Walk Score Research Articles

Neighborhood walkability and risk of gestational diabetes

ObjectiveHigher neighborhood walkability has been associated with a lower risk of type 2 diabetes mellitus (T2DM) by promoting greater physical activity (thereby reducing weight and lowering insulin resistance). However, it...

Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes

Background: Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self-efficacy, functional outcomes, stroke knowledge or characteristics of survivors who achieve these goals. Methods: Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factor/stroke knowledge, self-efficacy, psychosocial, driving and vocational issues. Results: 190 consecutive patients(117 men, 73 women, average age 62(18-90), 66 aphasic) with baseline modified Rankin Scores of 5(1%); 4(25%); 3(56%); 2(15%); 1(3%), and average NIHSS score of 6(range 0-18) were treated between 12/2011-7/2019. 136 Patients suffered ischemic strokes and 54 had hemorrhages. Locations were: 65 left, 69 right, 26 bilateral hemisphere, 30 brainstem. 41% had MCA territory strokes. Of 104 patients working pre-stroke, 50% returned to work and an additional 7% were work capable upon completion of program. 95% of patients driving pre-stroke could not drive on admission. After training, 43%(67/157) returned to driving. Patients had improvements in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 23%. Patients received an average of 33 physical therapy visits with average percent improvement of 72% and 41% on 6” walk and Berg Balance scores. Average percent improvement in Stroke Self Efficacy Scores was 29%. After individualized cardiovascular risk, stroke and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life’s Simple 7’s curriculum, stroke and risk factor knowledge quiz scores improved an average of 29%. Average length of stay was 5(range .5-24) months. Multiple other demographic and outcome measures are collected. Conclusions: Outcome data show a community-based team rehabilitation program can successfully combine CV/stroke education with rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self-efficacy for many types of stroke survivors with moderate to severe disability.

Showcasing Relationships between Neighborhood Design and Wellbeing Toronto Indicators

Cities are the keystone landscape features for achieving sustainability locally, regionally, and globally. With the increasing impacts of urban expansion eminent, policymakers have encouraged researchers to advance or invent methods for managing coupled human–environmental systems associated with local and regional sustainable development planning. Although progress has been made, there remains no universal instrument for attaining sustainability on neither regional nor local planning scales. Previous sustainable urbanization studies have revealed that landscape configuration metrics can supplement other measures of urban well-being, yet few have been included in public data dashboards or contrasted against local well-being indicators. To advance this sector of sustainable development planning, this study had three main intentions: (1) to produce a foundational suite of landscape ecology metrics from the 2007 land cover dataset for the City of Toronto; (2) to visualize and interpret spatial patterns of neighborhood streetscape patch cohesion index (COHESION), Shannon’s diversity index (SHDI), and four Wellbeing Toronto indicators across the 140 Toronto neighborhoods; (3) to quantitatively assess the global collinearity and local explanatory power of the well-being and landscape measures showcased in this study. One-hundred-and-thirty landscape ecology metrics were computed: 18 class configuration metrics across seven land cover categories and four landscape diversity metrics. Anselin Moran’s I-test was used to illustrate significant spatial patterns of well-being and landscape indicators; Pearson’s correlation and conditional autoregressive (CAR) statistics were used to evaluate relationships between them. Spatial “hot-spots” and/or “cold-spots” were found in all streetscape variables. Among other interesting results, Walk Score® was negatively related to both tree canopy and grass/shrub connectedness, signifying its lack of consideration for the quality of ecosystem services and environmental public health—and subsequently happiness—during its proximity assessment of socioeconomic amenities. In sum, landscape ecology metrics can provide cost-effective ecological integrity addendum to existing and future urban resilience, sustainable development, and well-being monitoring programs.

Neighborhood Walkability and Housing Prices: A Correlation Study

This study aims to examine the relationship between the level of walkability and housing prices in Seoul, Korea. The average transaction price per square meter for each apartment complex was set as a dependent variable and the walkability score was used as an independent variable. This study divided a total of 5986 apartment complexes into areas with high and low housing prices for analysis. Based on the strong spatial autocorrelations of housing prices, this study employed spatial regression models in addition to the Ordinary Least Squares (OLS) model. Results showed that housing prices positively correlated with the walkability score in areas with low housing prices, whereas no significant association was observed in areas with high housing prices. Additional findings showed that housing prices were associated with building age (−), number of households in the complex (+), slope (−), and greenness (+) in both subsamples. Results also showed that high school quality had a different association with housing prices depending on the subsample (e.g., the sign was positive in areas with high housing prices and no significance in areas with low housing prices). The results herein support public policy proposals relevant to urban planning, environmental design, and housing policies.

