Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease by John Maternoski

WHERE THE SIDEWALK ENDS THE ROLE OF DESIGN IN OBESITY AND DIET-RELATED DISEASE

JOHN M. MATERNOSKI

UNIVERSITY OF OREGON

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

ACKNOWLEDGEMENTS I would like to thank the following individuals for their kindness and support of this project. They have each taken time to assist me with research, interviews, site visits, and have shared invaluable resources with me. Without their help and support, this project would not have been possible.

Live Better Mobile, an initiative of Mobile United Mary Mullins, Project Director Downtown Mobile Alliance Elizabeth Sanders, President and CEO Carol Hunter, Communications Director Fred Rendfrey, Director of Downtown Economic Development MLK Avenue Redevelopment Corporation Michael Pierce, Executive Director Ben Brenner Designs Ben Brenner, Owner City of Mobile GIS Scott Kearney, GIS Manager Jimmy Doan, GIS Analyst 2

John M. Maternoski

TABLE OF CONTENTS

ACKNOWLEDGEMENTS 02

PART 03 // WHY THIS SITE?

INTRODUCTION 04

ADDRESSING THE ‘03

AN ASSET FOR THE COMMUNITY

PART 01 // WHY OBESITY?

SITE INFORMATION 22

OBESITY TRENDS IN AMERICA 06 THE CAUSES OF OBESITY 08

WORKS CITED

THE EFFECTS OF OBESITY 08

NOTES 24

HOW WALKABILITY CAN HELP 09

MAP DATA 26

THE ROLE OF CARS

PART O2 // WHY A GROCERY?

PHOTOGRAPHS 26

APPENDICIES

GROCERY VS. CONVENIENCE STORES

APPENDIX A: SITE PHOTOGRAPHS 29

THE EFFECTS OF A GROCERY STORE

APPENDIX B: ADDITIONAL DATA 37 03

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

INTRODUCTION In January of 2012, I participated in a week-long winter break trip to Mobile, Alabama, hosted by the University of Minnesota Habitat for Humanity Campus Chapter. Eight of my colleagues and I spent the week working with Habitat for Humanity of Southwest Alabama (HFHSWA) on several homes in suburban Mobile, as well as helping to complete work on the recently-moved Habitat ReStore and chapter offices. I was immediately taken back by the hospitality and kindness shown to our group by everyone we met while we were in Mobile, from the HFHSWA crew leaders to the staff and congregation of the Episcopal Church of the Redeemer, who hosted us during our trip. Furthermore, I was taken back by the charm of the city and of the area. To this day, I still consider Mobile to be one of the most overlooked and underrated cities in the United States - a true hidden gem in the American South. I would also be remiss to my friends in Mobile if I did not take this opportunity to share that Mobile is the proud home of the original Mardi Gras celebration, a fact far too often credited to nearby New Orleans.

University of Minnesota Habitat for Humanity Campus Chapter members at the build site in Mobile, Alabama; January, 2012. 04

John M. Maternoski

Because of the kindness and charm of the city, I continued to hold an affinity for Mobile long after the trip ended in early 2012. I made an effort to continue keeping up with news and events in Mobile after the trip, news that was often, unfortunately, dominated by tornadoes, tropical storms, oil spills and even an oil ship explosion. When the opportunity came in mid2013 to choose a site for a thesis project based on regenerative design, I knew that Mobile was the city I wanted to help, but struggled with exactly how. Because of the stories I had read in the news, my initial instinct was to research hurricanes, tornadoes and oil spills. After giving it some thought and conducting initial research, however, I discovered that while these events are catastrophic and certainly need attention, there is another catastrophic event happening every day that is not being well-addressed, and that affects 2/3 of Mobilians, and 2/3 of our nation. That catastrophe is the epidemic of being overweight or obese. Because Alabama consistently ranks in the top five most obese states year after year, and because Mobile’s largely autooriented layout is so typical of so many American cities, I decided that Mobile was a perfect compliment to a study of the affects of building and urban design on obesity and diet-related diseases.

