www.activelivingresearch.org
fax 619-260-1510
San Diego, California 92103 tel 619-260-5534
3900 Fifth Avenue, Suite 310
San Diego State University
James F. Sallis, Ph.D., Director
alr@projects.sdsu.edu
Carmen L. Cutter, MPH, Deputy Director
ccutter@projects.sdsu.edu
Introduction to the Active Living Research Reference List Aug.-Dec. 2009
The following pages are citations of studies of the relationships between the
environment, physical activity, and obesity published during the second half of 2009.
We have organized the publications into 8 categories to make them easier to review.
The categories are:
1.
2.
3.
4.
5.
6.
7.
8.
Built Environment – Child Physical Activity/Obesity,
Built Environment – Adult Physical Activity/Obesity,
Policy – Physical Activity/Obesity,
Social, Cultural & Family Environments – Child Physical Activity/Obesity,
Social, Cultural & Family Environments – Adult Physical Activity/Obesity,
Measurement,
Community Based Interventions – Physical Activity and Obesity,
Childhood Obesity & Miscellaneous
The searches were conducted using several databases and were designed to represent
the multiple disciplines in the active living research field. The number of citations
continues to grow, especially as there is an extraordinary amount of literature on built
environment and policy related to physical activity and obesity. Some citations do not
include a journal issue or page numbers; these are articles that are available online
ahead of print publication.
We have improved upon our search terms and hope that this list is inclusive. Please
send us relevant citations we have missed. Studies that focus on food environments will
be covered by the RWJF Healthy Eating Research program.
We will continue to publish twice yearly literature updates as the literature is expanding
so rapidly. The abstracts for the current 2009 update and the 2004-2007 abstracts can
be found at: http://activelivingresearch.org/resourcesearch/referencelist.
Papers that specifically report environmental correlates of physical activity behavior or
obesity will be included in the online ALR literature database
(http://www.activelivingresearch.org/resourcesearch/literaturedatabase).
If you have questions or comments please contact Chad Spoon at
cspoon@projects.sdsu.edu.
We would like acknowledgement the hard work of Ding Ding (Melody) and the Active
Living Research staff for searching several databases and compiling the 2009 reference
list.
An Active Living program supported by The Robert Wood Johnson Foundation and administered by San Diego State
University.
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
2009 Search Terms
Physical Activity/Obesity terms (abstract only)
non motorized OR NMT OR multimodal
transportation OR active transport* OR driving
OR active living OR inactivity OR inactive OR
fit OR fitness OR body mass index OR BMI OR
car OR cars OR automobile OR leisure OR
television OR TV OR obese OR obesity OR
weight OR overweight OR journey OR travel*
OR walk OR walking OR cycle OR cycling OR
bike OR bikers OR biking OR bicycle OR
bicycling OR sedentary OR commuter* OR
commuting OR exercise OR exercising OR
exerciser* OR physical activity OR physically
active OR play OR playground* OR playing OR
vehicle OR obesogenic
Environment terms (title or abstract)
environment OR environments OR environmental
OR sprawl OR neighbourhood* OR neighborhood*
OR recreation* OR metropolitan OR rural OR urban*
OR pedestrian OR pedestrians OR equipment OR
geograph* OR aesthet* OR convenient OR
convenience OR urban form OR destination* OR trail
OR trails OR park OR parks OR path OR paths OR
distance* OR density OR access* OR planning OR
location* OR feature* OR polic* OR facility OR
facilities OR crime OR architecture OR building* OR
transit OR street* OR stair* OR playground OR
playgrounds OR urban design OR neighborhood
development OR neighbourhood development OR
smart growth OR outdoor OR indoor OR connectivity
OR new urbanism OR healthy places OR healthy
communities OR greenway OR greenways OR railtrail OR home OR school OR schools OR land use
OR safe OR safety OR route OR routes OR
workplace OR community OR communities OR
attractive* OR green space* OR public space* OR
open space* OR place OR places OR site OR sites
OR siting OR greenery OR amenity OR amenities
OR attribute* OR walkable OR walkability OR
residential OR residence OR sidewalks OR
availability
Databases used in the literature searches included Pub Med, ISI Web of Science, Leisure and
Recreation Journals and other non-indexed journals.
For more specific information please contact Chad Spoon at cspoon@projects.sdsu.edu.
2
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Journal Counts:
These may indicate journals more interested in built environment research where
you could send your manuscripts. Note that only journals with more than one
count were included.
American Journal of Health Promotion- 6
American Journal of Preventive Medicine- 6
American Journal of Public health -4
BMC Public Health- 3
British Journal of Sports Medicine- 2
Health Education & Behavior--2
Health and Place- 10
International Journal of Pediatric Obesity- 2
Journal of Adolescent Health- 2
Journal of Nutrition Education and Behavior –3
Journal of Park and Recreation Administration – 4
Journal of Physical Activity and Health --10
Journal of School Health-5
Leisure Sciences –2
Medicine and Science in Sports and Exercise- 2
Pediatric Exercise Science- 2
Pediatrics –2
Pediatric Exercise Science –2
Preventing Chronic Diseases-2
Preventive Medicine- 2
Social Science and Medicine--2
3
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
1. Built Environment and Youth Physical Activity/Obesity
Chaloupka, F. J. and L. M. Powell (2009). "Price, availability, and youth obesity:
evidence from Bridging the Gap." Prev Chronic Dis 6(3): A93.
After a decade of analyzing environmental influences on substance use
and its consequences among youth in the United States, the Robert Wood
Johnson Foundation's Bridging the Gap program has begun studying the
effect of environmental factors on youth physical activity, diet, and weight
outcomes. Much of this research has focused on access to food, as
reflected by availability and price. Program researchers have documented
disparities in access to healthy foods and opportunities for physical
activity; healthier food outlets and opportunities for physical activity are
relatively less available in communities with lower income and larger
proportions of racial/ethnic minority populations. They also have found that
healthier environments are associated with more fruit and vegetable
consumption, more physical activity, lower body mass index, and reduced
likelihood of obesity among youth.
Cradock, A. L., S. J. Melly, et al. (2009). "Youth Destinations Associated with
Objective Measures of Physical Activity in Adolescents." Journal of Adolescent
Health 45(3): S91-S98.
Purpose: Limited availability of desirable destinations within walkable
distances and unsuitable weather may adversely affect physical activity
among adolescents on weekends. This study examines evidence for
associations between objective measures of local environment and
physical activity levels of adolescents. Methods: Students (n = 152, 59%
male; mean age, 13.7 years) from 10 neighborhoods with schools in four
communities wore TriTrac-R3D accelerometers recording physical
movements on weekends. Minute-by-minute data were summed over 15minute intervals providing estimates of proportion of time spent in
moderate and vigorous physical activity (MVPA) and (log) mean physical
activity levels on weekends (n = 7,506 intervals). Objective measures of
neighborhood characteristics were calculated using geographic
information systems including average daily traffic, housing density, open
space, and density of employees per square kilometer in youth
destinations. Linear mixed models were fit examining associations
between neighborhood environmental variables and accelerometer
measures of physical activity, controlling for time, day, age, body mass
index, gender of respondent, race/ethnicity, precipitation, and temperature
deviation. Results: On weekends, the presence of greater densities of
employees in neighborhood destinations serving youth (beta = 3.96, p =
0.050) was directly associated with MVPA, independent of student
characteristics. Conclusions: Young people attending schools in
neighborhoods characterized by greater densities of employees in
destinations for youth are more physically active on weekends. Compared
4
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
with neighborhoods with lower densities, attending a school in
neighborhoods with higher densities of employees in potential destinations
for youth may contribute to participation in an additional 30 minutes of
MVPA per day on weekends. (C) 2009 Society for Adolescent Medicine.
All rights reserved.
Dunton, G. F., J. Kaplan, et al. (2009). "Physical environmental correlates of
childhood obesity: a systematic review." Obes Rev 10(4): 393-402.
Increasing rates of childhood obesity in the USA and other Western
countries are a cause for serious public health concern. Neighborhood
and community environments are thought to play a contributing role in the
development of obesity among youth, but it is not well understood which
types of physical environmental characteristics have the most potential to
influence obesity outcomes. This paper reports the results of a systematic
review of quantitative research examining built and biophysical
environmental variables associated with obesity in children and
adolescents through physical activity. Literature searches in PubMed,
PsychInfo and Geobase were conducted. Fifteen quantitative studies met
the inclusion criteria for this systematic review. The majority of studies
were cross-sectional and published after 2005. Overall, few consistent
findings emerged. For children, associations between physical
environmental variables and obesity differed by gender, age,
socioeconomic status, population density and whether reports were made
by the parent or child. Access to equipment and facilities, neighborhood
pattern (e.g. rural, exurban, suburban) and urban sprawl were associated
with obesity outcomes in adolescents. For most environmental variables
considered, strong empirical evidence is not yet available. Conceptual
gaps, methodological limitations and future research directions are
discussed.
Franzini, L., M. N. Elliott, et al. (2009). "Influences of Physical and Social
Neighborhood Environments on Children's Physical Activity and Obesity."
American Journal of Public Health 99(2): 271-278.
Objectives. We investigated the association between physical and social
neighborhood environments and fifth-grade students' physical activity and
obesity. Methods. We collected data on 650 children and their primary
caregivers during phase 1 of Healthy Passages, a multisite, communitybased, cross-sectional study of health risk behaviors and health outcomes
in children. We conducted independent systematic neighborhood
observations to measure neighborhood physical characteristics, and we
analyzed survey data on social processes. We modeled children's
physical activity and obesity status with structural equation models that
included latent variables for the physical and social environments. Results.
After we controlled for children's sociodemographic factors, we found that
a favorable social environment was positively associated with several
5
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
measures of physical activity and that physical activity was negatively
associated with obesity in these children. Physical environment was not
significantly associated with physical activity. Conclusions. Our findings
suggest that neighborhood social factors as well as the physical
environment should be considered in the development of health policy and
interventions to reduce childhood obesity. [Am J Public Health 200999:271-278. doi:10.2105/AJPH.2007.128702)
Fyhri, A. and R. Hjorthol (2009). "Children's independent mobility to school,
friends and leisure activities." Journal of Transport Geography 17(5): 377-384.
Increased use of the car in the everyday transport of children can lead to
environmental problems, and cause increased obesity and decreased
independence among children. Using a structural equation model we
investigate the influence of a range of background variables on mode
choice for Norwegian children's transport to school or leisure activities.
Distance to school and children's age were the most influential variables
on children's independent mobility, measured as an index. Objective
descriptors of the traffic environment only explain independent mobility via
parents' safety experience. (C) 2008 Elsevier Ltd. All rights reserved.
Hawkins, S. S., A. Pearce, et al. (2009). "Perceived and objective measures of
the neighbourhood environment and overweight in preschool children and their
mothers." International Journal of Pediatric Obesity 4(3): 183-192.
Objectives. The primary aim was to examine the relationships between
perceived and objective measures of the neighbourhood environment,
measured in late infancy, and subsequent overweight (including obesity)
in 3-year-old children and their mothers. The secondary aim was to
assess whether moving residence confounded these relationships.
Methods. We analysed data on 8 154 children and their mothers from the
UK Millennium Cohort Study who had participated since birth and were
living in England. At the first contact (late infancy), mothers reported their
perceptions of their neighbourhood environment, and objective measures
of the neighbourhood environment were obtained by linking national
deprivation data to each child's postcode. We conducted logistic and
multilevel regression analyses to examine perceived and objective
measures of the neighbourhood environment, respectively, and
overweight at the second contact (3 years) in children and their mothers.
All analyses were adjusted for moving residence. Results. There were few
consistent patterns between measures of the neighbourhood environment
(perceived or objective) and early childhood overweight. However,
mothers' risk of overweight increased with increasingly poor
neighbourhood conditions (perceived) or residence in areas of increasing
deprivation (objective), after adjustment for individual socio-demographic
factors. All relationships were maintained after adjustment for moving
residence. Conclusions. While area-level factors have limited influence on
6
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
the development of overweight in preschool children, they are likely to
affect overweight in their mothers. Policies need to address both individual
and environmental factors to tackle obesity and its determinants across
the life course.
He, M., S. Harris, et al. (2009). "Understanding Screen-Related Sedentary
Behavior and Its Contributing Factors Among School-Aged Children: A SocialEcologic Exploration." American Journal of Health Promotion 23(5): 299-308.
Purpose. To explore the factors that contribute to children's screen-related
sedentary (S-RS) behaviors. Settings. Elementary schools. Subjects. A
random sample of children in grades five and six and their parents.
Measures. The outcome measure was children's S-RS activity level
measured by a self-administered questionnaire. A full spectrum of
potential contributing factors for children's S-RS behaviors was obtained
through surveys. Multilevel linear regression methods were used to
determine the associations between these factors and children's screen
time (hours per day) and results were expressed as regression
coefficients (g). Results. Of 955 child-parent pairs in 14 participating
schools, 508 pairs (53%) completed the surveys. At an intrapersonal level,
protective factors included being a girl (g = -.71); belonging to a sports
team inside (g = -.56) or outside (g = -.49) of school; having a negative
attitude toward S-RS activities (g = -.13); and having a positive attitude
toward physical activity (g = -.48). At the interpersonal and social levels,
parental leisure S-RS behaviors (g = .32) were positively associated,
whereas strict parental rules on computer use (g = -.27) and family income
(g = -.32) were inversely correlated with S-RS behavior. At the
environmental level, the presence of TVs in children's bedrooms (g = .44)
and owning videogame devices (g = .58) increased the risk of S-RS
behaviors, whereas after school programs (g = -.86) and schools'
participation in the Turn Off the Screen Week campaign (g = -.91)
decreased the risk. Conclusions. Public health interventions should target
multilevel factors, including increasing children's awareness, promoting
parental involvement in healthy lifestyle pursuits, and creating less
screenogenic environments.
Holt, N. L., C. T. Cunningham, et al. (2009). "Neighborhood physical activity
opportunities for inner-city children and youth." Health & Place 15(4): 1022-1028.
The purpose of this study was to assess perceived physical activity (PA)
opportunities and barriers for inner-city youth. Data were collected via
interviews with 59 children, 8 school staff, and 13 youth workers plus
objective neighborhood data. Analyses revealed three themes that
influenced PA: neighborhood characteristics, family involvement, and
adult-supervised programs. The neighborhood was highly walkable and
multiple play spaces were available, but safety concerns restricted access.
Children were rarely allowed out alone, but family accompaniment
facilitated PA. Organized programs provided adult-supervised PA, but
7
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
programs faced staffing problems that served to limit the provision of PA
opportunities. Multiple ecological factors constrain or enable PA among
inner-city youth. (C) 2009 Elsevier Ltd. All rights reserved.
Larsen, K., J. Gilliland, et al. (2009). "The Influence of the Physical Environment
and Sociodemographic Characteristics on Children's Mode of Travel to and From
School." American Journal of Public Health 99(3): 520-526.
Objectives. We examined whether certain characteristics of the social and
physical environment influence a child's mode of travel between home and
school. Methods. Students aged 11 to 13 years from 21 schools
throughout London, Ontario, answered questions from a travel behavior
survey. A geographic information system linked survey responses for 614
students who lived within 1 mile of school to data on social and physical
characteristics of environments around the home and school. Logistic
regression analysis was used to test the influence of environmental factors
on mode of travel (motorized vs "active") to and from school. Results.
Over 62% of students walked or biked to school, and 72% from school to
home. The likelihood of walking or biking to school was positively
associated with shorter trips, male gender, higher land use mix, and
presence of street trees. Active travel from school to home was also
associated with lower residential densities and lower neighborhood
incomes. Conclusions. Our findings demonstrate that active travel is
associated with environmental characteristics and suggest that school
planners should consider these factors when siting schools in order to
promote increased physical activity among students.
Loucaides, C. A. (2009). "School Location and Gender Differences in Personal,
Social, and Environmental Correlates of Physical Activity in Cypriot Middle
School Children." Journal of Physical Activity & Health 6(6): 722-730.
A number of studies indicate higher prevalence of overweight and obesity
among rural school children. The purpose of this study was to examine the
differences in personal, social, and environmental correlates of physical
activity between school location (urban versus rural) and gender.
Methods: Middle school children (N = 676) from different districts in
Cyprus completed questionnaires assessing physical activity and potential
correlates. Results: Children from rural schools reported higher friend
support for physical activity and more ease of walk to a bus station from
their home. Urban school children reported higher presence of sidewalks
in their neighborhood. Boys reported more hours per day playing outside
and higher enjoyment and friend support for physical activity than girls,
whereas girls reported higher means in the variable 'I see a lot of people
walking or being physically active in my neighborhood'. Significant twoway interactions between gender and school location were noted with
rural school girls having less favorable scores in a number of correlates of
physical activity. Conclusions: More studies are needed to further
understand the higher incidence of overweight and obesity observed
8
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
among rural youth. Girls from rural areas may be targeted as a priority
group for promoting physical activity.
Monge-Rojas, R., C. Garita-Arce, et al. (2009). "Barriers to and Suggestions for a
Healthful, Active Lifestyle as Perceived by Rural and Urban Costa Rican
Adolescents." Journal of Nutrition Education & Behavior 41(3): 152-160.
Objective: To assess the perceptions of rural and urban Costa Rican
adolescents regarding which barriers and motivators affect their adoption
of an active lifestyle. Design: Data were collected in focus group
discussions. Participants: 108 male and female adolescents aged 12 to 18
from the 7th to 11th grades. Setting: Two urban and 1 rural high school in
San José, Costa Rica. Phenomena of Interest: Active lifestyle; barriers
and motivators for active life. Analysis: Data were reviewed for emerging
themes, and themes were coded using content analysis procedures.
