Lawrence D Frank

University of British Columbia | UBC · School of Population and Public Health

Associations of built and natural environment and bike infrastructure features with neighborhood-level hypertension and obesity prevalence across the U.S. are not well explored. Identifying the environmental determinants of neighborhood-level disease prevalence can support community-based nonpharmacologic interventions. Additionally, little is know...

Walkable neighborhoods provide significant sustainability, health, and motorized user safety benefits. Far less consideration is given to the potential pedestrian/bicyclist safety-related implications of macro-level walkability. Making it desirable to walk and bike without providing the proper physical environment to make it safe is clearly problem...

Most adolescents do not meet physical activity guidelines, so understanding facilitators and barriers is important. This study used surveys and geocoded location data to examine associations of availability of parks and recreation facilities with adolescent-reported participation in organized team sports and physical activity classes. The study was...

Background Ecological models suggest that interventions targeting specific behaviors are most effective when supported by the environment. This study prospectively examined the interactions between neighborhood walkability and an mHealth intervention in a large-scale, adequately powered trial to increase moderate-to-vigorous physical activity (MVPA...

Objectives: Neighborhood walkability is favorably related to multiple physical health outcomes, but associations with social health are less clear. Present analyses examined how neighborhood walkability was related to neighborhood social health and explored the potential confounding role of neighborhood self-selection. Methods: Cross-sectional d...

Introduction Physical activity is important for children’s health and well-being. Supportiveness for physical activity of home and neighborhood environments may affect children’s PA, but most studies are cross-sectional. We examined environmental predictors of change in children’s physical activity over two years. Methods Data were from the longit...

Background A better understanding of the extent to which psychosocial and environmental correlates of physical activity are specific to locations would inform intervention optimization. Purpose To investigate cross-sectional associations of location-general and location-specific variables with physical activity and sedentary time in three common l...

Background The COVID-19 pandemic disrupted life in extraordinary ways impacting health and daily mobility. Public transit provides a strategy to improve individual and population health through increased active travel and reduced vehicle dependency, while ensuring equitable access to jobs, healthcare, education, and mitigating climate change. Howev...

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probab...

In September 2015, a new light rail transit (LRT) line opened in metro Portland, Oregon, USA. We used this natural experiment to conduct an interrupted time series analysis of the effects of LRT introduction on health care costs. We hypothesized that such costs would decline over time based on demonstrated health benefits of increased transit-relat...

Evidence connecting health care expenditures with physical activity and built environment is rare. We examined how detailed urban form relates to mode specific moderate-to-vigorous physical activity (MVPA) and health care costs—controlling for transit access, residential choices/preferences, sociodemographic factors. We harness high resolution data...

Introduction Greater transit use is associated with higher levels of physical activity, which is associated with lower health risks and better health outcomes. However, there is scant evidence about whether health care costs differ based on level of transit ridership. Methods A sample (n = 947) of members of Kaiser Permanente in the Portland, Oreg...

Background and objective No research to date has causally linked built environment data with health care costs derived from clinically assessed health outcomes within the framework of longitudinal intervention design. This study examined the impact of light rail transit (LRT) line intervention on health care costs after controlling for mode-specifi...

Objective: The Neighbourhood Environments in Waterloo: Patterns of Active Transportation and Health (NEWPATH) study examined built environment influences on travel, physical activity, food consumption, and health. This collaboration between researchers and practitioners in health and transportation planning is the first, to our knowledge, to integ...

Background Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable...

As evidence of the health impacts of transportation investments has grown, planners have increasingly used health impact assessments (HIAs) to evaluate transportation plans, projects, and policies. Most HIAs to date, however, have been limited in their ability to quantify health impacts due to a lack of validated methods and tools, scarcity of disa...

Background There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels. Objectives To examine how features of the built and natural environments relate to hyperten...

Most of the existing literature concerning the links between built environment and COVID-19 outcomes is based on aggregate spatial data averaged across entire cities or counties. We present neighborhood level results linking census tract-level built environment and active/sedentary travel measures with COVID-19 hospitalization and mortality rates i...

Objectives The use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency i...

Purpose Findings are reported from the original study that supported the creation and validation of the current road network-based (“Street Smart”) version of Walk Score. It shows how Street Smart Walk Score improved upon the former “airline” (Euclidean, crow-fly or straight-line) distance method. It further compares the ability to predict objectiv...

Compact walkable environments with greenspace support physical activity and reduce the risk for depression and several obesity-related chronic diseases, including diabetes and heart disease. Recent evidence confirms that these chronic diseases increase the severity of COVID-19 infection and mortality risk. Conversely, denser transit supportive envi...

Introduction Assessment and counseling by healthcare providers can successfully increase physical activity; however, a valid instrument to effectively measure physical activity is needed. This study examines the validity of the Exercise Vital Sign tool by comparing Exercise Vital Sign data collected at Kaiser Permanente Northwest with accelerometry...

