The Built Environment & Hispanics’
Health
Scott Brown, Ph.D.
sbrown@med.miami.edu
Coauthors:
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 of
Medicine, Miami, Florida.
2University of Miami School of
Architecture, Coral Gables, Florida.
3University of Maine College of
Education and Human Development,
Orono, Maine.
4Lehigh University College of
Education, Bethlehem, Pennsylvania.
Built Environment & Health Team, Miller School of Medicine & School of Architecture, University of Miami
Photo of Grove Park, East Little Havana, by Frank Martinez, 2007
Theoretical Model
Built Environment
Macrosystem
Exosystem
Social Connectedness
Monitoring of Children/
Support for Parenting
Social Support
Adolescent Behavior
School Records
RWJ Funding
Elder’s Health/Mental Health
NIA/NIMH/NIEHS Funding
Microsystem
Individual
Diversity of Use and Conduct Grades
Built Environment
(Diversity of Use)
Social Connectedness/
Neighboring Behavior
Monitoring of Children/
Support for Parenting
Child School Outcomes
Macrosystem
Exosystem
Microsystem
Behavior
Funded by the RWJ Grant No. 037377 and NIMH/NIEHS Grant No. MH 63709
East Little Havana
 Universe of children (n=2857) in East Little
Havana
 Archival data from school records- conduct grades
 Block-level diversity of use

All 3857 lots in 403 blocks of
East Little Havana were coded
for mixed use
Mixed Use & Conduct Grades
in Hispanic Boys
(Szapocznik et al., 2006; AJCP)
3.10
3.05
Grade
3.00
Residential
2.95
Commercial
Mixed
2.90
2.85
2.80
Residential
Commercial
Male
Mixed
Built Environment and Elders’
Health
Funded by NIMH/NIEHS Grant No. MH63709 and
NIA Grant No. AG27527
(PI: J. Szapocznik; Co-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 Environment “Eyes on the Street”
Above Grade
Stoop
Porch
Design
 Population based sample.
 16,000 households in East Little Havana
enumerated for Hispanic elders > 70 years.
 273 elder-blocks were included in the final study –
1 elder per block.
 Elders assessed at baseline, 12, 24, 36, and 54
months post baseline.
 Built environment coded before baseline.
“Eyes on the Street” (Jacobs, 1961)
Above Grade
Window Area
Stoop
Low Sill Height
Porch
Ground Floor Parking
Built environment predicts physical functioning
(Brown et al., 2008, EHP)
PRE-BASELINE
(2000-2002)
BASELINE
12 MONTHS
24 MONTHS
Above Grade
Stoop
Porch
.19
FRONT
ENTRANCE
PHYSICAL
FUNCTIONING*
.22
Window Area
-.18
-.24
SOCIAL
SUPPORT
Low Sill
-.55
-.32
-.17
PSYCHOLOGICAL
DISTRESS*
Grd. Parking
Small Setback
Χ2(121) = 161.283, p = .008
Χ2/df = 1.333
CFI = .95
RMSEA = .035
*Controls for age, gender, and income
Hispanics,
Built Environment & Metabolic
Syndrome
Funded by NIDDK Grant No. DK74687 (PI: J. Szapocznik)
The Metabolic Syndrome
 In visceral obesity, adipocites, particularly in the
visceral organs, secrete proteins that cause insulin
resistance and additional glucose production,
increase levels of triglycerides, reduced good (low
density lipoproteins), increase inflammatory
enzymes, such as CRP, which results in
atherosclerosis and hypertension. Finally, with
visceral obesity adiponectin is reduced. Adiponectin
improves insulin sensitivity and reduces
inflammation.
 Physical activity seems to protect from MetS by
reducing visceral adiposity.
Indicators of the Metabolic Syndrome

Metabolic syndrome (MetS) is the clustering of various
interrelated abnormalities, linked with increased risk of Type II
diabetes 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; >88
cm for women;
2) high blood pressure: >130/85 mm Hg
3) 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;
Obesity (BMI > 30) Trends Among U.S. Adults
Behavioral Risk Factor Surveillance System (BRFSS),
1991, 1996, 2003, & 2007
2007
Behavioral Research Factor Surveillance System, CDC http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm
Behavioral Research Factor Surveillance System, CDC http://www.cdc.gov/diabetes/statistics/maps/
Physical Activity and Obesity
From Schilling & Linton, 2004
Growth of Sprawl
(from H. V. Savitch, 2003; J. Urban Health)
How does New Urbanism
provide an alternative to
Sprawl?
www.vtsprawl.org
Mixed-use/Density/
Pedestrian
Infrastructure/
Aesthetics
New Urbanist projects
provide mixed uses
within a 5-minute walk,
making the use of the
car a choice rather than
a necessity.
