Implementation characteristics that may promote sustainability of a rural physical activity initiative: examination of Play Streets through the lens of community implementers.

BACKGROUND: Play Streets, which are community-based environmental initiatives where public spaces/streets are temporarily closed to create safe, low-cost physical activity opportunities, have demonstrated feasibility and physical activity benefit in rural US areas. Yet, information is needed to identify implementation characteristics that may promote sustainability. This study examined rural Play Streets implementation characteristics that could impact sustainability from local partners' perspectives. METHODS: Sixteen Play Streets implementation team members in rural Maryland, North Carolina, Oklahoma, and Texas, USA, participated in interviews. Semi-structured in-person individual and group interviews were conducted in the fall of 2018 (after Play Streets implementation in 2017 and 2018), recorded, and transcribed verbatim. Transcripts were analyzed using iterative, content analyses. Coding frameworks were based on the Public Health Program Capacity for Sustainability Framework, and emergent themes were also identified. RESULTS: Interviewees' perceived characteristics for facilitating Play Streets implementation aligned with the Public Health Program Capacity for Sustainability Framework: funding stability, political support, partnerships, organizational capacity, program adaption, and communication. Interviewees also noted the importance of cultural alignment/support and the reciprocal impact of community connectedness/engagement. CONCLUSIONS: Future research should examine the reciprocal role of public health impacts, as both outcomes and factors which may influence sustainability.

Identifying Social Network Characteristics Associated With Youth Physical Activity Skill Competency at a Summer Care Program.

While literature suggests that youth physical activity (PA) behaviors are affected by network influences, less is known about network influences on perceived skill competency, a component of physical literacy and self-efficacy. This study aims to provide an understanding of potential network characteristics which are associated with youth PA skill competency. Youth (n = 158) between the ages of 8 and 12 years recruited from two summer care programs (i.e., Boys & Girls Clubs) participated in researcher-administered surveys. Youth self-reported their age, sex, involvement in team sports, weekly PA, and skill competency assessed using a version of the PLAYself measure. Youth were also asked to report up to five people in the summer program and five out of the program with whom they interacted the most. Linear regression was used to evaluate associations between skill competency and demographics, PA, and social network characteristics. Skill competency was significantly associated (R2 = .17) with age (ß = -.06, p = .01), sex (ß = -.06, p = .01), sports team involvement (ß = .16, p < .001), and weekly PA (ß = -.20, p < .001). Skill competency was also significantly associated with the number of connections with whom the youth played frequently (ß = .09, p < .001), the number of connections that helped the youth to be active (ß = .18, p < .001), and the heterogeneity of the type of relationships within the youth's network (ß = .11, p < .001). Skill competency scores were significantly associated with both individual variables and social network composition. In addition, youth with networks comprising several types of relationships (heterogeneity) reported a significantly high skill competency. PA interventions can be most effective when considering the reinforcing aspects of networks and skill competency.

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.

Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth.

The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.

Prevalence of Meeting Aerobic, Muscle-Strengthening, and Combined Physical Activity Guidelines During Leisure Time Among Adults, by Rural-Urban Classification and Region - United States, 2020.

The healthful effects of physical activity on a multitude of physical and mental health outcomes are well documented (1). Despite promising increases in the percentage of U.S. adults meeting aerobic and muscle-strengthening physical activity guidelines (guidelines)* (1) during leisure time in nearly all demographic and regional subgroups 1998-2018 (2,3), differences by rurality and U.S. Census Bureau region (Northeast, Midwest, South, and West), persist (4). Before 2020, analyses of rural-urban differences were dichotomized into nonmetropolitan (rural) versus metropolitan (urban) areas; however, in 2020 a four-category rural-urban variable† to classify rural-urban status was included in the National Health Interview Survey (NHIS) public-use dataset. NHIS 2020 data were used to conduct multivariate logistic regression analyses by rural-urban status and U.S. Census Bureau region of the prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines during leisure time among adults aged ≥18 years, controlling for demographic characteristics. Prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines was consistently the lowest in Nonmetropolitan counties (38.2%, 21.1%, and 16.1%, respectively) and highest in the West region (52.1%, 35.3%, and 28.5%, respectively). Regardless of rural-urban classification and region, no more than 28% of adults met combined aerobic and muscle-strengthening guidelines. Adults in the most rural category were significantly less likely to meet aerobic, muscle-strengthening, and combined guidelines than were adults in each of the three other categories (adjusted odds ratio [aOR] range = 0.68-0.89). In addition, adults in medium and small metropolitan counties were less likely to meet guidelines than were adults in the two most urban categories (aOR range = 0.85-0.89). Adults in the Northeast, Midwest, and South U.S. Census Bureau regions were less likely to meet guidelines than were adults in the West region (aOR range = 0.75-0.82). These analyses identify geographic disparities in leisure-time physical activity where focused population-level intervention efforts could help reduce or eliminate the consequent disparities in chronic conditions (e.g., cardiovascular diseases) and the resulting mortality (5,6).

