How Does Community Design Impact Health?

    • January 26, 2010

Xuemei Zhu, PhD, Assistant Professor, Department of Architecture Fellow, Center for Health Systems and Design Texas A&M University College Station, Texas

The Problem: Which environmental factors do parents weigh in deciding whether their children should walk to or from school? The availability of sidewalks? The distance from home to school? Or do other "walkability" factors such as traffic patterns, crime and safety concerns, sidewalk appearance and a family's ethnic or economic background prove just as important when it comes to daily walking behaviors? Would a sound auditing or survey tool to measure these factors help researchers answer these questions and promote active lifestyles for children?

RWJF Approach: Robert Wood Johnson Foundation's Active Living Research (ALR) program stimulates and supports research to examine environmental factors and policies that influence physical activity. Funded researchers use a transdisciplinary approach-one that encourages experts from various disciplines to collaborate on identifying environmental factors and policies that are related to physical activity. See Program Results Report for more information on the program.

Programee Background: Xuemei Zhu, PhD, is an assistant professor in the Department of Architecture at Texas A&M University in College Station, where she also is a fellow at the school's Center for Health Systems and Design. As an architect, she works to combine her interest in design with her interest in health and physical activity. "I'm always thinking about community design and how it would impact health," she says.

Zhu brings a multicultural perspective to her work and research. Growing up in her native China, where she received a degree in architecture from Southeast University in Nanjing, Zhu recalls walking as a regular means of getting from place to place.

When Zhu arrived in the United States in 2002 to begin her graduate studies, walking was "not a natural thing to do," she recalls. "I saw the situation where everyone is driving and that you have to drive, as opposed to walk. Looking at how everyone spends so much time in vehicles each day and losing access to community—it was a cultural shock. But well, I thought, this is interesting. Why are we really doing this?"

Through its Active Living Research program, RWJF provided funding for Zhu to complete her doctoral dissertation, which explored design elements, the environment and health. Her dissertation was entitled Developing an Environmental Audit Tool for Safe Routes to School Programs.

The Project: From November 2005 to April 2008, Zhu studied students attending 73 public elementary schools in the Austin Independent School District in Austin, Texas, and the neighborhoods between schools and homes. She wanted to understand why children do or do not walk to school and to measure the extent to which neighborhood environments supported or inhibited the decision to walk. Part of Zhu's study focused on exploring whether economic disparities affected the walking behaviors of minority children, specifically Hispanic children.

To achieve her goals, Zhu analyzed neighborhoods and observed students' walking patterns. She calculated the percentage of sidewalks in each area and whether they were well maintained and clean. She researched crime rates and traffic crash rates, and the exact locations of crime reports and traffic crashes in the area. To obtain parental input and insights on the walking decision, Zhu developed a survey to collect information about how children get to school and parents' perceptions of their children's school routes; this survey was sent to parents and guardians in April and November of 2007.

Findings: Zhu learned that walking to school is a complicated matter. At the beginning of her project, Zhu set out to develop a School Buffer Walkability Index (SBWI) tool to integrate objective and subjective measures of the factors influencing whether children walked to school. But she quickly discovered that choosing to walk to school "is such a complex problem that it cannot be simplified into a single index. At the beginning, I was thinking we could quantify walkability using certain numbers. But when I really looked at it, it is multiple aspects and they cannot be easily combined."

For instance, Zhu explains, researchers often conclude that building more neighborhood sidewalks will encourage children to walk to school. But she discovered that other factors-crime, inadequate maintenance of the infrastructure, traffic safety-make this assumption false. For example, lower-income neighborhoods near inner-city schools had more sidewalks than affluent neighborhoods, but their use was compromised by crime, traffic accidents and poor maintenance. "All of the information shows that when it comes to walkability, there is not a single element we are talking about," Zhu says. "Before this project, I did not think about it from this perspective."

Based on this new information and insight, Zhu proceeded to use her dissertation grant to develop not one but three different survey tools to help measure and understand the factors that impact walking patterns to school:

  • A set of geographic information systems (GIS) measures that capture the objective walkability and safety of the physical environment in the area between home and school.
  • A field audit instrument to capture the objective walkability and safety of street segments between home and school.
  • The parental survey, which tests the association between the perceived walkability and safety of the physical environment and the likelihood that the student will walk to and from school. Some 2,695 parents responded to the survey, which Zhu sent to parents and guardians in 19 of the 73 schools involved in the study.

