Parks & Recreation

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Parks and recreation facilities provide opportunities for physical activity and can help people of all ages lead a more active lifestyle. People who live near parks are more likely to be active. However, some lower-income communities and communities of color tend to have less access to quality parks and recreation facilities. Our research documents the most effective ways to improve the design, quality and availability of parks and recreation resources. Making recreational facilities accessible in all communities is a critical strategy for increasing physical activity and preventing obesity.

Download our Parks and Recreation-related Resources Sheet for the best evidence available about a variety of park- and trail-based strategies for promoting physical activity.

View The Role of Parks and Recreation in Promoting Physical Activity infographic.

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Making the Case for Designing Active Cities

Date: 
02/15/2015
Description: 

Sallis, J.F., Spoon, C., Cavill, N., Engelberg, J., Gebel, K., Lou, D., Parker, M., Thornton, C.M., Wilson, A., Cutter, C.L., Ding, D. (2015). Making the Case for Designing Active Cities. San Diego, CA: Active Living Research.

A peer-reviewed paper based on this report is available online through open access in the International Journal of Behavioral Nutrition and Physical Activity.

Abstract: 

Creating "activity-friendly environments" is recommended to promote physical activity, but potential co-benefits of such environments have not been well described. An extensive but non-systematic review of scientific and "gray" literature was conducted to explore a wide range of literature to understand the co-benefits of activity-friendly environments on physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. Five physical activity settings were defined: parks/trails, urban design, transportation, schools, and workplaces/buildings.

KEY FINDINGS

  • A total of 418 higher-quality findings were summarized based on direction of association and quality of source.
  • The overall summary indicated 22 of 30 setting by outcome combinations showed “strong” evidence of co-benefits.
  • Each setting had strong evidence of at least 3 of the 6 co-benefits, and parks and trails had strong evidence of all 6 co-benefits. Thus, for each setting there are multiple features that can be designed to both facilitate physical activity and produce co-benefits.
  • All five physical activity settings could be designed so they have positive effects on economic outcomes, including increased home value, greater retail activity, reduced health care costs, and improved productivity.
  • Activity-friendly design in all settings had strong evidence of environmental co-benefits based on reduced pollution and carbon emissions.
  • There were many gaps in evidence of co-benefits in the schools and workplace settings as well the health consequences of environments that support active travel.
  • Overall, there was little evidence of negative consequences of activity-friendly environments.

 

IMPLICATIONS

The most important conclusion of this review is that creating communities, transportation systems, schools, and buildings that make physical activity attractive and convenient also produces a wide range of other benefits for communities. Rather than thinking that designing one feature of a transportation system or school is sufficient, we encourage decision-makers and designers to consider how features in all settings can be optimized for physical activity and multiple other benefits. We urge mayors, other city officials, and staff in multiple departments to consult these findings as an aid in decision-making.

DESIGNED TO MOVE: ACTIVE CITIES

The findings from our Making the Case for Designing Active Cities is prominently featured in Designed to Move: Active Cities, a guide for city leaders that provides a comprehensive summary of the evidence base to-date, along with bright spots and specific recommendations for leaders to make any city an active city.

 

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An Assessment of Schoolyard Renovation Strategies to Encourage Children's Physical Activity

Date: 
04/09/2011
Description: 

Anthamatten, P., Brink, L., Lampe, S., Greenwood, E., Kingston, B., & Nigg, C. (2011). An Assessment of Schoolyard Renovation Strategies to Encourage Children's Physical Activity. International Journal of Behavioral Nutrition and Physical Activity, 8(27).

Abstract: 

