Jeanette Gustat

Development of a Direct Observation Instrument to Measure Environmental Characteristics of Parks for Physical Activity

BACKGROUND The studys purpose is to describe the development and evaluate the reliability (inter-observer agreement) and validity (rater agreement with a gold standard) of a direct observation instrument to assess park characteristics that may be related to physical activity. METHODS A direct observation instrument of 181 items was developed based on a conceptual model consisting of the following domains: features, condition, access, esthetics, and safety. Fifteen pairs of observers were trained and sent to two parks simultaneously to assess two Target Areas each. RESULTS Overall domain reliability was 86.9%, and overall geographic area reliability was 87.5%. Overall domain validity was 78.7% and overall geographic area validity was 81.5%. CONCLUSIONS Inter-rater reliability and validity were generally good, although validity was slightly lower than reliability. Objective items showed the highest reliability and validity. Items that are time-sensitive may need to be measured on multiple occasions, while items asking for subjective responses may require more supervised practice.

Integrating Social Capital Into a Park-Use and Active-Living Framework

BACKGROUND Parks have been proposed as a feature of the built environment that may promote increased physical activity. Little, if any, research has investigated the role of the park social environment in promoting physical activity within parks, however. PURPOSE To examine whether social capital is a collective feature of the park environment and whether it is associated with park use and park-based physical activity. METHODS Adult park users (n=222) were surveyed in 27 neighborhood parks in New Orleans LA in July-August 2008. Direct observation methods were used to count the numbers and activity levels of all park users in these parks on weekdays during the hours of 4:00-7:00(PM). Multilevel linear regression models were used to calculate the intraclass correlation (ICC), which measures the variation in perceived social capital attributable to differences among parks and to test whether park use and physical activity outcomes differed between parks with high versus low levels of social capital. Analyses were conducted in 2009-2010. RESULTS In study parks, 27% of perceived social capital was attributable to differences among parks (ICC=0.27). Parks with higher levels of social capital had higher daily numbers of observed park users (42.5 vs 12.1, p=0.0044) and had more energy expended within the park (3200.3 vs 721.2 MET-minutes across all park users, p=0.0087). CONCLUSIONS Interventions to improve park social environments should be conducted to determine if they promote increased physical activity among park users.

The role of park conditions and features on park visitation and physical activity.

BACKGROUND Neighborhood parks play an important role in promoting physical activity. We examined the effect of activity area, condition, and presence of supporting features on number of park users and park-based physical activity levels. METHODS 37 parks and 154 activity areas within parks were assessed during summer 2008 for their features and park-based physical activity. Outcomes included any park use, number of park users, mean and total energy expenditure. Independent variables included type and condition of activity area, supporting features, size of activity area, gender, and day of week. Multilevel models controlled for clustering of observations at activity area and park levels. RESULTS Type of activity area was associated with number of park users, mean and total energy expenditure, with basketball courts having the highest number of users and total energy expenditure, and playgrounds having the highest mean energy expenditure. Condition of activity areas was positively associated with number of basketball court users and inversely associated with number of green space users and total green space energy expenditure. Various supporting features were both positively and negatively associated with each outcome. CONCLUSIONS This study provides evidence regarding characteristics of parks that can contribute to achieving physical activity goals within recreational spaces.

Effect of Bike Lane Infrastructure Improvements on Ridership in One New Orleans Neighborhood

BackgroundIncorporating cycling into daily life is one way to increase physical activity.PurposeThis study examined the impact of building new bike lanes in New Orleans to determine whether more people were cycling on the street and with the flow of traffic after bike lanes were built.MethodsThrough direct observation of one intervention and two adjacent streets, observers counted cyclists riding on the street and sidewalk, with and against traffic, before and after installation of the lanes. Data were tallied separately for adults, children, males, females, and by race for each location.ResultsThere was an increase in cyclists on all three streets after the installation of the bike lanes, with the largest increase on the street with the new lane. Additionally, the proportion of riders cycling with traffic increased after the lanes were striped.ConclusionsBike lanes can have a positive impact in creating a healthy neighborhood.

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.

Escaping to and being active in neighbourhood parks: park use in a post-disaster setting

Neighbourhood parks may serve as a coping resource in post-disaster communities, yet little is known about the impact of large-scale disasters on park use. The objective of this study is to explore the impact of Hurricane Katrina (August 2005) on park use by visitors from flooded areas of New Orleans, Louisiana, compared to visitors from non-flooded areas. In 2006 and 2007, following Hurricane Katrina, 201 adults who visited 27 New Orleans parks were interviewed. Visitors from flooded neighbourhoods used their parks less often and were less likely to engage in animal interaction than visitors from non-flooded neighbourhoods. They placed more importance on escape and physically-active motivations than visitors from non-flooded areas. Social reasons were also more important to visitors from flooded areas, but these differences disappeared after adjusting for race. Neighbourhood parks are a community asset that may play a role in the post-disaster recovery process by providing opportunities for escape and physical activity.

Co-Occurrence of Trichomonas vaginalis and Bacterial Vaginosis and Vaginal Shedding of HIV-1 RNA

Background Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA. Methods HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions. Results In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78–9.37), 5.65 (95% CI, 2.64–12.01), and 18.63 (95% CI, 6.71–51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load. Conclusions T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.

Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets

Background Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce. Methods A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects. Results In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips. Conclusion The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce.

Evaluating policy, systems, and environmental change interventions: Lessons learned from CDC's prevention research centers

Introduction The field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention’s (CDC’s) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions. Methods Seven Prevention Research Centers (PRCs) applied CDC’s framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned. Results Evaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences. Conclusion Framework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors.

Opportunity Meets Planning: An Assessment of the Physical Activity Emphasis in State Obesity-Related Plans

BACKGROUND In the United States, health promotion efforts often begin with state-level strategic plans. Many states have obesity, nutrition, or other topic-related plans that include physical activity (PA). The purpose of this study was to assess PA content in these state plans and make recommendations for future plan development. METHODS Publically available plans were collected in 2010. A content analysis tool was developed based on the United States National PA Plan and included contextual information and plan content. All plans were double coded for reliability and analyzed using SPSS. RESULTS Forty-three states had a statewide plan adopted between 2002 and 2010, none of which focused solely on PA. Over 80% of PA-specific strategies included policy or environmental changes. Most plans also included traditional strategies to increase PA (eg, physical education, worksite). Few plans included a specific focus on land use/community design, parks/recreation, or transportation. Less than one-half of plans included transportation or land use/community design partners in plan development. CONCLUSIONS Though the majority of states had a PA-oriented plan, comprehensiveness varied by state. Most plans lacked overarching objectives on the built environment, transportation, and land use/community design. Opportunities exist for plan revision and alignment with the National PA Plan sectors and strategies.