Health & Place

How our built environments impact children’s health
Environmental health
Environmental health
Environmental health
43% decrease in Medicaid claims for acute asthma
Percent (%)

Trends in U.S. Children’s Travel to School

Year

McDonald Am J Prev Med 2007
Percent (%)

Trends in U.S. Children’s Travel to School

Year

McDonald Am J Prev Med 2007
Percent (%)

Trends in U.S. Children’s Travel to School

Year

McDonald Am J Prev Med 2007
?

Environmental health
?

Environmental DESIGN
POLICY STATEMENT

The Built Environment: Designing
Communities to Promote Physical
Activity in Children

Organizational Pr...
POLICY STATEMENT

The Built Environment: Designing
Communities to Promote Physical
Activity in Children

Organizational Pr...
Traffic Injury
Fatality Rate per 100 Million Miles Traveled

Driver Age (years)
Urban Sprawl and Miles Driven Daily by Teenagers
in the United States
Matthew J. Trowbridge, MD, MPH, Noreen C. McDonald, ...
Urban Sprawl and Miles Driven Daily by Teenagers
in the United States
Matthew J. Trowbridge, MD, MPH, Noreen C. McDonald, ...
?
Sources of Inspiration
Times Square, NYC
High Line Park, NYC
High Line Park, NYC
NYC Citi Bikeshare
Citi Bikeshare
New Tools
CHAPTER 3 BUILDING DESIGN
ACTIVE DESIGN GUIDELINES
CHAPTER 3 BUILDING DESIGN

FINAL DRAFT OCTOBER 9, 2009

3.2 Stair locat...
Manassas Park Elementary
VMDO Architects
Poquoson Elementary School
Green Health

BUILDING
SUSTAINABLE
SCHOOLS FOR
HEALTHY KIDS
A Workshop Co-sponsored by the National
Collaborative for Chil...
T O O L S A N D T E CH N IQ U E S

Volume 10 — February 28, 2013

Healthy Eating Design Guidelines for School
Architecture...
Buckingham Elementary (VMDO Architects)
Dillwyn, VA
Buckingham Elementary (VMDO Architects)
Educational Signage
Opening Day
Schoolyard Garden
Matthew Trowbridge MD MPH
mtrowbridge@virginia.edu
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"
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Matthew Trowbridge, M.D., MPH - "Health & Place: How Our Built Environments Impact Children's Health" - Lunch Presentation

Trowbridge is a physician, public health researcher, and assistant professor at the University of Virginia School of Medicine.

Website: http://bit.ly/YNCONF13

Published in: Health & Medicine, Technology
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Matthew Trowbridge, M.D., MPH - "How Our Built Environments Impact Children's Health"

