title: Neighbourhood Walkability and Daily Steps in Adults with Type 2 Diabetes.
abstract: BACKGROUND
  There is evidence that greater neighbourhood walkability (i.e., neighbourhoods with more amenities and well-connected streets) is associated with higher levels of total walking in Europe and in Asia, but it remains unclear if this association holds in the Canadian context and in chronic disease populations. We examined the relationships of different walkability measures to biosensor-assessed total walking (i.e., steps/day) in adults with type 2 diabetes living in Montreal (QC, Canada).
  
  
  METHODS
  Participants (60.5±10.4 years; 48.1% women) were recruited through McGill University-affiliated clinics (June 2006 to May 2008). Steps/day were assessed once per season for one year with pedometers. Neighbourhood walkability was evaluated through participant reports, in-field audits, Geographic Information Systems (GIS)-derived measures, and the Walk Score®. Relationships between walkability and daily steps were estimated using Bayesian longitudinal hierarchical linear regression models (n = 131).
  
  
  RESULTS
  Participants who reported living in the most compared to the least walkable neighbourhoods completed 1345 more steps/day (95% Credible Interval: 718, 1976; Quartiles 4 versus 1). Those living in the most compared to the least walkable neighbourhoods (based on GIS-derived walkability) completed 606 more steps per day (95% CrI: 8, 1203). No statistically significant associations with steps were observed for audit-assessed walkability or the Walk Score®.
  
  
  CONCLUSIONS
  Adults with type 2 diabetes who perceived their neighbourhoods as more walkable accumulated more daily steps. This suggests that knowledge of local neighborhood features that enhance walking is a meaningful predictor of higher levels of walking and an important component of neighbourhood walkability.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hajna
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada.|Department of Geography, McGill University, 805 Sherbrooke Street West, Montréal, QC, Canada.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Ross
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada.|Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, Montréal, QC, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Harper
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, Canada.|Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, Montréal, QC, Canada.
authors.forename: Kaberi
authors.initials: K
authors.lastname: Dasgupta
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011792:Quebec; D012111:Residence Characteristics; D016138:Walking