Examining the feasibility of a youth advocacy program promoting healthy snacking in New York City: a mixed-methods process evaluation.

Adolescents from urban communities are at risk for unhealthy snacking behaviors. Youth advocacy interventions are shown to improve certain adolescent health behaviors, such as substance use. However, it remains unclear if youth advocacy is a feasible method to promote healthy snacking. As such, the aim of this study was to examine the feasibility of a youth advocacy program promoting healthy snacking among adolescents in New York City by conducting a mixed-methods process evaluation. Adolescents (12-18 years) at a Boys and Girls Club in New York City were recruited to participate in a 12-session adaptation of the Youth Engagement and Action for Health! program to advocate for the promotion of healthy snacks in corner stores. A mixed-methods process evaluation was conducted to assess recruitment, reach (attendance), dose delivered (amount of intervention delivered), fidelity (degree to which intervention was implemented according to curriculum) and dose received (participant engagement/satisfaction). Satisfaction was also evaluated through focus groups. Descriptive statistics were calculated for quantitative data, and focus groups were analyzed using thematic analysis. Participant retention (94.74%), attendance (93.52%), dose delivered (98.94%), fidelity (98.5%), engagement (4.97/5) and program satisfaction (4/5) were high. Focus groups (n = 6; 28 participants) revealed that participants learned about nutrition, enjoyed being advocates and improved snacking behaviors.

Building evidence to reduce inequities in youth physical activity and obesity: Introduction to the Physical Activity Research Center (PARC) Special Section.

This guest editorial introduces the rationale and goals of the Physical Activity Research Center. It provides an overview of the five papers in this Special Section plus six commissioned studies intended to inform advocacy efforts.

Demographic Inequities in Health Outcomes and Air Pollution Exposure in the Atlanta Area and its Relationship to Urban Infrastructure.

Environmental burdens such as air pollution are inequitably distributed with groups of lower socioeconomic statuses, which tend to comprise of large proportions of racial minorities, typically bearing greater exposure. Such groups have also been shown to present more severe health outcomes which can be related to adverse pollution exposure. Air pollution exposure, especially in urban areas, is usually impacted by the built environment, such as major roadways, which can be a significant source of air pollution. This study aims to examine inequities in prevalence of cardiovascular and respiratory diseases in the Atlanta metropolitan region as they relate to exposure to air pollution and characteristics of the built environment. Census tract level data were obtained from multiple sources to model health outcomes (asthma, chronic obstructive pulmonary disease, coronary heart disease, and stroke), pollution exposure (particulate matter and nitrogen oxides), demographics (ethnicity and proportion of elderly residents), and infrastructure characteristics (tree canopy cover, access to green space, and road intersection density). Conditional autoregressive models were fit to the data to account for spatial autocorrelation among census tracts. The statistical model showed areas with majority African-American populations had significantly higher exposure to both air pollutants and higher prevalence of each disease. When considering univariate associations between pollution and health outcomes, the only significant association existed between nitrogen oxides and COPD being negatively correlated. Greater percent tree canopy cover and green space access were associated with higher prevalence of COPD, CHD, and stroke. Overall, in considering health outcomes in connection with pollution exposure infrastructure and ethnic demographics, demographics remained the most significant explanatory variable.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. METHODS: We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. RESULTS: We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. CONCLUSION: This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes.

Supporting Youth Participation in Health and Climate Justice Through Advocacy Training Comment on "Between Rhetoric and Reality: Learnings From Youth Participation in the Adolescent and Youth Health Policy in South Africa".

This paper responds to lessons from the Adolescent and Youth Health Policy (AYHP) process in South Africa by drawing comparisons with youth participation within the climate justice movement. Relationship building is essential to successful youth participation in health policy and climate change as it creates intergenerational learning and cross-cultural engagement. At the same time, both sets of youth also deal with compounding challenges due to contemporary and historical legacies of colonialism and inequality. Yet, tokenism challenges the participatory process as adults profess to value youth perspectives, yet recommendations by youth often do not get incorporated into policies or plans. For organizations and agencies trying to build youth's capacity, organizations and agencies should look to programs that train youth in advocacy. These programs help build youth's confidence, increase their optimism for change, and give youth a sense of ownership.