  1. 1. Health & Place How our built environments impact children’s health
  2. 2. Environmental health
  3. 3. Environmental health
  4. 4. Environmental health
  5. 5. 43% decrease in Medicaid claims for acute asthma
  6. 6. Percent (%) Trends in U.S. Children’s Travel to School Year McDonald Am J Prev Med 2007
  7. 7. Percent (%) Trends in U.S. Children’s Travel to School Year McDonald Am J Prev Med 2007
  8. 8. Percent (%) Trends in U.S. Children’s Travel to School Year McDonald Am J Prev Med 2007
  9. 9. ? Environmental health
  10. 10. ? Environmental DESIGN
  11. 11. POLICY STATEMENT The Built Environment: Designing Communities to Promote Physical Activity in Children Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children Committee on Environmental Health ABSTRACT An estimated 32% of American children are overweight, and physical inactivity contributes to this high prevalence of overweight. This policy statement highlights how the built environment of a community affects children’s opportunities for physical activity. Neighborhoods and communities can provide opportunities for recreational physical activity with parks and open spaces, and policies must support this capacity. Children can engage in physical activity as a part of their daily lives, such as on their travel to school. Factors such as school location have played a significant role in the decreased rates of walking to school, and changes in policy may help to increase the number of children who are able to walk to school. Environment modification that addresses risks associated with automobile traffic is likely to be conducive to more walking and biking among children. Actions that reduce parental perception and fear of crime may promote outdoor physical activity. Policies that promote more active lifestyles among children and adolescents will enable them to achieve the recommended 60 minutes of daily physical activity. By working with community partners, pediatricians can participate in establishing communities designed for activity and health. Pediatrics 2009;123: 1591–1598 www.pediatrics.org/cgi/doi/10.1542/ peds.2009-0750 doi:10.1542/peds.2009-0750 All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict-of-interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. Pediatrics (June 2009)
  12. 12. POLICY STATEMENT The Built Environment: Designing Communities to Promote Physical Activity in Children Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children Committee on Environmental Health “...a pediatrician’s recommendation that a patient get regular physical activity loses its salience if this patient’s everyday world lacks opportunities to walk, play, or run.”
  13. 13. Traffic Injury
  14. 14. Fatality Rate per 100 Million Miles Traveled Driver Age (years)
  15. 15. Urban Sprawl and Miles Driven Daily by Teenagers in the United States Matthew J. Trowbridge, MD, MPH, Noreen C. McDonald, PhD Background: Urban sprawl’s association with increased automobile reliance and daily mileage is well established among adults. However, sprawl’s specific impact on teen driving exposure is unknown. Teen driver fatality rates per mile driven are significantly higher than adults, making the identification of environmental influences on travel behavior particularly Table 3. Predicted probability of adolescents driving Ͼ20 miles per day by county-level sprawl, age, and gendera important in this age group. County-level sprawl (95% years Driving and demographic data for 4528 teens (weightedϭ10.5 million) aged 16 –19 CI) were obtained from the 2001 National Household Transportation Survey (NHTS). Age (years) County-level sprawl was measured using an index developed by Ewing et al.(I‫)49؍‬b Gender Compact (I‫)231؍‬b Average The association Sprawling (I‫)65؍‬b between daily miles driven by teens and sprawl, controlling for demographic characterisAll teens Both 33.0 (25.5–40.6) 46.8 (38.4–55.2) tics, was modeled using ordinal21.7 (14.7–28.6) logistic regression. The predicted probability of driving 16–17 9.0 (5.8–12.1) 14.9 (10.8–19.1) 23.8 (17.8–29.9) Ͼ20 miles Male in counties with varying degrees of sprawl also was calculated. Female 6.5 (4.2–8.9) 11.0 (7.7–14.4) 18.1 (12.7–23.6) Results: Of the surveyed teens, 48% did 22.9drive, 27% drove Ͻ20 miles/day, (24.4–52.6) not (12.3–33.4) 18–19 Male 38.5 and 25% drove Ͼ20 56.9 (42.3–71.6) miles/day.Female 52% of teens who reported driving, the average distance driven was 15.6 Of the 16.4 (11.0–21.8) 25.9 (19.3–32.5) 38.4 (29.8–47.0) miles/day. More-pronounced sprawl was associated with increased daily mileage a All probabilities(pϽ0.001).using reference household income levelwere more than twice as likely to drive Ͼ20 calculated Overall, teens in sprawling counties ($25,000 –$50,000). b Sprawl categories represent the mean index value (94.2) Ϯ two standard deviations (SDϭ19). Higher values of the county sprawl index miles/day than teens in compact counties. This trend was most prominent among the correspond to more-compact development, lower values to more sprawling development. I ϭ county-level youngest drivers. For example, the predicted probability of boys aged 16 –17 years driving sprawl index value. Ͼ20 miles per day