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The Role of the Geographic Information Systems Infrastructure in Childhood Obesity Prevention
The Role of the Geographic Information Systems Infrastructure in Childhood Obesity Prevention Perspective from the Robert Wood Johnson Foundation Celeste Marie Torio, PhD, MPH
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hildhood obesity is a serious public health epidemic. Childhood obesity rates have soared in just 4 decades, nearly tripling in children aged 2–5 years and 12–19 years, while quadrupling in children and adolescents aged 6 –11 years.1,2 Recent estimates from the National Health and Nutrition Examination Survey report that 17% of children and adolescents aged 2–19 years are overweight.2 Genetics, although a partial explanation for excess weight, is not the cause of the soaring rates of childhood obesity. Changes in human genetic composition have not occurred during the time period over which the epidemic has developed; rather, societal changes that have occurred in the past 4 decades have fueled the epidemic.3 Children today engage much less with the world outside their homes in terms of physical activity and much more in terms of eating.4 Sadly, inactivity and unhealthful eating have become the social norm in many communities across the nation,3 resulting in energy imbalance. Such an imbalance impedes the reversal of the childhood obesity epidemic. For reversal to occur, energy balance must be maintained. Energy balance is defıned by the simple equation: energy intake ⫽ energy expenditure.3 Achieving energy balance seems very simple: People should consume less and move often. Given the multitude of factors that affect both energy intake and energy expenditure among children and adolescents, attaining normal weight remains both elusive and complex. These factors include genetic, biological, psychological, social, policy, and environmental determinants of diet and physical activity levels, as well as BMI.3 To fully understand the multifaceted nature of
From the Robert Wood Johnson Foundation Address correspondence to: Celeste Marie Torio, PhD, MPH, Program Lead, Science of Public Reporting Initiative, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, 540 Gaither Road, Rockville MD 20850. E-mail: [email protected] 0749-3797/$36.00 doi: 10.1016/j.amepre.2012.02.003
childhood obesity, a geographic perspective should be considered. In fact, many of the contributing factors to childhood obesity (particularly social, policy, and environmental determinants) have place-to-place variation and can be referenced to a particular location. A geographic perspective, however, can only be possible through the use of GIS. A computer-based system, GIS transforms spatial or geographic data into a visual representation of the dynamic connections among people, their health and well-being, and changes in the physical and social environment.5 It models complex reality by breaking it down to layers of information, represented by points, lines, areas, and images, covering a wide range of geography. GIS essentially allows for the simultaneous examination of multiple variables and their complex interactions across a variety of contexts. This makes it possible to investigate spatial patterns of disease outcomes in the population, to generate or test hypotheses of incidence and prevalence of disease, to develop theoretical and conceptual frameworks on health outcomes, and to intervene to reduce the risk in burdened populations.6,7 The methods and technology of GIS are rapidly evolving, are increasingly becoming a part of a methodologic arsenal across several disciplines, and are currently transforming research.7 However, GIS is still in the relatively early stages of application in the fıeld of childhood obesity. Looking toward the future, GIS may help enhance our understanding of how the multitude of factors and their interactions influence childhood obesity, and help us reverse this epidemic.
Mission and Goals of the Robert Wood Johnson Foundation The Robert Wood Johnson Foundation (the Foundation) has made a public commitment to reverse childhood obesity by 2015, defıning it as an urgent threat to the health of children in the U.S. The Foundation is uniquely
© 2012 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
Am J Prev Med 2012;42(5):513–515
513
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Torio / Am J Prev Med 2012;42(5):513–515
positioned to play a high-profıle role in making childhood obesity a top-priority national issue. It is well respected by policymakers and opinion leaders; it can leverage its reputation as the nation’s largest health philanthropy; and it is among the few institutions with the resources, experience, and influence to tackle a serious public health epidemic. In April 2007, the Foundation announced its pledge of $500 million to reverse the trend of childhood obesity, the largest donation toward the issue on record. To reverse the childhood obesity epidemic, the Foundation aims to change policies and environments in ways that result in increased physical activity in schools and communities and in the consumption of more nutritious foods and healthy beverages, especially among children at greatest risk (which include black, Latino, American Indian, Alaska Native, AsianAmerican, and Pacifıc Islander children, and children from lower-income communities). The Foundation particularly focuses on six policy priority areas: (1) ensure that all foods and beverages served and sold in schools meet or exceed the most recent dietary guidelines for Americans; (2) increase access to high-quality, affordable foods through new or improved grocery stores and healthier corner stores and bodegas; (3) increase the time, intensity, and duration of physical activity during the school day and in out-of-school programs; (4) increase physical activity by improving the built environment; (5) use pricing strategies to promote the purchase of healthier foods; and (6) reduce youth exposure to unhealthy food marketing through regulation, policy, and effective industry selfregulation. To change policies and environments, the Foundation invests in three interlocking and reinforcing strategies: building the evidence for what works to increase physical activity and improve nutrition among children; using the evidence to guide action at the community, state, and federal levels; and translating fındings into resources for advocates and decision makers.
