Addressing the Gap Between Academic Research and Grassroots Public Health Practice: Supporting Policy, Systems, and Environmental Changes in Rural Communities.

Public health practice continues to expand beyond traditional partners to increase reach and impact in communities. This is particularly important in rural communities, who face inequities in the social determinants of health and increased chronic disease burden. However, the capacity for non-traditional community organizations to understand and implement public health work varies widely. Promoting policy, systems, and environmental change strategies (PSE's) is a promising method to support public health in rural communities, due to their variety, flexibility, and potential impact.Using a mixed methods approach to data analysis, we explore the barriers, challenges, and lessons learned from efforts in two rural Appalachian counties to stimulate use of PSE strategies through micro-funding. Several significant barriers were identified: challenges with evaluation and reporting, and lack of understanding and limited utilization of PSE strategies. Successful approaches to overcome these barriers included (1) changing reporting processes to reduce reliance on technology and shift reporting burden from community partners to researchers, (2) adapting data collection to capitalize on strengths of project partners, and (3) abandoning scientific language to embrace more common terminology used in communities. Policy changes were the least utilized strategy. This strategy may be less relevant in rural grassroots organizations with a small staff. Additional research into barriers to policy change is recommended. Enhanced training and support for grassroots, local-level PSE interventions could expand public health promotion in rural areas, reducing rural health disparities.

Home Gardening Resurgence During COVID: Motivations and Perceived Benefits of Participating in Grow This!

Gardening is associated with a wide array of health benefits. We describe the dissemination of a low-cost social media-based campaign (Grow This!), an intervention intended to reach novice gardeners and which combined elements of old (seeds) and new (Facebook) technology. Grow This! was implemented before (2018, 2019) and during (2020) the COVID pandemic, providing an interesting framework for understanding participants' motivations for gardening. Pre- and post-surveys assessed a variety of topics, including participants' motivations for participating in Grow This!, how they planned to participate, previous gardening experience, the main benefits attributed to participation, and intentions to garden in the future. Descriptive statistics and qualitative analysis were used to analyze the survey data. More than 25,000 people participated in Grow This! over the 3 years, with the majority (77%) participating as a family. Participation in the project spiked during COVID. Primary motivations for participating in Grow This! pre-COVID were education, enjoyment, family engagement, and self-sufficiency; during COVID, motivations remained the same, but shifted in rank. Just over a third of participants were novice gardeners. Participants attributed numerous benefits to their participation, including stress reduction/relaxation, more outdoor time, reduced grocery bills, and eating more fruits and vegetables than normal. A total of 83% of respondents reported being highly likely to have a garden in the future. Home gardening as an intervention is ripe for dissemination, particularly in the aftermath of COVID. Public health professionals can benefit from this understanding of people's motivations to garden and the perceived benefits associated with gardening.

Maximizing the Potential of Mini-Grants to Promote Policy, Systems, and Environmental Changes: Outcomes and Challenges.

PURPOSE AND OBJECTIVES: This article describes the implementation and evaluation of a chronic disease mini-grant initiative, coordinated by a state health department in collaboration with multiple stakeholders. Braided funding from federal and state sources was used to build and implement the initiative. INTERVENTION APPROACH: Mini-grants, facilitated by five different facilitating organizations, were funded to promote implementation of policy, systems, and environmental (PSE) changes at the local level. Grant recipients represented a variety of sectors, including education, government, and nonprofit organizations. EVALUATION METHODS: Primary (surveys) and secondary (final reports) data documented achievement of PSE changes. RESULTS: A total of $196,369 was dispersed to 65 organizations; 126 PSE changes in the areas of physical activity, nutrition, and tobacco were reported. Challenges in implementing and evaluating mini-grants were identified, including the heterogeneity of the sectors/settings involved and associated variability of proposed activities, time lines, measurement, and evaluation activities. COVID-19 (coronavirus disease 2019) also disrupted the plans for many projects. IMPLICATIONS FOR PUBLIC HEALTH: The success of this initiative can be attributed to four main elements: (1) the use of intermediary organizations to facilitate the mini-grants; (2) a participatory evaluation process, combined with early and ongoing communication among all stakeholders; (3) a braided funding strategy; and (4) a multisector approach that engaged both traditional and nontraditional public health organizations. The processes and outcomes, including challenges, can inform other state health departments' efforts in braiding funding and engaging intermediary organizations to expand the reach of PSE changes at the local level.

