The way communities are designed has a great influence on how active we are. When communities are safe, well-maintained and have appealing scenery, children and families are more likely to be active. Unfortunately, many people—especially those at high risk for obesity—live in communities that lack parks and have high crime rates, dangerous traffic patterns and unsafe sidewalks. Such communities discourage residents from walking, bicycling and playing outside. Increasingly, local governments are considering how community design will impact residents’ physical activity. Our research documents effective strategies for creating communities that support active living and promote health.
View The Role of Communities in Promoting Physical Activity infographic.
Martinie, A., Brouwer, R. J., & Benjamin Neelon, S. E. (2012). Mebane on the Move: A Community-based Initiative to Reduce Childhood Obesity. North Carolina Medical Journal, 73(5), 382-383.
Burgoine, T., Jones, A. P., Namenek Brouwer, R. J., & Benjamin Neelon, S. E. (2015). Associations between BMI and Home, School and Route Environmental Exposures Estimated Using GPS and GIS: Do We See Evidence of Selective Daily Mobility Bias in Children? International Journal of Health Geographics, 14(8).
BACKGROUND: This study examined whether objective measures of food, physical activity and built environment exposures, in home and non-home settings, contribute to children's body weight. Further, comparing GPS and GIS measures of environmental exposures along routes to and from school, we tested for evidence of selective daily mobility bias when using GPS data. METHODS: This study is a cross-sectional analysis, using objective assessments of body weight in relation to multiple environmental exposures. Data presented are from a sample of 94 school-aged children, aged 5-11 years. Children's heights and weights were measured by trained researchers, and used to calculate BMI z-scores. Participants wore a GPS device for one full week. Environmental exposures were estimated within home and school neighbourhoods, and along GIS (modelled) and GPS (actual) routes from home to school. We directly compared associations between BMI and GIS-modelled versus GPS-derived environmental exposures. The study was conducted in Mebane and Mount Airy, North Carolina, USA, in 2011. RESULTS: In adjusted regression models, greater school walkability was associated with significantly lower mean BMI. Greater home walkability was associated with increased BMI, as was greater school access to green space. Adjusted associations between BMI and route exposure characteristics were null. The use of GPS-actual route exposure did not appear to confound associations between environmental exposures and BMI in this sample. CONCLUSIONS: This study found few associations between environmental exposures in home, school and commuting domains and body weight in children. However, walkability of the school neighbourhood may be important. Of the other significant associations observed, some were in unexpected directions. Importantly, we found no evidence of selective daily mobility bias in this sample, although our study design is in need of replication in a free-living adult sample.
Workshop at the 2015 Active Living Research Annual Conference.
Initiating and developing multi-national collaborations is a task- and socially-oriented, dynamic process that results in shared goals and products. The initiation of the collaboration can occur from any side, but the development process—the adoption of a shared identity with the collaboration, the transcultural learning and sharing, the tolerance of differences and the recognized benefits outweighing the limitations—must be endorsed by all sides to achieve desired outcomes. This workshop discussed strategies and techniques drawing on community based participatory research methodology, Cialdini’s Principles of Persuasion, reflective listening and cultural anthropology to identify culturally relevant practices and described lessons learned during the implementation of the CAMBIO Project – Canada and Mexico Battling Childhood Obesity and the development of the Multinational Collaboration to Increase Physical Activity in Hispanics. Participants in this workshop received classroom style training and interactive demonstrations along with small group work to master skills focused on identifying collaboration strengths and weaknesses along with areas of opportunity and threats to productivity. Specific examples came from innovations in reverse innovation, relevant technology and cultural trends.
Creating "activity-friendly environments" is recommended to promote physical activity, but potential co-benefits of such environments have not been well described. An extensive but non-systematic review of scientific and "gray" literature was conducted to explore a wide range of literature to understand the co-benefits of activity-friendly environments on physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. Five physical activity settings were defined: parks/trails, urban design, transportation, schools, and workplaces/buildings.
A peer-reviewed paper based on this report is available online through open access here.
Presentation at the 2015 Active Living Research Annual Conference.
