children and urban design

8/19/2019 Children and Urban Design

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What We Know About How Urban Design

Affects Children and Young People:

The Interaction etween Health !utco"es and the

uilt #n$iron"ent

Discussion Paper

August %&&'

Dr Anna (te$enson Public Health)egistrar Christchurch Cit* Council Canterbur* District Health oard


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2

Pro+ect rief

• To undertake a literature review focusing on what is known about the impact of urbandesign on children’s health.

• To consider the responsibilities of Local Government to consult with children in its

planning processes.• To reflect on some of the requirements for planning a child friendly city.

(earch (trateg*

The initial literature search was undertaken by a research fellow, Ms atriona Mackay, basedat the !ublic "ealth #nformation Team $!"#T% at ommunity and !ublic "ealth. The databasessearched were& 'besco "ost inclusive of $(cademic )earch !remier, (ustralia* +ew ealand-eference entre, !rofessional evelopment ollection, !sychology and /ehavioural )ciencesollection%0 1iley #nterscience0 !ubMed0 !roquest0 and #)# 1eb of 2nowledge. )earch termsused were& social planning0 city planning0 urban renewal0 urban planning0 urban design0

environment design0 child0 consumer participation0 focus groups0 social responsibility0community health0 social perception0 environmental health. 3urther searches were undertakenby the author, r (nna )tevenson.

!apers were reviewed based on their availability, i.e. they were written in 'nglish and they wereaccessible via the internet. -eferences from retrieved papers were searched for further relevantarticles and websites.

This paper should not be considered a systematic review of the literature. #t is a scan of literature available electronically through the 4niversity of 5tago library, with discussion of thekey themes that appeared. This paper has been reviewed by a number of people with aninterest in the area. #t seems unlikely $but not impossible% that any ma6or themes have beenmissed. "owever, a systematic review of the literature would add depth and weight to the keyfindings.

5f particular interest was the finding that despite considerable debate and discussion in theliterature around the importance of good urban design to children’s health and later adult healthoutcomes, the search we conducted found very little that adequately linked theory withevidence. The paucity of evidence as opposed to hypothesis was startling. This is clearly anarea where 7more research needs to be done78


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Imagine a city in which children are valued and pr ecious – where

politicians, children, parents, planners and business people recognise

the need to actively and deliberately move towards creating such a

city. It would be safe. Children’s opinions and perceptions would be

given validity by decision-maers. Children would en!oy a clean green

attractive environment. "ecr eation, health and educational facilities

would be easily accessible to all, regardless of where they lived or

what their parents earned. #hey would be positive about learning

and employment opportunities and be confident happy citi$ens.

Children would be proud and enthusiastic about their new families,

communities and city. #hey would belong. #his is the ind of vision

meant by a child friendly city.

hristchurch ity ouncil vision quoted in the hildren’s )trategy study

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Table of Contents

#ntroduction ...................................................................................................................... '"ow 4rban esign #ssues #mpact on hildren’s "ealth ........................................................ (

9. Transport............................................................................................................... (:. Traffic ................................................................................................................. )2;. !lay spaces ......................................................................................................... )%


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Introduction

3rom its earliest beginnings planning, as a profession, has been driven by the desire to improveliving conditions for the population. The planned communities of the -omans and Greeksfocused on spaces, structures and processes that facilitated the central activities of the

community A trade, food storage, worship, communal gatherings $uhl and )ancheB 9CCC%.'ngineering systems at the time enabled a great improvement in hygiene standards.

enturies later the need to control infectious diseases such as cholera, typhoid, malaria andtuberculosis led planners and public health officials to promote the need for fresh air, cleanwater, open spaces and sunlight. The hadwick report On the sanitary condition of thelabouring population of Great Britain led directly to the !ublic "ealth (ct of 9D


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How Urban Design Issues I"pact on Children2s Health

The available research focuses on three particular urban design issues&9. Transport:. Traffic

;. !lay

34 Transport

The issue of active transport is of particular interest to public health practitioners because of theinteraction between activity levels and obesity. 5besity is a risk>factor for many chronicdiseases such as heart disease, high blood pressure and stroke, gallstones, some cancers andType Two diabetes.

The :JJ: hildren’s +utrition )urvey showed us that about one-third of +ew ealand childrenbetween >9< years old were overweight or obese, as assessed by their body mass indeE. #n

9CCI it was estimated that 99.K of all deaths in +ew ealand were attributable in part toincreased body mass $reference=%.

