IPEN-related news from ICPAPH 2014

ICPAPH, the International Congress on Physical Activity and Public Health, was held in the beautiful city of Rio de Janeiro. This is an important conference for IPEN, because the attendees came from 70 countries, and IPEN supports the Council on the Environment and Physical Activity (CEPA), an official council of the ISPAH. I want to start by congratulating the organizers on a superb scientific meeting with a very successful social program. Special thanks to Pedro Hallal, Rodrigo Reis, and the program committee for ensuring the scientific quality of the meeting.

We had several CEPA sessions that were well-attended and of high quality. I congratulate Takemi Sugiyama, outgoing chair of CEPA, for organizing three excellent sessions. The CEPA symposium was packed with new data and convincing demonstrations that CEPA is moving the field forward. After my brief overview of IPEN, Jens Troelsen presented new IPEN Adult data from Denmark, and Erica Hinckson presented IPEN Adolescent data from New Zealand. Leaders of working groups presented very encouraging progress on almost all of them, and I believe attendees realized they could get involved in substantive international collaborations through CEPA. Billie Giles-Corti presented 10 specific strategies for conducting policy-relevant environment research, which are detailed in a paper developed by the Policy Working Group that is currently under review. This will be a useful guide for IPEN investigators and the broader field. Akira Hino presented strong ongoing collaborations among Latin American investigators. Jasper Schipperijn and Hayley Christian reported on review papers and other projects that have resulted from the Urban Green Spaces Working Group. Jelle Van Cauwenberg presented a review on environments and older adults’ physical activity, which has been published in IJBNPA. Adewale Oyeyemi described how the Africa Working Group is making excellent progress developing a version of the NEWS instrument for Africa. (NEWS-Africa was the subject of an earlier blog).

The CEPA symposium was a good introduction to the CEPA meetings over the next two days. In the first meeting, it was agreed that Rodrigo Reis will be the new CEPA Chair, and the new leaders are listed below. All existing groups will continue working, and there were suggestions for a new working group on social issues (such as safety and culture). One particular advancement was that the Early Career Working Group will be expanded to become a function of the entire ISPAH. This working group was seen as a good model to fill an important need, so new ISPAH President Fiona Bull volunteered to work with CEPA to accomplish this expansion. The first meeting ended with discussions among working groups as they made realistic actions plans to be accomplished over the next two years. The IPEN Coordinating Center will continue to support the working groups.

CEPA Leadership 2014-2016

Chair: Rodrigo Reis

Co-chairs: Jacqueline Kerr, Erica Hinckson

Working group coordinator: Deborah Salvo

Communications officer: Akira Hino

The second CEPA meeting was devoted to the Early Career Working Group. The lunchtime meeting was heavily attended and was designed for senior investigators to respond to the stated needs and questions of early career researchers. Both large-group discussion and small-group consultations were held. Many thanks to Neville Owen, Billie Giles-Corti, Jo Salmon, and Ulf Ekelund who offered their guidance. My assessment is that CEPA is performing useful functions for the environment and physical activity field, so we will start planning for CEPA activities in Bangkok, Thailand in 2016.

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CEPA meeting with Early Career Researchers, with Neville Owen providing guidance.

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CEPA meeting with Early Career Researchers, with Billie Giles-Corti mentoring in a small group session.

There were two notable advances for IPEN that came to my attention at the Rio meeting. First, I learned that an IPEN Adult study is being conducted in Chile, led by Jaime Leppe Zamora. The funds are already available, and the Latin American survey will be adopted. This was wonderful news, and this new study was largely due to support from the Latin American IPEN investigators. Second, I met Shifalika Goenka, who is a physician in India with a well developed interest in built environments and physical activity. She has written a book under the auspices of the regional WHO office that advocates for healthy environments and policies. She is very interested in pursuing an IPEN Adolescent study in India that can be included in the pooled dataset. We will work with her to identify funding for such a project. I made several other friends in Rio, but these two encounters were particularly meaningful for IPEN.

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Shafilika Goenka and Jim discuss an IPEN Adolescent study in India

There were many other highlights of the meeting, and some of them are partially captured in the photos. There were abundant standing tables at the back of many meeting rooms, and they were well used. The conference banquet transformed into a samba parade and then into a disco that gave attendees a welcome opportunity to be active. Victor and Sandra Matsudo organized an Agita Mundo parade to the beach, and hundreds of participants in yellow jerseys spelled out “Agita”. After an intensive and stimulating scientific conference, I was able to spend a day touring some spectacular beaches and Sugarloaf Mountain. It was great that so many physical activity experts from around the world were able to visit Latin America for the first time. ICPAPH in Rio was a big boost for IPEN as well as international physical activity research in general.