BACKGROUND: Children in poor and minority neighborhoods often lack adequate environmental support for healthy physical development and community interventions designed to improve physical activity resources serve as an important approach to addressing obesity. In Denver, the Learning Landscapes (LL) program has constructed over 98 culturally-tailored schoolyard play spaces at elementary schools with the goal to encourage utilization of play spaces and physical activity. In spite of enthusiasm about such projects to improve urban environments, little work has evaluated their impact or success in achieving their stated objectives. This study evaluates the impacts of LL construction and recency of renovation on schoolyard utilization and the physical activity rates of children, both during and outside of school, using an observational study design. METHODS: This study employs a quantitative method for evaluating levels of physical activity of individuals and associated environmental characteristics in play and leisure environments. Schools were selected on the basis of their participation in the LL program, the recency of schoolyard renovation, the size of the school, and the social and demographic characteristics of the school population. Activity in the schoolyards was measured using the System for Observing Play and Leisure Activity (SOPLAY), a validated quantitative method for evaluating levels of physical activity of individuals in play and leisure environments. Trained observers collected measurements before school, during school recess, after school, and on weekends. Overall utilization (the total number of children observed on the grounds) and the rate of activity (the percentage of children observed who were physically active) were analyzed. Observations were compared using t-tests and the data were stratified by gender for further analysis. In order to assess the impacts of LL renovation, recently-constructed LL schoolyards were compared to LL schoolyards with older construction, as well as un-renovated schoolyards. RESULTS: Overall utilization was significantly higher at LL schools than at un-renovated schools for most observation periods. Notably, LL renovation had no impact on girl's utilization on the weekends, although differences were observed for all other periods. There were no differences in rates of activity for any comparison. With the exception of the number of boys observed, there was no statistically significant difference in activity when recently-constructed LL schools are compared to LL schools with older construction dates and there was no difference observed in comparisons of older LL with unrenovated sites. CONCLUSIONS: While we observed greater utilization and physical activity in schools with LL, the impact of specific features of LL renovation is not clear. However, schoolyard renovation and programs to encourage schoolyard use before and after school may offer a means to encourage greater physical activity among children, and girls in particular. Additional study of schoolyard renovation may shed light on the specific reasons for these findings or suggest effective policies to improve the physical activity resources of poor and minority neighborhoods.

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An Assessment of Schoolyard Features and Behavior Patterns in Children's Utilization and Physical Activity

Date: 
03/01/2014
Description: 

Anthamatten, P., Brink, L., Kingston, B., Kutchman, E., Lampe, S., & Nigg, C. (2014). An Assessment of Schoolyard Features and Behavior Patterns in Children's Utilization and Physical Activity. Journal of Physical Activity and Health, 11(3), 564-573.

Abstract: 

BACKGROUND: Careful research that elucidates how behavior relates to design in the context of elementary school grounds can serve to guide cost-efficient design with the goal of encouraging physical activity (PA). This work explores patterns in children's PA behavior within playground spaces with the specific goal of guiding healthy playground design. METHODS: Data on children's utilization and PA behavior in 6 playgrounds divided into 106 observation zones were collected in 2005 and 2006 at Denver elementary school playgrounds using the System for Observing Play and Leisure Activity in Youth. Analyses of variance and t tests determined whether there were differences in utilization and behavior patterns across observations zones and between genders. RESULTS: This study provides evidence that children prefer to use certain types of playground zones and that they are more likely to practice moderate-to-vigorous physical activity (MVPA) in some zones. The authors observed statistically significant differences between genders. Boys were more likely to engage in MVPA in zones without equipment, girls were more likely to use zones with equipment. CONCLUSIONS: This work suggests that the inclusion or omission of specific playground features may have an impact on the way that children use the spaces.

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SOPARNA: System for Observing Physical Activity and Recreation in Natural Areas

Date: 
04/30/2014
Funding Source: 
SOPARNA development was supported by USDA Forest Service, Pacific Southwest Research Station, Riverside, California.
Description: 

SOPARNA is a direct observation tool for simultaneously assessing the physical activity and other characteristics of the users of outdoor recreation settings such as wilderness zones and natural open spaces.

Abstract: 

SOPARNA provides objective data on the number of participants and their physical activity levels in targeted wilderness and natural open spaces. Trained observers record the characteristics of each individual (i.e., gender, age group, apparent race/ethnicity) and his/her physical activity level (sedentary, moderate, vigorous) and activity type using momentary time sampling. Simultaneously the observers record the contextual characteristics of the targeted areas including their accessibility, usability, and whether or not supervision, organized activities, equipment, and recreational supports are being provided.

Authors: 
Vinod Sasidharan, PhD (vsasidha@mail.sdsu.edu) & Thomas L. McKenzie, PhD (tmckenzie@sdsu.edu)
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Creating an Online Platform for Healthier Changes in Latino Communities

Date: 
03/12/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
More than 39% of Latino children ages 2-19 are overweight or obese, compared to almost 32% of all U.S. children.(1)  These high rates of obesity among Latino children are particularly alarming because Latino children currently comprise 22% of all U.S. youth—and are expected to grow to comprise 30% of the youth population by 2025.(2-3)