Going out for a Pint: Exploring the Relationship between Craft Brewery Locations and Neighborhood Walkability

The purpose of this paper is to explore the relationship between neighborhood walkability and craft brewery locations. Craft breweries are emerging as Third Places across the United States as a part of a broader neolocalism movement. Walkable places can also reflect neolocalism, attracting people and amenities who share similar values. It is reasonable, then, to expect a relationship to exist between craft brewery locations and neighborhood walkability. Using the city of San Diego as a case study, craft breweries are mapped within San Diego neighborhoods. Walk Scores are used as a measure of walkability and correlation coefficients computed to test the existence of a relationship. Three correlations are computed with relation to Walk Scores: one each for microbrewery locations, brewpub locations, and all craft breweries (microbreweries and brewpubs combined). Results indicate that there is a positive correlation between neighborhood Walk Scores and brewpub locations, but not microbreweries or all craft breweries. Brewpubs, by definition, sell the majority of their beer on-site, which may necessitate location criteria such as walkability that are not as necessary for microbreweries. This research is, to date, the first that explores the relationship between craft breweries and walkability.

A Data-Driven Framework for Walkability Measurement with Open Data: A Case Study of Triple Cities, New York

Walking is the most common, environment-friendly, and inexpensive type of physical activity. To perform in-depth walkability analysis, one option is to objectively evaluate different aspects of built environment related to walkability. In this study, we proposed a computational framework for walkability measurement using open data. Three major steps of this framework include the web scrapping of publicly available online data, determining varying weights of variables, and generating a synthetic walkability index. The results suggest three major conclusions. First, the proposed framework provides an explicit mechanism for walkability measurement. Second, the synthetic walkability index from this framework is comparable to Walk Score, and it tends to have a slightly higher sensitivity, especially in highly walkable areas in urban core. Third, this framework was effectively applied in a metropolitan area that contains three small cities that together represent a small, old shrinking region, which extends the topical area in the literature. This framework has the potential to quantify walkability in any city, especially cities with a small population where walkability has rarely been studied, or those having no quantification indicator. For such areas, researchers can calculate the synthetic walkability index based on this framework, to assist urban planners, community leaders, health officials, and policymakers in their practices to improve the walking environment of their communities.

Motor tract integrity predicts walking recovery: A diffusion MRI study in subacute stroke.

To identify candidate biomarkers of walking recovery with motor tract integrity measurements using fractional anisotropy (FA) from the corticospinal tract (CST) and alternative motor pathways in patients with moderate to severe subacute stroke. Walking recovery was first assessed with generalized linear mixed model (GLMM) with repeated measures of walking scores (WS) over 2 years of follow-up in a longitudinal study of 29 patients with subacute ischemic stroke. Baseline FA measures from the ipsilesional and contralesional CST (i-CST and c-CST), cortico-reticulospinal pathway (i-CRP and c-CRP), and cerebellar peduncles were derived from a 60-direction diffusion MRI sequence on a 3T scanner. We performed correlation tests between WS and FA measures. Third, we investigated using GLMM whether motor tract integrity contributes to predict walking recovery. We observed significant improvements of WS over time with a plateau reached at ≈6 months after stroke. WS significantly correlated with FA measures from i-CST, c-CST, i-CRP, and bilateral cerebellar peduncles. Walking recovery was predicted by FA measures from 3 tracts: i-CST, i-CRP, and contralesional superior cerebellar peduncle (c-SCP). Diffusion tensor imaging (DTI) predictors captured 80.5% of the unexplained variance of the model without DTI. We identified i-CST and alternative motor-related tracts (namely i-CRP and c-SCP) as candidate biomarkers of walking recovery. The role of the SCP in walk recovery may rely on cerebellar nuclei projections to the thalamus, red nucleus, and reticular formation. Our findings suggest that a set of white matter tracts, part of subcortical motor networks, contribute to walking recovery in patients with moderate to severe stroke.

