1. Just the Facts…Leveraging Research to Promote Active Living in Army Communities James Sallis, PhD San Diego State University www.drjamessallis.sdsu.edu For Army MWR Conference Louisville, KY 1/26/10

2. 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.

3. 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

4. Deaths (thousands) attributable to individual risk factors in both sexes Danaei G et al, PLoS Medicine, 2009

5. Troiano, MSSE 2007

6. 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

7. Psychosocial Models of Health Behavior Individual Biological Psychological Skills Social/Cultural

8. How is it working? Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System

9. Will individual interventions ever be sufficient? Interventions based on psychosocial theories can be effective But not sufficient Reach is limited Effects are modest Maintenance is rare Programs are not designed to change the root causes of current behavioral patterns

10. Physical Activity Transition

11. Changing work practices

12. Increasing sedentary

13. An Ecological Model of Health Behavior Individual Biological Psychological Behavioral Skills Social/Cultural Physical Environment Policy Context

14. 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

15. O ccupational H ousehold T ransportation L eisure Domains of Activity: The SLOTH Model S leep

16. Physical Activity Settings & Experts Neighborhood Transportation facilities Recreation facilities Schools & workplaces Planners Transport engineers & planners Park & rec, landscape architects Educators, architects

17. Comm Design Destinations Home Elements of An Active Living Community

18. Walkable: Mixed use, connected, dense

19. Not walkable street connectivity and mixed land use

20. The Neighborhood Quality of Life (NQLS) Study: The Link Between Neighborhood Design and Physical Activity James Sallis Brian Saelens Lawrence Frank And team Results published March 2009 in Social Science and Medicine

21. NQLS Neighborhood Categories Walkability Socioeconomic Status Low High Low 4 per city

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

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

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

25. 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

26. Comm Design Destinations Home Park & Rec Elements of An Active Living Community

27. People with access to parks & recreation Facilities are more likely to be active

28. 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, 2006 http://www.pediatrics.org/cgi/content/full/117/2/417 *using Add Health data Odds of having 5 or more bouts of MVPA Odds of being overweight 1.26.68 Referent

29. People are Most Active on Tracks and Walking Paths Cohen. RAND

30. Change in Number of Skate Park Users Cohen. RAND

31. Use of 10 Renovated & Control Parks Declined Baseline: Avg of 2000 persons observed per park Follow-up: Avg of 1500 persons observed per park

32. Number of Organized Activities Declined Cohen. RAND

33. 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

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

35. Comm Design Destinations Home Park & Rec School & Preschool Elements of An Active Living Community

36. What PE istoo often

37. What PE should be

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

39. All Kids Should Be Active in PE (50% of class time) And Learn Skills

40. Evidence-based PE is Available Early Childhood/preschool Elementary schools Middle schools High schools SPARK CATCH M-SPAN (SPARK) TAAG LEAP SPARK

41. SPARK Effects on PE Class Time & Observed Physical Activity

42. 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

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

44. 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

45. 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

46. BeforeAfter Lois Brink, U Colorado Denver

47. Comm Design Destinations Home Park & Rec School & Preschool Elements of An Active Living Community

48. Designed for active travel

49. Not designed for active travel

50. Activity-Friendly Transportation Systems Complete Streets

51. Source: NPTS 1977, 1990 and NHTS 2001 for children 5-15 Walking to School as Percent of School Trips (Children 5-15)

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

53. 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 Hume et al, AJPM, 2009

54. Where do people bicycle? The role of infrastructure in determining bicycling behavior Jennifer Dill, Ph.D. Center for Transportation Studies

55. 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 infrastructure5192 Primary roads/highways, no bicycle lanes44 Secondary roads, no bicycle lanes1913 Minor streets, no bicycle lanes2763 Driveways, alleys, unimproved roads212 Bicycle Infrastructure 498 Primary roads/highway, with bicycle lanes93 Secondary roads, with bicycle lanes142 Minor streets, with bicycle lanes31 Bicycle/multi-use paths142 Bicycle boulevards9<1 N (miles)7,47910,564 Dill, JPHP, 2009

57. Promoting Cycling II - IV

58. Plan communities with schools, parks, public spaces, transit stops and commercial districts located as focal points within convenient walking distances of neighborhoods. Walkable Neighborhood Planning Create activity-friendly neighborhoods, towns, and military bases.

59. 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 –Womens 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

60. Resources at www.activelivingresearch.org

61. 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!

62. More of this Less of this Vision for The Future www.drjamessallis.sdsu.eduwww.drjamessallis.sdsu.edu www.activelivingresearch.orgwww.activelivingresearch.org