Walkable Destinations Research Articles

Structural and social determinants of health: The multi-ethnic study of atherosclerosis.

Researchers have increasingly recognized the importance of structural and social determinants of health (SSDOH) as key drivers of a multitude of diseases and health outcomes. The Multi-Ethnic Study of Atherosclerosis (MESA) is an ongoing, longitudinal cohort study of subclinical cardiovascular disease (CVD) that has followed geographically and racially/ethnically diverse participants starting in 2000. Since its inception, MESA has incorporated numerous SSDOH assessments and instruments to study in relation to CVD and aging outcomes. In this paper, we describe the SSDOH data available in MESA, systematically review published papers using MESA that were focused on SSDOH and provide a roadmap for future SSDOH-related studies. The study team reviewed all published papers using MESA data (n = 2,125) through January 23, 2023. Two individuals systematically reviewed titles, abstracts, and full text to determine the final number of papers (n = 431) that focused on at least one SSDOH variable as an exposure, outcome, or stratifying/effect modifier variable of main interest (discrepancies resolved by a third individual). Fifty-seven percent of the papers focused on racialized/ethnic groups or other macrosocial/structural factors (e.g., segregation), 16% focused on individual-level inequalities (e.g. income), 14% focused on the built environment (e.g., walking destinations), 10% focused on social context (e.g., neighborhood socioeconomic status), 34% focused on stressors (e.g., discrimination, air pollution), and 4% focused on social support/integration (e.g., social participation). Forty-seven (11%) of the papers combined MESA with other cohorts for cross-cohort comparisons and replication/validation (e.g., validating algorithms). Overall, MESA has made significant contributions to the field and the published literature, with 20% of its published papers focused on SSDOH. Future SSDOH studies using MESA would benefit by using recently added instruments/data (e.g., early life educational quality), linking SSDOH to biomarkers to determine underlying causal mechanisms linking SSDOH to CVD and aging outcomes, and by focusing on intersectionality, understudied SSDOH (i.e., social support, social context), and understudied outcomes in relation to SSDOH (i.e., sleep, respiratory health, cognition/dementia).

COVID-19 Impacts on Physical Activity Among Community-Dwelling Older Adults With Memory Problems: The Moderating Role of Walkable Neighborhood Destinations.

The number of people with memory problems who desire or are forced to age in place has been growing rapidly. Coronavirus disease 2019 (COVID-19) has brought significant challenges to the ability of those with memory problems to stay active and age in place. This study investigated the roles of neighborhood environments in helping community-dwelling people with memory problems maintain physical activity during the COVID-19 pandemic. We used retrospective online survey data from 75 caregivers who responded on behalf of their care recipients with memory problems living in Texas communities. We used difference-in-difference (DID) estimations based on zero-inflated negative binomial regression models to examine the changes in recreational walking and moderate-to-strenuous exercise before and during the COVID-19 pandemic and whether such changes vary by diversity of walkable neighborhood destinations. In the total sample, there was a significant reduction in both recreational walking (Δ change = -45.16 min/week, p < .001) and exercise (Δ change = -36.28 min/week, p = .03) after the COVID-19 outbreak. The pandemic's impact on exercise varied by diversity of neighborhood destinations (DID = 0.81, p = .03). Those living in neighborhoods with diverse walkable destinations experienced less decline in physical activity compared to those living in areas with limited destinations. These findings suggest that the impact of the COVID-19 pandemic on physical activity among people with memory problems may be partially explained by neighborhood land-use characteristics. Destination-rich, mixed-use neighborhood environments can help people with memory problems stay active even during pandemics such as COVID-19 in the United States and potentially elsewhere.

