Journal of General Internal Medicine

, Volume 22, Issue 12, pp 1674–1680 | Cite as

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

  • Ming WenEmail author
  • Namratha R. Kandula
  • Diane S. Lauderdale
Original Article



Patients are often advised to initiate a physical activity program by walking for transportation or leisure. This study explored whether neighborhood factors beyond the individual might affect compliance.


We examined the associations between total walking and neighborhood factors in a multi-ethnic population-based sample in California and the roles race/ethnicity plays in these associations.


Cross-sectional study


Individual-level data were obtained from the 2003 California Health Interview Survey. Participants’ census tracts were linked to Census 2000 data to capture neighborhood SES.

Measurements and Main Results

The dependent variable was self-reported walking at recommended levels. Neighborhood SES was measured by a scale of 4 Census-based variables (alpha = 0.83). Social cohesion was measured by a scale tapping the extent of perceived social connectedness, trust, and solidarity among neighbors (alpha = 0.70). Neighborhood access to a park, playground, or open space was measured by a single item. Safety was measured by a scale of three items (alpha = 0.66). We performed a series of multiple logit models with robust variance estimates while taking complex survey design into account. Neighborhood social cohesion (odds ratio [OR] = 1.09, 95% CI = 1.04, 1.14) and access to a park, playground, or open space (OR = 1.26, 95% CI = 1.16, 1.36) were significant environmental correlates of walking at recommended levels, independent of individual socio-demographics. Subgroup analysis showed that neighborhood effects were different by race/ethnicity.


Neighborhood physical and social environmental factors are significantly associated with walking at recommended levels. Being aware of the ways that the environment could affect a patient’s compliance with PA recommendations may help physicians tailor recommendations to circumstances.


physical activity walking neighborhood social cohesion trust neighborhood safety neighborhood SES 



This work was supported by a Research Scholars Grant GPHPS 107922 from the American Cancer Society, Atlanta, GA (Lauderdale is the PI; Wen and Kandula are co-investigators) and a grant awarded to Wen (NICHD R03 HD0525370-01). The authors thank UCLA Center for Health Policy Research for providing access to the confidential data of the 2003 California Health Interview Survey.

Conflict of Interest

This research was supported by a research grant from the American Cancer Society to all three authors, with Dr. Lauderdale as PI and Dr. Wen and Dr. Kandula as co-investigators. Dr. Wen also received a grant from the NICHD to partly support her work in this research.

No other potential conflict of interest is involved in this research.


