title: The unbuilt environment: culture moderates the built environment for physical activity.
abstract: While research has demonstrated a link between the built environment and obesity, much variation remains unexplained. Physical features are necessary, but not sufficient, for physical activity: residents must choose to use these features in health-promoting ways. This article reveals a role for local culture in tempering the effect of the physical environment on physical activity behaviors.
  
  
  
  We developed Systematic Cultural Observation (SCO) to observe place-based, health-related culture in Lenoir County, NC (population ~60,000). Photographs (N = 6450) were taken systematically from 150 most-used road segments and geocoded. Coders assessed physical activity (PA) opportunities (e.g., public or private activity spaces, pedestrian-friendly features) and presence of people in each photograph.
  
  
  
  28.7% of photographs contained some PA feature. Most were private or pedestrian; 3.1% contained public PA space. Only 1.5% of photographs with any PA features (2% of those with public PA space, 0.7% of those with private) depicted people despite appropriate weather and daylight conditions.
  
  
  
  Even when PA opportunities existed in this rural county, they were rarely used. This may be the result of culture ("unbuilt environment") that disfavors physical activity even in the presence of features that allow it. Policies promoting built environments designed for healthy lifestyles should consider local culture (shared styles, skills, habits, and beliefs) to maximize positive outcomes.
authors.affiliation: Department of Sociology, College of Arts and Sciences, University of North Carolina, CB#3210, 155 Hamilton Hall, Chapel Hill, NC, 27599-3210, USA. andrew_perrin@unc.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Perrin
authors.affiliation: Department of Sociology, College of Arts and Sciences, University of North Carolina, CB#3210, 155 Hamilton Hall, Chapel Hill, NC, 27599-3210, USA.
authors.forename: Neal
authors.initials: N
authors.lastname: Caren
authors.affiliation: The Duke Clinical Research Institute, 2400 Pratt Street, Office 8047, Durham, NC, 27705, USA.
authors.forename: Asheley C
authors.initials: AC
authors.lastname: Skinner
authors.affiliation: Medical University of South Carolina, 165 Ashley Avenue, MSC 561, Charleston, SC, 29425, USA.
authors.forename: Adebowale
authors.initials: A
authors.lastname: Odulana
authors.affiliation: Department of Pediatrics, School of Medicine, University of North Carolina, 231 MacNider, CB#7225, Chapel Hill, NC, 27599-7225, USA.
authors.forename: Eliana M
authors.initials: EM
authors.lastname: Perrin
mesh_terms: D003469:Culture; D004779:Environment Design; D015444:Exercise; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D009657:North Carolina; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D012111:Residence Characteristics; D012424:Rural Population
keywords: Built environment; Culture; Obesity; Physical activity; Rural