While there are many factors involved in the cause of obesity, the factor of the physical environment is one that can have significant and positive benefits if it is properly addressed by urban planners and building designers, and can lead to positive changes in the behavioral and sociological factors that also contribute to obesity. I cannot guarantee that a well-designed space or a well-placed grocery store will send neighborhood obesity rates plummeting, but it is a very important first step. After months of research, I am happy to share my findings as they relate to Mobile in the following pages, but I am even more excited to report that I am not alone in identifying the critical role that design plays in fighting the obesity epidemic. Robert Ivy, FAIA, Chief Executive Officer of the American Institute of Architects (AIA,) recently wrote an article (http://www.aia.org/ practicing/AIAB100644 ) discussing the role of design in public health and in creating healthy communities, and calling on the profession to seriously address health through architecture.

organizations and independent studios that are pioneering the integration of health issues into design curriculums. Other schools are also taking on the issue, such as the Clemson School of Architecture, which offers an ‘Architecture + Health Concentration’ within its program. I look forward to entering a profession that so deeply cares about human health, and is on the verge of being more cognizant than ever of the role that design really does play on human health. I am grateful to have had the opportunity to study this in great detail at such an early point in my career, and am proud to share my findings of this study with you in the following pages.

Design schools are also starting to recognize the importance of public health in architecture and design. The University of Virginia School of Architecture’s Center for Design and Health and The University of Arkansas Community Design Center are research 05

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

PART 01 // WHY OBESITY?

1990

2000 NO DATA

<10%

10%-14%

2010

15%-19%

20%-24%

25%-29%

>30%

FIGURE 1 // PERCENT OF RESIDENTS OBESE, 1990-2010 [U.S. CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM]

OBESITY TRENDS IN AMERICA Until recently, an active lifestyle was something that was woven into the fabric of everyday life. Jobs were more physically demanding, chores required more physical effort, people walked to and from work and errands, and took the stairs instead of the elevator or escalator. Over the last hundred years or so, however, modern conveniences have crept into all aspects of everyday life, 06

simplifying daily activities while slowly eroding physical activity from daily life. Elevators have largely replaced stairs as the preferred mode of vertical transportation, cars have replaced walking or biking, machines have taken the place of manual labor for chores, and the surge of computer and office jobs has led to an increasingly sedentary lifestyle. As a result, more Americans than ever are reporting a lifestyle lacking

in physical activity. In fact, more than half of adults in the United States are not regularly physically active, and over 25% of Americans report no leisure-time physical activity at all5. This lack of activity has taken a huge toll on obesity rates in America. In the mid-1970s, about one in ten Americans were obese, while today that number has mushroomed to one in three, with an additional third of the population

John M. Maternoski

classified as overweight9. Men today weigh an average of 17 pounds more than they did as recently as the late 1970s, and women are an average of 19 pounds heavier9. State-by-state obesity rates in the United States can be seen in figure 1, which show rates climbing at an alarming rate in just a 20 year span of time. Children are also affected by the growing trend towards living a sedentary lifestyle. Over 61% of children ages nine to thirteen are reported as not

participating in organized physical activity outside of school, and over 22% of children are reported as not taking part in free-time physical activity of any kind5. Since 1980, childhood obesity has tripled and teenage obesity has more than quadrupled9. While a decrease in physical activity has been proven to lead to a rise in obesity, changing eating habits also play a critical role in contributing to the obesity epidemic. While the consumption of total fat and saturated

fat has been on the decline over the past 30 years, the consumption of calories and carbohydrates has been on the rise, along with the intake of sugars and soda7. As consumption rates have risen, portion sizes have also continued to grow, and the availability of prepackaged foods high in sugars and energy have also been on the uptick7. A flood of marketing and the typically low cost of these energy-rich foods make them all the more appealing to Americans, particularly those with low income levels7.

