Walking to Work: The Roles of Neighborhood Walkability and Socioeconomic Deprivation.

BACKGROUND: There are few studies that aimed to find a relationship between transportation-related physical activity and neighborhood socioeconomic condition using a composite deprivation index. The purpose of this study is to assess the relationship of neighborhood walkability and socioeconomic deprivation with percentage of adults walking to work. METHODS: A walkability index and a socioeconomic deprivation index were created at block group-level. The outcome variable, percentage of adults who walk to work was dichotomized as < 5% of the block group walking to work low and ≥ 5% of the block group walking to work as high and applied logistic regression to examine the association of walkability and socioeconomic deprivation with walking to work. RESULTS: Individuals in the most walkable neighborhoods are almost 5 times more likely to walk to work than individuals in the least walkable neighborhoods (OR = 4.90, 95% CI = 2.80-8.59). After adjusting for neighborhood socioeconomic deprivation, individuals in the most walkable neighborhoods are almost 3 times more likely to walk to work than individuals in the least walkable neighborhoods (OR = 2.98, 95% CI = 1.62-5.49). CONCLUSIONS: Walkability (as measured by the walkability index) is a very strong indicator of walking to work even after controlling for neighborhood socioeconomic disadvantage.

A method for building evaluation competency among community-based organizations.

Community-based organizations often lack the capacity (e.g., time, staff, skills) to effectively evaluate programs, policies, and environmental changes. Providing evaluation technical assistance and training can be an effective and feasible way to build individual evaluation competency. The purpose of this article is to present a practical approach and related tools that can be used by evaluators and others (e.g., academic partners, funders) providing assistance to build evaluation skills in community organizations. The approach described was developed in collaboration with local universities and a regional health foundation to provide intensive technical support to 19 community-based organizations awarded funding to implement obesity prevention projects. Technical assistance processes and tools were designed to be tailored to organizations' capacity and needs and can be used as templates by others who provide technical assistance. Evaluators, funders, and academic partners can use lessons learned from this experience to help shape and implement evaluation technical assistance approaches with community-based organizations.

Using Google Street View to audit the built environment: inter-rater reliability results.

BACKGROUND: Observational field audits are recommended for public health research to collect data on built environment characteristics. A reliable, standardized alternative to field audits that uses publicly available information could provide the ability to efficiently compare results across different study sites and time. PURPOSE: This study aimed to assess inter-rater reliability of built environment audits conducted using Google Street View imagery. METHODS: In 2011, street segments from St. Louis and Indianapolis were geographically stratified to ensure representation of neighborhoods with different land use and socioeconomic characteristics in both cities. Inter-rater reliability was assessed using observed agreement and the prevalence-adjusted bias-adjusted kappa statistic (PABAK). RESULTS: The mean PABAK for all items was 0.84. Ninety-five percent of the items had substantial (PABAK ≥ 0.60) or nearly perfect (PABAK ≥ 0.80) agreement. CONCLUSIONS: Using Google Street View imagery to audit the built environment is a reliable method for assessing characteristics of the built environment.

Developing a research agenda for promoting physical activity in Brazil through environmental and policy change.

OBJECTIVE: To identify the highest priorities for research on environmental and policy changes for promoting physical activity (PA) in Brazil; to uncover any gaps between researchers' and practitioners' priorities; and to consider which tools, methods, collaborative strategies, and actions could be useful to moving a research agenda forward. METHODS: This was a mixed-methods study (qualitative and quantitative) conducted by Project GUIA (Guide for Useful Interventions for Activity in Brazil and Latin America) in February 2010-January 2011. A total of 240 individuals in the PA field (186 practitioners and 54 researchers) were asked to generate research ideas; 82 participants provided 266 original statements from which 52 topics emerged. Participants rated topics by "importance" and "feasibility;" a separate convenience sample of 21 individuals categorized them. Cluster analysis and multidimensional scaling were used to create concept maps and pattern matches. RESULTS: Five distinct clusters emerged from the concept mapping, of which "effectiveness and innovation in PA interventions" was rated most important by both practitioners and researchers. Pattern matching showed a divergence between the groups, especially regarding feasibility, where there was no consensus. CONCLUSIONS: The study results provided the basis for a research agenda to advance the understanding of environmental and policy influences on PA promotion in Brazil and Latin America. These results should stimulate future research and, ultimately, contribute to the evidence-base of successful PA strategies in Latin America.

