Walking for Transportation or Leisure: What Difference Does the Neighborhood Make?

Abstract

Background Patients are often advised to initiate a physical activity program by walking for transportation or leisure. This study explored whether neighborhood factors beyond the individual might affect compliance. Objective We examined the associations between total walking and neighborhood factors in a multi-ethnic population-based sample in California and the roles race/ethnicity plays in these associations. Design Cross-sectional study Participants Individual-level data were obtained from the 2003 California Health Interview Survey. Participants’ census tracts were linked to Census 2000 data to capture neighborhood SES. Measurements and Main Results The dependent variable was self-reported walking at recommended levels. Neighborhood SES was measured by a scale of 4 Census-based variables (alpha = 0.83). Social cohesion was measured by a scale tapping the extent of perceived social connectedness, trust, and solidarity among neighbors (alpha = 0.70). Neighborhood access to a park, playground, or open space was measured by a single item. Safety was measured by a scale of three items (alpha = 0.66). We performed a series of multiple logit models with robust variance estimates while taking complex survey design into account. Neighborhood social cohesion (odds ratio [OR] = 1.09, 95% CI = 1.04, 1.14) and access to a park, playground, or open space (OR = 1.26, 95% CI = 1.16, 1.36) were significant environmental correlates of walking at recommended levels, independent of individual socio-demographics. Subgroup analysis showed that neighborhood effects were different by race/ethnicity. Conclusions Neighborhood physical and social environmental factors are significantly associated with walking at recommended levels. Being aware of the ways that the environment could affect a patient’s compliance with PA recommendations may help physicians tailor recommendations to circumstances.