Parents' perceptions of neighborhood safety and children's physical activity
Lori A. Weira,⁎, Debra Etelsonb, Donald A. Brandb,c,d
aDepartment of Family Medicine, New York Medical College, Munger Pavilion, Room 306, Valhalla, NY 10595, USA
bDepartment of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
cDepartment of Medicine, New York Medical College, Valhalla, NY 10595, USA
dPrimary Care Research Unit, New York Medical College, Valhalla, NY 10595, USA
Available online 19 May 2006
Objective. The obesity epidemic disproportionately affects minority and poor children. Negative perceptions of neighborhood safety in poor
communities may affect overweight by inhibiting children's physical activity. This study investigates the degree to which parents in a poor inner
city vs. a middle-class suburban community limit their children's outdoor activity because of neighborhood safety concerns.
Method. Parents of children aged 5–10 years from an inner city family practice in a poor community and from a suburban pediatric practice in
a middle-class community completed a 20-item questionnaire. Parents estimated the amount of their child's activity in various situations and
indicated their level of anxiety concerning gangs, child aggression, crime, traffic, and personal safety in their neighborhood.
Results. Inner city children (n = 204) engaged in less physical activity than suburban children (N = 103) (P b 0.001). Inner city parents
expressed much greater anxiety about neighborhood safety than suburban parents (P b 0.0001). In the inner city population, children's physical
activity levels were negatively correlated with parental anxiety about neighborhood safety (r = −0.18, P b 0.05).
Conclusions. Inner city parents have high levels of anxiety about neighborhood safety. While these concerns may not entirely explain the
discrepancy in activity levels between inner city and suburban children, a safe environment is crucial to increasing opportunities for physical
© 2006 Elsevier Inc. All rights reserved.
Keywords: Exercise; Child; Poverty areas; Social problems; Residence characteristics; Socioeconomic factors
disadvantaged minority families have lower levels of physical
activity (Lee and Cubbin, 2002; Gorden-Larsen et al., 2000) and
These disparities may reflect differences in access to safe play
areas, availability of after-school programs, and environmental
factors such as traffic and street safety (Giles-Corti and Donovan,
2002; Saelens et al., 2003; Timperio et al., 2005).
A few studies have examined the relationship between percep-
tions of neighborhood safety and physical activity in selected
pediatric populations (Romero et al., 2001). Minority adolescent
girls but not boys are less active if they worry about neighborhood
safety (Gomez et al., 2004). School-age children are less likely to
walk or bicycle as a mode of transportation if their parents have
safety concerns (Timperio et al., 2004). Inner city minorityparents
and parents of chronically ill children may limit children's activity
due to environmental safetyconcerns (Goodway andSmith,2005;
Holoday et al., 1997). In preschool children, parental perceptions
watching television but do not appearto influence outdoor activity
(Burdette and Whitaker, 2005).
This study further explored this relationship with respect to
school-aged children. Specifically, we compared the degree to
which parents in a poor inner city vs. a middle-class suburban
community limit their children's outdoor activity because of
neighborhood safety concerns.
This cross-sectional study used a self-administered questionnaire to ask
parents of children 5 to 10 years old about their perceptions of neighborhood
safety and about their child's physical activities. The study included parents of
Preventive Medicine 43 (2006) 212–217
⁎Corresponding author. Fax: +1 914 594 4698.
E-mail address: firstname.lastname@example.org (L.A. Weir).
0091-7435/$ - see front matter © 2006 Elsevier Inc. All rights reserved.
children seen in a community health center located in a low-income inner city
community and, for comparison, parents of children seen in a private pediatric
practice in a middle-class suburban community.
The inner city family health center cares for a medically underserved,
predominately minority population in a community adjacent to New York City.
Over a quarter of children in this community live below the poverty line and
40% of residents do not speak English (USCB, 2005). The private pediatric
faculty practice is located 13 miles from the family health center, in the same
county. Thispracticeserves a predominately middle-class, Caucasianpopulation
from surrounding suburbs. Both practices are affiliated with and staffed by
physicians from New York Medical College.
