Abstract
We evaluated perceived social and environmental supports for physical activity and walking using multivariable modeling. Perceptions were obtained on a sample of households in a southeastern county. Respondents were classified according to physical activity levels and walking behaviors. Respondents who had good street lighting; trusted their neighbors; and used private recreational facilities, parks, playgrounds, and sports fields were more likely to be regularly active. Perceiving neighbors as being active, having access to sidewalks, and using malls were associated with regular walking.
The beneficial effect of physical activity on reducing chronic disease is well established,1–3 but most of the US population is not regularly active.1,4 A social ecological perspective of health5–7 suggests that social and environmental factors play an important role in increasing physical activity.8–13 In this study, we use a multivariable approach to evaluate how perceptions of social and physical environmental supports contribute to predicting physical activity and walking behavior.
METHODS
Data were collected from a sample of households in a predominantly rural southeastern county. Households were selected within each census tract of the county to guarantee a balance in racial and geographic distributions. Respondents aged 18 years or older were randomly selected from all adults living in each household. Based on 1194 telephone interviews, the survey response rate was 54%.
The interview assessed demographic characteristics, social and physical environmental perceptions, and physical activity and walking behavior. Survey items were developed from an extensive literature review,8,10,14,15 expert input, and community focus groups.16
Thirteen items addressed perceived supports and barriers of physical activity in the neighborhood, defined as a 0.5-mile radius or 10-minute walk from the respondent’s home. Supports for physical activity were sidewalks, public recreation facilities, streetlights, having a pleasant neighborhood for walking, and physically active neighbors. Barriers to physical activity included traffic volume, unattended dogs, crime, and perception of neighbors being untrustworthy.
Thirteen items related to perceived supports and barriers of physical activity in the community, defined as a 10-mile radius or 20-minute drive from the residence. Supports included walking/bike trails, swimming pools, recreation facilities, parks, playgrounds, sports fields, schools, malls, places of worship, and waterways. Barriers included crime and safety concerns associated with recreation facilities. Test–retest reliabilities ranged from .42 to .74 for neighborhood variables and from .28 to .56 for community variables, with modest κ coefficients between perceptions and objective data.17
Physical activity was measured using the 2001 Behavioral Risk Factor Surveillance System physical activity module18–20 to classify respondents as active (30 minutes or more of moderate physical activity 5 or more days per week, or 20 or more minutes of vigorous physical activity 3 or more days per week), insufficiently active (lower levels of physical activity than active), or inactive (no moderate or vigorous physical activity). Respondents also were classified as regular walkers (30 or more minutes 5 or more days per week), irregular walkers (lower levels than regular walkers), or nonwalkers (no walking for 10 minutes or more at a time).
Analysis weights were constructed to adjust for numbers of adults and voice telephone lines in each household and for the differential sampling and response rates. All statistical analyses incorporated these weights using SUDAAN Version 80 (Research Triangle Institute, Research Triangle Park, NC). Generalized logistic regression allowed for 3 levels of the dependent variables, with inactive and nonwalker categories used as referent levels for classifying physical activity and walking behavior. An odds ratio greater than unity reflects an increased likelihood of physical activity or walking at the specified level. The associations of demographic, neighborhood, and community variables with physical activity and walking were assessed to develop multivariable models.
RESULTS
The sample demographics are presented in Table 1 ▶. Multivariable modeling demonstrated that younger age; better street lighting; trust of neighbors; and use of private recreation facilities, parks, playgrounds, sports fields, schools, and worship facilities were associated with increased physical activity (Table 2 ▶). Younger age, more education, having physically active neighbors, having sidewalks available in the neighborhood, and using a mall for walking were associated with increased walking behaviors.
