This is an excerpt from Reversing the Obesogenic Environment by Rebecca Lee,Kristen McAlexander & Jorge Banda.
Accessibility is composed of many factors that influence the use of physical activity resources and is often used interchangeably with the term usability. One important accessibility factor is ease of travel to and from the resources as well as the ease of using the resources and equipment. An accessible resource is one that is easy to approach and use; one with little or no traffic en route; one that has adequate, convenient parking; and one that is accessible via inexpensive, convenient, and pleasant public transportation. In contrast, an inaccessible resource may have no readily available public transportation, inconvenient or no parking, equipment that is difficult to understand and use, or long lines for entry and equipment use. Cost is another important accessibility factor that can influence physical activity resource use, particularly among populations of lower socioeconomic status and children and adolescents.
Accessibility is a factor in determining whether people use physical activity resources and ultimately in whether they do physical activity. Research has indicated that children and adolescents with access to physical activity resources and physical activity programs are more physically active than those without access (Allison et al., 2005; Dwyer et al., 2006; Mota, Almeida, Santos, & Ribeiro, 2005). In addition, it's important to note that populations of lower socioeconomic status typically have more limited access to physical activity resources. This is important because reduced access to physical activity resources is associated with increased body fat and BMI in low-income, minority populations (Heinrich et al., 2008). As a result, it's important to consider this additional barrier when working with populations of lower socioeconomic status.
Proximity influences whether people use physical activity resources. Proximity can be measured subjectively using self-report questionnaires or objectively using street network or straight line distances. Briefly, network distance is the distance one would travel on streets to get to a resource, while straight line distance is the direct distance between two points; it represents the absolute distance one would travel if there were no buildings or obstacles. The more proximal a resource is to someone, the more accessible it is as well.
There is a strong relationship between proximity of physical activity resources and physical activity. In a study among low-income, midlife women, those who reported greater proximity to physical activity resources also did more physical activity (Jilcott, Evenson, Laraia, & Ammerman, 2007). There is also evidence that suggests there is a direct relationship between proximity to physical activity resources and meeting physical activity guidelines (Sallis, Patterson, Buono, & Nader, 1988). In addition, proximity to physical activity resources may be particularly important for children and adolescents, since most youth are limited to the immediate resources to which they can walk or bicycle.
Within the context of proximity, the density of physical activity resources is another factor to consider. For example, a study found that adolescent girls who lived near more parks did more physical activity than those who lived near fewer parks (Cohen et al., 2006). Similar results were found in women: Women who lived near more physical activity resources and parks were more physically active than those who lived near fewer physical activity resources and parks (Jilcott et al., 2007; Norman et al., 2006; Lee et al., 2007).
The findings from these studies stress the importance of proximity to physical activity resources. Furthermore, these studies suggest that the built environment plays a vital role in resident health and that careful community planning can affect the health of residents. Research has shown that having a nearby park or gym may help to buffer the relationship between lower socioeconomic status and engaging in less physical activity (Lee et al., 2007). As a result, creating a variety of opportunities for recreation and physical activity that are easily accessible can provide a means to increase the amount of energy expended by Americans, a crucial part of solving the obesity epidemic (figure 5.1).
Safety is freedom from danger, risk, and injury, and it plays a crucial role in determining whether physical activity resources are used. Safety can act as a motivator or a barrier to being physically active. For example, trails and walking paths may offer a feeling of personal safety because they are traditionally placed far away from cars and traffic and because they typically offer more privacy than other types of physical activity resources (Gobster & Dickhut, 1995). On the other hand, safety is most often cited as a deterrent to using physical activity resources (King et al., 2000). For example, crime and traffic are common safety concerns that prevent people from being physically active in outdoor recreation facilities (Molnar, Gortmaker, Bull, & Buka, 2004).
Playgrounds are an important setting in which children can be physically active. However, the safety of playground equipment, which has typically been overlooked in research, plays a pivotal role in determining whether children use physical activity resources. Parks and playgrounds must meet regulatory safety guidelines set forth by local, state, and federal agencies before they are deemed safe for use. Unfortunately, these safety guidelines are not always strictly enforced—older parks and playgrounds often do not meet current guidelines. This lack of enforcement has public health implications: Almost 190,000 children required emergency room treatment after being injured on public playground equipment in 2001. As a result, the condition of park and playground equipment is likely an important factor in parents' decisions about whether to let their children play in parks and playgrounds (Bedimo-Rung et al., 2005).
Some population groups are disproportionately burdened with unsafe areas that discourage physical activity. For example, children living in low socioeconomic status neighborhoods dominated by ethnic minorities typically have fewer safe playgrounds, do less physical activity, and have higher rates of overweight and obesity when compared to children in their counterpart neighborhoods (Cradock et al., 2005; Lee, Booth, Reese-Smith, Regan, & Howard, 2005).
Features, Amenities, Aesthetics, and Incivilities
The mere presence of physical activity resources is not the only determinant of their use; the availability and quality of features are important as well. Features are specific elements of resources that encourage physical activity. As an example, a baseball field is a feature that encourages users to play baseball or engage in some other types of physical activity. Features can be extremely influential in terms of the types of users they attract and in the amount of maintenance required for the physical activity resource. For example, parks with basketball courts may draw more young users, while parks with swimming pools may draw more families and adult users. However, features such as baseball fields and swimming pools require more maintenance and upkeep than features with fewer, less sophisticated features.
Features that encourage the use of physical activity resources, but are not specifically related to physical activity, are called amenities. Amenities add comfort or convenience that may influence people to visit the resource. For example, restrooms, lighting, drinking fountains, and benches are amenities that may be found in a park or along walking trails and that may influence whether people visit the park or trail. Research has shown that people are more likely to use physical activity resources with amenities than those without them (Shores & West, 2008). In addition, research has indicated that the quantity and quality of amenities at physical activity resources may be associated with the prevalence of obesity (Heinrich et al., 2008). As a result, it's important that health-conscious community planners include amenities when building or renovating physical activity resources.
Aesthetics refers to the quality, condition, and appeal of the physical activity resource and its features and can strongly influence whether a physical activity resource is used. For example, park users are more likely to visit a park with pleasant landscaping, appealing amenities, and well-maintained features. Research has shown that well-maintained amenities and features are associated with physical activity (Owen, Humpel, Leslie, Bauman, & Sallis, 2004). As a result, physical activity resources that are poorly maintained, worn down, or in disrepair will dissuade users and contribute to the obesogenic environment.
Incivilities are elements of physical activity resources that reduce the pleasure associated with their use. Examples of incivilities are auditory annoyances, broken glass, dog refuse, graffiti, litter, evidence of alcohol use, and other unpleasantries that could deter the use of a physical activity resource. It should be noted that incivilities are not created as part of the physical activity resource; they are created by users who do not consider the impact on others of the incivilities they create. In addition, incivilities may be considered a source of social disorder that can contribute to feelings of unhappiness and a lack of safety (Sampson & Raudenbush, 2004); incivilities are also associated with many poor health outcomes (Lee et al., 2005). There is no question that incivilities can deter people from using physical activity resources.
Having physical activity resources nearby, accessible, and available are good first steps toward a neighborhood that promotes physical activity among its residents. However, for most physical activity resources, the determination of whether and how they are used is much more complicated. Factors related to the accessibility of physical activity resources, along with physical activity resource features, amenities, incivilities, and aesthetics are also important to consider.