+ Julian A. Reed, Ed.D., MPH Evaluating Policy and Environmental Change Interventions Michigan...

+

Julian A. Reed, Ed.D., MPH

Evaluating Policy and Environmental Change Interventions

Michigan Department of Community Health:

Building Healthy Communities

+ACKNOWLEDGMENTS

Lisa Grost, MHSA, PAPHSMichigan Department of Community

HealthBHC and Physical ActivityPublic Health Consultant

Karah Mantinan, MPH, RDProject ManagerChildhood Obesity Prevention Mission

ProjectAltarum Institute

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MDCH Building Healthy Communities 2010


+Examples of Personal and Environmental Barriers to Physical Activity in the Built EnvironmentPersonal Barriers Environmental Barriers

Lack of MotivationPerceived Lack of TimeWeather (both)Family ObligationsFatigue

Lack of Exercise FacilitiesLack of Sidewalks, Bike Lanes on Roads, Nearby Public Parks or Hiking/Biking TrailsTopographyPerceived Low Levels of Safety of One’s Neighborhood

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+Does the Built Environment Influence Physical Activity? Examining the Evidence -- Special Report TRANSPORTATION RESEARCH BOARD

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES (2005)

Association between the built environment and physical activity.

Built environments that facilitate more active lifestyles and reduce barriers to physical activity are desirable.

Continuing modifications to the built environment provide opportunities, over time, to institute policies and practices that support the provision of more activity-conducive environments.

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+Why Trails?

Accessibility to no-cost recreational facilities like trails have been identified as elements related to physical activity promotion.

Recreational trails have also been identified as an environmental support for activity.

The Center for Disease Control and Prevention’s Task Force on Community Preventive Services recommends environmental interventions that include access to trails to promote physical activity.

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+Why Parks?

Parks have a variety of activity settings (e.g., tennis courts, trails, playgrounds, playing fields, etc.) yet we know little about specific features related to quantify activity in parks.

National Recreation and Park Association entitled: Step Up to Health-it Starts in the Parks.

The Trust for Public Land also recently disseminated a report entitled: The Health Benefits of Parks to illustrate the roles parks have in promoting regular activity.

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+More on Parks and Trails

Self-report most widely used.

The vast majority of trail and park-user data collected has focused on characteristics describing little information about the activity patterns of adults who use community trails and parks.

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+Background on Building Healthy Communities (BHC) Michigan is currently ranked 13th worst in the nation in

mortality from cardiovascular disease and has the 9th highest rate of obesity in the US.

Three risk factors are estimated to play a role in nearly 70% of all chronic diseases: poor nutrition, inadequate physical activity, and tobacco use.

The BHC initiative addresses these three risk factors in Michigan using a population-based approach grounded in the theoretical framework of the Social Ecological Model to prevent chronic disease and improve the health of residents.

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+BHC: The Role of Local Health Departments

Local health departments are funded to plan, implement, and evaluate evidence-based interventions with a coalition of local partners that focus on changing the policies and environments in their communities.

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+Background on BHC Interventions Grantees have completed or enhanced 72 miles of

trail.

Improved numerous parks since the inception of this initiative.

Eighteen local health departments from 2007 through 2009 received $1,041,972 to plan and implement community-based interventions.

Health departments and the coalitions completed an environmental assessment of physical activity prior to developing interventions to determine target areas and opportunities for intervention.

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+Trail and Park Interventions

Eleven health departments during two funding cycles for 2007/2008 and 2008/2009 chose to develop or enhance trails in their respective communities to promote physical activity.

BHC interventions to promote trail use ranged from: 1. building new trails

2. extending the distance of current trails

3. enhancements with trailheads, benches and lighting

4. trail promotion with signage and building connecting trails between cities

Seven health departments enhanced existing community parks by establishing walking trails within parks or installing new equipment such as playgrounds.

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+Why Evaluate Parks and Trails?

Mostly Free and Egalitarian

Distribute Resources Equitably

Who, When, Where

Contextual Elements Impacting Use

Open Environment

Was the Intervention Effective?

NEED OBJECTIVE DATA TO SUGGEST CHANGES

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+What is Direct Observation? Direct observation is a methodology to

classify free living behaviors into distinct categories in order to be analyzed.

Direct observation of human behavior in both natural and built environments has been used as an objective methodology to study human behavior for over a century.

It is has been frequently overlooked by physical activity researchers and practitioners.

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+Direct Observation and Intercept Surveys

Objective methodologies in concert with survey methods should be utilized.

Surveys are limited to respondents’ perceptions and do not provide contextual information (e.g., trail terrain, air temperature, time of day of trail use, etc.) that could be related to activity behavior.

