Active living collaboratives in the United States: understanding characteristics, activities, and achievement of environmental and policy change

Physical Activity-Friendly Policies and Community Design Features in the US, 2014 and 2021

INTRODUCTION

The 2014 Community-Based Survey of Supports for Healthy Eating and Active Living documented the prevalence of US municipal policy and community design supports for physical activity. The survey was repeated in 2021. Our study examined change in the prevalence of supports from 2014 to 2021, overall and by municipality characteristic.

METHODS

Municipalities were sampled independently each survey year. We calculated prevalence in 2014 and 2021 and the prevalence ratio (PR) for 15 supports covering zoning codes, park policies and budgets, design standards, Complete Streets policies, and shared use agreements. We used a Bonferroni-corrected Breslow-Day test to test for interaction by municipality characteristic.

RESULTS

In 2014 (2,009 municipalities) compared with 2021 (1,882 municipalities), prevalence increased for several zoning codes: block sizes of walkable distances (PR = 1.46), minimum sidewalk width (PR = 1.19), pedestrian amenities along streets (PR = 1.15), continuous sidewalk coverage (PR = 1.14), and building orientation to pedestrian scale (PR = 1.08). Prevalence also increased for design standards requiring dedicated bicycle infrastructure for roadway expansion projects or street retrofits (PR = 1.19). Prevalence declined for shared use agreements (PR = 0.87). The prevalence gap widened between the most and least populous municipalities for Complete Streets policies (from a gap of 33.6 percentage points [PP] in 2014 to 54.0 PP in 2021) and for zoning codes requiring block sizes that were walkable distances (from 11.8 PP to 41.4 PP).

CONCLUSION

To continue progress, more communities could consider adopting physical activity-friendly policies and design features.

Exploring Residents' Perceptions of Neighborhood Development and Revitalization for Active Living Opportunities

INTRODUCTION

Community fears of gentrification have created concerns about building active living infrastructure in neighborhoods with low-income populations. However, little empirical research exists related to these concerns. This work describes characteristics of residents who reported 1) concerns about increased cost of living caused by neighborhood development and 2) support for infrastructural improvements even if the changes lead to a higher cost of living.

METHODS

Data on concerns about or support for transportation-related and land use-related improvements and sociodemographic characteristics were obtained from the 2018 SummerStyles survey, an online panel survey conducted on a nationwide sample of US adults (n = 3,782). Descriptive statistics characterized the sample, and χ² tests examined associations among variables.

RESULTS

Overall, 19.1% of study respondents agreed that development had caused concerns about higher cost of living. Approximately half (50.7%) supported neighborhood changes for active living opportunities even if they lead to higher costs of living. Prevalences of both concern and support were higher among respondents who were younger and who had higher levels of education than their counterparts. Support did not differ between racial or ethnic groups, but concern was reported more often by Hispanic/Latino (28.9%) and other non-Hispanic (including multiracial) respondents (25.5%) than by non-Hispanic White respondents (15.6%). Respondents who reported concerns were more likely to express support (65.3%) than respondents who did not report concerns (47.3%).

CONCLUSION

The study showed that that low-income, racial, or ethnic minority populations support environmental changes to improve active living despite cost of living concerns associated with community revitalization.

Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes

Background

Community participation is widely believed to be beneficial to the development, implementation and evaluation of health services. However, many challenges to successful and sustainable community involvement remain. Importantly, there is little evidence on the effect of community participation in terms of outcomes at both the community and individual level. Our systematic review seeks to examine the evidence on outcomes of community participation in high and upper-middle income countries.

Methods and findings

This review was developed according to PRISMA guidelines. Eligible studies included those that involved the community, service users, consumers, households, patients, public and their representatives in the development, implementation, and evaluation of health services, policy or interventions. We searched the following databases from January 2000 to September 2016: Medline, Embase, Global Health, Scopus, and LILACs. We independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. No language restrictions were made. 27,232 records were identified, with 23,468 after removal of duplicates. Following titles and abstracts screening, 49 met the inclusion criteria for this review. A narrative synthesis of the findings was conducted. Outcomes were categorised as process outcomes, community outcomes, health outcomes, empowerment and stakeholder perspectives. Our review reports a breadth of evidence that community involvement has a positive impact on health, particularly when substantiated by strong organisational and community processes. This is in line with the notion that participatory approaches and positive outcomes including community empowerment and health improvements do not occur in a linear progression, but instead consists of complex processes influenced by an array of social and cultural factors.

Conclusion

This review adds to the evidence base supporting the effectiveness of community participation in yielding positive outcomes at the organizational, community and individual level.

Trial registration

Prospero record number:CRD42016048244.

