Association of Playground "Playability" With Physical Activity and Energy Expenditure.

INTRODUCTION: Children's physical activity, especially play, is important for healthy physical, social, and psychological development. Playgrounds are public spaces for children, but not all playgrounds are conducive to play and physical activity. We examined "playability," the ability of a space to promote active play, and associations with moderate-to-vigorous physical activity (MVPA) and energy expenditure. METHODS: This cross-sectional study assessed playground features with the Play Space Audit Tool; we calculated playability scores from audit data, overall and by domain (general amenities, surface, path, and play structure), from playgrounds in 70 parks in Chicago, Illinois, in 2017. We observed 2,712 individuals during the audits and used the System for Observing Play and Recreation in Communities tool to assess MVPA and energy expenditure. We used generalized estimating equation negative binomial regression to calculate incidence rate ratios for MVPA and mixed effects models to calculate energy expenditure (in kcal/kg/min) associated with playability scores. RESULTS: General amenities and play structure scores were associated with 1.28 (95% CI, 1.08-1.52) and 1.15 (95% CI, 1.00-1.31) times as many individuals (any age) engaged in MVPA, respectively. The general amenities score was significantly associated with 0.51 (95% CI, 0.24-0.79) and 0.42 (95% CI, 0.15-0.68) higher energy expenditure in renovated playgrounds and in all playgrounds, respectively. CONCLUSION: Overall, general amenities and play structure scores were associated with MVPA and were robust to adjustment for weather, neighborhood socioeconomic characteristics, and crime. These playground playability indices may strengthen future evaluations of community infrastructure for children's physical activity.

Examining the Implementation of Activity-Friendly Zoning and Land Use Policies Through the Use of Google Street View Measures: A Pilot Study.

INTRODUCTION: Pedestrian-oriented zoning and land use policies are being used by local jurisdictions as tools to implement population-level built environmental changes to create more walkable communities. There is a paucity of evidence examining whether these policies lead to actual changes in the built environment. We used Google Street View (GSV), an established, less expensive, alternative built environment data collection method, to conduct an exploratory pilot study of 19 jurisdictions to examine associations between variations in the presence of these adopted zoning policies and their corresponding specific street-level built environment features. METHODS: Samples of 10 large and 9 small jurisdictions (18 municipalities and 1 county) were purposively selected on the basis of the presence of activity-friendly zoning policy provisions (sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, trails/paths, bike lanes, bike parking, and other items). Corresponding activity-friendly street-level built environment measures were constructed using GSV. Street segments in these jurisdictions were sampled using ArcGIS and stratified by type (residential and arterial) and income (high, medium, and low). RESULTS: A total of 4363 street segments were audited across the 19 sampled jurisdictions. Results show significant differences in the presence of activity-friendly street features when the corresponding zoning policy element was addressed in New Urbanist zones/districts in the site's zoning code (eg, crosswalks, 24.48% vs 16.18%; and bike lanes, 12.60% vs 7.14%). Street segments in the middle- and high-income block groups were less likely to have activity-friendly features than low-income segments, except bike lanes. CONCLUSIONS: Results show that having activity-friendly policy provisions embedded in a jurisdiction's (municipality/county) zoning codes was associated with a greater presence of the corresponding built environmental street feature on the ground. Results suggest that the methods tested in this article may be a useful policy tool for local governments to identify high need areas that should be prioritized for built environment improvements.

Did Playground Renovations Equitably Benefit Neighborhoods in Chicago?

Between 2013 and 2016, the Chicago Park District renovated 327 playgrounds in need of repair across Chicago through a $44 million investment. This study evaluated whether short-term and longer-term impacts of renovations on park use and park-based moderate-to-vigorous physical activity (MVPA) differed by neighborhood income level and neighborhood concentration of Black residents. A total of 39 parks with renovated playgrounds and 39 matched comparison parks with playgrounds that needed repair but not selected for renovation in year 1 were studied. Three waves of observational data were collected at each park: baseline, 12 months post-renovation, and 24 months post-renovation. Difference-in-differences mixed-effects Poisson regression models estimated renovation effects. The effects of renovations differed by the income level and concentration of Black residents in the neighborhoods where parks were located. In low-income neighborhoods, renovations were associated with reductions in park use and park-based MVPA over the longer term. In contrast, renovations were associated with short- and longer-term increases in park use and park-based MVPA in medium-income neighborhoods and with longer-term increases in MVPA in high-income neighborhoods. Renovations were generally not associated with any changes in park use or park-based MVPA in high-percent Black neighborhoods, but they were associated with increased park use and park-based MVPA in low-percent Black neighborhoods. This study suggests playground renovations in Chicago may have had unintended consequences, increasing neighborhood income and racial disparities in park use and park-based MVPA. Future playground renovation efforts may need to allocate more resources for renovating the broader park where in disrepair, more intensely involve neighborhood residents, and employ complementary strategies such as additional park programming to ensure renovations benefit all neighborhoods.

