Date of Award
Brown School of Social Work
Doctor of Philosophy (PhD)
Background: Rapid rates of increase of obesity, diabetes, and associated chronic and co-morbid non-communicable diseases (e.g., cardiovascular diseases and some cancers) are being documented in India, yet in-country evidence-based research of associated risk factors is lacking. Physical activity has been identified as a preventative factor to counter the risk from obesity-related non-communicable diseases. Built environment supports for physical activity represent promising strategies to curb the rise in non-communicable diseases. Mounting research evidence suggests that the built environment can facilitate or constrain physical activity. However, a majority of this research has been conducted in developed nations. Built environment correlates of physical activity that have been documented in developed countries have yet to be studied among low-and-middle-income countries like India. The development and testing of reliable and culturally sensitive measures of built environment attributes is a necessary first step for accurate analysis of environmental correlates of physical activity in low-and-middle-income countries.
Methods: This study systematically adapted and pilot tested the Neighborhood Environment Walkability Scale (NEWS) for India. The adaptation of the NEWS was conducted by Indian and international experts. At baseline, participants (N=370; female=47.2%) from the city of Chennai, India, completed the adapted NEWS-India regarding perceived residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure and safety for walking and bicycling, aesthetics, traffic safety, and safety from crime. Modules from the International Physical Activity Questionnaire-Long Form (IPAQ-LF) were used to measure participants self-reported physical activity, specifically the frequency and duration of leisure-time and travel physical activities. Participants (N=62) were re-tested to evaluate aspects of reliability and validity of the adapted NEWS-India.
Results: The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.590.91). Residents of high-walkability/high-SES neighborhoods reported higher land use mix diversity, land use mix access, street connectivity, aesthetics, and safety from crime. Residential density and walking/bicycling infrastructure were highest in the high-walkability/low-SES neighborhood. Travel physical activity (PA) was the maximum contributor to total PA in low-SES neighborhoods, while residents of high-SES neighborhoods reported greater levels of leisure-time PA. Sitting time and BMI were greater among high-SES participants. Patterns of PA, sedentary time, and weight status varied significantly by neighborhood walkability and SES. Five of eight built environment (BE) characteristics (residential density, land use mix diversity, street connectivity, aesthetics, safety from crime) were significantly associated with travel PA. There was a two-fold increase in adjusted odds of meeting WHO recommendations of travel PA with greater residential density (aOR=1.9, 95% CI=1.2, 3.2) and land use mix-diversity (aOR=2.1, 95% CI=1.2, 3.6). Land use mix-diversity was positively related to travel PA (aOR=2.1, 95%CI=1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score significantly predicted an increase in adjusted odds of travel PA by approximately two times (aOR=1.9, 95% CI=1.1, 3.1). Results suggest that the relationship between the built environment and domain-specific physical activity may be context-specific, and that the context in Chennai, India, may differ markedly from that in high-income countries.
Conclusion: The adapted NEWS-India demonstrated acceptable measurement properties among Indian adults and may be useful for evaluation of the built environment in India. Further adaptation and evaluation in other states of India is needed to create a version that could be used throughout the Indian region. The development and testing of reliable and culturally sensitive measures of built environment attributes is a necessary first step for accurate analysis of environmental correlates of physical activity in low-and-middle-income countries, which can inform international evidence-based policies and interventions in the worldwide prevention of physical inactivity.
Chair and Committee
Ross C. Brownson
Amy A. Eyler, James A. Hipp, Carolyn K. Lesorogol, Bruce M. Lindsey,
Adlakha, Deepti, "Can We Walk? Environmental Supports for Active Travel in India" (2016). Arts & Sciences Electronic Theses and Dissertations. 725.