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.
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.
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:
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.
We visited a high school where they were having a girls’ handball tournament after school. Handball is like soccer but using the hands.
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.
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.
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.
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.
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.
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
Download this brief here.
Research Brief, January 2014
James Sallis, et al, Neighborhood Quality of Life Study
Download this brief here.
“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.
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.
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.
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.
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.
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.
I write this as I am wrapping up extended travel during May and early June 2013. It was a wonderful but exhausting series of meetings. I am sharing some observations and photos from my stops.
Salud America! Summit in San Antonio.
First stop was San Antonio where I learned about the goals of the new Salud America!, which are to build a network to fight childhood obesity among Latino youth and use research to guide prevention efforts. I’m pleased to be on the advisory board, and Amelie Ramirez and team organized a great Summit. Two of their communication approaches were particularly impressive. They have hired “curators” to search for research and stories of community change related to Latino childhood obesity. They summarize and distribute the research to their ever-growing network. They communicate the success stories through print, social media, and videos. There was a seemingly endless succession of short videos of community champions describing their inspiring efforts and researchers telling how they are using their findings to guide change.
The speakers at the conference were consistently outstanding. It was particularly encouraging to hear elected officials describe the actions they are taking to support healthy eating and active living among Latinos. I thank Amelie for adopting active applause to make the meeting more active, giving credit to ALR.
I was happy to have a chance to talk with Erualdo Gonzalez, an assistant professor in city planning at Cal State Fullerton. He is on the Program Committee for the Active Living Research 2014 Conference. Here is our photo at a historical museum in San Antonio.
International Society of Behavioral Nutrition and Physical Activity (ISBNPA) in Ghent, Belgium
I was already a fan of Ghent, because of the visits occasioned by my collaborations with Ilse de Bourdeaudhuij and her many talented colleagues. The most eventful part of the visit was prior to the ISBNPA conference, when we had two days of IPEN meetings. The first day was a writing retreat for the IPEN Adult investigators. We had attendees from 10 countries, and everyone made very good progress on papers and proposals. Analyses for several papers have been completed, so long-awaited IPEN Adult manuscripts will be submitted in the next few months.
The second day was a meeting of IPEN Adolescent investigators, and 12 countries were represented, including Zaki Islam and colleagues joining remotely from Bangladesh. It was great to get progress reports from all the countries. The commitment to the project, and to following the protocols, was gratifying. Highlights of the day were the overviews of GIS methods from Marc Adams and accelerometer methods from the team of Rodrigo Reis and Kelli Cain. I am sharing photos of both groups from Jasper Schipperijn’s high-tech camera.
IPEN Adolescent group in Ghent
IPEN Adolescent group being instructed by Rodrigo Reis
More of the IPEN Adolescent group
My favorite event in Ghent was the final PhD defense of Dr. Adewale Oyeyemi. It was a personal thrill to see this talented young investigator complete his doctorate. Ghent University’s PhD examination process is rigorous. The student must respond to written comments of external examiners, oral questions of an internal university committee, and finally the oral defense with the external examiners that was witnessed by a large audience including many IPEN investigators. My connection with Adewale started several years ago when he contacted me about his interest in doing a study of built environments and physical activity for his master’s thesis. This was the first inquiry about this field of study I had received from Africa, so I made sure to be supportive of his ambitions. He was well aware of the damage that chronic diseases are already inflicting on Africans, as a result of economic and technological development, and he realized the potential of environmental improvements to slow this process. For several years we have been corresponding, and I have advised him on his studies. Adewale’s research progress has been thoughtful and systematic. We were able to support his attendance at the 2011 ISBNPA conference in Melbourne where he made his first international presentation. It was there that Ilse de Bourdeaudhuij, Benedicte Deforche, and Delfien van Dyck arranged for Adewale to complete his doctoral studies at Ghent University. Only two years later he completed his degree, appropriately timed to coincide with the 2013 ISBNPA conference. And he really completed his degree in style. His PhD included 8 published or submitted papers, all related to built environment and physical activity in Nigeria. It was a joy to witness this professional triumph, and afterwards more than 50 people celebrated at a dinner. Here is a photo of Adewale and myself with some beautiful Ghent architecture behind us.
Adewale and his examiners
I was pleased that ISBNPA 2013 was in Ghent so many people could get to know this walkable and bikeable city with extravagant architecture, lovely canals, a concentration of historic churches, and an imposing castle right in the center. Many of the attendees got a chance to know better the many impressive physical activity and nutrition behavior researchers based in Belgium. Most conference events were held in a centuries-old former monastery, lending an elegant atmosphere to the paper sessions. The content of the papers was very strong, and many younger investigators had the opportunity to present their excellent studies. IPEN investigators were well represented. It was a treat to have the conference dinner in the Gravensteen castle, and the circus performers made everyone feel like it was the Middle Ages. Congratulations to Greet Cardon for organizing a successful conference, where the biggest problem was having 800+ attendees when the planning was for 500. I was pleased that ISBNPA also adopted active applause, crediting ALR. At the closing session I invited everyone to attend the 2014 ISBNPA Conference in San Diego (May 21-24).
