Rebecca Miles

The Effectiveness of Urban Design and Land Use and Transport Policies and Practices to Increase Physical Activity: A Systematic Review

BACKGROUND Although a number of environmental and policy interventions to promote physical activity are being widely used, there is sparse systematic information on the most effective approaches to guide population-wide interventions. METHODS We reviewed studies that addressed the following environmental and policy strategies to promote physical activity: community-scale urban design and land use policies and practices to increase physical activity; street-scale urban design and land use policies to increase physical activity; and transportation and travel policies and practices. These systematic reviews were based on the methods of the independent Task Force on Community Preventive Services. Exposure variables were classified according to the types of infrastructures/policies present in each study. Measures of physical activity behavior were used to assess effectiveness. RESULTS Two interventions were effective in promoting physical activity (community-scale and street-scale urban design and land use policies and practices). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess transportation policy and practices to promote physical activity. CONCLUSIONS Because community- and street-scale urban design and land-use policies and practices met the Community Guide criteria for being effective physical activity interventions, implementing these policies and practices at the community-level should be a priority of public health practitioners and community decision makers.

A hierarchy of sociodemographic and environmental correlates of walking and obesity

OBJECTIVES Initial studies demonstrate the need for further investigation of how the association of built environment with physical activity and BMI may differ by sociodemographic subgroups. The aim of this study was to use a novel statistical technique to identify possible subgroups. METHODS Data from the 2002 Strategies for Metro Atlantas Regional Transportation and Air Quality (SMARTRAQ) study were analyzed to explore relationships between measures of residential density, street connectivity, land use mix, and sociodemographic characteristics of individuals in predicting walking, overweight and obesity status. Chi-squared Automatic Interaction Detector (CHAID) analyses were used to partition the population into subgroups (N=13,065). RESULTS Subgroups, were more likely to walk if they lived in neighborhoods with greater residential density, greater street connectivity and greater land use mix. A similar relationship was seen in men for the outcomes of obesity and overweight. Male residents of more walkable neighborhoods were less likely to be obese or overweight. In contrast, features of walkability were related to higher rates of obesity and overweight in women and non whites. CONCLUSIONS These analyses reveal that gender and ethnic subgroups display substantially different weight outcomes across different levels of walkability. In contrast, walking was consistently higher for all groups in the more walkable neighborhoods. This information can contribute to better targeting of interventions, and calls for more detailed investigation of the moderators that affect weight and physical activity across subgroups. This information supports a more efficient use of scarce resources to promote physical activity and healthy body weight.

Employment and Unemployment in Jordan: The Importance of the Gender System

Abstract Using data from focus group interviews, this study investigates how the gender system influences employment and unemployment patterns in Jordan. Cultural and family-level factors affect not only whether women are in the labor market but also their success in finding a job. Cultural proscriptions on female mobility are a significant constraint in womens job searches. State and employer-level factors are also important in explaining high unemployment rates among women. The shrinking of the public sector disproportionately affects women, the location of jobs matters more for women than for men, and discrimination in the private sector remains.

Neighborhood Urban Form, Social Environment, and Depression

We examined whether neighborhood urban form, along with the social environment, was associated with depressive symptoms in a sample of Miami residents. Using a validated measure of depressive symptoms, we found that living in neighborhoods with higher housing density was associated with fewer symptoms. A larger acreage of green spaces was also linked to fewer depressive symptoms but did not reach significance in the full model. Our results suggest that how residents use the environment matters. Living in neighborhoods with a higher density of auto commuters relative to land area, an indicator of chronic noise exposure, was associated with more symptoms.

