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Purpose: The primary aim of this study was to compare steps per day across ActiGraph models, wear locations, and filtering methods. A secondary aim was to compare ActiGraph steps per day to those estimated by the ankle-worn StepWatch., Methods: We conducted a systematic literature review to identify studies of adults published before May 12, 2022, that compared free-living steps per day of ActiGraph step counting methods and studies that compared ActiGraph to StepWatch. Random-effects meta-analysis compared ActiGraph models, wear locations, filter mechanisms, and ActiGraph to StepWatch steps per day. A sensitivity analysis of wear location by younger and older age was included., Results: Twelve studies, with 46 comparisons, were identified. When worn on the hip, the AM-7164 recorded 123% of the GT series steps (no low-frequency extension (no LFE) or default filter). However, the AM-7164 recorded 72% of the GT series steps when the LFE was enabled. Independent of the filter used (i.e., LFE, no LFE), ActiGraph GT series monitors captured more steps on the wrist than on the hip, especially among older adults. Enabling the LFE on the GT series monitors consistently recorded more steps, regardless of wear location. When using the default filter (no LFE), ActiGraph recorded fewer steps than StepWatch (ActiGraph on hip 73% and ActiGraph on wrist 97% of StepWatch steps). When LFE was enabled, ActiGraph recorded more steps than StepWatch (ActiGraph on the hip, 132%; ActiGraph on the wrist, 178% of StepWatch steps)., Conclusions: The choice of ActiGraph model, wear location, and filter all impacted steps per day in adults. These can markedly alter the steps recorded compared with a criterion method (StepWatch). This review provides critical insights for comparing studies using different ActiGraph step counting methods., (Copyright © 2023 by the American College of Sports Medicine.)

Background: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality., Methods: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models., Findings: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28])., Interpretation: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity., Funding: US Centers for Disease Control and Prevention., Competing Interests: Declaration of interests AEP and CFP received funding for this project from US Centers for Disease Control and Prevention (CDC) Intergovernmental Personnel Act Agreement. BJJ receives grant funding through the British Heart Foundation. MRC and RSV have received grant funding through National Heart Lung and Blood Institute, National Institutes of Health (NIH). I-ML, KPG, and PP receive grant funding through NIH. KRE receives grant funding through NIH, Robert Wood Johnson Foundation, US Department of Transportation, and North Carolina Department of Transportation; receives consulting fees from NIH; and is on the Board of Trustees with the American College of Sports Medicine. DD has received grant funding through German Research Foundation, travel expenses for 10th International Meeting on Ageing, honoraria for being an instructor at Boston University School of Public Health, been an unpaid speaker for German Society of Epidemiology, and been an unpaid member of the Alumni Leadership Council of Boston University School of Public Health. JS receives grant funding through National Institutes on Aging, NIH. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Self-reported time spent standing has been associated with lower risk of mortality. No previous studies have examined this association using device-measured standing., Method: This was a prospective cohort study of 5878 older (median age = 80 years), racial/ethnically diverse, community-dwelling women in the WHI Objective Physical Activity and Cardiovascular Health Study (OPACH). Women wore accelerometers for 1 week and were followed for mortality. The study applied previously validated machine learning algorithms to ActiGraph GT3X+ accelerometer data to separately measure time spent standing with and without ambulation. Cox proportional hazards models were used to estimate mortality risk adjusting for potential confounders. Effect modification by age, body mass index, moderate-to-vigorous physical activity, sedentary time, physical functioning, and race/ethnicity was evaluated., Results: There were 691 deaths during 26 649 person-years of follow-up through March 31, 2018 (mean follow-up = 4.8 years). In fully adjusted models, all-cause mortality risk was lower among those with more standing without ambulation (quartile [Q] 4 vs Q1 HR = 0.63; 95% CI = 0.49-0.81, p-trend = .003) and more standing with ambulation (Q4 vs Q1 HR = 0.50; 95% CI = 0.35-0.71, p-trend < .001). Associations of standing with ambulation and mortality were stronger among women with above-median sedentary time (HR = 0.51; 95% CI = 0.38-0.68) compared to women with below-median sedentary time (HR = 0.80; 95% CI = 0.59-1.07; p-interaction = .02)., Conclusions: In this prospective study among older women, higher levels of accelerometer-measured standing were associated with lower risks of all-cause mortality. Standing is an achievable approach to interrupting prolonged sedentary time, and if not contraindicated, is a safe and feasible behavior that appears to benefit health in older ages., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes., Methods: A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations., Results: Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics., Conclusions: Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

Purpose: To assess predictors of stated support for policies promoting physically active transportation., Design: Cross-sectional., Setting: US counties selected on county-level physical activity and obesity health status., Participants: Participants completing random-digit dialed telephone survey (n = 906)., Measures: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle-pedestrian projects., Analysis: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county., Results: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs <0.7 hours) in cars were more likely to support street (odds ratio [OR]: 1.87; confidence interval [CI]: 1.09-3.22) and public transit (OR: 1.85; CI: 1.24-2.77) improvements. Residents in counties investing >$1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (<$276 100)., Conclusion: Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.

Background: Previous studies indicate that the design of streets and sidewalks can influence physical activity among residents. Park features also influence park use and park-based physical activity. Although individuals can walk on streets and sidewalks, walking loops in parks offer a setting to walk in nature and to avoid interruptions from traffic., Objectives: Here we describe the use of walking loops in parks and compare the number of park users and their physical activity in urban neighborhood parks with and without walking loops., Methods: We analyzed data from the National Study of Neighborhood Parks in which a representative sample of neighborhood parks (n = 174) from 25 U.S. cities with > 100,000 population were observed systematically to document facilities and park users by age group and sex. We compared the number of people and their physical activity in parks with and without walking loops, controlling for multiple factors, including park size, facilities, and population density., Results: Overall, compared with parks without walking loops, on average during an hourly observation, parks with walking loops had 80% more users (95% CI: 42, 139%), and levels of moderate-to-vigorous physical activity were 90% higher (95% CI: 49, 145%). The additional park use and park-based physical activity occurred not only on the walking loops but throughout the park., Conclusions: Walking loops may be a promising means of increasing population level physical activity. Further studies are needed to confirm a causal relationship. Citation: Cohen DA, Han B, Evenson KR, Nagel C, McKenzie TL, Marsh T, Williamson S, Harnik P. 2017. The prevalence and use of walking loops in neighborhood parks: a national study. Environ Health Perspect 125:170-174; http://dx.doi.org/10.1289/EHP293., Competing Interests: The authors declare they have no actual or potential competing financial interests.

