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Prev Med. 2018 Nov;116:60-67. doi: 10.1016/j.ypmed.2018.08.008. Epub 2018 Aug 6.

Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

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Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 462 1st Avenue, New York, NY 10016, USA. Electronic address:
Faculty of Kinesiology, University of Calgary, KNB 250, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada. Electronic address:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Longwood Avenue, Boston, MA 02115, USA. Electronic address:
Department of Health and Kinesiology, Purdue University, Lambert Fieldhouse, 800 West Stadium Avenue, West Lafayette, IN 47907, USA. Electronic address:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Longwood Avenue, Boston, MA 02115, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, 4th Floor West, Boston, MA 02215, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA 02215, USA. Electronic address:
Brian Lamb School of Communication, Purdue University, Beering Hall of Liberal Arts and Education, 100 North University Street, West Lafayette, IN 47907, USA. Electronic address:
Department of Exercise and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA. Electronic address:


Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age = 73.1 ± 6.7 years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI = 1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI = 1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

[Available on 2019-11-01]

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