Spatial equity in the layout of urban public sports facilities in Hangzhou.

This paper proposes a framework for a layout evaluation of urban public sports facilities. First, the buffer analysis method is used to measure the service level of public sports facilities. The study findings indicate that the overall service level of public sports facilities presents the spatial characteristics of a central agglomeration, and the value of the service level diffuses outward from high to low. There is evident spatial heterogeneity in the layout of public sports facilities in Hangzhou. Second, the Gini coefficient, Lorenz curve, and location entropy are employed to measure the equity of the distribution among spatial units and the intradistrict disparity. The results show a mismatch between the spatial distribution of the facilities and the distribution of the permanent population. The patterns of distribution of the location entropy classes of Hangzhou can be divided into three types: balanced, alternating, and divergent districts. The method in this paper is effective in measuring spatial equity and visualizing it. it has a certain degree of systemicity, universality and operability. At the same time, this method can compare the diachronic characteristics of the same city and the synchronic characteristics of different cities, which has universal application value.

Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data.

INTRODUCTION: In response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare to objectively evaluate the preplanned responses of a regional trauma care system and to show how routinely collected hospital performance data can be used to assess impact on regional healthcare. METHODS: Data about injury severity, management and outcome for patients presenting to hospitals were collated using England's major trauma registry for 30 days following hospital attendance. System-wide data about hospital performance were collated by National Health Service England's North West Utilisation Management Unit and presented as Shewhart charts from 15 April 2017 to 25 June 2017. RESULTS: Detailed information was obtained on 153 patients (109 adults and 44 children) who attended hospital emergency departments after the incident. Within 6 hours, a network of 11 regional trauma care hospitals received a total of 138 patients (90%). For the whole patient cohort, median Injury Severity Score (ISS) was 1 (IQR 1-10) and median New ISS (NISS) was 2 (IQR 1-14). For the 75 patients (49%) attending a major trauma centre, median ISS was 7.5 (IQR 1-14) and NISS was 10 (IQR 3-22). Limb and torso body regions predominated when injuries were classified as major life threatening (Abbreviated Injury Scale>3). Ninety-three patients (61%) required hospital admission following emergency department management, with 21 (14%) requiring emergency damage control surgery and 24 (16%) requiring critical care. Three fatalities occurred during early resuscitative treatment and 150 (98%) survived to day 30. The increased system-wide hospital admissions and care activity was linked to increases in regional hospital care capacity through cancellations of elective surgery and increased community care. Consequently, there were sustained system-wide hospital service improvements over the following weeks. CONCLUSIONS: The systematic collation of injured patient and healthcare system data has provided an objective evaluation of a regional major incident plan and provided insight into healthcare system resilience. Hospital patient care data indicated that a prerehearsed patient dispersal plan at incident scene was implemented effectively.

Supply-side reform measures of public sports service from the perspective of public health promotion / Reforma da oferta de serviços esportivos públicos do ponto de vista da promoção da saúde pública / Reforma de la oferta de servicios deportivos públicos desde la perspectiva de la promoción de la salud pública

ABSTRACT With the rapid development of public health construction, the supply of public sports services and the demand of residents at this stage are gradually divergent. In order to solve the contradiction between the supply and demand of public sports services, this study, from the perspective of public health, combined with the current situation of demand for public sports services, used the fuzzy analytic hierarchy process to build the supply-side optimization model of public sports services, and to verify it. The results show that the weight of the model optimization index from high to low is service level > resource conditions > public degree > service content > location and type of facilities; the fuzzy comprehensive evaluation result of the model is 85 points, which shows that the index of the optimization model has good applicability. The supply-side optimization model constructed in this study is evaluated by community residents and experts in related fields, so the evaluation results are closer to the residents' demand and have high practical value. The results of this study have reference significance for the supply-side reform of public sports services, and fundamentally ensure the close relationship between the supply-side reform measures and the actual demand of residents.

