Bike, walk, and wheel: a way of life in Columbia, Missouri

Novel public-private partnerships to address the double burden of malnutrition

Public–private partnerships are an effective way to address the global double burden of malnutrition. While public–private partnerships operate in multiple forms, their leadership usually falls to governments, public health agencies, or nongovernmental organizations, with the private sector taking a subordinate role. The rapid ascent of social media and mass communications worldwide has provided a disruptive technology for new nutrition intervention programs. A new model, provisionally called private–public engagement, takes advantage of social media, mass media, and integrated social marketing to reach parents, families, and communities directly. These new private–public engagement initiatives need to be managed in ways suggested for public–private partnerships by the World Health Organization, especially if the private sector is in the lead. Once the rationale for engagement is defined, there is a need to mobilize resources, establish in-country partnerships and codes of conduct, and provide a plan for monitoring, evaluation, and accountability. Provided here is an example consistent with the private–public engagement approach, ie, the United for Healthier Kids program, which has been aimed at families with children aged less than 12 years. Materials to inspire behavioral change and promote healthier diets and lifestyle were disseminated in a number of countries through both digital and physical channels, often in partnership with local or regional governments. A description of this program, along with strategies to promote transparency and communication among stakeholders, serves to provide guidance for the development of future effective private–public engagements.

Social Marketing as a Framework for Youth Physical Activity Initiatives: a 10-Year Retrospective on the Legacy of CDC's VERB Campaign

PURPOSE OF REVIEW

In 2002, the U.S. Centers for Disease Control and Prevention (CDC) launched the VERB. It's what you do! campaign to increase physical activity among tweens and concomitantly respond to the rise in childhood obesity. This retrospective study summarizes the history of the VERB campaign's social marketing approach and its effectiveness in promoting behavior change in the targeted population.

RECENT FINDINGS

The legacy of VERB, which ended in 2006, is discussed, with an emphasis on examining initiatives over the last decade and the degree to which they followed (or did not follow) the structural and thematic lead of the campaign. The article ends with suggestions for how VERB still has the potential to inform other social marketing campaigns going forward.

Adoption of Safe Routes to School in Canadian and the United States Contexts: Best Practices and Recommendations

BACKGROUND

Declines in physical activity (PA) in children and youth have contributed to increases in childhood overweight and obesity. The Safe Routes to School (SRTS) program was developed to promote school active transportation (AT) and reverse the trend.

METHODS

Adopting concepts of a realist approach, this article seeks to understand strategies of adoption that worked in the Canadian and United States context. Inclusion criteria consisted of adoption of SRTS program, identification and definition of SRTS, implementation in Canada /United States, and partnership identified.

RESULTS

Partnerships focused on increasing the number of children using AT to school. With unique political and funding atmospheres, a common strategy was developing multilevel comprehensive partnerships to mobilize knowledge and resources, as well as to align intervention planning. Key successes, tools used to measure success, as well as benefits, challenges and lessons learned from partnerships were identified.

CONCLUSION

This article is the first attempt to examine SRTS at the state/provincial/city level to understand key adoption strategies using a realist approach. It found collaborative community-research partnerships that initiated SRTS and created cultural shifts in communities from the individual to policy level. Researchers, schools and communities interested in increasing school AT should consider SRTS as a valuable approach.

Community wide interventions for increasing physical activity

BACKGROUND

Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown.

OBJECTIVES

To evaluate the effects of community wide, multi-strategic interventions upon population levels of physical activity.

SEARCH METHODS

We searched the Cochrane Public Health Group Segment of the Cochrane Register of Studies,The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, the British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORT Discus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platform on Diet, Physical Activity and Health; Health-Evidence.org; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA); the US Centre for Disease Control and Prevention (CDC) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were searched and we contacted experts in the field. The searches were updated to 16 January 2014, unrestricted by language or publication status.

SELECTION CRITERIA

Cluster randomised controlled trials, randomised controlled trials, quasi-experimental designs which used a control population for comparison, interrupted time-series studies, and prospective controlled cohort studies were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomised individuals from the same community were excluded.

DATA COLLECTION AND ANALYSIS

At least two review authors independently extracted the data and assessed the risk of bias. Each study was assessed for the setting, the number of included components and their intensity. The primary outcome measures were grouped according to whether they were dichotomous (per cent physically active, per cent physically active during leisure time, and per cent physically inactive) or continuous (leisure time physical activity time (time spent)), walking (time spent), energy expenditure (as metabolic equivalents or METS)). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated percentage change from baseline, unadjusted and adjusted.