A cultural event outside Gravensteen Castle in Ghent
A sample of international investigators at ISBNPA
Ghent is bikeable and walkable
Look what I saw at the Brussels airport. This is an exercycle you can use to charge your computer and phone. And people were using it!! I love this idea. Later I learned that a member of the Belgian Parliament is behind this company.
Brief visit to Lutry, Switzerland
I had some business meetings for our Santech company in this small town in southwest Switzerland. It is a World Heritage site because of the terraced vineyards in the area. The narrow streets, limited traffic, and sidewalk cafes made for a great quality of life. The highlight for me was the view of Lake LeMans with the snow-capped French Alps on the other side. Spectacular, as you can see from the photos.
Standing desks are not a new invention. This is in my hotel room in Grandvaux, Switzerland
The scenery was spectacular. That is France across the lake.
American College of Sports Medicine (ACSM) in Indianapolis
ACSM is always packed with committee meetings, extra meetings, working dinners, and the usual paper and poster sessions. I congratulate outgoing ACSM President Janet Rankin Walberg on two symposia related to her ActivEarth initiative that highlights the co-benefits of health, environmental protection, and economics. The first symposium was practice- and policy-oriented and featured great work from New York City, Indianapolis, and the League of American Bicyclists. I was a speaker in the second research-oriented symposium that included transportation planner Ralph Buehler, Karen Lee presenting evaluations of active transport interventions in New York City, and David Bassett. The content was outstanding, but unfortunately the attendance was sparse. I thank Janet for inviting me to deliver a Presidential Lecture, in which I touched on the past, present, and future of built environment research. I thank Billie Giles-Corti, Deborah Cohen, and Aaron Hipp for allowing me to present some of their recent work. A video will of the talk will be available in a few weeks, and we will post a link on my website. At the end of the talk, we enjoyed an Instant Recess activity break as a tribute to our treasured but departed colleague Toni Yancey. I was very pleased that an Instant Recess video was played before one of the plenary talks at ACSM.
The final ActivEarth event was a bike and walking tour of the new Cultural Trail network in Indianapolis. This is a beautifully designed bike path (separated from traffic) that was built with private funds. It is a great way to get around the city, and it has already stimulated new residential and commercial investments. I was impressed that a Midwest city transferred traffic lanes to bike paths. This is a model I hope other cities adopt. I enjoyed talking to Ralph Buehler during the ride, and he said it is the best designed bike facility he has seen in North America. A few days later, Neville Owen and I went riding on the trail again, connecting to the Monon Rail-Trail for a safe and relaxing long ride. Way to go, Indy. I posted a few photos from these rides.
Ralph Buehler on the Cultural Trail in Indianapolis. June 2013
Neville Owen and I take a bike ride in Indianapolis and fine a very colorful finish line to the Graffiti Run. June 2013
Institute of Medicine workshop on Achieving Equity in Opportunities for Healthy Eating and Physical Activity in Washington, DC
My last stop on this trip was Washington, DC. I thank Tracy Fox and Adam Zimmerman for arranging four visits with Congressional offices where I distributed and discussed ALR briefs on active transportation, biking, and school programs and policies. Just doing my part to make sure decision makers are informed about how physical activity can help solve several difficult issues faced in our country.
The last event of the IOM Standing Committee on Childhood Obesity Prevention was the June 6-7 workshop on working toward equity in opportunities for healthy behaviors. This topic deserves more study, but critically, more action. I congratulate Program Chair Shiriki Kumanyika, Lynn Parker, and her IOM staff for creating an outstanding meeting that was held in the historic National Academy of Sciences Building on the Mall and webcast. Did you know that Abraham Lincoln started the National Academy of Sciences?
The workshop was organized by the recommendations in the Accelerating Progress in Obesity Prevention report that was published in 2012. In her opening, Shiriki dedicated the workshop to the late Toni Yancey, who was a member of the Standing Committee since its beginning. I was honored to help lead an Instant Recess to carry on Toni’s work.
I moderated the first panel, and in my opinion, it was outstanding. Robert Garcia from The City Project in Los Angeles surprised the crowd by explaining how civil rights law can be applied to improving opportunities for physical activity in communities of color. He then reported his impressive successes in creating new parks, with solid evidence and community engagement being key ingredients in those successes. Then Myron Floyd from North Carolina State University summarized the scientific evidence about the potential for parks to contribute to increased physical activity among disadvantaged communities as well as the challenges to realizing that potential. The workshop had many powerful and informative moments. The videos will be posted on the IOM website, and a summary report will be published.