COVID-19 and Impact of School Closures on the Children of the United States; a Point of View with an Empirical Analysis

School closures due to the global pandemic of the novel coronavirus have impacted at least 124,000 U.S. public and private schools and affected at least 55.1 million students (Education Week, 2020b). As the COVID-19 hotspots continue to emerge across the United States, this study aims to understand the impact of school closures during the stay at home order on the health behavior of the school-age children as it relates to their mobility, physical activity, access to school meal services and psychological distress caused by the prolonged social distancing. The first segment of the study discusses the several aspects of social distancing and its effects on physiological and psychological health of the children. The following segment of the study presents an empirical analysis with the latest COVID-19 tracking results highlighting the different states of the USA at different stages of the novel Coronavirus outbreak. The empirical analysis is further expanded based on the publicly available state level data on school closures, childhood obesity rate and key socio-economic factors, including access to the playgrounds in neighborhood, walk score, prevalence of poverty and latest filing of the unemployment claims during the pandemic to identify the states at greater vulnerability. The concluding section discusses the need to advance the research further with future recommendations as the full impact of the pandemic continues to unfold.

Will Driverless Vehicle Adoption Cause More Urban Sprawl or Prevent It?

Driverless vehicles (DVs) will attain substantial traction in the next 10-20 years and will affect commuting patterns and demand for parking. We study the potential correlation between DV adoption and urban sprawl. There are two primary and counteracting effects: DVs may induce more sprawl by providing a desirable commute from the suburbs; or, DVs may lessen urban sprawl by inducing the redevelopment of underutilized urban parking, thus revitalizing commercial areas. We develop sprawl indicators, and rank 15 representative U.S. metro areas. The factors include commuting time, population growth, existing urban density, state government regulation of DVs, urban walkability score, existing sprawl, and presence of parking spaces. We then rank the same metro areas on likely DV adoption. We adopt CoStar 20-year growth forecasts, assume localized FARs, and score each metro’s ability to satisfy development land with redundant parking. We conclude that Detroit, San Diego, Houston, Pittsburgh, and Sacramento would have the easiest economic path to controlling and reversing urban sprawl, while Raleigh, Washington, D.C., Boston, Phoenix, and Portland would have the hardest path under the assumed growth conditions. Central cities need to prepare metro-wide parking redevelopment infill policies or face the prospect of continued sprawl.

Walkability and healthy aging: an analytical proposal for small and medium-sized Brazilian cities

Evidence has shown that urban environments that discourage walking contribute to functional incapacity in the elderly. Various indices have been proposed to describe an area's walkability, combining different aspects of the built environment that promote (or inhibit) walking. However, due to problems with the quality and availability of data in Brazil, there is no walkability index to date applies to all cities of the country and that has been properly tested in the population. The current study aimed to propose a walkability index based on geographic information systems for a medium-sized city, with open-access data, and to test its association with functional incapacity in the elderly. The study used data from the urban area of a medium-sized Brazilian city to select a parsimonious set of variables through factor analysis. The resulting index was tested for its association with the capacity to perform activities of daily living that require more movement, in 499 elderly, using generalized estimating equations. The resulting walkability index consists of residential density, commercial density, street connectivity, presence of sidewalks, and public lighting. These variables comprised the first factor in the factor analysis, excluding only arborization which was retained in the second factor. The worst walkability score was associated with the highest functional incapacity score. Based on the results and their validation, the study suggests an easily applicable walkability index with great potential for use in action plans to adapt environments.

Residential housing prices: impact of housing characteristics, accessibility and neighbouring apartments – a case study of Dortmund, Germany

ABSTRACT In this research we analyse the most important factors that determine housing prices. On the one hand, we test whether neighbourhoods with a good accessibility are more attractive and consequently show higher housing prices. For this purpose, we introduce an adapted Walk Score as part of the accessibility indicators. On the other hand, we compare an ordinary-least-squares regression (OLS) and a spatial lag model and test which model better explains residential housing prices. The regression models show the importance of classical factors such as dwelling characteristics or the types of neighbours. In addition, they also reveal that a differentiated approach is needed for analysing the accessibility, the location and the environment of a dwelling. The mere presence of a single amenity, a public transport stop or a motorway access is not a sufficient explanatory factor. Information such as density of supply, walking distances or public transport service quality needs to be taken into account as well as. The test of the spatial lag model reveals that prices of the most proximate dwellings can be taken into account as a relevant factor in explaining residential housing prices and should therefore be included in research on residential housing prices.

