Laura K. Brennan

Environmental and Policy Determinants of Physical Activity in the United States

OBJECTIVES This study examined (1) descriptive patterns in perceived environmental and policy determinants of physical activity and (2) associations between these factors and behavior. METHODS A cross-sectional study was conducted from 1999 to 2000 among US adults; individuals at lower income levels were oversampled. RESULTS Availability of areas for physical activity was generally higher among men than among women. The 4 most commonly reported personal barriers were lack of time, feeling too tired, obtaining enough exercise at ones job, and no motivation to exercise. Neighborhood characteristics, including the presence of sidewalks, enjoyable scenery, heavy traffic, and hills, were positively associated with physical activity. There was a high level of support for health policy-related measures. Up to one third of individuals who had used environmental supports reported an increase in physical activity. CONCLUSIONS An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions.

Accelerating Evidence Reviews and Broadening Evidence Standards to Identify Effective, Promising, and Emerging Policy and Environmental Strategies for Prevention of Childhood Obesity

The childhood obesity epidemic has stimulated the emergence of many policy and environmental strategies to increase healthy eating and active living, with relatively few research recommendations identifying the most effective and generalizable strategies. Yet, local, state, and national decision makers have an urgent need to take action, particularly with respect to lower-income and racial and ethnic populations at greatest risk. With the surge of promising and emerging policy and environmental strategies, this review provides a framework, criteria, and process modeled from existing expert classification systems to assess the strength of evidence for these strategies. Likewise, this review highlights evidence gaps and ways to increase the types and amount of evidence available to inform policy and environmental strategies. These priorities include documenting independent and interdependent effects, determining applicability to different populations and settings, assessing implementation fidelity and feasibility, identifying cumulative benefits and costs, ascertaining impacts on health equity, and tracking sustainability.

Opportunities for integrating public health and urban planning approaches to promote active community environments.

The growing emphasis on promoting environmental change as a means to increase physical activity has motivated conversation and collaboration between researchers and practitioners in the fields of public health and urban planning. Although these fields share similar objectives, their methodological approaches for examining the association between the environment and behavior often differ in significant ways. To facilitate communication, this article discusses ways these fields can collaborate in developing and applying conceptual frameworks, adopting behavioral and environmental measures, and strengthening study designs. By collaborating to build synergism in research and dissemination, public health and urban planning professionals can enhance efforts to increase the number of communities that promote active living.

Linking Perceptions of the Community to Behavior: Are Protective Social Factors Associated with Physical Activity?

Although the relationship of psychosocial factors to physical activity has been explored, there is increased interest in how perceptions of the community environment influence behavior.However, few methodological studies have incorporated perceptions of the social and community environment (protective social factors) or addressed key measurement issues.Computer-assisted telephone interviews were administered to a national sample of 1, 818 U.S.adults.Unadjusted and multivariate-adjusted odds ratios were calculated to compare active and inactive participants by Protective Social Factors (PSF) scores and selected sociodemographics. Confirmatory factor analysis and reliability analysis suggested strong PSF scale psychometric properties (• =. 92). After adjustment for potential confounders, a 10-point rise in the PSF score resulted in a 12% increased likelihood of meeting Centers for Disease Control and Prevention/American College of Sports Medicine recommendations. Additional analyses indicated that greater perceived PSFs were associated with meeting these recommendations among Whites but not among African Americans.

Identifying the Role of Community Partnerships in Creating Change to Support Active Living

BACKGROUND Active Living by Design (ALbD) partnerships were established to change environments and policies as well as support complementary programs and promotions to increase physical activity in 25 communities across the U.S. PURPOSE This paper summarizes the structural and functional aspects of partnerships identified as having a substantial influence on these initiatives. METHODS A mixed-methods evaluation included qualitative (e.g., key informant interviews, focus groups) and quantitative (e.g., survey, web-based tracking) methods. Data were collected from 2003 to 2008, systematically analyzed to identify influential factors, and triangulated for model development. RESULTS The partnerships identified a number of structural and functional factors that were important to their success, including multisectoral partners, flexible governance structures, leadership, group management, action planning, and assessment/evaluation. Three types of partnership models-utilitarian, lead agency, and collaboration-emerged across the community partnerships. Most partnerships reported challenges with engaging community members and ensuring equitable distribution of resources at the local level. CONCLUSIONS The ALbD community partnerships utilized several structural and functional factors to enhance the success of their multisector collaborations. Yet, the varied types of lead agencies, partners, and partnership structures suggest that there is no one best way to bring partners together.

Examining the evidence for policy and environmental strategies to prevent childhood obesity in black communities: new directions and next steps

Exposure to physical and policy environments that limit availability, affordability and appeal of healthy eating and active living options is higher for U.S. blacks than whites. This may contribute to high risk of obesity in black communities and limit effectiveness of preventive interventions. Here, we assess applicability to black Americans of findings from a prior evidence review system designed to accelerate the discovery and application of policy and environmental strategies for childhood obesity prevention and assess external validity. The database included 600 peer‐reviewed articles reporting data from 396 sets of studies (study groupings) published from January 2000 through May 2009 and pertained to 24 types of policy and environmental strategies. Only 33 study groupings (∼8%) included ≥50% black Americans or reported subgroup analyses. Of 10 evaluation studies for interventions rated as effective for all populations in the primary review, 8 suggested effectiveness of child‐focused interventions in school or child care settings for obesity‐ or physical activity‐related outcomes in black Americans. Overall findings highlight the need for rigorous evaluations of interventions that reach black children in community or institutional settings, and conceptual frameworks and research designs geared to identifying ethnic or ethnicity–income group differences in intervention effects.

