Multilevel modeling of walking behavior: advances in understanding the interactions of people, place, and time. Med Sci Sports Exerc, 40, S584-593

Department of Health Research and Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Medicine &amp Science in Sports &amp Exercise (Impact Factor: 3.98). 08/2008; 40(7 Suppl):S584-93. DOI: 10.1249/MSS.0b013e31817c66b7
Source: PubMed


It has become increasingly clear that the influences on walking as well as other forms of regular physical activity are complex and require an increased understanding of factors across multiple levels of influence. Ecological frameworks have provided the field with a heuristic means of capturing potential impacts on behavior across diverse domains, including personal, behavioral, social or cultural, and environmental. We discuss advances in both understanding and applying this framework through the inclusion of previously ignored dimensions of impact (e.g., time), the application of state-of-the-art statistical methods for understanding interactions among multiple domains (e.g., signal detection), and the development of computer technologies (e.g., agent-based modeling) aimed at simulating the complex relationships between multiple levels of impact and walking behavior. We conclude with suggestions for future research in this emerging field.

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    • "Agent-based methods have been used to facilitate understanding of relationships between macro-scale dynamics of the built environment and community social systems with micro-scale interactions and adaptations at the individual level (Auchincloss and Roux, 2008). Several multi-level models simulated interactions of the built environment and walking behaviours (King et al, 2008; Yang et al, 2011). One study used an agent-based approach to model dietary behaviours in relation to spatial segregation by income (Auchincloss et al, 2011). "
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    ABSTRACT: Socio-demographics of urban US populations have been associated with poor health status and chronic disease. Patterns of rising chronic disease prevalence have persisted in populations with lower socio-economic status despite substantial and costly public health efforts to the contrary. In this paper, we used a system dynamics model to simulate chronic disease prevalence, along with potential interventions, for a low-income urban community in Chicago, Illinois. We hypothesized that the ‘triple bottom line’ of sustainability—addressing economic, social, and environmental issues—would be key to mitigation and reduction of chronic disease over time in such a community. The aim was to inform decision making about urban design and public health programme planning towards formulation of approaches—some beyond the traditional boundaries of health interventions—to improve community chronic disease outcomes over time. We found that single interventions on the constructs of Income and Employment, Neighbourhood Attractiveness, and Social Cohesion were most impactful in reducing or reversing the rise of chronic disease prevalence. Increasing Housing Capacity allowed the Neighbourhood Attractiveness intervention to have a greater impact. In addition, interventions in Neighbourhood Attractiveness and Chronic Disease Prevention produced a greater combined mitigating effect on chronic disease prevalence than the sum of the individual intervention effects. Findings suggest that socio-environmental conditions should be addressed, with consideration of population migration dynamics, in formulating viable and sustainable solutions to improve community-level health outcomes such as chronic disease prevalence.
    Journal of Simulation 08/2014; 9(2). DOI:10.1057/jos.2014.16 · 0.58 Impact Factor
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    • "In our study, participants had been living in the same neighborhood for at least 10 years, and they reported several neighborhood changes over time that resulted in a decreasing sense of neighborliness. King et al. (2008) stressed that understanding behaviors such as daily walking requires consideration of the interplay between people and places over time. Our study supports the importance of duration of residency, because people noted that neighborhoods became less supportive, less older-people-friendly, and increasingly populated by young working adults who move house quite often. "
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    ABSTRACT: This mixed-methods study investigated personal, interpersonal, and environmental factors salient to decisions about being active in neighborhoods of different levels of deprivation. Twenty-five participants age 70 years and older (10 women) with diverse physical activity levels provided data on their weekly activity patterns (using accelerometry) and their perceived barriers to exercise (questionnaire). They also participated in semistructured individual interviews exploring the barriers and facilitators influencing neighborhood activity. Functional limitations, lack of intrinsic motivation, and not having an activity companion were the highest impact barriers. Walkable access to amenities, positive physical activity perceptions, and existing habit of being active were the highest impact facilitators. The perceived quality and accessibility of the built and natural environments influence neighborhood activity in older adults. However, this relationship might be altered through the influence of personal and interpersonal determinants such as maintenance of good health and functional ability and supportive social networks.
    Journal of Aging and Physical Activity 04/2012; 20(2):148-70. · 1.97 Impact Factor
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    • "From an empirical standpoint, although data are accumulating rapidly on the environmental determinants of physical activity among children and adults of working age, there are only a few studies that address the environmental determinants of physical activity among seniors (King et al., 2008). The dearth of data is even more glaring for one of the activities most engaged in by the population in general and seniors namely, walking. "
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    ABSTRACT: This paper examined whether or not closer proximity to local services and amenities was associated with maintenance of more frequent walking over time among urban-dwelling seniors over and above individual-level characteristics. A sample of 521 adults who were part of the VoisiNuAge study and who resided in a large North American urban area reported on the frequency of walking outside the home over a 3-year period and on their health, sociodemographic characteristics, social support and resources, and perceptions of different features of their residential environment. Information about the distance between their home and 16 services and amenities was obtained from a geographic information system. Seniors were then classified into quartiles of proximity (Q1, Q2, Q3, Q4). Unadjusted and adjusted ordinal growth curve models showed that closer proximity to services and amenities was associated with greater likelihood of frequent walking at all times throughout the 3-year period. Findings are consistent with the notion that environments may act as buoys for the maintenance of important health behaviors. Future experimental and quasi-experimental research is required to explore whether or not the environment can play a causal role in influencing patterns of walking over time.
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