Built Environment and Older Adults: Supporting Smooth Transitions Across the Life- Span. Dr. Lawrence Frank, Professor and Bombardier UBC

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1 Built Environment and Older Adults: Supporting Smooth Transitions Across the Life- Span Dr. Lawrence Frank, Professor and Bombardier UBC

2 The Hidden Health Costs of Transportation - Frank et al 2010 American Public Health Association

3 Provides Opportunity for Social Interaction Provides Independence and Mobility Distances to Destinations Are Short A Variety of Housing Choices Streets are Interconnected Sidewalks are Even and Street Crossings Are Short Has Parks and Streets With Benches Passive Places to Observe Others Slopes are Not Extreme

4 Proximity 2 KM 1 KM Connectivity

5 Lower Mainland Walkability Map

6 Walkability and Elderly

7 Comparing Two Communities

8 California will see its 65-plus population more than double in the next 25 years, from 3.5 million in 2000 (10.6 percent of the state's population) to 8.2 million in 2030 (17.8 percent). Where will the 65-plus population live? Access to services Less reliance on driving for safety reasons Maintaining Independence For elderly, considering cost of service delivery with Aging in Place Suburban Vs Urban setting

9 Population 2000 and 2011 (projection Age 60 and Over 68.1% 62.1% City of Seattle Data Source: Geolytics, Inc.

11 Variables 25 to 64 Years Old Years Old years Old 85+ Years Old Percent with no driver's license 6.8% 13.5% 23.1% 57.6% Percent with a medical condition impacting travel 3.6% 12.4% 23.2% 33.6% Percent with no household vehicles 4.2% 7.9% 16.9% 18.2% Total trips daily per person (all modes) Percent traveling by transit (1+ bus or rail trips over two day survey period) 5.0% 2.2% 1.2% 1.3% Miles traveled as driver Percent people whose willingness to walk is affected "very much" by traffic Percent people whose willingness to walk is affected "very much" by sidewalk availability 28.6% 28.8% 23.6% 22.1% 35.3% 35.8% 30.6% 46.2% Atlanta SMARTRAQ Data

12 Increased walkability was related with more walking (OR 2.02), less time spent traveling in a car (OR.53), and lower odds of being overweight (OR.68). Those with 1 or no cars were more likely to walk (OR 2.9) and spend less time in cars (OR.53); but also less likely to get recommended levels of PA (OR.55). Visiting a fast food outlet was associated with increased odds of obesity (OR 1.81).

13 age, number of cars, ethnicity, and walkability were significantly related to walking at least once over the two-day diary period. Only 4 percent of the sample reported walking Fifty seven percent of the sample was overweight and 20 percent were obese. those with one or less cars were almost three times more likely to walk, those with a degree were almost twice as likely to walk, and those living in a highly walkable neighborhood were two times more likely to walk than those in a low walkable neighborhood.

14 the youngest group (65-74), and those with a higher household income and a degree were more likely to travel in a car for an hour a day. Those with one car or less, non-whites, and women were significantly less likely to spend an hour a day in a car. Those living in neighborhoods with medium walkability were 35 percent less likely, and those in high walkable neighborhoods were 47 percent less likely, to travel over an hour a day by car. only those with a car were significantly more likely to meet recommended activity levels.

15 Increased walkability was related with lower odds of being overweight (OR.68). those who walked were significantly less likely (OR.51) to be overweight. Women and those with a degree were less likely to be overweight. Younger participates were more likely to be categorized as obese, as were non-whites and those with no college degree. Those who met the physical activity guidelines were 45 percent less likely to be obese but those who visited a fast food outlet at least once in the 2-day survey period were 1.8 times more likely to be obese.

16 Marshall, Brauer, and Frank 2008 Nitric Oxide

19 Total variance explained * p<.05 in final block Gender Stratified Linear regression Women Men T P value t P value Block 1 - % variance explained Age * * Race * * Education * * Income * Number in household * * Number of vehicles in household * Two or more children in household * Employment Block 2 - % variance explained Walkability of home * Block 3 - % variance explained Ate at fastfood restaurant * Shopped at grocery store * Block 4 - % variance explained Meeting guidelines for MVPA Walked at least once over 2 days

20 Residential Density and Mix of Housing Type

21 Prefers a Walkable Community Design Neighborhood Preferences 1 2 Low Walkability Built Environment High Walkability 3 4 Prefers Auto - Based Community Design

22 Preference (Subjective) 2 Auto Walk Quadrant 1: Unmatched Walkability -- Low Preference -- Walk Quadrant 3: Matched Walkability -- Low Preference -- Auto Quadrant 2: Matched Walkability -- High Preference -- Walk Quadrant 4: Unmatched Walkability -- High Preference -- Auto Low Neighborhood Walkability (Objective) High

Walkability & Preference Groups Preference for Neighborhood Type Walkability of Current Neighborhood I High Low II III High Low High Low IV Low High Percent Taking a Walk Trip (n) Average Daily

23 Walkability & Preference Groups Preference for Neighborhood Type Walkability of Current Neighborhood I High Low II III High Low High Low IV Low High Percent Taking a Walk Trip (n) Average Daily Vehicle Miles Traveled (n) 16.0% (188) (188) (1 33.9% (446) (446) (3 3.3% (246) (246) (2 7.0% (43) (43) ( FIGURE 12 - Walking, Driving and Obesity by Neighborhood Preferenc Pe Ob (

24 Policies are needed to bring older Americans closer to shops and services and healthy food outlets as a means of encouraging regular walking and healthy body weight. Incentives to encourage neighborhood grocery stores and affordable housing in central areas along with regulatory reform through zoning can encourage PA and healthy body weight in the elderly.

1) Housing affordability / Walkability 2) Transit access, physical activity, and site design 3) Design solutions to air pollution exposure 4) Measuring effects of changes in built 5)

26 1) Housing affordability / Walkability 2) Transit access, physical activity, and site design 3) Design solutions to air pollution exposure 4) Measuring effects of changes in built 5) Environment to support healthy aging 6) Re-assessing the meaning and costs of aging in place 7) Healthy eating and food environments for seniors MONETIZING THE BUILT ENVIRONMENTS INFLUENCE ON HEALTHY AGING

Percentage of households within a 0.6 mile (1 km) walking distance of a park entrance Uses field verified data from the Neighborhood Quality of Life Study (NQLS; Principal Investigator Dr.

27 Percentage of households within a 0.6 mile (1 km) walking distance of a park entrance Uses field verified data from the Neighborhood Quality of Life Study (NQLS; Principal Investigator Dr. James Sallis, San Diego State University) Supplemented with regional parks & open space data Nearly 70 percent of all multifamily households (and 58 percent of all households) have park access within a 0.6 mile walk Potential Healthy Works Application: City of Santee Park Master Plan

Neighborhood Quality of Life Study (NQLS) food outlet data - subject to detailed field

28 Percentage of households within 0.6 miles (1 km) of a grocery store, produce market, specialty market or farmers market Uses Neighborhood Quality of Life Study (NQLS) food outlet data - subject to detailed field verification in Over 80 percent of multi-family households - and nearly 60 percent of all households - have access to a grocery store or farmers market within walking distance.

30 Nothing Great Was Ever Achieved Without Enthusiasm Ralph Waldo Emerson

Carbonless Footprints: Health and Environmental benefits of Active Transportation

Carbonless Footprints: Health and Environmental benefits of Active Transportation Dr. Lawrence Frank, Professor and Bombardier Chair in Sustainable Transportation - University of British Columbia Health