OBESITY

DEMOGRAPHIC + BIOLOGICAL

-AGE -GENDER -RACE -SOCIOECONOMIC STATUS

PSYCHOLOGICAL, COGNITIVE, EMOTIONAL

-KNOWLEDGE -ATTITUDE -BELIEFS -STRESS LEVELS

BEHAVIORAL ATTRIBUTES + SKILLS

SOCIAL + CULTURAL

-PAST HISTORY OF PHYSICAL ACTIVITY

-FAMILY SUPPORT -SOCIAL SUPPORT

THE PHYSICAL ENVIRONMENT

PHYSICAL ACTIVITY CHARACTERISTICS

-SIDEWALKS -ATTRACTIVE SCENERY

-INTENSITY OF ACTIVITY

FIGURE 2 // OBESITY FACTORS [FRUMKIN ET. AL.] 07

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

THE CAUSES OF OBESITY Obesity, overweight, and diet-related disease are the results of a wide range and complex set of factors. The factors can organized into six groups (shown graphically in figure 2)5: -Demographic and biological -Psychological, cognitive, emotional -Behavioral attributes and skills -Social and cultural -The physical environment -Physical activity characteristics For simplicity, these factors can be further distilled into three categories, as shown in figure 3. While demographic and biological factors such as genetics, age, race, and gender are important factors in the susceptibility of an individual becoming overweight, it is often the physical environment that plays a critical role in determining the probability of a group or a neighborhood of individuals becoming overweight or obese7. For the purposes of this report, the focus will be on the role that the physical environment plays in obesity, overweight, and diet-related disease. Access to transportation, access to quality food, the physical demand of particular jobs, and even food processing and marketing all play critical 08

roles in the physical environment that can have a significant affect on rates of obesity7. Unfortunately, many of these factors of the physical environment disproportionately affect the poor and those of lower socioeconomic status. Areas of higher poverty tend to have less grocery stores and more convenience stores, factors that have both been proven to contribute to obesity. This will be discussed in greater detail in the following pages. People living in poverty also tend to have less access to private vehicles, making access to food stores beyond their immediate range of walking more difficult6.

BEHAVIOR

GENETICS OBESITY

ENVIRONMENT

FIGURE 3 // OBESITY FACTORS [MORLAND ET. AL.]

In addition to wealth, racial segregation also has an affect on obesity rates. African American neighborhoods are often the result of past housing discrimination, which often included a lack of mobility and easy access to neighborhood services6. For these reasons and many more, most obesity studies have found that inactivity leading to obesity is higher among minorities, women, and the poor5. Regardless of race, gender, wealth, or any other genetic or socioeconomic factors, there are certain environmental factors that deter physical activity and propagate obesity. These are factors such as neighborhood safety, weather and the environment, and a lack of facilities and resources for people to be physically active5. THE EFFECTS OF OBESITY It is clear that Americans are continuing to grow more overweight and obese, but what are the ultimate consequences of this trend? Economically, the consequences of excessive weight to the United States is estimated to be over $110 billion for treatment and lost wages as a result of obesity7. From a health and safety standpoint, there are an immeasurable amount of consequences, beginning with the loss of 280,000300,000 deaths each year as a result of

John M. Maternoski

obesity, which now kills more Americans annually than smoking7,9. Obesity is often associated with depression, partly due to genetic traits linking the two conditions, and partly due to cause-and-effect relationships such as low self-esteem as a result of obesity5. People who are obese face a 40 times greater risk of developing type 2 diabetes, and increase their risk of high blood pressure, osteoarthritis, high cholesterol, asthma, and gall bladder disease5. Heart disease and heart attacks are up to four times more likely for people who are overweight or obese5. Mortality rates for people who are overweight or obese are as much as 2.5 times greater than those who are not obese5. HOW WALKABILITY CAN HELP While much of what is seen in media today regarding weight and obesity revolves around diets and food intake, the problem cannot be solved by healthier eating alone. Regular physical activity is also a critical part of the equation5. Physical activity does not just lower obesity rates, but has, in fact, been proven to prolong life, while lower rates of physical activity have been shown

to increase the risk of cardiovascular disease, stroke, and all-cause mortality5. Men who have the lowest amounts of physical activity have a â&#x20AC;&#x153;two-to threefold increased risk of dying overall, and a three-to fivefold increased risk of dying of cardiovascular diseaseâ&#x20AC;? than men who are more physically active5. Women who walk ten blocks or more per day decrease their risk of cardiovascular disease by a third5. It is currently recommended that adults engage in at least a half hour of moderate physical activity at least five days per week5. This activity can be accomplished through brisk walking, bicycling, and even gardening, and can be accomplished through multiple short activities of even ten minutes5. Environments that are designed to help neighborhood residents achieve this level of activity are needed now more than ever. Neighborhoods with nearby stores and destinations provide a wonderful opportunity for residents to walk instead of drive to accomplish their errands - trips that make up the majority of all trips that people make5. Walkable neighborhoods promote utilitarian exercise, a form of exercise that is the easiest for people to An informal path is embedded in the landscape as residents walk along streets devoid of sidewalks in suburban Mobile, Alabama; December, 2013. 09

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FIGURE 4 // THE MOST WALKABLE NEIGHBORHOODS IN MOBILE, ALABAMA [IMAGE: GOOGLE MAPS, DATA: WALK SCORE] 10

