ARTICLE IN PRESS
Health & Place 15 (2009) 204– 209
Contents lists available at ScienceDirect
Health & Place
journal homepage: www.elsevier.com/locate/healthplace
Geographic location, physical activity and perceptions of the environment in
Queensland adults
Mitch J. Duncan a,, W. Kerry Mummery a,1, Rebekah M. Steele b,2,
Cristina Caperchione a,3, Grant Schofield c,4
a
Centre for Social Science Research, Central Queensland University, Rockhampton, Qld. 4702, Australia
Epidemiology Unit, Medicial Research Council, Cambridge, UK
c
Centre for Physical Activity and Nutrition Research, Auckland University of Technology, New Zealand
b
a r t i c l e in f o
a b s t r a c t
Article history:
Received 17 August 2007
Received in revised form
15 April 2008
Accepted 18 April 2008
This study examines how physical activity and perceptions of the built environment differ by degree of
urbanisation in Queensland, Australia. A statewide sample of adults (n ¼ 1208) completed a CATI survey
assessing physical activity and perceptions of the environment in July–August 2005. Results indicate
that residents in metropolitan areas were more likely to report the presence of shops and services,
footpaths, heavy traffic and physical activity facilities than non-metropolitan residents. Although
geographic location was not associated with achievement of sufficient levels of physical activity or
walking, a notable interaction in the associations between both physical activity measures and the
presence of footpaths in metropolitan and non-metropolitan areas was observed. This finding suggests
the presence of a differential mechanism in terms of the relationships between physical activity and
environmental supports by geographical location. Such effects require future investigation in terms of
replication and understanding.
& 2008 Elsevier Ltd. All rights reserved.
Keywords:
Physical activity
Urbanisation
Perceptions of the environment
Built environment
Introduction
In Australia, individuals living outside of metropolitan areas
are reported to have a higher prevalence of anxiety disorders
(Andrews et al., 2001), prostate cancer, (Strong et al., 2001) binge
drinking, higher body weight (Brown et al., 1999), diabetes
(Australian Institute of Health and Welfare, 1998), sedentary
behaviour (Australian Institute of Health and Welfare, 2005) and
overall mortality (Draper et al., 2004) compared to metropolitan
residents. These factors suggest that the health of non-metropolitan Australians may be less than that of their metropolitan
counterparts (Australian Institute of Health and Welfare, 1998)
and that geographical location may be associated with healthrelated behaviours. Participation in adequate amounts of physical
activity has been identified as an important determinant of health
Corresponding author. Tel.: +617 49306977; fax: +6174930 6402.
E-mail addresses: [email protected] (M.J. Duncan),
[email protected] (W.K. Mummery), [email protected]
(R.M. Steele), [email protected] (C. Caperchione),
grant.schofi[email protected] (G. Schofield).
1
Tel.: +6174930 6749; fax: +6174930 9871.
2
Tel.: +44 0 1223 769 157; fax: +44 0 1223 330 316.
3
Tel.: +6174930 6976; fax: +6174930 6402.
4
Tel.: +64 9 921 9999; fax: +64 9 921 9746.
1353-8292/$ - see front matter & 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.healthplace.2008.04.006
(Bauman, 2004), and is known to positively influence a number of
the health outcomes listed above (Paluska and Schwenk, 2000;
Vainio et al., 2002; Bauman, 2004). Therefore increasing levels of
physical activity may be useful in counteracting some of the
health disparities observed between metropolitan and nonmetropolitan residents.
Several studies have examined differences in physical activity
participation by geographical location in countries outside of
Australia with varied findings. Bertrais et al. (2004) observed rural
French populations to be more active compared to metropolitan
residents, although several studies of the American population
have observed the opposite (Centers for Disease Control, 1998;
Eyler et al., 2003; Parks et al., 2003) or no difference in regular
physical activity participation (Wilcox et al., 2000). Within the
Australian context there are similar variations across studies. For
example, Brown et al. (1999) reported that women outside of
metropolitan areas were more likely to report being physically
active, whereas other research has shown that individuals living
outside of metropolitan areas were more likely to report being
sedentary (Australian Institute of Health and Welfare, 2005;
Queensland Health, 2001).
Inequalities between geographic locations are not limited to
health-related behaviours and their outcomes as outlined above.
