Sprawl and Health

Frank 2006 - "Many Pathways from Land Use to Health"

Lawrence D. Frank, James F. Sallis, et al.
"Many Pathways from Land Use to Health"
Journal of the American Planning Association
72(1):75-87 (Winter 2006)
On the Web
Relevance: high

From the abstract: in King County neighborhoods and found that a 5% increase in walkability was associated with:

• a per capita 32.1% increase in time spent in physical activity
• 0.23 point reduction in average body mass index
• 6.5% fewer vehicle miles traveled
• 5.6% fewer grams of nitrogen oxides emitted
• 5.5% fewer grams of volatile organic compounds emitted

See study for more details.

Lopez n/a - "Urban Sprawl and the Risk of Physical Inactivity"

Lopez, Russ
"Urban Sprawl and the Risk of Physical Inactivity"
Unpublished
Not on the web (received from author)
Relevance: high

The author combines his sprawl index with 2001 BRFSS data on physical inactivity to estimate the sprawl connection. From the abstract

"For each one point increase in sprawl, the risk of being physically inactive [defined as no physical activity] increased by .04% ... Physical inactivity is associated with urban sprawl and other factors of the metropolitan social/physical environment, but the effect is small and minor changes in the overall metropolitan environment may not result in large changes in levels of physical activity."

Also see his published article on obesity.

McCann 2003 - "Measuring the Health Effects of Sprawl"

McCann, Barbara; Ewing, Reid
"Measuring the Health Effects of Sprawl: A National Analysis of Physical Activity, Obesity, and Chronic Disease."
Smart Growth America and Surface Transportation Policy Project
September 2003
On the Web
Relevance: high

This report is based on Ewing et al's earlier article (2003) and is longer with more details and sidebars. The conclusions, of course, are the same, but the report includes sprawl scores for all 448 counties and the web page has fact sheets for counties in most states.

Kelly-Schwartz 2004 - "Is Sprawl Unhealthy?"

Kelly-Schwartz, Alexia; Stockard, Jean, et al
"Is Sprawl Unhealthy? A Multilevel Analysis of the Relationship of Metropolitan Sprawl to the Health of Individuals"
Journal of Planning Education and Research
December 2004; v.24, n2; pp.184-196
On the Web
Relevance: high

The authors replicated and extended Ewing et al's work on the effect of sprawl on health. They compared self- and physican-rated health as well as a variety of chronic conditions across metropolitan areas while controlling for income, education, sex, etc. They found that sprawl does affect health somewhat, but in a complex way that is difficult to track.  It appears that a highly gridded street network is associated with better health while more density is associated with poorer health.  While sprawl was not significantly associated with a higher prevalence of chronic conditions, among those with those conditions, the gridded street network was associated with better health.

Ewing 2005 - "Can the Physical Environment Determine Physical Activity Levels?"

Ewing, Reid
"Can the Physical Environment Determine Physical Activity Levels?"
Exercise and Sport Sciences Reviews
April 2005; v.33, n.2; pp.69-75
On the Web (pdf)
Relevance: medium high

Ewing seems to be primarily reviewing and re-presenting earlier work, but does so in a concise, easy-to-grasp way. Although he doesn't show any of the data or analysis, Ewing offers elasticity estimates for the effect of the physical environment on physical activity and its mediators. The effects are greatest for the mode share of walking and public transportation. CAVEAT: Ewing shows no statistical tests or analysis, so the accuracy of these estimates is unknown.

Bauman 2002 - "Toward a Better Understanding of the Influences on Physical Activity: The Role of Determinants, Correlates, Causal Variables, Mediators, Moderators, and Confounders"

Bauman, Adrian E; Sallis, James F; et al
"Toward a Better Understanding of the Influences on Physical Activity: The Role of Determinants, Correlates, Causal Variables, Mediators, Moderators, and Confounders"
American Journal of Preventive Medicine
August 2002; v.23, n.2 (supplement); pp.5-14
On the Web (pdf)
Relevance: very low

The authors discuss and define the terms mentioned in the title. They show how complex are the influences on physical activity and demonstrate how they require careful thinking and vocabulary.

Handy 2002 - "How the Built Environment Affects Physical Activity: Views from Urban Planning"

Handy, Susan L.; Boarnet, Marlon G. et al
"How the Built Environment Affects Physical Activity: Views from Urban Planning"
American Journal of Preventive Medicine
August 2002; v.23, n.2 (supplement)
On the Web (pdf)
Relevance: low

The authors give a good overview of how urban planners think about how the built environment impacts physical activity, namely walking and biking.  They cover how to measure the built environment and travel behavior, how the built environment affects travel by foot differently from travel by car, and some tips on how empirically to connect the built environment to physical activity.

