Physical activity has benefical effects on numerous health outcomes. Higher physical activity levels decrease the risk of cardiovascular disease (CVD), including coronary heart disease, type 2 diabetes, colon cancer, and breast cancer, as well as increasing life expectancy [1
]. Active transportation (i.e., walking and cycling for travel purposes) has been recommended as a practical way of incorporating more physical activity into daily life [2
] and those who engage in active transportation tend to be more active in duration and frequency than those without active transportation [3
]. Furthermore, a systematic review and meta-analysis of 531,333 participants reported that active transportation had a significantly reduced risk of all-cause mortality, cardiovascular disease incidence and diabetes [4
Recently, Latin America has undergone a rapid urbanization process with demographic, epidemiological and socioeconomic changes and is currently the most urbanized region in the world (around 80% of Latin Americans live in cities) [5
]. The urbanization change people’s behaviour and in most cases decrease the physical activity levels. Between 2001 and 2016, the prevalence of physical inactivity (not meeting the physical activity recommendation proposed by the World Health Organization) increased by more than 5 percentage points in Latin America (from 33.4% in 2001 to 39.1% in 2016) [6
]. Overall, the prevalence of physical inactivity (<150 min/week in moderate-to-vigorous physical activity) ranging from 26.9% (Chile) to 47% (Costa Rica and Venezuela). Physical inactivity (>40%) was prevalent in Brazil (43.5%), Argentina (43.7%), Venezuela (47.1%), and Costa Rica (48.0%) [7
]. Furthermore, the highest mean of total sedentary behavior per day were in Costa Rica (524.6 min/day) followed by Brazil (455.1 min/day) [8
]. The Latin American region is characterized by high population density, disorganized and heavy traffic, air and noise pollution, rising crime rates, high-income inequality, high levels of poverty, and population aging [9
]. The dissimilar features of Latin American countries reduce, to translate findings from high-income countries (e.g., the United States, European countries) to this particular region. Therefore, the investigation of how the built environment can influence physical activity during transportation is warranted.
Different studies have explored associations between neighborhood built environmental (destination accessibility, street connectivity, recreational facilities, and public transport) and walking or cycling for transport [11
] and found that characteristics related to active transport infrastructure, connectivity, walkability, safety and aesthetics were associated with higher physical activity during transportation. Nonetheless, most previous research was done in the high-income countries [14
]. Only one of the existing Latin American studies used a representative sample of the urban population which may limit the generalizability of the observed associations, but it was related to a representative sample of only one city per country [13
] and had not sufficient power and variability to assess walking and cycling separately. Therefore, the purpose of the present study was to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in a representative sample of inhabitants from eight Latin America countries.
The present study aimed to investigate whether different perceived built environment characteristics are associated with walking and cycling for transportation. Our main findings were that land use mix-diversity and mix-access, the presence of different alternative routes to access the destination, lower speed limit in the roads, as well as the majority of the drivers respecting speed limit, were associated with higher walking for transportation. The presence of walking or cycling facilities and a higher aesthetics were associated with higher cycling for transportation. We also highlight some regional specific associations land use mix-diversity (Argentina, Brazil, and Colombia), aesthetics (Argentina, Brazil, and Peru), safety from crime (Argentina and Chile - inverse), proximity to public open spaces (Chile), few dead-end streets (Argentina) and low traffic along the nearby streets (Argentina and Venezuela) were associated with higher odds of walking for transport in specific countries. Similarly, land use mix-diversity (Brazil), land use mix-access (Peru), proximity to public open spaces (Brazil and Costa Rica), few dead-end streets (Colombia), the distance between intersections in the neighbourhood (Ecuador), different alternative routes to access the destination (Costa Rica) and the majority of the drivers respecting speed limit (Costa Rica) were associated with higher odds of cycling for transport in specific countries.
Our findings regarding walking for transport are in line with previous findings from economic developed countries [12
]. In this sense, we found that factors related to walkability as connectivity as well as related to traffic safety were the most associated with higher walking for transport. These findings highlight the role of planning compact cities aiming to shift the transportation mode towards higher active transportation through increasing the land use mix-access and connectivity [38
In addition, our findings support the important role of traffic safety on walking for transportation. Therefore, measures for traffic calming and safety as lowering the speed limit of the roads can increase physical activity during transportation as well as reduce road injuries [40
] and consequently, impact secondary health outcomes, producing a disability-adjusted life-years gain [38
The findings also pointed out the role of aesthetics in transportation through cycling. Even the majority of evidence found that aesthetics is important most for leisure-time activities as walking during leisure-time [12
], some previous studies also found an association between aesthetics and physical activity during transport [12
], therefore, a pleasant environment seems to be determinant for the choice of cycling for transportation. Another finding was related to the association of cycling facilities with the adoption of cycling for transportation, which highlightes the need for urban infrastructure supporting cyclists, as the build of bike paths as well as the expansion of integrated transportation systems with infrastructure for cyclists, including bike-sharing and parking [44
Our findings showed that there were more perceived environmental correlates of walking than cycling for transportation across countries. Country-specific associations can guide specific policies for each country included in the present study. For example, different correlates related to connectivity, land use, safety from crime, aesthetics and safety from traffic were associated with walking for transportation in Argentina, while only aesthetics and land use mix-diversity were associated with walking for transportation in Brazil. Similarly, Costa Rica presented the highest number of correlates of cycling for transportation, including the distance of public open spaces, the number of alternative routes and few drivers exceeding the speed limit, while other countries presented more specific unique determinants as land usemix-access for Peru and other did not present correlates as Argentina, Chile, and Venezuela.