This study evaluates changes in cycling trips before and after the construction of an urban greenway in Vancouver, Canada. Urban cycling has gained in popularity as a healthy and environmentally friendly mode of transport. Carsharing is also on the rise globally, and it has the potential to disrupt urban mobility, including cycling and public trans...

Introduction Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and...

A novel evidence-based methodology is presented for determining place-based thresholds of objectively measured built environment features’ relationships with active travel. Using an innovative machine-learning based Generalized Additive Modeling framework, systematic heterogeneity fundamental to the development of well-justified and objective envir...

Background Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors. Methods In total,...

This study uses residential relocation as a unique opportunity to assess how a change in exposure to different physical environments impacts walking. Few studies have successfully used a residential relocation "pre-post" study design to isolate the causal effect of urban form on travel behavior. Using a pre-post sample of 223 participants (2012–201...

Background Investigation of physical activity and dietary behaviors across locations can inform “setting-specific” health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in...

Public health impacts of transportation policies and infrastructure investment are becoming better understood, particularly for those associated with physical activity. Yet health impacts are not routinely evaluated within the context of the development of a Regional Transportation Plan (RTP) and subsequent programming and investment processes. Thi...

Creating more physical activity–supportive built environments is recommended by the World Health Organization for controlling noncommunicable diseases. The IPEN (International Physical Activity and Environment Network) Adult Study was undertaken to provide international evidence on associations of built environments with physical activity and weigh...

The study aimed to examine associations of neighborhood built environments and proximity of food outlets (BE measures) with body weight status using pooled data from an international study (IPEN Adult). Objective BE measures were calculated using geographic information systems for 10,008 participants (4463 male, 45%) aged 16-66 years in 14 cities....

Background: To examine relations between parents' perceived neighborhood recreation environments and multiple measures of adolescent physical activity (PA). Methods: Participants (N = 928; age 14.1 [1.4] y, 50.4% girls, and 33.4% nonwhite/Hispanic) and their parents were recruited. Teen moderate to vigorous PA (MVPA) was assessed with 7-day acce...

Background and purpose: A growing body of evidence documents multiple ways in which land use and transportation investments influence health. To date, most evidence linking the built environment to health either focuses on behavioral change or environmental exposures. Few studies simultaneously assess how behavior and exposure-based impacts of the...

Understanding neighborhood preferences remains a key focus for planners. While many studies document the effects of either neighborhood design or neighborhood preference on health and travel behavior, few have explored their combined effect in smaller regions. Using a sample of 2,597 adults in the Region of Waterloo, Ontario, we found an unmet dema...

Less is known about how neighborhood environments relate to sedentary time as compared to physical activity. This study examined relations of perceived and objective neighborhood environments with TV time, total screen time, total sedentary time, sedentary time at home, sedentary time in the home neighborhood, and time spent at home, in 524 12-16 y...

Background The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outco...

Studies of the built environment and physical activity (PA) have primarily been cross-sectional. Evidence on the causal impacts of transportation improvements on PA and sedentary behavior (SB) is lacking. This study assessed the effect of retrofitting an urban greenway on PA and SB in Vancouver, Canada. A sample of 524 participants (median age of 4...

(1) Background: Findings from observational studies of relations between neighborhood environments and health outcomes underscore the importance of both objective and perceived experiences of those environments. A clearer understanding of the factors associated with discrepancies between these two assessment approaches is needed to tailor public he...

[This corrects the article DOI: 10.1016/j.pmedr.2018.03.008.].

Objective: The aim of this study was to examine 2-year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments. Methods: A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Child...

There is mounting evidence linking land development and transportation investments to physical activity with resulting implications for chronic disease prevention. Links between the physical environment and health have traditionally focused on harmful exposures such as air pollution, noise, and traffic injury. Given limited funds and competition fo...

Purpose: To investigate whether adolescents cluster into profiles based on where they accumulate moderate-to-vigorous physical activity (MVPA), if overall MVPA differs across profiles, and if walking to school and participant and neighborhood characteristics explain profile membership. Methods: Adolescents (N=528; mean age=14.12±1.44; 50% girls)...

Purpose: To investigate relations of perceived worksite neighborhood environments to total physical activity and active transportation, over and above home neighborhood built environments. Design: Observational epidemiologic study. Setting: Baltimore, Maryland-Washington, DC, and Seattle-King County, Washington metropolitan areas. Participant...

This study examines the moderating effect of perceived safety on the association of green space with neighborhood social capital in older adults. Green space may play an important role for promoting neighborhood social capital and health for older adults; however, safety remains a significant challenge in maximizing the benefits of green space. Dat...

Numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage in a flow diagram.

Literature search protocol.

