Diverse school community engagement with the North Carolina active routes to school project: a diffusion study.

BACKGROUND: Schools located in rural parts of the United States and North Carolina have benefited proportionally less from the federal Safe Routes to School (SRTS) program than their more urban counterparts. We investigated whether and how diverse elementary and middle school communities throughout North Carolina have engaged in a SRTS-inspired, multi-sectoral initiative called the Active Routes to School (ARTS) project over the course of 5 years (2013 through 2017). METHODS: Analyses included a study sample of 2602 elementary and middle schools in North Carolina, 853 that participated in the ARTS project over the five-year study period and 1749 that had not. Statistical models controlling for county- and school-level confounders predicted schools' involvement in walking and bicycling-promotive events, programs, and policies over time. RESULTS: Schools' engagement with ARTS Project programming increased significantly over the study period, with 33% of eligible schools participating with the project by the end of 2017. Participation was most common in promotional events. Such event participation predicted engagement with regularly recurring programming and school- and district-level establishment of biking- and walking-facilitative policies. Lower income schools were more likely to establish recurring bike and walk programs than wealthier schools, whereas rural schools were less likely than city schools to participate in promotional events, yet equally as likely as other schools to participate in recurring bike and walk programs. CONCLUSIONS: Schools' engagement with the North Carolina ARTS Project diffused despite many schools' rural geographies and lower socioeconomic status. Further, participation in one-time promotional events can portend schools' establishment of recurring walking and biking programs and supportive policies.

Cost-effectiveness of Community-Based Minigrants to Increase Physical Activity in Youth.

CONTEXT: American youth are insufficiently active, and minigrant programs have been developed to facilitate implementation of evidence-based interventions in communities. However, little is known about the cost-effectiveness of targeted minigrant programs for the implementation of physical activity (PA) promoting strategies for youth. OBJECTIVE: To determine the cost-effectiveness of a minigrant program to increase PA among youth. DESIGN: Twenty community grantees were pair-matched and randomized to receive funding at the beginning of year 1 (2010-2011) or year 2 (2011-2012) to implement interventions to increase PA in youth. Costs were calculated by examining financial reports provided by the granting organization and grantees. SETTING: Twenty counties in North Carolina. PARTICIPANTS: A random sample of approximately 800 fourth- to eighth-grade youth (per year) from the approximately 6100 youth served by the 20 community-based interventions. MAIN OUTCOME MEASURE: Cost-effectiveness ratios (CERs) were calculated at the county and project levels to determine the cost per child-minute of moderate-to-vigorous PA (MVPA) increased by wave. Analyses were conducted utilizing cost data from 20 community grantees and accelerometer-derived PA from the participating youth. RESULTS: Of the 20 participating counties, 18 counties displayed increased youth MVPA between at least 2 waves of observation. Of those 18 counties, the CER (US dollars/MVPA minutes per day) ranged from $0.02 to $1.86 (n = 13) in intervention year 1, $0.02 to $6.19 (n = 15) in intervention year 2, and $0.02 to $0.58 (n = 17) across both years. CONCLUSION: If utilized to implement effectual behavior change strategies, minigrants can be a cost-effective means of increasing children's MVPA, with a low monetary cost per minute of MVPA.

Effectiveness of Community-Based Minigrants to Increase Physical Activity and Decrease Sedentary Time in Youth.

