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The Association Between Green Neighborhood Environments and Active Transportation
A. Macmillan, J. Woodcock / Journal of Transport & Health 3 (2016) S4–S61
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Results: Results show that Hong Kong's pedestrian planning framework, built environment and neighbourhood characteristics, including a mixed land use, urban design, pedestrian infrastructure and facilities and road design may bring important insights in developing more active settings. Conclusions: Outcomes of this study provide important information to policy-makers and planners as a crucial guide in enhancing the built and social environment, and to help progress towards a healthier and more active city. http://dx.doi.org/10.1016/j.jth.2016.05.094
SOT-14 Active Travel & Health A64 All-Cause and Injury-Specific Mortality Associated with Transportation-Related Physical Activity Among U.
S. Adults, NHANES 1999–2006 Emily Ussery, Geoffrey Whitfield, Tegan Boehmer Centers for Disease Control and Prevention, Atlanta, GA, USA
Abstract Background: Engaging in regular physical activity protects against premature all-cause mortality. Transportation-related physical activity (TPA) likely has similar mortality benefits related to chronic conditions (e.g. cardiovascular disease) as have been established for recreational physical activity. In contrast, TPA might convey heightened risk of death from injuries compared to recreational activity because it involves more frequent exposure to motorized vehicles. The competing mortality benefits and risks associated with TPA have not been widely investigated to date. In particular, these associations have not been evaluated in a nationally representative sample of U.S adults. Methods: We analyzed a publicly available dataset that linked National Health and Nutrition Examination Survey (1999–2006) respondents with the National Death Index through 2011. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to quantify all-cause and unintentional injury-specific mortality associated with self-reported levels of TPA (none, low [1– 70 minutes/week], and high [ 470 minutes/week]) among adults Z20 years. Covariates included age, sex, race/ethnicity, education, recreational physical activity, smoking, alcohol consumption, body mass index, and history of chronic diseases. Results: A total of 3,143 deaths (9.8% of respondents) occurred during the follow-up period (no TPA: 2,633; low TPA: 222; high TPA: 288). Of these deaths, 100 were categorized as unintentional injuries (no TPA: 83; low TPA: 7; high TPA: 10). The average length of follow-up was 8.4 years. Most adults reported no TPA in the previous month (76.5%), 12.5% reported low TPA, and 11.0% reported high TPA. Compared to no TPA, the risk of all-cause mortality was 22% lower among those with low TPA (HR ¼0.78, 95%CI: 0.64–0.96), but no significant difference was found among those with high TPA (HR ¼ 0.97, 95%CI: 0.80–1.17). TPA was associated with a reduced risk of injury-specific mortality, but the findings were not statistically significant. Compared to those with no TPA, the adjusted HR was 0.61 (95%CI: 0.24–1.58) among those with low TPA and 0.48 (95%CI: 0.19–1.27) among those with high TPA. Conclusions: Engaging in up to 70 minutes of weekly TPA protects against premature all-cause mortality among U.S. adults; however, there is no protective effect for higher levels of TPA. TPA was not significantly associated with injury-specific mortality, but analyses were limited by the small number of deaths. Moreover, unintentional injury includes causes of death that are unrelated to TPA, like accidental drowning. Future analyses are planned to evaluate additional cause-specific mortality risks associated with TPA. http://dx.doi.org/10.1016/j.jth.2016.05.095
A65 The Association Between Green Neighborhood Environments and Active Transportation Leah Yngve 1, Kirsten Beyer 2, Kristen Malecki 3, Laura Jackson 4 1
ASPPH/EPA, NC, USA Medical College of Wisconsin, WI, USA 3 University of Wisconsin, WI, USA 4 U.S. EPA, NC, USA 2
Abstract Background: Urban nature is an important aspect of health-promoting environments. In particular, street trees and green space can provide a low cost approach to improving public health by promoting physical activity, improving mental health, and facilitating social cohesion.