RESUMO Com o rápido desenvolvimento da construção da saúde pública, a oferta de serviços desportivos públicos e a procura por parte da população, nesta fase, são gradualmente divergentes. A fim de resolver a contradição entre a oferta e a demanda por serviços esportivos públicos, este estudo, sob a perspectiva da saúde pública, combinado com a atual situação da demanda por serviços esportivos públicos por parte da população, utilizou o processo hierárquico analítico difuso para construir o modelo de otimização da oferta de serviços esportivos públicos, e para verificar esse modelo. Os resultados mostram que o peso do índice de otimização do modelo de alto a baixo é o nível de serviço > condições de recursos > Grau público > conteúdo de serviço > localização e tipo de instalações. O resultado de avaliação abrangente difusa do modelo é 85 pontos, o que mostra que o índice do modelo de otimização tem boa aplicabilidade. O modelo de otimização da oferta construído neste estudo é avaliado por residentes da comunidade e especialistas em campos relacionados, de modo que os resultados da avaliação estão mais perto da demanda da população e têm alto valor prático. Os resultados deste estudo têm um significado de referência para a reforma da oferta dos serviços desportivos públicos e garantem fundamentalmente a estreita relação entre as medidas de reforma da oferta e a procura real por parte da população.

RESUMEN Con el rápido desarrollo de la implementación de la salud pública, la oferta de servicios deportivos públicos y la demanda de la población en esta etapa son gradualmente divergentes. Para resolver la contradicción entre la oferta y la demanda de servicios deportivos públicos, se realizó este estudio, desde la perspectiva de la salud pública, combinado con la situación actual de la demanda de servicios deportivos públicos. Para el mismo, se utilizó el proceso de jerarquía analítica difusa para construir el modelo de optimización de la oferta de los servicios deportivos públicos y verificarlo. Los resultados muestran que el peso del índice de optimización del modelo de mayor a menor es el nivel de servicio> las condiciones de los recursos> el grado público> el contenido del servicio> la ubicación y el tipo de instalaciones. El resultado de la evaluación integral difusa del modelo es de 85 puntos, lo que muestra que el índice del modelo de optimización tiene una buena aplicabilidad. El modelo de optimización del lado de la oferta construido en este estudio fue evaluado por habitantes de la comunidad y expertos en campos relacionados, por lo que los resultados de la evaluación están más cerca de la demanda de los residentes y tienen un alto valor práctico. Los resultados de este estudio tienen un significado de referencia para la reforma de la oferta de los servicios deportivos públicos y garantizan fundamentalmente la estrecha relación entre las medidas de reforma de la oferta y la demanda real de los habitantes.

The construction of urban public sports service from the perspective of public health / Construção de serviços desportivos públicos urbanos sob a perspectiva da saúde pública / Construcción de servicios deportivos públicos urbanos desde la perspectiva de la salud pública

ABSTRACT With the deepening of urban public sports service construction in China, the construction of public sports service system has become an important guarantee for mass sports rights in China. In view of this, this study takes City XX as an example, and analyzes the difference of public sports service construction in this city using the Theil index method, and determines the measurement index. It analyzes the equality degree of service resource allocation among and within the four regions of City XX, including A, B, C, D, and so on. The influencing factors of sports service efficiency are analyzed. The results show that there are significant differences in the allocation of public sports service resources among districts and counties of City XX. From the overall difference, the total Theil index of national fitness and sports clubs showed an upward trend, while others showed a downward trend. From the perspective of regional differences, there were 6 indicators with the highest equalization level in area C and 5 indicators in area A. The lowest level was found. Population density, per capita GDP, aging rate and urbanization rate of city XX have obvious positive correlations with public sports service efficiency. The aging rate is the most positive factor, while per capita GDP and population density have little influence. This study can provide some reference value for other cities in China in the construction of public sports services.

RESUMO Com o aprofundamento da construção de serviços públicos desportivos urbanos na China, a construção de um sistema público de serviço desportivo tornou-se uma importante garantia para o exercício dos direitos desportivos em massa na China. Em vista disso, este estudo toma a Cidade XX como exemplo, e analisa a diferença de construção de serviços públicos desportivo nessa Cidade pelo método índice de Theil, e determina o índice de medição. Analisa o grau de igualdade de alocação de recursos entre e dentro das quatro regiões da Cidade XX, incluindo as regiões A, B, C, D, e assim por diante. Os fatores que influenciam a eficiência do serviço esportivo são analisados. Os resultados mostram que há diferenças significativas na alocação de recursos públicos de serviços esportivos entre os distritos e condados da Cidade XX. A partir da diferença global, o índice total serviços de atividades físicas em âmbito nacional e clubes desportivos mostrou uma tendência ascendente, enquanto outros mostraram uma tendência descendente. Sob a perspectiva das diferenças regionais, havia seis indicadores com o mais alto nível de equalização na área C e 5 indicadores na área A. O nível mais baixo foi encontrado. A densidade populacional, o PIB per capita, a taxa de envelhecimento e taxa de urbanização da Cidade XX têm uma correlação positiva óbvia com a eficiência do serviço desportivo público. A taxa de envelhecimento é o fator mais positivo, enquanto o PIB per capita e a densidade populacional têm pouca influência. Este estudo pode fornecer algum valor de referência para outras cidades da China na construção de serviços desportivos públicos.