OBJECTIVE: To determine the effectiveness of targeted grant funding for the implementation of multilevel community interventions to increase moderate to vigorous physical activity (MVPA) and decrease time spent sedentary among a large sample of youth in North Carolina. DESIGN: A repeated, cross-sectional, group-randomized controlled trial design with a delayed treatment group. SETTING: Twenty counties in North Carolina. PARTICIPANTS: Analyses were conducted on 2138 youth, grades 4 to 8, who provided complete data across the 3 waves. INTERVENTION: The North Carolina Eat Smart, Move More Community Grants program consisted of 20 separate community interventions implemented by grantees that targeted increasing physical activity and/or decreasing sedentary time in youth. County grantees were pair-matched and randomized to receive funding for implementation in year 1 (2010-2011) or year 2 (2011-2012). MVPA/sedentary time was assessed via accelerometer with demographics assessed via self-report in 3 waves of data collection (fall 2010, 2011, and 2012). MAIN OUTCOME MEASURE: MVPA and sedentary time measured via accelerometry. RESULTS: After adjusting for covariates, there was no difference in MVPA between counties implementing in year 1 (2010-2011) and those implementing in year 2 (2011-2012; ie, waitlist controls) comparing data collection wave 1 to wave 2 (fall 2010-2011). A significant increase of 2.32 minutes per day of MVPA was observed following the implementation year across all counties as compared with the baseline year. Differences were largely driven by increased MVPA in elementary school youth (fourth and fifth grades). No significant changes in sedentary time were observed. CONCLUSIONS: Low-cost, high-reach mini-grants can have a small, but meaningful effect on children's MVPA, with greater effects seen in younger children. Future studies should examine characteristics of mini-grants projects that are associated with the greatest increases in MVPA among youth.

Lessons learned from a collaborative field-based collection of physical activity data using accelerometers.

CONTEXT: Recent improvements in the accuracy and availability of accelerometers present an opportunity to increase the validity of physical activity assessment. While use of these devices is now pervasive among researchers, accelerometers have not been widely used by community-based public health practitioners. OBJECTIVE: To present a case example of field-based data collection using accelerometers with youth. METHOD: A collaborative research team, including state- and county-level public health practitioners and university researchers, collected accelerometer data from 1313 youth, aged 9 to 14 years, in 20 North Carolina counties. RESULTS: This case example highlights some considerations for how to improve communication and streamline data collection logistics within a multidisciplinary research team. It demonstrates that a collaborative model can make objective physical activity evaluation feasible in community settings with limited resources. CONCLUSIONS: Lessons learned by our research team about coordinating the logistics of accelerometer use and scheduling a large-scale data collection in multiple sites can be adapted by other researchers and community-based practitioners who aim to evaluate physical activity using accelerometers or other mobile data collection devices.

Characteristics of successful community partnerships to promote physical activity among young people, North Carolina, 2010-2012.

INTRODUCTION: Success of community-based projects has been thought to hinge on the strength of partnerships between those involved in design and implementation. However, characteristics of successful partnerships have not been fully described, particularly in the context of community-based physical activity promotion. We sought to identify characteristics of successful partnerships from the perspective of project coordinators involved in a mini-grant program to promote physical activity among young people. METHODS: Semistructured qualitative interviews were conducted with county coordinators (n = 19) of 20 North Carolina's "Eat Smart, Move More" Community Grants projects funded during 2010 through 2012. Emergent themes were coded; then, overarching themes in the coded data were identified and grouped with similar codes under thematic headings. On the basis of project coordinators' responses, each partnership was classified as strong, moderate, or weak. RESULTS: Three overarching themes characterized partnership relationships: continuity (history with partner and willingness to engage in a future partnership), community connectedness, and capacity (interest, enthusiasm, engagement, communication, and clarity of roles and responsibilities). Strong partnerships were those in which project coordinators indicated a positive working history with partners, experienced a high level of engagement from partners, had clearly defined roles and responsibilities of partners, and expressed a clear interest in working with their partners in the future. CONCLUSION: In community partnerships aimed at increasing physical activity among young people, the perspectives of project coordinators are vital to identifying the characteristics of strong, moderate, and weak partnerships. These perspectives will be useful for future community program development and will influence potential health outcomes.

Day of the week is associated with meeting physical activity recommendations and engaging in excessive sedentary time in youth.