Diagram by DPZ
Proposal for Kendall Drive Miami, Florida, by Dover Kohl
Kendall Drive, Miami, Florida
Connectivity
Interconnectivity of routes and the
dimensioning of roadways
encourages pedestrian activity.
Diversity of mixed uses within a 5minute walk provides desirable
destinations as well as walkability
Diagram by DPZ
Study on Built Environment
and Metabolic Syndrome
 390 new Cuban immigrants ages 30 to 45 are recruited
within 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 environment
walkability of their zip code (high, medium, low) and
gender.
 Longitudinal design, participants tested at baseline, 12-month,
and 24-month post-baseline.
 Built environment is assessed by objective measures of
mixed use, street connectivity, and street density.
 Plasma stored for future genetic analysis and study of related
biochemistry.
National Institute on Diabetes, Digestive & Kidney Diseases Grant No. DK 74687
ENVIRONMENT
BEHAVIOR
BIOLOGY
OUTCOME
Insulin
Resistance
Resistance
Built
Environment
Adiposity
Metabolic
Syndrome
Physical
Activity
Social
Environment
Inflammation
Controlling for diet
Neighborhood & Individual Risk
for Obesity in Hispanics
R21 Study Proposal Submitted to NHLBI (PI: S. Brown)
Fig. 1:
Conceptual Model of Neighborhood and Individual Risk for Obesity
PREDICTORS
BEHAVIORS
OUTCOME
NEIGHBORHOOD
Aim 3
 Built Environment Walkability
 Food Environment
 Socioeconomic Conditions
Aim 1
PHYSICAL
ACTIVITY
ADIPOSITY
DIET
INDIVIDUAL
STRESS RISK
 Coping, Support, Perceived Stress
 Salivary Cortisol Activity
Aim 2
Built Environment, Physical Activity &
Hispanic Teen Drug Use & HIV Risk
Supplemental Study Proposal in Progress for NIDA
(PI: S. Schwartz; Co-PI: S. Brown)
Built Environment (walkability) is
associated 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);
Conceptual Model for NIDA Study Concept:
BUILT ENVIRONMENT
CONTROL VARIABLES:
•Individual Demographics
•Peer & Parental Substance Use
•Neighborhood Socioeconomic Conditions
•Neighborhood Crime & Pedestrian Safety
ADOLESCENT PROBLEM
BEHAVIORS
Physical Activity Reduced
Substance Use in Humans
 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).
Conceptual Model for NIDA Study Concept:
ADOLESCENT
PHYSICAL ACTIVITY
BUILT ENVIRONMENT
CONTROL VARIABLES:
•Individual Demographics
•Peer & Parental Substance Use
•Neighborhood Socioeconomic Conditions
•Neighborhood Crime & Pedestrian Safety
ADOLESCENT PROBLEM
BEHAVIORS
Built Environment, Social Environment,
& Adolescent Outcomes
 Supportive social processes have been associated
with 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 been
shown to reduce risk for adolescent problem
behaviors through improved family functioning
(Prado et al., 2006; Prado, Pantin, et al., in press).
Conceptual Model for NIDA Study Concept:
ADOLESCENT PROBLEM
BEHAVIORS
BUILT ENVIRONMENT
SUPPORT FOR
PARENTING
CONTROL VARIABLES:
•Individual Demographics
•Peer & Parental Substance Use
•Neighborhood Socioeconomic Conditions
•Neighborhood Crime & Pedestrian Safety
FAMILY
FUNCTIONING
Conceptual Model for NIDA Study Concept:
ADOLESCENT
PHYSICAL ACTIVITY
ADOLESCENT PROBLEM
BEHAVIORS
BUILT ENVIRONMENT
SUPPORT FOR
PARENTING
CONTROL VARIABLES:
•Individual Demographics
•Peer & Parental Substance Use
•Neighborhood Socioeconomic Conditions
•Neighborhood Crime & Pedestrian Safety
FAMILY
FUNCTIONING
Physical Activity, Built Environment &
Preventing Hispanic Youth’s Drug Use
R01 Study Proposal In Progress for NIDA (PI: S. Brown)
Built
Culture
God/Church
ic y
Pol
tion
Parent Job
ce
Ecodevelopmental Model
of Human Development
(Szapocznik & Coatsworth, 1999)
Im m
igra
INTERFACE
ci a
So
ue n
I nf l
AA/NA self-help
ns
di a
Me
Neighborhood
Friend’s Family
INTERFACE
INTERFACE
School
Peer
it io
INTERFACE
Family
nd
Co
lC
on
di
tio
ic
om
on
ns
Parent Support Networks
Ec
Environment
Ecodevelopmental Prevention
Intervention
 Familias Unidas is an existing ecodevelopmental
prevention intervention, shown to be efficacious in
preventing adolescent drug, alcohol, and cigarette
use (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 for
investigating “In which contexts do prevention
interventions work?”
