The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial.

AIMS: The study aimed to estimate the impact of introducing a draught alcohol-free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. DESIGN: Randomised crossover field trial. SETTING: England. PARTICIPANTS: Fourteen venues that did not previously sell draught alcohol-free beer. INTERVENTION AND COMPARATOR: Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol-free beer. Control periods operated business as usual. MEASUREMENTS: The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. FINDINGS: The adjusted mean difference in weekly sales of draught alcoholic beer was -20 L [95% confidence interval (CI) = -41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol-free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of -29 L per week (95% CI = -53 to -5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = -328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol-free beer was available. CONCLUSIONS: Introducing a draught alcohol-free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue.

Recurrent costs in primary health care in Ethiopia: facility and disease specific unit costs and their components in government primary hospitals and health centers.

BACKGROUND: Continued investment, especially from domestic financing, is needed for Ethiopia to achieve universal health coverage and a sustainable health system over time. Understanding costs of providing health services will assist the government to mobilize adequate resources for health, and to understand future costs of changes in quality of care, service provision scope, and potential decline in external resources. This study assessed costs per unit of service output, "unit costs", for government primary hospitals and health centers, and disease-specific services within each facility. METHODS: Quantitative and qualitative data were collected from 25 primary hospitals and 47 health centers across eight of the eleven regions of Ethiopia for 2013/14, and 2014/15 and 2015/16 but only for primary hospitals, and supplemented by other related health and financial institutions records. A top-down costing approach was used to estimate unit costs for each facility by department - inpatient, outpatient, maternal and child health, and delivery. A mixed-method approach was used for the disease-specific unit costs exempt from fees. RESULTS: Health center median unit cost was 146 Ethiopian birr (ETB) (17 PPP$, 2012), the Delivery department had the highest median unit cost (647 ETB; 76 PPP$, 2012) and Outpatient department (OPD) had the lowest (124 ETB; 14 PPP$, 2012). Primary hospital median unit cost was 339 ETB (40 PPP$, 2012), with Inpatient department having the highest median unit cost (1288 ETB; 151 PPP$, 2012), while OPD was the lowest (252 ETB; 29 PPP$, 2012). Drugs and pharmaceutical supplies accounted for most of the costs for both facilities. Among the exempted services offered, tuberculosis and antiretroviral treatment are the costliest with median unit costs from 1091 to 1536 ETB (128-180 PPP$, 2012), with drugs and supplies accounting for almost 90% of the costs. CONCLUSIONS: High unit costs of service provision could be indicative of underutilization of the primary health care system, coupled with inefficiencies associated with organization and delivery of health services. Data from this study are being used to assess efficiency and productivity among primary care facilities, facilitate premium setting for health insurance, and improve budgeting and allocating health resources for a more sustainable and effective primary health care system.

Green certification, e-commerce, and low-carbon economy for international tourist hotels.

Increasing population and over-consumption are placing unprecedented demands on agriculture and natural resources. The Earth is suffering from global warning and environmental destruction while our agricultural systems are concurrently degrading land, water, biodiversity, and climate on a global scale. For a sustainable future, green certification, e-commerce, and environment education can boost low-carbon economy with decreasing carbon emissions, but very few researches address them for the hotel industry. This research studies the performance impact of e-commerce, international hotel chain, local hotel chain, and green certification for carbon emission reductions of international tourist hotels of Taiwan. It reveals that, after a sufficiently long time, there is an improvement in the environmental and economic performance of the green-certified hotel group. In addition, it reveals that, as recommended by the operation policy, the international hotel chain group together with e-commerce has better performance than local hotel chain. It is also discussed how to sustain the continuing improvement in low-carbon performance of the hotel industry.

Greek economic crisis and impaired perinatal parameters: experience from a public maternity hospital.

Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (<2500 g), prematurity (<37 weeks) and caesarean section (CS). During 2012-2014, compared to 2005-2007, LBW rate increased from 8.4 to 10.5% (RR 1.16; 95%CI 1.01-1.33); prematurity from 9.7 to 11.2% (RR 1.09; 95%CI 0.96-1.24), comprising mainly late-preterm neonates; CS from 43.2 to 54.8% (RR 1.21; 95%CI 1.16-1.26). Maternal age ≥30 years was risk factor for LBW, prematurity and CS; LBW was additional risk factor for CS. However, LBW and CSs increased during the study period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.

