Associations between active living-oriented zoning and no adult leisure-time physical activity in the U.S

Pedestrian-oriented zoning moderates the relationship between racialized economic segregation and active travel to work, United States

OBJECTIVE

Pedestrian-oriented zoning, including zoning code reforms (ZCR), may be especially beneficial to racially and economically segregated communities, which may lack built environment features that support physical activity. This study examined associations between racialized economic segregation, measured by quintiles of the Index of Concentration at the Extremes, and public transit (PTW) and active travel (ATW) to work, and whether associations were moderated by pedestrian-oriented zoning provisions and ZCR, respectively.

METHODS

Zoning codes effective as of 2010 representing 3914 US municipalities (45.45% of US population) were evaluated for the presence of ZCR and eight pedestrian-oriented zoning provisions. These data were linked with American Community Survey 2013-2017 and NAVTEQ 2013 data on the outcomes and relevant covariates. Fractional logit regressions were computed with standard errors clustered on county.

RESULTS

Workers from more deprived quintiles were less likely to engage in PTW and ATW (OR = 0.22-0.55, p < 0.01), and tests revealed moderation by zoning (p < 0.05). ZCR was positively associated with PTW for the three most deprived quintiles (OR = 1.53-2.38, p < 0.01), and with ATW for the two most deprived quintiles (OR = 1.42-1.69, p < 0.01) and the second most privileged quintile (OR = 1.26, p < 0.05). In the most privileged quintile, the zoning scale score was negatively associated with PTW (OR = 0.91, p < 0.001) and ATW (OR = 0.94, p < 0.01). However, in the most deprived quintiles, the zoning scale score was positively associated with PTW (Q2: OR = 1.13, p < 0.01) and ATW (Q1-Q2: OR = 1.07-1.09, p < 0.05).

CONCLUSIONS

Pedestrian-oriented zoning can provide opportunities for ATW in the most deprived communities. Work is needed to explore zoning policy implementation in those communities.

The Built Environment and Population Physical Activity: Methods for Mapping the Relevant Laws

BACKGROUND

The development of policies that promote and enable physical activity (PA) is a global health priority. Laws are an important policy instrument that can enable enduring beneficial outcomes for individuals, organizations, and environments through multiple mechanisms. This article presents a systematic process for mapping laws relevant to PA, which can be used to understand the role of laws as a powerful PA policy lever.

METHODS

Building on methods used in public health law research, we developed a protocol for scientific mapping of laws influencing the built environment for PA in Australia. The MonQcle online legal research platform was used for data coding, analysis, and presentation.

RESULTS

We describe the 10 key stages of legal mapping that we applied to examine state and territory laws that influence walking and cycling in Australia.

CONCLUSIONS

Law is a neglected element of policy research for PA. There is a need for accessible legal data to drive the design, investment, and implementation of legal interventions to improve population PA. Legal mapping is a first step toward evaluation of such laws for PA. This paper provides a practical case study and guidance for the 10 stages in legal mapping of laws that influence the built environment for PA.

Active living-oriented zoning codes and cardiometabolic conditions across the lifespan

Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce high rates of cardiometabolic conditions. Local zoning codes are a policy and planning tool to create more walkable and bikeable environments. This study evaluated relationships between active living-oriented zoning code environments and cardiometabolic conditions (body mass index, hyperlipidemia, hypertension). The study used county identifiers to link electronic health record and other administrative data for a sample of patients utilizing primary care services between 2012 and 2016 with county-aggregated zoning code data and built environment data. The analytic sample included 7,441,991 patients living in 292 counties in 44 states. Latent class analysis was used to summarize municipal- and unincorporated county-level data on seven zoning provisions (e.g., sidewalks, trails, street connectivity, mixed land use), resulting in classes that differed in strength of the zoning provisions. Based on the probability of class membership, counties were categorized as one of four classes. Linear and logistic regression models estimated cross-sectional associations with each cardiometabolic condition. Models were fit separately for youth (aged 5-19), adults (aged 20-59), and older adults (aged 60+). Little evidence was found that body mass index in youth, adults, or older adults or the odds of hyperlipidemia or hypertension in adults or older adults differed according to the strength of active living-oriented zoning. More research is needed to identify the health impacts of zoning codes and whether alterations to these codes would improve population health over the long term.

Public Health Representation on Active Transportation Bodies Across US Municipalities

CONTEXT

Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown.

OBJECTIVE

To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative.