Results: Major barriers: (a) physical education curriculum was focused on
competitive sports; (b) lack of facilities in the school and community
environments; (c) family did not provide good role models and reinforced
the socially expected gender roles. Key motivators: (a) changed the
physical education curriculum to focus on leisure and recreational
activities; (b) increased the availability of facilities both in the school and in
the community; and (c) provided a strong social support network.
Conclusions and Implications: The school, community, and family
environments are potential targets for physical activity interventions for
adolescents. Future studies should explore in depth the influence of
adolescent socialization patterns (particularly for females) in the
establishment of an active lifestyle.
Morgenstern, M., J. D. Sargent, et al. (2009). "Relation Between Socioeconomic
Status and Body Mass Index Evidence of an Indirect Path via Television Use."
Archives of Pediatrics & Adolescent Medicine 163(8): 731-738.
Objective: To test the hypothesis that media use mediates the relation
between socioeconomic status (SES) and body mass index (BMI). Design:
Analysis of 2 large cross-sectional surveys, 1 from Germany and 1 from
the United States. Setting: Twenty-seven public schools in northern
Germany; telephone interviews in the United States. Participants: A total
of 4810 German children and adolescents aged 10 to 17 years (mean
age, 12.8 years); 4473 US children and adolescents aged 12 to 16 years
(mean age, 14.0 years) recruited using random-digit-dial methods. Main
Exposures: Media exposure was assessed via survey questions about the
presence of a television in the bedroom, television screen time, computer
and video game screen time, and movie viewing. The SES was derived
from type of school (German sample) or parental reports of their own
education and family income (US sample). Main Outcome Measures: The
BMI was assessed by the use of self-reports in both samples,
supplemented by parental reports (US sample) for height and weight.
Results: In both samples, SES was inversely associated with BMI, and
9
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
media use was directly associated with BMI. The effect of SES on
overweight was partially mediated by media exposure, which explained
35% of the SES-BMI association in the German sample and 16% in the
US sample. In both groups, television in the bedroom and television
screen time had statistically significant indirect paths, whereas video game
use and movie viewing did not. Conclusions: Students from low-SES
backgrounds are at higher risk for overweight in part because of higher
levels of television viewing. The change of media use habits could modify
this health disparity.
Mota, J., M. Almeida, et al. (2009). "Association of Perceived Environmental
Characteristics and Participation in Organized and Non-Organized Physical
Activities of Adolescents." Pediatric Exercise Science 21(2): 233-239.
Specific behavior context such as type of PA (organized vs. nonorganized)
might be associated with different environmental correlates. The main goal
of this cross-sectional survey was to examine perceived environmental
associations with type of adolescents' physical activity (PA) choices
(organized and nonorganized). A sample of this study comprised 425 girls
with mean age of 14.5 years-old. Environmental variables and PA were
assessed by questionnaire, which allowed to define the type (organized or
nonorganized) of PA. No associations were found between environmental
perceptions and the participation in organized activities. However, different
dimensions of environmental variables such as accessibilities to facilities
(p ⩽ .05) aesthetics (p ⩽ .05) and social environment (p ⩽ .05)
were associated to girls' PA participation in nonorganized activities
(NOPA). Our findings suggested that some environmental characteristics
might play an important role in girls' NOPA participation.
Nelson, N. M. and C. B. Woods (2009). "Obesogenic environments: Are
neighbourhood environments that limit physical activity obesogenic?" Health &
Place 15(4): 917-924.
The impact of obesogenic environments on adolescent health is poorly
understood. This study examines if neighbourhood features related to
physical activity are also related to unhealthy weight status. Adolescents
(N = 4587, age 15-17 years, 51.4% male) self-reported physical activity
and neighbourhood perceptions. Trained researchers measured height
and weight. Logistic regression identified if neighbourhood perceptions
predicted overweight or obesity. Adolescents who reported convenient
physical activity facilities were 2% less likely to be overweight/obese and
5% less likely to be obese, controlled for socio-demographic variables and
clustering by school. Physical activity does not appear to directly influence
or mediate the relationship between perceived convenient facilities and
weight status. (C) 2009 Elsevier Ltd. All rights reserved.
Nichol, M. E., W. Pickett, et al. (2009). "Associations Between School
Recreational Environments and Physical Activity." Journal of School Health
10
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
79(6): 247-254.
Background: School environments may promote or hinder physical activity
in young people. The purpose of this research was to examine
relationships between school recreational environments and adolescent
physical activity. Methods: Using multilevel logistic regression, data from
7638 grade 6 to 10 students from 154 schools who participated in the
2005/06 Canadian Health Behaviour in School-Aged Children Survey
were analyzed. Individual and cumulative effects of school policies, varsity
and intramural athletics, presence and condition of fields, and condition of
gymnasiums on students’ self-reported physical activity (≥2 h/wk
vs <2 h/wk) were examined. Results: Moderate gradients in physical
activity were observed according to number of recreational features and
opportunities. Overall, students at schools with more recreational features
and opportunities reported higher rates of class-time and free-time
physical activity; this was strongest among high school students.
Boys’ rates of class-time physical activity were 1.53 (95% confidence
interval (CI) = 1.12-1.80) times as high at high schools with the most
recreational features as at schools with the fewest. Similarly, girls’
rates of free-time physical activity at school were 1.62 (95% CI: 0.96-2.21)
times as high at high schools with the most opportunities and facilities as
compared to schools with the fewest. Modest associations were observed
between individual school characteristics and class-time and free-time
physical activity. Conclusions: Taken together, the cumulative effect of
school recreational features may be more important than any one
characteristic individually.
Oreskovic, N. M., J. P. Winickoff, et al. (2009). Obesity and the Built Environment
Among Massachusetts Children. Clinical Pediatrics 48(9):904-912.
Background: The built environment may influence weight status. Method:
Using cross-sectional data for children aged 2 to 18 years, the authors
linked clinical and spatial data using geographic information systems and
analyzed for associations between body mass index (BMI) and density of
and distance to nearest built environment variable (schools, sidewalks,
subway stations, bicycle trails, open space, and fast-food restaurants)
using bivariate and multilevel analyses. Results: The study sampled 21
008 children; 54% were white, 26% Hispanic, 37% overweight, and 20%
obese. In bivariate analysis, distance to nearest fast-food restaurant was
inversely associated with 13141, whereas density of fast-food restaurants
was positively associated with BMI. Distance to school and subway
station, amount of open space, and density of subway stations were
inversely associated with BMI. Controlling for sociodemographic factors,
only living near a greater density of subway stations was inversely
associated with overweight (odds ratio, 0.87; 95% confidence interval,
0.81-0.94) and obesity (odds ratio. 0.90; 95% confidence interval, 0.820.99). Conclusion: Distance to nearest subway station is associated with
BMI among Massachusetts children.
11
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Osypuk, T. L., A. V. Roux, et al. (2009). "Are immigrant enclaves healthy places
to live? The Multi-ethnic Study of Atherosclerosis." Soc Sci Med 69(1): 110-20.
The growing size and changing composition of the foreign-born population
in the USA highlights the importance of examining the health
consequences of living in neighborhoods with higher proportions of
immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in
four US cities, we examined whether neighborhood immigrant composition
was associated with health behaviors (diet, physical activity) among
Hispanic and Chinese Americans (n=1902). Secondarily we tested
whether neighborhoods with high proportions of immigrants exhibited
better or worse neighborhood quality, and whether these dimensions of
neighborhood quality were associated with healthy behaviors.
Neighborhood immigrant composition was defined based on the Census
2000 tract percent of foreign-born from Latin-America, and separately,
percent foreign-born from China. After adjustment for age, gender,
income, education, neighborhood poverty, and acculturation, living in a
tract with a higher proportion of immigrants was associated with lower
consumption of high-fat foods among Hispanics and Chinese, but with
being less physically active among Hispanics. Residents in neighborhoods
with higher proportions of immigrants reported better healthy food
availability, but also worse walkability, fewer recreational exercise
resources, worse safety, lower social cohesion, and lower neighborhoodbased civic engagement. Associations of neighborhood immigrant
composition with diet persisted after adjustment for reported neighborhood
characteristics, and associations with physical activity were attenuated.
Respondent-reported neighborhood healthy food availability, walkability,
availability of exercise facilities and civic participation remained associated
with behaviors after adjusting for immigrant composition and other
covariates. Results show that living in an immigrant enclave is not
monolithically beneficial and may have different associations with different
health behaviors.
Pont, K., J. Ziviani, et al. (2009). "Environmental correlates of children's active
transportation: a systematic literature review." Health Place 15(3): 827-40.
This systematic review investigated the environmental (physical,
economic, socio-cultural and political) correlates of active transportation
(AT) among young people aged 5-18 years to better inform the promotion
of active living. Greater distance, increasing household income and
increasing car ownership are consistently associated with lower rates of
AT among children. Having a non-white ethnic background has a
convincing positive association with AT. Having recreation facilities and
walk or bike paths present are possibly associated with higher rates of AT.
Further research requires longitudinal and intervention studies, utilizing
multi-level design methodologies and objective measures of
environmental attributes.
12
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Reis, R. S., A. A. Hino, et al. (2009). "Association between physical activity in
parks and perceived environment: a study with adolescents." J Phys Act Health
6(4): 503-9.
BACKGROUND: The purpose of this study was to analyze the relationship
between adolescents' physical activity practice and their perception about
the environment of urban parks. METHODS: A school-based
representative sample (n = 1,718; boys = 40.4%) of teenagers of Curitiba,
Southern region of Brazil. A questionnaire was employed to identify
perceived parks environmental features as well as physical activity
practice in the parks (PAP), habitual physical activity (HPA) and
demographics. The relationship between PAP and parks environments
was analyzed through multivariate logistic regression controlling for age
and socioeconomic status, HPA and parks distance. RESULTS: After
controlling for confounders PAP was associated with lack of space to be
physically active, activities to choose from and equipments for both boys
and girls, (odds ratio (OR)-ranging from 1.5 to 1.8). Among boys, having
people of same age (OR = 1.5) and accessibility (OR = 2.0) showed
association with PAP only in crude analysis. However, among girls, to be
bulled or teased (OR = 1.4) and accessibility (OR = 1.7) were associated
with PAP after confounding control. CONCLUSIONS: The results showed
that specific attributes in parks may be considered and offered to increase
the likelihood of physical activity practice among adolescents in such
locations.
Ries, A. V., C. C. Voorhees, et al. (2009). "A Quantitative Examination of Park
Characteristics Related to Park Use and Physical Activity Among Urban Youth."
Journal of Adolescent Health 45(3): S64-S70.
Purpose: Although several studies have identified a positive association
between recreational facility availability and physical activity, few have
examined facility attributes beyond availability and involved minority
adolescents. This study examines how both objective and perceived
measures of the facility environment are associated with urban
adolescents' use of parks and physical activity. Methods: Study
participants included 329 adolescents from two high schools in Baltimore,
Maryland, the majority (69%) of whom was African American. A Webbased survey assessed park use, neighborhood crime, and park
availability, quality, and use by friends and family. Geographical
Information Systems data were used to develop objective measures of
park availability and crime. Physical activity data were obtained from 316
participants using accelerometers. Hypotheses regarding environmental
correlates of park use and physical activity were tested using logistic
regression models (for park use) and linear regression models (for
physical activity). Results: Perceptions of greater park availability, quality,
and use by friends were associated with a significantly greater likelihood
of an adolescents' park use. Perceptions of more park availability was
13
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
associated with higher levels of physical activity, although this association
was marginally significant. Objective measures of park availability and
objective and subjective measures of crime were not associated with
either park use or physical activity. Conclusions: Efforts to promote park
use for physical activity among urban youth should increase awareness of
park availability, improve perceptions of park quality, and utilize social
networks. (C) 2009 Society for Adolescent Medicine. All rights reserved.
Rodriguez, A. and C. A. Vogt (2009). "Demographic, Environmental, Access, and
Attitude Factors That Influence Walking to School by Elementary School-Aged
Children." Journal of School Health 79(6): 255-261.
Background: Walking to school has been identified as an activity that
contributes to children’s daily exercise requirements. The purpose of
this study was to better understand factors that influence walking to school
by elementary school–aged children. Methods: A sample of 1,897
elementary school–aged children (84% response rate; 3rd-5th graders)
throughout Michigan completed the Michigan Safe Routes to School
Student Survey. The survey measures environmental, access, and
attitudinal perceptions toward school routes and transportation methods.
Results: Using logistic regression, the results indicate that the odds of
walking to school increase the older children are (odds ratio (OR) = 1.80,
95% confidence interval (CI) = 1.20-2.70) and if students perceive that
walking to school saves time (OR = 3.32, 95% CI = 1.44-7.66) or is safe
(OR = 2.60, 95% CI = 1.06-6.39). The odds of a student walking to school
decrease the farther a student lives from his or her school (OR = 0.11,
95% CI = 0.04-0.37), if his or her parents have a car (OR = 0.07, 95% CI =
0.02-0.22), and if the student has access to a school bus (OR = 0.07, 95%
CI = 0.03-0.18). These factors are significant ( p < .05) predictors of
walking to school after controlling for other demographic, environmental,
access, and attitude factors. Conclusions: The study results support
research indicating that environmental and access factors influence
whether elementary school–aged children walk to school. In addition,
when children perceive walking to school to be convenient (ie, saves
time), their odds of walking to school increase. Future school- and
community-based programs promoting walking to school should continue
to focus on making walking to school not only safer, but also more
convenient.
Rosenberg, D., D. Ding, et al. (2009). "Neighborhood Environment Walkability
Scale for Youth (NEWS-Y): Reliability and relationship with physical activity."
Preventive Medicine 49(2-3): 213-218.
Objectives. To examine the psychometric properties of the Neighborhood
Environment Walkability Scale-Youth (NEWS-Y) and explore its
associations with context-specific and overall physical activity (PA) among
youth. Methods. In 2005, parents of children ages 5-11 (n=116), parents of
adolescents ages 12-18 (n = 171), and adolescents ages 12-18 (n = 171)
14
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
from Boston, Cincinnati, and San Diego, completed NEWS-Y surveys
regarding perceived land use mix-diversity, recreation facility availability,
pedestrian/automobile traffic safety, crime safety. aesthetics,
walking/cycling facilities, street connectivity, land use mix-access, and
residential density. A standardized neighborhood environment score was
derived. Self-reported activity in the street and in parks, and walking to
parks, shops, school, and overall physical activity were assessed. Results.
The NEWS-Y subscales had acceptable test-retest reliability (ICC
range.56-.87). Being active in a park, walking to a park, walking to shops,
and walking to school were related to multiple environmental attributes in
all three participant groups. Total neighborhood environment, recreation
facilities, walking and cycling facilities, and land use mix-access had the
most consistent relationships with specific types of activity. Conclusions.
The NEWS-Y has acceptable reliability and subscales were significantly
correlated with specific types of youth PA. The NEWS-Y can be used to
examine neighborhood environment correlates of youth PA. (C) 2009
Elsevier Inc. All rights reserved.
Siqueira Reis, R., A. Akira Ferreira Hino, et al. (2009). "Association Between
Physical Activity in Parks and Perceived Environment: A Study With
Adolescents." Journal of Physical Activity & Health 6(4): 503-509.
Background: The purpose of this study was to analyze the relationship
between adolescents' physical activity practice and their perception about
the environment of urban parks. Methods: A school-based representative
sample (n = 1,718; boys = 40.4%) of teenagers of Curitiba, Southern
region of Brazil. A questionnaire was employed to identify perceived parks
environmental features as well as physical activity practice in the parks
(PAP), habitual physical activity (HPA) and demographics. The
relationship between PAP and parks environments was analyzed through
multivariate logistic regression controlling for age and socioeconomic
status, HPA and parks distance. Results: After controlling for confounders
PAP was associated with lack of space to be physically active, activities to
choose from and equipments for both boys and girls, (odds ratio
(OR)—ranging from 1.5 to 1.8). Among boys, having people of same age
(OR = 1.5) and accessibility (OR = 2.0) showed association with PAP only
in crude analysis. However, among girls, to be bulled or teased (OR = 1.4)
and accessibility (OR = 1.7) were associated with PAP after confounding
control. Conclusions: The results showed that specific attributes in parks
may be considered and offered to increase the likelihood of physical
activity practice among adolescents in such locations.
2. Built Environment and Adult Physical Activity/Obesity
Al-Hagla, K. S. (2009). "Evaluating new urbanism's walkability performance: A
15
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
comprehensive approach to assessment in Saifi Village, Beirut, Lebanon." Urban
Design International 14(3): 139-151.
'Walkability' is one of the core aspects of New Urbanism. Evaluation of the
factors that influence this marker requires further extension than just the
physical boundaries of a New Urbanism development. This paper
presents a comprehensive approach for assessing walkability based on a
combination of its conceptual and applicable aspects. This approach
works on two different, but compatible, scales: macro and micro. The
former is concerned with evaluating the Urban Framework that is
responsible for triggering walking behaviour, and indirectly influences
walkability in a New Urbanism development area. The latter is concerned
with evaluating the influence of different New Urbanism facets as either
generating walking, or encouraging and supporting it within the New
Urbanism development area itself. This paper uses this approach to
evaluate the performance of various New Urbanism facets that influence
'walkability' in Saifi Village, which is a New Urbanism Development in
downtown Beirut. URBAN DESIGN International (2009) 14, 139-151.
doi:10.1057/udi.2009.8
Badland, H. M., G. M. Schofield, et al. (2009). "Understanding the Relationship
between Activity and Neighbourhoods (URBAN) Study: research design and
methodology." Bmc Public Health 9.
