Communities

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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.

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Generating Rural Options for Weight-Healthy Kids and Communities

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The prevalence of childhood obesity has increased significantly with one in three children being overweight or obese (Flegal, Ogden, Wei, Kuczmarski, & Johnson, 2001; Ogden, Carroll, Kit, & Flegal, 2012; Troiano & Flegal, 1998). According to the Nevada Institute for Children’s Research and Policy (Haboush-Deloye, 2014), nearly 30% of Nevada children entering kindergarten are overweight or obese. Helping families and children develop healthy habits while providing healthy eating and activity supports to balance their energy intake with energy expenditure is an important aspect to maintaining healthy weight, preventing overweight and obesity, and minimizing chronic disease risk. Obesity is even greater among residents in rural areas of the United States (Befort, Nazir, & Perri, 2012) and therefore requires an understanding of the supports and barriers to healthy eating and active living within and among rural communities.

Objectives
The purpose of this mixed methods study is to address supports and barriers that either help or hinder healthy behaviors in rural communities of Nevada.  This session will present the findings from the study, including common supports, barriers, community readiness, recommendations for change and it's relevance to Nevada and other rural communities.

Methods
In a partnership with Oregon State University and 6 other land-grant institutions across the western region, researchers in Nevada engaged rural communities and individuals in Community-Based Participatory Research (CBPR) efforts using a HEAL MAPPS (Healthful Eating Active Living – Mapping Attributes: Participatory Photographic Survey) GPS mapping mechanism to assess features viewed as obesity preventing or promoting. Community resources were surveyed for readiness to implement and support environmentally-based obesity prevention efforts. Four communities in Nevada, Wells (Elko County), Gardnerville-Minden (Douglas County), Caliente (Lincoln County) and Laughlin (Clark County) participated in the project.  Each participating community required the staging of four face-to-face meetings, over a period of two to three months for each site, with most of the quantitative and qualitative data collected simultaneously. These included: 1) an initial stakeholder meeting, 2) a GPS unit training session, 3) a focus group and 4) a community conversation.

Results
Through a mixed methods design, both community features (qualitative) and community readiness (quantitative) results were combined to determine overall supports or barriers that help or hinder obesity prevention in rural Nevada. Qualitative data used for analysis included photos, GPS mapping and journal logs by select community members and as scribed narratives during community conversations.  This data explored resident’s perceptions of design features within their community environment that either promote or prevent obesity.  Environmental necessities for healthy living common to these 4 rural communities included few walkability supports, lack of pedestrian safety, and although many had nice local trails and parks, most were primarily auto-centric.  Recreation centers were also common in all communities but were not affordable and lacked adequate transportation to and from these facilities, particularly for vulnerable populations.  Rural communities also noted poor access to a variety of healthy, affordable fresh fruits and vegetables.

Conclusions
Colorado State University’s Community Readiness Model (Kelly, 2003) was used to gain an understanding of the rural community’s resources and readiness for obesity prevention efforts. The model is comprised of six dimensions that influence a community’s readiness to take action on an issue: community knowledge about the issue, community efforts, community knowledge of the efforts, local leadership, community climate, and local resources related to the issue. The results of the quantitative data, gathered by surveying community members, allow researchers to determine the community’s readiness to change. Community readiness is issue specific and can vary across dimensions and community sectors. Nevada’s stage of readiness to implement environmental and policy strategies to prevent obesity was found to be between Stage 3 (vague awareness) and Stage 4 (pre-planning) based on a scale of 1-9 (Kelly, 2003).  These results combined with an observed lack of engagement from local leaders and school administrators suggest a need to raise awareness among sectors.  Engaging local leaders in an awareness campaign at all levels will help guide appropriate policy implementation.

Implications
Implications from these findings will allow researchers to begin to understand the obesogenic environment of rural Nevadan and other rural communities critical to curbing obesity rates. Based on the communities level of readiness to make change, it can inform policy and aid in improvement of environmental factors that will ultimately lead to an enhanced quality of life for these rural communities.

References

  1. Befort, C. A., Nazir, N., & Perri, M. G. (2012). Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005-2008). J Rural Health, 28(4), 392-397.
  2. Flegal, K. M., Ogden, C. L., Wei, R., Kuczmarski, R. L., & Johnson, C. L. (2001). Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index. [Comparative Study]. The American journal of clinical nutrition, 73(6), 1086-1093.
  3. Haboush-Deloye, A. D., D., Phebus, T. (2014). Health Status of Children Entering Kindergarten in Nevada. Nevada Institute for Children’s Research and Policy.
  4. Kelly, K. J. e. a. (2003). The Community Readiness Model: A Complementary Approach to Social Marketing Marketing Theory, 3, 411-426.
  5. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. [Comparative Study]. JAMA : the journal of the American Medical Association, 307(5), 483-490. doi: 10.1001/jama.2012.40.
  6. Troiano, R. P., & Flegal, K. M. (1998). Overweight children and adolescents: description, epidemiology, and demographics. [Review]. Pediatrics, 101(3 Pt 2), 497-504.

 

Support / Funding Source
Supported in part by USDA/AFRI (Oregon State University)

Authors: 
Anne Lindsay, MS, University of Nevada, Reno
Location by State: 

The Chicago Plays! Initiative: Evaluation of a Natural Experiment to Increase Park Use

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
A needs assessment of all Chicago parks, conducted in 2009 through 2011, identified 300 playgrounds in need of repair. Using Chicago Park District (CPD) earmarked capital improvement funds, the Chicago Plays! Initiative was created to renovate these 300 playgrounds over the next five years and enhance safety and accessibility for all Chicago residents. The CPD and Friends of the Parks (FOTP), a local nonprofit organization, developed a competitive application process where community groups (e.g., park advisory councils, block and church groups): 1) nominated playgrounds to be renovated in Year 1 of the program and 2) proposed plans for ongoing playground maintenance. The process was meant to empower residents living in intervention areas (i.e., those receiving first stage renovated playgrounds) to improve their neighborhoods and health by increasing park utilization and PA for children and their families. Just over 100 of 300 possible applications were received, and 50 of those parks were selected for first stage (Year 1) renovation. This new initiative, using community engagement to enhance playground renovations, provides a rare opportunity to evaluate a timely natural experiment.

