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Rising rates of obesity and osteoporosis have public health implications; hence, understanding the relationships between body composition (fat mass (FM) and lean mass (LM)) and bone mineral density (BMD) is important. The purpose of this study is to investigate these associations in a large representative sample. A cross-sectional analysis was conducted using National Health and Nutrition Examination Survey participants (n = 1717, age 44.1 ± 14.2 years) who had complete dual energy x-ray absorptiometry (total BMD g/cm2, FM kg, and LM kg) and covariate data. Hierarchical linear regression models were fitted, controlling for demographic and behavioral covariates. Stratum-specific models were fitted by race, sex, and age group. Significant negative associations were found for FM and BMD (β = −0.003) and significant positive associations for LM and BMD (β = 0.007). Stratum-specific analyses by race were consistent between groups, while variations in negative association magnitudes were seen in FM for sex (males β = −0.005 vs. females β = −0.002) and age (under 45 years of age β = −0.005 vs. 45 years and older β = −0.002). Consistent positive linear associations in total and stratum-specified models between LM and BMD could suggest a potential mechanical influence on bone health. The biological mechanisms driving the magnitude variations between FM and BMD by sex and age require more investigation.

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women’s only wellness center that exchanged ExRx for free access (1–3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. &lt, 1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21–78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10, 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with &lt, 1 visit/week. Facilitators among women with ≥1 visit/week were “readiness” and “right timing” for ExRx utilization. Barriers among women with &lt, 1 visit/week (n = 20, 67%) were “mismatched expectations” and “competing priorities”. Common themes among all women were “sense of community” and “ease of location”. ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

PURPOSE: Most built environment studies have quantified characteristics of the areas around participants’ homes. However, the environmental exposures for physical activity (PA) are spatially dynamic rather than static. Thus, merged accelerometer and global positioning system(GPS) data were utilized to estimate associations between the built environment and PA among adults. METHODS: Participants (N = 142) were recruited on trails in Massachusetts and wore an accelerometer and GPS unit for 1–4days. Two binary outcomes were created: moderate-to-vigorous PA (MVPA vs. light PA-to-sedentary); and light-to-vigorous PA (LVPA vs. sedentary). Five built environment variables were created within 50-meter buffers around GPS points: population density, street density, land use mix (LUM), greenness, and walkability index. Generalized linear mixed models were fit to examine associations between environmental variables and both outcomes, adjusting for demographic covariates. RESULTS: Overall, in the fully adjusted models, greenness was positively associated with MVPA and LVPA (odds ratios [ORs] = 1.15, 95% confidence interval [CI] = 1.03, 1.30 and 1.25, 95% CI = 1.12, 1.41, respectively). In contrast, street density and LUM were negatively associated with MVPA (ORs = 0.69, 95% CI = 0.67, 0.71 and 0.87, 95% CI= 0.78, 0.97, respectively) and LVPA (ORs = 0.79, 95% CI = 0.77, 0.81 and 0.81, 95% CI = 0.74, 0.90, respectively). Negative associations of population density and walkability with both outcomes reached statistical significance, yet the effect sizes were small. CONCLUSIONS: Concurrent monitoring of activity with accelerometers and GPS units allowed us to investigate relationships between objectively measured built environment around GPS points and minute-by-minute PA. Negative relationships between street density and LUM and PA contrast evidence from most built environment studies in adults. However, direct comparisons should be made with caution since most previous studies have focused on spatially fixed buffers around home locations, rather than the precise locations where PA occurs.

The study was supported from European Regional Development Fund-Project “Effective Use of Social Research Studies for Practice” (No. CZ.02.1.01/0.0/0.0/16_025/0007294) and the Czech Science Foundation under reg. No. 18-24977S. Objectives: Associations between the perceived social and physical environment and self-reported moderate-to-vigorous physical activity (MVPA) and screen time (ST) were examined among adolescents in four European countries. Methods: Representative samples were surveyed with standardised methodologies. Associations between environmental variables and meeting MVPA recommendations and tertiles of ST were tested in gender-specific logistic regression models. Moderation by country and country-specific relationships were also examined. Results: The most consistent findings across countries were found for the significant associations between neighbourhood social environment and MVPA in both boys and girls. Significant associations with the physical environment varied more between countries and by gender. The most consistent negative associations with ST were found for the social environmental variable of having parental rules for spending time outside the home. Conclusions: The present findings provided evidence for the generalisability of the associations between environmental correlates and MVPA across four European countries. The findings show clear differences in correlates for MVPA and ST. Further research is needed to better understand the unique aspects of the social and physical environment which explain each of the two behaviours. Postprint

Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age = 73.1 ± 6.7 years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI = 1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI = 1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

Background: Concurrent use of accelerometers and global positioning system (GPS) data can be used to quantify physical activity (PA) occurring on trails. This study examined associations of trail use with PA and sedentary behavior (SB) and quantified on trail PA using a combination of accelerometer and GPS data. Methods: Adults (N = 142) wore accelerometer and GPS units for 1–4 days. Trail use was defined as a minimum of 2 consecutive minutes occurring on a trail, based on GPS data. We examined associations between trail use and PA and SB. On trail minutes of light-intensity, moderate-intensity, and vigorous-intensity PA, and SB were quantified in 2 ways, using accelerometer counts only and with a combination of GPS speed and accelerometer data. Results: Trail use was positively associated with total PA, moderate-intensity PA, and light-intensity PA (P Conclusions: Adult trail users accumulated more PA on trail use days than on nontrail use days, indicating the importance of these facilities for supporting regular PA. The combination of GPS and accelerometer data for quantifying on trail activity may be more accurate than accelerometer data alone and is useful for classifying intensity of activities such as bicycling.