Technical-financial evaluation of rainwater harvesting systems in commercial buildings-case ase studies from Sonae Sierra in Portugal and Brazil.

Water is an essential and increasingly scarce resource that should be preserved. The evolution of the human population and communities has contributed to the global decrease of potable water availability and the reduction of its consumption is now compulsory. Rainwater harvesting systems (RWHS) are emerging as a viable alternative source for water consumption in non-potable uses. The present study aims to contribute to the promotion of water efficiency, focusing on the application of rainwater harvesting systems in commercial buildings, and comprises four stages: (i) development of a technical evaluation tool to aid the design of RWHS and support their financial evaluation; (ii) validation of the tool using operational data from an existing RWHS installed at Colombo Shopping Center, in Lisbon, Portugal; (iii) assessment of the sensibility of the technical evaluation tool results to the variation of the inputs, namely the precipitation and consumption, through a parametric analysis for the Colombo Shopping Center; and (iv) comparison of the performance and financial feasibility of hypothetical RWHS in two existing commercial buildings. The technical tool was applied to two Sonae Sierra's shopping centers, one in Portugal and one in Brazil. The installation of a 200-m3 tank is advised for the first case study, allowing non-potable water savings of 60% but a payback period of about 19 years. In the Brazilian shopping, the implementation of a tank with a capacity ranging from 100 to 400 m3 leads to non-potable savings between 20 and 50%, but with smaller payback period, under 2 years, due to the relatively lower investment costs and higher water fees.

Establishment of lactaton rooms in public and private companies: potentialities and difficulties. / Implantação de salas de apoio à amamentação em empresas públicas e privadas: potencialidades e dificuldades.

OBJECTIVE: To know how managers of public and private companies view lactation support rooms and their implantation. METHOD: This is study is based on qualitative, exploratory, and descriptive research. Twenty managers from Greater Florianópolis participated in the research, in 2015. Data were collected by means of semi-structured/projective interviews, and subjected to content analysis associated with Atlas.ti software. RESULTS: Data analysis led to the following two categories: difficulties and facilities of establishing a lactation room, with a predominance of financial difficulties and the lack of physical space. Dialectically, the subjects also recognised the low cost involved, which facilitates establishment. CONCLUSION: Financial, cultural, and political aspects make it difficult to set up lactation rooms, but the importance of this measure was acknowledged. Although the success of breastfeeding partly depends on these support rooms, it also requires multiple actions, especially the effective participation of nurses and other health workers.

Perceived Health Benefits and Willingness to Pay for Parks by Park Users: Quantitative and Qualitative Research.

Whilst a growing body of evidence demonstrates people derive a range of health and wellbeing benefits from visiting parks, only a limited number of attempts have been made to provide a complementary economic assessment of parks. The aim of this exploratory study was to directly estimate the perceived health and wellbeing benefits attained from parks and the economic value assigned to parks by park users in Victoria, Australia. The research employed a mixed methods approach (survey and interviews) to collect primary data from a selection of 140 park users: 100 from two metropolitan parks in Melbourne and 40 from a park on the urban fringe of Melbourne, Victoria. Our findings suggest that park users derive a range of perceived physical, mental/spiritual, and social health benefits, but park use was predominantly associated with physical health benefits. Overall, our exploratory study findings suggest that park users are willing to pay for parks, as they highly value them as places for exercising, socialising, and relaxing. Importantly, most people would miss parks if they did not exist. The findings aim to provide park managers, public health advocates, and urban policy makers with evidence about the perceived health and wellbeing benefits of park usage and the economic value park visitors place on parks.

Shared Use of Physical Activity Facilities Among North Carolina Faith Communities, 2013.

