Sprawl and Health

Staunton 2003 - “Promoting Safe Walking and Biking to School: The Marin County Success Story”

Saunton, Catherine E.; Hubsmith, Deb; Kallins, Wendi.
“Promoting Safe Walking and Biking to School: The Marin County Success Story”
American Journal of Public Health
September 2003; v.93, n.9.; pp. 1431-1434
On the Web
Relevance: low

In 1999 Marin County residents started a program to increase the number of local children walking to school.  Over two school years participating public reported that trips by walking increased by 64%, biking by 114%, and carpooling by 91%.  Trips in which a private vehicle carried only one student decreased by 39%.

Retting 2003 - “A Review of Evidence-Based Traffic Engineering Measures Designed to Reduce Pedestrian-Motor Vehicle Crashes”

Retting, Richard A.; Ferguson, Susan A.; McCartt, Ann T.
“A Review of Evidence-Based Traffic Engineering Measures Designed to Reduce Pedestrian-Motor Vehicle Crashes”
American Journal of Public Health
September 2003; v.93, n.9.; pp. 1456-1463.
On the Web
Relevance: low

The authors reviewed studies on engineering measures used to reduce the risk of pedestrian injuries.  These measures were classified into speed control, separation of pedestrians from vehicles (in time and space), and increased visibility of pedestrians. Highly effective measures include:

• single-lane roundabouts,
• sidewalks,
• exclusive pedestrian signal phasing that stops all traffic while pedestrians cross all ways,
• pedestrian refuge islands, and,
• increased intensity of roadway lighting

Rivara 1989 - “Analysis of Fatal Pedestrian Injuries in King County, WA and Prospects for Prevention”

Rivara FP, Reay DT, Bergman AB.
“Analysis of Fatal Pedestrian Injuries in King County, WA and Prospects for Prevention”
Public Health Reports
May-June 1989; v.104, n.3; pp.293-297.
On the Web
Relevance: medium

The authors analyzed pedestrian fatalities for 12 months in King County, WA.  They found that victims were generally children (29%), the elderly (34%), or intoxicated adults (24%).

Lucy 2003 - “Mortality Risk Associated With Leaving Home: Recognizing the Relevance of the Built Environment”

Lucy, William H.
“Mortality Risk Associated With Leaving Home: Recognizing the Relevance of the Built Environment”
American Journal of Public Health
September 2003; v.93,n.9; pp.1564-1569
On the Web
Relevance: high

In looking traffic fatalities and homicides by stranger in 15 metropolitan areas, Lucy concluded that traffic fatalities pose a real danger to living in low density areas that should be balanced against the expected lower crime risk.  In short, he found that exurban areas were often more dangerous than central cities or inner suburbs, primarily due to the higher risk of traffic fatalities.  Low-density, outer counties had the most traffic fatalities and homicides by stranger while some inner suburban counties were the least dangerous areas overall.

Jacobsen 2003 - “Safety in Numbers: More Walkers and Bicyclists, Safer Walking and Bicycling”

Jacobsen, Peter Lyndon
“Safety in Numbers: More Walkers and Bicyclists, Safer Walking and Bicycling”
Injury Prevention
September 2003; v.9,n.1; pp.205-209.
One the Web
Relevance: high

Jacobsen analyzed various datasets from Europe and California to compare accident rates per capita across differing rates of walking/biking.  He found that as the rates of walking/biking increase, the total number of accidents increases as expected, but the likelihood that an individual pedestrian or cyclist will be hit by a car decreases.

Harruff 1998 - “Analysis of Circumstances and Injuries in 217 Pedestrian Traffic Fatalities”

Harruff RC, Avery A, Alter-Pandya AS.
“Analysis of Circumstances and Injuries in 217 Pedestrian Traffic Fatalities”
Accident Analysis and Prevention
January 1998; v.30,n.1; pp.11-20
On the Web
Relevance: high

Harruff et al analyzed 217 pedestrian fatalities in King County, WA to describe the most common situations and characteristics of pedestrian fatalities.  The average annual pedestrian fatality rate for all pedestrians overstates the risk for responsible, able-bodied adults but understates the risk for vulnerable groups such as the elderly.  Alcohol consumption, disregard of traffic rules, and being male also increase the fatality risk. 

