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Int. J. Environ. Res. Public Health 2017, 14(9), 953; doi:10.3390/ijerph14090953

Does Physical Activity Mediate the Associations Between Local-Area Descriptive Norms, Built Environment Walkability, and Glycosylated Hemoglobin?

1
Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, University Drive, Bruce 2617, Australia
2
Spatial Epidemiology & Evaluation Research Group, School of Health Sciences and Centre for Population Health Research, University of South Australia, North Terrace, Adelaide 5001, Australia
3
Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5005, Australia
4
Department of Medicine, University of Melbourne, St Vincent’s Hospital, Parkville, Melbourne 3010, Australia
*
Author to whom correspondence should be addressed.
Received: 21 July 2017 / Revised: 15 August 2017 / Accepted: 21 August 2017 / Published: 23 August 2017
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Abstract

Associations between local-area residential features and glycosylated hemoglobin (HbA1c) may be mediated by individual-level health behaviors. Such indirect effects have rarely been tested. This study assessed whether individual-level self-reported physical activity mediated the influence of local-area descriptive norms and objectively expressed walkability on 10-year change in HbA1c. HbA1c was assessed three times for adults in a 10-year population-based biomedical cohort (n = 4056). Local-area norms specific to each participant were calculated, aggregating responses from a separate statewide surveillance survey for 1600 m road-network buffers centered on participant addresses (local prevalence of overweight/obesity (body mass index ≥25 kg/m2) and physical inactivity (<150 min/week)). Separate latent growth models estimated direct and indirect (through physical activity) effects of local-area exposures on change in HbA1c, accounting for spatial clustering and covariates (individual-level age, sex, smoking status, marital status, employment and education, and area-level median household income). HbA1c worsened over time. Local-area norms directly and indirectly predicted worsening HbA1c trajectories. Walkability was directly and indirectly protective of worsening HbA1c. Local-area descriptive norms and walkability influence cardiometabolic risk trajectory through individual-level physical activity. Efforts to reduce population cardiometabolic risk should consider the extent of local-area unhealthful behavioral norms and walkability in tailoring strategies to improve physical activity. View Full-Text
Keywords: physical activity; cardiometabolic disease; residential environments; descriptive norms; built environment; walkability; mediation; glycosylated hemoglobin physical activity; cardiometabolic disease; residential environments; descriptive norms; built environment; walkability; mediation; glycosylated hemoglobin
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Carroll, S.J.; Niyonsenga, T.; Coffee, N.T.; Taylor, A.W.; Daniel, M. Does Physical Activity Mediate the Associations Between Local-Area Descriptive Norms, Built Environment Walkability, and Glycosylated Hemoglobin? Int. J. Environ. Res. Public Health 2017, 14, 953.

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