Since no existing instrument included all of the variables needed to address
our study objective, we developed a survey instrument by adapting content and
methods from previously tested and validated instruments. To assess physical
activity, parents estimated the average weekly time their child engaged in
physical activity in various contexts. Parental estimates strongly correlate with
direct measures of moderate to vigorous physical activity in children (Welk et
al., 2000). Weekly recall produces acceptable test–retest reliability (Sallis et al.,
1993; Sallis and Saelens, 2000) and – for children aged 5 to 10 – parental report
yields greater reliability and validity than self-report (Sallis and Saelens, 2000;
Koo and Rohan, 1999). For questions about parental perceptions of
neighborhood safety, we adapted items from the Neighborhood Environment
Walkability Scale (Sallis, 2004), International Physical Activity Prevalence
Study Self-administered Environmental Module (IPS, 2006) and from a study
about parental perceptions of local neighborhood (Timperio et al., 2004).
We adjusted the wording and format based on parents' feedback obtained
during pilot testing. The final 20-question survey was a reversible booklet
containing English and Spanish versions. Reverse translation confirmed the
equivalency of the English and Spanish wording.
child, the questionnaire asked a series of multiple-choice questions about the
physicalactivity, the surveyaskedhowmanyhoursperweek(none,1–6,7–13, or
14+) the childspentineachoffouractivities(school-sponsoredafter-schoolsports
or dance programs, other after-school sports or dance programs, outdoor play, and
outdoor play with an adult). To assess the extent of outside play, respondents
estimated the frequency of play (never, sometimes, frequently, always) in each of
foursituations (outsidethe house; in the neighborhood; ina neighborhood park;in
a neighborhood park with an adult). To assess anxiety about gangs, crime,
aggression by other children, traffic, and neighborhood safety in general,
respondents indicated their agreement with seven statements using a 4-point
or worry about neighborhood safety. Finally, the questionnaire requested the
provided space for comments.
Parents of appropriately aged children with a scheduled appointment at the
inner city health center between July 28 and October 22, 2004, or at the suburban
private practice between October22,2004,andFebruary 11,2005,wereinvitedto
the appointment were distributed to the parent in the examination room by the
incentives were offered to complete this 5-minute, anonymous, voluntary survey.
The institutional review board of New York Medical College approved the study.
For each question, we tabulated the number and percentage of parents who
chose each response. We createda composite activity score by assigningthe codes
0, 1, 2, and 3 to response categories “none”, “1–6”, “7–13”, and “14+” h/week,
respectively, and calculating the sum of the coded responses to the four activity
questions, giving a potential range of 0 to 12. When calculating the activity score,
we imputed missing values by replacing missing answers with the mean value of
the coded responses of all respondents from the site who answered the question.
However, if more than half the activity questions were blank, we did not compute
an activity score for that respondent. Imputed values comprised 2.8% ofresponses
from the inner city site and 1.0% of responses from the suburban site. We used
analogousmethodsto derive a compositeanxiety score based onthe seven anxiety
questions (potential range 0–21) and to impute missing values (2.6% of responses
at the inner city site and 0.8% at the suburban site).
We used Chi-squared tests to determine whether responses to individual
questions varied by study site, Mann–Whitney tests to compare activity and
anxiety scores across sites, and Kruskal–Wallis tests with Dunn's posttesting to
compare these scores across racial groups. To test for an association between
individual parents' anxiety and their child's overall activity, we calculated the
Spearman correlation coefficient from the anxiety and activity scores of
respondents with both scores.
Of the 564 eligible visits to the inner city site, 283 parents
received the survey. The remaining 281 parents did not receive
the survey because they failed to keep their scheduled
appointments or, in a few cases, because the medical record
parents who received surveys returned them, of which 204 (94
giving a response rate of 72% (204/283).