Local policymakers can support land use policies that encourage active living . Previous research has examined the motivation of local officials for participating in the development, adoption, and implementation of policies supportive of physical activity, particularly land use policies [2-5]. However, most studies only provide insight on the intrapersonal motivations for local policymakers to be engaged in land use policies, and not the contextual factors that may also impact policy participation.
The purpose of this study was to explore individual- and city-level predictors of involvement in land use policies supportive of active living among local policymakers.
In 2012, a cross-sectional survey was administered online to elected and appointed officials in urban areas with ≥50,000 residents. Recruitment targeted 94 communities in CO, GA, HI, KS, MA, MO, NC, and WV. The survey was developed and tested by Goins and colleagues and assessed the perceived attitudes, beliefs, and behaviors of municipal officials, with respect to built environment public policies.4 For this study, the dependent variable was participation in the development, adoption, or implementation of a municipal land use policy to increase mixed use, density, street connectivity, or pedestrian or bicycle access (yes/no). Two questions asked about perceived importance of physical activity and livability issues in their day-to-day job responsibilities using a 5-point scale. Two questions asked about perceived resident support of local government action to address physical activity and livability issues using a 5-point scale. Participants also indicated whether they lived in the city in which they worked (yes/no). City-level variables were collected from 2010 U.S. Census Data and included percentage of commuters by public transit, bicycle, and walking . A two-level hierarchical logistic regression model was developed to identify individual (Level-1) and city (Level-2) characteristics associated with municipal officials’ involvement in a local land use policy supportive of active living using R. The following multilevel model building approach was used: A null model for the binary outcome was fit to calculate the intraclass correlation coefficient. Second, Level-1 predictors were added to the logistic regression model as fixed effects. Third, Level-2 predictors were added simultaneously as fixed effects to the model with Level-1 predictors. The addition of each block of variables was evaluated using the Akaike Information Criterion (AIC).
463 individuals responded (response rate=26%). After excluding subjects with missing data for workplace zip code, 413 individuals representing 83 municipalities were included in the analyses. Participants were mostly male (70%), White (78%), had a college degree or higher (92%), and lived in the city where they worked (78%). Higher perceived importance of livability issues to job responsibilities was positively associated with land use policy participation (OR=1.81, 95% CI=0.33, 0.86). Participants residing in the city where they worked were 1.88 times more likely to participate in a land use policy supporting active living than those not living near their workplace. Among the city-level variables assessed, for every 1-percent increase in the city-level bicycling rate, the odds of participation in a land use policy significantly increased by a factor of 1.48 (95% CI=0.08, 0.71).
Our study resulted in several important findings. Higher perceived importance of livability issues to job responsibilities was positively associated with land use policy engagement. Thus, it may be beneficial for public health professionals to frame land use policies supportive of physical activity in terms of livability. Second, participants representing cities with a higher percentage of bicycle commuters were more likely to participate in a land use policy. Although not a measure of public support, this might suggest that local policymakers may be more likely to engage in a land use policy in cities where residents are supportive of bicycling. The current study has limitations. Policy development, adoption, and implementation were not assessed as separate policy activities, which represents an area of future research. The study response rate was low, the cross-sectional data collected does not allow causal inference, and data were self-reported. City-level predictors represented walking, bicycling, and public transportation rates only for employed individuals commuting to and from work, not for recreation. However, this is one of the first studies to apply multilevel approaches to examine factors associated with land use policy involvement of municipal officials.
These findings could be used to identify specific leverage points for land use policy advocacy at the local level and to inform opportunities for increasing involvement in land use policy decisions among local policymakers. Land use policy issues framed within the context of livability concerns may encourage local policymakers to become more engaged in these types of policies. Given that local policymakers representing cities with a higher proportion of bicyclist commuters were more likely to engage in land use policies, advocacy should also target communities where bicycling levels may not be as high. Further exploration of the broader contextual factors influencing the development, adoption, and implementation of policies supportive of active living is needed.
- Dannenberg AL, Jackson RJ, Frumkin H, et al. The impact of community design and land use choices on public health: A scientific research agenda. Am J Pub Health. 2003; 93:1500-8.
- Aytur SA, Rodriguez DA, Evenson, KR, Catellier DJ, Rosamon WD. Promoting active community environments through land use and transportation planning. Am J Health Promot. 2007; 21: 397-407.
