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Steps Forward: Review and Recommendations for Research on Walkability, Physical Activity and Cardiovascular Health

Public Health Reviews volume 33, pages 484–506 (2011)Cite this article

Abstract

Built environments that support walking and other physical activities have the potential to reduce cardiovascular disease (CVD). Walkable neighborhoods—characterized by density, land use diversity, and well-connected transportation networks—have been linked to more walking, less obesity, and lower coronary heart disease risk. Yet ongoing research on pedestrian-friendly built environments has the potential to address important gaps. While much of the literature has focused on urban form and planning characteristics, additional aspects of street-scapes, such as natural and architectural amenities, should also be considered. Promising future directions include (1) integration of multiple built environment measures that facilitate an understanding of how individuals perceive and act within their environment; (2) examination of both the daily physical activities that are most feasibly influenced by the local environment and those more deliberate or vigorous patterns of physical activity that are most predictive of CVD; (3) consideration of multiple pathways that could mediate a link between walkability and CVD, including not only physical activity, but also air quality improvements from reduced vehicle mileage and enhanced neighborhood social cohesion from unplanned interactions; (4) testing competing hypotheses that may explain interactions of built environment characteristics with each other and with personal barriers to walking; (5) stronger conceptualization of the multiple neighborhoods or activity spaces that structure opportunities for physical activity throughout the day; (6) collecting and strategically analyzing longitudinal data to support causal inference; and (7) studying neighborhood preferences and selection to move beyond biased assessments of neighborhood health effects. While walkability has been linked to health-related behaviors and CVD risk factors, the implications of the observed correlations are not yet clear. New theoretical insights, measurement technologies, and built environment changes represent opportunities to enhance the evidence base for bringing health promotion and cardiovascular disease prevention into the conversation about how communities are planned and built.

References

  1. Gaziano TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation. 2005;112:3547–53.

    Article  PubMed  Google Scholar 

  2. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray C, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058.

  3. Fineberg H. Why is Prevention a Hard Sell? Meeting a Crucial Challenge to Improve the Public’s Health. Mailman School of Public Health at Columbia University: Public Health Grand Rounds; 24 September, 2008; New York, NY. Availble from URL: http://www.mailman.columbia.edu/events/grand-rounds/fall-2008-archives (Accessed19 December, 2011).

    Google Scholar 

  4. Haskell WL, Lee I. Physical activity and public health. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;107:185649.

    Google Scholar 

  5. Kohl HW, 3rd. Physical activity and cardiovascular disease: evidence for a dose response. Med Sci Sports Exerc. 2001;33:S472–83; discussion S93-4.

    Article  Google Scholar 

  6. Wannamethee SG, Shaper AG. Physical activity in the prevention of cardiovascular disease: an epidemiological perspective. Sports Med. 2001;31:101–14.

    Article  CAS  PubMed  Google Scholar 

  7. Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109:3244–55.

    Article  PubMed  Google Scholar 

  8. Norcross JC, Mrykalo MS, Blagys MD. Auld lang Syne: success predictors, change processes, and self reported outcomes of New Year’s resolvers and nonresolvers. J Clin Psychol. 2002;58:397–405.

    Article  PubMed  Google Scholar 

  9. Eilat-Adar S, Eldar M, Goldbourt U. Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol. 2005;161:352–8.

    Article  PubMed  Google Scholar 

  10. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.

    Article  CAS  PubMed  Google Scholar 

  11. Varo JJ, Martínez-González MA, de Irala-Estévez J, Kearney J, Gibney M, Martínez JA. Distribution and determinants of sedentary lifestyles in the European Union. Int J Epidemiol. 2003;32:138.

    Article  PubMed  Google Scholar 

  12. King AC, Castro C, Wilcox S, Eyler AA, Sallis JF, Brownson RC. 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;19:354–64.

