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The way communities are designed has a great influence on how active we are. When communities are safe, well-maintained and have appealing scenery, children and families are more likely to be active. Unfortunately, many people—especially those at high risk for obesity—live in communities that lack parks and have high crime rates, dangerous traffic patterns and unsafe sidewalks.  Such communities discourage residents from walking, bicycling and playing outside. Increasingly, local governments are considering how community design will impact residents’ physical activity. Our research documents effective strategies for creating communities that support active living and promote health.

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Examining How a Community Coalition Creates and Implements Policy Changes to Promote Physical Activity: The Case of Get Fit Kauai

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Get Fit Kauai is the Nutrition and Physical Activity Coalition of Kauai County, a rural island community in Hawaii. Since 2009, Get Fit Kauai has made significant progress in addressing the built environment through multiple policy and program strategies. For example, Get Fit Kauai was instrumental in helping to pass a Complete Streets county resolution, Safe Routes to School state legislation, and, most recently, a change to the county subdivision ordinance that requires sidewalks and shorter block lengths. The purpose of this study is to understand how Get Fit Kauai was able to successfully catalyze policy changes that impact the built environment and what the role of a community coalition is in policy implementation..

Objectives
The primary objective of this study was to gain an understanding of the process through which a community coalition was able to create and implement policy changes that impact the built environment. Secondary objectives of the study included identifying the enabling factors as well as the barriers to policy change and implementation, examining the influence of community context, and determining ways that the coalition could improve its efforts.

Methods
This qualitative study consisted of in-depth interviews with 25 coalition stakeholders. Interview participants were purposefully selected for their unique insights into coalition activities. Interviews were semi-structured, framed by an interview guide, and lasted approximately one hour. A grounded theory approach guided data collection and analysis (Charmaz, 2006). To help validate the interview findings, multiple member checks were conducted (Creswell, 2013), including presenting preliminary results to coalition groups and asking for feedback from interview participants on a draft report. In addition, other data sources such as coalition progress reports, news articles, and policy documents were reviewed to fill in gaps in information obtained from interviews.

Results
Of the 25 interview participants, 52% were women, 64% were at least 45 years old, 56% identified as Caucasian, 48% had a Master’s or other graduate degree, and 68% were involved with the coalition as part of their jobs. Nearly half (44%) worked for county government agencies, including Planning and Public Works.   Participants viewed Get Fit Kauai as critical to achieving the policy changes because of the resources it contributed to capacity building efforts, its activities to increase public awareness of the link between the environment and active lifestyles, and how it coordinated member testimony before County Council. In addition to the policy changes, Get Fit Kauai organized Walk to School Days through its Safe Routes to School Task Force; held annual Mayor-a-thon events in which hundreds of community members celebrated using the coastal path; trained coalition members to lead community planning charrettes; and developed performance measures to track the progress of Complete Streets policy implementation.   One of the major themes to emerge was capacity building, which was seen as an essential first step in the process of policy change. Get Fit Kauai had the resources to hire a progression of national consultants that provided education, training, and targeted technical assistance to the County of Kauai departments and coalition members. The capacity building helped to break down silos between departments and generated support for policy changes. Other contributing factors to policy change were political support from the Mayor and County Council, an effective coalition director, garnering significant local media coverage, and using the Built Environment Task Force as a vehicle for discussion and decision-making for policy strategies.   The community context was mostly supportive of the built environment policy changes. As a small, rural community, people knew each other and cared deeply about preserving the unique character of the island. To overcome a barrier to implementation, one of the identified next steps for Get Fit Kauai was helping to educate communities about the Complete Streets policy and how implementation would not ruin the rural island character.

Conclusions
Get Fit Kauai played a critical role in helping to pass policy changes addressing Complete Streets and Safe Routes to School. For policy implementation, the role of the coalition is evolving into a more supportive one as the county government takes over the lead. Nevertheless, Get Fit Kauai still has meaningful functions to carry out, including community education and holding the county accountable for implementation.

Implications
Other coalitions undertaking similar efforts can learn several lessons from Get Fit Kauai. One of the lessons is to have patience: it will take time to see changes on the ground. Although the County is working hard to implement pilot projects, community members need to understand how long the process takes. Another lesson is that multiple champions are needed at different levels and in different places to keep pushing the work forward. Finally, Get Fit Kauai’s director was identified as the driving force behind the coalition, and other leaders can learn from her approaches in recruiting and motivating people to do the coalition work.

References

  1. Charmaz, K. (2006). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, CA: Sage Publications, Inc.
  2. Creswell, J. W. (2013). Qualitative Inquiry & Research Design: Choosing Among Five Approaches. Thousand Oaks, CA: Sage Publications, Inc.

 

Support / Funding Source
This study was funded by the Hawaii State Department of Health, Healthy Hawaii Initiative, through Tobacco Settlement Special Funds. Get Fit Kauai is funded by the Healthy Hawaii Initiative and received additional funding through Communities Putting Prevention to Work, Centers for Disease Control and Prevention.

Authors: 
Lehua Choy, MPH, University of Hawaii
Location by State: 
Study Type: 

Assessing Community Readiness for Childhood Obesity Prevention: Findings from Georgia

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Communities play a critical role in addressing the childhood overweight and obesity epidemic. Community members, organizations, and governments make the decisions that affect land use, nutrition, marketing, community planning, transportation and ultimately the health status of their residents. Communities provide the context, environment, and opportunity for children to eat well and be physically active (CDC,2009). They are ideally positioned to provide resources, promote behaviors fostering change, and develop effective strategies to promote healthy eating, healthy lifestyles, and healthy weight. Recent research highlights the important role collaboratives can play in promoting physical activity (Litt et al.,2013).  In Georgia, little is known about the number of collaboratives at work or their readiness and capacity to implement evidence-based childhood obesity prevention strategies. In 2012, Georgia State University’s School of Public Health (SPH) partnered with the Georgia Family Connection Partnership (GaFCP) to identify local communities in Georgia that have existing capacity and interest in expanding childhood obesity prevention efforts. SPH and GaFCP assessed community readiness related to the existence of collaboratives, leadership, partnerships, community knowledge, and local resources. This study presents findings on the community readiness of 15 communities engaged in childhood obesity prevention efforts across Georgia.