INTRODUCTION: Shared use of recreational facilities is a promising strategy for increasing access to places for physical activity. Little is known about shared use in faith-based settings. This study examined shared use practices and barriers in faith communities in North Carolina. METHODS: Faith communities in North Carolina (n = 234) completed an online survey (October-December 2013) designed to provide information about the extent and nature of shared use of recreational facilities. We used binary logistic regression to examine differences between congregations that shared use and those that did not share use. RESULTS: Most of the faith communities (82.9%) that completed the survey indicated that they share their facilities with outside individuals and organizations. Formal agreements were more common when faith communities shared indoor spaces such as gymnasiums and classroom meeting spaces than when they shared outdoor spaces such as playgrounds or athletic fields. Faith communities in the wealthiest counties were more likely to share their spaces than were faith communities in poorer counties. Faith communities in counties with the best health rankings were more likely to share facilities than faith communities in counties that had lower health rankings. The most frequently cited reasons faith communities did not share their facilities were that they did not know how to initiate the process of sharing their facilities or that no outside groups had ever asked. CONCLUSION: Most faith communities shared their facilities for physical activity. Research is needed on the relationship between shared use and physical activity levels, including the effect of formalizing shared-use policies.

The impact of alcohol management practices on sports club membership and revenue.

Issue addressed: The aim of this study was to assess the impact of an alcohol management intervention on community sporting club revenue (total annual income) and membership (number of club players, teams and spectators).Methods: The study employed a cluster randomised controlled trial design that allocated clubs either an alcohol accreditation intervention or a control condition. Club representatives completed a scripted telephone survey at baseline and again ~3 years following. Demographic information about clubs was collected along with information about club income.Results: Number of players and senior teams were not significantly different between treatment groups following the intervention. The intervention group, however, showed a significantly higher mean number of spectators. Estimates of annual club income between groups at follow-up showed no significant difference in revenue.Conclusions: This study found no evidence to suggest that efforts to reduce alcohol-related harm in community sporting clubs will compromise club revenue and membership.So what?: These findings suggest that implementation of an intervention to improve alcohol management of sporting clubs may not have the unintended consequence of harming club viability.

Implantação de salas de apoio à amamentação em empresas públicas e privadas: potencialidades e dificuldades / Despliegue de habitaciones lactancia de apoyo en empresas públicas y privadas: capacidades y dificultades / Establishment of lactaton rooms in public and private companies: potentialities and difficulties

RESUMO Objetivo Conhecer a visão de gestores de empresas públicas e privadas acerca das salas de apoio à amamentação, com vistas à sua implantação. Método Pesquisa qualitativa, exploratória descritiva, realizada em 2015, da qual participaram 20 gestores da Grande Florianópolis. Para a coleta de dados, foram utilizadas entrevistas semiestruturadas/projetivas e, para a análise, a Análise de Conteúdo, associada aos recursos do software Atlas.ti. Resultados Emergiram duas categorias, a saber, dificuldades e facilidades na implantação de sala de apoio à amamentação, com predomínio de aspectos dificultadores, especialmente financeiros, envolvidos na disponibilização de espaço físico. Dialeticamente, também houve reconhecimento do baixo custo envolvido, o que facilitaria sua implantação. Conclusões Aspectos financeiros, culturais e políticos dificultam a implantação de salas de apoio à amamentação, mas há o reconhecimento da importância da medida. Para o sucesso da amamentação, a implantação de salas de apoio é importante, porém, não suficiente, sendo necessárias múltiplas ações e, principalmente, uma atuação mais efetiva da enfermagem e dos demais profissionais de saúde.

RESUMEN Objetivo Conocer la visión de los gestores de la empresa pública y privada sobre las habitaciones de apoyo a la lactancia, con vistas a su puesta en práctica. Método La investigación fue cualitativa, exploratoria y descriptiva. Participaron 20 gerentes en Florianópolis en 2015. Para la recolección de datos se utilizaron entrevistas semiestructuradas/proyectiva y para análisis, Análisis de Contenido asociado a los recursos del software Atlas.ti. Resultados Surgieron dos categorías, las dificultades y las facilidades en la implantación de sala de apoyo a la lactancia, donde predominan los aspectos que obstaculizan, especialmente los financieros, involucrados en el espacio físico. Dialécticamente, también hubo reconocimiento del bajo costo involucrado, lo que facilitaría su aplicación. Conclusión Los aspectos financieros, culturales y políticos dificultan la implantación de salas de lactancia materna,es importsnte implantar salas de apoyo, sin embargo, no es suficiente, requiere múltiples acciones y, sobre todo, un funcionamiento más eficaz de la enfermería y otros profesionales de la salud.