Background: Built environment attributes are recognized as being
important contributors to physical activity (PA) engagement and body size
in adults and children. However, much of the existing research in this
emergent public health field is hindered by methodological limitations,
including: population and site homogeneity, reliance on self-report
measures, aggregated measures of PA, and inadequate statistical
modeling. As an integral component of multi-country collaborative
research, the Understanding the Relationship between Activity and
Neighbourhoods (URBAN) Study seeks to overcome these limitations by
determining the strengths of association between detailed measures of the
neighborhood built environment with PA levels across multiple domains
and body size measures in adults and children. This article outlines the
research protocol developed for the URBAN Study. Methods and design:
The URBAN Study is a multi-centered, stratified, cross-sectional research
design, collecting data across four New Zealand cities. Within each city,
12 neighborhoods were identified and selected for investigation based on
higher or lower walkability and Maori demographic attributes.
Neighborhoods were selected to ensure equal representation of these
characteristics. Within each selected neighborhood, 42 households are
being randomly selected and an adult and child ( where possible) recruited
into the study. Data collection includes: objective and self-reported PA
engagement, neighborhood perceptions, demographics, and body size
measures. The study was designed to recruit approximately 2,000 adults
and 250 children into the project. Other aspects of the study include
16
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
photovoice, which is a qualitative assessment of built environment
features associated with PA engagement, an audit of the neighborhood
streetscape environment, and an individualized neighborhood walkability
profile centered on each participant's residential address. Multilevel
modeling will be used to examine the individual-level and neighborhoodlevel relationships with PA engagement and body size. Discussion: The
URBAN Study is applying a novel scientifically robust research design to
provide urgently needed epidemiological information regarding the
associations between the built environment and health outcomes. The
findings will contribute to a larger, international initiative in which similar
neighborhood selection and PA measurement procedures are utilized
across eight countries. Accordingly, this study directly addresses the
international priority issues of increasing PA engagement and decreasing
obesity levels.
Bocarro, J. and M. S. Wells (2009). "Making A Difference through Parks and
Recreation: Reflections On Physical Activity, Health, and Wellness Research."
Journal of Park & Recreation Administration 27(3): 1-7.
The article discusses various reports published within the issue, including
a study on the relationship between adult physical activity, obesity levels
and recreation supply and demand; the physical activity patterns of a
certain park user group; and, the research on the significant partnership
between municipal park and recreation departments.
Brandon, C. A., D. P. Gill, et al. (2009). "Physical activity levels of older
community-dwelling adults are influenced by summer weather variables." Applied
Physiology, Nutrition & Metabolism 34(2): 182-190.
Adequate daily physical activity (PA) is important for maintaining functional
capacity and independence in older adults. However, most older adults in
Canada do not engage in enough PA to sustain fitness and functional
independence. Environmental influences, such as warmer daytime
temperatures, may influence PA participation; however, few studies have
examined the effect of summertime temperatures on PA levels in older
adults. This investigation measured the influence of summertime weather
variables on PA in 48 community-dwelling older adults who were randomly
recruited from a local seniors’ community centre. Each participant
wore an accelerometer for a single 7-consecutive-day period (between 30
May and 9 August 2006) during waking hours, and completed a PA
logbook to remark on major daily PA events. Local weather variables were
collected from a national weather service and compared with PA counts
per minute. Regression analysis revealed a curvilinear relationship
between log-transformed PA and mean daily temperature (r²
= 0.025; p < 0.05). Linear mixed effects models that accounted for
repeated measures nested within individuals were performed for monthly
periods, meteorological variables, sex, age, and estimated maximal
oxygen consumption, with PA as the dependent variable. Age and Air
17
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Quality Index remained significant variables within the model. Higher
fitness levels had no effect on allowing individuals to perform more
vigorous PA in warmer temperatures.
Brown, B. B., I. Yamada, et al. (2009). "Mixed land use and walkability: Variations
in land use measures and relationships with BMI, overweight, and obesity."
Health & Place 15(4): 1130-1141.
Few studies compare alternative measures of land use diversity or mix in
relationship to body mass index. We compare four types of diversity
measures: entropy scores (measures of equal distributions of walkable
land use categories), distances to walkable destinations (parks and transit
stops), proxy measures of mixed use (walk to work measures and
neighborhood housing ages), and land use categories used in entropy
scores. Generalized estimating equations, conducted on 5000 randomly
chosen licensed drivers aged 25-64 in Salt Lake County, Utah, relate
lower BMIs to older neighborhoods, components of a 6-category land use
entropy score, and nearby light rail stops. Thus the presence of walkable
land uses, rather than their equal mixture, relates to healthy weight. (C)
2009 Elsevier Ltd. All rights reserved.
Coogan, P. F., L. F. White, et al. (2009). "Prospective Study of Urban Form and
Physical Activity in the Black Women's Health Study." American Journal of
Epidemiology 170(9): 1105-1117.
The authors used data from the Black Women's Health Study to assess
the association between neighborhood urban form and physical activity.
Women reported hours/week of utilitarian and exercise walking and of
vigorous activity in 1995 and on biennial follow-up questionnaires through
2001. Housing density, road networks, availability of public transit,
sidewalks, and parks were characterized for the residential neighborhoods
of 20,354 Black Women's Health Study participants living in New York,
New York; Chicago, Illinois; and Los Angeles, California. The authors
quantified the associations between features of the environment and
physical activity using odds ratios for >= 5 relative to <5 hours/week of
physical activity. For all women, housing density had the strongest
association with utilitarian walking (odds ratio for the most- compared with
the least-dense quintile = 2.72, 95% confidence interval: 2.22, 3.31),
followed by availability of public transit. Women who moved during followup to neighborhoods of lower density were 36% more likely to decrease
their levels of utilitarian walking, and those who moved to neighborhoods
of higher density were 23% more likely to increase their levels of utilitarian
walking, relative to women who moved to neighborhoods of similar
density. These data suggest that increases in housing density may lead to
increases in utilitarian walking among African-American women.
Fan, Y. L. and A. J. Khattak (2009). "Does urban form matter in solo and joint
18
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
activity engagement?" Landscape and Urban Planning 92(3-4): 199-209.
This research examines how the residential built environment relates to
residents' solo versus joint engagement in shopping, dining, and
recreational/fitness activities. Using data from the 2006 Greater Triangle
Travel Survey in North Carolina, individual activity engagement is
innovatively measured using two indicators: total time spent alone and
total time jointly spent with household members on a specific non-work
activity type. The impact of the built environment on non-work activity
engagement is then estimated using Heckman sample selection models
along with a seemingly unrelated estimation system. We find that
residents living closer to parks and department stores on average are
more likely to participate in out-of-home recreation and shopping activities.
A comparison of coefficients in solo versus joint engagement models
shows that park accessibility is much more important to household joint
participation than to solo participation in recreational activities. The
research generates new knowledge on how the built environment may
influence solo versus joint activity engagement differently. The findings are
useful to urban planners who are interested in reviving local economy and
promoting active living/social interaction. Published by Elsevier B.V.
Gilson, N. D., B. Ainsworth, et al. (2009). "A multi-site comparison of
environmental characteristics to support workplace walking." Preventive Medicine
49(1): 21-23.
Objective. This study assessed the environmental characteristics of ten
universities, comparing the extent to which physical infra-structures are
able to support a route-based walking intervention. Method. Following
protocol standardization between and within sites, major pedestrian routes
at main suburban campuses in seven countries (Australia, Canada,
England, Northern Ireland, Scotland, Spain and the United States) were
audited by researchers using an established inventory (March-June 2008).
The inventory assessed key characteristics (e.g. size and employee
number) and nine specific items (pedestrian facilities, vehicle conflicts,
crossings, route-maintenance, walkway width, roadway buffer, universal
accessibility, aesthetics and cover), scored on a five-point scale (1 = very
poor; 5 = excellent). Item scores for each route. were combined and
weighted, to provide indicators of low (score of 20-39), fair (score of 4069), or good (score of 70-100) physical infra-structure support. Results.
Sites varied in area (range of 7-1000 acres) and employee numbers
(range of 700-7500 employees). Audits reported good support for routebased walking at seven sites (overall route score range = 72.5 +/- 13.982.2 +/- 17.4), fair support at two sites (overall route score of 69.1 +/- 11.7
and 61.7 +/- 14.6), and low Support at one site (overall route score of 22.1
+/- 7.3). Conclusions. Study methods highlight a valuable audit process,
while findings identify the need to improve aspects of physical infrastructure at sites where the built environment may be less conducive for
route-based walking. (C) 2009 Elsevier Inc. All rights reserved.
19
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Greaney, M. L., F. D. Less, et al. (2009). "College students' barriers and enablers
for healthful weight management: a qualitative study." J Nutr Educ Behav 41(4):
281-6.
OBJECTIVE: To identify barriers and enablers for healthful weight
management among college students. DESIGN: Sixteen on-line focus
groups, homogeneous by sex and university. SETTING: Eight universities
in 8 states. PARTICIPANTS: College students (N = 115; 55% female;
mean age 19.7 +/- 1.6). ANALYSIS: Qualitative software, Nvivo version 2
(QSR International, Victoria, Australia, 2002), was used; similar codes
were grouped together and categorized using an ecological model.
RESULTS: Males and females cited the same barriers to weight
management: intrapersonal (eg, temptation and lack of discipline);
interpersonal (social situations); and environmental (eg, time constraints,
ready access to unhealthful food). Similar enablers were identified by sex:
intrapersonal (eg, regulating food intake, being physically active);
interpersonal (social support); and environmental (eg, university's
environment supports physical activity). More barriers than enablers were
given, indicating that these college students were more sensitive to
barriers than the enablers for weight management. Factors viewed by
some students as barriers to weight management were viewed as
enablers by others. CONCLUSIONS AND IMPLICATIONS: When
designing weight management interventions for college students, sex
specificity may not be as important as considering that a barrier for one
student may be an enabler for another. From an ecological perspective,
individually focused interventions must be implemented in conjunction with
environmental-level interventions to facilitate behavior change.
Huang, L., D. G. Stinchcomb, et al. (2009). "Identifying Clusters of Active
Transportation Using Spatial Scan Statistics." American Journal of Preventive
Medicine 37(2): 157-166.
Background: There is an intense interest in the possibility that
neighborhood characteristics influence active transportation such as
walking or biking. The purpose of this paper is to illustrate how a spatial
cluster identification method can evaluate the geographic variation of
active transportation and identify neighborhoods with unusually high/low
levels of active transportation. Methods: Self-reported walking/biking
prevalence, demographic characteristics, street connectivity variables, and
neighborhood socioeconomic data were collected from respondents to the
2001 California Health Interview Survey (CHIS; N=10,688) in Los Angeles
County (LAC) and San Diego County (SDC). Spatial scan statistics were
used to identify clusters of high or low prevalence (with and without ageadjustment) and the quantity of time spent walking and biking. The data, a
subset from the 2001 CHIS, were analyzed in 2007-2008. Results:
Geographic clusters of significantly high or low prevalence of walking and
biking were detected in LAC and SDC. Structural variables such as street
20
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
connectivity and shorter block lengths are consistently associated with
higher levels of active transportation, but associations between active
transportation and socioeconomic variables at the individual and
neighborhood levels are mixed. Only one cluster with less time spent
walking and biking among walkers/bikers was detected in LAC, and this
was of borderline significance. Age-adjustment affects the clustering
pattern of walking/biking prevalence in LAC, but not in SDC. Conclusions:
The use of spatial scan statistics to identify significant clustering of health
behaviors such as active transportation adds to the more traditional
regression analysis that examines associations between behavior and
environmental factors by identifying specific geographic areas with
unusual levels of the behavior independent of predefined administrative
units. (Am J Prev Med 2009;37(2):157-166) Published by Elsevier Inc. on
behalf of American journal of Preventive Medicine
Hug, S. M., T. Hartig, et al. (2009). "Restorative qualities of indoor and outdoor
exercise settings as predictors of exercise frequency." Health & Place 15(4): 971980.
Positive environmental determinants of exercise frequency remain poorly
understood. Knowing that people often value exercise for psychological
restoration, we investigated the restorative quality of indoor and outdoor
exercise settings as predictors of exercise frequency. We surveyed 319
members of fitness centers in Zurich that offer indoor and outdoor
exercise alternatives. Outdoor settings were rated as more restorative. For
each type of environment, restorative quality predicted the frequency of
exercise in the past 30 days, independent of socio-demographic
characteristics, expectations of exercise benefits, and personal barriers.
We discuss the results with regard to the provision of exercise settings for
urban populations. (C) 2009 Elsevier Ltd. All rights reserved.
Inagami, S., D. A. Cohen, et al. (2009). "Body Mass Index, Neighborhood Fast
Food and Restaurant Concentration, and Car Ownership." Journal of Urban
Health-Bulletin of the New York Academy of Medicine 86(5): 683-695.
Eating away from home and particularly fast food consumption have been
shown to contribute to weight gain. Increased geographic access to fast
food outlets and other restaurants may contribute to higher levels of
obesity, especially in individuals who rely largely on the local environment
for their food purchases. We examined whether fast food and restaurant
concentrations are associated with body mass index and whether car
ownership might moderate this association. We linked the 2000 US
Census data and information on locations of fast food and other
restaurants with the Los Angeles Family and Neighborhood Study
database, which consists of 2,156 adults sampled from 63 neighborhoods
in Los Angeles County. Multilevel modeling was used to estimate
associations between body mass index (BMI), fast food and restaurant
concentration, and car ownership after adjustment for individual-level
21
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
factors and socioeconomic characteristics of residential neighborhoods. A
high concentration of local restaurants is associated with BMI. Car owners
have higher BMIs than non-car owners; however, individuals who do not
own cars and reside in areas with a high concentration of fast food outlets
have higher BMIs than non-car owners who live in areas with no fast food
outlets, approximately 12 lb more (p = 0.02) for an individual with a height
of 5 ft. 5 in. Higher restaurant density is associated with higher BMI among
local residents. The local fast food environment has a stronger association
with BMI for local residents who do not have access to cars.
Kaczynski, A. T. and M. E. Havitz (2009). "Examining the Relationship between
Proximal Park Features and Residents' Physical Activity in Neighborhood Parks."
Journal of Park & Recreation Administration 27(3): 42-58.
Physical inactivity is widely recognized as a significant public health
concern, and many attributes of the physical environment, including parks,
influence the opportunities people have to be active. However, most
research on parks and physical activity (PA) has largely ignored that parks
differ in their facilities and amenities and has employed measures of PA
that are not specific to parks. The purpose of this study was to examine
which features within proximal neighborhood parks were related to
residents using parks for PA. As such, this study provides direction to park
planners about what elements to incorporate into parks that might
encourage greater levels of PA therein. Detailed data were collected from
380 people in four neighborhoods that described the locations of
participants' PA episodes over the course of seven days. All 33 municipal
parks within the four neighborhoods were audited for whether they
included 28 specific features (13 facilities and 15 amenities) using the
Environmental Assessment for Public Recreation Spaces (EAPRS) tool.
Logistic regression was used to determine the likelihood of having
engaged in at least some PA in neighborhood parks during the study week
according to whether the participant had each of the 28 features within a
park within 1 km from his/her home. The EAPRS instrument was found to
be a valuable tool for examining the properties of parks that may be
related to PA. Data from participants showed that having five facilities
(unpaved trail, meadow, water area, basketball court, and soccer field)
and six amenities (restroom, historical/educational feature, landscaping,
bike rack, parking lot, and a roadway through the park) within a nearby
park was significantly related to an increased likelihood of using
neighborhood parks for PA. One other nearby facility, a ball diamond, was
related to significantly lower odds of engaging in at least some PA in
neighborhood parks. Parks with a variety of built and natural facilities and
amenities can support a range of PA behaviors. Research on park
attributes and PA is still emerging, but studies like the current investigation
can be conducted by individual agencies or collectives (e.g., NRPA) to
ascertain which facilities and amenities encourage or inhibit PA in order to
use this information in future park-planning discussions. ABSTRACT
22
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
FROM PUBLISHER
Kaczynski, A. T., L. R. Potwarka, et al. (2009). "Association of Parkland Proximity
with Neighborhood and Park-based Physical Activity: Variations by Gender and
Age." Leisure Sciences 31(2): 174-191.
This study examined how the number and total size of neighborhood
parks within 1 kilometer (km) of participants' homes, as well as distance to
the closest park, were associated with moderate-to-strenuous physical
activity (MSPA) in three contexts: total, neighborhood-based, and parkbased. Data were collected from 384 adults in a Canadian city. Each
additional hectare of park area within 1 km increased the odds of
participating in 150 or more minutes of total MSPA by 2% and each
additional park increased the odds of participating in 150 or more minutes
of neighborhood-based MSPA by 17% (p < .05). Living near more parks
and parkland showed more positive relationships with activity among
women than men, and among younger (18 to 34 years) and older (55+
years) adults.
Kondo, K., L. Jung Su, et al. (2009). "Association between daily physical activity
and neighborhood environments." Environmental Health & Preventive Medicine
14(3): 196-206.
The article presents a study on the connection between daily physical
activity (PA) and the neighborhood environments (NE) of residents in
Japan. The subjects were chosen through a random sampling method by
sex and age in region with high and low residential density, land use mixdiversity and street connectivity. Residents' activities include cycling in
female and walking in males. The study revealed that daily PA was high in
women and in men, PA is high for those are into leisure walking.
Larkin, M. (2009). "The great outdoors: a key to promoting physical activity for
older adults." Journal on Active Aging 8(3): 28-39.
The article discusses the importance of designing the outdoor
environment in maintaining the functional ability of older people in the U.S.
