Home Neighborhood Research Articles

O5-5 Neighbourhood Walkability and Physical Activity: Moderating Role of a Physical Activity Interventions in Overweight and Obese Older Adults with Metabolic Syndrome

BackgroundWhile urban built environments might promote active ageing, an infrequently studied question is how the neighbourhood walkability modulates physical activity changes during a physical activity intervention program in older adults. We assessed the influence of objectively assessed neighbourhood walkability on the change in physical activity during the intervention program used in the ongoing PREvención con DIeta MEDiterránea (PREDIMED)-Plus trial. PREDIMED-Plus is a parallel-group, randomized trial which tested the effect of an intensive lifestyle intervention on cardiovascular disease prevention, in overweight and obese participants with the metabolic syndrome.MethodThe present study involved 228 PREDIMED-Plus senior participants aged between 55 to 75, recruited in Palma de Mallorca (Spain). Overweight/obese older adults with metabolic syndrome were randomized to an intensive weight-loss lifestyle intervention or a control group (106 intervention group and 122 control group). A home neighborhood environment walkability index (residential density, land use mix, intersections density) was calculated using geographic information systems (1km sausage-network buffer). Physical activity was assessed using accelerometer for seven days, and a REGICOR validated physical activity questionnaire, at baseline and 2 follow-up visits (six-months and one-year later). Generalized Additive Mixed Models (GAMMs) were fitted to estimate the association between the neighbourhood walkability index and changes in physical activity during follow-up.ResultsHigher neighbourhood walkability (1 z-score increment) was associated with moderate-to-vigorous accelerometer assessed physical activity duration, (ß = 3,44; 95% CI = 0.52;6.36 minutes per day). When analyses were stratified by intervention arm, the association was only observed in the intervention group (ß = 6.357; 95% CI = 2.07;10.64 minutes per day) (p for interaction = 0.055). There were no statistically significant associations between neighbourhood walkability and self-reported physical activity nor brisk walking duration.ConclusionsThe results indicate that the walkability of the neighbourhood could support a physical activity intervention, helping to maintain or increase older adults' objectively measured physical activity. This research may modify evidence on whether environmental factors modify habits acquisition during physical activity intervention programs.

154. Social Vulnerability Index (SVI) can be used to predict health care resource utilization and persistent opioid use after elective lumbar spine surgery

<h3>BACKGROUND CONTEXT</h3> The national capacity for health care expenditures is nearing its limit, having experienced recent exponential growth nearing a total of 17% of US GDP. As with all other finite resources, the question of efficient utilization becomes essential. This is especially apparent in subsets of medicine, such as spine surgery, that are significantly more costly. Exploration of patient-specific traits and how they relate to health care resource utilization has become as essential to the practice of medicine as patient outcomes. <h3>PURPOSE</h3> The purpose of this study is to investigate the association between social determinants of health and healthcare resource utilization following elective lumbar spine surgery. <h3>METHODS</h3> Patients who underwent elective spine surgery for lumbar degenerative pathology between November 1, 2013 and September 30, 2018, at a single academic center were retrospectively identified. The Cook County Social Vulnerability Index (SVI) metrics for each patient were determined based on the ZIP code of their home neighborhood. The SVI is comprised of separate scores pertaining to socioeconomic status, household compensation, minority status & language, and housing & transportation. Possible scores range from 0 (lowest vulnerability) to 1 (highest vulnerability). Health resource utilization was quantified within one year postoperatively (imaging studies, emergency and urgent care visits, opioid prescriptions and others). These metrics were compared between patients with social vulnerability – defined as a SVI score in the upper quartile (SVI=0.75) and control patients (SVI score < 0.75). <h3>RESULTS</h3> A total of 92 patients were included in the final cohort. Of these, 33 (35.9%) were considered socially vulnerable based on their SVI metrics. Socially vulnerable patients were more likely to utilize the emergency department within 180 (0.5 ± 1.1 vs 0.1 ± 0.4; p=0.028) and 365 (0.7 ± 1.7 vs 0.2 ± 0.7; p=0.045) days postoperatively. Socially vulnerable patients were more than 3 times more likely to have persistent opioid use at 180 days postoperatively to controls (36.3% vs 11.9%; p=0.005). An overall SVI in the upper quartile was associated with persistent opioid use (OR 4.245; 95% CI: 1.469 – 12.265) and at least one emergency department visit within 180 days postoperatively (OR 4.050; 95% CI: 1.227 – 13.370). <h3>CONCLUSIONS</h3> The SVI was associated with postoperative opioid use and emergency department utilization after surgery. Socially vulnerable patients were more likely to utilize emergency department services and to have persistent opioid use at 6 months postoperatively from elective lumbar spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Between place and territory: Young people's emotional geographies of security and insecurity in Brussels' deprived areas

