The Built Environment & Hispanics’ Health Scott Brown, Ph.D. email@example.com 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?