Environmental Factors Affecting Rural Physical Activity Behaviors: Learning from Community Partners.

BACKGROUND: Rural environments present many barriers to regular physical activity (PA), and residents who live in these communities are at higher risk for a variety of health issues. OBJECTIVES: We used community-based participatory research (CBPR) to guide the development of project interventions and enhance partnerships within the communities. METHODS: University-community partnerships, including Extension professionals, were used to gather data from twenty key informants in two West Virginia counties. RESULTS: Respondents identified "places" as both barriers (lack of access or quality) and assets in their communities. "Community culture" was identified as a significant barrier. Solutions that emerged from the data include "new/enhanced places" or "events/programs". CONCLUSIONS: These data supported the notion that there are unique social, cultural, and environmental factors affecting rural PA behavior. These interviews also contributed to increased capacity for local engagement and reinforced the need for community member leadership in the larger project.

Municipal Officials' Participation in Built Environment Policy Development in the United States.

PURPOSE: This study examined municipal officials' participation in built environment policy initiatives focused on land use design, transportation, and parks and recreation. DESIGN: Web-based cross-sectional survey. SETTING: Eighty-three municipalities with 50,000 or more residents in eight states. SUBJECTS: Four hundred fifty-three elected and appointed municipal officials. MEASURES: Outcomes included self-reported participation in land use design, transportation, and parks and recreation policy to increase physical activity. Independent variables included respondent position; perceptions of importance, barriers, and beliefs regarding physical activity and community design and layout; and physical activity partnership participation. ANALYSIS: Multivariable logistic regression models. RESULTS: Compared to other positions, public health officials had lower participation in land use design (78.3% vs. 29.0%), transportation (78.1% vs. 42.1%), and parks and recreation (67.1% vs. 26.3%) policy. Perceived limited staff was negatively associated with participation in each policy initiative. Perceptions of the extent to which physical activity was considered in community design and physical activity partnership participation were positively associated with participation in each. Perceived lack of collaboration was associated with less land use design and transportation policy participation, and awareness that community design affects physical activity was associated with more participation. Perceived lack of political will was associated with less parks and recreation policy participation. CONCLUSION: Public health officials are underrepresented in built environment policy initiatives. Improving collaborations may improve municipal officials' policy participation.

In-depth interviews with state public health practitioners on the United States National Physical Activity Plan.

BACKGROUND: The United States National Physical Activity Plan (NPAP; 2010), the country's first national plan for physical activity, provides strategies to increase population-level physical activity to complement the 2008 physical activity guidelines. This study examined state public health practitioner awareness, dissemination, use, challenges, and recommendations for the NPAP. METHODS: In 2011-2012, we interviewed 27 state practitioners from 25 states. Interviews were recorded and transcribed verbatim. Transcripts were coded using a standard protocol, verified and reconciled by an independent coder, and input into qualitative software to facilitate development of common themes. RESULTS: NPAP awareness was high among state practitioners; dissemination to local constituents varied. Development of state-level strategies and goals was the most frequently reported use of the NPAP. Some respondents noted the usefulness of the NPAP for coalitions and local practitioners. Challenges to the plan included implementation cost, complexity, and consistency with other policies. The most frequent recommendation made was to directly link examples of implementation activities to the plan. CONCLUSIONS: These results provide early evidence of NPAP dissemination and use, along with challenges encountered and suggestions for future iterations. Public health is one of eight sectors in the NPAP. Further efforts are needed to understand uptake and use by other sectors, as well as to monitor long-term relevance, progress, and collaboration across sectors.

Understanding physical activity outcomes as a function of teen smoking cessation.

