Data Day 2012_James_Accessing Health Risks and Using Health Data

Accessing and Using Health Data about Your Neighborhood AN INTRODUCTION TO PRIMARY DATA COLLECTION AND ASSESSMENT TOOLS AND METHODOLOGIES FOR UNDERSTANDING LOCAL FOOD ENVIRONMENT, WALKABILITY AND MORE PETER JAMES PUBLIC HEALTH SPECIALIST METROPOLITAN AREA PLANNING COUNCIL JANUARY 27, 2012

Outline Background on the Built Environment and Health Measures of the Physical Activity Environment  Neighborhood Environment Walkability Survey Example  My Research Example  Walk Score Example  Irvine Minnesota Inventory Example Measures of the Food Environment  Food Atlas Example  NEMS-R and NEMS-S Example Other Relevant Measures

The Built Environment Land-Use Patterns  Spatial distribution of human activities Transportation Systems  Physical infrastructure and services that provide the spatial links or connectivity among activities Design Features  Aesthetic, physical, and functional qualities of the built environment, such as the design of buildings and streetscapes, and relates to both land use patterns and the transportation system

Background: The Built Environment and Health Low Density, Low High Density, HighConnectivity, Low Land Use Mix Connectivity, High Land Use Mix

The Built Environment and Health Air Quality Motor Vehicle Crashes and Motor Vehicle- Pedestrian Collisions Mental Health Water Quantity and Quality Disparities Physical Activity Diet

The Common Roots of Urban Planning and Public Health Industrial Revolution and Congestion in Cities  Infectious disease  Cholera, typhoid, yellow fever, smallpox, and tuberculosis  Deplorable housing conditions  Poor ventilation  Polluted waterways  Toxic industries in close proximity to residences

The Common Roots of Urban Planning and Public Health  Public Health Responses  1842: Report on the Sanitary Conditions of the Laboring Population of Great Britain  1850: Report of the Sanitary Commission of Massachusetts  1916: Zoning laws in New York City  1924: Standard Zoning Enabling ActLemuel Shattuck

Divergence of Public Health and Urban Planning Germ Theory  Focus on single-agent causes of specific diseases Economics  Investment in new communities Transportation  Investment in the automobile  Dismantling of transit Federal Policy  Federal Housing Administration  Veterans Affairs Mortgage Program

Modern Urban Form: Sprawl

Modern Urban Form: Sprawl Development outpaces population growth Low density Rigidly separated homes, shops, and workplaces Roads marked by large blocks and poor access Lack of well-defined activity centers, such as downtowns Lack of transportation choices Relative uniformity of housing options

Urban Form and Transportation Sprawling areas exhibit  Higher rates of vehicle ownership  More vehicle-miles traveled (VMTs) per person  Lower percentages of commuters taking transit or walking to work

Air Quality Urban form determines transportation patterns Transportation patterns determine vehicle emissions Vehicle emissions are associated with  Respiratorydisease  Cardiovascular disease  Cancer  Reproductive outcomes  Premature mortality

Motor Vehicle Crashes and Motor Vehicle- Pedestrian Collisions Urban form is associated with VMTs VMTs increase time at risk to the hazards of motor vehicle travel Urban form can dictate vehicle speeds Long commutes can lead to fatigue and the increased risk of a crash

Motor Vehicle Crashes and Motor Vehicle- Pedestrian Collisions NHTSA statistics  Less sprawling cities  New York (2.30 fatalities per 100,000 population)  San Francisco (2.45 fatalities per 100,000 population)  Portland (3.21 fatalities per 100,000 population)  More sprawling cities  Houston (10.08 fatalities per 100,000 population)  Atlanta (12.72 fatalities per 100,000 population)  Tampa (16.15 fatalities per 100,000 population)  Exceptions to this rule  Los Angeles (5.79 fatalities per 100,000 population)  Detroit (10.93 fatalities per 100,000 population)

Mental Health Urban form is associated with VMTs Higher VMTs are associated with higher levels of stress Known stress responses due to driving and commuting Chronic stress from driving  Cardiovasculardisease  Musculoskeletal symptoms

Mental Health Depression  Limits on physical activity may deny a treatment for depression  Low density leads to social isolation, which leads to depression  Monotony and aesthetic qualities of sprawl may be root of depression Road rage  Events in which an angry or impatient driver tries to kill or injure another driver after a traffic dispute  Risk factors are traffic volume and traffic distance

Water Quantity and Quality Water quality  Biological pollutants  Hepatitis A or E  Coxsackie viruses, Adenoviruses, and Norwalk viruses  Pathogenic bacteria Helicobacter or Legionella.  Parasites Cryptosporidium and Giardia  Chemical pollutants  Pesticides, metals, nitrates, radionuclides, and organic chemicals  Disinfection byproducts, such as iodinated trihalomethanes

