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Citations and Resources Related to the Introduction Module

• IOM Bridging the Evidence gap in obesity prevention

http://www.iom.edu/~/media/Files/Report%20Files/2010/Bridging-the-Evidence-Gap-in-Obesity-Prevention/Bridging%20the%20Evidence%20Gap%202010%20%20Report%20Brief.ashx

• Strategies to prevent childhood obesity, RWJF

http://www.rwjf.org/childhoodobesity/product.jsp?id=47908

• Brownson, R., Hoehner, C., Day, K., Forsyth, A., Sallis, J. (2009). Measuring the built environment for physical activity: state of the science. American Journal of Preventive Medicine 36(4S), S99-S123.

Abstract: Physical inactivity is one of the most important public health issues in the U.S. and internationally. Increasingly, links are being identified between various elements of the physical—or built—environment and physical activity. To understand the impact of the built environment on physical activity, the development of high-quality measures is essential. Three categories of built environment data are being used: (1) perceived measures obtained by telephone interview or self-administered questionnaires; (2) observational measures obtained using systematic observational methods (audits); and (3) archival data sets that are often layered and analyzed with GIS. This review provides a critical assessment of these three types of built-environment measures relevant to the study of physical activity. Among perceived measures, 19 questionnaires were reviewed, ranging in length from 7 to 68 questions. Twenty audit tools were reviewed that cover community environments (i.e., neighborhoods, cities), parks, and trails. For GIS-derived measures, more than 50 studies were reviewed. A large degree of variability was found in the operationalization of common GIS measures, which include population density, land-use mix, access to recreational facilities, and street pattern. This first comprehensive examination of built-environment measures demonstrates considerable progress over the past decade, showing diverse environmental variables available that use multiple modes of assessment. Most can be considered first-generation measures, so further development is needed. In particular, further research is needed to improve the technical quality of measures, understand the relevance to various population groups, and understand the utility of measures for science and public health.

(Am J Prev Med 2009; 36(4S):S99–S123) © 2009 American Journal of Preventive Medicine

• Carlson, S., Densmore, D., Fulton, J., Yore, M., Kohl, H. (2009). Differences in physical activity prevalence and trends from 3 U.S. surveillance systems: NHIS, NHANES and BRFSS. Journal of Physical Activity and Health 6(Suppl 1), S18-S27.

BACKGROUND: Three U.S. surveillance systems-National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and Behavioral Risk Factor Surveillance System (BRFSS)--estimate physical activity prevalence. METHODS: Survey differences were examined qualitatively. Prevalence estimates by sex, age, and race/ethnicity were assessed for comparable survey periods. Trends were examined from NHIS 1998 to 2007, NHANES 1999 to 2006, and BRFSS 2001 to 2007. RESULTS: Age-adjusted prevalence estimates appeared most similar for NHIS 2005 (physically active: 30.2%, inactive: 40.7%) and NHANES 2005 to 2006 (physically active: 33.5%, inactive: 32.4%). In BRFSS 2005, prevalence of being physically active was 48.3% and inactive was 13.9%. Across all systems, men were more likely to be active than women; non-Hispanic whites were most likely to be active; as age increased, overall prevalence of being active decreased. Prevalence of being active exhibited a significant increasing trend only in BRFSS 2001 to 2007 (P < .001), while prevalence of being inactive decreased significantly in NHANES 1999 to 2006 (P < .001) and BRFSS 2001 to 2007 (P < .001). CONCLUSIONS: Different ways of assessing physical activity in surveillance systems result in different prevalence estimates. Before comparing estimates from different systems, all aspects of data collection and data analysis should be examined to determine if comparisons are appropriate.

• Dill, J. (2009). Bicycling for transportation and health: the role of infrastructure. Journal of Public Health Policy 30, S95-S110.

ABSTRACT

This paper aims to provide insight on whether bicycling for everyday travel can help US adults meet the recommended levels of physical activity and what role public  infrastructure may play in encouraging this activity. The study collected data on bicycling behavior from 166 regular cyclists in the Portland, Oregon metropolitan area using global positioning system (GPS) devices. Sixty percent of the cyclists rode for more than 150 minutes per week during the study and nearly all of the bicycling was for utilitarian purposes, not exercise. A disproportionate share of the bicycling occurred on streets with bicycle lanes, separate paths, or bicycle boulevards. The data support the need for well-connected neighborhood streets and a network of bicycle-specific infrastructure to encourage more bicycling among adults. This can be accomplished through comprehensive planning, regulation, and funding.