Of the 165 eligible visits to the suburban site, 143 parents
received the survey, 111 of which were returned and 103 suffi-
ciently complete for analysis (101 English and 2 Spanish),
giving a response rate of 72% (103/143). The same reasons
Demographics of survey respondents and their children
Inner city (N = 204)Suburban (N = 103)
Child's age, in years
(mean ± SD)
Respondent's relationship to child
Less than high school
7.4 ± 1.96.9 ± 1.6
213 L.A. Weir et al. / Preventive Medicine 43 (2006) 212–217
Fig. 1. Numbersabovethebarsindicatepercents.Pvaluesrefertodifferencesbetweensitesinthedistributionofresponses.n/a=notanswered.NS=notsignificant(PN 0.05).
214 L.A. Weir et al. / Preventive Medicine 43 (2006) 212–217
(cancellations, no-shows, or unavailability of the medical
record) prevented 22 parents from receiving the survey.
Respondent demographics are summarized in Table 1. As
expected, inner city parents had higher minority representation
and lower education levels than suburban parents.
Children's physical activity
Fig. 1 summarizes respondents' answers to the activity and
outside questions. The activity score, which had a potential
range of 0 to 12, summarized responses to the four activity
questions. The mean activity scores were 2.8 (1.8) and 3.4 (1.4)
for the inner city and suburban children, respectively, indicating
less physical activity in the former group (P b 0.001 by Mann–
Whitney test). Analysis of responses to combinations of activity
questions (data not shown in Fig. 1) revealed that 58% (119/
204) of inner city children vs. 30% (31/103) of suburban
children do not participate in any organized sports or dance
programs (P b 0.0001 by Chi-squared test) and that 21% (42/
204) vs. 4% (4/103) neither participate in these programs nor
play outside their house, except when accompanied by an adult
(P b 0.0001).
To evaluate whether physical activity varied by respondents'
race, we computed mean activity scores for each racial group. At
Fig. 2. Numbers above the bars indicate percents. P values refer to differences between sites in the distribution of responses. n/a = not answered.
215 L.A. Weir et al. / Preventive Medicine 43 (2006) 212–217
Black, 2.5 for White, and 2.8 for Other/Unknown (not signi-
ficant).At the suburban site, the scoreswere3.6 for Hispanic, 2.8
Kruskal–Wallis test). The difference between Black and White
groups was statistically significant at the suburban site (P b 0.05
by Dunn's posttest).
Perceived neighborhood safety
Fig. 2 summarizes responses to the neighborhood safety
questions. The anxiety score, a composite of responses to the 7
12.4 (4.6) and 4.9 (3.3) for the inner city and suburban parents
respectively, indicating much higher anxiety about neighborhood
every question, inner city parents expressed markedly greater
concern than suburban parents. By combining “strongly agree”
70% of inner city parents vs. 12% of suburban parents worried
it was dangerous to let a child play outside, 60% vs. 27% felt that
traffic was a problem, 50% vs. 3% believed that neighborhood
crime made it unsafe to play outdoors, and 48% vs. 3% felt
comparison, by Chi-squared tests).
To evaluate whether perceived neighborhood safety varied
by respondents' race, we computed the mean anxiety scores for
each racial group. At the inner city site, the anxiety scores were
13.1 for Hispanic, 8.4 for Black, 11.6 for White, and 12.6 for
Other/Unknown (P b 0.0001 by Kruskal–Wallis test). At the
suburban site, the scores were 7.1 for Hispanic, 5.6 for Black,
3.7 for White, and 5.6 for Other/Unknown (P b 0.05). One pair-
wise difference (Hispanic vs. Black) was significant at the inner
city site (P b 0.001 by Dunn's posttest) and one pair-wise
difference (Hispanic vs. White) was significant at the suburban
site (P b 0.01).
