anne bradley mitchell

Perceptions of Neighborhood Built Environment and Health on Walking in

Minority Urban Older Adults

Anne Bradley Mitchell PhD(c), CRNP

University of Pennsylvania School of Nursing

Ann L. O’Sullivan PhD, FAAN, CRNP, (Chair),

Pamela Z. Cacchione PhD, APRN, GNP-BC

Jerry C. Johnson MD

Yvonne L. Michael ScD, SM

Background

Older adults are 14% of the population in PA

Philadelphia has the greatest percentage of older adults among the top 10 cities

Walking is the most common form of physical activity for older adults

Older adults: recommended walk > 150 minutes/week

Only 22% of older adults achieve recommended level

Purpose and Aims

Purpose: Describe the relationship of older adults’ self-reported health status and their perceived neighborhood built environment with the amount of self-reported walking

Aim: Examine whether the self-reported health status mediates the relationship between the perceived neighborhood built environment and the amount of self-reported walking

Built Environment Definition

Design: aesthetic, physical functional qualities

Land use patterns: spatial distribution of human activities

Transportation system physical infrastructure and services for connectivity

Variable Sample West Philadelphia

Median age 74.5 years 74 years

Age >75 years (percent) 50% 53%

Female 69% 66%

Minority race 98% 94%

Rates health as fair or poor 25% 52%

Sample Characteristics (n=140)

Sample and Setting

Range Mean MedianStandard Deviation

Total walking

0 to 910 201.18 150 184.24

Transport walking

0 to 700 123.53 90 123.16

Non-transport walking

0 to 420 66.07 20 107.77

Self-reported walking minutes per week

Variables Total walkingp values

Transport walking p values

Non-transport walking p values

Demographic ↓ Female ↓ Older age ↓ BMI > 30

↓ Female ↓ Older age ↓ Car Access

↓ Health problems

↓ Female ↓ BMI > 30

Perceived Neighborhood

Built Environment

↑ Proximity to services↑ Density

↑Proximity to services↑ Access to services

↑ Density

↑ Aesthetics

Self-reported health SF-12

↑Physical Component

Score

↑ Physical Component Score

↑Mental Component score

p value significant at <.05 level: ↑ increase s walking; ↓ decreases walking

Results

Summary of Significant Covariates

  Walk Total Walk Transport Walk Non-Transport

Gender .012* .045* .226

Age .003** .006** .018*

BMI .002** .017* .001***

Self Reported Health .021* .045* .057

Perceived Neighborhood .277 .093 .026*

Access to Car .106 .050* Not entered

R2adj .2209 .1896 .1192

Note. * p value < .05; ** p value < .01; *** p value < .001

Conclusions

Gender, age, BMI were significant for less walking similar to previous findings with non-minority samples

Older adults performed more transport walking than non-transport walking

Proximity to retail and neighborhood density significant for transport walking

Conclusions

Aesthetics significant for non-transport walking 53% achieved recommended amount of walking Health perceptions and demographic statistics had

greater significance than built environment features Traffic and crime were not significant variables

Implications

Research: – Findings of minority sample

similar to nonminority sample, non urban sample,

– Testing the theory – Dimension of time interacting with the environmental press

Clinical: – Use of Health Problem indicators– Counseling for BMI and activity– Adequate treatment of joint pain

Implications

Policy: – Modification of neighborhood built environment in

response to self-reported health status– Proximity, access, benches, public transit systems