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A4. Walkability, active travel and related health

Local infrastructure availability and walking

Aims and method:

Studies the effect of the design of urban environments on the health and well-being of residents by impacting social determinants of health including access to public transport, green space and local amenities. RESIDE is a longitudinal study examining the impact of urban planning on active living in Perth, Western Australia. Participants building homes in new housing developments were surveyed before relocation and approximately 12 months later (n = 1437). Changes in perceived and objective neighbourhood characteristics associated with walking following relocation were examined.

Key findings:

· Following relocation, transport-related walking declined overall (p < 0.001) and recreational walking increased (p < 0.001) reflecting access to transport and recreational destinations which changed in similar directions.

· For those with increased access to destinations, transport-related walking increased by 5.8 min/week for each type of transport-related destination that increased (p = 0.045); and recreational walking by 17.6 min/week for each type of recreational destination that increased (p = 0.070).

· This study provides longitudinal evidence that both transport and recreational-walking behaviours respond to changes in the availability and diversity of local transport and recreational destinations, and demonstrates the potential of local infrastructure to support health-enhancing behaviours.

Reference:

Giles-Corti, B., Bull, F., Knuiman, M., McCormack, G., Van Niel, K., Timperio, A., & Boruff, B. (2013). The influence of urban design on neighbourhood walking following residential relocation: longitudinal results from the RESIDE study. Social science & medicine, 77, 20-30.

http://www.sciencedirect.com/science/article/pii/S0277953612007381

Investment in the walking environment

Aims and method:

Set out the arguments and evidence for investing in the walking environment. Reviews the grey literature and discusses ten British case studies.

Key findings:

· Street improvements systematically increase pedestrian use.

· Improvements to Kensington High Street in London cost £5 million. Three years after completion traffic collisions in the affected area reduced by more than 40%, with pedestrian casualties reducing by 59%.

· In Sheaf Square and Howard Street, Sheffield, improvements cost £24 million and led to a reduction in vehicle use by 69% and an increase in pedestrian by around 150%

· Wanstead High Street improvements, in London cost £725,000, leading to a 122% increase in walking.

Reference:

Sinnett, D., Williams, K., Chatterjee, K., & Cavill, N. (2011). Making the case for investment in the walking environment: A review of the evidence.

https://www.livingstreets.org.uk/media/1394/2011-making-the-case-full-report.pdf

Environmental factors and obesity

Aims and method:

Examines associations between environmental and lifestyle factors and being overweight or obese. A cross-sectional survey and an environmental scan of recreational facilities in Metropolitan Perth (Western Australia) was undertaken. The subjects were healthy sedentary workers and homemakers aged 18 to 59 years (n = 1803) living in areas within the top and bottom quintiles of social disadvantage. The measures included four lifestyle factors, one social environmental factor, and five physical environment factors (three objectively measured).

Key findings:

· Overweight was associated with living on a highway (odds ratio [OR] 4.24; 95% confidence interval [CI] 1.62–11.09) or streets with no footpaths (sidewalks) or footpaths on one side only (OR 1.35; 95% CI 1.03–1.78) and perceiving no footpaths within walking distance (OR 1.42; 95% CI 1.08–1.86).

· Poor access to recreational facilities (OR 1.68; 95% CI 1.11–2.55) and footpaths (OR 1.62; 95% CI 0.98–2.68) or perceiving no shop within walking distance (OR 1.84; 95% CI 1.01–3.36) were associated with obesity.

Reference:

Giles-Corti, B., Macintyre, S., Clarkson, J. P., Pikora, T., & Donovan, R. J. (2003). Environmental and lifestyle factors associated with overweight and obesity in Perth, Australia. American Journal of Health Promotion, 18(1), 93-102.

http://journals.sagepub.com/doi/abs/10.4278/0890-1171-18.1.93

Neighbourhood-based differences and physical activity

Aims and method:

Evaluates the physical activity and weight status of the residents in two neighbourhood environments. On two occasions, 107 adults from neighbourhoods with differing ‘walkability’ were selected to complete a survey of their neighbourhood environment. Physical activity was assessed by self-report and by body worn accelerometers; height and weight were assessed by self-report.

