Neighborhood-level influences on physical activity among older adults: a multilevel analysis

There is a need for greater understanding of setting-specific influences on physical activity to complement the predominant research paradigm of individual-centered influences on physical activity. In this study, the authors used a cross-sectional multilevel analysis to examine a range of neighborhood-level characteristics and the extent to which they were associated with variation in self-reported physical activity among older adults. The sample consisted of 582 community-dwelling residents age 65 years and older (M = 73.99 years, SD = 6.25) recruited from 56 neighborhoods in Portland, OR. Information collected from participants and neighborhood data from objective sources formed a two-level data structure. These hierarchical data (i.e., individuals nested within neighborhoods) were subjected to multilevel structural-equation-modeling analyses. Results showed that neighborhood social cohesion, in conjunction with other neighborhood-level factors, was significantly associated with increased levels of neighborhood physical activity. Overall, neighborhood-level variables jointly accounted for a substantial variation in neighborhood physical activity when controlling for individual-level variables.     

Neighborhood and individual factors in activity in older adults: results from the neighborhood and senior health study

This study examined whether features of the built environment and residents' perceptions of neighborhood walkability, safety, and social cohesion were associated with self-reported physical activity (PA) and community-based activity among a sample of 190 older adults (mean age 74) residing in 8 Denver neighborhoods. Neighborhood walking audits were conducted to assess walkability and social capital. In multilevel analyses, a few walkability variables including curb cuts, crosswalks, and density of retail predicted greater frequency of walking for errands (p < .05), but mean frequency of walking for errands for this sample was low (<1/wk). Contrary to expectations, total PA and community-based activity were highest in neighborhoods with fewer walkability variables but higher respondent perceptions of safety and social cohesion (p < .01). For seniors, the importance of characteristics of the built environment in promoting PA and general activity engagement might be secondary to attributes of the social environment that promote safety and social cohesion.     

Neighborhood mechanisms and the spatial dynamics of birth weight

This study addresses two questions about why neighborhood contexts matter for individuals via a multilevel, spatial analysis of birthweight for 101,662 live births within 342 Chicago neighborhoods. First, what are the mechanisms through which neighborhood structural composition is related to health? The results show that mechanisms related to stress and adaptation (violent crime, reciprocal exchange and participation in local voluntary associations) are the most robust neighborhood-level predictors of birth weight. Second, are contextual influences on health limited to the immediate neighborhood or do they extend to a wider geographic context? The results show that contextual effects on birth weight extend to the social environment beyond the immediate neighborhood, even after adjusting for potentially confounding covariates. These findings suggest that the theoretical understanding and empirical estimation of 'neighborhood effects' on health are bolstered by collecting data on more causally proximate social processes and by taking into account spatial interdependencies among neighborhoods.     

Measuring the influence of built neighborhood environments on walking in older adults

There is a need for greater understanding of how perceptions and objective measures of the physical environment influence physical activity among seniors. The goal of this study was to examine the degree of association between perceived and objective characteristics of the neighborhood environment and the relation of each type of measurement to neighborhood walking in older adults. Data on self-reported frequency of walking in the neighborhood and perceived measures of neighborhood environment from 105 older adults were linked to objective measures assessed by geographic information systems and an audit instrument. Perceived and objective measurements of the built environment exhibited a low degree of agreement (kappas: <.20). After adjustment for education, age, and gender, presence of a mall was positively associated with neighborhood walking in both the objective and perceived models.     

Promoting walking among older adults living in retirement communities

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.     

