks.