Network influences on the development and implementation of active transportation policies in six U.S. cities.

Many communities have prioritized policy and built environment changes to promote active transportation (AT). However, limited information exists on the partnerships and processes necessary to develop and implement such policy and environmental changes, particularly among organizations in non-health sectors. Within the transportation sector, metropolitan planning organizations (MPOs) are increasingly recognized as organizations that can support AT policies. This study examined inter-organizational relationships among MPOs and their partners working to advance AT policies in six U.S. cities. In fall 2015, an average of 22 organizations in each city participated in an online survey about partnerships with MPOs and other organizations developing and implementing AT policies. Measures included organizational characteristics and relational attributes including: level of AT policy collaboration, information transmission, resource sharing, and perceived decisional power. Descriptive network analysis and exponential random graph modeling were used to examine organizational attributes and relational predictors associated with inter-organizational collaboration in each network. MPOs served as collaborative intermediaries, connecting other organizations around AT policies, in half of the cities examined. Organizations in each city were more likely to collaborate around AT policies when partners communicated at least quarterly. In half of the cities, the probability of AT policy collaboration was higher when two agencies exchanged resources and when organizations had perceived decisional authority. Network analysis helped identify factors likely to improve partnerships around AT policies. Results may contribute to best practices for collaboration among researchers, practitioners, policymakers, and advocates across diverse sectors seeking to promote population-level physical activity.

Built environment assessment: Multidisciplinary perspectives.

CONTEXT: As obesity has become increasingly widespread, scientists seek better ways to assess and modify built and social environments to positively impact health. The applicable methods and concepts draw on multiple disciplines and require collaboration and cross-learning. This paper describes the results of an expert team׳s analysis of how key disciplinary perspectives contribute to environmental context-based assessment related to obesity, identifies gaps, and suggests opportunities to encourage effective advances in this arena. EVIDENCE ACQUISITION: A team of experts representing diverse disciplines convened in 2013 to discuss the contributions of their respective disciplines to assessing built environments relevant to obesity prevention. The disciplines include urban planning, public health nutrition, exercise science, physical activity research, public health and epidemiology, behavioral and social sciences, and economics. Each expert identified key concepts and measures from their discipline, and applications to built environment assessment and action. A selective review of published literature and internet-based information was conducted in 2013 and 2014. EVIDENCE SYNTHESIS: The key points that are highlighted in this article were identified in 2014-2015 through discussion, debate and consensus-building among the team of experts. Results focus on the various disciplines׳ perspectives and tools, recommendations, progress and gaps. CONCLUSIONS: There has been significant progress in collaboration across key disciplines that contribute to studies of built environments and obesity, but important gaps remain. Using lessons from interprofessional education and team science, along with appreciation of and attention to other disciplines׳ contributions, can promote more effective cross-disciplinary collaboration in obesity prevention.

Evaluation of physical projects and policies from the Active Living by Design partnerships.

BACKGROUND: Between 2003 and 2008, a total of 25 partnerships funded through the Active Living by Design (ALbD) program worked to change built environments and policies in communities to help citizens be active in their daily routines. PURPOSE: This paper systematically summarized the scope of ALbD physical projects and policy changes, described resources generated by the partnerships, and highlighted supports and barriers to the process. METHODS: Using a mixed-methods approach, multiple data sources, including key informant interviews, focus groups, and a web-based tracking system, were used to collect data during project implementation. Qualitative results were analyzed using systematic coding procedures to identify themes, ideas, and concepts derived from the data. Data analysis occurred in 2008-2010. RESULTS: Most of the 25 partnerships documented physical projects and policy changes in each of the following sectors: urban planning (n=16); active transportation (n=23); trails/parks/recreation/open space (n=22); communities (n=22); and schools (n=18). ALbD community partnerships were successful at generating ≈ $256 million in resources beyond their initial grant, mostly through policy changes. Challenges included creating and sustaining political will and community support as well as securing technical expertise and resources. Planning and relationship building were critical to success in changing policy and implementing projects. CONCLUSIONS: Although there is more to understand about how these change processes affect physical activity and health across populations and settings, as well as how social, cultural, and psychosocial factors influence community responses to the policy changes and physical projects, findings from this initiative provide a foundation for subsequent research and practice.