Objectives
In a sample of racially, ethnically, and socioeconomically diverse neighborhoods, and using a quasi-experimental prospective longitudinal study design, we examined whether involvement of community groups influences park-based utilization and physical activity (PA) post-playground renovations (N=74 matched parks, 37 intervention and 37 control). We hypothesize that compared to playground renovation alone, sites with playground renovation plus community engagement will have increased park-based utilization and PA through positive effects on park programming, ongoing maintenance, and safety.

Methods
In summer/fall 2013 and 2014 baseline and 12 month follow up data were collected on park-based utilization and PA, presence and condition of existing playground equipment, presence of physical disorder, park programming, and park and neighborhood-based crime data. Field staff collected baseline park-based utilization and PA data (one weekday and one Saturday with 4 scans per day)  in 37 intervention and 37 matched control parks; 12-month follow up data collection includes 3 days of observation (2 weekdays and one Saturday with 4 scans per day).  Field staff also conducted playground environmental observations pre- and post-playground renovation, and took photographs of the equipment for future reference. Observation instruments were used to audit the presence and condition of the playground and all other park features and amenities.   Analyses of both the number of people in parks and the number of people in parks engaged in PA as determined by direct observations will be conducted using a mixed-effects linear regression model.

Results
Preliminary results of baseline data showed Of the 74 parks in the sample, nearly all parks (n=68) had posted signage regarding park rules and hours of operations, but only half (n=34) of the playgrounds observed had lighting present. Across the 74 parks, field staff observed a total of 5,592 visitors across the two days of observations. The majority of visitors (59%) were sedentary, with 23 and 18 percent observed engaging in moderate and vigorous activities respectively. Both control and intervention sites are subject to the same historical trends, thus we will be able to detect changes due to playground renovations prospectively even without having additional historical baseline measurements. Citywide crime data for the 12 months leading up to and including our park observation dates have been collected. During the 12-month period, a total of 304,276 reported crimes occurred in Chicago. Preliminary analyses show, over the past 12 months, 15 percent of all park-based crimes occurred in our sample of parks, which represent 13 percent of all CPD parks. The most commonly reported park-based crimes were drug, assault, battery, and theft-related crimes. Preliminary analyses also show approximately 40,000, or 13 percent of reported crimes occurred in the ¼ mile park buffers over the past 12 months. The most commonly reported street crimes were theft, vandalism, assault, battery, disorderly conduct, and prostitution-related crimes. Park program data for the past year is currently being compiled for analysis, but since January 2013 there were a total of 2,586 programs (e.g., team-based sports) or events (e.g., movie night) offered across the 74 parks with approximately 45,000 community participants across all ages (children, adolescents, adults and seniors). Programs and events are a mix of sedentary (e.g., sewing, arts and crafts) and active (e.g., basketball, gymnastics, swimming) activities. Following baseline data collection schedules, field staff is currently collecting 12-month follow up data this summer and fall.

Conclusions
Results of changes in park utilization, park-based PA, programming, maintenance and safety between baseline and 12-month follow up will be presented.

Implications
With recent evidence showing physical inactivity, and not diet, as the primary driver in obesity prevalence communities need rigorous scientific evidence to inform future policy decisions on how to increase park utilization in diverse neighborhoods.

Support / Funding Source
UIC Institute for Public and Civic Engagement

Authors: 
Sandy Slater, PhD, University of Illinois at Chicago
Location by State: 

Point-of-Decision Prompts Increase Walking in a Large Metropolitan Airport: The Walk to Fly Study

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Only half of American adults meet the public health guideline for aerobic physical activity. Those who walk for transportation or for leisure are three times more likely to meet the aerobic guideline. Encouraging adults to walk is therefore a viable strategy to increase physical activity levels in the U.S. Point-of-decision prompts are recommended by The Guide to Community Preventive Services as a strategy to increase stair use as one form of physical activity. We found no study that examines the efficacy of point-of-decision prompts to encourage walking instead of using an automated mode of transport, like a train. The Walk to Fly study was designed to develop and implement point-of-decision prompts to encourage walking, rather than riding the train, in a large metropolitan airport, and to evaluate their impact. The findings from this study may help airports and other venues with automated options like people movers, use tested intervention strategies to help people choose to be physically active.

Objectives
The objective of this intervention study is to evaluate, in a large metropolitan airport, the impact of point-of-decision prompts to encourage walking to one’s concourse, versus riding the train, by comparing walking before and after installation of the prompts.

Methods
Travelers entering the transportation mall connecting the concourses of the airport may choose to ride the train (operational 4am-midnight), walk, or use a moving walkway, to get to their departure concourses. Six ceiling-mounted infrared sensors automatically count all travelers who enter the transportation mall terminus, and those who walk or use the moving walkway to continue to their concourses. The count of travelers riding the train is the difference between the entry, and the combined walk and walkway sensor counts. Counts are aggregated and logged in 15-minute frames. Any count frame with train ridership below 50% of travelers is suggestive of interruption of train service and is dropped from the analysis. Sensors were validated against manual counts, and reconfigured to register fewer than 5% miscounts.  The point-of-decision prompts were developed through two surveys with probability samples of 517 travelers seated at the boarding areas of the airport. Findings from the surveys showed travelers would be more likely to walk than ride the train if the prompts clearly showed the distance and time to walk to concourses. Sensor counts were analyzed to determine the average number of travelers entering the transportation mall terminus daily and to discern mode choice before and after installation of point-of-decision prompts. A Bayesian time-series analysis was used to estimate counts in the absence of an intervention, which was compared to actual counts to assess impact of the intervention. Analyses were performed using R (version 3.0.2).