)port and -ecreation +ew ealand $)!(-% surveys of young people have shown us that&

• (ctivity levels for young people are declining overall with a change from HCK active in9CCI>CD to HHK in :JJJ*J90

• CK of >9I year old +ew ealanders are sedentary $no activity in last two weeks%0• ::K of >9I year olds are relatively inactive $less than :. hours of physical activity in

the last week%0 and,

• 5ne>third of +ew ealand young people are inactive. $+euwelt, :JJ%

343 enefits of Acti$e Transport

)even studies were reviewed that considered children’s ability to engage in active transport$walking and cycling%. (ctive transport is important for population health for several reasons&

• 1alking and cycling use energy. 'ven small amounts of such activity offer healthbenefits like reducing obesity rates, improving respiratory health and mental health,and increasing peak bone mass which reduces the likelihood of developingosteoporosis or osteoarthritis.

• /eing able to walk and cycle safely on their own contributes to children’s developingsense of control and independence, with positive mental health and social benefits.

• hildren who have developed good active transport habits are more likely to becomeadults with good active transport habits and therefore, they gain all the associatedhealth benefits.

• #mproved adult health status results from childhood physical activity. $+elson, :JJ%


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34% arriers to Acti$e Transport

hildren’s opportunities to walk and cycle are less than in their parents’ generation. ( 9CI9study of 'nglish I>D year olds found that DJK made the 6ourney to school unaccompanied byan adult. ( follow up study in 9CCJ found this figure had reduced to CK $ollins and 2earns,:JJ9%. +othing in the literature suggests divergence from this pattern in +ew ealand.

hildren’s activities are moderated by their parents’ choices. 1here parents perceive theenvironment to be unsafe $traffic dangers, stranger dangers% or unsuitable in any way, childrenare less likely to use active transport methods in their daily life $Timperio et al, :JJintuitive finding was that childrenwith high walking levels were more likely to perceive heavy traffic and low road safety levels intheir vicinity. /oth research groups postulated that this was due to high walkers having theFwatch out for cars’ message constantly reinforced by their parents. 5ne study showed thatwhen parents had few concerns, children were five times as likely to actively commute toschool as when parents had many concerns7 $2err et al, :JJH%. These researchers make thepoint that changing perception on its own is not enough, as they may be based on real dangers.The most responsible approach to reducing parental concerns about children’s activecommuting may be improvement in the walking and biking infrastructure, protection from traffic,and aesthetics of routes to schools. #n addition it is important to make the public aware of suchimprovements and promote active commuting7 $2err et al, :JJH%.

Mitchell presented a thesis in :JJ entitled FThrough the children’s eyes& $re%interpreting thefreedom and use of public space from children’s perspectives’, which considered the views of

(uckland primary school children through stories and photographs. )he comments the lack of play spaces, fear of strangers and traffic, combined with the unwillingness of parents toencourage their children to play outdoors, is increasingly creating a generation of children whoare unfamiliar with their local neighbourhood, have limited knowable geographies and havecultivated a dependence in the car7 $Mitchell, :JJ


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345 6ew 7ealand )esearch

There has been considerable interest in +ew ealand recently around school travel planning,and in particular, walking school buses. +euwelt $:JJ% cites three studies which show&

• 1alking to school can contribute about K of children’s daily physical activity, which isabout :.H more times than the activity levels obtained by travelling in the car0

• 1alking to school is associated with increased physical activity after school and in theevenings for boys0 and

• (n (uckland study of 9::C children aged >99 concluded that walking to schoolresulted in 9

ordinator, and the road safety co>ordinator’s subsequent audit of the route with traffic engineers.The identification and reduction of haBards along the routes to improve the visibility andconspicuity of pedestrians, parking restrictions around the school, and speed reductioninitiatives all contribute to road safety for not only those on the 1)/s, but the whole schoolpopulation7 $1ong et al, :JJ


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( useful study by Mackett et al $:JJ% collated children’s diaries with the output from a tri>aEialaccelerometer which recorded movements on a minute by minute basis and their intensity. #ntotal, 9C children returned usable data0 < boys and D girls aged 9J>99 and home activity is the least active part of a child’s day at J.H activity calories a minute.The only comparable level of activity was being in a classroom lesson at school.

