Relationship Between Cardiovascular Disease Rates and Amount of Greenspace in Florida Counties

RELATIONSHIP BETWEEN CARDIOVASULAR DISEASE RATES AND AMOUNTS OF GREENSPACE IN FLORIDA COUNTIES A PAPER SUBMITTED FOR COMPLETION OF SENIOR RESEARCH FOR THE COLLEGE OF ARTS AND SCIENCES STETSON UNIVERSITY BY Madison Kell IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE(S) OF BACHELOR OF SCIENCE ENVIRONMENTAL SCIENCE ADVISOR Dr. Jason M. Evans, Ph.D. MAY 2017 i CONTENTS LIST OF FIGURES ........................................................................................................................ ii LIST OF TABLES ......................................................................................................................... iii ACKNOWLEDGEMENTS ........................................................................................................... iv ABSTRACT ................................................................................................................................... v INTRODUCTION .......................................................................................................................... 1 LITERATURE REVIEW ............................................................................................................... 1 METHODS .................................................................................................................................... 2 GIS Work Flow ........................................................................................................................... 3 RESULTS ...................................................................................................................................... 7 CONCLUSION ............................................................................................................................... 9 APPENDIX .................................................................................................................................. 11 REFERENCES ............................................................................................................................. 13 ii LIST OF FIGURES Figure 1: Symbology...................................................................................................................... 4 Figure 2: Map of Florida with Color Gradient ................................................................................ 4 Figure 3: Map of Greenspace in Florida ......................................................................................... 5 Figure 4: Attribute Table ............................................................................................................... 6 Figure 5: Scatterplot ........................................................................................................................ 7 Figure 6: Completed Death Rate Map ............................................................................................ 8 Figure 7: Complete Greenspace Map ............................................................................................. 9 iii LIST OF TABLES Table 1: Compiled Data……………………………………………………………………………xvi iv ACKNOWLEDGEMENTS I would like to thank Dr. Jason Evans for being my primary mentor in this project. I would also like to thank Dr. Kirsten Work for assistance with the statistical analysis, as well as Dr. Asal Johnson for assistance with the public health aspects of this research. I would also like to thank the Environmental Science department for allowing me to use their resources. v ABSTRACT Cardiovascular disease is currently the leading cause of death in the United States, including Florida. Obesity and overweight rates, as well as their negative health impacts, have been increasing in the United States leading to more cases of cardiovascular disease. Some studies also suggest a relationship between cardiovascular disease and greenspace. This project was designed to find any relationship between cardiovascular disease and amount of greenspace in Florida. I hypothesized that more greenspace will contribute to lower rates of cardiovascular disease and vice versa. I collected data from public health records on cardiovascular disease deaths as well as Geographic Information Systems, or GIS, files representing areas of greenspace over Florida counties. For the purposes of this project, greenspace was defined as any public land consisting of parks and recreational areas, state parks, and recreational trails. After all of my information was compiled, I normalized the death rates for each county and compare to the total amount of greenspace, as a percentage, in each county. I performed a statistical analysis on the death rates and percentage of greenspace and found a very small relationship, suggesting that while greenspace may have an impact on cardiovascular disease rates, there are many other factors that are also in effect. 