Results
Sensor validation was completed on June 14th, 2013. The findings represent 21,127,953 travelers counted from June 15th, 2013 through September 16th, 2014. On average, more than 46,000 travelers entered the transportation mall terminus daily – 99% of them during train operation hours. Point-of-decision prompts were installed on September 4th, 2014. Of travelers who entered when the train was operational, 10.4% walked or used the moving walkway before the prompts were installed, and 11.8% did so after. Taking into account variations in traveler counts over the week and over the year, after the prompts were installed the number of travelers walking or using the moving walkway increased by 18.5%, representing an estimated 833 additional travelers walking or using the moving walkway daily (Table).

Conclusions
Preliminary data obtained at one point-of-decision location at a large metropolitan airport show that, of 46,000 travelers/day, installation of prompts increased the number of travelers walking or using the moving walkway to get to their departure concourse by 18.5% (833 travelers/day) in the first 10 days of the intervention.

Implications
With 17 million travelers per year facing the decision to walk or ride the train at just one location in a large metropolitan airport, this intervention has the potential to increase walking among a large number of air travelers. The findings of the Walk to Fly study can be used to develop and evaluate interventions to promote walking at other airports and as an important component of physical activity promotion in public venues.

Support / Funding Source
The Kresge Foundation and the CDC Foundation.

Authors: 
Janet Fulton, PhD, Centers for Disease Control and Prevention
Location by State: 
Population: 

Atlanta Streets Alive: A Movement Building a Culture of Health in an Urban Environment

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Ciclovias are multisectoral community-based programs that promote the use of public space for physical activity, recreation and socialization by closing streets temporarily to motorized vehicles, allowing access to pedestrians. The Ciclovias movement has grown exponentially worldwide, and in the US, where more than 70 events (called “Open Streets”) have been documented in different cities. The city of Atlanta hosted its first Ciclovia event,   Atlanta Streets Alive (ASA), in May 2010. For this initial event, the city closed 1.5 miles of streets in Downtown Atlanta and opened them for people to become physically active and enjoy a portion of the city safely and in the absence cars.  Since the initial launch of ASA, 8 additional events have been held in different parts of the city. Preliminary evidence has shown a positive association between Ciclovia programs and public health outcomes including  increased physical activity, improved social environments and air quality, enhanced perception of safety, and increased equity in access to recreational activities among low-income populations. In an effort to strengthen the evidence on the public health impact of “Open Streets” programs in the U.S, an evaluation sub-committee was established as part of the larger ASA steering committee. The sub-committee designed and implemented the evaluation of the first 5 ASA events from May 2010 to May 2012.  The purpose of the evaluation was to learn about the characteristics of ASA participants, the influence of the event on their physical activity, as well as their perceptions of safety and neighborhood social capital during the event.

Description
ASA’s evaluation had two components: participant counts and observation and a participant survey. Participant counts and observations included estimating the number of participants, their demographic characteristic, and type of physical activity they performed during the events. Participant surveys included 22 questions that assessed 5 components: (1) physical activity, (2) transportation mode to the event (3) social capital and safety perceptions, (4) characteristics of participation and perceptions about the event, and (5) demographics.

Lessons Learned
Participant counts The estimated participation at the 5 ASA events was 28,143 participants. The majority of participants were adults in each ASA event. Youth accounted for between 9 and 15% of participants.  The activity most commonly observed was walking across all five events. Survey A final sample of 589 surveys was included in the analysis. Overall, 19.4 percent of participants met the weekly PA recommendation of 150 minutes of PA during one ASA event. The estimated average number of minutes of PA for participants at the 3 events was 99 minutes. Walking and cycling were the most frequently primary activities reported at ASA (73.7% and 37.7%, respectively). Ninety-seven percent (97%) of participants reported feeling safe or very safe at ASA. Similarly most respondents agreed that ASA was an event that welcomed everyone (99.7%), and that people at “ASA” generally get along with each other (93.9%). Thirty eight percent (38%) of respondents indicated they would be at home indoors, watching TV, or on the computer if they were not participating at the event.

Conclusions
Attendance at ASA has increased significantly from approximately 5,000 in 2010 to more than 60,000 participants in 2013.  The route has expanded reaching some of the main streets in the city and increasing the number of miles of streets closings, ranging from 3 miles to 5 miles in 2013. Such growth suggests that ASA has been a widely received program, one that is beginning to achieve sustainability through partnerships and sponsorships. The preliminary findings of this study support previous research that have identified Ciclovias as promising interventions to increase PA levels while providing opportunities for recreation and health promoting social environments. The goals of increasing PA and decreasing sedentary time are important for population health in Atlanta given the strong evidence that shows that physical inactivity increases the risk of adverse health conditions including non-communicable diseases.5,6 Data from 2012 showed that 53.8% of the adult population in Metro Atlanta were not physically active at least moderately,7  60.9% were overweight or obese,8 and 8.7% had diabetes.7

Next Steps
This study provides important preliminary information to understand the potential impact that ASA can have in the local areas where it is implemented. However, future evaluations should increase efforts to move beyond cross-sectional evaluation to pre and post assessments in communities where ASA will be implemented for the first time. There is much to be learned from Open Streets events across the nation and internationally. More research is needed to build the evidence base for such programs.