ABSTRACT Objective To know how managers of public and private companies view lactation support rooms and their implantation. Method This is study is based on qualitative, exploratory, and descriptive research. Twenty managers from Greater Florianópolis participated in the research, in 2015. Data were collected by means of semi-structured/projective interviews, and subjected to content analysis associated with Atlas.ti software. Results Data analysis led to the following two categories: difficulties and facilities of establishing a lactation room, with a predominance of financial difficulties and the lack of physical space. Dialectically, the subjects also recognised the low cost involved, which facilitates establishment. Conclusion Financial, cultural, and political aspects make it difficult to set up lactation rooms, but the importance of this measure was acknowledged. Although the success of breastfeeding partly depends on these support rooms, it also requires multiple actions, especially the effective participation of nurses and other health workers.

Challenges in promoting joint use agreements: experiences from Community Transformation Grant awardees in North Carolina, Illinois, and Wisconsin, 2011-2014.

Community Transformation Grant awardees in North Carolina, Illinois, and Wisconsin promoted joint use agreements (formal agreements between 2 parties for the shared use of land or facilities) as a strategy to increase access to physical activity in their states. However, awardees experienced significant barriers to establishing joint use agreements, including 1) confusion about terminology and an aversion to complex legal contracts, 2) lack of applicability to single organizations with open use policies, and 3) questionable value in nonurban areas where open lands for physical activity are often available and where the need is instead for physical activity programs and infrastructure. Furthermore, promotion of formal agreements may unintentionally reduce access by raising concerns regarding legal risks and costs associated with existing shared use of land. Thus, joint use agreements have practical limitations that should be considered when selecting among strategies to promote physical activity participation.

Impact of park renovations on park use and park-based physical activity.

BACKGROUND: Given the concerns about low rates of physical activity among low-income minority youth, many community-based organizations are investing in the creation or renovation of public parks to encourage youth to become more physically active. To what degree park renovations accomplish this goal is not known. METHODS: We used the System for Observing Play and Recreation in Communities (SOPARC) to measure park users and their physical activity levels before and after 2 parks were renovated. We compared findings with 4 parks: 2 that were unrenovated parks and 2 that were undergoing renovation. We also surveyed park users and local residents about their use of the parks. RESULTS: Compared with parks that had not yet been renovated, the improved parks saw more than a doubling in the number of visitors and a substantial increase in energy expended in the parks. Increased park use was pronounced in adults and children, but was not seen in teens and seniors. Park renovations were associated with a significantly increased perception of park safety. CONCLUSIONS: Park improvements can have a significant impact on increasing park use and local physical activity.

Green space and mortality following ischemic stroke.

BACKGROUND: Residential proximity to green space has been associated with physical and mental health benefits, but whether green space is associated with post-stroke survival has not been studied. METHODS: Patients ≥ 21 years of age admitted to the Beth Israel Deaconess Medical Center (BIDMC) between 1999 and 2008 with acute ischemic stroke were identified. Demographics, presenting symptoms, medical history and imaging results were abstracted from medical records at the time of hospitalization for stroke onset. Addresses were linked to average Normalized Difference Vegetation Index, distance to roadways with more than 10,000 cars/day, and US census block group. Deaths were identified through June 2012 using the Social Security Death Index. RESULTS: There were 929 deaths among 1645 patients with complete data (median follow up: 5 years). In multivariable Cox models adjusted for indicators of medical history, demographic and socioeconomic factors, the hazard ratio for patients living in locations in the highest quartile of green space compared to the lowest quartile was 0.78 (95% Confidence Interval: 0.63-0.97) (p-trend = 0.009). This association remained statistically significant after adjustment for residential proximity to a high traffic road. CONCLUSIONS: Residential proximity to green space is associated with higher survival rates after ischemic stroke in multivariable adjusted models. Further work is necessary to elucidate the underlying mechanisms for this association, and to better understand the exposure-response relationships and susceptibility factors that may contribute to higher mortality in low green space areas.