Association between neighborhood walkability, cardiorespiratory fitness and body-mass index.

Many studies have found cross-sectional associations between characteristics of the neighborhood built environment and physical activity (PA) behavior. However, most are based on self-reported PA, which is known to result in overestimation of PA and differential misclassification by demographic and biological characteristics. Cardiorespiratory fitness (CRF) is an objective marker of PA because it is primarily determined by PA. Furthermore, it is causally related to long-term health outcomes. Therefore, analyses of the association between CRF and built environment could strengthen arguments for the importance of built environment influences on health. We examined the association between neighborhood walkability and CRF and body-mass index (BMI). This cross-sectional analysis included 16,543 adults (5017 women, 11,526 men) aged 18-90 years with home addresses in Texas who had a comprehensive clinical examination between 1987 and 2005. Outcomes included CRF from total duration on a maximal exercise treadmill test and measured BMI. Three neighborhood walkability factors emerged from principal components analyses of block-group measures derived from the U.S. Census. In multilevel adjusted analyses, the neighborhood walkability factors were significantly associated with CRF and BMI among men and women in the expected direction. An interaction between one of the neighborhood factors and age was also observed. The interaction suggested that living in neighborhoods with older homes and with residents traveling shorter distances to work was more strongly positively associated with CRF among younger adults and more strongly negatively associated with BMI among older adults. In conclusion, neighborhood characteristics hypothesized to support more PA and less driving were associated with higher levels of CRF and lower BMI. Demonstration of an association between built environment characteristics and CRF is a significant advance over past studies based on self-reported PA. Nevertheless, stronger causal evidence depends on more robust study designs and sophisticated measures of the environment, behavior, and their physiological consequences.

Environmental and policy approaches for promoting physical activity in the United States: a research agenda.

BACKGROUND: Environmental and policy approaches are promising strategies to raise population-wide rates of physical activity; yet, little attention has been paid to the development and prioritization of a research agenda on these topics that will have relevance for both researchers and practitioners. METHODS: Using input from hundreds of researchers and practitioners, a research agenda was developed for promoting physical activity through environmental and policy interventions. Concept mapping was used to develop the agenda. RESULTS: Among those who brainstormed ideas, 42% were researchers and 33% were practitioners. The data formed a concept map with 9 distinct clusters. Based on ratings by both researchers and practitioners, the policy research cluster on city planning and design emerged as the most important, with economic evaluation second. CONCLUSIONS: Our research agenda sets the stage for new inquiries to better understand the environmental and policy influences on physical activity.

Built environment correlates of walking: a review.

INTRODUCTION: The past decade has seen a dramatic increase in empirical investigation into the relations between built environment and physical activity. To create places that facilitate and encourage walking, practitioners need an understanding of the specific characteristics of the built environment that correlate most strongly with walking. This article reviews evidence on the built environment correlates with walking. METHOD: Included in this review were 13 reviews published between 2002 and 2006 and 29 original studies published in 2005 and up through May 2006. Results were summarized based on specific characteristics of the built environment and transportation walking versus recreational walking. RESULTS: Previous reviews and newer studies document consistent positive relations between walking for transportation and density, distance to nonresidential destinations, and land use mix; findings for route/network connectivity, parks and open space, and personal safety are more equivocal. Results regarding recreational walking were less clear. CONCLUSIONS: More recent evidence supports the conclusions of prior reviews, and new studies address some of the limitations of earlier studies. Although prospective studies are needed, evidence on correlates appears sufficient to support policy changes.

The causal influence of neighborhood design on physical activity within the neighborhood: evidence from Northern California.

