Delivering the Science and the Art of Health Promotion

Robert F. Allen
Symbol of HOPE
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THE SCIENCE OF HEALTH PROMOTION

Introduction 
Richard Killingsworth 
JoAnne Earp 
Robin Moore 

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The authors describe a conceptual framework that can be used to describe the extent to which environments promote health. They suggest that we consider which particular element of the environment has the greatest impact on an occupant’s wellbeing, the dimension of health impacted, and the dimensions within the environment that should be considered. Six guidelines for assessing the health promotive capacity are described. 

Although these fields of public health and urban planning share similar objectives, their methodological approaches for examining the association between the environment and behavior often differ in significant ways. The authors discuss ways these fields can collaborate in developing and applying conceptual frameworks, adopting behavioral and environmental measures, and strengthening study designs.

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A review of all published environmental audit instruments was conducted to provide a foundation for developing more valid and efficient audit tools. Existing tools measure only parts of the built environment that effect walking and biking. Also, few of the measures have been rigorously tested for validity.

Inter-rater reliability and criterion validity was measured for two instruments designed to measure the suitability of sidewalks and roads for walking and bicycling. The reliability and validity of both instruments were lower than ideal, but they represent a starting point for the development of such instruments.

Hierarchical modeling was used to examine the relationship between urban sprawl and physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease. 206,992 adults responded to the 1998, 1999, and 2000 Behavioral Risk Factor Surveillance System (BRFSS). Residents of sprawling counties were likely to walk less during leisure time (p 5 .004), weigh more (p , .005), and have greater prevalence of hypertension (p 5 .018) than residents of compact counties. At the metropolitan level, sprawl was similarly associated with minutes walked (p 5 .04) but not with the other variables.

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A telephone survey was conducted among a randomly selected sample of 1796 adults in six North Carolina counties to measure the association between environmental factors and leisure time physical activity. Trails (OR 1.62), streetlights (OR 1.57), and access to places to exercise (OR 2.94) were associated with engaging in any leisure time physical activity, while trails (OR 1.49) and access to places to exercise (OR 2.28) were associated with engaging in recommended levels of leisure time physical activity in univariate analysis. After controlling for demographics and environmental factors, access to places to exercise was associated with any (OR 1.94) recommended levels (OR 2.10) of leisure time physical activity, and trails (OR 2.10) and heavy traffic (OR 1.35) were associated with recommended levels of activity.

Genevieve Fridlund Dunton
Margaret Schneider Jamner
Dan Michael Cooper 

There was only moderate agreement (r 5 .62, p, , 001) between 47 sets of minimally-active adolescent females and their parents in perception of the number of exercise items available in the home, and no agreement (r 5 .14, p ..05) about items available in the community. Adolescents’ perceptions of availability of exercise items in the home and community were associated with cardiovascular fitness but not with amount of vigorous physical activity, energy expenditure, or lifestyle activity. Use of home items was associated with both lifestyle activity and vigorous physical activity.

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The relationship between convenient access to destinations and walking was measured among 149 community dwelling elderly women living in Pittsburgh, Pennsylvania. Living within 20 minutes walk of a park, trail, or store was related to higher pedometer readings. The greater the number of locations within walking distance, the greater the number of steps measured by pedometer, total walking by self report, and total activity by self report. Also, the higher the neighborhood ‘‘walkability’’ rating, the greater activity level measured by pedometer and self report.

Ilse De Bourdeaudhuij 
James F. Sallis 
Brian E. Saelens 

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An 81 item questionnaire on neighborhood design and recreational environmental variables and a 7 item questionnaire on physical activity were sent to 1000 randomly selected adults in Ghent, Belgium to measure the relationship between neighborhood design and recreational, environmental, and physical activity. A total of 521 completed questionnaires were returned. Minutes of walking and minutes of moderate intensity activity were related to quality of sidewalks and access to shopping and public transportation. Vigorous activity was related to presence of supplies in the home and number of convenient activity facilities outside the home. The variance in exercise explained by these variables ranged from 5% to 13%.

Billie Giles-Corti 
Sally Macintyre 
Johanna P. Clarkson 
Terro Pikora 
Robert J. Donovan 

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Environmental and Lifestyle Factors Associated With Overweight and Obesity in Perth, Australia 

Personal interviews and neighborhood environmental analyses were conducted with 1803 men and women representing the top and bottom economic quintiles in Perth, Australia, to examine the associations between environmental and lifestyle factors. After controlling for demographic factors, perceptions, and other behaviors, being overweight was associated with living on a highway (OR 4.24) or a street with no sidewalks (OR 5 1.35) and perceiving no paths within walking distance (OR 5 1.42). With the same controls, being obese was associated with poor access to recreational facilities (OR 5 1.68), perceiving no shopping within walking distance (OR 5 1.84), and not having access to a car all the time (OR 5 1.78). Watching television more than 3 hours per day (OR 5 1.92 and 1.85), and rating oneself as less active than others (OR 5 1.66 and 4.05) was associated with both being overweight and obese.)

Interdisciplinary Perspectives 

Conventional transportation planning tends to overlook negative health impacts resulting from increased motor vehicle travel and potential health benefits from shifts to alternative modes. Raising the priority of health objectives supports planning reforms that result in a more balanced transportation system. The author explores how transportation decision-making can better support public health objectives, including reduced crashes and pollution emissions, and more physical activity.

Policy Prescriptions for Healthier Communities 

The author discusses how current policies present barriers to physical activity and increase pollution by encouraging sprawl development and offering few transportation choices, then suggests ways the barriers might be overcome through policy revision.

The author describes the elements of social marketing and illustrates how they can be applied to create active living communities and identity opportunities at the state and national level that will enhance the effectiveness of local efforts.

American Journal of Health Promotion |  248-682-0707