Parks & Recreation

Show on Home Page: 
Yes

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.

Show on Audience Block: 
Yes
Topic Image: 
Show on About Page: 
Yes

Niche to Norm: Progress Made and Progress Needed

Date: 
03/10/2014
Description: 

Keynote speaker presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Dr. Fielding is a distinguished public health leader who has directed the Guide to Community Preventive Services and is Executive Editor of the Annual Review of Public Health, the most influential public health publication. In his keynote presentation, he discussed national examples of the increased application of environmental and policy strategies to increase active living and reduce disparities over the past few years. He highlighted work he has led in the LA County Department of Public Health, identified areas awaiting progress and suggested approaches for accelerating action.

Authors: 
Jonathan E. Fielding MD, MPH, MBA, Director and Health Officer, Los Angeles County Department of Public Health
Location by State: 
Study Type: 

Active Spaces for Latino Kids: Policy and Practice Implications

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
In the United States, rates of overweight and obesity among Latino children (38%) are higher than those among their White peers (29%).Physical activity is important for good health, physical and cognitive growth and development, and maintaining a healthy weight. (1) Latino children in underserved communities often have limited options for physical activity and Latinos, more so than their white counterparts perceive their neighborhoods as having few safe places for children to play (70% versus 82.5%). (2) To address this, Salud America! The Robert Wood Johnson Foundation Research Network to Prevent Obesity Among Latino Children, which aims to increase the number of stakeholders conducted research and community change to reduce and prevent Latino childhood obesity (LCO), has synthesizing research and developed policy recommendations on “Active Spaces and Latino Kids” to fuel discussions and stimulate changes in policies that will increase the amount of publicly available active spaces for Latino kids. The main objectives of this study were to: 1) review and consolidate the field of evidence related to initiatives and research focused on built environments and street-scale improvements and their impact on physical activity behaviors among Latino children in underserved communities; and 2) based on the field of evidence, create policy recommendations for improving environments in predominantly Latino communities.

Description
Electronic searches of PubMed, Google Scholar, and government and organization websites were performed to identify literature, policy statements, and legislation published between 2000 and 2012 that were relevant to the implementation of shared-use agreements (SUAs) and street-scale improvements to increase physical activity among Latino children, defined as individuals younger than 18.

Lessons Learned
This Salud America! study generated interesting findings on the factors that affect the opportunities Latino children have to seek physical activity in their neighborhoods and also provided guidance as to the best ways to increase active spaces in Latino communities.

Common themes and significant findings are outlined below.

  1. Latino children living in underserved communities in the United States have limited access to recreation sites. (3-6)
  2. Limited progress has been made in the sharing of school recreational facilities with community members. Some Latino communities have implemented SUAs and succeeded in providing residents with more access to recreational facilities. (7)
  3. Liability concerns, funding and staffing are among the top barriers to sharing school physical activity facilities with community members. (8,9)
  4. Characteristics of neighborhoods and the built environment may affect how frequently children and families walk or bike to sites available for recreation and physical activity. (10-12)
  5. Multi-dimensional tools for assessing the impact of the built environment on physical activity are crucial for planning recreation facilities that meet the needs of Latino communities and increasing the use of the facilities among Latino children in underserved communities. (13-15)

 

Conclusions and Implications
Shared use agreements and street-level improvements are among the best ways to improve access to these “active spaces” in underserved communities and may help young Latinos become more physically active and maintain a healthy weight.

Implications for Practice and Policy
Efforts should focus on meeting the following needs to increase access to physical activity sites and facilities in Latino underserved communities:

  1. Street-scale improvements (e.g., repairing sidewalks and installing bike lanes and street lights) can address concerns about environmental barriers and improve perceptions of the built environment, potentially increasing levels of physical activity among Latino children in the community.
  2. Appropriate measures must be used to assess the built environment and ensure that new and existing areas for physical activity meet the specific cultural needs of the Latino community.
  3. State and local governments should work with school administrators to address liability and other concerns for schools that pave the way for access to their facilities for recreational use during non-school hours.
  4. State and local governments should ensure that SUAs and other statutes specifically describe covered activities, terms and conditions.
  5. State and local governments should encourage awareness of current statutes and adoption of SUAs among school administrators.
  6. Local governments and policymakers should solicit community feedback to strengthen the development of new recreation sites and implementation of street-scale improvements.
  7. Local governments and policymakers should create Complete Streets policies for all new transportation projects near schools and recreation sites to improve active travel to those sites.

View complete findings and policy implications in the Salud America! report on “active spaces".

Next Steps
To increase access to physical activity sites in Latino communities, further research is needed on the effectiveness of SUAs for increasing physical activity in Latino communities. Real and perceived barriers to implementing SUAs should be further explored to identify areas for improvement in policies and legislation and to educate stakeholders on how to overcome the barriers. In addition, refinements to tools used to assess built environments are needed to potentially become more applicable to Latino communities to ensure that street-scale improvements and physical activity sites are well informed and in the best interest of the Latino community.

