Introduction to the Active Living Research Reference List 2007



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S. Allender, C. Foster, P. Scarborough and M. Rayner. (2007). The burden of physical activity-related ill health in the UK. Journal of Epidemiology and Community Health.

BACKGROUND: Despite evidence that physical inactivity is a risk factor for a number of diseases, only a third of men and a quarter of women are meeting government targets for physical activity. This paper provides an estimate of the economic and health burden of disease related to physical inactivity in the UK. These estimates are examined in relation to current UK government policy on physical activity. METHODS: Information from the World Health Organisation global burden of disease project was used to calculate the mortality and morbidity costs of physical inactivity in the UK. Diseases attributable to physical inactivity included ischaemic heart disease, ischaemic stroke, breast cancer, colon/rectum cancer and diabetes mellitus. Population attributable fractions for physical inactivity for each disease were applied to the UK Health Service cost data to estimate the financial cost. RESULTS: Physical inactivity was directly responsible for 3% of disability adjusted life years lost in the UK in 2002. The estimated direct cost to the National Health Service is pound 1.06 billion. CONCLUSION: There is a considerable public health burden due to physical inactivity in the UK. Accurately establishing the financial cost of physical inactivity and other risk factors should be the first step in a developing national public health strategy.

C. E. Autry, Anderson, S.C. (2007). Recreation and the Glenview Neighborhood: Implications for Youth and Community Development. Sport & Leisure Management.

The purpose of this interpretive study was to explore the voices of the ecological agents surrounding the youth of Glenview, a low-resource neighborhood. The research focused on a phenomenon that involved the establishment and discontinuation of a community organization effort to provide structured recreation programs for youth. Theoretical frameworks of the ecological perspective and community social organization guided the study. Twenty-one participants were interviewed. Four major themes were constructed from the data through constant comparison: the neighborhood environment, despondence, parental conditions and parental involvement. Implications relate to social capital and recreation's role in youth and community development.

E. M. Berke, L. M. Gottlieb, A. V. Moudon and E. B. Larson. (2007). Protective association between neighborhood walkability and depression in older men. Journal of the American Geriatrics Society.

OBJECTIVES: To evaluate the association between neighborhood walkability and depression in older adults. DESIGN: Cross-sectional analysis using data from Adult Changes in Thought (ACT), a prospective, longitudinal cohort study. SETTING: King County, Washington. PARTICIPANTS: Seven hundred forty randomly selected men and women aged 65 and older, cognitively intact, living in the same home for at least 2 years. MEASUREMENTS: Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. The Walkable and Bikable Communities Project provided objective data predicting the probability of walking at least 150 minutes per week in a particular neighborhood. ACT data were linked at the individual level via a geographic information system to this walkability score using buffer radii of 100, 500, and 1,000 meters around the subject's home. Multiple regression analysis tests were conducted for associations between the buffer-specific neighborhood walkability score and depressive symptoms. RESULTS: There was a significant association between neighborhood walkability and depressive symptoms in men when adjusted for individual-level factors of income, physical activity, education, smoking status, living alone, age, ethnicity, and chronic disease. The odds ratio for the interquartile range (25th to 75th percentile) of walkability score was 0.31 to 0.33 for the buffer radii (P=.02), indicating a protective association with neighborhood walkability. This association was not significant in women. CONCLUSION: This study demonstrates a significant association between neighborhood walkability and depressive symptoms in older men. Further research on the effects of neighborhood walkability may inform community-level mental health treatment and focus depression screening in less-walkable areas.

A. Bowling and M. Stafford. (2007). How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing. Social Science & Medicine.