While much of literature on place attachment describes it as an affective bond between a (young) person and place, with positive psychosocial consequences such as identification, rootedness and belonging, some authors are cautious and stress that an enhanced attachment to place, termed “territoriality”, may have negative consequences such as hostility towards outsiders and a sense of non-belonging elsewhere. In this paper, I ask how we should understand this difference and how the analysis of young people's emotional geographies of (in)security can bring light to this question. The paper finds that emotional geographies of (in)security are instrumental in understanding how a “positive” attachment to place may lead to a “negative” attachment to territory, how some young people emotionally attach to places and some are inclined to claim these places against outsiders (and also at the expense of other members of the community). This explicit appropriation of public spaces in the home neighbourhood is co-constituted by feeling secure inside and insecure outside the area. Territoriality may be a response to or an expression of ontological insecurity and of the inner unease that prompts them to strange avoidance and contorted strategies for manipulating spaces and setting boundaries designed to secure the self.

A Mixed-Methods Participatory Intervention Design Process to Develop Intervention Options in Immediate Food and Built Environments to Support Healthy Eating and Active Living among Children and Adolescents in Cameroon and South Africa.

Rates of obesity and related non-communicable diseases are on the rise in sub-Saharan Africa, associated with sub-optimal diet and physical inactivity. Implementing evidence-based interventions targeting determinants of unhealthy eating and physical inactivity in children and adolescents’ immediate environments is critical to the fight against obesity and related non-communicable diseases. Setting priorities requires a wide range of stakeholders, methods, and context-specific data. This paper reports on a novel participatory study design to identify and address contextual drivers of unhealthy eating and physical inactivity of children and adolescents in school and in their home neighborhood food and built environments. We developed a three-phase mixed-method study in Cameroon (Yaoundé) and South Africa (Johannesburg and Cape Town) from 2020–2021. Phase one focused on identifying contextual drivers of unhealthy eating and physical inactivity in children and adolescents in each setting using secondary analysis of qualitative data. Phase two matched identified drivers to evidence-based interventions. In phase three, we worked with stakeholders using the Delphi technique to prioritize interventions based on perceived importance and feasibility. This study design provides a rigorous method to identify and prioritize interventions that are tailored to local contexts, incorporating expertise of diverse local stakeholders.

Examination of the Relationship Between Daily Perceptions of Collective Efficacy and Marijuana Use Among Black Youth: Does the Location of the Perception Matters?

Neighborhood-level collective efficacy protects Black youth from substance use; however, neighborhood research does not account for the entirety of adolescents' exposure or their perceptions of space which may be critical to understanding the role of context in substance use. To address this limitation, the SPIN Project recruited 65 Black adolescents (M(SD) = 15.32(1.06)) to complete four brief surveys each day for a month describing their perceptions of spaces and marijuana use. Multilevel negative binomial models were estimated to test the relationship between an individual's perceptions of collective efficacy and the marijuana used during a day, and if the location of the observations moderated these relationships. Findings indicated that the perceptions of collective efficacy protected adolescents from marijuana use when occurring within their home neighborhood, but not outside of it; thereby suggesting important variations in adolescents' perceptions based on the location that matter for Black youth marijuana use.