RESUMEN La profundización de la construcción de servicios deportivos públicos urbanos en China se ha convertido en una garantía importante para los derechos deportivos de masas en China. Ante esto, este estudio toma como ejemplo la Ciudad XX y analiza la diferencia de construcción de servicios públicos deportivos en esta ciudad utilizando el método del índice de Theil y determina el índice de medición. Verifica el grado de igualdad en la asignación de recursos de servicios entre y dentro de las cuatro regiones de la Ciudad XX incluyendo A, B, C, D, etc. También analiza los factores que influyen en la eficiencia del servicio deportivo. Los resultados muestran que existen diferencias significativas en la asignación de los recursos de los servicios deportivos públicos entre los distritos y condados de la Ciudad XX. A partir de la diferencia general, el índice de Theil total de los clubes deportivos y de educación física nacionales mostró una tendencia al alza, mientras que otros mostraron una tendencia a la baja. Desde la perspectiva de las diferencias regionales, se encontraron 6 indicadores con el nivel más alto de igualación en el área C y 5 indicadores en el área A. Se encontró también el nivel más bajo. La densidad de población, el PIB per cápita, la tasa de envejecimiento y la tasa de urbanización de la ciudad XX tienen evidentes correlaciones positivas con la eficiencia de los servicios deportivos públicos. La tasa de envejecimiento es el factor más positivo, mientras que el PIB per cápita y la densidad de población tienen poca influencia. Este estudio puede aportar algún valor de referencia para otras ciudades de China en la construcción de servicios deportivos públicos.

Neighborhood environmental factors associated with leisure walking in adolescents.

OBJECTIVE To verify the associations of leisure walking with perceived and objective measures of neighborhood environmental factors stratified by gender and socioeconomic status (SES) in Brazilian adolescents. METHODS Cross-sectional study with a random sample of 1,130 high school students (47.3% girls; aged 14 to 20 years old) from Porto Alegre, Brazil. Leisure walking and SES were self-reported by the adolescents. Perceived environmental factors were assessed through Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Objective measures were evaluated using Geographic Information Systems, with road network calculated around the adolescent's residential address, using 0.5km and 1.0km buffers. Data collection was carried out in 2017 and generalized linear regression models were used. RESULTS Leisure walking was positively associated with access to services (0.5 km buffers [Odds ratio (OR) = 2.22] 1.0 km buffers [OR = 2.17]) and lower distance to parks and squares (0.5 km [OR=2.80] 1.0 km [OR = 2.73]) in girls from low SES. Residential density (0.5 km [OR = 1.57] 1.0 km [OR = 1.54]) and walkability index (0.5 km [OR = 1.17] 1.0 km [OR = 1.20]) were associated with leisure walking in girls from middle SES. Boys from low SES showed an inverse association between crime safety and leisure walking (0.5 km [OR = 0.59] 1.0 km [OR = 0.63]). Neighborhood recreation facilities was positively associated with leisure walking in middle SES (0.5 km [OR = 1.55] 1.0 km [OR = 1.60]). Land use mix (0.5 km [OR = 1.81] 1.0 km [OR = 1.81]), neighborhood recreation facilities (0.5 km [OR = 2.32] 1.0 km [OR = 2.28]) and places for walking (0.5 km [OR=2.07] 1.0 km [OR=2.22]) were positively associated with leisure walking in high SES. CONCLUSION Environmental factors (objectively and subjectively measured) and leisure walking show association in boys and girls of different SES.

Rationing social contact during the COVID-19 pandemic: Transmission risk and social benefits of US locations.