It is also suggested that the infrastructure relating to physical
activity also differs between locations (Wilcox et al., 2000; Parks
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M.J. Duncan et al. / Health & Place 15 (2009) 204–209
et al., 2003). Rural residents have been shown to be less likely to
report the presence of sidewalks, streetlights, than urban counterparts (Wilcox et al., 2000). In addition, rural women report
reduced access to recreation facilities, and are more likely to be
sedentary than urban women. Similarly, urban residents of low
socio-economic level reported greater availability of parks for
recreational activities than their rural counterparts (Parks et al.,
2003). Given the suggested importance of these infrastructures to
physical activity (Duncan et al., 2005; Transportation Research
Board-Institute of Medicine, 2005), understanding the differences
in the availability of these infrastructures and their relationship
with physical activity may assist in understanding any variations
in physical activity behaviour observed between metropolitan and
non-metropolitan populations. To date, no Australian data are
available that compare between metropolitan and non-metropolitan locations in terms of the presence of infrastructure that
supports physical activity, and examines the association of these
items to physical activity in metropolitan and non-metropolitan
locations.
Furthermore, studies examining environmental correlates in
Australia have been conducted in limited geographic regions. The
majority of the Australian research has been conducted in urban
locations (Humpel et al., 2004a, c; Giles-Corti et al., 2005a; GilesCorti and Donovan, 2002a, b, 2003), or combined urban and rural
residents in their analysis (Leslie et al., 1999; Ball et al., 2001), few
studies have been conducted explicitly in non-metropolitan areas
(Duncan and Mummery, 2005; Humpel et al., 2004b).
Given the established relationships between elements of the
built environment and physical activity and the health disparities
that exist between geographic locations (Australian Institute of
Health and Welfare, 1998, 2003b; Duncan et al., 2005) it is useful
to consider how these elements vary between locations. As such,
the objectives of this study were to (i) examine metropolitan and
non-metropolitan differences in perceptions of the environment;
(ii) examine metropolitan and non-metropolitan differences in
self-reported physical activity; (iii) examine whether the associations between environmental elements and physical activity differ
between geographical locations.
Methods
Design and sample
Participants were a random representative sample of Queensland adults, able to be contacted by landline telephone. When the
age distribution of the current sample was compared to that of the
estimated Queensland population, the current sample was found
to have a similar age distribution as reported elsewhere
(Caperchione et al., in press). Interviews were completed using
Computer-Assisted-Telephone-Interview by Central Queensland
University’s Population Research Laboratory. The sample was
separated into two areas, Brisbane and Moreton Statistical
Divisions and the rest of the state of Queensland, with sample
sizes of 798 and 410, respectively. These distributions are
reflective of the population distribution throughout the state of
Queensland.
The survey used a two-stage sampling procedure where
participant’s phone number was randomly selected from electronic white pages, following contact with a household; an eligible
respondent (person aged 18 or over) was invited to participate in
the interview. All interviews were conducted between July 2005
and August 2005, 1208 interviews were completed with an overall
response rate of 43.9% (Caperchione et al., 2008, in press). The
survey received ethical approval from the Human Ethics Research
Review panel at Central Queensland University.
205
Measures
Sociodemographic
Sociodemographic variables assessed included age, gender,
household income and education. Education was reported as the
number of schooling years attended including primary, secondary,
technical and university.
Physical activity
Questions were based on the Active Australia Questionnaire
(Australian Institute of Health and Welfare, 2003a) and assessed
previous week’s physical activity. The Active Australia Questionnaire is used nationally to determine the prevalence of physical
activity (Bauman et al., 2001) and has demonstrated good
reliability (Brown et al., 2004b). Physical activities assessed were
recreational and transportation walking, moderate intensity
activity, and vigorous intensity activity. Previously described
methods for determining total minutes of physical activity
(vigorous activity weighted by 2) and frequency of engagement
(Brown et al., 2004a) were used to determine compliance with
current National Physical Activity Guidelines (Department of
Health and Aged Care, 1999).
Perceived environment
Participants were asked to rate the presence or absence of the
following neighbourhood characteristics; physical activity facilities (public open space and recreational facilities), footpaths,
heavy traffic, and shops and services within walking distance of
the respondent’s home. These items were selected based upon
their significant association and hypothesised relationships with
physical activity participation in recent reviews (Duncan et al.,
2005; Transportation Research Board-Institute of Medicine, 2005).