Objectives
To  identify communities in Georgia that have an interest in expanding childhood obesity prevention efforts and assess their capacity and readiness for future implementation of policies and programs to address childhood obesity.

Methods
The Community Readiness Model (CRM) assesses the capacity to which a community is prepared to address an issue (Plested, Edwards, & Jumper-Thurman, 2006). The CRM has been applied to childhood obesity prevention and used to develop effective, culturally-appropriate, community interventions (Findholt,2007;Sliwa et al.,2011). The model is based on the Transtheoretical Model of Behavior Change and assesses six dimensions, including existing efforts, community knowledge of efforts, leadership, community climate, community knowledge of issue, and resources available to support efforts. The model includes prevention/intervention strategies for each stage of readiness.  Fifteen collaboratives across Georgia were identified in this study. Collaboratives with moderate to high levels of interest were included.  Collaboratives that existed within the last three years and were previously active were also included. Seventy-nine key informant interviews were conducted (4-6 interviews per collaborative) using a semi-structured questionnaire assessing the six dimensions of readiness. The key informants represented different sectors of the community (e.g., healthcare, education, community organizers, and policymakers). Data were analyzed using qualitative methods and the CRM scoring system. Researchers discussed and reconciled differences in scores and reached consensus for each dimension. An overall stage of readiness score was reached for each collaborative by taking the total of all calculated scores and dividing by the number of dimensions (6).

Results
Overall, total readiness scores ranged from 2.8 to 5.1 out of 9. Ten out of 15 communities scored in the Preplanning stage (clear recognition that something must be done; efforts are not focused or detailed). One community scored in the Denial/Resistance stage (there is little recognition that the problem is occurring locally); two communities scored in the Vague Awareness stage (a local concern, but no immediate motivation to take action); and two communities scored in the Preparation stage (active leaders with modest support of efforts). The average score across all collaboratives for community efforts was 6.3 (Initiation Stage), community knowledge of efforts was 3.5 (Vague Awareness Stage), leadership was 4.6 (Preplanning Stage), community climate was 3.1 (Vague Awareness Stage), community knowledge about the issue was 3.5 (Vague Awareness Stage), resources available was 5.1 (Preparation Stage), and total average score was 4.3 (Preplanning Stage).

Conclusions
In Georgia, only 15 out of 159 counties have established collaboratives dedicated to childhood obesity prevention. Efforts were not always coordinated, widely supported, or adequately publicized.  This was reflected in the lower scores in community climate and community knowledge. While many decisions related to nutrition and physical activity are made at an individual level, this is only one piece of the puzzle.  Individuals can only make healthy decisions when they have the resources, environments, and opportunities to do so.  Communities can respond to the obesity epidemic by creating environments that support healthy eating and encourage physical activity.  Evidence supports the efficacy of community involvement in promoting healthy eating and active living, which ultimately benefits the health of residents. The state has a growing number of communities with interest in childhood obesity prevention and many have expressed a need for support on effective approaches. There is a need for state action to catalyze efforts to support the establishment of additional collaboratives and build capacity to implement childhood obesity prevention programs and policies.

Implications
This study has demonstrated the utility of the CRM for understanding community capacity on childhood obesity prevention. Four of the collaboratives subsequently received grants from the Healthcare Georgia Foundation to implement childhood obesity prevention initiatives. GSU and GaFCP are providing technical assistance for implementation of their childhood obesity prevention policies and programs.

References

  1. Centers for Disease Control and Prevention. Recommended Community Strategies and Measurements to Prevent Obesity in the United States. MMWR 2009;58 (No.RR:07).
  2. Litt JS, Reed HL, Tabak RG, Zieff SG, Eyler AA, Lyn R, et al. Active Living Collaboratives in the United States: Understanding Characteristics, Activities, and Achievement of Environmental and Policy Change. Prev Chronic Dis 2013;10:120162.
  3. Plested B, Edwards R, Jumper-Thurman P. Community readiness: a handbook for successful change. Fort Collins (CO): Tri-Ethnic Center for Prevention Research; 2006.
  4. Findholt N. Application of the community readiness model for childhood obesity prevention. PH Nurs 2007, 24(6):565–570.
  5. Sliwa S, Goldberg JP, Clark V, Collins J, Edwards R, Hyatt RR, et al. Using the community readiness model to select communities for a community-wide obesity prevention intervention. Prev Chronic Dis 2011, 8(6):A150.

Support / Funding Source
The Healthcare Georgia Foundation funded this study.

Authors: 
Erica Sheldon, MPH, Georgia State University
Location by State: 
Population: 

Physical Activity among Native Youth: A Systematic Review

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The rapid rise in the incidence and the persistent multi-generational occurrence of chronic disease has grave implications for the immediate and long-term health of American Indian and Alaska Native children and the sustainability of our nation’s indigenous people.  Addressing social inequalities contributing to the etiology of multi-generational chronic disease among American Indians and Alaska Natives can occur within this generation’s lifespan.  One potential strategy of a comprehensive public health response may be targeting environmental and policy factors that promote or inhibit exercise, recreational activities, household and occupational activities, and active transportation.  Nevertheless, comparatively fewer studies have examined the associations between chronic diseases and the built environment that are exclusively focused on American Indian and Alaska Native communities; even less direct observational research has focused specifically on the features of the built environment that influence active living.  Far less is known about the role of tribal government in promoting or inhibiting exercise, recreational activities, household and occupational activities, and active transportation through its courses of action, regulatory measures, laws and policies, tribal resolutions, and funding priorities.