WALKABILITY IN MOBILE (APPROXIMATE)

IMAGE GOOGLE MAPS DATA WALK SCORE

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1 18

12 0

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FIGURE 5 // PUBLIC TRANSIT ROUTES IN MOBILE, ALABAMA [IMAGE: GOOGLE MAPS, DATA: THE WAVE TRANSIT] 11

TRANSIT NETWORK

IMAGE GOOGLE MAPS DATA THE WAVE TRANSIT

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

accomplish because it becomes a part of their daily routine, and is “secondary to other goals” making it easier to incorporate and maintain over time5. With this strategy, even people who practice no other forms of physical activity in a day can still achieve the recommended amount of exercise simply by walking to common destinations instead of driving. Additionally, walkable neighborhoods also make economic sense for developers, as people are willing to pay significantly more per square foot for apartments in walkable neighborhoods as opposed to those in suburban areas9. In Detroit, housing in walkable neighborhoods enjoy a 40% price premium over suburban neighborhoods9. In Seattle, that number is over 50%, and in Denver and New York, the premiums are 150% and 200%, respectively9.

THE ROLE OF CARS While walking can help to lower rates of obesity, driving can actually increase the risk, along with the risk of many other diseases and illnesses. A study in San Diego found that 60% of residents who lived in an auto-oriented neighborhood were obese, compared to only 35% of those who lived in a walkable neighborhood9. In Boston, a study revealed that the lowest body mass index (BMI) averages were concentrated in the central city and inner-ring suburbs, while the highest BMI averages were consistently found in Boston’s outer-ring, auto-oriented suburbs9. Yet another study, taking place in Atlanta, found that “for every additional five minutes commuters drove each day,

their likelihood of being obese rose 3%.9” Conversely, people who switch from driving to using public transit lose an average of five pounds9. Additionally, the stress of driving has been shown to increase the risk for disease and other ailments. People with longer commutes often report a lower satisfaction with life than those who drive less, shown in one study which revealed that “a 23 minute commute had the same effect on happiness as a 19% reduction in income.9” Asthma is steadily on the rise as a result of auto exhaust, especially in children who intake air at a quicker rate than adults, and who are more sensitive to air pollution5,9.

Cars pass by a series of fast food establishments in auto-oriented suburban Mobile, Alabama; December, 2013.

John M. Maternoski

PART 02 // WHY A GROCERY? GROCERY VS. CONVENIENCE STORES It stands to reason that those with access to fresher, higher-quality foods and produce would live healthier lives than those who do not enjoy similar access to grocery stores and supermarkets. In a study of grocery store availability in a selected area of Mobile, 13 grocery stores or supermarkets selling fresh produce were identified (figure 6.) In that same area, 54 convenience stores selling soda, chips, candy bars, and other traditional ‘junk food’ were identified (figure 7,) a convenience store-to-grocery store ratio of over 4:1. When overlaid with the areas of Mobile that were identified as having poverty rates of over 50% (figure 8,) 19 convenience stores were located within or immediately adjacent to these areas, while astonishingly, just one grocery store bordered one of these neighborhoods.

A typical supermarket in auto-oriented suburban Mobile, Alabama. The store’s location makes access difficult to those without a personal vehicle; December, 2013. 13

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FIGURE 6 // LOCATIONS OF GROCERY STORES IN MOBILE, ALABAMA [IMAGE AND DATA: GOOGLE MAPS] 14

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FIGURE 7 // LOCATIONS OF CONVENIENCE STORES IN MOBILE, ALABAMA [IMAGE AND DATA: GOOGLE MAPS] 15

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

This research study illustrates in Mobile what is already known nationwide - that “access to fruits, vegetables and other healthy foods is limited in many urban neighborhoods, particularly low-income communities1.”