    CAS  PubMed  Google Scholar 

  13. Taylor WC, Sallis JF, Lees E, Hepworth JT, Feliz K, Volding DC, et al. Changing social and built environments to promote physical activity: recommendations from low income, urban women. Journal of physical activity & health. 2007;4:54–65.

    Article  Google Scholar 

  14. Frank LD, Engelke PO. The built environment and human activity patterns: exploring the impacts of urban form on public health. J Planning Literature. 2001;16:202–18.

    Article  Google Scholar 

  15. Lovasi GS. Built environment and health. In: Rippe JM, editor. Encyclopedia of Lifestyle Medicine and Health: SAGE; In Press.

  16. Cervero R, Kockelman K. Travel demand and the 3Ds: density, diversity, and design. Transpn Res-D. 1997;2(3):199–219.

    Article  Google Scholar 

  17. Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC. The built environment and obesity. Epidemiol Rev. 2007;29:129–43.

    Article  PubMed  Google Scholar 

  18. Lee C, Moudon AV. Physical activity and environment research in the health field: implications for urban and transportation planning practice and research. J Planning Literature. 2004;19:147–81.

    Article  Google Scholar 

  19. Ottoson JM, Green LW, Beery WL, Senter SK, Cahill CL, Pearson DC, et al. Policy-contribution assessment and field-building analysis of the Robert Wood Johnson Foundation’s Active Living Research Program. Am J Prev Med. 2009;36:S34–43.

    Article  PubMed  Google Scholar 

  20. Perdue WC, Stone LA, Gostin LO. The built environment and its relationship to the public’s health: the legal framework. Am J Public Health. 2003;93:1390–4.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sallis JF, Linton LS, Kraft MK, Cutter CL, Kerr J, Weitzel J, et al. The active living research program: six years of grantmaking. Am J Prev Med. 2009;36:S10–21.

    Article  Google Scholar 

  22. Gutman MA, Barker DC, Samples-Smart F, Morley C. Evaluation of active living research progress and lessons in building a new field. Am J Prev Med. 2009;36:S22–33.

    Article  Google Scholar 

  23. Porter DE, Kirtland KA, Neet MJ, Williams JE, Ainsworth BE. Considerations for using a geographic information system to assess environmental supports for physical activity. Prev Chronic Dis. 2004;1:A20.

    Google Scholar 

  24. Nuckols JR, Ward MH, Jarup L. Using geographic information systems for exposure assessment in environmental epidemiology studies. Environ Health Perspect. 2004;112:1007–15.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, et al. To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. 2010;21:467–74.

    Article  PubMed  Google Scholar 

  26. Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health. 2007;61:853–61.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Unwin DJ. GIS, spatial analysis and spatial statistics. Progress in Human Geography. 1996;20:540–51.

    Article  Google Scholar 

  28. Renalds A, Smith TH, Hale PJ. A systematic review of built environment and health. Fam Community Health. 2010;33:68–78.

    Article  PubMed  Google Scholar 

  29. Lovasi GS, Hutson MA, Guerra M, Neckerman KM. Built environments and obesity in disadvantaged populations. Epidemiol Rev. 2009;31:7–20.

    Article  PubMed  Google Scholar 

  30. Leal C, Chaix B. The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obes Rev. 2011;12:217–30.

    Article  CAS  PubMed  Google Scholar 

  31. Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34:2475–81.

    Article  PubMed  Google Scholar 

  32. Ewing R, Cervero R. Travel and the built environment. J Am Planning Assoc. 2010;76(3).

    Google Scholar 

  33. Diez Roux AV. The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiol Rev. 2004;26:104–11.

    Article  PubMed  Google Scholar 

  34. Chaix B, Rosvall M, Merlo J. Recent increase of neighborhood socioeconomic effects on ischemic heart disease mortality: a multilevel survival analysis of two large Swedish cohorts. Am J Epidemiol. 2007;165:22–6.

    Article  PubMed  Google Scholar 

  35. Chaix B, Lindstrom M, Rosvall M, Merlo J. Neighbourhood social interactions and risk of acute myocardial infarction. J Epidemiol Community Health. 2008;62:62–8.