Key findings:

· Neighbourhood environment characteristics including 1. residential density; 2. proximity to, and ease of access to, non-residential land uses such as restaurants and retail stores 3. street connectivity; 4. walking/cycling facilities such as footpaths (sidewalks) and pedestrian/bike trails; 5. aesthetics; 6. traffic safety; and 7. crime safety had moderate to high test / retest reliabilities.

· Residents of high-walkability neighbourhoods reported higher residential density, land use mix, street connectivity, better aesthetics, and safety. They did 70 minutes more physical activity and had lower obesity prevalence (adjusted for individual demographics) than did residents of low-walkability neighbourhoods.

Reference:

Saelens, B. E., Sallis, J. F., Black, J. B., & Chen, D. (2003). Neighborhood-based differences in physical activity: an environment scale evaluation. American journal of public health, 93(9), 1552-1558.

http://ajph.aphapublications.org/doi/abs/10.2105/ajph.93.9.1552

Street pattern (walkability) and obesity-related diseases

Aims and method:

Explores the relationship between street patterns and health. The study compares two neighbourhoods with similar amounts of green spaces, shops and anthropological characteristics but with different street patterns and correlates this with health data.

Key findings:

· The residents of the more walkable environment were significantly less likely to have abdominal obesity (adjusted OR 0.83, 95% CI 0.77e0.91)

· Also lower hypertension (adjusted OR 0.88, 95% CI 0.80e0.97) and diabetes (adjusted OR 0.86, 95% CI 0.75e0.99).

Reference:

Lee, H., Kang, H. M., Ko, Y. J., Kim, H. S., Kim, Y. J., Bae, W. K. & Cho, B. (2015). Influence of urban neighbourhood environment on physical activity and obesity-related diseases. Public health, 129(9), 1204-1210.

http://www.publichealthjrnl.com/article/S0033-3506(15)00238-3/abstract

House age as a surrogate for walkability

Aims and method:

Examine the association between a proxy measure of the urban environment – the age of houses – and walking behaviour in American cities. Using data from the Third National Health and Nutrition Examination Survey, logistic regression was used to estimate odds ratios and 95% confidence intervals and to control for the effects of gender, race/ethnicity, age, education level, household income, and activity limitations

Key findings:

· Adults who lived in homes built before 1946 and from 1946 to 1973 were significantly more likely to walk 1 + miles ≥ 20 times per month than those who lived in homes built after 1973.

· This association was present among people living in urban and suburban counties, but absent among those living in rural counties.

· The results support the hypothesis that environmental variables (namely a walkable street environment) influence walking frequency and suggest that home age may be a useful proxy for features of the urban environment that influence physical activity in the form of walking.

Reference:

Berrigan, D., & Troiano, R. (2002). The Association Between Urban Form and Physical Activity in U.S. Adults. American Journal of Preventative Medicine, 23(2S), 74-79.

http://ahtd.info/yahoo_site_admin/assets/docs/urbanformphysicalactivityPIIS0749379702004762.276112209.pdf

Mixed use, travel and obesity by ethnic group

Aims and method:

Evaluates the relationship between built environment around participants’ (n=10878) places of residence and self-reported travel patterns (walking and time in a car), body mass index (BMI), and obesity for specific gender and ethnicity classifications

Key findings:

· Mix land-use has the strongest association with obesity, with each quartile increase in mix being associated with a 12.2% reduction in the likelihood of obesity across gender and ethnicity. Each additional kilometre walked per day was associated with a 4.8% reduction in the likelihood of obesity.

· As a continuous measure, BMI was most strongly associated with urban form for white cohorts. Relationships among urban form, walk distance, and time in a car were stronger among white than black cohorts.

Reference:

Frank, L. D., Andresen, M. A., & Schmid, T. L. (2004). Obesity relationships with community design, physical activity, and time spent in cars. American journal of preventive medicine, 27(2), 87-96.

http://www.sciencedirect.com/science/article/pii/S074937970400087X?via%3Dihub

Urban landscapes qualities, walking and bicycling

Aims and method:

Studying the links between urban environments and non-motorised travel is the aim of this paper. It contains up to two days of daily activity information for members of 15,066 randomly selected households in the San Francisco Bay Area

Key findings:

· Land-use diversity in and around a person’s neighbourhood (e.g. the presence of neighbourhood retail) was the strongest predictor of walking amongst built environment factors.

· Bicycling, on the other hand, was equally influenced by density, diversity, and design, especially at the origin (i.e. the residential end) of a trip.