Perception of place, active transportation, and community participation: A mediation analysis

IntroductionActive transportation is associated with many benefits, including community participation, a salient form of social capital. Positive neighborhood perceptions are likewise associated with higher social capital, including community involvement. However, little is known about how active transportation may mediate the relationship between perception of place and community participation. MethodsUsing representative data from the Survey of the Health of Wisconsin (n = 1758), path analysis within a structural equation modeling framework assessed mediation. Covariates include age, education, race/ethnicity, gender, and community size. ResultsResults suggest perception of place (well-maintained, interesting places with walkable destinations) has a relationship to community participation (p = 0.001); however, when assessed for mediation through active transportation, only an indirect effect remained significant (p = 0.003), indicating the relationship between perception of place and community participation occurs through active transportation. ConclusionsInvesting in bike and pedestrian infrastructure that connects places, creates interesting spaces, and protects funding for routine maintenance is critical to support higher participation in active transportation as well as higher social capital in the form of greater involvement in community participation. Inequities in maintenance and infrastructure may impact not only active transportation, but community participation as well.

Abstract IA038: Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors

Abstract Maintaining a healthy weight and cardiovascular health (CVH) after a breast cancer (BC) diagnosis is gaining clinical attention because they are essential for reducing the burden of cardiovascular disease, achieving optimal cancer survivorship, and possibly reducing mortality after a BC diagnosis. Individual behaviors and choices are largely influenced by the surrounding social and built environment; however, the neighborhood risk factors influencing post-diagnosis weight change and CVH are unclear among Black women, who have higher rates of obesity, unfavorable CVH and mortality than any other racial/ethnic group. To address this knowledge gap, we conducted analyses based on the Women's Circle of Health Follow-Up Study (WCHFS), a population-based prospective cohort of Black BC survivors in New Jersey. In the first analysis, adiposity changes during the period ~10 months to 2 years after diagnosis were evaluated among 785 women enrolled in the WCHFS. We found that despite a high baseline prevalence of overweight or obesity, weight gain was common. Greater density of fast-food restaurants and lower walkability were identified as neighborhood-level risk factors for weight gain. We also showed that intentional weight loss was much less common than weight gain, and its neighborhood risk factors were considerably different from unintentional weight loss. In a subsequent analysis, we aimed to capture the complex interplay between neighborhood features through neighborhood archetype analysis based on 16 social and built environment features, and to estimate their associations with CVH around 2 years after diagnosis among Black women. The CVH index used American Heart Association definition and scoring criteria for BMI, diet, smoking, physical activity, blood pressure, cholesterol, glucose, and sleep. We found that Black BC survivors, on average, reached only half of the recommended optimal CVH score, and no participant met all ideal CVH metrics. Among the four neighborhood archetypes identified, we found that the archetype associated with the most favorable post-diagnostic CVH was characterized by diverse racial and ethnic populations, a higher neighborhood socioeconomic status, greater densities of restaurants, food stores, physical activity facilities, walkable destinations, and ambulatory care. However, only 16% of our participants lived in this type of neighborhood. In summary, our work revealed that residential environments may considerably impact adiposity change and CVH among Black BC survivors. Through these studies, we provided insights into the distinct neighborhood characteristics and archetypes that may influence BC survivorship for Black women. Recognizing that social determinants of health act at multiple levels, domains, and factors, it is crucial that future research comprehensively investigates neighborhood and other multilevel determinants to identify the specific social barriers that must be addressed to achieve the most measurable improvements in BC survivorship for Black women. Citation Format: Bo Qin, Carola T. Sánchez-Díaz, Hari S. Iyer, Noreen Goldman, Nur Zeinomar, Andrew G. Rundle, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Gina S. Lovasi, Elisa V. Bandera. Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA038.