TABLE 1—
Demographic Characteristics and Physical Activity Behaviors
| Variable | n | Weighted % |
| Age, y | ||
| 18–34 | 256 | 35.6 |
| 35–54 | 456 | 36.2 |
| ≥ 55 | 482 | 28.2 |
| Race | ||
| African American | 477 | 41.0 |
| White | 687 | 59.0 |
| Other/data missing | 30 | . . . |
| Gender | ||
| Male | 473 | 43.7 |
| Female | 721 | 56.3 |
| Education | ||
| Some college or technical school | 630 | 54.3 |
| High school diploma or less | 551 | 45.7 |
| Data missing | 13 | . . . |
| Physical activity | ||
| Regularly active | 395 | 37.6 |
| Irregularly active | 555 | 44.6 |
| Inactive | 234 | 17.8 |
| Data missing | 10 | . . . |
| Walking behavior | ||
| Regular walking | 420 | 39.5 |
| Irregular walking | 438 | 34.8 |
| Nonwalker | 320 | 25.7 |
| Data missing | 16 | . . . |
TABLE 2—
Associations With Physical Activity and Walking Behavior
| Physical Activity Behavior | Walking Behavior | |||||
| Variable | Active vs Inactive OR (95% CI) | Sufficiently Active vs Inactive OR (95% CI) | Overall P | Regular Walking vs No Walking OR (95% CI) | Irregular Walking vs No Walking OR (95% CI) | Overall P |
| Demographic Variables | ||||||
| Age, y | 0.0121 | 0.0002 | ||||
| 18–34 | 2.17 (1.20, 3.92) | 1.35 (0.76, 2.38) | 3.44 (2.00, 5.93) | 1.53 (0.90, 2.61) | ||
| 35–54 | 2.06 (1.18, 3.60) | 1.92 (1.16, 3.18) | 1.99 (1.17, 3.37) | 1.24 (0.74, 2.06) | ||
| ≥ 55 | 1.00 | 1.00 | 1.00 | 1.00 | ||
| Education | . . . | 0.0424 | ||||
| Some college or technical school | . . . | . . . | 1.69 (1.07, 2.66) | 1.69 (1.08, 2.65) | ||
| High school or less | . . . | . . . | 1.00 | . . . | ||
| Neighborhood Variables | ||||||
| People active in neighborhood | . . . | 0.0002 | ||||
| Yes | . . . | . . . | 2.66 (1.67, 4.25) | 1.65 (1.06, 2.60) | ||
| No | . . . | . . . | 1.00 | 1.00 | ||
| Sidewalks in neighborhood | . . . | 0.0114 | ||||
| Yes | . . . | . . . | 1.39 (0.77, 2.51) | 2.23 (1.27, 3.92) | ||
| No | . . . | . . . | 1.00 | 1.00 | ||
| Street lighting in neighborhood | 0.0448 | . . . | ||||
| Good | 1.21 (0.70, 2.09) | 0.84 (0.49, 1.43) | . . . | . . . | ||
| Fair | 1.28 (0.68, 2.43) | 1.73 (0.96, 3.11) | . . . | . . . | ||
| Poor | 1.00 | 1.00 | . . . | . . . | ||
| Uses private recreation facility | < 0.0001 | . . . | ||||
| Yes | 7.26 (3.52, 14.95) | 4.36 (2.17, 8.76) | . . . | . . . | ||
| No | 1.00 | 1.00 | . . . | . . . | ||
| Neighbors can be trusted | 0.0002 | . . . | ||||
| Yes | 2.64 (1.32, 5.30) | 3.72 (1.99, 6.95) | . . . | . . . | ||
| No | 1.00 | 1.00 | . . . | . . . | ||
| Community Variables | ||||||
| Community parks | 0.0192 | . . . | ||||
| Uses parks | 2.20 (1.21, 3.98) | 1.96 (1.10, 3.49) | . . . | . . . | ||
| Does not use parks | 0.81 (0.46, 1.43) | 1.12 (0.66, 1.90) | . . . | . . . | ||
| No parks | 1.00 | 1.00 | . . . | . . . | ||
| Community malls for physical activity | . . . | 0.0030 | ||||
| Uses malls | . . . | . . . | 0.77 (0.40, 1.48) | 1.68 (0.87, 3.24) | ||
| Does not use malls | . . . | . . . | 0.45 (0.26, 0.78) | 1.03 (0.59, 1.77) | ||
| No malls | . . . | . . . | 1.00 | 1.00 | ||
Note. OR = odds ratio; CI = confidence interval.
DISCUSSION
Few investigators have used multivariable analysis to assess the influence of environmental supports on physical activity,14 and less is known about the impact of such supports on walking behavior.10,12,21,22 The findings in the present study are consistent with previously identified univariate associations between social and environmental supports and physical activity10,14 and between walking behavior and access to trails.14,23
Overall, neighborhood variables were stronger predictors of physical activity and walking than were community variables. Consistent with social ecological models,5–7 increasing awareness and use of environmental supports already available in neighborhoods may be cost-effective for increasing physical activity and walking. Interventions to increase environmental supports for physical activity should target proximal locations—such as private recreational facilities, parks, playgrounds, and sports fields—as well as adequate lighting and the presence of convenient, nearby opportunities for physical activity. Future research on community-based interventions should focus on expanding awareness, safety, and access to and use of places where people can engage in physical activity and walking.
This study is cross-sectional; therefore, causal inferences cannot be made. The survey was based on self-report measures of perceptions, physical activity, and walking and was conducted during the winter months in a predominantly rural, southeastern community with only 1 small metropolitan area, limiting potential generalizability.
In summary, perceptions of social and physical environmental supports were positively associated with physical activity and walking behavior, especially at the neighborhood level. Increasing awareness of environmental supports, social comparison, and safety issues as well as of the importance of using opportunities for physical activity at the neighborhood level may be an effective strategy for future community-based interventions.
Acknowledgments
The Cardiovascular Health Branch, Centers for Disease Control and Prevention (CDC) cooperative agreement U48/CCU409664-06 (Prevention Research Centers Program) funded this study (B. E. Ainsworth, principal investigator), and the CDC Division of Nutrition and Physical Activity provided administrative support. The Office of Minority Health of the Department of Health and Human Services provided additional support.
Human Participant Protection This study was approved by the institutional review board of the University of South Carolina.
Contributors C. L. Addy, B. E. Ainsworth, P. Sharpe, and D. Kimsey developed the environmental supports questionnaire and designed the overall study. C. L. Addy also designed and conducted the analyses for this article. K. A. Kirtland contributed to the implementation of the study, especially the data collection and management activities. D. K. Wilson contributed to the conceptual framework. All authors contributed to the writing of this brief.
Peer Reviewed
References
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