James E. Chapman

Many Pathways from Land Use to Health: Associations between Neighborhood Walkability and Active Transportation, Body Mass Index, and Air Quality

Abstract The literature shows single-use, low-density land development and disconnected street networks to be positively associated with auto dependence and negatively associated with walking and transit use. These factors in turn appear to affect health by influencing physical activity, obesity, and emissions of air pollutants. We evaluated the association between a single index of walkability that incorporated land use mix, street connectivity, net residential density, and retail floor area ratios, with health-related outcomes in King County, Washington. We found a 5% increase in walkability to be associated with a per capita 32.1% increase in time spent in physically active travel, a 0.23-point reduction in body mass index, 6.5% fewer vehicle miles traveled, 5.6% fewer grams of oxides of nitrogen (NOx) emitted, and 5.5% fewer grams of volatile organic compounds (VOC) emitted. These results connect development patterns with factors that affect several prevalent chronic diseases.

Neighborhood built environment and income: examining multiple health outcomes.

There is growing interest in the relation of built environments to physical activity, obesity, and other health outcomes. The purpose of the present study was to test associations of neighborhood built environment and median income to multiple health outcomes and examine whether associations are similar for low- and high-income groups. This was a cross-sectional study of 32 neighborhoods in Seattle, WA and Baltimore, MD regions, stratified by income and walkability, and conducted between 2001 and 2005. Participants were adults aged 20-65years (n=2199; 26% ethnic minority). The main outcomes were daily minutes of moderate-to-vigorous physical activity (MVPA) from accelerometer monitoring, body mass index (BMI) based on self-report, and mental and physical quality of life (QoL) assessed with the SF-12. We found that MVPA was higher in high- vs. low-walkability neighborhoods but did not differ by neighborhood income. Overweight/obesity (BMI > or = 25) was lower in high-walkability neighborhoods. Physical QoL was higher in high-income neighborhoods but unrelated to walkability. Adjustment for neighborhood self-selection produced minor changes. We concluded that living in walkable neighborhoods was associated with more physical activity and lower overweight/obesity but not with other benefits. Lower- and higher-income groups benefited similarly from living in high-walkability neighborhoods. Adults in higher-income neighborhoods had lower BMI and higher physical QoL.

A hierarchy of sociodemographic and environmental correlates of walking and obesity

OBJECTIVES Initial studies demonstrate the need for further investigation of how the association of built environment with physical activity and BMI may differ by sociodemographic subgroups. The aim of this study was to use a novel statistical technique to identify possible subgroups. METHODS Data from the 2002 Strategies for Metro Atlantas Regional Transportation and Air Quality (SMARTRAQ) study were analyzed to explore relationships between measures of residential density, street connectivity, land use mix, and sociodemographic characteristics of individuals in predicting walking, overweight and obesity status. Chi-squared Automatic Interaction Detector (CHAID) analyses were used to partition the population into subgroups (N=13,065). RESULTS Subgroups, were more likely to walk if they lived in neighborhoods with greater residential density, greater street connectivity and greater land use mix. A similar relationship was seen in men for the outcomes of obesity and overweight. Male residents of more walkable neighborhoods were less likely to be obese or overweight. In contrast, features of walkability were related to higher rates of obesity and overweight in women and non whites. CONCLUSIONS These analyses reveal that gender and ethnic subgroups display substantially different weight outcomes across different levels of walkability. In contrast, walking was consistently higher for all groups in the more walkable neighborhoods. This information can contribute to better targeting of interventions, and calls for more detailed investigation of the moderators that affect weight and physical activity across subgroups. This information supports a more efficient use of scarce resources to promote physical activity and healthy body weight.