Giles-Corti 2005 - "How Important is Distance To, Attractiveness, and Size of Public Open Space?"

Giles-Corti, Billie; Broomhall, Melissa; et al
"How Important is Distance To, Attractiveness, and Size of Public Open Space?"
American Journal of Preventive Medicine
February 2005; vol.28, n.2 (supplement 2); pp.169-176
On the Web
Relevance: low

The authors surveyed Australian adults in Perth and used some sort of GIS to conclude that people walk more if they have more access to large, attractive public open space with facilities for multiple types of users. While access alone to open space was not significantly associated with achieving recommended levels of physical activity, access to large, attractive open space increased the likelihood of walking at least 6 times per week totaling >180 minutes by 50%.

Humpel 2004 - "Perceived Environment Attributes, Residential Location, and Walking for Particular Purposes"

Humpel, Nancy; Owen, Neville; et al.
"Perceived Environment Attributes, Residential Location, and Walking for Particular Purposes"
American Journal of Preventive Medicine
February 2004; vol.26, n.2; pp.119-125
On the Web
Relevance: medium-low

The authors conducted a survey of 400 Australian adults (mean age 60) on their walking habits and environmental perceptions. "Aesthetics, convenience of facilities, and access to services were positively associated with the neighborhood walking for men; convenience was associated with neighborhood walking for women."  People who walked more were more likely to say that weather did not influence their decision to walk.  Women were also more likely to walk if they lived near the coast.

Owen 2000 - "Environmental Determinants of Physical Activity and Sedentary Behavior"

Owen, Neville; Leslie, Eva; et al.
"Environmental Determinants of Physical Activity and Sedentary Behavior"
Exercise and Sport Sciences Review
October 2000; vol.28, n.4; pp153-158
On the Web
Relevance: low

The authors describe a basic model for describing the environmental determinants of physical activity and sedentary behavior. They cite the limited research that had been done so far. One interesting nugget is that one study showed that even among those who are highly physically active, those who watched 4+ hours of TV per day were twice as likely to be overweight as were those who watched less than 1 hour of TV per day.

King 2003 - "The Relationship Between Convenience of Destinations and Walking Levels in Older Women"

King, Wendy C.; Brach, Jennifer S.; et al.
"The Relationship Between Convenience of Destinations and Walking Levels in Older Women"
American Journal of Health Promotion
Sept-Oct 2003; vol.18, n.1; pp.74-82
On the Web
Relevance: medium-high

Using a small sample (149) of older women, the authors found that living within a 20 minute walk of a park; biking or walking trail; or a department, discount, or hardware store was significantly related to walking more, as objectively measured by pedometer readings.  Walking was also associated with living near more destinations and with a better neighborhood rating for walking.

Humpel 2002 - "Environmental Factors Associated with Adults' Participation in Physical Activity: A Review"

Humpel, Nancy; Owen, Neville; Leslie, Eva.
"Environmental Factors Associated with Adults' Participation in Physical Activity: A Review"
American Journal of Preventive Medicine
May 2002; vol.22, n.3; pp.188-199
On the Web
Relevance: medium-low

The authors reviewed 19 studies, finding that "accessibility, opportunities, and aesthetic attributes had significant associations with physical activities. Weather and safety showed less-strong relationships." Several of the studies focused on excercise facilities and equipments, but others looked at neighborhood attributes.

Owen 2004 - "Understanding the Environmental Influences on Walking: Review and Research Agenda"

Owen, Neville; Humpel, Nancy; et al.
"Understanding the Environmental Influences on Walking: Review and Research Agenda"
American Journal of Preventive Medicine
July 2004; vol.27, n.1; pp.67-76.
On the Web
Relevance: medium

The authors review eighteen studies and conclude that the early evidence is promising.  The studies show that aesthetic attributes, convenience of walking facilities (sidewalks, trails), accessibility of destinations, and perceptions about traffic are associated with utilitarian walking.  However, better theoretical models and more studies, especially ones that examine a causal relationship, are needed.

Ewing 2003 - "Relationship Between Urban Sprawl and Physical Activity, Obesity, and Mortality"

Ewing, Reid; Schmid, Tom, et al
"Relationship Between Urban Sprawl and Physical Activity, Obesity, and Mortality"
American Journal of Health Promotion
September/October 2003; vol.18, n.1; pp.47-57
On the Web
Relevance: high

The authors estimated the impact of a county and metropolitan area sprawl index on obesity, physical activity, and related diseases. They found that the county  index significantly influenced the number of minutes spent in leisure-time walking, average BMI, obesity status, and prevalence of hypertension.