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+The System for Observing Play and Recreation in Communities (SOPARC)a

Based on momentary time-sampling. Separate scans are made for females and males, and for

estimating the age and ethnic groupings of participants. Summary counts describe the number of participants by

gender, activity modes and levels, and estimated age and gender groupings.

Proven valid and reliable for gathering data on: user demographics (e.g., age, sex, race) environmental features (e.g., temperature, weather, equipment) user features (e.g., type of activity) physical activity level (e.g., sedentary, walking, very active)

aMcKenzie et al. System for observing play and recreation in communities (SOPARC): reliability and feasibility measures. Journal of Physical Activity and Health. 2006;3:S208-S222.

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+Rationale for SOPARC

Activity and recreation are positively associated with good health.

Investigations of activity participants in “open” environments have been hampered by the lack of an objective tool.

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+BHC Overall Trail-Use

To date, (N=7,125) trail users were observed on 17 of Michigan’s trails between 2007 and 2009.

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Frequency Percent

Gender MaleFemale

36383487

51%49%

Age ChildTeenAdultSenior

89610894192 950

13%15%59%13%

Ethnicity WhiteOther

6826 238

97% 3%


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+Trail-Use by Gender

Fifty-one percent (N=3638) of Michigan trail users were male and 49% (N=3487) were female.

These findings were consistent with current census estimates for Michigan.

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Female Male


392(5.5%) 434(6.1%)2201(31%) 448(6.3%)

497(7%) 655(9.2%)1971(27.8%) 502(7.1%)


+Trail-Use for Gender and Activity Intensity by Age Fewer children and teens were observed using

Michigan’s trails. Only 28% of all Michigan trail users were children and teens.

Current data suggests that more than 33% of US adolescents, which equates to about 25 million youth are overweight or obese.

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Gender Activity Level

Child Teen Adult Senior

Female SedentaryWalkingVigorous

87(2.5%)205(5.9%)100(2.9%)

44(1.3%)219(6.3%)171(4.9%)

109(3%)1415(41%) 674(19%)

41(1.2%)327(9.4%) 80(2%)

Male SedentaryWalking Vigorous

110(3%)226(6.2%)161(4.5%)

102(2.8%)186(5.1%)367(10%)

167(4.6%)938(26%)859(24%)

47(1.3%)303(8.4%)151(4.2%)


+BHC Interventions to Promote Trail-Use: Awareness & Promotion

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Trail Pre (trail users)

Type of Intervention Post (trail users)

Number 1 N = 206 Extend length of trail; Placement of benches and signage on trail.

N =477

Number 2 N =193 Enhanced two routes of the trail by adding signage.

N = 373

Number 3 N = 214 Extend trail an additional five miles to connect two cities and enhance trail with signage.

N = 381

Number 4 N =168 Connect two cities and enhance trail with signage.

N = 328

Number 5 N =164 Enhance trail by adding signage N = 323


+Air Temperature Related to

Number of Trail Users

The majority of male and female trail users were observed using the trails when the temperatures were above 60 degrees, Fahrenheit.

Approximately, 80% of users (N=5336) were observed when the ambient temperature was between 61 and 90 degrees.

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+Intercept Survey Results (Trail)

Eight-hundred and seventy six (N=876) respondents completed the survey during evaluation periods from 2007-2009.

Many of the intercept survey results were consistent with direct observation findings*.

Approximately 63% of survey respondents between 2007 and 2009 were ‘walking’ when asked to complete the survey.

The majority of respondents were visiting the trail ‘with others’ (57%; N=493).

Trail users reported spending ‘between 1 and 2 hours’ on the trail per visit. In addition, 74% (N=639) of all respondents believed the maintenance of the trails was ‘excellent’.

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+Intercept Survey Results (Trail)

Approximately 56% of all respondents reported that the safety and security along the trails was ‘excellent’.

Survey respondents tended to be female which is consistent with previous research examining the demographics of trail users.

However, this finding was not consistent with the direct observation data.

Respondents used the trail primarily for exercise or recreation (89%; N=762); while few respondents used Michigan’s trails for transportation purposes.

Approximately 75% of Michigan survey respondents were 35 years of age or older.

Furthermore, 93% of respondents were white, consistent with Michigan’s trail direct observation findings*.

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+BHC Overall Park-Use To date, (N=4137) users were observed in 14 of Michigan’s parks. More males were observed in the parks (N=2369; 55%) than

females. The largest number of park users were children (N=1937; 45%),

followed by adults and teens.

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Frequency Percent

Gender MaleFemale

23691944

55%45%


193710821216 71

45%25%28% 2%

Ethnicity WhiteOther

23331816

56%44%


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+Park-Use by Gender Fifty-five percent (N=2369) of Michigan park users

were male and 45% (N=1944) were female. These findings are not consistent with current census

estimates for Michigan. Census estimates reveal that approximately 51% of Michigan residents are male and 49% are female.