• Saelens, B. & Handy, S. (2008). Built environment correlates of walking: a review. Medicine & Science In Sports & Exercise, 40(7), S550-S556.

Introduction: The past decade has seen a dramatic increase in empirical investigation into the relations between built environment and physical activity. To create places that facilitate and encourage walking, practitioners need an understanding of the specific characteristics of the built environment that correlate most strongly with walking. This article reviews evidence on the built environment correlates with walking. Method: Included in this review were 13 reviews published between 2002 and 2006 and 29 original studies published in 2005 and up through May 2006. Results were summarized based on specific characteristics of the built environment and transportation walking versus recreational walking. Results: Previous reviews and newer studies document consistent positive relations between walking for transportation and density, distance to nonresidential destinations, and land use mix; findings for route/network connectivity, parks and open space, and personal safety are more equivocal. Results regarding recreational walking were less clear. Conclusions: More recent evidence supports the conclusions of prior reviews, and new studies address some of the limitations of earlier studies. Although prospective studies are needed, evidence on correlates appears sufficient to support policy changes. Key Words: WALKING, BUILT ENVIRONMENT, PHYSICAL ACTIVITY, URBAN DESIGN

• Oxford Health Alliance:  www.3four50.org
• Healthy People 2020 Goals for Nutrition and Weight Status http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29
• Healthy People 2020 Goals for Physical activity

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=3

OPEN ARTICLE

http://ajph.aphapublications.org/cgi/content/full/98/8/1451

Kaczynski, A., Potwarka, L. & Saelens, B. (2008). Association of park size, distance, and features with physical activity in neighborhood parks. Innovations in Design and Analysis, 98(8), 1451-1456.

Abstract:

Objectives. We studied whether park size, number of features in the park, and distance to a park from participants’ homes were related to a park being used for physical activity.

Methods. We collected observational data on 28 specific features from 33 parks. Adult residents in surrounding areas (n=380) completed 7-day physical activity logs that included the location of their activities. We used logistic regression to examine the relative importance of park size, features, and distance to participants’ homes in predicting whether a park was used for physical activity, with control for perceived neighborhood safety and aesthetics.

Results. Parks with more features were more likely to be used for physical activity; size and distance were not significant predictors. Park facilities were more important than were park amenities. Of the park facilities, trails had the strongest relationship with park use for physical activity.

Conclusions. Specific park features may have significant implications for park based physical activity. Future research should explore these factors in diverse neighborhoods and diverse parks among both younger and older populations.

Kaczynski, A. & Henderson, K. (2007). Environmental correlates of physical activity: a review of evidence about parks and recreation. Leisure Sciences, 29(4), 315-354.

Abstract:

Research on physical activity (PA) has expanded in recent years to examine environmental influences that enhance or limit the opportunities people have to be active. The purpose of this study was to review and critically examine evidence related to parks and recreation as features of the built environment and the relationship of these settings to PA. Fifty studies were retrieved from four major databases that reported an empirical relationship between parks or recreation variables and PA variables. Mixed associations with PA were observed for different types of parks or recreation settings, while proximity to parks or recreation was generally associated with increased PA. Shortcomings exist in this literature and many opportunities for researching parks, recreation, and active living are evident for the future.

Bedimo-Rung, A., Mowen, A. & Cohen, D. (2005). The significance of parks to physical activity and public health: a conceptual model. American Journal of Preventative Medicine, 28(2S2),  159-168.

Abstract:

Park-based physical activity is a promising means to satisfy current physical activity requirements. However, there is little research concerning what park environmental and policy characteristics might enhance physical activity levels. This study proposes a conceptual model to guide thinking and suggest hypotheses. This framework describes the relationships between park benefits, park use, and physical activity, and the antecedents/correlates of park use. In this classification scheme, the discussion focuses on park environmental characteristics that could be related to physical activity, including park features, condition, access, aesthetics, safety, and policies. Data for these categories should be collected within specific geographic areas in or around the park, including activity areas, supporting areas, the overall park, and the surrounding neighborhood. Future research should focus on how to operationalize specific

measures and methodologies for collecting data, as well as measuring associations between individual physical activity levels and specific park characteristics. Collaboration among many disciplines is needed.