4nstructured out>of>home events were found to have significantly higher intensitiescompared with structured out>of>home activities. This means that playing soccer in thepark with friends tends to use more energy than playing soccer in an organised game.

• /oys were found to be more active than girls at the same age.• 1alking to and from school for a week can provided similar volumes of physical activity

to two hours of !' games and lessons.• hildren who walk to activities tend to be more active when they arrive than those who

travel in cars. $Mackett et al, :JJ%

The significance of unstructured activity fits in well with the findings discussed below on theimportance of Fnatural’ landscapes for play.

-oemmich et al $:JJH% studied the activity levels of ;: boys and :I girls aged I. They foundthat in this age group, boys who lived in high housing density neighbourhoods were mor ephysically active than boys in low housing density areas and girls in general. #ncreased accessto neighbourhood park and recreation areas was associated with greater physical activity. )treetconnectivity was not independently related to physical activity in this age group, probablybecause most children of this age are not allowed to travel far from home without adultsupervision $-oemmich et al, :JJH%.

There seems little doubt that an urban environment designed with the transport needs of infantsand children in mind will have a positive impact on the whole populations’ activity levels. (n

eEcellent guide to child>friendly transport planning was published in :JJ by the anadianentre for )ustainable Transportation.9 'ntitled Fhild and youth friendly land use and transportplanning guidelines’, some of its guidelines clearly reflect a anadian environment0 e.g.Guideline +umber +ine& ensure that sidewalks are always cleared of snow7. This simplyreinforces the point that urban design must be informed by the affected population. The casefor consulting with children on urban design decisions is summarised later in this paper.

)ttached as an appendi/ to this document


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Case (tud*: The Auc8land W(

1alking /uses fill a unique niche in (uckland’s transport system. (n (ucklandphenomenon that is becoming more widespread is the situation where very largecars travel very short distances to pick up very small children. #n fact, 9DK of all

6ourneys in (uckland are under :km long A and over half of these very short 6ourneysare made by car.Met when we ask primary school children how they want to travel to school, only ::Kchoose Lcar7 A and preference for the car is lowest among the youngest children. )owhat is going on within families to create a situation where HCK of all 6unior primaryschool children travel to school in the family car=#t is the parents who decide to travel by car A and parents are passionatelyconcerned about their children’s safety. !arents will not let a child travelindependently to school until they believe it is safe to do so. 4nfortunately, almost noparents think it is safe for a child to walk independently before age seven, and notuntil age nine are half of all parents happy to let their child walk independently toschool, as shown in 3igure 9.

-igure 3: 9At what age do *ou thin8 it is safe for *our child to;

9JJK

DJK

HJK


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%4 TrafficThe danger that traffic poses to children is a consistent theme inthe literature. 5ne study reports motor vehicles pose significanthaBards for children in a world where if a car hits a child, that is anaccident, but if a child damages a car, that is vandalism7 $ollins et

al, :JJ9%. Mullen $:JJ;% analysed data from 9C< children from Jwelsh schools and found that those children who reported that theroad nearest their home was busy all of the time, or full of parkedcars all the time, were less likely to consider the local area a goodplace to grow up, a safe place to walk alone after dark, a safe placefor children to play outside and less likely to generally feel safe.These relationships were independent of socio>economic status$Mullan :JJ;%.

Morrison et al $:JJ


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54 Pla* spaces

!lay has been described as children’s work. !lay is critical to children’s development for thefollowing reasons&

• Testing one’s abilities and improving them0

• 'Eperiencing autonomy and independence0• Learning social and language skills0• )tretching the imagination and developing

creativity0

• !hysical development and sensory pleasure0and,

• 'Eperiencing adventure and risk.

ertain spaces are more conducive to children’s playthan others. These include areas which are visuallyand physically accessible, have sufficient space to do

activities like ball games and cycling, are safe fromtraffic, are close to other activities A especially thosewith adults, offer a variety of opportunities for differenttypes of play suitable for different ages and stages,have Floose’ elements under the child’s control $e.g.stones and branches% and that are close to the child’shome base $hurchman, :JJ;%.

