“Just the Facts”…Leveraging Research to Promote Active Living in Army Communities

James Sallis, PhDSan Diego State Universitywww.drjamessallis.sdsu.edu

For Army MWR ConferenceLouisville, KY 1/26/10

Goals for this Talk

• You leave with new ideas, based on research, to promote physical activity on your base to enhance MWR.

• You are prepared to identify new partners to help you achieve your mission.

• Take lots of notes.

3Four50.com

• Oxford Health Alliance's key message: • 3 risk factors –

– tobacco use, poor diet, lack of physical activity

• Contribute to Four chronic diseases – – heart disease, type 2 diabetes, lung disease

and some cancers

• Which, in turn, contribute to more than 50 per cent of deaths in the world

Deaths (thousands) attributable to individual risk factors in both sexes

0 50 100 150 200 250 300 350 400 450 500

Low dietary polyunsaturated fatty acids

Low intake of fruits and vegetables

Alcohol use

High dietary trans fatty acids

Low dietary omega-3 fatty acids

High dietary salt

High LDL cholesterol

High blood glucose

Physical inactivity

Overweight-obesity (high BMI)

High blood pressure

Tobacco smoking

Danaei G et al, PLoS Medicine, 2009

49%

35%

10%

3.4%

10%5.4%

0%

20%

40%

60%

6-11 12-15 16-19

Age

Percentage of youth ages 6-19 meeting 60 min/day physical activity guidelines.

Based on accelerometers. NHANES 2003-4

Males

Females

Troiano, MSSE 2007

What is being done to improve PA?

• Minor investment in programs• Guided by theories that emphasize

psychological & social influences• Primary goals are education and

behavior change skills training targeting individuals

• Fragmented, poorly coordinated, poorly funded approaches

Psychosocial Models of Health Behavior

IndividualBiologicalPsychologicalSkills

Social/Cultural

How is it working?

Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System

Will individual interventions ever be sufficient?

Interventions based on psychosocial theories can be effective

But not sufficientReach is limitedEffects are modestMaintenance is rare

Programs are not designed to change the root causes of current behavioral patterns

Physical Activity Transition

Changing work practices

Increasing sedentary

An Ecological Model of Health Behavior

IndividualBiologicalPsychologicalBehavioral Skills

Social/Cultural

Physical Environment

Policy Context

Key Points from Ecological Models

• Interventions that work at all levels likely to be most effective

• Individual interventions will not work well when environments are not supportive

• Environment and policy changes likely to have most widespread and longest-lasting impacts

• First, create activity-friendly environments. Then motivate & educate people to be active

Occupational

Household

Transportation

Leisure

Domains of Activity: The SLOTH ModelSleep

Physical Activity Settings & Experts

• Neighborhood

• Transportation facilities

• Recreation facilities

• Schools & workplaces

• Planners

• Transport engineers & planners

• Park & rec, landscape architects

• Educators, architects

Comm DesignDestinations Home

Elements of An Active Living Community

“Walkable”: Mixed use, connected, dense

Not “walkable”

street connectivity and mixed land use

The Neighborhood Quality of Life (NQLS) Study: The Link Between

Neighborhood Design and Physical Activity

James SallisBrian Saelens

Lawrence FrankAnd team

Results published March 2009 in Social Science and Medicine

NQLS Neighborhood Categories

Walkability

Soc

ioec

onom

ic S

tatu

s Low High

Hig

hLo

w 4 per city

4 per city 4 per city

4 per city

Accelerometer-based MVPA Min/day in Walkability-by-Income Quadrants

28.5

33.4

29.0

35.7

0

5

10

15

20

25

30

35

40

MV

PA

min

ute

s p

er d

ay(M

ea

n *

)

Low Income High Income

Low Walk

High Walk

Walkability: p =.0002

Income: p =.36

Walkability X Income: p =.57

* Adjusted for neighborhood clustering, gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address.

Percent Overweight or Obese (BMI>25) in Walkability-by-Income Quadrants

63.156.8

60.4

48.2

0

10

20

30

40

50

60

70

% O

verw

eig

ht

or

Ob

ese

Low Income High Income

Low Walk

High Walk

Walkability: p =.007

Income: p =.081

Walkability X Income: p =.26

* Adjusted for neighborhood clustering, gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address.