- Dill J, Howe D. The role of health and physical activity in the adoption of innovative land use policy: findings from surveys of local governments. J Phys Act Health. 2011; 8:S116–24.
- Goins KV, Schneider KL, Brownson RC, et al. Municipal officials’ perceived barriers to consideration of physical activity in community design decision making. J Public Health Manag Pract. 2013; 19:S65–73.
- Maddock JE, Reger-Nash B, Heinrich K, Leyden KM, Bias TK. Priority of activity-friendly community issues among key decision makers in Hawaii. J Phys Act Health. 2009; 6:386-390.
- US Bureau of the Census. Commuting characteristics by sex, ACS Data from 2006-2010.
Support / Funding Source
This study was funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number U48/DP001903 from the CDC, Prevention Research Centers Program, Special Interest Project 9-09, and Physical Activity Policy Research Network.
Presentation at the 2015 Active Living Research Annual Conference.
Over 20% of Latino youth in the US are considered obese. Culturally adapted interventions that address the physical, social, and environmental influences on physical activity and diet are needed to help reduce health disparities in Latino youth. However, there is often a lack of understanding among researchers about how to tailor interventions to positively reach these communities. Community-Engaged Research (CEnR) can bridge this gap. This poster highlights lessons learned from The Healthy Activities Partnership Program for Youth (HAPPY), an ongoing intervention to promote healthy nutrition, physical activity, and media literacy among Latino children.
The HAPPY intervention is a partnership between the United Community Center and the University of Wisconsin School of Medicine and Public Health. Intervention design was guided by results from a previous pilot study, which analyzed individual, social, and environmental barriers to physical activity and healthy eating among Latino children (age 10-14) enrolled in UCC's Bruce-Guadalupe Community School (BGCS). Results indicated that there was a strong need for a multilevel intervention. The percentage of overweight children (n=190) in the pilot study was 52%, significantly higher than the national average (39%). The study found that higher body-mass index (BMI) values were associated with higher sugar intake and among those living on streets with heavy traffic. Despite the availability of fresh-food alternatives, almost all food trips made by children in the study were to convenience stores. The children explained the importance of snack foods for socializing. Children in the study whose parents paid more attention to their children’s diet and physical activity had lower BMI values, indicating that family support is a crucial component of a successful intervention program. The team worked together to develop a culturally appropriate intervention combining three components: enhanced physical activity curriculum, school and home-based nutrition education, and a media literacy/neighborhood environmental assessment class. The intervention was designed to improve (1) individual knowledge, skill and self-efficacy, (2) peer and family support, (3) media literacy, and (4) neighborhood support.
Establishing trust in CEnR takes time and hinges primarily on the involvement of all parties during all phases of research. Successful interventions are built on research results that are interpreted by both sides of the partnership. However, this does not guarantee success. The first year of the HAPPY intervention concluded in July 2014 and the team noted a number of challenges. · Identified Organizational Barriers Barriers were identified from within UCC’s organizational system that interfered with delivery of the intervention. (1) Another childhood obesity prevention research study was also being conducted at BGCS, which competed for recruits. (2) BCGS’s strong after school program lowered recruitment levels and created attendance difficulties for children who enrolled in HAPPY. (3) Lack of indoor recreation space during winter months limited the physical activity opportunities. · Qualitative Retention Barriers Students were generally pleased with the program and expressed appreciation for the class. One student stated, “I went to a fast food restaurant with my family and chose a salad instead of getting a hamburger and fries.” Another said, “I’m shocked by how many calories my favorite snacks have.” However, many experienced barriers to participation and translating what they learned in class to their everyday life. For example, students stated that they did not walk or ride their bikes, even though they had learned that these were healthy activities, because of real or perceived dangers in their neighborhoods, including high traffic volume, concerns about crime, and worries about sexual predators. We also learned from parents that there are many unpredictable barriers to participation including miscommunication between the child and the parent, unexpected lack of transportation, and the need to have a participating student stay at home to care for younger siblings.
CEnR has the potential to significantly increase the success of physical activity and healthy eating interventions for children. The HAPPY intervention will include students, parents and school administrators in planning changes to years two and three in order to address barriers to participation.
