Built Environment, Adiposity, and Physical Activity in Adults Aged 50–75


      Few studies have investigated the built environment and its association with health—especially excess adiposity—and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship.


      This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N=1221; aged 50–75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS-derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI ≥25), three walking activities, and physical activity. Data were collected in 2006–2007 and analyzed in 2007.


      Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics.


      Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • CDC
        U.S. obesity trends: 1985–2006.
        • Flegal K.M.
        • Carroll M.D.
        • Ogedn C.L.
        • et al.
        Prevalence and trends in obesity among U.S. adults, 1999–2000.
        JAMA. 2002; 288: 1723-1727
        • USDHHS
        The Surgeon General's call to action to prevent and decrease overweight and obesity.
        U.S. Public Health Services, Office of the Surgeon General, Rockville MD2001
        • Brown D.R.
        • Yore M.M.
        • Ham S.A.
        • Macera C.A.
        Physical activity among adults ≥50 yr with and without disabilities, BRFSS 2001.
        Med Sci Sports Exerc. 2005; 37: 620-629
        • CDC
        Prevalence of physical activity, including lifestyle activities among adults—U.S., 2000–2001.
        MMWR Morb Mortal Wkly Rep. 2003; 52: 764-769
        • CDC
        Prevalence of no leisure-time physical activity–35 States and the District of Columbia, 1988–2002.
        MMWR Morb Mortal Wkly Rep. 2004; 53: 82-86
        • Haskell W.L.
        • Lee I.M.
        • Pate R.R.
        • et al.
        Physical activity and public health: updated recommendation for adults from American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1423-1434
        • USDHHS
        Healthy People 2010, 2nd edition.
        • USDHHS
        Physical activity and health: a report of the Surgeon General.
        USDHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Atlanta GA1996
        • Dannenburg A.
        • Jackson R.J.
        • Frumkin H.
        • et al.
        The impact of community design and land-use choices on public health: a scientific research agenda.
        Am J Public Health. 2003; 93: 1500-1508
        • Ewing R.
        Can the physical environment determine physical activity levels?.
        Exerc Sport Sci Rev. 2005; 33: 69-75
        • Ewing R.
        • Cervero R.
        Travel and the built environment: a synthesis.
        Transportation Res Record. 2001; 1780: 87-114
        • Frank L.D.
        • Engelke P.O.
        • Schmid T.L.
        Health and community design: the impact of the built environment on physical activity.
        Island Press, Washington DC2003
        • Humpel N.
        • Owen N.
        • Leslie E.
        Environmental factors associated with adults' participation in physical activity: a review.
        Am J Prev Med. 2002; 22: 188-199
        • Lavizzo-Mourey R.
        • McGinnis J.M.
        Making the case for active living communities.
        Am J Public Health. 2003; 93: 1386-1388
        • Li F.
        • Fisher K.J.
        • Bauman A.
        • et al.
        Neighborhood influences on physical activity in older adults: a multilevel perspective.
        J Aging Phys Activ. 2005; 13: 87-114
        • Saelens B.E.
        • Sallis J.F.
        • Frank L.E.
        Environmental factors that promote walking and cycling: findings from the transportation, urban design and planning literatures.
        Ann Behav Med. 2003; 25: 80-91
        • Sallis J.F.
        • Owen N.
        Ecological models.
        in: Glanz K. Lewis F.M. Rimer B.K. Health behavior and health education: theory, research and practice. 3rd ed. Jossey-Bass, San Francisco CA2002
        • Berke E.M.
        • Koepsell T.D.
        • Moudon A.V.
        • Hoskins R.E.
        • Larson E.B.
        Association of the built environment with physical activity and obesity in older persons.
        Am J Public Health. 2007; 97: 486-492
        • Ewing R.
        • Schmid T.
        • Killingsworth R.
        • Zlot A.
        • Raudenbush S.
        Relationship between urban sprawl and physical activity, obesity, and morbidity.
        Am J Health Promot. 2003; 18: 47-57
        • Fisher J.K.
        • Li F.
        • Michael Y.
        • Cleveland M.
        Neighborhood level influences on physical activity among older adults: a multilevel analysis.