· The quality of the built environment around a person’s residential neighbourhood exerts a bigger impact on walking and bicycling than the quality at the destination.

Reference:

Cervero, R., & Duncan, M. (2003). Walking, bicycling, and urban landscapes: evidence from the San Francisco Bay Area. American journal of public health, 93(9), 1478-1483.

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.93.9.1478

Built environment variables and active travel decision-making

Aims and method:

This review article examines at various urban scales the relation between the built environment and human activity, and the causal link to obesity.

Key findings:

· Five variables describe characteristics of the neighbourhood-scale built environment that most influence household travel decisions: diversity (of land uses), design quality, destination accessibility, distance to public transport, and density.

· Currently there is no agreement over the extent to which each variable impacts on active travel.

Reference:

Garfinkel-Castro, A., Kim, K., Hamidi, S., & Ewing, R. (2017). Obesity and the built environment at different urban scales: examining the literature. Nutrition Reviews, 75 (suppl1), 51-61.

https://academic.oup.com/nutritionreviews/article-abstract/75/suppl_1/51/2797606/Obesity-and-the-built-environment-at-different

Relationship between urban sprawl, physical activity and health

Aims and method:

Determines the relationship between urban sprawl, health, and health-related behaviours. The project employed sprawl indices (derived from census and other data) as its independent variables and self-reported behaviour and health status from the U.S. Behavioural Risk Factor Surveillance System as the dependent variables. Cross-sectional analysis used hierarchical modelling to relate characteristics of individuals and places to levels of physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease in 448 U.S. counties and 83 metropolitan areas.

Key findings:

· Residents of sprawling counties were likely to walk less during leisure time, weigh more, and have greater prevalence of hypertension than residents of compact counties.

· At the metropolitan level, sprawl was similarly associated with minutes walked but not with the other variables.

Reference:

Ewing, R., Meakins, G., Hamidi, S., & Nelson, A. C. (2014). Relationship between urban sprawl and physical activity, obesity, and morbidity–update and refinement. Health & place, 26, 118-126.

http://journals.sagepub.com/doi/abs/10.4278/0890-1171-18.1.47

Walking, obesity and urban design

Aims and method:

Examines the connections between the design of the built environment and walking, between the design of the built environment and obesity, and between walking and obesity and income. Six neighbourhoods with different built environment characteristics, located in the Chinese cities of Shanghai and Hangzhou, were studied. Data on walking and other physical activity and obesity levels from 1,070 residents was collected through a street intercept survey conducted in 2013. Built environment features of 527 street segments were documented using the Irvine-Minnesota Inventory-China (IMI-C) environmental audit. Data was analysed using the State of Place™ Index.

Key findings:

· The result shows the direct relationship between the State of Place Index (incorporating urban form, parks and public spaces, pedestrian and cycle amenities, personal and traffic safety, and aesthetics) with individuals’ health.

· People in neighbourhoods with an above average State of Place rating walked 21.86 minutes more daily

· Respondents at either end of the income spectrum had lower BMIs (t = −2.149, p = 0.032) and walked more for commuting (t = 3.797, p = 0.018) than did middle income respondents.

Reference:

Alfonzo, M., Guo, Z., Lin, L., & Day, K. (2014). Walking, obesity and urban design in Chinese neighborhoods. Preventive Medicine, 69, S79-S85.

http://www.sciencedirect.com/science/article/pii/S0091743514003661

Urban design qualities and walkability

Aims and method:

Assesses the impact of urban design qualities on walkability in Salt Lake City, Utah. Utilising pedestrian counts and both on site and GIS data for a series of micro-urban design measures, the study examines walkability while controlling for spatial autocorrelation.

Key findings:

· Two urban design qualities were found to be significant for walkability: imageability (“the quality of a place that makes it distinctive, recognisable, and memorable”) and transparency (“the degree to which people can see or perceive what lies beyond the edge of a street”, in other words transparency of the building frontage).

· A third urban design quality, human scale (“a size, texture, and articulation of physical elements that match the size and proportions of humans and correspond to the speed at which humans walk”) approaches significance at the 90% probability level.