Developing a research agenda for promoting physical activity in Brazil through environmental and policy change / Diseño de un programa de investigación para promocionar la actividad física en el Brasil mediante cambios ambientales y de políticas

Objective. To identify the highest priorities for research on environmental and policy changes for promoting physical activity (PA) in Brazil; to uncover any gaps between researchers' and practitioners' priorities; and to consider which tools, methods, collaborative strategies, and actions could be useful to moving a research agenda forward. Methods. This was a mixed-methods study (qualitative and quantitative) conducted by Project GUIA (Guide for Useful Interventions for Activity in Brazil and Latin America) in February 2010­January 2011. A total of 240 individuals in the PA field (186 practitioners and 54 researchers) were asked to generate research ideas; 82 participants provided 266 original statements from which 52 topics emerged. Participants rated topics by "importance" and "feasibility;" a separate convenience sample of 21 individuals categorized them. Cluster analysis and multidimensional scaling were used to create concept maps and pattern matches. Results. Five distinct clusters emerged from the concept mapping, of which "effectiveness and innovation in PA interventions" was rated most important by both practitioners and researchers. Pattern matching showed a divergence between the groups, especially regarding feasibility, where there was no consensus. Conclusions. The study results provided the basis for a research agenda to advance the understanding of environmental and policy influences on PA promotion in Brazil and Latin America. These results should stimulate future research and, ultimately, contribute to the evidence-base of successful PA strategies in Latin America.

Objetivo. Identificar las máximas prioridades en la investigación sobre cambios ambientales y de políticas para promover la actividad física en el Brasil; descubrir las posibles disparidades en las prioridades de los investigadores y las de los profesionales; y evaluar qué herramientas, métodos, estrategias colaborativas y acciones podrían ser útiles para el avance de un programa de investigación. Métodos. Fue un estudio de metodología mixta (cualitativa y cuantitativa) llevado a cabo por el Proyecto GUIA (Guía para intervenciones útiles de actividades físicas en Brasil y Latinoamérica) entre febrero de 2010 y enero de 2011. Se pidió a 240 personas del campo de la actividad física (186 profesionales y 54 investigadores) que generaran ideas para la investigación; 82 de los participantes aportaron 266 afirmaciones originales de las que surgieron 52 temas. Los participantes puntuaron los temas en función de su "importancia" y "viabilidad" y otra muestra de conveniencia formada por 21 personas los clasificó. Se usó el análisis por conglomerados y el escalonamiento pluridimensional para crear mapas conceptuales y concordancias de patrones. Resultados. Con la elaboración de mapas conceptuales surgieron cinco conglomerados diferenciados y, de ellos, el que tanto los profesionales como los investigadores consideraron más importante fue "eficacia e innovación en las intervenciones de actividad física". La concordancia de patrones indicó una divergencia entre los grupos, especialmente con respecto a la viabilidad, sobre la que no hubo consenso. Conclusiones. Los resultados del estudio sirvieron de base para un programa de investigación con el que avanzar en la comprensión de la influencia que el ambiente y las políticas ejercen sobre la promoción de la actividad física en el Brasil y en América Latina. Estos resultados deben fomentar la futura investigación y, en último término, aumentar la base de evidencia sobre estrategias fructíferas de actividad física en América Latina

Assessing the built environment using omnidirectional imagery.

Observational audits commonly are used in public health research to collect data on built environment characteristics that affect health-related behaviors and outcomes, including physical activity and weight status. However, implementing in-person field audits can be expensive if observations are needed over large or geographically dispersed areas or at multiple points in time. A reliable and more efficient method for observational audits could facilitate extendibility (i.e., expanded geographic and temporal scope) and lead to more standardized assessment that strengthens the ability to compare results across different regions and studies. The purpose of the current study was to evaluate the degree of agreement between field audits and audits derived from interpretation of three types of omnidirectional imagery. Street segments from St. Louis MO and Indianapolis IN were stratified geographically to ensure representation of neighborhoods with different socioeconomic characteristics in both cities. Audits were conducted in 2008 and 2009 using four methods: field audits, and interpretation of archived imagery, new imagery, and Google Street View™ imagery. Agreement between field audits and image-based audits was assessed using observed agreement and the prevalence-adjusted bias-adjusted kappa statistic (PABAK). Data analysis was conducted in 2010. When measuring the agreement between field audits and audits from the different sources of imagery, the mean PABAK statistic for all items on the instrument was 0.78 (archived); 0.80 (new); and 0.81 (Street View imagery), indicating substantial to nearly perfect agreement among methods. It was determined that image-based audits represent a reliable method that can be used in place of field audits to measure several key characteristics of the built environment important to public health research.

