Physical Activity Policy, Systems, and Environment Change Through Extension SNAP-Ed: A Multistate Perspective.

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) provides nutrition education and support for healthy living in SNAP-qualifying communities. SNAP-Ed supports policy, systems, and environmental (PSE) efforts to make the healthy choice an easier choice. SNAP-Ed implementers have widely adopted healthy eating PSE supports. However, physical activity (PA) PSE strategies are less common, with limited awareness between states of how other SNAP-Ed implementers approach PA-focused PSE work. Physical Activity Policy, Research, and Evaluation Network (PAPREN) Rural Active Living Workgroup project members sought to explore how Extension-based SNAP-Ed implements PA-focused PSE approaches. A sample of Extension-based SNAP-Ed program (n = 8) leaders were purposefully recruited from eligible universities in six of the seven SNAP-Ed regions. An interview guide to systematically collect information about current Extension SNAP-Ed implementation focused on PA PSE strategies was developed iteratively by the PAPREN Rural Active Living Workgroup Extension PA PSE project team. PA PSE Extension SNAP-Ed implementation efforts occurred at the state, county, and community levels and/or within local organizations. PA PSEs included school PA policy change, shared-use agreements, active transportation promotion, park development, walking challenges, and PA-promoting signage. All interviews highlighted the importance of partnerships at local, county, and state levels for PSE efforts. Extension-based SNAP-Ed shows potential to bring community partners together to plan and implement PA-focused PSE approaches. With a focus on SNAP-eligible people and substantial geographic reach, Extension SNAP-Ed is uniquely situated as a public health partner to broadly implement PA PSE changes.

Empty Houses, Loose Dogs, and Engaged Citizens: Lessons Learned From Community Participatory Data Collection in Rural Areas.

Rural surveys tend to oversample easy to reach populations, which can misrepresent community health needs. To achieve baseline data reflective of the communities served by the high obesity program (HOP), an innovative evaluation plan was created to prioritize equity and reflect the whole community. Principles of Community-Based Participatory Research (CBPR) were used to guide instrument development, research protocols, and data collection. A random sample of addresses created with United States Postal Service records provided a representative list of addresses in three HOP counties in Louisiana. Local data collectors were recruited to go door to door at the selected addresses to collect in-person surveys (N = 682; response rate of 84%). Over a quarter of participants reported using the charitable food system and walking for transportation at least weekly. Collecting door to door data in rural communities presents unique challenges, including abandoned properties, inaccurate address records, loose dogs, and at times, racial tensions and houses far removed from public roads. Lessons learned include the importance of local knowledge, adapting protocols to fit local conditions, and community awareness of the survey. Health practitioners need confidence when they are making data-based decisions about interventions, and one way to provide this confidence is to collect data from a true cross-section of the community. With a plan and in partnership with community members, a probability sample is feasible to collect in rural communities.

Active transportation and social capital: The association between walking or biking for transportation and community participation.

Active transportation provides benefits to communities and individuals, yet little is known about its relationship with social capital. This study examined relationships between active transportation behavior and three indices of social capital (community participation, sense of community, and sociopolitical control). Linear regression was used to assess cross-sectional data (N = 1700) from the Survey of the Health of Wisconsin, a population-based representative sample collected in 2014, 2015, and 2016. Active transportation was associated with greater levels of community participation (p = 0.012). The association between active transportation and community participation was the third largest in terms of standardized coefficient (ß = 0.07), following only age and college degree or greater educational attainment. Active transportation was not significantly associated with sense of community or sociopolitical control. All models controlled for confounding background characteristics. These findings are important for policy and planning work, as designing supportive environments and removing barriers to active transportation can foster social capital through bolstering community participation. The benefits of active transportation may be broader than previously understood and underscore the need to promote active transportation.

Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities.

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents' perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security.

Implementing Policy, Systems, and Environmental Change Through Community Coalitions and Extension Partnerships to Address Obesity in Rural Louisiana.

Community coalitions and agents funded by the Louisiana State University Agricultural Center's Healthy Communities program implemented multilevel obesity prevention interventions in 3 rural parishes (ie, counties) with an obesity prevalence of 40% or higher. The Healthy Communities coalitions appraised local health concerns through needs assessments and community forums. On the basis of local needs and the evidence base, the coalitions identified and implemented policy, systems, and environmental (PSE) strategies and supporting education to promote healthy behavior change among residents, overcoming barriers in the process. Interventions varied by parish but included Complete Streets implementation plans, healthy retail initiatives, play space improvements, downtown beautification projects, and Smarter Lunchrooms.

Breastfeeding and the Role of Maternal Religion: Results From a National Prospective Cohort Study.

Background: Recent research on religion and breastfeeding from a low-income, urban sample in the USA found that religious affiliation and religious attendance were associated with breastfeeding initiation. Purpose: We assessed the relationship between religion (religious affiliation and religious attendance) and breastfeeding (initiation and duration) in a nationally representative prospective cohort study. We examined whether education and other sociodemographic characteristics mediated or moderated relationships. Methods: Using data from the National Longitudinal Survey of Youth 1979 (n = 3,719), we regressed breastfeeding initiation and breastfeeding duration for first births on religious affiliation and religious attendance, comparing conservative Protestants with other religious groups. Sociodemographic characteristics were explored as potential mediators or moderators of relationships. Results: Other than black Protestants, all religious groups reported higher odds of breastfeeding initiation compared to conservative Protestants (odds ratios = 1.43-3.01; p < .01 for all). All groups also breastfed longer than conservative Protestants, with the exception of black Protestants and Catholics. Educational attainment explained breastfeeding initiation differences with the exception of nonaffiliates and "other" religious affiliates. Educational attainment also explained religious group breastfeeding duration differences with the exception of nonaffiliates. In our final models, regular religious attendance was not directly associated with breastfeeding, but it magnified the breastfeeding duration advantage seen among mothers who had a later age at first birth. Conclusions: The role of educational attainment in explaining breastfeeding differences between conservative Protestants and other groups suggests that educational interventions may be beneficial within this population.