The Built Environment &The Built Environment

The Built Environment &The Built Environment & HispanicsHispanics’’

HealthHealth

Scott Brown, Ph.D.Scott Brown, Ph.D.

[email protected]@med.miami.edu

Built Environment & Health Team, Miller School of Medicine & School of Architecture, University of Miami

Coauthors:

Photo of Grove Park, East Little Havana, by Frank Martinez, 2007

Scott Brown1

Joanna Lombard2,1

Frank Martinez2,1

Craig A. Mason3

Elizabeth Plater-Zyberk2,1

Arnold R. Spokane4

Tatiana Perrino1

Hilda Pantin1

José Szapocznik1,2

1University of Miami Miller School ofMedicine, Miami, Florida.2University of Miami School ofArchitecture, Coral Gables, Florida.3University of Maine College ofEducation and Human Development,Orono, Maine.4Lehigh University College ofEducation, Bethlehem, Pennsylvania.

Theoretical ModelTheoretical Model

Built EnvironmentBuilt Environment

Social ConnectednessSocial Connectedness

Social SupportSocial SupportMonitoring of Children/Monitoring of Children/Support for ParentingSupport for Parenting

ElderElder’’s Health/Mental Healths Health/Mental HealthNIA/NIMH/NIEHS FundingNIA/NIMH/NIEHS Funding

Adolescent BehaviorAdolescent BehaviorSchool RecordsSchool RecordsRWJ FundingRWJ Funding

Macrosystem

Exosystem

Microsystem

Individual

Diversity of Use and Conduct GradesDiversity of Use and Conduct Grades

Built Environment(Diversity of Use)

Social Connectedness/Neighboring Behavior

Monitoring of Children/Support for Parenting

Child School Outcomes

Funded by the RWJ Grant No. 037377 and NIMH/NIEHS Grant No. MHFunded by the RWJ Grant No. 037377 and NIMH/NIEHS Grant No. MH 6370963709

Macrosystem

Exosystem

Microsystem

Behavior

East Little Havana

Universe of children (n=2857) in East LittleUniverse of children (n=2857) in East LittleHavanaHavana

Archival data from school recordsArchival data from school records-- conduct gradesconduct grades

BlockBlock--level diversity of uselevel diversity of use

All 3857 lots in 403 blocks ofEast Little Havana were codedfor mixed use

Mixed Use & Conduct GradesMixed Use & Conduct Gradesin Hispanic Boysin Hispanic Boys

(Szapocznik et al., 2006; AJCP)

2.80

2.85

2.90

2.95

3.00

3.05

3.10

Residential Commercial Mixed

Male

Gra

de Residential

Commercial

Mixed

Built Environment and EldersBuilt Environment and Elders’’HealthHealth

Funded by NIMH/NIEHS Grant No. MH63709 andFunded by NIMH/NIEHS Grant No. MH63709 and

NIA Grant No. AG27527NIA Grant No. AG27527

(PI: J. Szapocznik; Co(PI: J. Szapocznik; Co--PI: S. Brown)PI: S. Brown)

“Eyes on Street” and Elders’ Health

Built Environment(“Eyes on Street”)

Social Connectedness/Neighboring Behavior

Social Support

Elder’s Health/Mental Health

Funded by NIMH/NIEHS Grant No. MH 63709 and NIA Grant No. AG 27527

Built EnvironmentBuilt Environment ““Eyes on the StreetEyes on the Street””

Above Grade Stoop Porch

DesignDesign

Population based sample.Population based sample.

16,000 households in East Little Havana16,000 households in East Little Havanaenumerated for Hispanic elders > 70 years.enumerated for Hispanic elders > 70 years.

273 elder273 elder--blocks were included in the final studyblocks were included in the final study ––1 elder per block.1 elder per block.

Elders assessed at baseline, 12, 24, 36, and 54Elders assessed at baseline, 12, 24, 36, and 54months post baseline.months post baseline.

Built environment coded before baseline.Built environment coded before baseline.