Perceptions of Community Health Workers (CHWs/PS) in the U.S.-Mexico border HEART CVD study.

Although prior research has shown that Community Health Workers/Promotores de Salud (CHW/PS) can facilitate access to care, little is known about how CHW/PS are perceived in their community. The current study reports the findings of a randomized telephone survey conducted in a high-risk urban community environment along the U.S.-Mexico border. In preparation for a community-based CHW/PS intervention called the HEART ecological study, the survey aimed to assess perceptions of CHW/PS, availability and utilization of community resources (recreational and nutrition related) and health behaviors and intentions. A total of 7,155 calls were placed to complete 444 surveys in three zip codes in El Paso, Texas. Results showed that participants felt that healthful community resources were available, but utilization was low and variable: 35% reported going to a park, 20% reported having taken a health class, few reported using a gym (12%), recreation center (8%), or YMCA/YWCA (0.9%). Awareness and utilization of CHW/PS services were low: 20% of respondents had heard of CHW/PS, with 8% reporting previous exposure to CHW/PS services. Upon review of a definition of CHW/PS, respondents expressed positive views of CHW/PS and their value in the healthcare system. Respondents who had previous contact with a CHW/PS reported a significantly more positive perception of the usefulness of CHW/PS (p = 0.006), were more likely to see CHW/PS as an important link between providers and patients (p = 0.008), and were more likely to ask a CHW/PS for help (p = 0.009). Participants who utilized CHW/PS services also had significantly healthier intentions to reduce fast food intake. Future research is needed to evaluate if CHW/PS can facilitate utilization of available community resources such as recreational facilities among Hispanic border residents at risk for CVD.

An extension of the Theory of Planned Behavior to predict willingness to pay for the conservation of an urban park.

This paper relates the concept of moral obligation and the components of the Theory of Planned Behavior to determine their influence on the willingness to pay of visitors for park conservation. The sample consists of 190 visitors to an urban Spanish park. The mean willingness to pay estimated was 12.67€ per year. The results also indicated that moral norm was the major factor in predicting behavioral intention, followed by attitudes. The new relations established between the components of the Theory of Planned Behavior show that social norms significantly determine the attitudes, moral norms and perceived behavioral control of individuals. The proportion of explained variance shows that the inclusion of moral norms improves the explanatory power of the original model of the Theory of Planned Behavior (32-40%). Community-based social marketing and local campaigns are the main strategies that should be followed by land managers with the objective of promoting responsible, pro-environmental attitudes as well as a greater willingness to pay for this type of goods.

Multiple streams approach to tobacco control policymaking in a tobacco-growing state.

Smokefree policies (SFPs) have diffused throughout the US and worldwide. However, the development of SFPs in the difficult policy environment of tobacco-producing states and economies worldwide has not been well-explored. In 2007, Tennessee, the third largest tobacco producer in the US, enacted the Non-Smoker Protection Act (NSPA). This study utilizes the multiple streams model to provide understanding of why and how this policy was developed by triangulating interviews with key stakeholders and legislative debates with archival documents. In June 2006, the Governor unexpectedly announced support for SFP, which created a window of opportunity for policy change. The Campaign for Healthy and Responsible Tennessee, a health coalition, seized this opportunity and worked with the administration and the Tennessee Restaurant Association to negotiate a comprehensive SFP, however, a weaker bill was used by the legislative leadership to develop the NSPA. Although the Governor and the Tennessee Restaurant Association's support generated an environment for 100% SFP, health groups did not fully capitalize on this environmental change and settled for a weak policy with several exemptions. This study suggests the importance for proponents of policy change to understand changes in their environment and be willing and able to capitalize on these changes.

Using geographic information systems to compare municipal, county, and commercial parks data.

