neighbourhood walkability and physical activity levels in canadian communities

Neighbourhood Walkability and Physical Activity Levels in Canadian Communities

Justin ThielmanMichael LebenbaumLaura RosellaRay CopesHeather Manson

http://www.publichealthontario.ca/

PublicHealthOntario.ca

Outline of Presentation

• Background and Research Gaps

• Data Sources and Methods

• Results

• Discussion

2



Background and Research Gaps

3

HIGH WALKABILITY

LOW WALKABILITY



Background and Research Gaps

• Recent systematic reviews show some evidence of associations between walkability and some types of physical activity, but not conclusive [12-19]

• Non-significant estimates of associations identified in many studies may be due to type II error [16,18]

• Almost all studies done in one or two large metropolitan cities, so not generalizable to smaller centres [15,16,18-20]

4



Background and Research Gaps• Our study uses national-level data sources that cover all of

Canada• Large sample size• Diverse range of city sizes• Cross-Canada representation

• Research Questions: • Is walkability associated with walking for transportation or total leisure

and transportation physical activity among Canadians aged 12 and older?

• How, and to what extent are these associations affected by variables such as age of respondent and city size?

5



Data Sources and Methods• Canadian Community Health Survey (CCHS):• The CCHS is a national survey of health, health determinants, and health

care utilization among Canadians aged 12 and older

• Primary outcomes:• Walking to work or school • Energy expenditure on transportation and leisure physical activity

• Covariates:• Age, sex, race, immigration, income, education level, children in household,

location, work or school attendance, population centre size class

6



Data Sources and Methods

7

Walkability data: Street Smart Walk Score (SSWS) (www.walkscore.com)

Grocery stores

For given locations, SSWS algorithm based

on number and proximity of amenities

Parks

Schools

Book storesBanks

Entertainment

Coffee shops

Clothing/gift shops

Restaurants/bars

Penalties for lower intersection densities and longer block lengths

http://www.walkscore.com/




8

SSWSLatitude/longitude

CCHSPostal code

Postal Code Conversion FileLatitude/longitudePostal code

2007-08 CCHS + 2009-10 CCHS + 2011-12 CCHS - Rural residents - Respondents missing data on SSWS, primary outcomes, key covariates

= Final sample size: 240,595



Results

9

Forest plot based on multivariable analyses adjusting for age, sex, race, working or attending school, immigration to Canada, highest level of education, household income, number of children under 12, population centre size category

Odds Ratio

SSW

S Q

uinti

leAll Respondents: Walked to Work or School in Past 3 Months


PublicHealthOntario.ca 10Each analysis adjusted for sex, race, working or attending school, immigration to Canada, highest level of education, household income, number of children under 12, population centre size category

Age 12-17: Walked to Work or School in Past 3 Months

Age 65+: Walked to Work or School in Past 3 MonthsAge 30-64: Walked to Work or School in Past 3 Months

Age 18-29: Walked to Work or School in Past 3 MonthsSS

WS

Qui

ntile

SSW

S Q

uinti

leSS

WS

Qui

ntile

SSW

S Q

uinti

le

Odds Ratio Odds Ratio

Odds RatioOdds Ratio


PublicHealthOntario.ca 11

Each analysis adjusted for age, sex, race, working or attending school, immigration to Canada, highest level of education, household income, number of children under 12

Population 1,000-29,999: Walked to Work or School

Population 100,000+ : Walked to Work or School

Population 30,000-99,999: Walked to Work or School

SSW

S Q

uinti

le

SSW

S Q

uinti

le

SSW

S Q

uinti

le

Odds Ratio

Odds Ratio

Odds Ratio



Results

12

Forest plot based on multivariable analyses adjusting for age, sex, race, working or attending school, immigration to Canada, highest level of education, household income, number of children under 12, population centre size category

Similar results in age and population subgroups:

+ve assoc. for Q4 & Q5: • Age 30-64 • Pop. 1,000-29,999

+ve assoc. for Q5 only:• Age 18-29 • Pop. 100,000+

No significant assoc. • Remaining groups

Difference in Energy Expenditure (kcal/kg/hr)

SSW

S Q

uinti

le

All Respondents: Transport and Leisure Physical Activity



Discussion

• Limitations:• Information bias due to self-reported outcomes

• Selection bias due to residential self-selection

• Residual confounding

• Cross-sectional study design precludes inference of causality

13



Discussion

• SSWS and walking to work or school:• Positive associations identified for all quintile comparisons, increasing

strength in each successive quintile• Consistent across age groups and population centre sizes

• SSWS and energy expenditure on all leisure and transport activities:• Compared to lowest quintile, only top quintile shows positive

association

• Next steps:• Findings can be used to justify more resource-intensive longitudinal

studies in a variety of age and population groups

14



Thank you!