Rationale Physical environmental features of neighborhoods are associated with physical activity, but the influence of mental health factors, such as depression, on these associations is poorly understood. Objective We examined whether the perceived neighborhood environment mediated associations between the observed neighborhood environment and physical activity, and whether these associations were moderated by depressive symptoms. Methods Data consisted of systematic social observations of 343 neighborhoods and resident surveys. Participants’ ( N = 2969) mean age was 41.9 ± 16.2 years, 60.2% were female, and 67.9% were non-White. We conducted multiple linear regression and tests for mediation and moderated mediation. Results Observed recreation facilities, commercial destinations, physical disorder, and physical deterioration were indirectly associated with walking via perceived neighborhood environment variables. Observed recreation facilities was indirectly and positively associated with leisure-time physical activity via perceived park access, and indirectly and inversely associated with walking and leisure-time physical activity via perceived traffic danger, but only among participants with low depressive symptom scores. Observed recreation facilities was indirectly and inversely associated, and observed physical disorder and physical deterioration were indirectly and positively associated with walking via perceived disorder, but only among participants with high depressive symptom scores. Conclusion Depressive symptoms affected the strength and direction of associations between the observed neighborhood environment and physical activity via residents’ perceptions.

The purpose of this study was to examine the factorial invariance of the Abbreviated Neighborhood Environment Walkability Scale (NEWS-A) across subgroups based on demographic, health-related, behavioral, and environmental characteristics among Nurses’ Health Study participants (N = 2,919; age M = 73.0, SD = 6.9 years) living in California, Massachusetts, and Pennsylvania. A series of multi-group confirmatory factor analyses were conducted to evaluate increasingly restrictive hypotheses of factorial invariance. Factorial invariance was supported across age, walking limitations, and neighborhood walking. Only partial scalar invariance was supported across state residence and neighborhood population density. This evidence provides support for using the NEWS-A with older women of different ages, who have different degrees of walking limitations, and who engage in different amounts of neighborhood walking. Partial scalar invariance suggests that researchers should be cautious when using the NEWS-A to compare older adults living in different states and neighborhoods with different levels of population density.

A number of review studies document associations between the perceived and objectively measured neighborhood environment and physical activity. However, current evidence does not discern whether perceived or objective variables more consistently predict physical activity. A review is needed to examine the comparability of these variables and the consistency of their respective associations with the same physical activity outcome. We systematically searched three databases for studies that examined agreement between perceived and objective measures and/or associations between comparable variables and physical activity. We abstracted 85 relevant peer-reviewed studies published between 1990 and 2015, synthesized agreement coefficients, and compared these variables’ associations with physical activity. Perceived neighborhood environment variables were significantly associated with physical activity ( p < .05) at slightly higher rates than objective neighborhood environment variables (20.1% and 13.7%). Comparably defined variables exhibited low agreement and only 8.2% were associated with the same outcome. The perceived neighborhood environment and objectively measured neighborhood environment are related but distinct constructs that account for unique variance in physical activity.

Background:Promoting use of community trails is a recommended strategy for increasing population levels of physical activity. Correlates of walking and cycling for recreation or transportation differ, though few studies have compared correlates of trailbased physical activity for recreation and transportation purposes. This study examined associations of demographic, social, and perceived built environmental factors with trail use for recreation and transportation and whether associations were moderated by age, gender, and prior trail use.Methods:Adults (N = 1195) using 1 of 5 trails in Massachusetts responded to an intercept survey. We used multiple linear and logistic regression models to examine associations with trail use.Results:Respondents’ mean age was 44.9 years (standard deviation = 12.5), 55.3% were female, and 82.0% were white. Age (longer-term users only), trail use with others, travel time to the trail, and trail design were significantly associated with use for recreation (P < .05). Age, gender, trail safety (longer-term users only), travel time to the trail, trail design (younger users only), and trail beauty were associated with use for transportation (P < .05).Conclusions:Some common correlates were found for recreational and transportation trail use, whereas some variables were uniquely associated with use for 1 purpose. Tailored strategies are suggested to promote trail use for recreation and transportation.

The purpose of this study was to examine associations between the Walk Score and physical activity in young, overweight/obese urban women. Project Health included 45 White or African American women (BMI 31.5±3.9 kg/m2; age 26.5±4.6 years; 62% African American) living in the Boston area. An accelerometer estimated steps/day and mins/day in light physical activity (100–2019 counts-per-minute) and moderate-to-vigorous-physical activity (≥2020 cpm). Walk Score was used to estimate the walkability of home address by analyzing proximity to nearby amenities. General linear regression models estimated associations between total Walk Score and physical activity (light physical activity, moderate-to-vigorous-physical activity, steps, total activity counts, METs), adjusting for body mass index, age, race/ethnicity, seasonality, wear time, employment and student status. For physical activity variables that had significant associations with Walk Score (steps/day and steps/min), regression models were estimated for Walk Score sub-scores (parks, grocery, errands, shopping, dining/drinking, culture/entertainment and schools). Logistic regression models estimated the odds of meeting the guidelines for steps (≥10,000/day) and moderate-to-vigorous-physical activity (≥150mins MVPA/week) based on Walk Score. Participants had a Walk Score of 63.9±26.4, took 14,143±3,934 steps/day, and spent 206.2±66.0 mins/day in light physical activity and 46.7±17.5 mins/day in moderate-to-vigorous- physical activity. Walk Score was significantly and positively associated with steps/day (β = 51.4, p = 0.01) and steps/min (β = 0.06, p = 0.009) but was not associated with mins/day of light physical activity, moderate-to-vigorous-physical activity, total activity counts or METs. Parks, grocery, errands, shopping, dining/drinking, and culture/entertainment Walk Score sub-scores were significantly associated with steps and steps/min (all p