Home Tobacco Smoke Exposure and Neighborhood Support and Safety among U.S. School-Aged Children

Children who are socioeconomically disadvantaged face a myriad of environmental hardships in the neighborhoods in which they live. This study examined the associations between home tobacco smoke exposure (TSE) and neighborhood support, neighborhood safety, and school safety among U.S. school-aged children. Children ages 6-11 years were included in this secondary analysis of 2018-2019 National Survey of Children’s Health data (N = 17,300). Children’s home TSE status was categorized into three levels: (1) no TSE: Child did not live with a smoker; (2) Outside TSE only: Child lived with a smoker who did not smoke inside the home; and (3) Inside TSE: Child lived with a smoker who smoked inside the home. Parent-reported measures of perceived neighborhood support, and neighborhood and school safety were examined; covariates included the child’s age, sex, and race/ethnicity; the parent’s education; the family’s household structure, and federal poverty level. Weighted logistic and ordinal regression models were built adjusting for the covariates. In total, 13.2% of children had outside TSE and 1.7% of children had inside TSE. Multivariable logistic regression model results indicated that children with outside TSE were at decreased odds (AOR = 0.79, 95%CI = 0.65-0.96) of living in a supportive neighborhood compared to children with no TSE. Ordinal regression model results indicated that children with outside TSE (AOR = 0.77, 95%CI = 0.61-0.97) and children with inside TSE were at decreased odds (AOR = 0.62, 95%CI = 0.39-0.99) of going to a school that was perceived as safe. Community-level programs, policies, and funding are needed to improve neighborhood characteristics among children with TSE to improve their future health outcomes.

Severe neighborhood deprivation and nursing home staffing in the United States.

Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods.

Executive function mediates the association between cumulative risk and learning in Ghanaian schoolchildren.

Research on the associations among adversity, executive function (EF), and academic outcomes in low- and middle-income countries, where developmental risk factors are more prevalent and impoverished environments are more widespread than in high income countries, is sparse. This study examines the relations among cumulative risk, EF, and learning outcomes measured 2-years later in Ghanaian third- and fourth-graders (N = 371; 49% female), shedding light on underlying mechanisms of how risk can undermine learning. A cumulative risk index was created based on a set of four child-reported risk factors: home aggression, unsafe home neighborhood, hunger, and having worked for pay. Cumulative risk and EF were negatively correlated. Learning outcomes (literacy and math test scores) were negatively correlated with earlier measures of cumulative risk and positively correlated with earlier measures of EF. EF mediated the association between cumulative risk and later learning outcomes, accounting for 65.3% of the total effect for literacy and 100% for math. This mediated pathway was robust to controls for child and household sociodemographic characteristics. The findings contribute to a small evidence base on the mediating role of EF in linking adversity and learning outcomes in a global context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The association between adverse childhood experiences, neighborhood greenspace, and body mass index: A cross-sectional study

An association between adverse childhood experiences (ACEs) and elevated body mass index (BMI) has been found in previous investigations. ACEs’ effects on BMI have been primarily considered via individual-level physiological and behavioral frameworks. Neighborhood factors, such as greenspace, are also associated with BMI and may merit consideration in studies examining ACEs-BMI associations. This exploratory study examined associations of BMI with ACEs and neighborhood greenspace and tested whether greenspace moderated ACEs-BMI associations. Methods entailed secondary analysis of cross-sectional data. ACEs and BMI were captured from 2012/2013 Philadelphia ACE Survey and 2012 Southeastern Household Heath Survey data; greenspace percentage in participants’ (n = 1,679 adults) home neighborhoods was calculated using National Land Cover Database data. Multi-level, multivariable linear regression 1) examined associations between BMI, ACEs, (0 ACEs [reference], 1–3 ACEs, 4 + ACEs), and neighborhood greenspace levels (high [reference], medium, low) and 2) tested whether greenspace moderated the ACEs-BMI association (assessed via additive interaction) before and after controlling for sociodemographic and health-related covariates. Experiencing 4 + ACEs (β = 1.21; 95 %CI: 0.26, 2.15; p = 0.01), low neighborhood greenspace (β = 1.51; 95 %CI: 0.67, 2.35; p < 0.01), and medium neighborhood greenspace (β = 1.37; 95 %CI: 0.52, 2.21; p < 0.01) were associated with BMI in unadjusted models. Only low neighborhood greenspace was associated with BMI (β = 0.95; 95 %CI: 0.14, 1.75; p = 0.02) in covariate-adjusted models. The ACEs-greenspace interaction was not significant in unadjusted (p = 0.89–0.99) or covariate-adjusted (p = 0.46–0.79) models. In conclusion, when considered simultaneously, low neighborhood greenspace, but not ACEs, was associated with BMI among urban-dwelling adults in covariate-adjusted models.

