Walking for transportation or leisure: What difference does the neighborhood make?

Abstract

BACKGROUND: Patients are often advised to initiate a physical activity program by walking for transportation or leisure. This study explored whether neighborhood factors beyond the individual might affect compliance. OBJECTIVE: We examined the associations between total walking and neighborhood factors in a multi-ethnic population-based sample in California and the roles race/ethnicity plays in these associations. DESIGN: Cross-sectional study PARTICIPANTS: Individual-level data were obtained from the 2003 California Health Interview Survey. Participants' census tracts were linked to Census 2000 data to capture neighborhood SES. MEASUREMENTS AND MAIN RESULTS: The dependent variable was self-reported walking at recommended levels. Neighborhood SES was measured by a scale of 4 Census-based variables (alpha=0.83). Social cohesion was measured by a scale tapping the extent of perceived social connectedness, trust, and solidarity among neighbors (alpha=0.70). Neighborhood access to a park, playground, or open space was measured by a single item. Safety was measured by a scale of three items (alpha=0.66). We performed a series of multiple logit models with robust variance estimates while taking complex survey design into account. Neighborhood social cohesion (odds ratio [OR]=1.09, 95% CI=1.04, 1.14) and access to a park, playground, or open space (OR=1.26, 95% CI=1.16, 1.36) were significant environmental correlates of walking at recommended levels, independent of individual socio-demographics. Subgroup analysis showed that neighborhood effects were different by race/ethnicity. CONCLUSIONS: Neighborhood physical and social environmental factors are significantly associated with walking at recommended levels. Being aware of the ways that the environment could affect a patient's compliance with PA recommendations may help physicians tailor recommendations to circumstances. © 2007 Society of General Internal Medicine.