Questions?

[email protected]

15



References[1] Chronic Diseases and Their Common Risk Factors. (n.d.). In World Health Organization. Retrieved July 8, 2011 from http://www.who.int/chp/chronic_disease_report/media/Factsheet1.pdf

[2] Lynch, B.M., Neilson, H.K., Friedenreich, C.M. (2011). Physical activity and breast cancer prevention Recent Results in Cancer Research. 186:13-42.

[3] Lee, L.L., Watson, M.C., Mulvaney, C.A., Tsai, C.C., Lo, S.F. (2010). The effect of walking intervention on blood pressure control: a systematic review. International Journal of Nursing Studies. 47(12):1545-1561.

[4] Murtagh, E.M., Murphy, M.H., Boone-Heinonen, J. (2010). Walking: the first steps in cardiovascular disease prevention. Current Opinion in Cardiology. 25(5):490-6.

[5] Halle M, Schoenberg MH. (2009). Physical activity in the prevention and treatment of colorectal carcinoma. Deutsches Aerzteblatt International. 106(44):722-7.

[6] Caspersen CJ, Fulton JE. (2008). Epidemiology of walking and type 2 diabetes. Medical & Science in Sports & Exercise. 40(7 Suppl):S519-28.

[7] Ferrier, S., Blanchard, C.M., Vallis, M., Giacomantonio, N. (2011). Behavioural interventions to increase the physical activity of cardiac patients: A review. European Journal of Cardiovascular Prevention and Rehabilitation. 18(1):15-32.

[8] Foster, D.D., Summers, A.A. (2008). State executive/legislative and judicial activities and the strength of local regulation of residential housing. Urban Lawyer 40(1):1-16.

16

http://www.who.int/chp/chronic_disease_report/media/Factsheet1.pdf



References[9] Hui, E.C.M., Lam, M.C.M., Ho, V.S.M. (2006). Market disequilibrium and urban land shortages: Analysis of policy and patterns

in Hong Kong. Journal of Urban Planning and Development. 132(2):80-88.

[10] Hiwasaki, L. (2005). Toward sustainable management of national parks in Japan: Securing local community and stakeholder participation. Environmental Management. 35(6):753-764.

[11] De Vries, M.S. (2002). The changing functions of laws and its implication for government and governance. International Review of Administrative Sciences. 68(4):599-618.

[12] Wendel-Vos W, Droomers M, Kremers S, Brug J, van Lenthe F. Potential environmental determinants of physical activity in adults: a systematic review. Obesity Reviews. 2007; 8(5):425-440.

[13] Durand, C.P., Andalib, M., Dunton, G.F., Wolch, J., Pentz, M.A. A systematic review of built environment factors related to physical activity and obesity risk: Implications for smart growth urban planning. Obesity Reviews. 2011; 12(501):e173-e182.

[14] Foster, C., Hillsdon, M. Changing the environment to promote health-enhancing physical activity. Journal of Sports Sciences. 2004; 22:755-769.

[15] Saelens, B.E., Handy, S.L. Built Environment Correlates of Walking: A Review. Medicine and Science in Sports and Exercise. 2008; 40(7):S550-S566.

[16] Sugiyama T, Neuhaus M, Cole R, Giles-Corti B, and Owen N. Destination and Route Attributes Associated with Adults’ Walking: A Review. Med. Sci. Sports Exerc. 2012; 44(7):1275-1286

17



References[17] McCormack C, and Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity behaviour. International Journal of Behavioral Nutrition and Physical Activity. 2011; 8:125.

[18] Van Cauwenberg J, De Bourdeaudhuij I, De Meester F, Van Dyck D, Salmon J, Clarys P, Deforche B. Relationship between the physical environment and physical activity in older adults: A systematic review. Health & Place. 2011; 17:458-469.