Neighborhood Food Environment and Birth Weight Outcomes in New York City

Infants born with unhealthy birth weight are at greater risk for long-term health complications, but little is known about how neighborhood characteristics (eg, walkability, food environment) may affect birth weight outcomes. To assess whether neighborhood-level characteristics (poverty rate, food environment, and walkability) are associated with risk of unhealthy birth weight outcomes and to evaluate whether gestational weight gain mediated these associations. The population-based cross-sectional study included births in the 2015 vital statistics records from the New York City Department of Health and Mental Hygiene. Only singleton births and observations with complete birth weight and covariate data were included. Analyses were performed from November 2021 to March 2022. Residential neighborhood-level characteristics, including poverty, food environment (healthy and unhealthy food retail establishments), and walkability (measured by both walkable destinations and a neighborhood walkability index combining walkability measures like street intersection and transit stop density). Neighborhood-level variables categorized into quartiles. The main outcomes were birth certificate birth weight measures including small for gestational age (SGA), large for gestational age (LGA), and sex-specific birth weight for gestational age z-score. Generalized linear mixed-effects models and hierarchical linear models estimated risk ratios for associations between density of neighborhood-level characteristics within a 1-km buffer of residential census block centroid and birth weight outcomes. The study included 106 194 births in New York City. The mean (SD) age of pregnant individuals in the sample was 29.9 (6.1) years. Prevalence of SGA and LGA were 12.9% and 8.4%, respectively. Residence in the highest density quartile of healthy food retail establishments compared with the lowest quartile was associated with lower adjusted risk of SGA (with adjustment for individual covariates including gestational weight gain z-score: risk ratio [RR], 0.89; 95% CI 0.83-0.97). Higher neighborhood density of unhealthy food retail establishments was associated with higher adjusted risk of delivering an infant classified as SGA (fourth vs first quartile: RR, 1.12; 95% CI, 1.01-1.24). The RR for the association between density of unhealthy food retail establishments and risk of LGA was higher after adjustment for all covariates in each quartile compared with quartile 1 (second: RR, 1.12 [95% CI, 1.04-1.20]; third: RR, 1.18 [95% CI, 1.08-1.29]; fourth: RR, 1.16; [95% CI, 1.04-1.29]). There were no associations between neighborhood walkability and birth weight outcomes (SGA for fourth vs first quartile: RR, 1.01 [95% CI, 0.94-1.08]; LGA for fourth vs first quartile: RR, 1.06 [95% CI, 0.98-1.14]). In this population-based cross-sectional study, healthfulness of neighborhood food environments was associated with risk of SGA and LGA. The findings support use of urban design and planning guidelines to improve food environments to support healthy pregnancies and birth weight.

Program Infrastructure the Key to Success: A Pilot Crosswalk Installation to Promote Walkability, Pedestrian Safety, and Physical Activity in the U.S. Virgin Islands.

While physical inactivity can contribute to chronic diseases, regular activity like walking can help prevent them. In 2010, one in three adults in the U.S. Virgin Islands (USVI) was physically inactive, higher than most U.S. states and territories. There are few walkable destinations and sidewalks along streets in the USVI. Since community- and street-scale design features can influence walking, we convened a 3-day walkability institute in the USVI to (1) learn about physical activity and best practices for design and (2) develop public health infrastructure that supports implementation. Island teams were formed to develop and implement a territory-wide action plan, focused on passing a Complete Streets policy, and demonstration projects on the islands of St. Croix, St. John, and St. Thomas to advance and pass this policy. An example of the demonstration projects and their significance is the completed one in St. Croix, which is the focus of this article. Island teams applied critical components of functioning program infrastructure as described in the Component Model of Infrastructure (CMI) such as engaged data, multilevel leadership, responsive plans and planning, and networked partnerships. We evaluated whether a crosswalk installation in St. Croix could alter driver and pedestrian behavior and create a safer environment for pedestrians. Observers recorded pedestrian crossing time, driver speed, and other behaviors before and after crosswalk installation. Pedestrians took significantly fewer average seconds to cross the street in the postdemonstration period (9.83) compared with predemonstration (13.4) (p = .03). Average car speed declined between the predemonstration (24.3) and long-term demonstration periods (p < .01) and from the postdemonstration (24.7) to the long-term demonstration period (18.2) (p < .01). A greater percentage of pedestrians used the crosswalk to cross the street between the postdemonstration (12.5%) and long-term demonstration periods (53.7%) (p < .01). The demonstration project in St. Croix shows that improvements to built environment infrastructure can increase safety for pedestrians, thus improving walkability in the USVI. We discuss the importance of CMI elements observed in the success of the St. Croix demonstration and its effectiveness in promoting a Complete Streets policy and the lack of these elements on St. John hindering progress there. Public health practitioners can apply the CMI to future physical activity promotion projects in the USVI and other settings as having functioning program infrastructure helps overcome challenges including natural disasters and a global pandemic and can achieve progress toward sustained policy and systems change.

