Confronting the challenges in reconnecting urban planning and public health

The impact of the built environment on children's school conduct grades: the role of diversity of use in a Hispanic neighborhood

A population-based study examined the relationship between diversity of use of the built environment and teacher reports of children's grades. Diversity of use of the built environment (i.e., proportion of a block that is residential, institutional, commercial and vacant) was assessed for all 403 city blocks in East Little Havana, Miami-a Hispanic neighborhood. Cluster analysis identified three block-types, based on diversity of use: Residential, Mixed-Use, and Commercial. Cross-classified hierarchical linear modeling was used to examine the impact of diversity of use, school, gender, and year-in-school on academic and conduct grades for 2857 public school children who lived in these blocks. Contrary to popular belief, mixed-use blocks were associated with optimal outcomes. Specifically, follow-up analyses found that a youth living on a residential block had a 74% greater odds of being in the lowest 10% of conduct grades (conduct GPA <2.17) than a youth living on a mixed-use block. In fact, an analysis of the population attributable fraction suggests that if the risk associated with residential blocks could be reduced to the level of risk associated with mixed-use blocks, a 38% reduction in Conduct GPAs <2.17 could be achieved in the total population. These findings suggest that public policy targeting the built environment may be a mechanism for community-based interventions to enhance children's classroom conduct, and potentially related sequelae.

Obesity, physical activity, and the urban environment: public health research needs

Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built environment, physical activity, and overweight. Much of the focus of this research has been on the design and form of suburbs. It suggests that several features of the suburban built environment such as low densities, poor street connectivity and the lack of sidewalks are associated with decreased physical activity and an increased risk of being overweight. But compared to suburban residents, inner city populations have higher rates of obesity and inactivity despite living in neighborhoods that are dense, have excellent street connectivity and who's streets are almost universally lined with sidewalks. We suggest that the reasons for this apparent paradox are rooted in the complex interaction of land use, infrastructure and social factors affecting inner city populations. Sometimes seemingly similar features are the result of very different processes, necessitating different policy responses to meet these challenges. For example, in suburbs, lower densities can result from government decision making that leads to restrictive zoning and land use issues. In the inner city, densities may be lowered because of abandonment and disinvestment. In the suburbs, changes in land use regulations could result in a healthier built environment. In inner cities, increasing densities will depend on reversing economic trends and investment decisions that have systematically resulted in distressed housing, abandoned buildings and vacant lots. These varying issues need to be further studied in the context of the totality of urban environments, incorporating what has been learned from other disciplines, such as economics and sociology, as well as highlighting some of the more successful inner city policy interventions, which may provide examples for communities working to improve their health. Certain disparities among urban and suburban populations in obesity and overweight, physical activity and research focus have emerged that are timely to address. Comparable research on the relationship of built environment and health is needed for urban, especially inner city, neighborhoods.

Proximity of licensed child care facilities to near-roadway vehicle pollution

OBJECTIVES

We assessed child care facilities' proximity to heavily traveled roadways in an attempt to estimate the extent of potential exposure of young children to vehicle-related pollution in this understudied microenvironment.

METHODS

We examined approximately 24,000 licensed child care facilities in California located within 200 m of heavily traveled roadways.

RESULTS

Approximately 57000 of the available slots in California child care centers (7% of the overall capacity) are in facilities located within 200 m (650 ft) of roadways averaging 50000 or more vehicles per day, and another 172000 (21%) are in facilities located within 200 m of roadways averaging 25,000 to 49,000 vehicles per day. Facilities providing care to infants or preschool-aged children and facilities located in disadvantaged areas were more often situated in medium-or high-traffic areas.

CONCLUSIONS

Additional research is needed to further clarify the significance of the child care microenvironment in terms of potential childhood exposures to vehicle-related pollutants. Design strategies, notification standards, and distance-based siting restrictions should be considered in the facility licensing process and in land use and transportation planning.

A conceptual model of work and health disparities in the United States

Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled "disparities," are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.

How reliably do community members audit the neighborhood environment for its support of physical activity? Implications for participatory research

Environmental audits are used to assess supports for physical activity in the community. Understanding the suitability of such instruments for use by community members is crucial for advocacy and participatory research. This study examined the reliability of an audit instrument filled out by trained researchers and untrained community members. Two researchers and five community members conducted environmental audits on a total of 335 street segments in lower-income areas in St Louis, Missouri (representing a "low-walkable city"), and Savannah, Georgia (representing a "high-walkable" city). The audit tool consisted of six major sections--land use environment, recreational facilities, transportation environment, aesthetics, signage, and social environment. Interrater agreement between researchers and community members was assessed using percent observed agreement and the kappa statistic. According to observed agreement, the majority of audit items (67 of 76) had substantial to almost perfect agreement (> or =0.60) between researchers and community members. However, much lower agreement was observed using the kappa statistic (only 8 of 76 items with kappas > or =0.60). With some formal training, this audit tool may be useful for advocacy and participatory research to assess the activity friendliness of neighborhood environments.

Cities and population health

A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention.

Where does walkability matter the most? An environmental justice interpretation of New Jersey data

Physical inactivity contributes to a growing proportion of premature mortality and morbidity in the United States, and the last decade has been the focus of calls for action. Analysis of 340 residents of New Jersey found that 15%-20% reported multiple problems with using their immediate neighborhoods for physical activity. These respondents were disproportionately African Americans living in neighborhoods that they regard as only of fair or poor quality. Neighborhood walkability is a second-wave environmental justice issue meriting carefully designed research and ameliorative actions in concert with other neighborhood-level redevelopment activities.

Beyond Urban Penalty and Urban Sprawl: Back to Living Conditions as the Focus of Urban Health

Researchers have long studied urban health, both to describe the consequences of urban living and to design interventions to promote the health of people living in cities. Two approaches to understanding the impact of cities on health have been dominant, namely, urban health penalty and urban sprawl. The urban penalty approach posits that cities concentrate poor people and expose them to unhealthy physical and social environments. Urban sprawl focuses on the adverse health and environmental effects of urban growth into outlying areas. We propose a model that integrates these approaches and emphasizes urban living conditions as the primary determinant of health. The aim of the model is to move beyond describing the health-related characteristics of various urban populations towards identifying opportunities for intervention. Such a shift in framework enables meaningful comparisons that can inform public health activities at the appropriate level and evaluate their effectiveness in improving the health of urban populations. The model is illustrated with two examples from current urban public health practice.