Dog walking is associated with higher levels of physical activity (PA). However, not all dog owners walk their dog(s) at a level sufficient for health benefits. Therefore, identifying correlates of dog-walking may help to inform the design of more effective interventions to promote this specific form of PA. The purpose of this study was to examine psychosocial and environmental correlates of dog-walking and relationships of dog-walking with overall PA. In 2010, 391 dog owners (mean age = 43.6 ± 12.3 years) completed a survey. Multiple logistic regression and structural equation modeling were used to examine psychosocial and environmental correlates of dog-walking status, weekly minutes of dog-walking, and relationships of dog-walking with overall PA. Self-efficacy for dog-walking, dog-related outcome expectancies, family social support, dog social support, and neighborhood walking environment were associated with a 1.3–5.6 greater odds of being a dog walker. Self-efficacy mediated relationships between fa...

Objectives: To assess the relative accuracy and usefulness of web tools in evaluating and measuring street-scale built environment characteristics. Methods: A well-known audit tool was used to evaluate 84 street segments at the urban edge of metropolitan Boston, Massachusetts, using on-site visits and three web-based tools. The assessments were compared to evaluate their relative accuracy and usefulness. Results: Web-based audits, based-on Google Maps, Google Street View, and MS Visual Oblique, tend to strongly agree with on-site audits on land-use and transportation characteristics (e.g., types of buildings, commercial destinations, and streets). However, the two approaches to conducting audits (web versus on-site) tend to agree only weakly on fine-grain, temporal, and qualitative environmental elements. Among the web tools used, auditors rated MS Visual Oblique as the most valuable. Yet Street View tends to be rated as the most useful in measuring fine-grain features, such as levelness and condition of sidewalks. Conclusion: While web-based tools do not offer a perfect substitute for on-site audits, they allow for preliminary audits to be performed accurately from remote locations, potentially saving time and cost and increasing the effectiveness of subsequent on-site visits.

The built environment predicts walking in older adults, but the degree to which associations between the objective built environment and walking for different purposes are mediated by environmental perceptions is unknown. We examined associations between the neighborhood built environment and leisure and utilitarian walking and mediation by the perceived environment among older women. Women (N = 2732, M age = 72.8 ± 6.8 years) from Massachusetts, Pennsylvania, and California completed a neighborhood built environment and walking survey. Objective population and intersection density and density of stores and services variables were created within residential buffers. Perceived built environment variables included measures of land use mix, street connectivity, infrastructure for walking, esthetics, traffic safety, and personal safety. Regression and bootstrapping were used to test associations and indirect effects. Objective population, stores/services, and intersection density indirectly predicted leisure and utilitarian walking via perceived land use mix (odds ratios (ORs) = 1.01–1.08, 95 % bias corrected and accelerated confidence intervals do not include 1). Objective density of stores/services directly predicted ≥150 min utilitarian walking (OR = 1.11; 95% CI = 1.02, 1.22). Perceived land use mix (ORs = 1.16–1.44) and esthetics (ORs = 1.24–1.61) significantly predicted leisure and utilitarian walking, Perceived built environment mediated associations between objective built environment variables and walking for leisure and utilitarian purposes. Interventions for older adults should take into account how objective built environment characteristics may influence environmental perceptions and walking.

The path that the Active Living Research (ALR) program of the Robert Wood Johnson Foundation has taken over the past 10 years shows how a new transdisciplinary field has become established through evidence building, research translation, and community engagement. ALR’s multifaceted approach toward promoting environmental and policy approaches to increase physical activities among children and families 1 brought together researchers, policy makers, advocates, and practitioners from multiple fields that have traditionally worked separately. ALR’s main goal is to improve the health of the population by touching upon the daily lives of children and families through active living, but the ALR grants program has made many positive impacts on those involved in creating the research. This commentary shares three stories of ALR grantees whose careers developed closely with the evolution of ALR. The authors offer their personal reflections and insights for the future of ALR.

To develop a comprehensive inventory of state physical education (PE) legislation, examine trends in bill introduction, and compare bill factors.State PE legislation from January 2001 to July 2007 was identified using a legislative database. Analysis included components of evidence-based school PE from the Community Guide and other authoritative sources: minutes in PE, PE activity, teacher certification, and an environmental element, including facilities and equipment. Researchers abstracted information from each bill and a composite list was developed.In total, 781 bills were analyzed with 162 enacted. Of the 272 bills that contained at least 1 evidence-based element, 43 were enacted. Only 4 bills included all 4 evidence-based elements. Of these 4, 1 was enacted. Funding was mentioned in 175 of the bills introduced (37 enacted) and an evaluation component was present in 172 of the bills (49 enacted).Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation.

