Online versus in-person comparison of Microscale Audit of Pedestrian Streetscapes (MAPS) assessments: reliability of alternate methods.

BACKGROUND: An online version of the Microscale Audit of Pedestrian Streetscapes (Abbreviated) tool was adapted to virtually audit built environment features supportive of physical activity. The current study assessed inter-rater reliability of MAPS Online between in-person raters and online raters unfamiliar with the regions. METHODS: In-person and online audits were conducted for a total of 120 quarter-mile routes (60 per site) in Phoenix, AZ and San Diego, CA. Routes in each city included 40 residential origins stratified by walkability and SES, and 20 commercial centers. In-person audits were conducted by raters residing in their region. Online audits were conducted by raters in the alternate location using Google Maps (Aerial and Street View) images. The MAPS Abbreviated Online tool consisted of four sections: overall route, street segments, crossings and cul-de-sacs. Items within each section were grouped into subscales, and inter-rater reliability (ICCs) was assessed for subscales at multiple levels of aggregation. RESULTS: Online and in-person audits showed excellent agreement for overall positive microscale (ICC = 0.86, 95% CI [0.80, 0.90]) and grand scores (ICC = 0.93, 95% CI [0.89, 0.95]). Substantial to near-perfect agreement was found for 21 of 30 (70%) subscales, valence, and subsection scores, with ICCs ranging from 0.62, 95% CI [0.50, 0.72] to 0.95, 95% CI [0.93, 0.97]. Lowest agreement was found for the aesthetics and social characteristics scores, with ICCs ranging from 0.07, 95% CI [-0.12, 0.24] to 0.27, 95% CI [0.10, 0.43]. CONCLUSIONS: Results support use of the MAPS Abbreviated Online tool to reliably assess microscale neighborhood features that support physical activity and may be used by raters residing in different geographic regions and unfamiliar with the audit areas.

Reliability between online raters with varying familiarities of a region: Microscale Audit of Pedestrian Streetscapes (MAPS).

Background: To test inter-rater reliability of the online Microscale Audit of Pedestrian Streetscapes (MAPS) tool between raters with varying familiarities of Phoenix, Arizona. Methods: The online MAPS tool, based on the MAPS in-field audit tool and scoring system, was used for audits. Sixty route pairs, 141 segment pairs, and 92 crossing pairs in Phoenix were included. Each route, segment or crossing was audited by two independent raters: one rater in Phoenix and the other in San Diego, California, respectively. Item, subscale scores, and total scores reliability analyses were computed using Kappa or intra-class correlation coefficient (ICC). Results: The route overall score had substantial reliability (ICC: 0.832). Of the route subscale and overall scores, sixteen out of twenty had moderate to substantial reliability (ICC: 0.616-0.906), and the four subscales had fair reliability (ICC: 0.409-0.563). Sixteen out of twenty scores in segment and crossing sections demonstrated fair to substantial reliability (ICC: 0.448-0.897), and the remaining four had slight reliability (ICC: 0.348-0.364). Conclusions: Most of the online MAPS items, subscales, and overall scores demonstrated fair to substantial reliability between raters with varied familiarities of the Phoenix area. Results support use of online MAPS to measure microscale elements of the built environment by raters unfamiliar with a region.

Dog walking among adolescents: Correlates and contribution to physical activity.

PURPOSE: To assess the association of dog walking with adolescents' moderate-to-vigorous physical activity (MVPA) and body mass index (BMI), and identify correlates of dog walking. METHODS/DESIGN: Participants were 12-17year-olds (n=925) from the Baltimore, MD and Seattle, WA regions. Differences in accelerometer-assessed minutes/day of MVPA and self-reported BMI (percentile) were compared among adolescents (1) without a dog (n=441) and those with a dog who (2) did (≥1days/week, n=300) or (3) did not (n=184) walk it. Correlates of (1) dog walking (any vs. none) among adolescents with dogs (n=484), and (2) days/week of dog walking among dog walkers (n=300) were investigated. Potential correlates included: demographic, psychosocial, home environment, perceived neighborhood environment, and objective neighborhood environment factors. RESULTS: 52% of adolescents lived in a household with a dog, and 62% of those reported dog walking ≥1day/week. Dog walkers had 4-5 more minutes/day of MVPA than non-dog-walkers and non-dog-owners. BMI was not associated with dog walking or ownership. Among households with dogs, adolescents who lived in objectively walkable neighborhoods were 12% more likely to walk their dog than those in less walkable neighborhoods. Among dog walkers, having a multi-family home, college-educated parent, lower perceived traffic safety, higher street connectivity and less mixed use were related to more days/week of dog walking. CONCLUSIONS: Dog walkers had 7-8% more minutes/day of MVPA than non-dog walkers, and correlates of dog walking were found at multiple levels of influence. Results suggest multilevel interventions that include both environmental and psychosocial components to increase dog walking should be evaluated.

