Christine M. Hoehner

Measuring the Built Environment for Physical Activity: State of the Science

Physical inactivity is one of the most important public health issues in the U.S. and internationally. Increasingly, links are being identified between various elements of the physical-or built-environment and physical activity. To understand the impact of the built environment on physical activity, the development of high-quality measures is essential. Three categories of built environment data are being used: (1) perceived measures obtained by telephone interview or self-administered questionnaires; (2) observational measures obtained using systematic observational methods (audits); and (3) archival data sets that are often layered and analyzed with GIS. This review provides a critical assessment of these three types of built-environment measures relevant to the study of physical activity. Among perceived measures, 19 questionnaires were reviewed, ranging in length from 7 to 68 questions. Twenty audit tools were reviewed that cover community environments (i.e., neighborhoods, cities), parks, and trails. For GIS-derived measures, more than 50 studies were reviewed. A large degree of variability was found in the operationalization of common GIS measures, which include population density, land-use mix, access to recreational facilities, and street pattern. This first comprehensive examination of built-environment measures demonstrates considerable progress over the past decade, showing diverse environmental variables available that use multiple modes of assessment. Most can be considered first-generation measures, so further development is needed. In particular, further research is needed to improve the technical quality of measures, understand the relevance to various population groups, and understand the utility of measures for science and public health.

Physical Activity Interventions in Latin America A Systematic Review

BACKGROUND Recommendations for physical activity in the Guide to Community Preventive Services (the Community Guide) have not been systematically examined or applied in developing countries such as those in Latin America. The aim of this systematic review was to assess the current evidence base concerning interventions to increase physical activity in Latin America using a modified Community Guide process and to develop evidence-based recommendations for physical activity interventions. METHODS In 2006, a literature review of both peer-reviewed and non-peer-reviewed literature in Portuguese, Spanish, and English was carried out to identify physical activity interventions conducted in community settings in Latin America. Intervention studies were identified by searching ten databases using 16 search terms related to physical activity, fitness, health promotion, and community interventions. All intervention studies related to physical activity were summarized into tables. Six reviewers independently classified the intervention studies by the categories used in the Community Guide and screened the studies for inclusion in a systematic abstraction process to assess the strength of the evidence. Five trained researchers conducted the abstractions. RESULTS The literature search identified 903 peer-reviewed articles and 142 Brazilian theses related to physical activity, of which 19 were selected for full abstraction. Only for school-based physical education classes was the strength of the evidence from Latin America sufficient to support a practice recommendation. CONCLUSIONS This systematic review highlights the need for rigorous evaluation of promising interventions to increase physical activity in Latin America. Implementation and maintenance of school physical education programs and policies should be strongly encouraged to promote the health of Latin American children.

Perceived and observed neighborhood indicators of obesity among urban adults

Objective:The global obesity epidemic has been partially attributed to modern environments that encourage inactivity and overeating, yet few studies have examined specific features of the physical neighborhood environment that influence obesity. Using two different measurement methods, this study sought to identify and compare perceived and observed neighborhood indicators of obesity and a high-risk profile of being obese and inactive.Design:Cross-sectional telephone surveys (perceived) and street-scale environmental audits (observed) were conducted concurrently in two diverse US cities to assess recreational facility access, land use, transportation infrastructure and aesthetics.Subjects:A total of 1032 randomly selected urban residents (20% obese, 32% black, 65% female).Analysis:Bivariate and multivariate logistic regression analyses were conducted to estimate the association (adjusted prevalence odds ratio (aOR)) between the primary outcome (obese vs normal weight) and perceived and observed environmental indicators, controlling for demographic variables.Results:Being obese was significantly associated with perceived indicators of no nearby nonresidential destinations (aOR=2.2), absence of sidewalks (aOR=2.2), unpleasant community (aOR=3.1) and lack of interesting sites (aOR=4.8) and observed indicators of poor sidewalk quality (aOR=2.1), physical disorder (aOR=4.0) and presence of garbage (aOR=3.7). Perceived and observed indicators of land use and aesthetics were the most robust neighborhood correlates of obesity in multivariate analyses.Conclusions:The findings contribute substantially to the growing evidence base of community-level correlates of obesity and suggest salient environmental and policy intervention strategies that may reduce population-level obesity prevalence. Continued use of both measurement methods is recommended to clarify inconsistent associations across perceived and observed indicators within the same domain.

Effects of a community-based, professionally supervised intervention on physical activity levels among residents of Recife, Brazil.

OBJECTIVES We evaluated the effects of a community-based intervention, the Academia da Cidade program (ACP), on increasing leisure-time physical activity among residents of Recife, Brazil. METHODS We used the International Physical Activity Questionnaire to assess leisure-time physical activity and transport physical activity (i.e., activities involved in traveling from place to place) levels in a random sample of 2047 Recife residents surveyed in 2007. We also examined factors related to exposure to ACP (participation in the intervention, residing near an intervention site, hearing about or seeing intervention activities). We estimated prevalence odds ratios (ORs) of moderate to high leisure-time and transport physical activity levels via intervention exposures adjusted for sociodemographic, health, and environmental variables. RESULTS Prevalence ORs for moderate to high levels of leisure-time physical activity were higher among former (prevalence OR=2.0; 95% confidence interval [CI]=1.0, 3.9) and current (prevalence OR=11.3; 95% CI=3.5, 35.9) intervention participants and those who had heard about or seen an intervention activity (prevalence OR=1.8; 95% CI=1.3, 2.5). Transport physical activity levels were inversely associated with residing near an ACP site. CONCLUSIONS The ACP program appears to be an effective public health strategy to increase population-level physical activity in urban developing settings.

Opportunities for integrating public health and urban planning approaches to promote active community environments.

