Contributions of Built Environment to Childhood Obesity

MOUNT SINAI JOURNAL OF MEDICINE 78:49–57, 2011 49

Contributions of Built Environment toChildhood Obesity

Tamanna Rahman, MPH, Rachel A. Cushing, BA, and Richard J. Jackson, MD MPH

University of California at Los Angeles School of Public Health, Los Angeles, CA

OUTLINE

ROLE OF BUILT ENVIRONMENT IN

CHILDHOOD OBESITY

NUTRITION

SchoolsCommunity

PHYSICAL ACTIVITY

School-Related TransportationIndoor Environments and

Physical Activity

CONCLUSIONS AND RECOMMENDATIONS

DISCLOSURES

ABSTRACT

As childhood obesity has reached epidemic pro-portions, it is critical to devise interventions thattarget the root causes of obesity and its risk fac-tors. The two main components of childhood obesityare physical inactivity and improper nutrition, andit is becoming increasingly evident that the builtenvironment can determine the level of exposureto these risk factors. Through a multidisciplinaryliterature review, we investigated the associationbetween various built environment attributes andchildhood obesity. We found that neighborhood fea-tures such as walkability/bikeability, mixed land use,accessible destinations, and transit increase residentphysical activity; also that access to high-caloric foodsand convenience stores increases risk of overweightand obesity, whereas the presence of neighborhoodsupermarkets and farmers’ markets is associated with

Address Correspondence to:

Richard J. JacksonDepartment of Environmental

Health SciencesUCLA School of Public Health

Los Angeles, CAEmail: [email protected]

lower childhood body mass index and overweightstatus. It is evident that a child’s built environmentimpacts his access to nutritious foods and physi-cal activity. In order for children, as well as adults,to prevent onset of overweight or obesity, theyneed safe places to be active and local marketsthat offer affordable, healthy food options. Interven-tions that are designed to provide safe, walkableneighborhoods with access to necessary destina-tions will be effective in combating the epidemicof obesity. Mt Sinai J Med 78:49–57, 2011. 2011Mount Sinai School of Medicine

Key Words: built environment, childhood, nutrition,obesity, physical activity.

Physicians, parents, and policymakers alike areconcerned about the increasing rates of overweightand obesity in the US population, particularly amongchildren. Recent data from the National Health andNutrition Examination Survey show that the currentprevalence of obesity and overweight for adultsis approximately 68%.1 Over the last 3 decades,the number of obese children aged 6–11 years hastripled, and the prevalence has doubled for preschool

The rising rates of childhoodobesity parallel the emergence oftype 2 diabetes in children. Excessweight during childhood not onlyhas concurrent effects, but is alsoassociated with health problems inadulthood. The situation hasbecome so alarming that obesity ispredicted to shorten lifeexpectancy of the averageAmerican 2 to 5 years bymid-century unless aggressiveefforts are made to slow this majorpublic health epidemic.

Published online in Wiley Online Library (wileyonlinelibrary.com).DOI:10.1002/msj.20235

2011 Mount Sinai School of Medicine

50 T. RAHMAN ET AL.: CONTRIBUTIONS OF THE BUILT ENVIRONMENT TO CHILDHOOD OBESITY

children and adolescents (Table 1).2 Health risksassociated with childhood obesity include type 2diabetes,3 coronary heart disease,4 asthma,5 andothers that are linked to psychosocial disorders.6 Infact, the rising rates of childhood obesity parallel theemergence of type 2 diabetes in children.7 Excessweight during childhood not only has concurrenteffects, but is also associated with health problemsin adulthood.8 The situation has become so alarmingthat obesity is predicted to shorten life expectancyof the average American 2 to 5 years by mid-centuryunless aggressive efforts are made to slow this majorpublic health epidemic.9 Even with physicians edu-cating their patients about the benefits of a balanceddiet and regular exercise, the increasing obesity trendhas not abated. As more research has focused on theenvironmental factors that impact health outcomes,it has become increasingly evident that there is animportant relationship between community designand health.10