    Article  CAS  PubMed  Google Scholar 

  36. Wilkinson RG. Health, hierarchy, and social anxiety. Ann N Y Acad Sci. 1999;896:48–63.

    Article  CAS  PubMed  Google Scholar 

  37. Bird C, Seeman T, Escarce J, Bsurto-Davila R, Finch B, Dubowitz T, et al. Neighborhood Socioeconomic Status and Biological “Wear & Tear” in a Nationally Representative Sample of U.S. Adults. JECH. 2009.

    Google Scholar 

  38. Mookadam F, Arthur HM. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med. 2004;164:1514–8.

    Article  PubMed  Google Scholar 

  39. Rutledge T, Linke SE, Olson MB. Social networks and incident stroke among women with suspected myocardial ischemia. Psychosom Med. 2008;70:282–7

    Article  PubMed  Google Scholar 

  40. Smith KP, Christakis NA. Social networks and health. Ann Rev Sociol. 2008;34:405–29.

    Article  Google Scholar 

  41. Cohen S, Wills T. Stress, social support, and the buffering hypothesis. Psycholog Bull. 1985;98:310–957.

    Article  CAS  Google Scholar 

  42. Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357:370–9.

    Article  CAS  PubMed  Google Scholar 

  43. Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008;358:2249–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Hipp J, Perrin A. The simultaneous effect of social distance and physical distance on the formation of neighborhood ties. City & Community. 2009;8:5–25.

    Article  Google Scholar 

  45. Preciado P, Snijders TAB, Burk WJ, Stattin H, Kerr M. Does proximity matter? Distance dependence of adolescent friendships. Social Networks. 2011.

    Google Scholar 

  46. Cervero R, Duncan M. Walking, bicycling, and urban landscapes: evidence from the San Francisco Bay Area. Am J Public Health. 2003;93:1478–83.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Jacobsen PL. Safety in numbers: more walkers and bicyclists, safer walking and bicycling. Inj Prev. 2003;9:205–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Duncan SC, Duncan TE, Strycker LA, Chaumeton NR. Neighborhood physical activity opportunity: a multilevel contextual model. Res Q Exerc Sport. 2002;73:457–63.

    Article  PubMed  Google Scholar 

  49. Leyden KM. Social capital and the built environment: the importance of walkable neighborhoods. Am J Public Health. 2003;93:1546–51.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Carter SP, Carter SL, Dannenberg AL. Zoning out crime and improving community health in Sarasota, Florida: “Crime Prevention Through Environmental Design”. Am J Public Health. 2003;93:1442–5.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Rundle A, Neckerman KM, Freeman L, Lovasi GS, Purciel M, Quinn J, et al. Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect. 2009;117:442–7.

    Article  PubMed  Google Scholar 

  52. Wieczorek WF, Hanson CE. New modeling methods: geographic information systems and spatial analysis. Alcohol Health Res World. 1997;21:331–9.

    CAS  PubMed  Google Scholar 

  53. Chuang YC, Cubbin C, Ahn D, Winkleby MA. Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Community Health. 2005;59:568–73.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Eyler AA, Brownson RC, Bacak SJ, Housemann RA. The epidemiology of walking for physical activity in the United States. Med Sci Sports Exerc. 2003;35:1529–36.

    Article  PubMed  Google Scholar 

  55. Jacobs J. The Death and Life of Great American Cities. New York: Vintage Books; 1961.

    Google Scholar 

  56. Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sports Exerc. 2008;40:S550–66.

    Article  Google Scholar 

  57. Mujahid MS, Diez Roux AV, Morenoff JD, Raghunathan TE, Cooper RS, Ni H, et al. Neighborhood characteristics and hypertension. Epidemiology. 2008;19:590–8.

