1. Physical Activity and the Built Environment Data and Evidence-Based Practices Prevention for Healthier Communities October 8, 2009 Jennifer G. Walker, Active Living by Design jg_walker@unc.edu

2. Outline Discuss connection between Physical Activity and the Built Environment Trends in scientific evidence Emerging best practices

3. What is the Built Environment? “Environments that are human modified [for human use], including homes, schools, workplaces, highways, urban sprawl, and air pollution." Samuel H. Wilson, MD, Deputy Director, NIEHS 2004 Summit: Obesity and the Built Environment (What’s wrong with this picture?)

4. Built-in Barriers 4 Disconnected and dead end streets Few sidewalks, bike lanes and greenways Long distances between destinations Concentrated traffic on wide, high-speed roads Poor investment in streetscapes Single family only and commercial only zones Large parking lots, long blank walls Decline of neighborhood schools Long distances between destinations Single family only and commercial only zones Large parking lots, long blank walls Decline of neighborhood schools Few sidewalks, bike lanes and greenways Disconnected and dead end streets Concentrated traffic on wide, high-speed roads Poor investment in streetscapes

5. Links to Health Equity 1/3 of our population does not drive a car –Older adults, children, people with disabilities, people who cannot afford a car. (U.S. Census, 2000) Low-income communities and communities of color: –Report less access to green space and recreational facilities –More concerns about crime and traffic safety June 8, 2008 “In developing-world cities, the majority of people don’t have cars, so I will say, when you construct a good sidewalk, you are constructing democracy. A sidewalk is a symbol of equality.” -Enrique Peñalosa, Former Mayor of Bogota, Columbia

6. Links to Active Living Active Living is a way of life that integrates physical activity into daily routines. The goal is to accumulate at least 30 minutes of activity each day. Individuals may achieve this via “active transportation,” recreation on trails and greenways; play in the park; work in the yard or garden; use of stairs; recreation programs, etc.

7. Trend: focusing on the built environment State Health Departments Many More State and Local Health Departments

8. Trends in scientific evidence The science base is building re: the role of the built environment for physical activity “Changing the built environment to increase children’s physical activity for recreation and transportation… can help provide long-term solutions to the childhood obesity epidemic. Unlike the often-transitory effects of motivational and educational approaches to addressing obesity, changes in behavior prompted by changes in the built environment should be long lasting. Given the urgency of the childhood obesity epidemic, we cannot wait for optimal evidence and must instead base actions on the best available evidence.” - Jim Sallis and Karen Glanz, 2006 “The Role of Built Environments in Physical Activity, Eating, and Obesity in Childhood” The Future of Children, Vol. 16/No. 1/Spring 2006

9. If you build it….Transportation Brownson, Ross et al., American Journal of Public Health (2001), Vol. 91, No. 12; Humpel, et al. 2002 +28% +55% People who report having access to sidewalks are more likely to be active People reporting access to walking/jogging trails are more likely to be active Will they be more active?

10. If you build it…. Will they be more active? Recreation People with access to neighborhood parks were nearly twice as likely to be physically active Enhanced access to places for physical activity increases the frequency of physical activity and weight loss Brownson, Ross et al., American Journal of Public Health (2001); Kahn, et al, AJPM, 2002

11. If you build it…. Will they be more active? The more facilities that are available and destinations that are close by, the more people walk People who live within walking distance of trails, parks or stores report significantly more walking than those who do not Land Use King, W., Am. J. of Public Health 2003

12. Children and Physical Activity Access to facilities like parks and time outdoors is associated with more activity for both children and adolescents More children walk to school where there are sidewalks and safety improvements Elementary and middle school students are more active at school with more facilities, equipment and supervision Sallis et al, 2001, 2000; 1993; Klesges et al, 1990; Baranowski et al, 1993; Ewing; Staunton et al, 2003; Boarnet et al, 2005; Jago t al, 2004; Gomez, 2004; IOM/TRB, 2005; Timperio et al, 2004

13. Children and Physical Activity Parental concerns about traffic and “stranger danger” are clearly linked to children’s activity levels; schools afraid of liability. Safety in numbers: increasing the number of pedestrians reduces injury rate Jacobsen, 2003

14. Crime and Physical Activity Reducing crime and fear of crime lessens a major deterrent to outdoor physical activity Crime Prevention Through Environmental Design (CPTED) has been shown to reduce crime Many of its principles enhance walkability Access to parks, facilities and programs is strongly linked with lower crime and juvenile delinquency Saelens et al. 2003; Mair 2003, Crowe 2000, Taylor 1996

15. Emerging best practices: CDC Report Strategies to create safe communities that support physical activity: Improve access to outdoor recreational facilities Enhance infrastructure to support bicycling (e.g., shared-use paths and bike lanes) Enhance infrastructure to support walking (e.g., sidewalks) Support locating schools within easy walking distances of residential areas. Improve access to public transit Enhance personal safety in areas where people are or could be active Enhance traffic safety in areas where people are or could be active “Recommended Community Strategies and Measurements to Prevent Obesity in the United States” MMWR, Vol. 58 / July 24, 2009

16. Emerging Best Practices: IOM Recommendations IOM Recommendations: Local Governments Adopt a pedestrian / bicycle master plans Plan, build and maintain networks of: –Sidewalks that connect to schools, parks, and other destination –Off-street trails and paths for pedestrians and bicyclists Build new schools in locations central to residential areas and away from heavy traffic Increase destinations within walking and bicycling distance Build/maintain safe parks and playgrounds close to residential areas North Carolina IOM Recommendations: State-level Build Active Communities Expand Community Grant program Joint-use agreements to expand use of facilities. “Local Government Actions to Prevent Childhood Obesity” Institute of Medicine Report Brief, www.iom.edu/obesitylocalgov.

17. Health is in part, determined by elected officials, planners, public works, parks, transportation Collaboration across sectors is critical for changes to policy and the built environment Multidisciplinary Partnerships Public Health Officials Architects Housing Officials Parks & Recreation School Officials Public Safety Community Leaders Planning Transportation Bike/Ped Neighborhood Groups Business Also from the CDC Report: “Communities should participate in community coalitions or partnerships to address obesity” Importance of Partnerships

18. Value of Partnerships Grant requests Leverage dollars More accomplished Policy change Connecting the (un)usual suspects Administrative/fiduciary capacity

19. ALBD’s mission: Y. Amihere

20. Value of Community