DO OUR NEIGHBORHOODS REALLY MATTER FOR CHILDREN S HEALTH AND PHYSICAL ACTIVITY?
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1 DO OUR NEIGHBORHOODS REALLY MATTER FOR CHILDREN S HEALTH AND PHYSICAL ACTIVITY? Brian E. Saelens, Ph.D. Seattle Children s Research Institute, University of Washington Childhood Obesity and Public Health Conference Pennington Biomedical Research Center
2 Objectives Why neighborhood? What aspects of neighborhood? Framework - easiest choice exercise Movement in the right direction?
3 Percentage Meeting Physical Activity Recommendations in U.S % 90.0% 80.0% 70.0% 60.0% Self-report Accelerometer 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% NHANES ; Tucker 2011 AJPM
4 Percentage Meeting PA recommendation (Accelerometry Only) yo yo yo yo 60+ yo Male Female Total NHANES ; Troiano 2007 MSSE
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9 Neighborhood Matters % 11.5% % % 64.9% 88.5% Physical activity Sedentary or light activity 20 0 Home (51%) Neighborhood (12%) Far from home (37%) Hurvitz (in preparation)
10 Children s Physical Activity Environments Location % of total time at each location % of time spent at each location engaged in physical activity Home 48% 18% School 29% 18% Others Homes 7% 22% Service Locations 6% 17% Public, Outdoor Parks & Rec. 3% 40% Shopping 2% 19% Other Schools 2% 30% Food Eateries 1% 13% Private Rec. Facilities 1% 30% Public, Indoor Rec. Facilities 1% 32% Neighborhood (non-specific) 1% 42% Kneeshaw-Price 2013 Ped Exerc Sci
11 Our environment? Our culture? Our mindset? Our inattention?
12 greater Seattle
13 three locations Hunts Point Ballard Downtown Seattle
14 residential density 1.3 du/ac 14.1 du/ac 7.3 du/ac residential density du/ac High : 25.6 Low : 0
15 distance to closest fast food restaurant 7681 ft 174 ft 961 ft distance to FFR 0-1/4 mi 1/4-1/2 mi 1/2-1 mi > 1 mi
16 street intersection density 0/mi /mi /mi 2
17 each digital map layer provides its own set of built environment measures Hunts Point: intersection density = 0/mi 2 closest FFR = 7681 ft res density= 1.3 du/ac Ballard: intersection density = 1968/mi 2 closest FFR = 961 ft res density = 7.3 du/ac Downtown Seattle: intersection density = 6950/mi 2 closest FFR = 174 ft res density = 14.1 du/ac
18 Schematic for Neighborhood Environment Sugiyama (2012) MSSE
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21 Built Environment - Walking Associations (Adults) Destinations (utilitarian) - Presence - Proximity - Quality Destinations (recreational) - Presence - Proximity - Quality Routes - Sidewalk - Connectivity - Aesthetics - Traffic - Safety Transport walking High + (79%) High + (82%)??? Low (17%) Moderate + (50%)??? Moderate + (42%) Moderate + (58%) Low (15%) Low (15%) Low (18%) Recreation walking Low (24%) Low (13%)??? Low (21%) Low (38%) Limited High + (100%) Low (18%) Low (29%) Low (35%) Low (14%) Low (17%) Sugiyama (2012) MSSE
22 NIK Neighborhood Types
23 Neighborhood Impact on Kids (NIK) and Adult-NIK How do neighborhoods affect a child s weight status and related behaviors Kids age 6-11 & one parent Over 700 families from King County and San Diego Nearly 600 at the follow-up Assess body composition (height, weight, waist) Child wears activity meter for 7 days Complete survey about eating, home environment, activities, etc. Complete 3 dietary recalls detailing the foods the parent and child eat 2 year follow up - Measure change in the child s weight status and behaviors
24 NIK Environmental Data Macro-environmental data (streets, parks, food establishments, etc) Over 900 park audits Facilities, amenities, quality of amenities Over 1,800 food store and restaurant audits Availability, quality, cost (NEMS-R & NEMS-S audits) Pedestrian route audits (reaching 1/4 mile from participants residence) E.g., sidewalks, incivilities, crossings Place-based logs for child locations
25 NIK Study: Obesity by Neighborhood 35% 30% 34% 32% 29% 27% Low PAE, Low NE Low PAE, High NE High PAE, Low NE 25% High PAE, High NE 20% 15% 19% 15% 14% 12% 10% 5% 0% % Overweight %Obese
26 Tappe (2013) IJBNPA
27 TEAN Study: Walking Time and Other Activity Table 3. Associations among transportation and physical activity variables among adolescents (N = 3659 days from 696 participants) Additional minutes/day vs. reference, B (CI) a Walking time MVPA Sedentary time b None (reference) 31.0 (29.0, 32.3) (540.2, 551.5) Low +6.7 (4.5, 9.1) (-21.2, -7.4) High (16.8, 21.3) (-31.2, -17.6) Omnibus p for factor <.001 <.001 Carlson (2014) submitted
28 TEAN Study: Neighborhood Factors and Walking Factor Change in walking time from referent Age +11% Female -3% Non-Hispanic White -3% Parents married -31% # of vehicles -15% Neighborhood income +23% Residential density +36% Carlson (2014) submitted
29 Child PA Built Environment Associations (3-12 years; objectively Measured PA) Built environment (BE) characteristic Objectively measured BE Destinations - Parks - Recreation facilities - Utilitarian - Residential density Routes - Connectivity - Walk/bike facilities - Traffic safety Other - Crime safety - Incivilities - Vegetation Moderate + (43%) Moderate + (41%)? Moderate + (44%) Low/opposite? (19%) Low (33%)? Low (19%) Very low (0%) Low (38%) Ding (2011) AJPM
30 IOM Recommendations for Obesity Prevention I. Make physical activity an integral and routine part of life A. Enhance physical and built environment B. Provide/support community programs for PA C. Adopt requirements for child care providers D. Provide support for science/practice of PA
31 Model & Vision: Likelihood of Making the Healthy Choice Healthier option easier or better to choose than less healthy option Healthy option as easy as less healthy option Another (healthier) option exists, but unhealthy still easier Information about options
32 The Health Choice Hill: Physical Activity Example Church 2011 PLoS ONE Example: Getting to work
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36 What is the choice now? Drive to work Time/convenience (25 mins) Cost to park (-$10.00) Cost to drive (-$6.00) Perceived safety Comfort Not drive to work Convenience (bike 50 mins) Savings from not parking or driving Paid for not driving (+$4.00) Similar comfort Perceived safety (coming?)
