Increasing Walking in the Hartsfield-Jackson Atlanta International Airport: The Walk to Fly Study.

OBJECTIVES: To test the effectiveness of a point-of-decision intervention to prompt walking, versus motorized transport, in a large metropolitan airport. METHODS: We installed point-of-decision prompt signage at 4 locations in the airport transportation mall at Hartsfield-Jackson Atlanta International Airport (Atlanta, GA) at the connecting corridor between airport concourses. Six ceiling-mounted infrared sensors counted travelers entering and exiting the study location. We collected traveler counts from June 2013 to May 2016 when construction was present and absent (preintervention period: June 2013-September 2014; postintervention period: September 2014-May 2016). We used a model that incorporated weekly walking variation to estimate the intervention effect on walking. RESULTS: There was an 11.0% to 16.7% relative increase in walking in the absence of airport construction where 580 to 810 more travelers per day chose to walk. Through May 2016, travelers completed 390 000 additional walking trips. CONCLUSIONS: The Walk to Fly study demonstrated a significant and sustained increase in the number of airport travelers choosing to walk. Providing signage about options to walk in busy locations where reasonable walking options are available may improve population levels of physical activity and therefore improve public health.

Disparities in Adolescents' Residence in Neighborhoods Supportive of Physical Activity - United States, 2011-2012.

In 2013, only 27% of adolescents in grades 9-12 met the current federal guideline for aerobic physical activity (at least 60 minutes of physical activity each day*), and sex and racial/ethnic disparities in meeting the guideline exist (1). The Community Preventive Services Task Force has recommended a range of community-level evidence-based approaches(†) to increase physical activity by improving neighborhood supports for physical activity.(§) To assess the characteristics of adolescents who live in neighborhoods that are supportive of physical activity, CDC analyzed data on U.S. children and adolescents aged 10-17 years (defined as adolescents for this report) from the 2011-2012 National Survey of Children's Health (NSCH). Overall, 65% of U.S. adolescents live in neighborhoods supportive of physical activity, defined as neighborhoods that are perceived as safe and have sidewalks or walking paths and parks, playgrounds, or recreation centers. Adolescents who were Hispanic and non-Hispanic black race/ethnicity; who lived in lower-income households, households with less educated parents, and rural areas; or who were overweight or obese were less likely to live in neighborhoods supportive of physical activity than were white adolescents and adolescents from higher income households, with a more highly educated parent, living in urban areas, and not overweight or obese. Within demographic groups, the largest disparity in the percentage of adolescents living in these neighborhoods was observed between adolescents living in households with a family income <100% of the Federal Poverty Level (FPL) (51%) and adolescents living in households with a family income ≥400% of the FPL (76%). Efforts to improve neighborhood supports, particularly in areas with a substantial percentage of low-income and minority residents, might increase physical activity among adolescents and reduce health disparities.

The Physical Activity and Redesigned Community Spaces (PARCS) Study: Protocol of a natural experiment to investigate the impact of citywide park redesign and renovation.

BACKGROUND: The built environment plays a critical role in promoting physical activity and health. The association between parks, as a key attribute of the built environment, and physical activity, however, remains inconclusive. This project leverages a natural experiment opportunity to assess the impact of the Community Parks Initiative (CPI), a citywide park redesign and renovation effort in New York City, on physical activity, park usage, psychosocial and mental health, and community wellbeing. METHODS: The project will use a longitudinal design with matched controls. Thirty intervention park neighborhoods are socio-demographically matched to 20 control park neighborhoods. The study will investigate whether improvements in physical activity, park usage, psychosocial and mental health, and community wellbeing are observed from baseline to 3 years post-renovation among residents in intervention vs. control neighborhoods. DISCUSSION: This study represents a rare opportunity to provide robust evidence to further our understanding of the complex relationship between parks and health. Findings will inform future investments in health-oriented urban design policies and offer evidence for addressing health disparities through built environment strategies.