    Article  PubMed  Google Scholar 

  58. Auchincloss AH, Diez Roux AV, Brown DG, Erdmann CA, Bertoni AG. Neighborhood resources for physical activity and healthy foods and their association with insulin resistance. Epidemiology. 2008;19:146–57.

    Article  PubMed  Google Scholar 

  59. Mobley LR, Root ED, Finkelstein EA, Khavjou O, Farris RP, Will JC. Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med. 2006;30:327–32.

    Article  PubMed  Google Scholar 

  60. Frank L, Sallis JF, Conway JM, Chapman JE, Saelens BE, Bachman W. Many pathways from land use to health: associations between neighborhood walkability and active transportation, body mass index, and air quality. JAPA. 2006;72:75–87.

    Google Scholar 

  61. 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.

    Article  PubMed  Google Scholar 

  62. Neckerman KM, Lovasi GS, Davies S, Purciel M, Quinn J, Feder E, et al. Disparities in urban neighborhood conditions: evidence from GIS measures and field observation in New York City. J Public Health Policy. 2009;30:S264–85.

    Article  Google Scholar 

  63. Purciel M, Neckerman K, Lovasi G, Quinn J, Weiss C, Bader M, et al. Creating and validating GIS measures of urban design for health research. J Environmental Psychology. 2009;29:457–66.

    Article  Google Scholar 

  64. Bell JF, Wilson JS, Liu GC. Neighborhood greenness and 2-year changes in body mass index of children and youth. Am J Prev Med. 2008;35:547–53.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Ellaway A, Macintyre S, Bonnefoy X. Graffiti, greenery, and obesity in adults: secondary analysis of European cross sectional survey. BMJ. 2005;331:611–2.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Agyemang C, van Hooijdonk C, Wendel-Vos W, Ujcic-Voortman JK, Lindeman E, Stronks K, et al. Ethnic differences in the effect of environmental stressors on blood pressure and hypertension in the Netherlands. BMC Public Health. 2007;7:118.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Mitchell R, Popham F. Effect of exposure to natural environment on health inequalities: an observational population study. Lancet. 2008;372:1655–60.

    Article  PubMed  Google Scholar 

  68. Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. Am J Health Promot. 2004;18:378–86.

    Article  PubMed  Google Scholar 

  69. Mujahid MS, Roux AV, Shen M, Gowda D, Sanchez B, Shea S, et al. Relation between neighborhood environments and obesity in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2008;167:1349–57.

    Article  PubMed  Google Scholar 

  70. Cohen DA, Farley TA, Mason K. Why is poverty unhealthy? Social and physical mediators. Soc Sci Med. 2003;57:1631–41.

    Article  PubMed  Google Scholar 

  71. Ewing R, Handy S. Measuring the unmeasurable: urban design qualities related to walkability. J Urban Design. 2009;14:65–84.

    Article  Google Scholar 

  72. Blacksher E, Lovasi GS. Place-focused physical activity research, human agency, and social justice in public health: Taking agency seriously in studies of the built environment. Health Place. 10 September, 2011.

    Google Scholar 

  73. Weden MM, Carpiano RM, Robert SA. Subjective and objective neighborhood characteristics and adult health. Soc Sci Med. 2008;66:1256–70.

    Article  PubMed  Google Scholar 

  74. Popay J, Thomas C, Williams G, Bennett S, Gatrell A, Bostock L. A proper place to live: health inequalities, agency and the normative dimensions of space. Soc Sci Med. 2003;57:55–69.

    Article  PubMed  Google Scholar 

  75. Mujahid MS, Diez Roux AV, Morenoff JD, Raghunathan T. Assessing the measurement properties of neighborhood scales: from psychometrics to ecometrics. Am J Epidemiol. 2007;165:858–67.

    Article  PubMed  Google Scholar 

  76. De Vries SI, Van Hirtum HW, Bakker I, Hopman-Rock M, Hirasing RA, Van Mechelen W. Validity and reproducibility of motion sensors in youth: a systematic update. Med Sci Sports Exerc. 2009;41:818–27.