[19] Frost, SS, Goins RT, Hunter RH, Hooker SP, Bryant LL, Kruger J, Pluto D. Effects of the Built Environment on Physical Activity of Adults Living in Rural Settings. American Journal of Health Promotion. 2010; 24(4):267-283.

[20] Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of Built Environments in Physical Activity, Obesity, and Cardiovascular Disease. Circulation. 2012; 125:729-737.

[21] Statistics Canada. Canadian Community Health Survey, 2009-2010: Annual component [Data file and code book]. 2011.

[22] Statistics Canada. Canadian Community Health Survey, 2007-2008: Annual component [Data file and code book]. 2009.

[23] Statistics Canada. Canadian Community Health Survey, 2009-2010: Annual component [User Guide]. 2011.

[24] Walk Score. Walk Score Methodology. 2012.

[25] Duncan DT, Aldstadt J, Whalen J, Melly SJ, Gortmaker SL. Validation of walk score for estimating neighborhood walkability: an analysis of four US metropolitan areas. Int J Environ Res Public Health. 2011 Nov;8(11):4160-79.

[26] Carr LJ, Dunsiger SI, Marcus BH. Validation of Walk Score for estimating access to walkable amenities. Br J Sports Med. 2011 Nov;45(14):1144-8.

18



Next steps• Climate covariates

• CHMS

19




20

Quintile SSWS Range

1 0 – 19

2 20 – 36

3 37 – 53

4 54 – 71

5 72 - 100

2007-08 CCHS + 2009-10 CCHS + 2011-12 CCHS = 361,126

- Rural residents = 262,630

- Respondents missing SSWS data = 253,457 (3.5%)

- Respondents missing data on key covariates: immigrant, cultural origin, education =

(age, sex, children <12 missing none) 245,595 (3.1%) (6.5% overall)

- Respondents missing data on primary outcomes =Final sample size:240,595 (2.0%)



Appendix A: Table 1

21

Categorical Variables: Total N (PERCENT), N of each category Variable Total Q1 Q2 Q3 Q4 Q5

Urban category (GEODUR) 240397, 46123, 47509, 48304, 49009, 49452, 1 – Urban core 205538 (85.5) 36055 (78.2) 40411 (85.1) 41580 (86.1) 42494 (86.7) 44999 (91.0) 2 – Urban fringe 6233 (2.6) 2213 (4.8) 1676 (3.5) 1334 (2.8) 666 (1.4) 344 (0.7) 4 – UA outside CMA/CA 13579 (5.6) 3194 (6.9) 2454 (5.2) 2572 (5.3) 3193 (6.5) 2166 (4.4) 6 – Secondary urban core 4832 (2.0) 1622 (3.5) 1052 (2.2) 959 (2.0) 787 (1.6) 412 (0.8) 9 – NR (mix of urban/rural) 10215 (4.2) 3039 (6.6) 1917 (4.0) 1859 (3.8) 1869 (3.8) 1531 (3.1) Age category (Agecat) 240397, 46123, 47509, 48304, 49009, 49452, 0 – 12 to 17 20229 (8.4) 4734 (10.3) 4700 (9.9) 4244 (8.8) 3743 (7.6) 2808 (5.7) 1 – 18 to 29 48725 (20.3) 8245 (17.9) 9086 (19.1) 9662 (20.0) 10356 (21.1) 11376 (23.0) 2 – 30 to 64 136946 (57.0) 27653 (60.0) 27259 (57.4) 27062 (56.0) 27187 (55.5) 27785 (56.2) 3 – 65 and up 34498 (14.4) 5492 (11.9) 6465 (13.6) 7335 (15.2) 7722 (15.8) 7483 (15.1) Sex (DHH_SEX) 240397, 46123, 47509, 48304, 49009, 49452, 1 - Male 117085 (48.7) 22842 (49.5) 22991 (48.4) 23543 (48.7) 23635 (48.2) 24074 (48.7) 2 - Female 123312 (51.3) 23280 (50.5) 24518 (51.6) 24761 (51.3) 25374 (51.8) 25378 (51.3) Race (RACE) 240397, 46123, 47509, 48304, 49009, 49452, 0 – White 183455 (76.3) 39239 (85.1) 37644 (79.2) 36426 (75.4) 35418 (72.3) 34728 (70.2) 1 – South Asian 10684 (4.4) 1349 (2.9) 2169 (4.6) 2486 (5.1) 2561 (5.2) 2119 (4.3) 2 – Aboriginal 7593 (3.2) 1364 (3.0) 1448 (3.0) 1497 (3.1) 1768 (3.6) 1517 (3.1) 3 – Asian 16194 (6.7) 1821 (3.9) 2522 (5.3) 3369 (7.0) 3737 (7.6) 4745 (9.6) 4 – Black 6795 (2.8) 597 (1.3) 1131 (2.4) 1496 (3.1) 1671 (3.4) 1901 (3.8) 5 – Other 15676 (6.5) 1754 (3.8) 2595 (5.5) 3030 (6.3) 3855 (7.9) 4442 (9.0) Immigrant (SDCFIMM) 240397, 46123, 47509, 48304, 49009, 49452, 1 - Yes 63087 (26.2) 7769 (16.8) 10795 (22.7) 12609 (26.1) 14746 (30.1) 17169 (34.7) 2 - No 177310 (73.8) 38354 (83.2) 36715 (77.3) 35695 (73.9) 34263 (69.9) 32283 (65.3)