37 Transit-Related Physical Activity is Additive! 60 Non-walking PA Walking (not transit-related) Walking (transit-related) (SD=12.5) (SD=23.9) 24.6 (SD=24.9) 22.1 (SD=23.7) (SD=19.1) 12.2 (SD=20.0) 14.6 (SD=22.6) 0 Non-transit users Transit users (non-transit days) Transit users (transit days) Saelens AJPH 2014
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39 Youth Obesity Rate in King County Regions 2012
40 Obesity Disparities in South King County
41 CPPW in Highline ( ) Healthy Highline Community Coalition Joint Use Agreement between Highline, Burien, Des Moines, Normandy Park and SeaTac Recess Before Lunch in 16 elementary schools Safe Routes to School in 3 elementary schools Cafeteria Point of Sale Marketing in Middle and High School (expanded to elementary schools) Coordinated School Health Advisory Council
42 CPPW in Des Moines ( ) Leadership from Healthy Des Moines Movement Council and Technical Advisory Committee Health element and goals in comprehensive plan: Nutrition standards for city procurement Safer and easier walking and biking to school Increase fresh food access for low-income residents Community gardens Complete Streets Ordinance Recognition by CDC as Local Health Champion City of Des Moines Outcomes and Partners Report
43 Drop in Youth Obesity During CPPW Within county
44 Shifting Away from Trying to Convince Environments and policies set the parameters of our behaviors Incentives and influences are already there, but may not be aware of them Lack of reliance on call for healthfulness Focused on everyday behaviors rather than additions Multi-level interventions (neighborhood, schools, worksites, etc) for synergistic impact Alignment with programmatic interventions
45 Source American Academy of Pediatrics (2009) American Heart Association Policy Strategies (2011) CDC MAPPS interventions CDC (2009) Institute of Medicine (2009) National Physical Activity Plan White House Task Force on Childhood Obesity (2010) Primary target(s) Example built environment or policy recommendation for increasing physical activity Physical activity promotion in children Ideal cardiovascular health Obesity prevention Obesity prevention Childhood obesity prevention Physical activity promotion Create and maintain playgrounds, parks, and green spaces..[and]...means to access them safely Implement zoning/building ordinances that encourage pedestrian-friendly streets and roadways with appropriate crosswalks, sidewalks, traffic lights, etc and slower speed limits in walking/biking areas Incentives for active transit Zone for mixed-used development Adopt community policing strategies that improve safety and security for park use, especially in higher crime neighborhoods Increase accountability of project planning and selection to ensure infrastructure supporting active transportation and other forms of physical activity Childhood obesity EPA should assist school districts in siting guidelines for new schools that consider the promotion of physical activity Available at: lection/committee_on_environmental_heal th 23/ eventiontowork/strategies/index.htm ty_strategies_guide.pdf html Sallis 2012 Circulation
46 Local CTG Brief Overview of BE Work Overall Goal: Increase the number of city planning departments that adopt healthy community planning strategies and actions City of Auburn Incorporate health and equity policies into the comprehensive plan update through the Health Impact Assessment Process Puget Sound Regional Council Develop a web-based Health, Equity and Sustainable Development Toolkit for disseminating actionable planning strategies and policies; sharing ideas for local planning processes that can influence cities resident health City of SeaTac Develop and implement a community engagement process to inform vision and planning around future Angle Lake (Light Rail) Station Area Plan Study and engage community in planning for pedestrian and bicycle connectivity within the Angle Lake Station Area to allow for non-motorized transport in and around the station area
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48 Acknowledgments My excellent research staff Other investigators within Seattle Children s University of Washington (Vernez Moudon, Hurvitz) Public Health Seattle and King County University of California San Diego (Sallis, Kerr) University of British Columbia (Frank) University of Pennsylvania (Glanz) Funders NIH-NHLBI, NCI; CDC
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