Will moving into social and affordable housing in the Athletes' Village increase family physical activity levels? Evaluation of a natural experiment

Lead Research Organisation: St George's University of London
Department Name: Inst of Medical & Biomedical Education

Abstract

It is assumed that where you live has an impact on your health; this is often given as a reason for poor health amongst those living in less privileged surroundings. There have been a number of large-scale housing regeneration projects over the years, which aim to improve the living conditions and lifestyles of those living in low cost housing. However, these projects are long-term (often taking a decade or so to complete), making it difficult to demonstrate effects on lifestyle above those taking place over time. Effects of the built environment on physical activity levels are of particular interest as higher physical activity levels have a beneficial impact on a wide range of health outcomes. The specific provision of social and affordable housing provided by the Athletes' Village after the London 2012 Olympic Games (available from 2013) offers a unique opportunity to examine whether and how the 'built environment' affects physical activity patterns and body size in adults and children moving into the area. We will recruit a cohort of families before the Village accommodation becomes available, and follow up those that move into the Village, and compare physical activity patterns with those in families that do not move to the Village over a 2 year period. We will measure how the built environment is used in terms of walkability, ease of access, convenience of use etc., and how perceptions of the local environment influence its use, e.g. perceived levels of safety, social interactions and cohesion etc. Physical activity patterns will be assessed using accurate movement sensors, body size will be measured objectively using bio-electrical impedance. Geographical positioning systems will be employed to trace patterns of use of the local environment. While the short time scale of the intervention is unique, the findings will be generalisable, informing future design of residential developments that are destined to take place elsewhere. The key to public value of the proposal is that: (i) evidence based policy requires evidence on whether environmental changes thought to benefit residents actually do; (ii) the cost of evaluations such as that proposed is small compared to the costs of building and compared to the potential health benefit; (iii) small changes distributed widely in the population have the potential to deliver major health benefits; (iv) such benefits can only be identified by carefully designed evaluations of natural experiments. Finally we recognize the importance of disseminating our findings; we believe our proposed pathway to dissemination, including a stake holder forum including individuals identified by our extensive network of contacts, will provide this.

Technical Summary

We propose to examine whether people moving into the Athletes' Village increase their physical activity levels to a greater extent than people who do not. To observe the impact of this natural experiment, a two-year longitudinal (cohort) study will be carried out, examining changes in physical activity levels in 600 families which move into the Village (intervention) with 600 families which do not. Participants (who apply to live in social and affordable homes in the Village) will be studied initially in their current place of residence and then either in the Villlage (intervention) or the same place of residence (controls). Changes in physical activity (measured objectively using Actigraph monitors) and body build (including bio-electrical impedance) occurring in families living in the Village will be compared with changes occurring in those living in surrounding boroughs. Research objectives will examine:-
(i) whether families living in social and affordable housing in the Village show a sustained change in their physical activity levels, compared to their levels before moving into the Village, and by comparison with physical activity changes in families outside the Village.
(ii) whether any increase in physical activity in children and adults living in the Village is directly attributable to use of their local built environment, and if so, which facilities.
(iii) whether changes in physical activity patterns in families living in the Village are modified by other factors including age, gender, ethnicity, proximity to facilities, perceived social cohesion and safety, social class / employment status.
(iv) we will examine (i) in relation to adiposity as well as physical activity levels.
The study will provide proof of principle that the built environment can increase physical activity levels. Results will inform evidence-based urban planning that will happen in the future, and the way in which environmental changes impact on health inequalities.