Appendix A: Table 1

22

Income quintile (INC_QUINTILE) 240397, 46123, 47509, 48304, 49009, 49452, 1 – 42146 (17.5) 4754 (10.3) 6402 (13.5) 8200 (17.0) 10356 (21.1) 12434 (25.1) 2 – 42915 (17.9) 7025 (15.2) 7998 (16.8) 8775 (18.2) 9524 (19.4) 9594 (19.4) 3 – 44883 (18.7) 8849 (19.2) 9220 (19.4) 9375 (19.4) 9386 (19.2) 8053 (16.3) 4 – 44002 (18.3) 9975 (21.6) 9649 (20.3) 8724 (18.1) 8066 (16.5) 7588 (15.3) 5 – 43975 (18.3) 11195 (24.3) 9507 (20.0) 8537 (17.7) 7038 (14.4) 7698 (15.6) Missing 22477 (9.3) 4326 (9.4) 4734 (10.0) 4693 (9.7) 4639 (9.5) 4086 (8.3) EDUDR04 - Highest level/edu. 240397, 46123, 47509, 48304, 49009, 49452, 1 - < High school 46292 (19.3) 8455 (18.3) 9302 (19.6) 9800 (20.3) 10206 (20.8) 8528 (17.2) 2 - High school grad 37704 (15.7) 7092 (15.4) 7752 (16.3) 8191 (17.0) 7953 (16.2) 6717 (13.6) 3 - Some post-secon. 19511 (8.1) 3568 (7.7) 3859 (8.1) 3989 (8.3) 3969 (8.1) 4126 (8.3) 4 - Post-secon. Grad 136891 (56.9) 27008 (58.6) 26596 (56.0) 26324 (54.5) 26881 (54.8) 30082 (60.8) Worked at job (GEN_08) 240397, 46123, 47509, 48304, 49009, 49452, 1 – Yes 168847 (70.2) 33580 (72.8) 33584 (70.7) 33537 (69.4) 33677 (68.7) 34470 (69.7) 2 – No 49022 (20.4) 8593 (18.6) 9398 (19.8) 9996 (20.7) 10507 (21.4) 10529 (21.3) NA/missing (6, 7, 8) 22528 (9.4) 3951 (8.5) 4527 (9.5) 4771 (9.9) 4825 (9.8) 4453 (9.0) No. pers. < 12 years old in hhld (DHHDL12) 240397, 46123, 47509, 48304, 49009, 49452, 0 184148 (76.6) 33800 (73.3) 35426 (74.6) 36505 (75.6) 37922 (77.4) 40495 (81.9) 1 30541 (12.7) 6228 (13.5) 6416 (13.5) 6506 (13.5) 6205 (12.7) 5185 (10.5) 2 19854 (8.3) 4666 (10.1) 4368 (9.2) 4079 (8.4) 3711 (7.6) 3030 (6.1) 3 4694 (2.0) 1130 (2.5) 1064 (2.2) 977 (2.0) 920 (1.9) 603 (1.2) 4+ 1159 (0.5) 299 (0.7) 235 (0.5) 236 (0.5) 250 (0.5) 138 (0.3) Leis. or trans. phys. act., past 3 months (PACFLTI) 240397, 46123, 47509, 48304, 49009, 49452, Yes (1) 223108 (92.8) 43608 (94.5) 44293 (93.2) 44654 (92.4) 45092 (92.0) 45461 (91.9) No (2) 17289 (7.2) 2515 (5.5) 3216 (6.8) 3650 (7.6) 3917 (8.0) 3991 (8.1) Walked to work/school, past 3 months (PAC_7) 240397, 46123, 47509, 48304, 49009, 49452, Yes (1) 46603 (19.4) 5979 (13.0) 7748 (16.3) 8664 (17.9) 10037 (20.5) 14175 (28.7) No (2) 135594 (56.4) 30151 (65.4) 28721 (60.5) 27693 (57.3) 26154 (53.4) 22875 (46.3) Does not work/attend school (3) 58200 (24.2) 9992 (21.7) 11040 (23.2) 11947 (24.7) 12817 (26.2) 12403 (25.1)



