Restricted accessResearch articleFirst published online 2011-5
Statistical Approaches to Testing the Relationships of the Built Environment with Resident-Level Physical Activity Behavior and Health Outcomes in Cross-Sectional Studies with Cluster Sampling
To achieve valid conclusions, studies exploring associations of the built environment with residents' physical activity and health-related outcomes need to employ statistical approaches accounting for clustered data. This article discusses the following main statistical approaches: analysis of covariance, regression models with robust standard errors, generalized estimating equations, and multilevel generalized linear models. The choice of a statistical method depends on the characteristics of the study and research questions. While the first three approaches are employed to account for clustering in the data, multilevel models can also help unravel more substantive issues within a social ecological theoretical framework of health behavior.
AltmanDouglas G.Martin BlandJ.1995. Absence of evidence is not evidence of absence. British Medical Journal311:485.
2.
BerlinJesse A.KimmelStephen E.HaveThomas R. TenSammelMary D.1999. An empirical comparison of several clustered data approaches under confounding due to cluster effects in the analysis of complications of coronary angioplasty. Biometrics55:638–45.
3.
BeggMelissa D.ParidesMichael K.2003. Separation of individual-level and cluster-level covariate effects in regression analysis of correlated data. Statistics in Medicine22:2591–602.
4.
BurtonPaulGurrinLyleSlyPeter. 1998. Extending the simple linear regression model to account for correlated responses: An introduction to generalized estimating equations and multi-level mixed modeling. Statistics in Medicine17:1261–91.
5.
Centers of Disease Control and Prevention. 2007. Prevalence of regular physical activity among adults—United States, 2001 and 2005. Morbidity and Mortality Weekly Report56:1209–12.
6.
CerinEsterLeslieEva. 2008. How socio-economic status contributes to participation in leisure-time physical activity. Social Science and Medicine66:2596–609.
7.
CerinEsterLeslieEvaToitLorinne duOwenNevilleFrankLawrence D.2007. Destinations that matter: Associations with walking for transport. Health and Place13:713–24.
8.
CerinEsterLeslieEvaOwenNeville. 2009. Explaining socio-economic status differences in walking for transport: An ecological analysis of individual, social and environmental factors. Social Science and Medicine68:1013–20.
9.
CerinEsterSaelensBrian E.SallisJames F.FrankLawrence D.2006. Neighborhood environment walkability scale: Validity and development of a short form. Medicine and Science in Sports and Exercise38:1682–91.
10.
CraigCora L.RussellStorm J.CameronChristineBaumanAdrian. 2004. Twenty-year trends in physical activity among Canadian adults. Canadian Journal of Public Health95:59–63.
11.
DeBourdeaudhuijIlseJames F. SallisSaelensBrian E.2003. Environmental correlates of physical activity in a sample of Belgian adults. American Journal of Health Promotion18:83–92.
12.
DoyleScottKelly-SchwartzAlexiaSchlossbergMarkStockardJean. 2006. Active community environments and health. Journal of the American Planning Association72:19–31.
13.
EwingReidSchmidTomKillingsworthRichardZlotAmyRaudenbushStephen. 2003. Relationship between urban sprawl and physical activity, obesity, and morbidity. American Journal of Health Promotion18:47–57.
14.
FitzmauriceGarrett M.1995. A caveat concerning independence estimating equations with multivariate binary data. Biometrics51:309–17.
AnnForsythHearstMaryMichael OakesJ.SchmitzKathryn H.2008. Design and destinations: Factors influencing walking and total physical activity. Urban Studies45:1973–96.
17.
AnnForsythHearstMaryMichael OakesJ.SchmitzKathryn H.2007. Does residential density increase walking and other physical activity?Urban Studies44:679–97.
18.
FrankLawrence D.EngelkePeter O.2001. The built environment and human activity patterns: Exploring the impacts of urban form on public health. Journal of Planning Literature16:202–18.
19.
FrankLawrence D.SallisJames F.ConwayTerry L.ChapmanJames E.SaelensBrian E.BachmanWilliam. 2006. Many pathways from land use to health: Associations between neighborhood walkability, body mass index, and air quality. Journal of the American Planning Association72:75–87.
20.
FrootKenneth. A.1989. Consistent covariance matrix estimation with cross-sectional dependence and heteroskedasticity in financial data. Journal of Financial and Quantitative Analysis24:333–55.
21.
Giles-CortiBillieDonovanRobert J.2002. Socioeconomic status differences in recreational physical activity levels and real and perceived access to supportive physical activity environment. Preventive Medicine35:601–11.
22.
HandySusan L.CaoXinyuMokhtarianPatricia L.2006. Self-selection in the relationship between built environment and walking: Evidence from Northern California. Journal of the American Planning Association72:55–74.
23.
HandySuzan L.CaoXinyuMokhtarianPatricia L.2008. The causal influence of neighborhood design on physical activity within the neighborhood: Evidence from Northern California. American Journal of Health Promotion22:350–8.
24.
HandySuzan L.CliftonKelly J.2007. Planning and the built environment: Implications for obesity prevention. In Handbook of obesity prevention. A resource for health professionals, ed. KumanyikaS.BrownsonRoss, 167–88. New York, NY: Springer.
25.
HardinJames W.HilbeJoseph. 2001. Generalized linear models and extensions. College Station, TX: Stata Press.
26.
HenryGary T.1990. Practical sampling. Newbury Park, CA: Sage.
27.
HoehnerChristine M.RamirezLaura K. BrennanElliottMichael R.HandySusan L.BrownsonRoss C.2005. Perceived and objective environmental measures and physical activity among adults. American Journal of Preventive Medicine28:105–16.
28.