References

  1. Sarmiento O, Torres A, Jacoby E, Pratt M, Schmid TL, Stierling G. The Ciclovía-Recreativa: A mass-recreational program with public health potential. J Phys Act Health. 2010 Jul;7 Suppl 2:S163–180.
  2. Meisel JD, Sarmiento OL, Montes F, Martinez EO, Lemoine PD, Valdivia JA, et al. Network analysis of Bogotá’s Ciclovía Recreativa, a self-organized multisectorial community program to promote physical activity in a middle-income country. Am J Health Promot AJHP. 2014 Jun;28(5):e127–136.
  3. Zieff SG, Hipp JA, Eyler AA, Kim M-S. Ciclovía initiatives: engaging communities, partners, and policy makers along the route to success. J Public Health Manag Pract JPHMP. 2013 Jun;19(3 Suppl 1):S74–82.
  4. Torres A, Sarmiento OL, Stauber C, Zarama R. The Ciclovia and Cicloruta programs: promising interventions to promote physical activity and social capital in Bogotá, Colombia. Am J Public Health. 2013 Feb;103(2):e23–30.
  5. Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012 Jul 21;380(9838):294–305.
  6. Lee I-M, Bauman AE, Blair SN, Heath GW, Kohl HW, Pratt M, et al. Annual deaths attributable to physical inactivity: whither the missing 2 million? Lancet. 2013 Mar 23;381(9871):992–3.
  7. American College of Sports Medicine. American Fitness Index. Full report 2012 [Internet]. [cited 2014 Aug 7]. Available from: http://americanfitnessindex.org/report/.
  8. CDC. Behavioral Risk Factor Surveillance System-BRFSS City and County Data [Internet]. [cited 2014 Aug 7]. Available from: http://apps.nccd.cdc.gov/brfss-smart/MMSARiskChart.asp?yr=2012&MMSA=5&cat=EX&qkey=8041&grp=0.
Authors: 
Andrea Torres, MPH, PhD candidate, Georgia State University
Location by State: 

Travel Patterns and Socio-Demographic Correlates of Global Positioning System Derived Walking and Vehicle Trips among Church-Going Latinas

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Physical activity (PA) data collected through self-report suggest that fewer Hispanic adults meet the 2008 PA guidelines of aerobic activity compared to their white counterparts (45.8% vs. 53.9, respectively collected through BRFSS). Activity through active transportation and during leisure time is a viable way to accumulate the activity recommended.  Studies using objective methods of assessing active transport-related behaviors among Latinas are needed.

Objectives
The current analysis aims to (1) describe travel behaviors (number of trips, time, and distance) in walking and vehicle among adult Latinas living in a border community and (2) examine socio-demographic correlates of these travel behaviors.

Methods
Eighty eight churchgoing Latinas completed a baseline survey as part of a randomized controlled trial for PA promotion. Survey data was collected as well as anthropometric measures (in order to obtain BMI) for all participants. The average age of the women was 45 years (ranging from 18-65), with about 60% having a monthly household income less than $2,000, and about 55% reporting to have less than a high school education. Close to 85% of the sample was considered either overweight or obese, and 74% reported driving a vehicle. Global Positioning System (GPS) and accelerometer data were collected (for 2-7 days) and then integrated using the Personal Activity and Location Measurement System (PALMS), a web-based application that integrates objectively-measured activity and location-based data. The data can be interpreted as transportation minutes (minutes walking, biking, and in a vehicle). General linear models were conducted examining the relation between  age, years living in the US, education, income, employment status, driving status, body weight status, number of children living in the household; with mean minutes per day, trips per day, and distance in trips per day in each mode (walking and in a vehicle) as the outcome.

Results
Accelerometer-measured moderate to vigorous physical activity (MVPA) was 13 min/day. The average daily number of GPS-assessed walking trips across participants was 1.69 (SD=1.27), with an average daily distance of 0.67 km (SD=0.59) and an average time of 15.09 minutes (SD=12.62) minutes per day. The average daily number of vehicle trips across participants was 4.69 (SD=2.0), with an average daily distance of 41.13 km (SD=37.99) and an average time of 65.74 (SD=35.57) minutes per day. The average time (minutes) per trip was 9.33 (SD=8.79) for walking and 14.20 (SD=14.06) in a vehicle. The average distance (km) was 0.44 (SD=0.62) for walking and 8.77 (SD = 18.99) in a vehicle. When examining the relationship between average daily time in walking trips and body weight status, those of a higher weight status (overweight or obese) spent significantly less time walking  (p < 0.05) compared to those who were normal weight. Individuals who lived in the US longer were more likely to walk compared to those who have lived in the US for a lesser time (p=.07).  Those who  spent more time (minutes) in a vehicle were more educated, reported higher incomes, and were more likely to be employed (p<.05).

Conclusions
Because study findings show an inverse association between weight status and walking, encouraging walking may be a strategy to target the obesity epidemic in Latinos.  Overall, participants spent considerably more time in a vehicle compared to walking. Tailored interventions may target those from higher socioeconomic status as study findings suggest that they were more likely to spend time in their vehicles compared to those of other lower socio-demographic backgrounds.

Implications
This study suggests that Latinas may be spending substantially more time in a vehicle as opposed to walking. Because higher socio-economic status was associated with more vehicle time, transportation systems (i.e. public transportation and walking infrastructure) reaching communities from diverse backgrounds are likely needed to help increase minutes in walking  as well as reducing vehicle time.

References
1. Obesity and Hispanic Americans  - The Office of Minority Health - OMH. (n.d.). Retrieved July 09, 2014, from http://minorityhealth.hhs.gov/templates/content.aspx?ID=6459 2. Martinez, S. M., Arredondo, E. M., Perez, G., & Baquero, B. (n.d.). Individual, social, and environmental barriers to and facilitators of physical activity among Latinas living in San Diego County: focus group results. Family & Community Health, 32(1), 22–33. doi:10.1097/01.FCH.0000342814.42025.6d

Support / Funding Source
NIH/NCI [3R01CA138894-05S2]

Authors: 
Natalicio Serrano, BS, San Diego State University
Location by State: 
Population: 
Study Type: 

Transit Use, Physical Activity, and Body Mass Index Changes: Objective Measures Associated With Complete Street Light Rail Construction

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Although Complete Streets interventions, which change street infrastructure to accommodate active transportation users, are popular, they are seldom evaluated for relationships with physical activity among area residents.

Objectives
We test whether physical activity (PA) increases and body mass index (BMI) measures decrease for those using a Complete Street intervention that extended a light rail line in Salt Lake City.