Neighborhood influences on physical activity in middle-aged and older adults: a multilevel perspective

Over the past few years, attention has been drawn to the importance of neighborhood influences on physical activity behavior and the need to consider a multilevel analysis involving not only individual-level variables but also social- and physical-environment variables at the neighborhood level in explaining individual differences in physical activity outcomes. This new paradigm raises a series of issues concerning systems of influence observed at different hierarchical levels (e.g., individuals, neighborhoods) and variables that can be defined at each level. This article reviews research literature and discusses substantive, operational, and statistical issues in studies involving multilevel influences on middle-aged and older adults' physical activity. To encourage multilevel research, the authors propose a model that focuses attention on multiple levels of influence and the interaction among variables characterizing individuals, among variables characterizing neighborhoods, and across both levels. They conclude that a multilevel perspective is needed to increase understanding of the multiple influences on physical activity.     

Neighborhood disadvantage, disorder, and health.

We examine the question of whether living in a disadvantaged neighborhood damages health, over and above the impact of personal socioeconomic characteristics. We hypothesize that (1) health correlates negatively with neighborhood disadvantage adjusting for personal disadvantage, and that (2) neighborhood disorder mediates the association, (3) partly because disorder and the fear associated with it discourage walking and (4) partly because they directly impair health. Data are from the 1995 Community, Crime, and Health survey, a probability sample of 2,482 adults in Illinois, with linked information about the respondent's census tract. We find that residents of disadvantaged neighborhoods have worse health (worse self-reported health and physical functioning and more chronic conditions) than residents of more advantaged neighborhoods. The association is mediated entirely by perceived neighborhood disorder and the resulting fear. It is not mediated by limitation of outdoor physical activity. The daily stress associated with living in a neighborhood where danger, trouble, crime and incivility are common apparently damages health. We call for a bio-demography of stress that links chronic exposure to threatening conditions faced by disadvantaged individuals in disadvantaged neighborhoods with physiological responses that may impair health.     

Functional Ability,Neighborhood Resources and Housing Satisfaction among Older Adults in the U.S.

The purpose of this study was to explore neighborhood resources that influence the housing satisfaction of older adults. The study included 10,146 participants from the 2009 panel of the American Housing Survey who were 65 years and older. Hierarchical regression modeling was performed to examine older adults’ perceptions of neighborhood resources and consequently the role these resources play in predicting housing satisfaction among community dwelling and residents of assisted living, controlling for age, sex, ethnicity, education, and housing maintenance. In addition, three levels of physical functioning among residents of assisted living were examined. Results showed that there were differences in housing satisfaction by residences and levels of physical functioning. Subjective evaluations of neighborhoods and the near surrounds were significant predictors of housing satisfaction. Results of the study suggest that policy makers and housing professionals need to continue to consider the role of supportive neighborhoods and social environments in promoting successful aging particularly for frail older adults.     

RESIDENTIAL STABILITY, NEIGHBORHOOD RACIAL COMPOSITION, AND THE SUBJECTIVE ASSESSMENT OF NEIGHBORHOOD PROBLEMS AMONG OLDER ADULTS

This study investigates the effects of neighborhood racial composition and residential stability—as measured by the percentage of individuals who have lived in the same location for the past five years—on perceived neighborhood problems. Among a sample of older black and white adults, findings indicate that the patterns are contingent upon residents' race. For whites who reside in neighborhoods with a low percentage of black residents, greater residential stability is associated with fewer perceived neighborhood problems net of individual- and neighborhood-level disadvantage. For blacks, greater residential stability is associated with fewer neighborhood problems, but the percentage of black residents is associated with more neighborhood problems. In both cases, individual- and neighborhood-level socioeconomic disadvantages contribute to those patterns. These findings have implications for theories about the personal and social effects of residential stability and neighborhood racial composition, as well as race differences in the links between neighborhood context and the subjective assessment of neighborhood problems.     