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Brazilians were early adopters of the standing tables in most meeting rooms.

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Lise Gauvin celebrates the Agita Mundo parade.

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Jim, Adewale Oyeyemi, and Mike Pratt during the Agita Mundo parade to the beach

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The samba parade at banquet gave ICPAPH attendees a chance to apply what we learned from physical activity research

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Jelle van Cauwenberg, Neville Owen, Adewale Oyeyemi, and Jim enjoy the view of Copacabana Beach from atop Sugarloaf Mountain.

Taipei Delegation Visits ALR and IPEN Coordinating Center

A delegation of 7 colleagues from Taipei, Taiwan visited San Diego March 9-13. They were led by Jin Jong Chen from National Yang-Ming University and Kevin Chen from the Taipei Department of Health. The whole group attended the Active Living Research Conference and presented on their research and practice work. The Taipei group spent the morning of March 13 at the IPEN Coordinating Center offices, with another special guest, Ester Cerin of Deakin University in Melbourne, Australia. The meeting was attended by Kelli Cain, Carrie Geremia, Alex Mignano, and myself. Larry Frank joined by phone from Vancouver.

We learned that Taipei will be the World Design Capital (WDC) in 2016. Their winning application had the themes of ageing-friendly and healthy design for the city. WDC represents a collaboration of multiple city departments, including Health, Planning, and Parks, so there is clear relevance for active living. The Department of Health is sponsoring an IPEN study of older adults, and we discussed the progress of this study and possible next steps. The IPEN Senior protocol is being followed, using the NEWS and street audit tool adapted for Chinese Seniors by Ester Cerin as part of her studies in Hong Kong. This group may have the opportunity to evaluate the impact of intervention demonstration areas, and we discussed possible evaluation designs.

Two of the delegation were experts in computer science and information technology. Thus, they are able to design multi-level interventions that span the range from environmental changes to educational apps. On the afternoon of the March 13, the delegation met with Kevin Patrick, Jacqueline Kerr, and Nadir Weibel to discuss the integration of technology into several types of health interventions.

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We appreciate that both Drs Chen are using IPEN as an important element of plans for designing a healthy city that can be a model for the world. Taipei is already a mostly activity-friendly city, so it will fascinating to learn about the enhancements they will make. I commend the Taipei group on the close collaboration between University-based researchers in several disciplines and the Department of Health. The use of research in this design effort is innovative, and we will keep IPEN members informed about this project.

Malaysia Tour for IPEN

An invitation to speak at the International Conference on Obesity (ICO)  in Kuala Lumpur led to a whirlwind tour of 3 cities, a talk at the National Sports Institute, and several meetings with IPEN investigators. It was my first visit to Malaysia, and I learned how the rich mix of cultures makes for a vibrant experience. I was particularly impressed at how happy and friendly the Malaysian people are. However, my visit occurred a few days after the disappearance of Malaysian Air flight 370, so the unknown fate of the people on board was constantly in the news and on the minds of everyone.

ICO was at the beautiful convention center in the heart of Kuala Lumpur. A well-used park separated the convention center from Petronas Towers, dramatic buildings that once were the tallest in the world. The park had one of the largest playgrounds I have ever seen. Here is a small sample of the playground:

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At the ICO, I spoke in a session on the “exposome”. I asked who knew what an exposome was and only one hand went up. I told them it was still OK to refer to “environments.” I was encouraged that the session was full, with some people standing at the back. My talk focused on the expanding literature on evaluations of environment and policy interventions. A few people tweeted about my talk and others in the session. I want to congratulate Steve Blair who received the Population Health award at the conference.

Wan Manan is leading IPEN-related studies of adults and adolescents in Malaysia. The studies are being conducted in different cities, and he has assembled an excellent team. Marc Adams, now of Arizona State University, made the trip to provide instruction and guidance on creating GIS variables. The first meeting with IPEN investigators was held at the University of Malaya, at the Faculty of Built Environment. This was a new concept to me, but it made sense to pull the disciplines together with expertise in the built environment. After the meeting we toured potential study neighborhoods, a park, and a school. Here is the IPEN group in front of the Faculty building.

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We visited a high school where they were having a girls’ handball tournament after school. Handball is like soccer but using the hands.

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Marc and I then flew to Penang to tour some more potential IPEN study neighborhoods. We had two able and enthusiastic tour guides, Yi Yi Lee and Shuwen, who both work on IPEN studies. They have degrees in nutrition so we had a great food tour as well. Here we are getting an overview of Penang.