Planned Impact

The social rented sector (including accommodation rented from local authorities and housing associations) accounts for 3.6 million properties in England. Trends in the supply of social and affordable housing have increased over the last decade. The biggest increase has been in the affordable sector, with 58,000 additional affordable home being supplied in England from 2009 to 2010. In London, as elsewhere, there is a shortage of affordable housing and Strategic Housing Market Assessment (SHMA) estimates that at least 33,000 new homes, including 18,000 affordable homes, are needed every year. A target has been set by the London Mayor of delivering 50,000 affordable homes, of which 30,000 will be socially rented, by March 2012 (25,000 have been provided in the last 2 years). A number of housing activities are ongoing in London; these include the Kidbroke estate Greewich which will provide 1500 new affordable homes, Woodberry down in Hackney 2300, Clapham Park in Lambeth will provide 85 new affordable homes but will see a major regeneration of existing housing stock. The Athletes Village will also contribute to this housing stock, with 1400 new homes, but will be unique in providing these in a short space of time (within a year). While other initiatives are ongoing and future projects are needed to address the demand for new housing, it is important to appreciate the effect of these new built environments on health and health behaviour (physical activity levels) in both the young and old, privileged and less privileged. The findings from this study will identify features of new housing that result in higher physical activity levels, providing evidence-based recommendations for future builds which are needed to keep up with current demand. As such, there are many housing providers outside the academic community who will benefit from these findings. A major drive of this initiative will be to disseminate these findings to these individuals, using the network of contacts and stakeholders that we are currently involved with. It is important to recognise that these findings are generalisable to the wider provision of housing in major conurbations, both at a national and international level, in order to provide built environments which encourage healthy living.

Publications

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Clary C (2020) Longitudinal impact of changes in the residential built environment on physical activity: findings from the ENABLE London cohort study. in The international journal of behavioral nutrition and physical activity

 
Description NIHR Public Health Programme Call - Walking and Cycling
Amount £607,327 (GBP)
Funding ID 12/211/69 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 05/2014 
End 03/2017
 
Title Data supporting "Weekend and weekday associations between the residential built environment and physical activity: findings from the ENABLE-London Study" 
Description Data supporting "Weekend and weekday differences in associations between the residential built environment and physical activity: findings from the ENABLE-London Study"

The Examining Neighbourhood Activities in Built Living Environments in London (ENABLE London) study is a natural experiment. The primary aims were to examine whether objectively measured physical activity levels and body fatness showed change after two years, amongst individuals who moved to East Village compared with a control population who did not move to East Village. East Village is the former London 2012 Olympic Athletes' Village repurposed to provide social, affordable and market-rent accommodation with high levels of walkability and close proximity to improved public transport. Other data collected include mental health and wellbeing, mode of travel and information on the participants' built environment where they were living. A description of the baseline cohort, results from the main follow-up analysis and other secondary follow-up analyses of the data have already been published and are referenced below. These data relate to baseline analyses of the built environment data.

A cohort of 1278 adults aged 16+ who were looking to move into three different housing tenures in East Village was recruited between January 2013 and January 2016. Ethical approval was granted by City Road and Hampstead Review Board (REC reference number 12LO1031). The three housing tenures were social, intermediate (affordable market-rent/shared ownership/shared equity) and market-rent and were used as a marker of socio-economic status. Follow-up of participants was carried out two years after their baseline examination when approximately half the cohort had moved to East Village. Information was collected on participants at baseline and follow-up using computer-assisted self-complete questionnaires and physical examination (height, weight, body fat). Participants were asked to wear an accelerometer for seven consecutive days to objectively measure their physical activity. For those participants living in Greater London at baseline (n=1064), their residential locations were used to derive a range of built environment factors including walkability, distance to parks and accessibility to public transport.

The aims of this study were to assess whether at baseline, the residential built environment was associated with physical activity on week days and weekend days separately. Also, to explore two possible pathways in which the built environment may contribute to household-level socio-economic differences in physical activity levels.

The dataset available includes the variables listed below. There are restrictions on the availability of these data due to the signed consent agreements around data security, which only allow access to external researchers for research monitoring purposes. Requestors wishing to access the data for the purposes of replicating or checking our analyses should contact the SGUL RDM service at researchdata@sgul.ac.uk.

Variables available
Demographics: sex, age group, ethnic group, housing group

Residential built environment variables at baseline: walkability, distance to closest local park, distance to closest district park, distance to closest metropolitan park, accessibility to public transport (Transport for London PTAL score)
Physical activity variables at baseline: average adjusted daily steps on week days and weekend days, average adjusted minutes of moderate-to-vigorous-physical-activity (MVPA) on week days and weekend days. 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? Yes  
URL https://sgul.figshare.com/articles/dataset/Data_supporting_Weekend_and_weekday_associations_between_...
 