1 INTRODUCTION Cardiovascular disease is currently the leading cause of death in the United States, and as a result, is becoming a major matter of public health. Cardiovascular disease is largely linked to being overweight and obese. Currently, over two thirds of the adult American population is overweight or obese, with obesity prevalence rates still rising (West et al. 2016). Along with rates of cardiovascular disease, rates of urbanization have also increased. The majority of the global populations live in either cities or towns, and urban areas are growing much faster than any other type of land use (Dallimer et al. 2011). Based on this information, I wanted to see if there was any relationship between rates of cardiovascular disease and amounts of greenspace. I hypothesized that areas with higher amounts of greenspace would have lower cardiovascular disease rates. Conversely, areas with lower amounts of greenspace would have higher rates of cardiovascular disease. LITERATURE REVIEW Several studies have shown a positive physical effect greenspace can have on people. Greenspace areas, such as parks, are known to promote physical activity (Merriam 2016) One study shows that people are more likely to engage in physical activity when they reside in areas close to greenspace (Coombes et al. 2010). Greenspace also provides mental health benefits along with physical. Greenspace has been shown to provide stimuli that can reduce stress in fatigued individuals (Conniff and Craig 2016) Furthermore, exercise and greenspace areas are shown to have synergistic effects. People are more likely to receive more health benefits if they exercise in areas of greenspace as opposed to areas without greenspace (Ambrey 2016). 2 METHODS For my research, I correlated rates of cardiovascular disease with areas of greenspace within all of the counties located in the state of Florida. This project relied heavily on the use of computers, mainly for information gathering and ArcGIS. I began by collecting information from Florida public records on cardiovascular disease deaths. These public records are available online from http://www.flhealthcharts.com/charts/ChronicDiseases/default.aspx , a website directed by the Florida Department of Health. These records represent a population rate of those who have died from cardiovascular disease to the overall population in 2015 as there currently are no records for 2016. I relied on ArcGIS to help calculate the greenspace areas within Florida. For this project, greenspace is defined as any state regulated area consisting of parks and recreational areas, recreational trails, state parks, or any accessible water recreational area (such as springs). These shapefiles were obtained from the Florida Geographic Data Library ( http://www.fgdl.org/metadataexplorer/explorer.jsp ) and from the Florida Department of Environmental Protection and are listed below. PARKS AND RECREATIONAL FACILITIES BOUNDARIES IN FLORIDA – 2016. FDGL. This shapefile includes information on parks and recreational areas in the state of Florida for 2016. FLORIDA COUNTY BOUNDARIES - SEPTEMBER 2015. FDGL. This shapefile contains information on the boundaries of all 67 counties in the state of Florida. EXISTING RECREATIONAL TRAILS IN FLORIDA - DECEMBER 2015 (Florida Department of Environmental Protection). The shapefile contains information on the recreational trails in the state of Florida. The recreational trails include unpaved areas for hiking, biking, paddling, or motorized use open to the public. Does not include sidewalks. FLORIDA STATE PARKS – DECEMBER 2015. FDGL. This shapefile shows all of the state parks and state trails in Florida 3 FLORIDA MANAGED AREAS – DECEMBER 2016. FDGL. This shapefile contains a list of all the conservation areas in the state of Florida. GIS Work Flow 1. After all necessary information was gathered, I saved all of the files onto a jump drive which I worked out of. 2. I created a CSV file in Excel containing a list of the death rates of cardiovascular disease previously gathered for each county. 3. Before adding the CSV file to ArcMap, I checked the properties for each shapefile to ensure they were all projected in Albers Conical Equal Area from the Florida Geographic Data Library. 4. I imported the CSV file into ArcMap and joined it with the shapefiles representing county boundaries. 5. After the files were joined, the attribute table in the county shapefile contained the list of death rates. 6. I went into the shapefile properties and changed the symbology into 5 natural breaks with a color gradient to show variance in the death rates among the different counties, as shown below. 