Perspectives From Public Health Practitioners and Advocates on Community Development for Active Living: What are the Lasting Impacts?

PURPOSE: Evidence suggests differential impacts of community development, including gentrification and displacement. Public health practitioners and advocates are key stakeholders involved in the community development process related to active living, yet little is known about their perceptions of its impacts. We explored the perspectives of relevant leaders of public health departments and key community and advocacy organizations on community development, gentrification, and displacement. APPROACH: Purposive key informant interviews. SETTING: CDC State Physical Activity and Nutrition (SPAN) funding recipients. PARTICIPANTS: CDC SPAN recipient leadership (n = 10 of 16) and advocacy organizations they partnered with (n = 7 of 16). METHOD: Interviews were recorded, transcribed, coded, and thematically analyzed with direct quotes representing key themes. RESULTS: Both groups felt community development held important benefits, specifically by creating healthy living opportunities, but also potentially leading to the displacement of long-time residents. Practitioners reported the benefits were for all community members, whereas advocates noted the benefits were seen in those with privilege, and the consequences were disproportionately seen in disadvantaged communities. Both mentioned the importance and difficulty of getting diverse representation for community engagement. CONCLUSIONS: Learning how key stakeholders perceive and navigate the community development process can help inform recommendations for better equity in active living community improvements. More work is needed to further elucidate best practices for health and social equity in the community development process.

Pedestrian-oriented zoning moderates the relationship between racialized economic segregation and active travel to work, United States.

OBJECTIVE: Pedestrian-oriented zoning, including zoning code reforms (ZCR), may be especially beneficial to racially and economically segregated communities, which may lack built environment features that support physical activity. This study examined associations between racialized economic segregation, measured by quintiles of the Index of Concentration at the Extremes, and public transit (PTW) and active travel (ATW) to work, and whether associations were moderated by pedestrian-oriented zoning provisions and ZCR, respectively. METHODS: Zoning codes effective as of 2010 representing 3914 US municipalities (45.45% of US population) were evaluated for the presence of ZCR and eight pedestrian-oriented zoning provisions. These data were linked with American Community Survey 2013-2017 and NAVTEQ 2013 data on the outcomes and relevant covariates. Fractional logit regressions were computed with standard errors clustered on county. RESULTS: Workers from more deprived quintiles were less likely to engage in PTW and ATW (OR = 0.22-0.55, p < 0.01), and tests revealed moderation by zoning (p < 0.05). ZCR was positively associated with PTW for the three most deprived quintiles (OR = 1.53-2.38, p < 0.01), and with ATW for the two most deprived quintiles (OR = 1.42-1.69, p < 0.01) and the second most privileged quintile (OR = 1.26, p < 0.05). In the most privileged quintile, the zoning scale score was negatively associated with PTW (OR = 0.91, p < 0.001) and ATW (OR = 0.94, p < 0.01). However, in the most deprived quintiles, the zoning scale score was positively associated with PTW (Q2: OR = 1.13, p < 0.01) and ATW (Q1-Q2: OR = 1.07-1.09, p < 0.05). CONCLUSIONS: Pedestrian-oriented zoning can provide opportunities for ATW in the most deprived communities. Work is needed to explore zoning policy implementation in those communities.

Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity.

BACKGROUND: A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice. METHODS: Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice. RESULTS: When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms. CONCLUSIONS: To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts.

Healthy Community Design, Anti-displacement, and Equity Strategies in the USA: A Scoping Review.

Recent investments in built environment infrastructure to create healthy communities have highlighted the need for equity and environmental justice. Although the benefits of healthy community design (e.g., connecting transportation systems and land use changes) are well established, some reports suggest that these changes may increase property values. These increases can raise the risk of displacement for people with low incomes and/or who are from racial and ethnic minority groups, who would then miss out on benefits from changes in community design. This review scanned the literature for displacement mitigation and prevention measures, with the goal of providing a compilation of available strategies for a wide range of audiences including public health practitioners. A CDC librarian searched the Medline, EbscoHost, Scopus, and ProQuest Central databases, and we identified grey literature using Google and Google Scholar searches. The indexed literature search identified 6 articles, and the grey literature scan added 18 articles. From these 24 total articles, we identified 141 mitigation and prevention strategies for displacement and thematically characterized each by domain using an adapted existing typology. This work provides a well-categorized inventory for practitioners and sets the stage for future evaluation research on the implementation of strategies and practices to reduce displacement.