DESIGN

A cross-sectional survey administered from May through September 2014.

SETTING

Nationally representative sample of US municipalities with populations of 1000 or more people.

PARTICIPANTS

Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018).

MAIN OUTCOME MEASURES

The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them.

RESULTS

Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative.

CONCLUSIONS

Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.

Examining the Implementation of Activity-Friendly Zoning and Land Use Policies Through the Use of Google Street View Measures: A Pilot Study

INTRODUCTION

Pedestrian-oriented zoning and land use policies are being used by local jurisdictions as tools to implement population-level built environmental changes to create more walkable communities. There is a paucity of evidence examining whether these policies lead to actual changes in the built environment. We used Google Street View (GSV), an established, less expensive, alternative built environment data collection method, to conduct an exploratory pilot study of 19 jurisdictions to examine associations between variations in the presence of these adopted zoning policies and their corresponding specific street-level built environment features.

METHODS

Samples of 10 large and 9 small jurisdictions (18 municipalities and 1 county) were purposively selected on the basis of the presence of activity-friendly zoning policy provisions (sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, trails/paths, bike lanes, bike parking, and other items). Corresponding activity-friendly street-level built environment measures were constructed using GSV. Street segments in these jurisdictions were sampled using ArcGIS and stratified by type (residential and arterial) and income (high, medium, and low).

RESULTS

A total of 4363 street segments were audited across the 19 sampled jurisdictions. Results show significant differences in the presence of activity-friendly street features when the corresponding zoning policy element was addressed in New Urbanist zones/districts in the site's zoning code (eg, crosswalks, 24.48% vs 16.18%; and bike lanes, 12.60% vs 7.14%). Street segments in the middle- and high-income block groups were less likely to have activity-friendly features than low-income segments, except bike lanes.

CONCLUSIONS

Results show that having activity-friendly policy provisions embedded in a jurisdiction's (municipality/county) zoning codes was associated with a greater presence of the corresponding built environmental street feature on the ground. Results suggest that the methods tested in this article may be a useful policy tool for local governments to identify high need areas that should be prioritized for built environment improvements.

Do State Comprehensive Planning Statutes Address Physical Activity?: Implications for Rural Communities

Less than one-quarter of U.S. adults meet physical activity (PA) recommendations, with rural residents less likely to be active than urban residents. The built environment has been identified as a potential facilitator of PA and local comprehensive plans are a foundational tool for guiding the development of the built environment. The purpose of this study was therefore to understand the current landscape of comprehensive planning state statutes related to PA and rural communities. We used primary legal research methods to identify, compile, and evaluate all 50 state comprehensive planning statutes for items related to PA and conditional mandates based on population size of local jurisdictions. The presence of population-conditional planning mandates and the inclusion of PA-related items was analyzed by state-level rurality using Fisher's exact tests. Our analyses demonstrated that (1) broader PA-related items were addressed in state statutes more often than more specific PA-related items; (2) when PA-related items were addressed, they were most likely to be mandated, subsumed elements; (3) several PA-related items were less likely to be addressed in the most rural states and/or conditionally mandated for jurisdictions meeting minimum population requirements; and (4) only two states addressed PA directly and explicitly in their comprehensive planning statutes.

Does Online Social Connectivity Promote Physical Activity in a Wearable Tracker-Based Intervention? A Pilot Randomized Controlled Study

Wearable activity trackers have gained popularity among individuals who want to track their physical activity (PA). The features of wearable tracking technology that are known to facilitate positive behavior changes such as self-monitoring and social connectedness) are well documented; yet, the existing evidence is not conclusive in the literature requiring further investigation. This study was an 8-week pilot randomized controlled study examining the effectiveness of PA intervention incorporating a wearable activity tracker’s online connectivity feature. Forty participants were equally randomized into either an individual-based (n = 20) or a connected group (n = 20). A Jawbone UP24 tracker was provided to all participants in both groups as a means of self-monitoring PA for eight weeks, but the connected group was additionally instructed to share their PA levels with the others using the accompanying smartphone application. Participants’ weekly step counts were evaluated each week to examine the change in PA. Participants’ biometric variables such as body weight, body mass index, waist circumference, blood pressure, and psychological status, including self-efficacy (SE) and exercise motivation (EM), were measured from both groups before and after the intervention period. Additionally, the social support questionnaire (SSQ) was measured among the connected group. The statistical significance level was set at <0.05. The average step counts for eight weeks were significantly increased only in the connected group (p < 0.001). Significant differences in step count improved from the baseline to week 8 in the connected user group (p < 0.01), but only baseline vs. week 7 in the individual users. Also, no significant interaction effects for biometric variables, EM, and SE were founded. However, SSQ was significantly improved in the connected user group (p < 0.001). PA intervention combining a wearable activity tracker and online social connectivity feature shows a greater effectiveness of promoting PA than a wearable tracker alone