Geographical location
Geographical location of respondents was determined using
the Regional, Remote and Metropolitan Areas (RRMA) classification, (DPIE & DHSH, 1994) and is used as a proxy measure of
access to classify geographic areas (Australian Government
Department of Health and Ageing, 2005). The population density
of the area and the distance to other urban centres are combined
to provide the area with a RRMA classification (DPIE & DHSH,
1994). Areas are classified as either one of the following seven
categories: (1) capital cities, (2) other (non-capital) metropolitan
centres (population4100,000), (3) large rural centres (population
25,000–99,999), (4) small rural centres (population 10,000–
24,999), (5) other rural areas (populationo10,000), (6) remote
centres (population X5000), (7) other remote areas (population
o5000) (Australian Institute of Health and Welfare, 2004). These
categories were collapsed into metropolitan (RRMA classification
1–2), and non-metropolitan areas (RRMA classification 3–7)
(Australian Institute of Health and Welfare, 2004). Respondent’s
postcode was linked to RRMA classifications (Health Workforce
Queensland) to determine geographical location.
Statistical analysis
Descriptive statistics were calculated for socio-demographic
variables, geographic location and physical activity level using
chi-square analysis. The current analysis used two criteria for
assessing physical activity, ‘‘sufficiently active’’ and ‘‘sufficient
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M.J. Duncan et al. / Health & Place 15 (2009) 204–209
walking’’. The first criterion is consistent with Australian National
Physical Activity Guidelines, and classifies participants as ‘‘sufficiently active’’ if participants report greater than 150 min of
activity in five or more sessions (Department of Health and Aged
Care, 1999). Time spent in walking activities was determined by
summing the total time spent in recreational and transportation
walking, participants were considered to participate in sufficient
walking if they reported greater than 150 min of walking
irrespective of the number of sessions reported. The sufficient
walking category was based upon evidence that walking is the
most popular physical activity engaged in by Australian adults
(Armstrong et al., 2000).
A series of logistic regression models were performed to
examine associations between the presence of environmental
elements and geographic location when adjusting for age, gender,
household income and education. Logistic regression models were
used to examine the association between achieving each activity
criteria and geographical location when adjusting for age, gender,
household income, and education. To examine how the presence
of environmental elements was associated with physical activity a
separate series logistic regression models were run when adjusting for age, gender, household income, education and geographic
location. These analyses were repeated with the inclusion of an
interaction term (geographic location environmental element)
to examine the presence of interactions between geographic
location and presence of environmental elements. When a
significant association was observed between the interaction
term and physical activity the sample was split by geographic
location and the analysis repeated to determine how the presence
of environmental elements were associated with physical activity
in different geographic locations. All analysis was conducted using
SPSS Version 15. (SPSS Inc., Chicago, IL, USA).
Results
A descriptive summary of the total sample is presented in
Table 1. Approximately 56% of respondents lived in metropolitan
areas and there were no univariate relationships between
geographical location, gender and household income. A lower
proportion of non-metropolitan residents reported the presence
of shops and services, footpaths, heavy traffic and physical activity
facilities, compared to metropolitan residents (p ¼ o0.001). With
the exception of heavy traffic (40.2%) a large proportion of all nonmetropolitans reported the presence of physical activity facilities,
footpaths and shops and services (Table 1). No significant
relationship was observed between participation in sufficient
activity and geographic location (p ¼ 40.05), in contrast, a
significantly higher proportion of metropolitan residents participated in walking compared to non-metropolitan residents
(p ¼ 0.017).
Non-metropolitan residents were less likely to report the
presence of shops and services (OR ¼ 0.30, 95% C.I. 0.21–0.43),
footpaths (OR ¼ 0.29, 95% C.I. 0.21–0.41), heavy traffic (OR ¼ 0.53,
95% C.I. 0.40–0.71) and physical activity facilities (OR ¼ 0.27, 95%
C.I. 0.18–0.43) compared to metropolitan residents when adjusting for socio-demographic variables. There were no significant
relationships between geographical location and participation in
either sufficient physical activity or sufficient walking when
adjusting for socio-demographic variables (Table 2).
The presence of shops and services (OR ¼ 1.45, 95% C.I.
1.01–2.08) and footpaths (OR ¼ 1.79, 95% C.I. 1.26–2.54) were
positively associated with participation in sufficient physical
activity, and there was a significant interaction effect observed
for the presence of footpaths and geographical location (Table 3).