Objectives
To advance the state of the science, this review aims to examine the methodology and current evidence on physical activity among American Indian and Alaska Native communities, with particular attention to advancing our understanding of policy, systems and environmental change for promoting active living among these communities.  Taking into account the assets and barriers identified as influential among American Indian and Alaska Native communities, this review also aims to provide guidance on promising strategies and research opportunities to effectively develop, implement, evaluate, sustain and disseminate community changes that promote active living within and across diverse American Indian and Alaska Native communities.

Methods
A systematic review was conducted to identify all peer-reviewed literature addressing physical activity among American Indians and Alaska Natives using three strategies.  First, key words relating to physical activity and American Indian were used to conduct a literature search using PubMed (Medline), Web of Science, and Scopus through May 31, 2014.  In addition, the search engine of Active Living Research, a national program of the Robert Wood Johnson Foundation (http://activelivingresearch.org/) was searched using “Native American”.  The final strategy was searching the United States National Institutes of Health Human Nutrition Research Information Management system database (http://hnrim.nih.gov/) to identify relevant investigators and then conducting a search by their name in PubMed for any missed articles.  The references of each article were reviewed to identify any additional articles. Peer-reviewed studies were considered for review if they included human subjects, were published in English and reported on physical activity among American Indians and Alaska Natives living in the United States.  When possible, the following information was extracted from each study:  year of publication, year of data collection, sample age, sample size used for final analyses, study setting, study design, measures and methods, data sources, psychometric properties, intervening approaches, outcomes, covariates, results, funding, author identified strengths and limitations and author identified lessons learned particular to conducting research or fostering active living among American Indians and Alaska Natives.  One researcher (SF) conducted the search and coded all the articles.  Inter-rater reliability was conducted with high agreement on more than 31 articles categorized as interventions (ER) and 65 of articles categorized as descriptive/associational (RC).

Results
More than 250 articles providing insights on physical activity among American Indians and Alaska Natives have been identified.  Limited work has reported on physical activity patterns across varying life stages and from various geographical settings using objective measures.  More than 90 articles reported descriptive or associational observations providing insights on American Indians or Alaska Natives but a majority of these studies included very small sample sizes.  Few studies focused on measuring physical activity and the built environment associated with active living among American Indian and Alaska Native communities.  Youth interventions were predominantly school-based with one occurring at a childcare center and six having strong child-family-community components.  Few studies reported on community-level strategies to promote physical activity among American Indian and Alaska Native communities, one using a multilevel approach involving school, work site and church.

Conclusions
There is limited and mixed evidence available on physical activity patterns among American Indian and Alaska Native communities.  Family-, school- and community-based approaches have shown promise, as well as integrating cultural and historical connections around healthy living.  Very little research has focused on the role of tribal government actions in fostering community changes that promote active living.

Implications
Tribal leaders have untapped and unexamined potential to accelerate progress in childhood obesity prevention.  More work is needed to understand physical activity and inactivity among American Indian and Alaska Native communities from early infancy into adulthood.  Research is also needed on the role of tribally-led community changes that promote active living.

Authors: 
Ricky Camplain, MSPH, University of North Carolina at Chapel Hill
Location by State: 
Population: 
Study Type: 

Personal, Environmental and Social Predictors of Accelerometer Measured Moderate to Vigorous Physical Activity of Bruneian Adolescents

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Physical activity is one of the key factors of obesity prevention in children and adolescents. To encourage children and adolescent to participate in moderate to vigorous physical activity (MVPA) is a priority of public health practice. However, the PA of children and adolescents are reported to decline in early adolescence. Although studied have found that PA of adolescents may be influenced by personal physical ability, self-perceptions and environmental factors, what factors predict objectively measured MVPA in adolescents remains unclear. Therefore, the purpose of this study was to examine physical ability (body mass index [BMI] and physical fitness [PF]), self-perceptions (enjoyment of PA [EPA], attitudes towards physical education [ATPE], and self-competence in sports [SPCS]), social (school teacher encouragement, peer encourage and involvement, and family facilitation and role modeling) and environmental (school sports facilities, neighborhood sports facilities and parks) factors that influence adolescents’ participation in MVPA in Brunei Darussalam. Bandura’s social cognitive theory was used to be the framework for examining the determinants of PA behavior since it is based on reciprocal, dynamic and triadic relationships between personal, social and environmental factors and PA behaviors.

Objectives
To examine the personal, social and environmental predictors of MVPA in Bruneian adolescents.

Methods
The study was approved by University Ethics Committee and Ministry of Education of Brunei Darussalam.  A total of 468 12-14 year old Bruneian adolescents (boys = 200; girls = 268) from eight Brunei secondary schools voluntarily participate in this study. Subjects’ body height and weight were collected. Each subject wore the RT3 accelerometer for seven consecutive days to objectively measure light PA (LPA), moderate PA (MPA), vigorous PA (VPA) and MVPA. PF including six fitness components (push-up, sit-ups, sit and reach, standing broad jumps, shuttle run, and 1.6km run) were measured. BMI was calculated using body weight ∙height–2. A Physical Activity Questionnaire was administrated to examined personal, social and environmental factors. The questionnaire consisted 25 items that investigated the adolescents’ PA patterns and lifestyle, school sports facilities, neighborhood facilities and parks, teachers’ and peers’ encouragement and involvement and parent’s influences. Face and content validity of the instrument was established by a panel of three experts. One-week test-retest reliability of the instrument was established (r = .81) and internal consistency for this instrument was demonstrated (Cronbach’s Alpha [α] = .75). The Physical Activity Enjoyment Scale (PACES) (α = .87), ATPE (α = .69) and SPCS (α = .86) were administrated. Social Economic Status (SES) was provided by school administration.