Up until the recent decade, research has mainlyfocused on the nutritional aspects of this epidemic,but now increased attention is being given to Amer-icans’ low levels of physical activity. It is widelyrecognized that the design of cities and communitiescan promote or inhibit physical activity in childrenand adults. Due to the protective benefits of phys-ical activity, it is recommended that adults engagein at least 150 minutes of moderate-intensity aerobicactivity–such as brisk walking–each week, and chil-dren get at least 60 minutes of aerobic activity everyday.11 However, most Americans fail to follow theseguidelines.12

Across the United States, there is an emergingmovement to build communities that are healthy,vibrant, and sustainable. Fundamental to this move-ment is the recognition that the places where we live,the things we eat, and the ways we choose to getaround affect our health.

Across the United States, there isan emerging movement to buildcommunities that are healthy,vibrant, and sustainable.Fundamental to this movement isthe recognition that the placeswhere we live, the things we eat,and the ways we choose to getaround affect our health.

In the September 2003 issue of the AmericanJournal of Public Health, experts from a number

Table 1. Prevalence of Obesity Among Children Aged2–14 Years in the United States, 1976–2008.56

Prevalence ofObesity (%), 1976

Prevalence ofObesity (%), 2008Age (years)

2–5 5.0 10.46–11 6.5 19.612–14 5.0 18.1

of disciplines contributed groundbreaking researchrecognizing the emerging field of built environmentand health.13,14 Now, growing numbers of healthprofessionals, urban planners, community leaders,policymakers, and others are working to buildhealthy communities that promote physical and men-tal well-being. In fact, the American Academy ofPediatrics issued a policy statement calling for amultidisciplinary approach to designing communi-ties to promote active lifestyles among children.15 APubMed literature search demonstrates the increas-ing trend of publications in the arena of ‘‘builtenvironment and health’’ (Figure 1). These academiccontributions elucidate the ways in which the designof our homes, schools, workplaces, neighborhoods,cities, and transportation systems–our built environ-ment–impact health outcomes. In one example, amajor study in Atlanta, Georgia, found that walkableneighborhoods confer significant health benefits tolocal residents.16

Though there is a substantial body of literatureon neighborhood effects on adult obesity and relatedrisks, such research on childhood obesity is quitelimited. However, as Glanz and Sallis describe intheir investigation on the potential role of thebuilt environment in promoting childhood obesity,it is reasonable to expect that findings from adultstudies can justify the presence of similar associationsin pediatric populations.17 In fact, children areeven more vulnerable to the adverse effects oftheir environment, suggesting that improvementsto neighborhood conditions in conjunction withother preventive programs are promising strategiesto reduce childhood obesity.18

ROLE OF BUILT ENVIRONMENT INCHILDHOOD OBESITY

The United States has invested significant resourcesto educate children about the importance of goodnutrition and being active, yet we have seen limitedsuccess with this strategy. It is now commonlyrecognized that we must make health-promotingchanges to the environments in which children live,learn, eat, and play. There is strong evidence to show

DOI:10.1002/MSJ

MOUNT SINAI JOURNAL OF MEDICINE 51

Fig 1. Trend of the number of ‘‘built environment and health’’ publications foundon PubMed.

that long-term solutions to the childhood obesityepidemic can be achieved by modifying the builtenvironment to increase children’s physical activityand access to healthful foods, and reduce theiraccess to unhealthy foods.17 Although there are anumber of complex issues associated with obesity,research indicates that prevention programs shouldfocus on improving environmental conditions thatput children at risk for poor diets, physical inactivity,and sedentary behavior.

There is strong evidence to showthat long-term solutions to thechildhood obesity epidemic can beachieved by modifying the builtenvironment to increase children’sphysical activity and access tohealthful foods, and reduce theiraccess to unhealthy foods.