Background: Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population., Methods: The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up., Results: Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar., Conclusions: The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest., Trial Registration: clinicaltrials.gov Identifier: NCT01433484.

Background: Few studies have comprehensively evaluated the effectiveness of multi-faceted interventions intended to improve pedestrian safety. "Watch for Me NC" is a multi-faceted, community-based pedestrian safety program that includes widespread media and public engagement in combination with enhanced law enforcement activities (i.e., police outreach and targeted pedestrian safety operations conducted at marked crosswalks) and low-cost engineering improvements at selected crossings. The purpose of this study was to estimate the effect of the law enforcement and engineering improvement components of the program on motor vehicle driver behavior, specifically in terms of increased driver yielding to pedestrians in marked crosswalks., Methods: The study used a pre-post design with a control group, comparing crossing locations receiving enforcement and low-cost engineering treatments (enhanced locations) with locations that did not (standard locations) to examine changes in driver yielding over a 6-month period from 2013 to 2014. A total of 24,941 drivers were observed in 11,817 attempted crossing events at 16 crosswalks in five municipalities that were participating in the program. Observations of real pedestrians attempting to use the crosswalks ("naturalistic" crossing) were supplemented by observations of trained research staff attempting the same crossings following an established protocol ("staged" crossings). Generalized estimating equations (GEE) were used to model driver yielding rates, accounting for repeated observations at the crossing locations and controlling other factors that affect driver behavior in yielding to pedestrians in marked crosswalks., Results: At crossings that did not receive enhancements (targeted police operations or low-cost engineering improvements), driver yielding rates did not change from before to after the Watch for Me NC program. However, yielding rates improved significantly (between 4 and 7 percentage points on average) at the enhanced locations. This was true for both naturalistic and staged crossings., Conclusions: This study provides evidence that enhanced enforcement and low-cost engineering improvements, as a part of a broader program involving community-based outreach, can increase driver yielding to pedestrians in marked crosswalks. These data are important for the staff and decision-makers involved in pedestrian safety programs to gain a better understanding of the different engineering and behavioral mechanisms that could be used to improve driver yielding rates., (Published by Elsevier Ltd.)

Purpose: This study described the use of dog parks in several diverse locations and explored the contribution dog parks made to physical activity of the dog owners., Method: The Systematic Observation of Play and Recreation in Communities (SOPARC) tool was used to count the number and characteristics of people using parks. Observations were conducted 4 times per day, 4 days per week during for 1 week in 6 urban/suburban parks during different seasons. Collection sites included 3 dog parks in Chapel Hill/Durham, NC; 2 dog parks in Los Angeles, CA; and 1 dog park in Philadelphia, PA. Interviews at the NC and PA parks were conducted among 604 adults., Results: We counted 2,124 people (11.9%) in the dog park area compared with 15,672 people in the remaining park areas. Based on observations, dog park visitors were more likely to be female and White or Other race/ethnicity compared with Hispanics, and were less likely to be children or engaged in walking or vigorous activity. Park interviews revealed that compared with other park activities, reporting walking/watching a dog at the park was more common among those who visited the park more frequently ( ≥ 1 time per week), stayed at the park for a shorter time ( ≤  1 hr), or visited the park alone., Conclusion: Although dog parks may be an important destination for dog owners and contribute to physical activity, the contribution of dog parks to participants' moderate-to-vigorous physical activity was limited.

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004-2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Consumer-wearable activity trackers are electronic devices used for monitoring fitness- and other health-related metrics. The purpose of this systematic review was to summarize the evidence for validity and reliability of popular consumer-wearable activity trackers (Fitbit and Jawbone) and their ability to estimate steps, distance, physical activity, energy expenditure, and sleep., Methods: Searches included only full-length English language studies published in PubMed, Embase, SPORTDiscus, and Google Scholar through July 31, 2015. Two people reviewed and abstracted each included study., Results: In total, 22 studies were included in the review (20 on adults, 2 on youth). For laboratory-based studies using step counting or accelerometer steps, the correlation with tracker-assessed steps was high for both Fitbit and Jawbone (Pearson or intraclass correlation coefficients (CC) > =0.80). Only one study assessed distance for the Fitbit, finding an over-estimate at slower speeds and under-estimate at faster speeds. Two field-based studies compared accelerometry-assessed physical activity to the trackers, with one study finding higher correlation (Spearman CC 0.86, Fitbit) while another study found a wide range in correlation (intraclass CC 0.36-0.70, Fitbit and Jawbone). Using several different comparison measures (indirect and direct calorimetry, accelerometry, self-report), energy expenditure was more often under-estimated by either tracker. Total sleep time and sleep efficiency were over-estimated and wake after sleep onset was under-estimated comparing metrics from polysomnography to either tracker using a normal mode setting. No studies of intradevice reliability were found. Interdevice reliability was reported on seven studies using the Fitbit, but none for the Jawbone. Walking- and running-based Fitbit trials indicated consistently high interdevice reliability for steps (Pearson and intraclass CC 0.76-1.00), distance (intraclass CC 0.90-0.99), and energy expenditure (Pearson and intraclass CC 0.71-0.97). When wearing two Fitbits while sleeping, consistency between the devices was high., Conclusion: This systematic review indicated higher validity of steps, few studies on distance and physical activity, and lower validity for energy expenditure and sleep. The evidence reviewed indicated high interdevice reliability for steps, distance, energy expenditure, and sleep for certain Fitbit models. As new activity trackers and features are introduced to the market, documentation of the measurement properties can guide their use in research settings.