  1. 1.
    Centers for Disease Control and Prevention. Perceptions of neighborhood characteristics and leisure-time physical inactivity—Austin/Travis County, Texas, 2004. MMWR Morb Mort Wkly Rep. 2005;54(37):926–8.Google Scholar
  2. 2.
    U.S. Department of Health and Human Services. Healthy People 2010. With Understanding and Improving Health and Objectives for Improving Health. Vol 2 volumes, 2nd ed. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. Physical activity trends—United States, 1990–1998. MMWR Morb Mort Wkly Rep. 2001;50:166–9.Google Scholar
  4. 4.
    Dishman RK, Buckworth J. Increasing physical activity: a quantitative synthesis. Med Sci Sports Exerc. 1996;28(6):706–19.PubMedGoogle Scholar
  5. 5.
    Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med. 2002;22(4S).Google Scholar
  6. 6.
    Eyler AA, Brownson RC, Bacak SJ, Housemann RA. The epidemiology of walking for physical activity in the United States. Med Sci Sports Exerc. 2003;35(9):1529–36.PubMedCrossRefGoogle Scholar
  7. 7.
    Hillsdon M, Thorogood M, Antiss T, Morris J. Randomized controlled trials of physical activity promotion in a free-living populations: a review. J Epidemiol Community Health. 1995;49:448–53.PubMedGoogle Scholar
  8. 8.
    The Surgeon General’s Call to Action Prevent and Decrease Overweight and Obesity. Washington, DC: U.S. Government Printing Office; 2001.Google Scholar
  9. 9.
    Fletcher GF. How to implement physical activity in primary and secondary prevention: a statement for healthcare professionals from the task force on risk reduction, American Heart Association. Circulation. 1997;96:355–8.PubMedGoogle Scholar
  10. 10.
    U.S. Department of Health and Human Services, Centers of Disease Control and Prevention. Physical Activity and Health: A Report of the Surgeon General. National Center for Chronic Disease Prevention and Health Promotion; 1996:87–142.Google Scholar
  11. 11.
    Ainsworth BE, Wilcox S, Thompson WW, Richter DL, Henderson KA. Personal, social, and physical environmental correlates of physical activity in African-American Women in South Carolina. Am J Prev Med. 2003;25(3Si):23–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Huston SL, Evenson KR, Bors P, Gizlice Z. Neighborhood environment, access to places for activity, and leisure-time physical activity in a diverse North Carolina Population. Am J Health Promot. 2003;18:58–69.PubMedGoogle Scholar
  13. 13.
    Robinson TN, Sirard JR. Preventing childhood obesity: a solution-oriented research paradigm. Am J Prev Med. 2005;28(suppl 2):194–201.PubMedCrossRefGoogle Scholar
  14. 14.
    Duncan SC, Duncan TE, Strycker LA. A multilevel analysis of neighborhood context and youth alcohol and drug problems. Prevention Science 2002;3(2):125–33.PubMedCrossRefGoogle Scholar
  15. 15.
    Giles-Corti B, Donovan RJ. Relative influences of individual, social environmental, and physical environmental correlates of walking. Am J Public Health. 2003;93(9):1583–9.PubMedCrossRefGoogle Scholar
  16. 16.
    McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: a review of concepts and evidence. Soc Sci Med. 2006;63:1011–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Ross CE. Walking, exercising, and smoking: does neighborhood matter? Soc Sci Med. 2000;51(2):265–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Sundquist J, Malmström M, Johansson S-E. Cardiovascular risk factors and the neighborhood environment: a multilevel analysis. Int J Epidemiol. 1999;28(5):841–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Yen IH, Kaplan GA. Poverty area residence and changes in physical activity level: Evidence from the Alameda County study. Am J Public Health. 1998;88:1709–12.PubMedGoogle Scholar
  20. 20.
    Cubbin C, Hadden WC, Winkleby MA. Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation. Ethn Dis. 2001;11(4):687–700.PubMedGoogle Scholar
  21. 21.
    Lee RE, Cubbin C. Neighborhood context and youth cardiovascular health behaviors. Am J Public Health. 2002;92(3):428–36.PubMedGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention. Healthy places terminology-designing and building healthy places. Available at:; Accessed on: August 12, 2005.
  23. 23.
    Duncan MJ, Spence JC, Mummery WK. Perceived environment and physical activity: a meta-analysis of selected environmental characteristics. Int J Behav Nutr Phys Act. 2005;2(11):1–9.Google Scholar
  24. 24.
    Ewing R. Can the physical environment determine physical activity levels? Exerc Sport Sci Rev. 2005;33(2):69–75.PubMedCrossRefGoogle Scholar
  25. 25.
    Eyler AA, Baker E, Cromer L, King AC, Brownson RC, Donatelle RJ. Physical activity and minority women: a qualitative study. Health Educ Behav. 1998;25:640–52.PubMedCrossRefGoogle Scholar
  26. 26.
    Boslaugh SE, Luke DA, Brownson RC, Naleid KS, Kreuter MW. Perceptions of neighborhood environment for physical activity: Is it “who you are” or “where you live”? J Urban Health 2004;81(4):671–81.PubMedGoogle Scholar
  27. 27.
    King AC, Castro C, Wilcox S, Eyler AA, Sallis JF, Brownson RC. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychol. 2000;19(4):354–64.PubMedCrossRefGoogle Scholar