Active living in Saskatchewan: A review of official community plans

OBJECTIVE

Municipal policies may have a significant impact on the development of environments that provide sustainable opportunities for individuals to engage in healthy, active lifestyles. Little is known about how explicitly community planning in Canada integrates strategies to promote physical activity. In the context of Active Saskatchewan 2020 (AS2020), the strategic plan of Saskatchewan in motion, such an analysis would create a basis for identifying policy gaps and ongoing monitoring. The objective of this study was to review the official community plan (OCP) of each city in the province of Saskatchewan, Canada and identify policies supportive of physical activity.

METHODS

A conventional content analysis was completed of the OCPs of the 17 cities in Saskatchewan. Each OCP was reviewed and text extracted that related to supporting physical activity. Extracted text was thematically organized within and across cities, creating a set of indicators for ongoing monitoring.

RESULTS

Overall, 17 indicators were identified. The frequency of inclusion of these indicators within the 17 OCPs varied from 17.6% to 82.4%. The mean frequency of indicators identified per OCP was 7.4. The most commonly included indicators included residential neighbourhood plans associated with active living, downtown cycling and pedestrian plans, and joint-use agreements between communities and schools.

CONCLUSIONS

Most Saskatchewan OCPs make little direct reference to policies supportive of physical activity. Impacting community-level policy is an expected outcome of AS2020/Saskatchewan in motion. This study identifies a range of indicators for monitoring this process and highlights potential areas for policy development within OCPs.

Adopting State-Level Policy to Support Physical Activity Among School-Aged Children and Adolescents: Georgia's SHAPE Act

Physical inactivity among children is a public health problem associated with low levels of fitness, obesity, and increased risk of chronic diseases. Public health experts have identified policies targeting physical activity as a promising strategy to address this challenge. Understanding the process by which such policies are adopted may help to facilitate progress nationally. To examine lessons learned from the passage of the Student Health and Physical Education Act in Georgia, we conducted 15 interviews with people engaged in the adoption of the act. We found that several factors were vital to policy adoption: a shifting social and political climate, the organization and mobilization of diverse partners behind a common agenda, and the development of strategies to overcome impediments to legislative progress. These findings suggest that engagement and cooperation with partners, establishment of mutual interests as a basis for collaboration, and grassroots outreach and advocacy can facilitate adoption of policies that promote physical activity.

Priorities of Municipal Policy Makers in Relation to Physical Activity and the Built Environment: A Latent Class Analysis

OBJECTIVE

To examine policy makers' public policy priorities related to physical activity and the built environment, identify classes of policy makers based on priorities using latent class analysis, and assess factors associated with class membership.

DESIGN

Cross-sectional survey data from municipal officials in 94 cities and towns across 6 US states were analyzed.

PARTICIPANTS

Participants (N = 423) were elected or appointed municipal officials spanning public health, planning, transportation/public works, community and economic development, parks and recreation, and city management.

MAIN OUTCOME MEASURES

Participants rated the importance of 11 policy areas (public health, physical activity, obesity, economic development, livability, climate change, air quality, natural resource conservation, traffic congestion, traffic safety, and needs of vulnerable populations) in their daily job responsibilities. Latent class analysis was used to determine response patterns and identify distinct classes based on officials' priorities. Logistic regression models assessed participant characteristics associated with class membership.

RESULTS

Four classes of officials based on policy priorities emerged: (1) economic development and livability; (2) economic development and traffic concerns; (3) public health; and (4) general (all policy areas rated as highly important). Compared with class 4, officials in classes 1 and 3 were more likely to have a graduate degree, officials in class 2 were less likely to be in a public health job/department, and officials in class 3 were more likely to be in a public health job/department.

CONCLUSIONS

Findings can guide public health professionals in framing discussions with policy makers to maximize physical activity potential of public policy initiatives, particularly economic development.

State-Level Trends and Correlates for Cross-Sector Collaboration on School Nutrition and Physical Education Activities, 2000-2012

INTRODUCTION

Cross-sector collaboration on child obesity prevention is common, yet little research has examined the context of collaboration at the state level. This study describes secular trends in collaboration between state agency staff responsible for school nutrition and physical education activities and other organizations from 2000 to 2012.

METHODS

Data from the School Health Policies and Practices Study were used to describe collaboration between state agency staff and 13 types of public, private, and nonprofit organizations. Breadth of collaboration in 2012 was examined across political, social, and economic conditions.

RESULTS

Collaboration between state agency staff and other organization types increased from 2000 to 2006 and decreased or stabilized from 2006 to 2012. Breadth of collaboration was greater in states with a physical education coordinator, higher levels of poverty, higher prevalence of childhood obesity, and more public health funding. Breadth was similar across states by census region, political party of governor, majority party in state legislature, percentage non-Hispanic white population, high school graduation rate, and unemployment rate.