Appendix A: Table 1

23

Time spent walking to work/school (PAC_7B) 240397, 46123, 47509, 48304, 49009, 49452, 1 – 15 mins (1) 16988 (7.1) 2212 (4.8) 2973 (6.3) 3208 (6.6) 3819 (7.8) 4775 (9.7) 16 – 30 mins (2) 17828 (7.4) 2208 (4.8) 2901 (6.1) 3459 (7.2) 3772 (7.7) 5488 (11.1) 31 – 60 mins (3) 8782 (3.7) 1195 (2.6) 1357 (2.9) 1476 (3.1) 1819 (3.7) 2935 (5.9) > 60 mins (4) 2447 (1.0) 313 (0.7) 415 (0.9) 410 (0.8) 534 (1.1) 775 (1.6) NA/missing (6, 7, 9) 194351 (80.8) 40194 (87.1) 39863 (83.9) 39751 (82.3) 39066 (79.7) 35478 (71.7) Biked to work/school, past 3 months (PAC_8) 240397, 46123, 47509, 48304, 49009, 49452, Yes (1) 9558 (4.0) 1496 (3.2) 1572 (3.3) 1646 (3.4) 1793 (3.7) 3051 (6.2) No (2) 171748 (71.4) 34511 (74.8) 34700 (73.0) 34543 (71.5) 34196 (69.8) 33799 (68.3) Does not work/attend school (3) 59092 (24.6) 10116 (21.9) 11238 (23.7) 12115 (25.1) 13020 (26.6) 12603 (25.5) Time spent biking to work/school (PAC_8B) 240397, 46123, 47509, 48304, 49009, 49452, 1 – 15 mins (1) 3677 (1.5) 570 (1.2) 659 (1.4) 659 (1.4) 703 (1.4) 1085 (2.2) 16 – 30 mins (2) 3036 (1.3) 466 (1.0) 437 (0.9) 530 (1.1) 579 (1.2) 1025 (2.1) 31 – 60 mins (3) 1976 (0.8) 278 (0.6) 327 (0.7) 324 (0.7) 369 (0.8) 678 (1.4) > 60 mins (4) 772 (0.3) 170 (0.4) 135 (0.3) 118 (0.2) 124 (0.3) 224 (0.5) Missing (6, 7, 9) 230936 (96.0) 44638 (96.8) 45951 (96.7) 46673 (96.6) 47234 (96.3) 46439 (93.8) BMI category (bmicateg) 240397, 46123, 47509, 48304, 49009, 49452, Underweight 10568 (4.4) 1962 (4.3) 2099 (4.4) 2034 (4.2) 2177 (4.4) 2296 (4.6) Normal weight 111603 (46.4) 20510 (44.5) 21516 (45.3) 22037 (45.6) 22430 (45.8) 25110 (50.8) Overweight 73130 (30.4) 14771 (32.0) 14659 (30.9) 15020 (31.1) 14957 (30.5) 13722 (27.7) Obese 36916 (15.4) 7415 (16.1) 7605 (16.0) 7504 (15.5) 7756 (15.8) 6637 (13.4) NA/missing 8180 (3.4) 1465 (3.2) 1630 (3.4) 1710 (3.5) 1690 (3.4) 1686 (3.4) Diabetes (diab) 240397, 46123, 47509, 48304, 49009, 49452, No 226373 (94.2) 43717 (94.8) 45027 (94.8) 45188 (93.5) 45878 (93.6) 46563 (94.2) Yes 13886 (5.8) 2385 (5.2) 2463 (5.2) 3094 (6.4) 3104 (6.3) 2839 (5.7) NA/missing 138 (0.1) 21 (0.0) 19 (0.0) 22 (0.0) 27 (0.1) 50 (0.1)