    Article  PubMed  Google Scholar 

  77. Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000;71:S1–14.

    Article  PubMed  Google Scholar 

  78. Lovasi GS, Moudon AV, Pearson AL, Hurvitz PM, Larson EB, Siscovick DS, et al. Using built environment characteristics to predict walking for exercise. Int J Health Geographics. 2008;7:10.

    Article  Google Scholar 

  79. Li F, Fisher KJ, Brownson RC, Bosworth M. Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health. 2005;59:558–64.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Bertoni AG, Whitt-Glover MC, Chung H, Le KY, Barr RG, Mahesh M, et al. The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2009;169:444–54.

    Article  PubMed  Google Scholar 

  81. Pope CA, 3rd, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. N Engl J Med. 2009;360:376–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Williamson T. Sprawl, politics, and participation: A preliminary analysis. Nat Civic Rev. 2002;91:235–44.

    Article  Google Scholar 

  83. Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health. 2005;59:822–7.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Cohen-Cole E, Fletcher JM. Detecting implausible social network effects in acne, height, and headaches: longitudinal analysis. BMJ. 2008;337:a2533.

    Article  Google Scholar 

  85. Fullilove MT. Root Shock. How Tearing Up City Neighborhoods Hurts America, and What We Can Do About It. New York: Balantine Books; 2004.

    Google Scholar 

  86. Kumanyika S, Grier S. Targeting interventions for ethnic minority and low-income populations. The Future of children / Center for the Future of Children, the David and Lucile Packard Foundation. 2006;16:187–207.

    Google Scholar 

  87. Lovasi GS, Neckerman KM, Quinn JW, Weiss CC, Rundle A. Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and body mass index. Am J Public Health. 2009;99:279–84.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Brownson RC, Baker EA, Housemann RA, Brennan LK, Bacak SJ. Environmental and policy determinants of physical activity in the United States. Am J Public Health. 2001;91:1995–2003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Joshu CE, Boehmer TK, Brownson RC, Ewing R. Personal, neighbourhood and urban factors associated with obesity in the United States. J Epidemiol Community Health. 2008;62:202–8.

    Article  CAS  PubMed  Google Scholar 

  90. Alfonzo MA. To walk or not to walk? The hierarchy of walking needs. Environment Behavior. 2005;37:808.

    Article  Google Scholar 

  91. Jelinski DEW, J. The modifiable areal unit problem and implications for landscape ecology. Landscape Ecology. 1996;11:129–40.

    Article  Google Scholar 

  92. Rainham D, McDowell I, Krewski D, Sawada M. Conceptualizing the healthscape: contributions of time geography, location technologies and spatial ecology to place and health research. Soc Sci Med. 2010;70:668–76.

    Article  PubMed  Google Scholar 

  93. Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. Am J Public Health. 2007;97:486–92.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Duncan M, Mummery K. Psychosocial and environmental factors associated with physical activity among city dwellers in regional Queensland. Prev Med. 2005;40:363–72.

    Article  PubMed  Google Scholar 

  95. Hess P, Moudon AV, Snyder M, Stanilov K. Site design and pedestrian travel. Transportation Research Record. 1999;1674:9–19.

    Article  Google Scholar 

  96. Hoehner CM, Brennan LK, Brownson RC, Handy SL, Killingsworth R. Opportunities for integrating public health and urban planning approaches to promote active community environments. Am J Health Promot. 2003;18:14–20.

    Article  PubMed  Google Scholar 

  97. Coulton CJ, Korbin J, Chan T, Su M. Mapping residents’ perceptions of neighborhood boundaries: a methodological note. Am J Community Psychol. 2001;29:371–83.

    Article  CAS  PubMed  Google Scholar 

  98. Colabianchi N, Dowda M, Pfeiffer KA, Porter DE, Almeida MJ, Pate RR. Towards an understanding of salient neighborhood boundaries: adolescent reports of an easy walking distance and convenient driving distance. Int J Behav Nutr Phys Act. 2007;4:66.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Levine R, Norenzayan A. The pace of life in 31 countries. J Cross-Cultural Psychology. 1999;30:178–205.

