The relationship between perceived neighbourhood walkability and neighbourhood specific walking

among Calgarian adults: Preliminary findings from the EcoEUFORIA project

Public Health in Canada: Reducing Health Inequalities Through Evidence and Action, Canadian Public Health Association Conference,

Halifax, Nova Scotia, 1-4 June 2008

Gavin McCormack, Alan Shiell, Christine Friedenreich, Patricia Doyle-Baker, & Bev Sandalack

AcknowledgementsAcknowledgements

• EcoEUFORIA teamEcoEUFORIA team– Dr Alan Shiell (PI)Dr Alan Shiell (PI)– Dr Tish Doyle-BakerDr Tish Doyle-Baker– Dr Christine FriedenreichDr Christine Friedenreich– Dr Bev SandalackDr Bev Sandalack– Ms Whitney SmithersMs Whitney Smithers– Dr Billie Giles-CortiDr Billie Giles-Corti– Dr Gavin McCormackDr Gavin McCormack

• Funding Funding – Canadian Institutes of Health Research (project support)Canadian Institutes of Health Research (project support)– Alberta Heritage Foundation for Medical Research (salary support)Alberta Heritage Foundation for Medical Research (salary support)

• Project supportProject support– Calgary Health Region, Survey and Evaluation Unit (telephone-interviews)– Ms Brianna Butchart, Ms Betsy Setch and Dr Andrea Koop (data entry)

It is becoming too easy to be less physically active!It is becoming too easy to be less physically active!

Even walking the dog does not guarantee physical Even walking the dog does not guarantee physical activity anymore!activity anymore!

Physical activity is being engineered out of Physical activity is being engineered out of our daily lives in many waysour daily lives in many ways

Transport(motor vehicles, segways)

Communication(email, PDA)

Household chores(automation)

Urban design(sprawl)

Leisure(video games, internet)

Workplace(automation)

Physical inactivity

The problem is that being less active increases the The problem is that being less active increases the risk of developing chronic diseaserisk of developing chronic disease

0

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Relative risks (RR) of disease among inactive versus active adults

ActiveInactive

*Katzmarzyk (2000) The economic burden of physical inactivity in Canada. Katzmarzyk (2000) The economic burden of physical inactivity in Canada. CMAJCMAJ; **Paffenberger ; **Paffenberger (1994) Physical activity and personal characteristics associated with depression and suicide in (1994) Physical activity and personal characteristics associated with depression and suicide in American college menAmerican college men Acta Psychiatr. ScandActa Psychiatr. Scand (<1000Kcal versus 1000-2499Kcal PA/week); (<1000Kcal versus 1000-2499Kcal PA/week); ***Popkin et al . Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases. Popkin et al . Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases. Obesity ReviewsObesity Reviews..

Population-based problems require population-based answers

Creating built environments that are supportive of physical activity is one

strategy for increasing physical activity participation at the population level

Why is the built environment important for Why is the built environment important for promoting physical activity at a population level?promoting physical activity at a population level?

• Creating supportive built environments has the potential to Creating supportive built environments has the potential to influence the behaviour of entire communities and influence the behaviour of entire communities and populations and populations and not justnot just individuals individuals

Why is the built environment important for Why is the built environment important for promoting physical activity at a population level?promoting physical activity at a population level?

• Creating supportive built environments has the potential Creating supportive built environments has the potential to influence behaviour over a to influence behaviour over a long timelong time (e.g. many (e.g. many generations) because of generations) because of its semi-permanency semi-permanency

Why is the built environment important for Why is the built environment important for promoting physical activity at a population level?promoting physical activity at a population level?