The presence of footpaths (OR ¼ 2.87, 95% C.I. 1.57–5.23) was
Table 1
Demographic variables by geographic location of residence
Geographic Location of Sample
Metropolitan
Gender
Male
47.6
Female
52.4
Age
18–34
23.7
35–44
22.5
45–54
20.0
55+
33.8
Years of education
0–10
23.7
11–12
22.8
13–24
12.7
X15
40.7
Household income
o$26,000
20.2
$26,001–$52,000
26.6
$52,000–$100,000
31.4
4$100,000
21.8
Environmental characteristic
Shops & services present 86.8
Footpaths present
84.0
Presence of high traffic
52.4
PA facilities present
92.1
Physical activity
Sufficiently active
48.6
Sufficient walking
41.9
Non-metropolitan
w2
p-Value
48.9
51.1
0.18
0.67
21.8
21.6
27.5
29.1
9.41
0.02
30.5
25.1
11.6
32.7
10.61
0.01
21.8
27.9
31.3
19.0
1.1
0.77
66.3
59.5
40.2
74.1
68.24
85.57
16.83
68.61
o0.001
o0.001
o0.001
o0.001
42.9
34.9
3.668
5.676
0.055
0.017
positively associated with sufficient physical activity in metropolitan areas, but not in non-metropolitan areas. The presence of
shops and services (OR ¼ 1.45, 95% C.I. 1.00–2.10) and physical
activity facilities (OR ¼ 1.64, 95% C.I. 1.05–2.58) were associated
with participation in sufficient walking in the overall sample.
A significant interaction was observed between the presence of
footpaths and geographical area when examining sufficient
walking. Subsequent sub-sample analysis revealed that the
presence of footpaths was associated with sufficient walking in
metropolitan areas but not in non-metropolitan areas.
Discussion
This study is the first to examine how the presence of
environmental elements related to physical activity differ by
degree of urbanisation in an Australian setting and the first to
study the differential effects of these environmental elements on
physical activity behaviour in metropolitan and non-metropolitan
populations within this setting. The resultant observation that
non-metropolitan residents are less likely to report the presence
of the selected environmental elements than their non-metropolitan counterparts is, of itself, likely not particularly noteworthy.
The finding that the presence of some of these elements—specifically footpaths—interacted with geographical location when
correlated with physical activity is more worthy of comment. The
environmental elements examined have been previously associated with physical activity across studies in various geographical
settings (Duncan et al., 2005) and the pattern of reporting
infrastructure presence is similar to previous studies in US
populations (Wilcox et al., 2000).
The differential effects of the reported presence of footpaths
suggest that metropolitan and non-metropolitan populations may
respond differently in terms of physical activity to these
environmental support structures. This point is also important
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M.J. Duncan et al. / Health & Place 15 (2009) 204–209
207
Table 2
Associations between geographic location and the presence of environmental elements and achieving different activity classifications
Shops and servicesa
Footpathsa
Heavy traffica
PA facilitiesa
Sufficient PAa
Sufficient walkinga
Location
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
Metropolitan
Non-metropolitan
1.00
0.30
Referenceb
0.21–0.43
1.00
0.29
Referenceb
0.21–0.41
1.00
0.53
Referenceb
0.40–0.71
1.00
0.27
Referencec
0.18–0.43
1.00
0.94
Referenced
0.70–1.26
1.00
0.85
Referencee
0.63–1.15
a
Model adjusted for age, gender, household income, education.
n ¼ 788.
c
n ¼ 787.
d
n ¼ 776.
e
n ¼ 785.
b
Table 3
Associations between environmental elements and physical activity in the overall sample and different geographic locations
Sufficient PAa
Environmental Element
Shops and Services
No
Yes
Footpaths
No
Yes
Heavy traffic
No
Yes
PA facilities
No
Yes
Sufficient walkinga
Overall sample
Metropolitan
Non-metropolitan
Overall sample
Metropolitan
Non-metropolitan
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
OR
95% C.I.
1.00
1.45
Referenceb
1.01–2.08e
–
–
–
–
1.00
1.45
Referencec
1.00–2.10e
–
-
-
-
c
b
1.79
Reference
1.26–2.54f
2.87
Reference
1.57–5.23
1.39
Reference
0.88–2.19
1.00
1.24
Reference
0.87–1.77f
2.09
1.15–3.81
0.88
0.55–1.40
1.00
0.96
Referenceb
0.71–1.29e
–
Reference
–
–
Reference
–
1.00
1.00
Referencec
0.74–1.35e
–
–
–
–
1.00
1.44
c
1.00
1.64
d
–
–
–
–
Reference
0.93–2.21e
–
Reference
–
–
Reference
–
Reference
1.05-2.58e
a
Model adjusted for age, gender, household income, education and geographic location.
