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Visiting the Be Activ India team: IPEN Adolescent in Chennai

Visiting the Be Activ India team: IPEN Adolescent in Chennai
July 28 to August 6, 2015

The most recent team to join the IPEN Adolescent study is from Chennai, India. I want to thank Anna Timperio and Jo Salmon from Deakin University for introducing Dr RM Anjana and her group to IPEN during our meeting in San Diego May 2014 prior to the ISBNPA conference. I was extremely happy to receive an invitation to visit Chennai and be a featured speaker at Dr Mohan’s International Diabetes Update 2015. http://emedinews.in/2015/IJCPebook/diabetes/index.html

The visit was illuminating, inspiring, and productive. It was illuminating to learn more about Dr Mohan’s Diabetes Specialty Centre. The Centre has activities that span a wide range from comprehensive diabetes care in 20 clinics, large educational programs, diabetes products like specialized shoes, nutrition and fitness programs, and research. The research is impressive on its own, with a entire building for biomedical research and some studies funded by the NIH, to a huge national diabetes epidemiology study that will enroll 125,000 participants. The epidemiology study is using diet and physical activity surveys that were developed for India and validated. http://www.ijbnpa.org/content/pdf/s12966-015-0196-2.pdf

The conference was striking in its scope and organization. The 2500 attendees were primarily clinicians from throughout India engaged in diabetes care, though there were researchers, advocates, and government leaders attending as well. The faculty represented India and the rest of the world, and the presentations were high quality. I was pleased that the workshop on lifestyle included a good emphasis on prevention, and the Sunday session was packed. It made me happy to see that “mobility breaks” were offered every day during plenary sessions, and some people danced to rock music in the evenings. Dr Anjana implemented “Active Applause”, so I was pleased to play a role in disseminating this innovation to India. Of course, the Indian cuisine was outstanding and full of “new” dishes for me, so this was a great example of a healthy meeting.

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Opening ceremony for Dr. Mohan’s International Diabetes Update, attended by about 2500.

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The Prime Minister’s health advisor is second from the right.

The conference adopted Active Applause.
I had several opportunities to meet with the Be Activ India! team, which is the name of the IPEN-related study. They have made rapid progress in preparing for the study, and they have prioritized their data collection schedule to ensure the Indian data are included in the pooled analyses. It was a pleasure to meet the large team of talented and enthusiastic team members working on the study. They bring a variety of skills and substantial experience, so I am sure the Indian data will be very good quality. They are using a version of the NEWS built environment survey that was mainly developed by Deepti Adlahka, a doctoral student at Washington University in St Louis. Deepti performed a separate reliability and validity study that was presented at ISBNPA 2015 in Edinburgh. Be Active India! also is collecting GPS data and is planning to use MAPS-Global streetscape audits, in addition to blood and anthropometric variables, so they will have a particularly rich data set. I pilot tested MAPS-Global in a couple of sections of Chennai. Though it was challenging due to over-stimulation of the Chennai urban environment, it appears MAPS-Global will do a good job of assessing the strengths and weaknesses of the local environments.

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Most of the Be Activ India! team in Chennai. With me in the front row are Dr Pradeepa, Dr Anjana, and Dr Ranjani.

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More of the Be Activ India! team

On my suggestion, Dr Anjana organized meetings with local government and community representatives who could be partners in disseminating the results of Be Activ India! and may have the chance to put the findings into practice. We met with a city planner, architects, an epidemiologist in the health department, and leaders of a nonprofit dedicated to social justice and health equity. The planners were pleased to learn about the study and thought the health findings could help them generate enthusiasm for more attention in the government to pedestrians and bicyclists. The group pictured below laid the groundwork for ongoing collaboration, with one possible outcome being an open streets/ciclovia event, which is called “happy streets” in some places in India.

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Dr. Anjana organized a meeting with city planners, architects, and an epidemiologist from the health ministry.
I want to share my observations of the physical activity environments in Chennai. Keep in mind that I was present in this city of over 4 million for less than 2 weeks, and I’m sure I saw less than 5% of the city. However, the general situation seemed to be similar in the other two smaller cities I visited as well. My observations confirmed what our colleagues have been trying to describe. At a macro-level, most places in the city were walkable, in that density was high and land use was highly mixed, so people lived within walking distance of destinations like shops and schools. Though the road network was generally well-connected, the arterial streets presented serious barriers to pedestrians. Many arterial streets were clearly designed to keep cars moving, so there were few traffic signals. There could be miles between pedestrian crossings, and I saw very few overhead crossings. This created dangerous situations because it was common to see people dart across traffic and climb over the traffic barriers or squeeze through gaps in a fence. You can see in the photo below that the main streets are clogged with motorized traffic of every description, so there is no room for pedestrians or cyclists.