Methods
Residents living within 2km of the new line wore accelerometers and global positioning system (GPS) loggers for one week pre- and post-rail construction. Data were integrated so that we could discern who engaged in transit use when taking trips within the Complete Street corridor. The Complete Street intervention included five new residential TRAX stops along a new line extension (and a 6th non-residential stop at the airport), a bike path, and improved sidewalks. Participants completed surveys, had height and weight measures taken, and were fitted with the devices in their homes. Participants, typically recruited door-to-door, were selected to be over 18, able to walk a few blocks, intending to stay in the neighborhood ≥ 1 year, not pregnant, able to speak Spanish or English, and to wear the devices (at least 3 10-hour days) and fill out the surveys.  We use the subsample of 537 residents who had valid GPS data at both times.  GeoStats assigned trip modes to active travel and could identify walking, bus riding, and light rail riding.  Any trip that crossed into or through an area defined by a 40-meter buffer from street centerline, encompassing all five new residential TRAX stops, was counted as a trip that involved the new Complete Street.  The outcome variables include changes in accelerometer counts per minute (CPMs) and in measured BMI. An OLS regression estimated change in PA from Time 1 to Time 2 as a function of baseline measures of PA, plus socio-demographic control variables. A similar analysis was conducted on BMI change.  Effect code contrasts compared residents who never registered a transit trip that intersected the Complete Street buffer with the other three groups:  continuing riders, abandoned riders, and new riders.

Results
A test of the transit ridership groups shows significant changes in activity CPMs, F(10,517) = 13.67, p < .001.  Compared to those who never rode transit, those who abandoned using transit (from 2012 to 2013) experienced a decline in physical activity, t = -2.83 p = .005.  Compared to those who never rode transit, those who started to use transit in 2013 accrued more physical activity, t = 2.85, p = .005. The continuing transit riders did not experience much change in activity and their 2013 to 2102 change scores were not significantly different from those who never used transit.   Physical activity changes were consistent with BMI change scores (2013 BMI minus 2012 BMI).  Compared to those who never rode transit, those who abandoned using transit experienced an increase in measured BMI, t = 2.49, p = .013.  Compared to those who never rode transit, those who started riding transit had lower BMI change scores, which actually indicated a slight loss of BMI, t = -3.02, p < .003.

Conclusions
The Complete Street intervention demonstrated beneficial physical activity and BMI changes for new transit riders and detrimental changes for those who abandoned transit.  BMI changes were also significant and in the expected direction, despite the fact that the 2013 measures came after at most seven months after the new transit opportunities were provided.

Implications
Many endorse Complete Streets for their potential to support physical activity, obesity prevention, social equity, youth and elder mobility, pollution prevention, less automobile dependence and sprawl, open space preservation, and transit-oriented development. The current study underscores benefits to health conferred by transit use.

References

  1. McCann B. Completing Our Streets: The Transition to Safe and Inclusive Transportation Networks. Island Press; 2013.
  2. Litt JS, Reed HL, Tabak RG, et al. Active living collaboratives in the United States: Understanding characteristics, activities, and achievement of environmental and policy change. Preventing Chronic Disease. 2013;10(2).
  3. Rissel C, Curac N, Greenaway M, Bauman A. Physical activity associated with public transport use-a review and modelling of potential benefits. International Journal of Environmental Research and Public Health. // 2012;9(7):2454-2478.
  4. MacDonald JM, Stokes RJ,  Brown, B.B., Wilson, L., Tribby, C.P., Werner, C.M, Wolf, J., Miller, H.J., Smith, K.R. (2014).  Adding maps (GPS) to accelerometry data to improve study participants’ recall of physical activity: a methodological advance in physical activity research.  British Journal of Sports Medicine.  doi: 10.1136/bjsports-2014-093530.
  5. Brown, B.B., & Werner, C.M. (2007). A new rail stop: Tracking moderate physical activity bouts and ridership. American Journal of Preventive Medicine, 33(4), 306-309.

 

Support / Funding Source
Research reported in this publication was supported (in part) by grant number CA157509 from the National Cancer Institute at the National Institutes of Health and the Robert Wood Johnson Foundation.

Authors: 
Barbara Brown, PhD, University of Utah
Location by State: 

San Ysidro Border Health Equity Transportation Study

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Relationships between health and built environment are gaining increasing attention in local and regional policy arenas.  It is becoming more evident that the presence and concentration of various land uses and transportation systems shape communities and the people living there.  City planners and policy-makers however, typically do not directly consider individual and community health impacts of these features.  The Border Health Equity Transportation Study (BHETS) serves to evaluate the significance of various mobility/built environmental factors in the health of San Ysidro community members, with a particular focus on developing a model for integrating this understanding into typical long-range planning processes carried out by city planners and policy-makers at the local and regional level.  Ultimately, the study seeks to elucidate a process for directly including health considerations in long range land use and transportation planning practice.     San Ysidro is the southernmost community within the City of San Diego, adjacent to the world’s busiest land crossing border.  The San Ysidro community experiences a variety of distinct environmental, economic, and social impacts related to its proximity to the border.  As a majority of border crossers are traveling by car, approximately 35,000 northbound vehicles per day idling an average of 100 minutes, air quality impacts are of particular concern.  In addition to this unique dynamic, San Ysidro also shows high concentrations of low-income, minority populations, leading to broad concerns related to social and environmental quality.

Description
The initial existing conditions analysis utilized data from two publicly available sources: the 2012 Healthy Communities Atlas and the 2013 San Diego Community Profiles provided by the San Diego County Health and Human Services Agency.  The Healthy Communities Atlas includes seven groupings of mobility/built environment variables at the census block group level: 1) demographics; 2) transportation systems; 3) physical activity support; 4) traffic-related safety; 5) access to social support; 6) crime-related safety; and 7) food environment.  The community profiles provide health data aggregated by Subregional Areas (SRA), allowing for health outcome comparisons of 41 SRAs across San Diego County.   Partial correlations were performed to understand the significance, direction and strength of the relationships between mobility/built environment factors and health outcomes across San Diego County, while controlling for age and income.  Results of the partial correlations analysis were used to prioritize mobility/built environment factors having the most consistently significant effect on a range of health outcomes across the San Diego region.     Previous planning documents and studies were reviewed to identify a preliminary set of recommendations (for their potential to influence positively community health) related to the highest priority mobility/built environment factors resulting from the partial correlations analysis. These preliminary recommendations were then vetted with community members at a workshop and at a stakeholder group meeting.  The public review led to the identification of gaps in the preliminary recommendations, and further research was conducted to develop supplemental recommendations, leading to a final set of 16 focused mobility/built environment recommendations.