THE INFLUENCE OF THE PERCEIVED QUALITY OF COMMUNITY ENVIRONMENTS ON LOW-INCOME WOMEN’S EFFORTS TO WALK MORE

There is increasing interest in how the quality of community environments influences health. We present the results of a pilot study designed to encourage overweight and obese low-income women to increase their level of physical activity, and explore the factors that either support or constrain their walking. The findings suggest that even relatively small increases in lifestyle physical activity among overweight or obese low-income women (an increase in 2,000 steps per day) can lead to significant weight loss. The interviews we carried out with study participants suggest there are several ways in which the perceived quality of community environments affects low-income women’s efforts to increase their steps. Having friends and family living within walking distance was supportive of participant’s efforts, in some cases because their homes represented places to walk to, and in others because in addition, friends and family were walking companions. The perceived lack of safety participants reported as a constraint to walking reflected in some cases the fear of being assaulted or harassed, and in others the fear that passers-by would not stop to help if needed. Our findings point to the importance of including community-level interventions that address residents’ safety and security concerns, along with future efforts to increase physical activity and decrease obesity among low-socioeconomic status groups.

Social Policy From the Bottom Up: Abandoning FGC in Sub-Saharan Africa

The authors analyse the experience of Tostan, a Senegalese NGO, with the abandonment of female genital cutting (FGC) in Senegal, the Sudan, and Mali. Tostan uses non-formal, participatory methodologies to support village-based social change, especially in the areas of human rights and womens health. Following Tostans educational programme, some communities have declared a moratorium on the practice of FGC and have mobilised their families and villages to discontinue its use. This article describes the process used, considers issues that have arisen as the concept is marketed and disseminated beyond Senegal, and reviews implications for grassroots policy initiatives.

Good neighborhoods in Portland, Oregon: Focus on both social and physical environments

ABSTRACT: We conduct an empirical investigation of the social environment of “good” neighborhoods in physical form in a model of the “compact city,” Portland, Oregon and discuss the implications for design and evaluation of policies inspired by smart growth and new urbanist movements that focus on the urban form and transportation dimensions of neighborhoods, and of housing assistance policies designed to change the economic mix in neighborhoods. We conceptualize the physical and social dimensions of the “good” neighborhood environment and develop an approach to operationalization that uses publicly available data. Our findings indicate that for the most part, Portland has been successful in creating neighborhoods at several economic scales that feature not only the connectivity, accessibility, mixed land use, and access to public transit that characterize “good” neighborhoods from a physical perspective, but also a “good” social environment indicative of strong ties and collective efficacy. However, there are signs that in the process, Portland may be creating poverty areas that lack connectivity, accessibility, and access to public transit and a mix of destinations.

Seeking a contemporary understanding of factors that influence physical activity

The Mozart opera, Abduction from the Seraglio, went far beyond the usual limits of tradition with its long, elaborate arias. Asked about the opera, Emperor Joseph II responded with the terse and famous comment, “Too many notes.” This supplement to the American Journal of Preventive Medicine contains articles from the Cooper Clinic Conference Innovative Approaches to Understanding and Influencing Physical Activity. The articles paint a picture of “a very complex causal web” of factors affecting physical activity behavior. As one ponders the boxes and arrows in logic models of how determinants, correlates, mediators, confounders, and moderators operate at intrapersonal, interpersonal, physical environment, and social/cultural environmental levels, should our comment be the analogous “too many boxes and arrows?” Curiously, physical activity behavior is not inherently complex. Up until a few hundred years ago, the study of physical activity determinants was not as complicated, because the means to accomplish daily tasks in a sedentary manner had not been invented yet. We can now study the choice to be active or inactive because of technology that created many sedentary options for accomplishing daily tasks. But technology also opened the door to a large number of new types of activities that were either unusual or impossible prior to good equipment, including bicycling, skiing, basketball, and roller-skating. We have not met anyone proposing to promote physical activity by going backwards in time, for example, by returning to manual labor on farms. The tack we are on is to put back into our lives a healthful and enjoyable subset of physical activities. In pursuing this tack, we are undergoing a paradigm shift in our approaches to promoting physical activity. On the public health practice side of this shift, public health is rebuilding its emphasis on healthy environments by including a new focus on active community environments. Unheard of ten years ago, partnerships between public health and urban planners, transportation planners, and park planners are growing steadily. On the research side of the paradigm shift, researchers are shifting to transdisciplinary models and multilevel research designs. The conference essentially proposed and sought to encourage, as part of this shift, a more structured approach to research. The approach involves: (1) more standardization in terminology; (2) a shift away from disciplinary-based conceptual models focusing on a subset of variables, and a shift toward trans-disciplinary, multilevel models better suited to the breadth of variables affecting activity; and (3) more attention to the mechanisms and details of how interventions influence physical activity behavior. A more structured and coherent approach is important. To an ever greater extent, a research study influences practice because it is included in evidence syntheses. A case in point are the evidence syntheses of the Task Force on Community Preventive Services, that have recently identified six recommended or strongly recommended interventions to increase physical activity behaviors. Of 253 reports retained for full review, 159 were excluded from the syntheses, often because of limitations in execution or design. More structure also benefits an important group of “customers” of this research: practitioners who seek to do competent and useful evaluations of community physical activity initiatives. These practitioners need coherence to the logic models guiding the evaluation, e.g., which variables are the important mediators to track? They need measurement tools that correspond to boxes in the logic models. As research in physical activity evolves, it needs to pay increasing attention to such “customers.” In this way, the impact of research results is leveraged. As this supplement takes stock of where we are and where we need to go, several points are worth considering. First, the articles point us in the strategic direction of a comprehensive approach to promoting physical activity. Given the breadth of possible determinants, we do not sense that a few key determinants of physical activity behavior have emerged, and that just a few community interventions could produce large effects on activity. Rather, it appears that large effects on activity are From the Physical Activity and Health Branch, CDC/NCCDPHP (Buchner), Atlanta, Georgia; and the Department of Urban and Regional Planning and the Center for the Study of Population, Florida State University (Miles), Tallahassee, Florida Address correspondence and reprint requests to: David M. Buchner, MD, MPH, Chief, Physical Activity and Health Branch, CDC/ NCCDPHP, 4770 Buford Highway NE, MS K-46, Atlanta, GA 303413717. E-mail: DBuchner@cdc.gov OR zdg4@cdc.gov.