· Enclosure and complexity were not found to be significant

Reference:

Ameli, S. H., Hamidi, S., Garfinkel-Castro, A., & Ewing, R. (2015). Do better urban design qualities lead to more walking in Salt Lake City, Utah?. Journal of Urban Design, 20(3), 393-410.

http://www.tandfonline.com/doi/full/10.1080/13574809.2015.1041894

Urban quality and perceptions of walkability

Aims and method:

Explores the role of design in creating healthier cities through encouraging regular walking. The report studies three UK cities drawing on: Office of National Statistics mortality rates; Sport England 2009 and 2011 surveys of physical exercise; Public Health Observatories GP practices on diabetes; Health and Social Care Information Centre data on child obesity.

Key findings:

· If 75% of people failing to exercise enough across England did meet recommended levels of walking, £675 million could be saved each year.

· The healthiest local authorities in major cities have almost half the housing density and a fifth more green space than the least healthy ones.

· 75% of people in major cities who do not meet recommended levels of exercise say they could be encouraged to walk more each week.

· Streets and parks designed to be safer and more attractive were the most common changes people reported that would encourage them to walk more.

Reference:

Roberts-Hughes, R. (2013). City health check: How design can save lives and money. Architecture. com: Royal Institute of British Architects (RIBA).

https://www.architecture.com/-/media/gathercontent/city-health-check/additional-documents/ribacityhealthcheckpdf.pdf

Built environment and walking in a high density environment

Aims and method:

Examines the association between the built environment and walking activity by examining its impact in Seoul, a Korean megacity characterised by high-density development and a well-equipped public transportation system. Data was gathered using a Seoul-wide telephone survey of residents and their walking habits and this was linked to neighbourhood typology through GIS analysis. A regression analysis was used to identify associations between the two.

Key findings:

· Neighbourhoods with a relatively higher land-use mix and relatively greater access to public transportation have a significantly positive association with walking activity for destinations that are within a 500 m radius of residences.

· No positive association was found between development density by land use and walking activity.

· Higher densities, mixed land uses, and greater accessibility to public transportation systems within walking distance may be effective in reducing the use of private vehicles and increasing walking activity.

Reference:

Sung, H., Lee, S. & Jung, S. (2014). Identifying the Relationship between the Objectively Measured Built Environment and Walking Activity in the High-Density and Transit-Oriented City, Seoul, Korea. Environment and Planning B Urban Analytics and City Science, 41(4), 637-660.

http://journals.sagepub.com/doi/abs/10.1068/b39116

Pedestrian modal share and urban form

Aims and method:

Compares commuting characteristics of transit-oriented and auto-oriented suburban neighbourhoods, in the San Francisco Bay Area and in Southern California. The study used matched pair analyses of transit- and auto-oriented neighbourhoods. Transit neighbourhoods averaged higher densities and had more gridded street patterns compared to their nearby counterparts with auto-oriented physical designs. Neighbourhoods were matched in terms of median incomes and, to the extent possible, transit service levels, to control for these effects.

Key findings:

· For both metropolitan areas, pedestrian modal shares and trip generation rates tended to be considerably higher in transit than in auto-oriented neighbourhoods.

· The study found that residents of the transit-oriented communities patronised transit between 10 per cent and 45 per cent more than residents of nearby auto-oriented neighbourhoods did

· Islands of transit-oriented neighbourhoods in a sea of freeway-oriented suburbs seem to have negligible effects on transit commuting.

Reference:

Cervero, R. & Gorham, R. (1995). Commuting in Transit Versus Automobile Neighborhoods. Journal of the American Planning Association. 61(2), 210-225

http://www.tandfonline.com/doi/pdf/10.1080/01944369508975634?needAccess=true

Street design and active travel for utilitarian and leisure purposes

Aims and method:

Examines how a network of bike lanes (including set-aside street space for recreational cyclists and pedestrians on Sundays and holidays – the Ciclovía) along with other attributes of the built environment – urban densities, land-use mixes, accessibility, and proximity to public transport – are associated with rates of walking and cycling. Neighbourhoods and households from across Bogota are sampled and a large scale survey is used to compile primary data for subsequent modelling.

Key findings:

· The design of streets had the greatest impact on utilitarian cycle and pedestrian travel – specifically, street density, and in the case of cycling, route connectivity.

· For recreational activities, having reserved lanes for bicycles and pedestrians reasonably close to residences encouraged Ciclovía usage.

· The configuration, connectivity, and density of streets matter. Other built-environment factors (e.g. urban densities, land-use mix, and destination accessibility) did not, although this may be explained by the relative uniformity of Bogotá in these regards.