varied from 9% to 24% in compact versus sprawling counties. Methods: Conclusions: Sprawl is associated with increased daily mileage by teen drivers. Given the stark relationship between driving exposure and in walk to school. increased efforts to per day varied from 7% in compact counties to 18% fatality risk among teens,20 Recent efforts to encourage the coorunderstand and modify the effects of sprawl on adolescent driving behavior are necessary. sprawling counties. dination of school and (Am J Prev Med 2008;34(3):202–206) © 2008 American Journal of Preventive Medicineland-use planning may lead to more walkable schools. However, the size of high schools— often more then 1000 students—reduces opDiscussion non-use, which aretoTrowbridge Am J Prev Med (2008) students, Background portunities prevalentthe schools close to are locate among adolescents, most 4 not The results ofdramatic improvements in hypothesis that readily amenable to change. this study support the automotive except in very dense areas. espite Given the recalcitrant nature of adolescent risk besprawl is significantly associated past few decades, daily safety engineering over the with increased
  16. 16. Urban Sprawl and Miles Driven Daily by Teenagers in the United States Matthew J. Trowbridge, MD, MPH, Noreen C. McDonald, PhD Background: Urban sprawl’s association with increased automobile reliance and daily mileage is well established among adults. However, sprawl’s specific impact on teen driving exposure is unknown. Teen driver fatality rates per mile driven are significantly higher than adults, making the identification of environmental influences on travel behavior particularly Table 3. Predicted probability of adolescents driving Ͼ20 miles per day by county-level sprawl, age, and gendera important in this age group. County-level sprawl (95% years Driving and demographic data for 4528 teens (weightedϭ10.5 million) aged 16 –19 CI) were obtained from the 2001 National Household Transportation Survey (NHTS). Age (years) County-level sprawl was measured using an index developed by Ewing et al.(I‫)49؍‬b Gender Compact (I‫)231؍‬b Average The association Sprawling (I‫)65؍‬b between daily miles driven by teens and sprawl, controlling for demographic characterisAll teens Both 33.0 (25.5–40.6) 46.8 (38.4–55.2) tics, was modeled using ordinal21.7 (14.7–28.6) logistic regression. The predicted probability of driving 16–17 9.0 (5.8–12.1) 14.9 (10.8–19.1) 23.8 (17.8–29.9) Ͼ20 miles Male in counties with varying degrees of sprawl also was calculated. Female 6.5 (4.2–8.9) 11.0 (7.7–14.4) 18.1 (12.7–23.6) Results: Of the surveyed teens, 48% did 22.9drive, 27% drove Ͻ20 miles/day, (24.4–52.6) not (12.3–33.4) 18–19 Male 38.5 and 25% drove Ͼ20 56.9 (42.3–71.6) miles/day.Female 52% of teens who reported driving, the average distance driven was 15.6 Of the 16.4 (11.0–21.8) 25.9 (19.3–32.5) 38.4 (29.8–47.0) miles/day. More-pronounced sprawl was associated with increased daily mileage a All probabilities(pϽ0.001).using reference household income levelwere more than twice as likely to drive Ͼ20 calculated Overall, teens in sprawling counties ($25,000 –$50,000). b Sprawl categories represent the mean index value (94.2) Ϯ two standard deviations (SDϭ19). Higher values of the county sprawl index miles/day than teens in compact counties. This trend was most prominent among the correspond to more-compact development, lower values to more sprawling development. I ϭ county-level youngest drivers. For example, the predicted probability of boys aged 16 –17 years driving sprawl index value. Ͼ20 miles per day varied from 9% to 24% in compact versus sprawling counties. Methods: Conclusions: Sprawl is associated with increased daily mileage by teen drivers. Given the stark relationship between driving exposure and in walk to school. increased efforts to per day varied from 7% in compact counties to 18% fatality risk among teens,20 Recent efforts to encourage the coorunderstand and modify the effects of sprawl on adolescent driving behavior are necessary. sprawling counties. dination of school and (Am J Prev Med 2008;34(3):202–206) © 2008 American Journal of Preventive Medicineland-use planning may lead to more walkable schools. However, the size of high schools— often more then 1000 students—reduces opDiscussion non-use, which aretoTrowbridge Am J Prev Med (2008) students, Background portunities prevalentthe schools close to are locate among adolescents, most 4 not The results ofdramatic improvements in hypothesis that readily amenable to change. this study support the automotive except in very dense areas. espite Given the recalcitrant nature of adolescent risk besprawl is significantly associated past few decades, daily safety engineering over the with increased
  17. 17. ?
  18. 18. Sources of Inspiration
  19. 19. Times Square, NYC
  20. 20. High Line Park, NYC
  21. 21. High Line Park, NYC
  22. 22. NYC Citi Bikeshare
  23. 23. Citi Bikeshare
  24. 24. New Tools