Obesogenic Neighborhood Environments, Child and Parent Obesity The Neighborhood Impact on Kids Study

BACKGROUND Identifying neighborhood environment attributes related to childhood obesity can inform environmental changes for obesity prevention. PURPOSE To evaluate child and parent weight status across neighborhoods in King County (Seattle metropolitan area) and San Diego County differing in GIS-defined physical activity environment (PAE) and nutrition environment (NE) characteristics. METHODS Neighborhoods were selected to represent high (favorable) versus low (unfavorable) on the two measures, forming four neighborhood types (low on both measures, low PAE/high NE, high PAE/low NE, and high on both measures). Weight and height of children aged 6-11 years and one parent (n=730) from selected neighborhoods were assessed in 2007-2009. Differences in child and parent overweight and obesity by neighborhood type were examined, adjusting for neighborhood-, family-, and individual-level demographics. RESULTS Children from neighborhoods high on both environment measures were less likely to be obese (7.7% vs 15.9%, OR=0.44, p=0.02) and marginally less likely to be overweight (23.7% vs 31.7%, OR=0.67, p=0.08) than children from neighborhoods low on both measures. In models adjusted for parent weight status and demographic factors, neighborhood environment type remained related to child obesity (high vs low on both measures, OR=0.41, p<0.03). Parents in neighborhoods high on both measures (versus low on both) were marginally less likely to be obese (20.1% vs 27.7%, OR=0.66, p=0.08), although parent overweight did not differ by neighborhood environment. The lower odds of parent obesity in neighborhoods with environments supportive of physical activity and healthy eating remained in models adjusted for demographics (high vs low on the environment measures, OR=0.57, p=0.053). CONCLUSIONS Findings support the proposed GIS-based definitions of obesogenic neighborhoods for children and parents that consider both physical activity and nutrition environment features.

Income disparities in perceived neighborhood built and social environment attributes

The present study explored whether perceived neighborhood environmental attributes associated with physical activity differ by neighborhood income. Adults aged 20-65 years (n=2199; 48% female; mean age=45 years; 26% ethnic minority) were recruited from 32 neighborhoods from the Seattle, WA and Baltimore, MD regions that varied in objectively measured walkability and neighborhood income. Perceived built and social environment variables were assessed with the Neighborhood Environment Walkability Scale. There were neighborhood income disparities on 10 of 15 variables. Residents from high-income neighborhoods reported more favorable esthetics, pedestrian/biking facilities, safety from traffic, safety from crime, and access to recreation facilities than residents of low-income areas (all ps <0.001). Low-income neighborhoods may lack amenities and safety attributes that can facilitate high levels of physical activity for both transportation and recreation purposes.

Food outlet visits, physical activity and body weight: variations by gender and race–ethnicity

Purpose: Recent evidence documents significant associations between community design, physical activity and obesity when adjusting for demographic covariates. Yet it is well understood that energy imbalance and weight gain are also a function of dietary patterns, and perhaps the degree of access to healthy food choices. Methods: The current study builds upon the Atlanta-based SMARTRAQ study of over 10 000 respondents and reports an integrated assessment of obesity impacts of physical activity and food outlet visitation. Respondents in the SMARTRAQ survey aged 25–65 provided BMI, self-reported physical activity levels (IPAQ), demographic factors, and where they went for food over a 2 day period. Results: The relative effect of physical activity, neighbourhood walkability, and food outlet visitation on BMI differed significantly across gender and ethnicity. BMI in females increased with fast food and decreased with grocery store visitation and physical activity, but not with walkability or walking. BMI in males was not related to where they went for food but decreased with walking and overall physical activity and with walkability. Fast food visitation was associated with increased BMI in white respondents and grocery store visitation with decreased BMI in black respondents. Meeting moderate activity guidelines was associated with lower BMI in both black and white respondents, yet walking was only significant in predicting reduced BMI in white respondents. Conclusion: Obesity influences of physical activity, walkability, and where people go for food differ significantly across gender and ethnicity and offer important policy implications and insights for future research.

International variation in neighborhood walkability, transit, and recreation environments using geographic information systems: the IPEN adult study.

BackgroundThe World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions.MethodsThe International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant’s residential address using 1-km and 500-m street network buffers.ResultsEleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability.ConclusionsResults show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals’ physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose–response relationships from projected changes to the built environment that would otherwise be impossible.