Opportunities for public health to increase physical activity among youths.

Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity.

Vital signs: disability and physical activity--United States, 2009-2012.

BACKGROUND: Adults with disabilities are less active and have higher rates of chronic disease than the general population. Given the health benefits of physical activity, understanding physical activity, its relationship with chronic disease, and health professional recommendations for physical activity among young to middle-age adults with disabilities could help increase the effectiveness of health promotion efforts. METHODS: Data from the 2009-2012 National Health Interview Survey (NHIS) were used to estimate the prevalence of, and association between, aerobic physical activity (inactive, insufficiently active, or active) and chronic diseases (heart disease, stroke, diabetes, and cancer) among adults aged 18-64 years by disability status and type (hearing, vision, cognitive, and mobility). The prevalence of, and association between, receiving a health professional recommendation for physical activity and level of aerobic physical activity was assessed using 2010 data. RESULTS: Overall, 11.6% of U.S. adults aged 18-64 years reported a disability, with estimates for disability type ranging from 1.7% (vision) to 5.8% (mobility). Compared with adults without disabilities, inactivity was more prevalent among adults with any disability (47.1% versus 26.1%) and for adults with each type of disability. Inactive adults with disabilities were 50% more likely to report one or more chronic diseases than those who were physically active. Approximately 44% of adults with disabilities received a recommendation from a health professional for physical activity in the past 12 months. CONCLUSIONS: Almost half of adults with disabilities are physically inactive and are more likely to have a chronic disease. Among adults with disabilities who visited a health professional in the past 12 months, the majority (56%) did not receive a recommendation for physical activity. IMPLICATIONS FOR PUBLIC HEALTH: These data highlight the need for increased physical activity among persons with disabilities, which might require support across societal sectors, including government and health care.

Depressive symptoms and carotid artery intima-media thickness in police officers.

PURPOSE: Police work is a stressful occupation. Depressive symptoms, which may occur as a result of exposure to stressors in police work, have been known to be associated with an increased risk of cardiovascular disease. This cross-sectional study investigated the association between depressive symptoms and carotid artery intima-media thickness (CIMT) among police officers. METHODS: CIMT was measured with B-mode carotid ultrasonography. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D) scale. Analyses of variance and covariance were utilized to examine the mean values of common CIMT (CCA IMT) and maximum CIMT (MMXIMT) across quintiles of depressive symptoms. RESULTS: Participants included 412 officers (mean age = 41 years). Hypertension status significantly modified the association between CES-D score and CIMT. The association between CES-D score and CCA IMT was statistically significant (adjusted P = 0.030) but only among officers without hypertension. The associations between CES-D score and MMXIMT were not significant among officers with or without hypertension. Our results also showed that among officers who reported poor sleep quality, mean levels of CCA IMT, and MMXIMT tended to increase as depressive symptoms increased. CONCLUSIONS: Depressive symptoms may be therefore be independently associated with CIMT, yet masked by hypertension. Even though sleep quality did not significantly modify the main association, our results also suggest that poor sleep quality may act synergistically with depressive symptoms to increase CIMT. Future prospective work would help to clarify these associations.

Associations of objectively measured and self-reported sleep duration with carotid artery intima media thickness among police officers.

BACKGROUND: We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD). METHODS: Sleep duration was estimated using actigraphic data and through self-reports. The mean maximum IMT was the average of the largest 12 values scanned bilaterally from three angles of the near and far wall of the common carotid, bulb, and internal carotid artery. Linear and quadratic regression models were used to assess the association of sleep duration with IMT. RESULTS: Officers who had fewer than 5 or 8 hr or more of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Self-reported sleep duration was not associated with either IMT measure. CONCLUSION: Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers.

The association of park use and park perception with quality of life using structural equation modeling.