Results
All the adolescents in the study did not meet recommended PA guideline (MVPA: 4.07 ± 3.45 minutes∙day–1) and girls were more inactive than boys (girls MVPA: 2.93 ± 2.26 minutes∙day–1; boys MVPA: 5.60 ± 4.13 minutes∙day–1, t = 8.95, p < .001). BMI did not significantly predict all components of PA while PF significantly predicted high intensity of MVPA. Results from correlation analysis showed that PF was significantly related to MVPA (r = .19, p = .001), the ATPE (r= .23, p = .001) and PACES scores (r = .21, p = .001) while BMI was only related to the PACES scores (r= -.18, p = .001). Results from multiple stepwise regression analysis revealed that family doing PA together, doing fitness enhanced exercise, school sports facilities, proximity of neighborhood sports facilities and parks, friends doing PA together, total ATPE attitude scores and PF significantly predicted MVPA. These factors explained a significant proportion of variance in the PACE scores (R2 = .17, F(1, 462) = 5.11, p = .02, SEE = 3.16) while family doing PA together, school sports facilities and proximity of sports facilities and parks, watching TV, watching DVD and playing computer games, friends doing PA together and total enjoyment levels significantly predicted LPA (R2 = .25, F[1, 454] = 6.06, p = .01, SEE = 19.43).

Conclusions
PF but BMI was a significant predictor of adolescents’ participation in MVPA. Attitude but enjoyment was a significant predictor of MVPA while enjoyment was a significant predictor of LPA. Youth individual fitness levels, days of doing fitness enhanced exercise, parent role modeling, peer involvement, school sports facilities, neighborhood facilities and parks all play important roles in the youth’s participation in MVPA.

Implications
Health educators are suggested to encourage youth to improve and maintain physical fitness through participating in more MVPA. The findings from this research highlighted that personal (PF and attitude), social (parental role modeling) and environmental (school sports facilities and neighborhood facilities and park) factors were influencers of youths’ participation in MVPA. This study suggests government policy makers to improve sports environments in both schools and communities. It also appeals to adolescents and their parents to be aware of their PF levels, parental participation and role modeling in encouraging their children to participate in MVPA.

Authors: 
David Sun, PhD, Universiti Brunei Darussalam
Location by State: 
Study Type: 

Objectively Measured Walking and Built Environments in Small Towns and Urban Areas

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Rural-residing adults in the United States (U.S.) walk less than their urban counterparts. Yet micropolitan statistical areas – small towns geographically isolated from metropolitan areas – are home to 10% of the U.S. population and are centers of residential and employment land uses that may support walking. Little is known about the walking behaviors or built environments of small town residents and how they compare with better-studied urban populations.

Objectives
This study is the first to compare objectively measured walking behaviors and home neighborhood built environments in a sample of small town and urban area residents. It also summarizes prior research that separately assessed the association between the built environment and utilitarian walking in these two different locations.

Methods
Parcel-based sampling was used to randomly select adults living in the urbanized Seattle metropolitan area and in nine small towns across 3 regions in the U.S. In the Seattle sample, 699 participants completed a demographic, behavioral and attitudinal survey. They then wore an accelerometer, GPS device, and completed a travel diary for one week. In the nine small towns, 2,152 participants completed a demographic, behavioral and attitudinal survey. A sub-sample of 299 participants enrolled in a follow-up study and wore an accelerometer, GPS device, and completed a travel diary for one week. In both study populations, the accelerometer, GPS, and travel diary data were used to measure objective physical activity, which was further classified as walking for recreational or utilitarian purposes or non-walking (Kang et al. 2013). In both samples, home locations were geocoded and neighborhood built environments were measured within a 1-km network buffer using GIS techniques. First, this study summarizes differences in survey measures of socio-demographics, GIS measures of neighborhood built environment, and objective measures of walking between the urban Seattle participants and the small town sub-sample of participants that provided objective activity data. Second, this study summarizes previous research that assessed the association between GIS measures of home neighborhood built environment and survey measures of neighborhood walking in the full small town sample population (Doescher et al., under review). These results are compared to previous research that has assessed the association between GIS measures of home neighborhood built environment and objective measures of walking in the Seattle population (Kang 2013).

Results
Compared to the urban Seattle population, the small town population had lower household income, had a greater proportion of overweight or obese,  were older, were more likely to be married, were less educated, had more vehicles in the household and were more likely to live in a single family home. Small town residents also had lower home neighborhood residential density, fewer neighborhood destinations (including restaurants, food stores, schools, and parks), a lower neighborhood street intersection density, and a smaller area of steep slopes in their home neighborhood. The small town participants walked for utilitarian purposes an average of 38.6 minutes per week and for recreational purposes 50.0 minutes per week. The urban Seattle participants walked an average of 142.9 minutes per week for utilitarian purposes and 37.2 minutes per week for recreational purposes. Previous research found that in the small town population, after adjusting for socio-demographics and neighborhood perceptions, manufacturing land use and the presence of a post office within 1 km were positively associated with self-report utilitarian walking ≥150 minutes per week. In the urban population, after adjusting for socio-demographics and neighborhood perceptions, home neighborhood residential and employment density were positively associated with utilitarian walking minutes per week. For both populations, perception of neighborhood support for PA and walkability were associated with more walking.

Conclusions
This study found that the small town sample population was of lower socio-economic status and had less walkable objectively measured home neighborhoods than the urban Seattle population. These differences may explain why the small town population walked for utilitarian purposes much less than the urban population. However, the small town population walked for recreational purposes more than the urban population, suggesting that small town built environments can support walking, but may either not have the agglomeration of destinations to support utilitarian walking, or driving for short utilitarian purposes in small towns is easier than walking. Prior research found different home neighborhood built environment features associated with utilitarian walking in urban versus small towns, suggesting that different environmental interventions may be necessary to support utilitarian walking in small towns versus urban areas.

Implications
The differences noted between the urban and the small town populations in both walking levels and environmental influences on walking suggest different approaches to using the built environment to support more physical activity through walking. While in urban areas modifying the neighborhood environment can positively affect utilitarian walking, in small towns, environmental supports that relate to recreational walking might be more effective.

