how can we build healthy & active communities?
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How Can We Build Healthy & Active Communities?. James Sallis, PhD University of California, San Diego http://sallis.ucsd.edu For PAPH in Aruba June 14, 2012. Maintaining & Building Activity-Friendly Places in Aruba. S leep L eisure O ccupation T ransportation H ousehold. - PowerPoint PPT PresentationTRANSCRIPT
How Can We Build Healthy & Active Communities?
James Sallis, PhDUniversity of California, San Diego
http://sallis.ucsd.edu
For PAPH in ArubaJune 14, 2012
Maintaining & Building Activity-Friendly Places in Aruba
SLOTH Model of Physical Activity
• Sleep
• Leisure
• Occupation
• Transportation
• Household
What is being done to improve PA?
• Minor investment in programs• Guided by theories that emphasize
psychological & social influences• Primary goals are education and
behavior change skills training targeting individuals
• Fragmented, poorly coordinated, poorly funded approaches
Psychosocial Models of Health Behavior
IndividualBiologicalPsychologicalSkills
Social/Cultural
Will individual interventions ever be sufficient?
Interventions based on psychosocial theories can be effective
But not sufficientReach is limitedEffects are modestMaintenance is rare
Programs are not designed to change the root causes of current behavioral patterns
An Ecological Model of Health Behavior
IndividualBiologicalPsychologicalBehavioral Skills
Social/Cultural
Physical Environment
Policy Context
Different environments----Different congestion
Places for Physical Activity• Leisure
• Occupation
• Transportation
• Household
• Parks, health clubs, sidewalks
• Workplace
• Streets, bike facilities
• Home
Comm DesignDestinations Home
Park & RecSchool & Preschool
Elements of An Active Living Community
Transportation
“Walkable”: Mixed use, connected, dense
Not “walkable”
street connectivity and mixed land use
The Neighborhood Quality of Life (NQLS) Study: The Link Between
Neighborhood Design and Physical Activity
James SallisBrian Saelens
Lawrence FrankAnd team
Results published March 2009 in Social Science and Medicine
NQLS Neighborhood Categories
WalkabilityS
ocio
econ
omic
St a
tus Low High
Hig
hLo
w 4 per city
4 per city 4 per city
4 per city
Accelerometer-based MVPA Min/day in Walkability-by-Income Quadrants
28.533.4
29.0
35.7
0
5
10
15
20
25
30
35
40
MVP
A m
inut
es p
er d
ay(M
ean
*)
Low Income High Income
Low WalkHigh Walk
Walkability: p =.0002Income: p =.36Walkability X Income: p =.57
* Adjusted for neighborhood clustering, gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address.
Percent Overweight or Obese (BMI>25) in Walkability-by-Income Quadrants
63.156.8
60.4
48.2
0
10
20
30
40
50
60
70
% O
verw
eigh
t or O
bese
Low Income High Income
Low WalkHigh Walk
Walkability: p =.007Income: p =.081Walkability X Income: p =.26
* Adjusted for neighborhood clustering, gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address.
Multiple Pathways from Land Use to Health: Walkability Associations With Active Transportation,
Body Mass Index, and Air Quality.Frank et al. JAPA 2007
• 5% increase in walkability associated with:– 32% increase in walking for transport– ¼ point decrease in BMI (about 1.25 pounds)– 6.5% decrease in vehicle miles traveled– 5.6% decrease in oxides of nitrogen (NOx)
grams– 5.5% decrease in volatile organic compounds
(VOC) grams• County government is acting on results
Accelerometer-based MVPA Min/day in Walkability-by-Income Quadrants
Walkability: F=13.74; p =.000Income: F=2.59; p =.108Walkability X Income: F=.001; p =.981
* Adjusted for gender and age
Walkable neighborhoods encourage more walking in older adults
•Older women who live within walking distance of trails, parks or stores recorded significantly higher pedometer readings than women who did not. The more destinations that were close by, the more they walked.