In response, Salud America! The Robert Wood Johnson Foundation (RWJF) Research Network to Prevent Obesity Among Latino Children launched an online network in 2007 to mobilize four sectors of society (community leaders, researchers, policymakers and media) to collaborate to reverse the obesity epidemic. In its first five years, the network recruited more than 2,000 members and fed them with innovative video, online and e-communications.(4-5)

The network also made many research advancements: 1) Developed the first-ever Latino Childhood Obesity Research Priority Agenda; 2) Funded 20 grantee researchers; 3) Developed research briefs on Latino nutrition, physical activity and media/marketing issues; and 4) Developed the “Policy Contribution Spectrum” model.(6-7)

Based on its research success and the Spectrum model, Salud America! has created and is beta-testing a unique online platform that will expand its membership and activate them to create healthy lifestyle policy change to prevent and reduce Latino childhood obesity in the areas of: active play, active spaces, better food in the neighborhood, healthier school snacks, healthier marketing, and sugary drinks.

Objectives
Salud America! is creating, populating, and recruiting members for a multi-purpose online platform, Growing Healthy Change, to serve as a clearinghouse for news, research and evidence-based informational products, ongoing prevention policies, dynamic role model stories and videos, and other resources to prevent Latino childhood obesity. We hypothesize that this online platform, which will be launched following beta-testing in Fall 2013, will increase self and collective efficacy among members of the Salud America! network to drive community efforts that will lead to reductions in Latino childhood obesity.

Methods
Salud America! surveyed its network in January 2013 to gauge the use of Salud America! products—including monthly E-alerts, quarterly E-newsletters, a website, and the proposed Growing Healthy Change online platform—and determined network members’ baseline perceived self and collective efficacy for childhood obesity change. A total of 148 individuals responded, about 10% of the network. Most respondents were between ages 50-59 (30%) and female (80%). More than half of respondents were Latino (65%).

Results
Survey results found that the majority of respondents read our quarterly and monthly newsletters and a good proportion of our younger network members were connected and using our social media fed content. In regards to efficacy for advocacy, higher levels of Salud America! engagement was associated with collective efficacy—greater confidence in organized group advocacy as a way of advancing policies to reduce Latino child obesity. This sense of collective efficacy moderately predicts intentions to engage in advocacy behaviors. Salud America! engagement levels were less strongly associated with members’ confidence in their personal ability to be an effective advocate, and this sense of self- efficacy was a very strong predictor of intentions. Based on these findings, the Growing Healthy Change online platform will work toward increasing self- and collective efficacy through peer modeling—framed through the network’s evidence-based Policy Contribution Spectrum—and tools to help individuals interested in promoting change to connect with each other and with opportunities for concerted local actions in their communities.

Conclusions
Based on network feedback, Salud America! is working to expand its web-based network through improved and more frequent communication and through the development of the Growing Healthy Change online platform—a website which will allow users to stay informed about the latest in policies related to Latino childhood obesity. Visitors to the site will be able to browse through policy changes occurring at the national, state, and local level as well as success stories, resources, and multimedia products.  By becoming a registered user, visitors will be able to submit their own success stories, stories of change happening in their community, and will be able to connect with others who are also a part of the Salud America! network. After the launch of the “Growing Healthy Change Platform,” quarterly network surveys will be sent out to evaluate the use of our Salud America! products, platform and impact on self and collective efficacy.

Implications for Practice and Policy

  1. With research and multimedia products highlighting six areas of potential change—including active play and active spaces—Salud America! will continue to lead health communication efforts to reverse childhood obesity among Latinos.
  2. The Growing Healthy Change online platform will serve as an innovative learning and communications tool to drive change and reverse Latino childhood obesity.
  3. The platform will also track changes occurring at all levels and will help determine which communities lack policies to enforce healthier lifestyles and active living initiatives, and educate on how to make changes in those areas.

 