Background: Studies of the built environment and physical activity have implicitly assumed that a substantial amount of activity occurs near home, but in fact the location is unknown. Purpose: This study aims to examine associations between built environment variables within home and work buffers and moderate-to-vigorous physical activity (MVPA) occurring within these locations. Methods: Adults (n148) from Massachusetts wore an accelerometer and GPS unit for up to 4 days. Levels of MVPA were quantified within 50-m and 1-km home and work buffers. Multiple regression models were used to examine associations between five objective built environment variables within 1-km home and work buffers (intersection density, land use mix, population and housing unit density, vegetation index) and MVPA within those areas. Results: The mean daily minutes of MVPA accumulated in all locations61.132.8, whereas duration within the 1-km home buffers14.016.4 minutes. Intersection density, land use mix, and population and housing unit density within 1-km home buffers were positively associated with MVPA in the buffer, whereas a vegetation index showed an inverse relationship (all p0.05). None of these variables showed associations with total MVPA. Within 1 km of work, only population and housing unit density were significantly associated with MVPA within the buffer. Conclusions: Findings are consistent with studies showing that certain attributes of the built environment around homes are positively related to physical activity, but in this case only when the outcome was location-based. Simultaneous accelerometer-GPS monitoring shows promise as a method to improve understanding of how the built environment influences physical activity behaviors by allowing activity to be quantified in a range of physical contexts and thereby provide a more explicit link between physical activity outcomes and built environment exposures.

Purpose:This study assessed test-retest reliability of an interviewer-administered trail survey.Methods:An intercept survey was conducted with adults using 2 paved trails in Indiana and South Carolina (N = 295; mean age = 46.9 ± 18 y). The survey included items on frequency and duration of trail use for recreation and transportation, other patterns of trail use, and sociodemographic characteristics. Fifty-five adults completed the survey twice (2−16 d apart; mean = 7.4 ± 2.6 d). Test-retest reliability was assessed with Spearman rank correlation coefficients, Kappa coefficients, and percent agreement.Results:Kappa coefficients and percent agreement for 9 categorical items ranged from 0.65 to 0.96 and from 64.0% to 98.2%, respectively. Among these items, the lowest Kappas were found for perceived safety (0.65) and reported duration of visits for recreational purposes (0.67). Spearman rank correlation coefficients for travel distance to and on the trail and frequency of trail use during the past 7 days and past 4 weeks ranged from 0.62 to 0.93.Conclusion:Though further assessments of this survey with different populations and types of trails may be warranted, its overall high reliability indicates it can be used by researchers and practitioners in its current form.

Providing safe, convenient places for walking and bicycling can reduce barriers to participating in regular physical activity. We examined bicycle- and pedestrian-related investments authorized by federal transportation legislation in 3,140 counties in the United States by region, population size and urbanization, social and economic characteristics, and indicators of travel-related walking and bicycling. From 1992 to 2004, states and counties implemented 10,012 bicycle- and pedestrian-related projects representing $3.17 billion in federal expenditures. We found disparities in implementation and system-building outcomes according to population size and location and social and economic indicators. Counties characterized by persistent poverty (odds ratio=0.69, 95% confidence interval 0.53-0.91) or low educational status (odds ratio=0.66, 95% confidence interval 0.52-0.84) were less likely to implement projects. Three key policy recommendations for improving public health outcomes are drawn from this research: Improved data tracking, more explicit linkages between transportation projects and public health, and improved planning assistance to underserved communities are all seen as essential steps.

This study explores processes and policies that facilitate the development of community trails. With funding from Active Living Research and the research framework of the Physical Activity Policy Research Network (PAPRN), we conducted a multiple-site case study. A total of six trails in Hawaii, Massachusetts, Missouri, North Carolina, South Carolina, and Washington were chosen for study. The goals of this case study were to identify the policy influences on trail development, explore the roles of key players in trail development, and compare and contrast findings from the different trails. Trail development can be a long process. Some of the trails took over a decade to complete because of funding, opposition, and roadblocks in the form of design standard policies. Work in trail development requires a team of many players, and it is necessary to balance their varied motives to accomplish a shared overall goal. Foresight through the master planning process is also a vital component of successful trail development. Finally, community involvement is key. Communities contemplating trail development should explore the effects of policy on the trail projects reported here to proactively identify potential influence.

Background: Increasing physical activity in youth is a recommended approach to curbing the childhood obesity epidemic. One way to help increase children’s daily activity is to promote active transportation to and from school (ATS). Purpose: The purpose of this case study was to explore parental perception of and participation in, ATS initiatives. Methods: This study is part of a larger project on ATS initiatives conducted by the Physical Activity Policy Research Network. Sixty-nine key informants, including 10 parents, were interviewed at nine diverse elementary schools being studied for their ATS policies. A standard interview guide was used. The interviews were audio-recorded, transcribed, and analyzed. Results: Analysis revealed that parental support was a necessary component for ATS success. The parents' roles varied greatly. Most parents chose to become involved in ATS for a specificreason (e.g., promoting health). The parents and other key informants interviewed expressed participation bene...