        J Aging Phys Activ. 2004; 11: 49-67
        • Frank L.D.
        • Andresen M.A.
        • Schmid T.L.
        Obesity relationships with community design, physical activity, and time spent in cars.
        Am J Prev Med. 2004; 27: 87-96
        • Frank L.D.
        • Schmid T.L.
        • Sallis J.F.
        • Chapman J.
        • Saelens B.E.
        Linking objectively measured physical activity with objectively measured urban form: findings from SMARTRAQ.
        Am J Prev Med. 2005; 28: 117-125
        • King A.C.
        • Castro C.
        • Wilcox S.
        • Eyler A.A.
        • Sallis J.F.
        • Brownson R.C.
        Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women.
        Health Psychol. 2000; 19: 354-364
        • Li F.
        • Fisher K.J.
        • Brownson B.C.
        • Bosworth M.
        Multilevel modeling of built environmental characteristics in relation to neighborhood walking activity in older adults.
        J Epidemiol Community Health. 2005; 59: 558-564
        • Maddock J.
        The relationship between obesity and the prevalence of fast food restaurants: state-level analysis.
        Am J Health Promot. 2004; 19: 137-143
        • Morland K.
        • Diez Roux A.V.
        • Wing S.
        Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study.
        Am J Prev Med. 2006; 30: 333-339
        • Powell L.M.
        • Chaloupka F.J.
        • Bao Y.
        The availability of fast-food and full-service restaurants in the U.S.: associations with neighborhood characteristics.
        Am J Prev Med. 2007; 33: S240-S245
        • Rundle A.
        • Roux Diez A.V.
        • Freeman L.M.
        • Miller D.
        • Neckerman K.M.
        • Weiss C.C.
        The urban built environment and obesity in New York City: a multilevel analysis.
        Am J Health Promot. 2007; 21: 326-334
        • Saelens B.E.
        • Sallis J.F.
        • Black J.B.
        • Chen D.
        Neighborhood-based differences in physical activity: an environment scale evaluation.
        Am J Public Health. 2003; 93: 1552-1558
        • U.S. Census Bureau
        Population pyramids of U.S. Population division, interim state population projections.
        • Arterburn D.E.
        • Crane P.K.
        • Sullivan S.D.
        The coming epidemic of obesity in elderly Americans.
        J Am Geriatr Soc. 2004; 52: 1907-1912
        • Mehta N.K.
        • Chang V.W.
        Weight status and restaurant availability: a multilevel analysis.
        Am J Prev Med. 2008; 34: 127-133
        • Song Y.
        • Knapp G.J.
        Measuring urban form: Is Portland winning the war on sprawl?.
        J Am Planning Asso. 2004; 70: 210-225
        • Pfeiffer E.
        Short portable mental status questionnaire.
        J Am Geriatr Soc. 1975; 23: 433-441
        • CDC
        Behavioral Risk Factor Surveillance System.
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1435-1445
        • Pate R.R.
        • Pratt M.
        • Blair S.N.
        • et al.
        Physical activity and public health. a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.
        JAMA. 1995; 273: 402-407
        • Thompson F.E.
        • Kipnis V.
        • Subar A.F.
        • et al.
        Evaluation of 2 brief instruments and a food-frequency questionnaire to estimate daily number of servings of fruit and vegetables.
        Am J Clin Nutr. 2000; 71: 1503-1510
        • Raudenbush S.W.
        • Bryk A.S.
        Hierarchical linear models.
        Sage Publications, Thousands Oaks CA2002
        • Raudenbush S.W.
        • Bryk A.
        • Cheong Y.F.
        • Congdon R.
        HLM6: Hierarchical linear and nonlinear modeling.
        Scientific Software International, Lincolnwood IL2004
        • McNutt L.A.
        • Wu C.
        • Xue X.
        • Hafner J.P.
        Estimating the relative risk in cohort studies and clinical trials of common outcomes.
        Am J Epidemiol. 2003; 157: 940-943
        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Benfield F.K.
        • Raimi M.D.
        • Chen D.D.
        Once there were green fields: how urban sprawl is undermining America's environment, economy and social fabric.
        Natural Resources Defense Council, New York1999
        • Abbott C.
        Planning a sustainable city: the promise and performance of Portland's urban growth boundary.
        in: Squires G.D. Urban sprawl: causes, consequences and policy responses. Urban Institute Press, Washington DC2002