Introduction: The literature is limited on the impact of neighborhood parks on quality of life (QoL) and the mechanism linking them. Methods: In this paper, we applied the structural equation model to data from a cross-sectional sample of 650 participants in low-income communities of New York City, we examined the associations of neighborhood park use vs. park perception and QoL, and whether these associations were mediated through self-reported perceived stress. We also examined whether park use mediated the relationship between park perception and QoL. Results: We found that park use had a significant but weak association with QoL (standardized ß = 0.08, 95% confidence interval (CI): 0.02, 0.15, p = 0.02), but this relationship was not mediated by self-reported stress. Park perception was more strongly associated with QoL than park use (standardized ß = 0.23, 95% CI: 0.16, 0.30, p < 0.01), and this was partly mediated by self-reported stress (indirect effect- standardized ß = 0.08, 95% CI: 0.03, 0.13, p < 0.01) and, to a lesser extent, by park use (indirect effect- standardized ß = 0.01, 95% CI: 0.00, 0.02, p = 0.01). Discussion: Having well-perceived parks appears to be an important factor for QoL independent of park use, suggesting that quality parks may benefit everyone in a community beyond park users. This strengthens the argument in favor of increasing park investment as a strategy to improve population wellbeing.

Cross-cultural comparison of correlates of quality of life and health status: the Whitehall II Study (UK) and the Western New York Health Study (US).

Measures of quality of life (QoL) have been found to be predictors of mortality and morbidity; however, there is still limited understanding of the multifaceted nature of these measures and of potential correlates. Using two large populations from the UK and US, we aimed to evaluate and compare measured levels of QoL and the key factors correlated with these levels. Participants were 6,472 white subjects (1,829 women) from the Whitehall II Study (mean age 55.8 years) and 3,684 white subjects (1,903 women) from the Western New York Health Study (mean age 58.7 years). QoL was assessed in both using the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Analysis of covariance was used to compare gender-specific mean scores for the two populations across several potential correlates (including socio-demographic, lifestyle and co-morbidity factors). Levels of reported physical QoL tended to be higher in the UK population (51.2 vs. 48.6) while mental QoL was higher in the US group (53.1 vs. 51.1). Age, sleep duration and depressive symptoms were the main factors correlated with both physical and mental QoL in both samples. Increasing age was associated with poorer physical health but higher mental health scores in both populations (P<0.001). Sleep duration below 6 or above 8 h was associated with lower levels of QoL. Depressive symptoms were strongly associated with poorer mental health scores (P<0.001) while higher BMI, lower physical activity levels and presence of cardiovascular disease were associated with poorer physical health in both samples and gender (P<0.05). There were consistent findings for correlates of QoL in this cross-cultural comparison of two populations from the UK and US. Strongest associations were between lifestyle and co-morbidity factors and the physical health component of the SF-36 rather than the mental health component. This is a novel finding which warrants further consideration.

Implementation of Physical Activity Programs for Rural Cancer Survivors: Challenges and Opportunities.

Physical activity after cancer diagnosis has been consistently associated with improvements in quality of life and prognosis. However, few cancer survivors meet physical activity recommendations, and adherence is even lower among those living in rural settings. The purpose of this quasi-experimental study was to evaluate the implementation of a clinic-based physical activity program for cancer survivors at a rural community oncology setting. We also examined changes in quality-of-life measures among 24 cancer survivors participating in the physical activity program and described challenges and opportunities to optimize future implementation efforts in rural settings. Significant pre- to post-program improvements in fatigue (5.5 to 6.8; p = 0.03), constipation (7.7 to 9.0; p = 0.02), pain (6.7 to 8.0; p = 0.007), and sleep quality (p = 0.008) were observed. Participants also reported improved nausea, stamina, depression, stress, and overall physical health after participation in the physical activity program, although the differences were not statistically significant (all p-values > 0.13). However, the reach of the physical activity program was limited, with only 0.59% of cancer survivors participating. Fidelity to the physical activity program was relatively high, with 72.7% of survivors participating in at least five classes. Our findings suggest that physical activity programs in oncological settings may need tailoring to effectively reach rural cancer survivors.

Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods.

Longitudinal, natural experiments provide an ideal evaluation approach to better understand the impact of built environment interventions on community health outcomes, particularly health disparities. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. This paper shares practical lessons learned from the Physical Activity and Redesigned Community Spaces (PARCS) study, which is an evaluation of the impact of a citywide park renovation initiative on physical activity, psychosocial health, and community well-being. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants' needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color.

The Role of the Physical and Social Environment in Observed and Self-Reported Park Use in Low-Income Neighborhoods in New York City.

Physical and social environments of parks and neighborhoods influence park use, but the extent of their relative influence remains unclear. This cross-sectional study examined the relationship between the physical and social environment of parks and both observed and self-reported park use in low-income neighborhoods in New York City. We conducted community- (n = 54 parks) and individual-level (n = 904 residents) analyses. At the community level, observed park use was measured using a validated park audit tool and regressed on the number of facilities and programmed activities in parks, violent crime, stop-and-frisk incidents, and traffic accidents. At the individual level, self-reported park use was regressed on perceived park quality, crime, traffic-related walkability, park use by others, and social cohesion and trust. Data were collected in 2016-2018 and analyzed in 2019-2020. At the community level, observed park use was negatively associated with stop-and-frisk (ß = -0.04; SE = 0.02; p < 0.05) and positively associated with the number of park facilities (ß = 1.46; SE = 0.57; p < 0.05) and events (ß = 0.16; SE = 0.16; p < 0.01). At the individual level, self-reported park use was positively associated with the social cohesion and trust scale (ß = 0.02; SE = 0.01; p < 0.05). These results indicate that physical and social attributes of parks, but not perceptions of parks, were significantly associated with park use. The social environment of neighborhoods at both community and individual levels was significantly related to park use. Policies for increasing park use should focus on improving the social environment of parks and surrounding communities, not only parks' physical attributes. These findings can inform urban planning and public health interventions aimed at improving the well-being of residents in low-income communities.

Correlates of accelerometry non-adherence in an economically disadvantaged minority urban adult population.

OBJECTIVES: The purpose of this study was to examine socio-demographic and psychosocial correlates of non-adherence to an accelerometry protocol in an economically disadvantaged urban population. DESIGN: Cross-sectional study. METHODS: We analyzed 985 New York City adult participants aged 18-81 years from the Physical Activity and Redesigned Community Spaces (PARCS) study. Participants were asked to wear a hip-worn ActiGraph GT3X-BT accelerometer for one week. Adherent accelerometer wear was defined as ≥3 days of ≥8 h/day of wear over a 7-day period and non-adherent accelerometry wear was defined as any wear less than adherent wear from returned accelerometers. Examined correlates of adherence included sociodemographic and psychosocial characteristics (e.g., general physical/mental health-related quality of life, self-efficacy for exercise, stress, sense of community/neighborhood well-being, and social cohesion). RESULTS: From the total sample, 636 (64.6%) participants provided adherent wear and 349 (35.4%) provided non-adherent wear. In multivariable analysis, younger age (odds ratio [OR] = 0.63, 95% confidence interval [CI]: 0.53-0.75), poorer health-related quality of life (OR = 0.80, 95% CI: 0.65-0.98 for physical health and OR = 0.77, 95% CI: 0.62-0.94 for mental health), lower sense of community (OR = 0.79, 95% CI: 0.62-1.00) and current smoking status (OR = 1.97, 95% CI: 1.35-2.86) were associated with non-adherent wear. CONCLUSIONS: Non-adherent wear was associated with younger age, smoking, and lower self-reported physical/mental functioning and sense of community. This information can inform targeted adherence strategies to improve physical activity and sedentary behavior estimates from accelerometry data in future studies involving an urban minority population.

Vitality and recurrent event risk in acute myocardial infarction survivors.