Many neighborhoods remain poorly designed despite the known benefits
of outdoor physical activity. Outdoor features to promote physical activity
that are relatively easy and cheap to implement are discussed. The U.S.
Environmental Protection Agency (EPA) is making efforts to promote
physical activity by improving outdoor environment.
Lee, C. G. and Y. Cho (2009). "Relationship between perceived neighborhood
characteristics and vigorous physical activity among adult seoul residents." J
Prev Med Public Health 42(4): 215-22.
OBJECTIVES: Vigorous physical activity is a well-known method to
promote people s health. This research aims to investigate whether
perceived neighborhood characteristics affect vigorous physical activity
among adult Seoul residents (aged 19 to 64). METHODS: Utilizing the
23
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
2005 Seoul Citizens Health Indicators Survey data, this study estimates
the probability of vigorous physical activity. Particular attention is given to
the effects of three perceived neighborhood characteristics (satisfaction
with relationship to the neighborhood, satisfaction with park and
recreational facilities, and satisfaction with public security). Logistic
regression models are analyzed separately by gender for the parameter
estimation. RESULTS: Vigorous physical activity is positively associated
with three perceived neighborhood characteristics for women, while
neither significant nor substantive association is found for men.
CONCLUSIONS: As vigorous physical activity among Seoul citizens is
differentially affected by perceived neighborhood characteristics and by
gender, a different approach will be needed to increase vigorous physical
activity of men and women in Seoul.
Lee, I. M., R. Ewing, et al. (2009). "The Built Environment and Physical Activity
Levels The Harvard Alumni Health Study." American Journal of Preventive
Medicine 37(4): 293-298.
Background: Physical activity is associated with better health, but many
individuals are insufficiently active. Modifying the built environment may be
an approach capable of influencing population-wide levels of physical
activity, but few data exist from longitudinal studies that can minimize bias
from active people choosing activity-friendly neighborhoods. Purpose: This
study aims to examine cross-sectional and longitudinal associations
between the built environment and physical activity on a large scale.
Methods: This study examined cross-sectional associations between
urban sprawl (mapping addresses to corresponding counties) and physical
activity (self-reported) among men throughout the U.S. in 1993 and in
1988, and longitudinal associations between changes in exposure to
urban sprawl for movers and physical activity, 1988-1993. Included were
4997 men (mean age, 70 years) in the 1993 cross-sectional study; 4918
men in the 1988 cross-sectional study; and 3448 men in the longitudinal
study, 1988-1993. Data were collected prospectively in 1988 and 1993,
and analyses were performed in 2007-2008. Results: In cross-sectional
analyses, less sprawl was significantly associated with more walking OR,
comparing least with most sprawling areas, for meeting physical activity
recommendations by walking=1.38 [95% CI=1.09, 1.76] in 1993 and 1.53
[1.19, 1.96] in 1988). Less sprawl also was associated with lower
prevalence of overweight (corresponding OR=0.79 [0.64, 0.98] in 1993
and 0.81 [0.66, 1.00] in 1988). However, longitudinal analyses assessing
change did not show that decreasing sprawl was associated with
increased physical activity or decreased BMI. Conclusions: These findings
suggest that the cross-sectional results may reflect self-selection, rather
than indicating that the built environment-as measured by urban sprawlincreases physical activity. However, the longitudinal findings were limited
by small numbers of men changing residence and associated sprawl
levels. (Am J Prev Med 2009;37(4):293-298) (C) 2009 American journal of
24
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Preventive Medicine
Lin, J. J. and A. T. Yang (2009). "Structural Analysis of How Urban Form Impacts
Travel Demand: Evidence from Taipei." Urban Studies 46(9): 1951-1967.
This study empirically examines the connections between urban form and
travel demand at the aggregate level using traffic analysis zone data from
Taipei, Taiwan, for the year 2000. Nine latent variables and 26 observed
variables were analysed using structural equation modelling. By clarifying
the direct and indirect effects, the empirical evidence indicates that density
is positively related to trip generation and negatively associated with
private mode split; mixed land use reduces trip generation and indirectly
increases private mode split and a pedestrian-friendly built environment
significantly reduces private mode split. Empirical evidence indicates that
land use density, diversity and design affect travel demand in urban areas
both directly and indirectly.
Lovasi, G. S., K. M. Neckerman, et al. (2009). "Effect of Individual or
Neighborhood Disadvantage on the Association Between Neighborhood
Walkability and Body Mass Index." American Journal of Public Health 99(2): 279284.
Objectives. We sought to test whether the association between walkable
environments and lower body mass index (BMI) was stronger within
disadvantaged groups that may be particularly sensitive to environmental
constraints. Methods. We measured height and weight in a diverse
sample of 13102 adults living throughout New York City from 2000-2002
Each participant's home address was geocoded and surrounded by a
circular buffer with a 1-km radius. The composition and built environment
characteristics of these areas were used to predict BMI through the use of
generalized estimating equations. Indicators of individual or area
disadvantage included low educational attainment, low household income,
Black race, and Hisparic ethnicity. Results. Higher population density,
more mixed land use, and greater transit access were most consistently
associated with a lower BMI among those with more education or higher
incomes and among non-Hispanic Whites. Significant interactions were
observed for education, income, race, and ethnicity. Conclusions.
Contrary to expectations, built environment characteristics were less
consistently associated with BMI among disadvantaged groups. This
pattern may be explained by other barriers 13 maintaining a healthy
weight encountered by disadvantaged groups. {Am J Public Health.
2009;99:279-284. doi:10.2105/AJPH.2008.138230)
McAlexander, K. M., J. A. Banda, et al. (2009). "Physical Activity Resource
Attributes and Obesity in Low-Income African Americans." Journal of Urban
Health-Bulletin of the New York Academy of Medicine 86(5): 696-707.
More than two thirds of Americans are overweight or obese, and African
Americans are particularly vulnerable to obesity when compared to
25
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Caucasians. Ecological models of health suggest that lower individual and
environmental socioeconomic status and the built environment may be
related to health attitudes and behaviors that contribute to obesity. This
cross-sectional study measured the direct associations of neighborhood
physical activity resource attributes with body mass index (BMI) and body
fat among low-income 216 African Americans (Mean (M) age = 43.5
years, 63.9% female) residing in 12 public housing developments. The
Physical Activity Resource Assessment instrument measured
accessibility, incivilities, and the quality of features and amenities of each
physical activity resource within an 800-m radius around each housing
development. Sidewalk connectivity was measured using the Pedestrian
Environment Data Scan instrument. Ecological multivariate regression
models analyzed the associations between the built environment attributes
and resident BMI and body fat at the neighborhood level. Sidewalk
connectivity was associated with BMI (M = 31.3 kg/m(2); p < 0.05).
Sidewalk connectivity and resource accessibility were associated with
body fat percentage (M = 34.8%, p < 0.05). Physical activity resource
attributes and neighborhood sidewalk connectivity were related to BMI and
body fat among low-income African Americans living in housing
developments.
McCormack, G. R., J. C. Spence, et al. (2009). "Does Perceived Behavioral
Control Mediate the Association Between Perceptions of Neighborhood
Walkability and Moderate- and Vigorous-Intensity Leisure-Time Physical
Activity?" Journal of Physical Activity & Health 6(5): 657-666.
Background: Research regarding the path-ways via which the
environment influences physical activity is limited. This study examined
the role of perceived behavioral control (PBC) in mediating the relationship
between perceptions of neighborhood walkability and frequency of
moderate (MODPA) and vigorous physical activity (VIGPA). Methods:
Data were collected through a province-wide survey of physical activity.
Telephone-interviews were conducted with 1207 adults and captured
information about perceptions of neighborhood walkability, physical
activity, PBC and demo-graphics. Gender-stratified regression analyses
were conducted to test PBC mediation of the built environment-physical
activity association. Results: Among women easy access to places for
physical activity was positively associated with MODPA and VIGPA.
Having many shops and places within walking distance of homes was also
positively associated with MODPA among women however; reporting
sidewalks on most neighborhood streets, and crime rate in the
neighborhood were negatively correlated with MODPA. Among men, easy
access to places for physical activity was positively associated and crime
rate in the neighborhood negatively associated, with VIGPA. After
adjusting for PBC, the association between easy access to places for
physical activity and VIGPA and MODPA attenuated for men and women
suggesting mediation of this association by PBC. Conclusions: PBC
26
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
mediated the relationship between easy access to places for physical
activity and physical activity, but not for other perceived environmental
attributes.
Ming, W. and Z. Xingyou (2009). "Contextual Effects of Built and Social
Environments of Urban Neighborhoods on Exercise: A Multilevel Study in
Chicago." American Journal of Health Promotion 23(4): 247-254.
Purpose. Examine the contextual effects of neighborhood built and social
environments on exercise. Design. Cross-sectional, multilevel study.
Setting. City of Chicago. Subjects. A probability sample of Chicago adult
residents (response rate = 55%). Measures. The exercise measures were
based on two questions: "How often a week on average do you work out
or exercise?" (N = 3530) and, "Did you exercise regularly in the last year?"
(N = 907). Neighborhood social environment was measured by
socioeconomic and social capital indicators. Neighborhood built
environment was captured by pedestrian injury rate, residential density,
distance to subway or parks, land use mix, and access to neighborhood
amenities. Analysis. Random effects logit and multinomial models.
Results. For weekly workout/exercise, individuals with access to
restaurants and bars were more likely to report one to three times of
weekly exercise (OR = 1.08; 95% CI: 0.99, 1.19) and four times or more
weekly exercise (OR = 1.14; 95% CI: 1.03, 1.26) compared with those
who reported no weekly exercise. For regular exercise in the past year,
access to restaurants and bars (OR = 1.24; 95% CI: 1.05, 1.46) and
neighborhood social environment (OR = 1.37; 95% CI: 1.11, 1.69) were
significant. The social environment effects were stronger for women.
Conclusions. Neighborhood social and built environments are both
important for exercise independent of an individual's background.
Randall, S. R., R. B. Terry, et al. (2009). "Macro-Linkages between Health and
Outdoor Recreation: The Role of Parks and Recreation Providers." Journal of
Park & Recreation Administration 27(3): 8-20.
Physical inactivity, overweight, and obesity are growing national concerns
owing to their associations with chronic diseases and overall well-being.
Parks and recreation providers play a pivotal role in addressing these
public health issues by providing the public with infrastructure that enables
outdoor physical activity. Information about the health-related benefits of
outdoor recreation can aid parks and recreation managers and
policymakers in describing the benefits associated with recreation
infrastructure and in their decision making regarding investments of scarce
financial resources to provide high-quality recreation opportunities. Our
analysis of county-level data for Oregon shows a measurable relationship
between adult physical activity, overweight, obesity, and recreation supply
and demand. The proportions of adults that are physically active are
positively associated with the proportion of overweight adults, recreational
trail densities, and the frequency of participation in recreational activities.
27
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
The proportions of adults that are overweight are positively associated
with the proportion of physically active adults, but negatively associated
with hiking trail densities and frequency of participation in recreational
activities. The proportions of adults that are obese, however, are
negatively associated with frequency of participation in non-motorized
trail-related recreational activities. The results of this macro-level model
are consistent with information provided by micro-level analyses described
in previous literature, in particular that the supply of and demand for
recreation activities are associated with physically active people. In turn,
counties comprising more active residents are associated with healthier
counties as measured by the proportion of adults considered to be
overweight. These macro-level relationships can be used by parks and
recreation providers to indicate "at-risk" communities—those with low
recreation supply and demand, and high proportions of overweight and
obese people—and we provide an example using Oregon counties.
Several policy recommendations emerge for parks and recreation
providers based on our model results combined with evidence from the
reviewed literature. First, parks and recreation providers should support
the development of local recreation facilities, including non-motorized
trails, and promote their use by providing information about them and
other existing resources. Second, providers should promote the overall
health benefits of being physically active via outdoor recreation. Third,
providers should identify at-risk communities and allocate resources to
these communities in developing and promoting recreation opportunities.
We illustrate each of these recommendations with examples of how they
are being addressed in Oregon. ABSTRACT FROM PUBLISHER
Rashad, I. (2009). "Associations of Cycling With Urban Sprawl and the Gasoline
Price." American Journal of Health Promotion 24(1): 27-36.
Purpose. Determine the relationships between cycling and urban sprawl
and between cycling and the gasoline price. Analysis. Cross-sectional
multivariate regression analyses using pooled data from two individuallevel national surveys to analyze the effects of variations in levels of urban
sprawl and the gasoline price on cycling as a form of physical activity.
Setting. Metropolitan areas representative of the U.S. population, 1990 to
2001. Subjects. Behavioral Risk Factor Surveillance System: 146, 730
individuals at least 18 years old in the United States; Nationwide Personal
Transportation Survey: 73,903 individuals at least 18 years old in the
United States. Measures. Self-reported information on bicycling served as
the dependent variable. Urban sprawl and the gasoline price served as
key independent variables. Results. Living in a metropolitan area with a
lower degree of urban sprawl increased the probability of cycling in the
past month by 3.4 to 4.4 percentage points and 1.6 to 2.1 percentage
points from the means for men and women, respectively. Increasing the
gasoline price by one dollar increased the probability of cycling by 4.3 to
4.7 percentage points and 2.9 to 3.5 percentage points for men and
28
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
women, respectively. Conclusion. Results indicate that the prevalence of
cycling is higher in less sprawling areas and areas with higher gasoline
prices. More research is needed to refine results on how individuals
respond to incentives and the roles that monetary and time costs play in
improving public health.
Rastogi, R. and K. V. K. Rao (2009). "Segmentation Analysis of Commuters
Accessing Transit: Mumbai Study." Journal of Transportation Engineering-Asce
135(8): 506-515.
The paper presents the segmentation analysis of commuters accessing
suburban rail transit in Mumbai City, India. The emphasis is given to the
identification of most influencing variables. The commuters are segmented
based on household characteristics like type of accommodation,
household income, and dependency level in the household, and personal
characteristic like occupation level of the commuter. The data are
collected through household survey and logit models are developed under
all the four above-mentioned categories. Significant difference in the
model specifications is observed across segments. The most significant
and highly influencing variables describing the behavior of the commuter
are observed to be time of start, relationship to household head, gender,
dwelling unit, detour factor and access mode availability distance. The
subjective value of travel time is found lower than the average hourly
wage rate of the commuters' in a specified category. This varied logically
across segments. Categorization based on occupation level is expected to
give the best results, whereas, "type of accommodation" and "household
income" categories can substitute for each other.
Reed, J. A., A. Morrison, et al. (2009). "Profile Differences of Users of Paved
Versus Natural-Surface Trails." Journal of Physical Activity & Health 6(1): 112118.
Background: The goal of this study was to examine activity behavior
differences between users of natural-surface versus paved trails.
Methods: The System for Observing Play and Recreation in Communities
(SOPARC) direct observation instrument was used to measure activity
and demographic information. Survey data were used to compare
perception difference and body mass index (BMI) values among trail
users. Results: Significantly more pavedtrail users were female (F = 10.63,
P = .001). A larger percentage of paved-trail users reported it to be very
safe (F = 4.462, P = .036). Natural-surface-trail users participated in more
vigorous activity (F = 83.93, P = .000). Natural surface trail users reported
participating in longer activity bouts (F = 5.133; P = .024). Conclusion:
Natural-surface-trail users engaged in more vigorous activity, for a longer
duration, and had lower self-reported BMI values.
Rodriguez, D. A., E. M. Brisson, et al. (2009). "The relationship between
segment-level built environment attributes and pedestrian activity around
29
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Bogota's BRT stations." Transportation Research Part D-Transport and
Environment 14(7): 470-478.
Few studies have examined the relationship between micro-scale features
of the built environment and street segment usage. Micro-scale features of
the built environment include the width of the sidewalk, the presence of
amenities such as benches and trash bins, and the presence of crossing
aids such as stoplights and crosswalks. This study employs segment-level
primary data collected for 338 street segments in close proximity to one of.
71 bus rapid transit stations in Bogota, Colombia. We also use secondary
data to control for area-level characteristics such as density, socioeconomic stratum, unemployment, and crime. Factor and regression
analyses are to use identify two dimensions of the built environment that
are associated with higher levels of pedestrian activity: pedestrian-friendly
amenities, comprised of wider and higher quality sidewalks and the
presence of amenities such as benches, garbage cans, and bike paths;
and connectivity, comprised of higher levels of road density, three- and
four-way intersections, and density. In addition, we find greater pedestrian
activity on segments with higher development intensity, with more mix of
land uses, and with more crossing aids. Although the relationships
identified are not causal. they are suggestive in terms of planning
successful built environment interventions. (C) 2009 Elsevier Ltd. All rights
reserved.
Santos, M. S. R., M. S. S. Vale, et al. (2009). "Socio-demographic and perceived
environmental correlates of walking in Portuguese adults-A multilevel analysis."
Health & Place 15(4): 1094-1099.
Several studies have identified associations between walking levels and
socio-demographic and environmental variables. The aim of the present
study was to describe walking patterns and examine associations between
socio-demographic characteristics and perceived environmental attributes
with walking among adults living in the Azorean Archipelago (Portugal). In
all, 7330 adult participants (4104 women), aged 38.1 +/- 93 years, of the
2004 Azorean Physical Activity and Health Study answered the
Environmental Module and the short version of the International Physical
Activity Questionnaire. Among the Azoreans, the environmental dimension
"infrastructures, access to destinations, social environment and
aesthetics" and moderate to vigorous physical activity were positively
associated with walking levels; and smoking, sitting time and being
married were negatively related, regardless of gender, age or education
level. Through the cross-sectional nature of this study, our results suggest
that targeted programs for Azoreans aimed to increase walking levels
should consider that infrastructures, access to destinations, social
environment and aesthetics seem to act synergistically and associate
positively with walking behaviour. (C) 2009 Elsevier Ltd. All rights
reserved.
