Research articleNeighborhood Environments and Physical Activity Among Adults in 11 Countries
Introduction
The well-documented health burdens of physical inactivity have led national1, 2, 3 and international4, 5 health agencies to prioritize physical activity promotion. Efforts to motivate and educate individuals can be complemented by creating social and built environments that make physical activity safe and convenient.6 Authoritative groups found convincing evidence from a few developed countries that people are more active, especially for transportation, if they live in communities characterized by mixed land use (i.e., with stores in walking distance of homes); well-connected street networks; and high residential density than if they live in communities designed for automobile-dependent transportation with the opposite characteristics.7, 8 Other reviewers concluded that proximity to recreational facilities, along with pleasing aesthetics, was associated with more recreational physical activity.9, 10
Limitations of the existing research examining associations between built environments and physical activity are apparent. First, the lack of experimental and prospective studies prevents conclusions about the direction of causality.8 Second, specific characteristics of neighborhoods related to physical activity need to be identified to guide designers and planners to create more activity-friendly environments. Third, most studies examined subcomponents of physical activity, such as transportation or recreational activities, but the contribution of built environments to total physical activity, which should be most strongly related to health outcomes, has seldom been reported.11, 12, 13 Finally, because studies have been conducted within single countries, limited environmental variability may lead to underestimation of true associations with physical activity. Such underestimation could reduce the apparent relevance of built-environment changes as physical activity promotion strategies.
The present study aimed to address all but the first limitation with a cross-sectional analysis of how neighborhood attributes in 11 countries help adults meet health-enhancing physical activity guidelines. The use of common methods and survey translation/adaptation protocols justified pooling across countries, creating a database with very wide variability in environments and populations.
Section snippets
International Physical Activity Prevalence Study (IPS)
The aim of the IPS was to collect nationally representative and internationally comparable prevalence estimates on physical activity from diverse countries. Interested investigators were required to show capacity and intent to follow rigorous guidelines to address known limitations in physical activity prevalence studies (i.e., seasonality, instrument translation and training, data coding, analysis strategy). As described elsewhere,14 protocols for recruiting population samples and collecting
Description of Samples
About 70% of all participants (N=11,541) reported living in towns and cities with populations ≥30,000, ranging from 27.6% (Belgium) to 100% (Brazil, Colombia [Bogota], Hong Kong). Demographic characteristics of each country sample are shown in Table 1. Sample sizes ranged from 357 (Belgium) to 2674 (Colombia); genders were well balanced; and age distributions in the range of 20–64 years were generally balanced, except for that in Japan. Percentages of participants with >13 years of education
Discussion
Five of seven neighborhood environmental variables were significantly associated with meeting guidelines for physical activity in a study of 11 countries. There was evidence of a linear gradient in the relationship, such that the more supportive the reported built-environment attributes were for the neighborhood, the more likely the person was to be sufficiently physically active. Although adjusting for education reduced the association somewhat, having many favorable neighborhood environmental
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