NUTRITION

The availability, accessibility, and cultural accept-ability of food affect the health of the surroundingcommunity. People with better access to supermar-kets and limited access to convenience stores aremore likely to have healthier diets and lower levelsof obesity.19

Schools

In the United States, >55 million children are enrolledin elementary or secondary schools and on aver-age spend >6 hours at school each day.20 Theschool nutrition environment plays a significant role

in a child’s diet, as most children eat at least 1 mealper day at school, as well as snacks. Although schoolsoffer students at least some healthy food choices, thepresence of many unhealthy options means that fewchildren consume balanced meals.

Research also suggests that youth with limitedaccess to fast-food restaurants near their schools havea lower risk of obesity.21 One study found that amongninth-graders, the presence of a fast-food restaurantwithin a tenth of a mile–about 530 feet–of a schoolis associated with a ≥ 5.2% increase in obesity rates.There was no effect found for restaurants one-quarteror one-half mile away from the school.22 Therefore,policies that restrict access to fast food near schoolscould have significant impacts on childhood obesity.

Community

Lower–socioeconomic status neighborhoods are athigher risk, as these communities often have lim-ited access to recreational facilities and food storeswith healthful, affordable options–though the neigh-borhoods themselves may be designed in ways thatpromote physically active transportation. Availabilityof supermarkets is associated with lower adolescentbody mass index (BMI; a standard measure of weightto height used as an indicator of overweight and obe-sity) and overweight status.23 Morland et al. foundthat poorer neighborhoods have 3× fewer super-markets than wealthier neighborhoods but containmore fast-food restaurants and convenience stores,which constrains residents’ ability to access healthyfood locally.24 A high density of fast-food restaurants,convenience stores, and bars, along with concen-trated media marketing, all promote unhealthful foodchoices and hinder good nutrition.25

Neighborhoods that have access to communitygardens can promote both physical activity and

DOI:10.1002/MSJ


healthful eating for residents.26,27 Not only docommunity gardens generate fresh, locally grownproduce, they provide an opportunity to engagein physical activity. In turn, this can reduce thecost of transporting healthful foods to markets.School-aged children can gain multiple benefitsfrom being involved in gardening with their fam-ily or at school. In an effort to address elevatedchildhood-obesity rates and the overindustrializedfood system, Mayor Antonio Villaraigosa of Los Ange-les, California, established the Food Policy TaskForce (http://goodfoodla.org). The group recentlyendorsed the creation of a regional food system thatwould give low-income residents access to healthyfoods. Among the key recommendations are get-ting Electronic Benefits Transfer cards (California’sversion of the national Supplemental Nutrition Assis-tance Program) accepted at all farmers’ markets inLos Angeles County and encouraging city and countyinstitutions to buy more local food.

PHYSICAL ACTIVITY

Communities that have low-density development pat-terns, poor street connectivity, and a lack of destina-tions within safe walking distance adversely impacthealth behaviors, which in turn contributes to obe-sity and other chronic illnesses.28 Several studieshave found higher rates of adult obesity in sprawl-ing communities.29 Urban sprawl is characterized byareas in which homes are far from community ameni-ties, and often the only route to reach destinationsis a busy, high-speed arterial roadway that is unsafefor walking or biking (Figure 2). Driving is commonlythe only way to access essential goods and services insprawling areas, whereas communities that are morecompactly developed provide residents the opportu-nity to walk and engage in regular, utilitarian physicalactivity. The more time people spend in automobiles,the less time they spend engaging in physical activ-ity, and the more difficult it becomes to maintain ahealthy weight.

The more time people spend inautomobiles, the less time theyspend engaging in physicalactivity, and the more difficult itbecomes to maintain a healthyweight.