THE EFFECTS OF A GROCERY STORE Does the simple placement of a grocery store or supermarket in a neighborhood really have lasting effects on the health of that neighborhood? A study published in a 2006 issue of the American Journal of Preventive Medicine asked just that. The result? Not only was supermarket availability proven to have a correlation with neighborhood obesity rates, but the proximity of convenience stores were actually correlated with an increase in neighborhood obesity rates7. “People living in areas where supermarkets and convenience stores are the only types of food stores available,” the study reports, “have a 35% higher prevalence of obesity compared to people who live in areas where supermarkets are the only type of food store available7.” After years of studies regarding obesity and active design both at the building scale and at the urban design scale, the 16

City of New York, under the direction of Mayor Michael Bloomberg, published a report entitled Active Design Guidelines. The publication was meant to be a list of principles that can be followed by New York (or any city) to use design to encourage active lifestyles and help combat obesity. In its report about land use mixes, locating “supermarkets and full-service grocery stores near places of work and residence” was one of the three strategies identified as being the most helpful in promoting healthier diets in a community1. Like the American Journal of Preventive Medicine study, Active Design Guidelines also targets grocery store availability as playing a lead role in lowering obesity rates, and also points to research finding that fast food restaurants, as well as convenience stores, lead to increased obesity rates among neighboring residents1. In addition to simply lowering neighborhood obesity rates, the presence of a local grocery store or supermarket also has a strong correlation with the “reduced prevalence of diet-related disease” such as diabetes, high blood pressure, osteoarthritis, high cholesterol, asthma, heart attacks, and gall bladder disease1,5. Additionally,

the presence of neighborhood grocery stores actually leads to lower food costs than neighborhoods lacking grocery stores and supermarkets1. For these reasons, and for the alignment with the site owner’s and Mobile master plan’s goals (see pages 18-21,) a grocery store has been chosen as the major attraction and major focus on the site for this project.

WALKING RADIUS When designing for walkability, the distance that people are willing to travel must be kept in mind. Studies indicate that the average American is willing to walk less than a quarter of a mile for errands, and sometimes as little as 400 feet5. Below are the percentage of Americans willing to walk 500, 1,000, and 2,500 feet for their errands5. 70%

40%

10%

500 ft.

1,000 ft.

2,500 ft.

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75%+ 0

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FIGURE 8 // AREAS OF MOBILE, ALABAMA WITH POVERTY RATES OF 50%+ [IMAGE: GOOGLE MAPS, DATA: CITY-DATA.COM] 17

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

PART 03 // WHY THIS SITE?

Initial sketches to diagram and understand the site and its potential

ADDRESSING THE â&#x20AC;&#x2DC;03 In a December 18, 2013 interview with Michael Pierce, Executive Director of the MLK Avenue Redevelopment Corporation (MLKARC,) Pierce suggested a site at 320 N Broad Street as being a site in particular need of development. Located in the 36603 ZIP Code, one of the ZIP Code areas of Mobile County identified as having residents with the highest health risks (see figure 10,) the area is already being targeted for growth and development. MLKARC has already developed 18

Lincoln Square Retail Center, located just north of the site (figure 9) in 19992. Lincoln Square is a 15,000 square foot retail center, providing services and retail outlets that are needed in a neighborhood community2. MLKARC is continuing its mission by constructing another retail center, Renaissance Plaza, adjacent to the 320 N Broad Street site (figure 9,) and under construction as of 2014. Renaissance Plaza will provide needed neighborhood services and amenities to neighborhoods surrounding the location, as well as serve the downtown business community2.

Both Renaissance Plaza and Lincoln Square bring employment opportunities to the neighborhood (Renaissance Plaza is projected to add 60 jobs to the area) and serve as catalyst projects to attract new commercial developments2.

AN ASSET FOR THE COMMUNITY MLKARC owns the 320 N Broad Street site and has expressed interest in a grocery store development, complimenting its existing and under-construction developments, and continuing to promote its

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LU T

FLORENCE HOWARD ELEMENTARY SCHOOL

ING

NEW MAJOR HOUSING DEVELOPMENTS

OA D

KEN

NED Y ST

* *

TO M

IDT OW N

400

DEARBORN YMCA COMMUNITY CENTER

MOBILE RESCUE MISSION

TO DOWNTOWN

ING

ST SS E R

N CO

CALLOWAY SMITH MIDDLE SCHOOL

AV E

BISHOP STATE COMMUNITY COLLEGE RENAISSANCE PLAZA

SPR

LINCOLN SQUARE RETAIL CENTER

HIL

L AV

800 FT

FIGURE 9 // PROPOSED SITE OF INTERVENTION [DASHED] AND IMMEDIATE SURROUNDING CONTEXT [IMAGE: GOOGLE MAPS] 19

ZIP CODES AT HIGHEST HEALTH RISK

IMAGE GOOGLE MAPS DATA MOBILE COUNTY HEALTH DEPARTMENT

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

36610 36617

36610

36603 36607

36603 36603

36605

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FIGURE 10 // ZIP CODE AREAS OF MOBILE, ALABAMA WITH THE HIGHEST OVERALL HEALTH RISK [IMAGE: GOOGLE MAPS, DATA: MOBILE COUNTY HEALTH DEPARTMENT] 20