A Reliability Check of Walkability Indices in Seoul, Korea

The purpose of this study is to evaluate walkability levels using popular indices and check the measurement reliability between those indices. This study evaluates the city of Seoul, using 100 × 100 m grid points (N = 44,000) as spatial units of analysis. In this study, four types of indices were used to measure walkability levels: Walkability index (WI), Walk score (WS), Pedshed (Ps), and Movability index (MI). This study utilizes Pearson’s R, Brand–Altman plot with limit of agreement (LOA), and intraclass correlation coefficient (ICC) as reliability check methods. The measurement reliability among the four indices was found to be relatively high. The Pearson’s R values were between 0.308 and 0.645, and the range of inside LOA of Brand–Altman plots was 94.5% to 95.5%. The ICC value of the four indices was 0.544, indicating moderate reliability. The results reveal a relatively high level of measurement reliability between the four indices. On the basis of this study’s results, the level of walkability in other cities in Korea can be ascertained. The study may provide future direction for walkability index development that considers urban environmental characteristics. From the results, we expect that future urban planning and policies will aim to improve walkability.

108 Factors Associated with Hand Grip Strength of a Group of Pre and Postmenopausal Women from Sri Lanka

Abstract Hand grip strength (HGS) is a component of sarcopenia and provides an estimate on muscle strength and overall health status. This cross-sectional study examined the factors associated with HGS in community dwelling healthy premenopausal women (PrMW) and postmenopausal women (PMW). Randomly selected 184 PrMW (42.4±6.0years) and 166 PMW (55.8±3.8years) from Galle, Sri Lanka were studied. HGS (kg) of dominant side was evaluated using a hand-held-dynamometer. Body composition; Appendicular-skeletal-muscle-mass (ASMM, kg), total-body-fat-mass (TBFM, kg), total body bone-mineral-density (TBBMD, g/cm3) and total-body-bone mineral-content (TBBMC, g) were measured with DXA. Anthropometry indices; weight (kg), height (m), waist-circumference (WC, cm) and hip-circumference (HC, cm) were measured. Body-mass-index (BMI, kg/m2) and waist-to-hip-ratio (WHR) were calculated. Gait speed (GS, m/s) was evaluated. Consumption of nutrients; carbohydrate, protein, fats and total energy and physical activity (PA) pattern; walking, moderate, vigorous and total PA score were evaluated. Serum sample was analyzed for 25-hydroxy-vitamin-D (n/mol), estradiol (mlU/L), fasting insulin (μU/mL). Variables significantly correlated with HGS of PrMW and PMW were separately entered in to multiple linear regression models to extract the associated factors. Mean±SD HGS of PrMW and PMW were 19.06±6.06 kg and 15.27±4.86 kg (p<0.001) respectively. In multiple regression analysis, factors that showed significant association with HGS in PrMW were ASMM (β=0.57), TBBMC (β=0.31), vigorous PA score (β=0.12), age (β=-0.19) and weight (β=0.42) (R=0.58, adjusted R2=0.33). In the same analysis, the factors associated with HGS in PMW were ASMM (β=0.31) and height (β=0.22) (R=0.48, adjusted R2=0.22). The most significant factor associated with HGS was ASMM in both PrMW (R=0.44, R2=0.20) and PMW (R=0.44, R2=0.19). Age, anthropometry indices, PA and ASMM showed significant associations with HGS among middle-aged women, while ASMM was the main predictor of HGS irrespective of menopausal status.

