A Multicomponent Intervention to Encourage Stair Use in Municipal Buildings.

PURPOSE: Evaluate the incremental impact of environmental stairwell enhancements on stair usage in addition to prompts. DESIGN: Phased, nonrandomized, quasi-experimental intervention. SETTING: Two 6-story and one 8-story municipal government office buildings-each with 2 stairwells. PARTICIPANTS: Approximately 2800 municipal employees and 1000 daily visitors. INTERVENTION: All stairwells received door wraps and point-of-decision and wayfinding prompts. Environmental enhancements were installed in 1 stairwell in each of the 2 buildings: wall paint, upgraded stair treads and handrails, artwork, light-emitting diode (LED) lighting, fire-rated glass doors, and removal of security locks on at least the ground floor. MEASURES: Staff surveys and focus groups, electronic and direct measures of stair and elevator use occurred at baseline and over 3 years of phased implementation and follow-up. ANALYSIS: Change in the proportion of vertical movement by stairs using χ2 analysis. RESULTS: The prompts were associated with a significant increase in stair use (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.31-1.41), with an average absolute increase of 3.2%. Environmental enhancements were associated with an additional significant increase in stair use (OR = 1.31; 95% CI: 1.25-1.37) beyond prompts alone with an average absolute increase of a further 3.5% that was sustained for 1 year. The initial increases in stair use with prompts alone were not sustained. CONCLUSION: Implementing environmental stairwell enhancements in office buildings increased stair usage in a sustained manner beyond that achieved by prompts alone.

Incorporating consideration of health impacts into land use development approval processes: Development of a Health Background Study Framework.

OBJECTIVES: This project involved development of a Health Background Study (HBS) Framework to support consideration of health impacts within municipalities' approval process for land use development. PARTICIPANTS: Peel Public Health and Toronto Public Health led the project with the participation of planners, urban designers, engineers, public health staff and development industry representatives. SETTING: Historical growth in the Region of Peel and suburban Toronto has resulted in extensive low-density development, creating car-dependent communities with disconnected streets and segregated land uses. INTERVENTION: The inclusion of an HBS in developers' applications to municipalities is one approach by which health-related expectations for the built environment can be established within the approval process. Development of the HBS Framework used the six core elements of the built environment with the strongest evidence for impact on health and was informed by analysis of the provincial and local policy contexts, practices of other municipalities and stakeholder interviews. The Framework's contents were refined according to feedback from multidisciplinary stakeholder workshops. OUTCOMES: The HBS Framework identifies minimum standards for built environment core elements that developers need to address in their applications. The Framework was created to be simple and instructive with applicability to a range of development locations and scales, and to various stages of the development approval process. Peel Public Health is leading several initiatives to support the use of the HBS as a part of the development application process. CONCLUSION: The HBS Framework is a tool that public health and planning can use to support the consideration of health impacts within municipalities' land use development processes.