Evaluations of the relationship between the builtenvironment, travel patterns, and obesity show that

Fig 2. Comparison of land use patterns in sprawling andtraditional neighborhoods. Source: Drawing by DuanyPlater Zyberk as shown in Spielberg F. The traditionalneighborhood development: how will traffic engineersrespond? ITE J. 1989;59:17.

each additional hour spent in a car per day isassociated with a 6% increase in the likelihood of obe-sity, whereas any additional kilometer walked per dayis associated with a 4.8% decrease.30 The first nationalstudy to establish a direct association between com-munity design and the health of local residents foundthat people living in sprawling counties are likely tohave higher BMIs. There is also a direct relationshipbetween sprawl and hypertension.31

The disappearance of physical activity from thedaily lives of American adults and children is a com-plex problem. However, there is growing evidencedemonstrating that the presence of sidewalks, safeintersections, walkable communities, accessible des-tinations, appealing green spaces, and public transitcan improve population activity levels and relatedhealth outcomes.32,33 Neighborhoods that include amix of residential, commercial, retail, and recreationaldestinations frequently result in more resident phys-ical activity and less overweight and obesity.30,34

Walking for utilitarian purposes is consistently foundto be more prevalent in dense, mixed-use neigh-borhoods when compared with lower-density, exclu-sively residential neighborhoods.35 People who livein more walkable neighborhoods (with mixed use,connected streets, high residential density, andpedestrian-oriented retail) tend to walk and bikemore for transportation (also known as ‘‘active trans-portation’’), have lower BMIs, drive less, and emitless air pollution than people living in less-walkableneighborhoods.36 High-quality public transportationand transit-oriented development (Figure 3) impacthealth beyond physical activity rates, as they reduce

DOI:10.1002/MSJ


Fig 3. Crossings at Gresham Station, a high-density transit-oriented devel-opment in Gresham, Oregon. Photo Credit: Myhre Group Architects. Source:http://www.greenplaybook.org/neighborhoods/act/characteristics/density.htm.

traffic-related injuries, benefit mental health, improveaccess to healthy food and medical care, and increaseaffordability, which decreases financial stress onlower-income households.32

School-Related Transportation

Many communities developed after World War IIhave limited access to safe places to walk, bike, orplay, and as a consequence, children and adolescentsare less physically active than they were a generationago. For example, the number of students aged 5 to18 years who walk or bike to school declined from42% in 1969 to 13% in 2001.37 Today, approximately44% of kids commute to school by car (Figure 4),due in large part to a lack of neighborhoodsidewalks and concerns about distance and trafficsafety.38 The decline in active transportation to schoolhas notably coincided with the increasing rates ofchildhood obesity. Elementary and middle schoolaged youth who walk to and from school are morephysically active overall than those who commute byautomobile.39

The number of students aged 5 to18 years who walk or bike toschool declined from 42% in 1969to 13% in 2001. Elementary andmiddle school aged youth whowalk to and from school are morephysically active overall than thosewho commute by automobile.

Fig 4. Children’s Mode of Transport to School, 2009.

In fact, most studies of children and adoles-cents indicate that walking or bicycling to school isrelated to higher overall physical activity. Distancebetween school and home is the strongest influenceon whether kids will walk or bike to school: as thecommute distance increases, rates of walking andbiking decrease.40 A study involving 16 elementaryschools in California showed that students residingwithin 1 mile of school were 3× more likely to walkto school than travel by automobile. This has impor-tant implications for school-siting policies across theUnited States.

A number of recent studies found that rates ofactive transit to school are positively associated withneighborhood characteristics such as trails, physical-activity facilities, houses with windows facing thestreet, pedestrian and bicycle access to nearby transit,and mixed land uses.41 Forty-three percent of peoplewho live within a safe 10-minute walking distance ofdestinations achieve physical-activity targets, whereas

DOI:10.1002/MSJ


Table 2. Recommendations for Health Professionals in Addressing Childhood Obesity.

Recommendation Suggested Courses of Action

Provide access to safe and nutritiousfood at school.

• Offer technical assistance and expertise to local parent-teacher associationsin order to promote a healthy school-nutrition environment.

• Provide support to local schools in developing a robust nutrition-educationprogram.