Roemmich, J., Epstein, L., Raja, S., Yin, L., Robsinson, J. &  Winiewicz, D. (2006). Association of access to parks and recreational facilities with the physical activity of young children. Preventive Medicine, 43,  437-441.

Abstract:

Objective: To determine associations of the neighborhood and home television environments with young children's physical activity.

Method: 32 boys and 27 girls age 4 to 7 years wore accelerometers for 3 weekdays and 1 weekend day. The number of televisions in the home and television watching of the child were monitored using TV Allowance™ units for 3 weeks. A geographic information system was used to measure neighborhood environment variables.

Results:  Hierarchical regression analysis was used to predict physical activity, initially controlling for sex, age, socioeconomic status, adiposity, and child television watching in step 1. In step 2, the number of televisions did not significantly increase the amount of variability accounted for in the prediction of physical activity. In step 3, housing density and the interaction of housing density by sex accounted for an incremental 12% (p<0.05) of the variability and in step 4 percentage park plus recreation area accounted for a further 10% (p<0.05) of the variability. Greater housing density predicted increased physical activity of boys, but not girls.

Conclusion: Neighborhoods with increased proximity between homes and a greater proportion of park area are associated with greater physical activity in young children.

© 2006 Elsevier Inc. All rights reserved.

OPEN ARTICLE

http://ajph.aphapublications.org/cgi/content/full/94/3/440

Addy, C., Wilson, D., Kirtland, K., Ainsworth, B., Sharpe, P. & Kimsey, D. (2004). Associations of perceived social and physical environmental supports with physical activity and walking behavior. Research and Practice, 94(3), 440-443.

Abstract:

We evaluated perceived social and environmental supports for physical activity and walking using multivariable modeling. Perceptions were obtained on a sample of households in a southeastern county. Respondents were classified according to physical activity levels and walking behaviors. Respondents who had good street lighting; trusted their neighbors; and used private recreational facilities, parks, playgrounds, and sports fields were more likely to be regularly active. Perceiving neighbors as being active, having access to sidewalks, and using malls were associated with regular walking.

Duncan, M. & Mummery, K. (2005). Psychosocial and environmental factors associated with physical activity among city dwellers in regional Queensland. Preventive Medicine, 40, 363-372.

Abstract:

Background. Research has recently adopted the use of social–ecological models in the study of physical activity. Few studies, however, have addressed the influence of the environment on activity using Geographic Information System (GIS)-derived measures of environmental attributes and self-report ratings of other environmental attributes. Even fewer have examined walking behaviors.

Methods. Self-report measures of physical activity, social support, self-efficacy, and perceived neighborhood environment were obtained by means of a Computer-Assisted-Telephone-Interview (CATI) survey of 1,281 residents of Rockhampton, Queensland. Over 94% (1,215) of respondents’ residential locations were successfully geocoded into the existing city council GIS database. The self-report data, along with GIS-derived measures, were used to determine the relationships among selected variables of the neighborhood environment for each geocoded location.

Results. GIS-derived measures of street connectivity and proximity to parkland, the number of active people in a 1-km radius, and selfreported perceptions of neighborhood cleanliness showed associations with the likelihood of achieving sufficient levels of physical activity when adjusting for selected psychosocial variables. GIS-derived Euclidian distance to footpath networks, number of dogs in 0.8-km radius, network distance to newsagents, and perceptions of footpath condition were significantly associated with the likelihood of participating in any recreational walking.

Conclusion. Environmental characteristics were found to have differential influences on the two selected measures of physical activity. Aesthetics and safety appear to be important influences of physical activity, whereas proximal footpaths showed increased likelihood of participation in recreational walking. It is proposed that the strength of association between the environmental and physical activity may be improved if future research utilizes a Geographic Information System approach to the study of restricted geographical areas.

Copyright.  2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.

Giles-Corti, B., Broomhall, M.H., Knuiman, M., Collins, C., Douglas, K., Ng, K., Lange, A. & Donovan, R. (2005). Increase Walking: How Important is distance to, attractiveness, and size of public open space? American Journal of Preventative Medicine, 28(2S2), 169-176.