Familias Unidas Effectiveness Study
Study Hypotheses:
Proposed mediator
Family functioning
Intervention conditions
Familias Unidas
Community Practice
Outcomes
Cigarette use
Illicit drug use
Unprotected sexual behavior
Proposed Study Methods
 All 744 families in Familias Unidas III (DA-025192; PI:
Prado), a family-therapy prevention effectiveness trial, will
be 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 physical
activity in drug/alcohol/cigarette use.
Future research: Built Environment,
Physical Activity, and Drug Abuse
Built
Environment
Reduced Drug
Abuse
Physical
Activity
Built
Environment
Reduced Drug
Abuse
Physical
Activity
Increases in DA
and DA
Receptors
Dopaminergic
system only one
possible pathway
In rats, access to a running wheel
reduces 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% after
running at moderate and high speed
 Increases in DA synthesis persisted for up
to 7 days
 Increases in DA receptors persisted for up
to 2 days
 Interval and endurance running resulted in
greater increased D2 receptor densities in
the striatum when compared with no
intervention controls (Gilliam et al., 1984).
Built
Environment
Genes (Post-hoc)
Aim 3
•DRD2 (Dopamine D2
receptor gene, A1 allele)
•SLC6A3 (Dopamine
Adolescent
Physical
Post-hoc 2
Activity
Aim 3
Aim 2
Condition
Po
s
Post-hoc 2
Aim 1
transporter, 10-repeat allele)
t-h
oc
1
Drug,
• Familias Unidas
Alcohol &
•Community Practice
Cigarette Use
Built Environment and Health Team
Behavioral Scientists
José Szapocznik
Scott Brown
Tatiana Perrino
Arnie Spokane
Hilda Pantin
Guillermo Prado
Seth Schwartz
Jennifer Unger
Tiffany Linkovich Kyle
Methodologists
Craig Mason
Daniel Feaster
Fred Newman
Hendricks Brown
Geographers
Matthew Toro
Raehanna Karmally
J. Miguel Kanai
Architects
Joanna Lombard
Frank Martinez
Elizabeth Plater-Zyberk
Urban Planner
Lawrence Frank
Endocrinologists
Ronald Goldberg
Armando Mendez
Exercise Physiologist
Arlette Perry
Nutritionists
Olivia Thomas
Gianna Perez-Gomez
Health Economist
Margaret Byrne
Epidemiologist
Sandro Galea
Neuroendocrinologist
Mahendra Kumar
Geneticists
Evadnie Rampersaud
Janet Audrain-McGovern
Funding Agencies
National Institute of Mental Health
National Institute of Environmental Health Sciences
National Institute of Diabetes & Digestive & Kidney Diseases
National Center on Minority Health and Health Disparities
Robert Wood Johnson Foundation
Completed, Ongoing, & Future Research
 Completed Research
– Role of the Built Environment in Risk and Protection for Drug Abuse:
Policy Implications (Robert Wood Johnson Foundation Grant No. RWJF
037377, Szapocznik, PI)
– Built Environment & Hispanic Elders’ Behavioral Health (NIMH Grant
No. MH 63709, Szapocznik, PI)
 Ongoing Research
– Built Environment & Hispanic Elders’ Health (NIA Grant No. AG 27527,
Szapocznik, PI)
– Hispanics, Built Environment & Metabolic Syndrome (NIDDK Grant No.
DK 74687, Szapocznik, PI)
 Future Research
– Neighborhood & Individual Risk for Obesity in Hispanics (Submitted NIH
R21 exploratory grant proposal, Brown, PI)
– Physical Activity, Built Environment & Preventing Hispanic Youth’s
Drug Use (In-progress NIH R01 grant proposal, Brown, PI)
Questions?