WA Dept. of Health 2004 - "The Economic Cost of Physical Inactivity Among Washington State Adults"

Chenoweth & Associates, Inc.
"The Economic Cost of Physical Inactivity Among Washington State Adults"
Washington State Department of Health
February 2004
On the Web (pdf)
Relevance: high

Chenoweth and Associates estimate the direct costs of physical inactivity in Washington to be $4.8 billion in 2002:

• $197.8 million for direct medical care
• $9.2 million for worker's compensation
• $4600 million for lost productivity

They also calculate the indirect costs at $593 million for medical care and $36.8 million for worker's compensation, bringing the total cost (direct + indirect) to $5.46 billion. Per Washington resident, this total cost of physical inactivity was $899 in 2002; per Washington adult, the cost was $1,232.

Frank 2001 - "The Built Environment and Human Activity Patterns"

Frank, Lawrence D; Englke, Peter O
"The Built Environment and Human Activity Patterns: Exploring the Impacts of Urban Form on Public Health"
Journal of Planning Literature
November 2001; v.17, n.2; pp.202-218
On the Web
Relevance: low

Frank and Engelke reviews current literature to explore how physical activity affects public health and how urban form affects physical activity. The article is a good introduction to the subject with references to many useful studies (also reviewed in this  lit review), but a few of which are outdated.

Berrigan 1998 - "The Association Between Urban Form and Physical Activity in US Adults"

Berrigan, David; Troiano, Richard
"The Association Between Urban Form and Physical Activity in US Adults"
American Journal of Preventive Medicine
2002; v.23, n.2S; pp.74-79
On the Web
Relevance: medium

Using data from NHANES III, the authors found that people who lived in houses built before 1946 or between 1946 and 1973 were more likely to walk regularly than were people who lived in houses built after 1973. Those living in homes built before 1946 were 1.43 times more likely and those in homes built 1946-1973 were 1.36 times more likely to walk at least a mile at least 20 times a month than were those living in homes built after 1973.

B.C Health Planning 2004 - "The Cost of Physical Inactivity in British Columbia"

Colman, Ronald; Walker, Sally
"The Cost of Physical Inactivity in British Columbia"
B.C. Ministry of Health Planning
November 2004
On the Web (pdf)
Relevance: high

The authors use data from the Canadian Community Health Survey, the Economic Burden of Illness in Canada, and the literature to calculate the cost of physical inactivity in BC.  They estimate that physical inactivity costs the British Columbian health care system $211 million (2001CAN$) (1.8% of provincial health spendig) a year in direct costs.  They also estimate that indirect costs of productivity losses add up to $362 million a year due to premature death and disability, leading to a total cost of $573 million.  5% (1400) of all premature deaths are due to physical inactivity. This results in more than 4,380 potential years of life lost annually.

Katzmarzyk 2000 - "The Economic Burden of Physical Inactivity in Canada"

Katzmarzyk, Peter T; Gledhill, Norman; Shephard, Roy J.
"The Economic Burden of Physical Inactivity in Canada"
Canadian Medical Association Journal
November 28, 2002; v.163, n.11; 1435-1440
On the Web
Relevance: high

The authors reviewed the literature to calculate the burden of physical inactivity in Canada. They conclude that physical inactivity costs Canada about $2.1 billion, or 2.5% of total direct health costs.  The also calculate the about 21,000 lives were lost prematurely in 1995 and that a 10% reduction in inactivity could save Canada $150 million a year.

Pratt 2000 - "Higher Direct Medical Costs Associated with Physical Inactivity"

Pratt, Michael; Macera, Caroline A; Wang, Guijing
"Higher Direct Medical Costs Associated with Physical Inactivity"
The Physician and Sportsmedicine
October 2000; v.28, n.10; pp.63-70
On the Web
Relevance: medium

Using the 1987 National Medical Expenditures Survey, the authors estimate the costs of physical activity in the US. They conclude:

"The mean net annual benefit of physical activity [among people with no physical limitations] was $330 per person in 1987 dollars.  Our results suggest that increasing participation in regular moderate physical activity among the more than 88 million inactive Americans over the age of 15 might reduce annual national medical costs by as much as $29.2 billion in 1987 dollars--$76.6 billion in 2000 dollars."

Colditz 1999 - "Economic Costs of Obesity and Inactivity"

Colditz, Graham A
"Economic Costs of Obesity and Inactivity"
Medicine and Science in Sport and Exercise
November 1999; v.31, n.11 (supplement); pp.S663-S667
On the Web
Relevance: medium

Using similar methods to a previous study, Colditz estimates the direct costs of lack of physical exercise to be $24 billion per year (2.4% of national health care expenditures) and the direct costs for obesity, independent of lack of exercise, to be $70 billion (9.4%) for the year 1995.

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.

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.

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.

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."