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Background Self-reported and objectively-determined neighborhood built characteristics are associated with physical activity, yet little is known about their combined influence on walking. This study: 1) compared self-reported measures of the neighborhood built environment between objectively-determined low, medium, and high walkable neighborhoods; 2) estimated the relative associations between self-reported and objectively-determined neighborhood characteristics and walking and; 3) examined the extent to which the objectively-determined built environment moderates the association between self-reported measures of the neighborhood built environment and walking. Methods A random cross-section of 1875 Canadian adults completed a telephone-interview and postal questionnaire capturing neighborhood walkability, neighborhood-based walking, sociodemographic characteristics, walking attitudes, and residential self-selection. Walkability of each respondent's neighborhood was objectively-determined (low [LW], medium [MW], and high walkable [HW]). Covariate-adjusted regression models estimated the associations between weekly participation and duration in transportation and recreational walking and self-reported and objectively-determined walkability. Results Compared with objectively-determined LW neighborhoods, respondents in HW neighborhoods positively perceived access to services, street connectivity, pedestrian infrastructure, and utilitarian and recreation destination mix, but negatively perceived motor vehicle traffic and crime related safety. Compared with residents of objectively-determined LW neighborhoods, residents of HW neighborhoods were more likely (p < .05) to participate in (odds ratio[OR] = 3.06), and spend more time, per week (193 min/wk) transportation walking. Perceived access to services, street connectivity, motor vehicle safety, and mix of recreational destinations were also significantly associated with transportation walking. With regard to interactions, HW x utilitarian destination mix was positively associated with participation, HW x physical barriers and MW x pedestrian infrastructure were positively associated with minutes, and HW x safety from crime was negatively associated with minutes, of transportation walking. Neither neighborhood type nor its interactions with perceived measures of walkability were associated with recreational walking, although perceived aesthetics was associated with participation (OR = 1.18, p < .05). Conclusions Objectively-determined and self-reported built characteristics are associated with neighborhood-based transportation walking. The objectively-determined built environment might moderate associations between perceptions of walkability and neighborhood-based transportation walking. Interventions that target perceptions in addition to modifications to the neighborhood built environment could result in increases in physical activity among adults. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the association between objectively-assessed neighborhood walkability and local walking among adults. Two independent random cross-sectional samples of Calgary (Canada) residents were recruited. Neighborhood-based walking, attitude towards walking, neighborhood self-selection, and socio-demographic characteristics were captured. Built environmental attributes underwent a two-staged cluster analysis which identified three neighborhood types (HW: high walkable; MW: medium walkable; LW: low walkable). Adjusting for all other characteristics, MW (OR 1.40, p<0.05) and HW (OR 1.34, approached p<0.05) neighborhood residents were more likely than LW neighborhood residents to participate in neighborhood-based transportation walking. HW neighborhood residents spent 30-min/wk more on neighborhood-based transportation walking than both LW and MW neighborhood residents. MW neighborhood residents spent 14-min/wk more on neighborhood-based recreational walking than LW neighborhood residents. Neighborhoods with a highly connected pedestrian network, large mix of businesses, high population density, high access to sidewalks and pathways, and many bus stops support local walking. [Copyright &y& Elsevier]

Background: Walking in neighborhood environments is undertaken for different purposes including for transportation and leisure. We examined whether sidewalk availability was associated with participation in, and minutes of neighborhood-based walking for transportation (NWT) and recreation (NWR) after controlling for neighborhood self-selection. Method: Baseline survey data from respondents (n = 1813) who participated in the RESIDential Environment (RESIDE) project (Perth, Western Australia) were used. Respondents were recruited based on their plans to move to another neighborhood in the following year. Usual weekly neighborhood-based walking, residential preferences, walking attitudes, and demographics were measured. Characteristics of the respondent's baseline neighborhood were measured including transportation-related walkability and sidewalk length. A Heckman two-stage modeling approach (multivariate Probit regression for walking participation, followed by a sample selection-bias corrected OLS regression for walking minutes) estimated the relative contribution of sidewalk length to NWT and NWR. Results: After adjustment, neighborhood sidewalk length and walkability were positively associated with a 2.97 and 2.16 percentage point increase in the probability of NWT participation, respectively. For each 10 km increase in sidewalk length, NWT increased by 5.38 min/wk and overall neighborhood-based walking increased by 5.26 min/wk. Neighborhood walkability was not associated with NWT or NWR minutes. Moreover, sidewalk length was not associated with NWR minutes. Conclusions: Sidewalk availability in established neighborhoods may be differentially associated with walking for different purposes. Our findings suggest that large investments in sidewalk construction alone would yield small increases in walking. [ABSTRACT FROM AUTHOR]

