Elsevier

Public Health

Volume 181, April 2020, Pages 34-39
Public Health

Original Research
Relation between residential density and walking time among urban adults in Nanjing, China

https://doi.org/10.1016/j.puhe.2019.12.002Get rights and content

Highlights

  • •

    This is the first study to examine the association of residential density (RD) with walking time (WT) in China.

  • •

    A negative and gradient association between RD and WT was seen for urban adults in China.

  • •

    Physical activity should be promoted through development of walking-friendly built environment.

Abstract

Objectives

The interest in built environment attributes on physical activity has been rapidly increasing over recent decades. This study aimed to investigate the associations between residential density (RD) and walking time (WT), a common mode of physical activity, among urban adults in China.

Study design

This is a cross-sectional study.

Methods

Locally registered adults aged 35–74 years were randomly selected from eight urban neighbourhoods in Nanjing, China, in 2017. The outcome variable was self-reported WT (dichotomised), whereas RD (in tertiles) was the independent variable. Mixed-effects regression models were introduced to examine the RD–WT association via computing odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Of 1568 eligible participants, 98.9% completed the survey, with a mean age (standard deviation) of 54.7 (11.1) years, in which 46% were men. After adjustment for potential confounders, a negative gradient RD-WT association was seen across RD tertiles among the participants (OR = 2.88 [95% CI = 1.79, 4.64] and 2.10 [95% CI = 1.35, 3.26] for lower and middle tertiles, respectively, compared with the upper RD tertile). The negative RD-WT association was observed for both men and women.

Conclusions

RD was negatively associated with the WT of urban adults in China. These results have public health implications for improving community-level physical activity through development of walking-friendly built environment.

Introduction

Lack of physical activity (PA) is a worldwide public health problem, although PA promotion has been shown to be effective in preventing non-communicable diseases (NCDs).1 As the biggest country with rapid economic growth in the world, China has been witnessing a continuous nationwide decline in PA over recent decades.2 For population-based PA promotion, it is critically important to identify and focus on modifiable influencing factors of PA at the community level. Previous studies have shown that environmental and policy initiatives usually provide opportunities for residents to make easy and realistic choices of physically active lifestyles and behaviours.3,4 Moreover, neighbourhood built environment (BE) attributes, including residential density (RD), have recently been identified to be one of those modifiable factors of PA,5, 6, 7 resulting in a new option for community-based PA promotion.

BE can exert long-term impacts on residents' behaviours, particularly PA. As one of the key predictors of BE, RD is defined as the units within a specific geographic area reflecting the density of the population or households,8, 9, 10 and RD is often used to assess BE in terms of urban design and land use. In our study, RD specifically refers to the population density of our study neighbourhoods. Walking is the most common mode of leisure-time PA. The promotion of walking has become an important topic in the fields of public health and urban planning because it is an easy PA for residents during leisure time and a feasible option for daily convenient-distance commuting.11 Therefore, it is of public health importance to investigate the association between RD and walking at a population level.

To date, the relation between RD and walking has been investigated in developed societies (e.g. Western countries and Japan), where inconsistent findings were reported.12, 13, 14, 15, 16, 17, 18 The majority of previous studies reported that RD was positively associated with walking time (WT) because high-density neighbourhoods usually had benefits in terms of efficient use of infrastructure and recreational destinations.13, 14, 15, 16 On the other hand, few studies showed an inverse relation between RD and WT.17,18 Shigeru et al.17 found an inverse association of RD and WT among Japanese women, and Lee et al. reported that participants who lived in high-density neighbourhoods were less likely to engage in walking during leisure time in the US.18 However, to date, there are no studies regarding the association of RD and WT in China, the biggest society with continuous economic growth and rapid urbanisation in the world. Therefore, we conducted a population-based study with the aim to investigate the relation between RD and WT among adults in typical regional urban areas of China.

Section snippets

Study design and recruitment of participants

This study was a cross-sectional survey conducted between late March and early July 2017 in urban areas of Nanjing, one of the megacities in the developed region of eastern China. Nanjing had six urban districts and more than 8 million registered residents in 2017. The sample size estimation and participants' selection are described in detail in the studies by Zhao et al.19 and Wang et al.20 In brief, the eligible participants were local urban adults aged 35–74 years and without any physical

Results

The demographic characteristics of the participants by WT category are shown in Table 1. Of the 1568 eligible participants, 1551 were successfully interviewed (response rate = 98.9%), whose mean age (standard deviation) was 54.7 (11.1) years; 47.8% of participants were men, 35.9% were young adults, 22.7% had ≥13 years of educational attainment and 54.8% were white-collar workers. Only 51.3% of participants reported their weekly WT reaching the median value. Older participants and those with

Discussion

In this population-based study, we explored the association of RD and WT for urban adults in China. We observed a significantly negative relationship between RD and WT. Moreover, this negative association showed a marginally significant gradient across the RD tertiles. In addition, the significant association between RD and WT was also observed for men or women separately.

The findings of our study are not in line with those reported from Western countries, where RD was positively associated

Author contributions

F.X. (the PI of the project), Z.W. and Y.X. conceived, designed and directed the study. Z.Q., Z.W., Q.Y. and F.X. performed the experiments. Z.Q., Z.W. and F.X. analysed the data. Z.Q., Z.W., Q.Y., P.J., Y.X. and F.X. wrote the article. Z.Q., Z.W., Q.Y., P.J., Y.X. and F.X. contributed to critical revision of the manuscript.

Acknowledgements

The authors thank the staff and workers from Qinhuai and Yuhuatai District Center for Disease Control and Prevention for their assistance in collecting data. Prof. Fei Xu

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