Additionally, only one study examined differences in participants' built environment attributes inside and outside spatial clusters of transportation-related physical activity [ 31].
In Pennsylvania, the values for built environment characteristics inside obesity clusters tended to be lower compared to outside the clusters, regardless of whether or not it was a higher or lower obesity cluster (Table 4).
In contrast to the present study, Huang and colleagues found a consistent and expected pattern of built environment differences inside and outside clusters, for example, where inside high active transportation clusters the values of population density and intersection density index were higher than in areas outside of clusters in Los Angeles and San Diego counties in California [ 31].
To the best of this group's knowledge, this study is only the second to compare objective built environment characteristics inside and outside of spatial clusters of physical activity and the first to do so with obesity.
This study's aims were to detect spatial clusters of physical activity and obesity, examine whether the geographic distribution of covariates affects clusters, and compare built environment characteristics inside and outside clusters.
The present study contributes to the sparse literature on spatial clustering of physical activity and obesity among older women, including the limited assessments of spatial confounders, and comparisons of built environment characteristics inside and outside of clusters.
If separate measures of walking for recreation and transportation had been available, different clusters might have been detected and patterns in built environment characteristics inside and outside of spatial clusters might have been different for the two types of walking.
Among eight statistically significant differences in built environment characteristics inside and outside the lower obesity cluster, differences in three attributes were in the expected direction was lower inside the cluster compared to outside (e.g., fast-food facility density; 1.92 vs. 2.20).
In addition to the influence of built environment inside the square, the results confirmed the role of geometry on thermal conditions.