• Provide support for community gardens or programs that link local farmerswith schools, ensuring that school meals are healthier.

• Establish healthcare facilities as models for healthy eating by closing downfast-food outlets in hospitals and other care centers.

• Advocate for the use of zoning laws to require certain types of destinationsbe located within walking distance of most residences, and to limit thenumber of convenience stores and fast-food restaurants.

Encourage healthy eating habits. • Focus on health instead of weight to encourage children to make healthierchoices.

• Take time during patient visits to discuss the importance of a healthy diet.• Educate parents about what constitutes a healthy diet and the importance

of providing children with nutritious meals.• Conduct BMI or height-to-weight screenings and educate parents about the

significance of these measurements.Promote Safe Routes to School

(SRTS).• Support the reauthorization of the Surface Transportation Act so it provides

substantial financial support for walking, bicycling, public-transitinfrastructure, and programs such as SRTS.

• Work with community groups or schools to organize a SRTS program inthe local community.

Ensure that communities aredesigned or repurposed withhealthy living as a clear goal.

• Urge your local planning and transportation department to establishproject-review guidelines that incorporate Complete Streets principles,which consider the needs of all users, including children.

• Promote safe access to parks and recreational facilities.• Incorporate health items in public comments for projects.

Encourage agencies to evaluate theimpacts to human health whenconsidering policies andregulations.

• Spread the word that funds marked for highway development would bebetter spent to improve the quality of life of millions of Americans ifused to make communities more walkable and bikeable.

• Encourage the integration of Health Impact Assessments (HIA) in localdecision-making and provide technical assistance in the developmentprocess. A HIA incorporates quantitative and qualitative methods toanticipate the potential health-related consequences of a policy, project,or program.

Abbreviations: BMI, body mass index.

only 27% of people living in less-walkable neighbor-hoods achieve these goals.32 Children lacking accessto sidewalks or paths, parks, playgrounds, or recre-ational centers have 20%–45% higher odds of becom-ing obese or overweight compared with children whohave regular access to such amenities.17 Programssuch as Safe Routes to School (SRTS) have proven tobe effective in providing children the opportunity towalk or bike safely to school.42 In California, schoolsparticipating in the Safe Routes to School programincreased the number of students walking to schoolby 38%.43

One of the key determinants of whether childrenwalk or bike to school is their parents’ perception ofthe transportation route between home and school.Perceived safety from traffic and crime is associatedwith higher rates of children walking and bicycling toschool. A survey in Melbourne, Australia, found that

children whose parents believed they had to crossseveral roads to get to play areas were 40%–60% lesslikely than other children to walk or bicycle to schoolor parks at least 3 times per week.44 Therefore, thepresence of safe, convenient, and accessible facilitiesfor walking and biking is likely to increase parents’sense of security and children’s level of physicalactivity.

Indoor Environments andPhysical Activity

When a neighborhood lacks safe places to play,children tend to spend more time being inactiveindoors. Factors such as heavily trafficked streets,neighborhood crime, and graffiti are likely to preventchildren from being active outdoors and instead

DOI:10.1002/MSJ


promote indoor sedentary behavior. An increasein ‘‘screen time,’’ which includes activities such aswatching television, is directly associated with childand adult obesity.45

An increase in ‘‘screen time,’’which includes activities such aswatching television, is directlyassociated with child and adultobesity.

Among children, watching television and spend-ing time on computers or playing video games takesaway opportunities to engage in physical activity.Such sedentary behavior also impacts healthy eat-ing habits, as children watching television are morelikely to snack on junk food.46,47 Further, screen timehas been linked to children getting less and poorer-quality sleep,48 which in turn is associated with aheightened risk of obesity.49

CONCLUSIONS ANDRECOMMENDATIONS

It is undeniable that obesity and inactivity willincrease morbidity, mortality, and attendant health-care costs. In a report by the American PublicHealth Association, the national health cost associ-ated with obesity and overweight was estimated to beapproximately $142 billion. This estimation includeshealthcare costs, lost wages due to illness and dis-ability, and future earnings lost by premature death.50