To prevent the spread of coronavirus disease 2019 (COVID-19), some types of public spaces have been shut down while others remain open. These decisions constitute a judgment about the relative danger and benefits of those locations. Using mobility data from a large sample of smartphones, nationally representative consumer preference surveys, and economic statistics, we measure the relative transmission reduction benefit and social cost of closing 26 categories of US locations. Our categories include types of shops, entertainments, and service providers. We rank categories by their trade-off of social benefits and transmission risk via dominance across 13 dimensions of risk and importance and through composite indexes. We find that, from February to March 2020, there were larger declines in visits to locations that our measures indicate should be closed first.

Change in drink purchases in 16 Australian recreation centres following a sugar-sweetened beverage reduction initiative: an observational study.

OBJECTIVE: To assess the impact of a sugar-sweetened beverage (SSB) reduction initiative on customer purchasing patterns, including volume sales of healthy and unhealthy packaged drinks and sales value of all packaged drinks, in a major Australian aquatic and recreation provider, YMCA Victoria. DESIGN: Prospective SETTING: 16 aquatic and recreation centres in Victoria, Australia. INTERVENTIONS: The SSB-reduction initiative aimed to remove all SSBs (excluding sports drinks) and increase healthier drink availability over a 1-year period. PRIMARY AND SECONDARY OUTCOME MEASURES: Itemised monthly drink sales data were collected for 16 centres, over 4 years (2 years preimplementation, 1 year implementation and 1 year postimplementation). Drinks were classified as 'green' (best choice), 'amber' (choose carefully) or 'red' (limit). Interrupted time series analysis was conducted for each centre to determine the impact on volume sales of 'red' and 'green' drinks, and overall sales value. A novel meta-analysis approach was conducted to estimate the mean changes across centres. RESULTS: Following implementation, volume sales of 'red' drinks reduced by 46.2% across centres (95% CI: -53.2% to -39.2%), 'green' drink volume did not change (0.0%, 95% CI: -13.3% to 13.2%) and total drink sales value decreased by 24.3% (95% CI: -32.0% to -16.6%). CONCLUSIONS: The reduction of SSBs in health-promoting settings such as recreation centres is a feasible, effective public health policy that is likely to be transferable to other high-income countries with similarly unhealthy beverage offerings. However, complementary strategies should be considered to encourage customers to switch to healthier alternatives, particularly when translating policies to organisations with less flexible income streams.

Impact of Animal Characters at a Zoo Concession Stand on Healthy Food Sales.

OBJECTIVE: The primary objectives of the study were to examine: 1) how increased availability of healthier items at a zoo concession stand affects sales and 2) how animal character marketing on zoo menu boards affects sales revenue. METHODS: An intervention was conducted over an 8-week period. On alternating weeks, zoo animal characters were systematically paired with and removed from healthy food items on a zoo concession menu board. Sales and revenue data were analyzed using frequencies, a Poisson regression model, and a negative binomial regression model, respectively. RESULTS: Newly introduced healthy items represented 8.2% of sales and 4.9% of revenue. Healthy item unit sales were significantly higher (P = .006) during the weeks animal cartoon characters were displayed, although there was no impact on revenue. CONCLUSIONS AND IMPLICATIONS: Findings suggest nonbranded character marketing is a viable strategy for promoting healthy products in family-friendly venues where concessions are sold.

Neighborhood environmental factors associated with leisure walking in adolescents

ABSTRACT OBJECTIVE To verify the associations of leisure walking with perceived and objective measures of neighborhood environmental factors stratified by gender and socioeconomic status (SES) in Brazilian adolescents. METHODS Cross-sectional study with a random sample of 1,130 high school students (47.3% girls; aged 14 to 20 years old) from Porto Alegre, Brazil. Leisure walking and SES were self-reported by the adolescents. Perceived environmental factors were assessed through Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Objective measures were evaluated using Geographic Information Systems, with road network calculated around the adolescent's residential address, using 0.5km and 1.0km buffers. Data collection was carried out in 2017 and generalized linear regression models were used. RESULTS Leisure walking was positively associated with access to services (0.5 km buffers [Odds ratio (OR) = 2.22] 1.0 km buffers [OR = 2.17]) and lower distance to parks and squares (0.5 km [OR=2.80] 1.0 km [OR = 2.73]) in girls from low SES. Residential density (0.5 km [OR = 1.57] 1.0 km [OR = 1.54]) and walkability index (0.5 km [OR = 1.17] 1.0 km [OR = 1.20]) were associated with leisure walking in girls from middle SES. Boys from low SES showed an inverse association between crime safety and leisure walking (0.5 km [OR = 0.59] 1.0 km [OR = 0.63]). Neighborhood recreation facilities was positively associated with leisure walking in middle SES (0.5 km [OR = 1.55] 1.0 km [OR = 1.60]). Land use mix (0.5 km [OR = 1.81] 1.0 km [OR = 1.81]), neighborhood recreation facilities (0.5 km [OR = 2.32] 1.0 km [OR = 2.28]) and places for walking (0.5 km [OR=2.07] 1.0 km [OR=2.22]) were positively associated with leisure walking in high SES. CONCLUSION Environmental factors (objectively and subjectively measured) and leisure walking show association in boys and girls of different SES.