Lessons Learned
The analyses found that community members in the South Bay SRA (including the community of San Ysidro) appear to experience several health outcomes, such as diabetes, asthma, COPD, and rates of pedestrian injury, at relatively higher rates than the region as a whole.  In addition, mobility/built environment factors with the strongest and most consistent associations with health outcomes across the San Diego region include: Percent of Households within 500’ of Transportation-Related Air Pollution Sources; Sidewalks Coverage; Access to Trails and Parks; Pedestrian Safety (composite of pedestrian collisions, traffic density, high volume arterials, and sidewalks); Youth Safety (composite of access to parks, schools, daycare, cyclist collision, pedestrian collision, traffic density); and Youth Physical Activity Support (composite of trail access, sidewalks, and elementary school access).   A final set of 16 focused mobility/built environment recommendations have been identified, including a landscaped active transportation corridor that traverses the San Ysidro community, a recreational wayfinding program, an air quality monitoring program, installation of a traffic signals, and creation of a ten-acre park site.

Conclusions
The analysis process developed for this study is unique in that it establishes a framework for identifying significant health-related issues within a community, the mobility/built environment factors related to those health issues, and a set of land use/transportation recommendations intended to address the identified health issues.   It provides a model for integrating health directly into long range planning, thereby equipping local planners with ability to direct decision-making toward recommendations that will improve community health.

Next Steps
The next stage of the BHETS will focus on developing an evaluation and monitoring plan to provide a clear framework for local and regional governments to track trends in key mobility/built environment factors and health outcome known to be associated with them.

Support / Funding Source
The BHETS was made possible by funding from the Caltrans Environmental Justice Transportation Planning Grant program.

Authors: 
Sherry Ryan, PhD, Chen Ryan Associates / San Diego State University
Location by State: 

Investing in Health: An Analysis of Economic Development Initiatives that Promote Physical Activity and Healthy Lifestyles

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The health of New York’s economy, communities, and residents is inextricably linked. People living in low-income and distressed neighborhoods often experience poor health outcomes, and poor health and illness create an economic burden that affects individuals, companies, regions, and, ultimately, the entire state. New York ranks second highest in the United States for medical expenditures attributable to obesity, spending $11.1 billion (in 2009 dollars)[i] each year. Being physically active and eating healthy foods are two key variables that contribute to preventing obesity and other related chronic illnesses. Therefore, community and economic development that supports increased access to physical activity and healthy foods within all our communities is vital to addressing both the economic and physical health of New York State.   In 2011, New York State Governor Andrew M. Cuomo and Lieutenant Governor Robert Duffy created 10 Regional Economic Development Councils (REDCs) to develop long-term plans for economic growth across the state. The REDC plans have largely focused on job creation. An analysis was done by The New York Academy of Medicine (NYAM) as part of its Designing a Strong and Healthy New York (DASH-NY) Obesity Prevention Policy Center to show that economic development initiatives are also opportunities to simultaneously enhance public health. Staff reviewed the 725 projects funded through the REDC process in 2012 and 824 projects in 2013 and compared them against evidence-based and recommended interventions for increasing access to healthy foods and physical activity in communities. The analysis found close to two hundred projects that simultaneously meet health and economic development goals. This approach can be utilized by other states and communities to align economic development initiatives with community health improvement efforts.

Description
Research demonstrates that the way communities are designed can make it easier for people to live healthier lives.[ii]  For instance, physical activity has been shown to prolong life, and there are ways to design communities to make daily activities like walking, biking and shopping easier and safer.  Making physical activity an easier choice can reduce risks associated with leading chronic diseases, such as stroke, cardiovascular disease, and some types of cancer.[iii].  The methodology developed for this analysis can help others interested in building multi-sector partnerships develop and implement projects that promote health in a way that will have synergy with economic development goals.  This presentation will use NYAM's analysis of the New York State REDC funding process to show how specific evidence-based interventions that promote health can be incorporated into economic development initiatives.

Lessons Learned
1.  There are specific strategies to help shape communities’ physical and social environments in ways that promote healthy behaviors, prevent illness and premature death, and promote community and economic development. These strategies include promoting active design, encouraging transit oriented development, and making healthy and local foods available through investment in grocery stores, farmers markets, and improved regional agricultural infrastructure  2. Funding for projects that promote health in the REDC process is increasing, which shows there are great examples for how economic development and health can be mutually supportive. *Out of the 725 projects awarded in 2012, there were 45 potentially health promoting projects, with 21 projects supporting healthy eating and 24 projects supporting physical activity. The 45 projects represent 2.2% of total funding ($16 million of the total $738 million). *Out of the 824 projects that were awarded in 2013, there were 22 projects that support healthy eating and 109 that support physical activity. The 131 projects cover 7.4% of total funding ($53 million of the total $716 million).   3. The distribution of projects with potential to promote healthy eating and physical activity varies greatly. Opportunities exist through the REDC process to promote greater health equity across demographic and county lines.

Conclusions
Statewide economic development initiatives represent an exciting opportunity for strategic planning and alignment of multiple resources toward improving health. The 2012 and 2013 awards in New York State demonstrated increased opportunities for health promotion through the REDC process, the core goal of which may be economic development. As NYS refines its economic development initiatives, and other states consider similar initiatives, there will be additional opportunities to consider health as a core objective in economic development activities.  For example, the creation of metrics by which economic development projects can account for health in plans and setting targets for dollars invested in projects that have a positive impact on health.

