Examining the Relationship between Design Quality Indicators of the Built Environment and Health Status of Youth in Rural Pennsylvania
Numerous studies have linked health (and obesity in particular) to the active living opportunities close to where people live. Moreover, it is likely that the attractiveness of the sidewalks and parks in the community also have an effect on willingness to be physically active. This study looks at the relationship between body mass index (BMI) as a measure of obesity, and thus health; neighborhood walkability; and perceived attractiveness as measured by a design quality indicators analysis (DQI). This study is set in rural Pennsylvania. Many towns are characterized by a town morphology that has elements of design linked to walking: high density, mixed-land use, prevalence of street trees, and minimal building setbacks. Studies have found that people who walk generally have a lower BMI, and residents of walkable neighborhoods are more likely to walk. Instruments have been developed that calculate the walkability of neighborhoods based on existing infrastructure (including, for example, street connectivity and density). However, while a town may provide the physical infrastructure to walk, it may not be perceived as walkable due to safety and/or aesthetic reasons. Aesthetics, or design quality indicators (DQIs), are inherently subjective, and while there are validated instruments that include design quality factors, none focus exclusively on design quality. This study focused first on developing an instrument to operationalize features of the built environment related to DQIs. A sample of 30 municipalities located across rural PA was selected, and the DQI Survey was utilized to assess each. BMI data for youth living within each of the sample municipalities was obtained and analyzed to examine the relationship between the DQI Survey outcomes and the BMI data. As a control, the objective walkability of each sample was also calculated through a reliable and validated Walkability Index (WI) (Frank, et al., 2006). While the relationship between the WI, DQI, and BMI was largely inconclusive due to the limitations resulting from the available aggregate level BMI data, there were three significant outcomes from this study: (1) focus group outcomes indicate that there are two primary motivations for walking in youth: socialization and relaxation, which are linked to preference for environmental setting: urban or natural; (2) the DQI Survey, developed through this study, is a reasonable instrument to assess design quality; features of the built environment at the street scale that are linked to active living; and, (3) the preliminary categorization method utilized for sampling is an appropriate alternative to the WI, which can be time and resource intensive for rural areas lacking sufficient GIS data. This study lays the foundation for further refinement of the DQI Survey, including further exploration of the link between BMI and WI-DQI and youth motivations for walking. This project is significant in light of the obesity epidemic in the United States, and the realization of the important role played by the built environment in facilitating or discouraging active living. By examining the relationship between walkability (a measure of the objective walking infrastructure), DQI (a measure of the subjective features), and health (i.e. BMI) this study contributes to our understanding of the role of design quality factors in impacting health.