ZIP CODES AT HIGHEST HEALTH RISK

IMAGE GOOGLE MAPS DATA MOBILE COUNTY HEALTH DEPARTMENT

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mission of “creat[ing] within the MLK community an environment conducive for community and economic redevelopment and the perpetual quality management and preservation of the community’s most valuable assets that include its residents, businesses, and property2.” Additionally, the 320 N Broad Street site has been identified in Mobile’s 2009 master plan, A New Plan for Mobile, as being a site envisioned to include a “higher quality local grocery store and supporting retail4.” The plan suggests that this type of development at this specific site would redirect spending downtown, create job opportunities for nearby residents, and serve both the downtown and midtown areas with grocery, retail, office, and mixed-use development4. For these reasons, aligning with the goals of both MLKARC and A New Plan for Mobile, the 320 N Broad Street site has been chosen as the focus area of this thesis, with the intent of designing a mixed-use retail development including a major grocery store.

A row of trees at sunset creating a buffer between the site and North Broad Street, on the north and west sides of the site; December, 2013. 21

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

SITE INFORMATION According to the City of Mobile8, The property at 320 N Broad Street is both part of both the Neighborhood Revitalization Strategic Area (figure 11) and the Community Block Grant Area. It is designated as a “Moderate Risk Area,” described by FEMA as an area with a 1% annual chance of flooding “where average depths are less than one foot3.” A New Plan for Mobile vision for 320 N Broad Street4: -9 to 10 acre site -100,000 square foot retail center -40,000-50,000 square foot grocery store Selected zoning information about the site, located in the Zone B-4 Central Business District, from the City of Mobile10: -Minimum building site area: none -Maximum building site coverage: 100% -Maximum height limit: unlimited -Yards required? no -Grocery: ok -Multi-family dwelling: ok

Looking beyond the site in the foreground, construction on neighboring Renaissance Plaza can be seen against the towers of downtown beyond; December, 2013. 22

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THE BOTTOM CRICHTON

TEXAS HILLS

OAKDALE

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FIGURE 11 // CITY OF MOBILE NEIGHBORHOOD REVITALIZATION STRATEGIC AREAS [IMAGE: GOOGLE MAPS, DATA: CITY OF MOBILE] 23

NEIGHBORHOOD RENEWAL PROGRAM

IMAGE GOOGLE MAPS DATA CITY OF MOBILE

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

WORKS CITED NOTES Bloomberg, Michael, David Burney, Thomas Farley, Janette Sadik-Khan, and Amanda Burden. City of New York. Department of Design and Construction, et. al. Active Design Guidelines: Promoting Physical Activity and Health in Design. New York: City of New York, 2010. Print. This book is the culmination of a multi-year study by the City of New York of building and urban design, researching layout, amenities, signage, and other features that can be incorporated into the design of the built environment to promote health and physical activity among users. 1

“Commercial Development.” MLK Avenue Redevelopment Corporation. MLK Avenue Redevelopment Corporation, n.d. Web. 05 Jan 2014. <http://mlkarc.com/ commercial.asp>. This website contains valuable information about the MLK Avenue Redevelopment Corporation including its mission, projects that it has completed, and projects that are upcoming. 2

“Definitions of FEMA Flood Zones.” FEMA Map Service Center. Federal Emergency Management Agency. Web. 05 Jan 2014. <https://msc.fema. gov/webapp/wcs/stores/servlet/info?storeId=10001&catalogId=10001&lang Id=-1&content=floodZones&title=FEMA%20Flood%20Zone%20Designations>. This website answered questions about the specific flood zone of the project site, including information about how much water is expected to collect at the site in the event of a flood, and at what approximate frequency. 3

EDSA, Inc, . Mobile, Alabama. The City of Mobile. A New Plan for Mobile: An Urban Planning, Design and Economic Development Plan. 2009. Print. This is the 2009 master plan for the city of Mobile, containing detailed information regarding current and future plans for all parts of the city. Specifically, it details the envisioned land uses in and around the project site.