Objective: To explore the association of changes in perceived safety and police-recorded crime with changes in transport and leisure walking using longitudinal data from Chicago residents participating in the Multi-Ethnic Study of Atherosclerosis (2000-2012)., Method: Main exposures included perceived safety (self-reported as feeling safe walking in the neighborhood and reporting violence to be a problem in the neighborhood), and one-year counts of police-recorded crime occurring within a one-mile buffer of participants' residences. Main outcomes included transport and leisure walking (self-reported and calculated as total minutes/week across four study visits). Fixed effects models assessed the association of change in perceived safety and police-recorded crime with changes in transport and leisure walking over a 10-year period for 796 adults., Results: No associations were found between changes in perceived safety and either changes in transport or leisure walking. Residing in areas with increases in murder was associated with decreases in transport walking. However, no other associations were found with police-recorded crime., Conclusion: There continues to be a need to explore the benefits of cultivating safe neighborhoods that enhance resident health and well-being. Research should continue examining how community initiatives may build safe environments and community identity that promote walking., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Lack of longitudinal research hinders causal inference on the association between the built environment and walking. In the present study, we used data from 6,027 adults in the Multi-Ethnic Study of Atherosclerosis who were 45-84 years of age at baseline to investigate the association of neighborhood built environment with trends in the amount of walking between 2000 and 2012. Walking for transportation and walking for leisure were assessed at baseline and at 3 follow-up visits (median follow-up = 9.15 years). Time-varying built environment measures (measures of population density, land use, number of destinations, bus access, and street connectivity) were created using geographic information systems. We used linear mixed models to estimate the associations between baseline levels of and a change in each built environment feature and a change in the frequency of walking. After adjustment for potential confounders, we found that higher baseline levels of population density, area zoned for retail, social destinations, walking destinations, and street connectivity were associated with greater increases in walking for transportation over time. Higher baseline levels of land zoned for residential use and distance to buses were associated with less pronounced increases (or decreases) in walking for transportation over time. Increases in the number of social destinations, the number of walking destinations, and street connectivity over time were associated with greater increases in walking for transportation. Higher baseline levels of both land zoned for retail and walking destinations were associated with greater increases in leisure walking, but no changes in built environment features were associated with leisure walking. The creation of mixed-use, dense developments may encourage adults to incorporate walking for transportation into their everyday lives., (© The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We used an agent-based model to examine the impact of the walking school bus (WSB) on children's active travel to school. We identified a synergistic effect of the WSB with other intervention components such as an educational campaign designed to improve attitudes toward active travel to school. Results suggest that to maximize active travel to school, children should arrive on time at "bus stops" to allow faster WSB walking speeds. We also illustrate how an agent-based model can be used to identify the location of routes maximizing the effects of the WSB on active travel. Agent-based models can be used to examine plausible effects of the WSB on active travel to school under various conditions and to identify ways of implementing the WSB that maximize its effectiveness.

Objectives: We investigated whether moving to neighborhoods with closer proximity of destinations and greater street connectivity was associated with more walking, a greater probability of meeting the "Every Body Walk!" campaign goals (≥ 150 minutes/week of walking), and reductions in body mass index (BMI)., Methods: We linked longitudinal data from 701 participants, who moved between 2 waves of the Multi-Ethnic Study of Atherosclerosis (2004-2012), to a neighborhood walkability measure (Street Smart Walk Score) for each residential location. We used fixed-effects models to estimate if changes in walkability resulting from relocation were associated with simultaneous changes in walking behaviors and BMI., Results: Moving to a location with a 10-point higher Walk Score was associated with a 16.04 minutes per week (95% confidence interval [CI] = 5.13, 29.96) increase in transport walking, 11% higher odds of meeting Every Body Walk! goals through transport walking (adjusted odds ratio = 1.11; 95% CI = 1.02, 1.21), and a 0.06 kilogram per meters squared (95% CI = -0.12, -0.01) reduction in BMI. Change in walkability was not associated with change in leisure walking., Conclusions: Our findings illustrated the potential for neighborhood infrastructure to support health-enhancing behaviors and overall health of people in the United States.

Background: Walk Score® and Transit Score® are open-source measures of the neighborhood built environment to support walking ("walkability") and access to transportation., Purpose: To investigate associations of Street Smart Walk Score and Transit Score with self-reported transport and leisure walking using data from a large multicity and diverse population-based sample of adults., Methods: Data from a sample of 4552 residents of Baltimore MD, Chicago IL, Forsyth County NC, Los Angeles CA, New York NY, and St. Paul MN from the Multi-Ethnic Study of Atherosclerosis (2010-2012) were linked to Walk Score and Transit Score (collected in 2012). Logistic and linear regression models estimated ORs of not walking and mean differences in minutes walked, respectively, associated with continuous and categoric Walk Score and Transit Score. All analyses were conducted in 2012., Results: After adjustment for site, key sociodemographic, and health variables, a higher Walk Score was associated with lower odds of not walking for transport and more minutes/week of transport walking. Compared to those in a "walker's paradise," lower categories of Walk Score were associated with a linear increase in odds of not transport walking and a decline in minutes of leisure walking. An increase in Transit Score was associated with lower odds of not transport walking or leisure walking, and additional minutes/week of leisure walking., Conclusions: Walk Score and Transit Score appear to be useful as measures of walkability in analyses of neighborhood effects., (Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Dog walking is a strategy for increasing population levels of physical activity (PA). Numerous cross-sectional studies of the relationship between dog ownership and PA have been conducted. The purpose was to review studies comparing PA of dog owners (DO) to nondog owners (NDO), summarize the prevalence of dog walking, and provide recommendations for research., Methods: A review of published studies (1990-2010) examining DO and NDO PA and the prevalence of dog walking was conducted (N = 29). Studies estimating the relationship between dog ownership and PA were grouped to create a point- estimate using meta-analysis., Results: Most studies were conducted in the last 5 years, were cross-sectional, and sampled adults from Australia or the United States. Approximately 60% of DO walked their dog, with a median duration and frequency of 160 minutes/week and 4 walks/week, respectively. Meta-analysis showed DO engage in more walking and PA than NDO and the effect sizes are small to moderate (d = 0.26 and d = 0.16, respectively). Three studies provided evidence of a directional relationship between dog ownership and walking., Conclusions: Longitudinal and interventional studies would provide stronger causal evidence for the relationship between dog ownership and PA. Improved knowledge of factors associated with dog walking will guide intervention research.

Context: Pedestrian and bicycle plans support community-level physical activity. In North Carolina, pedestrian/bicycle plans are becoming more prevalent. However, no studies have examined the spatial and temporal diffusion of pedestrian/bicycle plans., Objectives: This study assessed (a) temporal trends associated with municipal pedestrian/bicycle planning from 1974 to 2011 and (b) spatial patterns associated with municipal plans, specifically, whether the publication of a pedestrian/bicycle plan in a given year was associated with the number of neighboring municipalities with plans., Setting: North Carolina from 1974 to 2011., Main Outcome Measures: The main outcome was date of publication of all North Carolina municipal pedestrian and bicycle plans (1974-2011). We calculated Euclidean distances from each municipality center to all other municipality centers to derive whether municipalities were within 20 and 50 miles of each other. Sociodemographic covariates (eg, education, grant funding status, poverty, urbanicity, racial composition, population size, population growth) were collected from the US Census of Population (1980-2010) and the American Community Survey (2006-2010). Time series models fitted by generalized estimating equations were used to assess relationships between plan presence and the temporal and spatial predictor variables., Results: The number of pedestrian and bicycle plans significantly increased over time, especially after 2006 when a state grant funding program was initiated. Unadjusted models indicated that municipalities were significantly more likely to have a pedestrian plan if higher numbers of neighboring municipalities had pedestrian plans. After adjustment for sociodemographic covariates and funding source, this relationship was attenuated but remained statistically significant. For bicycle plans, no significant associations were observed between plan presence and the number of neighboring municipalities with bicycle plans in adjusted models., Conclusions: Findings from this study can be used to generate hypotheses to test theories about diffusion of innovation and social contagion processes in pedestrian/bicycle planning.