30
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Scott, M. M., T. Dubowitz, et al. (2009). "Regional differences in walking
frequency and BMI: what role does the built environment play for Blacks and
Whites?" Health Place 15(3): 882-7.
Studies have found that urban sprawl explains many regional differences
in BMI and walking behavior. Yet, African Americans, who often live in
dense, urban neighborhoods with exemplar street connectivity, suffer
disproportionately from obesity. This study analyzed walking and BMI
among 1124 Whites and 691 Blacks in Los Angeles County and southern
Louisiana in relation to neighborhood safety, street connectivity, and
walking destinations. While the built environment partly explains regional
differences in walking and BMI among Whites, the magnitude of effect
was modest. There were no regional differences in outcomes for African
Americans; individual rather than neighborhood characteristics served as
the best predictors.
Shigematsu, R., J. F. Sallis, et al. (2009). "Age Differences in the Relation of
Perceived Neighborhood Environment to Walking." Medicine & Science in Sports
& Exercise 41(2): 314-321.
The article presents a study on the age differences in the relation of
perceived neighborhood environment to walking. The research aims to
analyze the age-related differences in associations between the
neighborhood environment and physical activity. Participants of the study
answered questionnaires about neighborhood environment attributes and
walking for transportation and for leisure intentions. Results of the study
show that walking for transportation purpose was associated to all
neighborhood environment variables in the youngest age group.
Environmental attributes such as nonresidential uses and recreation were
moderately related to walking for transportation in the two oldest groups.
Stanis, S. A. W., E. S. Ingrid, et al. (2009). "State Park Visitors' Leisure Time
Physical Activity, Constraints, and Negotiation Strategies." Journal of Park &
Recreation Administration 27(3): 21-41.
Although the health and well-being benefits of physical activity are
recognized and well documented, many U.S. citizens do not meet the
Center for Disease Control's recommended guidelines. Public parks are
important places that facilitate physical activity and, subsequently, public
health. However, constraints to recreation and physical activity at parks
exist despite the presence of parks. Studies that focus on visitors'
constraints to leisure time physical activity (LTPA) in public parks and
related negotiation strategies are lacking. Due to high obesity rates and
low prevalence of LTPA in the U.S., investigations of factors influencing
physical activity are needed. Therefore, this study assessed LTPA
participation, constraints to LTPA (interpersonal, intrapersonal and
structural), and negotiation strategies employed by individuals recreating
on public lands. Data were collected among state park visitors via onsite
and follow-up mail or online questionnaires. The majority of respondents
31
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
participated in either moderate or vigorous LTPA at the study site during
the past 12 months and parks and recreation areas were among the top
three locations for physical activity. Of the three constraint categories,
interpersonal constraints were respondents' greatest constraint to physical
activity at the park, followed by structural and intrapersonal constraints. To
negotiate constraints, respondents most frequently employed financial
management strategies, followed by cognitive and time management
strategies. Results suggest parks are indeed frequent and important
places for physical activity and point to several management implications
to assist recreation agencies increase physical activity on public lands.
First, park managers can move beyond awareness of the importance of
parks for LTPA to action and documentation of physical activity in parks.
Second, managers can attend to the LTPA constraints visitors face as well
as work to facilitate negotiation strategies. Finally, park managers and
administrators are encouraged to use these findings to promote the use of
parks for LTPA in coordination with public health agencies and resources.
Efforts such as these will help recreation land management agencies
position themselves as a public health resource, serving both individuals
and communities for long-term health and well-being. ABSTRACT FROM
PUBLISHER
Sugiyama, T., E. Leslie, et al. (2009). "Physical activity for recreation or exercise
on neighbourhood streets: Associations with perceived environmental attributes."
Health & Place 15(4): 1058-1063.
Studies have identified various environmental factors associated with
physical activity. However, mixed findings have been reported on
environment correlates of physical activity for recreation. Using a sample
of Australian adults (n = 2194), we examined perceived environmental
attributes associated with recreational physical activity or exercise taking
place on neighbourhood streets, which are known to be frequently used
for such activity. Attractiveness, street connectivity, access to outdoor
recreational facilities and access to places of interest were significantly
associated with neighbourhood street use after adjusting for sociodemographic variables. Enhancing these environmental attributes and
perceptions about them may be effective in promoting residents' physical
activity. (C) 2009 Elsevier Ltd. All rights reserved.
Suminski, R. R., S. Pyle, et al. (2009). "ENVIRONMENTAL CHARACTERISTICS
AND PHYSICAL ACTIVITY IN RACIAL/ETHNIC MINORITY AND EUROAMERICAN COLLEGE STUDENTS." Perceptual & Motor Skills 108(2): 465-478.
Little is known about the relations of environmental characteristics and
physical activity of college students, especially students from diverse
racial or ethnic backgrounds. Associations were examined between
environmental characteristics and moderate and vigorous activity in racial
or ethnic minority (n=418; M age= 24.3 ±4.5 yr.; 54.2% women) and
Euro-American (n=297; M age=23.5 ±4.4 yr.; 49.7% women) college
32
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
students. Participants completed questionnaires assessing demographic
measures, physical activity, exercise equipment at home, neighborhood
characteristics, and convenient places for physical activity. Moderate and
vigorous activity participation was similar between the two groups even
though racial or ethnic minorities had less supportive home and
neighborhood environments for activity and fewer convenient facilities.
Greater moderate and vigorous activity were related with more convenient
facilities in racial or ethnic minorities. Vigorous activity was associated with
better neighborhood characteristics for Euro-Americans. The findings can
inform the design and implementation of environmental approaches to
promoting activity of college students from diverse ethnic backgrounds.
Townshend, T. and A. A. Lake (2009). "Obesogenic urban form: Theory, policy
and practice." Health & Place 15(4): 909-916.
There is a growing body of research, which suggests that many
contemporary urban environments do not support healthy lifestyle choices
and are implicated in the obesity pandemic. This paper reviews the
evidence from this field in relation to theory, policy and practice, from three
different disciplinary perspectives: urban design, geography and public
health nutrition. In the UK, our development has been higher density and
our urban form more varied, yet the paper concludes that it still may be
making a contribution to our own obesity crisis. The dynamics of this,
however, are highly complex and currently little understood. (C) 2008
Elsevier Ltd. All rights reserved.
Tsai, Y. H. (2009). "Impacts of self-selection and transit proximity on commute
mode choice: evidence from Taipei rapid transit system." Annals of Regional
Science 43(4): 1073-1094.
Debate over how land use and self-selection affect travel behavior
continues. Prior research contributes limited empirical evidence to this
debate, and characterizing self-selection remains problematic. This
empirical research explores the impacts of self-selection and proximity to
transit at both residence and workplace. The research hypothesis is selfselection and proximity to transit increase the probability of workers
commuting by rapid rail transit. To conduct this research, a station-exit
passenger survey was conducted along the Taipei Rapid Transit System.
Analysis methods include binomial logit modeling and sensitivity analysis.
Research results support the idea that transit proximity to both work and
residence increase the probability of transit commuting, but the hypothesis
about the impact of self-selection is only partly supported. Policy
implications suggest that, on one hand, increasing density around transit
stations could realize unfulfilled self-selection; on the other hand,
improved quality-of-life characteristics in neighborhoods around station
areas may induce residents and companies to relocate to the
neighborhood, thereby increasing residents' and workers' probabilities of
commuting by transit.
33
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Zenk, S. N., J. Wilbur, et al. (2009). "Neighborhood Environment and Adherence
to a Walking Intervention in African American Women." Health Education &
Behavior 36(1): 167-181.
This secondary analysis examined relationships between the environment
and adherence to a walking intervention among 252 urban and suburban,
midlife African American women. Participants received an enhanced or
minimal behavioral intervention. Walking adherence was measured as the
percentage of prescribed walks completed. Objective measures of the
women's neighborhoods included walkability (land use mix, street
intersection density, housing unit density, public transit stop density),
aesthetics (physical deterioration, industrial land use), availability of
outdoor (recreational open space) and indoor (recreation centers,
shopping malls) walking facilities/spaces, and safety (violent crime
incidents). Ordinary least squares regression estimated relationships. The
presence of one and especially both types of indoor walking facilities were
associated with greater adherence. No associations were found between
adherence and other environmental variables. The effect of the enhanced
intervention on adherence did not differ by environmental characteristics.
Aspects of the environment may influence African American women who
want to be more active.
3. Policy
Durant, N., S. K. Harris, et al. (2009). "Relation of School Environment and Policy
to Adolescent Physical Activity." Journal of School Health 79(4): 153-159.
Background: Physical activity (PA) declines as children and adolescents
age. The purpose of this study was to examine how specific school factors
relate to youth PA, TV viewing, and body mass index (BMI). Methods: A
sample of 12- to 18-year-old adolescents in 3 cities (N = 165, 53%
females, mean age 14.6 ± 1.7 years, 44% nonwhite) completed surveys
assessing days of physical education (PE) class per week, school
equipment accessibility, after-school supervised PA, and after-school field
access. Regression analyses were conducted to examine relationships
between these school factors and PA at school facilities open to the public
(never active vs active), overall PA level (days per week physically active
for 60 minutes), BMI z score, and TV watching (hours per week). Results:
Adjusting for demographics, days of PE per week and access to school
fields after school were correlated with overall PA (β= 0.286, p = .002,
semipartial correlation .236 and β= 0.801, p = .016, semipartial correlation
.186, respectively). The association between after-school field access and
overall PA was mediated by use of publicly accessible school facilities for
PA. After-school supervised PA and school PA equipment were not
associated with overall PA. In adjusted regression analyses including all
school factors, days of PE remained correlated to overall PA independent
34
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
of other school factors (β= 0.264, p = .007, semipartial correlation = .136).
There were no associations between school factors and BMI or TV
watching. Conclusions: Based on these study findings, PE is a promising
intervention to address improving overall adolescent PA within the school
setting.
Evenson, K. R., K. Ballard, et al. (2009). "Implementation of a School-Based
State Policy to Increase Physical Activity." Journal of School Health 79(5): 231238.
Background: In 2005, the North Carolina State Board of Education
updated the Healthy Active Children Policy to include a requirement that
all kindergarten through eighth-grade children receive at least 30 minutes
of moderate-to-vigorous physical activity each school day through physical
education, recess, and other creative approaches. This study describes
how districts are meeting the physical activity-related portion of this policy
and explores the policy implementation successes and challenges.
Methods: An online survey was conducted in summer 2007 in all school
districts in the state (response rate 106/111; 95.5%). Respondents were
asked to describe the implementation successes and challenges
associated with including 30 minutes of physical activity in the school day.
Answers were double coded, checked, and grouped into themes. Results:
The physical activity requirement was most often met through recess,
physical education, classroom Energizers, and intramural sports. School
districts reported numerous positive effects of the policy in elementary and
middle schools. Benefits included increased student focus on studies,
physical activity participation, awareness of healthy habits, alertness and
enjoyment, and higher staff involvement. Implementation challenges to the
policy included lack of time in the school day, teacher participation, and
concerns about academics. Conclusions: School districts reported that
implementation of the policy produced many positive results for students
and staff. Addressing several implementation challenges common across
school districts would strengthen the ongoing success of the policy.
Naylor, P. J. (2009). "Prevention in the first place: schools a setting for action on
physical inactivity." British Journal of Sports Medicine 43(1): 10-13.
Promoting physical activity has become a priority because of its role in
preventing childhood obesity and chronic disease. Ecological approaches
that recognise the interaction between individuals and the settings in
which they spend their time are currently at the forefront of public health
action. Schools have been identified as a key setting for health promotion.
An overview of the literature addressed the promotion of physical activity
in schools and showed that school-based strategies (elementary or high
school) that utilised classroom-based education only did not increase
physical activity levels; one notable exception was screen time
interventions. Although evidence is sparse, active school models and
environmental strategies (interventions that change policy and practice)
35
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
appear to promote physical activity in elementary schools effectively.
There is also strong evidence to support multicomponent models in high
schools, particularly models that incorporate a family and community
component. An emerging trend is to involve youth in the development and
implementation of interventions. In the context of childhood obesity and
sedentary lifestyles, modest increases in physical activity levels in schoolbased trials are important. School initiatives must be supported and
reinforced in other community settings. Health professionals play a key
role as champions in the community, based on their influence and
credibility. Health professionals can lend support to school-based efforts
by asking about and emphasising the importance of physical activity with
patients, encouraging family-based activities, supporting local schools to
adopt an "active school" approach and advocating for support to sustain
evidence-based and promising physical activity models within schools.
Schwartz, M. A., S. A. Aytur, et al. (2009). "Are Perceptions About Worksite
Neighborhoods and Policies Associated With Walking?" American Journal of
Health Promotion 24(2): 146-151.
Purpose. To examine associations of the built environment surrounding
worksites and of work policies with walking behaviors. Design. Crosssectional convenience sample survey. Setting. Workplace. Subjects.
Employed adults residing in Montgomery County, Maryland. Measures.
Four different step measures taken at or near work as recorded using an
accelerometer and a fifth measure indicated self-reported walking from
work. Participants reported on eight built environment characteristics
surrounding the worksite (e.g., the presence of sidewalks, crosswalks, and
pedestrian signals) and on four worksite policies (e.g., the presence of
exercise facilities and exercise programs). Analysis. Cross-sectional
associations of self-reported built environment characteristics surrounding
worksites and worksite policies with walking behavior were examined.
Results. Although participants reported worksites exhibiting built
environment characteristics that were supportive of walking (seven of
eight characteristics were reported by >50% of participants), no built
environment characteristic was associated with walking more than the
median number of average weekday steps (p ≥ .05). All four worksite
policies were associated with walking more than the median number of
average weekday steps (p < .05). In addition, a perception of few cul-desacs and of the presence of litter, sidewalks, crosswalks, and pedestrian
signals surrounding the worksites was associated with a higher proportion
of participants taking at least one walking trip from work in the past month
(p < .05). Conclusions. Locating worksites in walkable environments and
implementing worksite policies may favorably influence employee walking.
Future studies should consider a prospective design and examine a
larger, more diverse employee population and worksite environment to
examine these associations.
36
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
4. Social Environment and Youth Physical Activity/Obesity
Brockman, R., R. Jago, et al. (2009). ""Get off the sofa and go and play": Family
and socioeconomic influences on the physical activity of 10-11 year old children."
Bmc Public Health 9.
Background: Physical activity declines as children approach puberty.
Research has focussed on psychosocial, environmental, and demographic
determinants. This paper explores how family and socioeconomic factors
are related to children's physical activity. Methods: Seventeen focus
groups were conducted with 113, 10-11 year old children from 11 primary
schools in Bristol, UK. Focus groups examined: 1) the way parents
encourage their children to be physically active; 2) the extent to which
physical activity is engaged in as a family; and 3) the types of non-family
based physical activities Year 6 children commonly participate in. Results:
Participants from all socioeconomic (SES) groups reported that parents
encouraged them to be physically active. However approaches differed.
Children from middle/high SES schools were assisted through actions
such as logistical and financial support, co-participation and modelling.
Parents of children from low SES schools mainly restricted their input to
verbal encouragement and demands. Participation in family-based
activities was reported to be higher in children from middle/high SES
schools than children from low SES schools. All SES groups reported time
to be a limiting factor in family-based activity participation. Cost was
reported as a significant barrier by children from low SES schools.
Children from middle/high SES schools reported engaging in more sports
clubs and organised activities than children from low SES schools, who
reported participating in more unstructured activities or 'free play' with
friends. Conclusion: The family is important for encouraging children to be
physically active, but families from different socioeconomic backgrounds
support their children in different ways. This research suggests that the
design of physical activity interventions, which might include working with
families, requires tailoring to groups from different socio-economic
backgrounds.
Cecil-Karb, R. and A. Grogan-Kaylor (2009). "Childhood Body Mass Index in
Community Context: Neighborhood Safety, Television Viewing, and Growth
Trajectories of BMI." Health & Social Work 34(3): 169-177.
The United States is currently experiencing art epidemic of children who
are overweight or obese. Recently, research on child obesity has begun to
examine the relationship between neighborhood environments and the
health behaviors of youths. The Current study used growth curve analysis
based on multilevel modeling to examine the relationship between parents'
perceptions of neighborhood safety and children's body mass index (BMI).
Parents' perceptions of neighborhood safety had a significant association
with children's BMI, and this relationship was fully mediated by television
viewing. The results of this study suggest that when parents perceive their
37
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
neighborhood to be unsafe, they will restrict their childrens outdoor
activities and increase the likelihood of sedentary indoor activity. Policies
aimed at reducing overweight and obesity in children should take into
account the neighborhood contexts in which children live.
Dowda, M., R. P. Saunders, et al. (2009). "Physical Activity and Sedentary
Pursuits of Children Living in Residential Children's Homes." Journal of Physical
Activity & Health 6(2): 195-202.
Purpose: Our goal was to describe the types of physical activities and
sedentary pursuits reported by children living in residential children's
homes and make comparisons by age, gender, and race/ethnic groups.
Methods: Participants were 263 children (52% male, 40% 11 to 14 years
old, 53% White, 23% African American, and 24% other race/ethnic
groups) in 23 residential children's homes in North and South Carolina.
The median length of stay in the homes was 6 months. Physical activities
and sedentary pursuits were reported over a 3-day period using the 3-Day
Physical Activity Recall (3DPAR). Results: Boys reported participating in
more basketball (P ≤ .001), football (P ≤ .001), and videogames or
surfing the net (P ≤ .001) than did girls. Girls reported more
cheerleading, social dance, and homework than did boys (P values ? .01).