Assessment of the environmental perceptions, attitudes, and awareness of city dwellers regarding sustainable urban environmental management: a case study of Dhaka, Bangladesh.

Environmental problems are very concerning, particularly in many cities of developing countries, because they obstruct the creation of a sustainable urban environment. Dhaka, Bangladesh was chosen as the research area of this study, as Bangladesh is a developing country with pollution; moreover, the level of residents’ environmental perception was assessed, and their environmental attitudes and awareness were examined in relation to their demographic characteristics. A face-to-face questionnaire survey involving 400 respondents was conducted across various zones of the study area. The mean score, standard deviation, and p value of each respondent’s answer were calculated separately using a one-way analysis of variance (ANOVA). Then, a grand mean, average standard deviation, and combined p values for environmental perception and attitude themes were computed theme-wise. Descriptive statistics were produced to illustrate the respondents’ level of environmental awareness. The study results revealed that the respondents had a moderate to high level of perceived knowledge about the causes and effects of environmental pollution. They also had an intention to reduce the environmental pollution in their surroundings. The score differences (p < .05) across the age groups, education levels, occupation types, and income groups were nearly all significant, except for those pertaining to the gender of the respondents. Surprisingly, only 18% of the respondents were aware of their home’s and neighborhood’s garbage management procedures. It is urgent to influence citizens’ environmental behaviors to ensure the city’s long-term sustainability. This study’s findings can be used in decision-making processes regarding sustainable urban environments worldwide.

Neighborhood built environments and Hispanic/Latino adults' physical activity in the U.S.: The Hispanic community health study/study of Latinos community and surrounding areas study

Despite experiencing health inequities, less is known about neighborhood environments and physical activity among Hispanic/Latino adults compared to other populations. We investigated this topic in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanic/Latino adults in the San Diego, California area of the U.S. completed measures of overall moderate-to-vigorous physical activity (MVPA) via accelerometry and domain-specific MVPA via questionnaire at Visits 1 (2008–2011; n = 4086) and 2 (2014–2017; n = 1776), ~6 years apart. 800-m home neighborhood buffers were used to create objective measures of residential, intersection, and retail density, bus/trolley stops, greenness, parks, and recreation area at Visit 1. Regression models tested the association of each neighborhood feature with MVPA at Visit 1 and over 6 years, adjusting for individual characteristics and neighborhood socioeconomic deprivation. At Visit 1, those in neighborhoods with higher vs. lower retail density or recreation area (+1 vs. -1 standard deviation from the mean) engaged in 10% more overall MVPA and 12–22% more active transportation. Those in neighborhoods with higher vs. lower residential density engaged in 22% more active transportation. Those in neighborhoods with higher vs. lower greenness and park count engaged in 14–16% more recreational MVPA. Neighborhood features were unassociated with changes in MVPA over 6 years. Although changes in MVPA over time were similar across neighborhoods, Hispanic/Latino adults living in neighborhoods with design features supportive of walking and recreational activity (e.g., greater residential and retail density, more parks and recreation facilities) were consistently more active. Improving neighborhood environments appears important for supporting physical activity among Hispanic/Latino adults.

Homeownership, Labor Supply, and Neighborhood Quality

This paper provides evidence on the external benefits of homeownership among low-income populations. A natural experiment in Israel generated large changes in neighborhood homeownership rates while holding fixed the residents and housing stock, two primary sources of bias in traditional estimates. When public housing tenants are given the opportunity to buy their units, buyers increase labor supply. Effects are felt in the neighborhood: when homeownership rises by 10 pp, neighborhood home prices rise 1.5–2 percent. Instrumenting for purchases using government discounts generates similar results. Results are relevant for policies using financial incentives to increase homeownership among low-income populations. (JEL H24, I38, J22, R21, R23, R31, R38)

Abstract P070: Individual And Environmental Correlates Of Objectively Assessed Physical Activity Levels In Rural Residents