Rural Libraries as Resources and Partners for Outside Active Play Streets.

BACKGROUND: Urban and rural areas have different types of built environments and community infrastructure, which lead to different types of successful community-based physical activity initiatives. Temporary Play Streets are a supported way to increase physical activity and perceptions of the built environment as a space for active lifestyles. PURPOSE: Within the field of public health, public libraries constitute an underutilized community partner. To begin to understand the capacity of rural librarians to support rural Play Streets, a cross-sectional questionnaire was developed for distribution to rural librarians. METHODS: The sampling frame targeted members of the membership-based U.S. Association for Rural & Small Libraries (ARSL). Among respondents, 65% reported offering outdoor physical activity programs in the past, and 61% reported continuing to offer versions of this programming during the COVID-19 pandemic. Librarians work with a broad range of community partners on this programming, and already own much of the equipment necessary for a successful Play Streets initiative. CONCLUSIONS: The results of this study corroborate claims from previous research, which shows that in small and rural communities, public libraries have the capacity to play a role in promoting physical activity through involvement in community partnerships. Additional work is needed to understand, evaluate, and support this opportunity to weave rural librarians into community-based physical activity promotion efforts more fully.

The role of self-regulation strategies in physical activity behavior change: results from an exercise prescription program at a Federally Qualified Health Center.

Physical activity (PA) improves quality of life and prevents chronic disease, yet many adults are inactive. Planning with health care providers in the form of exercise "prescriptions" may increase PA, but the role of individual psychosocial factors within exercise prescription programs is not well understood. Therefore, the purpose of this study is to describe the role of self-regulation strategies (e.g., goal setting, self-monitoring, reinforcements) in PA behavior change within the context of an exercise prescription program. Patients at a large, Federally Qualified Health Center with an on-site exercise facility (ie, "Wellness Center") referral were eligible to exercise with a personal fitness advisor. Self-reported PA and use of 15 self-regulation strategies were measured via survey at two time points and merged with electronic health records and attendance data. Patients (n = 151) were, on average, 50.3 ± 13.3 years and mostly female (76.8%). Almost one-third (30.5%) were Hispanic/Latino, 48.3% were non-Hispanic Black, and 20.5% were non-Hispanic white. Participants completed 10.7 ± 12.0 in-person exercise sessions with a fitness advisor. Between baseline and follow-up, the self-regulation strategies that had the largest change in frequency over time were keeping track of PA (p < 0.001), thinking about surroundings (p < 0.001), rewarding yourself for PA (p < 0.001), making PA more enjoyable (p < 0.001), setting goals (p < 0.001), and trying different kinds of PA (p < 0.001). Among exercise prescription program participants, the total self-regulation strategies score was significantly associated with physical activity at follow-up (p = 0.04). Leveraging self-regulatory skill-building activities within the context of exercise prescription programs in clinical settings may provide a personalized and multicomponent approach to PA promotion. Self-regulation strategy training for fitness advisors and/or health care providers has great potential for supporting long-term health behaviors like PA for managing chronic disease among underserved patients.

Conducting Physical Activity Research on Racially and Ethnically Diverse Adolescents Using Social Network Analysis: Case Studies for Practical Use.

Adolescent physical activity (PA) is significantly impacted by peer behaviors through peer influence, peer selection, and popularity. However, the scales for these social constructs may not fully capture the detailed social networks and mechanisms responsible for PA behavior changes. This level of detail and granularity can be quantified and analyzed through social network analysis (SNA). To demonstrate the variety, utility, and efficacy of SNA in adolescent PA research, this article aims to provide four case studies on the collection of social network and PA data on ethnically and racially diverse adolescents. Through case studies, this article provides tangible ways in which SNA can be used to evaluate social influences on PA behaviors. Case studies are presented on: (1) Youth Engagement in Sport-an egocentric analysis of middle school youth participation in an experiential sport program with 3- and 6-month follow-ups; (2) Summer care program networks-an egocentric and whole network longitudinal study of adolescents at summer care programs; (3) The Convoy method-a qualitative egocentric discussion activity with adolescents from colonias on the Texas-Mexico border; and (4) A father-focused, family-centered health program-an egocentric experimental analysis of children participating in a health program. Data collection procedures are listed and example surveys are provided. Descriptive analyses are included, as are recommendations on further analysis techniques for each type of network data. Using SNA, researchers can understand social contexts in a more specific manner, better positioning interventions to alter such influences.