Water Quantity and Quality Decreasing density, proximity, and connectivity require more impervious paved surface per capita  Decreases the ability of rainfall to recharge groundwater aquifers  High velocity runoff increases erosion and speeds the transfer of pollutants into the water supply  Storm surges overload sewage treatment plants and discharge excess untreated water directly into adjacent bodies of water, leading to bacterial contamination Modeling has shown that higher density development reduces peak flows and total runoff volume Higher rates of motor vehicle use leads to higher levels of pollutants in runoff

Disparities Low SES populations  More likely to  rely on walking and public transit to commute  live near high-speed traffic areas with fewer clearly marked and safe crossing routes  Pedestrian fatalities  Atlanta pedestrian fatality rates during 1994-1998: 9.74 for Hispanics, 3.85 for African Americans, and 1.64 for Whites  Hispanics: 8% of the population of the Virginia suburbs of Washington, DC; 21% of pedestrian fatalities

Disparities Older and Disabled Persons  Limited mobility  Reliance on automobiles  Fewer transit options  Social isolation  cognitive decline

Physical Activity  Obesity and overweight  Type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, osteoarthritis, sleep apnea, stroke, liver disease, musculoskeletal disease, reproductive function, some forms of cancer, and mortality  Sedentary lifestyle  Depression, hypertension, type 2 diabetes mellitus, colon cancer, osteoarthritis, osteoporosis, coronary heart disease, and all- cause mortality

Physical Activity Three factors of urban form that may determine physical activity  Transportation systems connect places and determine the feasibility of using different modes of transport  Land use patterns determine the proximity of destinations and thereby the feasibility of walking or cycling  Urban design characteristics alter individual perception of whether the environment is desirable or inviting for physical activity

Physical Activity Sprawling communities associated with  Lower rates of physical activity  Higher body mass index (BMI)  Higher prevalence of hypertension Overweight and obesity associated with  Streets with no sidewalks or sidewalks on one side only  Lower residential density  Lower land-use mix  Lower street connectivity

Diet The presence or density of food retailers and restaurants is thought to be related to diet  Supermarkets provide a variety of affordable healthy foods, such as fresh fruits and vegetables and whole grains  Convenience stores supply highly processed foods rather than fresh foods  Fast food outlets offer large portion sizes and energy-dense foods Growing literature shows diet correlated with the presence or density of food retailers and restaurants  Density of supermarkets associated with higher fruit and vegetable consumption and lower obesity prevalence

Summary Public health historically linked to urban planning The built environment is associated with  Air pollution  Water quality and quantity  Motor vehicle crashes  Pedestrian injuries and fatalities  Mental health  Health disparities  Physical activity  Diet

Significance The health behaviors and health outcomes discussed are major contributors to morbidity and mortality in the US The built environment is a ubiquitous and modifiable exposure Built environment studies generally have small sample sizes, cover small geographic ranges, and are cross-sectional

Conceptual model for the effects of the built environment on physical activity and obesity Street connectivity Residential or population Physical density activity Access to Physical environment physical activity activity resources Access, density, and diversity of Disease / destinations Obesity Mortality Supermarkets Access and grocery / stores density Dietary food retail Convenience intake Food storesenvironment Access Sit-down / restaurants density food Fast-food service * Food retail and food service facilities could be also restaurants be physical activity destinations.

Measuring theBuiltEnvironmentScaleObjective vSubjectiveFactual vPerceptionQuestion ofInterest Duany and Plater-Zyberk. 1989. ITE Journal. 59:17- 18.

The Physical Activity EnvironmentISSUES, MEASURES, AND EXAMPLES

Physical Activity Environment: Issues to Consider Scale  County, city, neighborhood, street? What to Measure  Walking destinations  Connectivity  Micro-scale factors  Walkability?

Physical Activity Environment Measures Self-Report  Questionnaires about perceptions of built environment  Neighborhood Environment Walkability Scale Example

Physical Activity Environment Measures Geographic Information System (GIS)-based  Software system linking multiple data sources to place  County Sprawl Index  http://www.smartgrowthamerica.org/documents/MeasuringSpr awlTechnical.pdf  Walkability Index from Frank et al.  LUM, Retail Floor Area Ratio, Intersection Density, Residential Density  Primary Research Example  Walk Score Example

Physical Activity Environment Measures Observations or Audits  Reliable and valid measures of the ground-level built environment  Require clear definitions and observer training  Agreement between observers indicates quality  SPACES (Systematic Pedestrian and Cycling Environment Scan instrument  One of the first audits of the built environment for physical activity  Am J Prev Med 2002  http://sydney.edu.au/medicine/public- health/cpah/research/spaces.php  BRAT-DO (Bedimo-Rung Assessment Tools-Direct Observation)  Focus on parks  Irvine Minnesota Inventory Example

Neighborhood EnvironmentWalkability Survey-Abbreviated EXAMPLE 1 SELF-REPORT

Neighborhood Environment Walkability Survey-Abbreviated The NEWS-A assesses perceived residential density, land use mix (including both indices of proximity and accessibility), street connectivity, infrastructure for walking/cycling, neighborhood aesthetics, and traffic and crime safety http://www.activelivingresearch.org/files/NEWS_ Abbreviated.pdf

GIS-Based Assessment of thePhysical Activity Environment for Research EXAMPLE 2 GIS-BASED

Exposure Assessment: Residence-Level Built Environment Residential density  Census tract density from US Census data Land use mix  Location density from InfoUSA Street connectivity  Intersection density from StreetMap USA

Street Network Buffers 800m road network buffers around geocoded home addresses, excluding interstates and ramps 800m is the upper limit of what individuals are willing to walk, based on urban planning literature Non-interstate roads are generally walkable; however, we did not specifically measure micro- environment features, such as sidewalk availability, crosswalks, etc .