Relevance of the GIS to the Robert Wood Johnson Foundation’s Strategic Objectives With its unique features and capabilities, GIS allows for the integration of the Foundation’s three-pronged strategic approach of building evidence, stimulating action, and fueling advocacy to reverse the trend of childhood obesity by 2015, especially in high-risk populations and communities. Not only will GIS integrate the three strategies, but its powerful features and capabilities will move us closer to achieving our objective of reversing the childhood obesity epidemic by 2015. GIS can provide mea-
sures of the availability and accessibility of healthy foods; the diversity of stores in the food environment; the walkability of a community; and the availability of private and public resources enabling physical activity such as recreation and activity centers, parks, trails, and bike paths. It can also track spatial behavior and measure access to built-environment resources and social risks and problems.7–11 GIS would help to advance the fıve approaches that the Foundation defınes as critical for reversing this epidemic—providing healthier foods to students at school; improving availability of healthy foods at home; increasing the frequency, intensity, and duration of physical activity at schools; improving access to safe places where children can play; and limiting screen time—and provide a powerful advocacy tool to compel critical policy and practice changes. A powerful tool, GIS will allow the Foundation to have the potential to capitalize on emerging opportunities and prioritize needs, both those of the Foundation and its grantees. It can promote a comprehensive approach (based on the multifactorial nature of childhood obesity) that can broaden the platform for reversing the epidemic and document disparities in obesity risks and identify populations at greatest risk. GIS can serve to foster collaborations and alliances of multiple stakeholders to promote coordinated efforts and a more integrated (and perhaps a more innovative) approach in reversing childhood obesity, while also documenting and disseminating success stories. The publication of this theme article was supported by a grant from the Robert Wood Johnson Foundation. No fınancial disclosures were reported by the author of this paper. Dr. Torio was employed at the Robert Wood Johnson Foundation during the time this commentary was written.
References 1. NCHS. Prevalence of overweight among children and adolescents: U.S., 2003–2004. www.cdc.gov/nchs/products/pubs/ pubd/hestats/overweight/overwght_child_03.htm. 2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999 –2004. JAMA 2006;295(13):1549 –55. 3. IOM. Preventing childhood obesity: health in the balance. Washington DC: National Academies Press, 2005. 4. Hillier A. Childhood overweight and the built environment: making technology part of the solution rather than part of the problem. Ann Am Acad Polit Soc Sci 2008; 615(1):56 – 82. 5. Cromley E, McLafferty S. GIS and public health. 1st ed. New York NY: Guilford Press, 2002. 6. Klassen AC, Platz EA. What can geography tell us about prostate cancer? Am J Prev Med 2006;30(2S):S7–S15. www.ajpmonline.org
Torio / Am J Prev Med 2012;42(5):513–515 7. Matthews SA, Moudon AV, Daniel M. Work Group II: using geographic information systems for enhancing research relevant to policy on diet, physical activity, and weight. Am J Prev Med 2009;36(4S):S171–S176. 8. Atkinson JL, Sallis JF, Saelens BE, Cain KL, Black JB. The association of neighborhood design and recreational environments with physical activity. Am J Health Promot 2005;19(4):304 –9. 9. Frank LD, Sallis JF, Conway TL, Chapman JE, Saelens BE. Multiple pathways from land use to health: walkability associations with active transportation, body mass index, and air quality. J Am Plann Assoc 2006;72:75– 87.
10. Morland K, Wing S, Roux AVD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med 2002;22(1):23–9. 11. Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health 2005;95(4):660 –7.
Supplementary data A pubcast created by the authors of this paper can be viewed at www.ajpmonline.org/content/video_pubcasts_collection.