Reference:

Cervero, R., Sarmiento, O. L., Jacoby, E., Gomez, L. F., & Neiman, A. (2009). Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation, 3(4), 203-226.

http://www.tandfonline.com/doi/abs/10.1080/15568310802178314

The built environment and obesity

Aims and method:

Summarises existing empirical research relating the built environment to obesity. The Medline, PsychInfo, and Web of Science databases were searched using the keywords ‘obesity’ or ‘overweight’ and ‘neighbourhood’ or ‘built environment’ or ‘environment’. The search was restricted to English language articles conducted between 1966 and 2007. To meet inclusion criteria, articles had to have a direct measure of body weight and an objective measure of the built environment. A total of 1,506 abstracts were obtained, and 20 articles met the inclusion criteria

Key findings:

· Most articles (84%) reported a statistically significant positive association between some aspect of the built environment and obesity.

· Several methodological issues were of concern, including the inconsistency of measurements of the built environment across studies, the cross-sectional design of most investigations, and the focus on aspects of either diet or physical activity but not both.

Reference:

Papas, M. A., Alberg, A. J., Ewing, R., Helzlsouer, K. J., Gary, T. L., & Klassen, A. C. (2007). The built environment and obesity. Epidemiologic reviews, 29(1), 129-143.

https://www.ncbi.nlm.nih.gov/pubmed/17533172

Neighbourhood commuting environment and obesity

Aims and method:

Examines the urban–rural differential effects of neighbourhood commuting on obesity. Data from the USA 1997–2005 National Health Interview Survey (NHIS) was linked to 2000 Census data to assess the effects of the neighbourhood commuting environment: census tract-level automobile dependency and commuting time, on individual obesity status.

Key findings:

· Higher neighbourhood automobile dependency was associated with increased obesity risk in urbanised areas but not in non-core rural areas

· Longer neighbourhood commuting time was associated with increased obesity risk in large central metro, less urbanised areas, and non-core rural.

Reference:

Zhang, X., Holt, J. B., Lu, H., Onufrak, S., Yang, J., French, S. P., & Sui, D. Z. (2014). Neighborhood commuting environment and obesity in the United States: An urban–rural stratified multilevel analysis. Preventive medicine, 59, 31-36.

http://www.sciencedirect.com/science/article/pii/S0091743513004155

Physical activity and urban form

Aims and method:

To assess how objectively measured levels of physical activity are related with objectively measured aspects of the physical environment around participants homes while controlling for sociodemographic covariates. Objective measures of the built environment unique to each household's physical location were developed within a geographic information system to assess land-use mix, residential density, and street connectivity. These measures were then combined into a walkability index. Accelerometers were deployed over a 2-day period to capture objective levels of physical activity in 357 adults

Key findings:

· Community design is significantly associated with moderate levels of physical activity.

· Measures of land-use mix, residential density, and intersection density were positively related with number of minutes of moderate physical activity per day

· Individuals in the highest walkability quartile were 2.4 times more likely (confidence interval=1.18-4.88) than individuals in the lowest walkability quartile to meet the recommended > or =30 minutes of moderate physical activity per day

Reference:

Frank, L., Schmid, T., Sallis, J., Chapman, J. & Saelens, B . (2005). Linking objectively measured physical activity with objectively measured urban form: findings from SMARTRAQ. American Journal of Preventative Medicine, 28(2), 117-125.

https://www.ncbi.nlm.nih.gov/pubmed/15694519

Compact, walkable, diverse districts and health

Aims and method:

Explores the relationship between the creation of compact, walkable, diverse districts and health outcomes in the USA through a systematic review of evidence from a range of disciplinary sources: health journals, planning/design journals and transportation journals.

Key findings:

· Of the 66 studies explored that make a direct link between health and the design of the built environment, 50 revealed a mostly positive association, 14 made no significant link either way, and 2 found a negative association.

· Similar positive associations were found between compact, walkable, diverse districts and both social interaction and safety, but on the basis of far fewer studies

Reference:

Talen, E., & Koschinsky, J. (2014). Compact, Walkable, Diverse Neighborhoods: Assessing Effects on Residents. Housing Policy Debate, 24(4), 717-750.

http://www.tandfonline.com/doi/pdf/10.1080/10511482.2014.900102?needAccess=true

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