Next Steps
NYAM plans to work with partners across the REDCs in NYS to inform its members about how health and economic development are mutually supportive and to identify future opportunities for synergistic projects.  NYAM also plans to repeat its analysis of the NYS REDCs with an expanded set of metrics for the next round of awards to see how funding for projects that support healthy behaviors are maybe changing over time.

References

  1. “Focus Area 1: Reduce Obesity in Children and Adults,” New York State Department of Health, accessed August 26, 2013, http://www.health.ny.gov/prevention/ prevention_agenda/2013-2017/plan/chronic_diseases/focus_area_1.htm.
  2. “Healthy Community Design,” Centers for Disease Control and Prevention, accessed August 14, 2014, http://www.cdc.gov/healthyplaces/factsheets/healthy_community_design_factsheet_final.pdf.
  3. McCann BA, Ewing R. Measuring the effects of sprawl: A national analysis of physical activity, obesity and chronic disease. Smart Growth America Surface Transportation Policy Project: September 2003, accessed August 14, 2014, http://www.smartgrowthamerica.org/documents/HealthSprawl8.03-1.pdf and Centers for Disease Control and Prevention. Physical activity for everyone [online], accessed August 14, 2014, www.cdc.gov/physicalactivity/everyone/guidelines/.

 

Support / Funding Source
The New York Academy of Medicine’s work on funding from the New York State Department of Health, DASH-NY serves as New York State’s Obesity Prevention Coalition and Policy Center.

Authors: 
Monica Chierici, MPA, The New York Academy of Medicine
Location by State: 
Study Type: 

Boosting Boston's State of Place: A Research and Practice Love Story

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Walkability is tied to many health, social, environmental, and most recently, economic benefits. Concurrently, walkability is influencing an increasing number of individuals and firms locational decisions: 80% of Americans aged 18-34 want to live in walkable places; over 40% of those over 50 want to live within a mile of daily needs and services; and in 2011, 58% of venture capital in the top five US markets went to firms located in walkable areas.   Yet walkability seems out of reach. The average walkability of US cities with populations over 200,000 is 47 out of a possible 100 based on Walk Score. While many real estate, community development, and government stakeholders recognize that walkability is key to livability and economic competitiveness, paving that path has proven challenging.   A number of barriers to implementing or facilitating walkable development exist. Public sector stakeholders lack mechanisms by which to identify the most effective interventions or investments. They often lack the metrics, capacity, expertise, or political will to implement evidence-based approaches that could maximize walkability and leverage community change. Moreover, many public stakeholders still find it difficult to communicate (and justify) the benefits – especially economic benefits – of walkable developments, both to the community and to developers (progressive or otherwise). On the private sector side, a growing number of responsible property investors are looking to fund projects with a social impact – like walkability – but lack proper metrics to gauge that impact, both in terms of predicting it pre-project and then measuring it post-project. This presentation will 1) describe State of Place, an empirically based data analytics and community engagement platform that helps cities and social impact stakeholders make smarter planning, economic development, and investment decisions to boost walkability and health and 2) present a case study of how State of Place served as a mechanism to guide the investment and development decisions of the Healthy Neighborhood Equity Fund (HNEF), a $30 million private equity real estate fund, created via a public-private partnership, that invests in high-impact, transformative real estate projects that deliver social, environmental, and community health benefits in addition to financial returns.

Description
State of Place was born out of the Irvine Minnesota Inventory (IMI), a widely-used, objective audit tool that measures built environment features tied to walkability funded by the Robert Wood Johnson foundation in the first round of Active Living Research grants. For years, practitioners sought ways to adapt this tool, but it lacked a non-researcher user friendly analytical framework. State of Place addresses that need and seeks to ameliorate existing barriers to implementing walkable development.  State of Place trains community stakeholders themselves to use an updated, app-based version of the IMI to collect data, block by block, on over 280 built environment features, fostering community engagement. The State of Place Index, a score from 0-100 that measures place quality, along ten urban design dimensions empirically tied to walkability and economic value, is then calculated. The State of Place Index classifies both existing places and projected projects’ assets and needs, helping to identify the most effective community interventions and investments, based on communities’ performance, budget, goals, capacity, feasibility, and community feedback. State of Place has been used in a number of projects, ranging from creating regional economic development strategies to guiding walkable development projects.   The HNEF was created by the Conservation Law Foundation Ventures (CLFV) group in partnership with the Massachusetts Housing Investment Corporation (MHIC) and the State’s Executive Office of Housing and Economic Development. The HNEF uses a “Quadruple Bottom Line” (QBL) approach, evaluating projects based on community, environmental, and health impacts in addition to financial returns, focusing on historically distressed Boston neighborhoods.   This presentation will explain the development of State of Place and how CLFV is using it as a key metric to screen and choose the projects they will fund and as a way to provide objective feedback to developers of ways to facilitate more walkability.

Lessons Learned
Translating research tools into evidence-based planning and real estate approaches is challenging, both in terms of establishing a viable business model and communicating the values of such tools in an effective, relatable way. Implementation requires flexibility on the researchers part and willing early adopters.

Conclusions
Building effective evidence based tools requires a transdisciplinary approach that not only incorporates various areas of research and methodologies, but also bridges academia and practice, including applying Lean Startup business development principles, using multi-channeled communication, and engaging across sectors – both in person and in print .

Next Steps
The State of Place tool will be translated into a Software as a Service (SaaS) platform that can be integrated into cities’, developers’, and investors’ decision-making processes. Also, additional studies will be conducted to assess the relationship between State of Place and potential health costs savings and to examine the actual impact of State of Place’s recommended investments and interventions.