1hile there are positive aspects of conventional children’s playgrounds, there are alsodisadvantages. They tend to be stereotypically similar, suitable for one age bracket only and

are not particularly conducive to creative play. )everal researchers and commentators haveraised questions regarding the risk>benefit tradeoffs in the safety engineering of children’splaygrounds0 as one eEample, /all $:JJ


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#he green space we need now is bacyard replacement green – f or

boys and girls aged between +-)%, those ids in low income ar eas

that are chocer with in-fill housing and apartments wher e there isnowhere to play hide-and-see or ic a ball. ...?amish and his two

brothers and )% other friends in the immediate vicinity ar e

constantly on the looout f or places to play. ;ometimes they go to

Champion ;treet @ar, but that means crossing Aeraldine and

Barbadoes ;treets to get ther e, and Barbadoes is a very busy

thoroughfare. ;t lbans par has sate board and bie ramps but

it’s dominated by bigger boys, who rule#he old rion site between

6adras and @ace ;treets has a long green sward between the

footpath and the high wire fences and is guarded by fierce dogs.

01e play cricet and soccer, touch and tacle there, but if the ball

goes over the fence we can’t get it bac until ;unday , when the

Dorean church is open and the dogs aren’t there9

:#he @ress, pril )&, 2(<

36ortoft $:JJordination $36ortoft, :JJ


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4 !ther -actors

The importance of community amenities to parents’ mental health, and therefore to their children’s mental health, was highlighted by Thomson et al $:JJ;% in a study of the impact of closing a swimming pool in one area, while opening a pool in another low socio> economic area

of Glasgow. #n this qualitative study, the physical activity health benefits of the pool were oftenmentioned, but the main benefits appeared to be Ffacilitating social contact with friends andneighbours across all age groups, $which was% directly linked to mental health.@The healthbenefits of social contact were said to be stress relief and reducing isolation@ in particular,mothers of young children reported using the pool as a stress reliever to cope with lively youngchildren @ and reported benefits to children of being able to participate in safe spacious andenergetic play7 $Thomson et al, :JJ;%.

$Last summer% "amish $9J years old% went swimming in the 'dgeware !ool. # used togo with my friends, and we went together.7 #t was safe and accessible, and the pool wassupervised. +ow it’s been demolished, and the centennial and O': pools are not so easy

to get to. They require Mums time or a long bike ride on busy roads, and they cost more7$The !ress, (pril 9


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Consulting With Children on Urban Design Issues

Wh* Consult With ChildrenB

There are a number of rationales for including children in any consultation process aroundurban design issues apart from the legal and moral imperatives. These include&

• hildren and young people are valuable members of the community, now and in thefuture0

• hildren have different needs and perspectives from adults0

• The built environment can help or hinder children’s development0

• 'verybody learns through children’s participation0

• hildren provide new perspectives and ideas0• 'nvironments that are better for children and young people are better for everyone0and,

• (sking children and designing to their needs ensures facilities are more likely toactually be used by children.

The inclusion of children and young people in the planning process provides plannerswith a win>win situation@ /enefits to children and young people include& new ways of seeing and understanding their community0 new networks of friends and role models0opportunities to learn about democracy and tolerance0 active engagement in environmentaland social change0 and the strengthening of confidence, self esteem and identity. Thecommunity benefits from their creativity and enthusiasm. onstructive alliances are forged

between the different generations, overcoming pre6udices and mistrust. !lanners are better in touch with the needs and issues of the communities they serve and will make moreinformed and effective decisions. They can educate young people in policy and decision>making and engage them in sustainable development0 implement the 4+ onventionson the -ights of the hild in their localities0 and create child friendly humane

environments.7 $3reeman et al, :JJ


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United 6ations Con$ention on the )ights of the Child

#n 9CC;, +ew ealand ratified the 4nited +ations onvention on the -ights of the hild$4+-5%. This committed the government to acknowledging children’s rights, including theright to be heard on matters that affect them. +ew ealand’s compliance with 4+-5 hasbeen Fpatchy’ and has earned the government significant criticism in the past. (s part of itsresponse to this criticism, two key documents were released in :JJ:& +ew ealand’s (genda for hildren& Making Life /etter for hildren $Ministry for )ocial evelopment% and outhevelopment )trategy (otearoa $Ministry for outh (ffairs%

#n March :JJ;, a coalition of concerned +G5s released a report detailing the government’sprogress on implementing the 4+-5. 1hile recognising the significance of recent policydevelopments, the authors noted that&

5ften new policy initiatives have not been followed by funding and effectiveimplementation. This has been aggravated by the shortage of inter>sectoral approachesto the delivery of services. #mpact analysis of new policies on the lives of children and

youth is almost non>eEistent. The benefits to children, young people, families, and society ,of prevention and early intervention A as opposed to Fcleaning up’ are often forgotten7.

