title: International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries.
abstract: BACKGROUND
  Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries.
  
  
  METHODS
  A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries.
  
  
  RESULTS
  Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI.
  
  
  CONCLUSIONS
  Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.
authors.affiliation: Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium. ilse.debourdeaudhuij@ugent.be.
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.affiliation: Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium. delfien.vandyck@ugent.be.|Research Foundation - Flanders (FWO), Brussels, Belgium. delfien.vandyck@ugent.be.
authors.forename: Delfien
authors.initials: D
authors.lastname: Van Dyck
authors.affiliation: Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico. dsalvo@stanford.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Salvo
authors.affiliation: Centre for Research & Action in Public Health, Faculty of Health, Canberra University, Canberra, Australia. Rachel.davey@canberra.edu.au.
authors.forename: Rachel
authors.initials: R
authors.lastname: Davey
authors.affiliation: School of Health and Biosciences, Pontificia Universidade Catolica do Parana, Curitiba, Brazil. reis.rodrigo@pucpr.br.|Department of Physical Education, Federal University of Parana, Curitiba, Brazil. reis.rodrigo@pucpr.br.
authors.forename: Rodrigo S
authors.initials: RS
authors.lastname: Reis
authors.affiliation: Human Potential Centre, AUT University, Auckland, New Zealand. grant.schofield@aut.ac.nz.
authors.forename: Grant
authors.initials: G
authors.lastname: Schofield
authors.affiliation: Department of Public Health, School of Medicine, Universidad de los Andes, Bogotá, Colombia. osarmien@uniandes.edu.co.
authors.forename: Olga L
authors.initials: OL
authors.lastname: Sarmiento
authors.affiliation: Institute of Active Lifestyle, Faculty of Physical Culture, Palacký Universitsy, Olomouc, Czech Republic. Josef.mitas@upol.cz.
authors.forename: Josef
authors.initials: J
authors.lastname: Mitas
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. lbchristiansen@health.sdu.dk.
authors.forename: Lars Breum
authors.initials: LB
authors.lastname: Christiansen
authors.affiliation: Institute of Human Performance, The University of Hong Kong, Hong Kong, China. djmac@hku.hk.
authors.forename: Duncan
authors.initials: D
authors.lastname: MacFarlane
authors.affiliation: School of Population Health, University of South Australia, Adelaide, Australia. takemi.sugiyama@unisa.edu.au.
authors.forename: Takemi
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain. ines.aguinaga@unavarra.es.
authors.forename: Ines
authors.initials: I
authors.lastname: Aguinaga-Ontoso
authors.affiliation: Baker IDI Heart & Diabetes Institute, Melbourne, VIC, Australia. Neville.Owen@bakeridi.edu.au.
authors.forename: Neville
authors.initials: N
authors.lastname: Owen
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, USA. tlconway@ucsd.edu.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Conway
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, USA. jsallis@ucsd.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Sallis
authors.affiliation: Institute of Human Performance, The University of Hong Kong, Hong Kong, China. ecerin@hku.hk.|Centre of Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia. ecerin@hku.hk.
authors.forename: Ester
authors.initials: E
authors.lastname: Cerin
mesh_terms: D000328:Adult; D001315:Australia; D001530:Belgium; D001642:Bicycling; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D001938:Brazil; D002681:China; D003105:Colombia; D003430:Cross-Sectional Studies; D018153:Czech Republic; D003718:Denmark; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009043:Motor Activity; D009520:New Zealand; D009765:Obesity / Q000208:ethnology* / Q000209:etiology; D050177:Overweight / Q000208:ethnology / Q000209:etiology; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D013030:Spain; D006113:United Kingdom; D014481:United States; D016138:Walking; D055815:Young Adult