BACKGROUND: Low vitality, characterized by fatigue and lack of energy, is common among survivors of acute myocardial infarction (AMI) and has been shown to be associated with increased risk of primary and secondary cardiac events. The goal of this study was to determine whether an association between vitality and recurrent cardiac events (nonfatal MI, cardiac death) among acute MI survivors persists after controlling for possible physiological and psychological confounders. DESIGN AND METHODS: Incident AMI survivors (n = 1328) from Erie and Niagara (New York) county hospitals were enrolled and followed up to 9 years. Vitality was measured by the Short Form-36 on a 0-100 scale approximately 4 months post-AMI. Cox proportional hazards models were developed to assess the vitality-recurrent event association controlling for traditional cardiovascular disease risk factors, index MI severity, and psychological correlates of vitality. RESULTS: Low-vitality individuals at baseline were more likely females, of higher BMI, smoking, diabetic, less physically active, and to have worse depression scores. Vitality was not strongly associated with MI severity markers. Lower vitality scores were associated with increased risk of recurrent cardiac events: adjusted hazard ratios (95% CI) for vitality scores 51-79, 21-50, and < or =20 (compared with > or =80) were 1.2 (0.8, 1.8), 1.4 (0.9, 2.2), and 2.9 (1.5, 5.4), respectively (Ptrend = 0.005). CONCLUSION: Low vitality was associated with increased risk of recurrent cardiac events among AMI survivors after controlling for physiological and psychological confounders. Mechanistic links with vitality should be sought as interventional targets.

Drinking patterns and myocardial infarction: a linear dose-response model.

BACKGROUND: The relation of alcohol intake to cardiovascular health is complex, involving both protective and harmful effects, depending on the amount and pattern of consumption. Interpretation of data available on the nature of these relations is limited by lack of well-specified, mathematical models relating drinking patterns to alcohol-related consequences. Here we present such a model and apply it to data on myocardial infarction (MI). METHODS: The dose-response model derived assumes: (1) each instance of alcohol use has an effect that either increases or decreases the likelihood of an alcohol-related consequence, and (2) greater quantities of alcohol consumed on any drinking day add linearly to these increases or decreases in risk. Risk was reduced algebraically to a function of drinking frequency and dosage (volume minus frequency, a measure of the extent to which drinkers have more than 1 drink on days when they drink). In addition to estimating the joint impact of frequency and dosage, the model provides a method for calculating the point at which risk related to alcohol consumption is equal to background risk from other causes. A bootstrapped logistic regression based on the dose-response model was conducted using data from a case-control study to obtain the predicted probability of MI associated with current drinking patterns, controlling for covariates. RESULTS: MI risk decreased with increasing frequency of drinking, but increased as drinking dosage increased. Rates of increasing MI risk associated with drinking dosage were twice as high among women as they were among men. Relative to controls, lower MI risk was associated with consuming < 4.55 drinks per drinking day for men (95% CI: 2.77 to 7.18) and < 3.08 drinks per drinking day for women (95% CI: 1.35 to 5.16), increasing after these cross-over points were exceeded. CONCLUSIONS: Use of a well-specified mathematical dose-response model provided precise estimates for the first time of how drinking frequency and dosage each contribute linearly to the overall impact of a given drinking pattern on MI risk in men and women.

Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction.