    Article  Google Scholar 

  100. Neckerman KM, Bader MD, Richards CA, Purciel M, Quinn JW, Thomas JS, et al. Disparities in the food environments of New York City public schools. Am J Prev Med. 2010;39:195–202.

    Article  PubMed  Google Scholar 

  101. Rainham D, Krewski D, McDowell I, Sawada M, Liekens B. Development of a wearable global positioning system for place and health research. Int J Health Geographics. 2008;7:59.

    Article  Google Scholar 

  102. Ewing R. Can the physical environment determine physical activity levels? Exerc Sport Sci Rev. 2005;33:69–75.

    Article  PubMed  Google Scholar 

  103. Maclure M, Mittleman MA. Should we use a case-crossover design? Annu Rev Public Health. 2000;21:193–221.

    Article  CAS  PubMed  Google Scholar 

  104. Angrist JD, Krueger AB. Instrumental variables and the search for identification: from supply and demand to natural experiments. J Economic Perspectives. 2001;15:69–85.

    Article  Google Scholar 

  105. Fisher KJ, Li F, Michael Y, Cleveland M. Neighborhood-level influences on physical activity among older adults: a multilevel analysis. J Aging Phys Act. 2004;12:45–63.

    Article  PubMed  Google Scholar 

  106. Humpel N, Marshall AL, Leslie E, Bauman A, Owen N. Changes in neighborhood walking are related to changes in perceptions of environmental attributes. Ann Behav Med. 2004;27:60–7.

    Article  PubMed  Google Scholar 

  107. Plantinga A, Bernell S. The association between urban sprawl and obesity: is it a two-way street? J Regional Sci. 2007;47:857–79.

    Article  Google Scholar 

  108. Handy S, Cao X, Mokhtarian P. Self-selection in the relationship between the built environment and walking. J Am Planning Assoc. 2006;72:55–74.

    Article  Google Scholar 

  109. Berry TR, Spence JC, Blanchard CM, Cutumisu N, Edwards J, Selfridge G. A longitudinal and cross-sectional examination of the relationship between reasons for choosing a neighbourhood, physical activity and body mass index. Int J Behav Nutr Phys Act. 2010;7:57.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Kaufman JS, Kaufman S, Poole C. Causal inference from randomized trials in social epidemiology. Soc Sci Med. 2003;57:2397–409.

    Article  PubMed  Google Scholar 

  111. Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11:550–60.

    Article  CAS  PubMed  Google Scholar 

  112. Angrist JD, Imbens GW, Rubin DB. Identification of causal effects using instrumental variables. J Am Statistical Assoc. 1996;91:444–55.

    Article  Google Scholar 

  113. Eid J, Overman H, Puga D, Turner M. Fat city: Questioning the relationship between urban sprawl and obesity. J Urban Economics. 2008;63:385–404.

    Article  Google Scholar 

  114. Levine J, Frank L. Transportation and land-use preferences and residents’ neighborhood choices: the sufficiency of compact devleopment in the Atlanta region. Transportation. 2007;34:255–74.

    Article  Google Scholar 

  115. Kaczynski AT, Sharratt MT. Deconstructing Williamsburg: Using focus groups to examine residents’ perceptions of the building of a walkable community. Int J Behav Nutr Phys Act. 2010;7:50.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St, Room 804, New York, NY, 10032, USA

    Gina S. Lovasi PhD, MPH, Stephanie Grady & Andrew Rundle DrPH, MPH

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Lovasi, G.S., Grady, S. & Rundle, A. Steps Forward: Review and Recommendations for Research on Walkability, Physical Activity and Cardiovascular Health. Public Health Rev 33, 484–506 (2011). https://doi.org/10.1007/BF03391647

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