Schilling 2005 - “The Public Health Roots of Zoning: In Search of Active Living’s Legal Genealogy”

Schilling, Joseph;  Linton , Leslie S.
“The Public Health Roots of Zoning: In Search of Active Living’s Legal Genealogy”
American Journal of Preventive Medicine
February 2005; v.28, n.2, Supplement 2; pp.96-104.
On the Web
Relevance: low

Schilling and Linton give a good overview of zoning, its origin in public health, and how to adapt zoning to today's public health problems.

Gordon 1999 - “Are Compact Cities a Desirable Planning Goal?”

Gordon, Peter; Richardson Harry W.
“Are Compact Cities a Desirable Planning Goal?”
Journal of the American Planning Association.
Winter 1997: v.63, n.1; pp.95-105.
On the Web
Relevance: low

Gordon and Richardson dispute the need for promoting compact development (see Ewing (1997) for a rebuttal).  They claim that standard suburban development:

• does not encroach on prime agricultural land,
• is preferred by consumers,
• is not less efficient for travel than compact development,
• does not consume more energy (and energy is not scarce),
• does not increase congestion (an may, in fact, reduce it), and
• does not increase infrastructure and public service costs.

Ewing 1997 - “Is Los Angeles-Style Sprawl Desirable?”

Ewing, Reid
“Is Los Angeles-Style Sprawl Desirable?”
Journal of American Planning Association.
Winter 1997; v.63, n.1; pp.107-126.
On the Web
Relevance: medium

In a literature review Ewing discusses the characteristics, causes, and costs of sprawl, refuting pro-sprawl arguments by Gordon and Richardson.  Causes include land market failure and housing and transportation subsidies.  Costs include longer commutes, energy consumption, air pollution, and loss of open space, among other things.  This article is a good introduction to the subject.

Saelens 2003 - “Neighborhood-Based Differences in Physical Activity: An Environment Scale Evaluation”

Saelens, Brian E.; Sallis, James F.; Black, Jennifer B.; Chen, Diana.
“Neighborhood-Based Differences in Physical Activity: An Environment Scale Evaluation”
American Journal of Public Health
September 2003; v.93, n.9.
On the Web
Relevance: high

Saelens et al conducted a small preliminary study using accelerometers and surveys to analyze how activity levels and body mass indexes differ between two neighborhoods: one with high-walkability, one with low-walkability.  They found that residents of high-walkability neighborhoods walked more for errands, engaged in more moderate to vigorous physical activity, and were less likely to be overweight.  Interestingly, this study suggests that walkability primarily affects walking for errands but not walking for exercise.

Powell 2003 - "Places to Walk: Convenience and Regular Physical Activity"

Powell, Kenneth E.; Martin, Linda M. ; Chowdhury, Pranesh P.
“Places to Walk: Convenience and Regular Physical Activity.”
American Journal of Public Health.
September 2003; v.93, n.9; pp. 1519-1521.
On the Web
Relevance: low

By a telephone survey study participants were asked to name safe and convenient places to walk.  Most participants could name at least one place and those who could name more places were more likely to be physically active.

Giles-Corti 2003 - “Relative Influences of Individual, Social Environmental, and Physical Environmental Correlates of Walking”

Giles-Corti, Billie and Donovan, Robert J.
“Relative Influences of Individual, Social Environmental, and Physical Environmental Correlates of Walking.”
American Journal of Public Health.
September 2003; v.93, n.9; pp. 1583-1589.
On the Web
Relevance: high

Using a survey of healthy residents of Perth, Australia and an objective measure of access to places to walk, Giles-Corti and Donovan found that living on a quiet street with sidewalks, trees, and shops increased the likelihood that survey participants walked  the recommended daily amount.

Craig 2002 - “Exploring the Effect of the Environment on Physical Activity: A Study Examining Walking to Work”

Craig CS, Brownson RC, Cragg SE, Dunn AL.
“Exploring the Effect of the Environment on Physical Activity: A Study Examining Walking to Work.”
American Journal of Preventive Medicine.
August 2002; v.23,n.2S2,s.1; pp36-43.
On the Web
Relevance: medium

Craig et al combined Canadian census data (demographics and journey to work) with neighborhood observations of walkability (density, diversity, design, safety) to find that environmental factors do influence walking to work.  Urbanization had the largest effect but variety of destinations, ease of walking, and social dynamics also played a role.