Recommendations for Keeping Parks and Green Space Accessible for Mental and Physical Health During COVID-19 and Other Pandemics.

The importance of engaging in any type of physical activity regularly, for both physical and mental health, is well established, and may be particularly beneficial in protecting the body and limiting the damage caused by the coronavirus disease 2019 (COVID-19). Exposure to nature or green space also has positive physical and mental health benefits. Closures of parks and green spaces during the COVID-19 pandemic has limited the options for physical activity and may affect vulnerable populations more than others. We provide both short-term and long-term recommendations to encourage access to green space for people while allowing for physical distancing.

Pedestrian-oriented zoning is associated with reduced income and poverty disparities in adult active travel to work, United States.

Active travel to work can provide additional minutes of daily physical activity. While the literature points to the relationship between zoning, equity and socioeconomic status, and physical activity, no study has quantitatively explored these connections. This study examined whether zoning may help to moderate any income and poverty inequities in active travel and taking public transit to work. Research was conducted between May 2012 and June 2015. Zoning data were compiled for 3914 jurisdictions covering 45.45% of the U.S. population located in 471 of the most populous U.S. counties and 2 consolidated cities located in 48 states and the District of Columbia. (Sensitivity analyses also captured unincorporated areas which, with the municipalities, collectively covered ~72% of the U.S. POPULATION: ) Zoning codes were obtained and evaluated to assess the pedestrian-orientation of the zoning codes. Public transit use, active travel to work, median household income, and poverty data were obtained for all study jurisdictions from the 2010-2014 American Community Survey estimates. Associations were examined through multivariate regression models, controlling for community sociodemographics, clustered on county, with robust standard errors. We found that certain pedestrian-oriented zoning provisions (e.g., crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, and more zoning provisions) were associated with reduced income and/or poverty disparities in rates of public transit use and active travel to work. Findings from this study can help to inform cross-sectoral collaborations between the public health, planning, and transportation fields regarding zoning for pedestrian-orientation and active travel.

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

Although zoning is recognized for its role in facilitating healthy communities, no study has examined whether active living-oriented zoning codes are associated with adult leisure time physical activity (PA). This study sought to fill this gap and hypothesized that adult leisure time PA would be greater in communities with more progressive zoning code reforms and more active living-oriented zoning. Zoning codes for 1,617 county and municipal jurisdictions located in 30 states (covering ~40% of the U.S. population) were evaluated for code reform zoning and 11 active living markers. County-aggregated zoning measures were created for linking with five adult PA behaviors obtained from the 2011 Behavioral Risk Factor Surveillance System controlling for individual and county sociodemographics. Zoning elements most associated with adult PA included requirements for mixed use, active and passive recreation, bike parking/street furniture, and bike-pedestrian trails/paths. This study provides new insights as to the role that zoning can play in facilitating adult PA.

Developing a Measure of Traffic Calming Associated with Elementary School Students' Active Transport.

The objective of this study is to develop a measure of traffic calming with nationally available GIS data from NAVTEQ and to validate the traffic calming index with the percentage of children reported by school administrators as walking or biking to school, using data from a nationally representative sample of elementary schools in 2006-2010. Specific models, with and without correlated errors, examined associations of objective GIS measures of the built environment, nationally available from NAVTEQ, with the latent construct of traffic calming. The best fit model for the latent traffic calming construct was determined to be a five factor model including objective measures of intersection density, count of medians/dividers, count of low mobility streets, count of roundabouts, and count of on-street parking availability, with no correlated errors among items. This construct also proved to be a good fit for the full measurement model when the outcome measure of percentage of students walking or biking to school was added to the model. The traffic calming measure was strongly, significantly, and positively correlated with the percentage of students reported as walking or biking to school. Applicability of results to public health and transportation policies and practices are discussed.

Association between state physical education (PE) requirements and PE participation, physical activity, and body mass index change.

