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Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

ABSTRACT: Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age?=?73.1?±?6.7?years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI?=?1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI?=?1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

SUBMITTER: Orstad SL

PROVIDER: S-EPMC6260982 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

Orstad Stephanie L SL McDonough Meghan H MH James Peter P Klenosky David B DB Laden Francine F Mattson Marifran M Troped Philip J PJ

Preventive medicine 20180806

Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the o ...[more]

PMID: 30092314

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Project description:BackgroundPreviously, we demonstrated that childhood maltreatment could worsen depressive symptoms through neuroticism. On the one hand, some studies report that sleep disturbances are related to childhood maltreatment and neuroticism and worsens depressive symptoms. But, to our knowledge, no reports to date have shown the interrelatedness between childhood maltreatment, neuroticism, and depressive symptoms, and sleep disturbance in the one model. We hypothesized that sleep disturbance enhances the influence of maltreatment victimization in childhood or neuroticism on adulthood depressive symptoms and the mediation influence of neuroticism between maltreatment victimization in childhood and adulthood depressive symptoms.Subjects and methodsTotal 584 Japanese volunteer adults recruited through convenience sampling from 4/2017 to 4/2018 were assessed regarding their characteristics of demographics, history of childhood maltreatment, sleep disturbance, neuroticism, and depressive symptoms with questionnaires self-administered. Survey data were analyzed using simple moderation models and a moderating mediation model.ResultsThe interaction of sleep disturbance with childhood maltreatment or neuroticism on depressive symptoms was significantly positive. Furthermore, the moderating effect of sleep disturbance on the indirect effect of childhood maltreatment to depressive symptoms through neuroticism was significantly positive.LimitationsBecause this was a cross-sectional study, a causal relationship could not be confirmed.ConclusionsOur findings indicate that individuals with milder sleep disturbance experience fewer depressive symptoms attributable to neuroticism and childhood maltreatment. Additionally, people with less sleep disturbance have fewer depressive symptoms arising from neuroticism owing to childhood maltreatment. Therefore, improvement of sleep disturbance will buffer the aggravating effect of childhood maltreatment, neuroticism caused by various factors, and neuroticism resulting from childhood maltreatment on depressive symptoms.

Project description:BackgroundLittle is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA.MethodsWe used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates.ResultsOur participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms.ConclusionsWe found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.

Project description:The study aimed to investigate if psychosocial factors moderate the association between objective walkability and different domains of children's physical activity (PA). A second aim of the study was to investigate the direct associations between psychosocial factors and children's PA. Based on previous literature, it was hypothesized that walkability would be more strongly related to PA among children with negative psychosocial profiles.Data were collected between December 2011 and May 2013 as part of the Belgian Environmental Physical Activity Study in children (BEPAS-child). In total, data from 494 children and one of their parents were included in the study. Children wore an accelerometer for 7 consecutive days and together with one of their parents, they completed the Flemish Physical Activity Questionnaire. Parents filled out a questionnaire concerning their child's psychosocial factors toward PA (i.e. parental attitude toward their child's PA, parental social norm toward their child's PA, parental support, friend support, children's self-efficacy, and perceived benefits and barriers toward sports and PA). Neighborhood walkability was calculated using geographical information systems (GIS). Multilevel cross-classified analyses were conducted.Of the 42 investigated interactions between neighborhood walkability and psychosocial factors in relation to PA among children, only 7 significant interactions were found of which 3 were only significant among children from low-income neighborhoods. Parental support and self-efficacy were positive correlates of children's PA in high- and low-income neighborhoods independent of the level of walkability, but effect sizes were small.The hypothesis that walkability would be more strongly related to PA among children with negative psychosocial profiles could not be confirmed and in general, psychosocial factors and objective walkability did not interact in relation to children's PA. Focusing on parental support and self-efficacy towards PA can possibly cause small effects on children's PA in both high- and low-walkable neighborhoods, as well as in high- and low-income neighborhoods.

Project description:BACKGROUND:Living in walkable neighborhoods may provide long-term cardio-metabolic health benefits to residents. Little empirical research has examined the behavioral mechanisms in this relationship. In this longitudinal study, we examined the potential mediating role of physical activity (baseline and 12-year change) in the relationships of neighborhood walkability with 12-year changes in cardio-metabolic risk markers. METHODS:The Australian Diabetes, Obesity and Lifestyle study collected data from adults, initially aged 25+ years, in 1999-2000, 2004-05, and 2011-12. We used 12-year follow-up data from 2023 participants who did not change their address during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. A walkability index was calculated, using dwelling density, intersection density, and destination density, within 1 km street-network buffers around participants' homes. Spatial data for calculating these measures were sourced around the second follow-up period. Physical activity was assessed by self-reported time spent in moderate-to-vigorous physical activity (including walking). Multilevel models, adjusting for potential confounders, were used to examine the total and indirect relationships. The joint-significance test was used to assess mediation. RESULTS:There was evidence for relationships of higher walkability with smaller increases in weight (P = 0.020), systolic blood pressure (P < 0.001), and high-density lipoprotein cholesterol (P = 0.002); and, for relationships of higher walkability with higher baseline physical activity (P = 0.020), which, in turn, related to smaller increases in waist circumference (P = 0.006), weight (P = 0.020), and a greater increase in high-density lipoprotein cholesterol (P = 0.005). There was no evidence for a relationship of a higher walkability with a change in physical activity during the study period (P = 0.590). CONCLUSIONS:Our mediation analysis has shown that the protective effects of walkable neighborhoods against obesity risk may be in part attributable to higher baseline physical activity levels. However, there was no evidence of mediation by increases in physical activity during the study period. Further research is needed to understand other behavioral pathways between walkability and cardio-metabolic health, and to investigate any effects of changes in walkability.

Dataset Information

Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

Publications

Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

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