Health Promoting Community Design
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Title: Health Promoting Community Design Author(s): Richard Killingsworth Publication: American Journal of Health Promotion Keyword(s): community design THE SCIENCE OF HEALTH PROMOTION Introduction  Richard Killingsworth  JoAnne Earp  Robin Moore   1   Supporting Health Through Design: Challenges and Opportunities Conceptual Approaches Daniel Stokols  Joseph G. Grzywacz  Shari McMahan  Kimari Phillips  4 Increasing the Health Promotive Capacity of Human Environments  The authors describe a conceptual framework that can be used to describe the extent to which environments promote health. They suggest that we consider which particular element of the environment has the greatest impact on an occupant’s wellbeing, the dimension of health impacted, and the dimensions within the environment that should be considered. Six guidelines for assessing the health promotive capacity are described.  Christine M. Hoehner  Laura K. Brennan  Ross C. Brownson  Susan L. Handy  Richard Killingsworth  14 Opportunities for Integrating Public Health and Urban Planning Approaches to Promote Active Community Environments Although these fields of public health and urban planning share similar objectives, their methodological approaches for examining the association between the environment and behavior often differ in significant ways. The authors discuss ways these fields can collaborate in developing and applying conceptual frameworks, adopting behavioral and environmental measures, and strengthening study designs. Building the Methods Anne Vernez Moudon Chanam Lee  21  Walking and Bicycling: An Evaluation of Environmental Audit Instruments A review of all published environmental audit instruments was conducted to provide a foundation for developing more valid and efficient audit tools. Existing tools measure only parts of the built environment that effect walking and biking. Also, few of the measures have been rigorously tested for validity. James Emery  Carolyn Crump  Philip Bors   38 Reliability and Validity of Two Instruments Designed to Assess the Walking and Bicycling Suitability of Sidewalks and Roads  Inter-rater reliability and criterion validity was measured for two instruments designed to measure the suitability of sidewalks and roads for walking and bicycling. The reliability and validity of both instruments were lower than ideal, but they represent a starting point for the development of such instruments. Building the Evidence— U.S. Approaches Reid Ewing  Tom Schmid  Richard Killingsworth  Amy Zlot  Stephen Raudenbush  47  Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity  Hierarchical modeling was used to examine the relationship between urban sprawl and physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease. 206,992 adults responded to the 1998, 1999, and 2000 Behavioral Risk Factor Surveillance System (BRFSS). Residents of sprawling counties were likely to walk less during leisure time (p 5 .004), weigh more (p , .005), and have greater prevalence of hypertension (p 5 .018) than residents of compact counties. At the metropolitan level, sprawl was similarly associated with minutes walked (p 5 .04) but not with the other variables. Sara L. Huston  Kelly R. Evenson  Philip Bors Ziya Gizlice   58 Neighborhood Environment, Access to Places for Activity, and Leisure-time Physical Activity in a Diverse North Carolina Population  A telephone survey was conducted among a randomly selected sample of 1796 adults in six North Carolina counties to measure the association between environmental factors and leisure time physical activity. Trails (OR 1.62), streetlights (OR 1.57), and access to places to exercise (OR 2.94) were associated with engaging in any leisure time physical activity, while trails (OR 1.49) and access to places to exercise (OR 2.28) were associated with engaging in recommended levels of leisure time physical activity in univariate analysis. After controlling for demographics and environmental factors, access to places to exercise was associated with any (OR 1.94) recommended levels (OR 2.10) of leisure time physical activity, and trails (OR 2.10) and heavy traffic (OR 1.35) were associated with recommended levels of activity. Genevieve Fridlund Dunton Margaret Schneider Jamner Dan Michael Cooper  70 Assessing the Perceived Environment Among Minimally Active Adolescent Girls: Validity and Relations to Physical Activity Outcomes  There was only moderate agreement (r 5 .62, p, , 001) between 47 sets of minimally-active adolescent females and their parents in perception of the number of exercise items available in the home, and no agreement (r 5 .14, p ..05) about items available in the community. Adolescents’ perceptions of availability of exercise items in the home and community were associated with cardiovascular fitness but not with amount of vigorous physical activity, energy expenditure, or lifestyle activity. Use of home items was associated with both lifestyle activity and vigorous physical activity. Wendy C. King  Jennifer S. Brach  Steven Belle  Richard Killingsworth  Mark Fenton  Andrea M. Kriska  74 The Relationship Between Convenience of Destinations and Walking Levels in Older Women  The relationship between convenient access to destinations and walking was measured among 149 community dwelling elderly women living in Pittsburgh, Pennsylvania. Living within 20 minutes walk of a park, trail, or store was related to higher pedometer readings. The greater the number of locations within walking distance, the greater the number of steps measured by pedometer, total walking by self report, and total activity by self report. Also, the higher the neighborhood ‘‘walkability’’ rating, the greater activity level measured by pedometer and self report. Building the Evidence— International Approaches Ilse De Bourdeaudhuij  James F. Sallis  Brian E. Saelens  83 Environmental Correlates of Physical Activity in a Sample of Belgian Adults  An 81 item questionnaire on neighborhood design and recreational environmental variables and a 7 item questionnaire on physical activity were sent to 1000 randomly selected adults in Ghent, Belgium to measure the relationship between neighborhood design and recreational, environmental, and physical activity. A total of 521 completed questionnaires were returned. Minutes of walking and minutes of moderate intensity activity were related to quality of sidewalks and access to shopping and public transportation. Vigorous activity was related to presence of supplies in the home and number of convenient activity facilities outside the home. The variance in exercise explained by these variables ranged from 5% to 13%. Billie Giles-Corti  Sally Macintyre  Johanna P. Clarkson  Terro Pikora  Robert J. Donovan  93 Environmental and Lifestyle Factors Associated With Overweight and Obesity in Perth, Australia  Personal interviews and neighborhood environmental analyses were conducted with 1803 men and women representing the top and bottom economic quintiles in Perth, Australia, to examine the associations between environmental and lifestyle factors. After controlling for demographic factors, perceptions, and other behaviors, being overweight was associated with living on a highway (OR 4.24) or a street with no sidewalks (OR 5 1.35) and perceiving no paths within walking distance (OR 5 1.42). With the same controls, being obese was associated with poor access to recreational facilities (OR 5 1.68), perceiving no shopping within walking distance (OR 5 1.84), and not having access to a car all the time (OR 5 1.78). Watching television more than 3 hours per day (OR 5 1.92 and 1.85), and rating oneself as less active than others (OR 5 1.66 and 4.05) was associated with both being overweight and obese.) Interdisciplinary Perspectives    Todd Litman  103 Integrating Public Health Objectives in Transportation Decision-Making  Conventional transportation planning tends to overlook negative health impacts resulting from increased motor vehicle travel and potential health benefits from shifts to alternative modes. Raising the priority of health objectives supports planning reforms that result in a more balanced transportation system. The author explores how transportation decision-making can better support public health objectives, including reduced crashes and pollution emissions, and more physical activity.  Trip Pollard  109 Policy Prescriptions for Healthier Communities  The author discusses how current policies present barriers to physical activity and increase pollution by encouraging sprawl development and offering few transportation choices, then suggests ways the barriers might be overcome through policy revision. Edward W. Maibach 114 Recreating Communities to Support Active Living: A New Role for Social Marketing  The author describes the elements of social marketing and illustrates how they can be applied to create active living communities and identity opportunities at the state and national level that will enhance the effectiveness of local efforts.