  25. 25. CHAPTER 3 BUILDING DESIGN ACTIVE DESIGN GUIDELINES CHAPTER 3 BUILDING DESIGN FINAL DRAFT OCTOBER 9, 2009 3.2 Stair location and visibility Objective Increase stair use by locating a highly visible and appealing stair within the building’s orientation areas and points of decision. Strategies Locate stairs near the building’s entrance. Research indicates that stairs located within 25 feet of an entrance and encountered prior to the elevator are more likely to be used for everyday travel.3 Locate a stair targeted for everyday use near the elevator. Users may consider taking a stair located near to and visible from the elevator lobby a more expedient option than waiting for the elevator.3,5 Visual and physical proximity of a stair to the elevator can be supplemented by point-of-decision signage encouraging people waiting for elevators to take the stairs. Locate stairs near the building’s entrance to encourage everyday use. Apple store, Manhattan, near the building’s entrance to encourage everyday use. Locate stairs Bohlin Cywinski Jackson with Ronette Riley Architect Locate an appealing, visible stair directly on the building’s principal entrance and paths of travel. Apple store, Manhattan, Bohlin Cywinski Jackson with Ronette Riley Architect Research indicates that stairs directly accessible and visible from a building’s elevator waiting areas, atrium, entry vestibules, and most-used public corridors are more likely to be utilized for everyday travel.3 One study found that stair use decreased as the number of turns required to access the stairs from either the building’s entrance or principal path of travel increased. Highly visible grand or ornamental stairs provide a clear indication that they are provided for use. Design stairs to be more visible, in order to encourage their everyday use. Stairs, particularly those designated for fire egress, often are not visible from a building’s main spaces. Code-mandated fire separations are traditionally achieved by encasing stairs in opaque masonry or gypsum board assemblies with solid metal doors. However, alternative assemblies, materials, and systems are available that allow egress stairs to be more visible while meeting code requirements for fire resistance ratings. Enclosing a stair with glass increases its visibility and encourages everyday use. The glass pictured here is fire protected through the Egress stairs can be made more visible by incorporating: use of a sprinkler water curtain. Memorial Sloan-Kettering Cancer Center interaction staircase, Manhattan, SOM in collaboration withFire-rated glass enclosures instead of traditional opaque enclosures. ZGF Architects • Open stairs between two or more floors with either the same or associated tenancies. Where Enclosing a stair with glass increases its visibility and encourages everyday use. Thestairs pictured here is fire protected through the additional sprinkler systems, smoke control open glass connect more than two floors, spaces, use of a sprinkler water curtain. system, and building code variance may be required, as per NFPA 13 and the New York City Memorial Sloan-Kettering Cancer Center interaction staircase, Manhattan, SOM in collaboration with ZGF Architects Building Code.4,6 •
  26. 26. Manassas Park Elementary VMDO Architects
  27. 27. Poquoson Elementary School
  28. 28. Green Health BUILDING SUSTAINABLE SCHOOLS FOR HEALTHY KIDS A Workshop Co-sponsored by the National Collaborative for Childhood Obesity Research and the National Academy of Environmental Design In partnership with the U.S. Green Building Council Center for Green Schools nccor.org/projects/greenhealth
  29. 29. T O O L S A N D T E CH N IQ U E S Volume 10 — February 28, 2013 Healthy Eating Design Guidelines for School Architecture Terry T-K Huang, PhD, MPH, CPH; Dina Sorensen, MArch; Steven Davis, AIA; Leah Frerichs, MS; Jeri Brittin, MM; Joseph Celentano, AIA; Kelly Callahan, AIA; Matthew J. Trowbridge, MD, MPH Suggested citation for this article: Huang TT, Sorensen D, Davis S, Frerichs L, Brittin J, Celentano J, et al. Healthy Eating Design Guidelines for School Architecture. Prev Chronic Dis 2013;10:120084. DOI: http://dx.doi.org/10.5888/pcd10.120084 . PEER REVIEWED Abstract Volume 10 - February 28, 2013 [Open Access Journal] We developed a new tool, Healthy Eating Design Guidelines for School Architecture, to provide practitioners in architecture and public health with a practical set of spatially organized and theory-based strategies for making school environments more conducive to learning about and practicing healthy eating by optimizing physical resources and learning spaces. The design guidelines, developed through multidisciplinary collaboration, cover 10 domains of the school food environment (eg, cafeteria, kitchen, garden) and 5 core healthy eating design principles. A school redesign project in Dillwyn, Virginia, used the tool to improve the schools’ ability to adopt a healthy nutrition curriculum and promote healthy eating. The new tool, now in a pilot version, is expected to evolve as its components are tested and evaluated through public health and design research.
  30. 30. Buckingham Elementary (VMDO Architects) Dillwyn, VA
  31. 31. Buckingham Elementary (VMDO Architects)
  32. 32. Educational Signage
  33. 33. Opening Day
  34. 34. Schoolyard Garden
  35. 35. Matthew Trowbridge MD MPH mtrowbridge@virginia.edu

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