References

  1. Ogden CL, Carroll MD, Curtin LR, Lamb MM, and Flegal KM, Prevalence of high body mass index in us children and adolescents, 2007-2008. JAMA, 2010. 303(3): p. 242-249.
  2. Moore LV, Diez Roux AV, Evenson KR, McGinn AP, and Brines SJ, Availability of Recreational Resources in Minority and Low Socioeconomic Status Areas. American Journal of Preventive Medicine, 2008. 34(1): p. 16-22.
  3. Wilson DK, Kirtland KA, Ainsworth BE, and Addy C, Socioeconomic status and perceptions of access and safety for physical activity. Annals of Behavioral Medicine, 2004. 28(1): p. 20-28.
  4. Powell LM, Slater S, Chaloupka FJ, and Harper D, Availability of Physical Activity–Related Facilities and Neighborhood Demographic and Socioeconomic Characteristics: A National Study. American Journal of Public Health, 2006. 96(9): p. 1676-1680.
  5. Babey SH, Hastert TA, and Brown ER, Teens Living in Disadvantaged Neighborhoods Lack Access to Parks and Get Less Physical Activity. 2007.
  6. Gomez-Feliciano L, McCreary LL, Sadowsky R, Peterson S, Hernandez A, McElmurry BJ, and Park CG, Active Living Logan Square: Joining Together to Create Opportunities for Physical Activity. American Journal of Preventive Medicine, 2009. 37(6, Supplement 2): p. S361-S367.
  7. US Department of Health and Human Services. Healthy People 2010 Final Review. 2010; Available from: http://www.cdc.gov/nchs/healthy_people/hp2010/hp2010_final_review.htm.
  8. Spengler JO, Connaughton DP, and Maddock, J, Liability Concerns and Shared Use of School Recreational Facilities in Underserved Communities. American Journal of Preventive Medicine, 2011. 41(4): p. 415-420.
  9. 9.Baker T and Masud H, Liability Risks for After-Hours Use of Public School Property to Reduce Obesity: A 50-State Survey. Journal of School Health, 2010. 80(10): p. 508-513.

A list of all references can be found here.

Support / Funding Source
Salud America! The Robert Wood Johnson Foundation Research Network to Prevent Obesity Among Latino Children is funded by the Robert Wood Johnson Foundation (ID 70208).

Authors: 
Rebecca Adeigbe, MS, Rosalie Aguilar, MS, Cliff Despres, MA, Kipling Gallion, MA, & Amelie G. Ramirez, DrPH
Location by State: 

Implementing Successful Promotora-led Advocacy Projects in Latino Churches and Neighborhoods in San Diego

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.c

Abstract: 

Background and Purpose
The built environment and neighborhood characteristics of a community are associated with the physical activity (PA) levels of its residents (Saelens, Sallis, Frank, 2003). For example, perceived neighborhood safety, aesthetics, traffic, and other factors, can facilitate or discourage physical activity among community residents (Kerr et al., 2010). Sallis and colleagues found that neighborhood income disparities are associated with perceived attributes of the built environment, and can discourage or facilitate physical activity (Sallis et al., 2011). In Texas border communities, frequent barriers to physical activity include: unleashed dogs, weather, heat, traffic, no streetlights, and no place like a park to exercise (Umstattd Meyer, Sharley, Patterson, Dean, 2013). Several programs have successfully utilized promotoras (Spanish-speaking community health workers) to promote healthy behaviors, provide access to community resources, and lead physical activity and nutrition sessions (Balcazar et al., 2006; McCloskey, 2009; Staten, Scheu, Bronson, Peña, & Elenes, 2005). A pilot study in San Diego found that promotoras and youth community members could successfully collaborate and advocate for resources to improve their neighborhood and a nearby park (Arredondo et al. 2013). Similarly, others have engaged promotoras as co-researchers and advocates for policy change in a project to promote environmental justice in a Latino community (Minkler, Garcia, Williams, LoPresti, & Lilly, 2010).

Objectives
The objectives of this study are to increase physical activity opportunities by: 1) identifying determinants of successful advocacy programs that aim to improve the built environment; and 2) outlining the steps and strategies necessary in empowering promotoras to lead health promotion activities and built environment improvement projects in their local communities.

Methods
Sixteen churches were recruited and randomized to either the intervention (PA) or attention control (cancer prevention) for the larger parent study between January 2011 and March 2013. Selection criteria for promotoras included involvement in church and community, bilingual (English/Spanish), and readiness for training. In each church, two to three women were recruited, hired, and trained to be promotoras.. The promotoras in the intervention (PA) churches were trained to lead multiple group exercise classes and walking groups at their for the two-year intervention period. After six months, WalkSanDiego conducted two 4-hour Advocacy Training Workshops to empower promotoras and members of each intervention church by providing tools to create local change on a grass-roots level and to advocate for improvement in their churches and surrounding neighborhoods. The first workshop reviewed the basics of advocacy, defined walkability, led participants in a walk audit of the church neighborhood, and detailed steps for creating an action plan. The second workshop taught participants how to create a fact sheet, provided tips on contacting local officials, assisted participants in identifying and prioritizing targets for change, and addressed sustainability. Promotoras then applied their learned advocacy skills during meetings with church members, where they identified targets for built environment change to promote physical activity. and prioritized one church-based and one community-based project. Once targets were identified, promotoras and church members partnered with WalkSanDiego, Fe en Acción staff, community organizations, and their churches to advocate for built environment changes.