Authors: 
Mariela Alfonzo, PhD, State of Place / New York University
Location by State: 
Study Type: 

The Role of Health-Related Community Investing as an Active Living Research Implementation Strategy

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The National Prevention Strategy [1] recognizes active living as a priority area for reducing the burden of chronic disease, and emphasizes safe and healthy community environments as a key strategic direction to guide actions that will demonstrably improve health. New financial incentives created by the Affordable Care Act to facilitate population health, complemented by recent private sector interest in health-related community investing [2-4] provide an unprecedented opportunity to implement active living policies and create healthy community environments, particularly for populations who need them most. For example, population subgroups that are at increased risk of obesity and related chronic diseases include lower socioeconomic (SES) persons [5], racial/ethnic minorities [6, 7], those living in rural areas of the U.S. [8], and persons with disabilities such as mobility limitations [9] [10, 11]. The purpose of this paper is to explore a key aspect of policy implementation pertaining to Active Living Research: Innovative financing mechanisms to support safe places for physical activity, such as high quality parks, trails, community recreation areas, access to healthy foods, and multi-modal transportation systems.   We will explore health-related community investing and new mechanisms created under the Affordable Care Act (ACA) that can be leveraged to support activity-friendly community environments.

Description
We will share lessons learned from the Financial Innovations Roundtable (FIR), which has created cross-sector partnerships among conventional and non-traditional lenders, community development organizations, and other types of financial institutions over the past 14 years to provide low-income communities with increased access to capital and financial services. Recently, the FIR entered into a partnership with the Federal Reserve Board of Governors in Washington, D.C., and selected health-related community investing as its focus for 2014. Although health is a new explicit focus for the FIR, many successful ideas developed at the FIR have been implemented, resulting in transformative investments in affordable housing, small and minority businesses, community facilities, and other community development efforts, in addition to new tools, policies and practices. Over the past year, the FIR engaged financial institutions, funders, and health partners to holistically examine the social determinants of health - including pertinent ALR domains such as community recreational environments and transportation systems.  Through document review, analysis of transcripts from the FIR’s 2014 dialogue, and interviews with FIR members, and case examples, we explore potential partnerships, synergies, and focus areas relevant to ALR goals.

Lessons Learned
We will have a complete summary of lessons learned as FIR continues its dialogues focused on healthy communities through 2014-15. Preliminary lessons learned include:  1)  FIR stakeholders established a matrix to delineate how various community stakeholders can define community, list accountability mechanisms, and identify opportunities for alignment; 2)   FIR stakeholders are deeply committed to addressing the social determinants of health and improving places where we live, learn, work, and play; 3)   FIR stakeholders expressed interest in learning more about shared metrics that allow us to measure positive change in communities. This is an important point of intersection with RWJF/ALR, as many existing metrics developed by RWJF/ALR may be useful to the FIR; 4)   Innovative examples from diverse communities were shared, such as Boston Community Capital’s focus on “transformation zones,” (which support grocery stores, health clinics, housing areas, commercial space, and housing).   Similarly, the Federal Reserve Bank of Boston’s Working Cities Challenge is helping to improve the health of low-income people while advancing collaborative leadership in Massachusetts’ smaller cities. As an awardee, the City of Fitchburg, MA works through its broad health promotion partnership, Fun ‘n FITchburg, to develop shared metrics for neighborhood health and well-being with the goal of making its North of Main neighborhood a place where residents choose to live, work, and invest. In Omaha, NE, traditional providers and funders of clinical care now invest in infrastructure projects to create better access to active transportation in the public space. The city’s new B-cycle membership bike rental system and rental stations have been supported by funders such as Blue Cross Blue Shield of Nebraska, Alegent Creighton Health, the Peter Kiewit Foundation and the Sherwood Foundation.  5)   FIR stakeholders identified Treasurers of hospitals as frequently overlooked partners,as they can facilitate collaborations between hospitals, Community Development Finance Institutions, and banks.

Conclusions
Raising awareness about innovative health-related community investing strategies and exploring ways to partner with community development and other types of financial institutions are key aspects of ALR policy implementation. By addressing these areas, the National Prevention Strategy’s key strategic directions pertaining to active living - safe and healthy community environments, empowered people, and elimination of health disparities - are more likely to be achieved.

Next Steps
The FIR stakeholders are currently exploring new opportunities for alignment, and discussing ways to diversify investment strategies to improve health outcomes. An important opportunity exists to explore synergies with ALR, particularly with respect to harnessing innovative financing mechanisms to  implement active living policies.

References

  1. National Prevention Council. National Prevention Strategy. 2011  [cited 2014 July 27]; Available from: http://www.surgeongeneral.gov/initiatives/prevention/strategy/index.html#The%20Strategic%20Directions.
  2. Mair, J., Milligan,K.,, Q&A Roundtable on Impact Investing. Stanford Social Innovation Review, 2012.
  3. Fleming, D., Achieving Individual Health through Community Investment: A Perspective from King County, Washington, R.C.t.B.a.H. America, Editor. 2013.
  4. Swack, M. Financial Innovations Roundtable. 2014  [cited 2014 August 14]; Available from: https://carsey.unh.edu/csif/financial-innovations-roundtable#.
  5. Go, A.S., et al., Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation, 2014. 129(3): p. e28-e292.
  6. Kurian, A.K. and K.M. Cardarelli, Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis, 2007. 17(1): p. 143-52.
  7. Mensah, G.A., et al., State of disparities in cardiovascular health in the United States. Circulation, 2005. 111(10): p. 1233-41.
  8. Cooper, R., et al., Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States findings of the national    conference on cardiovascular disease prevention. Circulation, 2000. 102(25): p. 3137-3147.
  9. Kirchner, C.E., E.G. Gerber, and B.C. Smith, Designed to deter. Community barriers to physical activity for people with visual or motor impairments. Am J Prev Med, 2008. 34(4): p. 349-52.
  10. US Census Bureau, American Community Survey and Peurto Rico Community Survey 2012 Subject Definitions. 2012.
  11. US Census Bureau, American FactFinder. Disability Characteristics 2010-2012 American Community Survey 3-Year Estimates. 2010.
Authors: 
Semra Aytur, PhD, MPH, University of New Hampshire
Location by State: 
Study Type: 

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