• Creating supportive built environments can encourage Creating supportive built environments can encourage people to be active without them even thinking about itpeople to be active without them even thinking about it

Major attributes that contribute to a supportive Major attributes that contribute to a supportive environment for physical activityenvironment for physical activity1,2

• Land use mix and destinations close to homeLand use mix and destinations close to home– Recreational and utilitarianRecreational and utilitarian

• ConnectivityConnectivity– Street patterns that make pedestrian movement convenient but motor vehicle Street patterns that make pedestrian movement convenient but motor vehicle

movement less convenientmovement less convenient

• Appeal and aestheticsAppeal and aesthetics– Trees, architecture, interesting, separation of pedestrians and motor vehiclesTrees, architecture, interesting, separation of pedestrians and motor vehicles

• Safe placesSafe places– Personal safety, traffic safety, evidence of order (i.e. no graffiti or vandalism)Personal safety, traffic safety, evidence of order (i.e. no graffiti or vandalism)

• Residential densityResidential density– See other people active, surveillance, economically viable for small businessSee other people active, surveillance, economically viable for small business

11McCormack et al (2004) An update of recent evidence of the relationship between objective and self-McCormack et al (2004) An update of recent evidence of the relationship between objective and self-reported measures of the physical environment and physical activity behaviours. reported measures of the physical environment and physical activity behaviours. Journal of Journal of Science and Medicine in SportScience and Medicine in Sport

2 2 Humpel et al (2002) Environmental factors associated with adults' participation in physical activity: A Humpel et al (2002) Environmental factors associated with adults' participation in physical activity: A review. review. American Journal of Preventive MedicineAmerican Journal of Preventive Medicine

The EcoEUFORIA projectThe EcoEUFORIA project

• DefinitionDefinition

– EcoEconomic nomic EEvaluation of Using valuation of Using UUrban rban ForForm to m to IIncrease ncrease AActivityctivity

• Overall objectiveOverall objective

– To examine the cost effectiveness of creating pedestrian-friendly To examine the cost effectiveness of creating pedestrian-friendly neighbourhoods as a an intervention for increasing physical neighbourhoods as a an intervention for increasing physical activity and improving healthactivity and improving health

• Project contextProject context

– Calgary metropolitan areaCalgary metropolitan area

The EcoEUFORIA projectThe EcoEUFORIA project

Methods (sampling)Methods (sampling)

– Two random samples (n = 2200 each wave)Two random samples (n = 2200 each wave)

• Wave 1: conducted in Wave 1: conducted in Summer/ummer/Early fall (August to October, 2007)arly fall (August to October, 2007)• Wave 2: conducted in Wave 2: conducted in Winter/inter/Early spring (January to April, 2008)arly spring (January to April, 2008)

– Telephone-interview with a follow-up postal surveyTelephone-interview with a follow-up postal survey• Interviews conducted by CHRInterviews conducted by CHR

– Households sampled from directory of listed telephone numbersHouseholds sampled from directory of listed telephone numbers

– One person per household >18 yearsOne person per household >18 years

The EcoEUFORIA projectThe EcoEUFORIA project

Methods (telephone-interviews)Methods (telephone-interviews)

• Neighbourhood-specific physical activity behaviourNeighbourhood-specific physical activity behaviour1,21,2

• InsideInside versus versus outsideoutside the neighbourhood the neighbourhood• Neighbourhood defined as a Neighbourhood defined as a 15-minute15-minute walk from home walk from home

• Walking for transportation; walking for recreation; vigorous-intensity Walking for transportation; walking for recreation; vigorous-intensity physical activity; and moderate-intensity physical activityphysical activity; and moderate-intensity physical activity

• Frequency and duration during a usual weekFrequency and duration during a usual week

11McCormack, Shiell, Doyle-Baker, Friedenreich, Sandalack, & Giles-Corti (in press). Testing the McCormack, Shiell, Doyle-Baker, Friedenreich, Sandalack, & Giles-Corti (in press). Testing the reliability of neighborhood-specific measures of physical activity among Canadian adults. reliability of neighborhood-specific measures of physical activity among Canadian adults. Journal Journal of Physical Activity and Healthof Physical Activity and Health