Results
Promotoras in all 8 intervention churches completed Advocacy Training Workshops with WalkSanDiego. Additionally, targets for change were identified at both the church and community levels. In most cases, church projects were more difficult to complete than community projects. Church readiness for change was a major factor in the success of the church-based projects. The priest’s readiness for change and the cohesion of church members and their interest in the project determined, in large part, the success of built environment changes. Success of community-based built environment improvements varied by site, which can be attributed to community characteristics (i.e. urban vs. rural, high-income vs. low-income, etc.), personal characteristics of the promotoras themselves, and the presence or lack of other groups already working on built environment improvements. Case studies will be presented on four different communities to illustrate factors that facilitated environmental changes.

Conclusions
Future programs should take into account a promotora’s availability and willingness to attend and present at large community and church meetings. Also, programs should aim to identify realistic targets for change, given the program’s timeline. In addition, relationships with key leaders, both at the church and community levels, should be developed from the beginning of the program and communication maintained throughout. Finally, future programs should consider partnering with other community programs and initiatives already working to improve community health and build on their success.

Implications for Practice and Policy
The environmental advocacy component of the Fe en Acción study found that churches are an untapped resource of organizing and advocacy power. Choosing the right leaders, in this case promotoras, makes all the difference. Finally, we found that the setting also matters in that heavy resistance from leaders, both at the church and communities levels, yields few positive results.

References

  1. Arredondo, E., Mueller, K., Mejia, E., Rovira-Oswalder, T., Richardson, D., & Hoos, T. (2013). Health Promotion Practice, 14(5): 759-766.
  2. Balcazar, H., Alvarado, M., Hollen, M. L., Gonzalez-Cruz, Y., Hughes, O., Vazquez, E., & Lykens, K. (2006). Salud para su Corazon-NCLR: A comprehensive promotora outreach program to promote heart-healthy behaviors among Hispanics. Health Promotion Practice, 7(1): 68-77.
  3. Kerr, J., Norman, G. J., Adams, M. A., Ryan, S., Frank, L., Sallis, J. F., Calfas, K. J., & Patrick, K. (2010). Do neighborhood environments moderate the effect of physical activity lifestyle interventions in adults? Health & Place, 16(5): 903-908.
  4. McCloskey, J. (2009) Promotores as partners in a community-based diabetes intervention program targeting Hispanics. Family & Community Health, 31(1): 48-57.
  5. Minkler, M., Garcia, A. P., Williams, J., LoPresti, T., & Lilly, J. (2010). Si se puede: Using participatory research to promote environmental justice in a Latino community in San Diego. Journal of Urban Health, 87(5) 796-812.
  6. Saelens, B. E., Sallis, J. F., & Frank, L. D. (2003). Environmental correlate of walking and cycling: Findings from the transportation, urban design, and planning literatures. Annals of Behavioral Medicine, 25(2): 80-91.
  7. Sallis, J. F., Slymen, D. J., Conway, T. L., Frank, L. D., Saelens, B. E., Cain, K., & Chapman, J. E. (2011). Income disparities in perceived neighborhood built and social environment attributes. Health & Place, 17(6): 1274-1283.
  8. Staten, L. K., Scheu, L. L., Bronson, D., Peña, V., & Elenes, J. (2005). Pasos adelante: The effectiveness of a community-based chronic disease prevention program. Preventing Chronic Disease, 2(1): A18.
  9. Umstattd Meyer, M. R., Sharkey, J. R., Patterson, M. S., & Dean, W. R. (2013). Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: A descriptive study. BMC Public Health, 13:14.

 

Support / Funding Source
NCI 1R01CA138894

Authors: 
Jessica Haughton, MPH, MA, Juan Antonio Ramirez, MCP, Tanya Manzo, BA, Jacqueline Montañez, Leah Stender, Lilian Perez Constanza, MPH, & Elva M. Arredondo, PhD
Location by State: 
Population: 

Physical Activity and Sedentary Behavior Trends among Brazilian Adults, 2009-2012

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Physical activity is an important determinant of overall health by preventing diseases and promoting health. Major advances in continuous monitoring of indicators of physical activity and sedentary behavior were achieved in Brazil in recent years through the consolidation of the Surveillance of Risk and Protective Factors for Chronic Diseases Telephone Survey (Vigitel). Previous data from Vigitel (2006-2009) showed unfavorable physical activity and sedentary behavior trends and persistency of inequities against vulnerable groups (children, elderly, women and less educated people). These have led to many national public policies seeking to promote physical activity and reduce sedentary behavior.

Objectives
To analyze time trends in physical activity levels and sedentary behavior in Brazilian adults from 2009 to 2012.

