Physical activity among transgender individuals: A systematic review of quantitative and qualitative studies.

Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.

Insights From a Community-Based Strategy to Assess Tobacco and Vape Shop Retailers' Implementation of Tobacco 21 Law in El Paso, Texas.

In 2019, the United States Congress passed Tobacco 21 (T21) legislation that raised the minimum legal sales age for tobacco products from 18 to 21. However, although the federal legislation superseded weaker state laws that were already in place in some states, including Texas, local guidance for retailers was inconsistent. Given that retailers are ultimately responsible for policy implementation, the American Heart Association (AHA) initiated a process of assessing retailers knowledge and perceptions of the law through a survey targeting all tobacco retailers and accompanying ethnography of a subset of vape shops in El Paso, Texas. The process yielded lessons learned for assessment of community-based policy implementation including key considerations for personnel and process that are applicable to other community-based assessment processes. While AHA considered an in-person approach ideal, having an alternate online response option was necessary. In addition, a focused approach and in-depth understanding of the purpose was key to responsiveness of the retailers.

Systems-Level Evaluation of Safe Routes to School Policies in El Paso, Texas: A Modeling Study on Health and Economic Outcomes.

Safe Routes to School (SRTS) policies are linked to physical health benefits for school-age children; however, few studies have assessed long-term impacts on cardiovascular disease (CVD). This study used systems science methods to predict long-term health and economic impact of SRTS among school-age children in El Paso County, Texas. We developed an agent-based model containing 2 modules: the pedestrian injury module and the CVD module. We simulated 10 000 school-age children under 2 scenarios-SRTS policies implemented and no SRTS policies implemented-and then calculated pedestrian injuries, pedestrian injury-related deaths, coronary heart disease (CHD) and stroke events, and health care costs. When SRTS policies were implemented, the model estimated 157 fewer CHD cases and 217 fewer stroke cases per 10 000 people and reduced CVD-related health care costs ($13 788 per person). The model also predicted 129 fewer pedestrian injuries and 1.3 injury-related deaths per 10 000 people and $2417 savings in injury-related health care costs. SRTS could save an estimated $16 205 per person in health care costs. This simulation shows SRTS in El Paso County could prevent pedestrian injuries among school-age children and protect cardiovascular health in the long term. Our findings provide evidence for practitioners and policy makers to advocate for SRTS policies at the local level.

The Development of a Systems-Level Approach to Address Adolescent Access to Health Care: A Novel Confidentiality Policy Intervention.

Most evidence-based interventions in adolescent sexual and reproductive health and mental health remain largely aimed at individual-level outcomes and do not conceptualize adolescent health within a social-ecological model. Interventions to affect policy, systems, and environmental change offer potential for sustained population impact. The current initiative used an innovation framework to develop a novel systems-level approach to address adolescent access to health care. The Framework for Public Health Innovation provided an approach to develop a novel intervention. Confident Teen is a systems-level intervention that creates the opportunity, through organizational policy change, to increase adolescents' access to confidential sexual and reproductive health services through organizational policies. Gaps in adolescents' access to health care services allowed for a systems-level approach to be designed through an adolescent pregnancy prevention innovation initiative. Confidentiality is a right and critical component to their health care; therefore, a policy and conversation between provider and patient is a prioritized component of the novel intervention.

Cultivating an Active Living Plan Through a Social-Ecological Evaluation.

Physical activity (PA) social-ecological model (SEM) posits the importance of several levels of influence critical for PA promotion within communities. The purpose of this study was to examine an SEM evaluation informing a county-wide active living plan in McLennan County, Texas in the United States. Mixed-methods evaluation occurred in 4 stages: (1) county policies (n = 15) were evaluated for PA promoting strategies; (2) PA resource assessments (PARAs) were conducted via Google Maps (n = 171); (3) surveys (n = 244) included the International Physical Activity Questionnaire and interpersonal and intrapersonal factors related to PA; and (4) focus groups (n = 5) were conducted with residents (n = 30), discussing barriers and facilitators to being active. Logistic regression determined significant associations between SEM factors and meeting PA recommendations. Policy scans and PARAs identified strengths and areas of improvement (eg, equitable project selection and disparities in resource quality). Residents reporting fewer barriers (OR = 0.89, P =.01), more perceived behavioral control (odds ratio [OR] = 1.38, P = .01), more social co-participation in PA (OR = 1.20, P = .03), and living in zip codes with higher mean PARA score (OR = 1.22, P = .04) were significantly more likely to meet PA recommendations (Nagelkerke R2 = 0.32). Focus groups also discussed safety and disparities in access and quality. This study suggests the utility of the SEM when evaluating and promoting community PA.

Bridging the Built and Social Environments: A Systematic Review of Studies Investigating Influences on Physical Activity.

BACKGROUND: The purpose of this review was to examine articles assessing aspects of the built and social environment simultaneously, and how these environments influence physical activity (PA). A thorough review of studies is needed to identify patterns across studies and gaps for future research and practice. METHODS: To be included, articles needed to contain: (1) self-report or objective measure of PA; (2) a measure of the built environment; (3) a measure of the social environment; and (4) an analysis between built environment, social environment, and PA. A systematic literature search of 4358 articles resulted in 87 articles. RESULTS: Several populations were present within the sample including various age groups and different countries. As previously established, the built environment and social environment were consistently associated with PA; however, mediating factors between these 2 layers were less clear. Further, there was a lack of longitudinal and experimental study designs. CONCLUSIONS: Results suggest a need for longitudinal and experimental designs with validated and granular measures. As communities recover from the COVID-19 pandemic, a thorough understanding of how built environment factors enhance or detract from social connectedness and how this reciprocal relationship impacts PA behavior is needed for future policy, environment, and systematic change.