CONCLUSION

Cross-sector collaboration on school nutrition and physical education was widespread and did not vary substantially across most political, social, and economic measures. Expanded monitoring and surveillance of state-level collaboration would assist efforts to understand how state agencies work across sectors and whether this collaboration affects the support they provide to schools.

Facilitators and barriers in the collaboration between the primary care and the sport sector in order to promote physical activity: A systematic literature review

INTRODUCTION

The aim of this review was to identify collaborative initiatives between the primary care and the sport sector in order to promote physical activity (PA), and barriers and facilitators in these initiatives.

METHOD

Pubmed, SportDiscus, Web of Science, and SOCindex were systematically searched for publications published between 2000 and June 2014. Publications reporting on collaboration between the primary care and the sport sector to promote PA were included. Publications reporting on non-empirical data were excluded, except for study protocols.

RESULTS

The search process yielded 1352 publications. After selection, 40 publications were included. Twenty-eight different initiatives were divided into four forms of collaboration, and two approaches to promote PA were distinguished with different kinds of facilitators and barriers. In the referral of patients, sport professionals' lack of medical knowledge, and health professionals' lack of time, were seen as barriers. In networks to organize activities to promote PA among the community, different shared interests and different cultures were seen as barriers.

CONCLUSION

This review showed that performance of intersectoral collaboration and the collaboration between both sectors are still unexplored. This review provides a first step towards an insight into collaboration and factors that facilitate or hinder collaboration between these sectors.

How to Identify Success Among Networks That Promote Active Living

OBJECTIVES

We evaluated organization- and network-level factors that influence organizations' perceived success. This is important for managing interorganizational networks, which can mobilize communities to address complex health issues such as physical activity, and for achieving change.

METHODS

In 2011, we used structured interview and network survey data from 22 states in the United States to estimate multilevel random-intercept models to understand organization- and network-level factors that explain perceived network success.

RESULTS

A total of 53 of 59 "whole networks" met the criteria for inclusion in the analysis (89.8%). Coordinators identified 559 organizations, with 3 to 12 organizations from each network taking the online survey (response rate = 69.7%; range = 33%-100%). Occupying a leadership position (P < .01), the amount of time with the network (P < .05), and support from community leaders (P < .05) emerged as correlates of perceived success.

CONCLUSIONS

Organizations' perceptions of success can influence decisions about continuing involvement and investment in networks designed to promote environment and policy change for active living. Understanding these factors can help leaders manage complex networks that involve diverse memberships, varied interests, and competing community-level priorities.

Transit Use, Physical Activity, and Body Mass Index Changes: Objective Measures Associated With Complete Street Light-Rail Construction

OBJECTIVES

We assessed effects on physical activity (PA) and weight among participants in a complete street intervention that extended a light-rail line in Salt Lake City, Utah.

METHODS

Participants in the Moving Across Places Study resided within 2 kilometers of the new line. They wore accelerometers and global positioning system (GPS) loggers for 1 week before and after rail construction. Regression analyses compared change scores of participants who never rode transit with continuing, former, and new riders, after adjustment for control variables (total n = 537).

RESULTS

New riders had significantly more accelerometer-measured counts per minute than never-riders (P < .01), and former riders had significantly fewer (P < .01). New riders lost (P < .05) and former riders gained (P < .01) weight. Former riders lost 6.4 minutes of moderate-to-vigorous PA (MVPA) per 10 hours of accelerometer wear (P < .01) and gained 16.4 minutes of sedentary time (P < .01). New riders gained 4.2 MVPA minutes (P < .05) and lost 12.8 (P < .05) sedentary minutes per 10 hours accelerometer wear.

CONCLUSIONS

In light of the health benefits of transit ridership in the complete street area, research should address how to encourage more sustained ridership.

New Perspective on Factors Related to Coalition Success: Novel Findings From an Investigation of Physical Activity Coalitions Across the United States

CONTEXT

Physical activity (PA) coalitions are a fundamental component of efforts to increase population levels of PA in the United States. Coalitions are often composed of organizational members including government agencies, for-profit corporations, and nonprofit organizations. Very little is known about PA coalitions, their organizational members, and the factors related to their success.

OBJECTIVE

First, this study aimed to describe the characteristics of PA coalitions across the United States. Second, the study aimed to describe the characteristics of organizational members of PA coalitions. Third, the study aimed to investigate the association between organizational membership and coalition success.

