Candace D. Rutt

Cost Effectiveness of Community-Based Physical Activity Interventions

BACKGROUND Physical inactivity is associated with the increased risk of many chronic diseases. Such risks decrease with increases in physical activity. This study assessed the cost-effectiveness of population-wide strategies to promote physical activity in adults and followed disease incidence over a lifetime. METHODS A lifetime cost-effectiveness analysis from a societal perspective was conducted to estimate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven public health interventions to promote physical activity in a simulated cohort of healthy U.S. adults stratified by age, gender, and physical activity level. Interventions exemplifying each of four strategies strongly recommended by the Task Force on Community Preventive Services were evaluated: community-wide campaigns, individually adapted health behavior change, community social-support interventions, and the creation of or enhanced access to physical activity information and opportunities. Each intervention was compared to a no-intervention alternative. A systematic review of disease burden by physical activity status was used to assess the relative risk of five diseases (coronary heart disease, ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer) across a spectrum of physical activity levels. Other data were obtained from clinical trials, population-based surveys, and other published literature. RESULTS Cost-effectiveness ratios ranged between

Use of Health Impact Assessment in the U.S.

14,000 and

Growing the field of health impact assessment in the United States: An agenda for research and practice

69,000 per QALY gained, relative to no intervention. Results were sensitive to intervention-related costs and effect size. CONCLUSIONS All of the evaluated physical activity interventions appeared to reduce disease incidence, to be cost-effective, and--compared with other well-accepted preventive strategies--to offer good value for money. The results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity.

Household motor vehicle use and weight status among Colombian adults: are we driving our way towards obesity?

OBJECTIVES To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. METHODS Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999-2007. Key characteristics of each HIA were abstracted from published and unpublished sources. RESULTS Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented. CONCLUSIONS These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.

Objectively Measuring Route-To-Park Walkability in Atlanta, Georgia

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the publics health.

The Impact of the Built Environment on Walking as a Leisure-Time Activity Along the U.S./Mexico Border

OBJECTIVE To determine the associations between household motor vehicle ownership and weight status among Colombian adults. METHODS Secondary analysis of data from the 2005 Demographic and HealthSurvey of Colombia. Height, weight and waist circumference were objectively measured in 49,079 adults, ages 18 to 64 that resided in urban settings. Abdominal obesity was defined as a waist circumference >80 cm in women and >90 cm in men. RESULTS Prevalence was 19.9% for motor vehicle ownership in household, 33.1% for BMI between 25 and 29.9 kg/m(2), 14.4% for BMI>30 kg/m(2), and 46% for abdominal obesity. Males reporting any household motor vehicle ownership were more likely to be overweight or obese, and to have abdominal obesity (p for genderexposure variables interaction=<0.001). CONCLUSIONS Household motor vehicle ownership is associated with overweight, obesity, and abdominal obesity among Colombian men but not women.

Measuring the food environment and its effects on obesity in the United States: a systematic review of methods and results.

Many people fail to achieve recommended levels of physical activity. Neighborhood parks serve as locations in which physical activity often occurs, and walking to parks provides added opportunity for leisure-time activity. The authors examine environmental characteristics of shortest pedestrian routes to parks to determine how route walkability affects park use. Using an objective environmental audit, the authors found that routes of park users were measurably more walkable than those of nonpark users and that each unit increase in total walkability score associated with a 20% increase in the likelihood of walking to the park, controlling for education and route length (odds ratio = 1.20; 95% confidence interval = [1.07, 1.34]). The most significant elements measured included route distance, traffic, neighborhood maintenance, street maintenance, safety, and aesthetics. Pedestrian scale environmental characteristics are associated with individuals’ use of neighborhoods for physical activity. Understanding these relationships can contribute to evidence-based design interventions to increase physical activity.