22Giles-Corti et al. (2006) Development of a reliable measure of walking within and outside the local Giles-Corti et al. (2006) Development of a reliable measure of walking within and outside the local neighborhood: RESIDE's Neighborhood Physical Activity Questionnaire. neighborhood: RESIDE's Neighborhood Physical Activity Questionnaire. Preventive MedicinePreventive Medicine

The EcoEUFORIA projectThe EcoEUFORIA project

• Reasons for residential-selectionReasons for residential-selection11

– Importance of certain neighbourhood characteristics associated with Importance of certain neighbourhood characteristics associated with physical activityphysical activity

– Affordability, aesthetics, attractive scenery and cleanlinessAffordability, aesthetics, attractive scenery and cleanliness– Proximity to: public transport; parks; shops; services; work; recreation; and Proximity to: public transport; parks; shops; services; work; recreation; and

trailstrails– Ease of walking and drivingEase of walking and driving– Access to places to be physically activeAccess to places to be physically active

• Neighbourhood self-selectionNeighbourhood self-selection

– A major limitation of previous researchA major limitation of previous research

• Psychological variables (TBP) and demographicsPsychological variables (TBP) and demographics

Cerin et al (2007). Destinations that matter: Associations with walking for transport. Cerin et al (2007). Destinations that matter: Associations with walking for transport. Health and PlaceHealth and Place

The EcoEUFORIA projectThe EcoEUFORIA project

Methods (postal-survey)Methods (postal-survey)

– Included those completing the telephone-survey and agreeing to follow-upIncluded those completing the telephone-survey and agreeing to follow-up

– Two follow-up letters sent and incentive for returned surveysTwo follow-up letters sent and incentive for returned surveys

• Captured data:Captured data:

– Perceptions of neighbourhood walkability (ANEWS)Perceptions of neighbourhood walkability (ANEWS)11

– Social support (dog ownership, club membership, friends and family)Social support (dog ownership, club membership, friends and family)

– Social capital and sense of communitySocial capital and sense of community

– Self-rated health and height and weightSelf-rated health and height and weight

– Motor vehicle access and driving behaviourMotor vehicle access and driving behaviour

– DemographicsDemographics

11http://www.ipenproject.org (International Physical Activity and Environment Network)http://www.ipenproject.org (International Physical Activity and Environment Network)

The EcoEUFORIA projectThe EcoEUFORIA project

Results to date (wave 1 completed)Results to date (wave 1 completed)

– N = 2200 telephone-interviews completed (RR ≈34%)N = 2200 telephone-interviews completed (RR ≈34%)

– N = 1813 agreed to postal-survey (RR ≈ 82%)N = 1813 agreed to postal-survey (RR ≈ 82%)

– N = N = 1055 returned completed postal-survey (RR ≈ 5 returned completed postal-survey (RR ≈ 58%)%)

– Respondents returning the postal-survey are similar on most espondents returning the postal-survey are similar on most demographic attributes to those completing the telephone-interview but demographic attributes to those completing the telephone-interview but not agreeing to postal surveynot agreeing to postal survey

ResultsResults

Perceptions of neighbourhood walkability assessed using the Abbreviated Neighbourhood Walkability Scale (ANEWS)

Perceptions of neighbourhood walkability (ANEWS subscales)Perceptions of neighbourhood walkability (ANEWS subscales)

Score range Mean ± SD (Median) α

Residential density (6-items) 173-692 231.3 ± 75.5 (210) 0.32

Land use mix (recreation) (8-items)* 0-8 4.2 ± 1.7 (4) -

Land use mix (utilitarian) (19-items)* 0-19 8.1 ± 4.9 (8) -

Access to services (3-items) 3-12 9.5 ± 2.2 (10) 0.65

Barriers to reaching services (3-items) 3-12 8.5 ± 1.7 (5) 0.34

Street connectivity (3-items) 3-12 8.5 ± 2.0 (9) 0.48

Pedestrian infrastructure (3-items) 3-12 8.9 ± 1.8 (9) 0.27

Aesthetics (4-items) 4-16 9.3 ± 2.0 (9) 0.78

Traffic safety (2-items) 2-8 4.6 ± 1.4 (5) 0.41

Safety from crime (3-items) 3-12 4.8 ± 2.0 (4) 0.47

Pedestrian safety (3-items) 3-12 9.1 ± 1.7 (9) 0.79

*Count of destinations located within 15-minute walk of home; N=1055; Higher scores indicate higher perceived walkability