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Cars, motorbikes, and trucks own the streets.
It is the micro-level where most of the challenges lie. I had heard that no one walked on the sidewalks, but that was hard for me understand. But I quickly saw that sidewalks are used for everything except pedestrians. There were sidewalks almost everywhere I went, but few of them were passable. Why not? Because cars and motorcycles are parked, hawkers are using the whole space, huge utility boxes and larger trees block the way, trash is piled up, seats for bus stops, and on and on. I just included a couple of photos illustrating the situation, and some videos are posted on my Active Living Clips youtube channel.

Because of the sidewalk situation, I saw thousands of people routinely walking in the street. It is clearly dangerous, and it can’t be pleasant. The circumstances seemed even worse for bicyclists. Every day that I read the local English language newspaper, there was at least one report of a bicyclist being killed by a car. Most of the reports described how the bicyclist was at fault, though one had fallen after hitting a pothole. Some colleagues talked about how Indians had grown accustomed to walking on the street, but I did see women walking on the few well-maintained sidewalks that I saw. That suggests people are willing to use good sidewalks.

I expect the MAPS-Global data to document the challenges, and hopefully the data will become a tool for advocacy. It will take a major societal change to make a priority of protecting and attracting people to walk and bicycle on well-designed facilities. I understand India is not a rich country. However, the sidewalks are already there in most cases, so a street-by-street effort to reclaim them can start anytime. Creating safe facilities for bicyclists will likely be even more difficult. But with India’s roads being full already and hospitals being packed with diabetics and heart disease patients, there is ample justification for a shift from cars being the priority to an increased emphasis on pedestrians and bicyclists.

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Deterioration and corruption of sidewalks is a common problem in Chennai

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Another illustration of why people can’t use the sidewalks.

I want to close by expressing my gratitude to Dr Anjana, Dr Mohan, and the Be Activ India team for making possible my first trip to India. I was inspired by learning more about one of the world’s oldest civilizations. I was stimulated by the chaos of the city, the charm of the people, the colorful clothing, and the magnificent art. I can only hope that our IPEN network can contribute it a small way to rethinking the role of physical activity in India and that I see progress in this direction on my next visit.

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I enjoyed sampling the cultural richness of India.

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IPEN at ISBNPA in Edinburgh, Scotland. June 1-6.

June 7, 2015

IPEN at ISBNPA in Edinburgh, Scotland. June 1-6.

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Edinburgh welcomed us with perfect Scottish weather, which means it was cold, windy, and/or raining almost all the time. The Scottish people were much warmer. Edinburgh itself is a pleasure to walk around, in part because the Old Town and New Town provide such different experiences. The week started with two days of IPEN meetings at the University of Edinburgh. Many thanks to Prof Nanette Mutrie for arranging a high-tech meeting room for our meetings.

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One of many charming sections of Old Town in Edinburgh.

 

IPEN Adult Writing Retreat

About a dozen investigators attended the IPEN Adult Writing Retreat on June 1. Several papers have been accepted this year, including Ilse de Bourdeaudhuij’s paper on perceived environment and BMI that was published in IJBNPA this week and received extensive media coverage around Belgium. However, our focus at the retreat was on future papers. Lead authors gave updates on their papers, plans for next steps were made, subgroup meetings were held, and several authors accomplished some writing. We had an extensive discussion about the approach we will take to papers that include both objective and perceived measures of environments. We developed a coherent plan to use the unique IPEN data to answer a variety of questions, and both new and revised paper proposals will be coming in the next few weeks. This was another productive writing retreat, and I thank everyone for their contributions and thoughtful discussion.

 

IPEN Adolescent Investigator Meeting

We had a much larger group for the June 2 IPEN Adolescent meeting. It was amazing to see our investigators from 11 countries who made the commitment to travel from near and far to be at this meeting. It is incredible to think about the diversity of the world represented by our investigators from Australia, Belgium, Brazil, Czech Republic (large team), China/Hong Kong, Denmark, India, New Zealand, Spain, Taiwan, and USA. Technology allowed investigators from the UCSD Coordinating Center, Urban Design for Health, and Portugal to participate. I wish our colleagues in Bangladesh, Israel, Malaysia, and Nigeria could have been with us, but they are making good progress in their studies.