OBJECTIVE: To determine if state physical education (PE) laws are associated with student physical education attendance and physical activity (PA), and whether physical education and competitive food laws, in conjunction, are associated with lower BMI change. METHOD: State laws regarding physical education time requirements and competitive foods in 2003 and 2006 were classified as strong, weak, or none, based on codified law ratings obtained from the Classification of Laws Associated with School Students. Laws were linked to student data on PE attendance and physical activity (8th grade, Spring 2007) and BMI change (5th-8th grade, 2004-2007), obtained from the Early Childhood Longitudinal Study (n=5510 students in 40 states). RESULTS: Girls reported 0.31 more days of activity (95% CI: 0.02, 0.61) and were more likely to attend physical education ≥ 3 days/week (74.1% versus 52.1%, difference=22.0, 95% CI: 2.1, 42.0) if they resided in states with strong physical education laws compared to no physical education laws. Weak physical education laws had modest associations with PE and activity, and there was no evidence that weak laws reduce BMI gain regardless of competitive food laws. CONCLUSION: Strong physical education laws with specific time requirements may increase physical education attendance and activity in girls. There is insufficient evidence that physical education laws reduce student weight gain.

Active living-oriented zoning codes and cardiometabolic conditions across the lifespan.

Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce high rates of cardiometabolic conditions. Local zoning codes are a policy and planning tool to create more walkable and bikeable environments. This study evaluated relationships between active living-oriented zoning code environments and cardiometabolic conditions (body mass index, hyperlipidemia, hypertension). The study used county identifiers to link electronic health record and other administrative data for a sample of patients utilizing primary care services between 2012 and 2016 with county-aggregated zoning code data and built environment data. The analytic sample included 7,441,991 patients living in 292 counties in 44 states. Latent class analysis was used to summarize municipal- and unincorporated county-level data on seven zoning provisions (e.g., sidewalks, trails, street connectivity, mixed land use), resulting in classes that differed in strength of the zoning provisions. Based on the probability of class membership, counties were categorized as one of four classes. Linear and logistic regression models estimated cross-sectional associations with each cardiometabolic condition. Models were fit separately for youth (aged 5-19), adults (aged 20-59), and older adults (aged 60+). Little evidence was found that body mass index in youth, adults, or older adults or the odds of hyperlipidemia or hypertension in adults or older adults differed according to the strength of active living-oriented zoning. More research is needed to identify the health impacts of zoning codes and whether alterations to these codes would improve population health over the long term.

Development and Testing of a Brief Play Space Audit Tool.

BACKGROUND: Spaces that promote play are important for the physical, social, and psychological growth of children. Public spaces, including playgrounds, provide an important venue for children to engage in play. A simple tool is needed to evaluate playground features and conditions. METHODS: A simple play space audit instrument to assess the presence and condition of playground features was tested on a sample of 70 playgrounds during the summer of 2017, in Chicago, IL. Duplicate observations were collected on 17 playgrounds. Frequencies of features were tabulated, and reliability of variables was assessed using percent agreement and kappa statistic. Scores were created to summarize playground "playability," overall and within domains of general overview, surface, path, and play equipment/structure features. RESULTS: The tool demonstrated acceptable reliability with high kappa values between .79 and .90 for all items in domains. The overall score, general overview score, and play equipment/structure scores were correlated with mean playground usage. CONCLUSIONS: This brief instrument allows reliable assessment of playground features and their conditions. The scoring method generates a summary of playground conditions and features, which facilitates comparison of playgrounds. This tool has the potential to assist communities in evaluating their play spaces and identifying where to focus resources for improvements.

Encouraging "Active Learning": Assessing Implementation of Head Start's Physical Activity Requirements Within the Teaching and Learning Environment.

BACKGROUND: Head Start serves over 1 million diverse low-income preschool children and is an ideal setting for developing and implementing obesity prevention efforts, which is expected to have positive impacts on behavior as youth age. This study examined how regional- and state-level Head Start offices have supported implementation of the recently updated physical activity (PA) requirement within the teaching and learning environment Head Start Program Performance Standard (1302.31). METHODS: Key informant telephone interviews were conducted with 8 regional- and 36 state-level Head Start representatives. Interviews were recorded and professionally transcribed. Data were coded and analyzed using constant comparative methods in ATLAS.ti (version 8). Audit trails were maintained, and disagreements in codes were discussed and resolved among coders. RESULTS: The following 3 overarching themes emerged: communication, resources and technical assistance, and challenges. Results showed variation in respondent knowledge regarding the Standards. Although regional contacts provide technical assistance, state-level contacts have many information sharing strategies for programs. Implementation challenges included the need for frequent professional development opportunities given staff turnover and low PA competency, and additional PA curricula. CONCLUSION: Findings can help identify existing or potential strategies that could be adopted more widely or developed to assist Head Start programs incorporate PA into daily activities.

Would increasing access to recreational places promote healthier weights and a healthier nation?