Predictors of trips to food destinations

BackgroundFood environment studies have focused on ethnic and income disparities in food access. Few studies have investigated distance travelled for food and did not aim to inform the geographic scales at which to study the relationship between food environments and obesity. Further, studies have not considered neighborhood design as a predictor of food purchasing behavior.MethodsAtlanta residents (N = 4800) who completed a travel diary and reported purchasing or consuming food at one of five food locations were included in the analyses. A total of 11,995 food-related trips were reported. Using mixed modeling to adjust for clustering of trips by participants and households, person-level variables (e.g. demographics), neighborhood-level urban form measures, created in GIS, and trip characteristics (e.g. time of day, origin and destination) were investigated as correlates of distance travelled for food and frequency of grocery store and fast food outlet trips.ResultsMean travel distance for food ranged from 4.5 miles for coffee shops to 6.3 miles for superstores. Type of store, urban form, type of tour, day of the week and ethnicity were all significantly related to distance travelled for food. Origin and destination environment, type of tour, day of week, age, gender, income, ethnicity, vehicle access and obesity status were all significantly related to visiting a grocery store. Home neighborhood environment, day of week, type of tour, gender, income, education level, age, and obesity status were all significantly related to likelihood of visiting a fastfood outlet.ConclusionsThe present study demonstrated that people travel sizeable distances for food and this distance is related to urban. Results suggest that researchers need to employ different methods to characterize food environments than have been used to assess urban form in studies of physical activity. Food is most often purchased while traveling from locations other than home, so future studies should assess the food environment around work, school or other frequently visited destinations, as well as along frequently traveled routes.

Association between neighborhood walkability and GPS-measured walking, bicycling and vehicle time in adolescents

OBJECTIVES To investigate relations of walking, bicycling and vehicle time to neighborhood walkability and total physical activity in youth. METHODS Participants (N=690) were from 380 census block groups of high/low walkability and income in two US regions. Home neighborhood residential density, intersection density, retail density, entertainment density and walkability were derived using GIS. Minutes/day of walking, bicycling and vehicle time were derived from processing algorithms applied to GPS. Accelerometers estimated total daily moderate-to-vigorous physical activity (MVPA). Models were adjusted for nesting of days (N=2987) within participants within block groups. RESULTS Walking occurred on 33%, active travel on 43%, and vehicle time on 91% of the days observed. Intersection density and neighborhood walkability were positively related to walking and bicycling and negatively related to vehicle time. Residential density was positively related to walking. CONCLUSIONS Increasing walking in youth could be effective in increasing total physical activity. Built environment findings suggest potential for increasing walking in youth through improving neighborhood walkability.

Development, scoring, and reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS)

BackgroundStreetscape (microscale) features of the built environment can influence people’s perceptions of their neighborhoods’ suitability for physical activity. Many microscale audit tools have been developed, but few have published systematic scoring methods. We present the development, scoring, and reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS) tool and its theoretically-based subscales.MethodsMAPS was based on prior instruments and was developed to assess details of streetscapes considered relevant for physical activity. MAPS sections (route, segments, crossings, and cul-de-sacs) were scored by two independent raters for reliability analyses. There were 290 route pairs, 516 segment pairs, 319 crossing pairs, and 53 cul-de-sac pairs in the reliability sample. Individual inter-rater item reliability analyses were computed using Kappa, intra-class correlation coefficient (ICC), and percent agreement. A conceptual framework for subscale creation was developed using theory, expert consensus, and policy relevance. Items were grouped into subscales, and subscales were analyzed for inter-rater reliability at tiered levels of aggregation.ResultsThere were 160 items included in the subscales (out of 201 items total). Of those included in the subscales, 80 items (50.0%) had good/excellent reliability, 41 items (25.6%) had moderate reliability, and 18 items (11.3%) had low reliability, with limited variability in the remaining 21 items (13.1%). Seventeen of the 20 route section subscales, valence (positive/negative) scores, and overall scores (85.0%) demonstrated good/excellent reliability and 3 demonstrated moderate reliability. Of the 16 segment subscales, valence scores, and overall scores, 12 (75.0%) demonstrated good/excellent reliability, three demonstrated moderate reliability, and one demonstrated poor reliability. Of the 8 crossing subscales, valence scores, and overall scores, 6 (75.0%) demonstrated good/excellent reliability, and 2 demonstrated moderate reliability. The cul-de-sac subscale demonstrated good/excellent reliability.ConclusionsMAPS items and subscales predominantly demonstrated moderate to excellent reliability. The subscales and scoring system represent a theoretically based framework for using these complex microscale data and may be applicable to other similar instruments.