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Kenneth E. Powell, MD, MPH, Linda M. Martin, MS and Pranesh P. Chowdhury, MBBS, MPH

The authors are with the Division of Public Health, Georgia Department of Human Resources, Atlanta.

Correspondence: Requests for reprints should be sent to Kenneth E. Powell, MD, MPH, Division of Public Health, 2 Peachtree St, Room 14-392, Atlanta, GA 30303 (e-mail: kepowell{at}dhr.state.ga.us).

	INTRODUCTION

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
Regular physical activity fosters good physical and mental health.¹ Described as "today’s best buy in public health,"² one needs to accumulate only 30 minutes per day, 5 days per week, of moderately intense physical activity, such as brisk walking.³ For almost everyone, walking is a familiar activity performed in the conduct of normal daily activities. Nevertheless, only 25% to 30% of Americans report doing activities that meet current recommendations for physical activity, and 30% to 40% report no participation in physical activities away from their work.^4,5 These data have not changed over at least the past decade.⁵

The availability^6–8 and awareness⁹ of places conducive to physical activity are associated with higher levels of physical activity. To guide our efforts to promote regular physical activity, we used the Georgia Behavioral Risk Factor Surveillance System to determine (1) whether adult Georgians were aware of safe and convenient places for walking, (2) what places they most commonly envisioned, and (3) whether the proximity of those places was associated with self-reported physical activity behaviors.

	METHODS

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
Data were collected via the Georgia Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey of health-related behaviors of adults aged 18 years and older.¹⁰ The 2001 questionnaire (available at http://www.cdc.gov/brfss/pdf-ques/2001brfs.pdf) asked about the frequency and duration of both moderate and vigorous physical activity. Respondents were categorized as meeting current recommendations for activity or not (moderate activity for at least 30 minutes per day, 5 days per week, or vigorous activity for at least 20 minutes per day, 3 days per week).

In Georgia, we added questions about safe and convenient places to walk. Respondents were informed that they would be asked "about places where people can walk for exercise or recreation, such as trails, parks, sidewalks, and treadmills" and that the survey was concerned with "their convenience and safety for you, whether or not you actually use them." Respondents were then asked, "Is there a place you could go where you would feel safe walking for exercise or recreation?" If they responded, "yes," they were asked, "What is the most convenient place? Is it . . . ?," and they were read the places listed in Table 1. If the place was their neighborhood or a home treadmill, we assumed that the respondent could walk to the place in less than 10 minutes. All others were asked, "How many minutes would it take to get there from your home?" and "How would you get there?" Three categories of convenience were created based on time and mode of travel to the place: (1) less than 10 minutes walking, (2) less than 10 minutes not walking, and (3) 10 minutes or greater regardless of mode.

	RESULTS

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
An estimated 91.8% (95% confidence interval [CI] = 90.8%, 92.8%) of Georgians had a place where they would feel safe walking for exercise or recreation. The most commonly reported place was neighborhood streets or sidewalks (32.0%; 95% CI = 30.2%, 33.8%), followed by public parks (26.8%; 95% CI = 25.0%, 28.6%), school track (10.2%; 95% CI = 9.1%, 11.4%), gym or fitness center (7.8%; 95% CI = 6.6%, 9.0%), walking or jogging trail (6.6%; 95% CI = 5.7%, 7.6%), treadmill at home (4.1%; 95% CI = 3.3%, 4.9%), or shopping mall (2.9%; 95% CI = 2.2%, 3.5%). Omitting those whose place was their neighborhood or treadmill at home, 49.7% (95% CI = 47.2%, 52.3%) reported that they could reach the place in less than 10 minutes; 75.9% (95% CI = 73.6%, 78.1%) reported that they would drive there, and 22.4% (95% CI = 20.2%, 24.6%) reported that they would walk.

