How Can We Build Healthy & Active Communities?

1. 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

2. Maintaining & Building Activity-Friendly Places in Aruba

3. Sleep Leisure Occupation Transportation Household SLOTH Model of Physical Activity

4. 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

5. Psychosocial Models of Health Behavior Social/Cultural Individual Biological Psychological Skills

6. Will individual interventions ever be sufficient? • Interventions based on psychosocial theories can be effective • But not sufficient • Reach is limited • Effects are modest • Maintenance is rare • Programs are not designed to change the root causes of current behavioral patterns

7. An Ecological Model of Health Behavior Policy Context Physical Environment Social/Cultural Individual Biological Psychological Behavioral Skills

8. Different environments----Different congestion

9. Leisure Occupation Transportation Household Parks, health clubs, sidewalks Workplace Streets, bike facilities Home Places for Physical Activity

10. Elements of An Active Living Community Comm Design Destinations Home Transportation School & Preschool Park & Rec

11. “Walkable”: Mixed use, connected, dense

12. Not “walkable”street connectivity and mixed land use

13. The Neighborhood Quality of Life (NQLS) Study: The Link Between Neighborhood Design and Physical Activity James Sallis Brian Saelens Lawrence Frank And team Results published March 2009 in Social Science and Medicine

14. NQLS Neighborhood Categories Walkability High Low 4 per city 4 per city Low Socioeconomic Status High 4 per city 4 per city

15. Accelerometer-based MVPA Min/day in Walkability-by-Income Quadrants Walkability: p =.0002 Income: p =.36 Walkability 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.

16. Percent Overweight or Obese (BMI>25) in Walkability-by-Income Quadrants Walkability: p =.007 Income: p =.081 Walkability 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.

17. 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

18. Accelerometer-based MVPA Min/day in Walkability-by-Income Quadrants Walkability: F=13.74; p =.000 Income: F=2.59; p =.108 Walkability X Income: F=.001; p =.981 * Adjusted for gender and age

19. 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, ODOT King, W., Am. J. of Public Health 2003

20. Atlanta, USA Ghent, Belgium We can learn from international studies

21. Multiple Environmental Factors Are Needed to Support Physical Activity: An 11-Country Study of Neighborhood Environments James F. Sallis, USA Heather Bowles, Australia Barbara E. Ainsworth, USA Adrian Bauman, Australia Et al Am J Prev Med. May 2009

23. Sallis. Am J Prev Med. 06/09

24. 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

25. photo: O.L. Sarmiento

26. 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)

27. People with access to parks & recreation Facilities are more likely to be active

28. 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 Odds of having 5 or more bouts of MVPA 1.26 Referent Odds of being overweight .68 *using Add Health data Gordon-Larsen et al, Pediatrics, 2006 http://www.pediatrics.org/cgi/content/full/117/2/417

29. People are Most Active on Tracks and Walking Paths Cohen. RAND

30. Activity-Friendly Transportation Systems

31. Room for ImprovementPlan & Build for Pedestrians

32. Walkability > Driving > Obesity? Lopez Zetina 2006

33. Obesity falls sharply with increased walking, cycling, and transit use! Credit: John Pucher

34. Wener & Evans, Environment and Behavior, 2007

35. 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

36. Where do people bicycle?The role of infrastructure in determining bicycling behavior Jennifer Dill, Ph.D. Center for Transportation Studies

37. Where do people bicycle in Portland, OR? Based on GPS. Jennifer Dill. J Public Health Policy. 2008.

38. Odense – The National Cycle City of Denmark • The Ministry of Traffic designated Odense as Denmark’s National Cycle City 1999-2002 (186.000 citizens)

39. II - IV Right-hand turn lanes

40. II - IV Awareness of cyclists

41. Odense – The National Cycle City of Denmark • Results • 1999-2003: • > 50 sub-projects • Bicycle traffic increase by 20% • Accidents involving cyclists decrease by 20% www.cyclecity.dk

42. Increase in Bike Share of Trips in Cities Around the World Source: Pucher, Dill, and Handy, “Infrastructure, Programs, and Policies to Increase Bicycling,” Preventive Medicine, Jan 2010, Vol. 50, S.1, pp. S106-S125.

43. Bogota, Colombia has invested heavily in walking, cycling, & PA events

44. Boulder, CO

45. Brisbane, Australia has invested in pedestrian facilities *Beautiful pedestrian bridge *Walkways along the river *Pleasing aesthetics

46. Amsterdam is a model for being friendly to pedestrians & cyclists The Incredible Bicycle Parking Structure At the Train Station

47. Decisions about Climate change and Controlling chronic Disease are related

48. Resources from www.activelivingresearch.org