Forty inner city parents wrote comments. The most common
of these included 13 that expressed a need for greater security in
the community, noting slow police response times, racism, ab-
sence of a neighborhood crime watch, drugs, and prostitution; 7
that expressed worry about children's safety; and 6 that
mentioned the need for improved access to child care and
after-school programs. Of the 13 suburban parents who wrote
comments, 10 mentioned that weather influences their child's
Joint analysis of the activity and anxiety scores revealed that,
in the inner city environment, the overall amount of children's
physical activity had a weak negative correlation with parental
anxiety about neighborhood safety (Spearman r = −0.18; P =
0.01; N = 188). No correlation was found in the suburban
environment (P = 0.35; N = 97).
Although it is not surprising to find high anxiety about
neighborhood safety in an inner city community but not in a
suburban community, the degree of contrast is unsettling. Inner
city parents worried not only about the safety of their children's
play environment but also about their own personal safety.
Actual crime statistics justify the differing perceptions in the
two communities: 25% more violent crimes per capita occur in
the inner city vs. the suburban community (Area Connect
2005a,b). Our findings suggest that safety concerns play a key
role in limiting children's outdoor activities and underscore the
basic need for security to create an environment that supports
Our survey revealed a higher level of parental anxiety about
neighborhood safety and a lower level of children's physical
activity in a poor inner city community as compared with a
middle-class suburban community. Although this type of cross-
sectional study cannot prove a cause–effect relationship
(Morgenstern, 1995), the results support the study hypothesis.
Furthermore, parents' responses to the neighborhood safety
questions in themselves strongly suggest that inner city parents
restrict their children's activities because they believe their
neighborhoods are unsafe (Fig. 2).
If safety concerns cause parents to restrict their children's
correlation between individual parents' anxiety scores and their
children's activity scores. The negative correlation we found at
the inner city site demonstrates that the relationship between
anxiety and activity leans in the hypothesized direction in that
community. However, the low magnitude of the correlation
(−0.18) implies that a combination of factors must determine
children's activity levels, since parental anxiety explains only a
small portion of the variability.
Because we collected inner city data during summer and fall
months and suburban data during the winter, weather effects
would not have been equivalent. Since adverse winter weather
would have hindered physical activity in suburban children, the
contrast in physical activity between the two populations may
have been more pronounced had we collected data at the two
sites concurrently. It is unlikely that concurrent data collection
would have changed the direction of our findings with respect to
Since our data were obtained from one inner city and one
suburban site, the data may not be representative of all such
practices. It will be important to replicate this survey at other
sites. It is also important to acknowledge that our study could
not discern which specific characteristics of the inner city and
suburban populations were most responsible for the observed
differences between them. It is reasonable to hypothesize that a
combination of socioeconomic and demographic characteris-
tics, population density, living arrangements, attitudes toward
police, and actual crime statistics might explain the different
perceptions, but further studies are needed to examine these
issues in more detail.
Our study targeted an underserved inner city population, while
using a more affluent, suburban population for comparison. The
216 L.A. Weir et al. / Preventive Medicine 43 (2006) 212–217
study suggests that parental concerns about neighborhood safety Download full-text
play a role in limiting children's outdoor activities in the former
population, but not in the latter. Physicians should be sensitive to
activity. In addition, by communicating with public officials and
community activists – especially in inner city areas – physicians
could become advocates for enhanced neighborhood safety and
improved options for physical activity.
This study found high levels of worry about neighborhood
safety in a poor inner city community and relatively low levels
of concern in a neighboring suburban community. The study
also found that inner city children were less physically active
than suburban children. These results, combined with a
negative correlation between parents' concern and children's
activity in the inner city population, suggest that inner city
parents restrict their children's physical activity due to safety
We thank Marybeth Radley and Will Sheldon for their assis-
tance with data collection and Patricia A. Patrick, MPH, for
assistance with the analysis.
This study was supported by Award 2D54HP00022 from the
Health Resources and Services Administration.
Area Connect White Plains Crime Statistics and Data Resources. Accessed online
at: http://whiteplains.areaconnect.com/crime1.htm. Accessed October 31, 2005.