Perceived barriers to walking in the neighborhood environment: a survey of middle-aged and older adults

The authors investigated whether low levels of walking among older adults in the UK were associated with demographic and health characteristics, as well as perceived environmental attributes. Survey data were obtained from self-administered standard questionnaires given to 680 people age 50+ (mean age 64.4 yr) attending nationally led walking schemes. Items concerned with demographic characteristics and perceived barriers to neighborhood walking were analyzed using multiple logistic regression. Citing more than 1 environmental barrier to walking, versus not, was associated with significantly reduced levels of (leisure) walking (MET/hr) in the preceding week (Z = -2.35, p = .019), but physical activity levels overall did not differ significantly (Z = -0.71, p = .48). Citing a health-related barrier to walking significantly adversely affected overall physical activity levels (Z = -2.72, p = .006). The authors concluded that, among older people who favor walking, health problems might more seriously affect overall physical activity levels than perceived environmental barriers.     

Evaluating Potential Environmental Variables and Active Aging in Older Adults for Age-Friendly Neighborhoods in Malaysia

As Malaysia's population is aging rapidly, and since there is no specific housing policy for the elderly, it is vital that neighborhoods meet the different needs of elderly for active aging to maintain their quality of life. This study aims to investigate the neighborhood environmental variables, the outcome active aging, and potential variables that inhibit active aging in the elderly that lead to their quality of life. It examined quality-of-life determinants that are influenced by the existence of certain neighborhood characteristics. In the study, 385 older adults aged 60+ years residing in two different cities in Malaysia were surveyed. Multiple regression was used to explore how much variance in active aging variables the neighborhood environmental factors explained as a group. The results showed that permeability, accessibility, and facilitators to walking are key determinants of active aging. There is a need to improve the physical design of the neighborhoods with regard to these three factors.     

Race differentials in obesity: the impact of place

This article reveals race differentials in obesity as both an individual- and neighborhood-level phenomena. Using neighborhood-level data from the 1990-1994 National Health Interview Survey, we find that neighborhoods characterized by high proportions of black residents have a greater prevalence of obesity than areas in which the majority of the residents are white. Using individual-level data, we also find that residents of neighborhoods in which at least one-quarter of the residents are black face a 13 percent increase in the odds of being obese compared to residents of other communities. The association between neighborhood racial composition and obesity is completely attenuated after including statistical controls for the poverty rate and obesity prevalence of respondents' neighborhoods. These findings support the underlying assumptions of both institutional and social models of neighborhood effects.     

Reliability and Validity of the IPAQ-L in a Sample of Hong Kong Urban Older Adults: Does Neighborhood of Residence Matter?

This study examined reliability and validity of the Chinese version of the International Physical Activity Questionnaire-Long Form (IPAQ-LC) in Chinese seniors, including moderating effects of neighborhood walkability and socioeconomic status (SES) on reliability and validity. The IPAQ-LC was interviewer-administered (n = 96), accelerometer and 7-day walk-diary data were collected (n = 94), and the IPAC-LC was readministered (N = 92). Acceptable reliability was found for all measures of physical activity (PA) overall and across different types of neighborhood. Participants from highly walkable neighborhoods were more reliable at estimating walking for transport. Participants from low-SES areas were less reliable at estimating leisure-time PA and sitting but more reliable at estimating transport-related walking. IPAQ-LC walking was significantly related to light- but not moderate-intensity accelerometry-based PA. It was moderately to strongly related to a 7-day diary of walking. The data imply slow-paced walking, probably due to age, climate, and terrain. The findings suggest that the IPAQ-LC's reliability and validity are acceptable in Chinese seniors.     

Reducing attrition in physical activity programs for older adults

This study investigated attrition in a 6-month physical activity intervention for older adults. The program was based on the social-cognitive theory incorporating self-efficacy factors. Two hundred forty-eight insufficiently active 65- to 74-year-olds were recruited from the Australian federal electoral roll. The intervention comprised walking and strength and flexibility exercises and was conducted in 30 local neighborhoods where the participants resided. Characteristics of individuals lost to attrition (n = 86, 35%) were compared with those of program completers (n = 162, 65%). Logistic-regression analysis showed that those lost to attrition came from areas of lower socioeconomic status, were overweight and less physically active, and had lower walking self-efficacy scores and higher loneliness scores. The results suggest that early assessment of these characteristics should be undertaken to identify individuals at risk of attrition, to improve retention, and to avoid potential bias.     