The recent rapidity of increase in weight has beennothing short of astonishing. Given the gravity of thisepidemic, it is essential that all possible interventionsbe put in place. Even though researchers have yet toprove through randomized trials that all of the afore-mentioned interventions aimed to decrease caloricintake and increase energy expenditure are effec-tive, it would be imprudent to miss opportunities toimplement meaningful interventions. In medicine, alltreatment outcomes may not be evident, as patientscan react differently to certain medication; however,treatments are still prescribed because they have thepotential to alleviate the health condition. Accord-ingly, given the best-available evidence, we suggestthat prescribing healthy changes in the environmentswhere children live, learn, eat, and play will havelasting positive impacts.

In order for people to be more active andhave healthier diets, they need access to safe placesfor recreation, neighborhoods that are walkable,

and local markets that offer healthful, affordablefood. Moving away from the norm of high-densityfoods and toward high-density environments requirescollaboration between multiple disciplines, and callsfor physicians to act as advocates for healthycommunities. Table 2 shows a nonexhaustive list ofsome ways in which health professionals can beinvolved in battling childhood obesity.

DISCLOSURES

Potential conflict of interest: Nothing to report.

REFERENCES

1. Flegal K, Carroll M, Ogden C, et al. Prevalence andtrends in obesity among US adults, 1999–2008. JAMA2010; 303: 235–241.

2. US Centers for Disease Control and Prevention. Child-hood overweight and obesity. http://www.cdc.gov/obesity/childhood/index.html. Updated March 31,2010.; Accessed on October 9, 2010.

3. Fagot-Campagna A, Venkat Narayan KM, ImperatoreG. Type 2 diabetes in children: exemplifies the growingproblem of chronic diseases [editorial]. BMJ 2001; 322:377–378.

4. Freedman D, Khan L, Dietz W, et al. Relationshipof childhood obesity to coronary health disease riskfactors in adulthood: the Bogalusa Health Study.Pediatrics 2001; 108: 712–718.

5. Gilliland FD, Berhane K, Islam T, et al. Obesity and therisk of newly diagnosed asthma in school-age children.Am J Epidemiol 2003; 158: 406–415.

6. US Centers for Disease Control and Prevention. Over-weight and obesity: consequences. http://www.cdc.gov/obesity/childhood/consequences.html. UpdatedOctober 20, 2009. Accessed on October 1, 2010.

7. Amed S, Daneman D, Mahmud F, et al. Type 2 diabetesin children and adolescents. Expert Rev Cardiovasc Ther2010; 8: 393–406.

8. Baker JL, Olsen LW, Thorkild S. Childhood body-mass index and the risk of coronary health disease inadulthood. N Engl J Med 2007; 357: 2329–2337.

9. Olshansky S, Passaro D, Hershow R, et al. A potentialdecline in life expectancy in the United States in the21st century. N Engl J Med 2005; 352: 1138–1145.

10. Frumkin H, Frank L, Jackson RJ. Urban Sprawl andPublic Health: Designing, Planning, and Building forHealthy Communities. Washington DC: Island Press;2004.

11. HHS announces physical activity guidelines for Amer-icans [press release]. Washington, DC: US Departmentof Health and Human Services; October 7, 2008. http://www.hhs.gov/news/press/2008pres/10/20081007a.html. Accessed on October 1, 2010.

12. US Centers for Disease Control and Prevention.1988–2008 No Leisure-Time Physical Activity TrendChart. http://www.cdc.gov/nccdphp/dnpa/physical/stats/leisure time.htm. Updated February 2, 2010.Accessed on October 4, 2010.

DOI:10.1002/MSJ


13. Jackson RJ. The impact of the built environment onhealth: an emerging field. Am J Public Health 2003; 93:1382–1384.

14. Frumkin H. Healthy places: exploring the evidence.Am J Public Health 2003; 93: 1446–1450.

15. Committee on Environmental Health. The builtenvironment: designing communities to promotephysical activity in children. Pediatrics 2009; 123:1591–1598.