Methods
We used data from Vigitel, a cross-sectional telephone-based study of adults (18 or older) living in households with a fixed telephone line in all 26 Brazilian capitals and the Federal District. We estimated trends from 2009 to 2012 for four indicators: (I) active in leisure time (weekly practice of at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity during leisure time), (II) active in transportation to work or school (usual roundtrip of at least 30 minutes to work or school using bicycle or walking), (III) physically inactive (absence of any physical activity in leisure time in the last three months; of physical exertion at work; of commuting to work or school by walking or cycling and of performing heavy house cleaning), (IV) time watching television of three or more hours a day (proxy of sedentary behavior). The prevalence of indicators was presented by sex, age and education level of the study population for the year 2012. Poisson regression models were used to determine significant variation in the indicator between 2009 and 2012, having the year as the independent variable. We considered changes significant when regression coefficients for the variable 'year of survey' were statistically different from zero for a p-value of less than 0.05.

Results
Between 2009 and 2012, we identified an increase in the proportion of actives in leisure time (men: 39.0 to 41.5%; women: 22.1 to 26.5%) (p<0.01) and a reduction in the proportion of actives at transportation (men: 17.6 to 13.8%, women: 16.5 to 14.5%) (p<0.001). Also, the prevalence of physical inactivity in both sexes remained unchanged (~15%), while the proportion of men who watch three or more hours of TV daily increased (22.4 to 26.5%)  (p <0.001). In 2012, leisure-time physical activity was higher in men, directly associated with education and inversely associated with age. Active transportation decreased only after 55 years of age and was inversely associated with education. Watching TV for more than 3h/day was more prevalent in the youngest (18-24 y) and in the oldest (= 55 y) and inversely associated with education. Physical inactivity increased only after 55 years of age.

Conclusions
The time-trend analysis reveals a worrying scenario: stagnation in high levels of physical inactivity, reduction of active transportation and increase of TV watching among men. Also, similarly to what had been previously observed, inequities against vulnerable groups persist in all outcomes, even in leisure-time physical activity (the only indicator with positive trends in the studied period). This scenario might indicate low short-term effectiveness of the increasing governmental efforts to promote physical activity in the country, although specific evaluation studies are still needed.

Implications for Practice and Policy
Improvements in surveillance systems have provided valuable information on population levels of physical activity and sedentary behavior in Brazil. The current unfavorable context concerning physical activity requires cross-sector policies and comprehensive evaluation of interventions. Also, programs and policies with evidence of suitability and cost-effectiveness in developing countries should be prioritized, such as the consolidation of physical activity at school and the expansion of Open Streets programs for active recreation.

Support / Funding Source
Agency of the São Paulo Research Foundation (Fapesp).

Authors: 
Thiago Herick Sa, MSc, Maria Carolina Borges, MSc, Leandro Martin Totaro Garcia, MSc, & Rafael Moreira Claro, PhD
Location by State: 
Study Type: 

Disparities in Park Availability, Features, and Characteristics by Social Determinants of Health within a U.S.-Mexico Border Urban Area

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Parks are key environmental features for promoting physical activity and health [1,2] and several studies highlight that park availability, features, and quality are often not be equally-distributed across socioeconomically-deprived and racially/ethnically diverse neighborhoods in the U.S.[3-7]  However, to date, little, if any, such research has been conducted in minority-heavy areas along the U.S.-Mexico border where poverty, justice, and health disparities are prominent concerns.[8]

Objectives
The purpose of this study was to examine disparities in park availability, park features, and park characteristics according to median household income and the percentage of foreign-born population in a predominately Hispanic border community.

Methods
All census tracts (CTs) within the City of El Paso, TX were included in the study (n=112). Data on median household income and the percentage of foreign-born population for each CT were extracted from the U.S. Census Bureau’s 2005-2009 American Community Survey. All CTs were categorized into even tertiles (low/medium/high) for both variables. To measure park availability, a GIS shape file provided by the City of El Paso was used to identify all parks within the study area. Using ArcGIS 9.3, the edited park layer was cross-referenced with the CTs layer to determine the number of parks that intersected each CT. Data on park features and characteristics were obtained by a trained auditor visiting each park (n=144) using the Community Park Audit Tool (CPAT), which has demonstrated excellent reliability.[9]  The total number of each of i) park facilities (e.g., playgrounds, basketball courts, trails), ii) park amenities (e.g., benches, drinking fountains, picnic tables), iii) aesthetic features (e.g., landscaping, artistic features, historical/educational monuments), iv) park quality/safety concerns (e.g., evidence of threatening behavior, dangerous spots, vandalism), and iv) quality/safety concerns in the neighborhood visible around the park (e.g., inadequate lighting, graffiti) were summed for each CT. Univariate analyses were conducted on all park variables to provide descriptive statistics and to assess normality (skewness between -1 and 1 and symmetrical histograms). ANOVA F-tests (for normally-distributed park variables) and Kruskal-Wallis X2 tests (for non-normal variables) with post-hoc analyses were used to determine significant (p<.05) differences in the total number of parks, park features (facilities and amenities), and park characteristics (aesthetic features, park quality/safety concerns, neighborhood quality/safety concerns) across CT income and percent foreign-born tertiles (low/medium/high).