Cervero 2003 - "Walking, Bicycling, and Urban Landscapes: Evidence from the San Francisco Bay Area

Cervero R and Duncan M.
“Walking, Bicycling, and Urban Landscapes: Evidence from the San Francisco Bay Area.”
American Journal of Public Health.
September 2003; v.93, n.9; pp1478-1483.
On the Web
Relevance: high

Cervero and Duncan used the 2000 Bay Area Transportation Survey, GIS, and meteorological data to determine the factors that influenced whether participants made short (<5 miles) trips by walking or biking.  The built environment (street design, mixed-use) had less influence than factors such as trip length, steep slopes, rain, nightfall, and demographics.

Brownson 2001 - "Environmental and Policy Determinants of Physical Activity in the United States

Brownson RC, Baker EA, Housemann RA, Brennan LK, Bacak SJ.
"Environmental and Policy Determinants of Physical Activity in the United States."
American Journal of Public Health
December 2001; v.91,n12; pp1995-2003.
On the Web
relevance: low

Using a telephone survey based on the BRFSS, Brownson et al asked participants about  the environmental characteristics (parks, sidewalks, traffic, gyms) near their homes that may influence their physical activity.  Participants who met the daily physical activity requirements generally lived near sidewalks, enjoyable scenery, heavy traffic, and hills, and they had access to places to exercise.

Burchell 2003 - "Conventional Development Versus Managed Growth: The Costs of Sprawl"

Burchell RW and Mukherji S.
“Conventional Development Versus Managed Growth: The Costs of Sprawl.”  American Journal of Public Health.
December 2003; v.91, n.9; pp1534-1540.1
On the Web
relevance: medium

Using a mathematical model to compare the effects of sprawl versus compact development, the authors find that sprawl requires converting more undeveloped land and building more roads and water/sewer infrastructure.  Sprawl also leads to higher pubic service costs and housing costs.

Wang 2002 - "Economic burden of cardiovascular disease associated with excess body weight in U.S. adults"

Wang G, Zheng ZJ, Heath G, Macera C, Pratt M, Buchner D.
"Economic burden of cardiovascular disease associated with excess body weight in U.S. adults."
Am J Prev Med. 2002 Jul;23(1):1-6.
On the web
Relevance: medium

For normal weight, overweight, and obese people, cardiovascular disease prevalence was 20%, 28%, and 39%, respectively.

There were 12.95 million CVD cases among overweight people, more than 25% of which was associated with overweight. There were 9.3 million CVD cases among obese people, of which more than 45% was associated with obesity.

This extra disease burden led to $22.17 billion in direct medical costs in 1996 ($31 billion in 2001 dollars, 17% of the total direct medical cost of treating CVD).

Olshansky 2005 - "A Potential Decline in Life Expectancy in the United States in the 21st Century"

S. Jay Olshansky, Douglas J. Passaro et al.
"A Potential Decline in Life Expectancy in the United States in the 21st Century"
New England Journal of Medicine
March 17, 2005; 352;11; pp1138-1145
On the web
relevance:  medium

Assuming that current rates of death associated with obesity remain constant in this century, the overall negative effect of obesity on life expectancy in the United States is a reduction in life expectancy of one-third to three-fourths of a year--a reduction that is larger than the negative effects of all accidental deaths combined.

Sturm 2002 - "The Effects of Obesity, Smoking, And Drinking on Medical Problems and Costs"

Roland Sturm
"The Effects of Obesity, Smoking, And Drinking on Medical Problems and Costs"
Health Affairs
March/April 2002, pp245-253
On the web
relevance: medium<

Based on data from Healthcare for Communities, a national household phone survey conducted in 1997-1998, obesity has the same effect on chronic health conditions as does twenty years' aging -- a much larger effect than either smoking or problem drinking.  Obesity is associated with a 36 percent increase in inpatient and outpatient spending, and a 77 percent increase in medications.

Flegal 2005 - "Excess Deaths Associated with Underweight, Overweight, and Obesity"

Katherine M. Flegal, Barry I. Graubard, David F. Williamson, Mitchell H. Gail
"Excess Deaths Associated with Underweight, Overweight, and Obesity"
Journal of the American Medical Association
April 20, 2005; Vol 293, No. 15; pp1861-1867;
On the web
relevance: medium

The authors used data from the National Health and Nutrition Examination Survey (NHANES), with followups, to estimate the relative risks of mortality associated with different levels of BMI (body mass index).

Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to normal weight.  Overweight, however, was assocated with lower risk of death than was normal weight.