Development and validation of automated microscale walkability audit method.

Measuring microscale factors of walkability has been labor-intensive and expensive. To reduce the cost, various efforts have been made including virtual audits (i.e., manual audits using street view images) and the introduction of computer vision techniques. Although studies have shown that virtual audits (i.e., manual audits using street view images) can reliably replicate in-person audits, they are still prohibitively expensive to be applied to a large geographic area. Past studies used computer vision techniques to help automate the audit process, but off-the-shelf models cannot detect some of the important microscale walkability characteristics, falling short of fully capturing the multi-facetted concept of walkability. This study is one of the earliest attempts to use the combination of custom-trained computer vision models, geographic information systems, and street view images to automatically audit a complete set of items of a validated microscale walkability audit tool. This study validates the reliability of the automated audit with virtual audit results. The automated audit results show high reliability, indicating automated audit can be a highly scalable and reliable replacement of virtual audit.

How Youth of Color Create Communities of Hope: Connecting Advocacy, Activity, and Neighborhood Change.

The primary aim of this paper was to assess the association of after-school club characteristics with changes in physical activity, nutrition, and attitudes in students of color after participating in the "YEAH!" Advocacy-based Physical Activity Program. We examine the strengths of school-based vs. non-school based programs in promoting feelings of self-efficacy and empowerment among students learning to become more physically active-and importantly, also test the strength of how programs that are more connected (to community-based partners) may contribute to students' optimism around policy and public health as it directly affects them. This study examined differences in the youth advocacy training impact across four after-school club types: school-based with community partnerships, school-based without partnerships, non-school-based with community partners, and non-school-based clubs without partnerships. We measured improvements in youth's "optimism for change", "assertiveness" and "decision-making" as related to after school activities and found that non-school-based programs with community partners showed highest positive impact.

Youth Advocacy Programs: Lessons From YEAH! Adult Leaders Evaluation Study.

Disparities in youth obesity continue despite an increasing number of programs designed to address this challenge. Policy, systems, and environmental (PSE) changes hold promise. Youth Engagement & Action for Health! (YEAH!) is a youth advocacy curriculum for PSE change that promotes healthy behaviors. From 2017-2019, 18 youth-serving organizations hosted YEAH! clubs serving 237 middle school youth from low-income communities. Study data include YEAH! adult leader surveys and interviews. Data were coded on themes of youth advocacy action, youth retention, and opportunities and threats to program success. After coding, the data were organized into four categories for validation by representative adult leaders. This study found that positive outcomes were facilitated by adult leaders who had previous engagement with the youth, who showed enthusiasm for youth advocacy, and who had access to resources to motivate group cohesion, participation, and commitment. Best practices highlighted from this study offer tested strategies for adult leaders of youth advocacy groups.

A multilevel scenario based predictive analytics framework to model the community mental health and built environment nexus.

The built environment affects mental health outcomes, but this relationship is less studied and understood. This article proposes a novel multi-level scenario-based predictive analytics framework (MSPAF) to explore the complex relationships between community mental health outcomes and the built environment conditions. The MSPAF combines rigorously validated interpretable machine learning algorithms and scenario-based sensitivity analysis to test various hypotheses on how the built environment impacts community mental health outcomes across the largest metropolitan areas in the US. Among other findings, our results suggest that declining socio-economic conditions of the built environment (e.g., poverty, low income, unemployment, decreased access to public health insurance) are significantly associated with increased reported mental health disorders. Similarly, physical conditions of the built environment (e.g., increased housing vacancies and increased travel costs) are significantly associated with increased reported mental health disorders. However, this positive relationship between the physical conditions of the built environment and mental health outcomes does not hold across all the metropolitan areas, suggesting a mixed effect of the built environment's physical conditions on community mental health. We conclude by highlighting future opportunities of incorporating other variables and datasets into the MSPAF framework to test additional hypotheses on how the built environment impacts community mental health.