Most walkability indices do not capture the topological structure of urban forms. Space syntax models these topological relationships. We estimated associations between the space syntax measure of street integration and walkability (SSW) and neighborhood-specific leisure (LW) and transportation (TW) walking among 4422 Canadian adults. Street integration and SSW were found to be positively associated with TW and LW participation in a usual week. A one-unit increase in SSW was associated with a 6-min increase in usual weekly minutes of TW. Street integration and SSW were also positively associated with TW participation in the last week. Higher street integration and walkability conceptualized using space syntax support neighborhood walking. [ABSTRACT FROM AUTHOR]

The Physical Activity Neighborhood Environment Scale (PANES) has been used internationally; however, PANES properties have not been assessed in all geographical contexts. Our objectives were to assess the reliability and validity of an online and paper version of the PANES in Canadian adults. Reliability was estimated using intraclass correlation coefficients (ICC), percent of overall agreement (p0) and Cohen's Kappa coefficient (κ). Lower 95% confidence interval (CI) ICC ranged from 0.10 to 0.70. Lower 95%CI for κ statistics ranged from −0.20 to 0.64 and p0 ranged from 80.1% to 95.7%. Cronbach's alpha coefficients (α) estimated internal consistency of the PANES (α = 0.58 for the paper version and α = 0.55 for the online version). Mean scores for the PANES Built Environment Index (BEI) significantly differed by neighborhood street pattern (p <.05). The PANES administrated via paper or online provides reliable overall agreement and valid estimates of the self-reported neighborhood built environment supportiveness of physical activity. [ABSTRACT FROM AUTHOR]

The neighbourhood built environment can support the physical activity of adults regardless of their individual-level socioeconomic status. However, physical activity supportive (walkable) neighbourhoods may not be accessible to those with lower incomes if homes in walkable neighbourhoods are too expensive. The objectives of this study were: 1) to estimate the associations between neighbourhood walkability and home values in Canadian cities, and 2) to test whether these associations differ by city size and residential property type composition within neighbourhoods. We linked built environment data from the 2016 Canadian Active Living Environments (Can-ALE) index with neighbourhood-level structural home characteristics and sociodemographic data from the 2016 Canadian census for 33,026 neighbourhoods across 31 Census Metropolitan Areas. We used multilevel linear regression models to estimate covariate-adjusted associations between neighbourhood walkability and natural-log median home values and tested city size and neighbourhood property type composition as moderators. There were no statistically significant associations between walkability and home values overall. The associations between neighbourhood walkability and home values were jointly moderated by city size and property type composition. For small and medium sized cities, within neighbourhoods containing a high proportion of detached homes, walkability was negatively associated with home values (b = -0.05, 95% CI: -0.10, -0.01; and, b = -0.04, 95% CI: -0.06, -0.02, for small and medium cities, respectively). However, for extra-large cities, within neighbourhoods containing a high proportion of detached homes, walkability was positively associated with home values (b = 0.06, 95% CI: 0.01, 0.10). Our findings suggest that, based on housing affordability, higher walkable neighbourhoods are likely accessible to lower income households that are situated in small and medium Canadian cities. In larger cities, however, municipal interventions (e.g., inclusionary zoning or targeted development of subsidized or social housing) may be needed to ensure equitable access to walkable neighbourhoods for lower income households. [ABSTRACT FROM AUTHOR]

New 'big data' streams such as street-level imagery are offering unprecedented possibilities for developing health-relevant data on the urban environment. Urban environmental features derived from street-level imagery have been used to assess pedestrian-friendly neighbourhood design and to predict active commuting, but few such studies have been conducted in Canada. Using 1.15 million Google Street View (GSV) images in seven Canadian cities, we applied image segmentation and object detection computer vision methods to extract data on persons, bicycles, buildings, sidewalks, open sky (without trees or buildings), and vegetation at postal codes. The associations between urban features and walk-to-work rates obtained from the Canadian Census were assessed. We also assessed how GSV-derived urban features perform in predicting walk-to-work rates relative to more widely used walkability measures. Results showed that features derived from street-level images are better able to predict the percent of people walking to work as their primary mode of transportation compared to data derived from traditional walkability metrics. Given the increasing coverage of street-level imagery around the world, there is considerable potential for machine learning and computer vision to help researchers study patterns of active transportation and other health-related behaviours and exposures. [ABSTRACT FROM AUTHOR]