Future Directions in Housing and Public Health: Findings From Europe With Broader Implications for Planners

Problem: Chronic diseases such as asthma are rising at alarming rates in the United States and worldwide. Housing environments play an important, underappreciated role in these trends. Purpose: In this article, we document the magnitude of the association between housing conditions and asthma and related respiratory symptoms, present examples of new systems for addressing adverse effects of housing on health, and discuss how planners might require or encourage such innovations. Methods: We use logistic regressions based on household survey data from seven European cities to show the magnitude of the association between housing conditions and noise annoyance and the exacerbation of asthma and related respiratory symptoms. To support our argument that new housing intervention systems show great promise for alleviating current housing-related health challenges, we offer several different examples of green building criteria that incorporate health measures. Results and conclusions: After taking into consideration individual-level characteristics, we found that respondents across a range of cities who were strongly annoyed by general neighborhood noise had twice the odds of a doctor-diagnosed asthma attack or related respiratory symptom than those not at all annoyed. Those strongly annoyed by traffic noise had 68% higher odds. Drainage problems at the housing unit were associated with 54% higher odds of experiencing respiratory symptoms, building structural problems with 27% higher odds, and a leaky roof with 35% higher odds. We identify healthy housing development, construction, and housing rehabilitation systems as promising initiatives for addressing the web of associations between housing and health. We suggest that funds such as Community Development Block Grants or housing trusts could subsidize such efforts, and various existing planning processes could incorporate health requirements or scoring criteria. Takeaway for practice: There is compelling evidence that housing conditions are associated with poor health. Planners should inform themselves about these and identify opportunities to incorporate health considerations into planning that affects housing. Research support: None.

Ranking of Cities According to Public Health Criteria: Pitfalls and Opportunities

Popular magazines often rank cities in terms of various aspects of quality of life. Such ranking studies can motivate people to visit or relocate to a particular city or increase the frequency with which they engage in healthy behaviors. With careful consideration of study design and data limitations, these efforts also can assist policymakers in identifying local public health issues. We discuss considerations in interpreting ranking studies that use environmental measures of a city populations public health related to physical activity, nutrition, and obesity. Ranking studies such as those commonly publicized are constrained by statistical methodology issues and a lack of a scientific basis in regard to design.