There were few race differences. Fewer older children reported
participation in physical education classes, and more reported working
part-time than younger children (P values ≤ .001). Conclusions:
Children in residential homes appear to participate in activities that are
similar to children living with their parents, with boys reporting more team
activities and girls reporting more individual activities. However, children in
residential children's homes may participate in some physical activities for
shorter periods of time than children living with their parents.
Duncan, D. T., R. M. Johnson, et al. (2009). "Association between neighborhood
safety and overweight status among urban adolescents." Bmc Public Health 9.
Background: Neighborhood safety may be an important social
environmental determinant of overweight. We examined the relationship
between perceived neighborhood safety and overweight status, and
assessed the validity of reported neighborhood safety among a
representative community sample of urban adolescents (who were racially
and ethnically diverse). Methods: Data come from the 2006 Boston Youth
Survey, a cross-sectional study in which public high school students in
Boston, MA completed a pencil-and-paper survey. The study used a twostage, stratified sampling design whereby schools and then 9(th)-12(th)
grade classrooms within schools were selected (the analytic sample
included 1,140 students). Students reported their perceptions of
neighborhood safety and several associated dimensions. With selfreported height and weight data, we computed body mass index (BMI,
kg/m(2)) for the adolescents based on CDC growth charts. Chi-square
statistics and corresponding p-values were computed to compare
38
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
perceived neighborhood safety by the several associated dimensions.
Prevalence ratios (PRs) and 95% confidence intervals (CI) were
calculated to examine the association between perceived neighborhood
safety and the prevalence of overweight status controlling for relevant
covariates and school site. Results: More than one-third (35.6%) of
students said they always felt safe in their neighborhood, 43.9% said they
sometimes felt safe, 11.6% rarely felt safe, and 8.9% never felt safe.
Those students who reported that they rarely or never feel safe in their
neighborhoods were more likely than those who said they always or
sometimes feel safe to believe that gang violence was a serious problem
in their neighborhood or school (68.0% vs. 44.1%, p < 0.001), and to have
seen someone in their neighborhood assaulted with a weapon (other than
a firearm) in the past 12 months (17.8% vs. 11.3%, p = 0.025). In the fully
adjusted model (including grade and school) stratified by race/ethnicity,
we found a statistically significant association between feeling unsafe in
one's own neighborhood and overweight status among those in the Other
race/ethnicity group [(PR = 1.56, (95% CI: 1.02, 2.40)]. Conclusion: Data
suggest that perception of neighborhood safety may be associated with
overweight status among urban adolescents in certain racial/ethnic
groups. Policies and programs to address neighborhood safety may also
be preventive for adolescent overweight.
Hume, C., M. Jorna, et al. (2009). "Are children’s perceptions of
neighbourhood social environments associated with their walking and physical
activity?" Journal of Science & Medicine in Sport 12(6): 637-641.
Abstract: This study aimed to examine cross-sectional associations
between neighbourhood social environmental factors and physical activity
(PA) among Australian primary school children. Baseline data from a
large-scale trial among 957 children (48% boys) aged 9–12 years were
utilised. Children self-reported their perceptions of the neighbourhood
social environment including social networks (e.g. there are lots of other
children around to play with), and social capital (e.g. there are lots of
people in my area I could go to if I need help). Children also self-reported
their weekly walking frequency and PA from which average daily moderate
to vigorous PA (MVPA) was calculated. Linear regression analyses
examined these associations. Boys performed 17min/day more MVPA
than girls (p <0.01), and girls performed one extra trip/week than boys (p
<0.001). Children’s perceptions of social capital (p <0.0001) and
social networks (p <0.01) were both positively associated with MVPA and
social capital was positively associated with walking frequency (p <0.05).
These associations were not moderated by the child’s sex. These
findings suggest that children who had positive perceptions of
neighbourhood social capital and social networks in the neighbourhood,
tended to be more physically active. Longitudinal and experimental studies
are required to further test the influence of these factors among children.
Copyright 2009 Elsevier
39
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Koehly, L. M. and A. Loscalzo (2009). "Adolescent obesity and social networks."
Prev Chronic Dis 6(3): A99.
The prevalence of overweight among children worldwide is growing at an
alarming rate. Social relationships may contribute to the development of
obesity through the interaction of biological, behavioral, and environmental
factors. Although there is evidence that early environment influences the
expression of obesity, very little research elucidates the social context of
obesity among children or adolescents. Social network approaches can
contribute to research on the role of social environments in overweight
and obesity and strengthen interventions to prevent disease and promote
health. By capitalizing on the structure of the network system, a targeted
intervention that uses social relationships in families, schools,
neighborhoods, and communities may be successful in encouraging
healthful behaviors among children and their families.
ShukIa, M., R. Venugopal, et al. (2009). "A cross sectional study of body
composition, somatotype and motor quality of rural and urban boys of
Chhattisgarh." International Journal of Fitness 5(1): 1-7.
A cross sectional study on the motor quality, body composition and
somatotype has been made on 900 boys, aged 10-18 years in Jawahar
Navodaya Vidyalaya (JNV) and Kendriya Vidyalaya (KV) of Chhattisgarh
in India. The study was aimed to compare the body composition and
fitness status of the rural children of residential school with that of urban
boys of non residential school. Body fat % was calculated by using the
skin fold methods. It was observed that there was an increase in stature
and weight with increment of age in boys of both the groups. Performance
in various fitness variables also improved with the increase of age in both
the groups. A comparative analysis revealed that rural boys (JNV) were
better in fitness variables as compared to urban boys (KV).
Stodolska, M., J. C. Acevedo, et al. (2009). "Gangs of Chicago: Perceptions of
Crime and its Effect on the Recreation Behavior of Latino Residents in Urban
Communities." Leisure Sciences 31(5): 466-482.
Perception of safety is an important factor affecting the leisure behavior of
Latinos residing in urban neighborhoods. Yet research on how fear of
crime and fear of gangs in particular affect leisure of ethnic and racial
minorities is underdeveloped. The objectives of this study are to examine
how gangs operate in recreation spaces in Latino neighborhoods, how
gangs affect the use of outdoor recreation environments and how Latinos
respond to these issues. The study is based on focus groups conducted
with Latino residents in Chicago. Findings indicate gang members are
almost constantly present in parks, which serve as spaces for drug use
and distribution. Moreover, gangs operate in other areas of the
neighborhood making it unsafe to access parks. Participants employ
strategies to address the gang problem including avoidance, protective
40
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
and collective behaviors.
Voorhees, C. C., D. J. Catellier, et al. (2009). "Neighborhood Socioeconomic
Status and Non School Physical Activity and Body Mass Index in Adolescent
Girls." Journal of Physical Activity & Health 6(6): 731-740.
Socioeconomic status (SES) has well known associations with a variety of
health conditions and behaviors in adults but is unknown in adolescents.
Methods: Multilevel analysis was conducted to examine the associations
between individual and neighborhood-level measures of SES and physical
activity and body mass index in a sample of 1554 6th grade girls selected
at random from 36 middle schools across 6 geographic regions in the
United States that participated in the Trial of Activity for Adolescent Girls
(TAAG). Data on parental education and employment, and receipt of
subsidized school lunch were collected by questionnaire. Neighborhoodlevel SES was measured by the Townsend Index. Nonschool physical
activity levels were measured by accelerometer and type, location and
context was measured using a 3 day physical activity recall (3DPAR).
Results: After controlling for race, lower parental education and higher
levels of social deprivation were associated with higher BMI. In a model
with both variables, effects were attenuated and only race remained
statistically significant. None of the indices of SES were related to
accelerometer measured physical activity. Bivariate associations with selfreported Moderate-Vigorous Physical Activity (MVPA) location and type
(3DPAR) varied by SES. Conclusion: Among adolescent girls in the TAAG
Study, the prevalence of overweight is high and inversely related to
individual and neighborhood SES.
Wenthe, P. J., K. F. Janz, et al. (2009). "Gender Similarities and Differences in
Factors Associated With Adolescent Moderate-Vigorous Physical Activity."
Pediatric Exercise Science 21(3): 291-304.
This study investigated the relationship between predisposing, reinforcing,
and enabling factors conceptualized within the Youth Physical Activity
Promotion Model (YPAP) and moderate to vigorous physical activity
(MVPA) of adolescent males and females. Specifically, self-efficacy to
overcome barriers, enjoyment of physical activity; family support, peer
support, perceived school climate, neighborhood safety and access to
physical activity were examined. The Physical Activity Questionnaire for
Adolescents (PAQ-A) and the Actigraph 7164 were used to obtain three
different measures of MVPA in 205 adolescents (102 males, 103 females).
Family support emerged as the most significant and consistent factor
associated with the MVPA of both adolescent males and females. This
relationship was noted even when different methods of measuring MVPA
were employed. These findings should increase the confidence of public
health officials that family support has the potential to positively alter the
physical activity behavior of adolescents.
41
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Withall, J., R. Jago, et al. (2009). "Families' and health professionals' perceptions
of influences on diet, activity and obesity in a low-income community." Health &
Place 15(4): 1078-1085.
This qualitative study examined reported barriers to consuming a healthy
diet and engaging in regular physical activity among low-income families
with existing issues of overweight or obesity. Parents and health
professionals reported that issues of access, availability and cost were
perceived as major barriers to a healthy lifestyle along with familial shape,
metabolism and safety. Many felt their diet and activity levels were already
good. The study concluded that improving access, availability and income
may increase activity but only in some groups. Issues of perceived
helplessness (genetics/metabolism) and high optimistic bias may provide
rationalisations that undermine behaviour change. Together these issues
may mask the more complex, less easily articulated influences (cultural.
social and family influences and practices, knowledge and skill levels, and
emotional status) that lead to unhealthy behaviours. (C) 2009 Elsevier Ltd.
All rights reserved.
5. Social Environment and Adult Physical Activity/Obesity
Amarasinghe, A., G. D'Souza, et al. (2009). "The Influence of Socioeconomic
and Environmental Determinants on Health and Obesity: A West Virginia Case
Study." International Journal of Environmental Research and Public Health 6(8):
2271-2287.
A recursive system of ordered self assessed health together with BRFSS
data were used to investigate health and obesity in the Appalachian state
of West Virginia. Implications of unobserved heterogeneity and
endogeneity of lifestyle outcomes on health were investigated. Obesity
was found to be an endogenous lifestyle outcome associated with
impaired health status. Risk of obesity is found to increase at a decreasing
rate with per capita income and age. Intervention measures which
stimulate human capital development, diet-disease knowledge and careful
land use planning may improve health and obesity outcomes in
Appalachia in particular and rural America in general.
Chang, V. W., A. E. Hillier, et al. (2009). "Neighborhood Racial Isolation, Disorder
and Obesity." Social Forces 87(4): 2063-2092.
Recent research suggests that racial residential segregation may be
detrimental to health. This study investigates the influence of
neighborhood racial isolation on obesity and considers the role of
neighborhood disorder as a mediator in this relationship. For the city of
Philadelphia, we find that residence in a neighborhood with high black
racial isolation is associated with a higher body mass index and higher
odds of obesity among women, but not men, highlighting important sex
42
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
differences in the influence of neighborhood structure on health.
Furthermore, the influence of high racial isolation on women's weight
status is mediated, in part, by the physically disordered nature of such
neighborhoods. Disorder of a more social nature (as measured by incident
crime) is not associated with weight status.
Boone-Heinonen, J., D. R. Jacobs, et al. (2009). "A Walk (or Cycle) to the Park
Active Transit to Neighborhood Amenities, the CARDIA Study." American Journal
of Preventive Medicine 37(4): 285-292.
Background: Building on known associations between active commuting
and reduced cardiovascular disease (CVD) risk, this Study examines
active transit to neighborhood amenities and differences between walking
and cycling for transportation. Methods: Year-20 data from the Coronary
Artery Risk Development in Young Adults Study (3549 black and white
adults aged 38-50 years in 2005-2006) were analyzed in 2008-2009.
Sociodemographic correlates of transportation mode (car-only, walk-only,
any cycling, other) to neighborhood amenities were examined in
multivariable multinomial logistic models. Gender-stratified multivariable
linear or multinomial regression models compared CVD risk factors across
transit modes. Results: Active transit was most common to parks and
public transit stops; walking was more common than cycling. Among those
who used each amenity, active transit (walk-only and any cycling versus
car-only transit) was more common in men and those with no live-in
partner and less than full-time employment (significant ORs [95% CI]
ranging from 1.56 [1.08, 2.27] to 4.54 [1.70, 12-14]), and less common in
those with children. Active transit to any neighborhood amenity was
associated with more favorable BMI, waist circumference, and fitness
(largest coefficient [95% CI] -1.68 [-2.81, -0.55] for BMI, -3.41 [-5.71, 1.11] for waist circumference [cm], and 36.65 [17.99, 55.31.] for treadmill
test duration [seconds]). Only cycling was associated with lower lifetime
CVD risk classification. Conclusions: Active transit to neighborhood
amenities was related to sociodemographics and CVD risk factors.
Variation in health-related benefits by active transit mode, if validated in
prospective studies, may have implications for transportation planning and
research. (Am J Prev Med 2009;37(4):285-292) (C) 2009 Americau
Journal of Preventive Medicine
Dunton, G. F., D. Berrigan, et al. (2009). "Environmental Influences on Exercise
Intensity and Duration in a U.S. Time Use Study." Medicine & Science in Sports
& Exercise 41(9): 1698-1705.
The article investigates whether the intensity and duration of sports and
exercise bouts differ across physical and social environments. It is found
that vigorous-intensity exercise usually occurs when the exercise bout is
done alone as compared with other social conditions and when it is done
at a gym, health club or at home as compared with outdoors. It is also
43
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
found that exercise bouts were shorter when exercising alone versus with
family members, friends and acquaintances. For this reason, it is
concluded that intensity and duration of exercise bouts are differentially
affected by social contexts and physical settings.
Lee, J., D. Macdonald, et al. (2009). "Young Men's Physical Activity Choices The
Impact of Capital, Masculinities, and Location." Journal of Sport & Social Issues
33(1): 59-77.
This article draws on data from an Australian longitudinal study into the
place and meaning of physical activity and physical culture in the lives of
young people. The aim of the national study is to add meaning to the
statistics based on quantitative surveys that suggest a declining
participation rate and satisfaction of young people in organized sports,
recreational physical activities, and exercise. Frequently, socioeconomic
status, gender, and geography are used as explanatory variables. In this
article, the authors aim to provide an alternative reading of the statistical
patterns by exploring how differences in capital (economic, social, and
cultural) are played out in the lives of four young Australian males. The
authors argue that schooling, geographical location, and access to capital
play important roles in the intersection among masculinities, participation
in physical activity, and engagement with physical culture.
Li, W., J. L. Kelsey, et al. (2009). "Small-area Estimation and Prioritizing
Communities for Obesity Control in Massachusetts." American Journal of Public
Health 99(3): 511-519.
Objectives. We developed a method to evaluate geographic and temporal
variations in community-level obesity prevalence and used that method to
identify communities in Massachusetts that should be considered high
priority communities for obesity control. Methods. We developed smallarea estimation models to estimate community-level obesity prevalence
among community-living adults 18 years or older. Individual-level data
from the Behavioral Risk Factors Surveillance System from 1999 to 2005
were integrated with community-level data from the 2000 US Census.
Small-area estimation models assessed the associations of obesity (body
mass index ≥30 kg/m²) with individual- and community-level
characteristics. A classification system based on level and precision of
obesity prevalence estimates was then used to identify high-priority
communities. Results. Estimates of the prevalence of community-level
obesity ranged from 9% to 38% in 2005 and increased in all communities
from 1999 to 2005. Fewer than 7% of communities met the Healthy
People 2010 objective of prevalence rates below 15%. The highest
prevalence rates occurred in communities characterized by lower income,
less education, and more blue-collar workers. Conclusions. Similar to the
rest of the nation, Massachusetts faces a great challenge in reaching the
national obesity control objective. Targeting high-priority communities
identified by small-area estimation may maximize use of limited resources.
44
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Murakami, K., S. Sasaki, et al. (2009). "Neighborhood socioeconomic status in
relation to dietary intake and body mass index in female Japanese dietetic
students." Nutrition 25(7-8): 745-52.
OBJECTIVE: An increasing number of studies conducted in Western
countries have shown that living in a socioeconomically disadvantaged
neighborhood is associated with unfavorable dietary intake patterns and
an unfavorable health status. However, information on such neighborhood
socioeconomic differences in diet and health among different cultural
settings, including Japan, is absolutely lacking. This cross-sectional study
examined the association of neighborhood socioeconomic status (SES)
with dietary intake and body mass index (BMI) in a group of young
Japanese women. METHODS: Subjects were 3892 female Japanese
dietetic students 18-20 y of age from 53 institutions, residing in 1033
municipalities in 47 prefectures in Japan. Neighborhood SES index was
defined by seven municipal-level variables, namely unemployment,
household overcrowding, poverty, education, income, home ownership,
and vulnerable groups, with an increasing index signifying increasing
neighborhood socioeconomic disadvantage. Dietary intake was estimated
using a validated, comprehensive self-administered diet history
questionnaire. BMI was computed from self-reported body weight and
height. RESULTS: Neighborhood SES index was not materially
associated with most of the dietary variables. However, neighborhood
SES index was positively associated with BMI, with significance (P for
trend=0.020). This significant association remained after adjustment for
potential confounding or mediating factors including household SES,
dietary, other lifestyle, and geographic factors (P for trend=0.037).
CONCLUSION: Although no material association was seen between
neighborhood SES and dietary intake, increasing neighborhood
socioeconomic disadvantage was independently associated with
increasing BMI in a group of young Japanese women.