Muscular strength and body composition are important components of health-related fitness (HRF). Grip strength and body fat percent, in particular, are associated with chronic disease and affected by health behaviours. Evidence suggests relationships between the neighbourhood built environment (BE) and HRF exist, however, few studies have focused on grip strength and body fat percent. Therefore, our study aimed to estimate the sex-specific associations between the neighbourhood BE, grip strength, and body fat percent among urban-dwelling Canadian adults. We analyzed cross-sectional survey and HRF data collected in 2011-2015 from 4052 males and 7841 females (Alberta's Tomorrow Project, Canada). Grip strength and body fat percent were measured via handgrip dynamometry and bioelectrical impedance analysis, respectively. Walkability (Canadian Active Living Index) and greenness (Normalized Difference Vegetation Index) estimates were linked to participant data. Sex-stratified covariate-adjusted linear regression models estimated the associations between the BE and HRF variables. Walkability was negatively associated with grip strength and body fat percent in males (β -0.21, 95%CI: -0.31 to -0.11 and β -0.08, 95%CI: -0.15 to -0.02, respectively) and females (β -0.06, 95%CI: -0.10 to -0.01 and β -0.08, 95%CI: -0.14 to -0.02, respectively). Greenness was positively associated with grip strength in males (β 6.99, 95%CI: 3.62 to 10.36) and females (β 2.72, 95%CI: 1.22 to 4.22) but not with body fat percent. Controlling for physical activity and sitting did not attenuate these associations. Characteristics of the neighbourhood BE appear to be associated with muscular strength and body composition, independent of physical activity and sedentary behaviour. • Walkability and greenness are associated with body fat percent and grip strength. • Associations are not attenuated by adjustment for physical activity or sitting time. • Associations are present for both males and females. • Grip strength associations were robust to different greenness buffer sizes. • Our results may inform the design of health-supportive neighbourhoods. [ABSTRACT FROM AUTHOR]

Background: Walkability is a popular term used to describe aspects of the built and social environment that have important population-level impacts on physical activity, energy balance, and health. Although the term is widely used by researchers, practitioners, and the general public, and multiple operational definitions and walkability measurement tools exist, there are is no agreed-upon conceptual definition of walkability.Method: To address this gap, researchers from Memorial University of Newfoundland hosted "The Future of Walkability Measures Workshop" in association with researchers from the Canadian Urban Environmental Health Research Consortium (CANUE) in November 2017. During the workshop, trainees, researchers, and practitioners worked together in small groups to iteratively develop and reach consensus about a conceptual definition and name for walkability. The objective of this paper was to discuss and propose a conceptual definition of walkability and related concepts.Results: In discussions during the workshop, it became clear that the term walkability leads to a narrow conception of the environmental features associated with health as it inherently focuses on walking. As a result, we suggest that the term Active Living Environments, as has been previously proposed in the literature, are more appropriate. We define Active Living Environments (ALEs) as the emergent natural, built, and social properties of neighbourhoods that promote physical activity and health and allow for equitable access to health-enhancing resources.Conclusions: We believe that this broader conceptualization allows for a more comprehensive understanding of how built, natural, and social environments can contribute to improved health for all members of the population. [ABSTRACT FROM AUTHOR]

