Translating Research Into Public Policy:

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1 An Active Living Program supported by The Robert Wood Johnson Foundation and administered by San Diego State University. Translating Research Into Public Policy: The Case of Active Living NCSL. November 17, 2008 James F. Sallis, Ph.D. San Diego State University

2 3Four50.com Oxford Health Alliance's key message: 3 risk factors tobacco use, poor diet, lack of physical activity Contribute to Four chronic diseases heart disease, type 2 diabetes, lung disease and some cancers Which, in turn, contribute to more than 50 percent of deaths in the world

3 Promoting exercise has not worked Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System

4 Walking for Transport Is Declining, While the Number of Overweight Adults Is Climbing Based on data from the Nationwide Personal Transportation Survey and the Centers for Disease Control and Prevention.

5 60% Percentage of youth ages 6-19 meeting 60 min/day physical activity guidelines. Based on accelerometers. NHANES % 40% 20% 0% 35% 10% 3.4% 10% 5.4% Age Males Females Troiano, MSSE, 2007

6 Sleep Domains of Activity: The SLOTH Model Leisure Occupational Transportation Household

7 The nature of transportation has changed dramatically Tim Armstrong, WHO

8 Work is no longer physical work Tim Armstrong, WHO

10 The Political Debate The Political Debate The Right says People can choose to be active Educate them so they choose wisely The Left says We need to engineer society so it is easy for people to be active Change environments & policies The Evidence says People need activity-friendly places AND educational/motivational programs

11 A Multi-Level Approach Is Needed Policy Context Physical Environment Social/cultural Individual Biological Psychological Skills

12 Use of Physical Activity Facilities by Teens Commercial School- Weekend Girls Boys Rec Center School-after Park Neighborhood Hoefer, Mckenzie, et al., 2001, AJPM Times per Week N= 1678 parent reports; 24 schools Gender P=.001, except NS for commercial facilities

13 Neighborhood Physical Activity Settings Mixed use, connected streets Transportation facilities Sidewalks, bike lanes, transit Recreation facilities Parks, trails, private facilities, aesthetics Schools & workplaces Siting, buildings, rec facilities, showers

14 Research on Built Environment & Physical Activity Built Environment Attribute Youth Adults Seniors Walkability: mixed land use, street connectivity, residential density Sidewalks + +? Proximity of recreation facilities (parks, trails, private facilities) Aesthetics of recreation facilities Sallis & Kerr. For PCPFS Research Digest. 2007

15 Designing Activity-Friendly Communities

16 Designing for Active Transportation Walkability Proximity: Are there places nearby to walk to? Connectivity: Are there safe and direct ways to make the trip?

17 High walkable, low income Shopping

18 Low walkable, High income Residences

19 Our Heritage of Walkability

20 The Neighborhood Quality of Life (NQLS) Study: The Link Between Neighborhood Design and Physical Activity Funded by NHLBI, James Sallis Brian Saelens Lawrence Frank

21 MVPA minutes per day (Mean *) Accelerometer-based MVPA Min/day in Walkability-by by-income Quadrants Low Income High Income Walkability: p =.0002 Income: p =.36 Walkability X Income: p =.57 Low Walk High Walk * 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.

22 70 Percent Overweight or Obese (BMI>25) in Walkability-by by-income Quadrants Walkability: p =.007 Income: p =.081 Walkability X Income: p =.26 % Overweight or Obese Low Walk High Walk 0 Low Income High Income * 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.

23 NEWS Pedestrian/Traffic Safety in Walkability-by by-income Quadrants Income: p = <.0001 Walkability X Income: p = NEWS Pedestrian/Traffic Safety (Mean *) Low Income High Income Low Walk High Walk *All models adjusted for gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address. Neighborhood was included as a random effect to adjust for clustering.

24 Youth ages 5 to 18 years who live in mixed-use neighborhoods walk more for transportation 20% 15% 9% of children had walking trip over two days 18% of children had walking trip over two days 10% 5% 0% No mixed land use Mixed land use

25 Neighborhood Walkability and Active Commuting to School 201 parents reported on 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

Walkable neighborhoods encourage more walking in older adults Older women who live within walking distance of trails, parks or stores recorded significantly higher

26 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. King, W., Am. J. of Public Health 2003 Photo: Michael Ronkin, ODOT

27 2.50 Dose Response between Number of Environmental Correlates and Walking (Pooled Urban Sample) Odds Ratio Walk 150 minutes/week Total Number of Environmental Correlates (Zero is referent)

28 Multiple Pathways from Land Use to Health: Walkability Associations With Active Transportation, Body Mass Index, and Air Quality. J Am Plan Assoc 07. 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

29 100% Support for Traditonally Designed Communities Increased between 2003 and 2005 Percent expressing support 80% 60% 40% 20% 44% 59% 0% Handy et al. J Am Plan Assoc National Surveys.

an urban tapestry of homes, shops, offices, parks, and

30 Commercialization of Active Living From home page: Stapleton, the nation s largest urban development, is an urban tapestry of homes, shops, offices, parks, and schools in a walkable community of classic city architecture