DESIGN

A cross-sectional design was employed to study individuals from a diverse sample of PA coalitions across the United States. A total of 120 individuals (86% response rate) completed the Member Involvement in Physical Activity Coalitions (MIPAC) survey. The MIPAC included 3 sections: (1) demographic items assessing descriptive characteristics of PA coalitions and their organizational members; (2) 3 subscales for assessing key organizational membership factors (Strategic Alignment, Organizational Alignment, and Providing Input); and (3) 2 subscales for assessing perceived coalition success.

MAIN OUTCOME MEASURES

Descriptive statistics characterize PA coalitions and their organizational members. Univariate analyses were employed to investigate associations between key organizational membership factors and perceived coalition success.

RESULTS

Statistically significant associations were observed between the key organizational membership factors (Strategic Alignment, Organizational Alignment, and Providing Input) and measures of perceived coalition success. Many PA coalitions lacked organizational members from the settings in which the coalitions strive to make change.

CONCLUSIONS

Physical activity coalitions and health-based coalitions overall may be more likely to succeed when they can identify ways in which their coalition provides opportunities for strategic alignment, organizational alignment, and providing input to existing and perspective organizational members. In addition, PA coalitions may benefit from engaging more organizational members from the built environment and education sectors.

Organizational member involvement in physical activity coalitions across the United States: development and testing of a novel survey instrument for assessing coalition functioning

INTRODUCTION

Coalitions are often composed of member organizations. Member involvement is thought to be associated with coalition success. No instrument currently exists for evaluating organizational member involvement in physical activity coalitions. This study aimed to develop a survey instrument for evaluating organizational member involvement in physical activity coalitions. The study was carried out in three phases: (a) developing a draft survey, (b) assessing the content validity of the draft survey, and (c) assessing the underlying factor structure, reliability, and validity of the survey.

METHOD

A cross-sectional design was employed. In Phase 1, a team of experts in survey development produced a draft survey. In Phase 2, the content validity of the draft survey was evaluated by a panel of individuals with expertise in physical activity coalitions. In Phase 3, the survey was administered to 120 individuals on local-, state-, and national-level physical activity coalitions. Responses were subjected to an exploratory factor analysis in order to determine the survey's underlying factor structure, reliability, and validity.

RESULTS

Phases 1 and 2yielded a survey instrument with demonstrated content validity. Phase 3 yielded a three-factor model with three subscales: Strategic Alignment, Organizational Alignment, and Providing Input. Each subscale demonstrated high internal consistency reliability and construct validity.

DISCUSSION

The survey instrument developed here demonstrated sound psychometric properties and provides new insight into organizational member involvement in physical activity coalitions. This instrument may be an important tool in developing a more complete picture of coalition functioning in physical activity coalitions specifically and health-based coalitions overall.

Municipal Officials' Participation in Built Environment Policy Development in the United States

PURPOSE

This study examined municipal officials' participation in built environment policy initiatives focused on land use design, transportation, and parks and recreation.

DESIGN

Web-based cross-sectional survey.

SETTING

Eighty-three municipalities with 50,000 or more residents in eight states.

SUBJECTS

Four hundred fifty-three elected and appointed municipal officials.

MEASURES

Outcomes included self-reported participation in land use design, transportation, and parks and recreation policy to increase physical activity. Independent variables included respondent position; perceptions of importance, barriers, and beliefs regarding physical activity and community design and layout; and physical activity partnership participation.

ANALYSIS

Multivariable logistic regression models.

RESULTS

Compared to other positions, public health officials had lower participation in land use design (78.3% vs. 29.0%), transportation (78.1% vs. 42.1%), and parks and recreation (67.1% vs. 26.3%) policy. Perceived limited staff was negatively associated with participation in each policy initiative. Perceptions of the extent to which physical activity was considered in community design and physical activity partnership participation were positively associated with participation in each. Perceived lack of collaboration was associated with less land use design and transportation policy participation, and awareness that community design affects physical activity was associated with more participation. Perceived lack of political will was associated with less parks and recreation policy participation.

CONCLUSION

Public health officials are underrepresented in built environment policy initiatives. Improving collaborations may improve municipal officials' policy participation.

Policy, systems, and environmental approaches for obesity prevention: a framework to inform local and state action

The public health literature has not fully explored the complexities of the policy process as they relate to public health practice and obesity prevention. We conducted a review of the literature across the policy science and public health fields, distilled key theories of policy making, and developed a framework to inform policy, systems, and environmental change efforts on obesity prevention. Beginning with a conceptual description, we focus on understanding three domains of the policy process: the problem domain, the policy domain, and the political domain. We identify key activities in the policy process including the following: (a) assessing the social and political environment; (b) engaging, educating and collaborating with key individuals and groups; (c) identifying and framing the problem; (d) utilizing available evidence; (e) identifying policy solutions; and (f) building public support and political will. The article provides policy change resources and case studies to guide and support local and state efforts around obesity prevention.