Street Network Buffers Polygons created radiating from residence 800m via local road network with 50m on each side of the road Estimates of the area that is 800m walking distance from each residence via the local road network

Residential Density Area weighted sum for network buffers based on intersecting census tracts from US 2000 Census data

Land Use Mix Location Count: Counts of businesses within 800m network buffers based on stores, facilities, and services from 2009 InfoUSA spatial database on businesses, which include grocery stores, restaurants, ban ks, etc.

Street Connectivity Intersection Count: Number of 3-way or greater intersections per square km within each network buffer Interstates and ramps will be excluded

Walk Score EXAMPLE 3 GIS-BASED

Walk Score http://www.walkscore.com/ The “Street Smart” Walk Score algorithm is based on walking distances from an address to a diverse set of nearby amenities Certain categories are weighted more heavily than others to reflect destinations associated with more walking trips In addition, road connectivity metrics such as intersection density and average block length are factored into the score Walk Score uses a variety of data sources such as Open Street Map, local business listings, and public data sources such as parks and schools

Irvine Minnesota Inventory EXAMPLE 4 OBSERVATION OR AUDIT

Irvine Minnesota Inventory Understanding the impact of the built environment on physical activity levels requires reliable methods to measure potentially relevant built environment features The Irvine Minnesota Inventory was designed to measure a wide range of built environment features that are potentially linked to active living, especially walking The Irvine Minnesota inventory includes 160 items, which cover four domains: accessibility (62 items), pleasurability (56 items), perceived safety from traffic (31 items), and perceived safety from crime (15 items)

Irvine Minnesota Inventory The inventory includes both a paper version and a version in Microsoft Access, to allow data to be input into the computer directly The items in the inventory were tested for inter-rater reliability in both southern California and the Minneapolis - St. Paul metropolitan area Inter-rater reliability was high, with 77 percent of the items attaining 80% agreement or better in both southern California and Minnesota reliability tests

Irvine Minnesota Inventory https://webfiles.uci.edu/kday/public/Irvine_MN_I nventory.pdf Link with full information: https://webfiles.uci.edu/kday/public/index.html

Interested in Learning More? Brownson RC, Hoehner CM, Day K, Forsyth A, Sallis JF. Measuring the built environment for physical activity: state of the science. Am J Prev Med. 2009 Apr;36(4 Suppl):S99-123. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2 844244/?tool=pubmed

The Food Environment ISSUES, MEASURES, AND EXAMPLES

Food Environment: Issues to Consider Scale  Community Nutrition Environments  Type and location of food outlets  Accessibility (e.g., hours)  Consumer Nutrition Environment  Availability of healthy food choices  Pricing, promotion, placement  Information availability Relevant Measure  Grocery store v. Fast food  Proximity to closest v. Density Not covered here: School or Home Nutrition Environment?

Food Environment Measures Self-report  Reports: How far to the nearest store?  Perceptions: How easy is it to find fresh fruits or vegetables? GIS-Based  Food Environment Atlas Example

Food Environment Measures Observation/Audit  Nutrition Environment Measures Survey for Restaurants and Stores (NEMS-R, NEMS-S ) Example Combinations of Both  Block JP, Christakis NA, OMalley AJ, Subramanian SV. Proximity to food establishments and body mass index in the Framingham Heart Study offspring cohort over 30 years. Am J Epidemiol. 2011 Nov 15;174(10):1108-14.

Food Environment Atlas EXAMPLE 5 GIS-BASED

Food Environment Atlas http://www.ers.usda.gov/foodatlas/atlas/

NEMS-R and NEMS-S EXAMPLE 6 AUDIT

NEMS-R and NEMS-S http://www.med.upenn.edu/nems/ NEMS-R: http://www.med.upenn.edu/nems/docs/NEMS_R_Detailed.pdf NEMS-S: http://www.med.upenn.edu/nems/docs/NEMS_S_Detailed.pdf

Interested in Learning More? Lytle LA. Measuring the food environment: state of the science. Am J Prev Med. 2009 Apr;36(4 Suppl):S134-44. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2 716804/

Other Relevant Measures Parks  Environmental Assessment of Public Recreation Spaces  http://www.activelivingresearch.org/node/10651 Paths  Path Environmental Audit Tool  http://www.activelivingresearch.org/files/PEAT_MANUAL.doc Neighborhood Safety Audits  Toronto Safety Checklist  http://www.toronto.ca/safetyaudits/pdf/scarb_safety_checklist. pdf

Thank You! Any questions? Feel free to email me at: pjames@mapc.org

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