The growing emphasis on promoting environmental change as a means to increase physical activity has motivated conversation and collaboration between researchers and practitioners in the fields of public health and urban planning. Although these fields share similar objectives, their methodological approaches for examining the association between the environment and behavior often differ in significant ways. To facilitate communication, this article discusses ways these fields can collaborate in developing and applying conceptual frameworks, adopting behavioral and environmental measures, and strengthening study designs. By collaborating to build synergism in research and dissemination, public health and urban planning professionals can enhance efforts to increase the number of communities that promote active living.

Perceived environmental correlates of physical activity for leisure and transportation in Curitiba, Brazil

BACKGROUND Physical activity (PA) has consistently been associated with perceived environmental characteristics. OBJECTIVE To examine the association between perceived environmental attributes and various forms of PA in Curitiba, Brazil. METHODS A cross-sectional phone survey of adults was conducted in 2008 (n=2097). The questionnaire included environmental perceptions and PA. Principal components analysis was used to identify groups of perceived environmental attributes. Multivariate methods tested the associations of PA with perceived environment characteristics. RESULTS Perceptions of moderate and high personal safety were positively associated with walking for transportation (53.0%, 53.1% vs. 47.3%, both adjusted ORs [aOR]=1.5). Number of destinations within a 10-minute walk (4 and >6 vs. <3) was positively associated with bicycling for transportation (7.8%, 9.9% vs.4.8%, aOR=2.5). Perception of high accessibility was positively associated with MVPA during leisure time (35.1% vs. 19.1, aOR=1.7) and meeting recommendations for total PA (58.7% vs. 45.1%, aOR=1.4). Perception of high quality of the pedestrian space (57.3% vs. 46.5%, aOR=1.4) and moderate levels of personal safety (54.3% vs. 47.6%, aOR=1.3) were also positively associated with meeting recommendations for total PA. CONCLUSIONS Different environmental attributes were associated with different PA outcomes, suggesting that these relationships are complex and may differ from those in high-income countries.

Assessing Physical Activity in Public Parks in Brazil Using Systematic Observation

OBJECTIVES We assessed park use in Recife, Brazil, and differences in physical activity and occupation rates in public parks with and without the Academia da Cidade Program (ACP), which provides cost-free, supervised physical activity classes. METHODS We used the System for Observing Play and Recreation in Communities (SOPARC) in 128 targeted areas in 10 park sites (5 ACP sites, 5 non-ACP sites) to obtain data on the number of users and their physical activity levels and estimated age. Each area was assessed 4 times a day for 11 days over a 4-week period. RESULTS A total of 32 974 people were observed during 5589 observation visits to target areas. People using ACP parks were more likely to be seen engaging in moderate-to-vigorous (64% vs 49%) and vigorous (25% vs 10%) physical activity. Relatively more participants in ACP sites than in non-ACP sites were females (45% vs 42% of park users) and older adults (14.7% vs 5.7% of park users). CONCLUSIONS On the basis of systematic observation, ACP appears to be a useful strategy in promoting park use and physical activity among the population in Recife.

Designing for Dissemination Among Public Health Researchers: Findings From a National Survey in the United States

OBJECTIVES We have described the practice of designing for dissemination among researchers in the United States with the intent of identifying gaps and areas for improvement. METHODS In 2012, we conducted a cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research. The sample involved scientists at universities, the National Institutes of Health, and the Centers for Disease Control and Prevention in the United States. RESULTS In the pooled sample, 73% of respondents estimated they spent less than 10% of their time on dissemination. About half of respondents (53%) had a person or team in their unit dedicated to dissemination. Seventeen percent of all respondents used a framework or theory to plan their dissemination activities. One third of respondents (34%) always or usually involved stakeholders in the research process. CONCLUSIONS The current data and the existing literature suggest considerable room for improvement in designing for dissemination.

Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk

BACKGROUND Limited evidence exists on the metabolic and cardiovascular risk correlates of commuting by vehicle, a habitual form of sedentary behavior. PURPOSE To examine the association between commuting distance, physical activity, cardiorespiratory fitness (CRF), and metabolic risk indicators. METHODS This cross-sectional study included 4297 adults who had a comprehensive medical examination between 2000 and 2007 and geocoded home and work addresses in 12 Texas metropolitan counties. Commuting distance was measured along the road network. Outcome variables included weekly MET-minutes of self-reported physical activity, CRF, BMI, waist circumference, triglycerides, plasma glucose, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, and continuously measured metabolic syndrome. Outcomes were also dichotomized using established cut-points. Linear and logistic regression models were adjusted for sociodemographic characteristics, smoking, alcohol intake, family history of diabetes, and history of high cholesterol, as well as BMI and weekly MET-minutes of physical activity and CRF (for BMI and metabolic risk models). Analyses were conducted in 2011. RESULTS Commuting distance was negatively associated with physical activity and CRF and positively associated with BMI, waist circumference, systolic and diastolic blood pressure, and continuous metabolic score in fully adjusted linear regression models. Logistic regression analyses yielded similar associations; however, of the models with metabolic risk indicators as outcomes, only the associations with elevated blood pressure remained significant after adjustment for physical activity and CRF. CONCLUSIONS Commuting distance was adversely associated with physical activity, CRF, adiposity, and indicators of metabolic risk.

Effects of buffer size and shape on associations between the built environment and energy balance

Uncertainty in the relevant spatial context may drive heterogeneity in findings on the built environment and energy balance. To estimate the effect of this uncertainty, we conducted a sensitivity analysis defining intersection and business densities and counts within different buffer sizes and shapes on associations with self-reported walking and body mass index. Linear regression results indicated that the scale and shape of buffers influenced study results and may partly explain the inconsistent findings in the built environment and energy balance literature.