Sarah Foster

A place for play? The influence of the home physical environment on children's physical activity and sedentary behaviour.

The home environment is an important influence on the sedentary behaviour and physical activity of children, who have limited independent mobility and spend much of their time at home. This article reviews the current evidence regarding the influence of the home physical environment on the sedentary behaviour and physical activity of children aged 8–14 years. A literature search of peer reviewed articles published between 2005 and 2011 resulted in 38 observational studies (21 with activity outcomes, 23 with sedentary outcomes) and 11 experimental studies included in the review. The most commonly investigated behavioural outcomes were television watching and moderate to vigorous physical activity. Media equipment in the home and to a lesser extent the bedroom were positively associated with children’s sedentary behaviour. Physical activity equipment and the house and yard were not associated with physical activity, although environmental measures were exclusively self-reported. On the other hand, physical activity equipment was inversely associated with sedentary behaviours in half of studies. Observational studies that investigated the influence of the physical and social environment within the home space, found that the social environment, particularly the role of parents, was important. Experimental studies that changed the home physical environment by introducing a television limiting device successfully decreased television viewing, whereas the influence of introducing an active video game on activity outcomes was inconsistent. Results highlight that the home environment is an important influence on children’s sedentary behaviour and physical activity, about which much is still unknown. While changing or controlling the home physical environment shows promise for reducing screen based sedentary behaviour, further interventions are needed to understand the broader impact of these changes. Future studies should prioritise investigating the influence of the home physical environment, and its interaction with the social environment, on objectively measured sedentary time and home context specific behaviours, ideally including technologies that allow objective measures of the home space.

The association between neighborhood greenness and cardiovascular disease: an observational study

BackgroundPrevious studies have demonstrated links between cardiovascular disease and physical inactivity and poor air quality, which are both associated with neighborhood greenness. However, no studies have directly investigated neighborhood greenness in relation to coronary heart disease risk. We investigated the effect of neighborhood greenness on both self-reported and hospital admissions of coronary heart disease or stroke, accounting for ambient air quality, socio-demographic, behavioral and biological factors.MethodCross-sectional study of 11,404 adults obtained from a population representative sample for the period 2003–2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600 m service area surrounding the residential address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Logistic regression was used to assess associations with medically diagnosed and hospitalization for coronary heart disease or stroke.ResultsThe odds of hospitalization for heart disease or stroke was 37% (95% CI: 8%, 57%) lower among adults in neighborhoods with highly variable greenness (highest tertile) compared to those in predominantly green, or predominantly non-green neighborhoods (lowest tertile). This effect was independent of the absolute levels of neighborhood greenness. There was weaker evidence for associations with the mean level of neighborhood greenness.ConclusionVariability in neighborhood greenness is a single metric that encapsulates two potential promoters of physical activity - an aesthetically pleasing natural environment and access to urban destinations. Variability in greenness within a neighborhood was negatively associated with coronary heart disease and stroke.

A Longitudinal Analysis of the Influence of the Neighborhood Built Environment on Walking for Transportation The RESIDE Study

The purpose of the present analysis was to use longitudinal data collected over 7 years (from 4 surveys) in the Residential Environments (RESIDE) Study (Perth, Australia, 2003-2012) to more carefully examine the relationship of neighborhood walkability and destination accessibility with walking for transportation that has been seen in many cross-sectional studies. We compared effect estimates from 3 types of logistic regression models: 2 that utilize all available data (a population marginal model and a subject-level mixed model) and a third subject-level conditional model that exclusively uses within-person longitudinal evidence. The results support the evidence that neighborhood walkability (especially land-use mix and street connectivity), local access to public transit stops, and variety in the types of local destinations are important determinants of walking for transportation. The similarity of subject-level effect estimates from logistic mixed models and those from conditional logistic models indicates that there is little or no bias from uncontrolled time-constant residential preference (self-selection) factors; however, confounding by uncontrolled time-varying factors, such as health status, remains a possibility. These findings provide policy makers and urban planners with further evidence that certain features of the built environment may be important in the design of neighborhoods to increase walking for transportation and meet the health needs of residents.

The influence of the built environment, social environment and health behaviors on body mass index. results from RESIDE.

OBJECTIVE To examine the individual, behavioral, social and built environment correlates of body mass index (BMI) in an Australian adult population. METHOD Using data from 2003 to 2005 on 1151 participants in the RESIDential Environments project (RESIDE), Perth, Western Australia, linear regression was used to construct multivariate models to examine the variance in BMI explained by significant socio-demographic, environmental and health behavior variables. Both self-report and GIS-derived measures of the built environment were examined. RESULTS Age, gender, hours of work, total physical activity, sedentary leisure time and dietary fat were all associated with BMI (p≤0.05). BMI was not associated with any objective measures of the built environment or social capital, social cohesion or dog ownership but was independently associated with one perceived environment measure (perceived safety from crime). Overall, 3.3% of the variance in BMI was explained by socio-demographic factors, a further 2.7% by health behaviors and a further 1.5% by perceived environment factors. CONCLUSION Whilst evidence mounts of built environment correlates to physical activity, the demonstrated translation of these effects on BMI remain more elusive. Nevertheless, built environment factors that constrain physical activity warrant further exploration.