Including persons whose place to walk was their neighborhood or home treadmill, 47.1% (95% CI = 45.1%, 49.1%) of persons could walk to their place in less than 10 minutes (Table 1). However, fewer than 15% of the persons whose place was a public park, school track, gym or fitness center, or shopping mall could walk to their place in less than 10 minutes.

Persons reporting a place to walk were significantly more likely to meet current recommendations for regular physical activity (41.5%; 95% CI = 39.4%, 43.6%) than were those reporting no place to walk (27.4%; 95% CI = 21.2%, 33.7%) (Table 2). There was a direct relation between the convenience of the walking place and the proportion of respondents meeting current activity recommendations. The trend across categories of convenience was significant for all places combined, places not home based, and public parks (Table 2). The same direct pattern was seen for other specified places, but the trend was not significant.

	DISCUSSION

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

Our conclusions might be strengthened if we had evidence that the respondents actually used the place they envisioned for walking. However, the questions we asked were simple, have construct validity, and, based on their association with self-reported behaviors, have predictive validity. It is programmatically helpful to know that most Georgians can envision and identify a safe and convenient place to walk.

The data suggest that proximity is an important factor in the identification of a safe and convenient place to walk. The most commonly mentioned place was the respondent’s neighborhood. Public parks were the next most commonly mentioned place. Efforts to design new and to retrofit old neighborhoods with sidewalks and streets that make them easily walkable and the development of nearby park space would appeal to residents and be beneficial from a public health perspective.

	Acknowledgments

 
The Georgia Behavioral Risk Factor Surveillance System is supported in part through Centers for Disease Control and Prevention Cooperative Agreement U58/CCU400591.

Human Participant Protection
The Georgia Behavioral Risk Factor Surveillance System was determined to be exempt from institutional review board review.

	Footnotes

 
Contributors
K. E. Powell and L. M. Martin recognized the opportunity to obtain helpful programmatic information and designed the questions. L. M. Martin and P. P. Chowdhury analyzed the data. K. E. Powell drafted the article that was revised by all 3 authors.

Peer Reviewed

Accepted for publication April 10, 2003.

	References

TOP INTRODUCTION METHODS RESULTS DISCUSSION References

 
1. Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga: Centers for Disease Control and Prevention; 1996.

2. Morris JN. Exercise in the prevention of coronary heart disease: today’s best buy in public health. Med Sci Sports Exerc. 1994;26:807–814.[ISI][Medline]

3. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA.1995;273:402–407.[Abstract]

4. Schoenborn CA, Barnes PM. Leisure-time physical activity among adults: United States, 1997–1998. Adv Data Vital Health Stat. April 7, 2002;325.

5. Centers for Disease Control and Prevention. Physical activity trends—United States, 1990–1998. MMWR Morb Mortal Wkly Rep.2001;50(9):166–169.[Medline]

6. Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity, a systematic review. Am J Prev Med.2002;22(4S):73–107.[ISI][Medline]

7. Humpel N, Owen N, Leslie E. Environmental factors associated with adults’ participation in physical activity: a review. Am J Prev Med.2002;22:188–199.[ISI][Medline]

8. Giles-Corti B, Donovan RJ. The relative influence of individual, social, and physical environment determinants of physical activity. Soc Sci Med.2002;54:1793–1812.

9. Leslie E, Owen N, Salmon J, et al. Insufficiently active Australian college students: perceived personal, social, and environmental influences. Prev Med.1999;28:20–27.[ISI][Medline]

10. Frazier EL, Franks AL, Sanderson LM. Behavioral risk factor surveillance data. In: Using Chronic Disease Data: A Handbook for Public Health Practitioners. Atlanta, Ga: Centers for Disease Control and Prevention; 1992:1–17.

11. SUDAAN User’s Manual, Release 8.0. Research Triangle Park, NC: Research Triangle Institute; 2001.

12. Fisher RA, Yates F. Statistical Tables for Biological, Agricultural and Medical Research. 5th ed. Edinburgh, United Kingdom: Oliver & Boyd; 1938.

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