Title Data supporting "Weekend and weekday associations between the residential built environment and physical activity: findings from the ENABLE-London Study" 
Description Data supporting "Weekend and weekday differences in associations between the residential built environment and physical activity: findings from the ENABLE-London Study"

The Examining Neighbourhood Activities in Built Living Environments in London (ENABLE London) study is a natural experiment. The primary aims were to examine whether objectively measured physical activity levels and body fatness showed change after two years, amongst individuals who moved to East Village compared with a control population who did not move to East Village. East Village is the former London 2012 Olympic Athletes' Village repurposed to provide social, affordable and market-rent accommodation with high levels of walkability and close proximity to improved public transport. Other data collected include mental health and wellbeing, mode of travel and information on the participants' built environment where they were living. A description of the baseline cohort, results from the main follow-up analysis and other secondary follow-up analyses of the data have already been published and are referenced below. These data relate to baseline analyses of the built environment data.

A cohort of 1278 adults aged 16+ who were looking to move into three different housing tenures in East Village was recruited between January 2013 and January 2016. Ethical approval was granted by City Road and Hampstead Review Board (REC reference number 12LO1031). The three housing tenures were social, intermediate (affordable market-rent/shared ownership/shared equity) and market-rent and were used as a marker of socio-economic status. Follow-up of participants was carried out two years after their baseline examination when approximately half the cohort had moved to East Village. Information was collected on participants at baseline and follow-up using computer-assisted self-complete questionnaires and physical examination (height, weight, body fat). Participants were asked to wear an accelerometer for seven consecutive days to objectively measure their physical activity. For those participants living in Greater London at baseline (n=1064), their residential locations were used to derive a range of built environment factors including walkability, distance to parks and accessibility to public transport.

The aims of this study were to assess whether at baseline, the residential built environment was associated with physical activity on week days and weekend days separately. Also, to explore two possible pathways in which the built environment may contribute to household-level socio-economic differences in physical activity levels.

The dataset available includes the variables listed below. There are restrictions on the availability of these data due to the signed consent agreements around data security, which only allow access to external researchers for research monitoring purposes. Requestors wishing to access the data for the purposes of replicating or checking our analyses should contact the SGUL RDM service at researchdata@sgul.ac.uk.

Variables available
Demographics: sex, age group, ethnic group, housing group

Residential built environment variables at baseline: walkability, distance to closest local park, distance to closest district park, distance to closest metropolitan park, accessibility to public transport (Transport for London PTAL score)
Physical activity variables at baseline: average adjusted daily steps on week days and weekend days, average adjusted minutes of moderate-to-vigorous-physical-activity (MVPA) on week days and weekend days. 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? Yes  
URL https://sgul.figshare.com/articles/dataset/Data_supporting_Weekend_and_weekday_associations_between_...
 
Description ENABLE London engagement activities 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Although the East Village development is unique in some respects, the specific features of the East Village development which could influence physical activity, walking, cycling levels in residents are (or could be) features of many built environment developments. The findings of this study will therefore have substantial potential for wider application. Opportunities for dissemination have been sought both in academic and non-academic forums. In addition to the six ENABLE London papers published to date, we have one further paper which has been positively reviewed by the Journal of Epidemiology and Community Health, and further papers under review with the International Journal of Behavioral Nutrition and Physical Activity examining the effect of individual change in built environment on physical activity, and PLoS One outlining the baseline residential built environment associations with weekday and weekend physical activity. Importantly the ENABLE London final report has been accepted for publication (September 2019) in the NIHR Journal Library - the report has been through final editing and will be published once pending submissions outlined above are finalised. Once published our ENABLE London website (see - http://www.enable.sgul.ac.uk/) will be updated with a summary of the key findings. We continue to seek conference opportunities to present finding from the ENABLE London study. These conferences provide forums for dissemination both to academic and non-academic stake holders. Moreover, further peer reviewed publications emanating from the study, will provide further opportunity to share findings with the wider scientific community.
Year(s) Of Engagement Activity 2015,2017,2018