Findings: In addition to developing these three tools, Zhu and her colleagues reported key findings from the survey:

  • Personal and social factors that have a negative influence on whether children walk to school include a higher level of parental education, whether parents own a car, parents' personal barriers, and availability of school bus services.
  • Personal and social factors that have a positive influence on whether children walk to school include parents' and children's positive attitudes about walking and regular walking habits coupled with supportive peer influences.
  • When considering physical environmental factors, distance to school and safety concerns are the strongest negative influences, followed by the presence of highways or freeways, convenience stores, office buildings and bus stops en route to school.

Zhu also reported specific findings related to her research on whether economic and ethnic disparities affect the walking behaviors of minority children, specifically Hispanic children.

  • "Economic and ethnic disparities exist in the environmental support for walking in Austin, Texas," Zhu reports, "suggesting the need for tailored interventions in promoting active living. Low-income, Hispanic children are more likely to live in unsafe areas with poor street conditions but with some favorable neighborhood-level conditions."
  • Although schools with more low-income, Hispanic students often are located close to students' homes, they are surrounded by streets that are not favorable to walking and bicycling. Zhu concluded that high crime rates, a lack of amenities and poor street maintenance can influence the physical activity levels not only of students but of all residents.
  • In an ironic twist, Zhu found that many "walking children from lower-income families were forced to walk [to school] due to limited access to private vehicles and other alternative travel options. They may be exposed to serious safety threats from traffic and crime while walking."

During her grant period, Zhu encountered difficulties administering the surveys through the school district. The solution surprised even Zhu: She joined the Task Force for the City of Austin's Safe Routes to School (SRTS) plan, a step she called "ideal."

Zhu explains: "At that time, the city was preparing an application for the state's Safe Routes to School funding. So I developed a collaborative relationship with the city. The city's Child Safety Program helped to print, distribute and collect the surveys, while I helped the city analyze the survey results and write a relevant section for the grant application. Our team was successful in obtaining a $976,682 grant in 2007 from the federal Safe Routes to School funding."

Since her Active Living Research dissertation grant concluded, Zhu has continued to be a part of Austin's SRTS program and has received an additional grant from RWJF to pursue her research (ID# 065695).

"I found it really exciting to integrate my research with community service, and to help the city in obtaining the SRTS funding and promoting active and safe transportation to school," says Zhu. "In addition, since the SRTS programs are being planned and implemented in many cities, they provide potential research sites for quasi-experimental studies. We will continue my collaboration with the city of Austin and study the impact of the funded SRTS projects. Since the pre-intervention data has already been collected, we will be able do a pre-post comparison and reach more convincing results in terms of the impact of built environments on children's walking-to-school behaviors."

RWJF Perspective: Launched in 2000, Active Living Research is a $31-million national program that supports research to examine how physical and built environments and policies influence the amount of physical activity Americans get as part of everyday life. Findings from the research are used to help inform policy, the design of the built environment and other factors necessary to reengineer healthy levels of physical activity into everyday lifestyles for all Americans. Over the past few years, the program has focused on reversing the rise in childhood obesity, particularly in the lower-income and racial/ethnic minority communities in which childhood obesity levels are highest and rising fastest.

ALR research teams are required to be transdisciplinary, involving investigators from multiple disciplines and backgrounds who work together across traditional disciplinary boundaries. ALR researchers represent more than 20 different disciplines (e.g., public health, urban planning, architecture, behavioral science, exercise science, transportation, sociology, political science). "In addition to building an evidence base to guide physical activity policy and community design, Active Living Research is developing a vibrant, new transdisciplinary field and diverse network of researchers," says C. Tracy Orleans, PhD, RWJF distinguished fellow and senior scientist.

ALR actively seeks to translate research findings rapidly into policy and practice change. Says Orleans: "For instance, if we find out that adding bike paths and sidewalks or walk-to-school programs significantly increases physical activity, we want to get this information out to key decision- and policy-makers as quickly and effectively as possible, so they can start using it."

Orleans adds, "The Active Living Research program has sparked new awareness among policy-makers and community leaders in many sectors that how active we are depends greatly on the built environment and on the presence or absence of environmental and policy supports for physical activity. In addition, a growing number of urban planners and transportation policy-makers recognize that community design is critical for health."