The HAPPY project will continue for two more years. Findings will be disseminated through presentations, publications, and to state and local education policy makers. Lessons learned will be incorporated into a curriculum guide that will support project duplication through other Latino serving community organizations.
Support / Funding Source
HAPPY 1: 2010 Wisconsin Partnership Program (WPP); Partnership Education and Research Committee; University of Wisconsin School of Medicine and Public Health (PI: Aaron Carrol, MD and David Allen, MD) HAPPY 2: 2012 Wisconsin Partnership Program (WPP); Community-Academic Partnership Implementation Grant; University of Wisconsin School of Medicine and Public Health (PI: Samuel F Dennis Jr, PhD, Community Partner: Al Castro, MS, United Community Center).
Presentation at the 2015 Active Living Research Annual Conference.
The use of technology is permeating all strata of our global population. This presents exciting opportunities to engage previously marginalized populations in technology driven research activities. This presentation will describe how an innovative technology application (the Stanford Healthy Neighborhood Discovery Tool (the Discovery Tool) and a citizen scientist approach have been used in a variety of community based interventions to build capacity for improving neighborhood environments that better support healthy lifestyles. An important component of this work has been empowering the citizen scientists to communicate with key public and private sector partners about the neighborhood level barriers and facilitators that impact their ability to be physically active and eat healthfully to inform potential solutions.
This presentation will describe the lessons learned in adapting the Discovery Tool and the citizen scientist approach for use in different locations and contexts.
The Discovery Tool is a wireless neighborhood environmental assessment application that enables citizen scientists to document features of their built environments (via photographs and audio narratives) that impact their opportunities to be physically active and eat healthfully. The citizen scientists not only gather the data, but also meet collectively to review their images and audio narratives and prioritize issues to address. They receive advocacy training to equip them to communicate their findings to public and private sector partners with whom they can work to achieve positive change. This model has been successfully adapted for various settings. The challenges and opportunities in disseminating this approach will be discussed.
To date this approach has been used by diverse communities to capture key environmental features that affect healthy lifestyles, and, importantly, has been the catalyst for a number of neighborhood improvements: US built environments; Ethnically diverse, low income, older adults in East Palo Alto, CA have successfully engaged with local policy makers and contributed to the decision to allocate significant government dollars for built environment improvements and the inclusion of public health in the city’s general plan.; The concerns expressed by Latino adolescents and older adult immigrants residents of North Fair Oaks, CA have spurred the formation of a Community Advisory Board to address the issue of illegal dumping and trash that impede walking in the neighborhood; Older adult citizen scientists in rural up state New York have identified the specific challenges they encounter being physically active and eating healthfully in rural environments; International built environment; Older adult citizen scientists from different socio-cultural neighborhoods in Israel (wealthy vs. poor and predominantly Jewish vs. Arab) have identified major differences in barriers and facilitators of physical activity. Adolescent and older adult citizen scientists from different socio-economic neighborhoods in Mexico have successfully used the Discovery Tool to identify neighborhood features that impact physical activity, however, the citizen scientist approach requires adaptation to the Mexican setting to accommodate cultural differences in the way local policy and decision makers interact with their constituents. US food environments; Shoppers at an urban Farmer’s Market in Phoenix, AZ identified environmental features that enhanced or detracted from their shopping experience. This information can be used to develop targeted interventions and social marketing strategies to potentially increase the utilization of farmer’s markets, with accompanying nutritional and economic benefits. Ethnically diverse, low income, older adults in Daly City and South San Francisco, CA have connected with local policy makers and non profit service organizations to address identified barriers to accessing healthful nutrition that include transportation and knowledge about supplemental nutrition programs.
The Discovery Tool and the citizen scientist approach have successfully been used in a wide range of settings to empower community residents to identify neighborhood features that impact their ability to lead healthy, active lifestyles. An important component of this research is to connect the citizen scientists with representatives of the local public and private sectors to generate policy level changes.
This approach is potentially cost effective and harnesses the power of both citizen scientists and technology. There is the potential to use this approach in a broad range of locations, contexts and target populations, including those who are technology naive and of low socio-economic status. Planned future applications of this technology-driven citizen scientist approach include: assessing the effect of open street programs such as Sunday Streets in San Francisco and ciclovias in Columbia and Chile on community residents; harnessing the creativity and energy of school children to assess barriers and enablers of healthier food choices at school; and empowering older adults in South Africa and Brazil to become part of the solution to building healthier communities.