Understanding subjective well-being: perspectives from psychology and public health.

BACKGROUND: Individual subjective well-being (SWB) is essential for creating and maintaining healthy, productive societies. The literature on SWB is vast and dispersed across multiple disciplines. However, few reviews have summarized the theoretical and empirical tenets of SWB literature across disciplinary boundaries. METHODS: We cataloged and consolidated SWB-related theories and empirical evidence from the fields of psychology and public health using a combination of online catalogs of scholarly articles and online search engines to retrieve relevant articles. For both theories and determinants/correlates of SWB, PubMed, PsychINFO, and Google Scholar were used to obtain relevant articles. Articles for the review were screened for relevance, varied perspectives, journal impact, geographic location of study, and topicality. A core theme of SWB empirical literature was the identification of SWB determinants/correlates, and over 100 research articles were reviewed and summarized for this review. RESULTS: We found that SWB theories can be classified into four groups: fulfillment and engagement theories, personal orientation theories, evaluative theories, and emotional theories. A critical analysis of the conflicts and overlaps between these theories reveals the lack of a coherent theoretical and methodological framework that would make empirical research systematically comparable. We found that determinants/correlates of SWB can be grouped into seven broad categories: basic demographics, socioeconomic status, health and functioning, personality, social support, religion and culture, and geography and infrastructure. However, these are rarely studied consistently or used to test theories. CONCLUSIONS: The lack of a clear, unifying theoretical basis for categorizing and comparing empirical studies can potentially be overcome using an operationalizable criterion that focuses on the dimension of SWB studied, measure of SWB used, design of the study, study population, and types of determinants and correlates. From our review of the empirical literature on SWB, we found that the seven categories of determinants/correlates identified may potentially be used to improve the link between theory and empirical research, and that the overlap in the determinant/correlates as they relate to multiple theory categories may enable us to test theories in unison. However, doing so in the future would require a conscious effort by researchers in several areas, which are discussed.

Connecting Air Quality with Emotional Well-Being and Neighborhood Infrastructure in a US City.

Cities in the United States have announced initiatives to become more sustainable, healthy, resilient, livable, and environmentally friendly. However, indicators for measuring all outcomes related to these targets and the synergies between them have not been well defined or studied. One such relationship is the linkage between air quality with emotional well-being (EWB) and neighborhood infrastructure. Here, regulatory monitoring, low-cost sensors (LCSs), and air quality modeling were combined to assess exposures to PM2.5 and traffic-related NOx in 6 Minneapolis, MN, neighborhoods of varying infrastructure parameters (median household income, urban vs suburban, and access to light rail). Residents of the study neighborhoods concurrently took real-time EWB assessments using a smart phone application, Daynamica, to gauge happiness, tiredness, stress, sadness, and pain. Both LCS PM2.5 observations and mobile-source-simulated NOx were calibrated using regulatory observations in Minneapolis. No statistically significant (α = 0.05) PM2.5 differences were found between urban poor and urban middle-income neighborhoods, but average mobile-source NOx was statistically significantly (α = 0.05) higher in the 4 urban neighborhoods than in the 2 suburban neighborhoods. Close proximity to light rail had no observable impact on average observed PM2.5 or simulated mobile-source NOx. Home-based exposure assessments found that PM2.5 was negatively correlated with positive emotions such as happiness and to net affect (the sum of positive and negative emotion scores) and positively correlated (ie, a higher PM2.5 concentration led to higher scores) for negative emotions such as tiredness, stress, sadness, and pain. Simulated mobile-source NOx, assessed from both home-based exposures and in situ exposures, had a near-zero relationship with all EWB indicators. This was attributed to low NOx levels throughout the study neighborhoods and at locations were the EWB-assessed activities took place, both owing to low on-road mobile-source NOx impacts. Although none of the air quality and EWB responses were determined to be statistically significant (α = 0.05), due in part to the relatively small sample size, the results are suggestive of linkages between air quality and a variety of EWB outcomes.

