Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative.

BACKGROUND: Although successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables). METHODS: PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size. RESULTS: Strategy intensity scores ranged from 0.3 to 3.0 with 20% considered "higher-scoring" (score > 2.1) and 47% considered "lower-scoring" (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday. CONCLUSIONS: We found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes.

An eLearning series for staff working in Title X-funded settings: An effort to disseminate national family planning recommendations.

OBJECTIVES: A team of trainers and instructional designers who develop federally funded training for staff working in Title X-funded settings developed an eLearning series of seven modules to support dissemination of Providing Quality Family Planning Services: Recommendations from CDC and the US Office of Population Affairs. QFP outlines how to provide services related preventing and achieving pregnancy. STUDY DESIGN: We evaluated participant reactions and intention to apply what they learned from the eLearning modules. RESULTS: In 2021, 6132 unique individuals completed 12,102 modules, and of those, 5324 unique individuals completed 10,460 evaluations (86% evaluation response rate). Nearly all respondents agreed that the modules were useful (97%), that they would recommend the training to others (96%), and that they were confident in their ability to apply what they learned (97%). More than half (60%) of respondents intended to share information and tools with colleagues and with clients; one in ten (10%) intended to change program practices. CONCLUSIONS: eLearning modules can be an efficient way to disseminate recommendations.

Building Support for Place-Based Solutions to Childhood Obesity: Findings From Missouri.

BACKGROUND: Place-based efforts offer promise in reducing childhood obesity. Yet, lack of public demand and support may hinder implementation. AIMS: This study aimed to assess whether the emphasis on place-based solutions, community-wide strategies, and multisector engagement in the Healthy Schools Healthy Communities (HSHC) initiative would shift public views on obesity including the need for greater public involvement and an increase in awareness and support for strategies. METHOD: As part of the evaluation, two surveys were conducted-in 2014 and 2016-to examine the relationship between HSHC strategies and changes in public perception, support, and awareness of obesity. Both surveys were cross-sectional and conducted with a randomized sample of households. RESULTS: Most respondents indicated that parents/family (84.3% in 2014; 87.8% in 2016) and children (70.9% in 2014; 74.8% in 2016) had a large/very large responsibility for addressing childhood obesity. A higher percentage of 2016 respondents indicated willingness to work with others to increase availability of healthy foods (71.3% vs. 64.2%, respectively; p = .0280) and increase the number of places to be physically active in their community (71.1% vs. 60.7%, respectively; p = .0015). DISCUSSION: Findings suggest awareness and support of place-based efforts and willingness to engage may help garner ongoing support. However, individuals and families are still perceived as primarily responsible for addressing childhood obesity. Countering this mindset remains an ongoing challenge. CONCLUSION: Streamlined messaging regarding the issue and associated solutions, enhanced skills and capacity to implement these efforts, and citizen engagement to garner support for place-based initiatives are important.

Risk factors associated with life jacket wear among adult canoeists and kayakers in the United States, 1999-2017.

Drowning is the most common cause of death in recreational boating. Life jackets prevent drowning, yet adult wear rates remain relatively low on most types of boats. Canoes and kayaks are among the least used boat types, yet maintain the third and first highest annual boating-related drowning rates in 2012, respectively. This 1999-2017 study collected data from 124 study sites across the US. Life jacket wear was calculated for 13 dichotomized risky and non-risky variables, using Chi-square tests. A count variable based on number of risks was created, and Cochran-Armitage trend tests examined linearity in life jacket use. Three illustrative variables for each boat type were represented in tree diagrams. Kayakers had higher wear rates than canoeists among all variables observed. For both boats, the majority of risky conditions had higher life jacket wear rates than their non-risky alternatives. As the number of risks increased, life jacket wear rate increased. Boaters seemingly conduct a mental assessment of risk to determine whether to wear a life jacket.

Factors associated with life jacket use among cabin sailboat and day sailor boaters in the United States.

INTRODUCTION: In 2015, drowning accounted for 68% of the 626 recreational boating related deaths in the United States. Although life jackets are estimated to prevent between 50% to 80% of boating deaths, approximately 83% of sailboat-related drowning victims were reported to not be wearing life jackets. Life jacket use among adult boaters has remained consistently low across most boat types and may vary by boater, boating, and environmental conditions. Although many risky environmental and boating factors may be associated with a higher risk of boating death, drowning occurs in all situations and it is useful to understand adult life jacket wearing behaviors in differing boating situations. METHODS: This study uses observational survey data from 61318 adult sailors collected during the summer months of 1999 - 2017 from 124 selected study sites across 30 states in the US. Life jacket use was compared for day sailors and cabin sailboats by multiple boating, boater, and environmental conditions using Chi-square tests for equality of proportions. Results of these tests led to a choice of 3 informative and scientifically compelling variables to summarize variation in life jacket use for each sailboat type. Odds ratios were calculated comparing life jacket use from each boating situation to the lowest risk situation as determined by the 3 selected variables. These variables were represented in a tree diagram, detailing the additive impact of each factor. Following these analyses, all boating conditions were categorized to be risky or non-risky and a count variable was created for each observation based on the number of risks present. Cochran-Armitage trend tests were conducted to test for linearity in life jacket use for both boat types. RESULTS: The overall life jacket wear rate was higher among adults in day sailor sailboats (51.6%) compared to cabin sailboats (13.8%) and in all measured demographic, boating, and environmental circumstances. Comparing high-risk cabin sailboat conditions of low water temperatures, small boat size, and high wind speed to the lowest-risk situation accounted for a 23.3% range in life jacket wear rate (OR=4.7). Comparing high-risk day sailor sailboat conditions of small boat size, one boater on board, and choppy/rough wave height to the lowest-risk situation accounted for a 39.3% range in life jacket wear rate (OR=5.9). For both boat types, the number of risks present and life jacket wear rate exhibited a statistically significant positive linear relationship at p<0.0001. CONCLUSION: Study results suggest that boaters are aware of the connection between life jacket use and drowning prevention and are more likely to wear life jackets when boating in conditions perceived to be risky. PRACTICAL APPLICATIONS: Boating safety promotion efforts should recommend adult life jacket use in all boating situations, as seemingly non-risky conditions may still result in drownings.