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Physical Activity From Transportation: New Insights and Lingering Questions

      See Related Article on p.263
      In 2009, the American Academy of Pediatrics issued a policy statement promoting active transportation, such as walking or cycling to work and school, as a way to increase physical activity (PA) among youths in the United States (US) [
      Committee on Environmental Health
      The built environment: Designing communities to promote physical activity in children.
      ]. As few as 42.5% of 6- to 11-year-old individuals, 7.5% of 12- to 15-year-old individuals, and 5.1% of 16- to 19-year-old individuals meet PA recommendations based on accelerometry-derived estimates of PA [
      • Katzmarzyk P.T.
      • Denstel K.D.
      • Beals K.
      • et al.
      Results from the United States 2018 Report card on physical activity for children and youth.
      ], and there is some evidence that active transportation is associated with higher moderate-to-vigorous physical activity (MVPA) in school-age children [
      • Larouche R.
      • Saunders T.J.
      • Faulkner G.
      • et al.
      Associations between active school transport and physical activity, body composition, and cardiovascular fitness: A systematic review of 68 studies.
      ]. Despite the potential for increased PA, evidence suggests that the prevalence of active transportation among US youths is low. For example, only about 10% of students between the ages of 5 and 17 years usually walk to school and as few as 1% bike to school based on data from the National Household Travel Survey [
      • Kontou E.
      • McDonald N.C.
      • Brookshire K.
      • et al.
      U.S. active school travel in 2017: Prevalence and correlates.
      ].
      D'Agostino et al [
      • D’Agostino E.M.
      • Armstrong S.C.
      • Alexander E.P.
      • et al.
      Predictors and patterns of physical activity from transportation among United States youth, 2007-2016.
      ] recently examined predictors and patterns of active transportation among US adolescents and young adults using data from the nationally representative National Health and Nutrition Examination Survey. Their work is both timely and important given recent calls for expanding active transportation and active living across the US through policies, systems, and environmental changes [
      • Young D.R.
      • Cradock A.L.
      • Eyler A.A.
      • et al.
      Creating built environments that expand active transportation and active living across the United States: A policy statement from the American Heart association.
      ]. D'Agostino et al largely focused on differences in active transportation across sociodemographic characteristics and contend that having safe and accessible opportunities to engage in active transportation may promote PA and reduce health disparities. They found that low-income and minority youths were more likely to engage in active transportation, yet evidence suggests these youths are less likely to meet recommended PA levels and engage in less MVPA [
      • Armstrong S.
      • Wong C.A.
      • Perrin E.
      • et al.
      Association of physical activity with income, race/ethnicity, and sex among adolescents and young adults in the United States: Findings from the national health and Nutrition Examination survey, 2007-2016.
      ,
      • Miller J.M.
      • Pereira M.A.
      • Wolfson J.
      • et al.
      Are correlates of physical activity in adolescents similar across ethnicity/race and sex: Implications for interventions.
      ].
      The findings of D'Agostino et al raise several important questions that warrant further scientific inquiry. One question pertains to youths' motivations for engaging in active transportation, particularly for low-income and minority youths who tend to live in environments that are less supportive of PA. Data from the 2011–2012 National Survey of Children's Health show that racial and income inequities exist in access to neighborhoods that support PA [
      • Watson K.B.
      • Harris C.D.
      • Carlson S.A.
      • et al.
      Disparities in adolescents' residence in neighborhoods supportive of physical activity - United States, 2011-2012.
      ]. In this survey, neighborhood support for PA was a compositive measure reflecting perceived neighborhood safety and the availability of sidewalks, walking paths, parks, playgrounds, and recreation centers. The proportion of youths living in neighborhoods that support PA was approximately 60% for non-Hispanic black and Hispanic youths compared with 67% for non-Hispanic white youths and 70% for non-Hispanic youths representing multiple or other racial groups. By income, the proportion of youths living in neighborhoods that support PA ranged from 51% among those living in households less than 100% of the federal poverty level to 76% of those in households at least 400% greater than the federal poverty level [
      • Watson K.B.
      • Harris C.D.
      • Carlson S.A.
      • et al.
      Disparities in adolescents' residence in neighborhoods supportive of physical activity - United States, 2011-2012.
      ]. Given low-income and minority youths tend to reside in less-active-friendly environments, these youth may be more likely to engage in active transportation owing to necessity rather than personal preference. Ensuring these youths can safely engage in active transportation should be a national priority given they are less likely to reside in active-friendly environments.