Factors influencing adolescents' decision not to smoke.

OBJECTIVE: Although adolescents ultimately make their own decisions to smoke or not to smoke, social, economic, and environmental circumstances shape their choices. Most research on prevention of youth tobacco use focuses on predictors of smoking initiation. In this study, we explored nonsmoking attitudes, beliefs, and norms from the perspective of 16-17-year-old nonsmokers. DESIGN: This qualitative study targeted nonsmoking youths because most social policy in the arena of tobacco prevention aims to support adolescents who are tobacco free. SAMPLE: Participants were 39 nonsmokers recruited from youth organizations in an urban community and included 22 African Americans (12 females; 10 males) and 17 Caucasian Americans (10 females; 7 males). METHODS: A health behavior framework guided the development of semistructured questions on attitudes, beliefs, and norms associated with nonsmoking, used in eight in-depth group interviews. RESULTS: Concerns for health and addiction, a positive self-image, and perceived confidence, emerged as factors affecting participants' decisions not to smoke. The approval of parents and friends, and personal beliefs further reinforced adolescents' nonsmoking decisions. CONCLUSIONS: There were more commonalities than differences in nonsmoking attitudes across gender and race. Future studies of youth tobacco prevention should employ multifaceted approaches targeting adolescents' attitudes, families, and peer networks.

Policy and Practice-Relevant Youth Physical Activity Research Center Agenda.

BACKGROUND: The Physical Activity Research Center developed a research agenda that addresses youth physical activity (PA) and healthy weight, and aligns with the Robert Wood Johnson Foundation's Culture of Health. This paper summarizes prioritized research studies with a focus on youth at higher risk for inactive lifestyles and childhood obesity in urban and rural communities. METHODS: Systematic literature reviews, a survey, and discussions with practitioners and researchers provided guidance on research questions to build evidence and inform effective strategies to promote healthy weight and PA in youth across race, cultural, and economic groups. RESULTS: The research team developed a matrix of potential research questions, identified priority questions, and designed targeted studies to address some of the priority questions and inform advocacy efforts. The studies selected examine strategies advocating for activity-friendly communities, Play Streets, park use, and PA of youth in the summer. A broader set of research priorities for youth PA is proposed. CONCLUSION: Establishing the Physical Activity Research Center research agenda identified important initial and future research studies to promote and ensure healthy weight and healthy levels of PA for at-risk youth. Results will be disseminated with the goal of promoting equitable access to PA for youth.

A model curriculum for a course on the built environment and public health: training for an interdisciplinary workforce.

Despite growing evidence of the direct and indirect effects of the built environment on public health, planners, who shape the built environment, and public health professionals, who protect the public's health, rarely interact. Most public health professionals have little experience with urban planners, zoning boards, city councils, and others who make decisions about the built environment. Likewise, few planners understand the health implications of design, land use, or transportation decisions. One strategy for bridging this divide is the development of interdisciplinary courses in planning and public health that address the health implications of the built environment. Professional networking and Internet-based searches in 2007 led to the identification of six primarily graduate-level courses in the U.S. that address the links between the built environment and public health. Common content areas in most of the identified courses included planning and public health histories, health disparities, interdisciplinary approaches, air and water quality, physical activity, social capital, and mental health. Instructors of these courses collaborated on course content, assignments, and evaluations to develop a model curriculum that follows an active learning-centered approach to course design. The proposed model curriculum is adaptable by both planning and public health departments to promote interdisciplinary learning. Results show that students gain planning and public health perspectives through this instruction, benefiting from active-learning opportunities. Faculty implementation of the proposed interdisciplinary model curriculum will help bridge the divide between the built environment and public health and enable both planners and public health professionals to value, create, and promote healthy environments.