Neighborhood-based differences in walkability, physical activity, and weight status in India

Adlakha, Deepti; Hipp, J. Aaron; Brownson, Ross C.

doi:10.1016/j.jth.2016.10.008

Cited by 30 publications

(27 citation statements)

References 85 publications

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“…Despite these benefits, the mass adoption of private motorized transport and the design of cities to favor automobile use likely resulted in declining levels of active commuting and a rise in population prevalence of overweight, obesity, and related NCDs in India [ 14 ]. Our previous research from India showed that urban living was associated with lower leisure time and transport, physical activity, and increasingly sedentary lifestyles [ 15 , 16 ]. Active commuting may be influenced by characteristics of the neighborhood’s built environments, yet few studies quantify the associations between these factors in India.…”

Section: Introductionmentioning

confidence: 99%

Exploring Neighborhood Environments and Active Commuting in Chennai, India

Adlakha

Hipp

Sallis

et al. 2018

IJERPH

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Few studies assess built environment correlates of active commuting in low-and-middle-income countries (LMICs), but the different context could yield distinct findings. Policies and investments to promote active commuting remain under-developed in LMICs like India, which grapples with traffic congestion, lack of activity-supportive infrastructure, poor enforcement of traffic rules and regulations, air pollution, and overcrowding. This cross-sectional study investigated associations between home neighborhood environment characteristics and active commuting in Chennai, India. Adults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling; n = 56); (2) public transit (n = 52); and (3) private transport (n = 111). Environmental attributes around participants’ homes were assessed using the Neighborhood Environment Walkability Scale for India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modeled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. Consistent with other international studies, participants living in neighborhoods with a mix of land uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (adjusted odds ratio (aOR) = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05), and street connectivity (aOR = 0.2, p = 0.003). Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high-quality epidemiologic studies with greater context specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

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Section: Introductionmentioning

confidence: 99%

Exploring Neighborhood Environments and Active Commuting in Chennai, India

Adlakha

Hipp

Sallis

et al. 2018

IJERPH

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“…Within this context, many observations have been made about PA and slum dwellers. In studying the effect of BE on the PA of citizens of South India, Adlakha et al [51] concluded that people with lower socio-economic status (SES) and living in an area of lower walkability spend more time walking (225 minutes/week) and biking (75 minutes/week) than people with higher SES in an area of high walkability (walking 30 mins/week; biking 1.0 min/week). They attributed the discrepancy to the prohibitive traffic conditions in Chennai, which discourage people with high SES from using their private vehicles.…”

Section: Resultsmentioning

confidence: 99%

“…As one of the first studies conducted on this issue in India, the authors recommended that their findings should be contextualised. In another study, Adlakha et al [51] combined the IPEN with the Neighborhood Environment Walkability Scale (NEWS) to measure the effects of BE on PA. They observed that residents from both lower and higher SES meet the WHO’s recommended levels of PA, yet residents from lower SES get their PA from travel, whilst residents with higher SES obtain theirs from leisure and recreation.…”

Section: Resultsmentioning

confidence: 99%

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health

Lumagbas

Coleman

Bunders

et al. 2018

Global Health Action

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Background: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled. Objective: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term. Methods: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs. Results: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention. Conclusion: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

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“…Despite these benefits, mass adoption of private motorised transport and the design of cities to favour automobile use has likely resulted in declining levels of active commuting and a rise in population prevalence of overweight, obesity, and related NCDs in India [14]. Our previous research from India showed that urban living was associated with lower leisure-time and transport physical activity and increasingly sedentary lifestyles [15,16]. Active commuting may be influenced by characteristics of the neighbourhood built environments, yet few studies have quantified the associations between these factors in India.…”

Section: Introductionmentioning

confidence: 99%

Neighbourhood Environment Features and Active Commuting in Chennai, India

Adlakha¹,

Ja²,

Sallis³

et al. 2018

Preprint

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BackgroundFew studies have assessed built environment correlates of active commuting in low-and-middle-income countries, but the different context could yield distinct findings. This cross-sectional study investigated associations between home neighbourhood environment characteristics and active commuting in Chennai, India. MethodsAdults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling); (2) public transit; and (3) private transport. Environmental attributes around participants' homes were assessed using the Neighborhood Environment Walkability Scale-India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modelled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. ResultsConsistent with other international studies, participants living in neighbourhoods with a mix of land-uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (aOR = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05) and street connectivity (aOR = 0.2, p = 0.003). ConclusionsDifferent environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high quality epidemiologic studies with greater context-specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

show abstract

Neighborhood-based differences in walkability, physical activity, and weight status in India

Cited by 30 publications

References 85 publications

Exploring Neighborhood Environments and Active Commuting in Chennai, India

Exploring Neighborhood Environments and Active Commuting in Chennai, India

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health

Neighbourhood Environment Features and Active Commuting in Chennai, India

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