Background Environmental audit tools must be reliable in order to accurately estimate the association between built environmental characteristics and bicycling injury risk. Objective To examine the inter-rater agreement of a built environment audit tool within a case-control study on the environmental determinants of bicycling injuries. Methods Auditor pairs visited locations where bicycling injuries occurred and independently recorded location characteristics using the Systematic Pedestrian and Cyclist Environmental Scan (SPACES). Two case groups were defined: (1) where a bicyclist was struck by a motor-vehicle (MV) and (2) where the bicyclist's injuries required hospitalisation. The two corresponding control groups were (1) where non-MV bicycle-related injuries occurred and (2) where minor bicycle-related injuries occurred. Inter-rater reliability of each item on the tool was assessed using observed agreement and κ with 95% CI. Results Ninety-seven locations were audited. Interobserver agreement was generally high (≥95%); most items had a 1-2% difference in responses. Items with ≥5% differences between raters included path condition, slope and obstructions. For land use, path and roadway characteristics,κ ranged from 0.3 for presence of offices and cleanliness to 0.9 for schools and number of lanes; overall, 78% of items had at least substantial agreement (κ≥0.61). For bicyclists struck by a MV the proportion of items with substantial agreement was 60%, compared with 73% for non-MV related injuries. For hospitalisations and minor bicycle-related injuries, 76% of items had substantial agreement. Conclusions Agreement was substantial for most, but not all SPACES items. The SPACES provides reliable quantitative descriptions of built environmental characteristics at bicycling injury locations. [ABSTRACT FROM AUTHOR]

Background: Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality.Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex.Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator.Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that the built environment may be associated with cardiovascular disease via its influence on health behaviours. The aim of this study was to estimate the associations between traditional and novel neighbourhood built environment metrics and clinically assessed cardio-metabolic risk factors among a sample of adults in Canada. A total of 7171 participants from Albertas Tomorrow Project living in Alberta, Canada, were included. Cardio-metabolic risk factors were clinically measured. Two composite built environment metrics of traditional walkability and space syntax walkability were calculated. Among men, space syntax walkability was negatively associated with systolic and diastolic blood pressure (b = −0.87, 95% CI -1.43, −0.31 and b = −0.45, 95% CI -0.86, −0.04, respectively). Space syntax walkability was also associated with lower odds of overweight/obese among women and men (OR = 0.93, 95% CI 0.87, 0.99 and OR = 0.88, 95% CI 0.79, 0.97, respectively). No significant associations were observed between traditional walkability and cardio-metabolic outcomes. This study showed that the novel built environment metric based on the space syntax theory was associated with some cardio-metabolic risk factors. • The built environment may be associated with the risk of CVD via health behaviours. • Space syntax walkability was associated with lower odds of overweight/obesity. • Space syntax walkability was negatively associated with blood pressure in men. [ABSTRACT FROM AUTHOR]

This study examined the individual and joint effects of modifiable risk factors mediating the associations between socioeconomic position (SEP) and morbidity and mortality from cardiovascular diseases (CVD) in a nationally representative sample of adults in Canada. Participants in the Canadian Community Health Survey (n = 289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data. SEP was measured as a latent variable consisting of household income and individual educational attainment. Mediators included smoking, physical inactivity, obesity, diabetes and hypertension. The primary outcome was CVD morbidity and mortality, defined as the first fatal/nonfatal CVD event during follow-up (median 6.2 years). Generalized structural equation modeling tested the mediating effects of modifiable risk factors in associations between SEP and CVD in the total population and stratified by sex. Lower SEP was associated with 2.5 times increased odds of CVD morbidity and mortality (OR: 2.52, 95% CI: 2.28, 2.76). Modifiable risk factors mediated 74% of associations between SEP and CVD morbidity and mortality in the total population and were more important mediators of associations in females (83%) than males (62%). Smoking mediated these associations independently and jointly with other mediators. The mediating effects of physical inactivity were through joint mediating effects with obesity, diabetes or hypertension. There were additional joint mediating effects of obesity through diabetes or hypertension in females. Findings point to modifiable risk factors as important targets for interventions along with interventions that target structural determinants of health to reduce socioeconomic inequities in CVD. • Lower socioeconomic position was associated with 2.5 times increased odds of CVD morbidity and mortality. • Modifiable risk factors mediated 74% of associations between socioeconomic position and CVD morbidity and mortality. • Modifiable risk factors suggest targets for interventions to reduce socioeconomic inequities in CVD. [ABSTRACT FROM AUTHOR]