4 Figure 1: Symbology. The symbology screen in ArcMap. Graduated colors are used to show differenced in cardiovascular death rates. Figure 2: Map of Florida with Color Gradient Figure 2 shows the map of Florida with the color gradient applied. 5 7. For the greenspace data, I began by compiling the shapefiles containing greenspace into ArcMap. 8. In order to calculate for total greenspace, I needed assistance in joining the greenspace files and converting them into a raster form to calculate total square kilometers. 9. To start, we formed a union between the two shapefiles containing city parks and state parks and named it FLMA_GC_Parks_Union. 10. Next we opened ArcToolbox and went to Conversion tools. 11. Within Conversion tools, there is a subsection To Raster. In this subsection we selected Polygon to Raster. 12. We named the new raster file GS_Count and set the cell size to 1 square kilometer. The map containing the raster file is shown below. Figure 3: Map of Greenspace in Florida 6 13. Using Zonal Statistics in ArcToolbox, we calculated the total amount of square kilometers of greenspace for each county by dividing the greenspace area by the total county area. 14. The statistics showed as percentages of total county area and were placed into a field in the attribute table. Figure 4: Attribute Table. The attribute table with the percentage of greenspace in each county 15. From there, I was able to open the attribute table in Excel to perform a regression analysis, as a correlation did not provide me with enough comprehensive information. 7 RESULTS There was a significant, although weak, relationship between greenspace and cardiovascular disease (p = 0.028 and R²= 0.0717), confirming that areas with higher greenspace had lower levels of cardiovascular death rates. Figure 5: Scatterplot. A scatterplot showing the relationship between the cardiovascular disease death rates and percentage of greenspace per county. While the relationship is loose, cardiovascular death rates tend to decrease as greenspace increases, and vice versa. R² = 0.0718 R² = 0.0718 R² = 0.0718 R² = 0.0718 0.00% 0.00% 20.00% 20.00% 40.00% 40.00% 40.00% 60.00% 60.00% 80.00% 80.00% 100.00% 100.00% 120.00% 120.00% 0 50 100 100 150 150 200 200 250 250 300 300 350 350 400 400 Percent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each CountyPercent of Greenspace in Each County Death Rate Death Rate Death Rate Death Rate Death Rate Death Rate Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Relationship Between Greenspace and CVD Death Rate Death Rate Death Rate Death Rate Death Rate Death Rate Death Rate Death Rate Death Rate 8 Figure 6: Completed Death Rate Map. A complete map that shows the death rates per county in Florida. The death rates from cardiovascular disease seem to become higher towards the northern part of the state. 9 Figure 7: Complete Greenspace Map. A map of the total greenspace in Florida, such as city and municipal parks as well as state parks. Much of the greenspace seems to be scattered among central and south Florida. With a few clusters in north Florida. CONCLUSION My hypothesis was supported by this study, although the statistical analysis shows there is a somewhat loose relationship. A literature study by Kate Lachowycz and A. Jones examined similar articles and studies and found that 68% of papers also found a positive or weak relationship (Lachowycz and Jones. 2011). From looking at my maps, we can see some relationship between greenspace and cardiovascular death rates. For example, northern Florida generally has higher rates of cardiovascular disease death as well as lower amounts of greenspace. Conversely, central and southern Florida have lower rates of cardiovascular disease 10 death and higher amounts of greenspace. However, physical activity and proximity to greenspace are not the only determinants of cardiovascular disease. Cardiovascular disease risk can be affected by genetics, levels of physical activity, diet, and stress levels. My main purpose of this study was to help highlight the importance of greenspace, especially in today’s urbanized world. As urbanization continues to spread, we are losing access to valuable greenspace areas that can contribute to health and wellbeing. Greenspace has not only been linked to higher levels of physical activity, but it also seems to share synergistic effects with physical activity in people that choose to take advantage of their environment (Ambrey 2016). Apart from physical activity, greenspace has also been associated with restorative mental effects, especially in reducing stress in stressed and fatigued individuals (Conniff and Craig. 