Examining the Associations of and Interactions Between Intrapersonal and Perceived Environmental Factors With Objectively Assessed Physical Activity Among Rural Midwestern Adults, USA.

PURPOSE: We investigated associations of intrapersonal and environmental factors with objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes, and their interactions in rural adults. DESIGN: Cross-sectional. SETTING: 14 rural towns participating in a multilevel intervention to promote physical activity. SAMPLE: Baseline data from 241 rural community members (19% losses due to missing data). MEASURES: Self-reported demographics, behavioral factors, and neighborhood environment perceptions. Weekly MVPA minutes were assessed using accelerometry data. ANALYSIS: Generalized linear models using a negative binomial distribution examined associations of and interactions between intrapersonal and environmental correlates with weekly MVPA. RESULTS: Older age (ß = -1.37; P= .025) and identifying as a woman (ß = -.71; p= <.001) were inversely associated with MVPA. Self-efficacy (ß = .34; p = <.001) and trail use (ß = .44; P-value = .003) were directly associated with MVPA. Further, among women, perceived safety from traffic was inversely associated with MVPA (ß = -.37; P = .003), while indoor recreational facility access was directly associated with MVPA (ß = .24; P = .045). CONCLUSIONS: Rural residents, especially women, face disproportionately lower MVPA levels. Improving recreational access and self-efficacy may be effective strategies for increasing MVPA.

Multilevel correlates of domain-specific physical activity among rural adults - a cross-sectional study.

BACKGROUND: Increasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities. METHODS: Surveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19-96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire. RESULTS: Rural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA. CONCLUSIONS: PA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults.

Exploring Residents' Perceptions of Neighborhood Development and Revitalization for Active Living Opportunities.

INTRODUCTION: Community fears of gentrification have created concerns about building active living infrastructure in neighborhoods with low-income populations. However, little empirical research exists related to these concerns. This work describes characteristics of residents who reported 1) concerns about increased cost of living caused by neighborhood development and 2) support for infrastructural improvements even if the changes lead to a higher cost of living. METHODS: Data on concerns about or support for transportation-related and land use-related improvements and sociodemographic characteristics were obtained from the 2018 SummerStyles survey, an online panel survey conducted on a nationwide sample of US adults (n = 3,782). Descriptive statistics characterized the sample, and χ2 tests examined associations among variables. RESULTS: Overall, 19.1% of study respondents agreed that development had caused concerns about higher cost of living. Approximately half (50.7%) supported neighborhood changes for active living opportunities even if they lead to higher costs of living. Prevalences of both concern and support were higher among respondents who were younger and who had higher levels of education than their counterparts. Support did not differ between racial or ethnic groups, but concern was reported more often by Hispanic/Latino (28.9%) and other non-Hispanic (including multiracial) respondents (25.5%) than by non-Hispanic White respondents (15.6%). Respondents who reported concerns were more likely to express support (65.3%) than respondents who did not report concerns (47.3%). CONCLUSION: The study showed that that low-income, racial, or ethnic minority populations support environmental changes to improve active living despite cost of living concerns associated with community revitalization.

Two-year outcomes of Faith in Action/Fe en Acción: a randomized controlled trial of physical activity promotion in Latinas.

BACKGROUND: Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas. METHODS: The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference. RESULTS: After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference. CONCLUSIONS: Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits. TRIAL REGISTRATION: NCT01776632 , Registered March 18, 2011.

Objective Measures of Physical Activity in Rural Communities: Factors Associated With a Valid Wear and Lessons Learned.

BACKGROUND: Compared with urban/suburban counterparts, rural communities experience lower rates of physical activity (PA) and higher rates of chronic disease. Promoting PA is important for disease prevention but requires reliable and valid measurement of PA. However, little is known about effectively collecting objective PA data in rural communities. Using data from a cluster randomized trial (Heartland Moves), which aims to increase PA in rural Missouri, this study explored factors associated with successful objective PA data collection and presents lessons learned. METHODS: Baseline survey and accelerometry data were collected through Heartland Moves (n = 368) from August 2019 to February 2021, in southeast Missouri. Chi-square and logistic regression analyses were used to explore factors (demographics, subjective PA, and SMS reminders) associated with valid wear of PA devices. RESULTS: Overall, 77% had valid wears. Participants who were not married (odds ratio [OR] 0.48, 95% confidence interval [CI], 0.30-0.79) and those living alone (OR 0.49, 95% CI, 0.30-0.81) were less likely to have valid wears. Participants who met PA guidelines (OR 1.69, 95% CI, 1.03-2.75) or received SMS reminders (OR 3.25; 95% CI, 1.97-5.38) were more likely to have valid wears. CONCLUSIONS: Results are supported by lessons learned, including importance of communication (SMS reminders), accessing hard-to-reach groups (living alone), and need to adapt during data collection.