n ¼ 776.
n ¼ 785.
d
n ¼ 784.
e
No significant interaction between presence of environmental element and geographic location.
f
Significant interaction between presence of environmental element and geographic location.
b
c
given that nearly 60% of non-metropolitan residents reported the
presence of footpaths, and further reinforces that the presence of
these particular infrastructure are differentially associated with
activity in each location. Given the predominance for previous
research to focus on metropolitan areas (Humpel et al., 2004a;
Giles-Corti and Donovan, 2002a; Suminski et al., 2005), it is
difficult to understand as to why these findings may have
occurred in the current population. It may be that the presence
of footpaths is more strongly related to physical activity behaviour
in metropolitan areas as footpaths provide a location separate
from traffic and other physical activity impediments that are not
as prolific in non-metropolitan areas. Or factors related to
footpath network continuity may be different between locations,
as this has been associated with activity previously in nonmetropolitan areas (Duncan and Mummery, 2005). Alternatively,
as activity levels were not different between locations, it may
indicate that other unmeasured factors are more influential in
non-metropolitan areas, including environmental and psychosocial correlates. Social support or social norms towards participating in physical activity may be such psycho-social correlates, as
previous US based studies have observed rural residents to report
less social support for engagement in physical activity (Wilcox
et al., 2000). Ultimately there is a need to further investigate these
differential effects, both in terms of replication and with a specific
effort to understand the underlying reasons for these findings
using ecological models that explicitly target not only environmental characteristics but also personal characteristics.
In contrast to previous Australian data (Brown et al., 1999;
Queensland Health, 2004) and other international data (Centers
for Disease Control, 1998; Eyler et al., 2003; Parks et al., 2003;
Bertrais et al., 2004) no differences in physical activity levels were
observed between geographic locations. Previous data specific to
Queensland suggests that those people living in more remote
locations are less active compared to those in less remote
locations (Queensland Health, 2004), although the current study
does not support this assertion. These differences may be due to
methodological differences in the classification of geographic
locations. Additionally, in comparison to previous data, the
prevalence of sufficient activity was higher in the current study
than compared to previous Queensland surveys (Queensland
Health, 2004; Queensland Health and Australian Institute of
Health and Welfare, 2003) and similar to that reported for the
overall Australian population (Bauman et al., 2001). The proportion of both metropolitan and non-metropolitan residents who
reported sufficient walking activity is higher than previously
observed in other Australian surveys (Cole et al., 2006), however
differences in the recall period for activity limit direct comparison.
Although insightful, the current study was subject to several
limitations including delimiting potential participants to those
contactable by landline telephone. Only leisure time physical
activity was assessed and the contribution of occupational activity
to total physical activity was not considered. Employment in
occupational categories varies according to degree of urbanisation
(Australian Bureau of Statistics, 2004) and occupational physical
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M.J. Duncan et al. / Health & Place 15 (2009) 204–209
activity also varies according to occupational category (Steele and
Mummery, 2003; Schofield et al., 2005; Caban-Martinez et al.,
2007). As such assessment of physical activity should include
measures of occupational physical activity when examining
participation in physical activity by degree of urbanisation. Selfreport perceptions of the environment were also used which may
be biased in terms of reporting element presence and prevalence
and may be overcome by the application of objective measures of
environmental elements when data are available. However, this
poses an issue in some non-metropolitan areas as data may not be
available or in sufficient detail for comparison to metropolitan
areas. Also there has been recent attention directed at identifying
context specific influences of specific behaviours (Giles-Corti
et al., 2005b) the current study combined recreational and
transport-related walking due to small proportions of people
engaging in ‘‘sufficient’’ walking in either domain of walking
alone. This may have obscured associations between physical
activity behaviours and environmental elements. Comparison of
the current sample to Queensland estimated sample on gender
and socio-economic status was not possible, and should be
considered when assessing the representativeness of the sample.
Strengths of this study include the use of a large state-wide
sample to conduct an analysis of physical activity correlates that
has not been performed in the study the location previously.
Conclusion
This study adds to the growing body of literature regarding
environmental correlates of physical activity and perceptions of the
environment. Specifically, this research highlights that differences
exist in the presence of environmental elements between metropolitan and non-metropolitan Australians. And that the presence of
these elements is differentially associated with physical activity in
metropolitan and non-metropolitan areas.
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