title: Perceived neighborhood environment and physical activity in 11 countries: do associations differ by country?
abstract: BACKGROUND
  Increasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country.
  
  
  METHODS
  Population representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported.
  
  
  RESULTS
  Significant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries.
  
  
  CONCLUSIONS
  There is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.
authors.affiliation: Department of Family Preventive Medicine, University of California San Diego, La Jolla, California, USA. melody.ding@sydney.edu.au
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.forename: Marc A
authors.initials: MA
authors.lastname: Adams
authors.forename: James F
authors.initials: JF
authors.lastname: Sallis
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Norman
authors.forename: Melbourn F
authors.initials: MF
authors.lastname: Hovell
authors.forename: Christina D
authors.initials: CD
authors.lastname: Chambers
authors.forename: C Richard
authors.initials: CR
authors.lastname: Hofstetter
authors.forename: Heather R
authors.initials: HR
authors.lastname: Bowles
authors.forename: Maria
authors.initials: M
authors.lastname: Hagströmer
authors.forename: Cora L
authors.initials: CL
authors.lastname: Craig
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Gomez
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Macfarlane
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: Lena
authors.initials: L
authors.lastname: Klasson-Heggebo
authors.forename: Shigeru
authors.initials: S
authors.lastname: Inoue
authors.forename: Norio
authors.initials: N
authors.lastname: Murase
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: Michael
authors.initials: M
authors.lastname: Sjöström
authors.forename: Heidi
authors.initials: H
authors.lastname: Tomten
authors.forename: Johan
authors.initials: J
authors.lastname: Lefevre
authors.forename: Vida
authors.initials: V
authors.lastname: Volbekiene
authors.forename: Adrian E
authors.initials: AE
authors.lastname: Bauman
mesh_terms: D001642:Bicycling; D004779:Environment Design; D015444:Exercise; D015438:Health Behavior / Q000208:ethnology*; D006798:Housing; D006801:Humans; D038622:Internationality; D016015:Logistic Models; D010465:Perception; D011633:Public Facilities; D011998:Recreation; D012111:Residence Characteristics; D014186:Transportation