Background: Well-designed public open space (POS) that encourages physical activity is a community asset that could potentially contribute to the health of local residents.

Methods: In 1995–1996, two studies were conducted—an environmental audit of POS over 2 acres (n =516) within a  408-km2 area of metropolitan Perth, Western Australia; and personal interviews with 1803 adults (aged 18 to 59 years) (52.9% response rate). The association between access to POS and physical activity was examined using three accessibility models that progressively adjusted for distance to POS, and its attractiveness and size. In 2002, an observational study examined the influence of attractiveness on the use of POS by observing users of three pairs of high- and low-quality (based on attractiveness) POS matched for size and location.

Results: Overall, 28.8% of respondents reported using POS for physical activity. The likelihood of using POS increased with increasing levels of access, but the effect was greater in the model that adjusted for distance, attractiveness, and size. After adjustment, those with very good access to large, attractive POS were 50% more likely to achieve high levels of walking (odds ratio, 1.50; 95% confidence level, 1.06 –2.13). The observational study showed that after matching POS for size and location, 70% of POS users observed visited attractive POS.

Conclusions: Access to attractive, large POS is associated with higher levels of walking. To increase walking, thoughtful design (and redesign) of POS is required that creates large, attractive POS with facilities that encourage active use by multiple users (e.g., walkers, sports participants, picnickers).

ATL Park Access Report

ATL Park Access Poster

Park Enumeration Citations and Resources - spacestoplay.org (broken link)

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Life after PARA presentation

• Handy, S. & Clifton, K. (2007). Chapter 8: Planning and the built environment: implications for obesity prevention. In S. Kumanyika & R. Brownson (Eds.), Handbook of Obesity Prevention (167-188). New York, NY: Springer.

• Saelens, B. & Handy, S. (2008). Built environment correlates of walking: a review. Medicine & Science In Sports & Exercise, 40(7), S550-S556.

Introduction: The past decade has seen a dramatic increase in empirical investigation into the relations between built environment and physical activity. To create places that facilitate and encourage walking, practitioners need an understanding of the specific characteristics of the built environment that correlate most strongly with walking. This article reviews evidence on the built environment correlates with walking. Method: Included in this review were 13 reviews published between 2002 and 2006 and 29 original studies published in 2005 and up through May 2006. Results were summarized based on specific characteristics of the built environment and transportation walking versus recreational walking. Results: Previous reviews and newer studies document consistent positive relations between walking for transportation and density, distance to nonresidential destinations, and land use mix; findings for route/network connectivity, parks and open space, and personal safety are more equivocal. Results regarding recreational walking were less clear. Conclusions: More recent evidence supports the conclusions of prior reviews, and new studies address some of the limitations of earlier studies. Although prospective studies are needed, evidence on correlates appears sufficient to support policy changes. Key Words: WALKING, BUILT ENVIRONMENT, PHYSICAL ACTIVITY, URBAN DESIGN

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Citation:

Troped, P.J., Cromley, E.K., Fragala, M.S., Melly, S.J., Hasbrouck, H.H., Gortmaker, S.L., et al. (2006). Development and reliability and validity testing of an audit tool for trail/path characteristics: The Path Environment Audit Tool (PEAT). Journal of Physical Activity & Health, 3, Suppl 1, S158-S175.

Background: To determine how trail characteristics may influence use, reliable and valid audit tools are needed. Methods: The Path Environment Audit Tool (PEAT) was developed with design, amenity, and aesthetics/maintenance items. Two observers independently audited 185 trail segments at 6 Massachusetts facilities. GPS-derived items were used as a “gold standard.” Kappa (k) statistics, observed agreement and intraclass correlation coefficients (ICCs) were calculated to assess inter-observer reliability and validity. Results: Fifteen of 16 primary amenity items had k-values = 0.49 (“moderate”) and all had observed agreement = 81%. Seven binary design items had k-values ranging from 0.19 to 0.71 and three of 5 ordinal items had ICCs = 0.52. Only two aesthetics/maintenance items (n = 7) had moderate ICCs. Observed agreement between PEAT and GPS items was = 0.77; k-values were = 0.57 for 7 out of 10 comparisons. Conclusions: PEAT has acceptable reliability for most of its primary items and appears ready for use by researchers and practitioners