References

  1. Ogden Cl, Carroll MD, Kit BK., Flegel KM. Prevalence of obesity and trends in body mass index among us children and adolescents, 1999-2010. JAMA: The Journal of the American Medical Association. 2012;307(5): 483-90.
  2. Humes KR, Jones A, Ramirez RR. Overview of Race and Hispanic Origin: 2010. 2011.
  3. Fry R, Passel JS. Latino Children: A Majority Are U.S.-Born Offspring of Immigrants. Washington, D.C.: Pew Research Center 2009.
  4. Ramirez AG, Chalela P, Gallion KJ, Green LW, Ottoson JM. Salud America! Developing a National Latino Childhood Obesity Research Agenda. Health Educ Behav. 2011;38: 251-260.
  5. Ramirez AG, Gallion KJ, Despres CE, Adeigbe RT. Salud America!: A National Research Network to Build the Field and Evidence to Prevent Latino Childhood Obesity. American journal of preventive medicine. 2013;44(3): S178-185.
  6. Ottoson JM, Green LW, Beery WL, Senter SK, Cahill CL, Pearson DC, et al. Policy-Contribution Assessment and Field-Building Analysis of the Robert Wood Johnson Foundation’s Active Living Research Program. American Journal of Preventive Medicine. 2009;36(2, Supplement):S34-S43.
  7. Ottoson JM, Ramirez AG, Green LW, Gallion KJ. Exploring Potential Research Contributions to Policy: The Salud America! Experience. American Journal of Preventive Medicine. 2013;44(3, Supplement): S282-S289.

 

Support / Funding Source
This research project is funded by the Robert Wood Johnson Foundation (ID 70208).

Authors: 
Rosalie Aguilar, MS, Amelie Ramirez, DrPH, MPH, Rebecca Adeigbe, MS, Cliff Despres, BJ, & Kipling Gallion, MA
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Using Ecological Momentary Assessment to Examine Whether Environmental Perceptions Mediate the Effects of Smart Growth Planning on Physical Activity and Obesity

Date: 
03/12/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Smart growth urban planning strategies (e.g., preservation of open space, integration of mixed land uses, establishment of compact building design, creation of walkable neighborhoods) may increase physical activity and lower obesity risk. It is thought that smart growth communities offer greater opportunities to be physically active in settings that are safer, have lower traffic exposure, and are more aesthetically pleasing (e.g., greater greenness, vegetation, shade). However, it is unknown whether residents of smart growth communities actually perform physical activity in safer and more aesthetically pleasing settings, and how performing physical activity in safe and aesthetically pleasing settings is related to overall physical activity levels and obesity. This limitation, known as the uncertain geographic context problem (UGCoP), is a growing concern in research on the built environment and physical activity, It is characterized by a lack of clarity about (1) the specific context or setting that has a direct influence on health-related behaviors; and (2) the timing and duration of individuals’ actual exposures to these contextual influences. To address these concerns, the present study used a real-time data capture strategy, Ecological Momentary Assessment (EMA), to measure where physical activity occurs and perceptions of those settings.

Objectives
This study used EMA with electronic surveys delivered through mobile phones to determine whether perceived safety, traffic, and aesthetics of settings, where physically activity actually occurred, mediate the effects of living in a smart growth community on physical activity, body mass index (BMI), and waist circumference in adults.

Methods
Research used a two-group quasi-experimental (“natural experiment”) design. Participants included 58 adults who had recently moved to a smart growth community in Southern California and a demographically-matched set of 59 adults living in nearby urban-sprawling comparison communities. The groups were comparable in age (M = 40.7 years, SD = 9.6), gender, (72% female), ethnicity (31% Hispanic), and income (27% < $40,000/yr). Individuals participated in eight days of EMA via mobile phones, with eight random EMA surveys per day between 6:30am and 10:00pm. EMA items measured current activity (e.g., eating, watching TV, physical activity/sports), physical context (e.g., home [indoors], home [outdoors], outdoors [not at home], work), and perceptions of that context if outdoors (i.e., safety, traffic, greenness/vegetation, shade, litter). Adults wore an Actigraph GT2M accelerometer to assess daily moderate-to-vigorous physical activity (MVPA). Height, weight and waist circumference were measured by research staff. Person-level average scores for perceived safety, traffic, greenness/vegetation, shade, and litter were calculated across EMA prompts when physical activity was reported in outdoor contexts. Direct and indirect effects of living in a smart growth community on perceptions of physical activity contexts, MVPA, BMI, and waist circumference were tested using linear regressions and bootstrapping in the SOBEL macro for SPSS.

Results
Residents of the smart growth community reported greater safety in outdoor physical activity settings than the comparison group (ß = .38, p = .017). Also, greater perceived safety of outdoor physical activity settings was negatively associated with lower BMI (ß = -.266, p = .050) and waist circumference (ß = -.298, p = .033), and positively related to daily MVPA (ß = .239, p = .079). The indirect effect of living in a smart growth community (through perceived safety of physical activity settings) was statistically significant for waist circumference (estimate = -3.39, 95% CI = -6.89 to -0.48) but not for BMI or MVPA. Perceptions of greenness, shade, traffic, and litter did not differ between individuals living in the smart growth versus control communities (p’s > .05). However, greater perceived greenness of outdoor physical activity contexts was associated with lower BMI (ß = -.297, p = .028), and greater perceived shade protection of outdoor physical activity contexts was associated with higher daily MVPA (ß = .274, p = .043) regardless of group.