This study examined the association between the presence of pedestrian and bicycle plans to pedestrian and bicyclist nonfatal and fatal injuries from 1997 to 2009 among 553 North Carolina (NC) municipalities. We considered all municipal plans (n=92; 49 pedestrian; 34 bicycle; and 9 combined plans featuring pedestrian and bicyclist components) published through 2009. Counts of pedestrian and bicyclist nonfatal and fatal injuries came from the NC Department of Transportation crash database, and the estimated number of pedestrian and bicycle trips per municipality in one year were used to calculate pedestrian and bicyclist nonfatal and fatal injury rates. In the 13-year study period, pedestrian/combined municipality plans and bicycle/combined municipality plans were present for 189 (2.6%) and 238 (3.3%) municipality-years, respectively. There were 11,795 nonfatal injuries, 9237 possible nonfatal injuries, and 1075 fatal injuries sustained by pedestrians in pedestrian-motor vehicle crashes. There were 4842 nonfatal injuries, 3666 possible nonfatal injuries, and 134 fatal injuries sustained by bicyclists in bicyclist-motor vehicle crashes. Although not statistically significant, unadjusted nonfatal and fatal injury rates among pedestrians and bicyclists were lower in those municipality-years in which plans had been published that year or in a year prior, compared to municipality-years lacking a plan. Adjusted rate ratios (RR) indicated that pedestrian nonfatal and fatal injury rates decreased in municipality-years with publication of pedestrian/combined plans (nonfatal injury RR: 0.75, 95% confidence interval (CI): 0.68, 0.82; fatal injury RR: 0.63, 95% CI: 0.46, 0.85). However, bicyclist nonfatal and fatal injury rates did not significantly change with publication of bicyclist/combined plans. Our research suggests that plan publication is associated with lower rates of nonfatal and fatal injury in pedestrians; this association was not observed for bicyclists. Further work must determine how the extent of implementation and quality of safety-related content within these plans affects changes in nonfatal and fatal injury rates., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Due to the inconsistent findings of prior studies, we explored the association of perceived safety and police-recorded crime measures with physical activity., Methods: The study included 818 Chicago participants of the Multiethnic Study of Atherosclerosis 45 to 84 years of age. Questionnaire-assessed physical activity included a) transport walking; b) leisure walking; and c) non-walking leisure activities. Perceived safety was assessed through an interviewer-administered questionnaire. Police-recorded crime was assessed through 2-year counts of selected crimes (total and outdoor incivilities, criminal offenses, homicides) per 1000 population. Associations were examined using generalized estimating equation logistic regression models., Results: Perceiving a safer neighborhood was positively associated with transport walking and perceiving lower violence was associated with leisure walking. Those in the lowest tertile of total or outdoor incivilities were more likely to report transport walking. Models with both perceived safety and police-recorded measures of crime as independent variables had superior fit for both transport walking and leisure walking outcomes. Neither perceived safety nor police-recorded measures of crime were associated with non-walking leisure activity., Conclusions: Perceived and police-recorded measures had independent associations with walking and both should be considered in assessing the impact of neighborhood crime on physical activity.

Purpose: To examine "travel by walking" (TBW) before and after school among eighth-grade girls., Methods: Participants attended 36 middle schools from Arizona, Maryland, Minnesota, Louisiana, California, and South Carolina participating in the Trial of Activity for Adolescent Girls. The cross-sectional sample consisted of 3,076 eighth-grade girls, and the longitudinal sample included 1,017 girls who participated in both sixth and eighth grades. Before- or after-school TBW status was determined from the 3-Day Physical Activity Recall. The main outcomes were body mass index and physical activity, which was measured by accelerometry, estimated for total physical activity (light, moderate, vigorous) and moderate-to-vigorous physical activity (MVPA)., Results: Eighth-grade girls who reported TBW had 4 more minutes (95% confidence interval = 2.1-6.1) of MVPA before and after school than nonwalkers, and 2 more minutes of MVPA (95% confidence interval = 1.1-3.1) on an average weekday. In the longitudinal sample, girls who reported TBW before and after school in both sixth and eighth grades (consistent walkers) accumulated more minutes of MVPA for an average weekday than inconsistent walkers in both sixth (27 ± 2.2 vs. 25 ± 1.9 minutes; p = .03) and eighth (28 ± 2.6 vs. 25 ± 2.3 minutes; p = .003) grades. There were no differences in body mass index by walking status., Conclusions: Adolescent girls who reported TBW before and after school accumulated more minutes of MVPA than nonwalkers. Efforts to prevent the decline in walking to school in middle school girls could contribute to their overall physical activity., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

A pedestrian plan is a public document that explains a community's vision and goals for future pedestrian activity. This study explored whether involvement by public health professionals in the development of pedestrian plans was associated with certain characteristics of the plan (vision, goals, identified programs, and evaluation). This study identified, collected, and analyzed content of all pedestrian plans in North Carolina through 2008. Among the 46 plans, 39% reported involvement by public health professionals in their development. Overall, 72% of pedestrian plans included a vision statement; health was mentioned four times and quality of life was mentioned five times. Slightly more than half (52%) of the plans included goals to improve public health. Plans that involved public health professionals more often included the type of physical activity, safety, or education program. Only 22% of all pedestrian plans included a proposal to evaluate their implementation. Plans that included public health professionals were less likely to include an evaluation proposal (11%) compared with those that did not involve public health professionals (21%). Public health professionals are encouraged to seek involvement in the pedestrian planning process, particularly in the areas of health program development, implementation, and evaluation.

