An Integrative Analysis of the Effect of Lifestyle and Pharmacological Interventions on Glucose Metabolism in the Prevention and Treatment of Youth-Onset Type 2 Diabetes.

Preventing and managing youth-onset type 2 diabetes are a major challenge. This paper reviews the evidence of lifestyle and drug therapies in improving glucose, insulin, and insulin sensitivity. Forty-four interventions were analyzed, of which 11 were drug (mainly metformin) interventions combined with lifestyle while the remainder used lifestyle strategies only. Fewer than a dozen out of 44 interventions reported significant improvements in glucose-related outcomes. Metformin in addition to lifestyle therapy did not necessarily enhance intervention effects. The overall lack of findings can be partially attributed to the heterogeneity of study populations, the lack of intervention intensity, under-powered study design, and the challenging lives of at-risk populations. New treatment options in both drugs and lifestyle strategies are direly needed.

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.

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.

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.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model.

OBJECTIVES: Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling. DESIGN: Cross-sectional survey by probability sampling. SETTING: Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students. PARTICIPANTS: 2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame. PRIMARY OUTCOME MEASURES: Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour. RESULTS: Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ2=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05). CONCLUSIONS: This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

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.

Design Thinking to Improve Implementation of Public Health Interventions: An Exploratory Case Study on Enhancing Park Use.

Design thinking, a human-centred, iterative process to innovate solutions aligned with communities' tacit knowledge, has the potential to augment public health interventions. This paper presents a case study of a design thinking workshop to illustrate the process and methods to train public health researchers. A workshop was conducted to engage participants in a systematic, non-linear process of design thinking to design possible interventions to enhance use of renovated New York City parks. Participants engaged in exercises to rapidly craft proposals for park re-design. The process involved learning about design methods to overcome limitations of linear thinking and how design thinking can be applied to public health problems that require community input. The case study demonstrated the feasibility of training public health researchers in design thinking methods that can be applied to public health problems. With increased capacity, public health researchers could apply design thinking to community collaborations to develop solutions embedded in the unique contexts of the community.

A protocol for developing an evaluation framework for an academic and private-sector partnership to assess the impact of major food and beverage companies' investments in community health in the United States.

Public health leaders increasingly recognize the importance of multi-sector partnerships and systems approaches to address obesity. Public-private partnerships (PPP), which are joint ventures between government agencies and private sector entities, may help facilitate this process, but need to be delivered through comprehensive, transparent frameworks to maximize potential benefits and minimize potential risks for all partners. The City University of New York (CUNY) School of Public Health and the Healthy Weight Commitment Foundation (HWCF) propose to engage in a unique academic-private-sector research partnership to evaluate the impact and effectiveness of the food and beverage industry's investment in obesity and hunger prevention and reduction through community-level healthful eating and active living programs. The CUNY-HWCF academic-private partnership protocol described here incorporates best practices from the literature on PPP into the partnership's design. The CUNY-HWCF partnership design demonstrates how established guidelines for partnership components will actively incorporate and promote the principles of successful PPPs identified in various research papers. These identified principles of successful PPP, including mutuality (a reciprocal relationship between entities), and equality among partners, recognition of partners' unique strengths and roles, alignment of resources and expertise toward a common cause, and coordination and delegation of responsibilities, will be embedded throughout the design of governance, management, funding, intellectual property and accountability structures. The CUNY-HWCF partnership responds to the call for increased multi-sector work in obesity prevention and control. This framework aims to promote transparency and the shared benefits of complementary expertise while minimizing shared risks and conflicts of interest. This framework serves as a template for future academic-private research partnerships.