Active transportation to and from school (ATS) is a viable strategy to help increase physical activity among youth. ATS can be challenging because initiatives require transdisciplinary collaboration, are influenced by the built environment and are affected by numerous policies. The purpose of this study is to identify policies and factors that influence ATS initiatives. Nine elementary schools in seven states participated in this case study. Sixty-nine stakeholders were interviewed. The interviews were transcribed, coded and analyzed using a master thematic codebook. This study identified two distinct aspects of policies: 'influential factors' which are factors that might impact policies related to ATS and 'policy actions' which are policies reported by people involved in ATS initiatives that directly affected their success. Influential factors included sidewalks, crosswalks/crossing guards, funding, personal safety concerns, advocacy group involvement and others. Policy actions included policies on school speed zone, drop-off, no-transport zones, school siting, school start/dismissal time and school choice. Despite the diversity of the schools studied, similarities included influence of built environment, safety concerns, funding and transdisciplinary collaboration. Stakeholders need to work together to stimulate action and ensure successful initiatives. Influential factors appear to be important to this process.

Background:Persistent disparities suggest that multiple aspects of social context may influence leisure-time physical activity levels and weight status in multiethnic, working-class populations.Methods:Among participants in two randomized, controlled intervention trials (n = 1,969 in 10 health centers; n = 1,545 in 26 manufacturing businesses) we used general linear mixed models to examine the relationship of variables posited by a social-contextual framework for behavior change with h/wk of self-reported leisure-time physical activity and with body mass index (BMI; weight (kg)/(height (m))2) at baseline, adjusting for clustering within study site.Results:Age, sex, race/ethnicity, and socioeconomic position were independently associated with leisure-time physical activity in both settings; multivariable models explained 15% of the variance in health centers and 11% in small businesses. Leisure-time physical activity and motivation to change lifestyle behaviors were inversely associated with BMI, adjusting for individual, interpersonal, and neighborhood factors. Models explained 12% of variance in BMI in health centers and 10% in small businesses.Conclusions:A social-contextual framework highlights the contribution of social class and race/ethnicity in the variance in leisure-time physical activity and weight status but suggests other behavioral influences vary in multiethnic, working-class populations.

Objective There is need for a youth-informed conceptualization of how environmental and social neighborhood contexts influence physical activity. We assessed youths’ perceptions of their neighborhood physical and peer environments as affecting physical activity. Methods Thirty-three students (20 girls; ages 12-14 years) participated in focus groups about the physical environment and peers within their neighborhoods, and their understanding of how they affect physical activity. Results Inductive analysis identified themes of access (e.g., to equipment); aesthetics; physical and social safety; peer proximity and behavior (e.g., bullying); adult support or interference; and adult boundary setting. Participants also identified interconnections among themes, such as traffic shaping parent boundary setting and, in turn, access to physical spaces and peers. Conclusions Young adolescents view neighborhoods in ways similar to and different from adults. Examining physical and social environments in tandem, while mindful of how adults shape and youth perceive these environments, may enhance understanding of youth physical activity behavior.

Objective To examine associations between use of school vending machines and fast-food restaurants and youth intake of sugar-sweetened beverages. Design A cross-sectional observational study. Subjects/setting From a group randomized obesity intervention, we analyzed baseline data from 1,474 students in 10 Massachusetts middle schools with vending machines that sold soda and/or other sweetened drinks. Main Outcome Measures Daily sugar-sweetened beverage consumption (regular soda, fruit drinks, and iced tea), purchases from school vending machines, and visits to fast-food restaurants in the preceding 7 days were estimated by self-report. Statistical Analyses Performed χ 2 and nonparametric tests were performed on unadjusted data; multivariable models adjusted for sex, grade, body mass index, and race/ethnicity, and accounted for clustering within schools. Results Among 646 students who reported using school vending machines, 456 (71%) reported purchasing sugar-sweetened beverages. Overall, 977 students (66%) reported eating at a fast-food restaurant. Sugar-sweetened beverage intakes averaged 1.2 servings per day. In adjusted models, relative to no vending machine purchases, servings per day increased by 0.21 for one to three purchases per week ( P =0.0057), and 0.71 with four or more purchases ( P P =0.07), 0.49 with two to three visits ( P =0.0013), and by 1.64 with four or more visits ( P =0.0016). Conclusions Among students who use school vending machines, more report buying sugar-sweetened beverages than any other product category examined. Both school vending machine and fast-food restaurant use are associated with overall sugar-sweetened beverage intake. Reduction in added dietary sugars may be attainable by reducing use of these sources or changing product availability.

Background:To determine how trail characteristics may influence use, reliable and valid audit tools are needed.Methods:The Path Environment Audit Tool (PEAT) was developed with design, amenity, and aesthetics/maintenance items. Two observers independently audited 185 trail segments at 6 Massachusetts facilities. GPS-derived items were used as a “gold standard.” Kappa (k) statistics, observed agreement and intraclass correlation coefficients (ICCs) were calculated to assess inter-observer reliability and validity.Results:Fifteen of 16 primary amenity items had k-values ≥ 0.49 (“moderate”) and all had observed agreement ≥ 81%. Seven binary design items had k-values ranging from 0.19 to 0.71 and three of 5 ordinal items had ICCs ≥ 0.52. Only two aesthetics/maintenance items (n = 7) had moderate ICCs. Observed agreement between PEAT and GPS items was ≥ 0.77; k-values were ≥ 0.57 for 7 out of 10 comparisons.Conclusions:PEAT has acceptable reliability for most of its primary items and appears ready for use by researchers and practitioners.