Conclusions
Using a novel, real-time data collection strategy, this study found that greater perceived safety of physically activity settings may partially account for lower waist circumference among smart growth residents as compared with individuals living in urban sprawling comparison communities. Results suggest that smart growth planning may not influence perceived greenness, shade, traffic, and litter of outdoor physical activity contexts. However, these findings need to be replicated in other smart growth communities. Among all participants, regardless of community residency, those who performed physical activity in contexts with greater perceived shade from the sun were more physically active overall. Also, individuals who performed physical activity in contexts with greater perceived greenness had lower BMI’s on average. These findings suggest that performing activity in outdoor settings with specific features such as greater shade, greenness, and safety may offer conditions that promote more sustained, intense and/or frequent activity and lower obesity risk.

Implications for Practice and Policy
Designing communities according to smart growth urban planning principles may create subjectively safer places to be physically active, leading to lower obesity risk.

Support / Funding Source
American Cancer Society (118283-MRSGT-10-012-01-CPPB) and the National Cancer Institute (R01CA123243).

Authors: 
Genevieve Dunton, PhD, MPH, Yue Liao, MPH, Zhaoqing Huang, MD, MA, & Mary Ann Pentz, PhD
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2013 Texas Legislator Health Perception Survey: Determining Texas State Legislators Attitudes and Support for Physical Activity-focused Policies

Date: 
03/12/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
During the past 15 years, the Texas State Legislature has passed several progressive policies related to physical activity.  These policies have predominantly focused on requirements for coordinated school health programs, for oversight of physical activity and nutrition school policies by School Health Advisory Councils (SHACs), and for requirements for Fitnessgram testing. These policies have been supported by the Partnership for a Healthy Texas (the ‘Partnership’), a coalition composed of stakeholders focused on obesity prevention through policy change; the Partnership has made significant and incremental gains in obesity prevention-related legislation since 2001.  Evaluation of the physical activity policies implemented in Texas has shown significant changes in school environments and physical activity among public school children.

The recent turnover in the Texas Legislature because of the 2012 election has resulted in over 50% of Texas State Legislators (181 in total) being new or junior members.  Thus, many of the new legislative members and their staff have limited knowledge of previous legislative history, educational activities, and obesity issues in Texas.  This situation has created a challenge for the successful dissemination of research findings and potential for continued impact on policy actions.  Information is needed on current legislative knowledge and resources related to childhood obesity so our policy-focused partners can develop both effective communications and strategic dissemination efforts for childhood obesity-related legislation. 

Description
The primary focus of this project funded in November 2012 was to assess the knowledge, attitudes, and perceptions about obesity prevention and control measures of legislators from the 83rd Texas legislative session.  The purpose of this presentation is to present results for physical activity and related environmental changes.

This mixed-methods study included a cross-sectional quantitative survey conducted among the Texas legislature, together with qualitative interviews with a subset of legislators.  Survey questions were drawn from previously used legislative surveys and adapted specifically for the Texas environment and policy targets.  Investigators collaborated with an Advisory Board consisting of members of the Partnership, as well as other stakeholders, such as the Texas Medical Association and University governmental liaisons, to identify appropriate survey topics and legislative language/wording to develop the survey.  A complete legislator listing, including both descriptive and contact information, was compiled prior to the start of the session in January, 2013; a total of 181 legislators were identified from both the House and the Senate.  Letters of introduction and copies of the survey were distributed to all legislators, along with a link to an online survey during March, 2013.  Surveys were administered by hardcopy, online or by interview, as most convenient for the legislator/staff person.

Interview questions were created and administered to a targeted group of representatives from certain legislative committees: Appropriations, Education, Finance, Health & Human Services, Public Education, Public Health, Transportation, and the Farm to Table Caucus.

Data collection continued through the end of the third special session (August 2013).  Quantitative survey data are compiled and presented in aggregate.  Interview data were reviewed for common themes, and were triangulated with survey quantitative results.