References

  1. Doescher M, Lee C, Berke EM, Adachi-Mejia AM, Lee C-K, Stewart O, et al. The Built Environment and Utilitarian Walking in Small U.S. Towns. Preventive Medicine under review.
  2. Kang B, Moudon AV, Hurvitz PM, Reichley L, Saelens BE. Walking objectively measured: classifying accelerometer data with GPS and travel diaries. Med Sci Sports Exerc 2013;45(7):1419-28.
  3. Kang B. Chapter 4 Utilitarian and Recreational Walking in Objectively Measured Walking: Temporal, Spatial, and Built Environmental Characteristics (doctoral dissertation). 2013.

 

Support / Funding Source
This study was funded by the National Institute of Health grants R01HL091881 and 1R01HL103478-01A1 Note to reviewers: We are in the process of running analyses that pool the urban and the small town populations to assess differences in BE influences on walking for transport and for recreation, adjusting for socio-demographic and neighborhood perception. While, unfortunately, the results of these analyses are not available at this time, we intend to present them at the conference. To our knowledge, this would be the first analyses comparing these two populations based on objective measures of both walking and the built environment.

Authors: 
Orion Stewart, MUP, University of Washington
Location by State: 
Population: 

Road Safety Policy Implementation for Improving Pedestrian Environment: Lessons from France and Sweden

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
For more than a decade, efforts to evaluate the impact of the built environment on human health have been central to the planning field. Substantial attention has been devoted to the areas of New Urbanism, Smart Growth, and Active Living to improve health conditions by increasing physical activity. However, crash prevention are becoming more critical, as there are increasing demands to proactively improve pedestrian safety on roads. This research aims to inform policy-makers of the factors that affect pedestrian safety by examining how road safety policies in France and Sweden have substantially reduced the number of pedestrian fatalities and exploring potential implementations for the United States.

Description
Based on the available government documents, published studies, and pedestrian fatality data in European countries, this study explored the French and Swedish approaches of improving general road and pedestrian safety over particular periods: between 2002 and 2005 for the French case, and between 1997 and 2006 for Swedish safety program.

Lessons Learned
In France and Sweden, public officials hold the main responsibility for road safety and undertake rigorous and innovative interventions to improve safety awareness and to reduce pedestrian deaths on roads. In the French road safety program, the primary responsibility for road crashes is on “everyone”, including road users, policy-makers, road designers, and other population groups. Less blame is put on road users, and the government took on the main responsibilities for road collisions. This principle of responsibility-share helps alter individuals’ attitudes toward road safety. In Sweden, the road system designers hold the main responsibility for traffic safety. When road users violate traffic rules or if any crashes occur, the system designers are required to take any necessary further steps.

Conclusions
A major similarity between the two nations’ programs was the emphasis on improving the traffic safety culture of the society, particularly by shifting the responsibility of road safety from road users to decision-makers. However, France focused more on improving road behavior through campaigns and education programs. In comparison, Sweden focused more on improving error-tolerant roadway design combined with stricter road enforcement by heavily placing road safety responsibility on road system designers. The findings suggest that the strategies from the cases of France and Sweden can potentially be modified and implemented in the United States. It is true that the U.S. is a much larger country than France and Sweden, and most cities in the U.S. were designed to encourage auto-oriented development over the decades, while those two European countries were not. Also, land use patterns, traffic systems, and the policy-making process among the countries are different. However, in general, the implementation of new safety interventions in the U.S. should involve raising awareness among the public and encouraging policy-makers to more effectively improve walking environments. All in all, legitimate road safety interventions must be consistent with the overall goals for the transportation planning system.

Next Steps
Along these lines, further research on how planners and professionals in other fields, including architecture, public health, and public policy, can support pedestrian safety should be carried out. Today, in the U.S., pedestrian safety is considered a transportation and public health problem, however, safety components should be addressed along with land-use, design, and policy issues. Therefore, future research is needed that examines how planners, safety program coordinators, and other policy-makers can help raise the salience of pedestrian safety and shift the balance of responsibility to reflect experts’ roles in system risk.

References

  1. Ewing, R., and E. Dumbaugh. 2009. “The Built Environment and Traffic Safety: A Review of Empirical Evidence.” Journal of Planning Literature 23 (4) (May 21): 347–367.
  2. Gerondeau, Christian. 2006. “Road Safety in France: Reflections on Three Decades of Road Safety Policy.” FIA Foundation for the Automobile and Society.
  3. Whitelegg, John, and Gary Haq. 2006. “VISION ZERO: Adopting a Target of Zero for Road Traffic Fatalities and Serious Injuries”. Stockholm Environment Institute.
  4. Zegeer, Charlie, William Hunter, Loren Staplin, Fran Bents, Richard Huey, and Janet Barlow. 2010. “White Papers for ‘Toward Zero Deaths’, A National Strategy on Highway Safety: 5. Safer Vulnerable Road Users : Pedestrians , Bicyclists , Motorcyclists , and Older Users”. Washington, D.C.
Authors: 
Jean Kim, Master of Urban Planning, University of Washington
Location by State: 
Population: 
Study Type: 

Contributions of Neighborhood Street Scale Elements to Physical Activity in Mexican School Children

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Residence in neighborhoods where streets are safe, attractive, and connected has been related to physical activity (PA).[1,2] Research has focused more on adults and has been conducted in high income countries.[3] This relationship is as yet undocumented in most low and middle income countries, such as Mexico, an emerging influence on North American countries, and burdened with the highest childhood obesity rate in the world. Specific types of environmental factors might influence particular types of PA (eg, recreational, transportation) differently;[4] however, many of these findings are based on perceived or resident self-reported environmental variables with few studies using objective, in-person audits of the environment.

Objectives
This study investigated the relationship of objectively assessed street scale data with PA among Mexican children.

