Neighborhood built environment and socioeconomic status in relation to physical activity, sedentary behavior, and weight status of adolescents☆
Introduction
Improvements in built environments are recommended to improve physical activity and reduce risk of obesity by numerous authoritative organizations (Institute of Medicine, 2012; Heath et al., 2006; U.S. Department of Health and Human Services, 2015; Mozaffarian et al., 2012; US Department of Health and Human Services, 2012; World Health Organization, 2004). Exposure to built environments can affect entire populations over long time periods, and the design of neighborhoods has been related to several important health outcomes and behaviors (Dannenberg et al., 2011). The most-studied behavior has been physical activity. Walkable community designs are believed to encourage walking and bicycling to destinations and contribute to total physical activity (U.S. Department of Health and Human Services, 2015; Sallis et al., 2012). Evidence linking walkability with physical activity is less consistent for youth than for adults (Ding et al., 2011).
Sedentary time, or sitting behaviors, are of interest because excessive sitting is a risk factor for metabolic disorders and weight gain, with most studies of youth based on television viewing (Zhu and Owen, 2016). A few studies of adults examined hypotheses that neighborhood environments with few opportunities for physical activity may lead residents to do more sedentary recreation, such as television viewing and computer games, but results have been inconsistent (Van Dyck et al., 2012). Many studies demonstrate that adult and youth residents of low-walkable, automobile-oriented neighborhoods spend more time in cars, a necessarily sedentary activity (Ewing and Cervero, 2010; Carlson et al., 2015). One study reported adolescents living in mixed-use neighborhoods spent less time watching television (Christian et al., 2017).
Increased physical activity is recommended as a youth obesity prevention strategy (Institute of Medicine, 2012; Barlow, 2007). Though overall sedentary time has not been consistently related to youth weight status (Ekelund et al., 2012), television viewing time is related to youth obesity, possibly due to effects on eating behaviors (Barlow, 2007). Studies of the relation of neighborhood environment attributes to weight status in adolescents have been inconsistent (Dunton et al., 2009).
There is growing evidence of socioeconomic status (SES) disparities in built environment variables (Lovasi et al., 2009; Sallis et al., 2011), so it useful to understand whether SES variables are effect modifiers between built environments and health-related outcomes. The present study examined the association of walkability to physical activity, sedentary time, and body mass index (BMI) among adolescents and examined SES as an effect modifier.
Section snippets
Study design
Data were from the TEAN (Teen Environment and Neighborhood) study conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington metropolitan areas 2009–2011. A cross-sectional 2 × 2 design was used to select census block groups of higher- versus lower-walkability and higher- versus lower-median household income, similar to prior studies (Frank et al., 2010; King et al., 2011).
Block group selection for participant recruitment
Census block group selection procedures were similar to those of a previous study (Frank et
Participant characteristics and representativeness
Participants were 928 adolescents; n = 443 in Seattle/King County, WA and n = 445 in the Baltimore/Maryland region. There were 468 (50.4%) girls and 460 (49.6%) boys; 66.3% were non-Hispanic white and 33.7% were nonwhite or Hispanic. The average adolescent participant's age was 14.1 (SD = 1.4) years old, with a range from 12 to 17 years (upper age for recruitment was 16 years old; however, 7 teens turned 17 between recruitment and data collection); 5.9% of adolescents had a driver's license,
Accelerometer measures
Adolescents' average daily MVPA was higher in walkable neighborhoods for both accelerometer cutpoints examined, with the Evenson-cutpoint scores also showing higher MVPA for youth in higher income neighborhoods. Youth living in areas with higher-walkability accumulated approximately 4.5 more minutes of objectively measured MVPA per day (4.7 min/day for 3-METs; 4.9 min/day for Evenson cutpoints) than youth living in lower-walkability areas, averaged across income groups.
Physical activity: survey measures
Adolescents' reported
Discussion
Greater home neighborhood walkability was associated as expected with adolescents having higher objectively-measured total MVPA, as well as more active transport to non-school destinations compared to adolescents living in low walkable neighborhoods. Walkability was also associated with less reported out-of-school sedentary time and less time watching TV/videos/DVDs, but not with objectively-measured total sedentary time. These findings applied similarly across income levels. For a few outcomes
Conclusion and implications
Neighborhood walkability was significantly associated with more favorable objectively-measured total physical activity and frequency of active transportation. Present cross-sectional results justify more prospective and natural experiment studies to evaluate whether stronger evidence for a causal role of the built environment can be developed. Almost all walkability effects were found to apply across income categories, suggesting the potential of improving walkability to have population-wide
Acknowledgment
The authors declare no conflicts of interest.
Financial interests
James Sallis is co-owner of Santech Inc.; receives royalties from the San Diego State University Research Foundation; and is a consultant to Sportime featuring SPARK Programs, owned by School Specialty Inc. Lawrence Frank is owner of Urban Design 4 Health.
The study was supported by NIH Grant HL083454. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Terry
Contributors' statement page
James F. Sallis conceptualized the study, obtained funding, participated in study design, drafted sections, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.
Terry L. Conway conceptualized the study, participated in study design, conducted analyses, contributed to interpretation, drafted sections, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.
Kelli L. Cain conceptualized and designed the study,
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Conflict of interest: The authors have no conflicts of interest to disclose.