16. Goldberg D, Frank L, McCann B, et al. New Datafor a New Era: A Summary of the SMARTRAQ Find-ings. Linking Land Use, Transportation, Air Qualityand Health in the Atlanta Region. http://www.act-trans.ubc.ca/smartraq/files/smartraq summary.pdf.Published January 2007. Accessed on October 1, 2010.

17. Sallis JF, Glanz K. The role of built environmentsin physical activity, eating, and obesity in childhood.Future Child 2006; 16: 89–108.

18. Doxey J, Tran T, Kimball K, et al.; for Surface Trans-portation Policy Project, Transportation and Land UseCoalition, and Latino Issues Forum. Can’t Get Therefrom Here: The Declining Independent Mobility ofCalifornia’s Children and Youth. http://transformca.org/resource/cant-get-there-here. Published September2003. Accessed October 4, 2010.

19. Morland K, Diez Roux A, Wing S. Supermarkets, otherfood stores, and obesity: the atherosclerosis risk incommunities study. Am J Prev Med 2006; 30: 333–339.

20. US Department of Education, National Center forEducation Statistics. Projections of Education Statisticsto 2018. Table 1: Actual and projected numbersfor enrollment in grades PK-12, PK-8, and 9-12 inelementary and secondary schools, by control ofschool, Fall 1993–Fall 2018. Washington, DC: USGovernment Printing Office; 2009. http://nces.ed.gov/programs/projections/projections2018/index.asp.

21. Treuhaft S, Karpyn A. The Grocery Gap: Who HasAccess to Healthy Food and Why It Matters. Oakland,CA: PolicyLink; 2010.

22. Currie J, DellaVigna S, Moretti E, et al. NationalBureau of Economic Research. The Effect of Fast FoodRestaurants on Obesity. http://www.econ.berkeley.edu/∼sdellavi/wp/fastfoodJan09.pdf. Published Jan-uary 2009. Accessed on October 9, 2010.

23. Powell L, Ault C, Chaloupka K, et al. Associationsbetween access to food stores and adolescent bodymass index. Am J Prev Med 2007; 33: S301–S307.

24. Morland K, Wing S, Diez Roux A, et al. Neighborhoodcharacteristics associated with the location of foodstores and food service places. Am J Prev Med 2002;22: 23–29.

25. Hinkle A, Wu E. California Adolescent Nutrition andFitness Program and California Pan Ethnic HealthNetwork. Addressing the Obesity Epidemic–PublicPolicies for Healthy Eating and Physical Activity En-vironments [Communities of Color issue briefing pa-per]. http://www.canfit.org/pdf/CANFit-CPEHNbrief.pdf. Published August 2003. Accessed on October 4,2010.

26. Mikkelsen L, Chehimi S. The Links Between theNeighborhood Food Environment and ChildhoodNutrition. Princeton, NJ: Robert Wood JohnsonFoundation; 2007.

27. Glanz K, Yaroch A. Strategies for increasing fruit andvegetable intake in grocery stores and communities:

policy, pricing and environmental change. Prev Med2004; 39: S75–S80.

28. McCann B, Ewing R. Smart Growth America SurfaceTransportation Policy Project. Measuring the HealthEffects of Sprawl: A National Analysis of PhysicalActivity, Obesity and Chronic Disease. http://www.smartgrowthamerica.org/report/HealthSprawl8.03.pdf.Published September 2003.

29. Lopez R. Urban sprawl and risk of being overweightor obese. Am J Public Health 2004; 94: 1574–1579.

30. Frank LD, Andresen MA, Schmid TL. Obesityrelationships with community design, physical activity,and time spent in cars. Am J Prev Med 2004; 27: 87–96.