Background: Studies that have combined accelerometers and global positioning systems (GPS) to identify walking have done so in carefully controlled conditions. This study tested algorithms for identifying walking trips from accelerometer and GPS data in free-living conditions. The study also assessed the accuracy of the locations where walking occurred compared with what participants reported in a diary., Methods: A convenience sample of high school females was recruited (N = 42) in 2007. Participants wore a GPS unit and an accelerometer, and recorded their out-of-school travel for 6 days. Split-sample validation was used to examine agreement in the daily and total number of walking trips with Kappa statistics and count regression models, while agreement in locations visited by walking was examined with geographic information systems., Results: Agreement varied based on the parameters of the algorithm, with algorithms exhibiting moderate to substantial agreement with self-reported daily (Kappa = 0.33-0.48) and weekly (Kappa = 0.41-0.64) walking trips. Comparison of reported locations reached by walking and GPS data suggest that reported locations are accurate., Conclusions: The use of GPS and accelerometers is promising for assessing the number of walking trips and the walking locations of adolescent females.

Background: We surveyed North Carolina (NC) municipalities to document the presence of municipal walking- and bicycling-related projects, programs, and policies; to describe whether prevalence of these elements differed if recommended in a plan; and to characterize differences between urban and rural municipalities., Methods: We surveyed all municipalities with ≥ 5000 persons (n = 121) and sampled municipalities with < 5000 persons (216/420), with a response rate of 54% (183/337). Responses were weighted to account for the sampling design., Results: From a list provided, staff reported on their municipality's use of walking- and bicycling-related elements (8 infrastructure projects, 9 programs, and 14 policies). The most commonly reported were projects on sidewalks (53%), streetscape improvements (51%), bicycle/walking paths (40%); programs for cultural/recreational/health (25%), general promotional activities (24%), Safe Routes to School (24%), and law enforcement (24%); and policies on maintenance (64%), new facility construction (57%), and restricted automobile speed or access (45%). Nearly all projects, programs, or policies reported were more likely if included in a plan and more prevalent in urban than rural municipalities., Conclusion: These results provide cross-sectional support that plans facilitate the implementation of walking and bicycling elements, and that rural municipalities plan and implement these elements less often than urban municipalities.

Background: This comparative case study investigates 2 successful community trail initiatives, using the Active Living By Design (ALBD) Community Action Model as an analytical framework. The model includes 5 strategies: preparation, promotion, programs, policy, and physical projects., Methods: Key stakeholders at 2 sites participated in in-depth interviews (N=14). Data were analyzed for content using Atlas Ti and grouped according to the 5 strategies., Results: PREPARATION: Securing trail resources was challenging, but shared responsibilities facilitated trail development. PROMOTIONS: The initiatives demonstrated minimal physical activity encouragement strategies., Programs: Community stakeholders did not coordinate programmatic opportunities for routine physical activity. POLICY: Trails' inclusion in regional greenway master plans contributed to trail funding and development. Policies that were formally institutionalized and enforced led to more consistent trail construction and safer conditions for users. PHYSICAL PROJECTS: Consistent standards for wayfinding signage and design safety features enhanced trail usability and safety., Conclusions: Communities with different levels of government support contributed unique lessons to inform best practices of trail initiatives. This study revealed a disparity between trail development and use-encouragement strategies, which may limit trails' impact on physical activity. The ALBD Community Action Model provided a viable framework to structure cross-disciplinary community trail initiatives.

Pedestrian and bicycle planning has traditionally been viewed from an urban design perspective, rather than a rural or regional planning perspective. This study examined the prevalence and quality of pedestrian and bicycle plans in North Carolina according to geography, regional planning, and sociodemographics. Plan prevalence was lower, but plan quality tended to be higher, in rural areas compared with urban areas. Correlations between plan prevalence and active commuting were strongest in lower-income rural areas. By engaging in the planning process, rural residents and other stakeholders can support active living.

Background: The Guide to Community Preventive Services recommends implementing community- and street-scale urban design, as well as land use policies and practices, to promote walking and bicycling. To better understand barriers to municipal walking and bicycling projects and policies, we surveyed municipal staff in North Carolina., Methods: We surveyed all 121 municipalities with at least 5,000 persons, and 62% responded. We also surveyed 216 of 420 municipalities with less than 5,000 persons, and 50% responded. The municipal staff member most knowledgeable about walking and bicycling planning was asked to complete the survey. Responses were weighted to account for the sampling design, to reflect prevalence estimates for all North Carolina municipalities., Results: Common barriers to walking and bicycling projects and policies were selected from a 14-item list. For walking, barriers included lack of funding (93% of responding municipalities), other infrastructure priorities (79%), automobile infrastructure priorities (66%), and staffing challenges (65%). For bicycling, barriers included lack of funding (94% of responding municipalities), other infrastructure priorities (79%), automobile infrastructure priorities (73%), issues were not high priorities for the municipality (68%), staffing challenges (68%), and insufficient support from residents (63%). Barriers generally were more prevalent among rural municipalities than among urban municipalities (9 of 14 barriers for walking and 5 of 14 for bicycling; P < .10)., Limitations: The study relied on 1 respondent to report for a municipality. Additionally, job titles of respondents varied with municipality size., Conclusions: Health professionals and multidisciplinary partners can assist in overcoming the common local- and state-level barriers to walking and bicycle projects and policies that are reported by North Carolina municipalities.

Purpose: this study developed and tested algorithms to identify outdoor walking trips from portable global positioning system (GPS) units in free-living conditions., Methods: the study included a calibration and a validation phase. For the calibration phase, we determined the best algorithm from 35 person-days of data. Measures of agreement regarding the daily number and duration of diary-reported and GPS-identified trips were used. In the validation phase, the best algorithm was applied to an additional and separate 136 person-days of diary and GPS data., Results: the preferred algorithm in the calibration phase resulted in 90% of trips identified from the GPS data being found in the diary, whereas 81% of trips reported in the diary being found in the GPS data. The preferred algorithm used 1) a maximum 3-min gap between points to define a trip, 2) at least 5 min or more of continuous GPS points, 3) a speed range between 2 and 8.0 km·h, 4) at least 30 m of displacement between the start and end points of a trip, and 5) merged walking trips when the time gap between trips was less than 3 min. With the validation data, substantial agreement between the GPS and the diary was achieved, with 86% of trips identified from the GPS data found in the diary and 77% of trips reported in the diary found in the GPS data., Conclusions: the algorithm identified free-living walking trips of more than 5 min in duration. The ability to identify outdoor walking trips from GPS data can be improved by reducing recording intervals used in the GPS units and monitoring participant compliance. Further research is desirable to determine whether concurrent wearing of an accelerometer may improve the ability to detect walking more accurately.