Results
The results of all analyses are shown in Table 1. Park availability differed significantly by median household income (X2=6.71,p=0.03), with the medium tertile having more parks than the high tertile (p=0.01). There was no significant difference for park availability across percent foreign-born tertiles (X2=1.51,p=0.47). The number of park facilities (F=10.21,p<0.01) significantly differed across income tertiles, with the medium income tertile having significantly more facilities than the low (p<0.01) or high (p=0.02) income tertiles. The overall ANOVA test examining the number of amenities across income tertiles was significant (F=3.77,p=0.03), but further post-hoc pairwise comparisons showed no significant differences between the three groups. Neither the number of park facilities (F=2.10,p=0.13) nor amenities (F=1.64,p=0.20) differed significantly across percent foreign-born tertiles. Finally, the number of park aesthetic features did not differ significantly across either income (F=0.29,p=0.75) or percent foreign-born (F=0.09,p=0.91) tertiles. However, there were several differences in park quality/safety concerns and neighborhood quality/safety concerns across income and percent foreign-born tertiles (X2=26.21,30.40,39.95,42.69,p<0.01 for all tests). Specifically, the low and medium income tertiles had significantly more park quality/safety concerns than the high income tertile (both p<0.01). The low income tertile also had more neighborhood quality/safety concerns than the medium or high income tertiles (both p<0.01). Both the high and medium foreign-born tertiles had significantly more park quality/safety concerns than the low foreign-born tertile (both p<0.01) and the high foreign-born tertile had significantly more neighborhood quality/safety concerns than the low or medium foreign-born tertiles (both p<0.01).

Conclusions
This study adds to the current literature on park disparities by income and race/ethnicity and provides evidence of the complexity of examining such issues within a U.S.-Mexico border community. Our findings further demonstrate how publically-available recreational facilities, and their features and characteristics, are often not equally-distributed across neighborhoods by income or foreign-born composition.

Implications for Practice and Policy
The present study was unique in that it highlighted these issues within a predominately Hispanic community. Planners and policymakers must be careful not to negate the reported “barrio advantage” – a paradoxical situation in which certain sociocultural benefits of living in high-density Mexican American neighborhoods (e.g., intact family structures, shelter from negative aspects of American culture) outweigh the disadvantages of high rates of poverty in those neighborhoods [10] – through the provision of less than optimal environmental resources (e.g., parks) as well. Moreover, especially in traditionally under-empowered and under-resourced communities, citizens, health researchers, and policy makers should be encouraged to collectively engage in evaluating community environments to facilitate partnerships and collaborative efforts to make parks and other recreational facilities more accessible, attractive and safe for physical activity for all.[11,12]

References

  1. Bedimo-Rung AL, Mowen AJ, Cohen DA. The significance of parks to physical activity and public health: A conceptual model. Am J Prev Med 2005;28:159-168.
  2. Kaczynski AT, Henderson KA. Environmental correlates of physical activity: A review of evidence about parks and recreation. Leisure Sciences 2007;29(4):315-354.
  3. Estabrooks PA, Lee RE, Gyurcsik NC. Resources for physical activity participation: Does availability and accessibility differ by neighborhood socioeconomic status? Ann Behav Med 2003;25:100-104.
  4. Wolch J, Wilson JP, Fehrenbach J. Parks and park funding in Los Angeles: An equity-mapping analysis. Urban Geogr 2005;26:4-35.
  5. Gordon-Larsen P, Nelson MC, Page P, et al. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics 2006;117:417-424.
  6. Moore LV, Diez-Roux AV, Evenson KR, et al. Availability of recreational resources in minority and low socioeconomic status areas. Am J Prev Med 2008;34:16-22.
  7. Vaughan KB, Kaczynski AT, Wilhelm Stanis SA, et al. Exploring the distribution of park availability, features, and quality across Kansas City, Missouri by income and race/ethnicity: An environmental justice investigation. Ann Behav Med 2013; 45 Suppl 1:S28-38.
  8. United States-Mexico Border Health Commission. Health disparities and the U.S.-México Border: challenges and opportunities. United States-Mexico Border Health Commission. 2010. http://www.borderhealth.org/files/res_1719.pdf.
  9. Kaczynski AT, Wilhelm Stanis SA, Besenyi GM. Development and testing of a community stakeholder park audit tool. Am J Prev Med 2012;42(3):242-249.
  10. Eschbach K, Ostir GV, Patel KV, et al. Neighborhood context and mortality among older Mexican Americans: Is there a barrio advantage? Am J Public Health 2004;94(10):1807-1812.
  11. Hoehner CM, Ivy A, Ramirez LB, et al. How reliably do community members audit the neighborhood environment for its support of physical activity? Implications for participatory research. J Public Health Manag Pract 2006;12(3):270-277.
  12. DeBate RD, Koby EJ, Looney TE, et al. Utility of the physical activity resource assessment for child-centric physical activity intervention planning in two urban neighborhoods. J Community Health 2011;36(1):132–40.

 

Support / Funding Source
This study was partially supported by funding from Hispanic Health Disparities Research Center (NIH 1P20MD002287-03) and the Pan American Health Organization.