The impact of the built environment on health across the life course: design of a cross-sectional data linkage study

Introduction The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course. Methods and analysis This cross-sectional data linkage study involves 15 954 children (0–15 years), young adults (16–24 years), adults (25–64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australias (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants’ residential address was geocoded and features of their ‘neighbourhood’ were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages. Ethics and dissemination The University of Western Australias Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents.

The association between neighborhood greenness and weight status: an observational study in Perth Western Australia

BackgroundFew studies have examined the relationship between weight status and objectively measured neighborhood greenness and no study has examined this relationship across the different stages of adulthood. This research was an investigation of weight status and neighborhood greenness using objectively measured satellite remote sensing for a large population representative sample.MethodCross-sectional study of 10,208 young adults (16–24 years), mid-age adults (25–64 years) and older adults (65+ years) from a population representative sample for the period 2004–2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600m road network service area around each participant’s address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Multiple logistic regression was used to assess associations with weight status (overweight-or-obese, obese) adjusted for socio-demographics and health-related behaviors.ResultsThe adjusted odds ratio (OR) comparing obesity in the highest to the lowest tertile of mean greenness was 0.78 (95% CI 0.69-0.89). For the same comparison, the OR for overweight-or-obese was similar, 0.84 (95% CI 0.76-0.92). The OR comparing obesity in the highest to lowest tertile of variation in greenness was 0.75 (95% CI 0.66-0.85). For the same comparison, the OR for overweight-or-obese was similar, 0.75 (95% CI 0.68-0.82).ConclusionHigher levels and greater variation of neighborhood greenness are associated with lower odds of obesity among adults of all ages. Research examining neighborhood characteristics correlated with variability in greenness will help better understand these relationships.

Sense of Community and Its Association With the Neighborhood Built Environment

We investigated the influence of neighborhood built form on sense of community in Perth, Western Australia. It was hypothesized that sense of community would be stronger in individuals living in pedestrian-friendly neighborhoods. Multivariate linear regression models explored associations between walking and sense of community, with progressive adjustment for objective and perceived neighborhood characteristics. Sense of community was positively associated with walking for transport and positive perceptions of neighborhood quality, and negatively associated with residential density. The findings highlight the influence of local area perceptions on sense of community that appeared to be more important than objective environment characteristics. However, the latter may influence perceptions, and this requires investigation.

A new urban planning code's impact on walking: The residential environments project

OBJECTIVES We examined whether people moving into a housing development designed according to a state government livable neighborhoods subdivision code engage in more walking than do people who move to other types of developments. METHODS In a natural experiment of 1813 people building homes in 73 new housing developments in Perth, Western Australia, we surveyed participants before and then 12 and 36 months after moving. We measured self-reported walking using the Neighborhood Physical Activity Questionnaire and collected perceptions of the environment and self-selection factors. We calculated objective measures of the built environment using a Geographic Information System. RESULTS After relocation, participants in livable versus conventional developments had greater street connectivity, residential density, land use mix, and access to destinations and more positive perceptions of their neighborhood (all P < .05). However, there were no significant differences in walking over time by type of development (P > .05). CONCLUSIONS Implementation of the Livable Neighborhoods Guidelines produced more supportive environments; however, the level of intervention was insufficient to encourage more walking. Evaluations of new urban planning policies need to incorporate longer term follow-up to allow time for new neighborhoods to develop.

The influence of the neighborhood physical environment on early child health and development: A review and call for research

This review examines evidence of the association between the neighborhood built environment, green spaces and outdoor home area, and early (0-7 years) child health and development. There was evidence that the presence of child relevant neighborhood destinations and services were positively associated with early child development domains of physical health and wellbeing and social competence. Parents׳ perceptions of neighborhood safety were positively associated with children׳s social-emotional development and general health. Population representative studies using objective measures of the built environment and valid measures of early child development are warranted to understand the impact of the built environment on early child health and development.

Does Fear of Crime Discourage Walkers? A Social-Ecological Exploration of Fear As a Deterrent to Walking

Few studies have specifically investigated fear of crime as a deterrent to walking. This study tested the hypothesis that fear would inhibit residents from walking in their local neighborhoods. Homeowners (n = 1,044) in Perth, Western Australia, reported their fear of crime, neighborhood problems and walking, and objective environmental measures were generated for each participant’s neighborhood. Multivariate logistic regression models examined the association between fear and walking, with progressive adjustment for other correlates. Fear was associated with lower odds of transport walking (OR = 0.79, p = .034); however, car access was ubiquitous so fearful participants could avoid walking. A similar association between fear and recreational walking attenuated after controlling for other neighborhood factors. Findings suggest that the capacity for fear to deter recreational walkers is not fixed, and that a supportive environment can lessen its impact. Community initiatives that encourage social interaction between residents and improve neighborhood aesthetics may increase levels of recreational walking.