Area Connect: Yonkers New York Crime Statistics and Data Resources. Accessed
online at: http://yonkers.areaconnect.com/crime1.htm. Accessed October 26,
Burdette, H.L., Whitaker, R.C., 2005. A national study of neighborhood safety,
outdoor play, television viewing, and obesity in preschool children. Pediatrics
Centersfor Disease Controland
Health Statistics. National Health and Nutrition Examination Survey
Federal Interagency Forum on Child and Family Statistics. America's Children
Prevention,National Center for
2004, Table POP8.C. Available at: http://childstats.gov/ac2004. Accessed
January 19, 2005.
Giles-Corti, B., Donovan, R.J., 2002. Socioeconomic status differences in
recreational physical activity levels and real and perceived access to a
supportive physical environment. Prev. Med. 35, 601–611.
Gomez, J.E., Johnson, B.A., Selva, M., Sallis, J.F., 2004. Violent crime and
outdoor physical activity among inner-city youth. Prev. Med. 39,
Goodway, J.D., Smith, D.W., 2005. Keeping all children healthy: challenges to
leading an active lifestyle for preschool children qualifying for at-risk
programs. Fam. Commun. Health 28 (2), 142–155.
Gorden-Larsen, P., McMurray, R.G., Popkin, B.M., 2000. Determinants of
adolescent physical activity and inactivity patterns. Pediatrics 105, E83.
Holoday, B., Swan, J.H., Turner-Henson, A., 1997. Images of the neighborhood
and activity patterns of chronically ill school age children. Environ. Behav.
International Physical Activity Prevalence Study Self-Administered Environ-
mental Module. Available at: http://www.drjamessallis.sdsu.edu/IPAQIPS.
pdf. Accessed March 13, 2006.
Koo, M.M., Rohan, T.E., 1999. Comparison of four habitual physical activity
questionnaires in girls aged 7–15 yr. Med. Sci. Sports Exerc. 31, 421–427.
Lee, R.E., Cubbin, C., 2002. Neighborhood context and youth cardiovascular
health behaviors. Am. J. Public Health 92, 428–436.
Morgenstern, H., 1995. Ecologic studies in epidemiology: concepts, principles,
and methods. Annu. Rev. Public Health 16, 61–81.
Romero, A.J., Robinson, T.N., Kraemer, H.C., Erickson, S.J., Haydel, F.,
Mendozo, F., Killen, J.D., 2001. Are perceived neighborhood hazards a
barrier to physical activity in children? Arch. Pediatr. Adolesc. Med. 155,
Saelens, B.E., Sallis, J.F., Black, J.B., Chen, D., 2003. Neighborhood-based
differences in physical activity: an environment scale evaluation. Am. J.
Public Health 93, 1552–1558.
Sallis, J.F. Neighborhood Environment Walkability Scale. Available at: http://
www.drjamessallis.sdsu.edu/NEWS.pdf. Accessed February 18, 2004.
Sallis, J.F., Saelens, B.E., 2000. Assessment of physical activity by self report:
status, limitations, and future directions. Res. Q. Exerc. Sport 71, 1–14.
Sallis, J.F., Buono, M.J., Roby, J.J., Micale, F.G., Nelson, J.A., 1993. Seven-day
recall and other physical activity self-reports in children and adolescents.
Med. Sci. Sports Exerc. 25, 99–108.
Timperio, A., Crawford, D., Telford, A., Salmon, J., 2004. Perceptions about the
local neighborhood and walking and cycling among children. Prev. Med. 38,
Timperio, A., Salmon, J., Telford, A., Crawford, D., 2005. Perceptions of local
neighbourhood environments and their relationship to childhood overweight
and obesity. Int. J. Obes. 29 (2), 170–175.
pdf. Accessed January 24, 2005.
Welk, G.J., Corbin, C.B., Dale, D., 2000. Measurement issues in the assessment
of physical activity in children. Res. Q. Exerc. Sport 71 (suppl. 2), S59–S73.
217L.A. Weir et al. / Preventive Medicine 43 (2006) 212–217