 

Each country gave updates on the status of their studies, and there was a wide range, from just starting data collection to completing it and working on the GIS variable creation. It is now clear that neighborhood selection methods vary considerably. We will describe in the Methods paper the various ways countries are implementing the principle of enhancing variability of environments and SES.

 

Several challenges were identified and discussed. Perhaps the most common issue was the difficulty of obtaining complete parent surveys. However, several countries offered effective strategies, such as having the parents complete the survey at the same time they sign the consent form. I encourage each country to make an additional effort to obtain high completion rates of the parent surveys, because they are the source of the perceived environment (NEWS-Youth) measures that are central to our analyses. In most cases, collection of adolescent survey, accelerometer, and GPS data are going reasonably well. I personally appreciate everyone’s efforts and commitment to following the common protocol as much as possible.

 

Marc Adams, Larry Frank, and Jim Chapman led a useful session on GIS methods. Marc explained the templates and important new approaches for IPEN Adolescent, including use of the Qualtrics online system for completing templates. Larry presented results of final analyses comparing various GIS buffer methods, and a manuscript is in progress. Many thanks to the GIS experts from 4 countries who conducted many additional analyses, and to the UD4H team for conducting analyses. Larry also presented on the “new” regional accessibility variable.

 

Thanks to investigators in 5 countries and analyses by Carrie Geremia, Kelli Cain, and Terry Conway, we had inter-observer reliability data for MAPS-Global conducted in person. The results are very encouraging. We will have further discussion about the papers coming from these data. Investigators from the majority of countries are planning to collect MAPS Global data. We had a discussion of options for mapping the routes and collecting data for the main study. Investigators will have another chance to provide input on final variables for the instrument and the construction of scales.

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The same day as our discussion of MAPS Global assessed by StreetView, I ran across this Google car updating Streetview images in Edinburgh.

 

Carrie Geremia has been working hard to develop a park audit strategy for IPEN Adolescent, and she returned from maternity leave just in time to prepare a presentation for this meeting. She identified overlapping items from the POST and EAPRS instruments and showed the “joint” scale had good validity based on correlations with park use and PA in parks. There was interest in using Kaczynski’s Park Audit Tool, so we will compare the overlapping items with the other two instruments. Billie Giles-Corti sent around papers that described collection of POST data using Google Earth, so we will consider this option.

 

A couple of investigators are measuring school environments. These methods were not discussed but deserve further attention. We will ask for all school environment protocols and share with everyone. We will try to identify a common method and encourage assessment of school environments when possible.

image004One of the pedestrian zones in New Town, Edinburgh.

Ilse de Bourdeaudhuij began the segment on publications by describing the Publication Committee and our procedures for submitting paper proposals, identifying writing groups and authors, and ensuring quality of the papers. These methods have worked well for IPEN Adult, because all submitted papers have been published in high quality journals so far. Assignments for lead authors were noted, and nominations for writing groups were made. Based on the IPEN Adult discussion the previous day, we will have further conversation about using perceived and objective environment measures in the same analyses. Looking forward to publications was a good way to end the IPEN Adolescent investigator meeting.

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Participants at the IPEN Adolescent investigator meeting in Edinburgh. June 2, 2015

 

ISBNPA: International Society of Behavioral Nutrition and Physical Activity

Ester Cerin’s IPEN Adult symposium had the honor of being listed as the first symposium at ISBNPA. A sizeable audience came to hear 4 data-packed papers presented by Ilse (substituting for Delfien van Dyck who is on maternity leave), Ester, Neville Owen, and myself. Stay tuned for the papers coming from these presentations.

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Presenters in Ester’s IPEN Adult symposium at ISBNPA: Jim Sallis, Rodrigo Reis, Ilse de Bourdeaudhuij, Ester Cerin, Neville Owen.

 

The ISBNPA conference had many environment-focused sessions, with many contributions by IPEN investigators. Here are a few of my IPEN-related observations. I was surprised to see a paper on built environment (PANES/E-module), PA (IPAQ), and obesity from Saudi Arabia. This is an encouraging sign from a region that has built activity-UNfriendly environments and is suffering from high rates of obesity and chronic diseases. Deepti Adlahka, from Washington University in St Louis, presented promising reliability and validity results on NEWS-India, which is her dissertation project. I was impressed by the substantial numbers of natural experiments of change in PA environments. The studies came from several countries. Though the findings were not always as expected, in general these quasi-experimental studies advance the quality of evidence about the role of environments in PA.

 

IPEN Meeting 2016?

Based on an informal poll of participants, the next IPEN investigator meetings will likely be at ICPAPH (International Congress of Physical Activity and Public Health) in Bangkok, Thailand in November 2016. The theme of the meeting is “Active People, Active Places, Active Policies,” and I am pleased to be on the scientific committee which is planning a program with several innovative features. Please plan to attend if you can.