Background: The specific health benefits of meeting physical activity guidelines are unclear in older adults. We examined the association between meeting, not meeting, or change in status of meeting physical activity guidelines through walking and the 5-year incidence of metabolic syndrome in older adults., Methods: A total of 1,863 Health, Aging, and Body Composition (Health ABC) Study participants aged 70-79 were followed for 5 years (1997-1998 to 2002-2003). Four walking groups were created based on self-report during years 1 and 6: Sustained low (Year 1, <150 min/week, and year 6, <150 min/week), decreased (year 1, >150 min/week, and year 6, <150 min/week), increased (year 1, <150 min/week, and year 6, >150 min/week), and sustained high (year 1, >150 min/week, and year 6, >150 min/week). Based on the Adult Treatment Panel III (ATP III) panel guidelines, the metabolic syndrome criterion was having three of five factors: Large waist circumference, elevated blood pressure, triglycerides, blood glucose, and low high-density lipoprotein (HDL) levels., Results: Compared to the sustained low group, the sustained high group had a 39% reduction in odds of incident metabolic syndrome [adjusted odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.40-0.93], and a significantly lower likelihood of developing the number of metabolic syndrome risk factors that the sustained low group developed over 5 years (beta = -0.16, P = 0.04)., Conclusions: Meeting or exceeding the physical activity guidelines via walking significantly reduced the odds of incident metabolic syndrome and onset of new metabolic syndrome components in older adults. This protective association was found only in individuals who sustained high levels of walking for physical activity.

Purpose: Walking to and from school contributes to total physical activity levels. This study investigated whether perceived and actual neighborhood features were associated with walking to or from school among adolescent girls., Methods: A sample of geographically diverse eighth-grade girls (N = 890) from the Trial of Activity in Adolescent Girls (TAAG) study living within 1.5 miles of their middle school was recruited. Participants completed a self-administered survey on their neighborhood and walking behavior. Geographic information system data were used to assess objective neighborhood features. Nested multivariable logistic regression analyses were conducted to determine the contribution of perceived and objective measures of walking to or from school., Results: Fifty-six percent (n = 500) of the girls walked to or from school for at least 1 d in a week. White (42%) girls walked more frequently than Hispanic (25%) and African American (21%) girls. Girls were nearly twice as likely to walk to or from school if they perceived their neighborhoods as safe and perceived that they had places they liked to walk, controlling for other potential confounders. In addition, girls who lived closer to school, had more active destinations in their neighborhood, and had smaller-sized blocks were more likely to walk to or from school than those who did not., Conclusions: Safety, land use, and school location issues need to be considered together when designing interventions to increase walking to and from school.

Background: Recent research demonstrates the importance of targeting the built environment to support individual physical activity, particularly for people experiencing health disparities. Master plans to promote biking and/or pedestrians (BPMPs) are a potential method for environmental change. This descriptive study aims to provide a snapshot of plan attributes and better understand demographic, social and transportation characteristics of communities with BPMPs., Methods: We collected a census sample of BPMPs from 4 states. Population and commuting data were obtained from national statistics., Results: 294 master plans were included, with most plans representing municipalities. 62% of plans targeted biking only, one-fifth targeted biking and walking, and 15% targeted walking only. The sampled locations have a similar demographic profile as the overall U.S. for median age and household income, people of color, high school education, and income inequality. The degree of racial diversity of sampled communities is slightly less than the U.S. average and the percentage of people who walk to work were slightly higher., Conclusions: Given that communities with master plans have a similar profile as the overall U.S., BPMPs could feasibly be spread to communities throughout the country. Further research is planned to describe BPMPs in detail toward informing future plan development.

Background: Trails provide opportunities for recreation, transportation and activity. The purpose of this article is to describe state legislation related to community trails, to analyze legislation content, and to evaluate legislation on inclusion of evidence-informed elements., Methods: State trail legislation from 2001 to 2008 was identified using online legislative databases. An analysis of evidence-informed elements included in the legislation was conducted. These elements included: funding, liability, accessibility, connectivity, and maintenance., Results: Of the total 991 trail bills, 516 (52.0%) were appropriations bills, of which 167 (32.2%) were enacted. We analyzed 475 (48%) nonappropriation trail bills of which 139 (29.3%) were enacted. The percentage of enactment of appropriations bills decreased over time while enactment of nonappropriations trail bills increased. Over half of the nonappropriations trail bills included at least 1 evidence-informed element, most commonly funding. Few bills contained liability, connectivity, accessibility, or maintenance., Conclusions: There is opportunity for providing evidence-informed information to policy-makers to potentially influence bill content. The number of bills with a funding element demonstrates that fiscal support for trails is an important policy lever that state legislatures may use to support trails. Lastly, trails should be considered in over-all state-level physical activity legislation to provide opportunities for communities to be active.

Background: Evidence is growing that the built environment has the potential to influence walking--both positively and negatively. However, uncertainty remains on the best approaches to representing the pedestrian environment in order to discern associations between walking and the environment. Research into the relationship between environment and walking is complex; challenges include choice of measures (objective and subjective), quality and availability of data, and methods for managing quantitative data through aggregation and weighting. In particular, little research has examined how to aggregate built environment data to best represent the neighborhood environments expected to influence residents' behavior. This study examined associations between walking and local pedestrian supports (as measured with an environmental audit), comparing the results of models using three different methods to aggregate and weight pedestrian features., Methods: Using data collected in 2005-2006 for a sample of 251 adult residents of Montgomery County, MD, we examined associations between pedestrian facilities and walking behaviors (pedestrian trips and average daily steps). Adjusted negative binomial and ordinary least-squares regression models were used to compare three different data aggregation techniques (raw averages, length weighting, distance weighting) for measures of pedestrian facilities that included presence, condition, width and connectivity of sidewalks, and presence of crossing aids and crosswalks., Results: Participants averaged 8.9 walk trips during the week; daily step counts averaged 7042. The three aggregation techniques revealed different associations between walk trips and the various pedestrian facilities. Crossing aids and good sidewalk conditions were associated with walk trips more than were other pedestrian facilities, while sidewalk facilities and features showed associations with steps not observed for crossing aids and crosswalks., Conclusion: Among three methods of aggregation examined, the method that accounted for distance from participant's home to the pedestrian facility (distance weighting) is promising; at the same time, it requires the most time and effort to calculate. This finding is consistent with the behavioral assumption that travelers may respond to environmental features closer to their residence more strongly than to more distant environmental qualities.

