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Research?

Research?. ? THE QUESTION. Can the built environment make us fat? by fostering unhealthy lifestyles such as physical inactivity, automobile dependency, and poor diet?. Density Land Use Transportation Infrastructure Urban & Architectural Design Aesthetics Safety. B UILT ENVIRONMENT.

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Research?

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  1. Research?

  2. ?THE QUESTION Can the built environment make us fat? by fostering unhealthy lifestyles such as physical inactivity, automobile dependency, and poor diet?

  3. Density Land Use Transportation Infrastructure Urban & Architectural Design Aesthetics Safety BUILT ENVIRONMENT PHYSICAL Activity OBESITY Transportation Household Leisure & Recreation Work-related Quality of Life Cardiovascular Diseases Diabetes Respiratory Diseases Cancers Depression Aging

  4. Our Behaviors… 60+% of US adults (BRFSS) and 60+% of global population (WHO) are not regularly active. In the US, active transport (walk & bike) to school among 5 to 18 years reduced from 42% in 1969 to 16% in 2001 (CDC).

  5. Walking to school Active Transport to SchoolAmong Youth 5 to 18 Years of Age http://www.cdc.gov/nccdphp/dnpa/kidswalk/then_and_now.htm

  6. Los Angeles: The architecture of four ecologies (Banham, 1971) Drive-through voting draws early voters in Southern California (AP Photo/Mark Avery, Oct. 21, 2008) AP Photo/Mark Avery, Oct. 21, 2008)

  7. http://www.treehugger.com/files/2008/10/bike-thru-banking.phphttp://www.treehugger.com/files/2008/10/bike-thru-banking.php

  8. Empirical EvidenceThe Link Between Built Environment and Lifestyle Physical Activity

  9. A Few Findings on Health Benefits of Walking and Biking • Sesso and colleagues (1999) found that walking more than 10 blocks everyday resulted in a 33 % reduced cardiovascular disease risk. • LaCroix et al (1996) observed that the increased hours of walking is related with reduced rate of cardiovascular disease hospitalization. • Oja and colleagues (1998) reported that daily walking and bicycling to work improves the cardio-respiratory and metabolic fitness of previously inactive adults and health beneficial. • Pollock et al (1978) also concluded that moderate to high energy cost activities such as running, jogging, walking, and bicycling, show a significant increase in cardio-respiratory fitness.

  10. A Few Findings on Health Benefits of Walking and Biking Lifestyle interventions (i.e., walking and bicycling), compared to structured intervention (i.e., exercise program and health club activities), are • more likely to induce long-term lifestyle changes • effective for currently sedentary people • more cost effective (i.e., Dunn et al., 1999; Owen and Bauman, 1992; Sevick et al., 2000)

  11. Correlates of Overall or Recreational Physical Activity Objective Measures: • Geographic location (levels of urbanization, coastal location, etc.) • Age of the neighborhood/housing (neighborhood design) • Density • Destination (physical activity facilities, shops, etc.) • Streets (sidewalks, safety, route quality and barriers) Perceived Measures: • Land use mix • Accessibility • Convenience • Safety • Route quality • Barriers (distance, etc.) • Aesthetic/visual quality • Etc. Lee C and Moudon AV (2004). Physical activity and environment research in the health field: Implications for urban and transportation planning practice and research. Journal of Planning Literature, 19(2), 147-181.

  12. Correlates of Transportation Behaviors (mode choice, VMT, non-motorized mode use, etc.) • Density • Land use mix • Infrastructure design • Transit service • Neighborhood design • Safety • Topography • Visual quality • Etc.

  13. Environments that support Walking The 3Ds+R Destination Distance Density Route Lee C, Moudon AV (2006). 3Ds+R: Land use and urban form correlates of walking. Transportation Research D, 11(3), 204-215.

  14. How far do people walk? Seattle, WBC Survey

  15. Where people walk to? Seattle Seattle, WBC Survey

  16. Where people walk to? El Cenizo, TX

  17. Where do people go for “recreational” walking? Seattle, WBC Survey

  18. What are the barriers to walking?El Cenizo, TX SWUTC survey

  19. What are the environmental factors that can help people walk or walk more?Seattle Seattle, WBC Survey

  20. Assessments: Examples of objectivemeasures of the built environment

  21. Audit

  22. Geographic Information System

  23. Other Relevant Measurement Tools • Global Positioning System • Ecological Momentary Assessment • Photography & Video Recorder • Infrared Motion Sensor (indoor)