$(ction for hildren and outh in (otearoa :JJ;%

6ew 7ealand2s Agenda for Children a8ing 0ife etter for Children

This document was released in Pune :JJ: by the Ministry of outh (ffairs and the Ministry of )ocial evelopment. The strategy promotes a Fwhole child approach’, meaning that policy

makers should&• 3ocus on the big picture, on the child’s whole life and circumstances, not 6ust isolatedissues or problems0

• 3ocus from the outset what children need for healthy development, rather than simplyreacting to problems as they arise0 and

• Looking across the whole public service at what can be done to support children’shealthy development, instead of looking for single sector solutions.

The strategy has seven key action areas&

9. !romoting a whole child approach0

:. #ncreasing children’s participation0;. (n end to child poverty0


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Christchurch Cit* Council Polic* and (trateg* (tud*

This research pro6ect was initiated by the then Mayor of hristchurch, Nicki /uck, in 3ebruary 9CC.

“The Christchurch City Council’s Strategy for Children refers tocurrent and future initiatives undertaken by, or in partnership ith,the CCC ith the vision of a healthy, child-friendly city! Thestrategy is both a vision for the future and a plan for action-e"bracing initiatives in the public, private and voluntary sectors#$nitiatives cover health, safety and elfare% physical design and layout of the city% children’s e&perience of education and opportunities for sti"ulation and recreation! The Strategy isco""itted to e'uitable access for children fro" all sectors of theco""unity! $t is underpinned by the assu"ption that decisions"ade today i"pact upon the 'uality of life our city offers children

both no and in the future. $, 9CC%

(t the time, the study was the largest consultation ever undertaken by a local authority in +ewealand. #t included a citywide children’s survey involving DC: children aged from I>9; yearsfrom :C hristchurch primary and intermediate schools, a city wide parent survey involving C<parents, interviews with representatives of -ose, :JJ%.


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Conclusions

This scan of the literature has revealed several recurrent themes. 3irstly, there is world>wideand increasing concern at the epidemic levels of chronic diseases in adulthood that are stronglylinked to being overweight or obese. There is increasing evidence not only that childhood levelsof obesity are high and rising, but that the overweight child becomes an overweight adult. Thecosts of obesity in health and economic terms for the overall population are eEtremely high.

(lready, one third of +ew ealand children are overweight or obese.

)econdly, the built environment is a ma6or contributor to levels of obesity. #t is not the onlyreason for the populations over>eating and under>eEercising, but it is a significant andmodifiable factor.

Thirdly, the built environment can adversely affect the health of children from pre>natal lifethrough to adulthood. The immediate health effects $e.g. impaired lung function% and the daily

habits of life developed in childhood $e.g. car>dependency% can have adverse health impactsthroughout adult life.

The evidence base concerning links between urban design issues and children’s health iscurrently sparse. !artly this is because the study designs needed to show causality in this areaare very compleE and eEpensive. !artly it demonstrates the lack of recognition of theimportance of early life eEperiences to total population outcomes. 1hat evidence there ispresent is remarkably consistent.

The increasing recognition of the importance of consulting with children and young people ininternational and national conventions and strategies has, to date, not been consistently

implemented at a local government level. There is eEpertise and tools available both here inhristchurch and nationally that could be of assistance in this area to the hristchurch ityouncil.


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)eco""endations

9. Children should be used as the starting point for de$elop"ent4 This recognises thatan environment that promotes the health, safety and wellbeing of children is likely to be anenvironment that supports the health of the whole community. There are a variety of

different approaches that can be used to consult with children and young people. Tappinginto already established networks and key people already working in this area would be costeffective and productive. The following diagram, "art’s Ladder of !articipation, illustratesthe appropriate framework when consulting with children. #t is important the consultationprocess does not include the first three steps of the Ladder, as this is not true democraticprocess when engaging children.

:. 6eighbourhoods should be assessed on how well the* encourage acti$e transportusing ob+ecti$e and ,ualitati$e "easures4 (ppropriate changes should be made if necessary. "abits around physical activity are formed very early in life. The builtenvironment needs to promote physical activity for every age group.

