Daniel A. Rodriguez

Role of Built Environments in Physical Activity, Obesity, and Cardiovascular Disease

There is a growing consensus that large changes in population levels of physical activity and other behaviors required to improve cardiovascular health will require major modifications in environments and policies. Ecological models are the conceptual basis for comprehensive interventions that emphasize environmental and policy changes and that can have widespread and sustainable effects. These interventions are complemented with individual education and motivation and efforts to change social support and norms. Physical activity-specific ecological models indicate which environmental factors are expected to be related to physical activity in multiple life domains: Leisure/recreation/exercise, occupation (school for youth), transportation, and household. Over the past decade, a proliferation of interdisciplinary research has generally supported hypotheses derived from ecological models and identified specific built environment attributes and combinations of attributes that are related to physical activity, mainly for recreation and transportation purposes, and obesity. It is becoming clear that racial/ethnic minority and low-income communities are disadvantaged in access to recreation facilities, positive aesthetics, and protection from traffic. These results provide an empirical rationale for intervention. There are recent examples of environmental changes or community-wide multilevel interventions that had positive effects on physical activity or obesity. Continuing research needs are to improve the rigor of study designs, confirm subgroup- or context-specific built environment associations, identify optimal combinations of attributes, improve understanding of the policy change processes required to achieve environmental changes, and evaluate multilevel interventions. Both research teams and community-based initiatives are collaborating with a wide range of professionals and sectors of society, such as recreation, transportation, city planning, architecture, landscape architecture, geography, criminal justice, and law, in addition to health professionals and behavioral scientists. These diverse teams have stimulated innovations in research, new approaches to intervention, and improved connections with decision makers who can make environment and policy changes in nonhealth sectors of society. The practice of physical activity promotion, obesity prevention, and CVD risk reduction has changed to reflect the shift to multilevel interventions. Major foundations and public health agencies are implementing community-based interventions targeting environment and policy change. Continuing challenges for these community-wide interventions are to maintain support for the multisector, long-term efforts required to change environments, evaluate interventions so they become ever more evidence-based, and integrate explicit chronic disease prevention objectives into professional practices of diverse disciplines, government agencies, and industries whose primary work can affect physical activity and health. Among the largest initiatives was the Centers for Disease Control and Preventions Communities Putting Prevention to Work grant program, which awarded more than

Improving health through policies that promote active travel: A review of evidence to support integrated health impact assessment

250 million in 2010 to change environments and policies to improve nutrition and physical activity and prevent obesity. Recommended strategies were based on MAPPS: Media, Access, Point of decision information, Price, and Social support/services. Strategies ranged from improving physical activity in school physical education (access) to subsidizing memberships to recreational facilities (price) to promoting safe routes to school (eg, social support/services). Experience with these initiatives, as well as systematic evaluations, will lead to a better understanding of how to accomplish policy and environmental change in diverse communities and provide important information about the impact of these changes. Language: en

Exploring associations between physical activity and perceived and objective measures of the built environment.

BACKGROUND Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences. OBJECTIVES AND METHODS We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions. RESULTS AND DISCUSSION Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time. CONCLUSION Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs.

A systematic review of fast food access studies.

The built environment may be responsible for making nonmotorized transportation inconvenient, resulting in declines in physical activity. However, few studies have assessed both the perceived and objectively measured environment in association with physical activity outcomes. The purpose of this study was to describe the associations between perceptions and objective measures of the built environment and their associations with leisure, walking, and transportation activity. Perception of the environment was assessed from responses to 1,270 telephone surveys conducted in Forsyth County, NC and Jackson, MS from January to July 2003. Participants were asked if high-speed cars, heavy traffic, and lack of crosswalks or sidewalks were problems in their neighborhood or barriers to physical activity. They were also asked if there are places to walk to instead of driving in their neighborhood. Speed, volume, and street connectivity were assessed using Geographic Information Systems (GIS) for both study areas. Locations of crashes were measured using GIS for the NC study area as well. Objective and perceived measures of the built environment were in poor agreement as calculated by kappa coefficients. Few associations were found between any of the physical activity outcomes and perception of speed, volume, or presence of sidewalks as problems in the neighborhood or as barriers to physical activity in regression analyses. Associations between perceptions of having places to walk to and presence of crosswalks differed between study sites. Several associations were found between objective measures of traffic volume, traffic speed, and crashes with leisure, walking, and transportation activity in Forsyth County, NC; however, in Jackson, MS, only traffic volume was associated with any of the physical activity outcomes. When both objective and perceived measures of the built environment were combined into the same model, we observed independent associations with physical activity; thus, we feel that evaluating both objective and perceived measures of the built environment may be necessary when examining the relationship between the built environment and physical activity.

Value of accessibility to Bogotá's bus rapid transit system

The frequent consumption of energy‐dense fast food is associated with increased body mass index. This systematic review aims to examine the methodology and current evidence on fast food access and its associations with outcomes. Six databases were searched using terms relating to fast food. Only peer‐reviewed studies published in English during a 10‐year period, with data collection and analysis regarding fast food access were included. Forty articles met the aforementioned criteria. Nearly half of the studies (n = 16) used their own set of features to define fast food. Studies predominantly examined the relationship between fast food access and socioeconomic factors (n = 21) and 76% indicated fast food restaurants were more prevalent in low‐income areas compared with middle‐ to higher‐income areas. Ten of 12 studies found fast food restaurants were more prevalent in areas with higher concentrations of ethnic minority groups in comparison with Caucasians. Six adult studies found higher body mass index was associated with living in areas with increased exposure to fast food; four studies, however, did not find associations. Further work is needed to understand if and how fast food access impacts dietary intake and health outcomes; and if fast food access has disparate socioeconomic, race/ethnicity and age associations.