Authors: 
Amir Kamel, MPH, Andrew Kaczynski, PhD, & Paula Ford, PhD
Location by State: 
Study Type: 

Distance and Wayfinding Signage

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
The purpose of this study was to assess the effect of distance markings and the long term effect of a promotional media campaign on urban trail traffic in Southern Nevada.

Description
As noted in the literature, promotional campaigns may increase trail usage. Our previous study indicated that trail traffic on 10 urban trails increased significantly shortly after a campaign designed by the Southern Nevada Health District (SNHD). This study repeated those trail traffic counts to determine if trail traffic remained higher several months after the promotional campaign. This round of traffic counts also compared traffic on four control trails with six experimental trails which received incremental distance markings. In the fall of 2011, we placed infrared sensors on 10 local trails to count all users for one week. We repeated the counts for another week in the fall of 2012. Manual user counts were also conducted to validate sensor data. We compared traffic counts from before the media campaign and marking project to the counts taken one year later.

Lessons Learned
Mean hourly trail users increased 33%, from 3.84 users per hour to 5.12 users per hour, from Fall 2011 to Fall 2012. Although these increases are smaller than those measured immediately after the media campaign, they remain significant (p<.001). Results varied at individual trails. Traffic counts increased at nine of the study trails, but one trail saw a significant decline in usage. Usage patterns by time of day and day of week were similar before and after the campaign for summary level data, but varied at the individual trail level. When we compared traffic on the six experimental trails, which received incremental distance markings in the summer of 2012, to the four control trails, we observed no significant differences in mean hourly users between the two groups after the markings were applied. The effect of the trail markings may become more clear over time.

Conclusions and Implications
Between the fall of 2011 and the fall of 2012, trail traffic increased significantly (p<.001) on 10 urban trails in Southern Nevada, after a media campaign promoting trail use. Promotional campaigns may be an effective approach to increasing the use of urban trails. This project also analyzed the effect of incremental distance markings for six of the study trails. We observed no difference in mean hourly trail users between the study and control trails.

Next Steps
An additional round of data collection may be scheduled to assess differences in use between the marked and unmarked trails over time.

Support / Funding Source
This project was funded by the Communities Putting Prevention to Work (CPPW) grant from the Centers for Disease Control (CDC) to SNHD (CPPW 1U58DP002382-01).

Authors: 
Sheila Clark, MEd, Timothy Bungum, DrPH, Mindy Meacham, CHES, & Lisa Coker, MPH
Location by State: 
Population: 

How Much Do Neighborhood Parks Contribute to Local Residents MVPA in the City of Los Angeles? A Meta-Analysis

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
It is still largely unknown the extent to which local parks facilitate their local population’s moderate-to-vigorous physical activity (MVPA). As a result, it is unclear as to whether building new parks and facilities or further promoting the use of existing ones should be the higher priority in order to effectively address insufficient MVPA in the U.S. population.

Objectives
To quantify the contribution of Los Angeles City Parks to population-level MVPA.

Methods
We conducted a meta-analysis of park observation data as well as surveys of park users and local residents.  Data collected over 7 years from 4 studies and nearly 100 parks were included. We pooled the park observation and survey data and used a stochastic process model based on nonhomogeneous queue process.  To determine the contribution of parks to population-level MVPA, we compared the average amount of hours spent on MVPA in a neighborhood park to the total hours spent on MVPA by the local population using an age-gender stratified analysis of accelerometry data collected by NHANES.(1)

Results
The mean acreage of parks and recreation centers in Los Angeles is roughly 12 acres with an average of 2 sports fields and 8 facilities per park. The average population density within a one-mile radius is between 40,000-50,000 people. We estimate that, on average, 500 to 1,200 hours of vigorous PA (VPA) are accrued in a typical neighborhood park during one week; 1/4  to 1/3of these hours are accrued by female park users.  A park also supports on average 800 to 2,000 hours of moderate PA (MPA) during one week, where the proportion of time accrued by female users is slightly larger (300 to 1,000 hours).  In total, a park supports an average of 800 to 3,000 hours of MVPA during a week.  Another 2,800 to 6,000 hours of park use is spent in various sedentary behaviors such as sitting and socializing, which likely are associated with a modest proportion of MPA (e.g., walking to and from the parking lot).  The majority of MVPA and VPA in particular are accrued by children, teenagers, and non-elderly adults.  Estimates vary by park acreage, programming, number of facilities, local population density, and other factors. The estimated mean number of hours spent on MVPA in a single neighborhood park is roughly equivalent to the total number of MVPA hours that would have been accrued by 66-250 children and 150-600 adults if they fully adhered to national physical activity guidelines (6 hours for children and 2.5 hours for adults per week). However, since the actual number of hours spent on MVPA  is much lower than national guidelines, parks support a substantial proportion of the actual MVPA time for their local population.  NHANES data show that the average person engages in 1-4 minutes of VPA per day, thus we estimate that roughly 30 to 80 percent of the total hours spent on VPA by the population living within a half mile of the park is spent in parks.  On the other hand, roughly half of all park-supported MVPA is accrued by the local population living within a half mile of parks, a quarter is accrued by people living between a half and one mile of parks, and the remaining quarter is accrued by people living farther away than one mile.  The proportion of users from longer distances declines sharply as the poverty level of a park’s neighborhood increases. Self-reported data also suggest that parks are the most common place for exercise (i.e., vigorous activities) among the population they serve (park users and local residents).  Among the 60% of 17,000 respondents who reported engaging in some exercise, parks were the primary places for exercise for 40-60%, who also reported an average of roughly 130 minutes of vigorous physical activities per week, most of which were spent in parks. In contrast, we observed relatively few people doing MVPA at any time during any day in the average 12-acre neighborhood park (5-50 people).  Parks were even less used in low income neighborhoods compared to higher income neighborhoods, after accounting for size and other park facilities.

