Ciclovia, also known as Open Streets initiatives in other countries, are city streets that are closed to motorized traffic and opened during certain times to residents for engaging in physical activity (PA). These initiatives are viewed by policy makers and health and community advocates as being beneficial to social, environmental, and community health. This study explores the geographic distribution of Ciclovia and Recreovia and the differences in geographic access assessed via distance-based measures, based on the socioeconomic status (SES) of the area. Results from this study show that the median distance to the Ciclovia according to SES ranges from 2930 m for SES 1 (most disadvantaged) to 482 m for SES 6 (wealthiest). The median distance to the Recreovia sites ranges from 5173 m for SES 1 to 3869 m for SES 6. This study found revealing urban inequities in the distribution of Ciclovia, whereas there was less inequalities within the Recreovia sites. This study shows that urban interventions are needed to promote recreational activity and reduce health disparities in under resourced, low SES areas. ... Read more

Overweight and obesity are steadily rising in South Asia, the world’s most populous region. India, a low- and middle-income country in South Asia is experiencing an obesity epidemic. Built environment features may profoundly influence physical activity and counter the risk from overweight and obesity. This cross-sectional study investigated built environment correlates of overweight and obesity among adults (N = 370, 47.2% female, mean age = 37.9 years) in Chennai, India. Participants from low-socioeconomic status households were more likely to be overweight/obese (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.1–2.9) than participants from high-socioeconomic status households. Driving to work predicted a three-fold increase in overweight or obesity compared to active commuting (OR = 2.9, 95%CI = 1.3–6.4). Household car ownership was linked with an increased likelihood of overweight or obesity (OR = 1.5, 95%CI = 0.7–3.2). Low walkability neighbourhoods significantly predicted an increase in odds of overweight or obesity (OR = 1.8, 95%CI = 1.1–2.8). By 2030, Indian cities are projected to add 250 million people accompanied by a 9.9% annual motor vehicle growth rate. As car ownership increases across Southern Asia, there is an urgent need to develop interventions to promote physical activity. ... Read more

Few studies assess built environment correlates of active commuting in low-and-middle-income countries (LMICs), but the different context could yield distinct findings. Policies and investments to promote active commuting remain under-developed in LMICs like India, which grapples with traffic congestion, lack of activity-supportive infrastructure, poor enforcement of traffic rules and regulations, air pollution, and overcrowding. This cross-sectional study investigated associations between home neighborhood environment characteristics and active commuting in Chennai, India. Adults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling; n = 56); (2) public transit (n = 52); and (3) private transport (n = 111). Environmental attributes around participants’ homes were assessed using the Neighborhood Environment Walkability Scale for India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modeled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. Consistent with other international studies, participants living in neighborhoods with a mix of land uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (adjusted odds ratio (aOR) = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05), and street connectivity (aOR = 0.2, p = 0.003). Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high-quality epidemiologic studies with greater context specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries. ... Read more

Physical inactivity is the fourth leading risk factor for global mortality, with most of these deaths occurring in low and middle-income countries (LMICs) like India. Research from developed countries has consistently demonstrated associations between built environment features and physical activity levels of populations. The development of culturally sensitive and reliable measures of the built environment is a necessary first step for accurate analysis of environmental correlates of physical activity in LMICs. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for India and evaluated aspects of test-retest reliability of the adapted version among Indian adults. Cultural adaptation of the NEWS was conducted by Indian and international experts. Semi-structured interviews were conducted with local residents and key informants in the city of Chennai, India. At baseline, participants (N = 370; female = 47.2%) from Chennai completed the adapted NEWS-India surveys on perceived residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. NEWS-India was administered for a second time to consenting participants (N = 62; female = 53.2%) with a gap of 2–3 weeks between successive administrations. Qualitative findings demonstrated that built environment barriers and constraints to active commuting and physical activity behaviors intersected with social ecological systems. The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.48–0.99). The NEWS-India demonstrated acceptable measurement properties among Indian adults and may be a useful tool for evaluation of built environment attributes in India. Further adaptation and evaluation in rural and suburban settings in India is essential to create a version that could be used throughout India. ... Read more