New kid on the block: An investigation of the physical, operational, personnel, and service characteristics of recovery community centers in the United States

BackgroundProfessional treatment and non-professional mutual-help organizations (MHOs) play important roles in mitigating addiction relapse risk. More recently, a third tier of recovery support services has emerged that are neither treatment nor MHO that encompass an all-inclusive flexible approach combining professionals and volunteers. The most prominent of these is Recovery Community Centers (RCCs). RCC's goal is to provide an attractive central recovery hub facilitating the accrual of recovery capital by providing a variety of services (e.g., recovery coaching; medication assisted treatment [MAT] support, employment/educational linkages). Despite their growth, little is known formally about their structure and function. Greater knowledge would inform the field about their potential clinical and public health utility. MethodOn-site visits (2015–2016) to RCCs across the northeastern U.S. (K = 32) with semi-structured interviews conducted with RCC directors and online surveys with staff assessing RCCs': physicality and locality; operations and budgets; leadership and staffing; membership; and services. ResultsPhysicality and locality: RCCs were mostly in urban/suburban locations (90%) with very good to excellent Walk Scores reflecting easy accessibility. Ratings of environmental quality indicated neighborhood/grounds/buildings were moderate-good attractiveness and quality. Operations: RCCs had been operating for an average of 8.5 years (SD = 6.2; range 1–33 years) with budgets (mostly state-funded) ranging from $17,000–$760,000/year, serving anywhere from a dozen to more than two thousand visitors/month. Leadership and staffing: Center directors were mostly female (55%) with primary drug histories of alcohol (62%), cocaine (19%), or opioids (19%). Most, but not all, directors (90%) and staff (84%) were in recovery. Membership: A large proportion of RCC visitors were male (61%), White (72%), unemployed (50%), criminal-justice system-involved (43%) and reported opioids (35%) or alcohol (33%) as their primary substance. Roughly half were in their first year of recovery (49%), but about 20% had five or more years. Services: RCCs reported a range of services including social/recreational (100%), mutual-help (91%), recovery coaching (77%), and employment (83%) and education (63%) assistance. Medication-assisted treatment (MAT) support (43%) and overdose reversal training (57%) were less frequently offered, despite being rated as highly important by staff. ConclusionsRCCs are easily accessible, attractive, mostly state-funded, recovery support hubs providing an array of services to individuals in various recovery stages. They appear to play a valued role in facilitating the accrual of social, employment, housing, and other recovery capital. Research is needed to understand the relative lack of opioid-specific support and to determine their broader impact in initiating and sustaining remission and cost-effectiveness.

Is Seoul Walkable? Assessing a Walkability Score and Examining Its Relationship with Pedestrian Satisfaction in Seoul, Korea

Studies have assessed neighborhood walkability responding to increasing interest in academics, practitioners, and policy makers. While Walk Score is a well-operationalized and efficient measure of neighborhood walkability, it is not supported in the Asian context. We thus developed a “Walkability Score” for use in Seoul, South Korea, following the Walk Score algorithm and then conducted a logistic regression for a satisfied versus dissatisfied binary outcome in order to conduct an empirical test. Results showed a significant association between Walkability Score and pedestrian satisfaction. We also explored sample locations and found some discrepancies between Walkability Score and the degree of pedestrian satisfaction. While some sample locations near parks, and rivers and waterfront spaces (but without destinations for walking trips such as banking or shopping) revealed low Walkability Scores, the degree of pedestrian satisfaction was relatively high in these areas. Some samples located in residential areas with well-designed sidewalks and greenery revealed relatively high pedestrian satisfaction, but Walkability Scores were insufficient. This study’s Walkability Score was somewhat valid for approaching the issue, but further research is needed to complete this measure, especially in high-density areas with well-equipped pedestrian infrastructures (e.g., crosswalks, pedestrian streets).

The effect of increasing body mass index on the pain and function of patients with adult spinal deformity.

Both adult spinal deformity (ASD) and obesity are growing concerns internationally. This study therefore aims to determine the effect of increasing body mass index (BMI) on the pain and function of patients with ASD. A retrospective review of prospectively collected data from a multicentre European database was undertaken. Initially a univariate analysis was performed on the effect of BMI on the initial presentation of functional scores in patients with ASD. The functional scores included the Numerical Rating Scale (NRS) back and leg score, Core Outcome Measures Index (COMI) back score, SRS22 total score, Short Form 36 (SF-36) [general health, physical component score (PCS) and mental component score (MCS)] and Oswestry Disability Index (ODI) score (including all domains). Subsequently a multivariate analysis controlling for age, sex, comorbidities, employment status, smoking status and radiological parameters [coronal cobb, coronal balance, sagittal balance, global tilt, and pelvic incidence minus lumbar lordosis (PI - LL) mismatch] was performed. A total of 1,004 patients were included in this study (166 male, 838 female). On univariate analysis a statistically significant (P<0.05) moderate correlation between NRS leg pain, ODI (walking, standing, sex life, social life and total score), SF-36 (physical component), sagittal balance, global tilt and age were recognised (P<0.05). A statistically significant low correlation was identified for all other outcomes, except coronal balance (P=0.640). On multivariate analysis BMI remained significantly related to all functional outcomes except ODI-pain and ODI-travelling (P>0.05). Increasing BMI has a significant adverse effect on the pain and functioning of patients with ASD. Clinicians should recognise this association and treat patients accordingly.