Did you know? The AJPM online archive includes issues back to 1998. Visit www.ajpmonline.org today!
May 2012
515
C
hildhood obesity is a serious public health epidemic. Childhood obesity rates have soared in just 4 decades, nearly tripling in children aged 2–5 years and 12–19 years, while quadrupling in children and adolescents aged 6 –11 years.1,2 Recent estimates from the National Health and Nutrition Examination Survey report that 17% of children and adolescents aged 2–19 years are overweight.2 Genetics, although a partial explanation for excess weight, is not the cause of the soaring rates of childhood obesity. Changes in human genetic composition have not occurred during the time period over which the epidemic has developed; rather, societal changes that have occurred in the past 4 decades have fueled the epidemic.3 Children today engage much less with the world outside their homes in terms of physical activity and much more in terms of eating.4 Sadly, inactivity and unhealthful eating have become the social norm in many communities across the nation,3 resulting in energy imbalance. Such an imbalance impedes the reversal of the childhood obesity epidemic. For reversal to occur, energy balance must be maintained. Energy balance is defıned by the simple equation: energy intake ⫽ energy expenditure.3 Achieving energy balance seems very simple: People should consume less and move often. Given the multitude of factors that affect both energy intake and energy expenditure among children and adolescents, attaining normal weight remains both elusive and complex. These factors include genetic, biological, psychological, social, policy, and environmental determinants of diet and physical activity levels, as well as BMI.3 To fully understand the multifaceted nature of
From the Robert Wood Johnson Foundation Address correspondence to: Celeste Marie Torio, PhD, MPH, Program Lead, Science of Public Reporting Initiative, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, 540 Gaither Road, Rockville MD 20850. E-mail: [email protected] 0749-3797/$36.00 doi: 10.1016/j.amepre.2012.02.003
childhood obesity, a geographic perspective should be considered. In fact, many of the contributing factors to childhood obesity (particularly social, policy, and environmental determinants) have place-to-place variation and can be referenced to a particular location. A geographic perspective, however, can only be possible through the use of GIS. A computer-based system, GIS transforms spatial or geographic data into a visual representation of the dynamic connections among people, their health and well-being, and changes in the physical and social environment.5 It models complex reality by breaking it down to layers of information, represented by points, lines, areas, and images, covering a wide range of geography. GIS essentially allows for the simultaneous examination of multiple variables and their complex interactions across a variety of contexts. This makes it possible to investigate spatial patterns of disease outcomes in the population, to generate or test hypotheses of incidence and prevalence of disease, to develop theoretical and conceptual frameworks on health outcomes, and to intervene to reduce the risk in burdened populations.6,7 The methods and technology of GIS are rapidly evolving, are increasingly becoming a part of a methodologic arsenal across several disciplines, and are currently transforming research.7 However, GIS is still in the relatively early stages of application in the fıeld of childhood obesity. Looking toward the future, GIS may help enhance our understanding of how the multitude of factors and their interactions influence childhood obesity, and help us reverse this epidemic.
Mission and Goals of the Robert Wood Johnson Foundation The Robert Wood Johnson Foundation (the Foundation) has made a public commitment to reverse childhood obesity by 2015, defıning it as an urgent threat to the health of children in the U.S. The Foundation is uniquely
© 2012 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
Am J Prev Med 2012;42(5):513–515
513
514
Torio / Am J Prev Med 2012;42(5):513–515
positioned to play a high-profıle role in making childhood obesity a top-priority national issue. It is well respected by policymakers and opinion leaders; it can leverage its reputation as the nation’s largest health philanthropy; and it is among the few institutions with the resources, experience, and influence to tackle a serious public health epidemic. In April 2007, the Foundation announced its pledge of $500 million to reverse the trend of childhood obesity, the largest donation toward the issue on record. To reverse the childhood obesity epidemic, the Foundation aims to change policies and environments in ways that result in increased physical activity in schools and communities and in the consumption of more nutritious foods and healthy beverages, especially among children at greatest risk (which include black, Latino, American Indian, Alaska Native, AsianAmerican, and Pacifıc Islander children, and children from lower-income communities). The Foundation particularly focuses on six policy priority areas: (1) ensure that all foods and beverages served and sold in schools meet or exceed the most recent dietary guidelines for Americans; (2) increase access to high-quality, affordable foods through new or improved grocery stores and healthier corner stores and bodegas; (3) increase the time, intensity, and duration of physical activity during the school day and in out-of-school programs; (4) increase physical activity by improving the built environment; (5) use pricing strategies to promote the purchase of healthier foods; and (6) reduce youth exposure to unhealthy food marketing through regulation, policy, and effective industry selfregulation. To change policies and environments, the Foundation invests in three interlocking and reinforcing strategies: building the evidence for what works to increase physical activity and improve nutrition among children; using the evidence to guide action at the community, state, and federal levels; and translating fındings into resources for advocates and decision makers.