Appendix A: Table 1

24

Continuous Variables: N, MEAN (S.D.) , MEDIAN (I.Q.R.)

Variable Total Q1 Q2 Q3 Q4 Q5

Age (DHH_AGE)

240592, 43.1 (18.7), 42.0 (30.0)

52454, 42.4 (16.9), 43.0 (29.0)

48714, 42.8 (18.5), 43.0 (29.0)

48555, 43.4 (19.0), 43.0 (30.0)

48326, 43.6 (19.2), 43.0 (30.0)

42543, 43.1 (20.1), 41.0 (28.0)

Income (income_equivalized)

219712, 49436.9 (57430.8), 40414.5 (38890.9)

47825, 57145.2 (63043.2), 49296.1 (38956.4)

44279, 52259.2 (58893.8), 44721.4 (38797.8)

44120, 48567.6 (45418.2), 40414.5 (37500.0)

44199, 44499.3 (43926.8), 36000.0 (34568.5)

39289, 45338.9 (71353.6), 35000.0 (37735.0)

Leis. or trans. phys. act. daily energy expen. (PACDTLE)

239101, 2.4 (2.5), 1.7 (2.6)

52162, 2.5 (2.4), 1.8 (2.6)

48415, 2.4 (2.6), 1.7 (2.6)

48248, 2.4 (2.6), 1.6 (2.7)

48001, 2.2 (2.4), 1.6 (2.5)

42275, 2.3 (2.6), 1.7 (2.6)

Number of times walked to work/school, past 3 mo. (PAC_7A)

40136, 47.6 (42.5), 48.0 (46.0)

6361, 42.4 (37.9), 36.0 (50.0)

7300, 44.1 (38.7), 40.0 (48.0)

7946, 44.3 (38.5), 40.0 (48.0)

8424, 48.3 (42.8), 48.0 (45.0)

10105, 53.2 (49.1), 60.0 (45.0)

Number of times biked to work/school, past 3 months (PAC_8A)

8175, 24.6 (30.0), 13.0 (32.0)

1535, 20.6 (26.2), 10.0 (27.0)

1568, 21.3 (26.0), 12.0 (27.0)

1572, 23.1 (25.8), 12.0 (32.0)

1544, 24.5 (29.4), 14.0 (32.0)

1956, 29.2 (37.5), 20.0 (43.0)

Body Mass Index (HWTDBMI)

231640, 25.5 (5.1), 24.9 (6.1)

50505, 25.6 (4.8), 24.9 (6.2)

46905, 25.6 (5.1), 24.9 (6.3)

46734, 25.5 (5.1), 24.9 (6.2)

46488, 25.5 (5.2), 24.9 (6.2)

41008, 25.0 (5.4), 24.2 (5.8)