Promotoras de Salud in a Father-Focused Nutrition and Physical Activity Program for Border Communities: Approaches and Lessons Learned from Collaboration.

Promotoras de salud (promotoras) have been a valuable part of community research for Latino families, such as in the recruitment or delivery of health promotion programs. However, there has been limited discussion of how to integrate a promotora model into a father-focused program to support nutrition and physical activity within Latino families. This manuscript's purpose is to describe how to engage and collaborate with promotoras in a father-focused, family-centered program for Latino families living in colonias near the U.S.-Mexico border. As part of a longstanding community-academic partnership, the authors outline approaches and lessons learned from collaboration with promotoras during the design (including formative work and training), implementation, and evaluation of a behavioral program-¡Haz Espacio para Papi! (HEPP, Make Room for Daddy!). Promotoras' contributions supported the entire program, from design through evaluation. The team of all-female promotoras created a balance between the needs and preferences of the community and the goals and requirements of the research. While there is considerable time and human capital required for collaboration, the mutual benefits can make this work meaningful to all involved.

Lessons from sustainability of Play Streets in the United States.

Communities around the world lack safe places for children to play and be physically active. One solution to this issue is Play Streets, which involves the temporary closure of streets for several hours to create a safe space for active play and physical activity. While the benefits of these programs are greater when they are recurring over many years, there is a dearth of literature regarding how to successfully sustain Play Streets. To understand how Play Streets can be sustained in the long term, we conducted semi-structured interviews with 24 Play Streets organizers representing 22 Play Streets programs across the United States. Four recurring sustainability challenges were highlighted from the thematic analysis: 1) securing and sustaining funding, 2) managing community and city resistance to street closures, 3) navigating government bureaucracy, and 4) retaining interest amongst organizers and volunteers. With each challenge, we describe how Play Streets organizers navigated those challenges, with a goal of generating recommendations for those wishing to sustain Play Streets programs in the long term.

Summer Friends and Physical Activity: Social Network Effects on Child Self-Reported Physical Activity at Summer Care Programs.

Summer is a time of reduced physical activity (PA) for children; however, summer care programs (SCPs) can provide opportunities for children to be active and foster friendships. This study investigated associations between PA and friendship formation at SCPs. Children (ages 8-12 years) from two SCPs reported demographics, PA, and up to five friends at the program. Exponential random graph modeling determined significant factors associated with connections at each time point and between time points. PA was a significant factor in sending and maintaining friendship connections. A further understanding of the social dynamics which assist in the maintenance of PA behaviors during summer may improve the odds children engage in the recommended amounts of PA during this crucial time.

¿Qué Está Haciendo Papá? Mexican-Heritage Fathers' Physical Activity Networks After a Father-Focused Health Program.

Physical activity (PA) is a public health priority due to holistic health benefits; however, many adults do not meet PA guidelines. Few studies have examined Mexican-heritage fathers' social networks, specifically with whom they are physically active. This study examines changes in Mexican-heritage fathers' PA networks after participation in a father-focused, family-centered health program. Families consisting of child (aged 9-11 years), mother, and father were recruited from colonias on the Texas-Mexico border for participation in a 6-week father-focused, family-centered program concentrated on healthy eating and active living. Fathers reported up to 5 people with whom they were active most in the previous month before and after the program as well as how often they were active with the person and what activities they did most often. Multilevel regression models examined changes in networks. Fathers (n = 42; mean age = 39.07 years, SD = 7.45) were significantly more likely to report more frequent PA with others after the program as compared with before. General active play and conditional support were mentioned most frequently. This study provides context to the social networks and PA behaviors of Mexican-heritage fathers and suggests that a father-focused, family-centered health program can increase the PA frequency with social network connections.

Beyond Walking: An Assessment and Description of Streets as Potential Physical Activity Places in Low-Income Communities.