Neighbourhood socioeconomic disadvantage and body size in Australia's capital cities: The contribution of obesogenic environments.

Residents of socioeconomically disadvantaged neighbourhoods have higher rates of overweight and obesity and chronic disease than their counterparts from advantaged neighbourhoods. This study assessed whether associations between neighbourhood disadvantage and measured body mass index (BMI) and waist circumference, are accounted for by obesogenic environments (i.e., residential distance to the Central Business District [CBD], supermarket availability, access to walkable destinations). The study used 2017-18 National Health Survey data for working-aged adults (aged ≥18 years, n = 9,367) residing in 3,454 neighbourhoods across Australia's state and territory capital cities. In five of eight cities (i.e., Sydney, Melbourne, Brisbane, Adelaide, and Perth) residents of disadvantaged neighbourhoods had significantly higher BMI and a larger waist circumference than residents of more advantaged areas. There was no association between neighbourhood disadvantage and body size in Hobart, Darwin, and Canberra. Associations between neighbourhood disadvantage and body size were partially explained by neighbourhood differences in distance to the CBD but not supermarket availability or walkable amenities. The results of this study point to the role of urban design and city planning as mechanisms for addressing social and economic inequities in Australia's capital cities, and as solutions to this country's overweight and obesity epidemic and associated rising rates of chronic disease.

Neighbourhood walkability is associated with risk of gestational diabetes: A cross-sectional study in New York City.

Despite the links between neighbourhood walkability and physical activity, body size and risk of diabetes, there are few studies of neighbourhood walkability and risk of gestational diabetes (GD). Assess whether higher neighbourhood walkability is associated with lower risk of GD in New York City (NYC). Cross-sectional analyses of a neighbourhood walkability index (NWI) score and density of walkable destinations (DWD) and risk of GD in 109,863 births recorded in NYC in 2015. NWI and DWD were measured for the land area of 1km radius circles around the geographic centroid of each Census block of residence. Mixed generalised linear models, with robust standard error estimation and random intercepts for NYC Community Districts, were used to estimate risk ratios for GD for increasing quartiles of each of the neighbourhood walkability measures after adjustment for the pregnant individual's age, race and ethnicity, parity, education, nativity, and marital status and the neighbourhood poverty rate. Overall, 7.5% of pregnant individuals experienced GD. Risk of GD decreased across increasing quartiles of NWI, with an adjusted risk ratio of 0.81 (95% Confidence Interval (CI) 0.75, 0.87) comparing those living in areas in the 4th quartile of NWI to those in the first quartile. Similarly, for comparisons of the 4th to 1st quartile of DWD, the adjusted risk ratio for GD was 0.77 (95% CI 0.71, 0.84). These analyses find support for the hypothesis that higher neighbourhood walkability is associated with a lower risk of GD. The analyses provide further health related support for urban design policies to increase walkability.

Neighborhood Walkability, Historical Redlining, and Childhood Obesity in Denver, Colorado.