MAIN RESULTS

After the selection process had been completed, 33 studies were included. A total of 267 communities were included in the review (populations between 500 and 1.9 million). Of the included studies, 25 were set in high income countries and eight were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organisations (NGOs) (29 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity. However, of those included studies undertaken in high income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio-economic communities. Nineteen studies were identified as having a high risk of bias, 10 studies were unclear, and four studies had a low risk of bias. Selection bias was a major concern with these studies, with only five studies using randomisation to allocate communities. Four studies were judged as being at low risk of selection bias although 19 studies were considered to have an unclear risk of bias. Twelve studies had a high risk of detection bias, 13 an unclear risk and four a low risk of bias. Generally, the better designed studies showed no improvement in the primary outcome measure of physical activity at a population level.All four of the newly included, and judged to be at low risk of bias, studies (conducted in Japan, United Kingdom and USA) used randomisation to allocate the intervention to the communities. Three studies used a cluster randomised design and one study used a stepped wedge design. The approach to measuring the primary outcome of physical activity was better in these four studies than in many of the earlier studies. One study obtained objective population representative measurements of physical activity by accelerometers, while the remaining three low-risk studies used validated self-reported measures. The study using accelerometry, conducted in low income, high crime communities of USA, emphasised social marketing, partnership with police and environmental improvements. No change in the seven-day average daily minutes of moderate to vigorous physical activity was observed during the two years of operation. Some program level effect was observed with more people walking in the intervention community, however this result was not evident in the whole community. Similarly, the two studies conducted in the United Kingdom (one in rural villages and the other in urban London; both using communication, partnership and environmental strategies) found no improvement in the mean levels of energy expenditure per person per week, measured from one to four years from baseline. None of the three low risk studies reporting a dichotomous outcome of physical activity found improvements associated with the intervention.Overall, there was a noticeable absence of reporting of benefit in physical activity for community wide interventions in the included studies. However, as a group, the interventions undertaken in China appeared to have the greatest possibility of success with high participation rates reported. Reporting bias was evident with two studies failing to report physical activity measured at follow up. No adverse events were reported.The data pertaining to cost and sustainability of the interventions were limited and varied.

AUTHORS' CONCLUSIONS

Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings in the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that the multi-component community wide interventions studied effectively increased physical activity for the population, although some studies with environmental components observed more people walking.

Bike, walk, and wheel: a way of life in Columbia, Missouri, revisited

BACKGROUND

In 2003, Columbia MO was the recipient of a Robert Wood Johnson Foundation (RWJF) Active Living by Design (ALbD) grant to foster active living in the community through behavioral (social marketing, education) and environmental change (improved street design standards, sidewalks around schools, activity-friendly infrastructure) strategies.

PURPOSE

To examine the extent to which the ALbD intervention was associated with increased active living in children and adults community-wide.

METHODS

Seasonal pedestrian and bicyclist counts were performed quarterly in January, April, July, and October at four intersections in downtown Columbia from 2007 to 2009.

RESULTS

Pedestrian counts increased significantly during July 2009 and October 2009 compared to 2007 and 2008, whereas cyclist counts increased significantly during only July 2009 compared to 2007 and 2008.

CONCLUSIONS

The ALbD intervention in Columbia was associated with modest increases in active living in the community, and continued evaluation of these behavior patterns is warranted. The combination of multiple strategies (social marketing, local programming, and infrastructure changes) may be a critical factor in improving active living in communities.

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 ≈ $256 million in resources beyond their initial grant, mostly through policy changes. Challenges included creating and sustaining political will and community support as well as securing technical expertise and resources. Planning and relationship building were critical to success in changing policy and implementing projects.

CONCLUSIONS

Although there is more to understand about how these change processes affect physical activity and health across populations and settings, as well as how social, cultural, and psychosocial factors influence community responses to the policy changes and physical projects, findings from this initiative provide a foundation for subsequent research and practice.

The Active Living by Design national program: community initiatives and lessons learned

Public health advocates have increasingly highlighted the importance of implementing comprehensive physical activity interventions that use an ecologic framework. Such a framework can broadly address physical activity barriers, such as the lack of opportunities, social support, policies, built environments, and community awareness. The Active Living by Design (ALbD) was a community grant program of the Robert Wood Johnson Foundation (RWJF), which was established to help 25 communities create environments that support active living. Each funded site established a multidisciplinary community partnership and implemented the 5P strategies: preparation, promotions, programs, policy, and physical projects. The community partnerships worked within neighborhoods, schools, worksites, and other organizations to increase physical and social supports for physical activity. Ten community examples illustrate the 5Ps. Throughout the 5-year grant, the ALbD national program office provided community partnerships with group and individualized learning opportunities. Technical assistance and peer-to-peer learning was facilitated by ALbD project officers, who also coached each community partnership via site visits, regular phone calls, and electronic communications. The ALbD grant program provided valuable lessons for communities, technical assistance organizations, and funders. Community partnerships experienced success in a variety of settings and their collaborative approaches encouraged multiple organizations, including funders, to participate in improving conditions for active living. Strong local leadership was a key to success and community partnerships benefited considerably from peer-to-peer learning. The 5P model, while challenging to implement comprehensively, proved to be a useful model for community change.