Leslie S. Linton

A middle school immunization law rapidly and substantially increases immunization coverage among adolescents.

OBJECTIVES This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents. METHODS Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif. RESULTS Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P <.001), and 8th- through 12th-grade students not subject to the requirement (27%, P <.0001). CONCLUSIONS Middle school-entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.

The Active Living Research Program: Six Years of Grantmaking

Changes in policies and built environments are advocated as part of efforts to increase physical activity, but in 2001 the knowledge base to inform these changes was limited. The Robert Wood Johnson Foundation addressed this deficit by initiating Active Living Research (ALR). The mission of ALR was to stimulate and support research that could guide the improvement of environments, policies, and practices to promote active living. The programs goals were to (1) build the evidence base about environmental and policy factors related to physical activity, (2) build the capacity of researchers in multiple fields to collaborate, and (3) inform and facilitate policy change. To build the evidence base, 121 grants were supported with

Implementing a seventh grade vaccination law: school factors associated with completion of required immunizations.

12.5 million. Efforts were made to support new investigators, fund investigators from numerous disciplines, and increase the demographic diversity of researchers. Activities to build capacity to conduct collaborative research included annual conferences, journal supplements, seminars for multiple disciplines, and the posting of environmental measures. Coordination with Active Living Leadership was a primary means of communicating research to policymakers. Other activities to facilitate the application of research included research summaries written for nonresearchers, collaborations with Active Living by Design, several components of the website (www.activelivingresearch.org), and using policy relevance as a funding criterion. Two independent evaluations were accomplished, and they concluded that ALR made progress on all three goals. ALR has been renewed through 2012. The new mission is to use a

Youth Advocacy as a Tool for Environmental and Policy Changes That Support Physical Activity and Nutrition: An Evaluation Study in San Diego County

15.4 million research budget to contribute to reversing the childhood obesity epidemic, especially among youth in the highest-risk groups.

Comparing telephone and written surveys to assess local adolescent immunization coverage rates.

OBJECTIVES We investigated school factors associated with successful implementation of a seventh grade vaccination requirement. METHODS The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage. RESULTS In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students. CONCLUSIONS In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.

The Second Active Living Research Conference: Signs of Maturity

Background As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention. Community Context San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers. Methods In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative’s half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers. Outcomes Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts. Interpretation Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change.

How the environment shapes physical activity: a transdisciplinary research agenda.

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the childs parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.

The public health roots of zoning: In search of active living’s legal genealogy

This special issue highlights some of the papers presented at the second annual Active Living Research (ALR) Conference in February 2005. Each represents an important building block in developing a comprehensive knowledge base concerning environmental and policy influences on physical activity. In the summer of 2000 when the Robert Wood Johnson Foundation (RWJF) Board of Trustees approved the concept paper for what would become Active Living Research, none of us could have imagined how quickly this evidence base would emerge. The program staff of RWJF was charged with developing grantmaking strategies that would lead to better approaches to increase population physical activity levels. The 1996 Surgeon General’s report on physical activity had clearly demonstrated the health benefits of exercise, yet health educators, exercise physiologists, and others had shown limited impact in significantly increasing the number of people engaging in even moderate levels of physical activity. 1 RWJF was eager to stimulate substantial improvements in a behavior that had such potential for improving the health of all Americans, as they had with smoking. Physical activity was determined to be an appropriate and worthy target. Much has been written about using ecological models to promote health behavior change, and the benefits of targeting environmental and policy solutions to change population level behavior are generally accepted. 2-7 However, few foundations have invested in developing and evaluating these types of interventions. RWJF has been unique in its understanding of environmental action strategies and its willingness to support policy research to inform those approaches. (See RWJF initiatives such as A Matter of Degree, Reducing Underage Drinking Through Coalitions, Smokeless States and the Substance Abuse Policy Research Program, for example.) As the first step in creating a social change strategy designed to increase population physical activity levels, Active Living Research was funded to investigate which environments and what policies would have the greatest potential to impact physical activity. Initial studies focused on developing and validating measures of the built environment for use in establishing a systematic evidence base. Measurement studies were followed by correlational studies to help determine the relationships between the environment and physical activity levels. Some of the papers in this special issue report on these initial measurement and correlation studies.