;. Addressing the perceptions of local residents is critical4 This may be as simple asensuring residents know about local cycle routes, or increasing lighting at neighbourhoodparks to address safety concerns.


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Hart’s Ladder of Participation3

8. Child initiated / shared decisionsChildren have the ideas, set up the pro!ect, and invite adults to !oin in

with decision maing. 7.g. youth-adult partnerships

7. Child initiatedChildren have initial idea and decide on how pro!ect is to be carriedout. dults available but do not tae chargeE e.g. youth-led activism.

6. Adult initiated

dults have the initial idea. Children involved in all steps of planningand implementation. Involved in decisionsE e.g. participatory action.

5. Consulted@ro!ect designed and run by adults but children consulted. Childrenhave full understanding of process. pinions valuedE e.g. youth

4. Assineddults decide on the pro!ect = children volunteer. Children understandthe pro!ect and now why they are involved. Fiews on pro!ectrespectedE e.g. community youth boards.

3. !o"enis#Children are ased to say what they thin about an issue but have nochoice as to how they e/press these views.

$. %ecorationChildren tae part in an event but not aware of why they are taing

part.

&. 'anipulationChildren do or say what adults suggest. Go real understanding of theissues. sed ideas but may have no bearing on outcome.

%#han you to Gicy ?arrall, health promoter at Community and @ublic ?ealth for bringing this to my

attention. www.freec h il d .o rg=la dd er. h tm

http://www.freechild.org/ladder.htmhttp://www.freechild.org/ladder.htmhttp://www.freechild.org/ladder.htm


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)eferences

(ction for children and youth in (otearoa $:JJ;%. hildren and youth in (otearoa :JJ;. Thesecond non>governmental organisations’ report from (otearoa +ew ealand to the4nited +ations ommittee on the rights of the child.

(lton, ., !. (dab, et al. $:JJI%. Q-elationship between walking levels and perceptions of thelocal neighbourhood environment.Q (rchives of isea s e in hildhood @%$9%& :C>;;./all, . P. $:JJbenefit trade>offs of ?safer surfacing? for children?s

playgrounds.Q (ccident (nalysis R !revention 5?$IJ./linkert, /. $:JJ99:./oarnet, M. G., . L. (nderson, et al. $:JJ%. Q'valuation of the alifornia )afe -outes to

)chool legislation& urban form changes and children?s active transportation to school.Q (merican Pournal of !reventive Medicine %>$: )uppl :%& 9;"ee, . /., G. )andlin, et al. $:JJI%. QThe eEposure of disadvantaged populations infreeway air>pollution sheds& a case study of the )eattle and !ortland regions.Q'nvironment and !lanning /& !lanning and esign 5& 99IJ.

hurchman, (. $Pune :JJ;%. Q#s there a place for children in the city=Q Pournal of 4rban esign>$:%& CC>999.

ollins, . . and -. (. 2earns $:JJ9%. QThe safe 6ourneys of an enterprising school&negotiating landscapes of opportunity and risk.Q "ealth R !lace '$;JH.

uhl, L. P. and (. 2. )ancheB. $9CCC%. Q"ealthy cities and the city planning process. (background document on links between health and urban planning.Q -etrieved (pril:JJI, :JJI, from www.who.int .

36ortoft, #. $:JJ$C:9C.Mitchell, ". $:JJ$9J%& D;I>


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+elson, +. $:JJ%. Q#nfluences in childhood on the development of cardiovascular disease andType Two diabetes in adulthood.Q -etrieved May :JJI, fromhttp&**www.moh.govt.nB*moh.nsf*pagesmh*;IIJ=5pen.

+euwelt, !. $:JJ%. Q1alking is good for my health8Q -etrieved May :JJI, fromhttp&www.hp f orum.org.nB*resources*walkingsch o olb u s.pd f.

+olan, T. $9CC99.!ercy, (. $:JJI%. (uckland’s )chool Travel !rog r amme@some lessons for the 42= :JJI (nnual )chool Transport onference, 4nited 2ingdom.

-oemmich, P. +., L. ". 'pstein, et al. $:JJH%. Q(ssociation of access to parks and recreationalfacilities with the physical activity of young children.Q !reventive Medicine 5$H%&

children and urban design

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