HoltzclawJohnClearRobertDittmarHankGoldsteinDavidHaasPeter. 2002. Location efficiency: Neighborhood and socio-economic characteristics determine auto ownership and use—studies in Chicago, Los Angeles, and San Francisco, Transportation Planning and Technology25:1–27.
29.
HortonNicholas J.LipsitzStuart R.1999. Review of software to fit generalized estimating equation regression models. The American Statistician53:160–9.
30.
HoxJoop. 2002. Multilevel analysis: Techniques and applications. Mahawah, NJ: Lawrence Erlbaum Associates.
31.
HuberPeter J.1967. The behavior of maximum likelihood estimates under nonstandard conditions. In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, 221–223. Berkeley, CA: University of California Press.
32.
KauermannGöranCarrollRaymond J.2001. A note on the efficiency of sandwich covariance matrix estimation. Journal of American Statistical Association96:1387–96.
KrizekKevin J.2003. Residential location and changes in urban travel: Does neighborhood-scale urban form matter?Journal of the American Planning Association69:265–81.
35.
LeeChananMoudonAnne V.CourboisJean-Yves P.2006. Built environment and behavior: Spatial sampling using parcel data. Annals of Epidemiology16:387–94.
36.
LeitzmannMichael F.ParkYikyungBlairAaronBallard-BarbashRachelMouwTraciHollenbeckAlbert R.SchatzkinArthur. 2007. Physical activity recommendations and decreased risk of mortality. Archives of Internal Medicine167:2453–60.
37.
LiangKung-YeeZegerScott L.1986. Longitudinal data analysis using generalized linear models. Biometrica73:13–22.
38.
LovasiGina S.HutsonMalo A.GuerraMonicaNeckermanKathryn M.2009. Built environments and obesity in disadvantaged populations. Epidemiologic Reviews31:7–20.
39.
MacintyreSallyEllawayAnne. 2003. Neighbourhoods and health: Overview. In Neighborhoods and health, ed. , 20–43. New York, NY: Oxford Press.
40.
MackinnonJames G.HalbertWhite. 1985. Some heteroskedasticity consistent covariance matrix estimators with improved finite sampling properties. Journal of Econometrics29:53–7.
41.
ManclLoyd A.LerouxBrian G.1996. Efficiency of regression estimates for clustered data. Biometrics52:500–11.
42.
McCullaghPeter. 1992. Discussion of the paper by Liang, Zeger & Qaqish”Multivariate regression analysis for categorical data”. Journal of the Royal Statistical Society, Series B, 54:24–6.
43.
MurrayDavid M.HannanPeter J.WolfingerRussel D.BakerWilliam L.DwyerJames H.1998. Analysis of data from group-randomized trials with repeat observations on the same groups. Statistics in Medicine17:1581–600.
44.
NeuhausJohn M.1992. Statistical methods for longitudinal and clustered designs with binary responses. Statistical Methods in Medical Research1:249–73.
45.
NeuhausJohn M.KalbfleischJohn D.1998. Between- and within-cluster covariate effects in the analysis of clustered data. Biometrics54:638–645.
46.
NeuhausJohn M.LesperanceMary L.1996. Estimation efficiency in a binary mixed effects model setting. Biometrica83:441–6.
47.
NortonEdward C.BielerGayle S.EnnettSusan T.ZarkinGary A.1996. Analysis of prevention program effectiveness with clustered data using Generalized Estimating Equations. Journal of Consulting and Clinical Psychology64:919–26.
48.
OwenNevilleCerinEsterLeslieEvaToitLorinne duCoffeeNeil T.FrankLawrence D.BaumanAdrianHugoGraeme J.SaelensBrian E.SallisJames F.2007. Neighborhood walkability and the walking behavior of Australian adults. American Journal of Preventive Medicine33:387–95.
49.
PrenticeRoss L.1988. Correlated binary regression with covariates specific to each binary observation. Biometrics44:1033–1048.
50.
QuillianLincolnPagerDevah. 2001. Black neighbors, higher crime?The role of racial stereotypes in evaluations of neighborhood crime. American Journal of Sociology107:717–67.
51.
RivaMyleneGauvinLiseApparicioPhilippeBrodeurJean-Marc. 2009. Disentangling the relative influence of the built and socioeconomic environments on walking: The contribution of areas homogenous along exposures of interest. Social Science and Medicine69:1296–305.
52.
RodriguezDaniel A.JooJoonwon. 2004. The relationship between non-motorized mode choice and the local physical environment. Transportation Research Part D: Transport and Environment9:151–73.
53.
SallisJamesTracy OrleansC.2004. Ecological models: Application to physical activity. In Encyclopedia of health and behavior, ed. AndersonNorman B., 288–90. Thousand Oaks, CA: Sage.
SnijdersTomBoskerRoel. 1999. Multilevel analysis: An introduction to basic and advanced multilevel modeling. London, UK: Sage.
57.
StokolsDaniel. 1992. Establishing and maintaining healthy environments: Towards a social ecology of health promotion. American Psychologist47:6–22.
58.
Transportation Research Board, and Institute of Medicine of the National Academies. 2005. Does the built environment influence physical activity? Examining the evidence. Washington, DC: Transportation Research Board.
59.
WhiteHalbert. 1980. A heteroscedasticity-consistent covariance matrix and a direct test for heteroscedasticity. Econometrica48:817–38.
60.
ZhaoLue PingPrenticeRoss L.SelfSteven.G.1992. Multivariate mean parameter estimation by using a partial exponential model. Journal of the Royal Statistical Society, Series B54:805–11.
61.
ZornChristopher J. W.2001. Generalized estimating equation models for correlated data: A review with applications. Journal of Political Science45:470–90.