Background: The neighborhood environment may play a role in encouraging sedentary patterns, especially for middle-aged and older adults., Purpose: The aim of this study was to examine the associations between walking and neighborhood population density, retail availability, and land-use distribution using data from a cohort of adults aged 45 to 84 years., Methods: Data from a multi-ethnic sample of 5529 adult residents of Baltimore MD, Chicago IL, Forsyth County NC, Los Angeles CA, New York NY, and St. Paul MN enrolled in the Multi-Ethnic Study of Atherosclerosis in 2000-2002 were linked to secondary land-use and population data. Participant reports of access to destinations and stores and objective measures of the percentage of land area in parcels devoted to retail land uses, the population divided by land area in parcels, and the mixture of uses for areas within 200 m of each participant's residence were examined. Multinomial logistic regression was used to investigate associations of self-reported and objective neighborhood characteristics with walking. All analyses were conducted in 2008 and 2009., Results: After adjustment for individual-level characteristics and neighborhood connectivity, it was found that higher density, greater land area devoted to retail uses, and self-reported proximity of destinations and ease of walking to places were each related to walking. In models including all land-use measures, population density was positively associated with walking to places and with walking for exercise for more than 90 minutes/week, both relative to no walking. Availability of retail was associated with walking to places relative to not walking, and having a more proportional mix of land uses was associated with walking for exercise for more than 90 minutes/week, while self-reported ease of access to places was related to higher levels of exercise walking, both relative to not walking., Conclusions: Residential density and the presence of retail uses are related to various walking behaviors. Efforts to increase walking may benefit from attention to the intensity and type of land development.

Purpose: To examine associations of the built environment surrounding worksites and of work policies with walking behaviors., Design: Cross-sectional convenience sample survey., Setting: Workplace., Subjects: Employed adults residing in Montgomery County, Maryland., Measures: Four different step measures taken at or near work as recorded using an accelerometer and a fifth measure indicated self-reported walking from work. Participants reported on eight built environment characteristics surrounding the worksite (e.g., the presence of sidewalks, crosswalks, and pedestrian signals) and on four worksite policies (e.g, the presence of exercise facilities and exercise programs)., Analysis: Cross-sectional associations of self-reported built environment characteristics surrounding worksites and worksite policies with walking behavior were examined., Results: Although participants reported worksites exhibiting built environment characteristics that were supportive of walking (seven of eight characteristics were reported by >50% of participants), no built environment characteristic was associated with walking more than the median number of average weekday steps (p > or = .05). All four worksite policies were associated with walking more than the median number of average weekday steps (p < .05). In addition, a perception of few cul-de-sacs and of the presence of litter, sidewalks, crosswalks, and pedestrian signals surrounding the worksites was associated with a higher proportion of participants taking at least one walking trip from work in the past month (p < .05)., Conclusions: Locating worksites in walkable environments and implementing worksite policies may favorably influence employee walking. Future studies should consider a prospective design and examine a larger, more diverse employee population and worksite environment to examine these associations.

Little is known about relationships between attributes of land use plans and sociodemographic variations in physical activity (PA). This study evaluates associations between policy-relevant plan attributes, sociodemographic factors, and PA in North Carolina. Results suggest that land use plans that included non-automobile transportation improvements and more comprehensive policies to guide development were positively associated with both leisure and transportation-related PA. However, residents of counties with lower-income levels and higher proportions of non-white residents were less likely to have attributes supportive of PA included in their plans. Implications for transdisciplinary collaboration with respect to reducing health disparities are discussed.

Barriers to and facilitators of walking and bicycling to school were explored through 12 focus groups made up of fourth- and fifth-grade students and their parents who lived near their respective schools. The barriers and facilitators reported by parents and children generally fell into one of three categories: intrapersonal and interpersonal characteristics of parents and children, environmental characteristics of the neighborhood, and environmental and policy characteristics of the school. Findings indicate that a supportive environment is a necessary but insufficient condition to increase walking and biking to school. Initiatives to increase active school travel may need to include multiple levels of intervention to be effective.

The purpose of this study was to quantify the agreement between perceived and objective measures of the natural environment and to assess their associations with physical activity. Perception of the natural environment was obtained through survey data. Objective measures of weather and hills were created using Geographic Information Systems (GIS). When objective measures were compared to respondent's perceptions little agreement was found. Objective measures were not associated with any physical activity outcomes; however, several associations were seen between perceived measures and physical activity. These results indicate that researchers should consider perceptions of the natural environment when developing physical activity interventions.

The built environment may be responsible for making nonmotorized transportation inconvenient, resulting in declines in physical activity. However, few studies have assessed both the perceived and objectively measured environment in association with physical activity outcomes. The purpose of this study was to describe the associations between perceptions and objective measures of the built environment and their associations with leisure, walking, and transportation activity. Perception of the environment was assessed from responses to 1,270 telephone surveys conducted in Forsyth County, NC and Jackson, MS from January to July 2003. Participants were asked if high-speed cars, heavy traffic, and lack of crosswalks or sidewalks were problems in their neighborhood or barriers to physical activity. They were also asked if there are places to walk to instead of driving in their neighborhood. Speed, volume, and street connectivity were assessed using Geographic Information Systems (GIS) for both study areas. Locations of crashes were measured using GIS for the NC study area as well. Objective and perceived measures of the built environment were in poor agreement as calculated by kappa coefficients. Few associations were found between any of the physical activity outcomes and perception of speed, volume, or presence of sidewalks as problems in the neighborhood or as barriers to physical activity in regression analyses. Associations between perceptions of having places to walk to and presence of crosswalks differed between study sites. Several associations were found between objective measures of traffic volume, traffic speed, and crashes with leisure, walking, and transportation activity in Forsyth County, NC; however, in Jackson, MS, only traffic volume was associated with any of the physical activity outcomes. When both objective and perceived measures of the built environment were combined into the same model, we observed independent associations with physical activity; thus, we feel that evaluating both objective and perceived measures of the built environment may be necessary when examining the relationship between the built environment and physical activity.

Objectives: To describe the development of an original scale that measures perceived school climate for active travel in fourth- and fifth-grade girls and boys., Methods: The data were analyzed using confirmatory factor analysis (CFA) to provide evidence of factorial validity, factorial invariance, and construct validity., Results: The CFA supported the fit of a 3-factor (encouragement, praise, and importance) correlated model for the school climate for active travel measure. This hierarchical model was invariant between sex and across a 7-month time period, and initial evidence for construct validity was provided., Conclusions: School climate for active travel is a measurable construct, and preliminary evidence suggests relationships with more support for active travel from friends and family.

