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Perceived neighborhood environment and physical activity in 11 countries: Do associations differ by country?

Ding Ding123*, Marc A Adams14, James F Sallis1, Gregory J Norman1, Melbourn F Hovell2, Christina D Chambers1, C Richard Hofstetter2, Heather R Bowles5, Maria Hagströmer67, Cora L Craig8, Luis Fernando Gomez9, Ilse De Bourdeaudhuij10, Duncan J Macfarlane11, Barbara E Ainsworth12, Patrick Bergman13, Fiona C Bull14, Harriette Carr15, Lena Klasson-Heggebo16, Shigeru Inoue17, Norio Murase18, Sandra Matsudo19, Victor Matsudo19, Grant McLean20, Michael Sjöström21, Heidi Tomten22, Johan Lefevre23, Vida Volbekiene24 and Adrian E Bauman3

Author Affiliations

1 Department of Family Preventive Medicine, University of California San Diego, La Jolla, California, USA

2 Graduate School of Public Health, San Diego State University, San Diego, California, USA

3 Faculty of Medicine, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia

4 School of Nutrition and Health Promotion, Arizona State University, Phoenix, ArizonaUSA

5 Risk Factor Monitoring and Methods Branch, Applied Research Program, National Cancer Institute, Bethesda, Maryland, USA

6 Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden

7 Department of Neurobiology Care Sciences and Society, Karolinska Institute, Stockholm, Sweden

8 Canadian Fitness and Lifestyle Research Institute, Ottawa, Canada

9 Pontificia Universidad Javeriana, Bogotá, Colombia

10 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium

11 Institute of Human Performance, University of Hong Kong (Macfarlane), Hong Kong, China

12 School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona, USA

13 School of Education, Psychology and Sports Science, Linneaus University, Kalmar, Sweden

14 School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia

15 New Zealand Ministry of Health, Wellington, New Zealand

16 Valnesfjord Rehabilitation Center, Osterkloft, Norway

17 Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan

18 Department of Sports Medicine for Health Promotion, Tokyo Medical University, Tokyo, Japan

19 Center of Studies of the Physical Fitness Research Center from São Caetano do Sul, CELAFISCS, São Paulo, Brazil

20 Sport New Zealand (McLean), Wellington, New Zealand

21 Department of Biosciences and Nutrition at Novum, Unit for Preventive Nutrition, Karolinska Institute, Stockholm, Sweden

22 Oppegård Municipality, Oppegård, Norway

23 Department of Kinesiology and Rehabilitation Sciences, Katholic University, Leuven, Belgium

24 Department of Sport Science, Lithuanian Academy of Physical Education, Kaunas, Lithuania

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International Journal of Behavioral Nutrition and Physical Activity 2013, 10:57  doi:10.1186/1479-5868-10-57

Published: 14 May 2013



Increasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country.


Population representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported.


Significant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries.


There is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

Physical activity; Built environment; Neighborhood environment; International; Generalizability; Moderator