Public open spaces and physical activity: disparities of resources in Florianópolis.

OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1-3.0) and high-income (OR = 2.4; 95%CI 1.4-4.0), in those with medium (OR = 1.7; 95%CI 1.0-2.7) and high residential density (OR = 2.0; 95%CI 1,2-3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9-5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2-0.6) and non-white residents (OR= 0.6; 95%CI 0.3-0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4-11.3) and high-income (OR = 3.6; 95%CI 1.2-10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1-0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.

Associations among Neighborhood Socioeconomic Deprivation, Physical Activity Facilities, and Physical Activity in Youth during the Transition from Childhood to Adolescence.

BACKGROUND: This study aims to examine the longitudinal association of neighborhood socioeconomic deprivation (SED) with physical activity in youth during the transition from elementary to middle school, and to determine if access to physical activity facilities moderates this relationship. METHODS: Data were obtained from the Transitions and Activity Changes in Kids (TRACK) study, which was a multilevel, longitudinal study designed to identify the factors that influence changes in physical activity as youth transition from elementary to middle school. The analytic sample for the current study included 660 youth with complete data in grades 5 (baseline) and 7 (follow-up). A repeated measures multilevel framework was employed to examine the relationship between SED and physical activity over time and the potential moderating role of elements of the built environment. RESULTS: Decreases in physical activity varied by the degree of neighborhood SED with youth residing in the most deprived neighborhoods experiencing the greatest declines in physical activity. Access to supportive physical activity facilities did not moderate this relationship. CONCLUSION: Future research studies are needed to better understand how neighborhood SED influences youth physical activity over time.

Sports facilities, socio-economic context and overweight among the childhood population in two southern European cities: a cross sectional study.

BACKGROUND: To evaluate relationship between socio-economic environment and overweight in Madrid and Barcelona, adjusting for possible confounding factors. METHODS: We obtained three indicators which reflected socio-economic context, namely, unemployment rate, percentage of population with tertiary education, and percentage with a second home. The design is a cross sectional study. The association with overweight was estimated using odds ratios by multilevel logistic regression. The statistical analysis, data synthesis, or model creation was performed from the 2017. In all, 707 children from 21 districts of Madrid and 474 children from 10 districts of Barcelona were analysed. RESULTS: In Madrid, standardised ORs for personal and family characteristics were 1.17, 1.53 and 1.57 by reference to unemployment rate and percentages of population with a university education and second home. After adjustment, only the OR obtained with unemployment rate decreased, specifically by 58%. In Barcelona, the following ORs were obtained: 1.80 with unemployment rate; 1.80 with population having a university education; and 1.86 with population having a second home. After being standardised, these ORs decreased by 14% in the case of unemployment rate, 10% in the case of population with a university education, and 9% in the case of population with a second home. CONCLUSIONS: Overweight displayed a risk gradient in Madrid and Barcelona alike. This risk of overweight is not accounted for by physical inactivity and could, in part, be due to the availability of sports facilities.

Short-and Long-Term Effectiveness of a Physical Activity Intervention with Coordinated Action between the Health Care Sector and Local Sports Clubs. A Pragmatic Trial in Austrian Adults.