 

I want to end with huge thanks to Kelli Cain, Carrie Geremia, Terry Conway, Marc Adams, Larry Frank, and Jim Chapman for preparing presentations and other materials for our fruitful two days of IPEN meetings and team building in Edinburgh.

 

So long, Edinburgh. On to the next meeting.

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A typical scene on the Royal Mile in Old Town, Edinburgh.

 

2015 Publications (so far)

2015 Publications List As of June 2015

James F. Sallis, Ph.D.

 

Peer-Reviewed Papers

Van Dyck, D., Cerin, E., De Bourdeaudhuij, I., Hinckson, E., Reis, R.S., Davey, R., Sarmiento, O.L., Mitáš, J., Troelsen, J., Macfarlane, D., Salvo, D., Aguinaga-Ontoso, I., Owen, N., Cain, K.L., and Sallis, J.F. (2015). International study of objectively measured physical activity and sedentary time with body mass index and obesity: IPEN Adult study. International Journal of Obesity, 39, 199-207.

Gebel, K., Ding, D., Foster, C., Bauman, A.E., and Sallis, J.F. (2015). Improving current practice in reviews of the built environment and physical activity. Sports Medicine, 45(3), 297-302.

Sallis, J.F., Spoon, C., Cavill, N., Engelberg, J., Gebel, K., Lou, D., Parker, M., Thornton, C.M., Wilson, A.L., Cutter, C., and Ding, D. (2015). Co-benefits of designing communities for active living: An exploration of literature. International Journal of Behavioral Nutrition and Physical Activity, 12: 30. DOI 10.1186/s12966-015-0188-2.   Link        Longer report, data tables, slides:    Link

Glanz, K., Sallis, J.F., and Saelens, B.E. (2015). Advances in physical activity and nutrition environment assessment tools and applications: Recommendations. American Journal of Preventive Medicine, 48(5), 615-619.  Link

Molina-Garcia, J., Castillo, I., Queralt, A., and Sallis, J.F. (2015).  Bicycling to university: Evaluation of a bicycle-sharing program in Spain. Health Promotion International, 30(2), 350-358.

De Bourdeaudhuij, I., Van Dyck, D., Salvo, D., Davey, R., Reis, R.S., Schofield, G., Sarmiento, O.L., Mitas, J., Christiansen, L.B., Macfarlane, D., Sugiyama, T., Aguinaga-Ontoso, I., Owen, N., Conway, T.L., Sallis, J.F., and Cerin, E. (2015). International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries. International Journal of Behavioral Nutrition and Physical Activity, 12: 62. Link

 

 

Papers Accepted and In Press

Couch, S.D., Glanz, K., Zhou, C., Sallis, J.F., and Saelens, B.E. (accepted). Home food environment in relation to children’s diet quality and weight status. Journal of the Academy of Nutrition and Dietetics.

Esteban-Cornejo, I., Tejero-Gonzalez, C.A., Martinez-Gomez, D., del-Campo, J., Gonzalez-Galo, A., Padilla-Modelo, C., Sallis, J.F., and Veiga, O. , on behalf of the UP & DOWN Study Group. (in press). Independent and combined influence of the components of physical fitness on academic performance in youth. Journal of Pediatrics.

Esteban-Cornejo, I., Tejero-Gonzalez, C.A., Castro-Pinero, J., Conde-Caveda, J., Cabanas-Sanchez, V., Sallis, J.F., and Veiga, O. (in press). Independent and combined influence of neonatal and current body composition on academic performance in youth: The UP & DOWN Study. Pediatric Obesity. doi: 10.1111/ijpo.239.

Giles-Corti, B., Sallis, J.F., Sugiyama, T., Frank, L.D., Lowe, M., and Owen, N. (in press). Translating active living research into policy and practice: One important pathway to chronic disease prevention. Journal of Public Health Policy. Open access.  Link

Esteban-Cornejo, I., Tejero-Gonzalez, C.M., Sallis, J.F., and Veiga, O.L. (accepted). Physical activity and cognition in adolescents: A systematic review. Journal of Science and Medicine in Sport.

Jakicic, J.M., Sox, H., Blair, S.N., Bensink, M., Johnson, W.G., King, A.C., Lee, I.-M., Nahum-Shani, I., Sallis, J.F., Sallis, R.E., Craft, L., Whitehead, J.R., and Ainsworth, A.E.  (in press). Comparative effectiveness research: a roadmap for physical activity and healthy lifestyles.  Medicine and Science in Sports and Exercise. [Epub ahead of print: November 25, 2014]. PMID: 25426735.