Conclusions
Self-reported MVPA data is subject to sizable self-report bias, due to the general tendency of over-reporting MVPA.   Nevertheless, there is a great potential to further improve parks’ contribution to people’s MVPA without affecting other social, recreational, and environmental purposes of parks.  Because the radius of influence of a neighborhood park is correlated with income level of the local neighborhood residents, it can be beneficial to build new parks in low-income areas.

Implications for Practice and Policy
Parks in high-income neighborhoods should focus their efforts to develop and promote programmed activities that support MVPA, while in low-income neighborhoods, more parks and facilities may be needed in addition to more vigorous marketing and MVPA promotion efforts.

References

  1. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. Jan 2008;40(1):181-188.

 

Support / Funding Source
NHLBI: R01HL114283 and R01 HL114432

Authors: 
Deborah Cohen, MD, MPH, Bing Han, PhD, & Kathryn Pitkin Derose, PhD
Location by State: 

Park Prescriptions in Practice: The Community Driven Way

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Park prescriptions is a movement to strengthen the connection between health care and parks and public lands to improve the physical and mental health among individuals and communities. Park prescriptions offers an alternative to treating or preventing health problems that focuses less on traditional medicine and more on connecting with parks and nature to increase levels of physical activity and reduce levels of stress. The movement has quickly grown from a conceptual phase into a period of rapid implementation with programs being developed across the country. The sustainability of the movement will require that we solve the operational hurdles present in parks and health collaborations, and that we hone and measure the best delivery models currently in practice. We hope you can join us and other leaders representing parks and health to refine on-the-ground tactics for program development, program delivery, measurement, and professional training around park prescriptions. While numerous park prescription programs exist at the local and state levels, little has been done to collect successful strategies and share them with other communities looking to implement similar models. Furthermore, programs that do exist each look different from one another, which raises a concern that agencies are “reinventing the wheel” as opposed to learning and building from successes.

Description
The Institute at the Golden Gate, the National Recreation and Park Association, and the Centers for Disease Control and Prevention are partnering to elevate park prescriptions and related programs from a new idea to a best practice in preventive health. The partners are convening local, state, and national experts to evaluate and refine aspects of current park prescription programs. Program standards created from shared knowledge will increase the quality of new and existing programs as well as support more accurate evaluation of program impacts.

Lessons Learned
Together we are defining park prescriptions, gaining a better understanding of the national landscape, and identifying standardized measurement and data collection methods needed to determine the effectiveness of park prescriptions.

Conclusions and Implications
By taking best practices from park prescription programs around the country we are aligning our objectives to more easily measure areas of success and improvement for the future. One area we have honed in on for improvement is better including leaders in the communities that we are working in. By including the community in creating the health intervention we can create a more sustainable and effective program that meets the unique needs of the population it serves. Sharing best practices and measurement tools will also help create opportunities for funding new and improved park prescription programs. Creating a strong national collaborative with agreed upon metrics and health intervention steps will also lead to policy.

Next Steps
A convening will take place in October 2013 to bring together leaders representing parks, public health, and health plan providers to refine on-the-ground tactics for program development, program delivery, measurement, and professional training. This convening will produce national standards based on qualitative and quantitative evidence from programs across the country, elevating the initiative from a new idea to a best practice in preventive health. This work will result in a nationally created toolkit with relevant training's and collateral so parks and health care providers across the country can more easily implement an effective and sustainable park prescriptions model.

Support / Funding Source
Kaiser Permanente; National Recreation and Park Association.

Authors: 
Kristin Wheeler, BA, Nooshin Razani, MD, MPH, & Zarnaaz Bashir, MPH
Location by State: 

E-valu-ation: Creating Value Frameworks for Active Living Strategies

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Obesity rates have tripled over the last three decades among U.S. children and adolescents, rising to 17% by 2009-2010.1-3 In response, the Robert Wood Johnson Foundation (RWJF) created a national program, Healthy Kids, Healthy Communities (HKHC), designed to support 49 communities throughout the United States and Puerto Rico in implementing healthy eating and active living policy, system, and environmental changes. This initiative placed emphasis on reaching children who are at highest risk for obesity on the basis of race/ethnicity, income and/or geographic location. The evaluation of the communities combines participatory and evaluation methods, tools, and resources to document practical considerations for adopting, implementing, and sustaining system, policy, and environmental initiatives as well as to assess the impact. Value frameworks were created as part of the HKHC evaluation to document and describe the value of common childhood obesity prevention strategies. These frameworks were designed to help communities translate the value of their work to advocates, policy- and decision-makers, practitioners, and community residents and prepare communities for implementation of the strategies in an effort to revitalize and sustain these initiatives into the future.