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After a hike through the rain forest we toured the old part of the city, which was designed to be walkable but had too much traffic. A recent signature of Penang is an explosion of mixed-media murals. The murals appear to be attracting many tourists, suggesting this is a promising approach to art for economic development that also encourages walking and biking. Several of the murals have physical activity themes, including this one.

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It looked to me like Malaysia has embraced automobile dependence, and pedestrian and bicycle infrastructure was not a priority. Here is an example of the downside of lack of attention to pedestrians. Here are Marc and Yi Yi risking their lives to cross a busy road with no intersection controls to get to a major tourist destination.

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Finally, we traveled to Kota Bharu, where Wan Manan is based. We met at the Universiti Sains Malaysia, School of Health Sciences. The main topic again was GIS variables and neighborhood selection. It seems like each city has different GIS variables available, which is a common challenge for this type of work. But the team in Malaysia is well prepared to conduct two excellent studies. It was a treat to work with them. Here is the group meeting in Kota Bharu.

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An unexpected opportunity arose to speak to the National Sports Institute in Kuala Lumpur. They recently started an Active Living program, and the Ministry of Health is looking to the Institute to provide guidance on physical activity interventions. Thus, I had a receptive audience for my talk on the need for collaborating with multiple sectors to design, implement, and evaluate multi-level interventions. We had a deep discussion with a small group afterwards about using research to inform policy change. I was pleased to learn they are evaluating a national campaign to increase physical activity and are studying the energy expenditure of traditional Malaysian games. Here is a photo of Yeo Wee Kian and Zack Ghazali who work at the Institute.

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The hospitality at every stop on this trip was outstanding and humbling. I especially want to thank the organizers of ICO, Wan Manan, and Yi Yi Lee for making all the arrangements and ensuring my trip was enjoyable and stress free. It was a great introduction to a wonderful country, and I hope I have the chance to return.

Low Income Neighborhoods Provide Less Supportive Environments for Physical Activity – Research Brief

 

Research Brief, January 2014

 

James Sallis, et al, Neighborhood Quality of Life Study

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Download this brief here.

Improving Bicycling Safety Could Encourage More Bicycling – Research Brief

Research Brief, January 2014

James Sallis, et al, Neighborhood Quality of Life Study

Bicycling_Brief_thumbnailDownload this brief here.

Just 1 in 4 U.S. Teens Gets Enough Exercise

“For his part, Sallis said, ‘I would ask parents to resolve to make sure their children get physical activity every day, and they can’t count on schools to provide all the activity teens need.'” Read more here.

NEWS for Africa

Non-communicable diseases (NCDs) already kill the majority of Africans, though almost all the public health focus is on the continuing burden of communicable diseases. Documenting the role of built environments in physical activity, sedentary behaviors, and NCDs can provide an empirical foundation for environmental improvements contributing to NCD prevention. Research on built environments and physical activity has expanded rapidly throughout the world, except the continent of Africa. Our colleague Adewale Oyeyemi conducted the first built environment and physical activity studies in Nigeria and documented the relevance of this research field for Africa. Adewale adapted the Neighborhood Environment Walkability Scale (NEWS) for the Nigerian context and found several associations with physical activity that were consistent with results from higher income countries (Oyeyemi, 2013). For more than two years I have been trying to organize an initiative to develop an Africa-wide version of the NEWS. Vickie Lambert, from the University of Cape Town in South Africa and Director of the African Physical Activity Network (AFPAN), identified investigators from several countries who were interested in this research field. We have been working on the mechanism to provide a modest amount of funding to support the development of NEWS-Africa and reliability/validity studies. This effort was accelerated when Mark Tremblay from the University of Ottawa in Canada inquired about the applicability of the NEWS for a multi-country study of youth physical activity his group was planning in Africa. I informed him of our plan to create a NEWS version for Africa. We agreed to collaborate on the development of NEWS-Africa that could be used in his study, funded by Canada’s International Development Research Centre, Adewale’s NIH-supported IPEN Adolescent Study, and hopefully other studies on the continent. Vincent Onywera, a long-time collaborator with Mark, agreed to host a workshop at Kenyatta University in Nairobi, Kenya. Adewale led the development of the agenda, and I assisted.

NEWS-Africa workshop group in Nairobi, Kenya. August 19, 2013

NEWS-Africa workshop group in Nairobi, Kenya. August 19, 2013

The NEWS-Africa Training Workshop was held August 19-21, 2013 in Nairobi. Fourteen people attended representing Ghana, Kenya, Nigeria, South Africa, Uganda, as well as Canada and the US. An investigator from Cameroon was unable to attend but may participate in the project. On Day 1, the main activity was to discuss how NEWS-Nigeria could be adapted to be relevant throughout Africa. The goal was to reflect urban and rural environments, be applicable across the lifespan, and retain some comparability to the original NEWS and especially to NEWS-Abbreviated (Cerin, 2009). We went through all the sections of the survey discussing the relevance of each item for Africa, modifications of current items, and additional items needed to reflect African environments and cultures. Several items were added to characterize rural environments. This productive day resulted in many adaptations to make this a truly African instrument.