Photo: Michael Ronkin, ODOTKing, W., Am. J. of Public Health 2003
We can learn from international studies
Atlanta, USA
Ghent, Belgium
Multiple Environmental Factors Are Needed to Support Physical
Activity: An 11-Country Study of Neighborhood Environments
James F. Sallis, USAHeather Bowles, Australia
Barbara E. Ainsworth, USAAdrian Bauman, Australia
Et alAm J Prev Med. May 2009
Associations Between Individual Environmental Characteristics and HEPA/Minimal Activity Among Respondents who Live in Cities with Population ≥ 30,000
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Single FamilyHouses
Shops NearHome
T ransit StopNear Home
SidewalksPresent
Facilit ies toBicycle
Low Cost RecFacilit ies
Unsafe to Walkdue to Crime
'Agre e ' with Environm e ntal C haracte ri stic('Disagre e ' i s re fe re nt)
Odd
s R
atio
HE
PA
/Min
imal
Act
ivit
y
Dose Response between Number of Environmental Characteristics and HEPA/Minimal Activity
(Pooled City Sample)
0.60
1.00
1.40
1.80
2.20
2.60
3.00
1 2 3 4 5 6Total Num be r of Environm e ntal C haracte ristics
(Ze ro i s re fe re nt)
Odd
s R
atio
HE
PA
/Min
imal
ly A
ctiv
e
Sallis. Am J Prev Med. 06/09
Built environment correlates of physical activity behaviours in a developing city:
The case of Bogota, Colombia
Olga Lucia Sarmiento and team
Universidade de los Andes
photo: O.L. Sarmiento
Main Results• Walking for transport (30 min/day for at least 5 days/week) was positively associated with:
– Street density (POR 1.71, 95% CI 1.19-2.46)– Street connectivity (POR 2.21, 95% CI 1.40-3.49)– Bus Rapid Transit stations in the neighborhood (POR
1.71, 95% CI 1.19-3.47)
• Leisure time physical activity (30 min/day for at least 5 days/week) was positively associated with:
– Park density (POR 2.05, 95%CI 1.13-3.72)– Bus Rapid Transit stations in the neighbohood (POR
1.27, 95% CI 1.07-1.50)
People with access to parks & recreationFacilities are more likely to be active
A national study of US adolescents (N=20,745)* found a greater number of physical activity facilities is directly related to physical activity and inversely related to risk of overweight
Gordon-Larsen et al, Pediatrics, 2006http://www.pediatrics.org/cgi/content/full/117/2/417
*using Add Health data
0.5
0.75
1
1.25
1.5
One Two Three Four Five Six Seven
Number of facilities per block group
Odd
s ra
tio
Odds of having 5 or more bouts of MVPA
Odds of being overweight
1.26
.68
Referent
People are Most Active on Tracks and Walking Paths
0
50
100
150
200
250
300
Track
Sidewalk
Gymnas
ium
Multi-p
urpose fie
ld
Playgro
und
Outdoor B
aske
tball
Lawn
Baseb
all
Senior C
enter
Ave
rage
Num
ber o
f Par
k U
sers Sedentary Walking, Moderate & Vigorous
Cohen. RAND
Activity-Friendly Transportation Systems
Room for ImprovementPlan & Build for Pedestrians
Walkability > Driving > Obesity?The more miles a person travels by vehicle, the
more likely they are to be obese
9.5
14.3
27.08
18.05
0%
5%
10%
15%
20%
25%
30%
Q1 Q2 Q3 Q4
Quartiles of vehicle miles traveled (VMT)
Lopez Zetina 2006
0
5
10
15
20
25
30
Perc
ent o
f Obe
sity
0
10
20
30
40
50
60
Perc
ent W
alk,
Bik
e,T
rans
it
Obesity Walk, Bike, Transit
Obesity falls sharply with increased walking, cycling, and transit use!
Credit: John Pucher
Daily steps are higher among adults who commute by train instead of car
7500
9500
6000
7000
8000
9000
10000
Train CarCommuting Mode
Ave
rage
Dai
ly S
teps
(p
edom
eter
)
Wener & Evans, Environment and Behavior, 2007
Neighborhood Walkability and Active Commuting to School
• 201 parents of children aged 4 to 17• Active commuting to school:
– 25% in hi-walkable neighborhoods– 11% in lo-walkable neighborhoods
• Parent concerns, mostly about traffic, were higher in lo-walkable neighborhoods
• Kerr, et al. MSSE, 2006
Where do people bicycle? The role of infrastructure in determining bicycling behavior
Jennifer Dill, Ph.D. Center for Transportation Studies
Where do people bicycle in Portland, OR? Based on GPS.
Type of road % of bicycle miles
% of road miles
Without bicycle facilities
51 92
With bicycle facilities (lane, separate path, bike boulevard
49 8
Jennifer Dill. J Public Health Policy. 2008.
•The Ministry of Traffic designated Odense as Denmark’s National Cycle City 1999-2002 (186.000 citizens)
Odense – The National Cycle City of Denmark
Right-hand turn lanesII - IV
Awareness of cyclistsII - IV
•Results •1999-2003: •> 50 sub-projects• Bicycle traffic increase by 20%•Accidents involving cyclists decrease by 20%
Odense – The National Cycle City of Denmark
www.cyclecity.dk
London('03-'06)
Barcelona('05-'07)
Paris('01-'07)
Bogota('95-'07)
Minneapolis('80-'08)
Portland('90-'08)
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1.20.8
1.00.8 1.0 1.1
1.6 1.8
2.5
3.2
4.3
6.0
Perc
ent o
f Tri
ps
Source: Pucher, Dill, and Handy, “Infrastructure, Programs, and Policies to Increase Bicycling,” Preventive Medicine, Jan 2010, Vol. 50, S.1, pp. S106-S125.
Increase in Bike Share of Trips in Cities Around the World
Bogota, Colombia has invested heavily in walking, cycling, & PA events
Boulder, CO
Brisbane, Australia has invested in pedestrian facilities
*Beautiful pedestrian bridge*Walkways along the river*Pleasing aesthetics
Amsterdam is a model for being friendly to pedestrians & cyclists
TheIncredibleBicycleParkingStructure At theTrainStation
Decisions aboutClimate change andControlling chronicDisease are related
Resources from www.activelivingresearch.org