Socioeconomic and race/ethnic disparities in observed park quality.

BACKGROUND: Though park presence and access disparities are well studied for their associations with physical activity (PA), disparities in the availability and quality of amenities and facilities within parks have been infrequently examined. METHODS: Five hundred forty-three parks from 472 block groups in the Seattle, WA and Baltimore, MD regions were audited using the Environmental Assessment of Public Recreation Spaces (EAPRS) to assess presence and quality (e.g., condition, cleanliness) of amenities (e.g., restrooms, seating) and facilities (e.g., fields, courts). General linear model regressions investigated Census 2000-derived neighborhood race/ethnicity and income main effect and interactive relationships with 7 park quality summary scores: 1) trails, 2) open space, 3) sports facilities, 4) PA facilities count, 5) PA facilities quality, 6) aesthetics, and 7) overall amenities, controlling for park size. The regions were analyzed separately due to differing race/ethnicity distributions. RESULTS: In the Seattle region, neighborhood income was significantly negatively associated with sports quality score (p < .043), PA facilities total count (p < .015) and the overall amenities quality score (p < .004) (unexpected direction). In the Baltimore region, neighborhood race/ethnicity (percent White/non-Hispanic) was significantly positively related to the open spaces quality score (p < .011) (expected direction). A significant income-by-race/ethnicity interaction was found for PA facilities quality (p = .014), with high-percent minority neighborhoods having higher quality parks in high- vs. low-income neighborhoods, yet was opposite in mostly White/non-Hispanic neighborhoods. The other income-by-race/ethnicity interaction was for overall amenities quality score (p = .043), where scores in high-percent minority neighborhoods were best in high- vs. low-income neighborhoods. There was little difference in scores within mostly White or mixed neighborhoods by income. CONCLUSIONS: Patterns of association of neighborhood race/ethnicity and income with park qualities differed between regions. In the Seattle region, "equitable differences" were found, where lower income neighborhoods had better park quality on average. In the Baltimore region, park quality was more consistently negatively associated with income and race/ethnic diversity, and complex interactions of race/ethnicity by income were detected. These findings emphasize the need to explore other factors that may explain variations in park quality, like local policy, citizen involvement in park decision-making, park funding and allocation, sources of funding and park priorities.

Co-benefits of designing communities for active living: an exploration of literature.

To reverse the global epidemic of physical inactivity that is responsible for more than 5 million deaths per year, many groups recommend creating "activity-friendly environments." Such environments may have other benefits, beyond facilitating physical activity, but these potential co-benefits have not been well described. The purpose of the present paper is to explore a wide range of literature and conduct an initial summary of evidence on co-benefits of activity-friendly environments. An extensive but non-systematic review of scientific and "gray" literature was conducted. Five physical activity settings were defined: parks/open space/trails, urban design, transportation, schools, and workplaces/buildings. Several evidence-based activity-friendly features were identified for each setting. Six potential outcomes/co-benefits were searched: physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. A total of 418 higher-quality findings were summarized. The overall summary indicated 22 of 30 setting by outcome combinations showed "strong" evidence of co-benefits. Each setting had strong evidence of at least three co-benefits, with only one occurrence of a net negative effect. All settings showed the potential to contribute to environmental sustainability and economic benefits. Specific environmental features with the strongest evidence of multiple co-benefits were park proximity, mixed land use, trees/greenery, accessibility and street connectivity, building design, and workplace physical activity policies/programs. The exploration revealed substantial evidence that designing community environments that make physical activity attractive and convenient is likely to produce additional important benefits. The extent of the evidence justifies systematic reviews and additional research to fill gaps.

Implementing classroom physical activity breaks: Associations with student physical activity and classroom behavior.

OBJECTIVE: To investigate the relation of classroom physical activity breaks to students' physical activity and classroom behavior. METHODS: Six elementary-school districts in California implemented classroom physical activity interventions in 2013-2014. Students' (N=1322) accelerometer-measured moderate-to-vigorous physical activity (MVPA) during school and teachers' (N=397) reports of implementation and classroom behavior were assessed in 24 schools at two time points (both post-intervention). Mixed-effects models accounted for nested data. RESULTS: Minutes/day of activity breaks was positively associated with students' MVPA (ßs=.07-.14; ps=.012-.016). Students in classrooms with activity breaks were more likely to obtain 30 min/day of MVPA during school (OR=1.75; p=.002). Implementation was negatively associated with students having a lack of effort in class (ß=-.17; p=.042), and student MVPA was negatively associated with students being off task or inattentive in the classroom (ß=-.17; p=.042). Students provided with 3-4 physical activity opportunities (classroom breaks, recess, PE, dedicated PE teacher) had ≈5 more min/day of school MVPA than students with no opportunities (B=1.53 min/opportunity; p=.002). CONCLUSIONS: Implementing classroom physical activity breaks can improve student physical activity during school and behavior in the classroom. Comprehensive school physical activity programs that include classroom-based activity are likely needed to meet the 30 min/day school physical activity guideline.