Low-income communities often have fewer quality community-level physical activity places (PAPs) or resources (e.g., parks, playgrounds). When present, barriers like traffic, distance, and crime often prevent access. Creative solutions and better understanding of current and potential realistic PAPs are necessary for children and families to be active. Streets are rarely considered potential PAPs despite their ubiquity and accessibility. This article describes street segments as potential PAPs in two low-income Mexican-heritage colonias communities along the Texas-Mexico border. Promotora-researchers conducted PAP assessments of all street segments (n=867) in the two communities to describe the availability and quality of their physical activity features (e.g., basketball hoops, bicycles), amenities (e.g., paved driveways, yard space), and incivilities (e.g., vandalism, loose dogs). Streets in these communities did contain features and amenities associated with physical activity promotion. On average, street segments had 6.10 (SD=7.20) physical activity-promoting features, 27.65 (SD=27.30) physical activity-promoting amenities, and both were assessed as good-to-fair quality. Future physical activity programming should consider incorporating streets as potential PAPs to enhance physical activity and active play. Further, evaluating streets as PAPs in this way may provide insight into locations for temporary place-based programs such as Play Streets. Future research should also examine residents' perceptions of their streets as PAPs for safe physical activity and active play, not just as places to walk, and which PAP characteristics matter for safe physical activity and active play to occur on streets.

I Play, You Play, We Play: Concurrent Activity at Play Streets.

Purpose: Despite multiple health benefits, many children and teens do not achieve recommended amounts of physical activity (PA). Temporary changes to the built environment like Play Streets, temporarily closing streets to create safe places to play, are one solution to encourage PA in summer months. Play Streets can promote social cohesion by creating opportunities for concurrent activity, being active in the same area simultaneously. This study assesses concurrent activity at Chicago PlayStreets. Methods: During summer 2018, the System for Observing Play and Recreation in Communities (SOPARC) and iSOPARC mobile application were used to measure PA at PlayStreets (n = 11) organized by eight community partners. Odds ratios were used to determine odds of observing an individual as active when in the same target area as another individual, and when in the same target area as an active individual, separated by sex and age categories. Results: Presence of an active individual significantly increased odds of observing an individual as active for several sex and age stratifications. Specifically, presence of active children or an active male adult significantly increased odds of observing children and teens as active. In contrast, presence of another person alone was not shown to significantly increase odds of observing an individual as active, except in two instances when stratified by sex and age. Conclusions: Active male adults have a significant positive impact on activity levels at PlayStreets underlining the importance of engaged male figures. Additionally, findings suggest that active children can promote PA among other children at PlayStreets.

Implementing Play Streets in Low-Income Rural Communities in the United States.

Play streets involve the temporary closure of streets that for a specified time create a safe place for active play. Play streets have been implemented primarily in cities; it is unknown if they could be adapted and implemented in rural areas. To learn about implementation, core components of play streets and inform adaptation, we conducted systematic peer-reviewed and grey literature searches and interviews with a purposive sample of key informants. Data were analyzed by theme and used to inform implementation of play streets by four community organizations in low-income rural areas of Maryland, North Carolina, Oklahoma, and Texas from June to September 2017. Core elements of play streets in urban areas were present in rural settings-the content (e.g., activities offered), delivery of the intervention in partnership with community members and local organizations, and reoccurrence of play streets at a single location. There were three key adaptations relating to delivery and context to consider uniquely when implementing play streets in rural areas (1) using locations other than streets, (2) varying locations to account for geographic dispersion, and (3) maximizing participation and resources by coupling play streets with community events. Play streets can be successfully implemented in rural settings with these modifications, which support feasibility, reach, and access. Play streets in rural areas should include activities for active play that are age-appropriate and fun, without necessarily tailoring content for rural areas.

Sport Participation Associations With Child Friend Selection and Physical Activity While at Summer Care Programs.

