BackgroundUnderstanding the relationship between urban design and physical activity is a high priority. Different representations of land use diversity may impact the association between neighbourhood design and specific walking behaviours. This study examined different entropy based computations of land use mix (LUM) used in the development of walkability indices (WIs) and their association with walking behaviour.MethodsParticipants in the RESIDential Environments project (RESIDE) self-reported mins/week of recreational, transport and total walking using the Neighbourhood Physical Activity Questionnaire (n = 1798). Land use categories were incrementally added to test five different LUM models to identify the strongest associations with recreational, transport and total walking. Logistic regression was used to analyse associations between WIs and walking behaviour using three cut points: any (> 0 mins), ≥ 60 mins and ≥ 150 mins walking/week.ResultsParticipants in high (vs. low) walkable neighbourhoods reported up to almost twice the amount of walking, irrespective of the LUM measure used. However, different computations of LUM were found to be relevant for different types and amounts of walking (i.e., > 0, ≥ 60 or ≥ 150 mins/week). Transport walking (≥ 60 mins/week) had the strongest and most significant association (OR = 2.24; 95% CI:1.58-3.18) with the WI when the LUM included 'residential', 'retail', 'office', 'health, welfare and community', and 'entertainment, culture and recreation'. However, any (> 0 mins/week) recreational walking was more strongly associated with the WI (OR = 1.36; 95% CI:1.04-1.78) when land use categories included 'public open space', 'sporting infrastructure' and 'primary and rural' land uses. The observed associations were generally stronger for ≥ 60 mins/week compared with > 0 mins/week of transport walking and total walking but this relationship was not seen for recreational walking.ConclusionsVarying the combination of land uses in the LUM calculation of WIs affects the strength of relationships with different types (and amounts) of walking. Future research should examine the relationship between walkability and specific types and different amounts of walking. Our results provide an important first step towards developing a context-specific WI that is associated with recreational walking. Inherent problems with administrative data and the use of entropy formulas for the calculation of LUM highlight the need to explore alternative or complimentary measures of the environment.

A recursive system of ordered self assessed health together with BRFSS data were used to investigate health and obesity in the Appalachian state of West Virginia. Implications of unobserved heterogeneity and endogeneity of lifestyle outcomes on health were investigated. Obesity was found to be an endogenous lifestyle outcome associated with impaired health status. Risk of obesity is found to increase at a decreasing rate with per capita income and age. Intervention measures which stimulate human capital development, diet-disease knowledge and careful land use planning may improve health and obesity outcomes in Appalachia in particular and rural America in general.

BackgroundWalking in neighborhood environments is undertaken for different purposes including for transportation and leisure. We examined whether sidewalk availability was associated with participation in, and minutes of neighborhood-based walking for transportation (NWT) and recreation (NWR) after controlling for neighborhood self-selection.MethodBaseline survey data from respondents (n = 1813) who participated in the RESIDential Environment (RESIDE) project (Perth, Western Australia) were used. Respondents were recruited based on their plans to move to another neighborhood in the following year. Usual weekly neighborhood-based walking, residential preferences, walking attitudes, and demographics were measured. Characteristics of the respondent’s baseline neighborhood were measured including transportation-related walkability and sidewalk length. A Heckman two-stage modeling approach (multivariate Probit regression for walking participation, followed by a sample selection-bias corrected OLS regression for walking minutes) estimated the relative contribution of sidewalk length to NWT and NWR.ResultsAfter adjustment, neighborhood sidewalk length and walkability were positively associated with a 2.97 and 2.16 percentage point increase in the probability of NWT participation, respectively. For each 10 km increase in sidewalk length, NWT increased by 5.38 min/wk and overall neighborhood-based walking increased by 5.26 min/wk. Neighborhood walkability was not associated with NWT or NWR minutes. Moreover, sidewalk length was not associated with NWR minutes.ConclusionsSidewalk availability in established neighborhoods may be differentially associated with walking for different purposes. Our findings suggest that large investments in sidewalk construction alone would yield small increases in walking.

Obesity has joined the list of "wicked problems" with associated implications for public health, food security, and the entire food supply chain. This paper examines the possible causes, consequences, and policy implications, especially important in an environment of shrinking budgets. The causes of obesity are multifaceted and involve complex interactions; hence any successful prevention and mitigation strategy should identify the key factors and interactions thereof. We propose a dynamic and integrated individual, social, economic and environmental model (ISEEM) to accomplish this. Within this framework, the optimal mix of economic incentives, better education, and land use planning emerge as key factors in obesity prevention and mitigation and the promotion of healthier, more sustainable communities. The use of the ISEEM framework, involving a combination of strategies targeted to specific circumstances of individual communities and localities, could address this wicked problem in an environment characterized by increasing conflicts among budgets, heuristics, and politics.

Objectives To project hospitalisation trends due to selected non-communicable diseases (NCD) from 2005 to 2010. Design Morbidity data, maintained at the Medical Statistics Unit of the Ministry of Health, from 1981 to 2000, were used to model trends of hospitalisation due to diabetes mellitus, hypertensive disease and ischaemic heart disease. Linear and quadratic trends were used to model morbidity trends. Results For all three diseases considered, the increase in the incidence of hospitalisation is exponential. An increase is estimated in the incidence of hopsitalisation by 36%, 40% and 29% due to diabetes mellitus, hypertensive disease and ischaemic heart disease, respectively, in 2010 as compared to 2005. The greatest burden and the largest increase in the rate of hospitalisation will be due to hypertensive disease. Conclusions There will be an exponential increase in hospitalisation due to diabetes, hypertension and ischaemic heart disease. The health sector should provide additional resources to meet the demand.