  24. SummaryActivity Friendly Community as a Strategy to Reduce Obesity: Modifiable environmental factors

  25. Land Use DestinationDistance

  26. Street and Transport Infrastructure (Adopted from Lee and Moudon 2005)

  27. Site Design

  28. Pedestrian & Bicycle Facilities

  29. Recreational Facilities

  30. Visual Quality

  31. Architecture

  32. Urban Design & Amenity

  33. Safety! Safety! Safety!

  34. Changes in Major Food Sources of Energy From Snacking: Young Adults Aged 19-29 Total 15.7 Desserts 23.0 Sweetened Beverages 15.7 Regular Soft Drinks Diet Soft Drinks Fruit Drinks 14.3 Alcoholic Beverages 12.5 Beer Liquor Wine 10.0 Milks 5.8 Skim ½% Whole 8.8 Salty SnackFoods 11.5 Low Fat Snack Foods High Snack Foods 5.9 Zizza et al 2001 Prev Med 32:303

  35. Portion Sizes for Selected Foods for Individuals Aged 2 and Older, USA 1977-1998 Nielsen & Popkin 2003 JAMA 289:450-453.

  36. Trends in Total Energy Intake: The Proportion of Energy by Food Source for US Adolescents Aged 12-18 Percentage of total daily kcal Nielsen et. Al. (2002). Obesity Research 10: 370-378.

  37. Trends in Total Energy Intake by Location, 1977- 96 Ages 12-18 Ages 19-29 '77-78 '89-91 '94-96 Nielsen et. Al. (2002). Obesity Research 10: 370-378.

  38. Trends in Beverage Consumption Between 1977 and 2001 (the % of total daily calorie intake from each beverage for all Americans aged 2 and older) Percentage of daily calorie intake Source: Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10. *All changes significant at the 0.01 level between 1977-78 and 1999-2001

  39. Trends in the Mean Percentage of Consumers, Mean Servings/Day, and Mean Portions of Specific Beverages Calorically-Sweetened beverages Milk beverages Source: Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.

  40. Trends in Sweetened Beverages and Milk Consumption by Location 1977-96. (Each figure represents the % of total daily calorie intake by location and meal type for each year) Source: Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.

  41. U.S. Beverage Consumption in 1999-2001: What proportion of our calories come from each type of beverage? 0.3 0.3 1.0 0.5 0.3 0.3 0.9 4.8 2.7 0.3 3.5 1.6 1.2 0.6 2.0 8.3 3.8 1.1 4.9 Percentage of total daily kcal from each beverage 2.6 5.0 2.5 1.6 2.4 3.4 2.2 3.9 4.6 1.2 9.8 1.2 7.0 6.9 5.0 3.0 Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.

  42. Level 1: Water • Water-essential for life • For average person with 2200 kcal per day: 16-24 ounces or more per day but this could provide all beverage needs of about 98 ounces • Needed for adequate hydration • Dehydration: impaired cognition, moodiness, physical work performance, increased risk of bladder, colon, breast cancer

  43. Level 2: Tea and Coffee • Tea and Coffee – selected benefits on chronics, no adverse health effects in terms of obesity and chronic diseases. The only issue is for high added cream and sugar such as for gourmet coffees • Tea: animal work strong for tea’s protective role against selected cancers; unclear benefits in humans. Potential health benefits of flavonoids in tea are unclear • Coffee: mild antidepressant, some evidence lowers risk of Type 2 diabetes • Caffeine: 400 mg limit. 32 ounce limit coffee [150 mg caffeine limit if pregnant]

  44. Level 3: Low Fat and Skim Milk and Soy Beverages • Skim Milk – unclear benefits on weight gain and bone density and fractures. Range of meta-analyses and one recent 48-week trial show no benefits for weight loss. Important benefits as protein source for child linear growth. Also major provider of calcium and vitamin D • Adult milk intake may adversely affect several chronic diseases (prostate cancer, ovarian cancer) • Current consumption patterns indicate milk products are important contributors of many key nutrients

  45. Level 4: Noncalorically-Sweetened Beverages • High sweetness in these beverages holds the possibility that consumption of these sweet beverages may condition a preference for sweetness • Animal work suggests that altering the ability of the sensory properties of food to predict the caloric consequences of consuming that food may impact energy regulation and body weight

  46. Level 5: Caloric Beverages with Some Nutrients • Fruit juices: high in energy content, contribute limited nutrients. IOM states that two-thirds of all fruit intake should be from fruit. Limit to 4-8 ounces/day • Vegetable juices: fewer calories, significant amounts of sodium • Whole milk: Saturated fats are not needed beyond infancy

  47. Level 5: Caloric Beverages with Some Nutrients (continued) • Sports drinks – reduced energy density over soft drinks, helpful for hydrating endurance athletes, provides small amounts of key minerals • Alcohol – only the ethanol benefit is clear. Moderate intake (1 drink-women, 2 for men) linked with reduced mortality, CVD, type II diabetes

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