“Eyes on the Street” (Jacobs, 1961)

Above Grade

Ground Floor ParkingLow Sill Height

Stoop Porch

Window Area

Χ2(121) = 161.283, p = .008Χ2/df = 1.333CFI = .95RMSEA = .035

*Controls for age, gender, and income

Built environment predicts physical functioningBuilt environment predicts physical functioning(Brown et al., 2008, EHP)

PRE-BASELINE BASELINE 12 MONTHS 24 MONTHS(2000-2002)

PHYSICALPHYSICALFUNCTIONING*FUNCTIONING*

-.17

-.18

.22

.19

SOCIALSOCIALSUPPORTSUPPORT

-.55

FRONTFRONTENTRANCEENTRANCE

-.24

PSYCHOLOGICALPSYCHOLOGICALDISTRESS*DISTRESS*

-.32

Above Grade

Stoop

Porch

Window Area

Low Sill

Grd. Parking

Small Setback

Hispanics,Hispanics,Built Environment & MetabolicBuilt Environment & Metabolic

SyndromeSyndrome

Funded by NIDDK Grant No. DK74687 (PI: J. Szapocznik)Funded by NIDDK Grant No. DK74687 (PI: J. Szapocznik)

The Metabolic Syndrome

In visceral obesity, adipocites, particularly in thevisceral organs, secrete proteins that cause insulinresistance and additional glucose production,increase levels of triglycerides, reduced good (lowdensity lipoproteins), increase inflammatoryenzymes, such as CRP, which results inatherosclerosis and hypertension. Finally, withvisceral obesity adiponectin is reduced. Adiponectinimproves insulin sensitivity and reducesinflammation.

Physical activity seems to protect from MetS byreducing visceral adiposity.

Indicators of the Metabolic Syndrome

Metabolic syndrome (MetS) is the clustering of variousinterrelated abnormalities, linked with increased risk of Type IIdiabetes and cardiovascular disease (Isomaa et al., 2001; Lakka et al.,2002).

Criteria for MetS (NHLBI/AHA, 2005) involves 3 or more of the following:

1) abdominal obesity: waist circumference >102 cm for men; >88cm for women;

2) high blood pressure: >130/85 mm Hg3) high fasting glucose: >100 mg/ dl (> 6.1 mmol/ L).4) hypertriglyceridemia: > 150 mg/dL (1.69 mmol/ L);5) low level of high density lipoprotein (HDL) cholesterol: <40 mg/

dL (1.04 mmol/ L) for men; < 50 mg/ dL (1.29 mmol/ L)for women;

2007

Behavioral Research Factor Surveillance System, CDC http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm

Obesity (BMI > 30) Trends Among U.S. AdultsBehavioral Risk Factor Surveillance System (BRFSS),

1991, 1996, 2003, & 2007

Behavioral Research Factor Surveillance System, CDC http://www.cdc.gov/diabetes/statistics/maps/

From Schilling & Linton, 2004

Physical Activity and Obesity

Growth of Sprawl(from H. V. Savitch, 2003; J. Urban Health)

www.vtsprawl.org

How does New Urbanismprovide an alternative toSprawl?

Mixed-use/Density/PedestrianInfrastructure/Aesthetics

New Urbanist projectsprovide mixed useswithin a 5-minute walk,making the use of thecar a choice rather thana necessity.

Diagram by DPZKendall Drive, Miami, Florida

Proposal for Kendall Drive Miami, Florida, by Dover Kohl

Connectivity

Interconnectivity of routes and thedimensioning of roadwaysencourages pedestrian activity.

Diversity of mixed uses within a 5-minute walk provides desirabledestinations as well as walkability

Diagram by DPZ

Study on Built Environmentand Metabolic Syndrome

390 new Cuban immigrants ages 30 to 45 are recruitedwithin 3 months of arrival in U.S.- Avoiding the typical bias of self-selection: people deciding where they

move

Immigrants are randomly stratified by built environmentwalkability of their zip code (high, medium, low) andgender.

Longitudinal design, participants tested at baseline, 12-month,and 24-month post-baseline.

