Promoting Healthy and Active Communities: Medical Students and the Built Environment Jan K Carney MD MPH Lynn Zanardi Blevins MD MPH Kelly Huynh

Background:

Vermont Integrated Curriculum (VIC) Implemented at the UVM College of Medicine in fall 2003 Implemented at the UVM College of Medicine in fall 2003 Integrates sciences and clinical medicine Integrates sciences and clinical medicine Develops skills for life-long learning Develops skills for life-long learning Public health competencies Public health competencies

Project background One of 13 public health projects 2004 One of 13 public health projects 2004 Group of seven students (second year) Group of seven students (second year) Faculty mentor Faculty mentor 2-3 hours/week; 16 weeks 2-3 hours/week; 16 weeks Partnership between university and community Partnership between university and community Timely area of public health Timely area of public health

Public Health Projects: Educational Goals Understand the breadth and scope of public health Understand the breadth and scope of public health Understand current and emerging public health issues Understand current and emerging public health issues Understand how public health interfaces with clinical medicine Understand how public health interfaces with clinical medicine Understand and apply public health research methods Understand and apply public health research methods

Public Health Projects Educational Goals Understand the role of the community in improving individuals’ health Understand the role of the community in improving individuals’ health Learn practical ways to improve the health of both individuals and populations Learn practical ways to improve the health of both individuals and populations Be creative and have fun! Be creative and have fun!

For each Public Health Project: 1. must address a public health issue 1. must address a public health issue 2. must ask and answer a scientific question 2. must ask and answer a scientific question 3. must show a public health benefit 3. must show a public health benefit

Public Health Framework

Healthy People 2010 Overarching goals 1. increase quality and years of healthy life 1. increase quality and years of healthy life 2. eliminate health disparities 2. eliminate health disparities

Healthy People 2010 Focus Areas Access to quality health services Access to quality health services Arthritis Arthritis Cancer Cancer Chronic Kidney Disease Chronic Kidney Disease Diabetes Diabetes Disability Disability Educational programs Educational programs Environmental health Environmental health Family planning Family planning Food Safety Food Safety Health Communication Health Communication Heart Disease and Stroke Heart Disease and Stroke HIV HIV Immunization and Infectious Diseases Immunization and Infectious Diseases Injury and violence prevention Injury and violence prevention Maternal, infant and child health Maternal, infant and child health Medical Product Safety Medical Product Safety Mental health Mental health Nutrition and overweight Nutrition and overweight Occupational health Occupational health Oral health Oral health Physical activity Physical activity Public Health Infrastructure Public Health Infrastructure Respiratory Diseases Respiratory Diseases Substance abuse Substance abuse Tobacco Tobacco Vision and Hearing Vision and Hearing

2004 Public Health Projects : HP 2010 areas Access to Quality Health Services Access to Quality Health Services Health Communication Health Communication Environmental Health Environmental Health Diabetes Diabetes Immunizations and infectious disease Immunizations and infectious disease Nutrition/Physical Activity Nutrition/Physical Activity Mental Health Mental Health

Promoting Healthy and Active Communities: goals Educate medical students about the environment and health Educate medical students about the environment and health Engage community planners Engage community planners Share and promote best practices to promote healthy and active Vermont communities Share and promote best practices to promote healthy and active Vermont communities

Chittenden County, VT: Project Communities Burlington Burlington Williston Williston Winooski Winooski

Burlington, Vermont

Williston, Vermont

Project methods: Literature review Literature review CDC, NIEHS CDC, NIEHS Development of questionnaire Development of questionnaire Recruitment of local communities Recruitment of local communities “promote the positive” strategy to engage community planners “promote the positive” strategy to engage community planners

Project methods (cont’) 3 towns in VT’s largest county 3 towns in VT’s largest county Various development stages Various development stages Interview of town planners Interview of town planners Pre-interview questionnaire Pre-interview questionnaire Questionnaire Questionnaire Identify and share “best practices” Identify and share “best practices”

Pre-interview Questionnaire: Population Population % residents with stores and recreation within ½ mile radius of homes % residents with stores and recreation within ½ mile radius of homes % land for mixed use neighborhoods % land for mixed use neighborhoods Public spaces for physical activity (% or acres) Public spaces for physical activity (% or acres) % budget for parks and recreation % budget for parks and recreation

Pre-interview questionnaire (cont’-2) % streets with sidewalks (residential) % streets with sidewalks (residential) % streets with sidewalks (commercial and mixed use) % streets with sidewalks (commercial and mixed use) Estimate of miles of bike path Estimate of miles of bike path Documents or references used in planning to promote physical activity Documents or references used in planning to promote physical activity

Questionnaire Introduction, summary, what town will receive from project, timeline Introduction, summary, what town will receive from project, timeline Definition of “built environment’ Definition of “built environment’ Current infrastructure Current infrastructure Future development Future development Goal to identify “best practices” Goal to identify “best practices”

Questionnaire (cont’-2) Collaboration with health professionals in town planning? Collaboration with health professionals in town planning? Town provides information to residents on public spaces for physical activity? Town provides information to residents on public spaces for physical activity? Recreation classes and programs? Recreation classes and programs? Accessible? Accessible?

Questionnaire (cont-3) Guidelines for aesthetically pleasing elements to encourage activity? Guidelines for aesthetically pleasing elements to encourage activity? Does town plan identify natural resources? Does town plan identify natural resources? Requirement for sidewalks in new residential areas? Requirement for sidewalks in new residential areas? Traffic calming measures in public recreation areas? Traffic calming measures in public recreation areas?

Questionnaire (cont’-4) Traffic signals pedestrian-controlled? Traffic signals pedestrian-controlled? Bypass of dangerous roads/intersections? Bypass of dangerous roads/intersections? Bicycle parking? Bicycle parking? School crossing guards? School crossing guards? Practices to increase safety in public recreation areas? Practices to increase safety in public recreation areas?

Questionnaire (cont’-5) Education – signs to promote stairs? Education – signs to promote stairs? Community outreach to promote physical activity? Community outreach to promote physical activity? Planning new recreation areas? Planning new recreation areas? 3 top practices to promote physical activity? 3 top practices to promote physical activity?

Questionnaire (cont’-6) Town “Observations” Town “Observations” –Student visits to best town assets –Photos –Descriptions

Promoting Healthy and Active VT Communities: Progress to date Progress to date Preliminary findings Preliminary findings Timeline and format for sharing “best practices” Timeline and format for sharing “best practices” Summary paper Summary paper Poster presentation Poster presentation Future directions Future directions

Questions ? Comments? Suggestions?

Jan K Carney, MD MPH, Associate Dean for Public Health, University of Vermont College of Medicine 371 Pearl St, Burlington VT (802)