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A. Macmillan, J. Woodcock / Journal of Transport & Health 3 (2016) S4–S61
Active transportation, such as walking or biking, increases not only physical activity, but also exposure to the neighborhood environment. Though many factors may influence an individual's mode of transportation, this study focuses on the cross-sectional association between neighborhood street environment and walking or biking as transportation using new detailed metrics of tree cover on walkable roads. Methods: Data on self-reported active transportation were from the Survey of the Health of Wisconsin (SHOW) participants residing in Milwaukee, WI, and Green Bay, WI (n¼712). Street trees were estimated using 1-meter resolution land cover data produced by the U.S. EPA's EnviroAtlas tool, and NavTeq road centerlines for walkable roads. Percent tree cover along walkable roads was determined within road network buffers of 500 and 1000 m from study participants’ home addresses. Logistic regression was used to assess the association between neighborhood environment and active transportation, controlling for socio-demographics such as poverty, education, job status, and race. Results: Study participants with less than 15% tree cover along walkable roads within 500 m of their homes were approximately half as likely to choose active transportation once within a 30 day window than those with greater than 15% tree cover, adjusting for socio-demographics (odds ratio¼0.50, 95% confidence interval [0.26, 0.96]). The association was similar using a 1000 m buffer to assess tree cover along walkable roads (odds ratio¼0.47, 95% confidence interval [0.21, 1.06]). Unadjusted crude results were consistent with adjusted results. Conclusions: The proximate neighborhood environment may influence an individual's decision to choose active transportation. Study participants who live in neighborhoods with greater tree cover along walkable roads were more likely to walk or bike to work or to run an errand. This effect was significant for tree cover along walkable roads within 500 network meters of a participant's home, but not within 1000 network meters, suggesting that the immediate environment may have a greater influence on transportation decisions or those choosing active transportation are more likely choose neighborhoods based on aesthetics. However, more work on neighborhood preference is needed to understand these associations. This research has been reviewed and approved by EPA; it does not necessarily reflect Agency policy. http://dx.doi.org/10.1016/j.jth.2016.05.096
Are Leisure and Work Physical Activity Associated with Active Transport? Evidence from the Geographic Research on Wellbeing (GROW) Study
A66
Rebecca Lee 1, Elizabeth Lorenzo 1, Katherine Heck 2, Harold Kohl 3, Catherine Cubbin 3 1
Arizona State University, AZ, USA University of California, San Francisco, CA, USA 3 University of Texas at Austin, TX, USA 2
Abstract Background: Active transport (AT) helps to meet physical activity (PA) guidelines, bestowing health benefits to individuals. Little research has distinguished between non-work vs work AT or has accounted for how PA done in specific domains, such as leisure time (LTPA) or at work (WPA), may be related to AT. Conventional wisdom has suggested a compensatory effect suggesting more LTPA or WPA might be related to less AT. This study explored this question by investigating correlates of non-work AT by employment status, accounting for LTPA; and correlates of work AT among employed women, accounting for LTPA and WPA, in a population-based sample of California mothers (N¼ 2,906) participating in the Geographic Research on Wellbeing (GROW) study (2012–2013). Methods: AT was measured by items from the National Household Travel Survey. LTPA was measured using the Stanford Leisure-Time Activity Categorical Item. WPA was measured with items adapted from the Stanford Brief Activity Survey. Weighted descriptive and multivariate regression analyses were employed. Results: Over half of employed mothers (53%) worked in sedentary jobs, and less than 10% used non-work AT or work AT. In contrast, over 20% of unemployed mothers used non-work AT, although their LTPA levels were slightly lower (2.5, range 1–6, higher values indicating more LTPA) than for employed women (2.7). Multiple regression models demonstrated that employed and unemployed mothers with low education and income, and unemployed African American or Latina immigrant mothers, were more likely to use non-work AT compared with their reference groups. Employed and unemployed mothers who were younger, and unemployed women who had four or more children or had “light” LTPA were less likely to use non-work AT compared with their reference groups. In terms of work AT among employed women, multiple regression models demonstrated that women with low education and income, African American women, those who worked part time, and those with relatively low LTPA were more likely to use work AT, while younger women were less likely to use work AT, compared with their reference groups (all ps. Conclusions: Different AT patterns were seen for employed vs unemployed women. After accounting for sociodemographic factors, LTPA was associated with non-work AT among unemployed mothers and with work AT among employed mothers in this representative sample. Policy and practice strategies should support a variety of messages to encourage these unique and seemingly unrelated domains of PA. http://dx.doi.org/10.1016/j.jth.2016.05.097
S43
Results: Results show that Hong Kong's pedestrian planning framework, built environment and neighbourhood characteristics, including a mixed land use, urban design, pedestrian infrastructure and facilities and road design may bring important insights in developing more active settings. Conclusions: Outcomes of this study provide important information to policy-makers and planners as a crucial guide in enhancing the built and social environment, and to help progress towards a healthier and more active city. http://dx.doi.org/10.1016/j.jth.2016.05.094
SOT-14 Active Travel & Health A64 All-Cause and Injury-Specific Mortality Associated with Transportation-Related Physical Activity Among U.