John M. Maternoski

Frumkin, Howard, Lawrence Frank, and Richard Jackson. Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities. Washington, DC: Island Press, 2004. Print. This book provides a wealth of facts, figures, and statistics linking urban sprawl to negative health impacts. The book takes into account architecture, urban design, and transportation in its research of public health. The book also discusses public policy challenges in incorporating design beneficial to human health.

Morland, Kimberly, Steve Wing, Ana Diez Roux, and Charles Poole. “Neighborhood Characteristics Associated with the Location of Food Stores and Food Service Places.” American Journal of Preventive Medicine. 22.1 (2001): 23-29. Print. This article studies and releases findings of disparities in food access across neighborhoods and groups of individuals, as well as studies food store location in relation to wealth and racial segregation. 6

Morland, Kimberly, Ana Diez Roux, and Steve Wing. “Supermarkets, Other Food Stores, and Obesity: The Atherosclerosis Risk in Communities Study.” American Journal of Preventive Medicine. 30.4 (2006): 333-339. Print. This article discusses the study of food store location and access to food as it relates to health risk factors and cardiovascular disease. It discusses the findings that food store locations can have an affect in preventing obesity and diet-related disease. 7

“My Place.” City of Mobile. City of Mobile Geographic Information Systems. Web. 05 Jan 2014. <http://maps.cityofmobile.org/myplace/myplace.html>. This webservice is used to learn pragmatic information about the project site. 8

Speck, Jeff. Walkable City: How Downtown can Save America, One Step at a Time. New York: Farrar, Straus and Giroux, 2012. Print. This book explores the idea of walkability in cities, explaining the factors that can quickly and easily help to make a city more walkable. The book offers case studies and examples of decisions that can have long-lasting, beneficial effects on city planning and public health. 9

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

“Urban Development: Land Use Administration Section / GIS (Zoning).” Mobile Urban Development Department. The City of Mobile, n.d. Web. 29 Dec 2013. <http://urban.cityofmobile.org/landuse.php>. This webservice is used to learn pragmatic information about the project site as it relates to zoning laws and public ordinances. 10

MAP DATA Figure 1 // U.S. CDC Behavioral Risk Factor Surveillance System http://www.cdc.gov/obesity/data/adult.html Figure 2 // Frumkin, Howard, Lawrence Frank, and Richard Jackson. Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities. Washington, DC: Island Press, 2004. Print. Figure 3 // Morland, Kimberly, Ana Diez Roux, and Steve Wing. “Supermarkets, Other Food Stores, and Obesity: The Atherosclerosis Risk in Communities Study.” American Journal of Preventive Medicine. 30.4 (2006): 333-339. Print. Figure 4 // Walk Score http://www.walkscore.com/ Figure 5 // The Wave Transit http://www.thewavetransit.com/ Figure 6 // Google Maps https://maps.google.com/ Figure 7 // Google Maps https://maps.google.com/

John M. Maternoski

Figure 8 // City-Data.com http://www.city-data.com/ Figure 9 // Google Maps https://maps.google.com/ Figure 10 // Mobile County Health Department http://www.mobilecountyhealth.org/ Figure 11 // City of Mobile http://maps.cityofmobile.org/citymap/index.html

PHOTOGRAPHS All photographic images were taken by the author or are otherwise property of the author unless otherwise noted.

APPENDIX A: SITE PHOTOGRAPHS

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

IMAGE A.01 // VIEW OF SIDEWALK CONDITION DOWN CONGRESS ST, SITE ON RIGHT OF IMAGE 30

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IMAGE A.02 // CURRENT CONDITION OF EAST END OF SITE, CONSTRUCTION OF RENAISSANCE PLAZA SHOWN 31

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

IMAGE A.03 // VIEW OF WEST END OF SITE 32

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IMAGE A.04 // OVERALL VIEW OF SITE 33

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

IMAGE A.05 // VIEW OF NEIGHBORING BISHOP STATE COMMUNITY COLLEGE, NEARBY THE SITE 34

John M. Maternoski

IMAGE A.06 // VIEW OF NEARBY MLK AVENUE REDEVELOPMENT CORPORATION’S RENAISSANCE PLAZA UNDER CONSTRUCTION 35

APPENDIX B: ADDITIONAL DATA

Where the Sidewalk Ends: The Role of Design in Obesity and Diet-Related Disease

MOBILE COUNTY HEALTH ZIP CODES AT RISK MOBILE COUNTY HEALTH DEPARTMENT ZCTA

Post Office

State

Total Population

% Pop. in Poverty % Low-Income Pop.

