title: The built environment and utilitarian walking in small U.S. towns.
abstract: OBJECTIVE
  The role of the built environment on walking in rural United States (U.S.) locations is not well characterized. We examined self-reported and measured built environment correlates of walking for utilitarian purposes among adult residents of small rural towns.
  
  
  METHODS
  In 2011-12, we collected telephone survey and geographic data from 2152 adults in 9 small towns from three U.S. regions. We performed mixed-effects logistic regression modeling to examine relationships between built environment measures and utilitarian walking ("any" versus "none"; "high" [≥150min per week] versus "low" [<150min per week]) to retail, employment and public transit destinations.
  
  
  RESULTS
  Walking levels were lower than those reported for populations living in larger metropolitan areas. Environmental factors significantly (p<0.05) associated with higher odds of utilitarian walking in both models included self-reported presence of crosswalks and pedestrian signals and availability of park/natural recreational areas in the neighborhood, and also objectively measured manufacturing land use.
  
  
  CONCLUSIONS
  Environmental factors associated with utilitarian walking in cities and suburbs were important in small rural towns. Moreover, manufacturing land use was associated with utilitarian walking. Modifying the built environment of small towns could lead to increased walking in a sizeable segment of the U.S. population.
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: mark-doescher@ouhsc.edu.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Doescher
authors.affiliation: Landscape Architecture Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
authors.forename: Chanam
authors.initials: C
authors.lastname: Lee
authors.affiliation: The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Berke
authors.affiliation: The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Adachi-Mejia
authors.affiliation: Landscape Architecture Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
authors.forename: Chun-Kuen
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Urban Form Lab, College of Built Environments, University of Washington, Seattle, WA, USA.
authors.forename: Orion
authors.initials: O
authors.lastname: Stewart
authors.affiliation: WWAMI Rural Health Research Center, School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Davis G
authors.initials: DG
authors.lastname: Patterson
authors.affiliation: Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Hurvitz
authors.affiliation: The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Carlos
authors.affiliation: Department of Epidemiology, College of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Glen E
authors.initials: GE
authors.lastname: Duncan
authors.affiliation: Urban Form Lab, College of Built Environments, University of Washington, Seattle, WA, USA.
authors.forename: Anne Vernez
authors.initials: AV
authors.lastname: Moudon
mesh_terms: D000328:Adult; D004779:Environment Design; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D012111:Residence Characteristics; D012424:Rural Population; D057566:Self Report; D014481:United States; D016138:Walking / Q000706:statistics & numerical data*
keywords: Exercise/physical activity; Health promotion; Physical environment; Prevention; Rural health; Social environment; Walking