(1) Background: Collaboration between the health care sector and the sports sector to increase physical activity (PA) behaviour among inactive adults is still rare. The objective of the study was to evaluate the short- and long-term effectiveness of a mixed PA intervention on the PA behaviour in an adult population. (2) Methods: In a quasi-experimental study with two follow-up measurements (four and 12 months), adults were contacted by post before their stay in a health resort. During the health resort stay, the intervention group (IG) received PA counselling and a coupon for 12 standardised free-of-charge sessions in a sports club. The participants in the comparator group (CG) received PA counselling and written material. PA was measured with an accelerometer (GENEActive). Linear mixed-effects models were applied to examine the change in PA behaviour, both within and between groups in moderate- to vigorous-intensity PA over time. (3) Results: We obtained at least one follow-up measurement from 217 participants (IG = 167, CG = 50), who were 50% female, with an average age of 53 (±6) years. PA significantly increased from the baseline to the four-month measurement by 58 min./wk (95% CI 36, 80) and to the 12-month measurement by 24 min./wk (95% CI 2, 46) within the IG. No change in PA occurred in the CG. We also found a short-term between-group (IG vs. CG) difference in change over time, but not a long-term difference. (4) Conclusions: The study confirms that a collaboration between the health care sector and local sports clubs is a feasible method of recruiting people into a standardised PA programme and to increase their PA over the long term.

A Qualitative Examination of the Physical Activity Needs of People with Severe Mental Illness.

It is recognised that physical activity has a positive impact on quality of life, social well-being and overall health of people with severe mental illness. However, there is a lack of theory informed programmes that support people with mental illness to adopt regular physical activity behaviour. The aim of this case study was to identify determinants of long-term physical activity among people with severe mental illness that may then inform the development of more suitable physical activity programmes. Semi-structured interviews were conducted with 15 people (13 men and 2 women) with a mean age of 36.7 [standard deviation (SD)=11.8] who had a diagnosed mental illness and were attending a physical activity programme run by a mental health non-governmental organisation. Interview data was analysed using the documentary method to emphasise the perspective of people with severe mental illness. Three participation types were generated in the context of individuals' physical activity orientation and social background-first 'rehabilitative orientated' (physical activity as a supportive measure to re-enter the labour market and develop a daily routine); second 'social-orientated' (social well-being within the group as the primary motive); finally, 'trust-orientated' (a sense of trust that encourages participation). Based on these type-specific categories, it is suggested that different settings (mental health care centres and sport clubs) might be needed to attract and maintain the physical activity engagement of people with severe mental illness. In the context of sport clubs, it is recommended that coaches undergo training in mental health literacy.

Access to and availability of exercise facilities in Madrid: an equity perspective.

BACKGROUND: Identifying socioeconomic determinants that are associated with access to and availability of exercise facilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reduce health inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to, and availability of, exercise facilities in Madrid, Spain. METHODS: Area-level SES was measured using a composite index based on seven sociodemographic indicators. Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional. Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the 125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilities in a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflated Poisson regression analyses to assess the association between area-level SES and exercise facility accessibility and availability. RESULTS: Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities. Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities. CONCLUSION: Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number of facilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lower SES areas may be an intervention to improve health equity.

Attitudes Toward Smoke-Free Casino Policies Among US Adults, 2017.

Research shows that there is no risk-free level of exposure to secondhand smoke (SHS) and that eliminating smoking indoors fully protects nonsmokers from indoor SHS exposure. Casinos often allow smoking indoors and can be a source of involuntary SHS exposure for employees and visitors. We examined attitudes toward smoke-free casino policies among US adults. During June and July 2017, we used a web-based survey to ask a nationally representative sample of 4107 adults aged ≥18 about their attitudes toward smoke-free casinos. Among 4048 respondents aged ≥18, a weighted 75.0% favored smoke-free casino policies, including respondents who visited casinos about once per year (74.1%), several times per year (75.3%), and at least once per month (74.2%). Although the sociodemographic characteristics of respondents who favored smoke-free casino policies varied, the majority in each group, except current smokers (45.4%), supported smoke-free policies. Allowing smoking inside casinos involuntarily exposes casino employees and visitors to SHS, a known and preventable health risk. Further assessment of public knowledge and attitudes toward smoke-free casinos at state and local levels may help inform tobacco control policy, planning, and practice.

A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers.

INTRODUCTION: Improving children's tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. METHODS: The "Hydrate Philly" intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling "hydration stations", conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n = 28 centers) of the intervention's impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6-12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. DISCUSSION: Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study. ClinicalTrials.gov Registration: #NCT03637465.