31 Different environments----different congestion

32 Walkability > Driving > Obesity? The more miles a person travels by vehicle, the more likely they are to be obese 30% 25% % 15% 10% % 0% Q1 Q2 Q3 Q4 Quartiles of vehicle miles traveled (VMT) Lopez Zetina 2006

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

34 Men ride in bike lanes more Average % of bike travel (distance) Men Women sig? Primary arterials/highways, no bike lanes 3% 2% no Secondary arterials, no bike lanes 13% 11% no Minor streets, no bike lanes 33% 41% <0.05 Driveways, alleys, unimproved roads 2% 1% no Primary arterials/highways, with bike lanes 9% 4% <0.10 Secondary arterials, with bike lanes 12% 6% <.01 Minor streets, with bike lanes 6% 7% no Bike paths 12% 12% no Bike boulevards 9% 14% <0.10

35 II - IV A culture of cycling

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

37 Access to Recreation Facilities Related to MVPA & Overweight in Youth Availability of recreational & PA facilities and relative odds of overweight and bouts of moderate and vigorous physical activity (MVPA) One Two Three Four Five Six Seven Number of facilities per block group Gordon Larsen Pediatr 2006

38 Myron Floyd Observed Physical Activity in Park Activity Zones (Chicago) Scheffe s post hoc test Softball/Baseball Open Area Playground Basketball Tennis/Racketball Volleyball Energy Expenditure (Kkcal/kg/min) Chicago, F = 10.20, p <.001

39 Built Environments May Be More Important for Minorities Percent being active with high and low recreational resources within 1 mile of home 55 Low recreational resources High recreational resources Diez-Roux Blacks & Hispanics Non-Hispanic Whites

40 % with no recreation facility 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent of census tracts without a recreational facility by race/ethnicity 70% 81% 38% African American Hispanic White

41 Lois Brink, U Colorado Denver Before After

42 What PE should be

43 What PE is too often

44 All Kids Should Be Active in PE (50% of class time) And Learn Skills

45 SPARK Outcomes PE specialists>trained classroom teachers> controls Improved quality of PE instruction Increased physical activity in PE Improved cardiorespiratory & muscle fitness Improved sports skills Positive impact on academic achievement Students enjoyed SPARK lessons SPARK is now serving 1 million kids/day

46 School Environment Interventions Stratton et al. from the UK conducted several studies showing simple markings on elementary playgrounds increases PA about 18 min/day Verstraete from Belgium showed Equipment at Recess increased PA

47 Investments in Active Living Walkable communities Pedestrian & cycling facilities Improved parks & programs School PE & other activity programs Potential savings to governments Redirect transport funds May be substantial, but offset by incr tax receipts Minor (recess) to substantial (PE reform)

48 Trails are cost-effective Wang studied 4 trails in Nebraska (Prev Med, 2004) Trail development cost $300,000, of which 73% was for construction Of 4000 trail users, 88% were active at least 3 days per week Annual cost per person becoming more active was $98 Inactive people cost $ more for health care

49 Promoting stair Use through Signs/prompts And aesthetic Improvements Is an effective, Low cost Intervention Principles: Access Aesthetics Advice/promotion

50 The challenge for governments: Connecting the silos transport housing education

51 Vision for The Future Less of this More of this

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

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

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

55 Ciclovia in Bogota On Sundays & holidays Many streets are closed To cars. Bike supplies & Repairs; volunteer Traffic controllers.

56 Pedestrian Bridge Redding, CA. The $23.5 million Pedestrian bridge Is now Redding s No. 1 tourist Attraction. Mayor Dick Dickerson. LA Times 6/3/07

57 Decisions about Climate change and Active living Are related

58 NEWS Safety from Crime in Walkability-by by-income Quadrants Income: p = <.0001 Walkability X Income: p = NEWS Safety from Crime (Mean *) Low Walk High Walk 2.6 Low Income High Income *All models adjusted for gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address. Neighborhood was included as a random effect to adjust for clustering.

59 Multi-Level Physical Activity Promotion Framework for Governments Initiators Leaders Strategies Change Mechanisms Outcomes Communications, Mass media Psychological Individual Interagency Task force, Broad Coalition, Work Groups Capacity & resources for change Evidence-based programs & Policies in schools, worksites, Community orgs, health care Local Coalitions, Events, Communications, Mass media Policies Urban planning & design, Transportation facilities, Recreation facilities, Zoning, Building codes Implementation of strategies Organizations Social Cultural Built Environment Incentives -Mission- Physical Activity (Recreation Transportation), Obesity, Injuries, Air Quality -Money- Health care Costs, Infrastructure Costs Population-Specific Strategies and Community Participation Research and Evaluation

Active and Green: Healthy Communities Are Sustainable Communities

Active and Green: Healthy Communities Are Sustainable Communities James Sallis, PhD San Diego State University www.drjamessallis.sdsu.edu For LISC Webinar May 4, 2011 Goals of talk Physical inactivity