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Preventing Chronic Disease: Public Health Research, Practice and Policy

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Emerging Infectious Diseases Journal


Volume 2: No. 2, April 2005

Engaging Older Adults to Be More Active Where They Live: Audit Tool Development


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Melissa Kealey, Judy Kruger, Rebecca Hunter, Susan Ivey, William Satariano, Constance Bayles, Laura Brennan Ramirez, Lucinda Bryant, Courtney Johnson, Chanam Lee, David Levinger, Kathleen McTigue, Gwen Moni, Anne Vernez Moudon, Delores Pluto, Thomas Prohaska, Christen Sible, Sabrina Tindal, Sara Wilcox, Kendra Winters, Kathy Williams

Suggested citation for this article: Kealey M, Kruger J, Hunter R, Ivey S, Satariano W, Bayles C, et al. Engaging older adults to be more active where they live: audit tool development [abstract]. Prev Chronic Dis [serial online] 2005 Apr [date cited]. Available from: URL:


Track: Social Determinants of Health Inequities

Because of an increase in the prevalence of chronic diseases and an aging population, older adults are at highest risk for poor health. Health disparities by age and socioeconomic status have been shown to exist for many physical activity outcomes and may be explained in part by differences in the built environment in which older adults live, work, and play. Partners of the Environmental Workgroup of the Centers for Disease Control and Prevention Healthy Aging Research Network (HAN) have designed and piloted an instrument that focuses on the relationship between the built environment and physical activity in older adults.

Neighborhoods in seven diverse U.S. communities served by HAN were studied: Alamosa, Colo; Columbia, SC; Hendersonville, NC; Seattle, Wash; McKeesport, Pa; Chicago, Ill; and Berkeley, Calif. An environmental audit instrument, developed to be sensitive to issues of importance to older adults, was designed to assess street-scale factors associated with physical activity across multiple settings. Audit items included land use, destinations, sidewalk and intersection conditions, amenities such as benches, social disorder such as litter, and the types of human activity observed. In the pilot study, 15–30 street segments were audited by two or more trained researchers at each of the seven HAN sites. In addition to the audit, qualitative semi-structured interviews were conducted to identify additional items of importance to adults aged 65 years or older.

Inter-rater reliability among the trained researchers was examined. Researchers across the seven HAN sites examined differences in neighborhood segments audited to determine the distribution of study variables, such as presence of sidewalks and crosswalks. Qualitative interviews of older adults about environmental influences on walking behavior revealed that having destinations to walk to appeared to be an important motivator for walking, although many people reported both walking to reach destinations as well as taking walks just for pleasure. Destinations such as grocery stores, banks, pharmacies, restaurants, and beauty parlors were mentioned, as were churches, libraries, parks, and the homes of family, friends, and neighbors. Personal safety was another frequently mentioned topic, with many residents feeling safe walking during the daytime but not at night. Interviewees indicated that their choice of walking routes was influenced by the length of the route, sidewalk quality, people along the route, amount of traffic, crosswalks and signals for crossing the street, perceived safety from crime, scenery, aesthetics, and presence of interesting things to look at. Future directions include using the environmental audit instrument in a study to see which environmental audit items are correlated with actual walking behavior in an older population.

Corresponding Author: Judy Kruger, PhD, Epidemiologist, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Hwy NE, Mail Stop K-46, Atlanta, GA 30341. Telephone: 770-488-5922. Email:

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