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

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

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

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

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

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 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

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

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

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

Affective experiences and intentions to walk

Aims and method:

The study explored the influence of affective experiences of walking on walking intentions. A group of adults working or studying in Bristol, UK participated in an experiment involving virtual exposure to one of five environments, with evaluations of their affective experience and of intentions to walk in the setting. A subsample then took part in photo-elicited semi-structured interviews.

Key findings:

·      Affective experiences of walking influenced walking intentions, which in turn are influenced by traffic, city busyness, and poor aesthetics.

·      Safety, comfort, and moderate sensory stimulation are crucial elements for the walking experience.

Reference:

Bornioli, A., Parkhurst, G., & Morgan, P. L. (2019). Affective experiences of built environments and the promotion of urban walking. Transportation Research. Part A, Policy and Practice, 123, 200–215. 

https://doi.org/10.1016/j.tra.2018.12.006

Walkability and health

Aims and method:

The study evaluated the association between a single index of walkability that incorporated land use mix, street connectivity, net residential density, and retail floor area ratios, with health-related outcomes in King County, Washington. Among other measures, participants completed an extensive self-administered survey from which demographic covariates and measures of physical activity, weight, and height used in this analysis were taken.

Key findings:

·      There is a 5% increase in walkability to be associated with a per capita 32.1% increase in time spent in physically active travel, a 0.23-point reduction in body mass index, 6.5% fewer vehicle miles travelled, 5.6% fewer grams of oxides of nitrogen (NOx) emitted, and 5.5% fewer grams of volatile organic compounds (VOC) emitted.

·      The results connect development patterns with factors that affect several prevalent chronic diseases.

Reference:

Frank, L. D., Sallis, J. F., Conway, T. L., Chapman, J. E., Saelens, B. E., & Bachman, W. (2006). Many Pathways from Land Use to Health: Associations between Neighborhood Walkability and Active Transportation, Body Mass Index, and Air Quality. Journal of the American Planning Association, 72(1), 75–87. 

https://doi.org/10.1080/01944360608976725

New Urbanism principles and public health benefits

Aims and method:

This paper investigates how ten New Urbanism principles – walkability; connectivity; mixed use and diversity; mixed housing; quality architecture and urban design; traditional neighbourhood structure; increased density; smart transportation; sustainability; and quality of life – produce outcomes that affect public health. It includes a statistical analysis based on data obtained from selected counties in the United States to test the effect of walkability and connectivity and a literature review to examine the effect of the other eight.

Key findings:

·      New Urbanism principles lead to the higher usage of non-motorised and public transit modes, which results in more physical activity, less air pollution and safer streets featuring fewer traffic accidents

·      Complete community planning for residents, regardless of income, age or ideas, also resulted in better access to health resources

Reference:

Iravani, H., & Rao, V. (2019). The effects of New Urbanism on public health. Journal of Urban Design, 25(2), 218–235. 

https://doi.org/10.1080/13574809.2018.1554997

Walkable environment and active commuting

Aims and method:

This study examined the association between walkability and active commuting in Seoul, South Korea. A multilevel logistic regression model was used to examine the correlation between Walkability Score and the probability of active commuting after controlling for individual variables. The analysis used 129,044 individual samples nested within 424 administrative districts.

Key findings:

·      Walkability Score was significantly correlated with the odds of active commuting.

·      Public transportation density was also positively correlated with the odds of active commuting.

Reference:

Kim, E. J., Kim, J., & Kim, H. (2020). Does Environmental Walkability Matter? The Role of Walkable Environment in Active Commuting. International Journal of Environmental Research and Public Health, 17(4), 1261. 

https://doi.org/10.3390/ijerph17041261

Benefits of active travel in different socioeconomic contexts

Aims and method:

The study examined the relationships of walking and cycling benefits and varying socioeconomic contexts, identifying associations between cycling or walking and self-reported health.  Also whether socioeconomic status moderates these associations and whether gentrification influences the potential moderating effects. It used the 2017 US National Household Travel Survey subset of adults who lived in central cities (n = 91,541). Weighted logistic regression models with interaction terms were fit to estimate self-reported health status separately for cycling and walking. Gentrification was measured using an indicator based on previous research drawing on US Census data.

Key findings:

·      Cycling in the previous week and each additional walking trip were associated with higher odds of reporting better health.