Child physical activity (PA) declines during summer reducing PA-related health benefits. Summer care programs (e.g., Boys & Girls Clubs) can promote active play while providing opportunities for friendships. Sport participation is a positive influence on PA and social development. Purpose: This article investigates the role of sport participation in PA attainment, perceived skill competency, and social connection at a summer care program. Methods: Children self-reported PA, sport participation, and the names of up to five peers whom they played with most at the program at the start (T1; n = 100; M age = 9.94 years; SD = 1.34; 47% male) and end (T2; n = 77; M age = 9.83 years; SD = 1.46; 51% male) of summer. Network autocorrelation models were used to determine if child sport participation was significantly associated with those they played with at the program. Results:Children who reported sport participation reported significantly more PA than those who did not at T1, but not T2. Child sport participation was significantly related to that of the peers they said they spent time with while at the program for T1 (ß = 0.07, p < .01), but not T2 (ß = 0.06, p = .10). Additionally, PA (ß = 0.08, p < .01; ß = 0.07, p = .01) and skill competency (ß = 0.11, p = .02; ß = 0.15, p < .01) were significantly associated with sport participation at both time points. While sports participation was a key factor in child friendships at the start of summer, the program allowed children, regardless of sport participation, to become friends outside of sports. Conclusions: These results suggest summer care programs promote PA through play and provide opportunities for children to facilitate friendships regardless of sport participation.

Real-Time Video Scan Method for Community Partner Use to Inform Play Streets Implementation.

System for Observing Play and Recreation in Communities (SOPARC) can provide accurate assessment of physical activity; however, the skills, time, and human resources necessary to collect/interpret SOPARC data can be challenging for community organizations. This article describes a more accessible adaptation of SOPARC using video recordings for community organizations to obtain physical activity feedback at Play Streets. Narrated panoramic video scans occurred every 30 minutes at each Play Street using an iPad. Videographers narrated: (1) sex, (2) age group (child, teen, adult, senior), and (3) activity level (sedentary, walking, vigorous) for everyone recorded. SOPARC video scans, in-person iSOPARC observations, and interviews were conducted with Play Streets implementors to determine validity and feasibility. Validity was examined using Lin's concordance correlation coefficient (CCC). In-person and video scans showed near perfect agreement for sedentary individuals (CCC = .95) and substantial agreement for active individuals (CCC = .72). Overall, community partners felt that they "could see how [the scans] could be useful" and "help[ed] see a bit more clearly what's happening." The method described here is a more accessible systematic observation approach to measure physical activity for communities implementing Play Streets. Further, this method can be used without research training while still providing valuable activity feedback.

What Sets Physically Active Rural Communities Apart from Less Active Ones? A Comparative Case Study of Three US Counties.

BACKGROUND: Rural US communities experience health disparities, including a lower prevalence of physical activity (PA). However, "Positive Deviants"-rural communities with greater PA than their peers-exist. The purpose of this study was to identify the factors that help create physically active rural US communities. METHODS: Stakeholder interviews, on-site intercept interviews, and in-person observations were used to form a comparative case study of two rural counties with high PA prevalence (HPAs) and one with low PA prevalence (LPA) from a southern US state, selected based on rurality and adult PA prevalence. Interview transcripts were inductively coded by three readers, resulting in a thematic structure that aligned with a Community Capital Framework, which was then used for deductive coding and analysis. RESULTS: Fifteen stakeholder interviews, nine intercept interviews, and on-site observations were conducted. Human and Organizational Capital differed between the HPAs and LPA, manifesting as Social, Built, Financial, and Political Capital differences and a possible "spiraling-up" or cyclical effect through increasing PA and health (Human Capital), highlighting a potential causal model for future study. CONCLUSIONS: Multi-organizational PA coalitions may hold promise for rural PA by directly influencing Human and Organizational Capital in the short term and the other forms of capital in the long term.

The Effects of Play Streets on Social and Community Connectedness in Rural Communities.

Promoting physical activity (PA) is a long-standing public health initiative to improve overall health and wellbeing. Innovative strategies such as Play Streets, temporary activation of public spaces to provide safe places for active play, are being adopted in urban and rural communities to increase PA among children. As part of these strategies, aspects of social and community connectedness may be strengthened. This study analyzes focus groups and interviews from rural Play Street implementation team members (n = 14) as well as adults (n = 7) and children (n = 25) who attended Play Streets hosted in rural North Carolina, Maryland, Oklahoma, and Texas to better understand the added benefits of Play Streets in community connectedness. Overall, elements of social support and social cohesion are mentioned most frequently with instrumental and conditional support; however, concepts of social capital, collective-efficacy, and social identification are also presented. Participants expressed that Play Streets provided more than just PA; they provided opportunities to access and share resources, build perceptions of safety and trust in the community, and develop relationships with others. Fostering community connection through Play Streets may reduce health inequities in rural communities by building community resilience. Community-based PA programming that enhance and capitalize on community connectedness could be effective ways to improving the overall health and wellbeing of residents.