Lessons Learned
Through the end of August, a total of 81 surveys were collected (45% response rate), with an approximately equal split between Republicans and Democrats (n = 40 and 39, respectively), and 68 House and 11 Senate members/staff; in addition, 16 interviews were completed (n = 9 House and 7 senate members/staff).  Preliminary results indicate policy recommendations with strong legislator support included improving nutrition and physical activity in early childhood programs, enhancing community environments to promote physical activity, providing more physical activity in schools, and supporting coordinated school health programs that increase physical activity and nutrition education.  Policy recommendations with little support generally included limiting sales of foods.  Legislators generally believed that the groups with the biggest role in righting obesity in Texas were individuals, parents & families, and healthcare providers; transportation groups were mentioned as the least likely to have a role in fighting obesity.  Funding and personal responsibility were listed as the biggest obstacles for passing obesity prevention-related legislation.  Most Texas legislators and their staff cited the use of online resources as a primary source of information (e.g., websites, Google).

Conclusions and Implications
In general, Texas legislators support physical activity-related policies; however, some key sectors that influence physical activity (e.g., transportation groups) are not seen as playing a key role in obesity prevention.

Next Steps
Communications to address physical activity policies should be framed to address funding and individual-level concerns. In particular, more efforts should be devoted to educating legislators about the role of transportation resources and policies in increasing physical activity. Resources for legislative action need to be available on the Internet, and search terms for websites and other resources should be optimized to allow for easy access. 

Support / Funding Source
This study was funded by the Robert Wood Johnson Foundation (Grant ID: 70474) with contributions from The University of Texas Health Science Center at Houston, School of Public Health Austin Regional Campus; the Michael & Susan Dell Center for Healthy Living.

Authors: 
Deanna Hoelscher, PhD, RD, LD, Heather Atteberry, MPH, Tiffni Menendez, MPH, Donna Nichols, MEd, Diane Dowdy, PhD, & Marcia Ory, PhD, MPH
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Accelerometer Assessment of Children’s Physical Activity Levels at Summer Camps

Date: 
03/12/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Approximately 14.3 million American children attend summer camps(1), which may last up to 10 hours/day for up to 12 weeks.  There is some evidence that fitness gains and body weight reductions achieved from school-based interventions are not maintained during the summer months (2,3).  The evidence base is growing for the impact out-of-school time (OST) programs can have on childhood obesity prevention, but little is known about children’s activity levels in summer camps.  Two assessments using systematic observation found that 20-25%(4) and 28%(5) of children were engaged in walking or vigorous activity at any time during camp hours.  However, no known studies to date have assessed daily summer camp activity levels using accelerometers.

Objectives
To assess baseline levels of physical activity via accelerometer among elementary school children attending summer camps, and to inform adaptation of an evidence-based afterschool obesity prevention program [Out of School Nutrition and Physical Activity (OSNAP) Initiative(6)] to the summer camp setting.

Methods
This study used a cross-sectional and repeated measures design to assess accelerometer-measured physical activity levels among children ages 5-12 attending 5 summer camps in Boston, Massachusetts, from July-August 2013.  Children attending 5 camps selected via convenience sample were recruited to wear accelerometers during camp hours for one week (5 days).  Each consenting child wore an accelerometer (Actigraph GT3X/GT3X+, Pensacola, FL) on an elastic belt on the hip throughout the camp day except during swimming periods.  Data collectors visited camps each day to observe activities and distribute and collect accelerometers.  Primary outcomes were daily minutes of moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) accumulated overall and occurring in bouts.  Vertical axis intensity counts captured using the low-frequency extension were converted into minutes spent in MVPA and VPA using the Freedson(7) age-specific 1-minute cut points for children, at MET thresholds of 4 and 6 METs for moderate and vigorous activity, respectively.  Linear regression analysis was used to estimate differences in daily activity levels according to demographic characteristics, adjusting for clustering of children within camps.  Associations between daily activity levels and physical activity opportunities observed will be investigated to determine sources of daily variation in activity levels within children.