Background: Cross-sectional studies suggest a positive association between the presence of trails and physical activity participation. Prospective evaluations of the impact of building a multi-use trail, in terms of change in physical activity levels among nearby residents, are needed., Design: The study was designed as a quasi-experimental noncontrol pre-post design., Setting/participants: Participants included 366 adults aged > or =18 years living within 2 miles of the evaluated trail., Intervention: A railway of >23 miles was under development for conversion to a multi-use trail in central North Carolina. A segment of the trail was evaluated by randomly selecting and telephone interviewing adults living within 2 miles of the planned trail before trail construction began and approximately 2 months after completion of construction., Main Outcome Measures: Outcomes were time spent in leisure activity, leisure activity near home, walking, bicycling, moderate activity, vigorous activity, and transportation activity., Results: At follow-up, of the 366 adults living within 2 miles of the trail, 11.0% had not heard of the trail, and 23.1% had heard of the trail and had used it at least once. In multivariable logistic models, leisure activity, leisure activity near home, moderate activity, vigorous activity, and walking for transportation did not significantly change for those who used the trail compared to those not using the trail., Conclusions: This prospective study of the building of a multi-use trail did not demonstrate an increase in physical activity among adults living near the trail. Other prospective studies are encouraged, to take advantage of rigorously evaluating different types of trails that are to be constructed in rural and urban settings.

Background: Travel to and from school can be an important and regular source of physical activity for youth. Few US studies have documented the prevalence and correlates of walking and bicycling to school., Objective: To examine the prevalence and correlates of walking and bicycling to school among middle and high school youth., Design: Cross-sectional survey., Setting: Sixty middle schools and 62 high schools selected in North Carolina., Participants: Students in 6th through 8th grades (n = 2151) and in 9th through 12th grades (n = 2297) during the spring of 2001., Main Outcome Measures: Walking or bicycling to school in a usual week., Results: Among middle school students, 9.4% usually walked to school and 4.1% usually bicycled to school at least 1 day per week. Among high school students, 4.9% usually walked to school and 2.8% usually bicycled to school at least 1 day per week. For middle school youth, walking or bicycling to school was more prevalent among boys and among nonwhites. For high school youth, walking or bicycling to school was also more prevalent among nonwhites. For middle school youth (but not high school youth), a higher body mass index (85th to less than 95th percentile) was associated with a reduced odds of walking to school. For high school youth (but not middle school youth), participating in physical education 1 to 4 days per week or never having an adult at home immediately after school was associated with walking or bicycling to school. Higher parental educational level was associated with a reduced odds of walking to school among high school youth., Conclusions: The descriptive information provided by this study broadens our limited understanding of the prevalence and correlates of walking and bicycling to school in the United States. Further qualitative and quantitative descriptive data are needed to develop successful interventions to increase walking and bicycling to school.

BackgroundFew studies have comprehensively evaluated the effectiveness of multi-faceted interventions intended to improve pedestrian safety. "Watch for Me NC" is a multi-faceted, community-based pedestrian safety program that includes widespread media and public engagement in combination with enhanced law enforcement activities (i.e., police outreach and targeted pedestrian safety operations conducted at marked crosswalks) and low-cost engineering improvements at selected crossings. The purpose of this study was to estimate the effect of the law enforcement and engineering improvement components of the program on motor vehicle driver behavior, specifically in terms of increased driver yielding to pedestrians in marked crosswalks.MethodsThe study used a pre-post design with a control group, comparing crossing locations receiving enforcement and low-cost engineering treatments (enhanced locations) with locations that did not (standard locations) to examine changes in driver yielding over a 6-month period from 2013 to 2014. A total of 24,941 drivers were observed in 11,817 attempted crossing events at 16 crosswalks in five municipalities that were participating in the program. Observations of real pedestrians attempting to use the crosswalks ("naturalistic" crossing) were supplemented by observations of trained research staff attempting the same crossings following an established protocol ("staged" crossings). Generalized estimating equations (GEE) were used to model driver yielding rates, accounting for repeated observations at the crossing locations and controlling other factors that affect driver behavior in yielding to pedestrians in marked crosswalks.ResultsAt crossings that did not receive enhancements (targeted police operations or low-cost engineering improvements), driver yielding rates did not change from before to after the Watch for Me NC program. However, yielding rates improved significantly (between 4 and 7 percentage points on average) at the enhanced locations. This was true for both naturalistic and staged crossings.ConclusionsThis study provides evidence that enhanced enforcement and low-cost engineering improvements, as a part of a broader program involving community-based outreach, can increase driver yielding to pedestrians in marked crosswalks. These data are important for the staff and decision-makers involved in pedestrian safety programs to gain a better understanding of the different engineering and behavioral mechanisms that could be used to improve driver yielding rates.

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004-2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health.

We examined the influence of the built environment on pedestrian route selection among adolescent girls. Portable global positioning system units, accelerometers, and travel diaries were used to identify the origin, destination, and walking routes of girls in San Diego, CA and Minneapolis, MN. We completed an inventory of the built environment on every street segment to measure the characteristics of routes taken and not taken. Route-level variables covering four key conceptual built environment domains (Aesthetics, Destinations, Functionality, and Safety) were used in the analysis of route choice. Shorter distance had the strongest positive association with route choice, while the presence of a greenway or trail, higher safety, presence of sidewalks, and availability of destinations along a route were also consistently positively associated with route choice at both sites. The results suggest that it may be possible to encourage pedestrians to walk farther by providing high quality and stimulating routes.

Physical inactivity among the general population is of great concern in public health. This narrative review aims to identify promising physical activity (PA) public policies based on the best available evidence from the literature. The study is a narrative synthesis of 'reviews of reviews' of public policies designed to increase physical activity among either (a) youths or (b) the community at large. We searched the literature for reviews of reviews of public policies of any country relevant to physical activity, physical inactivity, or sedentary behaviour published since 1 January 2000, in four databases. Based on 12 reviews of reviews published between 2011 and 2022, we identified seven potentially effective PA public policies. Six of the seven were youth-based public policies that would be implemented in schools. The seventh was a policy aimed at establishing and promoting walking groups. Policymakers seeking to increase PA should consider focusing on school-based PA policies and community-based walking groups, as this is where the evidence base is greatest. To implement these policies, pilot studies to assess the efficacy of such programmes in local communities should first be conducted due to methodological limitations in the underlying literature and questions of generalisability and reproducibility. [ABSTRACT FROM AUTHOR]