Childhood obesity is a precursor to future health complications. In adults, neighborhood walkability is inversely associated with obesity prevalence. Recently, it has been shown that current urban walkability has been influenced by historical discriminatory neighborhood disinvestment. However, the relationship between this systemic racism and obesity has not been extensively studied. The objective of this study was to evaluate the association of neighborhood walkability and redlining, a historical practice of denying home loans to communities of color, with childhood obesity. We evaluated neighborhood walkability and walkable destinations for 250 participants of the Healthy Start cohort, based in the Denver metropolitan region. Eligible participants attended an examination between ages 4 and 8. Walkable destinations and redlining geolocations were determined based on residential addresses, and a weighting system for destination types was developed. Sidewalks and trails in Denver were included in the network analyst tool in ArcMap to calculate the precise walkable environment for each child. We implemented linear regression models to estimate associations between neighborhood characteristics and child body mass index (BMI) z-scores and fat mass percent. There was a significant association between child BMI and redlining (β: 1.36, 95% CI: 0.106, 2.620). We did not find an association between walkability measures and childhood obesity outcomes. We propose that cities such as Denver pursue built environment policies, such as inclusionary zoning and direct investments in neighborhoods that have been historically neglected, to reduce the childhood health impacts of segregated poverty, and suggest further studies on the influences that redlining and urban built environment factors have on childhood obesity.

Changes in Perceptions of the Near-Home Walking Environment Among US Adults-2015 and 2020 National Health Interview Survey.

The built environments in which we work, live, and play can influence physical activity behaviors, and perceptions of these environments are associated with walking behavior. This study's objective is to compare national-level data on perceptions of the near-home walking environment from the 2015 and 2020 National Health Interview Survey. Adults in 2015 (n = 30,811) and 2020 (n = 29,636) reported perceptions of walkable supports (roads, sidewalks, paths, or trails; sidewalks on most streets), destinations (shops, stores, or markets; bus or transit stops; movies, libraries, or churches; places that help you relax, clear your mind, and reduce stress), and barriers to walking (traffic; crime; animals). Age-adjusted prevalence estimates, prevalence differences, and 95% confidence intervals were calculated overall and by demographic characteristics. The reported prevalence of roads, sidewalks, paths, or trails for walking increased overall (85.3% in 2015 to 88.0% in 2020) and for many subgroups. Perceived places to walk to for relaxation, to clear your mind, and to reduce stress increased overall (72.1% in 2015 to 77.1% in 2020) and for all subgroups. Perceptions of crime as a barrier to walking decreased overall (12.5% in 2015 to 11.2% in 2020) and for some subgroups. From 2015 to 2020, the proportion of adults perceiving roads, sidewalks, paths, or trails; places to relax; and crime as a barrier to walking improved. Continuing to monitor perceptions of the walking environment could contribute to progress toward national walking and walkability goals in the United States.

Salient Targets and Fear of Falling Changed the Gait Pattern and Joint Kinematic of Older Adults

Fear of falling and environmental barriers in the home are two major factors that cause the incidence of falling. Poor visibility at night is one of the key environmental barriers that contribute to falls among older adult residents. Ensuring their visual perception of the surroundings, therefore, becomes vital to prevent falling injuries. However, there are limited works in the literature investigating the impact of the visibility of the target on older adults' walking destinations and how that impact differs across them with different levels of fear of falling. The purpose of the study was to examine the effects of target salience on older adults' walking performance and investigate whether older adults with varying levels of fear of falling behave differently. The salient target was constructed with LED strips around the destination of walking. Fifteen older adults (aged 75 years old and above), seven with low fear of falling and eight with high fear of falling, volunteered for the study. Participants walked from the designated origin (i.e., near their beds) to the destination (i.e., near the bathroom entrance), with the target turned on or off around the destination of the walking trials. Spatiotemporal gait variables and lower-body kinematics were recorded by inertial sensors and compared by using analysis of variance methods. Data from inertial sensors showed that a more salient target at the destination increased older adults' gait speed and improved their walking stability. These changes were accompanied by less hip flexion at heel strikes and toe offs during walking. In addition, older adults with low fear of falling showed more substantial lower-body posture adjustments with the salient target presented in the environment. Older adults with a low fear of falling can potentially benefit from a more salient target at their walking destination, whereas those with a high fear of falling were advised to implement a more straightforward falling intervention in their living areas.