OBJECTIVE: Recent evidence suggests physical activity may be protective against smoking initiation and increased smoking among youth. The present study explored the effects of a teen smoking cessation intervention supplemented with a physical activity module on participants' physical activity outcomes. A secondary aim examined the relationship between participants' physical activity outcomes and postprogram smoking intensity. DESIGN: The study reports primary data from a 3-arm randomized group trial consistent with CONSORT guidelines (Registry # NCT01242657). SETTING: Public high schools (N = 19) in West Virginia. PARTICIPANTS: Teens aged 14-19 years (N = 233) who reported current smoking, ≥1 cigarette in the past 30 days. INTERVENTION: High schools were randomly selected, then randomly assigned to Brief Intervention (standard of care), Not-On-Tobacco (N-O-T, teen cessation program), or N-O-T plus a physical activity module (N-O-T+FIT). OUTCOME MEASURES: Standardized instruments at baseline and end of treatment/3-months postbaseline measured physical activity outcomes. The study assessed smoking intensity using cigarettes smoked per day. We conducted ANCOVA controlling for school-level variance to measure physical activity changes. Multiple linear and logistic regression analyses explored favorable change influence of physical activity on smoking cessation outcomes, controlling for potential clustering. RESULTS: Teens who increased the number of days on which they received at least 20 minutes of exercise were significantly more likely to reduce their daily cigarette use, with those in the N-O-T+FIT condition having the highest likelihood of reducing smoking. Teens in the N-O-T+FIT condition who increased the number of days on which they received at least 30 minutes of exercise were significantly more likely than those in other groups to quit smoking. CONCLUSION: Findings suggest that it is possible to alter simultaneously more than one health behavior among teens-favorable changes in physical activity and smoking cessation may be particularly compatible targets for dual behavior change.

Active living collaboratives in the United States: understanding characteristics, activities, and achievement of environmental and policy change.

INTRODUCTION: Changing the built environment to promote active lifestyles requires collaboration among diverse sectors. Multisectoral collaborative groups in the United States promote active lifestyles through environmental and policy changes. The objective of this study was to examine the characteristics of these collaborative groups and the extent to which they have achieved change. METHODS: We identified, recruited, and interviewed the coordinators of active living collaborative groups in the United States. We used descriptive statistics to characterize groups by composition, stakeholder engagement, and the extent of environmental and policy change in 8 strategic areas. RESULTS: Fifty-nine groups from 22 states participated in the study. Most groups had a diverse set of partners and used a range of activities to advance their agendas. Most groups achieved some form of environmental or policy change. On average, groups reported working on 5 strategy areas; parks and recreation (86%) and Safe Routes to School (85%) were named most frequently. More than half of groups reported their environmental initiatives as either in progress or completed. Groups reported the most success in changing policy for public plazas, street improvements, streetscaping, and parks, open space, and recreation. Complete Streets policy and zoning ordinances were the most frequently cited policy types. Engaging in media activities and the policy-making process in addition to engaging stakeholders appear to influence success in achieving change. CONCLUSION: Although many groups successfully worked on parks and recreation improvements, opportunities remain in other areas, including transit and infill and redevelopment. Additional time and resources may be critical to realizing these types of changes.

Examination of trends and evidence-based elements in state physical education legislation: a content analysis.

OBJECTIVES: To develop a comprehensive inventory of state physical education (PE) legislation, examine trends in bill introduction, and compare bill factors. METHODS: State PE legislation from January 2001 to July 2007 was identified using a legislative database. Analysis included components of evidence-based school PE from the Community Guide and other authoritative sources: minutes in PE, PE activity, teacher certification, and an environmental element, including facilities and equipment. Researchers abstracted information from each bill and a composite list was developed. RESULTS: In total, 781 bills were analyzed with 162 enacted. Of the 272 bills that contained at least 1 evidence-based element, 43 were enacted. Only 4 bills included all 4 evidence-based elements. Of these 4, 1 was enacted. Funding was mentioned in 175 of the bills introduced (37 enacted) and an evaluation component was present in 172 of the bills (49 enacted). CONCLUSIONS: Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation.

The West Virginia Health Education Assessment Project.

Well-designed school health education should provide students with the knowledge and skills to prevent the health risk behaviors most responsible for the major causes of morbidity and mortality. This paper reports the methodology and findings of a West Virginia statewide health education assessment initiative and describes how the findings are used to design professional development training for school health educators. Selected response items from the State Collaborative on Assessment and Student Standards, Health Education Assessment Project were used to develop a 40-item assessment instrument for 6 health education content areas. In West Virginia, 51 counties and 242 schools were recruited (county response rate = 93%; school response rate = 53%); 17,549 students were tested in grades 6, 8, and high school health education classes. Mean total scores by grade were 30.61 (grade 6), 26.55 (grade 8), and 26.53 (high school), indicating a slight decline in scores as grade level increased. Females in each grade level scored higher on total Health Education Assessment Project (HEAP) scores and subtest scores than males. The results suggest notable differences across grade levels. High school students failed to meet the standard on any health education content areas, indicating the need for enhanced knowledge and skill development. During professional development training, HEAP scores were examined in the context of results from the West Virginia Youth Risk Behavior Survey to underscore the importance of providing quality skills-based health education in West Virginia schools.