Healthy and unhealthy food environments are linked with neighbourhood socio-economic disadvantage: an innovative geospatial approach to understanding food access inequities.

OBJECTIVE: This study examined the separate relationships between socio-economic disadvantage and the density of multiple types of food outlets, and relationships between socio-economic disadvantage and composite food environment indices. DESIGN: Cross-sectional data were analysed using geospatial kernel density techniques. Food outlet data included convenience stores, discount stores, fast-food and fast casual restaurants, and grocery stores. Controlling for urbanicity and race/ethnicity, multivariate linear regression was used to examine the relationships between socio-economic disadvantage and density of food outlets. SETTING: This study occurred in a large Southeastern US county containing 255 census block groups with a total population of 474 266, of which 77·1 % was Non-Hispanic White, the median household income was $48 886 and 15·0 % of residents lived below 125 % of the federal poverty line. PARTICIPANTS: The unit of analysis was block groups; all data about neighbourhood socio-economic disadvantage and food outlets were publicly available. RESULTS: As block group socio-economic disadvantage increased, so too did access to all types of food outlets. The total food environment index, calculated as the ratio of unhealthy food outlets to all food outlets, decreased as block group disadvantage increased. CONCLUSIONS: Those who reside in more disadvantaged block groups have greater access to both healthy and unhealthy food outlets. The density of unhealthy establishments was greater in more disadvantaged areas; however, because of having greater access to grocery stores, disadvantaged populations have less obesogenic total food environments. Structural changes are needed to reduce access to unhealthy food outlets to ensure environmental injustice and reduce obesity risk.

'We need a safe, walkable way to connect our sisters and brothers': a qualitative study of opportunities and challenges for neighborhood-based physical activity among residents of low-income African-American communities.

OBJECTIVE: The purpose of this study was to explore perceptions of the benefits of and influencing factors for neighborhood-based physical activity (PA), and elicit suggestions for increasing neighborhood-based PA among primarily Black residents living in lower income neighborhoods. DESIGN: Eight focus groups were conducted in low-income, predominantly Black neighborhoods (n = 8) in Greenville, SC during Spring 2014. Using a semi-structured focus group guide with open-ended questions, residents were asked to describe benefits of PA, neighborhood factors associated with PA, and ways to increase PA within their neighborhoods. Trained research assistants transcribed audio recordings verbatim. Using grounded theory and an ecological perspective, emergent coding was employed to generate initial categories with open and axial coding used to achieve consensus on themes. RESULTS: Primarily Black (95%), female (72%), and older (M = 61.5 years) residents (N = 76) participated in the study. Seven themes were identified across the three main focus group topics: physical and mental health benefits of neighborhood PA, safety/hazards and social factors as influencing neighborhood PA, and improving safety, structural opportunities, and programing support to improve neighborhood PA. Most participants reported walking within their communities, despite describing several community-level barriers (e.g. drugs, safety). Residents desired structured neighborhood-based opportunities for increasing PA, including walking tracks and walking groups, and reported social benefits to being active, including increased awareness within the community and trust. Participants conveyed that walking strengthened the social environment of their community as well as the health of residents. CONCLUSION: Few studies of contextual factors and PA have focused on African-American, low-income neighborhoods. Despite diverse environmental constraints, residents reported walking within their communities as part of a healthy lifestyle. Social ecological interventions tailored to promote PA and reduce health disparities among residents of low-income communities should highlight neighborhood-based opportunities for PA, focusing on personal and collective social benefits of neighborhood walking.

ParkIndex: Development of a standardized metric of park access for research and planning.

OBJECTIVE: A lack of comprehensive and standardized metrics for measuring park exposure limits park-related research and health promotion efforts. This study aimed to develop and demonstrate an empirically-derived and spatially-represented index of park access (ParkIndex) that would allow researchers, planners, and citizens to evaluate the potential for park use for a given area. METHODS: Data used for developing ParkIndex were collected in 2010 in Kansas City, Missouri (KCMO). Adult study participants (n=891) reported whether they used a park within the past month, and all parks in KCMO were mapped and audited using ArcGIS 9.3 and the Community Park Audit Tool. Four park summary variables - distance to nearest park, and the number of parks, amount of park space, and average park quality index within 1mile were analyzed in relation to park use using logistic regression. Coefficients for significant park summary variables were used to create a raster surface (ParkIndex) representing the probability of park use for all 100m×100m cells in KCMO. RESULTS: Two park summary variables were positively associated with park use - the number of parks and the average park quality index within 1 mile. The ParkIndex probability of park use across all cells in KCMO ranged from 17 to 77 out of 100. CONCLUSION: ParkIndex represents a standardized metric of park access that combines elements of both park availability and quality, which was developed empirically and can be represented spatially. This tool has both practical and conceptual significance for researchers and professionals in diverse disciplines.

Longitudinal associations with changes in outdoor recreation area use for physical activity during a community-based intervention.

Outdoor recreation areas (ORA) are important resources for physical activity (PA) and health promotion. While past research has identified correlates of ORA use, few studies have examined predictors of longitudinal changes in park- and trail-based PA in community settings. Using data from a 6-month community-based walking intervention study, we examined cross-sectional and longitudinal predictors of PA in ORAs. Data were collected from baseline and 6-month assessments from participants (n=295) in a group walking intervention in South Carolina; participants enrolled from January 2012-May 2013. A decomposition scheme was used to examine the cross-sectional and longitudinal predictors of average group ORA use for PA, including social support, self-efficacy for PA, perceptions of neighborhood environment, and accelerometer-based PA, adjusting for gender. On average, participants were 49.4+13.3years old, 66.1% were Black, and the majority were women. There was a mean increase in group ORA use of 2.1+0.4days/month from baseline to 6months. Cross-sectionally, higher levels of the percentage of time in MVPA, self-efficacy, and social support were associated with greater group-average ORA use. Longitudinally, increased social support from friends and rating of lighter motorized traffic were associated with increased group ORA use. Additionally, longitudinal increases in percentage of MVPA and more favorable rating of the neighborhood as a place to walk were both associated with decreased group ORA use. Better understanding how social and physical environmental characteristics impact ORA use for PA can lead to more effective intervention strategies and warrants greater attention in future research and public health promotion efforts.

Efforts of a Kansas foundation to increase physical activity and improve health by funding community trails, 2012.

INTRODUCTION: Trails are associated with increased physical activity; however, little is known about the process of building trails by various types of organizations. From 2005 through 2012 the Sunflower Foundation: Health Care for Kansans (Sunflower) funded multiple organizations to construct 70 trails of varying lengths and surfaces in municipalities, schools, and communities across Kansas. The purpose of this study was to assess the process of developing and implementing community trail projects across Kansas with funding from a public foundation. METHODS: In 2012, we stratified funded organizations by type and conducted proportional random sampling to select 20 key informants from those organizations to participate in structured telephone interviews. Interviews were recorded and transcribed verbatim. Two researchers coded interview transcripts according to issues identified by participants. RESULTS: Issues associated with trail-building identified as important were collaboration among groups, unexpected construction costs, champions for the project, and level of difficulty of construction. Participants indicated that trails facilitated physical activity. Trails were integrated into communities through events such as walking events and other promotional efforts; these efforts were thought to increase trail use. The perceived outcomes of building the trails included providing the community with a physical activity resource, inspiring the community to start additional trail projects, and increasing the physical activity of local residents. CONCLUSION: Sunflower's funding was instrumental in developing trail projects to provide new physical activity resources across Kansas. Public health practitioners seeking to increase physical activity should seek funding from foundations that focus on health.