Predicting habitual physical activity using coping strategies in older fallers engaged in falls-prevention exercise

One third of adults over 65 yr old fall each year. Wide-ranging consequences include fracture, reduced activity, and death. Research synthesis suggests that falls-prevention programs can be effective in reducing falls by about 20%. Strength and balance training is the most efficacious component, and the assumed method of effect is an improvement in these performance domains. There is some evidence for this, but the authors have previously proposed an alternative method, activity restriction, leading to a reduction in subsequent falls through a reduction in exposure. The aim of this study was to examine physical activity in older fallers, applying a theory of adaptation, to ascertain predictors of habitual physical activity. Referrals to hospital- and community-based exercise programs were assessed for (a) habitual walking steps and (b) coping strategies, falls self-efficacy, social support, and balance mobility. There was no average group change in physical activity. There was high interindividual variability. Two coping strategies, loss-based selection and optimization, best explained the change in physical activity between baseline and follow-up. Notwithstanding some limitations, this work suggests further use of adaptation theory in falls research. A potential application is the creation of a profiling tool to enable clinicians to better match treatment to patient.     

Seven years later: effects of a neighborhood mobility program on poor Black and Latino adults' well-being

This study explored program effects on adults' well-being seven years following the implementation of a court-ordered neighborhood mobility program. Low-income black and Latino adults residing in poor, segregated neighborhoods in Yonkers, New York were randomly selected to relocate to publicly funded townhouses in middle-class neighborhoods within the city. Adults who moved (n = 141) and demographically similar adults who were not selected to move (n = 106) were interviewed. Data indicate that 85 percent of adults who moved to the new housing remained there at follow-up. Results revealed that adults who moved resided in neighborhoods with higher collective efficacy and less disorder and danger but had fewer neighborhood social ties than adults who stayed in poor neighborhoods. Movers were also more likely to work and less likely to receive welfare than nonmovers. Adults who remained in low-poverty neighborhoods at the time of the follow-up reported better physical health than adults residing in poor neighborhoods, but mental health did not vary by neighborhood.     

Item-response-theory analysis of two scales for self-efficacy for exercise behavior in people with arthritis

Benefits of physical activity for those with arthritis are clear, yet physical activity is difficult to initiate and maintain. Self-efficacy is a key modifiable psychosocial determinant of physical activity. This study examined two scales for self-efficacy for exercise behavior (SEEB) to identify their strengths and weaknesses using item response theory (IRT) from community-based randomized controlled trials of physical activity programs in adults with arthritis. The 2 SEEB scales included the 9-item scale by Resnick developed with older adults and the 5-item scale by Marcus developed with employed adults. All IRT analyses were conducted using the graded-response model. IRT assumptions were assessed using both exploratory and confirmatory factor analysis. The IRT analyses indicated that these scales are precise and reliable measures for identifying people with arthritis and low SEEB. The Resnick SEEB scale is slightly more precise at lower levels of self-efficacy in older adults with arthritis.     

Environmental changes to increase physical activity: perceptions of older urban ethnic-minority women

Despite the numerous benefits of physical activity, older adults continue to be more sedentary than their younger counterparts, and sedentary behavior is more prevalent among older racial and ethnic minorities than among Whites. This study used the nominal group technique (NGT) to examine participants' perceptions of what neighborhood environmental changes would encourage greater physical activity for older African American and Hispanic women. Participants age 50-75 years were recruited from 2 urban community health clinics. Nine NGT sessions (45 participants) were conducted. The women were asked what changes in their neighborhood environment would encourage them to become more physically active. Responses to the research question were tabulated, and qualitative analysis was used to identify themes and categories. Major categories were physical environment changes, safety, and activities/social support. Although the physical environment received the greatest number of points, concerns for personal safety cut across categories. Participants indicated the need for more facilities in which to be active.