Multidimensional Neighborhood Environments, Domain-Specific Physical Activity and Sedentary Behavior: A Multilevel Study in Nagpur, India.

Evidence linking multidimensional neighborhood environment (NE) domains to domain-specific physical activity (PA) and sedentary behavior (SB) remains limited in low- and middle-income countries (LMICs). This study investigated these associations among 740 adults in Nagpur, India, using multilevel modeling. Perceived NE was assessed using the Comprehensive Neighborhood Environment Physical Activity Questionnaire, and domain-specific PA and SB (assessed as sitting time, ST) using the International Physical Activity Questionnaire. Two-level linear mixed-effects models were used to estimate the associations, and intraclass correlation coefficients (ICCs) quantified the neighborhood-level variance in PA and SB. Small-to-moderate neighborhood-level clustering was observed across outcomes (ICC range: 0.02-0.15). Greater destination accessibility, social and ambient environments were associated with higher leisure-time PA (LTPA) and overall PA, with ambient environment also positively linked to higher transport-related PA (TPA). Residential density was inversely associated with LTPA and overall PA, while destination accessibility was modestly associated with lower weekday and weekend ST. Higher income was associated with lower TPA but higher LTPA and ST. Obesity was associated with lower LTPA and overall PA and with higher ST. This study highlights the importance of multidimensional NE contexts as correlates of PA behaviors. Integrated, context-sensitive urban planning and public health strategies that address environmental, social, and accessibility issues may help support active lifestyles in rapidly urbanizing LMIC settings.