Navarro Rodriguez, M. C., P. Saavedra Santana, et al. (2009). "[Lifestyle,
socioeconomic status and morbidity in postmenopausal women with grade II and
III obesity]." Endocrinol Nutr 56(5): 227-32.
BACKGROUND: Obesity has become a major public health problem in all
western countries, and its prevalence is increasing. This condition is
associated with a higher prevalence of diabetes mellitus, hypertension,
and coronary heart disease; furthermore, obesity is a risk factor for
mortality. OBJECTIVE: To study the association of some prevalent
diseases (diabetes mellitus, thyroid disease, obesity, hypertension,
inflammatory rheumatic disease, urolithiasis), the distribution of some
lifestyle factors (tobacco, alcohol and caffeine consumption and physical
activity during leisure time) and the prevalence of poverty in a population
of postmenopausal women in the Canary Islands with obesity class II or III
(BMI>35). METHOD: A personal interview was performed in all patients. A
45
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
questionnaire was administered to assess their lifestyles and current
medication use. The women's medical records were reviewed to confirm
the existence of certain diseases. A complete physical examination was
performed in all patients. Weight and height were measured with the
patient dressed in light clothing. Blood samples were obtained with the
patient in a fasting state for subsequent analysis. Poverty was defined
according to the criteria of the Spanish National Institute of Statistics.
RESULTS: Women with obesity class II or III were older (56.8+/-11 vs
53.9+/-11.6 years, p=0.02), shorter (153.7+/-6.3 vs 156.9+/-36.1 cm,
p=0.001), heavier (89.6+/-9.3 vs 66.6+/-10.4 kg, p=0.001) and had a
greater body surface than controls (1.73+/-0.13 vs 1.54+/-0.13 m2,
p=0.001). Alcohol and tobacco consumption were lower in obese women
than in controls. Obese women drank more coffee and took less physical
activity during leisure time than controls. The prevalence of hypertension 36% vs 17.9%, p=0.001, odds ratio [OR] [95% confidence interval
(IC)]=2.57 (1.56-4.24)-, diabetes mellitus -24.4% vs 11.3%, p=0.001,
OR=2.52 (1.47-1.05)-and hypothyroidism -14.3% vs 8%, p=0.04; OR=1.91
(0.99-3.68)-was higher in obese women than in controls. More than half
lived in rural areas and were below the poverty threshold.
CONCLUSIONS: More than half of postmenopausal women with obesity
class II or III were below the poverty threshold and lived in a rural area. In
these women there was a lower consumption of alcohol and tobacco,
lesser physical activity during leisure time, and a higher prevalence of
diabetes mellitus, hypertension and hypothyroidism than in control
postmenopausal women.
PSellstrom, E., G. Arnoldsson, et al. (2009). "Obesity prevalence in a cohort of
women in early pregnancy from a neighbourhood perspective." BMC Pregnancy
Childbirth 9: 37.
BACKGROUND: The evidence of an association between neighbourhood
deprivation and overweight is established for different populations.
However no previous studies on neighbourhood variations in obesity in
pregnant women were found. In this study we aimed to determine whether
obesity during early pregnancy varied by neighbourhood economic status.
METHODS: A register based study on 94,323 primiparous pregnant
women in 586 Swedish neighbourhoods during the years 1992-2001.
Multilevel technique was used to regress obesity prevalence on
socioeconomic individual-level variables and the neighbourhood economic
status. Five hundred and eighty-six neighbourhoods in the three major
cities of Sweden, Stockholm, Goteborg and Malmo, during 1992-2001,
were included. The majority of neighbourhoods had a population of 4
00010 000 inhabitants. RESULTS: Seven per cent of the variation in
obesity prevalence was at the neighbourhood level and the odds of being
obese were almost doubled in poor areas. CONCLUSION: Our findings
supports a community approach in the prevention of obesity in general
and thus also in pregnant women.
46
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
Tucker-Seeley, R. D., S. V. Subramanian, et al. (2009). "Neighborhood Safety,
Socioeconomic Status, and Physical Activity in Older Adults." American Journal
of Preventive Medicine 37(3): 207-213.
Background: Neighborhood environment can have a substantial influence
on the level of physical activity among older adults. Yet, the moderating
influence of various measures of SES on the association between
perceived neighborhood safety and leisure-time physical activity (LTPA)
among older adults remains unknown. Purpose: The study was designed
to investigate the association between perceived neighborhood safety and
LTPA in a nationally representative sample of older adults, and to evaluate
SES characteristics as potential effect modifiers in the association
between perceived neighborhood safety and LTPA. Methods: Crosssectional data from the 2004 Health and Retirement Study of older adults
aged >= 50 years were used to examine the association between
perceived neighborhood safety and LTPA. Differences in LTPA were
evaluated across three measures of SES: education, household income,
and household wealth. SES was also evaluated as a potential effect
modifier in the association between perceived neighborhood safety and
LTPA. The analysis was conducted in 2008. Results: An SES gradient in
LTPA was noted across measures of SES used in this Study. After
controlling for SES and demographic characteristics and functional
limitations, older adults who perceived their neighborhood as safe had an
8% higher mean rate of LTPA compared to older adults who perceived
their neighborhood as unsafe. The association was no longer significant
when self-rated health was added. Additionally, SES was not a significant
effect modifier in the association between perceived neighborhood safety
and LTPA. Conclusions: SES, demographic characteristics, and functional
limitations substantially attenuated the positive association between
perceived neighborhood safety and LTPA; however, with the inclusion of
self-rated health, the association was no longer present. This finding
suggets that self-rated health may mediate this association. The lack of
significance in the interaction between perceived neighborhood safety and
SES suggests that prevention efforts to increase physical activity among
older adults should consider perceptions of neighborhood safety as a
potential barrier regardless of SES. (Am J Prev Med 2009;37(3):207-213)
(C) 2009 American Journal of Preventive Medicine
6. Measurements
Edwards, K. L. and G. P. Clarke (2009). "The design and validation of a spatial
microsimulation model of obesogenic environments for children in Leeds, UK:
SimObesity." Soc Sci Med 69(7): 1127-34.
Obesogenic environments are a major explanation for the rapidly
increasing prevalence in obesity. Investigating the relationship between
47
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
obesity and obesogenic variables at the micro-level will increase our
understanding about local differences in risk factors for obesity.
SimObesity is a spatial microsimulation model designed to create microlevel estimates of obesogenic environment variables in the city of Leeds in
the UK: consisting of a plethora of health, environment, and socioeconomic variables. It combines individual micro-data from two national
surveys with a coarse geography, with geographically finer scaled data
from the 2001 UK Census, using a reweighting deterministic algorithm.
This creates a synthetic population of individuals/households in Leeds with
attributes from both the survey and census datasets. Logistic regression
analyses identify suitable constraint variables to use. The model is
validated using linear regression and equal variance t-tests. Height,
weight, age, gender, and residential postcode data were collected on
children aged 3-13 years in the Leeds metropolitan area, and obesity
described as above the 98th centile for the British reference dataset.
Geographically weighted regression is used to investigate the relationship
between different obesogenic environments and childhood obesity.
Validation shows that the small-area estimates were robust. The different
obesogenic environments, as well as the parameter estimates from the
corresponding local regression analyses, are mapped, all of which
demonstrate non-stationary relationships. These results show that social
capital and poverty are strongly associated with childhood obesity. This
paper demonstrates a methodology to estimate health variables at the
small-area level. The key to this technique is the choice of the model's
input variables, which must be predictors for the output variables; this
factor has not been stressed in other spatial microsimulation work. It also
provides further evidence for the existence of obesogenic environments
for children.
7. Community Interventions
Ayers, S. F.(2009). "Recreation Facilitation Styles and Physical Activity
Outcomes in Elementary School Children." JOPERD: The Journal of Physical
Education, Recreation & Dance 80(2): 10-15.
Anderson, L. M., T. A. Quinn, et al. (2009). "The effectiveness of worksite
nutrition and physical activity interventions for controlling employee overweight
and obesity: a systematic review." Am J Prev Med 37(4): 340-57.
This report presents the results of a systematic review of the effectiveness
of worksite nutrition and physical activity programs to promote healthy
weight among employees. These results form the basis for the
recommendation by the Task Force on Community Preventive Services on
the use of these interventions. Weight-related outcomes, including weight
in pounds or kilograms, BMI, and percentage body fat were used to
48
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
assess effectiveness of these programs. This review found that worksite
nutrition and physical activity programs achieve modest improvements in
employee weight status at the 6-12-month follow-up. A pooled effect
estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine
RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based
on six RCTs. The findings appear to be applicable to both male and
female employees, across a range of worksite settings. Most of the
studies combined informational and behavioral strategies to influence diet
and physical activity; fewer studies modified the work environment (e.g.,
cafeteria, exercise facilities) to promote healthy choices. Information about
other effects, barriers to implementation, cost and cost effectiveness of
interventions, and research gaps are also presented in this article. The
findings of this systematic review can help inform decisions of employers,
planners, researchers, and other public health decision makers.
Banchonhattakit, P., C. Tanasugarn, et al. (2009). "Effectiveness of school
network for childhood obesity prevention (SNOCOP) in primary schools of
Saraburi Province, Thailand." Southeast Asian J Trop Med Public Health 40(4):
816-34.
This research was designed to test the effectiveness of a school network
for childhood obesity prevention (SNOCOP) in primary schools; a program
that aimed to improve student behavior in terms of knowledge, attitude,
intention towards obesity prevention, and their food consumption behavior.
A quasi-experimental pretest-posttest time series study was conducted.
By 2-stage stratified sampling selection 180 students from 6 schools were
assigned to the intervention group and 195 students from 6 schools to the
control group at Saraburi Province, Thailand in 2006- 2007. In addition,
thirty-one participants being school administrators, teachers, parents, and
community members from six schools formed the social network initiating
the intervention. The schoolchildren in the intervention group improved
their eating behavior, knowledge, attitude, intention towards obesity
preventive behavior. The six schools of the intervention group changed
school policies and school activities aiming to reduce the proportion of
obesity among their student. No such activities could be observed in the
control group. These findings suggest that the School-Social Network of
Childhood Obesity Prevention program is an effective means to prevent
childhood obesity.
Batt, M. E. (2009). "Physical activity interventions in the workplace: the rationale
and future direction for workplace wellness." British Journal of Sports Medicine
43(1): 47-48.
The developing and developed worlds are both facing an obesity epidemic
with their workers getting bigger, or to be more specific, fatter. As
demonstrated elsewhere in this issue, the individual and societal health
and economic costs of obesity and physical inactivity are enormous. There
is thus a need for regional, national and global action to combat the
49
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
issues, with programmes broadly divisible into children and adolescents,
the workforce, active aging, healthy aging and a broad cross-cutting
agenda that focuses on the built environment.
de Barros, M. V. G., M. V. Nahas, et al. (2009). "Effectiveness of a School-Based
Intervention on Physical Activity for High School Students in Brazil: The Saude
na Boa Project." Journal of Physical Activity & Health 6(2): 163-169.
Background: We evaluated the effectiveness of a school-based
intervention on the promotion of physical activity among high school
students in Brazil: the Saude na Boa project. Methods: A school-based,
randomized trial was carried out in 2 Brazilian cities: Recife (northeast)
and Florianopolis (south). Ten schools in each city were matched by size
and location, and randomized into intervention or control groups. The
intervention included environmental/organizational changes, physical
activity education, and personnel training and engagement. Students age
15 to 24 years were evaluated at baseline and 9 months later (end of
school year). Results: Although similar at baseline, after the intervention,
the control group reported significantly fewer d/wk accumulating 60
minutes+ moderate-to-vigorous physical activity (MVPA) in comparison
with the intervention group (2.6 versus 3.3, P < .001). The prevalence of
inactivity (0 days per week) rose in the control and decreased in the
intervention group. The odds ratio for engaging at least once per week in
physical activity associated with the intervention was 1.83 (95% CI = 1.242.71) in the unadjusted analysis and 1.88 (95% CI = 1.27-2.79) after
controlling for gender. Conclusion: The Saude na Boa intervention was
effective at reducing the prevalence of physical inactivity. The possibility of
expanding the intervention to other locations should be considered.
Dzewaltowski, D. A., P. A. Estabrooks, et al. (2009). "Healthy Youth Places: A
Randomized Controlled Trial to Determine the Effectiveness of Facilitating Adult
and Youth Leaders to Promote Physical Activity and Fruit and Vegetable
Consumption in Middle Schools." Health Education & Behavior 36(3): 583-600.
The Healthy Youth Places (HYP) intervention targeted increased fruit and
vegetable consumption (FV) and physical activity (PA) through building
the environmental change skills and efficacy of adults and youth. HYP
included group training for adult school site leaders, environmental change
skill curriculum, and youth-led FV and PA environment change teams.
Sixteen schools were randomized to either implement the HYP program or
not. Participants (N =1,582) were assessed on FV and PA and
hypothesized HYP program mediators (e.g., proxy efficacy) at the end of
sixth grade (baseline), seventh grade (Postintervention Year 1), and
eighth grade (Postintervention Year 2). After intervention, HYP schools did
not change in FV but did significantly change in PA compared to control
schools. Proxy efficacy to influence school PA environments mediated the
program effects. Building the skills and efficacy of adults and youth to lead
school environmental change may be an effective method to promote
50
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
youth PA.
Heelan, K. A., B. M. Abbey, et al. (2009). "Evaluation of a Walking School Bus for
Promoting Physical Activity in Youth." Journal of Physical Activity & Health 6(5):
560-567.
Background: Walking to and from school has potential to increase daily
physical activity among children. Methods: A Walking School Bus (WSB)
intervention was implemented for 2 years in 2 schools with a third school
as a control. The primary aim evaluated school-wide prevalence of
walking to school by self-report 6 times (fall, winter, spring). The
secondary aims compared objective physical activity levels among a
subsample of research participants (intervention [INT] = 201, control
[CON] = 123) and between frequency of walking to school groups. INT
and CON participants wore an accelerometer during 4 time periods to
assess daily physical activity and were measured for body mass index
(BMI) and body fat each fall and spring. Results: School- wide prevalence
of walking to school frequently (>50% of the time each week) was 27%
higher in the WSB schools than in the control school. INT obtained
significantly more daily physical activity than CON (78.0 [38.9] vs 60.6
[27.7] min/d, P < .05). In addition, across all schools, frequent walkers
obtained 25% more physical activity (P < .05), gained 58% less body fat
(P < .05), and attenuated BMI by 50% (P < .05) compared with passive
commuters. Conclusion: This study suggests a WSB intervention may
increase frequency of walking to school and establishes a link with
increased daily physical activity.
Hendricks, K., R. Wilkerson, et al. (2009). "Transforming a Small Midwestern City
for Physical Activity: From the Sidewalks Up." Journal of Physical Activity &
Health 6(6): 690-698.
Jackson, Michigan (population 36,000) started active living interventions to
help solve residents' low physical activity levels. Jackson's experience can
serve as a case study for beginning similar efforts in smaller communities.
Methods: In 2003, Jackson began a 3-prong community intervention
utilizing the 5P model to increase safe physical activity opportunities and
encourage walking and biking for short trips. The focus included work on
projects at 1) elementary schools, 2) worksites, and 3) city-wide networks.
Results: Evaluation results show changes in attitudes toward active
transportation (8% increase in children who thought walking to school was
"safer" postintervention), intentions to try active transportation (43% of
Smart Commute Day participants "would" smart commute more often
postevent), and increased physical activity (the percentage of students
walking to school more than doubled at 3 of 4 intervention schools). In
addition, a community level observational study was conducted at 10
locations in the city in 2005 and 2006. The number of people seen using
active transportation increased from 1,028 in 2005 to 1,853 people in 2006
(a 63% increase). Conclusions: Local community-driven projects to
51
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
increase walking and biking can be effective by utilizing a variety of
interventions, from the individual to the policy level.
Kain, J., B. Leyton, et al. (2009). "Two-year controlled effectiveness trial of a
school-based intervention to prevent obesity in Chilean children." Public Health
Nutr 12(9): 1451-61.
OBJECTIVE: Obesity prevalence among Chilean children is 19.4%. The
present study aimed to assess the effectiveness of a school-based obesity
prevention programme. DESIGN: Non-randomized controlled study. The
intervention included activities in nutrition and physical activity, fully
applied the first year and partially in the second one. Primary outcomes
were BMI Z-score (BMIZ) and obesity prevalence; secondary outcomes
were waist circumference and triceps skinfold thickness. Time effects
were assessed by changes in BMI-related variables by gender and period
(ANOVA and Tukey test), while intervention effects were determined by
comparing changes in (i) obesity prevalence by gender and period (PROC
GENMOD) and (ii) BMIZ according gender, age and period (PROC
MIXED). SETTING: Primary schools in the Chilean cities of Casablanca
(intervention group) and Quillota (control group). SUBJECTS: One
thousand seven hundred and fifty-nine children from three schools
(intervention group) and 671 from one school (control group). RESULTS:
Over the two years, obesity prevalence and BMIZ declined significantly in
the intervention group; from 17.0% to 12.3% and 14.1% to 10.3% in boys
and girls, respectively, and from 0.62 to 0.53 and 0.64 to 0.58,
respectively. In the control group, obesity remained stable at about 21%
and 15%, while BMIZ increased significantly in the second year. BMIZ
declined in both genders and all age categories in the intervention group
during the first year (significant only in younger boys). No changes
occurred during the summer, while during the second year, BMIZ
increased in boys and girls from both groups (significant only in the
younger control boys). Obesity declined significantly only in boys during
the first year. CONCLUSION: Effectiveness was greater in the first school
year and more evident in younger boys.