Exploring the spatial scale effects of built environments on transport walking: Multi-Ethnic Study of Atherosclerosis

We employed a longitudinal distributed lag modeling approach to systematically estimate how associations between built environment features and transport walking decayed with the increase of distance from home to built environment destinations. Data came from a cohort recruited from six U.S. cities (follow-up 2000-2010, N=3913, baseline mean age 60). Built environment features included all walkable destinations, consisting of common and popular destinations for daily life. We also included two subsets frequent social destinations and food stores to examine if the spatial scale effects differed by varying density for different types of built environment destinations. Adjusted results found that increases in transport walking diminished when built environment destinations were farther, although distance thresholds varied across different types of built environment destinations. Higher availability of walking destinations within 2-km and frequent social destinations within 1.6-km were associated with transport walking. Food stores were not associated with transport walking. This new information will help policymakers and urban designers understand at what distances each type of built environment destinations influences transport walking, in turn informing the development of interventions and/or the placement of amenities within neighborhoods to promote transport walking. The findings that spatial scales depend on specific built environment features also highlight the need for methods that can more flexibly estimate associations between outcomes and different built environment features across varying contexts, in order to improve our understanding of the spatial mechanisms involved in said associations.

Cognability: An ecological model of cognitive function and neighborhood design

AbstractBackgroundNeighborhood environments are linked to multiple established risk factors for cognitive decline and dementia including physical inactivity, depression, obesity, hypertension, and diabetes. As an upstream influence on modifiable risk factors, neighborhood environments may help delay or prevent the onset of cognitive impairment. They may promote physical activity, social engagement, intellectual stimulation, and healthy eating; reduce exposure to air pollution; and limit stress levels related to environmental factors such as traffic and noise. Ecological theoretical models of cognitive health are needed to systematically investigate the environments in which people develop and navigate cognitive decline. This paper builds evidence for a new concept of ‘cognability’: an innovative theoretical approach to indicate how supportive a neighborhood is to cognitive health through community resources and neighborhood amenities that support socially, physically, and intellectually active aging in place.MethodWe conducted analyses in the Reasons for Geographic and Racial Differences in Stroke study, a national sample of aging Black and white Americans (n=21,151, mean age at assessment 67 years). We used a confirmatory factor analysis of five cognitive tests measuring verbal learning, memory, and executive function (Root Mean Square Error of Approximation=0.013; Comparative Fit Index=0.999), and output standardized scores for each participant. Contextual measures were created for urban‐dwelling participants using a kernel density method to capture proximity and availability of neighborhood amenities. Multilevel generalized additive models estimated associations between global cognitive function and access to neighborhood places for physical activity, socialization, and intellectual stimulation.ResultAnalyses identified statistically significant positive associations between cognitive function and access to civic and social organizations (p‐value=&lt;0.001), senior centers (p‐value=0.004), coffee shops and fast‐food restaurants (p‐value=&lt;0.001), parks (p‐value=&lt;0.001), recreation amenities (p‐value=0.023), walkable destinations (p‐value=&lt;0.001), and arts/cultural sites (p‐value=&lt;0.001).ConclusionLiving in neighborhoods with more opportunities for social interaction, physical activity, and intellectual stimulation may support cognitive function among older adults aging in place. Promoting ‘cognability’ via neighborhood intervention and urban planning may complement and enhance biomedical and individual lifestyle approaches.

261Can a physical activity supportive environment reduce socioeconomic inequities in incident coronary heart disease?