Youth ages 5 to 18 years who live in mixed-use neighborhoods walk more for transportation

9% of children had walking trip over two days

18% of children had walking trip over two days

0%

5%

10%

15%

20%

No mixed land use Mixed land use

Frank, Kerr, et al., Am J of Health Promotion, 2007

Walkable neighborhoods encourage more walking in older adults

•Older women who live within walking distance of trails, parks or stores recorded significantly higher pedometer readings than women who did not. The more destinations that were close by, the more they walked.

Photo: Michael Ronkin, ODOT

King, W., Am. J. of Public Health 2003

Comm DesignDestinations Home

Park & Rec

Elements of An Active Living Community

People with access to parks & recreationFacilities are more likely to be active

A national study of US adolescents (N=20,745)* found a greater number of physical activity facilities is directly related to physical activity and inversely related to risk of overweight

Gordon-Larsen et al, Pediatrics, 2006http://www.pediatrics.org/cgi/content/full/117/2/417

*using Add Health data

0.5

0.75

1

1.25

1.5

One Two Three Four Five Six Seven

Number of facilities per block group

Od

ds

rati

o

Odds of having 5 or more bouts of MVPA

Odds of being overweight

1.26

.68

Referent

People are Most Active on Tracks and Walking Paths

0

50

100

150

200

250

300

Track

Sidew

alk

Gymnas

ium

Mul

ti-pu

rpos

e fie

ld

Playg

roun

d

Outdo

or Bas

ketb

all

Lawn

Baseb

all

Senio

r Cen

ter

Ave

rag

e N

um

ber

of

Par

k U

sers Sedentary Walking, Moderate & Vigorous

Cohen. RAND

Change in Number of Skate Park Users

0

500

1000

1500

2000

# of

Par

k U

sers

RemodeledSkate Park

ComparisonSkate Park

Baseline

Follow-up

Cohen. RAND

Use of 10 Renovated & Control Parks Declined

6449

8801

3459

870436

4717

3387

6142

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Children Teens Adults Seniors

# o

f P

ark

Use

rs

Baseline Follow-up

Baseline: Avg of 2000 persons observed per parkFollow-up: Avg of 1500 persons observed per park

Number of Organized Activities Declined

2727

4

35

5

1 0

9

0

5

10

15

20

25

30

35

40

Gymnasium OutdoorBasketball

Court

Multi-purpose

Field

BaseballField

# o

f O

rga

niz

ed

Ac

tiv

ite

s Baseline Follow-up

Cohen. RAND

Lessons from Park Renovation Studies

• Improving physical structures alone may not be enough to change physical activity

• Programs and events may be needed to help park users make use of physical changes

• Probably need more attention to outreach

Cohen. RAND

Percent of 8-14 year-olds meeting 60 min/day of MVPA during sports practice

0

5

10

15

20

25

30

35

Soccer Baseball

Boys

Girls

Comm DesignDestinations Home

Park & RecSchool & Preschool

Elements of An Active Living Community

What PE is—too oftenWhat PE is—too often

What PE What PE shouldshould be be

PE classes in lower income schools spend less time being active. Yancey. www.calendow.org

Percent (%) of time in MVPA, by percent % of students eligible for Free and Reduced Price Lunch (FRPL)

43%

34%

0%

10%

20%

30%

40%

50%

0-74% 75-100%

Percent (%) of students eligible for FRPL

Pe

rce

nt

(%)

of

PE

tim

e in

MV

PA

All Kids Should Be Active in PE(50% of class time)

And Learn Skills

Evidence-based PE is Available

• Early Childhood/preschool

• • Elementary schools

• Middle schools

• High schools

• SPARK

• SPARK• CATCH

• M-SPAN (SPARK)• TAAG

• LEAP• SPARK

SPARK Effects on PE Class Time & Observed Physical Activity

SPARK Outcomes• PE specialists>trained classroom teachers>

controls• Improved quality of PE instruction• Increased physical activity in PE• Improved cardiorespiratory & muscle

fitness• Improved sports skills• Positive impact on academic achievement• Students enjoyed SPARK lessons• 1.3 million kids a day getting active with