S. Adults, NHANES 1999–2006 Emily Ussery, Geoffrey Whitfield, Tegan Boehmer Centers for Disease Control and Prevention, Atlanta, GA, USA
Abstract Background: Engaging in regular physical activity protects against premature all-cause mortality. Transportation-related physical activity (TPA) likely has similar mortality benefits related to chronic conditions (e.g. cardiovascular disease) as have been established for recreational physical activity. In contrast, TPA might convey heightened risk of death from injuries compared to recreational activity because it involves more frequent exposure to motorized vehicles. The competing mortality benefits and risks associated with TPA have not been widely investigated to date. In particular, these associations have not been evaluated in a nationally representative sample of U.S adults. Methods: We analyzed a publicly available dataset that linked National Health and Nutrition Examination Survey (1999–2006) respondents with the National Death Index through 2011. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to quantify all-cause and unintentional injury-specific mortality associated with self-reported levels of TPA (none, low [1– 70 minutes/week], and high [ 470 minutes/week]) among adults Z20 years. Covariates included age, sex, race/ethnicity, education, recreational physical activity, smoking, alcohol consumption, body mass index, and history of chronic diseases. Results: A total of 3,143 deaths (9.8% of respondents) occurred during the follow-up period (no TPA: 2,633; low TPA: 222; high TPA: 288). Of these deaths, 100 were categorized as unintentional injuries (no TPA: 83; low TPA: 7; high TPA: 10). The average length of follow-up was 8.4 years. Most adults reported no TPA in the previous month (76.5%), 12.5% reported low TPA, and 11.0% reported high TPA. Compared to no TPA, the risk of all-cause mortality was 22% lower among those with low TPA (HR ¼0.78, 95%CI: 0.64–0.96), but no significant difference was found among those with high TPA (HR ¼ 0.97, 95%CI: 0.80–1.17). TPA was associated with a reduced risk of injury-specific mortality, but the findings were not statistically significant. Compared to those with no TPA, the adjusted HR was 0.61 (95%CI: 0.24–1.58) among those with low TPA and 0.48 (95%CI: 0.19–1.27) among those with high TPA. Conclusions: Engaging in up to 70 minutes of weekly TPA protects against premature all-cause mortality among U.S. adults; however, there is no protective effect for higher levels of TPA. TPA was not significantly associated with injury-specific mortality, but analyses were limited by the small number of deaths. Moreover, unintentional injury includes causes of death that are unrelated to TPA, like accidental drowning. Future analyses are planned to evaluate additional cause-specific mortality risks associated with TPA. http://dx.doi.org/10.1016/j.jth.2016.05.095
A65 The Association Between Green Neighborhood Environments and Active Transportation Leah Yngve 1, Kirsten Beyer 2, Kristen Malecki 3, Laura Jackson 4 1
ASPPH/EPA, NC, USA Medical College of Wisconsin, WI, USA 3 University of Wisconsin, WI, USA 4 U.S. EPA, NC, USA 2
Abstract Background: Urban nature is an important aspect of health-promoting environments. In particular, street trees and green space can provide a low cost approach to improving public health by promoting physical activity, improving mental health, and facilitating social cohesion.