Introduction: Rural communities in the US face disproportionately higher rates of physical inactivity as well as coronary heart disease mortality, when compared to their urban and suburban counterparts. As such, increasing physical activity (PA) and reducing barriers to PA is critical in improving population health. Neighborhood characteristics have been shown to influence PA, but are understudied in rural communities. The current analysis: (1) describes PA patterns in rural mid-western communities, and (2) examines the associations of and interactions between individual and environmental correlates of objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes. Hypotheses: Overall, we expected low levels of weekly MVPA in rural residents; with lower levels anticipated in female, older, and low-income participants. We also expected positive associations of favorable perceptions of the neighborhood environment, trail use, and self-efficacy for PA with weekly MVPA. Finally, the test of interactions between intrapersonal and perceived environmental factors in relation to weekly MVPA is exploratory. Methods: Telephone surveys were conducted with 280 adults in 14 rural southeast Missouri communities, who were also asked to wear accelerometer devices for seven days. Participants were recruited via address-based sampling, and at local community events. Participants self-reported demographic information (age, sex, income), individual level behavioral factors (self-efficacy for PA, trail use) and neighborhood environment perceptions (indoor recreational access, safety from traffic, home neighborhood environment). Weekly MVPA minutes were assessed using the accelerometry data. Generalized linear mixed models using a negative binomial distribution were used examining associations of and interactions between individual characteristics and environmental correlates with weekly MVPA (Analyses were conducted using STATA V15). Results: Participants had a weekly average of 97 minutes MVPA, with 21% meeting PA guidelines. Increased age and being female were significantly associated with lower weekly MVPA. Additionally, increased self-efficacy and trail use were significantly associated with higher weekly MVPA. When exploring interaction effects, there was a significant interaction between gender and safety from traffic. For females, increased perceived safety from traffic was associated with lower MVPA. Conclusions: Rural residents have low levels of PA with less than a quarter meeting PA guidelines (75 minutes of vigorous and/or 150 minutes of moderate PA per week). Specifically, female residents face disproportionately lower levels of MVPA, with only 75 weekly minutes compared to 135 weekly minutes in males. Promoting trail use and targeting self efficacy for PA, may be effective strategies for increasing PA in rural residents.

Beyond home neighborhood: Mobility, activity and temporal variation of socio-spatial segregation

Recent studies on socio-spatial segregation have revealed the uneven segregation experiences of individuals within their daily life contexts. However, little is known about its temporal variations across the week. The advancement of GIS and GPS tracking technology also poses methodological challenges in processing rich mobility–activity data efficiently in identifying the socio-spatial segregation patterns. With data collected by a mobile phone app that ran on the participants' mobile phone for a whole week, this paper integrates the spatial, temporal, mobility, and activity dimensions with the demographic data to segregation patterns of the participants and assesses segregation at the individual level. Our findings indicate that the socio-spatial segregation level decreased in the daytime and increased at night, and this pattern was consistent across a week. However, no significant differences are found between different age groups, occupation, housing types and home neighborhood types. To improve the efficiency of data processing, this paper employs decision tree algorithms supplemented by the analysis of variance and Tukey's honestly significant difference test to identify meaningful mobility–activity patterns with significant intergroup differences. It is able to pinpoint temporal and spatial activity-mobility patterns that crosscut home location, location of workplace, and socioeconomic status. It also helps connect residential segregation and segregation that goes beyond the home neighborhoods.

Food insecurity status is of added value in explaining poor health: a cross-sectional study among parents living in disadvantaged neighbourhoods in the Netherlands

ObjectivesThe aim of this study was to examine the added value of food insecurity in explaining poor physical and mental health beyond other socioeconomic risk factors.Design, setting, participants and outcome...

Perceived accessibility: How access to dockless bike-sharing impacts activity participation

The emergence and popularity of dockless bike-sharing systems have attracted extensive attention due to the associated environmental and health benefits. However, little consideration has been given to the potential individual social implications of dockless bike-sharing. Our knowledge about whether dockless bike-sharing systems have the ability to facilitate individuals’ engagement in daily activities is limited. The goal of this study is to gain more insight into how individuals’ personal characteristics and neighborhood environment features influence perceived access to different types of activities by dockless bike-sharing. Using survey data collected from residents in Beijing, we employed four ordinary least squares (OLS) regressions to assess the effect of individual and spatial attributes on the role dockless bike-sharing plays in users’ perceived accessibility to activities overall as well as to three different categories of activities—subsistence, maintenance and leisure. The results indicated that male users reported enjoying more benefits in accessing activities. Dockless bike-sharing users’ perceived benefits in accessing activities largely relied on their social support from their family and friends and their attitudes towards environmental and health concerns of travel. Additionally, users who agreed that dockless bike-sharing has helped them access bus stops and metro stations perceived higher benefits of dockless bike-sharing on activity participation. Our analysis also highlighted that dockless bike-sharing users in Beijing benefited most in their commuting trips, and to a lesser degree, when attending maintenance and leisure activities. The percentage of cycling paths within the home neighborhood tended to be positively associated with individuals’ perceived accessibility to subsistence activities.