El entorno construido en los programas diseñados para promover la actividad física entre las niñas, niños y jóvenes latinos que viven en Estados Unidos y América Latina.

Prevenir la obesidad entre los jóvenes latinos que viven en Estados Unidos y en países latinoamericanos requiere reconocer la especificidad de los contextos y las interacciones entre actividad física (AF) y entorno construido (EC). El objetivo de este artículo es avanzar en la agenda de investigación sobre el EC y la AF con el fin de prevenir la obesidad en Latinoamérica y entre los jóvenes latinos de Estados Unidos mediante (1) la identificación de indicadores del entorno que contribuyan en el diseño de intervenciones y políticas; (2) la identificación de enfoques metodológicos interdisciplinarios para el estudio de la relación compleja que se establece entre el EC y la AF y (3) la presentación de estudios de casos sobre programas de EC que promueven la AF. Un grupo de científicos estadounidenses y latinoamericanos trabajó en colaboración para proponer nuevos indicadores sobre el EC, establecer enfoques metodológicos que permitan estudiar la relación compleja entre EC y AF, y revisar estudios de caso sobre programas de EC que promueven la AF en ambas regiones. Como resultado, se identificaron lagunas de conocimiento, se propusieron indicadores del entorno (como el paisaje, el diseño de las calles, los patrones de movilidad, la delincuencia y la seguridad), se revisaron enfoques metodológicos (análisis de redes sociales, métodos de ciencia ciudadana) y se analizaron estudios de caso de programas del EC que promueven la AF (calles para el juego, desplazamiento activo a la escuela e intervenciones en el entorno escolar). La prevención de la obesidad entre los jóvenes latinos y latinoamericanos exige una investigación avanzada del EC y de la AF que aborde las prioridades específicas de cada contexto y permita intercambiar las lecciones aprendidas.

Built environment in programs to promote physical activity among Latino children and youth living in the United States and in Latin America.

To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA-promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA-promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA-promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context-specific priorities and exchanging lessons learned.

Building the capacity - examining the impact of evidence-based public health trainings in Europe: a mixed methods approach.

OBJECTIVE: Since 2002, a course entitled 'Evidence-Based Public Health (EBPH): A Course in Noncommunicable Disease (NCD) Prevention' has been taught annually in Europe as a collaboration between the Prevention Research Center in St Louis and other international organizations. The core purpose of this training is to strengthen the capacity of public health professionals, in order to apply and adapt evidence-based programmes in NCD prevention. The purpose of the present study is to assess the effectiveness of this EBPH course, in order to inform and improve future EBPH trainings. METHODS: A total of 208 individuals participated in the European EBPH course between 2007 and 2016. Of these, 86 (41%) completed an online survey. Outcomes measured include frequency of use of EBPH skills/materials/resources, benefits of using EBPH and barriers to using EBPH. Analysis was performed to see if time since taking the course affected EBPH effectiveness. Participants were then stratified by frequency of EBPH use (low v. high) and asked to participate in in-depth telephone interviews to further examine the long-term impact of the course (n = 11 (6 low use, 5 high use)). FINDINGS: The most commonly reported benefits among participants included: acquiring knowledge about a new subject (95%), seeing applications for this knowledge in their own work (84%), and becoming a better leader to promote evidence-based decision-making (82%). Additionally, not having enough funding for continued training in EBPH (44%), co-workers not having EBPH training (33%) and not having enough time to implement EBPH approaches (30%) were the most commonly reported barriers to using EBPH. Interviews indicated that work-place and leadership support were important in facilitating the use of EBPH. CONCLUSION: Although the EBPH course effectively benefits participants, barriers remain towards widely implementing evidence-based approaches. Reaching and communicating with those in leadership roles may facilitate the growth of EBPH across countries.

A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial.

BACKGROUND: Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents. METHODS/DESIGN: Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments. DISCUSSION: This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations. TRIAL REGISTRATION: Clinical Trials NCT03683173 , September 25, 2018.

Pay to Play? State Laws Related to High School Sports Participation Fees.