Differences in Physical Activity, Sedentary Behavior, and Mental Health of the Older Population in South Korea Based on Marital Status and Gender.

The primary purpose of the present study was to assess differences in physical activity (PA), sedentary behavior (SB), and mental health (i.e., depression, suicidal thoughts, and cognitive function) by marital status (i.e., married and widowed) within an aging population in South Korea. PA, SB, and mental health were evaluated in 9092 older adults by comparing the married group (n = 5773, 73.2 ± 5.9 years, 63.5%) to the widowed group (n = 3319, 75.8 ± 6.8 years, 36.5%). Between-group differences in PA, SB, depression, and cognitive function were tested using independent t-tests, and the association between marital status and gender was evaluated using two-way ANOVA. Suicidal thoughts were analyzed using a Mann-Whitney U-test. Older adults in the widowed group participated in significantly less PA (p < 0.001) and had higher SB (p < 0.001) per week, especially the widows, who had significantly less PA (p < 0.01) and had higher SB (p < 0.001) compared to married women. Participants in the widowed group experienced more depression (p < 0.001) and suicidal thoughts (p < 0.001) and had significantly lower cognitive function compared to participants in the married group (p < 0.001). Between the two groups, widowers were more vulnerable to all mental health factors compared to those in the married group. At the same time, widows were only more vulnerable to depression and cognitive function compared to women in the married group. Findings indicated that the presence of a spouse is strongly associated with higher PA levels, lower SB, and better mental health among older adults. Spouses are the primary social supports and play a major role in the health and emotional well-being of the aging population. Given the importance of the spouse, our study suggests that health educators working with older widows should prioritize several different forms of social support to benefit their physical and mental health.

Multifaceted Scoping Review of Black/African American Transportation and Land Use Expert Recommendations on Activity-Friendly Routes to Everyday Destinations.

Promoting physical activity (PA) at the community level is a complex, multisector approach requiring researchers and practitioners to impact the individual, interpersonal, environment, and policy levels. One such strategy aiming to impact systems, policies, and environments is the Centers for Disease Control and Prevention's Activity Friendly Routes to Everyday Destinations (Routes to Destinations). This strategy specifically aims to connect pedestrian, bicycle, and public transportation systems with built environment and land use destinations. This article examines Black/African American transportation and land use experts' perspectives and concerns-across multiple mediums-around inequities that have discouraged PA among Black/African American persons specifically Routes to Destinations strategies. In March 2021, a multifaceted scoping review was conducted of peer-reviewed literature, gray literature, and social media authored by Black/African American transportation and land use experts focusing on policy, system, and environmental changes which promote or discourage equitable and inclusive access to physical activity. Themes from peer-reviewed and gray literature resources included: (1) Assessing Racism, Discrimination, and Segregation; (2) Addressing Equity and Inclusion Through Policy; (3) Community Engagement and Place-Based Interventions; (4) Infrastructure Changes; (5) Safety; and (6) Reporting Health Disparities. Twitter topic models suggested the main topics included elements of race/racism, equity, safety, infrastructure, and advancing social justice. Experts called for systemic and systematic change through new policies and implementation of existing policies as well as enhanced community inclusion in decision-making through ownership of policy and built environment change. Safety was discussed differently between peer-reviewed and gray literature and Twitter discussions indicating a publication bias.

Racial/Ethnic Differences in Chronic Disease Predictors Among American High School Students.

BACKGROUND: Few studies have attempted to define clusters of chronic disease predictors with additional focus on racial/ethnic differences. The purpose of this study was to highlight differences in predictors of chronic diseases among American high school students by identifying subgroups using latent class analysis (LCA). METHODS: The chronic disease predictor variable used in the analysis was created from 5 modified items in the 2019 Youth Risk Behavior Surveillance that were identified to be critical to healthy lifestyles in Healthy People 2020. Descriptive, bivariate, multinomial logistic regression and LCA were performed using SAS 9.4 and Mplus in 9th to 12th grade students, using data from the Youth Risk Behavior Survey (N = 13,677). RESULTS: Three distinct classes emerged for US high school students and were characterized as high, moderate, and low risk of chronic disease (38%, 33%, and 29%, respectively). Black and Asian students had a higher chance of being in the high-risk class of chronic diseases. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Emphasis should be placed on sociocultural and socio-environmentally structured prevention programs for at risk/students, ensuring that policy formation reflects the language, identity, and needs of the populations at risk. CONCLUSIONS: The behavioral similarities of the classes identified highlight the need for continued research, novel interventions, and culturally sensitive strategies and policies in US high schools.

'Tracking Together'-Simultaneous Use of Human and Dog Activity Trackers: Protocol for a Factorial, Randomized Controlled Pilot Trial.

Dog-walkers are more likely to achieve moderate-intensity physical activity. Linking the use of activity trackers with dog-walking may be beneficial both in terms of improving the targeted behavior and increasing the likelihood of sustained use. This manuscript aims to describe the protocol of a pilot study which intends to examine the effects of simultaneous use of activity trackers by humans and their dogs on the physical activity level of humans and dogs. This study uses nonprobability sampling of dog owners of age 25-65 (N = 80) and involves four parallel groups in an observational randomized controlled trial with a 2 × 2 factorial design, based on use of dog or human activity trackers for eight weeks. Each group consists of dog-human duos, in which both, either or none are wearing an activity tracker for eight weeks. At baseline and end, all human subjects wear ActiGraph accelerometers that quantify physical activity for one week. Commercial activity trackers are used for tracking human and dog activity remotely. Additional measures for humans are body composition and self-reported physical activity. Dog owners also report dog's weight and physical activity using a questionnaire. A factorial analysis of covariance (ANCOVA) is used to compare physical activity across the four groups from baseline to week-10.