Lessons from a mixed-methods approach to evaluating Active Living by Design.

BACKGROUND Beginning in 2003, Active Living by Design (ALbD) established innovative approaches across 25 communities to increase physical activity through community design, public policies, programming, and communication strategies. PURPOSE The complexity of the ALbD projects called for a mixed-methods evaluation to understand implementation as well as perceived and actual impacts of these efforts. METHODS Six primary evaluation methods addressed three primary aims: (1) to assess impacts of physical projects and policy changes on community environments; (2) to document intervention strategies implemented, as well as intended and unintended consequences; and (3) to identify strengths and challenges in planning, developing, and implementing interventions. The ALbD evaluation included cross-site comparisons and more in-depth case studies. This article describes the methods used to address the three aims. RESULTS Analysis of the strengths and challenges associated with the different methods, including partnership capacity surveys, Concept Mapping, an online progress reporting system, key informant interviews, focus groups, and photos and videos. Additional methods, including environmental audits and direct observation, were explored to specifically assess environmental changes. Several important challenges included the lack of baseline data, difficulty in evaluating natural experiments, the need for ongoing policy surveillance, and the need to capture longer-term endpoints. CONCLUSIONS The mixed-methods evaluation of ALbD advances implementation and evaluation science related to community-based efforts for promoting active living through identification of methods and measures to capture multicomponent and complex interventions as well as translation of a range of approaches to create community change across a variety of populations and settings.

Developing web-based training for public health practitioners: what can we learn from a review of five disciplines?

During a time when governmental funding, resources and staff are decreasing and travel restrictions are increasing, attention to efficient methods of public health workforce training is essential. A literature review was conducted to inform the development and delivery of web-based trainings for public health practitioners. Literature was gathered and summarized from five disciplines: Information Technology, Health, Education, Business and Communications, following five research themes: benefits, barriers, retention, promotion and evaluation. As a result, a total of 138 articles relevant to web-based training design and implementation were identified. Key recommendations emerged, including the need to conduct formative research and evaluation, provide clear design and layout, concise content, interactivity, technical support, marketing and promotion and incentives. We conclude that there is limited application of web-based training in public health. This review offers an opportunity to learn from other disciplines. Web-based training methods may prove to be a key training strategy for reaching our public health workforce in the environment of limited resources.

Evaluation of Active Living by Design: Implementation Patterns Across Communities

BACKGROUND Twenty-five cross-sector, multidisciplinary community partnerships received funding through the Active Living by Design (ALbD) national program to design, plan, and implement innovative initiatives to support active living. PURPOSE This paper examines implementation patterns across ALbD community partnerships related to community characteristics; preparation efforts; and policy, environmental, programmatic, and promotional strategies. METHODS Investigators used a mixed-methods, participatory evaluation design, triangulating multiple qualitative and quantitative data sources collected from 2007 to 2009. Configural frequency analysis facilitated detection of variables as well as configurations of variables occurring more (types) or less (anti-types) frequently than patterns expected by chance alone. RESULTS Overall, community partnerships with more preparation activities (assessment, sustainability) implemented a larger number of active living promotions, programs, policy influences, and physical projects, cumulatively (type). Yet, community partnerships working in communities with >40% of the population from a non-Caucasian racial and ethnic background and >40% of the population in poverty implemented fewer active living promotions, programs, policy influences, and physical projects, cumulatively (type). CONCLUSIONS The resulting types and anti-types provide insight into patterns across communities that may be ascribed to varying configurations of community contexts, resources, and strategies implemented. Rigorous, systematic examination of the underlying causal structures related to the configurations of community characteristics, preparation efforts, and implementation strategies is needed.

Evaluation of Physical Projects and Policies from the Active Living by Design Partnerships

BACKGROUND Between 2003 and 2008, a total of 25 partnerships funded through the Active Living by Design (ALbD) program worked to change built environments and policies in communities to help citizens be active in their daily routines. PURPOSE This paper systematically summarized the scope of ALbD physical projects and policy changes, described resources generated by the partnerships, and highlighted supports and barriers to the process. METHODS Using a mixed-methods approach, multiple data sources, including key informant interviews, focus groups, and a web-based tracking system, were used to collect data during project implementation. Qualitative results were analyzed using systematic coding procedures to identify themes, ideas, and concepts derived from the data. Data analysis occurred in 2008-2010. RESULTS Most of the 25 partnerships documented physical projects and policy changes in each of the following sectors: urban planning (n=16); active transportation (n=23); trails/parks/recreation/open space (n=22); communities (n=22); and schools (n=18). ALbD community partnerships were successful at generating ≈