Influences of Built Environment with Hilly Terrain on Physical Activity in Dalian, China: An Analysis of Mediation by Perceptions and Moderation by Social Environment.

Neighborhood built environment may influence residents' physical activity, but evidence of non-major Chinese cities is lacking. We investigated the impact of five socio-demographic characteristics, 10 objectively assessed environment characteristics, eight perceived neighborhood attributes, and social environment on physical activity and health outcomes (sense of community, body mass index, as well as self-reported health status). We also examined (1) five conceptually comparable perceived neighborhood attributes as mediators of the relationship between objective environment attributes and physical activity; (2) other perceived indicators and social environment as moderators of those relationships, using the mediation analysis in regression. Objectively assessed residential density, land use mix, street connectivity, and accessibility were curvilinearly and/or linearly related to physical activity. The slope of terrain was inversely associated with body mass index (BMI). None of the perceived attributes were found as mediators probably due to the weak associations between subjective and objective environments. High density facilitated physical activity but hindered the sense of community. Further, the perceived aesthetic and safety were associated with physical activity. Additionally, social environment moderated the positive associations of all perceived environments (except for slope) and sense of community. The present study demonstrated that both physical and social environment attributes significantly correlated with physical activity in Dalian.