The main goal of Day 2 was to test our ideas in the real world by visiting neighborhoods and talking with experts and residents. Vincent recruited some true experts in urban planning, transportation planning, and public health advocacy. Each provided useful background from their professional perspectives and offered input into components of the NEWS. Our interviews with community residents was particularly dramatic because they took place in Kibera, which is the world’s largest slum. It is a huge and bustling, though poor and dangerous, community. The inadequate infrastructure was apparent from the lack of plumbing, limited play spaces, piled up garbage, and walking paths that also served as drainage ditches.

Conferring a community resident in the Kibera slum in Nairobi

Conferring a community resident in the Kibera slum in Nairobi

Adewale Oyeyemi and others meeting children in Kibera slum.

Adewale Oyeyemi and others meeting children in Kibera slum.

A streetscape view in Kibera.

A streetscape view in Kibera.

Despite these challenges, the community has many strengths. We spoke with two women in a women’s empowerment group. They informed us of the positives, such as proximity to shops to take care of most daily needs, sense of community, and nearby schools. Negatives included ever-present security concerns, high cost of goods within Kibera, many women spending virtually all their time in their houses, and need to walk long distances for groceries. One woman estimated she walked 2 hours per day, and Kibera is clearly a walkable area. We talked to an articulate 10-year-old boy who told us about his daily life. He spends most of his non-school time at the library, studying at home, watching TV at home, or playing video games at an arcade. Thus, his physical activity seemed limited. Open fields were available at the edges of Kibera, and we saw plenty of young people playing soccer there. A special moment for me occurred during a short meeting with the women’s group. The Director, Anjanga, explained to them our interest in physical activity. They immediately rose up, sang a song, and inspired us all to dance. In the evening we went to dinner, a very high energy demonstration of African dancing, and more dancing to the live band.

Vincent Onywere and others interviewing a boy about opportunities for play in Kibera.

Vincent Onywera and others interviewing a boy about opportunities for play in Kibera.

We started Day 3 by reflecting on the experiences from the day before. There was strong consensus that the interviews and observations confirmed that we were on the right path with the modifications of the NEWS discussed on Day 1. Issues such as connectivity and pedestrian infrastructure did seem relevant in the African context, though somewhat differently than in North America. We were able to contrast the total neglect of sidewalks in Kibera with a brand-new installation of well-designed sidewalks, bike paths, and crosswalks in an upscale neighborhood. We learned that the World Bank and other donors were requiring pedestrian and bicycle facilities on roads they built. We considered this a positive development, because the facilities provided a good model of how to improve quality and safety of the pedestrian experience in Nairobi. We ended the workshop by discussing the protocols for completing the draft of NEWS-Africa, refining it, and completing reliability and validity studies. Investigators in each country will interview experts to obtain their feedback on the draft survey and local residents to determine if further additions or clarifications are needed. Then each country will conduct  a test-retest reliability and validity study. The goal is to complete multiple studies with youth, adults, and older adults. Participants will be recruited from high/low income, high/low walkability, and rural settings. Main analyses will be conducted with pooled data from all countries, hopefully with age-specific analyses for youth, adults, and older adults.

A new highway in Nairobi, required by the funders to include facilities for bicycling and walking.

A new highway in Nairobi, required by the funders to include facilities for bicycling and walking.

A more typical situation for pedestrians in Nairobi.

A more typical situation for pedestrians in Nairobi.

The NEWS-Africa workshop was a delightful experience in the pleasant Kenyatta University Conference Center, with stimulating discussions and most importantly, new relationships with colleagues throughout Africa. The workshop created a unified sense of mission in the group. My hope is that the development and evaluation of NEWS-Africa is the first step on a productive road. Next steps will be more studies on built environments, physical activity, and health outcomes throughout Africa and use of those data to inform policy and practice in multiple sectors of government and society. We met some valuable partners in Kenya, and investigators will be identifying similar experts in their countries. Everyone left the workshop satisfied with the work we have done. I am pleased that IPEN played an important role in this initiative. This workshop helps fulfill IPEN’s goal of building capacity for environment and physical activity research worldwide. NEWS-Africa has now been conceived, and we are looking forward to the birth of a new instrument in 2014 that is tailored for Africa and contributes to preventing further growth of the NCD epidemic.

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