Results
Among 184 children eligible and consenting to participate in the study, 153 children (83%) wore monitors on at least 2 days for at least 5 hours/day.  Camp duration was 7.5-10 hours/day.  Children were on average 7.6 (SD 1.4) years of age, and 47% were female.  Children were multi-ethnic (8% White non-Hispanic, 37% Black non-Hispanic, 27% Hispanic/Latino, 3% Asian, 25% multi-racial/other race/ethnicity).  Children wore monitors for an average of 4.2 (SD 0.9) days for 8.9 (SD 1.1) hours/day.  On average, children attending summer camps accumulated 78.0 (SD 37.5) minutes/day MVPA overall, with 38.8 (SD 31.1) minutes/day in bouts.  They accumulated 17.0 (SD 13.4) minutes/day VPA overall, with 3.2 (SD 6.8) minutes/day in bouts.  Among 77 children with 5 monitored days, 23 (30%) met recommendations for 60 minutes/day MVPA on all 5 days, and 22 (29%) met recommendations on 4 days.  Since activity levels during swimming periods were not captured via accelerometer, these results likely underestimate actual physical activity levels.  In multiple regression analysis accounting for clustering within camps, results showed that boys were more active than girls (Beta=11.9 minutes/day MVPA overall; p=0.01), and younger children were more active than older children (B=9.1 minutes/day MVPA per year of age; p<0.001).  No differences by race/ethnicity were found.  Activity levels differed significantly between camps (p<0.001; range 54.9-118.3 minutes/day MVPA), and were highly clustered among children within camps (intraclass correlation=0.37 for MVPA overall).

Conclusions
Elementary school children attending summer camps in Boston, Massachusetts achieved, on average, daily recommended levels of MVPA during camp hours.  Males and younger children engaged in higher levels of physical activity.  Both males and females achieved overall MVPA levels (86.3 and 68.6, respectively) during the camp day similar to national objectively-measured averages above 4 METs (95.4 and 75.2 for 6-11 year old males and females)(8).  Analysis of variation in activity levels according to duration and types of physical activities offered to children attending camps will provide further insight into potential areas of intervention.  Additional research will assess foods and beverages consumed in summer camps and thus describe overall energy balance among children during the summer months.

Implications for Practice and Policy
This study lays the groundwork for adapting successful OST interventions designed for traditional afterschool programs to full day summer camps.  Results indicate that activities in summer camps may need to be targeted to engage females and older children in recommended levels of physical activity.  As community leaders work to disseminate evidence-based physical activity and nutrition interventions in Boston and nationwide, these results will help them set realistic goals.  In Boston, academic and city agency partners will use these results to inform dissemination of the OSNAP intervention via the Racial and Ethnic Approaches to Community Health (REACH) Obesity and Hypertension Demonstration Project.

References

  1. Afterschool Alliance. America After 3PM Special Report on Summer: Missed Opportunities, Unmet Demand. Washington, DC: Afterschool Alliance; 2010.
  2. Carrel AL, Clark RR, Peterson S, Eickhoff J, Allen DB. School-based fitness changes are lost during the summer vacation. Arch Pediatr Adolesc Med. 2007;161(6):561-564.
  3. Gutin B, Yin Z, Johnson M, Barbeau P. Preliminary findings of the effect of a 3-year after-school physical activity intervention on fitness and body fat: The Medical College of Georgia Fitkid Project. International Journal of Pediatric Obesity: IJPO. 2008;3(Suppl 1):3-9.
  4. Beets MW, Weaver RG, Beighle A, Webster C, Pate RR. How physically active are children attending summer day camps? J Phys Act Health. 2013;10:850-855.
  5. Zarrett N, Sorensen C, Skiles B. Environmental and social-motivational contextual factors related to youth physical activity: systematic observations of summer day camps. International Journal of Behavioral Nutrition and Physical Activity. 2013;10:63.
  6. Harvard School of Public Health Prevention Research Center. The Out of School Nutrition and Physical Activity Initiative (OSNAP). Available at: www.osnap.org. Accessed September 4, 2013.
  7. Freedson P, Pober D, Janz KF. Calibration of accelerometer output for children. Med Sci Sports Exerc. 2005;37(11):S523-S530.
  8. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sport Exerc. 2008;40(1):181-188.

 

Support / Funding Source
Support for this project was provided by cooperative agreements with the Centers for Disease Control and Prevention [CDC U48DP001946]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the CDC.

Authors: 
Jessica Barrett, MPH, Angie Cradock, ScD, Steven Gortmaker, PhD, Rebekka Lee, ScD, Catherine Giles, MPH, & Rosalie Malsberger, BA
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Evidence Review: Reporting Guidelines to Enhance Evidence-Based Practice

Date: 
03/12/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Over the past decade, public and private U.S. funders have invested in research and evaluation to understand the most effective, feasible, and sustainable strategies to combat childhood obesity. This evidence is used to aid practitioners and decision-makers at the organizational or agency, community, state, or national levels in selecting strategies to best fit their health, economic, environmental, and social circumstances. Current comprehensive review systems (such as the Community Guide and the Cochrane Review) provide guidance to practitioners and decision-makers interested in implementing change; yet, keeping up with the vast amount of research and evaluation data generated in the field is an ongoing challenge. In turn, decision-makers often rely on insufficient evidence as well as reviews focused more on assessing the internal validity of study results without complementary evaluation of the external validity (e.g., reach, implementation fidelity, and sustainability) associated with intervention impacts.

