title: Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis.
abstract: BACKGROUND
  Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA.
  
  
  METHODS
  A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country.
  
  
  RESULTS
  A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e.g., U.S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA.
  
  
  CONCLUSIONS
  Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.
authors.affiliation: Exercise and Wellness, School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA. marc.adams@asu.edu
authors.forename: Marc A
authors.initials: MA
authors.lastname: Adams
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.forename: James F
authors.initials: JF
authors.lastname: Sallis
authors.forename: Heather R
authors.initials: HR
authors.lastname: Bowles
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Ainsworth
authors.forename: Patrick
authors.initials: P
authors.lastname: Bergman
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Bull
authors.forename: Harriette
authors.initials: H
authors.lastname: Carr
authors.forename: Cora L
authors.initials: CL
authors.lastname: Craig
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Gomez
authors.forename: Maria
authors.initials: M
authors.lastname: Hagströmer
authors.forename: Lena
authors.initials: L
authors.lastname: Klasson-Heggebø
authors.forename: Shigeru
authors.initials: S
authors.lastname: Inoue
authors.forename: Johan
authors.initials: J
authors.lastname: Lefevre
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Macfarlane
authors.forename: Sandra
authors.initials: S
authors.lastname: Matsudo
authors.forename: Victor
authors.initials: V
authors.lastname: Matsudo
authors.forename: Grant
authors.initials: G
authors.lastname: McLean
authors.forename: Norio
authors.initials: N
authors.lastname: Murase
authors.forename: Michael
authors.initials: M
authors.lastname: Sjöström
authors.forename: Heidi
authors.initials: H
authors.lastname: Tomten
authors.forename: Vida
authors.initials: V
authors.lastname: Volbekiene
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003132:Commerce; D003625:Data Collection; D004777:Environment; D004779:Environment Design; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D038622:Internationality; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011998:Recreation; D012111:Residence Characteristics / Q000145:classification*; D012449:Safety; D011795:Surveys and Questionnaires; D014186:Transportation; D016138:Walking; D055815:Young Adult