PURPOSE: Test for a causal relationship between neighborhood design and physical activity within the neighborhood by controlling for self-selection. DESIGN: Cross-sectional and quasi-longitudinal analyses of residents of selected neighborhoods. SETTING: Eight Northern California neighborhoods. SUBJECTS: Random sample of 1682 adults stratified by movers (moved within 1 year) and nonmovers (moved > 1 year ago) responding to self-administered mail surveys (24.7% response rate). MEASURES: Self-reported number of days in last 7 days of moderate to vigorous physical activity somewhere in the neighborhood and self-reported change in physical activity in the neighborhood from prior to moving (for movers) or from 1 year ago (for nonmovers). ANALYSIS: Zero-inflated Poisson regression for cross-sectional analysis (n = 1497); ordered probit model for quasi-longitudinal analysis (n = 1352). RESULTS: After we controlled for physical activity attitudes and neighborhood preferences, selected neighborhood design characteristics were associated with physical activity within the neighborhood and changes in selected neighborhood design characteristics were associated with changes in physical activity within the neighborhood. CONCLUSIONS: Both cross-sectional and quasi-longitudinal analyses provided evidence of a causal impact of neighborhood design. Improving physical activity options, aesthetic qualities, and social environment may increase physical activity. Critical limitations included self-report measures of physical activity, lack of measures of duration and intensity of neighborhood physical activity, lack of measures of total physical activity, and limited measures of preferences related to physical activity.

Perceived and objective environmental measures and physical activity among urban adults.

BACKGROUND: Enhancing community environments to support walking and bicycling serves as a promising approach to increase population levels of physical activity. However, few studies have simultaneously assessed perceptions and objectively measured environmental factors and their relative association with transportation or recreational physical activity. METHODS: For this cross-sectional study, high- and low-income study areas were selected among census tracts in St. Louis MO ("low-walkable" city) and Savannah GA ("high-walkable" city). Between February and June 2002, a telephone survey of 1068 adults provided measures of the perceived environment and physical activity behavior. In this timeframe, objective measures were collected through environmental audits of all street segments (n =1158). These measures were summarized using 400-m buffers surrounding each respondent. Neighborhood characteristics included the land use environment, transportation environment, recreational facilities, aesthetics, and social environment. Associations were examined between neighborhood features and transportation- and recreation-based activity. RESULTS: After adjusting for age, gender, and education, transportation activity was negatively associated with objective measures of sidewalk levelness and perceived and objective neighborhood aesthetics. It was positively associated with perceived and objectively measured number of destinations and public transit, perceived access to bike lanes, and objective counts of active people in the neighborhood. Recreational activity was positively associated with perceived access to recreational facilities and objective measures of attractive features. CONCLUSIONS: These findings indicate that physical activities for transportation or recreational are associated with different perceived and objective environmental characteristics. Modifications to these features may change the physical activity behavior of residents exposed to them.

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

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

How the built environment affects physical activity: views from urban planning.

The link between the built environment and human behavior has long been of interest to the field of urban planning, but direct assessments of the links between the built environment and physical activity as it influences personal health are still rare in the field. Yet the concepts, theories, and methods used by urban planners provide a foundation for an emerging body of research on the relationship between the built environment and physical activity. Recent research efforts in urban planning have focused on the idea that land use and design policies can be used to increase transit use as well as walking and bicycling. The development of appropriate measures for the built environment and for travel behavior is an essential element of this research. The link between the built environment and travel behavior is then made using theoretical frameworks borrowed from economics, and in particular, the concept of travel as a derived demand. The available evidence lends itself to the argument that a combination of urban design, land use patterns, and transportation systems that promotes walking and bicycling will help create active, healthier, and more livable communities. To provide more conclusive evidence, however, researchers must address the following issues: An alternative to the derived-demand framework must be developed for walking, measures of the built environment must be refined, and more-complete data on walking must be developed. In addition, detailed data on the built environment must be spatially matched to detailed data on travel behavior.