Whose Walkability?

The Walk Score is a patented algorithm for measuring the walkability of a given geographic area. In addition to its use in real estate, the accompanying API is used in a range of research in public health and urban development. This study explores how neighborhood residents differently understand the notion of walkability as well as the extent to which their personal definitions of neighborhood walkability are reflected in the Walk Score's underlying algorithm. We find that, while the Walk Score generally aligns with residents' priorities around walkability, significant subjective aspects that influence walking behavior are not reflected in the score, raising the need to consider implications for using algorithmic tools like the Walk Score in certain research contexts. We discuss the challenge of measuring subjective experience and how designers might begin to address it. We call for qualitative evaluations of algorithmic tools to help determine appropriate contexts of use.

Outcomes of Severely Obese Patients Supported by a Centrifugal-Flow Left Ventricular Assist Device

Ventricular assist devices provide improved outcomes for patients with advanced heart failure, but their benefit in the severely obese is not well documented. Patients enrolled in the HeartWare ADVANCE trial (n=382) were divided into 2 body mass index (BMI) groups. Patients with severe obesity (>35 kg/m2) were compared with a control group with BMI ≤35 kg/m2. The association of BMI with survival was tested using Kaplan-Meier analysis and major adverse events were compared. At implantation, 48 (13%) of patients were severely obese. There was no difference in survival through 2 years of support between severely obese patients and the control group. Severely obese patients were at higher risk of driveline infection (P = .01) and acute renal dysfunction (P = .002). Both groups experienced similar improvements in quality of life. Functional capacity improved in both severely obese and control patients, although severely obese patients had smaller improvements than controls in their 6-minute walk scores. Despite an increased risk of adverse events, severe obesity was not associated with reduced survival or quality of life. A better understanding of the risks and benefits of left ventricular assist device therapy in obese patients will help in the shared decision-making of the patient selection process.

Is neighbourhood walkability related to body mass index among different age groups? A cross-sectional study of Canadian urban areas

BackgroundStudies of neighbourhood walkability and body mass index (BMI) have shown mixed results, possibly due to biases from self-reported outcomes or differential effects across age groups. Our objective was to...

Assessing the Walkability Environments of Churches in a Rural Southeastern County of the United States.

Churches can serve as important health promotion partners, especially in rural areas. However, little is known about the built environment surrounding churches in rural areas, including how these environments may impact opportunities for physical activity (PA) and may differ by neighborhood income levels. This study described walkability around churches in a rural county and examined differences in church walkability between high-, medium-, and low-income neighborhoods. As part of the Faith, Activity, and Nutrition study, trained data collectors conducted a windshield survey of adjacent street segments within a half-mile of churches. Churches (N = 54) in a rural southeastern county in the United States. A summary walkability score (eg, presence of sidewalks, safety features, low traffic volume) was created with a possible range from 0 to 7. Analysis of variance was used to assess differences in walkability of churches by neighborhood income levels. Walkability scores ranged from 0 to 6 (M = 2.31, SD = 1.23). Few churches had sidewalks, shoulders or buffers, or amenities nearby. In contrast, most churches had low traffic volume and no environmental incivilities. While not statistically significant, churches in low-income neighborhoods scored higher for walkability than churches in medium- and high-income neighborhoods. This study used low-cost environmental audits to analyze walkability in a sample of churches in a rural area and examined differences by neighborhood income. While churches may improve reach of people living in underserved and rural communities, a lack of environmental supports may limit effective PA promotion activities. Partnerships focused on improving existing areas or providing alternative PA opportunities for church and community members may be needed, especially in African American communities.