Addressing gaps in evidence on causal associations, this study tested the hypothesis that better access to recreational places close to home helps people to maintain lower body mass index (BMI) using a retrospective longitudinal study design and up to 6 years of data for the same individuals (1,522,803 men and 183,618 women). Participants were military veterans aged 20-64 who received healthcare through the U.S. Department of Veterans Affairs in 2009-2014 and lived in a metropolitan area. Although there were cross-sectional associations, we found no longitudinal evidence that access to parks and fitness facilities was associated with BMI for either men or women in the full sample or in subgroups of residential movers and stayers. Our findings suggest that simply increasing the number of parks and fitness facilities may not be enough to achieve needed population-level reductions in weight.

The impact of retail cigarette marketing practices on youth smoking uptake.

OBJECTIVE: To examine the differential associations of cigarette retail marketing practices on youth smoking uptake. DESIGN: Analyses from annual, nationally representative, cross-sectional surveys of 8th, 10th, and 12th graders in the United States. SETTING: The February 1999 through June 2003 Monitoring the Future surveys involved 109,308 students and data on retail cigarette marketing collected from 966 communities in which the students reside, as part of the Bridging the Gap Initiative: Research Informing Practice and Policy for Healthy Youth Behavior. PARTICIPANTS: A total of 26,301 students were selected for this study. MAIN EXPOSURES: Point-of-sale advertising, promotions, prices, and placement. OUTCOME MEASURE: Using a smoking uptake measure to account for stages that identify the process by which adolescents begin smoking, we calculated odds ratios and confidence intervals through generalized ordered logit analyses, with weighted data that controlled for demographic and socioeconomic characteristics and accounted for clustering at the community level. RESULTS: Higher levels of advertising, lower cigarette prices, and greater availability of cigarette promotions were associated with smoking uptake. Advertising increased the likelihood of youth initiating smoking, price increased the likelihood of smoking at most levels of uptake, and availability of promotions increased the likelihood that youth will move from experimentation to regular smoking. CONCLUSIONS: Cigarette retail marketing practices increase the likelihood of smoking uptake. These findings suggest that specific restrictions on retail cigarette marketing may reduce youth smoking.

Missed opportunities: local health departments as providers of obesity prevention programs for adolescents.

BACKGROUND: This study examined the availability of local health department programs related to youth healthy eating, obesity control, and physical activity. METHODS: Data were obtained in the spring and summer of 2003. Selection of communities was based on a nationally representative sample of 8th-, 10th-, and 12th-grade students. Health departments with jurisdiction over these communities were contacted. Information was collected on departmental activities around healthy eating, weight loss, and physical activity. RESULTS: Results reveal that on average less than half the health departments surveyed provide, support, or advocate for programs targeting these activities. While the majority of informants indicated that these programs are of high priority, there is still an opportunity for health departments to expand these types of services. CONCLUSIONS: By increasing and expanding these programs and advocacy efforts, health agencies could be an important resource in helping to curb the current obesity epidemic.

The availability of local-area commercial physical activity-related facilities and physical activity among adolescents.

BACKGROUND: A significant number of American youth do not participate in sufficient levels of physical activity. METHODS: This article reports the association between the availability of commercial physical activity-related facilities and self-reported physical activity behavior among United States adolescents. Geographic identifiers at the ZIP-code level were used to combine repeated cross-sections of individual-level data on 8th-, 10th-, and 12th-grade adolescents from the Monitoring the Future (MTF) Survey with external commercial physical activity-related facility outlet density measures obtained from business lists from Dun and Bradstreet for the years 1997 through 2003. The estimation samples based on questions from different survey forms included a total of 195,702 observations on which information on physical activity (sports, athletics, or exercise) was available and 58,876 observations on which information on vigorous exercise behavior was available. RESULTS: The results showed a statistically significant but very small association between local-area per capita availability of commercial physical activity-related facilities and physical activity behavior among U.S. adolescents. An additional local-area facility per 10,000 capita was associated with only a 0.22 percentage point increase in frequent vigorous exercise among the full sample of adolescents. By gender and grade level, the study found significant associations among female and older students: increasing availability from a low (1 facility) to a high (8 facilities) number of local-area facilities was associated with a 6.6% and 9.0% increase in frequent physical activity and frequent vigorous exercise among 12th-grade girls, respectively, and a 6.4% increase in frequent vigorous exercise among 12th-grade boys. CONCLUSIONS: Improving the availability of commercial physical activity-related opportunities among underserved populations may help to increase activity levels among older adolescents and girls.

Does Pedestrian Danger Mediate the Relationship between Local Walkability and Active Travel to Work?

