Contextualizing Walkability: Do Relationships Between Built Environments and Walking Vary by Socioeconomic Context?

PROBLEM RESEARCH STRATEGY AND FINDINGS: Supportive built environments for walking are linked to higher rates of walking and physical activity, but little is known about this relationship for socioeconomically disadvantaged (e.g., low-income and racial/ethnic minority) populations. We review 17 articles and find that most show that the built environment has weaker effects on walking and physical activity for disadvantaged than advantaged groups. Those who lived in supportive built environments walked more and were more physically active than those who did not, but the effect was about twice as large for advantaged groups. We see this difference because disadvantaged groups walked more in unsupportive built environments and less in supportive built environments, though the latter appears more influential. TAKEAWAY FOR PRACTICE: Defining walkability entirely in built environment terms may fail to account for important social and individual/household characteristics and other non-built environment factors that challenge disadvantaged groups, including fear of crime and lack of social support. Planners must be sensitive to these findings and to community concerns about gentrification and displacement in the face of planned built environment improvements that may benefit more advantaged populations. We recommend five planning responses: Recognize that the effects of the built environment may vary by socioeconomics; use holistic approaches to improve walkability; expand walkability definitions to address a range of social and physical barriers; partner across agencies, disciplines, and professions; and evaluate interventions in different socioeconomic environments.

Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers.

Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV; previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons.

Should we rely only on physician-diagnosed arthritis?

The purpose of this study was to compare Latinos who have chronic joint pain symptoms that have been diagnosed as arthritis by a physician with those who have chronic joint pain symptoms but have not received a physician's diagnosis of arthritis. This study is based on a recently completed survey of 588 Latinos interviewed, using a convenience sampling approach. Of the 576 Latinos with chronic joint pain, 45% were physician-diagnosed with arthritis. For all age groups, using the chi-square test, we found no differences between the two groups in terms of over-the-counter drug use, application of home therapies, use of vitamins, and self-assessed health status. Physician-diagnosed participants were more likely to have health insurance, to have seen a health professional, to use prescription drugs, and to have co-morbid conditions. Eliminating the question about chronic joint pain symptoms from BRFSS poses potential harm to the uninsured and to minority populations by underestimating the burden of arthritis on this population.