CONTEXT: Participation in high school sports can impact the physical and mental health of students and influence other positive social and economic outcomes. To maintain sports programs amidst school budget deficits, many districts are implementing sports participation fee policies. Although locally implemented, these district policies can be guided by state law. OBJECTIVE: The main objective of this study was to assess state laws and regulations related to high school sports participation fees. DESIGN: Codified statutes and administrative regulations were compiled for all 50 states and the District of Columbia using subscription-based services from LexisNexis and WestlawNext. A content assessment tool was developed to identify key components of school sports participation fee laws and used for summarization. Key components identified included legislation summarization, years in effect, whether it allows fees, whether there is any fee waiver, qualifications needed for fee waiver, whether there is a tax credit, and whether there is disclosure of implementation. State information was aggregated and doubled-coded to ensure reliability. RESULTS: As of December 31, 2016, 18 states had laws governing sports participation fees; 17 of these states' laws allowed for such fees, whereas 1 state prohibited them. Most laws give authority to local school boards to set and collect fees. The laws in 9 states have provisions for a waiver program for students who cannot pay the fees, although they do not all mandate the existence of these waivers. Other content within laws included tax credits and disclosure. CONCLUSION: This analysis shows that states with laws related to school sports participation fees varied in scope and content. Little is known about the implementation or impact of these laws at the local level and the effect of fees on different student population groups. This warrants future investigation.

Sub-population differences in the relationship between the neighborhood environment and Latinas' daily walking and vehicle time.

BACKGROUND: Over 60% of Latinas report not meeting moderate to vigorous physical activity (MVPA) guidelines of 150 minutes/week. Ecological models of health posit that intrapersonal and environmental factors interact with one another to influence physical activity. Understanding their interactions in relation to transportation behaviors may inform interventions to increase Latinas' physical activity. PURPOSE: To 1) objectively estimate walking and vehicle time in Latinas, 2) examine the association of, and interactions between, intrapersonal (socio-demographics and weight status) and neighborhood environmental correlates with objective daily walking and vehicle time. METHODS: A subsample of Latinas (n=87) participating in a health intervention wore an accelerometer and GPS device for at least two valid wear days at baseline. The Personal Activity Location and Measurement System (PALMS) software estimated daily walking and vehicle time. Participants' anthropometrics were measured, and they completed a survey assessing socio-demographic characteristics and perceived neighborhood environment. Generalized linear mixed models examined main effects and interactions of four intrapersonal and five environmental factors on daily walking and vehicle time. RESULTS: On average, participants walked 16 min/day and spent 69 min/day in a vehicle. Overweight/obesity was negatively associated with walking time (p=.04) and positively associated with vehicle time (p=0.01). Household income was positively associated with vehicle time (p=0.02). For daily walking time, two interactions were significant: perceived access to destinations X household income (p=0.01), and perceived sidewalk maintenance X acculturation (p= 0.01). For daily vehicle time, two interactions were significant: perceived access to destinations X weight status (p<0.001), and perceived safety from crime X education (p=0.01). CONCLUSION: Latinas participated in relatively low walking time and high amounts of vehicle time. Findings suggest intrapersonal sub-group differences in the association of the neighborhood environment with walking and vehicle time. Improving neighborhood environments to promote walking and reduce vehicle time may help improve Latinas' overall physical activity.

Perspectives on High School "Pay to Play" Sports Fee Policies: A Qualitative Study.

BACKGROUND: Participation in high school athletics is associated with many physical and psychosocial benefits. School budget cuts and increased program costs have resulted in policies requiring student athletes to pay fees for sports participation. The purpose of this study was to explore the implementation and perception of these policies among state and district key informants. METHODS: We conducted an Internet search to compile a list of state and district athletic directors for study recruitment to participate in qualitative interviews. Twelve key informants were interviewed via telephone, digitally audio-recorded, and the conversations transcribed verbatim. Two team members coded transcripts and themes were identified and summarized. RESULTS: The main reasons for implementing fee policies were increasing program costs, revenue loss or decreased school budget, and unsuccessful levy passage. The policies varied in fee structure, and were reported by sport, by athlete, by year, or by family. Participants discussed fee waivers as a strategy to assist athletes unable to pay the sports participation fees. Waivers were most likely linked with federal poverty qualifications. CONCLUSION: The results from these interviews provided insight into sports participation policies in US high schools. More information is needed to explore the consequences of these policies on high school sports participation as well as longer-term outcomes.

Fe en Acción: Promoting Physical Activity Among Churchgoing Latinas.

OBJECTIVES: To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. METHODS: We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. RESULTS: Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. CONCLUSIONS: A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.