Background Identifying spatial clusters of chronic diseases has been conducted over the past several decades. More recently these approaches have been applied to physical activity and obesity. However, few studies have investigated built environment characteristics in relation to these spatial clusters. This study’s aims were to detect spatial clusters of physical activity and obesity, examine whether the geographic distribution of covariates affects clusters, and compare built environment characteristics inside and outside clusters. Methods In 2004, Nurses’ Health Study participants from California, Massachusetts, and Pennsylvania completed survey items on physical activity (N = 22,599) and weight-status (N = 19,448). The spatial scan statistic was utilized to detect spatial clustering of higher and lower likelihood of obesity and meeting physical activity recommendations via walking. Clustering analyses and tests that adjusted for socio-demographic and health-related variables were conducted. Neighborhood built environment characteristics for participants inside and outside spatial clusters were compared. Results Seven clusters of physical activity were identified in California and Massachusetts. Two clusters of obesity were identified in Pennsylvania. Overall, adjusting for socio-demographic and health-related covariates had little effect on the size or location of clusters in the three states with a few exceptions. For instance, adjusting for husband’s education fully accounted for physical activity clusters in California. In California and Massachusetts, population density, intersection density, and diversity and density of facilities in two higher physical activity clusters were significantly greater than in neighborhoods outside of clusters. In contrast, in two other higher physical activity clusters in California and Massachusetts, population density, diversity of facilities, and density of facilities were significantly lower than in areas outside of clusters. In Pennsylvania, population density, intersection density, diversity of facilities, and certain types of facility density inside obesity clusters were significantly lower compared to areas outside the clusters. Conclusions Spatial clustering techniques can identify high and low risk areas for physical activity and obesity. Although covariates significantly differed inside and outside the clusters, patterns of differences were mostly inconsistent. The findings from these spatial analyses could eventually facilitate the design and implementation of more resource-efficient, geographically targeted interventions for both physical activity and obesity.

This study examines the usefulness of complementing accelerometry-based physical activity measurement with spatial data from portable global positioning system (GPS) units to determine where physical activity occurs.First, using the geographic distribution of data points and Bland-Altman plots, we examined GPS units' validity and interunit reliability by measuring the distance to a geodetic point. We also assessed interunit reliability by comparing GPS data collected in three built environment contexts. Second, we conducted a pilot study in which 35 participants wore GPS units and accelerometers in free-living conditions for 3 d. Moderate and vigorous physical activity (MVPA) bouts were matched to GPS data. We classified each bout as occurring inside or outside the participant's home neighborhood. Using unpaired t-tests and Fisher's exact tests, we compared neighborhood attributes for participants having the majority of MVPA bouts within their home neighborhood, relative to those with most bouts away from their home neighborhood.Average distance from each unit to the geodetic point was 3.02 m (SD 2.51). Average bias among units using Bland-Altman plots was 0.90 m, ranging from -0.22 to 1.86 m, within the limits of agreement. For interunit reliability in the built environment contexts, the mean distance difference among units ranged between 10.7 m (SD 11.9) and 20.1 m (SD 21.8). For the pilot study involving participants, GPS data were available for 59.3% of all bouts (67% of MVPA time), of which 46% were in the participants' neighborhood. Participants obtaining most of their MVPA in their neighborhoods tend to live in areas with higher population density, housing unit density, street connectivity, and more public parks.Data recorded by portable GPS units is sufficiently precise to track participants' movements. Successful matching of activity monitor and locational data suggests GPS is a promising tool for complementing accelerometry-based physical activity measures. Our pilot analysis shows evidence that the relationship between environment and activity can be clarified by examining where physical activity occurs.

Background:Physical activity research on trails is limited. We compared rail-trail users and nonusers on demographics, physical activity, and barriers/concerns about trail use; and described use among men and women.Methods:Four hundred thirteen adults completed a physical activity survey during fall 1998. Chi-square statistics and t-tests were used to compare trail users to nonusers, and men and women on trail use.Results:More trail users (79%) performed recreational physical activity ≥ 3 d/wk, compared to nonusers (47%). Walking was the most common activity for trail users and nonusers. Both groups shared concerns about safe access to the trail and certain trail conditions. A higher percentage of female versus male users traveled to the trail by walking, walked on the trail, used the trail with a friend, and perceived that if the trail were not available their activity would decrease.Conclusions:Trail users perform more recreational physical activity than nonusers. Gender differences in trail use patterns should be considered in the design and promotion of trails.

This report presents the effectiveness of the Massachusetts Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Project (MWWP) in reducing the cardiovascular disease (CVD) risk of uninsured and underinsured women agedor =50.Healthcare sites were randomly assigned to an enhanced intervention (EI) or minimum intervention (MI). Women enrolled at all sites received CVD risk factor screening, onsite counseling, education, referral, and follow-up as needed. Women enrolled at EI sites received additional services and specially designed interventions, including one-on-one nutritional and physical activity counseling and group activities, such as walking groups, nutrition classes, and cultural festivals. We report results for 1443 women who attended the initial screening in 10 study sites. Blood pressure, total cholesterol, number of servings of fruits and vegetables, and level of moderate or vigorous physical activity were assessed at baseline and 12-month follow-up screenings. Baseline data were collected between March and June 1996; follow-up data were collected 12 months later.The comprehensive screenings significantly lowered the overall prevalence of hypertension, resulting in a 7% reduction in high blood pressure among women at the EI sites (p = 0.02) and a 9% reduction at MI sites (p = 0.009). A significantly greater percentage of women became physically active at the EI sites (18%) than at the MI sites (6%) (p = 0.04).MWWP is a promising model for providing comprehensive preventive healthcare to uninsured and underinsured women.