Peeters 2003 - "Obesity in Adulthood and Its Consequences for Life Expectancy"

Anna Peeters, Jan J. Varendregt, et al.
"Obesity in Adulthood and Its Consequences for Life Expectancy"
Annals of Internal Medicine
Jan 7 2003; 138,1; Health Module
relevance: medium

Using data from the Framingham Heart Study -- a longitudinal study that tracked more than 5,000 people over 40 years -- the study found that overweight and obesity were associated with large decresase in life expectancy.

Frank 2004 - "Obesity Relationships with Community Design, Physical Activity, and Time Spent in Cars"

Lawrence D. Frank, Martin A. Anderson, Thomas L. Schmid
"Obesity Relationships with Community Design, Physical Activity, and Time Spent in Cars"
American Journal of Preventative Medicine
2004; 27(2), pp87-96

Based on a survey of 10,878 Atlanta residents taken in 2000-2002, Frank and colleagues investigated the relationships among body mass index (BMI), time spent in cars, distance walked, and built environment measures (including residential density, street connectivity, and land use mix) within a 1-km walk or drive of respondents' homes.

Adjusting for demographics, each quartile increase in land use mix was associated with a 12.2 percent reduction in the odds of being obese.  More time spent in cars increased the risk of obesity:  an additional 60 minutes per day in the car translated into an additonal 6 percent odds of being obese.  Each kilometer walked translated into a 4.8 percent reduction in the odds of being obese.

However, connectivity and residential density were not significantly related to obesity; though they were closely correlated with land use mix.

Sturm 2004 - "Suburban sprawl and physical and mental health"

R. Sturm, D.A. Cohen
“Suburban sprawl and physical and mental health”
Public Health
2004; 118; pp488-496
Relevance: high

Sturm and Cohen analyzed Healthcare for Communities phone survey data from 1998 and 2000/2001 that assessed 16 chronic physical health conditions or symptom clusters (e.g., asthma, diabetes, hypertension, arthritis, etc.) and health-related quality of life, as well as depression and anxiety.

They correlated these findings with Reid Ewing/Smart Growth America's ranking of sprawl in major US metropolitan areas.  This ranking considered residential density, land use mix, degree of centering, and street accessibility. 

The result:  an increase in sprawl from one standard deviation less to one standard deviation more than average led to 96 more chronic medical problems per 1000 residents, which is approximately similar to an aging of the population of 4 years.  No correlation was found between sprawl and mental health.

Frank 2000 - "Linking land use with household vehicle emissions in the central Puget Sound"

Frank, Lawrence, Brian Stone Jr., and William Bachman. 2000.
"Linking Land Use with Household Vehicle Emissions in the Central Puget Sound: Methodological Framework and Findings."
2000, Transportation Research Part D 5, 3: 173-96.
On the web
Relevance: high

Frank and colleagues used data from the Puget Sound Transportation Panel (a survey of 1,700 households taken every 2 years) to estimate the total amount of vehicle pollution (carbon monoxide, nitrogen oxides, and volatile organic compounds) generated by households in different kinds of neighborhoods.

They concluded that households in higher-density neighborhoods, with more interconnected street grids, and with greater mixes of land use, produced lower total emissions than households in more sprawling neighborhoods.  Also, as might be expected, long-distance commutes increased total household vehicle emissions.  Perhaps more surprisingly, commutes to places with very high employment density (e.g., downtowns) were associated with lower total household vehicle emissions -- though this effect that was seen mostly for the places with the densest employment.

Frumkin 2003 - “Healthy Places: Exploring the Evidence”

Frumkin, Howard
“Healthy Places: Exploring the Evidence”
American Journal of Public Health
September 2003; v.93, n.9; pp1451-1456
On the web
Relevance: low

Frumkin looks at evidence supporting the importance of place and a “sense of place”. Four aspects of the built environment offer promising opportunities for health research: nature contact (e.g. trees, ponds, flowers), buildings (better building design to avoid “sick buildings”), public places (e.g. streets and sidewalks, parks and cafes, theaters and sports facilities), and urban form (design, transportation, and land use decisions at a larger scale than buildings and public places).

Semenza 2003 - "The Intersection of Urban Planning, Art, and Public Health: The Sunnyside Piazza"

Semenza, Jan C
"The Intersection of Urban Planning, Art, and Public Health: The Sunnyside Piazza"
American Journal of Public Health
September 2003, v.93, n9; pp1439-1441
On the Web
Relevance: low

In 2001 residents of the Sunnyside neighborhood in Portland, OR transformed a central intersection into the Sunnyside Piazza, a public gathering place. A small survey and observations indicate that residents of Sunnyside have higher satisfaction with their neighborhood, better sense of community, and better health than residents of adjacent neighborhoods.