Land Use, Residential Density, and Walking: The Multi-Ethnic Study of Atherosclerosis

With several successful cases world‐wide, bus rapid transit (BRT) has reemerged as a cost‐effective transportation alternative for urban mobility. Despite the resurgence of BRT, there is a world‐wide paucity of research examining its ability to spur and development. By estimating spatial hedonic price functions, the paper determines the extent to which access to BRT stations in Bogotá, Colombia, currently are capitalized into land values. Results suggest that for every 5 min of additional walking time to a BRT station, the rental price of a property decreases by between 6.8 and 9.3%, after controlling for structural characteristics, neighbourhood attributes and proximity to the BRT corridor. Evaluated at the average walking time to a BRT station, this effect translates into an elasticity of between − 0.16 and − 0.22. Although these estimates cannot be attributable directly to the presence of the BRT system because a cross‐sectional design is used, they suggest that the land market in Bogotá values access to BRT station locations.

Out and about: association of the built environment with physical activity behaviors of adolescent females.

BACKGROUND The neighborhood environment may play a role in encouraging sedentary patterns, especially for middle-aged and older adults. PURPOSE The aim of this study was to examine the associations between walking and neighborhood population density, retail availability, and land-use distribution using data from a cohort of adults aged 45 to 84 years. METHODS Data from a multi-ethnic sample of 5529 adult residents of Baltimore MD, Chicago IL, Forsyth County NC, Los Angeles CA, New York NY, and St. Paul MN enrolled in the Multi-Ethnic Study of Atherosclerosis in 2000-2002 were linked to secondary land-use and population data. Participant reports of access to destinations and stores and objective measures of the percentage of land area in parcels devoted to retail land uses, the population divided by land area in parcels, and the mixture of uses for areas within 200 m of each participants residence were examined. Multinomial logistic regression was used to investigate associations of self-reported and objective neighborhood characteristics with walking. All analyses were conducted in 2008 and 2009. RESULTS After adjustment for individual-level characteristics and neighborhood connectivity, it was found that higher density, greater land area devoted to retail uses, and self-reported proximity of destinations and ease of walking to places were each related to walking. In models including all land-use measures, population density was positively associated with walking to places and with walking for exercise for more than 90 minutes/week, both relative to no walking. Availability of retail was associated with walking to places relative to not walking, and having a more proportional mix of land uses was associated with walking for exercise for more than 90 minutes/week, while self-reported ease of access to places was related to higher levels of exercise walking, both relative to not walking. CONCLUSIONS Residential density and the presence of retail uses are related to various walking behaviors. Efforts to increase walking may benefit from attention to the intensity and type of land development.

A Spatial Agent-Based Model for the Simulation of Adults' Daily Walking Within a City

Locational data, logged on portable GPS units and matched with accelerometer data, was used to examine associations of the built environment with physical activity and sedentary behaviors of adolescent females. In a sample of 293 adolescent females aged 15 to 18 years old in Minneapolis and San Diego, the built environment around each GPS point and its corresponding sedentary, light, and moderate-to-vigorous intensity physical activity was examined using random intercept multinomial logistic regression models. The odds of higher physical activity intensity (3-level outcome: sedentary, light, MVPA) were higher in places with parks, schools, and high population density, during weekdays, and lower in places with more roads and food outlets. Understanding the places where physical activity and sedentary behaviors occur appears to be a promising strategy to clarify relationships and inform policy aimed at increasing physical activity and reducing sedentary behaviors.

The built environment and health: impacts of pedestrian-friendly designs on air pollution exposure.

Environmental effects on walking behavior have received attention in recent years because of the potential for policy interventions to increase population levels of walking. Most epidemiologic studies describe associations of walking behavior with environmental features. These analyses ignore the dynamic processes that shape walking behaviors. A spatial agent-based model (ABM) was developed to simulate peoples walking behaviors within a city. Each individual was assigned properties such as age, SES, walking ability, attitude toward walking and a home location. Individuals perform different activities on a regular basis such as traveling for work, for basic needs, and for leisure. Whether an individual walks and the amount she or he walks is a function of distance to different activities and her/his walking ability and attitude toward walking. An individuals attitude toward walking evolves over time as a function of past experiences, walking of others along the walking route, limits on distances walked per day, and attitudes toward walking of the other individuals within her/his social network. The model was calibrated and used to examine the contributions of land use and safety to socioeconomic differences in walking. With further refinement and validation, ABMs may help to better understand the determinants of walking and identify the most promising interventions to increase walking.

Comparing measures of urban land use mix

In the wake of the growing popularity of pedestrian-oriented community designs, it is timely to assess potential risk trade-offs of such urban planning strategies. Pedestrian-friendly designs are currently being called for and implemented in the US to tackle in particular problems associated with insufficient physical activity in the population. Unintended consequences may emerge, however, especially due to potential increases in the inhalation of pollutants as the population walking or cycling in polluted environments increases. A risk assessment of such built environment transformations was undertaken to evaluate quantitatively the competing risks and benefits of community design changes in active travel. A simulation model, built incorporating research from the fields of transportation, environmental sciences and exposure analysis, is applied to a case study area that undergoes hypothetical urban transformations. We find that the simulated population experiences roughly the same number of days in a year with decreases as number of days with increases in energy expenditure or inhalation of pollutants. In the 5% of days with greatest shifts, PM(10) inhalation was shown to increase by 175% or more, while the 5% of days of greatest decreases exhibited reductions of 45% or more (with similar results for ozone). Of particular concern, some individuals are shown to double their intake of the pollutants on high pollution days. However, uncertainty in the estimates is high. In particular, interpretations are very different according to the approach used to characterize year-long activity patterns. This innovative risk assessment uncovers critical gaps in the literature that must be further researched to allow essential comprehensive analyses of planning decisions.