Built environment is assessed by objective measures ofmixed use, street connectivity, and street density.

Plasma stored for future genetic analysis and study of relatedbiochemistry.

SocialEnvironment

PhysicalActivity

Resistance

Adiposity

ENVIRONMENTENVIRONMENT BEHAVIORBEHAVIOR BIOLOGYBIOLOGY OUTCOMEOUTCOME

Built

Environment

Metabolic

Syndrome

Inflammation

Insulin

Controlling for diet

National Institute on Diabetes, Digestive & Kidney Diseases Grant No. DK 74687

Resistance

Neighborhood & Individual RiskNeighborhood & Individual Riskfor Obesity in Hispanicsfor Obesity in Hispanics

R21 Study Proposal Submitted to NHLBI (PI: S. Brown)R21 Study Proposal Submitted to NHLBI (PI: S. Brown)

Fig. 1: Conceptual Model of Neighborhood and Individual Risk for Obesity

PREDICTORS BEHAVIORS OUTCOME

NEIGHBORHOOD

Built Environment Walkability

Food Environment

Socioeconomic Conditions

INDIVIDUALSTRESS RISK

Coping, Support, Perceived Stress

Salivary Cortisol Activity

PHYSICALACTIVITY

DIET

ADIPOSITY

Aim 1

Aim 2

Aim

3

Built Environment, Physical Activity &Built Environment, Physical Activity &

Hispanic Teen Drug Use & HIV RiskHispanic Teen Drug Use & HIV Risk

Supplemental Study Proposal in Progress for NIDASupplemental Study Proposal in Progress for NIDA

(PI: S. Schwartz; Co(PI: S. Schwartz; Co--PI: S. Brown)PI: S. Brown)

Built Environment (walkability) isassociated with Physical Activity

(walking) (National Academy of Sciences, 2005)

Mixed Use

Aesthetics

Pedestrian Infrastructure

Street Connectivity

Density

Access to Public and Recreational Facilities

Built Environment (walkability)characteristics have been associated with

multiple adolescent problem behaviors:

Mixed Use and:

– Conduct Problems (Szapocznik et al., 2006);

– Drugs (Ford & Beveridge, 2004);

Aesthetics (e.g., Dilapidation) and:

– Heavy Drinking (Bernstein et al., 2007);

– Drug Overdose (Hembree et al., 2005; Nandi et al.,2007);

– STDs (D. Cohen et al., 2000, 2003);

BUILT ENVIRONMENTADOLESCENT PROBLEM

BEHAVIORS

CONTROL VARIABLES:•Individual Demographics

•Peer & Parental Substance Use•Neighborhood Socioeconomic Conditions•Neighborhood Crime & Pedestrian Safety

Conceptual Model for NIDA Study Concept:

Physical activity is related to decreased:

– Alcohol use (Correia, Benson, & Carey,2005; Murphy, Pagano, & Marlatt, 1986);

– Drug use (Correia, Benson, & Carey,2005);

– Smoking (review of 12 RCTs by Taylor,Ussher, & Faulker, 2006).

Physical Activity ReducedSubstance Use in Humans


BEHAVIORS


ADOLESCENTPHYSICAL ACTIVITY



Built Environment, Social Environment,& Adolescent Outcomes

Supportive social processes have been associatedwith neighborhoods high in “built walkability”characteristics:

– Mixed use (Ford & Beveridge, 2004; Leyden, 2003);

– Connectivity (Kim & Kaplan, 2004);

– Parks and recreational facilities (Cohen et al., 2007);

Providing social support for parenting has beenshown to reduce risk for adolescent problembehaviors through improved family functioning(Prado et al., 2006; Prado, Pantin, et al., in press).