Methods
Neighborhoods were an 800 meter radial buffer circumscribed[5] around public schools selected by the State of Jalisco Secretary of Education (Guadalajara n=12; Puerto Vallarta n=5) or from another study of policy implementation in Mexico (Mexico City n=18). Trained American and Mexican field assessors measured5 25% of residential and all arterial street segments[3] within the radial buffer were coded using an adapted version of the Pedestrian Environment Data Scan.[6] Traffic buffers (eg, fence, trees, grass), path connections, traffic control devices, traffic lanes, crossing aids, amenities (eg, benches, trash cans, street vendors), bicycle facilities and traffic speed limit were measured to represent street scale features. Assessments were conducted in teams of at least 2 people following established data collection and safety protocols.[5, 6]   Mexican school children participated in a multisite investigation of neighborhood and health in Mexican school children in Guadalajara (n=804), Mexico City (n=703) and Puerto Vallarta (n=207) in 2012. Demographic characteristics of child’s age, gender, and the number of children in the home and PA were measured using a translated version of the 4th grade School Physical Activity and Nutrition (SPAN) survey that was distributed to parents for completion.[7] Parents completed items measuring the days of outdoor play, participation on sports teams (yes/no) and participation in other organized PA (yes/no).[8] Children provided assent and parents provided consent following approved IRB protocols.   Descriptive, bivariable analyses were conducted using correlation, t, one-way ANOVA or Chi Square tests. Initial bivariable associations (correlations) conducted for PEDS variables determined high multicollinearity; therefore, each PEDS variable was tested in a separate model for each of the three PA outcomes. Street segment data were aggregated to the neighborhood level by taking the mean across street segments for each neighborhood, using established protocols for ecologic analyses.[9] Hierarchical regression models were used to estimate the effect of aggregated environmental factors on individual days played outside, and hierarchical logistic regression models were used to determine associations with participation in sports teams and other organized physical activities. All models were controlled for individual child age, gender, number of children in household, and city of residence.

Results
The sample (M=9.6±1.0 years) was nearly evenly divided by gender (n=817 boys, 46.9%; n= 924 girls, 53.1%), with an average of 2.5±1.6 children per household. On average, parents reported that their child played outdoors for 30 minutes about twice a week (M=2.4±2.3), nearly half participated in at least one sports team (n=619, 47.2%) and over one third participated in other organized physical activities (n=566, 40.6%). Gender was consistently associated with PA participation, with girls spending fewer days playing outdoors (m=2.1±2.1 vs.  m=2.6±2.3, p

Conclusions
Outdoor play may occur on streets with fewer street elements that focus on pedestrian safety and comfort (buffers, connectivity, crossing aids, amenities), on streets that may have less traffic (fewer lanes, control devices). Perhaps these are quieter streets with less traffic and fewer pedestrian enhancements. Participation in sports and other organized activities was related to few neighborhood variables. Participating in other organized activities was associated with having more children in the household (not shown). Perhaps participation in extracurricular activities is driven by time and access to resources.

Implications
The lower levels of participation in play, sports and other activities suggest that strategies at all levels are needed to increase PA among Mexican children. Increasing access to safe and pleasant areas in neighborhoods may help to increase PA.

References

  1. Giles-Corti B, Donovan RJ. Relative influences of individual, social environmental, and physical environmental correlates of walking. Am J Public Health. 2003;93:1583–9.
  2. Handy SL, Boarnet MG, Ewing R, Killingsworth RE. How the built environment affects physical activity: views from urban planning. Am J Prev Med. 2002;23:64–73.
  3. Giles-Corti B, Kelty SF, Zubrick SR, Villanueva KP. Encouraging walking for transport and physical activity in children and adolescents: how important is the built environment? Sports Med. 2009;39(12):995-1009. doi: 10.2165/11319620-000000000-00000. Review. PubMed PMID: 19902982. http://www.ncbi.nlm.nih.gov/pubmed/19902982.
  4. Cain KL, Millstein RA, Sallis JF, Conway TL, Gavand KA, Frank LD, Saelens BE, Geremia CM, Chapman J, Adams MA, Glanz K, King AC. Contribution of streetscape audits to explanation of physical activity in four age groups based on the Microscale Audit of Pedestrian Streetscapes (MAPS). Soc Sci Med. 2014 Sep;116:82-92. doi: 10.1016/j.socscimed.2014.06.042. Epub 2014 Jun 24. PubMed PMID: 24983701.
  5. Lee RE, Booth KM, Reese-Smith JY, Regan G, Howard HH. The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods. Int J Behav Nutr Phys Act. 2005 Sep 14;2:13. PubMed PMID: 16162285; PubMed Central PMCID: PMC1262748.
  6. McMillan TE, Cubbin C, Parmenter B, Medina AV, Lee RE. Neighborhood sampling: how many streets must an auditor walk? Int J Behav Nutr Phys Act. 2010 Mar 12;7:20. doi: 10.1186/1479-5868-7-20. PubMed PMID: 20226052; PubMed Central PMCID: PMC3224902.
  7. Thiagarajah K, Fly AD, Hoelscher DM, Bai Y, Lo K, Leone A, Shertzer JA. Validating the food behavior questions from the elementary school SPAN questionnaire. J Nutr Educ Behav. 2008 Sep-Oct;40(5):305-10. doi: 10.1016/j.jneb.2007.07.004. PubMed PMID: 18725149.
  8. Penkilo M, George GC, Hoelscher DM. Reproducibility of the School-Based Nutrition Monitoring Questionnaire among fourth-grade students in Texas. J Nutr Educ Behav. 2008 Jan-Feb;40(1):20-7. doi: 10.1016/j.jneb.2007.04.375. PubMed PMID: 18174100.
  9. Heinrich KM, Lee RE, Suminski RR, Regan GR, Reese-Smith JY, Howard HH, Haddock CK, Poston WS, Ahluwalia JS. Associations between the built environment and physical activity in public housing residents. Int J Behav Nutr Phys Act. 2007;4:56.

 

Support / Funding Source
This work made possible by a Fulbright-García Robles Core Scholar Fellowship awarded to Dr. Lee, the Canadian Institutes for Health Research and the Public Health Agency of Canada.

Authors: 
Rebecca Lee, PhD, Arizona State University
Location by State: 
Population: 
Study Type: 

Do Personal-Level Characteristics Moderate Neighborhood Correlates of Physical Activity among Adult Latinas?