Leyden 2003 - "Social Capital and the Built Environment: The Importance of Walkable Neighborhoods"

Leyden, Kevin M.
“Social Capital and the Built Environment: The Importance of Walkable Neighborhoods” American Journal of Public Health
September 2003; v.93, n.9; pp. 1546-1551.
On the web
Relevance: high

Leyden investigated the relationship between neighborhood design and residents' social capital using a household survey in Galway, Ireland.  People who lived in walkable, mixed-use neighborhoods had higher levels of social capital, and were more likely to know their neighbors, participate politically, trust others, and be socially engaged, than those who lived in car-oriented suburbs.

Freeman 2001 - "The Effects of Sprawl on Neighborhood Social Ties: An Explanatory Analysis"

Freeman, Lance
“The Effects of Sprawl on Neighborhood Social Ties: An Explanatory Analysis.”
Journal of the American Planning Association.
Winter 2001; v.67, n.1; pp69-77
Relevance: medium

To test whether low-density sprawl weakens neighborhood social bonds, Freeman compared survey data on neighborhood social ties with the density and demographic characteristics of the census blockgroups in which the respondents lived.

After controlling for poverty and other factors, he concluded that residential density is not significantly related to the formation of neighborhood social ties; however, such ties are affected by how much neighborhood residents rely on their cars.

Lopez 2004 - “Urban Sprawl and Risk for Being Overweight or Obese”

Lopez, Russ, MCRP, DSc
“Urban Sprawl and Risk for Being Overweight or Obese”
American Journal of Public Health
September 2004; v.94, n.9; pp1574-1579
On the web
Relevance: High

Lopez compared responses to the CDC's nationwide Behavioral Risk Factor Surveillance System survey with a "sprawl index," derived from 2000 US Census data, that measured density and compactness in 330 US metro areas. The results: living in a sprawling, low-density metro area increased the risk of being overweight or obese.

Frank 2005 - "Linking Objectively Measured Physical Activity with Objectively Measured Urban Form: Findings from SMARTRAQ"

Frank, Lawrence D. PhD, Thomas L. Schmid PhD, James F. Sallis PhD, James Chapman MS, and Brian E. Saelens PhD
“Linking Objectively Measured Physical Activity with Objectively Measured Urban Form: Findings from SMARTRAQ”
American Journal of Preventative Medicine
2005:28(2S2)
On the web
Relevance: high

Frank et al compared objective measures of neighborhood walkability (including street connectivity, land use mix, and residential density within a half-mile walk of each participant's home) with objective measures of physical activity (2 days with an accelerometer that measured walking and other physical activity) for 357 residents of Atlanta. 

People who lived in more walkable neighborhoods were more likely to get at least 30 minutes of moderate physical activity per day.

Ewing 2003 - "Urban Sprawl as a Risk Factor in Motor Vehicle Occupant and Pedestrian Fatalities"

Ewing, Reid, PhD; Richard A. Scheiber; Charles v. Zegeer
“Urban Sprawl as a Risk Factor in Motor Vehicle Occupant and Pedestrian Fatalities”
American Journal of Public Health
September 2003; v93, n.9; pp 1541-1545.
On the web
Relevance: High

The authors created a sprawl index for 448 US Counties in the largest 101 metropolitan areas.  For every 1% increase in the index (i.e. more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% and pedestrian fatality rates fell by 1.47% to 3.56%, after adjusting for pedestrian exposure. In short, places that sprawled more had higher death rates from traffic accidents.

In short -- people who live in more sprawling metropolitan counties were more likely to die in car accidents.

Cervero 2003 - “Walking, bicycling, and urban landscapes: Evidence from the San Francisco Bay Area”

Cervero, Robert, PhD; Michael Duncan, MCP
“Walking, bicycling, and urban landscapes: Evidence from the San Francisco Bay Area”
American Journal of Public Health
Sep 2003; v.93, n.9; pp. 1478-1483
On the web
Relevance: Medium

For trips of 5 miles or less in San Francisco, the built environment did influence travel mode (driving vs. biking vs. walking). But the influence was weak. Other factors, such as trip distance, steepness of slope, rainfall, nightfall, gender, race, purpose of trip, number of vehicles in household, and so on, had greater effects on mode choice. Thus, the built environment had a "modest and sometimes statistically insignficant effect on walking and biking."