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
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
Promoting exercise has not worked Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System
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.
60% Percentage of youth ages 6-19 meeting 60 min/day physical activity guidelines. Based on accelerometers. NHANES 2003-4 49% 40% 20% 0% 35% 10% 3.4% 10% 5.4% 6-11 12-15 16-19 Age Males Females Troiano, MSSE, 2007
Sleep Domains of Activity: The SLOTH Model Leisure Occupational Transportation Household
The nature of transportation has changed dramatically Tim Armstrong, WHO
Work is no longer physical work Tim Armstrong, WHO
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
A Multi-Level Approach Is Needed Policy Context Physical Environment Social/cultural Individual Biological Psychological Skills
Use of Physical Activity Facilities by Teens Commercial School- Weekend Girls Boys Rec Center School-after Park Neighborhood 0 1 2 3 Hoefer, Mckenzie, et al., 2001, AJPM Times per Week N= 1678 parent reports; 24 schools Gender P=.001, except NS for commercial facilities
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
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
Designing Activity-Friendly Communities
Designing for Active Transportation Walkability Proximity: Are there places nearby to walk to? Connectivity: Are there safe and direct ways to make the trip?
High walkable, low income Shopping
Low walkable, High income Residences
Our Heritage of Walkability
The Neighborhood Quality of Life (NQLS) Study: The Link Between Neighborhood Design and Physical Activity Funded by NHLBI, 2001-2005 2005 James Sallis Brian Saelens Lawrence Frank
MVPA minutes per day (Mean *) 40 35 30 25 20 15 10 5 0 Accelerometer-based MVPA Min/day in Walkability-by by-income Quadrants 28.5 33.4 Low Income 29.0 35.7 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.
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 60 50 40 30 20 10 63.1 56.8 60.4 48.2 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.
NEWS Pedestrian/Traffic Safety in Walkability-by by-income Quadrants Income: p = <.0001 Walkability X Income: p =.48 3.20 NEWS Pedestrian/Traffic Safety (Mean *) 3.10 3.00 2.90 2.80 2.70 2.60 2.50 2.40 3.12 2.87 2.87 2.70 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.
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
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 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
2.50 Dose Response between Number of Environmental Correlates and Walking (Pooled Urban Sample) Odds Ratio Walk 150 minutes/week 2.00 1.50 1.00 0.50 1 2 3 4 5 6 Total Number of Environmental Correlates (Zero is referent)
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
100% Support for Traditonally Designed Communities Increased between 2003 and 2005 Percent expressing support 80% 60% 40% 20% 44% 59% 0% 2003 2005 Handy et al. J Am Plan Assoc 2008. National Surveys.
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
Different environments----different congestion
Walkability > Driving > Obesity? The more miles a person travels by vehicle, the more likely they are to be obese 30% 25% 27.08 20% 15% 10% 9.5 14.3 18.05 5% 0% Q1 Q2 Q3 Q4 Quartiles of vehicle miles traveled (VMT) Lopez Zetina 2006
Where do people bicycle? The role of infrastructure in determining bicycling behavior Jennifer Dill, Ph.D. Center for Transportation Studies
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
II - IV A culture of cycling
People with access to parks & recreation Facilities are more likely to be active
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) 1.5 1.25 1 0.75 0.5 One Two Three Four Five Six Seven Number of facilities per block group Gordon Larsen Pediatr 2006
Myron Floyd Observed Physical Activity in Park Activity Zones (Chicago) 0.0980 0.0930 0.0880 0.0830 0.0780 0.0730 0.0680 0.0630 0.0580 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
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 50 45 40 35 30 Diez-Roux 2007 25 Blacks & Hispanics Non-Hispanic Whites
% 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
Lois Brink, U Colorado Denver Before After
What PE should be
What PE is too often
All Kids Should Be Active in PE (50% of class time) And Learn Skills
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
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
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)
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 $300-400 more for health care
Promoting stair Use through Signs/prompts And aesthetic Improvements Is an effective, Low cost Intervention Principles: Access Aesthetics Advice/promotion
The challenge for governments: Connecting the silos transport housing education
Vision for The Future Less of this More of this www.drjamessallis.sdsu.edu
Amsterdam is a model for being friendly to pedestrians & cyclists The Incredible Bicycle Parking Structure At the Train Station
Brisbane, Australia has invested in pedestrian facilities *Beautiful pedestrian bridge *Walkways along the river *Pleasing aesthetics
Bogota, Colombia has invested heavily in walking, cycling, & PA events
Ciclovia in Bogota On Sundays & holidays Many streets are closed To cars. Bike supplies & Repairs; volunteer Traffic controllers.
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
Decisions about Climate change and Active living Are related
NEWS Safety from Crime in Walkability-by by-income Quadrants Income: p = <.0001 Walkability X Income: p =.24 3.6 NEWS Safety from Crime (Mean *) 3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.7 3.18 2.97 3.54 3.54 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.
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