Katz, D. L. (2009). "School-Based Interventions for Health Promotion and Weight
Control: Not Just Waiting on the World to Change." Annual Review of Public
Health 30: 253-272.
Controversy persists regarding the utility of school-based interventions for
obesity prevention and control and for related health promotion. This
article reviews the pertinent evidence, based partly on a recent systematic
review and meta-analysis by the author and colleagues. Of 64 relevant
papers, 21 papers representing 19 distinctstudies met quality criteria; half
of these were published since 2000. Despite marked variation in
measures, methods, and populations that handicap interpretation of this
literature, evidence clearly demonstrated that school-based interventions
had significant effects on weight. Thus available research evidence does
52
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
present a case for school-based interventions. Despite the fact that such
evidence is limited to date, the urgency of the obesity and diabetes
epidemics cries out for action. Intervention is warranted on the basis of
both extant evidence and common sense, with methodologically robust
evaluation concomitantly to test our assumptions and verify our intuition.
Kitscha, C. E., K. Brunet, et al. (2009). "Reasons for non-return to a pediatric
weight management program." Can J Diet Pract Res 70(2): 89-94.
PURPOSE: Obesity in childhood has become a major public health
concern because of increasing rates of overweight and obesity. To
address this epidemic, effective dietetic interventions must be developed.
We examined parent/caregiver and/or patient reasons for not returning for
follow-up clinical care in the Alberta Health Services, Edmonton Area's
Nutrition Services Pediatric Weight Management Program (NS PWMP) in
Edmonton, Alberta. METHODS: A qualitative telephone survey was
developed to identify reasons for non-return to the NS PWMP. Face
validity was evaluated by five pediatric registered dietitians (RDs).
RESULTS: The survey was administered to parents/caregivers of children
or adolescents aged 2.5 to 14.2 years (n=21) who attended fewer than two
appointments in the NS PWMP. The major reasons for non-return
included physical barriers (scheduling, parking, location), organizational
barriers (clinic environment), and program educational content (type of
educational tools, the focus of lifestyle education on the individual rather
than the family, physical activity interventions, and appropriateness of
information for the parent or child). CONCLUSIONS: Development and
delivery of effective dietetic interventions for children and adolescents at
risk of overweight and obesity may be achieved by emphasizing skill
building within the child and the family. Analysis of child and family
feedback on clinical RD services is critical to optimization of care in a
pediatric weight management program.
Kong, A. S., A. L. Sussman, et al. (2009). "Implementation of a Walking School
Bus: Lessons Learned." Journal of School Health 79(7): 319-325.
Background: Obesity is rapidly becoming the most common chronic
medical condition affecting children. To address this crisis, an
Albuquerque, New Mexico, elementary school partnered with University of
New Mexico researchers and conducted a Walking School Bus (WSB).
The purpose of this article is to examine the feasibility of implementing a
WSB. Methods: This pilot study featured 2 WSBs conducted for 10 weeks
with kindergarten through fifth-grade students from a predominantly
Hispanic elementary school. Qualitative and quantitative data, including
coordinator field notes, attendance records, surveys of student and parent
satisfaction, and a focus group, were used to evaluate feasibility. Results:
Student and adult participants expressed a high degree of enthusiasm
regarding their involvement in the WSB. Participants uniformly indicated
that the WSB provided a supportive and safe environment to promote
53
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
social interaction and physical activity. Conducting a WSB in an urban,
underserved school district is feasible but requires attention to ensure
participants¿ involvement and safety. In particular, it is recommended to
begin the planning process early to enhance investment from key
stakeholders. Conclusion: Effective, low-cost interventions are
increasingly desired as solutions to the problem of obesity. The WSB has
emerged as a promising strategy to address obesity and encourage
partnerships across different social levels. Further research is necessary
to assess the logistical challenges associated with conducting a largescale WSB trial and whether such efforts lead to reductions in obesity risk
factors.
McNeil, D. A., B. N. Wilson, et al. (2009). "Connecting children to recreational
activities: results of a cluster randomized trial." Am J Health Promot 23(6): 37687.
PURPOSE: Identify if outreach support increases school-aged children's
participation in recreational activities. DESIGN: Cluster randomized trial.
SETTING: Sixteen schools in economically vulnerable neighborhoods
were randomized to either an intervention or control group. SUBJECTS:
Children in grades 3 to 5 and their families were invited to participate.
INTERVENTION: Children in intervention schools were assigned a
"connector" (outreach worker) to facilitate participation in recreation
activities. MEASURES: The Children's Assessment of Participation and
Enjoyment (CAPE) was the primary measure at baseline, middle, and end
of 1 year. Demographics, body mass index, child physical and
psychosocial health, coordination, and self-esteem were measured.
ANALYSIS: A generalized linear model was used to test differences
between intervention and control groups. RESULTS: Three hundred and
sixty children enrolled, and 306 (85%) completed the study. A greater
proportion of children in the intervention group compared with the control
group increased participation in physical activity (21% vs. 10%, p = .02).
Children who increased their activity were more likely to have higher levels
of contact with the connectors (31% vs. 8%, p = .001). Study limitations
included (1) 29% of eligible families participated, (2) first use of the CAPE
instrument as a longitudinal measure, and (3) connectors were not blinded
to group assignment. CONCLUSION: Children living in vulnerable
neighborhoods benefit from outreach workers to connect them with
physical activity programs.
Vaughn, A. E., S. C. Ball, et al. (2009). "Promotion of Walking for Transportation:
A Report From the Walk to School Day Registry." Journal of Physical Activity &
Health 6(3): 281-288.
Background. In the United States, promoting active transportation to
school has received increased attention as a means of encouraging
physical activity and preventing obesity among youth. However, little
systematic evaluation of existing programs such as Walk to School (WTS)
54
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
has occurred. Methods: WTS coordinators from across the United States
were surveyed (via Web, mail, and telephone) about program activities,
school and environmental characteristics, and perceived changes in
children walking to school. As an exploratory aim, logistic-regression
analyses were used to examine program characteristics associated with
perceived increases in children walking. Results: From a database of 783
coordinators, 493 usable surveys were returned. Almost all respondents
(98.2%) participated in a 1-day WTS event. Other common activities
included promotional activities (72.7%), safety trainings (49.6%),
walkability audits (48.5%), and designated safe walking routes (46.5%).
As part of their WTS efforts, 24.4% made policy changes and 38.4% made
changes to the physical environment. Logistic-regression analyses
showed that policy changes, physical environment improvements, and
number of activities were associated with the largest perceived increased
in children walking to school. Conclusions: These findings help address
the gap in knowledge about schools' participation in WTS programs, and
strategies are suggested to increase active transportation to school.
Wendel-Vos, G. C., A. E. Dutman, et al. (2009). "Lifestyle factors of a five-year
community-intervention program: the Hartslag Limburg intervention." Am J Prev
Med 37(1): 50-6.
BACKGROUND: Community-based health promotion is a widely
advocated strategy in public health to favorably alter lifestyle. The aim of
this study was to investigate the net effect of a cardiovascular diseaseprevention program (Hartslag Limburg) on lifestyle factors after 5 years of
intervention (1998-2003). METHODS: In a cohort study, 5-year mean
changes in lifestyle factors (energy intake; fat intake; time spent on
leisure-time physical activity; walking, bicycling, and sports; and smoking
behavior) between subjects from the intervention area (n=2356) and the
control area (n=758) were compared for men and women and for those
with a low (less than intermediate secondary education) and a moderate
(intermediate vocational or higher secondary education) or high (higher
vocational education or university) educational level. Adjustments were
made for age and the mean of the individual pre- and post-intervention
measurement of the variable under study. When stratifying for gender,
adjustments were made for educational level, and vice versa. RESULTS:
In general, lifestyle factors changed unfavorably in the control group,
whereas changes were less pronounced or absent in the intervention
group. The adjusted difference in mean change in lifestyle factors between
the intervention group and the control group was significant (p<or=0.05)
for energy intake (-0.2 megajoule per day among both women and those
with a low educational level); fat intake (-2.5 grams per day [g/d] among
women and -3 g/d among those with a low educational level); time spent
walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk
among those with a low educational level); time spent on total leisure-time
physical activity (+2.1 hrs/wk among women); and time spent bicycling
55
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
(+0.6 hrs/wk among those with a low educational level). CONCLUSIONS:
The community intervention Hartslag Limburg succeeded in preventing
age- and time-related unfavorable changes in energy intake, fat
consumption, walking, and bicycling, particularly among women and those
with low SES.
Zenzen, W. and S. Kridli (2009). "Integrative review of school-based childhood
obesity prevention programs." J Pediatr Health Care 23(4): 242-58.
Childhood and adolescent overweight and obesity in the United States are
rapidly becoming a major pediatric health concern. Schools are a critical
part of the social environment that shape children's eating and physical
activity patterns. While school-based programs may affect a student's
perception of physical activity and the influence of dietary practices on
overall health, the current variability in the theoretical underpinnings and
methodological approaches used to implement these programs makes
them difficult to evaluate for quality and evidence of effectiveness of the
outcomes achieved across programs. The purpose of this study is to
conduct an integrative research review using Cooper's framework to
provide an overview of the degree of variability in the methodological
approaches and theoretical frameworks of school-based obesity
prevention programs that utilize one or more of the following interventions:
dietary, physical activity, healthy lifestyle education, and/or parental
involvement. This review will examine the variations in the duration of the
interventions; whether the interventions were guided by the use of a
theoretical framework; the strength of evidence supporting the studies;
and whether the interventions demonstrated a reduction in body mass
index or weight loss. A total of 16 articles were found based on the
inclusion criteria for this study. Eight of the 16 studies (50%) applied
theoretical frameworks. Significant variability was found in the duration of
intervention between the studies analyzed. The range of duration was 5
weeks to 8 years, with an average of 16.8 months. Fourteen of 16 studies
(88%) implemented dietary habit interventions. Fourteen of 16 studies
(88%) implemented physical education programs. All 16 studies applied
healthy lifestyle education. Nine of 16 studies integrated family
involvement into the obesity intervention. Nine of 16 studies (56%)
evaluated the effect of their intervention on body mass index.
8. Childhood Obesity & miscellaneous
Biddle, S. J. H., S. J. Marshall, et al. (2009). "Temporal and Environmental
Patterns of Sedentary and Active Behaviors during Adolescent Leisure Time."
International Journal of Behavioral Medicine 16(3): 278-286.
There is great interest in young people’s overweight and obesity. Few
data, however, describe when sedentary and physically active behaviors
are likely to occur during the day or how these behaviors are related to
56
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
location. The purpose of this study was to describe sedentary and active
leisure-time behaviors of adolescents across the day and setting.
Adolescents (male n = 579, female n = 967; aged 13–16 years)
completed time-use diaries for three weekdays and one weekend day. At
15 min intervals, participants recorded what they were doing and where
they were. TV viewing and sports/exercise peaked at different times in the
day, although TV viewing was two to three times more likely to occur than
sports/exercise. TV viewing was most likely to occur during the middle to
late evening. The playing of computer games was low, particularly for
girls. Weekend data showed TV viewing was the most reported activity
throughout the day. For boys, “being in the garden― was highly
predictive of engaging in sports/exercise, but this declined rapidly with
age. Motorized travel to school was reported twice as often as active
travel. Momentary assessments of behavior, in conjunction with
contemporaneous reports of environmental factors, describe important
patterns of leisure-time active and sedentary behaviors in youth.
Harris, C. V. and W. A. Neal (2009). "Assessing BMI in West Virginia Schools:
Parent Perspectives and the Influence of Context." Pediatrics 124: S63-S72.
West Virginia is a state at the forefront of the obesity epidemic and one
that is experiencing immense health and economic costs as a result. The
childhood obesity research discussed in this article was conducted over
the past 10 years through 4 projects that range from a school-based
cardiovascular risk screening program to an evaluation of state legislation
targeting childhood obesity via modifications in the school environment. In
the course of these projects, we have collected BMI and other health
indices on students, provided feedback to students and their parents, and
assessed the obesity and health-related beliefs of West Virginians through
individual and focus-group interviews and questionnaires. Our work has
been accomplished by using an active-consent process, and BMI has
typically been only 1 component of the comprehensive health data we
collect and feedback we provide. Collaboration with state and local
partners and regular dissemination of our findings have been key
elements of the approach taken. The research and policy implications of
our findings and approach are discussed. Pediatrics 2009;124:S63-S72
Hessler, K. L. (2009). "Physical activity behaviors of rural preschoolers." Pediatr
Nurs 35(4): 246-53.
PURPOSE: The purpose of this qualitative study was to investigate the
physical activity and active play of rural preschoolers. METHOD: A microethnography approach using observation, photography, individual
interviews, and focus groups led to five major themes describing
preschool activity and play in the rural area. FINDINGS: The five major
themes describing preschool activity and play in the rural area were SelfReliance, Learning Through Play, One Big Rural Family, Rural
Surroundings, and Money Matters. CONCLUSIONS: Rural areas may not
57
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
be as conducive to every day physical activity for children as traditionally
believed. Nurses can apply these results when intervening to increase
physical activity levels of preschool children.
Olstad, D. L. and L. McCargar (2009). "Prevention of overweight and obesity in
children under the age of 6 years." Appl Physiol Nutr Metab 34(4): 551-70.
Although obesity was rarely observed among children 30 years ago, it is
now evident among Canadian children of all ages. Currently, 15.2% of 2to 5-year-old children are overweight, whereas 6.3% are obese. Limited
data suggest that poor dietary and physical activity patterns are increasing
obesity risk among these young children. Body weight and lifestyle
behaviours are known to track from childhood to adulthood, thereby
increasing the risk for obesity and other chronic diseases later in life.
Intrauterine life, infancy, and the preschool years may all include critical
periods that program the long-term regulation of energy balance, and
therefore obesity-prevention strategies should be initiated in utero and
continue throughout childhood and adolescence. Although single-strategy
obesity-prevention initiatives have had limited success, programs that
target multiple behaviours may help reduce body weight and body fat
among young children. Parental involvement is key to the success of
obesity-prevention programs at a young age, as parents have primary
control over their children's food and activity environments. Accordingly,
parental obesity is the best predictor of childhood obesity. Parents should
be encouraged to teach and role model healthy lifestyle behaviours for
their young children. Health professionals can also be involved in obesity
prevention, as they are ideally placed to identify young children at risk for
obesity. By calculating and plotting the body mass index for all children,
and initiating obesity-prevention strategies in utero, health professionals
can help curb the rise in overweight and obesity among young children.
Trent, M., J. M. Jennings, et al. (2009). "Finding targets for obesity intervention in
urban communities: school-based health centers and the interface with affected
youth." J Urban Health 86(4): 571-83.
Urban schools and school-based health centers (SBHCs) in low-income
minority communities may be important points of intervention for
overweight and obese youth. To date, little is known about the interface of
overweight youth and the public health system through SBHCs. The
objective of this study is to determine the prevalence, geographic
distribution, sociodemographic, and comorbidity factors associated with
obese status as a part of a public health system needs assessment. We
conducted a cross-sectional clustered sampling utilizing prospective
anthropometric measurement and chart review. Demographic,
anthropometric, and medical comorbidity data were collected from 2,630
students in SBHCs in Baltimore, MD, USA. Students were geocoded to
their primary residential address and assigned to a census block group
using MapInfo v6.5. Demographic and comorbidity associations were
58
Active Living Research Literature Summary 2009
Draft Published Oct. 2010
analyzed using multivariable logistic regression analysis. Overall, the
mean body mass index (BMI) was 25.5 (SD 6.6), and prevalence of
obesity (BMI > 95th percentile) and overweight (BMI 85th-95th percentile)
was 26.5% and 15.7%, respectively. Obesity was distributed among all the
schools without one school being significantly more affected than others.
Obese status was associated with gender, poverty, and several medical
comorbidities such as asthma, high blood pressure, and disordered
eating. Public health practitioners in this SBHC system appear to be faced
with a greater burden of obesity than predicted by Centers for Disease
Control and Prevention estimates. Given the ongoing interface with
affected youth, these schools and health centers may be well situated to
deliver public health obesity interventions.
Williamson, D. A., C. M. Champagne, et al. (2009). "Increased obesity in children
living in rural communities of Louisiana." International Journal of Pediatric
Obesity 4(3): 160-165.
Objective. Rates of obesity among children have been rising in recent
years. Information on the prevalence of obesity in children living in rural
communities is needed. We report the prevalence of overweight and
obesity in children enrolled in grades 4 to 6 who live in rural areas of
Louisiana, USA. Methods and Procedures. These data were collected as
baseline assessment for the Louisiana (LA) Health project. Height, weight,
and estimates of body fat (using body impedance analysis) were collected
on 2 709 children. Average age was 10.5 years and the sample
composition was 57.3% girls, 61.7% African-American, 36.0% Caucasian,
and 2.3% other minority. A majority of children (77%) met the criterion for
poverty status. Results. The distribution of body mass index (BMI)
percentile was highly skewed toward obesity. The most frequent BMI
percentile scores were 98th and 99th percentile. Using Centers for
Disease Control and Prevention (CDC) norms, the overall prevalence of
obesity was 27.4%, and for overweight was 45.1%, of which 17.7% were
between the 85th and 95th percentile. The prevalence of childhood
overweight and obesity were much higher than the national norm and this
increased prevalence was observed in both genders and in Caucasian
and African-American children. Discussion. The prevalence of childhood
overweight and obesity was found to be much higher in rural and primarily
poor (77%) children living in Louisiana when compared with national
norms. This observation suggests that rural children from Louisiana may
be experiencing an epidemic of obesity that exceeds national prevalence
estimates.
59