·      Socioeconomic status moderated the positive associations between active transportation and health for a few variables.

·      Cyclists of colour had smaller health effects from cycling for utilitarian trips, while race and ethnicity had only a marginal moderating effect on the association between walking and health.

·      Gentrification was an insignificant moderating factor in general.

Reference:

Barajas, J. M., & Braun, L. M. (2021). Are cycling and walking good for all? Tracking differences in associations among active travel, socioeconomics, gentrification, and self-reported health. Journal of Transport & Health, 23, Article 101246. 

https://doi.org/10.1016/j.jth.2021.101246

Built environment walkability and diabetes hospitalisation

Aims and method:

The study evaluated the association between walkability indicators and hospital admissions due to diabetes in the Lisbon Metropolitan Area by different methods through a proposed ecological model. The built environment characteristics were evaluated using walkability measures including density, diversity and design, but also air quality and access to green areas. The socio-economic characteristic was controlled by the most common indicators, but it also included house size and house cost. The diabetes incidence was measured by hospital admissions due to diabetes. The statistical analysis was performed by a path analysis model that considers the complexity of effects on diabetes.

Key findings:

·      Built environment influences diabetes through air pollution and active travel.

·      Health can be improved through the promotion of active travel and the improvement of air quality.

Reference:

Pereira, M. F., Almendra, R., Vale, D. S., & Santana, P. (2020). The relationship between built environment and health in the Lisbon Metropolitan area – can walkability explain diabetes’ hospital admissions? Journal of Transport & Health, 18, Article 100893.

https://doi.org/10.1016/j.jth.2020.100893

Walkability and hypertension

Aims and method:

The study examined the associations between neighbourhood walkability and hypertension in a large and diverse population-based cohort. It examined the association between neighbourhood walkability and blood pressure outcomes for N = 429,334 participants drawn from the UK Biobank aged 38–73 years. Neighbourhood walkability was objectively modelled from detailed building footprint-level data within multi-scale functional neighbourhoods. A series of linear and modified Poisson regression models were employed to examine the association between walkability and outcomes of diastolic blood pressure and systolic blood pressure and prevalent hypertension adjusting for socio-demographic, lifestyle and related physical environmental covariates.

Key findings:

·      Neighbourhood walkability within a one-kilometre street catchment was beneficially associated with all the three blood pressure outcomes, independent of all other factors. 

·      Each interquartile increment in walkability was associated with the lower blood pressure outcomes of diastolic blood pressure and systolic blood pressure as well as reduced hypertension risk.

Reference:

Sarkar, C., Webster, C., & Gallacher, J. (2018). Neighbourhood walkability and incidence of hypertension: Findings from the study of 429,334 UK Biobank participants. International Journal of Hygiene and Environmental Health, 221(3), 458–468. 

https://doi.org/10.1016/j.ijheh.2018.01.009

Residents’ preferences for walkable neighbourhoods

Aims and method:

The study explored residents’ environmental preferences and examined their relationship to neighbourhood attributes commonly associated with walking through focus groups with 11 diverse residents’ groups.

Key findings:

·      Five dominant preferences relating to: the availability of local amenities, facilitating social interaction, a peaceful environment, a leafy locale and lower densities were identified.

·      Positive interactions between these and the attributes commonly associated with walking suggest that many groups will support the creation of walkable neighbourhoods, although those living in less walkable areas may not.

Reference:

Brookfield, K. (2016). Residents’ preferences for walkable neighbourhoods. Journal of Urban Design, 22(1), 44–58. 

https://doi.org/10.1080/13574809.2016.1234335

Environmental characteristics and people’s behaviours and perceptions of walking

Aims and method:

The study examined the relationship of the physical, land‐use, and social characteristics of the environment at the microscale to people's behaviour and perceptions toward walking. It used data from surveys and interviews to integrate user perceptions and subjective measures to understand the impact of environmental characteristics on walking behaviour on Main Streets.

Key findings:

·      Social qualities are significant in supporting walking.

·      Given a safe and comfortable setting, people look for usefulness, sense of belonging and pleasurability as additional and distinct needs to enhance their walking experience.

Reference:

Mehta, V. (2008). Walkable streets: pedestrian behavior, perceptions and attitudes. Journal of Urbanism: International Research on Placemaking and Urban Sustainability, 1(3), 217–245. 

https://doi.org/10.1080/17549170802529480