Ciclovía participation and impacts in San Diego, CA: the first CicloSDias.

OBJECTIVE: Ciclovía or Open Streets initiatives support physical activity through cycling/rolling, and walking/running. We evaluated San Diego's first Open Streets event, CicloSDias, to document attendance, reach and marketing, and effects on social cohesion, businesses, and physical activity. METHODS: The comprehensive evaluation consisted of a city-wide survey 1 week before and after the event (n=805), counts of event attendees, and surveys of event attendees (n=713) and businesses (n=26). RESULTS: An estimated 8311 people attended the event. Attendees had an average of 144 min (SD=85) of physical activity, 97% met the 30 min/day guideline, and 39% met the 150 min/week guideline during the event. 27% of attendees would have been inactive without the event. Awareness of the event was 10% before and 26% after the event. When comparing event attendees to San Diego residents, Latinos and non-White race/ethnicities were under-represented. Restaurants/pubs, services, and most retail stores excluding liquor stores and food markets reported positive or neutral impacts on business. CONCLUSION: Open Street initiatives are promising ways to promote physical activity and are desired by the community. Positive effects were observed for physical activity, social cohesion, and businesses, though reach should be expanded to include more underserved community members. Evaluating Open Streets is important for sustaining and improving these efforts.

Leveraging Home-Delivered Meal Programs to Address Unmet Needs for At-Risk Older Adults: Preliminary Data.

BACKGROUND: Home-delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social. DESIGN: A pilot study was designed to test the feasibility of leveraging routine meal-delivery service in two home-delivered meal programs to proactively identify changes in older adult meal recipients' (clients') health, safety, and well-being and address unmet needs. INTERVENTION: Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services. RESULTS: Over a 12-month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self-care or personal safety (12%) and mobility (11%). On follow-up, a total of 132 referrals were issued, with most referrals for self-care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution. CONCLUSION: Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early-warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home-delivered meal programs. J Am Geriatr Soc 67:1946-1952, 2019.

Crime and Physical Activity: Development of a Conceptual Framework and Measures.

BACKGROUND: A common hypothesis is that crime is a major barrier to physical activity, but research does not consistently support this assumption. This article advances research on crime-related safety and physical activity by developing a multilevel conceptual framework and reliable measures applicable across age groups. METHODS: Criminologists and physical activity researchers collaborated to develop a conceptual framework. Survey development involved qualitative data collection and resulted in 155 items and 26 scales. Intraclass correlation coefficients (ICCs) were computed to assess test-retest reliability in a subsample of participants (N = 176). Analyses were conducted separately by age groups. RESULTS: Test-retest reliability for most scales (63 of 104 ICCs across 4 age groups) was "excellent" or "good" (ICC ≥ .60) and only 18 ICCs were "poor" (ICC < .40). Reliability varied by age group. Adolescents (aged 12-17 y) had ICCs above the .40 threshold for 21 of 26 scales (81%). Young adults (aged 18-39 y) and middle-aged adults (aged 40-65 y) had ICCs above .40 for 24 (92%) and 23 (88%) scales, respectively. Older adults (aged 66 y and older) had ICCs above .40 for 18 of 26 scales (69%). CONCLUSIONS: The conceptual framework and reliable measures can be used to clarify the inconclusive relationships between crime-related safety and physical activity.

Contextual factors related to implementation of classroom physical activity breaks.

Brief structured physical activity in the classroom is effective for increasing student physical activity. The present study investigated the association between implementation-related contextual factors and intervention implementation after adoption of a structured classroom physical activity intervention. Six elementary-school districts adopted structured classroom physical activity programs in 2013-2014. Implementation contextual factors and intervention implementation (structured physical activity provided in past week or month, yes/no) were assessed using surveys of 337 classroom teachers from 24 schools. Mixed-effects models accounted for the nested design. Availability of resources (yes/no, ORs = 1.91-2.93) and implementation climate z-scores (ORs = 1.36-1.47) were consistently associated with implementation. Teacher-perceived classroom behavior benefits (OR = 1.29) but not student enjoyment or health benefits, and time (OR = 2.32) and academic (OR = 1.63) barriers but not student cooperation barriers were associated with implementation (all z-scores). Four implementation contextual factor composites had an additive association with implementation (OR = 1.64 for each additional favorable composite). Training and technical assistance alone may not support a large proportion of teachers to implement structured classroom physical activity. In addition to lack of time and interference with academic lessons, school climate related to whether administrators and other teachers were supportive of the intervention were key factors explaining whether teachers implemented the intervention. Evidence-based implementation strategies are needed for effectively communicating the benefits of classroom physical activity on student behavior and improving teacher and administrator climate/attitudes around classroom physical activity.