Abstract Background This research aims to: (1) explore the contribution of physical activity supportive environments to income inequities in coronary heart disease (CHD) incidence, and (2) investigate whether income inequities in CHD incidence are modified by physical activity supportive environments. Methods We used data from the REGARDS study, which recruited US-residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n = 20808), followed until December 31st 2014. We categorized household income and treated it as ordinal: (1) $75,000+, (2) $35,000-$74,000, (3) $20,000-$34,000, and (4) &amp;lt;$20,000. We operationalized physical activity supportive environments within a 1-km residential buffer as density of walkable destinations and physical activity facilities, and proportion green land cover. Cox models were estimated the adjusted association of income with incident CHD, and tested effect modification by environment variables. Results We found a 17% (95% CI 8% to 25%) increased hazard of CHD per decrease in household income category. After adjusting for physical activity environments, the HR was attenuated by 3% (HR = 1.15), and the income-CHD association was stronger in areas lacking walking destinations (HR = 1.54 vs 1.16). Conclusions Physical activity supportive environments, especially those with walking destinations, may moderate associations between household income and CHD. Key messages Low-income individuals have greater risk of developing CHD, however, the built environment has a small moderating effect on this association. Income inequities in CHD were also noted to be higher in areas with no walking destinations

Longitudinal Associations between the Neighborhood Built Environment and Cognition in US Older Adults: The Multi-Ethnic Study of Atherosclerosis.

Few studies have examined associations between neighborhood built environments (BE) and longitudinally measured cognition. We examined whether four BE characteristics were associated with six-year change in global cognition and processing speed. We obtained data on 1816 participants without dementia from the Multi-Ethnic Study of Atherosclerosis. BE measures included social destination density, walking destination density, proportion of land dedicated to retail, and network ratio (street connectivity). Global cognition was measured with the Cognitive Abilities Screening Instrument (CASI) and processing speed with the Digit Symbol Coding test (DSC). Multivariable random intercept logistic models tested associations between neighborhood BE at 2010–2012 and maintained/improved cognition (versus decline) from 2010–2018, and mediation by minutes of physical activity (PA)/week. The sample was an average of 67 years old (standard deviation = 8.2) (first cognitive measurement) and racially/ethnically diverse (29% African American, 11% Chinese, 17% Hispanic, 44% White). Compared to individuals with no walking destinations in the 1-mile surrounding their residence, those with 716 walking destinations (maximum observed) were 1.24 times more likely to have maintain/improved DSC score (Odds ratio: 1.24; 95% confidence interval: 1.03–1.45). No other associations were observed between BE and cognition, and PA minutes/week did not mediate the association between walking destination density and DSC change. This study provides limited evidence for an association between greater neighborhood walking destinations and maintained/improved processing speed in older age and no evidence for associations between the other BE characteristics and cognition. Future studies with finer grained BE and cognitive measures and longer-term follow up may be required.

Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study.

We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age=73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5km of home was associated with a respective 7% (95% confidence interval (CI)=0.87-0.99) and 12% (95% CI=0.73-1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.

Neighborhood active aging infrastructure and cognitive function: A mixed-methods study of older Americans

Physical exercise benefits cognitive functioning and can protect against neurodegeneration. Neighborhood environments may be pivotal to physically active aging, and thus help shape older adults' cognitive function. This mixed-methods study investigated where older adults exercised outside the home, and whether availability of these neighborhood sites was associated with cognitive function. We thematically analyzed qualitative data from semi-structured interviews in 2015 with 125 older adults (mean age = 71) in the Minneapolis (MN) metropolitan area. Results identified nearby public parks, fitness/sports amenities, and walkable destinations as motivators for recreational exercise and active transit among participants. These findings informed quantitative analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national sample of older Black and white Americans (n = 21,151; mean age at assessment = 67; data collected 2006–2017). We used generalized additive multilevel models to examine whether neighborhood features that qualitative participants identified as encouraging physical activity were associated with elevated levels of cognitive function. Results indicated that residing in neighborhoods with greater availability of local parks, access to recreational amenities, and business density was associated with higher levels of cognitive function. We found no evidence to suggest a significant association between availability of these neighborhood resources and rate of cognitive decline. This study identifies specific neighborhood active aging infrastructure that may support cognitive function among older adults aging in place.