India is currently facing a non-communicable disease epidemic. Physical activity (PA) is a preventative factor for non-communicable diseases. Understanding the role of the built environment (BE) to facilitate or constrain PA is essential for public health interventions to increase population PA. The objective of this study was to understand BEs associations with PA occurring in two major life domains or life areas—travel and leisure—in urban India. Between December 2014 and April 2015, in-person surveys were conducted with participants (N = 370; female = 47.2%) in Chennai, India. Perceived BE characteristics regarding residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking and bicycling, aesthetics, traffic safety, and safety from crime were measured using the adapted Neighborhood Environment Walkability Scale-India (NEWS-India). Self-reported PA was measured the International Physical Activity Questionnaire. High residential density was associated with greater odds of travel PA (aOR = 1.9, 95% CI = 1.2, 3.2). Land use mix-diversity was positively related to travel PA (aOR = 2.1, 95%CI = 1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score predicted a two-fold increase in odds of travel PA (aOR = 1.9, 95% CI = 1.1, 3.1) and a 40% decrease in odds of leisure PA (aOR = 0.6, 95% CI = 0.4, 1.0). However, the association of the aggregated score with leisure PA was not significant. Results suggest that relationships between BE and PA in low-and-middle income countries may be context-specific, and may differ markedly from higher income countries. Findings have public health implications for India suggesting that caution should be taken when translating evidence across countries. ... Read more

Dietary behaviors are associated with obesity, and may be influenced by the environment. The objective of the current work was to investigate whether perceptions of built environment factors related to eating in the residential neighborhood will have different, independent associations with BMI and dietary behaviors than perceived built environment factors in the worksite neighborhood. In 2012–2013, a cross-sectional telephone-survey of Missouri adults (n = 2015) assessed perceptions of home and workplace built environment factors related to eating, dietary behaviors, and height and weight. Logistic regression models explored associations between perceived neighborhood built environment variables, diet, and obesity. The only variable associated with any of the outcomes explored in the fully adjusted models was the home neighborhood composite scale. None of the work environment variables were significantly associated with any of the health/behavior outcomes after adjustment. Few associations were found after adjustment for personal and job-related characteristics, and none were identified with the workplace neighborhood environment. While few home environment associations were found after adjustment, and none were identified with the perceived workplace neighborhood environment, the current study adds to the limited literature looking at associations between the perceived neighborhood around the workplace neighborhood and the perceived neighborhood around the home and dietary behaviors and obesity in adults. Future studies are needed to determine whether relationships between these environments and behavior exist, and if so, if they are causal and warrant intervention attempts. ... Read more

Introduction Data on built environment (BE) and physical activity (PA) in low- and middle- income countries is sparse. This study compared BE features, PA levels, and weight status among adults living in neighborhoods stratified by walkability and socio-economic status (SES) in the city of Chennai, India. Methods This cross sectional study design surveyed 370 adults (≥18 years) from four neighborhoods with differing walkability and socio-economic status. Participants were asked to complete a survey on their neighborhood environment, leisure and travel PA, height, weight, and demographic characteristics. One-way analysis of variance tests were used to examine differences across neighborhoods. Results Residents of high-walkability/high-SES neighborhoods reported higher land use mix diversity, land use mix access, street connectivity, aesthetics, and safety from crime. Residential density and walking/bicycling infrastructure were highest in the high-walkability/low-SES neighborhood. Transport PA was the maximum contributor to total PA in low-SES neighborhoods, while residents of high-SES neighborhoods reported greater levels of leisure-time PA. Sitting time and BMI were greater among high-SES participants. Patterns of PA, sedentary time, and weight status varied significantly by neighborhood walkability and SES. Conclusions An understanding of BE correlates of domain-specific PA can support the development of contextually tailored interventions to promote physical activity and reverse the determinants of inactivity occurring through patterns of urbanization and sedentary behaviors in India. ... Read more

Background
Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA.

Purpose
To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel).

Methods
Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA.

Results
In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods’ BE features and workplace PA were small but in the expected direction.

Conclusions
This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments. ... Read more

Background Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity. Purpose To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees’ commuting modes. Method Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n=1338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting. Result The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10–15 min walking distance from home (p=0.05) and using worksite incentive for public transit (p<0.001) were associated with commuting by public transit. Commuting distance (p<0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p<0.001) were associated with active commuting. Conclusion Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements. ... Read more