Introduction: Poor diet quality has been shown to increase the risk of common chronic diseases that can negatively impact quality of life and burden the healthcare system. Canada's Food Guide evidence-based recommendations provide dietary guidance aimed at increasing diet quality. Compliance with Canada's Food Guide can be assessed with the Canadian Healthy Eating Index (C-HEI), a diet quality score. The recently designed Canadian Diet History Questionnaire II (C-DHQ II), a comprehensive food frequency questionnaire could be used to estimate the C-HEI in Canadian populations with the addition of food group equivalents (representing Canada's Food Guide servings) to the C-DHQ II nutrient database. We describe methods developed to augment the C-DHQ II nutrient database to estimate the C-HEI. Methods: Food group equivalents were created using food and nutrient data from existing published food and nutrient databases (e.g. the Canadian Community Health Survey -- Cycle 2.2 Nutrition [2004]). The variables were then added to the C-DHQ II companion nutrient database. C-HEI scores were determined and descriptive analyses conducted for participants who completed the C-DHQ II in a cross-sectional Canadian study. Results: The mean (standard deviation) C-HEI score in this sample of 446 adults aged 20 to 83 was 64.4 (10.8). Women, non-smokers, and those with more than high school education had statistically significant higher C-HEI scores than men, smokers and those with high school diplomas or less. Conclusion: The ability to assess C-HEI using the C-DHQ II facilitates the study of diet quality and health outcomes in Canada. [ABSTRACT FROM AUTHOR]

Health promotion views collaborations between local governments and citizens as key to improving health and lessening inequities in urban areas. Public parks, which are typically managed by local governments, are key settings for promoting physical activity, positive social interactions and overall well-being. Yet research on civic participation in park management is essentially absent from the health promotion literature. When the City of Calgary began to implement a new policy on off-leash dogs in parks, we had an opportunity to study civic participation in decision-making. We did so by examining policy documents, participating in meetings and conducting interviews. Off-leash parks have particular relevance for health promotion because they may support physical activity and networking for some, but may escalate conflict and deter park use amongst others. In this case study, the local government engaged citizens in developing an overarching off-leash policy for the city as a whole and in implementing the new policy at the level of neighbourhoods. Of the first three parks to be considered under the new policy, an off-leash area was ultimately designated in just one: a park located in a disadvantaged neighbourhood. By exploring this unexpected outcome, our case study suggests thatpublic engagement, as practiced by local policymakers, may differ fromcommunity participation, as endorsed in health promotion. Further reflection on the meaning of ‘public’ is warranted in public health. [ABSTRACT FROM PUBLISHER]

Background: The neighbourhood environment may play an important role in diet quality. Most previous research has examined the associations between neighbourhood food environment and diet quality, and neighbourhood socioeconomic status and diet quality separately. This study investigated the independent and joint effects of neighbourhood food environment and neighbourhood socioeconomic status in relation to diet quality in Canadian adults.Methods: We undertook a cross-sectional study with n = 446 adults in Calgary, Alberta (Canada). Individual-level data on diet and socio-demographic and health-related characteristics were captured from two self-report internet-based questionnaires, the Canadian Diet History Questionnaire II (C-DHQ II) and the Past Year Physical Activity Questionnaire (PAQ). Neighbourhood environment data were derived from dissemination area level Canadian Census data, and Geographical Information Systems (GIS) databases. Neighbourhood was defined as a 400 m network-based 'walkshed' around each participant's household. Using GIS we objectively-assessed the density, diversity, and presence of specific food destination types within the participant's walkshed. A seven variable socioeconomic deprivation index was derived from Canadian Census variables and estimated for each walkshed. The Canadian adapted Healthy Eating Index (C-HEI), used to assess diet quality was estimated from food intakes reported on C-DHQ II. Multivariable linear regression was used to test for associations between walkshed food environment variables, walkshed socioeconomic status, and diet quality (C-HEI), adjusting for individual level socio-demographic and health-related covariates. Interaction effects between walkshed socioeconomic status and walkshed food environment variables on diet quality (C-HEI) were also tested.Results: After adjustment for covariates, food destination density was positively associated with the C-HEI (β 0.06, 95 % CI 0.01-0.12, p = 0.04) though the magnitude of the association was small. Walkshed socioeconomic status was not significantly associated with the C-HEI. We found no statistically significant interactions between walkshed food environment variables and socioeconomic status in relation to the C-HEI. Self-reported physical and mental health, time spent in neighbourhood, and dog ownership were also significantly (p < .05) associated with diet quality.Conclusions: Our findings suggest that larger density of local food destinations may is associated with better diet quality in adults. [ABSTRACT FROM AUTHOR]