  28. 28.
    California Health Interview Survey. The 2003 California Health Interview Survey Response Rates. Los Angeles, CA: UCLA Center for Health Policy Research; 2003.Google Scholar
  29. 29.
    Bedimo-Rung AO, Mowen AJ, Cohen D. The significance of parks to physical activity and public health: a conceptual model. Am J Prev Med. 2005;28(suppl 2):159–68.PubMedCrossRefGoogle Scholar
  30. 30.
    Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N. Contribution of public parks to physical activity. Am J Public Health. 2007;97(3):509–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Godbey GC, Caldwell LL, Floyd M, Payne LL. Contributions of leisure studies and recreation and park management research to the active living agenda. Amerique. 2005;28(suppl 2):150–8.Google Scholar
  32. 32.
    Sallis JF, Bauman A, Pratt M. Environmental and policy interventions to promote physical activity. Am J Prev Med. 1998;15:379–97.PubMedCrossRefGoogle Scholar
  33. 33.
    Sallis JF, Linton LS, Kraft MK. The first Active Living Research conference: growth of a transdisciplinary field. Am J Prev Med. 2005;28(2S2):93–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Centers for Disease Control and Prevention. Physical activity among Asians and Native Hawaiian or other Pacific Islanders—50 states and the District of Columbia, 2001–2003. MMWR Morb Mort Wkly Rep. 2004;53(33):756–60.Google Scholar
  35. 35.
    Kandula NR, Lauderdale DS. Leisure time, non-leisure time, and occupational physical activity in Asian Americans. Ann Epidemiol. 2005;15(4):257–65.PubMedCrossRefGoogle Scholar
  36. 36.
    Grzywacz JG, Marks NF. Social inequalities and exercise during adulthood: toward an ecological perspective. J Health Soc Behav. 2001;42(2):202–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Humpel N, Owen N, Iverson D, Leslie E, Bauman A. Perceived environment attributes, residential location, and walking for particular purposes. Am J Prev Med. 2004;26(2):119–25.PubMedCrossRefGoogle Scholar
  38. 38.
    Motl RW, Dishman RK, Ward DS, et al. Perceived physical environment and physical activity across one year among adolescent girls: self-efficacy as a possible mediator? J Adolesc Health. 2005;37(5):403–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Shenassa ED, Liebhaber A, Ezeamama A. Perceived safety of area of residence and exercise: a pan-European study. Am J Epidemiol. 2006;163(11):1012–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Voorhees CC, Young DR. Personal, social, and physical environmental correlates of physical activity levels in urban Latinas. Am J Prev Med. 2003;25(3Si):61–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Wen M, Browning CR, Cagney K. A multi-level study of neighborhood environment and its relationship to physical activity in adulthood. Urban Stud. 2007;44(13):1–18.Google Scholar
  42. 42.
    Degrance JM, Mouton CP, Lichtenstein MJ, Hazuda HP. Potential mediators of ethnic differences in physical activity in older Mexican Americans and European Americans: Results from the San Antonio Longitudinal Study of Aging. J Am Geriatr Soc. 2005;53:1240–7.CrossRefGoogle Scholar
  43. 43.
    Lindström M, Hanson BS, Wirfalt E, Ostergren PO. Socioeconomic differences in the consumption of vegetables, fruit and fruit juices. The influence of psychosocial factors. Eur J Public Health. 2001;11(1):51–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Berrigan D, Troiano RP, McNeel T, DiSogra C, Ballard-Barbash R. Active transportation increases adherence to activity recommendations. Am J Prev Med. 2006;31(3):210–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. Am J Public Health. 2007;97(3):486–92.PubMedCrossRefGoogle Scholar
  46. 46.
    Jacobson D, Strohecker L, Compton M, Katz D. Physical activity counseling in the adult primary care setting position statement of the American College of Preventive Medicine. Am J Prev Med. 2005;29(2):158–62.PubMedCrossRefGoogle Scholar
  47. 47.
    Bolognesi M, Nigg CR, Massarini M, Lippke S. Reducing obesity indicators through PACE in Italian Primary Care settings. Annals Behav Med 2006;31:179–85CrossRefGoogle Scholar
  48. 48.
    Heymann J, Fishcher A. Neighborhoods, Health Research, and Its Relevance to Public Policy. In: Kawachi I, Berkman LF, eds. Neighborhoods and Health. New York: Oxford University Press; 2003:335–47.Google Scholar
  49. 49.
    Katx L, Kling J, Liebman J. Moving to opportunity in Boston: early results of a randomized mobility experiment. Q J Econ. 2001;116(2):604–54.Google Scholar
  50. 50.
    Rosenbaum JE. Changing the geography of opportunity by expanding residential choice: lessons from the Gautreaux Program. Hous Policy Debate. 1995;6:231–69.Google Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Ming Wen
    • 1
    Email author
  • Namratha R. Kandula
    • 2
  • Diane S. Lauderdale
    • 3
  1. 1.Department of SociologyUniversity of UtahSalt LakeUSA
  2. 2.Division of General Internal MedicineNorthwestern UniversityChicagoUSA
  3. 3.Department of Health StudiesUniversity of ChicagoChicagoUSA

Personalised recommendations