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Latinas are less likely to engage in the recommended levels of physical activity (PA) for health compared to women of other racial/ethnic backgrounds (CDC, 2012). The reasons for these disparities are unknown but several studies suggest that factors across various levels of the socio-ecological model influence PA (López et al., 2008; Martinez et al., 2009). To date, few studies have examined the influence of factors at both the individual- and environmental- levels on either domain-specific activities (e.g., leisure time PA) or accelerometer-assessed moderate-to-vigorous physical activity (MVPA) among Latinos. Therefore, the purpose of this study was to test a principle of the socio-ecological model by assessing the moderating influence of personal-level characteristics on neighborhood-level correlates of self-report leisure-time MVPA (LTMVPA) and accelerometer-assessed MVPA among Latina women in San Diego, CA.

Objectives
The objective of this study was to assess whether Latinas with more advantaged personal-level characteristics (higher income, education, and acculturation levels and lower body weight status) and favorable perceptions of neighborhood features (built and social environment) were more likely to meet the Physical Activity Guidelines for Americans (PA Guidelines) using LTMVPA and accelerometer-assessed MVPA than those with less-advantaged characteristics.

Methods
This study used cross-sectional baseline data obtained from 437 Latina women participating in a multilevel intervention for PA promotion in San Diego, CA, Fe en Acción [Faith in Action].  Participants were recruited from 16 churches that met the inclusion criteria and were randomized to either the PA intervention or attention-control group. After providing informed consent, participants had their anthropometric measures taken, completed a face-to-face interview, and wore an accelerometer for at least 5 complete days (i.e., 10 or more valid hours/day). Subscales from the Neighborhood Walkability Scale were used to examine five neighborhood features (e.g., safety from crime, safety from traffic, and aesthetics). Mixed effects models accounting for church clustering effects, and adjusted for confounders, examined the associations of neighborhood features with whether or not participants met the PA Guidelines using LTMVPA and accelerometer-assessed MVPA. To test for moderation by income, education, acculturation, and body weight status on the associations of neighborhood features with LTMVPA and accelerometer-assessed MVPA, interaction terms were created between each personal-level characteristic and neighborhood feature.

Results
Latinas with higher levels of perceived safety from crime were more likely to meet the PA Guidelines using LTMVPA than those with lower levels of perceived safety (ORadj = 1.27, 95% CI: 1.03-1.58). None of the neighborhood features were significantly related to meeting the PA Guidelines using accelerometer-assessed MVPA. Tests for moderation showed that the associations between neighborhood features and meeting the PA Guidelines varied by personal-level characteristics. Specifically, Latinas were significantly more likely to meet the PA Guidelines using LTMVPA if they had at least a high school education and higher levels of perceived safety from crime compared to those with lower education (ORadj=1.69, 95% CI: 1.16-2.45); had more assimilated acculturation levels and higher perceived safety from crime compared to less acculturated women (ORadj=1.93, 95% CI: 1.19-3.15); had a normal body weight and favorable neighborhood aesthetics compared to overweight/obese women (ORadj=2.73, 95% CI: 1.37-5.42); and had a monthly household income of $2000 or higher and better sidewalk maintenance compared to lower income women (ORadj = 2.05, 95% CI: 1.05-4.01). In addition, Latinas with more assimilated acculturation levels and higher levels of perceived safety from crime were twice as likely to meet the PA Guidelines using accelerometer-assessed MVPA as less acculturated Latinas (ORadj=2.11, 95% CI: 1.16-3.82).

Conclusions
Higher perceived safety from crime was the only significant correlate of meeting PA Guidelines using LTMVPA among Latinas. Of 20 interactions tested for LTMVPA, four personal-level characteristics were found to moderate neighborhood features: income, education, acculturation, and body weight status. None of the neighborhood features were significantly associated with meeting PA Guidelines using accelerometer-assessed MVPA; however, of the 20 interactions tested for accelerometer-assessed MVPA, acculturation was found to moderate perceived safety from crime. Our findings provide support for the socio-ecological model with significant interactions found across levels of influence of PA among Latinas.

Implications
Improvements in the neighborhood environment may only increase PA among subgroups of Latinas, such as women with higher income and education, more assimilated acculturation levels, or normal body weight. Subgroup differences among Latinas should be considered when developing interventions and policies targeting improvements of the neighborhood environment to promote PA. In addition, those with lower education and less acculturated to the US may need interventions beyond environmental changes.

References

  1. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. 2012.
  2. López IA, Bryant CA, McDermott RJ. Influences on physical activity participation among Latinas: an ecological perspective. American Journal of Health Behavior. 2008;32(6):627-639.
  3. Martinez SM, Arredondo EM, Perez G, Baquero B. Individual, social, and environmental barriers to and facilitators of physical activity among Latinas living in San Diego County: Focus group results. Family & Community Health. 2009;32(1):22-33.

 

Support / Funding Source
This study was supported by a diversity supplement from the National Cancer Institute of the National Institutes of Health (3R01CA138894-04S1).

Authors: 
Lilian Perez, MPH, University of California, San Diego / San Diego State University
Location by State: 
Study Type: 

More Active Living-oriented County and Municipal Zoning is Associated with Increased Adult Physical Activity—United States, 2011

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Zoning code reforms have emerged throughout the U.S. as a potential policy strategy for reducing sprawl, reliance on cars, and increasing physical activity (PA) opportunities.(1-3) Code reforms seek to create pedestrian-friendly neighborhoods with increased street connectivity, mixed-use and higher density, open space, transportation infrastructure, and a traditional neighborhood structure. (1-3) Zoning code reforms have been adopted by jurisdictions in at least 35 states, with the number of communities considering such reforms increasing regularly.(4-6) The purpose of this study was to examine the relationship between zoning code reforms/zoning codes containing more active living-oriented requirements (e.g., trails, connectivity, parks, open space, etc.) and adult PA.

