Mismatch between perceived and objectively assessed neighborhood walkability attributes: Prospective relationships with walking and weight gain
Introduction
There is a consistent body of evidence on the health benefits of physical activity (Pate et al., 1995, US Department of Health and Human Services, 1996, Haskell et al., 2007). Over the last decade there has been an increasing interest in the role of the physical environment as a determinant of physical activity: neighborhood built-environment attributes have been shown to be associated with walking (Owen et al., 2004, Transportation Research Board, 2005, Heath et al., 2006, Gebel et al., 2007, Saelens and Handy, 2008), and with obesity (Frank et al., 2004, Papas et al., 2007, Black and Macinko, 2008, Joshu et al., 2008, Mujahid et al., 2008). According to ecological models of health behavior, appropriate opportunities and settings that facilitate particular forms of activity, such as walking for recreation and exercise, or walking to get to and from places, help adults to achieve sufficient levels of physical activity for health benefits (Owen et al., 2000, Sallis et al., 2008).
However, the provision of such built-environment facilitators alone might not automatically influence the behavior in the absence of awareness of them, or without relevant awareness-raising initiatives (Kahn et al., 2002, Salmon et al., 2003, Timperio et al., 2004, Humpel et al., 2004, Mowen et al., 2007, Frohlich et al., 2007, McCormack et al., 2008, Ball et al., 2008). It has been argued that the relationships between the attributes of neighborhood environments and physical activity may be mediated by environmental cognitions (Kremers et al., 2006). The outcomes of the processing, coding, and storing of information about environmental attributes may be construed as cognitive maps. However, the literature on spatial cognition and environmental psychology states that these cognitive maps are unlikely to provide precise representations of the actual environment, and may reflect systematic cognitive distortions (Kaplan and Kaplan, 1982, Golledge, 1987, Golledge, 1991, Lloyd, 1997). This is indicated by the relatively low rates of awareness of objectively present opportunities for physical activity that have been reported in some studies (Merom et al., 2003, Reed et al., 2004, Reed, 2007). As well, recent cross-sectional studies have found low agreement between objective and perceived measures of environmental attributes known to be associated with physical activity (McCormack et al., 2008, Ball et al., 2008, Reed et al., 2004, Kirtland et al., 2003, Boehmer et al., 2006, Kweon et al., 2006, McGinn et al., 2007, Macintyre et al., 2008, Gebel et al., 2009, Lackey and Kaczynski, 2009, Prins et al., 2009).
It has been hypothesized that the level of concordance of perceptions with actual characteristics of the environment might affect physical activity behavior (Kirtland et al., 2003, Gebel et al., 2009, Napolitano et al., 2006). If the outcomes of such spatial cognition processes mediate the relationship between environmental attributes and behavior, then the targeting of environmental cognitions (and particularly the awareness of settings for physical activity) could be a promising public health communication strategy (Mowen et al., 2007, van Stralen et al., 2008).
The potential mediating role of environmental cognitions on the relationships between environmental attributes and physical activity may be moderated by socio-demographic factors (Kremers et al., 2006). Such factors could either influence the relationships between the environmental attributes and cognitions, or the relationships between such cognitions and physical activity (Kremers et al., 2006). For example, in a cross-sectional study (Gebel et al., 2009) we found that adults of lower socio-economic status, who had children in the household, or who were overweight were more likely to perceive a high-walkable neighborhood as low-walkable.
Few longitudinal studies have investigated either objectively assessed or perceived environmental attributes in relation to prospective changes in physical activity. For example, a prospective study in the USA (Li et al., 2005) examined objectively assessed environmental correlates of change in neighborhood walking among older adults. One year after baseline measurement, walking levels had declined. Those living in neighborhoods with low accessibility to playgrounds, parks, or gyms, or with low perceived safety for walking showed greater decreases in walking than those living in more walkable neighborhoods. Another study from the USA (Li et al., 2009) found that objectively assessed high neighborhood walkability positively moderated the relationship between people’s eating and physical activity habits and prospective changes in their weight and waist circumference. An Australian study (Humpel et al., 2004) examining perceptions and behavior at two time points, found that improved perceptions of accessibility to destinations and aesthetics were associated with increased walking levels. These findings from prospective studies provide some evidence for the relevance of both objectively assessed and perceived environmental attributes in relation to prospective changes in physical activity; one study has shown a prospective association with weight gain (Li et al., 2009).
However, cross-sectional studies have found agreement between these objective measures of walkability and participant’s perceptions of the corresponding environmental attributes to be low (McCormack et al., 2008, Ball et al., 2008, Reed et al., 2004, Kirtland et al., 2003, Boehmer et al., 2006, McGinn et al., 2007, Macintyre et al., 2008, Gebel et al., 2009, Lackey and Kaczynski, 2009, Prins et al., 2009). As well, at baseline, we found that those with more positive perceptions are more likely to be physically active (Gebel et al., 2009). In the baseline study, we examined the correlates of non-concordance between perceived and objective measures of environmental attributes, and found that about a third of those living in objectively determined high walkable neighborhoods perceived their local environment as low in walkability. Similarly, a third of those living in neighborhoods with low walkability perceived them to be high walkable. This was the case for a composite measure of walkability, and for the sub-domains of dwelling density, street connectivity, land use mix, and retail density (Gebel et al., 2009). It has been suggested that strategies to improve perceptions of the relevant environmental attributes particularly among those who live in objectively determined high walkable neighborhoods may have the potential to increase physical activity levels (Reed et al., 2004, Gebel et al., 2009) and improve other health outcomes (Parra et al., 2010). No study has examined whether mismatch between perceived and objectively determined walkability influences change in walking and weight.
Here, we examine prospective relationships of perceiving objectively measured high walkability as low with changes in adults’ walking, and weight gain. We hypothesized that over time, those who perceive their objectively measured high walkable environment as low walkable would decrease their walking more and would gain more weight than would those with matched perceptions.
Section snippets
Data collection procedure
Data were from the PLACE (Physical Activity in Localities and Community Environments) study conducted in 2003 (baseline) and in 2007 (follow-up) in the city of Adelaide, Australia. Ethical approval for the study was given by the Behavioural and Social Sciences Ethics Committee of the University of Queensland. Prior to being enrolled in the study, all participants provided informed consent and were explicitly informed that they were free to withdraw from the study at any time.
An account of the
Agreement between objective and perceived measures of neighborhood walkability
Consistent with the baseline study (Gebel et al., 2009), there was only a modest agreement between the objective and the perceived environmental measures. One third of the subjects who lived in objectively determined high walkable neighborhoods perceived them to be low walkable. Among those in low walkable environments, a third perceived walkability to be high (Table 1). The agreement between objective and perceived measures for the four sub domains of walkability was similar (data not provided
Discussion
In the total sample, over the four years between the baseline and follow-up surveys, there was a significant decrease in walking levels and a significant increase in BMI. These findings are consistent with those of other studies, which have found that with increasing age, adults become physically less active and gain more weight (US Department of Health and Human Services, 1996, Trost et al., 2002, Lewis et al., 2000, Jacobsen et al., 2001, Allman-Farinelli et al., 2008, Gordon-Larsen et al.,
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