The objective was to investigate associations between type of area, individuals' perceptions of their neighbourhoods, and indicators of social and physical functioning. Social functioning was measured using numbers of social activities and frequency of social contacts in the past month. Physical functioning was measured with Townsend's Activities of Daily Living scale. The study was a British cross-sectional population survey of people aged 65 plus living at home. Multilevel analyses indicated that respondents who lived in affluent areas were less likely to have low levels of social activity independently of individual demographic and socio-economic characteristics. Individuals' perceptions of the area as neighbourly and having good facilities were also independently associated with lower likelihood of low social activities. Affluence of the area and perceived neighbourhood were associated with physical functioning, although these associations disappeared once adjustment was made for individuals' characteristics. Both objective and more subjective measures of the neighbourhood independently contributed to our understanding of the determinants of social and physical functioning in older age. The unique value of this paper is its inclusion of the influence of perceived neighbourhood on the social and physical functioning of an older population, which are key components of active ageing.

A. G. Capon. (2007). Health impacts of urban development: key considerations. N S W Public Health Bull.

The urban environment is an important determinant of health. Health impact assessment is a tool for systematic analysis of the health consequences of urban development and management. This paper identifies key considerations, including opportunities for physical activity, food access and local economic development. Time use by urban residents has health implications. The schedule for infrastructure development in new release areas (in particular transport, education and health infrastructure) also has health implications. Health impacts should be considered a primary outcome of urban development and management.

F. J. Chaloupka and L. D. Johnston. (2007). Bridging the Gap: research informing practice and policy for healthy youth behavior. American Journal Of Preventive Medicine.

BACKGROUND: Bridging the Gap (BTG) is a collaborative research initiative supported by the Robert Wood Johnson Foundation. Ten years ago, BTG was created to assess the impact of policies, programs, and other environmental influences on adolescent alcohol, tobacco, and illicit drug use and related outcomes. This multidisciplinary, multisite initiative examines these factors at multiple levels of social organization, including schools, communities, and states. More recently, the significant increases in obesity among children, adolescents, and adults led BTG to expand its efforts to include research on the role of policies, programs, and other factors on adolescent obesity and the physical inactivity and dietary habits that contribute to this growing problem. Eleven papers resulting from BTG's obesity-related research are contained in this supplement, along with two papers describing the National Cancer Institute-supported efforts to track relevant state policies. METHODS: Bridging the Gap involves a variety of data-collection efforts built largely around the Monitoring the Future (MTF) surveys of 8th-, 10th-, and 12th-grade students. These include: surveys of administrators in the MTF schools that gather extensive information on the school food environment, physical education in schools, and other relevant information; collection of contextual information from the communities in which the MTF schools are located; tracking of relevant state policies; and gathering of a wide variety of data from archival and commercial databases. TheSEatabases are analyzed individually and in various combinations. DISCUSSION: Bridging the Gap's extensive research has shown the importance of a range of school, community, state, and other influences in affecting adolescent substance use and related outcomes. BTG's early research on adolescent diet, physical activity, and obesity--much of which is contained in this supplement--similarly demonstrates the role of environmental factors in influencing these outcomes and in explaining observed racial/ethnic and socioeconomic-related disparities in them. CONCLUSIONS: The growing recognition of the public health and economic consequences of childhood, adolescent, and adult obesity has led to a variety of policies, programs, and other interventions to stimulate healthy eating and physical activity, often despite the lack of evidence on their impact. BTG and others are working to build the evidence base for effective interventions to address this significant problem, but much remains to be learned.

C. Cutler, L. Cunningham-Roberts, S. Steinaway and K. Hare. (2007). Under construction: The journey of creating a healthy work environment. Critical Care Nurse.
N. Dragano, M. Bobak, N. Wege, A. Peasey, P. E. Verde, R. Kubinova, S. Weyers, S. Moebus, S. Mohlenkamp, A. Stang, R. Erbel, K. H. Jockel, J. Siegrist and H. Pikhart. (2007). Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health.

BACKGROUND: Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany. METHODS: We combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates. RESULTS: Smoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02-1.66] in the Czech Republic and 1.60 [95% CI 1.29-1.98] in Germany. CONCLUSION: In this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.

D. Fone, F. Dunstan, G. Williams, K. Lloyd and S. Palmer. (2007). Places, people and mental health: A multilevel analysis of economic inactivity. Social Science & Medicine.

This paper investigates multilevel associations between the common mental disorders of anxiety, depression and economic inactivity measured at the level of the individual and the UK 2001 census ward. The data set comes from the Caerphilly Health & Social Needs study, in which a representative survey of adults aged 18-74 years was carried out to collect a wide range of information which included mental health status (using the Mental Health Inventory (MHI-5) scale of the Short Form-36 health status questionnaire), and socio-economic status (including employment status, social class, household income, housing tenure and property value). Ward level economic inactivity was measured using non-means tested benefits data from the Department of Work and Pensions (DWP) on long-term Incapacity Benefit and Severe Disablement Allowance. Estimates from multilevel linear regression models of 10,653 individuals nested within 36 census wards showed that individual mental health status was significantly associated with ward-level economic inactivity, after adjusting for individual-level variables, with a moderate effect size of -0.668 (standard error = 0.258). There was a significant crosslevel interaction between ward-level and individual economic inactivity from permanent sickness or disability, such that the effect of permanent sickness or disability on mental health was significantly greater for people living in wards with high levels of economic inactivity. This supports the hypothesis that living in a deprived neighbourhood has the most negative health effects on poorer individuals and is further evidence for a substantive effect of the place where you live on mental health. (c) 2006 Elsevier Ltd. All rights reserved.

C. O. Gregory, J. Dai, M. Ramirez-Zea and A. D. Stein. (2007). Occupation is more important than rural or urban residence in explaining the prevalence of metabolic and cardiovascular disease risk in Guatemalan adults. The Journal of Nutrition.

Diet and activity pattern changes consequent to urbanization are contributing to the global epidemic of cardiovascular disease; less research has focused on activity within rural populations. We studied 527 women and 360 men (25-42 y), all rural-born and currently residing in rural or urban areas of Guatemala. We further classified rural male occupations as agricultural or nonagricultural. Overweight status (BMI > or = 25 kg/m(2)) differed by residence/occupation among men (agricultural-rural, 27%; nonagricultural-rural, 44%; and urban, 55%; P< 0.01) and women (rural, 58%; and urban, 68%; P= 0.04). A moderate-to-vigorous lifestyle was reported by 76, 37, and 20% of men (agricultural-rural, nonagricultural-rural, and urban, respectively; P< 0.01); most women were sedentary, with no difference by residence. Prevalence of the metabolic syndrome was 17, 24, and 28% in agricultural-rural, nonagricultural-rural, and urban men, respectively (P= 0.2), and 44 and 45% in rural and urban women (P= 0.4). Dietary variables were largely unassociated with adiposity or cardio-metabolic risk factors; physical activity was inversely associated with the percentage of body fat in men. Percent body fat was inversely associated with HDL-cholesterol, and positively associated with triglycerides, blood pressure, and the metabolic syndrome in both men and women, and with LDL-cholesterol and fasting glucose in women. Differences in physical activity level, mainly attributable to occupation, appear more important than residence, per se, in influencing the risk for cardiovascular disease among men; differences among these sedentary women are likely related to other factors associated with an urban environment.

L. G. Irwin, J. L. Johnson, A. Henderson, V. S. Dahinten and C. Hertzman. (2007). Examining how contexts shape young children's perspectives of health. Child Care Health Development.

BACKGROUND: We know that the social conditions in which children live exert a strong influence on their health; yet, we do not know how children's experience of these conditions of daily life shape their perspectives of health. METHODS: Through ethnographic research methods, the first author spent 1 year with the 14 6-year-old children involved in this research and examined how the contexts of daily life influenced the children's perspectives of health. The children involved in this study all lived in a neighbourhood characterized as having a complex of mid to high range of neighbourhood factors associated with vulnerability. RESULTS: The findings demonstrate that the children were able to articulate the health requirements of physical activity and healthy eating that supports their health. However, there was a disparity between the children's health knowledge, their perceptions and their contextual realities in relation to health. Children spoke of concerns for their physical safety within their schools and neighbourhoods; their lack of free range of play, and that they had few opportunities to play with or get to know neighbourhood friends. CONCLUSION: Professionals in contact with children and families who live in challenging social conditions need to be aware of how these contexts shape children's understanding of their own health potential.

L. Kann, N. D. Brener and H. Wechsler. (2007). Overview and summary: School Health Policies and Programs Study 2006. Journal of School Health.

BACKGROUND: The School Health Policies and Programs Study (SHPPS) 2006 is the largest, most comprehensive assessment of school health programs in the United States ever conducted. METHODS: The Centers for Disease Control and Prevention conducts SHPPS every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=538). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=1103) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n=912) and teachers of required physical education classes and courses (n=1194). RESULTS: SHPPS 2006 describes key school health policies and programs across all 8 school health program components: health education, physical education and activity, health services, mental health and social services, nutrition services, healthy and safe school environment, faculty and staff health promotion, and family and community involvement. SHPPS 2006 also provides data to monitor 6 Healthy People 2010 objectives. CONCLUSIONS: SHPPS 2006 is a new and important resource for school and public health practitioners, scientists, advocates, policymakers, and all those who care about the health and safety of youth and their ability to succeed academically and socially.

H. Meltzer, P. Vostanis, R. Goodman and T. Ford. (2007). Children's perceptions of neighbourhood trustworthiness and safety and their mental health. Journal of Child Psychology and Psychiatry.

BACKGROUND: Many studies have described associations between adult psychiatric disorder among adults and their biographic, socio-demographic and social capital characteristics. Fewer studies have focused on children, and most of these have looked at structural indicators of the neighbourhood. Our objective was to examine one aspect of social capital--perceived neighbourhood trust and safety in relation to childhood psychopathology. METHODS: Data on childhood psychopathology and perceived neighbourhood trust and safety were obtained on 3,340 11 to 16-year-olds included in a large survey of the mental health carried out in 426 postal sectors in Great Britain. Data were collected on biographic and socio-demographic characteristics of the child and the family, measures of social capital and neighbourhood prosperity. We entered all these variables into a logistic regression analysis to establish the strength of association between perceived neighbourhood trust and safety separately for emotional and conduct disorders. RESULTS: Children's perception of their neighbourhoods in terms of the trustworthiness or honesty of the people who live there or feeling safe walking alone had a strong association with childhood psychopathology, particularly emotional disorders, rather than the nature of the neighbourhood itself. Children's behaviour, however, such as going to the park or shops alone, did not vary by measures of childhood psychopathology. CONCLUSIONS: Regeneration of less prosperous neighbourhoods is likely to increase children's positive perceptions of trust, honesty and safety which in turn can have a positive effect on their mental health.

A. Niakara, F. Fournet, J. Gary, M. Harang, L. V. Nebie and G. Salem. (2007). Hypertension, urbanization, social and spatial disparities: a cross-sectional population-based survey in a West African urban environment (Ouagadougou, Burkina Faso). Trans R Soc Trop Med Hyg.

Data show that hypertension has become a public health problem in developing countries. Many studies have reported social disparities among the affected populations, but few of them pointed out spatial disparities within towns. We aimed to show that hypertension could be a good indicator of the medical change that occurs unequally in towns. A cross-sectional survey was done in April and October 2004 in Ouagadougou, Burkina Faso, among 2087 adults over 35 years old in different kinds of urban areas. Social and demographic data were collected and blood pressure was measured. Prevalence of hypertension was 40.2%. Age, body mass index, level of equipment, absence of community integration, absence of occupation, duration of residence over 20 years, protein-rich diet and absence of physical activity were identified as risk factors, but there were social and spatial disparities according to location of housing (parcelled-out or non-parcelled-out areas) and to integration within the town. The high rate of hypertension found in Ouagadougou and the heterogeneity of the risk within the population highlights that social and spatial risk factors have to be taken into account for the prevention of the non-transmissible diseases in countries in full process of urbanization and medical change.

C. Nygren, F. Oswald, S. Iwarsson, A. Fange, J. Sixsmith, O. Schilling, A. Sixsmith, Z. Szeman, S. Tomsone and H. W. Wahl. (2007). Relationships between objective and perceived housing in very old age. Gerontologist.

PURPOSE: Our purpose in this study was to explore relationships between aspects of objective and perceived housing in five European samples of very old adults, as well as to investigate whether cross-national comparable patterns exist. DESIGN AND METHODS: We utilized data from the first wave of the ENABLE-AGE Survey Study. The five national samples totalled 1,918 individuals aged 75 to 89 years. Objective assessments of the home environment covered the number of environmental barriers as well as the magnitude of accessibility problems (an aspect of person-environment fit). To assess perceptions of housing, we used instruments on usability, meaning of home, and housing satisfaction. We also assessed housing-related control. RESULTS: Overall, the results revealed that the magnitude of accessibility problems, rather than the number of physical environmental barriers, was associated with perceptions of activity-oriented aspects of housing. That is, very old people living in more accessible housing perceived their homes as more useful and meaningful in relation to their routines and everyday activities, and they were less dependent on external control in relation to their housing. The patterns of such relationships were similar in the five national samples. IMPLICATIONS: Objective and perceived aspects of housing have to be considered in order to understand the dynamics of aging in place, and the results can be used in practice contexts that target housing for senior citizens.

S. R. Silburn, E. Blair, J. A. Griffin, S. R. Zubrick, D. M. Lawrence, F. G. Mitrou and J. A. De Maio. (2007). Developmental and environmental factors supporting the health and well-being of Aboriginal adolescents. International Journal of Adolescent Medicine and Health.

Little progress has been made in the past 30 years in closing the gap between Aboriginal and non-Aboriginal Australians in terms of their educational outcomes, rates of incarceration, risks for chronic illnesses and reduced life-expectancy. The Western Australian Aboriginal Child Health Survey is the first population based survey of its kind developed specifically to inform policy and planning to improve the developmental health of Aboriginal children and youth. A random representative sample of 5,289 Aboriginal children aged 0-17 years, including 1,480 adolescents aged 12-17 years was surveyed through household based interviews with carers and adolescents, questionnaire data from schools and consensual record linkage to health service and education system data. The findings describe the prevalence and relative impact of developmental and environmental factors associated with the health and mental outcomes of Aboriginal adolescents. The major portion of the overall burden of disorder is now evident in the more urbanised living settings of Aboriginal families. Some health risk behaviours such as poor dietary intake, smoking, unprotected sex and insufficient physical exercise are more common in Aboriginal adolescents. However, others such as alcohol and marijuana use and suicidal behaviour occur at similar levels to those seen in non-Aboriginal youth.

R. J. Stokes, J. MacDonald and G. Ridgeway. (2008). Estimating the effects of light rail transit on health care costs. Health & Place.

In recent years, there has been a proliferation of research on the effects of the built environment, including mass transit systems, on health-related outcomes. While there is general agreement that the built environment affects travel choices and physical activity, it remains unclear how much of a public health benefit (in dollars) can be derived from land use policies that support walking, biking, and transit. In the present study, we develop a model to assess the potential cost savings in public health that will be realized from the investment in a new light rail transit system in Charlotte, NC. Relying on estimates of future riders, area obesity rates, and the effects of public transit on physical activity (daily walking to and from the transit stations), we simulated the potential yearly public health cost savings associated with this infrastructure investment. Our results indicate that investing in light rail is associated with a 9-year cumulative public health cost savings of dollars 12.6 million. While these results suggest that there is a sizable public health benefit associated with the adoption of light rail, they also indicate that the effects are relatively small compared to the costs associated with constructing and operating such systems. These findings suggest that planning efforts that focus solely on the health impact of modifications in the built environment are likely to overstate the economic benefits. Public health benefits should be considered along with broader environmental health benefits.

J. Williams, J. Toumbourou and R. Smith. (2007). The Healthy Neighbourhoods Study: Associations between BMI and other health and behaviour problems in early adolescence. International Journal Of Obesity.

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