BUILT ENVIRONMENT

SUPPORT FORPARENTING

FAMILYFUNCTIONING

ADOLESCENT PROBLEMBEHAVIORS





BEHAVIORS


ADOLESCENTPHYSICAL ACTIVITY



BUILT ENVIRONMENT

SUPPORT FORPARENTING

FAMILYFUNCTIONING

ADOLESCENT PROBLEMBEHAVIORS



Physical Activity, Built Environment &Physical Activity, Built Environment &Preventing Hispanic YouthPreventing Hispanic Youth’’s Drug Uses Drug Use

R01 Study Proposal In Progress for NIDA (PI: S. Brown)R01 Study Proposal In Progress for NIDA (PI: S. Brown)

Built

Environment

Family

School

Peer

Neighborhood

Culture

Eco

nom

icC

onditio

ns

Soci

alC

onditio

ns

Imm

igra

tio

nP

olicy

Pare

nt

Jo

b

Parent Support Networks

Frie

nd

’sF

am

ily

INT

ER

FA

CE

INTERFACEINTERFACE

AA/NA self-help

God/Church

Med

iaIn

fluen

ce

INT

ER

FA

CE

Ecodevelopmental Modelof Human Development(Szapocznik & Coatsworth, 1999)

Familias Unidas is an existing ecodevelopmentalprevention intervention, shown to be efficacious inpreventing adolescent drug, alcohol, and cigaretteuse (Prado et al., 2007; Pantin, Prado et al.,2009).

An existing effectiveness trial of Familias Unidas(DA-025192; PI: G. Prado) will be the platform forinvestigating “In which contexts do preventioninterventions work?”

EcodevelopmentalEcodevelopmental PreventionPreventionInterventionIntervention

FamiliasFamilias UnidasUnidas Effectiveness StudyEffectiveness Study

Intervention conditionsFamiliasFamilias UnidasUnidas

Community PracticeCommunity Practice

Proposed mediator

Family functioningFamily functioning OutcomesCigarette useCigarette useIllicit drug useIllicit drug useUnprotected sexual behaviorUnprotected sexual behavior

Study Hypotheses:Study Hypotheses:

All 744 families in Familias Unidas III (DA-025192; PI:Prado), a family-therapy prevention effectiveness trial, willbe approached for participation throughout Miami-Dade.

The primary aims will examine whether new measures-- physical activity and built environment walkability --moderate the effectiveness of the intervention.

We will also explore:1) Whether physical activity and/or built environment

directly impact adolescent drug, alcohol, & cigarette use;2) The role of dopaminergic genes (dopamine receptor

D2 gene; and dopamine transport genes) and physicalactivity in drug/alcohol/cigarette use.

Proposed Study MethodsProposed Study Methods

Future research: Built Environment,Physical Activity, and Drug Abuse

BuiltEnvironment

PhysicalActivity

Reduced DrugAbuse

BuiltEnvironment

PhysicalActivity

Increases in DAand DA

Receptors

Reduced DrugAbuse

Dopaminergicsystem only onepossible pathway

In rats, access to a running wheelreduces self-administration of

cocaine (Cosgrove, Hunter, & Carroll, 2002),

amphetamine (Kanarek, Marks-Kaufman,D'Anci, & Przypek, 1995),

opiates (McLachlan, Hay, & Coleman, 1994),

ethanol (McMillan, McClure, & Hardwick,1995)

Physical Activity and DA/DRDA(Hattori, Naoi, & Nishino, 1994)

In rats, DA increased 130-140% afterrunning at moderate and high speed

Increases in DA synthesis persisted for upto 7 days

Increases in DA receptors persisted for upto 2 days

Interval and endurance running resulted ingreater increased D2 receptor densities inthe striatum when compared with nointervention controls (Gilliam et al., 1984).