S44
A. Macmillan, J. Woodcock / Journal of Transport & Health 3 (2016) S4–S61
Active transportation, such as walking or biking, increases not only physical activity, but also exposure to the neighborhood environment. Though many factors may influence an individual's mode of transportation, this study focuses on the cross-sectional association between neighborhood street environment and walking or biking as transportation using new detailed metrics of tree cover on walkable roads. Methods: Data on self-reported active transportation were from the Survey of the Health of Wisconsin (SHOW) participants residing in Milwaukee, WI, and Green Bay, WI (n¼712). Street trees were estimated using 1-meter resolution land cover data produced by the U.S. EPA's EnviroAtlas tool, and NavTeq road centerlines for walkable roads. Percent tree cover along walkable roads was determined within road network buffers of 500 and 1000 m from study participants’ home addresses. Logistic regression was used to assess the association between neighborhood environment and active transportation, controlling for socio-demographics such as poverty, education, job status, and race. Results: Study participants with less than 15% tree cover along walkable roads within 500 m of their homes were approximately half as likely to choose active transportation once within a 30 day window than those with greater than 15% tree cover, adjusting for socio-demographics (odds ratio¼0.50, 95% confidence interval [0.26, 0.96]). The association was similar using a 1000 m buffer to assess tree cover along walkable roads (odds ratio¼0.47, 95% confidence interval [0.21, 1.06]). Unadjusted crude results were consistent with adjusted results. Conclusions: The proximate neighborhood environment may influence an individual's decision to choose active transportation. Study participants who live in neighborhoods with greater tree cover along walkable roads were more likely to walk or bike to work or to run an errand. This effect was significant for tree cover along walkable roads within 500 network meters of a participant's home, but not within 1000 network meters, suggesting that the immediate environment may have a greater influence on transportation decisions or those choosing active transportation are more likely choose neighborhoods based on aesthetics. However, more work on neighborhood preference is needed to understand these associations. This research has been reviewed and approved by EPA; it does not necessarily reflect Agency policy. http://dx.doi.org/10.1016/j.jth.2016.05.096
Are Leisure and Work Physical Activity Associated with Active Transport? Evidence from the Geographic Research on Wellbeing (GROW) Study
A66
Rebecca Lee 1, Elizabeth Lorenzo 1, Katherine Heck 2, Harold Kohl 3, Catherine Cubbin 3 1
Arizona State University, AZ, USA University of California, San Francisco, CA, USA 3 University of Texas at Austin, TX, USA 2
Abstract Background: Active transport (AT) helps to meet physical activity (PA) guidelines, bestowing health benefits to individuals. Little research has distinguished between non-work vs work AT or has accounted for how PA done in specific domains, such as leisure time (LTPA) or at work (WPA), may be related to AT. Conventional wisdom has suggested a compensatory effect suggesting more LTPA or WPA might be related to less AT. This study explored this question by investigating correlates of non-work AT by employment status, accounting for LTPA; and correlates of work AT among employed women, accounting for LTPA and WPA, in a population-based sample of California mothers (N¼ 2,906) participating in the Geographic Research on Wellbeing (GROW) study (2012–2013). Methods: AT was measured by items from the National Household Travel Survey. LTPA was measured using the Stanford Leisure-Time Activity Categorical Item. WPA was measured with items adapted from the Stanford Brief Activity Survey. Weighted descriptive and multivariate regression analyses were employed. Results: Over half of employed mothers (53%) worked in sedentary jobs, and less than 10% used non-work AT or work AT. In contrast, over 20% of unemployed mothers used non-work AT, although their LTPA levels were slightly lower (2.5, range 1–6, higher values indicating more LTPA) than for employed women (2.7). Multiple regression models demonstrated that employed and unemployed mothers with low education and income, and unemployed African American or Latina immigrant mothers, were more likely to use non-work AT compared with their reference groups. Employed and unemployed mothers who were younger, and unemployed women who had four or more children or had “light” LTPA were less likely to use non-work AT compared with their reference groups. In terms of work AT among employed women, multiple regression models demonstrated that women with low education and income, African American women, those who worked part time, and those with relatively low LTPA were more likely to use work AT, while younger women were less likely to use work AT, compared with their reference groups (all ps. Conclusions: Different AT patterns were seen for employed vs unemployed women. After accounting for sociodemographic factors, LTPA was associated with non-work AT among unemployed mothers and with work AT among employed mothers in this representative sample. Policy and practice strategies should support a variety of messages to encourage these unique and seemingly unrelated domains of PA. http://dx.doi.org/10.1016/j.jth.2016.05.097