2016). In urban environments, employees felt positive mental health benefits from simply being in proximity to a window facing greenspace (Gilchrist et al. 2015). Furthermore, a study conducted in the United Kingdom observed that people who lived in close proximity to greenspace (within approximately 300 meters) were more likely to visit that greenspace site (Coombes et al. 2010). This information should be taken into account with urban planning and design. Cardiovascular disease is the leading cause of death in the United States, and we should be putting more focus on how we can reduce the increase of cardiovascular disease. From this study, we can infer that use of greenspace can help to reduce the rates of cardiovascular disease. Likewise, we should be prioritizing the use of greenspace in urban areas to help lower obesity rates and stress levels typically associated with cardiovascular disease. 11 APPENDIX County Name Total Area Greenspace Area Percent Greenspace Death Rate Alachua 2509.2 472 18.81% 195.1 Baker 1524.75 678 44.47% 263.8 Bay 2005.53 291 14.51% 261.2 Bradford 778.269 83 10.66% 233.3 Brevard 2733.74 1177 43.05% 214.4 Broward 3165.43 2002 63.25% 206.5 Calhoun 1487.46 30 2.02% 256.5 Charlotte 1881.57 718 38.16% 173.9 Citrus 1622.91 560 34.51% 276 Clay 1666.79 572 34.32% 245.3 Collier 5287.35 3590 67.90% 133 Columbia 2075.22 598 28.82% 245.8 DeSoto 1656.23 207 12.50% 204 Dixie 1852.92 478 25.80% 196.8 Duval 2205.46 456 20.68% 254.9 Escambia 1734.19 193 11.13% 249.1 Flagler 1315.15 192 14.60% 244.8 Franklin 1431.63 1151 80.40% 209.5 Gadsden 1368.17 82 5.99% 210.7 Gilchrist 920.064 30 3.26% 260.3 Glades 2556.03 438 17.14% 199.4 Gulf 1473.77 205 13.91% 206.6 Hamilton 1343.76 90 6.70% 220.8 Hardee 1653.31 20 1.21% 268.5 Hendry 3081.64 602 19.54% 191.1 Hernando 1270.08 371 29.21% 220 Highlands 2864.6 744 25.97% 190.1 Hillsborough 2775.72 473 17.04% 189 Holmes 1266.57 58 4.58% 214 Indian River 1334.39 415 31.10% 314.4 Jackson 2470.39 85 3.44% 177.6 Jefferson 1584.92 429 27.07% 269.6 Lafayette 1419.07 242 17.05% 221.7 Lake 2996.53 872 29.10% 215.9 Lee 2176.41 388 17.83% 203.7 Leon 1817.29 637 35.05% 187.9 Levy 2949.13 723 24.52% 200.7 Liberty 2183.69 1375 62.97% 252.1 Madison 1853.5 74 3.99% 204 Manatee 1976.4 246 12.45% 311.8 12 Marion 4306.27 1488 34.55% 188.9 Martin 1724.67 383 22.21% 241.8 Miami-Dade 5140.35 3515 68.38% 161.7 Monroe 2756.51 2626 95.27% 202.7 Nassau 1722.52 111 6.44% 226.6 Okaloosa 2442.37 1288 52.74% 209.8 Okeechobee 2310.01 411 17.79% 262.6 Orange 2598.37 420 16.16% 205.5 Osceola 3900.61 758 19.43% 244.3 Palm Beach 5736.81 2003 34.91% 168.4 Pasco 1982.25 451 22.75% 209.2 Pinellas 749.266 97 12.95% 190.4 Polk 5207.02 1181 22.68% 232.5 Putnam 2141.72 485 22.65% 248.6 Santa Rosa 2656.62 1049 39.49% 180.3 Sarasota 1499.09 481 32.09% 206.6 Seminole 894.35 165 18.45% 230.1 St. Johns 1718.48 343 19.96% 149 St. Lucie 1497.37 150 10.02% 192.7 Sumter 1501.74 464 30.90% 178.7 Suwannee 1792.94 86 4.80% 266 Taylor 2721.39 398 14.62% 252 Union 646.856 28 4.33% 345.2 Volusia 3167.47 882 27.85% 236.3 Wakulla 1601.78 1000 62.43% 252 Walton 2770.45 1053 38.01% 237.7 Washington 1595.32 225 14.10% 285.2 Table 1: Compiled Data. Information on the total county areas, as well as greenspace area, percent greenspace, and cardiovascular disease rate. 13 REFERENCES Ambrey, C. 2016. Urban greenspace, physical activity and wellbeing: The moderating role of perceptions of neighbourhood affability and incivility. Land Use Policy Vol 57: 638-44. Conniff, A. and T. Craig. 2016. A methodological approach to understanding the wellbeing and restorative benefits associated with greenspace. Urban Forestry & Urban Greening. 19: 103-109. Coombes, E., A. Jones, and M. Hillsdon. 2010. The relationship of physical activity and overweight to objectively measured green space accessibility and use. Social Science & Medicine 70: 816-822. Dallimer, M., Tang, Z., Bibby, P. R., Brindley, P., Gaston, K. J., and Davies, Z. G. 2011. Temporal changes in greenspace in a highly urbanized region. Biology Letters 7: 763-766. Gilchrist, K., C. Brown, and A. Montarzino. 2015. Workplace settings and wellbeing: Greenspace use and views contribute to employee wellbeing at peri-urban business sites. Landscape and Urban Planning 138: 32-40. Lachowycz, K. and A. Jones. 2011. Greenspace and obesity: a systematic review of the evidence. Obesity Reviews 12: e183-e189. Merriam, D. (2016) Parks: An Opportunity to Leverage Environmental Health. Journal of Environmental Health, Vol, 78, 112-14. West, D., S. Coulon, C. Monroe, and D. Wilson. 2016. Evidence-based lifestyle interventions for obesity and Type 2 diabetes: The Look AHEAD intensive lifestyle intervention as exemplar. American Psychologist 71: 614-627.