BACKGROUND: Most youth fail to achieve 60 minutes of moderate-to-vigorous physical activity (MVPA) daily while engaging in excessive amounts of sedentary behaviors. The objective of this investigation was to identify modifiable factors associated with meeting MVPA recommendations or engaging in greater than 55% of observed time sedentary. METHODS: Youth (N = 1005, 10.5 yrs, 52% girls) wore accelerometers with daily minutes of MVPA (≥ 2296 counts · min(-1)) classified as ≥ 60 min s/d vs. < 60 min/d of MVPA. Sedentary behavior (< 100 counts · min(-1)) was classified as < 55% or ≥ 55% of total wear-time. Two-level random effects logit survival models for repeated events (days of monitoring) examined the association of psychosocial self-report measures and demographic characteristics to meeting the MVPA recommendation and spending ≥ 55% of time sedentary. RESULTS: Wednesdays, Thursdays, and Sundays were associated with a decreased likelihood of meeting MVPA recommendations relative to Mondays. Wednesday thru Sunday were associated with a decreased likelihood of spending ≥ 55% of time sedentary. Being a boy, receiving transportation, and fewer reported barriers to physical activity were associated with meeting MVPA recommendations. CONCLUSIONS: Relatively few youth are engaging in recommended levels of physical activity. Provision of transportation and reduction of barriers to physical activity are relevant targets for physical activity promotion.

Comparison of objectively measured physical activity levels of rural, suburban, and urban youth.

BACKGROUND: Nationally, youth are generally not achieving 60 minutes of daily moderate-to-vigorous physical activity (MVPA). Studies suggest that rural adults are less active than their urban counterparts, although studies of children are equivocal. PURPOSE: To compare objectively measured physical activity across the rural-urban continuum in a sample of fourth- to eighth-grade youth. METHODS: In fall 2010, youth from 20 North Carolina counties wore an accelerometer a minimum of 4 monitored days (n=804, 54% female, 25% African American, 54% urban). In spring 2013, two random-effects regression models were estimated separately for boys and girls. Comparisons among minutes of MVPA/day continuous and binary (≥60 minutes vs <60 minutes MVPA/day) among rural, suburban, and urban children were made, controlling for race, monitor wear time, and grade. RESULTS: For boys, there were no differences in MVPA/day among urbanicity categories. However, a 4.2 minutes/day decrease in MVPA occurred with each increase in grade. For girls, rural girls accumulated 9.3 minutes MVPA/day and 8.0 minutes MVPA/day more than suburban and urban girls, respectively. A 3 minutes/day decrease in MVPA occurred with each increase in grade. Rural girls were 4.6 times and 2.8 times more likely to accumulate ≥60 minutes MVPA/day compared to suburban and urban girls, respectively. No interactions across all models were significant for boys or girls. CONCLUSIONS: The relationship between urbanicity and MVPA in youth appears to be more complex than previously envisioned. Rural residence appears to be supportive of MVPA in girls but not boys. Future research should consider urbanicity when investigating correlates/determinants of MVPA in youth.

Sex moderates associations between perceptions of the physical and social environments and physical activity in youth.

PURPOSE: To determine if the sex of the child moderates the relationships between perceptions of the physical/social environments and moderate to vigorous physical activity (MVPA) in youth. DESIGN: Cross-sectional. SETTING: North Carolina. SUBJECTS: A final sample of 711 children, 8 to 17 years of age, was available for analysis. MEASURES: Self-reported presence of environmental factors previously identified to be associated with physical activity in youth was collected via survey. Daily MVPA was assessed via accelerometry for a minimum of 4 days. ANALYSIS: Multilevel linear regression models were employed, adjusted for clustering at the county and individual level. MVPA was first regressed onto sex and environmental perception items while controlling for grade and race. The interaction term between sex and environmental perception was then added to the model. RESULTS: A significant positive association was observed in the first models between MVPA and two items related to parent permission to (1) walk and (2) ride a bike in the neighborhood. These effects were fully moderated by sex, with males indicating "yes" on these items exhibiting 6.87 and 5.21 more minutes of MVPA (respectively) than males indicating "no." CONCLUSION: Environmental perceptions appear to be related to MVPA, but this relationship is present only in males. Future research should be conducted to identify modifiable social and physical characteristics that are associated with MVPA in females.