Objectives
To examine the relationship between the proportion of county populations exposed to zoning code reforms and/or active living-oriented zoning provisions and adult PA behaviors (i.e., biking, vigorous biking, walking, running/jogging, and vigorous running/jogging).

Methods
Zoning codes effective as of 2010 for the 97 most populous counties in the U.S. (covering 40% of the U.S. population) and 1,261 municipal jurisdictions located in those counties were compiled (representing 98% of all municipal jurisdictions in the 97 counties with populations >=0.5% of a given county's population). Zoning codes were coded by trained Master’s level urban planners using a systematic zoning code audit tool developed by the study team. Code reform zoning (=1) if a given jurisdiction’s zoning code was a new urbanist type of code (e.g., SmartCode) or the zoning code was form-based or included transects, pedestrian-oriented developments, transit-oriented developments, or traditional neighborhood developments. Other active living-oriented provisions coded included requirements for: sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, bike-pedestrian trails/paths, mixed use development, active recreation (e.g., playgrounds, recreation structures, play areas, golf courses, parks with trails/amenities, exercise areas, etc.); and passive recreation (e.g., open space, greenways, nature preserves, generic parks). The zoning provisions for each jurisdiction were multiplied by the proportion of the county population represented by the given population and summed to a county-level, population-weighted measure of population exposure to a code reform zoning or active living-oriented zoning provisions. Zoning measure are continuous and range from 0-1 with 1 representing that the entire county population was exposed to a given measure and 0 indicating no exposure. Individual-level adult PA behaviors were obtained from the 2011 Behavioral Risk Factor Surveillance System (BRFSS), which  included 59,786 adults residing in the 97 counties of interest. Zoning data were lagged onto BRFSS data for analyses and were linked using state and county geocodes. Multivariate logistic regression models, controlling for individual demographics and BMI and county-level factors (deprivation index, race/ethnicity, Southern region) were computed to predict the odds of adult biking, vigorous biking, walking, running/jogging, and vigorous running/jogging.

Results
Descriptive statistics for the sample are presented in Table 1 and the full logistic regression results are presented in Table 2. In summary, the multivariate results indicate that for a 1-percentage point increase in the proportion of the population exposed to code reform zoning or zoning requirements for sidewalks, bike lanes, bike parking, bike-pedestrian trails/paths, active recreation, and/or passive recreation, the odds of adult biking and walking are statistically higher when controlling for individual and county-level factors. For example, for a 1-percentage point increase in the mean population exposure to zoning requirements for bike-pedestrian trails/paths, the odds of biking increases by 74%. Similarly, for a 1-percentage point increase in the mean population exposure to zoning requirements for sidewalks, the odds of adult walking increases by 13%.  Bike-pedestrian connectivity is associated with higher odds (OR=1.30, 95% CI: 1.02-1.65) of adult biking but no other PA measure. And, adult running/jogging was only associated with zoning requirements for bike lanes, mixed use, and active recreation. Overall, the most common zoning provisions to be associated with increased adult PA were code reform zoning and requirements for sidewalks, bike lanes, bike parking, active recreation, and passive recreation and, to a lesser extent, requirements for bike-pedestrian connectivity, bike-pedestrian trails/paths, and mixed use.

Conclusions
Zoning code reforms and more active living-oriented zoning provisions are associated with increased odds of adult PA.

Implications
Jurisdictions nationwide are seeking to identify policy and environmental strategies for increasing adult PA. Implementing changes to zoning codes to be more active living-oriented may be a key strategy for improving adult population-level PA in communities.

References

  1. Schilling J, Linton LS. The public health roots of zoning: In search of active living's legal genealogy. Am J Prev Med. 2005;28:96-104.
  2. Schilling J, Mishkovsky N. Creating a Regulatory Blueprint for Healthy Community Design: A Local Government Guide to Reforming Zoning and Land Development Codes. E-43346. 2005. Washington, D.C., ICMA.
  3. American Planning Association. Planning and Urban Design Standards. 1st ed. Hoboken, NJ: John Wiley & Sons, Inc., 2006.
  4. SmartCodes adopted collaborative map. Updated 2013. Accessed April 11, 2014.
  5. SmartCodes in progress collaborative map. Updated 2013. Accessed April 11, 2014.
  6. Other form-based codes collaborative map. Updated 2013. Accessed April 11, 2014.

 

Support / Funding Source
R01CA158035, National Cancer Institute, National Institutes of Health--Impact of Zoning Code Reforms on the Built Environment, Attitudes, and Physical Activity Behaviors (PI: Chriqui).

Authors: 
Jamie Chriqui, PhD, MHS, University of Illinois at Chicago
Location by State: 
Study Type: 

Influencing Active Living Policy and Practice: How Can I Improve My Pitch?

Description: 

Workshop at the 2015 Active Living Research Annual Conference.

Date: 
02/22/2015
Abstract: 

Researchers are often disappointed or frustrated that their research is ignored by policy-makers and practitioners. This partly stems from ‘the gap’ between researchers and policy-makers and a lack of understanding of the policy-making process. The aim of this workshop was to assist participants to understand how to better ‘pitch’ their ideas and research to active living decision-makers:  bureaucrats, practitioners and politicians. Workshop participants were invited to write a letter or email to a policy-makers, practitioner or bureaucrat requesting an opportunity to meet to discuss an issue, an opportunity for a collaboration, and/or a need for policy-reform. The letters were reviewed and all participants received feedback on their written communication. Four participants were also invited to present a five minute ‘pitch’. After receiving feedback, workshop participants worked together in four teams to discuss and distill key lessons about how a future pitch could be improved to achieve one’s goal.

Download the summary notes from the workshop: Strategies for an Effective Pitch

Authors: 
Billie Giles-Corti, PhD, McCaughey VicHealth Centre for Community Wellbeing, The University of Melbourne; Peter McCue, Executive Officer, NSW Premier's Council for Active Living, Sydney, Australia; Tracy Delaney, PhD, Public Health Alliance of Southern California; William Fulton, Kinder Institute for Urban Research, Rice University
Location by State: 
Population: 

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