PURPOSE: To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI). DESIGN: The study was a cross-sectional descriptive survey. A convenience sample of Jordanians with AMI were interviewed at the coronary care units of two teaching hospitals in Jordan. METHODS: The Arabic version of the modified Response to Symptom Questionnaire was used to assess predictors of decision delay and patterns of health care-seeking behaviors. Decision delay was evaluated by assisting patients to triangulate time of symptom onset and time of decision to seek professional health care by placing both times in context of daily activities that participants could easily remember. Regression analysis was conducted to elicit predictors of decision delay. FINDINGS: Decision delay time among Jordanian men (n=110) and women (n=24) with AMI was alarmingly long (medians 3.5 and 3.6 hours, respectively). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others' responses to patients' symptoms. While 16 other variables (cognitive, emotional, and clinical) independently predicted delay among men, equivalent evidence was not established among women due to the relatively small sample size. CONCLUSIONS: Similarities and differences existed between Jordanian men's and women's decision delay to seek health care for AMI. Decision delay time among Jordanians with AMI requires intervention that incorporates awareness of delay predictors. Future research needs to utilize adequate sample sizes of both sexes to obtain a better understanding of sex differences. CLINICAL RELEVANCE: To reduce decision delay among Jordanians, health educators should emphasize early symptom recognition and the value of prompt health care-seeking behaviors.

Correlates of short and long sleep duration: a cross-cultural comparison between the United Kingdom and the United States: the Whitehall II Study and the Western New York Health Study.

The authors examined sociodemographic, lifestyle, and comorbidity factors that could confound or mediate U-shaped associations between sleep duration and health in 6,472 United Kingdom adults from the Whitehall II Study (1997-1999) and 3,027 US adults from the Western New York Health Study (1996-2001). Cross-sectional associations between short (<6 hours) and long (>8 hours) durations of sleep across several correlates were calculated as multivariable odds ratios. For short sleep duration, there were significant, consistent associations in both samples for unmarried status (United Kingdom: adjusted odds ratio (AOR) = 1.49, 95% confidence interval (CI): 1.15, 1.94; United States: AOR = 1.49, 95% CI: 1.10, 2.02), body mass index (AORs were 1.04 (95% CI: 1.01, 1.07) and 1.02 (95% CI: 1.00, 1.05)), and Short Form-36 physical (AORs were 0.96 (95% CI: 0.95, 0.98) and 0.97 (95% CI: 0.96, 0.98)) and mental (AORs were 0.95 (95% CI: 0.94, 0.96) and 0.98 (95% CI: 0.96, 0.99)) scores. For long sleep duration, there were fewer significant associations: age among men (AORs were 1.08 (95% CI: 1.01, 1.14) and 1.05 (95% CI: 1.02, 1.08)), low physical activity (AORs were 1.75 (95% CI: 0.97, 3.14) and 1.60 (95% CI: 1.09, 2.34)), and Short Form-36 physical score (AORs were 0.96 (95% CI: 0.93, 0.99) and 0.97 (95% CI: 0.95, 0.99)). Being unmarried, being overweight, and having poor general health are associated with short sleep and may contribute to observed disease associations. Long sleep may represent an epiphenomenon of comorbidity.

Feasibility of using pedometers in a state-based surveillance system: 2014 Arizona Behavioral Risk Factor Surveillance System.

BACKGROUND: Despite their utility in accessing ambulatory movement, pedometers have not been used consistently to monitor physical activity in U.S. surveillance systems. This study was designed to determine the feasibility of using pedometers to assess daily steps taken in a sub-sample of adults from Maricopa County who completed the 2014 Arizona Behavioral Risk Factor Surveillance System Survey. METHODS: Respondents were sent an Omron HJ324U pedometer, a logbook to record steps taken, and a walking questionnaire. The pedometer was worn for 7 days. Feasibility was assessed for acceptability (interest in study), demand (procedures followed correctly), implementation (time to complete study), and practicality (cost). RESULTS: Acceptability was modest with 23.9% (830/3476) agreeing to participate. Among those participating (92.9%; 771/830), 50.1% (386/771) returned the logbook. Demand was modest with 39.3% (303/771) of logbooks returned with valid data. Implementation represented 5 months to recruit participants. The cost to obtain valid step-count data was USD61.60 per person. An average of 6363 ± 3049 steps/day were taken with most participants classified as sedentary (36.0%) or low active (35.6%). CONCLUSION: The feasibility of using pedometers in a state-based surveillance system is modest at best. Feasibility may potentially be improved with easy-to-use pedometers where data can be electronically downloaded.