Molina-Garcia, J., Queralt, A., Castillo, I., and Sallis, J.F. (accepted). Changes in physical activity domains during the transition out of high school: Psychosocial and environmental correlates. Journal of Physical Activity and Health.

Carlson, J.A., Saelens, B.E., Kerr, J., Schipperijn, J., Conway, T.L., Frank, L.D., Chapman, J.E., Glanz, K., Cain, K., and Sallis, J.F. (2015). Association between neighborhood walkability and GPS-measured walking, bicycling and vehicle time in adolescents. Health and Place, 32. Published online January 9, 2015.

Lopez Castillo, M.A., Carlson, J.A., Cain, K., Bonilla, E.A., Chuan, E., Elder, J.P., and Sallis, J.F. (accepted). Dance class structure affects youth physical activity and sedentary behavior: A study of seven dance types. Research Quarterly for Exercise and Sport.

Cain, K.L., Gavand, K.A., Conway, T.L., Peck, E., Bracy, N.L., Bonilla, E., Rincon, P., and Sallis, J.F. (in press). Physical activity in youth dance classes. Pediatrics. Online first, posted May 18, 2015. Link

Kneeshaw-Price, S.H., Saelens, B.E., Sallis, J.F., Frank, L.D., Grembowski, D.E., Hannon, P.A., Smith, N.L., and Chan, K.C.G. (in press). Neighborhood crime-related safety and its relation to children’s physical activity. Journal of Urban Health, 2015.  Posted online March 27, 2015.   Link

Kercood, S., Conway, T.L., Saelens, B.E., Frank, L.D., Cain, K.L., and Sallis, J.F. (accepted). Parent rules, barriers, and places for youth physical activity vary by neighborhood walkability and income. Children, Youth, and Environments.

Adams, M.A., Todd, M., Conway, T.L., Cain, K.L., Frank, L.D., and Sallis, J.F. (accepted). Patterns of walkability, transit and recreation environments for physical activity. American Journal of Preventive Medicine.

Sallis, J.F., Cain, K.L., Conway, T.L., Gavand, K., Millstein, R.A., Geremia, C.M., Frank, L.D., Saelens, B.E., Glanz, K., and King, A.C. (accepted). 15-item streetscape audit suitable for use by community groups: MAPS-Mini. Preventing Chronic Disease.

Esteban-Cornejo-I., Martinez-Gomez, D., Tejero-Gonzalez, C.M., Izquierdo-Gomez, R., Carbonell-Baeza, A., Castro-Pinero, J., Sallis, J.F., and Veiga, O.L., on behalf of the UP&DOWN Study Group. (accepted). Maternal physical activity before and during the prenatal period and the offspring’s academic performance in youth. The UP&DOWN study. The Journal of Maternal-Fetal and Neonatal Medicine.

Kurka, J. (accepted). Patterns of neighborhood environment attributes in relation to children’s physical activity. Health & Place.

Esteban-Cornejo, I., Martinez-Gomez, D., Sallis, J.F., Cabanas-Sanchez, V., Fernandez-Santos, J., Castro-Pinero, J., and Veiga, O.L. (accepted). Objectively measured and self-reported leisure-time sedentary behavior and academic performance in youth: The UP&DOWN Study. Preventive Medicine.

 

 

Non-Peer-Reviewed Papers and Commentaries

Sallis, J.F. International innovations in physical activity promotion. A summary of my presentation, published in a Summary Report. Building a Culture of Health: Lessons Learned from Global Efforts: Case Study of Childhood Obesity. Co-sponsored by the Robert Wood Johnson Foundation and National Collaborative on Childhood Obesity Research. February 2015.  Link

Sallis, J.F. (2015). Advancing systems thinking through the Healthy Kids Healthy Communities evaluation. Journal of Public Health Management and Practice, 21(3, suppl), S88-S89. (invited commentary).

Carlson, J.A., and Sallis, J.F. (in press). Environment and policy interventions. In W. Zhu and N. Owen, eds. Sedentary Behavior and Health: Concepts, Assessment, and Intervention. Champaign, IL: Human Kinetics.

Sallis, J.F., and Carlson, J.A. (in press). Physical activity: Numerous benefits and effective interventions. In R.M. Kaplan, M.J. Spittel, D.H. David, eds. Emerging behavioral and social science perspectives on population health. US Government Printing Office: Agency for Healthcare Research and Quality, 2015.