Environmental Factor, August 2007, National Institute of Environmental Health Sciences
Obesity and Built Environment Progress Reports
By Eddy Ball
The Division of Extramural Research and Training (DERT) hosted a meeting on September 5 and 6 for investigators funded through the Obesity and Built Environments program. The researchers gathered at the Sheraton Imperial Hotel in Research Triangle Park to present progress reports on their grants and share their successes and challenges with their colleagues. The series of presentations was chaired by Mike Humble, Ph.D., health scientist administrator in the DERT Cellular, Organ and Systems Pathobiology Branch.
The group included epidemiologists, public health professionals, behavioral and social scientists, architects and planners engaged in innovative interdisciplinary research into ways to impact the obesity epidemic through understanding and modifying environmental influences. The program is funded by NIEHS in conjunction with three other NIH institutes and centers and two centers within the Centers for Disease Control and Prevention.
The program, which began project funding in September 2005, supports seven four-to-five-year R01 projects to provide insights into treatment mechanisms or to develop models for prevention of obesity and related health problems. It also funds seven two-year R21 grants supporting the development and validation of built-environment measures and methods of data collection.
The grantees are working in cities, suburbs, college and corporate campuses, and rural areas across America to uncover the physical and psychological factors that encourage physical activity and discourage unhealthy eating habits. These factors range from the potential impact of Charlotte's light rail system on physical activity (PA) and body mass index (BMI) of residents to the effects of housing density and distance from homes to consolidated schools in 29 rural communities in New Hampshire and Vermont on adolescent overweight.
Unlike much of the bench science supported by intra- and extramural NIEHS funding, most of the Obesity and Built Environment grantees rely on measuring instruments that investigators have had to develop themselves or adapt from other contexts. Several of the projects have needed to refine city planning and administration data bases, census figures and socioeconomic data, business directories and public works mapping to characterize neighborhoods. In a study of PA, nutrition and environment in the neighboring border cities of El Paso, Texas and Ciudad Juarez, Mexico, investigators field tested a belt-mounted monitoring system that combined Global Positioning System data logging receivers and digital cameras with triaxial accelerometers to supplement seven-day diet diaries kept by study participants.
In a project studying childcare center preschool play areas by researchers in North Carolina State University's College of Design, a landscape architect and his team are relating engineering and aesthetic criteria, such as slope, shade, appearance and ground surface to levels of PA. The Lean and Green in Motown Project in Detroit is assessing a matrix of methods, including spatial indicators, typologies, resident perceptions, BMI and obesity-related biomarkers, for assessing the neighborhood environments and their impact on health.
While the R21 projects are research-enabling efforts to develop and validate measurements, factors and outcomes, the R01 projects typically see their translational component in terms of education, behavioral modification, publications and policy making.
To that end, several projects have formed working alliances with government officials, non-profit organizations and community organizers to impact policy. The University of Massachusetts project, for example, has submitted its obesity and neighborhood characteristics data - what researcher Wenjun Li, Ph.D., has dubbed an "Obesogenic Map" of the state - to Department of Public Health policy makers. Researchers with the University of Illinois at Chicago (see text box) have worked with the Mayor's Office for People with Disabilities and the Chicago Board of Aldermen to improve sidewalk access through public works projects and developed incentives for businesses that are making an effort to improve accessibility.
Built Environment, Obesity and the Disabled in Chicago
With her background in physical therapy, Investigator Jennifer Rowland, Ph.D., fits well with the University of Illinois at Chicago (UIC) Health Empowerment Zone for People with Disabilities Project. Rowland and the project's principal investigator, James Rimmer, Ph.D., are professors in the Department of Disability and Human Development, part of the College of Applied Health Sciences at UIC. The aim of their project is to create a model program for improving access to the built environment, resulting in improved health and the reduction of secondary conditions among people with mobility disabilities.
The two-phase project is developing measurement instruments and using a community-based participatory research model to implement its model. Investigators have developed a multilevel intervention involving partnerships between UIC and the Illinois Americans with Disabilities Act Project, the Chicago-based American Planning Association and the Urban Transportation Planning Center at UIC.
The research team is using pre- and post-intervention telephone surveys of 120 subjects recruited at an Access Chicago Health Fair to evaluate the project's effects on physical activity, obesity and quality of life measures. The mean age of subjects is 55 years, and mean BMI is 36.1. Fifty-five percent are unable to work, and 73 percent use multiple devices for mobility. Physical activity levels are low, and most report secondary health problems that are not directly related to their mobility deficit.
Phase one of the project, the subject of Rowland's presentation, involves creation of a three square-mile Health Empowerment Zone in downtown Chicago, creating a "natural laboratory" for observing the impact of improved access on the physical activity and eating behaviors of residents with mobility limitations. In conjunction with city government, non-profit organizations and business owners, the project is overseeing improvements to walking networks, parks and recreation facilities, mass transit, and grocery stores and retail outlets. Project staff are educating businesses about the accessibility needs of persons with disabilities and recognizing disability-friendly facilities with special stickers they can display at their entrances.
Phase two of the project will introduce a proactive effort to alter behaviors with a "Ticket to Health" Campaign. This campaign will involve the distribution of pre-paid vouchers to a random sample of phase-one participants. The participants will be able to redeem their vouchers for specific products from participating businesses in the Health Empowerment Zone. These health-promoting goods and services may include healthy foods from disability-friendly grocery stores, sessions at community fitness and recreation centers, and travel on mass transit.