Neighborhood environments and objectively measured physical activity in 11 countries
Purpose: Environmental changes are potentially effective population-level physical activity (PA) promotion strategies. However, robust multisite evidence to guide international action for developing activity-supportive environments is lacking. We estimated pooled associations of perceived environmental attributes with objectively measured PA outcomes, between-site differences in such associations, and the extent to which perceived environmental attributes explain between-site differences in PA. Methods: This was a cross-sectional study conducted in 16 cities located in Belgium, Brazil, Colombia, Czech Republic, Denmark, China, Mexico, New Zealand, Spain, United Kingdom, and United States of America. Participants were 6968 adults residing in administrative units stratified by socioeconomic status and transport-related walkability. Predictors were 10 perceived neighborhood environmental attributes. Outcome measures were accelerometry-assessed weekly minutes of moderate-to-vigorous PA (MVPA) and meeting the PA guidelines for cancer/weight gain prevention (420 min·wk−1 of MVPA). Results: Most perceived neighborhood attributes were positively associated with the PA outcomes in the pooled, site-adjusted, single-predictor models. Associations were generalizable across geographical locations. Aesthetics and land use mix—access were significant predictors of both PA outcomes in the fully adjusted models. Environmental attributes accounted for within-site variability in MVPA, corresponding to an SD of 3 min·d−1 or 21 min·wk−1. Large between-site differences in PA outcomes were observed; 15.9%–16.8% of these differences were explained by perceived environmental attributes. All neighborhood attributes were associated with between-site differences in the total effects of the perceived environment on PA outcomes. Conclusions: Residents' perceptions of neighborhood attributes that facilitate walking were positively associated with objectively measured MVPA and meeting the guidelines for cancer/weight gain prevention at the within- and between-site levels. Associations were similar across study sites, lending support for international recommendations for designing PA-friendly built environments. ; All authors declare financial support for the submitted work from the National Cancer Institute of the National Institutes of Health. Data collection in Hong Kong was supported by the Hong Kong Research Grants Council General Research Fund grants (#HKU740907H and #747807H) and Hong Kong University University Research Committee Strategic Research Theme (Public Health). US data collection and coordinating center processing was supported by the National Institutes of Health grants R01 HL67350 (National Heart, Lung, and Blood Institute) and R01 CA127296 (National Cancer Institute). The study conducted in Bogotá was funded by Colciencias grant 519_2010, Fogarty, and CeiBA. The contributions of N. O. were supported by National Health and Medical Research Council program grant #569940, National Health and Medical Research Council Senior Principal Research Fellowship #1003960, and by the Victorian Government's Operational Infrastructure Support Program. The Danish study was partly funded by the Municipality of Aarhus. Data collection in the Czech Republic was supported by the grant Ministry of Education, Youth and Sports (#MSM 6198959221). Data collection in New Zealand was supported by the Health Research Council of New Zealand grant #07/356. Data collection in Mexico was supported by the Centers for Disease Control and Prevention Foundation, which received a training grant from the CocaCola Company. The United Kingdom study was funded by the Medical Research Council under the National Preventive Research Initiative. D. S. received a research grant from the Centers for Disease Control and Prevention Foundation; O. L. S. received a research grant from the Coca-Cola Company outside of submitted work; K. L. C. is a consultant for Santech, Inc.; J. F. S. received grants and personal fees from the Robert Wood Johnson Foundation outside of submitted work, grants and nonfinancial support from Nike, Inc., outside of submitted work, is a Santech, Inc., shareholder, and is a consultant and receiver of royalties from SPARK Programs of School Specialty, Inc.