Support / Funding Source
Clinical Translational Science Award Seed Grant awarded through the Stanford University Office of Community Health Center for Innovation in Global Health, Stanford University Get Healthy San Mateo County Community Implementation Grant At the time this study was conducted Drs Winter and Sheats were supported by US Public Health Service grant 5T32L007034 from the National Heart, Lung and Blood Institute.
Presentation at the 2015 Active Living Research Annual Conference.
Physical inactivity is one of major preventable health risks among the Korean population. According to the latest statistics, more than 60% of Korean adults do not engage in the recommended amount of walking, and it appears as if this percentage is increasing. The rates of many public health challenges such as obesity, type 2 diabetes, cardiovascular and respiratory diseases, and depression have grown rapidly during the past decade. To cope with such challenges, both public health scientists and urban planners have been investigating the relationship between the built environment and health and devoted a great deal of effort to understanding the link between health and planning. However, until now, researchers have focused mainly on verifying and demonstrating the relationship between the built environment and health (including physical activities), not on determining ways to promote healthy communities in real-world contexts. In addition, few related policies have been implemented in Korea. The situations are the same in other countries, including the U.S. The purpose of this study was to develop and examine a systematic process (or protocol) for promoting healthy communities that encourage active, safe, pleasant, and socially-supportive living. Local governments will be able to use the proposed protocol to locate the most problematic areas in their neighborhoods, identify the latent factors influencing them, and finally develop strategies for improving the environmental quality of such places.
In this study, the authors designed a standardized protocol for diagnosing problem areas and prescribing strategies for mitigating the problems in a neighborhood environment and conducted a case study using the designed protocol. The protocol included instructions for collecting and analyzing data using three different research techniques: map and archival data analysis, a site investigation, and user (or resident) surveys. Following a detailed process that identified vulnerable places and major factors influencing environmental quality, the authors conducted a “triangulation” of the results of the analyses. Through the map and archival data analysis, this study examined the overall context of a neighborhood and arranged field investigations and collected resident surveys. Then, trained observers conducted field investigations to collect detailed and objective information about the physical environment and user behaviors. Finally, user surveys provided data pertaining to residents’ subjective and integrative perception of the environmental quality of their neighborhood. In particular, respondents provided spatial data by marking problematic places on a map. To test its usability and improve the protocol, the authors conducted a case study, testing the designed protocol in a neighborhood of the City of Anyang, a local municipality located in the Seoul metropolitan area.
The results of the case study showed that the protocol as useful for identifying problematic areas in the neighborhood and the challenges that must be tackled to improve them. For instance, vulnerable places indicated by the three different methodological approaches generally coincided and particularly, detailed data collected from field investigations and surveys provided background information for identifying latent influencing factors. For example, the most problematic place was a narrow alley behind large commercial buildings. In particular, narrow and uneven pedestrian paths, frequent, dangerous contact between pedestrian and vehicle traffic, confusing signage, and stench from uncollected waste made the place unpleasant and inadequate for pedestrians, particularly for the disabled and elderly.
This study has important policy implications that differ from those of previous studies, particularly on the scale of a neighborhood, where citizens’ everyday lives occur. For instance, the procedural process that this study proposed can be a useful tool with which each local municipality and its citizens can develop context-sensitive solutions for their own neighborhoods.
As an early prototype, the protocol still requires two improvements before it can work on a widespread basis. First, the content and processes of the protocol currently create an undue burden on lay persons. For its widespread use, the protocol should be simpler and more concise. Second, the case study neighborhood consisted mainly of an urban, adult population. Therefore, future studies should test the protocol in diverse environmental settings that contain child, senior, and disabled populations.
Presentation at the 2015 Active Living Research Annual Conference.
Land use mix reflects the availability of diverse destinations providing opportunities for active transportation. Land uses can be measured by in-person field audits or virtual audits. Google mapping platforms show promise for measuring neighborhood features due to their ease of use and accessibility to the public1. Street View offers a panoramic view of the street and local establishments. Aerial View offers a “bird’s eye view” with the option of quickly searching for neighborhood destinations. These two virtual perspectives have yet to be compared empirically to field audits.
