The contribution of area-level walkability to geographic variation in physical activity: a spatial analysis of 95,837 participants from the 45 and Up Study living in Sydney, Australia

Abstract

BackgroundIndividual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation.MethodsData on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA “disease maps” and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage.ResultsWithin-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4–32.0), 69.4 (95% CI 69.1–69.7), and 56.1 (95% CI 55.8–56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12–1.29) and 1.07 (95% CrI 1.01–1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01–1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors.ConclusionsWalkability is associated with area-level prevalence and geographic variation in sufficient walking and sufficient MVPA to improve health in Sydney, Australia. Our study supports the use of walkability indexes at multiple spatial scales for informing population-level action to increase physical activity and the utility of spatial analysis for walkability research and planning.

Neighborhood Walkability and BMI Change: A National Study of Veterans in Large Urban Areas

“…To increase walkability, cities might build well-connected street networks and/or adopt mixed-use zoning policies that help bring shopping, dining, and entertainment destinations close to where people live. These strategies are fueled partly by research showing that people living in more walkable communities tend to be more physically active and weigh less (3)(4)(5)(6)(7)(8)(9)(10)(11). But the results in the literature are inconsistent (12)(13)(14)(15)(16).…”

Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia

“…Indexes originating out of the North American Neighborhood Quality of Life Study (NQLS) [ 22 ] and Australian Physical Activity in Localities and Community Environments (PLACE) Study [ 8 ] projects have contributed to an extensive evidence base within the transportation, planning, and public health literatures linking the walkability of built environments to improvements in health behaviours and outcomes [ 24 , 25 , 26 , 27 , 28 , 29 ]. Much of this evidence comes from individual-level studies of participants and the micro (personal) and meso (neighbourhood) environments in which they live [ 21 , 30 ]. However, there is increasing interest in meso (area) environment walkability, its contributions to the distribution of health within populations, and how it may be used to inform population health programming at larger regional scales [ 8 , 23 , 30 , 31 , 32 ].…”

“…Much of this evidence comes from individual-level studies of participants and the micro (personal) and meso (neighbourhood) environments in which they live [ 21 , 30 ]. However, there is increasing interest in meso (area) environment walkability, its contributions to the distribution of health within populations, and how it may be used to inform population health programming at larger regional scales [ 8 , 23 , 30 , 31 , 32 ].…”

“…Between-group analyses of outcomes such as psychosocial distress can identify population sub-groups at increased risk of adverse mental health outcomes but provide limited information on the geography of these risks. In contrast, spatial analyses may be used to identify areas at increased risk of adverse outcomes or spatially structured influences on health by focusing on geographic variation in excess of that due to known demographic, social, economic, and health factors [ 30 , 37 , 38 ].…”

“…Spatial analyses of health outcomes and behaviours are increasingly common in the epidemiological literature as statistical methods and geographically-referenced administrative, surveillance and research data become more accessible [ 39 ]. Spatial analyses are especially informative for population health programming [ 30 ], which typically occurs at larger, regional spatial scales [ 31 ]. For example, Chaix et al identified differing spatial distributions and cluster resolutions of psychoactive substance use and neurotic disorders in Malmö, Sweden, which were associated with adverse social environments [ 40 ].…”