Stanford Medicine Newsletter Updates For the Local Community


Taking it to the streets

Residents help document community health hazards

Feliciana Jimenez uses a tablet computer to document hazards in her neighborhood.


People who live in places  that promote walking, socializing and eating fresh foods are physically and mentally healthier than those who do not.

Feliciana Jimenez, an 80-year-old with nine children, squints with a critical eye at the camera window of a tablet computer. Through this lens, she sees her street in a whole new light. She takes pictures of crumbling sidewalks and a construction worker’s hose, coiled at her feet. She hits the record button on the tablet to describe how these hazards could cause seniors to trip and fall. She captures images of clogged sewer drains covered in stagnant water that could breed mosquitoes. As each problem is recorded, the tablet uses its built-in geographic positioning system to record its precise location on a map.

Jimenez lives in the North Fair Oaks neighborhood of Redwood City, where she is fighting for a safer, healthier neighborhood. She has volunteered to test two new devices—a customized tablet computer and a wearable camera—both of which can be used to notify city planners about things that need to be fixed and improved.

The benefits of these changes in the “built environment”—the man-made structures that define a place—go well beyond aesthetics: People who live in places that promote walking, socializing and eating fresh foods are physically and mentally healthier than those who do not.

For the record

Abby King, PhD, a Stanford professor of health research and policy and of medicine, developed the customized tablet for documenting neighborhood hazards. She and her team at the Stanford Prevention Research Center are now creating a social blueprint for teaching residents and grassroots organizations how to persuasively communicate these community needs to city planners.

Jimenez’s street is lined with boxcar rows of houses adorned with cast-iron grates on windows, brick fences and plaster lawn ornaments. Around the corner are small retail stores selling Mexican groceries, piñatas and quinceañera gowns in Easter-egg colors.

Two Stanford researchers observe Jimenez’s interactions with the tablet computer, looking for ways to improve it. Called the Stanford Healthy Neighborhood Discovery Tool, the simple-to-use tablet is loaded with software developed by King’s team to track users’ walking routes and geographically tag hazard locations, linking them with audio narratives and photographs. Afterward, it leads the user through a questionnaire about the walk.

As Jimenez stops to snap pictures of graffiti and an overflowing trash bin, the two researchers—Sandra Jane Winter, PhD, a Stanford postdoctoral scholar, and Priscilla Padilla Romero, MPH, MPP, a community partner from San Mateo Medical Center—take a few moments to show her how to verbally record her impressions of each neighborhood feature.

After the walk, images and location coordinates can be uploaded to an online map, which can be shared with researchers, city planners, policymakers or others involved in the project. The walking routes of all participants are overlaid on the map, making it easy to identify the more frequently used routes where repairs need to be made first.

Data collection

Jimenez also wears a Microsoft SenseCam camera around her neck. It automatically snaps a picture of everything in her field of vision every 12 seconds. These images will be analyzed using software developed by King’s collaborators at the British Heart Foundation Health Promotion Research Group in Oxford, England. The camera’s built-in GPS provides information on distances and walkability to food sources, jobs and local transportation. It also allows researchers to identify hazards that participants might have overlooke

King hopes that her tablet-based tool will provide a low-cost way for community advocates like Jimenez to work with city officials to improve their neighborhoods. But first, she and her Healthy Aging Research & Technology Solutions team need to collect more evidence not only to improve the tool but also to teach community groups how to use it.

About a year ago, King tested a precursor to the tablet in a community of 400 seniors in East Palo Alto. The study looked at ways to better inform city planners about the physical barriers to fresh-food sources. In February, the team celebrated its first success, after being contacted by Brent Butler, planning manager for East Palo Alto. “Some of the street issues that this Stanford study brought to our attention have been added to our comprehensive sidewalk inventory and repair program,” Butler said

The study suggestions were influential in the city’s addition of countdown timers to crosswalks on its main thoroughfare, University Avenue, to ensure that seniors and children had enough time to cross. The study also helped the city to document sidewalk obstacles that impede people using wheelchairs, walkers and strollers.

Helping change happen

Some of these future improvements may be funded by Mark Zuckerberg, founder and CEO of Facebook. The company has pledged more than $800,000 annually to East Palo Alto and neighboring towns over the next 15 years to help improve traffic flow and create better pedestrian and bike paths.

This fortuitous collaboration with Facebook shows how valuable it is to have “shovel-ready” priorities documented when funding opportunities arise and how useful the discovery tool tablet can be for identifying those priorities.

After more data was collected, King and her colleagues organized a community advocacy meeting to help participants prioritize neighborhood issues by importance to the community and feasibility of being addressed. Together these residents developed  an action plan and presented ideas to local policymakers

“This phase of the study is important because it ensures that the community members, not outside researchers, are advocating for change within their own neighborhoods,” Winter said. 

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