Appendix B: Results Tables

25

SSWS and Daily Energy Expenditure for All Resondents

WS Quintile

N Estimate LowerCL UpperCL P-valueQ1

REF REF REF REFQ2

0.128869 -0.03478 0.292517 0.122729Q3

0.024102 -0.1174 0.165604 0.738498Q4

0.02316 -0.1348 0.181117 0.773826Q5

0.320969 0.110406 0.531532 0.002811



SSWS and Daily Energy Expenditure by Age Category

Age Category WS Quintile

N Estimate LowerCL UpperCL P-value12-17 Q1 REF REF REF REF

Q20.470359 -0.49718 1.437898 0.340684

Q30.251054 -0.65164 1.153751 0.585687

Q4-0.25968 -1.11259 0.593219 0.550674

Q5-0.22748 -1.18826 0.733307 0.642615

18-29 Q1 REF REF REF REFQ2

0.041075 -0.3829 0.465048 0.849402Q3

-0.0309 -0.43389 0.372083 0.880523Q4

-0.08857 -0.54162 0.364474 0.701587Q5

0.91461 0.259204 1.570017 0.00623630-64 Q1 REF REF REF REF

Q20.133481 -0.03222 0.299178 0.114363

Q30.060961 -0.0741 0.196026 0.376361

Q40.237715 0.059469 0.415961 0.008952

Q50.455608 0.219263 0.691954 0.000158

65+ Q1 REF REF REF REFQ2

-0.03701 -0.22585 0.151831 0.700881Q3

-0.09176 -0.24037 0.056858 0.226235Q4

-0.11545 -0.25608 0.025178 0.107603Q5

-0.09807 -0.24869 0.052545 0.201883



SSWS and Daily Energy Expenditure by Population Centre Size ClassPopulation

ClassWS

QuintileN Estimate LowerCL UpperCL P-value

1,000 – 29,999 Q1 REF REF REF REFQ2 0.197115 -0.09331 0.487536 0.183429Q3 0.169152 -0.0681 0.406403 0.162296Q4 0.678292 0.179869 1.176714 0.007647Q5 0.460043 0.185392 0.734694 0.001027

30,000 – 99,999

Q1 REF REF REF REFQ2 0.386996 -0.17701 0.951007 0.17868Q3 -0.13839 -0.46298 0.186195 0.403351Q4 -0.12908 -0.44318 0.185016 0.420545Q5 -0.17223 -0.53075 0.186302 0.346446

100,000+ Q1 REF REF REF REFQ2 0.065253 -0.1289 0.259402 0.51006Q3 -0.00033 -0.17746 0.176802 0.997105Q4 -0.06352 -0.25174 0.124705 0.508358Q5 0.317782 0.068136 0.567428 0.012599




SSWS and Walking to Work/School for All Respondents

WS Quintile

N Odds Ratio LowerCL UpperCL P-valueQ1

REF REF REFQ2

1.38 1.29 1.48Q3

1.64 1.52 1.76Q4

2.06 1.91 2.21Q5

3.54 3.29 3.81




SSWS and Walking to Work/School by Age Category

Age Category WS Quintile

N Odds Ratio LowerCL UpperCL P-value12-17 Q1 REF REF REF

Q2 1.69 1.49 1.92Q3 1.84 1.61 2.1Q4 2.25 1.94 2.6Q5 2.39 2.02 2.82

18-29 Q1 REF REF REFQ2 1.29 1.13 1.46Q3 1.52 1.33 1.73Q4 1.81 1.6 2.05Q5 3.01 2.64 3.43

30-64 Q1 REF REF REFQ2 1.34 1.19 1.51Q3 1.75 1.56 1.97Q4 2.36 2.1 2.65Q5 4.54 4.06 5.07

65+ Q1 REF REF REFQ2 1.28 0.82 2.01Q3 1.41 0.93 2.13Q4 2.41 1.63 3.56Q5 3.87 2.65 5.64



SSWS and Walking to Work/School by Population Centre Size ClassPopulation

ClassWS

QuintileN Odds Ratio LowerCL UpperCL P-value

1,000 – 29,999 Q1 REF REF REFQ2 1.39 1.19 1.63Q3 1.73 1.48 2.03Q4 2 1.73 2.33Q5 2.53 2.13 3.01

30,000 – 99,999

Q1 REF REF REFQ2 1.49 1.26 1.75Q3 1.7 1.44 2.02Q4 2.18 1.85 2.58Q5 3.33 2.73 4.07

100,000+ Q1 REF REF REFQ2 1.37 1.26 1.5Q3 1.63 1.49 1.78Q4 2.07 1.9 2.26Q5 3.69 3.38 4.03




Appendix C: Unadjusted Results

31


neighbourhood walkability and physical activity levels in canadian communities

Documents

research gapsdata sources

research team

physical activity levels

types of physical activity

nationallevel data sources

research gapsour study

major research gap4background

national survey of health