      Another important question is the role that active transportation might have in addressing PA disparities. D'Agostino et al. conclude from their findings that active transportation is a feasible target for reducing health disparities and improving health. Given that minority and low-income youths are less likely to meet PA recommendations but are more likely to engage in active transportation, a plausible question for future research is whether promoting active transportation will reduce or widen PA disparities. To some extent, this will depend on how PA is defined. Initiatives to promote active transportation may inadvertently widen PA disparities if the resulting active transportation is of low intensity and/or is viewed as a replacement for other types of PA that would meet MVPA thresholds. This concern has been echoed by others who speculate that conflicting evidence on the relationship between active transportation and body composition may be owing to compensatory reductions in other types of PA [
      • Larouche R.
      • Saunders T.J.
      • Faulkner G.
      • et al.
      Associations between active school transport and physical activity, body composition, and cardiovascular fitness: A systematic review of 68 studies.
      ]. This may partially explain why minority and low-income youths engage in less MVPA despite being more likely to engage in active transportation. Youths who engage in active transportation out of necessity may also be less likely to have opportunities to engage in recreation activity, which is the activity domain that accounts for the highest proportion of adolescents meeting PA recommendations [
      • Moseley C.A.
      • Skinner A.C.
      • Perrin E.M.
      • et al.
      Adolescent and young adult recreational, occupational, and transportation activity: Activity recommendation and weight status relationships.
      ]. Differences in achieving MVPA recommendations may also widen if improvements to the built environment to support active transportation exert differential effects among population subgroups. For example, analyses of the Eating and Activity in Teens trial suggest that neighborhood road connectivity was not associated with MVPA among white and African-American girls and that increased road crossings were associated with less MVPA among Hispanic and Asian girls [
      • Miller J.M.
      • Pereira M.A.
      • Wolfson J.
      • et al.
      Are correlates of physical activity in adolescents similar across ethnicity/race and sex: Implications for interventions.
      ]. These questions and issues pertaining to active transportation should be pursued as part of ongoing and future research and have important implications for public health policy addressing PA inequities and disparities among low-income and minority youths.
      Although the National Health and Nutrition Examination Survey represents a nationally representative sample of US youth, D'Agostino et al raise an important point about the generalizability of their findings from a rural-urban perspective. In one systematic review of studies conducted in North America, distance to school was the factor most strongly associated with active school transportation [
      • Rothman L.
      • Macpherson A.K.
      • Ross T.
      • Buliung R.N.
      The decline in active school transportation (AST): A systematic review of the factors related to AST and changes in school transport over time in North America.
      ]. Distance may particularly be a barrier for active transportation among rural youths given evidence that distance to schools, restaurants, supermarkets, and convenience stores is negatively associated with MVPA among rural but not urban youths [
      • Moore J.B.
      • Brinkley J.
      • Crawford T.W.
      • et al.
      Association of the built environment with physical activity and adiposity in rural and urban youth.
      ]. This may partially reflect limited opportunities for rural youths to feasibly and safely walk or cycle to school, work, or other locations owing to the combined effects of longer travel distances and less environmental support for PA. Various aspects of the built environment including land use mix, street connectivity, walkability, and residence density have been associated with active transportation among US youths [
      • Tewahade S.
      • Li K.
      • Goldstein R.B.
      • et al.
      Association between the built environment and active transportation among U.S. adolescents.
      ], and these factors are likely to be less prevalent in many rural areas. Indeed, evidence suggests that adolescents living in rural areas are less likely to live in neighborhoods that support PA compared with those in urban areas [
      • Watson K.B.
      • Harris C.D.
      • Carlson S.A.
      • et al.
      Disparities in adolescents' residence in neighborhoods supportive of physical activity - United States, 2011-2012.
      ]. With respect to active transportation to school, approximately 78% of students who usually walk to school travel less than one mile and nearly 83% of those who bike travel less than two miles. However, even when schools are located within half a mile, proportionally fewer rural students walk to school than urban students (46% vs. 61%, respectively) [
      • Kontou E.
      • McDonald N.C.
      • Brookshire K.
      • et al.
      U.S. active school travel in 2017: Prevalence and correlates.
      ]. For distances greater than two miles, more than 95% of both rural and urban students rely on an automobile or school bus to travel to school. Future research is needed to identify effective strategies for overcoming distance and other environmental barriers to active transportation, particularly among rural residents.
      In summary, D'Agostino et al have made an important contribution to the literature that raises several questions for further inquiry about active transportation and PA among US youths. Promoting PA among US youths across diverse populations and settings remains an important public health priority and examining active transportation to achieve this goal is a worthwhile endeavor.

      Acknowledgments

      Demetrius Abshire was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number K23MD013899. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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