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Perceived and Objective Neighborhood Characteristics Associated with Physical Activity Among Asian Americans Residing in Philadelphia County

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Perceived and Objective Neighborhood Characteristics Associated with Physical Activity Among Asian Americans Residing in Philadelphia County PERCEIVED AND OBJECTIVE NEIGHBORHOOD CHARACTERISTICS ASSOCIATED WITH PHYSICAL ACTIVITY AMONG ASIAN AMERICANS RESIDING IN PHILADELPHIA COUNTY A Dissertation Submitted to the Temple University Graduate Board In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY by Aisha Bhimla May 2020 Examining Committee Members: David B. Sarwer, Ph.D., Advisory Chair, Department of Social and Behavioral Sciences Grace X. Ma, Ph.D., Department of Clinical Sciences Levent Dumenci, Ph.D., Department of Epidemiology and Biostatistics Lois A. Butcher-Poffley, Ph.D., Department of Kinesiology Kevin A. Henry, Ph.D., External Member, Department of Geography and Urban Studies Andrew T. Kaczynski, Ph.D., External Member, University of South Carolina ABSTRACT Introduction: Physical activity is an important lifestyle behavior known to improve overall health as well as provide substantial reductions in the risk of chronic illnesses, including obesity, cardiovascular disease, certain cancers, hypertension, stroke, depression, and anxiety. The built environment that surrounds where individuals reside has substantial impacts on physical activity behavior. Neighborhood walkability and the availability of physical activity resources such as parks and facilities within neighborhoods serve as opportunities to engage in leisure-based physical activity and active transportation. The purpose of this study was to determine whether objective and perceived built environmental characteristics were associated with neighborhood physical activity levels among Asian Americans living in Philadelphia County, Pennsylvania. Methods: Participants were recruited from July to December 2019. A Built Environment and Physical Activity questionnaire that included socio-demographics, the Neighborhood Environment Walkability Scale (NEWS), and the Neighborhood Physical Activity Questionnaire (NPAQ) were administered in English, Mandarin, Korean, and Vietnamese. The Walk Score was obtained online for each participant’s address. Furthermore, proximity to parks and recreational facilities was measured using Geographic Information Systems (GIS) to find the network distance to the nearest facility and park. Zero-inflated negative binomial regression models were used while controlling for the clustered sample design and for socio-demographic characteristics. Physical activity was generally examined with respect to active transportation, recreational walking/cycling, and overall physical activity. Additional analyses were also conducted ii to examine how perceived versus objective characteristics, and ethnic group differences explained the relationship between built environment predictors and meeting the physical activity guidelines. These findings were assessed through logistic regression models. Results: In research question 1, greater perceived neighborhood walkability was associated with an increased likelihood of engaging in recreational walking/cycling and overall physical activity, but not active transportation. When examining subscales separately, there were differences in which built environmental factors affected various physical activity domains. Physical barriers to walking and fewer cul-de-sacs predicted fewer hours of engaging in active transportation. Having fewer cul-de-sacs, more physical barriers and higher residential density predicted lower odds of engaging in active transportation. Greater perceived land-use mix, lower perceived crime, and having more cul-de-sacs predicted greater hours and lower odds of engaging in recreational walking/cycling. Greater perceived land use mix, aesthetics, more cul-de-sacs, and lower residential density were associated with greater weekly METs of physical activity and a greater likelihood of engaging in overall physical activity. In research question 2, ethnic identity moderated the relationship between perceived neighborhood walkability for active transportation and moderate-intensity physical activity but not overall physical activity. In research question 3, the Walk Score was not statistically significantly associated with various participation in physical activity domains. Lastly, results of research question 4 illustrated that longer driving time to the nearest park was associated with greater METs associated with MVPA and overall PA, and to a specialty exercise facility was linked to greater METs associated with walking and active transportation. iii Furthermore, a shorter walking time to a park was associated with less weekly METs of walking, active transportation, and overall PA, but greater odds of engaging in walking and active