Background: Using validated measures of individuals’ perceptions of their neighborhood built environment is important for accurately estimating effects on physical activity. However, no studies to date have examined the factorial validity of a measure of perceived neighborhood environment among older adults in the United States. The purpose of this measurement study was to test the factorial validity of a version of the Abbreviated Neighborhood Environment Walkability Scale (NEWS-A) modified for seniors in the Nurses’ Health Study (NHS). Findings: A random sample of 2,920 female nurses (mean age = 73 ± 7 years) in the NHS cohort from California, Massachusetts, and Pennsylvania completed a 36-item modified NEWS-A for seniors. Confirmatory factor analyses were conducted to test measurement models for both the modified NEWS-A for seniors and the original NEWS-A. Internal consistency within factors was examined using Cronbach’s alpha. The hypothesized 7-factor measurement model was a poor fit for the modified NEWS-A for seniors. Overall, the best-fitting measurement model was the original 6-factor solution to the NEWS-A. Factors were correlated and internally consistent. Conclusions: This study provided support for the construct validity of the original NEWS-A for assessing perceptions of neighborhood environments in older women in the United States.

Background. To effectively promote physical activIty, researchers and policy makers have advocated for greater use of environmental approaches, such as the construction of community paths and trails. However, research on the use of these facilities is limited. Methods. In this cross-sectional community study, we examined associations between self-reported and objective physical environmental variables and use of the Minuteman Bikeway (Arlington, MA) in a random sample of 413 adults. Sociodemographic and perceived environmental variables were measured with a mail survey during September 1998. Geographic information system (GIS) data were used to geocode survey respondents' homes and create three objective environmental variables: distance to the Bikeway, steep hill barrier, and a busy street barrier. Results. In logistic models, age and female gender showed statistically significant inverse associations with Bikeway use over the previous 4-week period. Increases in self-reported (OR = 0.65) and GIS distance (OR = 0.57) were associated with decreased likelihood of Bikeway use. Absence of self-reported busy street (OR = 2.01) and GIS steep hill barriers (OR = 1.84) were associated with Bikeway use. Conclusions. Environmental barriers such as travel distance and hilly terrain should be considered when planning community trails. A better understanding of such factors may lead to more effective promotion of trail use.

This prospective study evaluated regular physical activity and self-reported physician-diagnosed osteoarthritis of the knee and/or hip joints among 16,961 people, ages 20‐87, examined at the Cooper Clinic between 1970 and 1995. Among those aged 50 years and older, osteoarthritis incidence was higher among women (7.0 per 1000 person-years) than among men (4.9 per 1000 person-years, P 5 0.001), while among those under 50 years of age, osteoarthritis incidence was similar between men (2.6) and women (2.7). High levels of physical activity (running 20 or more miles per week) were associated with osteoarthritis among men under age 50 after controlling for body mass index, smoking, and use of alcohol or caffeine (hazard ratio 5 2.4, 95% CI: 1.5, 3.9), while no relationship was suggested among women or older men. These findings support the conclusion that high levels of physical activity may be a risk factor for symptomatic osteoarthritis among men under age 50. © 2000 Elsevier Science Inc. All rights reserved.

Introduction: Spatial clustering methods have been applied to cancer for over a decade. These methods have been used in studies on physical activity (PA) and obesity. One recent study examined differences in built environment attributes inside and outside PA clusters. We tested two hypotheses: 1) PA and obesity would spatially cluster in older women; and 2) built environment attributes typically related to higher walkability would be found in high PA clusters, while attributes related to lower walkability would appear in high obesity clusters. Methods: We used data from 22,589 Nurses’ Health Study participants (mean age = 69.9 ± 6.8y) in California, Massachusetts, and Pennsylvania. Two outcomes were examined: meeting PA guidelines via self-reported walking (≥ 500 MET-min/week) and obesity (BMI ≥ 30.0). Objective built environment variables were created: population and intersection density, diversity of facilities, and facility density. We used a spatial scan statistic to detect clusters (i.e., areas with high or low rates) of the two outcomes. Built environment attributes were compared inside and outside clusters. Results: Six spatial clusters of PA were found in California and Massachusetts. Two obesity clusters were found in Pennsylvania. Overall there were significant differences (p Conclusion: Although PA and obesity clusters emerged, the comparison of built environment attributes inside and outside clusters revealed a complex picture not fully consistent with existing literature. Further examination of PA and obesity clusters in older adults should include other built environment factors that may be related to these outcomes.

Context aware Physical Activity (PA) monitoring of humans is important for the study of diseases associated with obesity and lack of physical activity. This paper introduces a wearable context aware PA monitoring device which determines if the user is indoors or outside in situations of disrupted Global Positioning System (GPS) reception. In addition to a GPS sensor, multiple light and temperature sensors were added to our PA monitoring device. Differences in inside and outside temperature and the intensity of light are used to distinguish the context of location. Location, Light and temperature values were recorded using a controlled route during a period of 20 days in January and February. One of the non-parametric pattern recognition techniques (K-nearest neighbors) was used to classify indoor and outdoor conditions based on the combination of sensor values. Results show that the K-nearest neighbors algorithm could distinguish indoor and outdoor conditions during daytime and nighttime with the error of 0.003.