Multilevel Risk Factors for Weight Change after Breast Cancer Diagnosis Among Black Women

Abstract Background: Weight gain after breast cancer diagnosis increases the risk of mortality. African American/Black breast cancer survivors are more likely to have excess body weight than their White counterparts, which may contribute to their higher mortality rate. Emerging evidence suggests that post-diagnosis weight gain may result from multilevel determinants. However, no study has investigated the multilevel characteristics among Black breast cancer survivors. Objective: To evaluate associations between individual-level factors and neighborhood social and built environment factors with weight change after breast cancer diagnosis among Black women. Methods: We evaluated associations of interest among 785 women enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), a longitudinal study of Black breast cancer survivors in New Jersey. Weight change was primarily based on measurements at baseline and follow-up visits (Median: 10.3 and 23.2 mo. since diagnosis, respectively). Participants were grouped into categories of stable weight (52.4%), ≥3% weight loss (20.0%), and ≥3% weight gain (27.6%). Using multivariate- adjusted multinomial logistic regression and multilevel multinomial logistic regression, we evaluated relative risk ratios (RRRs) for associations between multilevel factors and post-diagnosis weight change category. Results: Black breast cancer survivors who were older at diagnosis, had higher household income, post-menopausal status, and higher baseline BMI were less likely to gain weight compared to women with stable weight. Former smoking, higher tumor stage, and chemotherapy were associated with increased relative risk of weight gain (e.g. RRR-chemo: 1.45, 95% CI: 1.01, 2.08). Black women residing in neighborhoods in the highest tertile for density of walkable destinations had a decreased relative risk of post- diagnosis weight gain (e.g. RRR-T3 highest density vs. T1 lowest: 0.39, 95% CI: 0.20, 0.75), while those residing in neighborhoods with higher density of fast food restaurants had increased relative risk of weight gain (RRR-T3 highest density vs. T1 lowest: 1.94, 95% CI: 1.23, 3.05). Conclusion: Both individual and neighborhood factors may influence the risk of weight gain among Black women after breast cancer diagnosis.

Associations between supermarket availability and body size in Australia: a cross-sectional observational study comparing state and territory capital cities

BackgroundResidential environment features such as availability of supermarkets may shape dietary behaviour and thus overweight and obesity. This relationship may not be consistent between cities. This Australian national-level study examined: 1) the relationship between supermarket availability and body size; and 2) whether this relationship varied by capital city.MethodsThis study used 2017–18 Australian National Health Survey data including individual-level socio-demographic information (age, sex, country of birth, education, occupation, household income), and measured body size (height and weight to derive body mass index [BMI], and waist circumference [WC]). Objectively-expressed measures of residential environments included: counts of supermarkets (major chain outlets), counts of amenities (representing walkable destinations including essential services, recreation, and entertainment), and area of public open space - each expressed within road-network buffers at 1000 m and 1500 m; population density (1km2 grid cells); and neighbourhood disadvantage (Index of Relative Socioeconomic Disadvantage) expressed within Statistical Area Level 1 units. Data for adult respondents ≥18 years residing in each of Australia’s state and territory capital cities (n = 9649) were used in multilevel models to estimate associations between supermarket availability and body size sequentially accounting for individual and other environment measures. An interaction term estimated city-specific differences in associations between supermarket availability and body size. Models were consequently repeated stratified by city.ResultsBody size (BMI and WC) and supermarket availability varied between cities. Initial inverse associations between supermarket availability and body size (BMI and WC) were attenuated to null with inclusion of all covariates, except for BMI in the 1000 m buffer model (beta = − 0.148, 95%CI -0.27, − 0.01, p = 0.025). In stratified analyses, the strengths of associations varied between cities, remaining statistically significant only for some cities (BMI: Melbourne, Brisbane Hobart; WC: Brisbane, Hobart) in fully adjusted models. Different patterns of attenuation of associations with inclusion of covariates were evident for different cities.ConclusionsFor Australian capital cities, greater availability of supermarkets is associated with healthful body size. Marked between-city variations in body size, supermarket availability, and relationships between supermarket availability and body size do not, however, support universal, “one-size-fits-all” solutions to change built environments to support healthful body size.

Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?

BackgroundEfforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated...