Skip Navigation



Journal of Public Health Advance Access published online on June 6, 2007
Journal of Public Health, doi:10.1093/pubmed/fdm027
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/3/222    most recent
fdm027v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Burgoyne, L.
Right arrow Articles by Perry, I. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Burgoyne, L.
Right arrow Articles by Perry, I. J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Walking in a city neighbourhood, paving the way


L. Burgoyne, Lecturer in Public Health1,
R. Coleman, Community Health Worker2
I. J. Perry, Professor of Epidemiology and Public Health1

1 Department of Epidemiology and Public Health, Brookfield Health Sciences Complex, University College Cork, Ireland
2 Northside Community Health Initiative, Harbour View Road, Knocknaheeny, Cork, Ireland


Address correspondence to L. Burgoyne, E-mail: l.burgoyne{at}ucc.ie

Background There is an increasing interest in the use of walking routes to promote physical activity. We explored the stated attitudes of selected residents from two adjacent low-income city neighbourhoods towards walking. This was in response to negative results obtained in a quantitative study assessing the impact of the Slí-na-Sláinte (path to health), a signed heart health walking route.

Method This was a qualitative focus group study.

Results The impact of the walking route was marginal. Four major themes influencing local walking emerged, centring on the social and physical environment.

Conclusion Findings suggest that the neighbourhoods are unreceptive to health promotion initiatives such as the Slí-na-Sláinte since residents are dealing with fundamental social and physical environmental issues. Initiatives such as the Slí-na-Sláinte need to be embedded in a supportive and facilitative environment if they are to achieve substantial impact.

Keywords: walking, physical activity, neighbourhood, environment, Slí-na-Sláinte


   Introduction
TOP
 Introduction
Methods
 Results
 Discussion
 Funding sources
 Conflict of interest
 Acknowledgements
 References
 
Promotion of physical activity is a major challenge for contemporary public health practitioners. Walking is reported as the most preferred form of physical activity in the EU1 and in Ireland.2 The literature shows that lower levels of leisure time activity are generally associated with lower levels of education and income.3–9 Of late there has been considerable research on environmental factors that influence outdoor activities such as walking.10–17 Studies designed to promote health-related walking in lower income communities are limited but show promising results.18,19

Several studies have used environmental cues such as signage to promote stair use.20–24 However there is less research on the use of signage to encourage walking.19 We recently carried out an evaluation of the Slí-na-Sláinte (path to health) in two adjacent low-income city neighbourhoods where walking was the preferred form of activity.25,26 The Slí-na-Sláinte is the Irish Heart Foundation's international walking initiative which uses colourful signage on designated walking routes (Fig. 1). The scheme incorporates community walking leader training, formation of local walking groups and the Slí ‘challenge’ which helps people achieve walking targets. Slí-na-Sláinte routes are maintained to acceptable safety standards and are accessible to the general public at all times. Negative results from this study showed no significant increases in self-reported or objectively measured (video camera) levels of walking. This prompted us to do a follow-up qualitative investigation in order to increase our understanding of the walking routes marginal impact.


Figure 1
View larger version (66K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 1. Slí-na-Sláinte (path to health) sign.

 

   Methods
TOP
 Introduction
 Methods
Results
 Discussion
 Funding sources
 Conflict of interest
 Acknowledgements
 References
 
Study design
Focus groups were the chosen method of enquiry since they are a useful method of evaluating the relevance, clarity and practicality of health promotion materials.27 The groups (n = 6) were moderated by one of the authors (L.B.) and a community health worker (R.C) from a local agency (Northside Initiative for Community Health NICHE) which facilitated the study. The study was completed in August and September 2004.

Participants and recruitment
Resident men and women between the ages of 18 and 60 were recruited through a purposive sampling procedure (n = 23 men, n = 30 women). This was facilitated through the health agency staff who have extensive local knowledge. Consideration was given to inclusion of information rich cases that would reflect the population diversity. Factors taken into consideration included: sex, approximate age, levels of physical activity, occupation, marital status, dependents, interaction with the local health agency and neighbourhood involvement. Each focus group consisted of participants with a variety of these characteristics (Table 1).


View this table:
[in this window]
[in a new window]

  		Table 1 Characteristics of focus group participants

 
Potential participants were sampled from lists of residents held by the health agency, the local clergy and by other local associates such as childcare employees. Approximately 10 days prior to each focus group, 14 potential group members were contacted by letter explaining the purpose of the study and where their names had been sourced. The groups were over-sampled in this way to ensure adequate attendance. Those who could not attend, stated that this was due to lack of time or family/work reasons.

Focus group procedures
Interview topics covered residents' thoughts on neighbourhood walking, related facilities and amenities and views on what promotes or hinders walking. Since the objective of the study was to assess walking after introduction of the Slí-na-Sláinte, the topic of the walking route was not directly introduced into the sessions by the moderators. Any discussions on the route were initiated by participants.

Each group was hosted at the health agency premises in a room used by residents for community events/meetings, and was approximately one hour's duration. All sessions were recorded. After initial introductions and signing of consent forms, topics were posed to the group by the moderators using a flipchart as a reminder. Participants were encouraged to give their points of view and to clarify their responses. When there was a lull or a pause in conversation, probes were used to stimulate the discussion. Group members who were shy or less inclined to respond were encouraged by the moderators. Each member received a token for participation to the value of {euro}20.

Analytic tools and coding procedures
Qualitative analysis was carried out using constant comparison methods with a grounded theory approach. The Anno Tape 1.0 solution28 for qualitative data together with paper systems were used to manage and code the findings. Using techniques explained in Strauss and Corbin29 open, axial and selective coding procedures were applied. Concepts, themes and their properties and dimensions, were identified. Initially, each interview or focus group was listened to in order to get an idea of content. After this, open coding was used to ‘fracture’ the data or break it down into meaningful phrases, sentences or words. These were subsequently grouped into sub-categories and categories. Axial coding facilitated the process of reassembling the fractured data and was used to uncover relationships between categories and sub-categories. Selective coding was used to integrate the data to reach a ‘central category’, explaining the main theme of the research.


   Results
TOP
 Introduction
 Methods
 Results
Discussion
 Funding sources
 Conflict of interest
 Acknowledgements
 References
 
Analysis of the focus groups showed several emerging themes. These centred on the social and physical environment and its relevance for walking. There was limited discussion within the groups on the Slí-na-Sláinte itself, however mention of it tended to spark discussion on walking in a wider sense.

Main themes
The central theme of the study was about a ‘nurturing environment’. If the social and physical environment is a nurturing one, then residents are more likely to walk in the neighbourhood. The definition of nurture taken by the authors in this instance is foster, develop, sustain, support. Four main themes emerged in support of the central theme. Although these are identified separately, there was some clear overlap between them. For example, there was a strong sense of dissatisfaction in each theme with work being done in the neighbourhoods by the local authorities.

Theme 1—positive dynamics
This theme focused on positive neighbourhood aspects (Table 2). Residents spoke of key neighbourhood personalities who contribute to community development e.g. cleaning and maintaining the estates, lobbying politicians and forming positive working relationships with local authorities and law enforcement. The feeling was that these residents facilitate positive environments in which to live and be active. They are also influential through their actions, by encouraging others to become involved.


View this table:
[in this window]
[in a new window]

  		Table 2 Positive dynamics

 
Positive neighbourhood contributions by groups or committees were identified. Residents said that these groups are often brought together by the aforementioned ‘active’ residents. Linked to views on neighbourhood groups was the opinion that action and organization on the part of a greater number of residents is required. In this context, it was noted that Slí-na-Sláinte walks hosted by two local walking leaders comprise of very small groups. Leading on from views on neighbourhood organization, a number of residents felt keenly about the need for strong community ‘voices’ to convey local needs e.g. facilities and improvements for walking and for making the local authorities and the politicians more aware of neighbourhood problems. Connected to this was a necessity for persistence with regard to lobbying and conveying of needs. There was a level of fear that lack of organization on the part of residents will ultimately result in loss of facilities, amenities and development opportunities. Feelings were especially strong with regard to a particular neglected amenity area.

Theme 2—negative dynamics
This theme emerged from discussions on negative neighbourhood aspects (Table 3). Residents expressed that higher than average levels of anti-social behaviour makes neighbourhood walking difficult. Other areas of the city were viewed as safer for walking and several regular walkers said that they chose to use these instead. Outside walking routes cited included three existing Slí-na-Sláinte routes. Factors cited as deterrents in using the study neighbourhood for recreational purposes included: burned out cars, groups drinking, blocked alleyways, illegal dumps and gangs of youths.


View this table:
[in this window]
[in a new window]

  		Table 3 Negative dynamics

 
Problems with anti-social neighbours were highlighted. These were described as being troublesome in their dealings with others and in their treatment of the local physical environment. Residents remarked on a lack of discipline on the part of some parents and resulting disruption. Problems with the youth of the area were centred on gang behaviour and joy riders. Several residents made the point that the local youth have little to do with their time and thus spend it in an unruly manner.

Feelings of neglect on the part of local authorities emerged clearly. Residents felt that their neighbourhoods were ignored in terms of city improvements and developments e.g. amenity walks, community halls and leisure centres. Compared with other areas of the city, residents were of the view that there is very little being done in their locality.

Related to feelings of neglect were feelings of disillusionment. Several residents spoke of a lack of expectation about where they live, and how things never seem to change or get any better. This was de-motivating for walking and other types of locally based activities. Closely related to this was the view that the local authorities are ‘weary’ from dealing with problems such as burned out cars, and extensive rubbishing. Stemming from feelings of disillusionment and weariness was a sense of apathy. Residents spoke about neighbours who isolate themselves insofar as possible from interacting in the locality or with other residents. This has a negative effect on overall community progression.

Theme 3—personal and social factors
Incentives for walking among residents included mental benefits such as stress release and stress management (Table 4). Walking was viewed as particularly useful since it is easy to do, requiring a minimum of co-ordination and skill. Sociability was an especially important incentive for women walkers. The point was made that local women tend to walk in groups, but local men prioritise walking their dogs. Some residents felt that there were more local activities for women. They also felt that in general, women are better at doing activities such as walking. Another key incentive for walking was being in the fresh air and experiencing the countryside. The Slí-na-Sláinte was not viewed positively in this sense since the route is near the road and the estates.


View this table:
[in this window]
[in a new window]

  		Table 4 Social and personal factors

 
Over half of the residents who took part in the study were aware of the Slí-na-Sláinte signage and route, and several said that they liked to use it. There were mixed views about its usefulness to the neighbourhood. Some regarded it as a nice walk that is easy to do, while others were not quite sure about the benefits of its presence in the area. Others were clearly unimpressed with it and felt it does not add value to the locality.

A number of residents spoke about the costs of amenities. These were strong in their views that neglected amenity areas could become neighbourhood assets if developed. It was acknowledged that this would require considerable initial investment on the part of local government. Requirements for a maintenance strategy were also stressed since previous repairs to a section of one specific area for walking did not last beyond the short term.

Physical activity initiatives assisted by the local health agency were acknowledged across the groups. On the whole though, it was felt that there are insufficient facilities for the neighbourhood population to engage in regular activity. Linked to this opinion were views on the availability of information about neighbourhood classes or events. Some participants said that they never saw any information whereas others said they saw advertising for activities in the local supermarket, occasionally saw flyers in their letterboxes and on the local newsletters.

Theme 4—physical environmental factors
There was considerable discussion on access to facilities and amenities for walking and physical activity in general (Table 5). Several older residents talked about previous amenities such as a currently neglected walk on the periphery of the neighbourhood. Such amenities are now disused due to destruction. A majority of residents felt that current facilities are insufficient. Some stated that they were not impressed with the recently launched Slí-na-Sláinte route.


View this table:
[in this window]
[in a new window]

  		Table 5 Facilities and the physical environment

 
Several disincentives to walking emerged. Residents discussed the local dog population which is higher than in other city areas. Some were nervous of dogs and this stopped them walking certain routes. Others were not nervous but still found walking in areas with loose dogs off-putting. Un-tethered horses were also a barrier, particularly for those who ventured on the neighbourhood hinterland.

Personal safety was high on the list of environmental barriers to walking in the neighbourhood. While some residents were more fearful than others, all agreed that there are certain parts of the locality that are unsafe for walking. Residents also expressed their fears about aforementioned gangs of youths and the speed of traffic. Those with children were particularly concerned with traffic. There were some contradictions in terms of safety. For example, although several residents cited traffic as a safety issue for walking, others viewed areas with traffic as safer for walkers in that they are less likely to be intimidated by gangs. This bears some relation to the concept of ‘witness’ where people are less likely to commit crime or behave in an anti-social manner if they are likely to be witnessed. Although there is a large population of dogs in the area, which can be intimidating for walkers, it was suggested that bringing your own dog on a walk can be a protective factor.

The issue of neighbourhood cleanliness emerged frequently. Residents talked about broken glass on footpaths and on green areas, rubbish and dumped household appliances. It was felt that the local authorities are not doing enough to maintain cleanliness. Positive environmental changes would include clean routes for walking, having a higher law enforcement presence and provision of areas that are safe from traffic and designed for family activity.


   Discussion
TOP
 Introduction
 Methods
 Results
 Discussion
Funding sources
 Conflict of interest
 Acknowledgements
 References
 
Main findings of the study
Although neighbourhood walking was considered by the participants, this was merely a catalyst for discussion on a far wider set of neighbourhood issues. Efforts on the part of the local health agency and Irish Heart Foundation to involve locals in the running of a newly established walking route were marginally productive. Findings suggest that the neighbourhoods are unreceptive to health promotion initiatives such as the Slí-na-Sláinte since they are dealing with more fundamental social and physical environmental issues. It may be the case that residents discount the benefits achieved by initiatives such as the Slí-na-Sláinte since these need to be deeply embedded in a supportive and facilitative environment if they are to achieve substantial impact.

The analyses indicate that sufficient organization and commitment by residents and local authorities may result in advances that could facilitate walking amenities. Residents felt that neighbours who are actively involved in local concerns can assist this progression. Other facilitative elements include neighbourhood cohesiveness and persistence in conveyance of needs. There was a strong sense of frustration that local government and agencies are currently neglectful of the locality. Aspects of the social environment were seen to affect walking both positively and negatively. While anti-social behaviour is constraining, sociability among residents and adequate social supports were viewed as important. Residents drew attention to the fact that walking and the physical environment are inextricably linked. Barriers to walking included personal safety concerns regarding crime, traffic and animals and problems with rubbish and dumping in several areas. Although it is not stated that women walk more than men in the neighbourhood, there is a general feeling that this is the case.

In retrospect, the Slí-na-Sláinte was introduced to the neighbourhood at an inappropriate stage in the community development process and had marginal impact.

What is already known on this topic
Communities that have confidence, commitment and a range of skills are better positioned to influence circumstances than those that are apathetic and alienated.30 Physical activity intervention design and implementation can benefit from meaningful participation of the community and relevant agencies.31–33 Residents who are more involved in their local community tend to be happier about where they live34 and have better health.35 Community opinion leaders are among those likely to have the greatest influence on delivering physical activity intervention messages.36 The important role of community leaders in facilitation of locally based health promotion is supported by the literature.37–40 Additionally, community participation is more likely when there is equity between authorities and the community or where the professional is clearly recognized as a partner in the process of decision making.41

The evidence that social support is beneficial to health and that social isolation leads to ill health is now considerable.42 The positive association between social support and physical activity has been established.43,44 Personal safety is an important influence on walking patterns and behaviour.11,14,16,45,46 Accessibility is shown to be sensitive to walking behaviour.10,14,15,46 Walking may appeal to women more than men.47,48

Health promotion had traditionally tended to individualize health thus removing it from the broader social context. Of late attempts to address this are being made through, for example, physical activity health research incorporating environmental aspects44,46,49–51 and through development of a broader bio-psycho-social model of health and its determinants.

What this study adds
There is an urgent need for research into the effectiveness of environmental interventions, particularly within socially excluded sectors of the population who have the highest prevalence of physical inactivity.52 Desire to engage in local activity lies at the heart of the community. Health professionals need to be aware of the social context in which they are working, since there is little advantage in introducing promotional health incentives without first addressing underlying social and environmental matters. Initiatives such as the Slí-na-Sláinte can subsequently be introduced if it is clear that they will be a useful community resource. Fostering a nurturing environment can be done by looking at ways to enhance neighbourhood self-esteem, examining formation of lasting partnerships between residents and local authorities, and through formal assessment of neighbourhood needs. Neighbourhoods such as those who participated in this research, with ongoing problems in terms of community development and self-esteem require particular attention. Consistent long-term commitment to progressive development is required since lesser albeit well-intentioned supports are unlikely to show success.

Limitations of this study
Since the study took place in a specific location in one Irish city using a purposive sampling strategy, the views of participating residents cannot be generalized. Although purposive sampling offers researchers a degree of control, selection bias cannot be ruled out. Participants attended the groups because they had time and inclination. It would be interesting to assess the views of additional locals. For example, participants talked about residents who do not appear to care about maintaining a clean and functional environment. It would be useful to obtain the views of someone from this minority population of residents, although it is unlikely that they would attend a focus group discussion. Researchers can subconsciously or even consciously cause respondents to answer in a certain way through the use of leading questions and handling of views. Interviewer bias cannot be ruled out since both moderators have professional interests in health promotion and community development. A neutral moderator was beyond the study resources. Despite efforts to remain objective and to allow the participants' to direct discussions towards issues of personal relevance, this may have impacted upon the results.


   Funding sources
TOP
 Introduction
 Methods
 Results
 Discussion
 Funding sources
Conflict of interest
 Acknowledgements
 References
 
Funding for this study came from the Northside Initiative for Community Health and the National Health Promotion Unit.


   Conflict of interest
TOP
 Introduction
 Methods
 Results
 Discussion
 Funding sources
 Conflict of interest
Acknowledgements
 References
 
None declared.


   Acknowledgements
TOP
 Introduction
 Methods
 Results
 Discussion
 Funding sources
 Conflict of interest
 Acknowledgements
References
 
We thank the Northside Initiative for Community Health and the residents of Knocknaheeny and Hollyhill for their contribution to this study. We would also like to acknowledge Dr Catherine Woods at Dublin City University who was instrumental in the planning and design of the Slí-na-Sláinte study.


   References
TOP
 Introduction
 Methods
 Results
 Discussion
 Funding sources
 Conflict of interest
 Acknowledgements
 References
 

  1. Kearney JM, de Graaf C, Damkjaer S, et al. Stages of change towards physical activity in a nationally representative sample in the European Union. Public Health Nutr (1999) 2(1A):115–24.[Medline]
  2. Fahey T, Layte R. Sports participation and health among adults in Ireland (2004) Economic and Social Research Institute.
  3. Kamphuis CB, van Lenthe FJ, Giskes K, Brug J, Mackenbach JP. Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands. Health and Place (2007) 13:493–503.[CrossRef]
  4. Kavanagh AM, Goller JL, King T, et al. Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia. J Epidemiol Commun Health (2005) 11:934–40.
  5. Hallal PC, Azevedo MR, Reichert FF, et al. Who, when, and how much? Epidemiology of walking in a middle-income country. Am J Prev Med (2005) 2:156–61.
  6. van Lenthe FJ, Brug J, Mackenbach JP. Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Social Sci Med (2005) 4:763–75.
  7. Kelleher C, Nic Gabhainn S, Friel S. The national health and lifestyle surveys. (1999) NUI Galway: Centre for Health Promotion Studies.
  8. Burton NW, Turrell G. Occupational, hours worked, and leisure-time physical activity. Prev Med (2000) 31(6):673–81.[CrossRef][Web of Science][Medline]
  9. Baumann A, Bellew D, Booth M, et al. Towards Best Practice for the Promotion of Physical Activity in the Areas of New South Wales (1996) NSW Health Department, Centre for Disease Prevention and Health Promotion.
  10. Giles-Corti B, Donovan RJ. The relative influence of individual, social and physical environment determinants of physical activity. Social Sci Med (2002) 54::1793–1812.[CrossRef]
  11. Pilkora T, Giles-Corti B, Bull F, et al. Developing a framework for assessment of the environmental determinants of walking and cycling. Social Sci Med (2002) 8:1693–703.
  12. Tolley R, Bickerstaff K, Lumsdon L. The Future of walking in Europe: a Delphi project to identify expert opinion on future walking scenarios. Transport Policy (2001) 8:307–15.[CrossRef]
  13. Seaton J, Wall S. A summary of walkers and walking in the Perth Metropolitan Region. (2001) Proceedings of the Walking in the 21st Century conference, 20–22nd February: Perth, Western Australia.
  14. Suminiski RR, Poston WS, Petosa RL, et al. Features of the neighbourhood environment and walking by US adults. Am J Prev Med (2005) 2:149–55.
  15. Giles-Corti B, Broomhall MH, Knuiman M, et al. Increasing walking: how important is distance to, attractiveness, and size of public open space? Am J Prev Med (2005) 28:69–176.[Medline]
  16. Foster C, Hillsdon M, Thorogood M. Environmental perceptions and walking in English adults. J Epidemiol Commun Health (2004) 11:924–8.
  17. Trayers T, Deem R, Fox KR, et al. Improving health through neighbourhood environmental change: are we speaking the same language? A qualitative study of views of different stakeholders. J Public Health (Oxf) (2006) 1:49–55.
  18. Wen LM, Thomas M, Jones H, et al. Promoting physical activity in women: evaluation of a 2-year community-based intervention in Sydney, Australia. Health Promot Int (2002) 17:127–37.[Abstract/Free Full Text]
  19. Brownson RC, Housemann RA, Brown DR, et al. Promoting physical activity in rural communities, walking trail access, use and effects. Am J Prev Med (2000) 3:235–41.
  20. Brownell KD, Stunkard AJ, Albaum JM. Evaluation and modification of exercise patterns in the natural environment. Am J Psychiatry (1980) 12:1540–5.
  21. Blamey AM, Mutrie N, Aitchison T. Promoting active living: a step in the right direction. J Inst Health Educat (1996) 34:5–9.
  22. Andersen RE, Franckowiak SC, Snyder J, et al. Can inexpensive signs encourage the use of stairs? Results from a community intervention. Ann Intern Med (1999) 130:616–7.[Free Full Text]
  23. Coleman KJ, Gonzales EC. Promoting stair use in a US-Mexico border community. Am J Public Health (2001) 91:2007–9.[Abstract/Free Full Text]
  24. Kerr NA, Yore MM, Ham SA, et al. Increasing stair use in a worksite through environmental changes. Am J Health Promot (2004) 4:312–5.
  25. Burgoyne L. Determinants of physical activity in two city neighbourhoods: physical activity in an urban environment. (2006) University College Cork. PhD Thesis.
  26. Burgoyne L. City walk, a walking initiative and media awareness study: physical activity in an urban environment. (2006) University College Cork. PhD Thesis.
  27. Branigan P, Mitchell K. The role of focus groups in evaluation. In: Evaluating Health Promotion, Practice and Methods—Thorogood M, Coombes Y, eds. (2000) Oxford University Press. 57–69.