INTRODUCTION: Parks are an integral part of a favorable built environment, and several studies have found a positive association between a favorable built environment and physical activity. Parks data are available to researchers from various sources; however, the accuracy of data sources in representing parks is unknown. This study compared secondary parks data obtained from a commercial vendor with data from municipal/county government records, all of which were verified by using Internet searches, telephone inquiries, or on-the-ground audits. METHODS: We studied large metropolitan areas in 3 states: North Carolina (1,837 sq mi), Maryland (1,351 sq mi), and New York (260 sq mi). We collected information on park land area (shapefiles) from municipal/county governments from 2009 through 2012 and from a commercial source in 2010. RESULTS: Commercial parks data did not include 31.1% (119/383, 20.3 sq mi) of North Carolina, 42.9% (187/436, 21.8 sq mi) of Maryland, and 71.7% (640/892, 13.5 sq mi) of New York parks that we found and verified from municipal/county sources. Municipal/county data did not include 15.7% (60/383, 9.9 sq mi) of North Carolina parks, 27.5% (120/436, 74.6) of Maryland parks, and 9.0% (80/892, 6.3 sq mi) of New York parks that we found and verified from commercial sources. CONCLUSION: In this study, the combination of commercial and municipal/county data sources that were verified provided the most complete and accurate shapefile. The quality of secondary sources of parks data should be checked prior to use and, if needed, methods incorporated to improve the capture of parks.

Profit versus public health: the need to improve the food environment in recreational facilities.

Despite their wellness mandate, many publicly funded recreational facilities offer primarily unhealthy foods. Governments have developed programs and resources to assist facilities to improve their food offerings, however the challenge to incent preferential sale of healthier foods remains substantial. In the Canadian province of Alberta, uptake of government-issued voluntary nutrition guidelines for recreational facilities has been limited, and offers of free assistance to implement them as part of a research study were not embraced. Financial constraints appear to be the most important barrier to offering healthier items in Alberta's recreational facilities, as facility and food service managers perceive that selling healthier foods is unprofitable and might jeopardize sponsorship agreements. Mandatory government regulation may therefore be required to overcome the barriers to offering healthier foods in this setting. The advantages of a regulatory approach appear to outweigh any disadvantages, with benefits for population health, more effective use of public funds, and greater equity for the public and industry. Adverse effects on corporate profitability and freedom of choice are expected to be limited. Regulation may offer an efficient, effective and equitable means of ensuring that recreational facilities support child health and do not undermine it by exposing children to unhealthy food environments.

Association of available parkland, physical activity, and overweight in America's largest cities.

OBJECTIVE: To examine associations between the densities of available parkland, parkland provided per capita, and levels of physical activity (PA) and overweight in urban United States. DESIGN: Cross-sectional correlation research using data drawn from the Trust for Public Land's 2010 City Park Facts and The Behavioral Risk Factor Surveillance System (BRFSS). City Park Facts is a report containing "basic information on urban park systems--from acreage, to facilities, to staffing, to budgets, to usership, and more" for America's 85 largest cities. The Behavioral Risk Factor Surveillance System is a state-based surveillance system that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. SETTING: Sixty-seven metropolitan statistical areas in the United States that provided data for both reports. PARTICIPANTS: Randomly selected adults aged 18 years and older who participated in the 2009 Behavioral Risk Factor Surveillance Survey in the 67 metropolitan statistical areas. MAIN OUTCOME MEASURE(S): Total parkland per acre of metropolitan area was correlated to inactivity, engaging in recommended levels of moderate or vigorous PA, engaging in recommended levels of vigorous PA, and body weight. Parkland acreage per 1000 residents was correlated to these same variables. Multilevel models considered these relationships while controlling for race, family income, and age of respondents and accounting for clustering by metropolitan statistical area. RESULTS: There were significant, positive correlations between park density and PA (r(s) = 0.37, n = 67, P < .01) and between park density and exercise (r(s) = 0.35, n = 67, P < .01), and a negative correlation between park density and being above normal weight (r(s) = -0.32, n = 67, P < .01). Adjusted multilevel models showed that parkland density in the highest versus lowest quartile was associated with significantly higher odds of meeting PA guidelines (aOR = 1.19, 95% CI: 1.08-1.30) and reduced odds of being overweight/obese (aOR = 0.85, 95% CI: 0.76-0.95). CONCLUSIONS: Each of these findings substantiates the need for providing parkland in a community. As such, this research helps to support the notion that the development of a strong park system may lead to positive PA and health outcomes for that community.