Relevance of the GIS to the Robert Wood Johnson Foundation’s Strategic Objectives With its unique features and capabilities, GIS allows for the integration of the Foundation’s three-pronged strategic approach of building evidence, stimulating action, and fueling advocacy to reverse the trend of childhood obesity by 2015, especially in high-risk populations and communities. Not only will GIS integrate the three strategies, but its powerful features and capabilities will move us closer to achieving our objective of reversing the childhood obesity epidemic by 2015. GIS can provide mea-
sures of the availability and accessibility of healthy foods; the diversity of stores in the food environment; the walkability of a community; and the availability of private and public resources enabling physical activity such as recreation and activity centers, parks, trails, and bike paths. It can also track spatial behavior and measure access to built-environment resources and social risks and problems.7–11 GIS would help to advance the fıve approaches that the Foundation defınes as critical for reversing this epidemic—providing healthier foods to students at school; improving availability of healthy foods at home; increasing the frequency, intensity, and duration of physical activity at schools; improving access to safe places where children can play; and limiting screen time—and provide a powerful advocacy tool to compel critical policy and practice changes. A powerful tool, GIS will allow the Foundation to have the potential to capitalize on emerging opportunities and prioritize needs, both those of the Foundation and its grantees. It can promote a comprehensive approach (based on the multifactorial nature of childhood obesity) that can broaden the platform for reversing the epidemic and document disparities in obesity risks and identify populations at greatest risk. GIS can serve to foster collaborations and alliances of multiple stakeholders to promote coordinated efforts and a more integrated (and perhaps a more innovative) approach in reversing childhood obesity, while also documenting and disseminating success stories. The publication of this theme article was supported by a grant from the Robert Wood Johnson Foundation. No fınancial disclosures were reported by the author of this paper. Dr. Torio was employed at the Robert Wood Johnson Foundation during the time this commentary was written.
References 1. NCHS. Prevalence of overweight among children and adolescents: U.S., 2003–2004. www.cdc.gov/nchs/products/pubs/ pubd/hestats/overweight/overwght_child_03.htm. 2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999 –2004. JAMA 2006;295(13):1549 –55. 3. IOM. Preventing childhood obesity: health in the balance. Washington DC: National Academies Press, 2005. 4. Hillier A. Childhood overweight and the built environment: making technology part of the solution rather than part of the problem. Ann Am Acad Polit Soc Sci 2008; 615(1):56 – 82. 5. Cromley E, McLafferty S. GIS and public health. 1st ed. New York NY: Guilford Press, 2002. 6. Klassen AC, Platz EA. What can geography tell us about prostate cancer? Am J Prev Med 2006;30(2S):S7–S15. www.ajpmonline.org
Torio / Am J Prev Med 2012;42(5):513–515 7. Matthews SA, Moudon AV, Daniel M. Work Group II: using geographic information systems for enhancing research relevant to policy on diet, physical activity, and weight. Am J Prev Med 2009;36(4S):S171–S176. 8. Atkinson JL, Sallis JF, Saelens BE, Cain KL, Black JB. The association of neighborhood design and recreational environments with physical activity. Am J Health Promot 2005;19(4):304 –9. 9. Frank LD, Sallis JF, Conway TL, Chapman JE, Saelens BE. Multiple pathways from land use to health: walkability associations with active transportation, body mass index, and air quality. J Am Plann Assoc 2006;72:75– 87.
10. Morland K, Wing S, Roux AVD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med 2002;22(1):23–9. 11. Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health 2005;95(4):660 –7.
Supplementary data A pubcast created by the authors of this paper can be viewed at www.ajpmonline.org/content/video_pubcasts_collection.
Did you know? The AJPM online archive includes issues back to 1998. Visit www.ajpmonline.org today!
May 2012
515