The Notifiction: How Push Notifications from Neighbourhood Surveillance Apps Can Create an Alternative Narrative of Place

This article concerns the author’s attempt to stay connected with his home neighborhood in Austin, TX, and how that conflicts with using the neighbourhood surveillance platform Ring Neighbors during the pandemic. Utilizing a mixed methodology based in autoethnography, the author considers how the notifications produced by this platform can create new potential narratives about his neighbourhood during a pandemic. While this app is theoretically helpful by showing what community members are thinking, the notifications that it thrusts into his daily life tend to create a fictional representation of his home, which he deems a “notifiction.”

Home and nearby nature: Uncovering relational flows between domestic and natural spaces in three countries during COVID-19

This paper addresses the role of living spaces, neighborhood environments, and access to nearby nature in shaping individual experiences of health and well-being during the first wave of the COVID-19 pandemic. Key data is drawn from the GreenCOVID study across Spain, England and Ireland. The survey gathered contextual information about home environments, neighborhood spaces, and access to nature elements, and standardized measures of health and wellbeing between April and July 2020 (n = 3,127). The paper used qualitative data from the survey to document flows between home and nearby nature. These were framed as barriers/mediators with specific focus on differing interpretations of home as both trap and refuge, with additional dimensions of loss, disruption and interruption shaping the broad responses to the pandemic. By contrast nearby nature was an enabler/moderator of health and wellbeing, offering healthy flows between home and nature as well as respite and additional health-enabling factors. Differences were identified between the three countries but important commonalities emerged too, recognising the role nature plays as an asset both within and immediately beyond the home. The use of flow as metaphor also recognises the importance of embodiment and the elastic nature of connections between home and nearby nature for wellbeing. More broadly, flow provides a valuable way to trace affective relational geographers to develop a wider understanding of assemblages of health during pandemics.

A Mixed-Methods Description of the Home Physical Activity Environments of Racially/Ethnically Diverse and Immigrant/Refugee Children.

Disparities in childhood obesity prevalence by race/ethnicity remain high. Physical activity is an important factor to consider, however little is known about how physical activity resources in the home environment and neighborhood differ by race/ethnicity. This study examines the physical activity environments in the homes and neighborhoods of diverse households using both quantitative and qualitative data. Home visits were conducted with 150 families, and accelerometry data was collected for both parents and children (5-7 years old). Qualitative interviews were also conducted with parents, which provided context to quantitative data. Racial/ethnic differences were found for physical activity, sedentary behavior, and family-level resources for physical activity (P < .05). There were also differences by race/ethnicity in neighborhood physical activity promoters and perceived lack of neighborhood safety (P < .05). This study is important in informing providers and future interventions of the varying promoters and barriers to optimal physical activity that exist across race/ethnicity.

Structural model of predicting marital commitment in married women based on religious orientation mediated by spirituality

Aim: The aim of this study was to explain the structural model of predicting marital commitment in married women based on religious orientation mediated by spirituality. Methods: This was a correlation descriptive study and the population of this study consisted of all married women referred to neighborhood homes with a total of 1095,000 in 2019 from which 347 people were selected by two-stage random sampling. Study tools were included Adams &amp; Jones Marital Commitment Inventory (1977), Underwood &amp; Teresi Daily Spiritual Experience Scale (2002), Allport &amp; Ross Religious Orientation Questionnaire (1967). The data of the present study were analyzed using structural equation modeling. Results: In the present study, the indirect path coefficient between external religious orientation (P=0.001, β=0.104) and internal religious orientation (P=0.001, β=0.201) with marital commitment were positive at the level of 0.01. Conclusion: It seems that when couples' conflicts escalate so much that the collapse of family life threatens them, religious couples rely on religious principles and spirituality to confront each other. It is necessary to pay more attention to the role of religious beliefs and spirituality in increasing marital commitment in all institutions of society, especially the family.