Description
Value frameworks were created for three commonly implemented active living strategies: childcare physical activity standards, active transportation, and parks and play spaces. For each strategy, data was collected through policy and cost interviews with leaders, partners, and/or community residents involved with day-to-day implementation of the active living strategies. In addition, the evaluation team incorporated knowledge from an evidence review project,4 a committee to assess cost-effectiveness,5 and an integrated framework for assessing the value of community-based prevention.6 Value was summarized at four ecological levels: individual, organizational/agency, community, and societal through a comprehensive understanding of inputs (i.e., investments/resources, economic/financial investments, and social/environmental resources) and outcomes (i.e., costs/savings and benefits/harms) at each ecologic level. The assessment of value takes into context the available investments and resources (inputs) as well as the costs and savings associated with planning, implementing, and maintaining the strategy and potential benefits or harms as a result (outcomes).

Lessons Learned
From 49 HKHC communities, 9 (18%) were implementing child care physical activity strategies, 30 (61%) active transportation strategies, and 29 (59%) parks and play space strategies. Within child care physical activity standards (defined as a policy/practice or environment change that takes place in public or private child care settings to increase moderate and vigorous levels of physical activity), both implementation efforts (e.g., advocacy and organizing, policy development, and/or policy implementation and enforcement activities) and potential impacts (e.g., policies, environments and services, and/or populations) are considered.  Examples of inputs and outcomes for child care physical activity standards are illustrated in figure 1. As an individual investment, parents and guardians contribute financially to support a child care facility and pay for oversight and education of their children. Agency/organizational level resources may include donated meeting space or equipment suitable for training staff. Community-level costs/savings include those related to local committee and taskforce meetings that recommend policy changes related to physical activity standards in child care settings to elected or appointed officials . Societal-level benefits and harms include incorporating minimum levels of physical activity into the daily schedule of young children can produce healthier adolescents and adults and increase equity of physical activity opportunities across the system, regardless of income level or social demographics.

Conclusions and Implications
The value frameworks provide a novel rubric for presenting how active living strategies impact individuals, organizations, communities, and societies. These value frameworks represent an initial effort to respond to the demand for resources that can be used by communities to express the value of their childhood obesity prevention efforts. The frameworks were designed to be customized for different community contexts in order to identify the range of inputs and impacts associated with local childhood obesity prevention strategies.

Next Steps
In evaluation, customized value frameworks can be used by communities to develop measures of strategy dose and impact. In collaboration with economists, communities may assign monetary values to some or all of these measures to weigh and summarize the overall value of the prevention strategies. These efforts bring communities another step closer to engaging in value-based decision-making for childhood obesity prevention. Additionally, the frameworks introduce the longer-term effects of social determinants of health into the “cost” and “value” inputs and outputs, encouraging investigation into health disparities and inequities that interfere with positive, sustainable outcomes. Further research needs to be done to quantify the value frameworks to further the benefit-cost analysis for policy, system, and environmental approaches to reducing childhood obesity. Additionally, creating methods and process to measure each level of value will move us closer to demonstrating the impact of childhood obesity prevention strategies. Moving forward, the use of value frameworks will enable practitioners to plan and prepare for advocacy initiatives; policy adoption, implementation, enforcement, and sustainability efforts; and changes to the built environment for healthy communities.

References

  1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004;291(23):2847-50.
  2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-55.
  3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010. JAMA 2012.
  4. Brennan LK, Brownson RC, Orleans CT. A review of the evidence for policy and environmental strategies to prevent childhood obesity: Findings and directions for future research, practice, and policy. Am J Prev Med under review.
  5. Gortmaker SL, Swinburn B, Levy D, Carter R, Mabry P, Finegood D, Huang T, Marsh T, Moodie M. Changing the Future of Obesity: Science, Policy and Action, Lancet. 2011; 378(9793): 838–847.
  6. IOM (Institute of Medicine). 2012. An integrated framework for assessing the value of community-based prevention. Washington, DC: The National Academies Press.

 

Support / Funding Source
Support for the Evaluation of Healthy Kids, Healthy Communities came from the Robert Wood Johnson Foundation grant #67099.

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

Shared Use of School Facilities With Community Organizations and Afterschool Physical Activity Program Participation: A Cost-Benefit Assessment

Date: 
05/01/2014
Description: 

Kanters, M. A., Bocarro, J. N., Filardo, M., Edwards, M. B., McKenzie, T. L., & Floyd, M. F. (2014). Shared Use of School Facilities With Community Organizations and Afterschool Physical Activity Program Participation: A Cost-Benefit Assessment. Journal of School Health, 84(5), 302-309.

Abstract: 

BACKGROUND: Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities. METHODS: Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011. RESULTS: Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses. CONCLUSIONS: These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy.

Location by State: 
Study Type: 

Pages

Subscribe to RSS - Parks & Recreation