31. Ewing R, Schmid T, Killingsworth R, et al. Relationshipbetween urban sprawl and physical activity, obesityand morbidity. Am J Health Promot 2003; 18: 47–57.

32. Litman T. Evaluating Public TransportationHealth Benefits. http://www.apta.com/resources/reportsandpublications/Documents/APTA HealthBenefits Litman.pdf. Victoria, BC: Victoria TransportPolicy Institute; 2010.

33. Brownson RC, Hoehner CM, Day K, et al. Measuringthe built environment for physical activity: state ofthe science. Am J Prev Med 2009; 36(4 suppl):S99–S123e12.

34. Frank LD, Schmid TL, Sallis JF, et al. Linking objectivelymeasured physical activity with objectively measuredurban form: findings from SMARTRAQ. Am J Prev Med2005; 28(2 suppl 2): 117–125.

35. Saelens BE, Sallis JF, Frank LD. Environmentalcorrelates of walking and cycling: findings from thetransportation, urban design and planning literature.Ann Behav Med 2003; 25: 80–91.

36. Frank LD, Sallis JF, Conway TL, et al. Many pathwaysfrom land use to health: associations betweenneighborhood walkability and active transportation,body mass index and air quality. J Am Plann Assoc2006; 72: 75–87.

37. US Centers for Disease Control and Prevention. KidsWalk-to-School: Then and now–barriers and solutions.Available at: http://www.cdc.gov/nccdphp/dnpa/kidswalk/then and now.htm. Accessed on December 5,2010.

38. Federal Highway Administration. 2009 National House-hold Travel Survey. Washington, DC: US Depart-ment of Transportation; 2009. http://nhts.ornl.gov/introduction.shtml. Accessed on October 1, 2010.

39. Cooper AR, Andersen LB, Wedderkopp N, et al.Physical activity levels of children who walk, cycleor are driven to school. Am J Prev Med 2005; 29:179–184.

40. Yeung J, Wearing S, Hills AP. Child transport practicesand perceived barriers in active commuting to school.Transp Res A Policy Pract 2008; 42: 895–900.

41. Kerr J, Rosenberg D, Sallis JF, et al. Active commutingto school: associations with environmental andparental concern. Med Sci Sports Exerc 2006; 38:787–794.

42. Watson M, Dannenberg A. Investment in safe routesto school projects: public health benefits for the largercommunity. Prev Chronic Dis 2008; 5: A90.

43. Boarnet M, Day K, Anderson C, et al. California’sSafe Routes to School program impacts on walking,bicycling, and pedestrian safety. J Am Plann Assoc2008; 71: 301–317.

DOI:10.1002/MSJ


44. Timperio A, Crawford D, Telforn A, et al. Perceptionsabout the local neighborhood and walking and cyclingamong children. Prev Med 2004; 38: 39–47.

45. Dietz WH, Gortmaker SL. Preventing obesity inchildren and adolescents. Annu Rev Public Health2001; 22: 337–353.

46. Taveras EM, Sandora TJ, Shih MC, et al. The associationof television and video viewing with fast food intakeby preschool-age children. Obesity (Silver Spring) 2006;14: 2034–2041.

47. Harris JL, Bargh JA, Brownell KD. Priming effects oftelevision food advertising on eating behavior. HealthPsychol 2009; 28: 404–413.

48. Owens J. Sleep: the missing link in preventingchildhood obesity. J Clin Sleep Med 2010; 6: 18–19.

49. Anderson S, Whitaker R. Household routines andobesity in US preschool-aged children. Pediatrics 2010;125: 420–428.

50. American Public Health Association. The HiddenHealth Costs of Transportation: Backgrounder.Table 2: The Cost of Transportation-Related HealthOutcomes. www.apha.org/advocacy/reports/reports.Published February 2010. Accessed on October 4, 2010.

DOI:10.1002/MSJ

Contributions of Built Environment to Childhood Obesity

Documents

Transcript of Contributions of Built Environment to Childhood Obesity