SPARK

Elementary students' on-task classroom behavior improves with physical activity breaks

breaks withno physical activity

-3%

physical activity breaks,

students overall

8%

physical activity breaks, off-task

students

20%

-5%

0%

5%

10%

15%

20%

25%

Pe

rce

nt

imp

rov

em

en

t in

on

-ta

sk

be

ha

vio

r

Mahar, Murphy, et al., Medicine and Science in Sports and Exercise, 2006

School Environment Interventions

• Stratton et al. from the UK conducted several studies showing simple markings on elementary playgrounds increases PA about 18 min/day

• Verstraete from• Belgium showed• Equipment at• Recess increased• PA

After School Programs

• Primary time for youth to be active

• Key issues– Transportation access– Cost– Quality of program & leadership– Amount of activity provided

• SPARK Active Recreation Program

Before After

Lois Brink, U Colorado Denver

Comm DesignDestinations Home

Park & Rec

School & Preschool

Elements of An Active Living Community

Designed for active travel

Not designed for active travel

Activity-Friendly Transportation SystemsComplete Streets

Source: NPTS 1977, 1990 and NHTS 2001 for children 5-15  

Walking to School as Percent of School Trips (Children 5-15)

20.2

16.6

12.5

0

5

10

15

20

25

1977 1990 2001

More parents report children walking or biking to school after Safe Routes to Schools project completion

10.9%

20.6%19%

3.1%

12%

28.6%

11.6%

15.6%13.7%

6.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

JuanCabrillo

Murrieta Sheldon Valley WestRandall

Glenoaks Jasper Mt.Vernon

CesarChavez

Newman

% c

ha

ng

e in

wa

lkin

g o

r b

ikin

g t

o s

ch

oo

l

Boarnet, Anderson, Day, et al, Am J Prev Med, 2005

Adolescents in Melbourne, Australia (N=188) are more likely to increase active commuting (walking and biking) to school if their parents are satisfied with the number of traffic lights and pedestrian crossings in their neighborhood

0.4

2.4

1 1

0

0.5

1

1.5

2

2.5

3

No traffic lights orcrossings

Adequatenumber ofcrossingsL

ikel

iho

od

of

incr

easi

ng

wal

kin

g o

r b

ikin

g t

o s

cho

ol

(Od

ds

rati

o)

Referent

Hume et al, AJPM, 2009

Where do people bicycle?  The role of infrastructure in determining bicycling behavior

Jennifer Dill, Ph.D. Center for Transportation Studies

•

Distribution of recorded bicycle travel by facility type, compared to network mileage (based on 166 adult cyclists in Portland, OR). Location of travel assessed by GPS.

% of all bicycle travel (miles)

% of network 

Roads without bicycle infrastructure 51 92

Primary roads/highways, no bicycle lanes 4 4

Secondary roads, no bicycle lanes 19 13

Minor streets, no bicycle lanes 27 63

Driveways, alleys, unimproved roads 2 12

Bicycle Infrastructure 49 8Primary roads/highway, with bicycle lanes 9 3

Secondary roads, with bicycle lanes 14 2

Minor streets, with bicycle lanes 3 1

Bicycle/multi-use paths 14 2

Bicycle boulevards 9 <1

N (miles) 7,479 10,564

Dill, JPHP, 2009

Promoting CyclingII - IV

Plan communities with schools, parks, public spaces, transit stops and commercial districts located as focal points within convenient walking distances of neighborhoods.

Walkable Neighborhood PlanningWalkable Neighborhood Planning

Create activity-friendly neighborhoods, towns, and military bases.

A model for military bases Linenger. Am J Prev Med. 1991

• Environmental changes on a Naval base– Bike paths along roadways– Extend hours for rec facilities– Regular athletic & PA events on base– Running & biking clubs organized– Women’s fitness center opened– Healthy foods more visible– Recognition for improved fitness– Newspaper listed top performers– Fitness testing with feedback

• Significant fitness improvements in 1 year

Resources at www.activelivingresearch.org

Next Steps• Assess conditions on your base

– Places– Policies– Programs

• What interventions could have the biggest and longest-lasting impact?

• What interventions could serve both military and civilian residents & workers?

• Gather the right partners & resources• Develop & implement a plan• Evaluate it!

More of this

Less of thisVision for The Future

www.drjamessallis.sdsu.edu www.activelivingresearch.org