1. AN INTRODUCTION TO PRIMARY DATA
COLLECTION AND ASSESSMENT TOOLS AND
METHODOLOGIES FOR UNDERSTANDING
LOCAL FOOD ENVIRONMENT, WA LK ABILITY
A ND MOR E
PETER JAMES
PUBLIC HEALTH SPECIALIST
METROPOLITAN AREA PLANNING COUNCIL
JANUARY 27, 2012
Accessing and Using Health Data
about Your Neighborhood

2. 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

3. 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

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

5. 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

6. 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

7. 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 Act
Lemuel Shattuck

8. 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

9. Modern Urban Form: Sprawl

10. 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

11. 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

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

13. 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

14. 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)

15. 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
 Cardiovascular disease
 Musculoskeletal symptoms

16. 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

17. 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

18. 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

19. 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

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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

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

28. Measuring the
Built
Environment
Scale
Objective v
Subjective
Factual v
Perception
Question of
Interest
Duany and Plater-Zyberk. 1989. ITE Journal. 59:17-
18.

29. I S S U E S , M E A S U R E S , A N D E X A M P L E S
The Physical Activity
Environment

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

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

32. 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

33. 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

34. E X A M P L E 1
S E L F - R E P O R T
Neighborhood Environment
Walkability Survey-Abbreviated

35. 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

36. E X A M P L E 2
G I S - B A S E D
GIS-Based Assessment of the
Physical Activity Environment for
Research

37. 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

38. 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.

39. 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

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

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

42. 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, banks, etc.

43. 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, banks, etc.

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

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

46. E X A M P L E 3
G I S - B A S E D
Walk Score

47. 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

48. E X A M P L E 4
O B S E R V A T I O N O R A U D I T
Irvine Minnesota Inventory

49. 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)

50. 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

51. 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

52. 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

53. I S S U E S , M E A S U R E S , A N D E X A M P L E S
The Food Environment

54. 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?

55. 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

56. 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, O'Malley 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.

57. E X A M P L E 5
G I S - B A S E D
Food Environment Atlas

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

59. E X A M P L E 6
A U D I T
NEMS-R and NEMS-S

60. 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

61. 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/

62. 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

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

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