Purpose: Dog owners represent 40% of the population, a promising audience to increase population levels of physical activity. The purpose of this study was to develop and test the psychometric properties of a new instrument to assess social cognitive theory (SCT) constructs related to dog walking. Methods: Dog owners (N=431) completed the Dogs and WalkinG Survey (DAWGS). Survey items assessed dog walking behaviors, and self-efficacy, social support, outcome expectations, and outcome expectancies for dog walking. Test-retest reliability was assessed among 252 (58%) survey respondents who completed the survey twice. Factorial validity and factorial invariance by age and walking level were tested using confirmatory factor analysis. Results: DAWGS items demonstrated moderate test-retest reliability (r=.39-.79; k=.41-.89). Acceptable model fit was found for all subscales. All subscales were invariant by age and walking level, except self-efficacy, which showed mixed evidence of invariance. Conclusions: The DAWGS is a psychometrically sound instrument for examining individual and interpersonal correlates of dog walking.

Purpose Engaging in prolonged screen-time behaviors (STBs) is detrimental for health. The objective of the present analyses was to examine temporal trends in TV viewing and computer use among adolescents across 30 countries. Methods Data were derived from the cross-national Health Behaviour in School-aged Children study. Data on TV viewing and computer use for gaming and nongaming purposes were collected in 2002 (n = 139,725 [51.4% girls]), 2006 (n = 149,251 [51.3% girls]), and 2010 (n = 154,845 [51.2% girls]). The temporal trends in TV viewing and computer use were each tested for all countries combined and for each individual country by sex-specific univariate analysis of variance. Results Between 2002 and 2010, TV viewing decreased slightly in most of the 30 countries among both boys and girls. This decrease was more than offset by a sharp increase in computer use, which was consistent across all countries. Overall, boys reported more hours of STBs. They also reported a slightly larger decrease in TV viewing and slightly larger increase in computer use. STBs were generally more frequent on weekend days. Conclusions The overall cross-national increases in STBs should be a call to action for public health practitioners, policy-makers, and researchers that interventions specifically focused on reducing STBs in youth are sorely needed. Because all countries experienced a trend in the same direction, it might be fruitful to learn more about the determinants of STBs among those countries in which hours of STBs are generally low as compared with other countries.

Objectives. We evaluated the association between the county sprawl index, a measure of residential density and street accessibility, and physical activity and body mass index (BMI). Methods. We conducted a multilevel cross-sectional analysis in a sample of Nurses’ Health Study participants living throughout the United States in 2000 to 2001 (n = 136 592). Results. In analyses adjusted for age, smoking status, race, and husband’s education, a 1-SD (25.7) increase in the county sprawl index (indicating a denser, more compact county) was associated with a 0.13 kilograms per meters squared (95% confidence interval [CI] = −0.18, −0.07) lower BMI and 0.41 (95% CI = 0.17, 0.65) more metabolic equivalent (MET) hours per week of total physical activity, 0.26 (95% CI = 0.19, 0.33) more MET hours per week of walking, and 0.47 (95% CI = 0.34, 0.59) more MET hours per week of walking, bicycling, jogging, and running. We detected potential effect modification for age, previous disease status, husband’s education level (a proxy for socioeconomic status), and race. Conclusions. Our results suggest that living in a dense, compact county may be conducive to higher levels of physical activity and lower BMI in women.

Purpose:To provide a synthesis of research on trails and physical activity from the public health, leisure sciences, urban planning, and transportation literatures.Methods:A search of databases was conducted to identify studies published between 1980 and 2008.Results:52 studies were identified. The majority were cross-sectional (92%) and published after 1999 (77%). The evidence for the effects of trails on physical activity was mixed among 3 intervention and 5 correlational studies. Correlates of trail use were examined in 13 studies. Several demographic (eg, race, education, income) and environmental factors (eg, land-use mix and distance to trail) were related to trail use. Evidence from 31 descriptive studies identified several facilitators and barriers to trail use. Economic studies (n = 5) examining trails in terms of health or recreational outcomes found trails are cost-effective and produce significant economic benefits.Conclusion:There is a growing body of evidence demonstrating important factors that should be considered in promoting trail use, yet the evidence for positive effects of trails on physical activity is limited. Further research is needed to evaluate the effects of trails on physical activity. In addition, trail studies that include children and youth, older adults, and racial and ethnic minorities are a research priority.

Background and Aims: Spatial analyses have been applied to examine relationships between the built environment and obesity. However, few studies have examined this relationship from the aspect of s...

Background A number of studies have demonstrated relationships between the perceived built environment and physical activity among adults. However, little is known about whether these associations differ by U.S. region and level of urban sprawl. Purpose To examine associations between the perceived built environment and physical activity in U.S. women by region and urban sprawl. Methods Nurses' Health Study II participants (N=68,968) completed four perceived neighborhood environment survey items in 2005. Logistic regression was used to estimate associations with meeting physical activity recommendations, adjusting for demographic and weight-status variables, and stratifying by region and sprawl. Data analyses were completed in 2011. Results Perceived proximity to shops/stores was positively associated with physical activity across regions and levels of sprawl (ORs=1.21–1.46). Perceived access to recreation facilities was also a positive physical activity correlate in most region–sprawl strata, with strongest relationships found in the West (ORs=1.31–1.70). Perceived crime and presence of sidewalks did not show statistically significant associations with physical activity in most region–sprawl strata, although ORs for perceived crime showed a consistent pattern of negative associations (ORs=0.60–0.95). A higher number of positive environmental attributes was associated with a greater odds of meeting physical activity recommendations. Conclusions Findings indicate that perceived proximity to shops/stores and access to recreation facilities are important correlates of physical activity for women, irrespective of region or sprawl.