▪ Abstract The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy resear...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.27.021405.102100

An ecological approach to creating active living communities.

Obesity relationships with community design, physical activity, and time spent in cars

CONTEXT. Environmental factors are suggested to play a major role in physical activity (PA) and other obesity-related behaviors, yet there is no national research on the relationship between disparity in access to recreational facilities and additional impact on PA and overweight patterns in US adolescents. 

OBJECTIVE. In a nationally representative cohort, we sought to assess the geographic and social distribution of PA facilities and how disparity in access might underlie population-level PA and overweight patterns. 

DESIGN, SETTING, AND PARTICIPANTS. Residential locations of US adolescents in wave I (1994–1995) of the National Longitudinal Study of Adolescent Health (N = 20745) were geocoded, and a 8.05-km buffer around each residence was drawn (N = 42857 census-block groups [19% of US block groups]). PA facilities, measured by national databases and satellite data, were linked with Geographic Information Systems technology to each respondent. Logistic-regression analyses tested the relationship of PA-related facilities with block-group socioeconomic status (SES) (at the community level) and the subsequent association of facilities with overweight and PA (at the individual level), controlling for population density. 

MAIN OUTCOME MEASURES. Outcome measures were overweight (BMI ≥ 95th percentile of the Centers for Disease Control and Prevention/National Center for Health Statistics growth curves) and achievement of ≥5 bouts per week of moderate-vigorous PA. 

RESULTS. Higher-SES block groups had a significantly greater relative odds of having 1 or more facilities. Low-SES and high-minority block groups were less likely to have facilities. Relative to zero facilities per block group, an increasing number of facilities was associated with decreased overweight and increased relative odds of achieving ≥5 bouts per week of moderate-vigorous PA. 

CONCLUSIONS. Lower-SES and high-minority block groups had reduced access to facilities, which in turn was associated with decreased PA and increased overweight. Inequality in availability of PA facilities may contribute to ethnic and SES disparities in PA and overweight patterns.

/pdf/inequality-in-the-built-environment-underlies-key-health-4ktbglkmwo.pdf

Inequality in the Built Environment Underlies Key Health Disparities in Physical Activity and Obesity

Tracking restoration in natural and urban field settings.

Purpose. To determine the relationship between urban sprawl, health, and health-related behaviors. Design. Cross-sectional analysis using hierarchical modeling to relate characteristics of individuals and places to levels of physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease. Setting. U.S. counties (448) and metropolitan areas (83). Subjects. Adults (n 5 206,992) from pooled 1998, 1999, and 2000 Behavioral Risk Factor Surveillance System (BRFSS). Measures. Sprawl indices, derived with principal components analysis from census and other data, served as independent variables. Self-reported behavior and health status from BRFSS served as dependent variables. Results. After controlling for demographic and behavioral covariates, the county sprawl index had small but significant associations with minutes walked (p 5 .004), obesity (p , .001), BMI (p 5 .005), and hypertension (p 5 .018). Residents of sprawling counties were likely to walk less during leisure time, weigh more, and have greater prevalence of hypertension 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. Conclusion. This ecologic study reveals that urban form could be significantly associated with some forms of physical activity and some health outcomes. More research is needed to refine measures of urban form, improve measures of physical activity, and control for other individual and environmental influences on physical activity, obesity, and related health outcomes. (Am J Health Promot 2003;18[1]:47‐57.)

/pdf/relationship-between-urban-sprawl-and-physical-activity-10oykrbw21.pdf

Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity

This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches.

Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease.

From a public health perspective, a cost-benefit analysis of using bike/pedestrian trails in Lincoln, Nebraska, to reduce health care costs associated with inactivity was conducted. Data was obtained from the city's 1998 Recreational Trails Census Report and the literature. Per capita annual cost of using the trails was 209.28 U.S. dollars (59.28 U.S. dollars construction and maintenance, 150 U.S. dollars of equipment and travel). Per capita annual direct medical benefit of using the trails was 564.41 U.S. dollars. The cost-benefit ratio was 2.94, which means that every 1 U.S. dollar investment in trails for physical activity led to 2.94 U.S. dollars in direct medical benefit. The sensitivity analyses indicated the ratios ranged from 1.65 to 13.40. Therefore, building trails is cost beneficial from a public health perspective. The most sensitive parameter affecting the cost-benefit ratios were equipment and travel costs; however, even for the highest cost, every 1 U.S. dollar investment in trails resulted in a greater return in direct medical benefit.

https://sienadeepservice.pbworks.com/f/Cost+Benefit+Analysis+--+Health.pdf

A cost-benefit analysis of physical activity using bike/pedestrian trails

We estimated the annual cost of bike and pedestrian trails in Lincoln, Neb, using construction and maintenance costs provided by the Department of Parks and Recreation of Nebraska. We obtained the number of users of 5 trails from a 1998 census report. The annual construction cost of each trail was calculated by using 3%, 5%, and 10% discount rates for a period of useful life of 10, 30, and 50 years. The average cost per mile and per user was calculated. Trail length averaged 3.6 miles (range = 1.6-4.6 miles). Annual cost in 2002 dollars ranged from 25,762 to 248,479 (mean = 124,927; median = 171,064). The cost per mile ranged from 5735 to 54,017 (mean = 35,355; median = 37,994). The annual cost per user was 235 (range = 83-592), whereas per capita annual medical cost of inactivity was 622. Construction of trails fits a wide range of budgets and may be a viable health amenity for most communities. To increase trail cost-effectiveness, efforts to decrease cost and increase the number of users should be considered.

/pdf/cost-analysis-of-the-built-environment-the-case-of-bike-and-2ymxq8dxth.pdf

Tom Schmid

Papers

Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity

Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease.

A cost-benefit analysis of physical activity using bike/pedestrian trails

Cost Analysis of the Built Environment: The Case of Bike and Pedestrian Trials in Lincoln, Neb

Cost effectiveness of a bicycle/pedestrian trail development in health promotion.