Our results shows positive association between walking for transport and land use mix-diversity in Argentina, Brazil and Colombia; land use mix-access was positively associated in overall, Argentina, Colombia, and Venezuela. We found an unequal association between the neighborhood built environment characteristics (e.g., aesthetics [Argentina, Brazil, and Peru], safety from crime [Argentina, and Chile], distance to public open spaces [and Chile]) and walking for transportation by country. The documentary analysis of the ten Latin American cities show several programs in Latin America that positively impact active transportation [44
]. Several cities have implemented policies and programs aimed promoting walking and cycling for transport. Some of the most relevant and commonly implemented programs are the Ciclovia Recreativa Programs, and the implementation of Bus Rapid Transit systems (BRT) projects [44
]. In Latin America, BRT systems have been implemented in Brazil, Ecuador, Peru, Mexico, and Colombia where they are considered an efficient and cost-effective solution for urban mobility [47
]. Although the main objective of BRT is to increase urban mobility and reduce transport-related time, they also have the potential to stimulate the use of walking and cycling for transport and reduce car ownership use, thus promoting prysical activity [48
Despite the health benefits of these systems implemented in Latin American countries, private car ownership in this region has been increasing steadily [49
] such as Brazil, Argentina, Chile, and Colombia [51
]. Studies show that in high-income countries, increasing car ownership does not necessarily lead to an increase in car-usage [52
]. However, lower use of non-motorized modes of transport, the higher social advantage offered by owning a car, unequal public transport systems and the trend of increasing car ownership is likely to have a negative influence on walking and cycling for transport [53
In our results, the odds of reporting cycling for transport was higher in respondents living in neighborhoods perceived to be more aesthetically pleasing and better walking/cycling facilities. It may be that aesthetically pleasing environments and green spaces can act as motivators for engaging in or spending more time in active transportation [55
]. The way aesthetics are associated with active transportation has an important implication [13
]. The aesthetics may play a different role in deciding whether or not to engage in different types of physical activity. While aesthetics may not be a relevant environmental feature for walking, it may play a more relevant role for involvement in moderate-to-vigorous physical activity [56
]. Aesthetics ratings, like safety ratings, were low across all coutries, and this may be an area for improvement with less cost implications than other structural changes.
Some limitations should be considered in the interpretation of our study. These data do not include car ownership that is likely to have a negative influence on walking and cycling for transport [53
]. We used self-reported measures of the built environment (perceived) and physical activity, which can lead to recall bias. Also, the cross-sectional design does not allow a causality interpretation, even the reverse-causality is not probable after the adjustment for sociodemographic factors as socioeconomic status. The use of self-report measures of both neighborhood environments and physical activity should be considered in the interpretation of the findings since there is evidence that items from the IPAQ—long (the measure of physical activity used in this study) may be interpreted differently across different cultures and contexts [57
]. Also, the NEWS scale has been found to assess density and access to services more accurately in low-to-medium density urban environments [17
]. Considering these measurement issues, some of the between-country differences in associations observed in this study might have been due to differences in the interpretation of the survey items. Furthermore, low variability within countries and the small sample sizes in some countries, especially for cycling, may lead to non significant coefficients for variable that affect walking or cycling. This study has several strengths. We presented data on the association between perceived built environment and transportation physical activity (walking and cycling) from eight different Latin-American countries, which enables a regional as well as country-specific vision with more than 9000 participants. By providing a unique Latin American dataset, the present study enabled wider cross-country comparisons and, thus, expanded the existing literature. In addition to identifying neighborhood built environment characteristcs associated with physical activity that might inform public health policies and investments, our findings should be viewed as an opportunity to inform and motivate researchers in Latin America to further examine these relationships. Prospective studies of environmental characteristics and active transportation are needed as well as evidence from intervention studies to better inform policy changes and large-scale environmental interventions.