  28. O'Brien C, Jackson S. Annotape for PC version 1.0. 1999–2002.
  29. Strauss A, Corbin J. Basics of Qualitative Research, Techniques and Procedures for Developing Grounded Theory (1998) Thousand Oaks, CA: Sage.
  30. Tones K, Tilford S. Health Promotion, Effectiveness, Efficiency and Equity (2001) 3rd Ed. Cheltenham: Nelson Thornes Ltd.
  31. Sallis JF, Bauman A, Pratt M. Environmental and policy interventions to promote physical activity. Am J Prev Med (1998) 15:379–97.[CrossRef][Web of Science][Medline]
  32. Task Force on Community Preventive Services. Recommendations to Increase Physical Activity in Communities. Am J Prev Med (2002) 22:67–72.[CrossRef][Web of Science][Medline]
  33. Taylor WC, Baranowski T, Young DR. Physical activity interventions in low-income, ethnic minority and populations with disability. Am J Prev Med (1998) 15:334–43.[CrossRef][Web of Science][Medline]
  34. Halpern D. Mental Health and the Built Environment. More than Bricks and Mortar? (1995) London: Taylor and Francis.
  35. Gatrell A, Thomas C, Bennett S, et al. Understanding health inequalities: locating people in geographical and social spaces'. In: Understanding Health Inequalities—Graham H, ed. (2000) Oxford University Press.
  36. King AC. How to promote physical activity in a community: research experiences from the US highlighting different community approaches. Patient Educat Counsell (1998) 33:S3–12.[CrossRef]
  37. Parker DR, Assaf AR. Community interventions for cardiovascular disease. Primary Care (2005) 32:865–81.[Web of Science][Medline]
  38. Dutcher GA, Hamasu C. Community-based organizations' perspective on health information outreach: a panel discussion. J Med Library Assoc (2005) 93:S35–42.[Web of Science][Medline]
  39. Hickie I. Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative. Australia's Psychiatry (2004) 12:S38–46.
  40. Massaro E, Claiborne N. Effective strategies for reaching high-risk minorities with diabetes. Diabetes Educat (2001) 27:820–6.
  41. McMurray A. Community Health and Wellness: A Sociological Approach (2003) 2nd Ed. London: Mosby.
  42. Stansfield S. Social support and social cohesion. In: Social Determinants of Health—Marmot M, Wilkinson RG, eds. (1999) Oxford University Press.
  43. Wallace LS, Buckworth J, Kirby TE, et al. Characteristics of exercise behavior among college students: application of social cognitive theory to predicting stage of change. Prev Med (2000) 31:494–505.[CrossRef][Web of Science][Medline]
  44. Stahl T, Rutten A, Nutbeam D, et al. The importance of the social environment for physically active lifestyle—results from an international study. Social Sci Med (2001) 52:1–10.[CrossRef][Web of Science]
  45. De Bourdeaudhuij I, Teixeira PJ, Cardon G, et al. Environmental and psychosocial correlates of physical activity in Portuguese and Belgian adults. Public Health Nutr (2005) 8:886–95.[CrossRef][Web of Science][Medline]
  46. Duncan M, Mummery K. Psychosocial and environmental factors associated with physical activity among city dwellers in regional Queensland. Prev Med (2005) 40:363–72.[CrossRef][Web of Science][Medline]
  47. Simpson ME, Serdula M, Galuska DA, et al. Walking trends among US Adults: The BRFSS, 1987–2000. Am J Prev Med (2003) 25:95–100.[CrossRef][Web of Science][Medline]
  48. Suminski RR, Poston WS, Petosa RL, et al. Features of the neighborhood environment and walking by US adults. Am J Prev Med (2005) 28:149–55.[CrossRef][Web of Science][Medline]
  49. Brownson RC, Baker EA, Housemann RA, et al. Environment and policy determinations of physical activity in the United States. Am J Public Health (2001) 91:1995–2003.[Abstract/Free Full Text]
  50. Saelens BE, Sallis JF, Black JB, et al. Neighbourhood-based differences in physical activity: an environmental scale evaluation. Am J Public Health (2003) 93:552–8.
  51. Leydon KM. Social capital and the built environment: the importance of walkable neighbourhoods. Am J Public Health (2003) 93:1546–51.[Abstract/Free Full Text]
  52. Foster C, Hillsdon M, Cavill N, et al. Interventions that use the environment to encourage physical activity. National Inst Health Clinical Excellence (2006) September.

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/3/222    most recent
fdm027v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Burgoyne, L.
Right arrow Articles by Perry, I. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Burgoyne, L.
Right arrow Articles by Perry, I. J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?