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Female Male


898(20%)338(8%)679(16%) 29(1%)

1036(24%) 749(17%) 542(13%) 42(1%)


+Park-Use for Ethnicity and Activity Intensity by Age Approximately 44% of Michigan park users were minorities.

This finding was significantly different than Michigan’s trail user profile

and was not consistent with current census estimates for Michigan. Current census estimates reveal that only 19% of Michigan residents are

minorities.

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Age Activity Level White (%) Other (%)

Child SedentaryWalkingVigorous

102(5.6%)228(12.6%)661(36.5%)

119(6.6%)422(23.3%)276(15.3%)

Teen SedentaryWalking Vigorous

58(5.7%) 91(8.9%)306(30%)

120(11.8%)241(23.6%)204(20%)

Adult SedentaryWalkingVigorous

307(27%)281(24.7%)149(13.1%)

144(12.7%)211(18.5%) 46(4%)

Senior SedentaryWalking Vigorous

14(9.7%) 32(45.1%) 5(7.0%)

11(15.5%) 9(12.7%) 0(0%)

+Target Areas in Parks

The most frequently used target areas within Michigan’s parks were trails and playgrounds.

Approximately 41% (N=1529) of all park users were observed using these two targets.

The overwhelming majority of users of playgrounds were children and teens.

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+Interventions to Promote Park-Use

BHC funded interventions to promote increases in park use were identified following five interventions.

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Park Pre (park users)

Type of Intervention Post (park users)

Number 1 158 Extend length of trail in the park; Placement of benches and signage on trail in the park. 371

Number 2 152 Improve and enhance park by replacing 7 pieces of playground equipment, installing 3 bike racks, putting down wood chips, paving a .25 mile walking path and adding signage to the path.

558

Number 3 22 Implement neighborhood specific non-motorized transportation plans and safety improvement plans.

85

Number 4 79 Improve safety and increase usability of park through installation of benches along a half mile walking path, removal of brush and installation of lighting.

108

Number 5 122 Installed walking path around perimeter of the park. 147


+Air Temperature Related to

Number of Park Users Similar to Michigan’s trail findings, approximately

83% of male and female park users were observed between 61 and 90 degrees Fahrenheit (N=2936).

Contextual elements like weather and temperature have been found to impact physical activity.

The limited studies available suggest physical activity levels do vary with seasonality and the impact of poor and extreme weather has been identified as a barrier to activity among various populations.

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+Intercept Survey Results (Park)

One-hundred and eighty-seven (N=187) park respondents were surveyed.

Michigan survey respondents tended to be female This finding was not consistent with the direct observation findings.

Similar to the survey findings for trail users, walkers were surveyed most.

In addition, 60% (N=110) of park users visited the park ‘with others’. This finding was consistent with trail users surveyed.

Similar to the target area findings using direct observation, the most common activity among park visitors was trail use.

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+Intercept Survey Results (Park)

The majority of park users (26%) visited their respective park 4 or more times per week.

Initially, the majority of survey respondents (36%) reported that the ‘safety and security’ in their park was ‘excellent’. This perception changed during subsequent evaluations among

users as respondents reported the ‘safety and security’ of their park to be ‘good’ (27%) instead of ‘excellent’.

Approximately, 21% of park users surveyed in 2007/2008 transported themselves to their respective park by ‘motorized vehicle’; yet by 2008/2009 the most frequently cites response was ‘walking’ (36%).

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+Conclusions and Implications for Increasing Trail Use among Michigan Residents

More males use Michigan’s trails for physical activity White, adults were the primary users of trails Fewer children, teens and seniors use Michigan’s trails Walking was the most common behavior observed on the trail Interventions including signage/prom. had significant increases in trail use Males used trails for walking and vigorous activity Michigan’s trails were perceived to be well maintained and relatively safe Users tended to visit the trail with someone and spend 1 to 2 hours on the trail each

visit

Based on the summary of findings presented above, additional strategies to promote trail use among children, teens and seniors need to be examined.

Greater efforts to promote trail use among underserved populations such as minorities should be considered. This is an extremely important element, since the majority of trail users surveyed were white, college graduates.

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+Conclusions and Implications for Increasing Park Use among Michigan Residents

Children and teens were the primary users of Michigan’s parks Few seniors used parks for physical activity in Michigan Playgrounds were a popular target area for child and teen physical activity Adults primarily engaged in walking behavior in Michigan’s parks Interventions: the enhancement of trails within a park led to increases in park

use Michigan’s parks are used by both white and minorities for physical activity Park users spend between 1 to 2 hours per visit in Michigan’s parks Michigan’s park users visit their respective park 4 or more times per week Michigan’s parks are perceived to be well maintained and safe and secure

Considering that minorities are less active than white youth and adults-enhancing parks should be considered an appropriate intervention approach among Michigan residents.

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