% Non-White

36603 Mobile AL 7922 42% 67% 90% 36610 Mobile AL 13209 42% 69% 99% 36602 Mobile AL 1057 37% 52% 44% 36612 Prichard AL 4541 36% 71% 94% 36605 Mobile AL 30111 33% 58% 73% 36617 Mobile AL 13967 32% 63% 99% 36607 Mobile AL 6852 32% 55% 62% 36604 Mobile AL 10456 24% 47% 50% 36611 Chickasaw AL 6106 24% 49% 37% 36522 Citronelle AL 7183 24% 42% 27% 36521 Chunchula AL 5431 22% 39% 12% 36606 Mobile AL 18733 22% 48% 55% 36509 Bayou La Batre AL 1983 21% 52% 43% 36560 Mount Vernon AL 3690 20% 55% 76% 36609 Mobile AL 25846 18% 40% 47% 36544 Irvington AL 12476 18% 43% 22% 36541 Grand Bay AL 15647 17% 37% 16% 36582 Theodore AL 24624 17% 39% 23% 36587 Wilmer AL 12053 17% 40% 8% 36613 Eight Mile AL 12749 16% 37% 49% 36608 Mobile AL 36864 15% 35% 33% 36528 Dauphin Island AL 1237 15% 40% 3% 36523 Coden AL 2818 14% 50% 9% 36571 Saraland AL 14423 14% 31% 16% 36619 Mobile AL 14269 14% 35% 11% 36525 Creola AL 1935 14% 30% 15% 36575 Semmes AL 18345 12% 32% 11% 36618 Mobile AL 16737 11% 28% 59% 36505 Axis AL 1481 11% 24% 24% 36695 Mobile AL 45118 8% 21% 22% 36693 Mobile AL 17847 7% 23% 27% 36572 Satsuma AL 6340 7% 25% 12% 38

John M. Maternoski

Mobile (MO)

Health Outcom es Mortality Premature death Morbidity Poor or fair health Poor phy sical health day s Poor mental health day s Low birthweight Health Factors Health Behav iors Adult smoking Adult obesity Phy sical inactiv ity Ex cessiv e drinking Motor v ehicle crash death rate Sex ually transmitted infections Teen birth rate Clinical Care Uninsured Primary care phy sicians** Dentists** Prev entable hospital stay s Diabetic screening Mammography screening Social & Econom ic Factors High school graduation** Some college Unemploy ment Children in pov erty Inadequate social support Children in single-parent households V iolent crime rate Phy sical Env ironm ent Daily fine particulate matter Drinking water safety Access to recreational facilities Limited access to healthy foods** Fast food restaurants

Mobile County

Error Margin

Alabam a

National Benchm ark*

1 0,1 88

9,844-1 0,532

9,609

5,31 7

22% 4.4 4.5 1 1 .9%

20-24% 3.9-4.8 4.0-5.0 1 1 .6-1 2.3%

20% 4.2 4.1 1 0.4%

1 0% 2.6 2.3 6.0%

Rank (of 67 ) 39 31 47

33 37 24% 32% 31 % 1 5% 23 7 85 59

22-26% 30-34% 29-33% 1 3-1 7 % 22-25

1 9% 1 ,7 1 4:1 2,246:1 72 83% 64%

1 7 -20%

58-61

23% 33% 31 % 1 2% 23 562 49

1 3% 25% 21 % 7% 10 92 21

17 % 1 ,641 :1 2,488:1 80 84% 65%

11% 1 ,067 :1 1 ,51 6:1 47 90% 7 3%

69-7 5 80-85% 61 -67 %

47 64% 56% 1 0.1 %

54-58%

7 2% 56% 9.0%

7 0% 5.0%

30% 24% 44% 61 2

26-34% 22-27 % 42-46%

28% 23% 37 % 427

1 4% 1 4% 20% 66

1 1 .8 0% 7 11% 55%

1 1 .7 -1 1 .9

1 2.9 1% 7 8% 54%

8.8 0% 16 1% 27 %

* 90th percentile, i.e., only 1 0% are better. ** Data should not be compared with prior y ears due to changes in definition. Note: Blank v alues reflect unreliable or missing data

201 3