transportation. A greater walking time to the nearest specialty exercise facility was associated with greater active transportation and MVPA, but decreased odds of walking and active transportation. Greater driving or walking time/distance to the nearest gym/recreation center were not associated with any type of physical activity. Conclusions: This study illustrated that the built environment could enhance participation in various forms of physical activity among Asian Americans. Having wide and accessible destinations in one’s neighborhood, known as land-use mix, promotes overall physical activity. Furthermore, greater aesthetically pleasing environments and areas with cul-de-sacs can provide spaces to engage in various forms of physical activity. Perceived neighborhood walkability had a strong impact on physical activity behaviors in this population, while mixed evidence was found for the influence of Walk Score and proximity to parks and recreational facilities as predictors of physical activity. While this study provides unique findings among a predominantly Asian American immigrant population, study limitations and recommendations for research suggest future areas to investigate. Nevertheless, major findings can be used to inform environmental and policy strategies to maximize active transportation and recreational based physical activity in order to sustain the health of Asian-American immigrants living in urban areas. DEDICATION iv To my parents, Ishaq and Estrellita Bhimla To the study participants and community organizations who dedicated their time to take part in this study, thank you for all that you continue to do to make this city vibrant, unique, and an overall better place. v ACKNOWLEDGMENTS I am deeply indebted to many individuals who have supported me on this Ph.D. journey during my five years at Temple. I would like to thank my advisor/chair, Dr. Sarwer, for supporting me in the process of completing this project and for drastically helping me improve my scientific writing and critical thinking skills. I am truly grateful to have finished my final year of my Ph.D. under your guidance, expertise, and continuous encouragement to get me to the finish line. Second, I would like to thank Dr. Ma for her unwavering support and mentoring since the beginning of my Ph.D. A major reason I came to Temple was for the opportunity to be part of the Center for Asian Health-- thank you for believing in me, for allowing me to be part of your team, and for the immense opportunities you have provided to allow me to grow into a health disparities researcher. I’d like to thank Dr. Butcher-Poffley (Dr. B), for always being a helping hand and all that she has contributed to my learning and growth as a kinesiology professional. Thank you, Dr. Dumenci, for your willingness to spend a significant amount of time with me in enhancing my statistical and data analysis skills over the past years. I am immensely thankful to Dr. Henry and Dr. Kaczynski (We the North!) for providing their expertise and assistance on my dissertation as experts in the field. This project would not have been possible with the help of several colleagues--I am tremendously thankful for Phuong, Chul, Amy, and Jin, for their support in collecting data for this project. Also, I am enormously thankful to Will Tagliamonte from the Spatial Analytics Lab at Temple for the time he spent assisting me on the GIS portion of this project. I would also like to express my gratitude towards CPH for awarding me the vi Visionary Research Fund and the support of grant funding by Dr. Ma and The Center for Asian Health to carry out the dissertation study activities. My professors, classmates, and co-workers in the Department of Kinesiology have supported me since I began the program. Thank you to Dr. Sachs for shaping me into the researcher I am today and the life lessons you have taught me. A big thank you to Dr. Tierney and Dr. Gehris for always caring, and the great career/life advice you have provided. Sean, Andrea, and Rosalind, thanks for all that you’ve done to support me as a student and TA and for your genuine/kind personalities. I am so thankful for Mr. Harris, Dr. Phillips, and Dr. Rooney for the incredible opportunities that I was able to have as an A&P TA and which I hope to apply as a future professor one day. Lastly, thanks to my classmates, Ksenia Power, Allison Casola, Eric Aurelien, Chrissy Garcia, Jen Ciaccio, Amanda Manu, Gabi Salvatore, and the A&P TA’s who made this experience all the better. A tremendous thanks to all of my incredible co-workers at the Center for Asian Health: Lin, Wenyue, Yin, Minsun, Kerry, Tina, Anastasia, Tyrell, Liz, Timmy, Taylor, and the late Joanne. These past five years have been the best learning experience, and I am grateful to have such a passionate, hardworking, and intellectual team to work with every day. A huge thank you for also helping me on this dissertation, from Taylor
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