title: Coastal proximity and physical activity: Is the coast an under-appreciated public health resource?
abstract: BACKGROUND
  Recent findings suggest that individuals living near the coast are healthier than those living inland. Here we investigated whether this may be related to higher levels of physical activity among coastal dwellers in England, arising in part as a result of more visits to outdoor coastal settings.
  
  
  METHODS
  Participants (n=183,755) were drawn from Natural England's Monitor of Engagement with the Natural Environment Survey (2009-2012). Analyses were based on self-reported physical activity for leisure and transport.
  
  
  RESULTS
  A small, but significant coastal proximity gradient was seen for the likelihood of achieving recommended guidelines of physical activity a week after adjusting for relevant area and individual level controls. This effect was statistically mediated by the likelihood of having visited the coast in the last seven days. Stratification by region, however, suggested that while the main effect was relatively strong for west coast regions, it was not significant for those in the east.
  
  
  CONCLUSIONS
  In general, our findings replicate and extend work from Australia and New Zealand. Further work is needed to explain the marked regional differences in the relationship between coastal proximity and physical activity in England to better understand the coast's potential role as a public health resource.
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, UK. Electronic address: mathew.white@exeter.ac.uk.
authors.forename: Mathew P
authors.initials: MP
authors.lastname: White
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, UK.
authors.forename: Benedict W
authors.initials: BW
authors.lastname: Wheeler
authors.affiliation: Natural England, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Herbert
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Alcock
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, UK.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Depledge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004739:England; D004777:Environment; D015444:Exercise; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009792:Oceans and Seas; D011634:Public Health; D055815:Young Adult
keywords: Coastal proximity; England; Monitor of Engagement with the Natural Environment; Physical activity