Built environment policies and physical activity among U.S. adults: A regional analysis from 2006-2013

Introduction: The number of policies designed to improve built environments for physical activity has increased in the U.S. The purpose of this study was to examine relationships between state policies related to the built environment and differences in physical activity behavior of U.S. adults by race/ethnicity.

Methods: Individual-level data (N=158,842) were obtained from the National Health Interview Survey (NHIS) from 2006-2013. The sample consisted of white (n=95,078), black (n=26,422), and Hispanic (n=33,038) adults. Data on built environment policies (N=137) were obtained from the CDC’s Chronic Disease State Policy Tracking System and merged with NHIS data. Zero-inflated negative binomial regressions estimated the relationship between leisure-time moderate and vigorous physical activity and built environment policies, adjusting for potential confounders.

Results: The number of built environment policies enacted per year among U.S. Census regions ranged from 0 to 43, with a mean of 7. A significant (p<.0001) interaction between public health spending and built environment policies was detected. Built environment policies were associated (p. <.002) with increases in moderate and vigorous leisure-time physical activity for black, white, and Hispanic adults who live in the Western U.S. Built environment policies were positively associated (p<.001) with vigorous physical activity in white and black adults who live in the South, but had no association for Hispanic adults.

Conclusion: Policies designed to improve the built environment for physical activity may be more effective in some regions and for some racial/ethnic groups than others. Understanding the content of these policies may clarify why these policies vary in effectiveness.