BACKGROUND: Environmental and policy factors play an important role in influencing people's lifestyles, physical activity (PA), and risks for developing obesity. Research suggests that more walkable communities are needed to sustain lifelong PA behavior, but there is a need to determine what local built environment features facilitate making being active the easy choice. PURPOSE: This county-level study examined the association between local walkability (walkability and traffic calming scales), pedestrian danger, and the percent of adults who used active transport to work. METHODS: Built environment and PA outcome measures were constructed for the 496 most populous counties representing 74% of the U.S. population. Geographic information system-based walkability scales were constructed and include a census of roads located within the counties using 2011 Navteq data. The pedestrian danger index (PDI) includes data collected from the Fatality Analysis Reporting System 2009-2011, and measures the likelihood of a pedestrian being hit and killed by a vehicle. Four continuous outcome measures were constructed using 2009-2013 American Community Survey county-level 5-year estimates. The measures represent the percentage of workers living in a county who worked away from home and (1) walked to work; (2) biked to work; (3) took public transit; and (4) used any form of active transport. Linear regression and mediation analyses were conducted to examine the association between walkability, PDI, and active transport. Models accounted for clustering within state with robust SEs, and controlled for median household income, families with children in poverty, race, ethnicity, urbanicity, and region. RESULTS: The walkability scale was significantly negatively associated with the PDI (ß = -0.06, 95% CI = -0.111, -0.002). In all models, the PDI was significantly negatively associated with all active travel-related outcomes at the p < 0.01 level. The walkability scale was positively associated with all four outcomes at the p < 0.01 level. Results showed that the significant positive relationship between local walkability and the four active transport outcome measures was partially mediated by the PDI. We found no association between traffic calming, the PDI, and the active transport outcomes. CONCLUSION: Results from this study show that, at the county-level, walkability is associated with active travel, and this association is partially mediated by an index of pedestrian safety.

Built environment assessment: Multidisciplinary perspectives.

CONTEXT: As obesity has become increasingly widespread, scientists seek better ways to assess and modify built and social environments to positively impact health. The applicable methods and concepts draw on multiple disciplines and require collaboration and cross-learning. This paper describes the results of an expert team׳s analysis of how key disciplinary perspectives contribute to environmental context-based assessment related to obesity, identifies gaps, and suggests opportunities to encourage effective advances in this arena. EVIDENCE ACQUISITION: A team of experts representing diverse disciplines convened in 2013 to discuss the contributions of their respective disciplines to assessing built environments relevant to obesity prevention. The disciplines include urban planning, public health nutrition, exercise science, physical activity research, public health and epidemiology, behavioral and social sciences, and economics. Each expert identified key concepts and measures from their discipline, and applications to built environment assessment and action. A selective review of published literature and internet-based information was conducted in 2013 and 2014. EVIDENCE SYNTHESIS: The key points that are highlighted in this article were identified in 2014-2015 through discussion, debate and consensus-building among the team of experts. Results focus on the various disciplines׳ perspectives and tools, recommendations, progress and gaps. CONCLUSIONS: There has been significant progress in collaboration across key disciplines that contribute to studies of built environments and obesity, but important gaps remain. Using lessons from interprofessional education and team science, along with appreciation of and attention to other disciplines׳ contributions, can promote more effective cross-disciplinary collaboration in obesity prevention.

The Whole-of-School Approach to Physical Activity: Findings From a National Sample of U.S. Secondary Students.

INTRODUCTION: The IOM recommends schools adopt a Whole-of-School (WOS) approach--one that is comprehensive, coordinated, and provides opportunities for students to be active before, during, and after school. This study examined, in a nationally representative sample of secondary students in the conterminous U.S., (1) the degree of implementation of a WOS approach and (2) the association between WOS implementation and student physical activity. METHODS: A WOS index--based on six school practices--was calculated using self-reported school administrator data gathered in 2010 and 2011 (N=1,031). Student-level data were obtained from nationally representative samples of eighth-, tenth-, and 12th-grade students during the same years (eighth grade, nschools=96, nstudents=3,689; tenth/12th grades, nschools=178, nstudents=4,670). Multilevel Poisson models were estimated in 2013-2014 to examine the relationship between the WOS index and self-reported physical activity. RESULTS: Few students attended schools with high WOS index scores. Middle school students attending schools with higher WOS index scores were physically active for at least 60 minutes on more days than students attending schools with lower WOS index scores (exp[ß]=1.031, 95% CI=1.008, 1.054). The WOS index score was not associated with physical activity among high school students. CONCLUSIONS: This study finds that many schools are not offering the full array of practices comprising a WOS approach to physical activity, especially at the high school level. Yet, middle school students could have increased physical activity levels if schools were to implement a WOS approach to physical activity.