Office-based physical activity: mapping a social ecological model approach against COM-B

BACKGROUND

There are growing concerns over the health impacts of occupational sedentary behaviour on office-based workers and increasing workplace recognition of the need to increase physical activity at work. Social ecological models provide a holistic framework for increasing opportunities for physical activity at work. In this paper we propose a social ecological model of office-based physical activity and map it against the Capability Motivation Opportunity (COM-B) framework to highlight the mechanisms of behaviour change that can increase levels of physical activity of office-based workers.

DISCUSSION

The paper proposes a social ecological model of physical activity associated with office-based settings. The model considers opportunities for both incidental and discretionary activities, as well as macro and micro factors on both socio-cultural and physical dimensions. The COM-B framework for characterising behaviour change interventions is used to highlight the underlying mechanisms of behaviour change inherent in the model. The broad framework provided by social ecological models is important for understanding physical activity in office-based settings because of the non-discretionary nature of sedentary behaviour of office-based work. It is important for interventions not to rely on individual motivation for behaviour change alone but to incorporate changes to the broader social ecological and physical context to build capability and create opportunities for more sustainable change.

Healthy by Design: Using a Gender Focus to Influence Complete Streets Policy

BACKGROUND

Public health leaders in Yellowstone County, Montana, formed an alliance to address community-wide issues. One such issue is Complete Streets, with its vision of safe streets for all. This case study focuses on development and adoption of a Complete Streets policy. It examines how a community coalition, Healthy By Design, infused a gender focus into the policymaking process.

METHODS

An incremental and nonlinear policymaking process was aided by a focus on gender and health equity. The focus on a large constituency helped to frame advocacy in terms of a broad population's needs, not just special interests.

RESULTS

The city council unanimously adopted a Complete Streets resolution, informed by a gender lens. Healthy By Design further used gender information to successfully mobilize the community in response to threats of repeal of the policy, and then influenced the adoption of a revised policy.

CONCLUSIONS

Policies developed with a focus on equity, including gender equity, may have broader impact on the community. Such policies may pave the way for future policies that seek to transform gender norms toward building a healthier community for all residents.

Exploring the Linkage between Activity-Friendly Zoning, Inactivity, and Cancer Incidence in the United States

Background: Physical activity (PA) protects against cancer and enhances cancer survivorship. Given high inactivity rates nationwide, population-level physical activity facilitators are needed. Several authoritative bodies have recognized that zoning and planning helps create activity-friendly environments. This study examined the association between activity-friendly zoning, inactivity, and cancer in 478 of the most populous U.S. counties.Methods: County geocodes linked county-level data: cancer incidence and smoking (State Cancer Profiles), inactivity (Behavioral Risk Factor Surveillance System), 11 zoning measures (compiled by the study team), and covariates (from the American Community Survey and NAVTEQ). For each zoning measure, single mediation regression models and Sobel tests examined whether activity-friendly zoning was associated with reduced cancer incidence, and whether inactivity mediated those associations. All models were clustered on state with robust SEs and significance at the P < 0.05 level.Results: Zoning for crosswalks, bike-pedestrian connectivity, and bike-pedestrian trails/paths were associated with reduced cancer incidence (β between -0.71 and -1.27, P < 0.05), about 1 case per 100,000 for each 10 percentage-point increase in county population exposure to zoning. Except for crosswalks, each association was mediated by inactivity. However, county smoking attenuated these results, with only crosswalks remaining significant. Results were similar for males (with zoning for bike-pedestrian connectivity, street connectivity, and bike-pedestrian trails/paths), but not females, alone.Conclusions: Zoning can help to create activity-friendly environments that support decreased inactivity, and possibly reduced cancer incidence.Impact: Given low physical activity levels nationwide, cross-sectoral collaborations with urban planning can inform cancer prevention and public health efforts to decrease inactivity and cancer. Cancer Epidemiol Biomarkers Prev; 26(4); 578-86. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."