Drug,

Alcohol &

Cigarette Use

Genes (Post-hoc)

•DRD2 (Dopamine D2

receptor gene, A1 allele)

•SLC6A3 (Dopamine

transporter, 10-repeat allele)

Condition

• Familias Unidas

•Community Practice

Post-hoc 2

Po

st-ho

c2

Aim

1

Aim

2

Aim

3A

im3

Post-hoc 1

Adolescent

Physical

Activity

Built

Environment

Built Environment and Health TeamBuilt Environment and Health TeamBehavioral ScientistsBehavioral ScientistsJosJoséé SzapocznikSzapocznikScott BrownScott BrownTatiana PerrinoTatiana PerrinoArnieArnie SpokaneSpokaneHilda PantinHilda PantinGuillermo PradoGuillermo PradoSeth SchwartzSeth SchwartzJennifer UngerJennifer UngerTiffanyTiffany LinkovichLinkovich KyleKyle

MethodologistsMethodologistsCraig MasonCraig MasonDaniel FeasterDaniel FeasterFred NewmanFred NewmanHendricks BrownHendricks Brown

GeographersGeographersMatthew ToroMatthew ToroRaehanna KarmallyRaehanna KarmallyJ. Miguel KanaiJ. Miguel Kanai

ArchitectsArchitectsJoanna LombardJoanna LombardFrank MartinezFrank MartinezElizabeth PlaterElizabeth Plater--ZyberkZyberk

Urban PlannerUrban PlannerLawrence FrankLawrence Frank

EndocrinologistsEndocrinologistsRonald GoldbergRonald GoldbergArmando MendezArmando Mendez

Exercise PhysiologistExercise PhysiologistArlette PerryArlette Perry

NutritionistsNutritionistsOlivia ThomasOlivia ThomasGianna PerezGianna Perez--GomezGomez

Health EconomistHealth EconomistMargaret ByrneMargaret Byrne

EpidemiologistEpidemiologistSandro GaleaSandro Galea

NeuroendocrinologistNeuroendocrinologistMahendra KumarMahendra Kumar

GeneticistsGeneticistsEvadnie RampersaudEvadnie RampersaudJanet AudrainJanet Audrain--McGovernMcGovern

Funding AgenciesFunding AgenciesNational Institute of Mental HealthNational Institute of Mental HealthNational Institute of Environmental Health SciencesNational Institute of Environmental Health SciencesNational Institute of Diabetes & Digestive & Kidney DiseasesNational Institute of Diabetes & Digestive & Kidney DiseasesNational Center on Minority Health and Health DisparitiesNational Center on Minority Health and Health DisparitiesRobert Wood Johnson FoundationRobert Wood Johnson Foundation

Completed, Ongoing, & Future ResearchCompleted, Ongoing, & Future Research

Completed ResearchCompleted Research–– Role of the Built Environment in Risk and Protection for Drug AbRole of the Built Environment in Risk and Protection for Drug Abuse:use:

Policy Implications (Robert Wood Johnson Foundation Grant No. RWPolicy Implications (Robert Wood Johnson Foundation Grant No. RWJFJF037377, Szapocznik, PI)037377, Szapocznik, PI)

–– Built Environment & Hispanic EldersBuilt Environment & Hispanic Elders’’ Behavioral Health (NIMH GrantBehavioral Health (NIMH GrantNo. MH 63709, Szapocznik, PI)No. MH 63709, Szapocznik, PI)

Ongoing ResearchOngoing Research–– Built Environment & Hispanic EldersBuilt Environment & Hispanic Elders’’ Health (NIA Grant No. AG 27527,Health (NIA Grant No. AG 27527,

Szapocznik, PI)Szapocznik, PI)

–– Hispanics, Built Environment & Metabolic Syndrome (NIDDK Grant NHispanics, Built Environment & Metabolic Syndrome (NIDDK Grant No.o.DK 74687,DK 74687, Szapocznik, PI)Szapocznik, PI)

Future ResearchFuture Research–– Neighborhood & Individual Risk for Obesity in Hispanics (SubmittNeighborhood & Individual Risk for Obesity in Hispanics (Submitted NIHed NIH

R21 exploratory grant proposal, Brown, PI)R21 exploratory grant proposal, Brown, PI)

–– Physical Activity, Built Environment & Preventing Hispanic YouthPhysical Activity, Built Environment & Preventing Hispanic Youth’’ssDrug Use (InDrug Use (In--progress NIH R01 grant proposal, Brown, PI)progress NIH R01 grant proposal, Brown, PI)

Questions?Questions?

Documents

The Built Environment &The Built Environment