ResultsResults

Where does walking take place in relation to neighbourhoods and how

is it associated with walkability?

Where does physical activity take place Where does physical activity take place (participation)?(participation)?

Prevalence inside neighbourhood

Prevalence outside neighbourhood

Walking for transport

62.7% 33.6%

Walking for recreation

76.6% 35.9%

(N = 2199)

Prevalence of Prevalence of walking for transportwalking for transport inside the neighbourhood by inside the neighbourhood by neighbourhood walkabilityneighbourhood walkability

**

***

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*p<0.05 (n=1014-1024)

Prevalence of Prevalence of walking for recreationwalking for recreation inside the neighbourhood by inside the neighbourhood by neighbourhood walkabilityneighbourhood walkability

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LowMediumHigh

*p<0.05 (n=1014-1024)

Where does physical activity take place (minutes)?Where does physical activity take place (minutes)?

Minutes/week inside neighbourhood

Minutes/week outside neighbourhood

Walking for transport

121 ± 145 135 ± 167

Walking for recreation

187 ± 182 151 ± 158

(N = 2199)

(210 minutes/wk = 30 minutes/day or 420 minutes/wk = 60 minutes/day guideline)

Spearman’s Rank correlations between perceptions of Spearman’s Rank correlations between perceptions of neighbourhood walkability (ANEWS subscales) and walking neighbourhood walkability (ANEWS subscales) and walking

inside the neighbourhoodinside the neighbourhoodWT WR

Residential density (6-items) .18* -.01

Land use mix (recreation: 8-destinations) .14* -.02

Land use mix (utilitarian: 19 destinations) .15* -.02

Access to services or places (3-items) .16* -.01

Barriers to reaching service or places (3-items) .06 .01

Street connectivity (3-items) .17* .02

Pedestrian infrastructure (3-items) .08 -.02

Aesthetics (4-items) .04 .08*

Traffic safety (2-items) .05 .02

Safety from crime (3-items) .10* -.04

Pedestrian safety (3-items) .02 .01

Overall walkability (sum of all subscales) .20* -.02

*p<.05; N=626-638; Higher scores indicate higher perceived walkability

Prevalence of walking Prevalence of walking insideinside the neighbourhood by the neighbourhood by perceivedperceived overall walkabilityoverall walkability

56.1

78.1 79.871.1*

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WT inside WR inside

%

Low walkabilityHigh walkability

*p<0.05 (N=1034)

Minutes of walking Minutes of walking insideinside the neighbourhood by the neighbourhood by perceivedperceived overall walkabilityoverall walkability

93.4

184.3 181.2

130.1*

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WT inside WR inside

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Low walkabilityHigh walkability

*p<0.05; includes only those reporting minutes of participation (N[WT] = 650; N[WR] = 812)

ConclusionsConclusions

• Most walking behaviour is undertaken close to home

• Different attributes of the built environment are associated with specific types of walking (i.e. for transport versus recreation)

• Preliminary analysis adjusting for demographics (age, gender, education, No. children<18 years at home) show similar patterns of results

• Next step: examine the relationship between objective measures of the built environment and physical activity behaviour

For more information

Dr Gavin McCormack, PhD

AHFMR Postdoctoral Research Fellow

Population Health Intervention Research Centre

University of Calgary

Phone: 403-220-8193

Email: gmccorma@ucalgary.ca