To evaluate the validity of Google Aerial View (AV), Street View (SV) and the sum of non-overlapping land uses compared to field-observed (criterion) uses using an adapted version of the Microscale Audit of Pedestrian Streetscapes tool for use with Google (GMAPS). Agreement was also explored after stratifying neighborhoods by low/high socio-economic status.
Block groups in San Diego, CA and Phoenix, AZ regions were categorized as low versus high on GIS-measured walkability and median income (SES) to create a 2X2 matrix of four quadrants to ensure variance in neighborhood features. Pre-determined quarter mile routes (N=120, 60 per region, 30 per quadrant) were selected starting in residential areas moving towards commercial destinations. Raters in each region audited routes in person while the other region’s team completed virtual audits using the route section of the GMAPS tool. Field auditors tallied establishments and land uses on both sides of the street. Raters conducted similar assessments via SV by travelling the route and rotating perspective 180 degrees approximately every 100 feet. AV audits were conducted from approximately 2000 feet above ground level by searching for establishments. Raters audited 30 items on a scale ranging from 0 (none) or 1, or ≥ 2 land use establishments. Land uses were tallied along with the method of collection (field, AV or SV). A non-overlapping combination was calculated creating a sum of unique establishments collected by virtual audit (Total). Related items were grouped into scales with valence scores reflecting positive and negative influence on physical activity. An overall score was calculated from the difference between positive and negative valence scores2. Validity was explored using percent agreement, weighted kappa statistics (κ) for individual items, and intra-class correlation coefficients (ICCs) for scales. Kappa statistics were not possible when field audits revealed 95% or more of the routes contained no establishments. Agreement statistics were conducted after stratifying by low and high SES.
Percent agreement between field and virtual audit approaches (Table 1) were good to perfect3 across all items (74.2-100.0%). Field and virtual audits showed moderate to substantial agreement across items (κ=0.28–0.88), with the majority of items classified as substantial. SV or AV showed no distinct pattern favoring one method over the other compared to field audits. Total was not substantially better (κ>0.05) than either SV or AV. Most item agreement statistics were qualified similarly across low and high SES with the exceptions of Specialty Food Stores and Unmaintained Lot/Field, which showed better agreement in high SES neighborhoods (κ=0.39-0.52 vs 0.55-0.81, κ=0.34 vs 0.57 respectively), and Public Parks, which showed better agreement in low SES neighborhoods (κ=0.70-0.75 vs 0.40-0.46). Subscales, valence scores, and the overall land use score showed moderate to perfect agreement between the field observation and AV, SV, and Total observations (Table 2; ICC=0.48–0.93). In low SES neighborhoods, field audits agreed better with AV, SV, and Total for the Public Recreation item (ICC=0.60, 0.62, 0.51). In high SES neighborhoods, field audits agreed better with AV, SV, and Total observations for the Government Service subscale (ICC=0.39, 0.57, 0.39) and Negative Destination Land Use valence score (ICC=0.60, 0.54, 0.60).
In two US regions virtual audits provided an acceptable alternative for evaluating land uses compared to the time consuming and costly field audits. Few appreciable differences were found among SV and AV methods, suggesting either approach is acceptable. The improved validity of the non-overlapping total was minimal. Agreement between field and virtual audits showed no systematic differences across items after stratification by SES, suggesting that validity of virtual audits was not dependent on SES but rather on the nature of the land use. The exceptions were Government Service and Public Recreation subscales and Negative Destination Land Use valence score.
Results suggest that auditing neighborhoods virtually for various land uses is a valid approach and neighborhood socio-economic status does not influence these audits. The GMAPS tool is acceptable to use virtually for the assessment of land uses.
- Lefer TB, Anderson MR, Fornari A, Lambert A, Fletcher J, Baquero M. Using Google Earth as an innovative tool for community mapping. Public Health Rep Wash DC 1974. 2008;123(4):474-480.
- Millstein RA, Cain KL, Sallis JF, et al. Development, scoring, and reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS). BMC Public Health. 2013;13:403. doi:10.1186/1471-2458-13-403.
- Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977;33(1):159. doi:10.2307/2529310.