New rapid transit investments have been motivated by environmental, economic, and health benefits. Given transit's potential to increase active travel, recent research leverages transit changes for natural experiment studies to examine physical activity outcomes. We aimed to quantify the association size, critically examine existing literature, and...

b>Methods MAPS-Global was developed by compiling concepts and items from eight environmental measures relevant to walking and bicycling. Inter-rater reliability data were collected in neighborhoods selected to vary on geographic information system (GIS)-derived macro-level walkability in five countries (Australia, Belgium, Brazil, Hong Kong-China,...

Introduction: The study examined the association of neighborhood walkability to multiple activity-related outcomes and BMI among adolescents and evaluated socioeconomic status as an effect modifier. Method: Cross-sectional study, with adolescents recruited from neighborhoods that met criteria for a 2 × 2 matrix defined by high/low GIS-defined wa...

There is mounting evidence linking transportation investments and land development with walking and other physical activity, which has implications for chronic disease prevention. Links between the physical environment and health have traditionally focused on harmful exposures such as air pollution, noise, and traffic injury. Given limited funds an...

Background: Evidence for an association between transportation noise and cardiovascular disease has increased; however, few studies have examined metabolic outcomes such as diabetes or accounted for environmental coexposures such as air pollution, greenness, or walkability. Objectives: Because diabetes prevalence is increasing and may be on the...

Several systematic reviews have reported mixed associations between access to parks and physical activity, and suggest that this is due to inconsistencies in the study methods or differences across countries. An international study using consistent methods is needed to investigate the association between access to parks and physical activity. The I...

Background Youth are active in multiple locations, but it is unknown whether more physical activity in one location is associated with less in other locations. This cross-sectional study examines whether on days with more physical activity in a given location, relative to their typical activity in that location, youth had less activity in other loc...

The present study examined independent and interacting associations of psychosocial and neighborhood built environment variables with adolescents' reported active transportation. Moderating effects of adolescent sex were explored. Mixed-effects regression models were conducted on data from the Teen Environment and Neighborhood observational study (...

Background: The after-school period provides an opportune context for adolescent physical activity. This study examined how characteristics of after-school recreation environments related to adolescent physical activity. Methods: Participants were 889 adolescents aged 12-17 (M = 14.1, SD = 1.4) from two US regions. Adolescents reported on whethe...

Background Advancements in geographic information systems over the past two decades have increased the specificity by which an individual’s neighborhood environment may be spatially defined for physical activity and health research. This study investigated how different types of street network buffering methods compared in measuring a set of common...

Growing evidence suggests that microscale pedestrian environment features, such as sidewalk quality, crosswalks, and neighborhood esthetics, may affect residents’ physical activity. This study examined whether disparities in microscale pedestrian features existed between neighborhoods of differing socioeconomic and racial/ethnic composition. Using...

Trial registration: clinicaltrials.gov Identifier=NCT01072500.

The purpose of this study was to enhance the understanding of the health-promoting potential of trees in an urbanized region of the United States. This was done using high-resolution LiDAR and imagery data to quantify tree cover within 250 m of the residence of 7910 adult participants in the California Health Interview Survey, then testing for main...

Background Studies identifying correlates of physical activity (PA) at all levels of the ecological model can provide an empirical basis for designing interventions to increase older adults’ PA. PurposeApplying ecological model principles, this study concurrently examined individual, psychosocial, and environmental correlates of older adults’ PA to...

Background: Though park presence and access disparities are well studied for their associations with physical activity (PA), disparities in the availability and quality of amenities and facilities within parks have been infrequently examined. Methods: Five hundred forty-three parks from 472 block groups in the Seattle, WA and Baltimore, MD regio...

Background: Physical inactivity is a global pandemic responsible for over 5 million deaths annually through its effects on multiple non-communicable diseases. We aimed to document how objectively measured attributes of the urban environment are related to objectively measured physical activity, in an international sample of adults. Methods: We b...

Purpose: The purpose of this study was to examine the association between adolescent and parental perceptions of neighborhood safety and adolescents' physical activity in multiple locations and to investigate the moderating effect of sex within this association. Method: This cross-sectional study was conducted with 928 adolescents aged 12 to 16...

Objective: The present study aimed to: (i) examine associations between food store patronage and diet and weight-related outcomes; and (ii) explore consumer motivations for visiting different types of food store. Design: A stratified probability sample of residents completed household and individual-level surveys in 2009/2010 on food purchasing...

There is growing evidence that communities can be designed to support physical activity, but it is important to understand whether neighborhood features related to health are also considered satisfactory by residents. The study aimed to determine if there is an association between perceived and objective neighborhood environment variables and neigh...

Objectives: To compare adolescents' physical activity at home, near home, at school, near school, and at other locations. Methods: Adolescents (N = 549) were ages 12 to 16 years (49.9% girls, 31.3% nonwhite or Hispanic) from 447 census block groups in 2 US regions. Accelerometers and Global Positioning System devices assessed minutes of and prop...