Page Avenue health impact assessment: building on diverse partnerships and evidence to promote a healthy community.

The Page Avenue health impact assessment (HIA) was focused on a redevelopment in Missouri. This case study describes a comprehensive HIA led by an interdisciplinary academic team with community partners, as well as compliance with North American HIA Practice Standards. Some of the key lessons learned included: (1) interdisciplinary teams are valuable but they require flexibility and organization; (2) engaging community stakeholders and decision-makers prior to, during, and following the HIA is critical to a successful HIA; and (3) HIA teams should not be too closely affiliated with decision-makers. It is hoped that this case study will inform future HIAs.

Environmental and policy approaches for promoting physical activity in the United States: a research agenda.

BACKGROUND: Environmental and policy approaches are promising strategies to raise population-wide rates of physical activity; yet, little attention has been paid to the development and prioritization of a research agenda on these topics that will have relevance for both researchers and practitioners. METHODS: Using input from hundreds of researchers and practitioners, a research agenda was developed for promoting physical activity through environmental and policy interventions. Concept mapping was used to develop the agenda. RESULTS: Among those who brainstormed ideas, 42% were researchers and 33% were practitioners. The data formed a concept map with 9 distinct clusters. Based on ratings by both researchers and practitioners, the policy research cluster on city planning and design emerged as the most important, with economic evaluation second. CONCLUSIONS: Our research agenda sets the stage for new inquiries to better understand the environmental and policy influences on physical activity.

The association of sidewalk walkability and physical disorder with area-level race and poverty.

INTRODUCTION: There are significant differences in physical inactivity in various geographical areas and among demographic groups. Previous research suggests that walking is the most common form of physical activity; however, not all built environments support walking for recreational or transportation purposes. OBJECTIVE: The purpose of this study was to assess the extent to which area-level factors, poverty rate and racial distribution, are associated with aspects of the street-scale environment (i.e. sidewalk walkability and physical disorder) using community audits. METHODS: Street segments were randomly selected from 210 block groups. Pairs of trained auditors walked each street segment using an audit tool designed to capture aspects of the street environment. Multilevel logistic regression was used to assess the degree of neighborhood (i.e. block group) variation in sidewalk unevenness, sidewalk obstruction and the presence of physical disorder and the association with area-level characteristics. RESULTS: 1780 street segments were audited. Block groups that were predominantly African-American were 38 times more likely to have a lot of unevenness, 15 times more likely to have many obstructions, and 12 times more likely to have physical disorder. Poverty rate was not independently associated with sidewalk walkability; however, block groups with the highest poverty rates were 21 times more likely to have physical disorder. CONCLUSION: The results indicate that aspects of the built environment vary by characteristics of the neighborhood. This suggests that there is a differential investment in community infrastructures and resources in neighborhoods that are mostly African-American. This differential investment is likely to influence disparities in rates of physical activity.

Translating research into practice: using concept mapping to determine locally relevant intervention strategies to increase physical activity.

PURPOSE: To translate intervention strategies to increase physical activity interventions recommended by the Community Guide for higher and lower income African-American adults living in an urban, Midwestern community. METHOD: Structured interviews were conducted with a stratified random sample of African-American men and women from high- and low-income groups. Data were analyzed using concept mapping, a six-step process that incorporates qualitative and quantitative analysis. RESULTS: The results suggest differences among men and women, high and low income, in the conceptualization of factors associated with physical activity behavior. The different conceptualizations suggest different intervention strategies and action steps may be necessary for subgroups of a population. CONCLUSION: Concept mapping is a participatory method that community members and health practitioners can use to develop locally defined intervention strategies. From the strategies and action steps identified, evidence-based interventions can be developed in light of the optimal characteristics necessary within a community.

Organizational capacity's effects on the delivery and outcomes of health education programs.

Community-based public health efforts to change health behaviors and health outcomes generally involve the implementation of complex, multipronged programs, which utilize many resources, both inside and outside a single community-based organization or agency. It is becoming more apparent that the organizational capacities of these agencies influence the implementation and success of health promotion programs. However, research is limited on the specific organizational capacities (e.g., resources, training, workload, trust, communication) that influence program implementation and, thus, the ultimate impact of these programs. This article seeks to address this gap in the literature by identifying organizational capacity variables that may have influenced the delivery of a dietary change program.