Objectives
The aims of the review were to: 1) develop and apply replicable methods – modeled after respected formal systematic evidence review systems (e.g., Community Guide) – to assess the scientific and grey literature addressing policy and environmental strategies for reducing obesity levels, improving healthy eating, and/or increasing physical activity among youth aged 3-18 years of age; 2) summarize these findings using easy-to-read evidence maps that identify effects/associations related to obesity/overweight, physical activity, and nutrition/diet outcomes; and 3) classify intervention strategies, based on their effectiveness and population impact using  ratings ranging from “effective” (recommended for use) to “promising” and  “emerging” (recommended for further testing).

More comprehensive reviews stemming from improved reporting and review standards may provide a better platform for practitioners, decision-makers, evaluators, and researchers to understand the effectiveness and impact of interventions to prevent childhood obesity.

Methods
Investigators created a protocol to systematically identify, abstract, review, and rate evidence from a variety of sources (e.g., intervention evaluations, associational studies). The ratings were designed to reflect effectiveness (study design, intervention duration, effects or associations) and population impact (effectiveness plus potential population reach –participation or exposure and representativeness) of multicomponent and complex interventions, with a particular emphasis on impacts for racial/ethnic and lower-income populations of greatest need for these interventions. Over 2,000 documents, published between January 2000 and May 2009 in the scientific and grey literature, were identified (2008-2009) and systematically analyzed (2009-2012). Studies focused on policy or environmental strategies to reduce obesity/overweight, increase physical activity, and/or improve nutrition/diet among youth (3-18 years). Related articles (i.e., those corresponding to an intervention or associational study) were grouped together into a “study grouping.” Study groupings were categorized into one or more of 24 independent strategies to increase healthy eating or active living. Investigators used the RE-AIM framework (i.e., Reach, Effectiveness, Adoption, Implementation, and Maintenance) both to assess internal and external validity, and to derive standard, objective ratings of intervention effectiveness and impact for each study grouping.  The assigned ratings were then entered into an Access database to generate reports for a range of indicators (e.g., outcomes assessed, intervention components, funding sources) within and across strategies.

Results
From 396 study groupings (600 independent articles) included in this analysis, 142 (36%) were intervention evaluations and 254 (64%) were associational studies. Reported outcomes varied, including physical activity (45%), obesity/overweight (25%), nutrition (18%), sedentary behavior (2%), and other shorter-term proxies, such as trail use or fruit and vegetable purchases (10%). Evidence for intervention effectiveness was reported in 56% of the evaluation, and 77% of the associational, study groupings. Among intervention evaluations, 49% had sufficient data for population impact ratings, and only 28% qualified for a rating of “high population impact.” Moreover, only 15% of intervention evaluations had sufficient data to provide high-risk population impact ratings, and only 9% qualified for a rating of “high” for high-risk population impact.

Conclusions
This study employed ways to build on assessments of internal validity to rate effectiveness and to evaluate external validity to rate population impact, thereby helping to characterize and synthesize practice-based evidence. Among studies eligible to receive ratings, investigators noted significant variation in methods, measures, and reporting. Other studies failed to report on key elements required for assessing the internal or external validity of intervention effects and impacts, including those elements specified by the RE-AIM framework.

Implications for Practice and Policy
This work helps to accelerate the pipeline of evidence, moving from evaluability assessments to syntheses of effectiveness and impact to rigorous expert review systems. To increase real-time evidence review and dissemination efforts, researchers and evaluators have to agree on standardized indicators and reporting mechanisms in all peer-reviewed publications. This analysis identifies several indicators that can be incorporated consistently to improve review and reporting standards, thus enhancing the ability of evaluators to assess internal and external validity.  In response, these efforts can more systematically enhance the knowledge base and improve recommendations for practitioners and decision-makers interested in childhood obesity prevention in both the general population and in high-risk populations.

Support / Funding Source
Support for this study was provided by a series of grants from the Robert Wood Johnson Foundation (#63675, 65518, 67413).

Authors: 
Allison Kemner, MPH, Melissa Swank, MPH, & Laura Brennan, PhD, MPH
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