Sustainability Planning for a Community Network to Increase Participation in Evidence-Based Lifestyle Change Programs: A Mixed-Methods Approach

Community-based chronic disease prevention programs can have long-term, broad public health benefits. Yet, only 40 to 60% of evidence-based health programs are sustained. Using established frameworks and evidence-based tools to characterize sustainability allows programs to develop structures and processes to leverage resources effectively to sustain effective program activities and systems. This study used a mixed-methods, partner-engaged approach to identify barriers and facilitators to sustaining a community network (the Alliance program) aimed to increase participation in evidence-based lifestyle change programs delivered in the community. Surveys and qualitative interviews were conducted with the Alliance partners based on the Program Sustainability Assessment Tool and Consolidated Framework for Implementation Research. Overall, partners felt Alliance had a high capacity for sustainability. Strategic planning, communication, and partnerships were areas partners prioritized to improve the potential for sustaining the program. Results informed the co-development of a sustainability action plan. This paper furthers our understanding of factors critical for the sustainability of community-based programs for chronic disease prevention and health equity and presents a process for developing action plans to build sustainability capacity.

Effectively communicating with local policymakers: a randomized trial of policy brief dissemination to address obesity

Introduction

Evidence-based policies are a powerful tool for impacting health and addressing obesity. Effectively communicating evidence to policymakers is critical to ensure evidence is incorporated into policies. While all public health is local, limited knowledge exists regarding effective approaches for improving local policymakers' uptake of evidence-based policies.

Methods

Local policymakers were randomized to view one of four versions of a policy brief (usual care, narrative, risk-framing, and narrative/risk-framing combination). They then answered a brief survey including questions about their impressions of the brief, their likelihood of using it, and how they determine legislative priorities.

Results

Responses from 331 participants indicated that a majority rated local data (92%), constituent needs/opinions (92%), and cost-effectiveness data (89%) as important or very important in determining what issues they work on. The majority of respondents agreed or strongly agreed that briefs were understandable (87%), believable (77%), and held their attention (74%) with no brief version rated significantly higher than the others. Across the four types of briefs, 42% indicated they were likely to use the brief. Logistic regression models showed that those indicating that local data were important in determining what they work on were over seven times more likely to use the policy brief than those indicating that local data were less important in determining what they work on (aOR = 7.39, 95% CI = 1.86,52.57).

Discussion

Among local policymakers in this study there was no dominant format or type of policy brief; all brief types were rated similarly highly. This highlights the importance of carefully crafting clear, succinct, credible, and understandable policy briefs, using different formats depending on communication objectives. Participants indicated a strong preference for receiving materials incorporating local data. To ensure maximum effect, every effort should be made to include data relevant to a policymaker's local area in policy communications.

Perspectives From Public Health Practitioners and Advocates on Community Development for Active Living: What are the Lasting Impacts?

PURPOSE

Evidence suggests differential impacts of community development, including gentrification and displacement. Public health practitioners and advocates are key stakeholders involved in the community development process related to active living, yet little is known about their perceptions of its impacts. We explored the perspectives of relevant leaders of public health departments and key community and advocacy organizations on community development, gentrification, and displacement.

APPROACH

Purposive key informant interviews.

SETTING

CDC State Physical Activity and Nutrition (SPAN) funding recipients.

PARTICIPANTS

CDC SPAN recipient leadership (n = 10 of 16) and advocacy organizations they partnered with (n = 7 of 16).

METHOD

Interviews were recorded, transcribed, coded, and thematically analyzed with direct quotes representing key themes.

RESULTS

Both groups felt community development held important benefits, specifically by creating healthy living opportunities, but also potentially leading to the displacement of long-time residents. Practitioners reported the benefits were for all community members, whereas advocates noted the benefits were seen in those with privilege, and the consequences were disproportionately seen in disadvantaged communities. Both mentioned the importance and difficulty of getting diverse representation for community engagement.

CONCLUSIONS

Learning how key stakeholders perceive and navigate the community development process can help inform recommendations for better equity in active living community improvements. More work is needed to further elucidate best practices for health and social equity in the community development process.

Understanding Health Equity in Public Health Practice in the United States

CONTEXT

Understanding the extent to which equity-focused work is occurring in public health departments (eg, in chronic disease programs) can identify areas of success and what is needed to move the needle on health equity.

OBJECTIVE

The study objective was to characterize the patterns and correlates of equity-related practices in US state and territorial public health practice.

DESIGN

The design was a multimethod (quantitative and qualitative), cross-sectional study.

SETTING

The setting included US state and territorial public health departments.

PARTICIPANTS

Chronic disease prevention practitioners (N = 600) completed self-report surveys in July 2022 through August 2022 (analyzed in September 2022 through December 2022).

MAIN OUTCOME MEASURES

Health equity data were obtained across 4 domains: (1) staff skills, (2) work unit practices, (3) organizational priorities and values, and (4) partnerships and networks.

RESULTS

There was a wide range in self-reported performance across the health equity variables. The highest values (those agreeing and strongly agreeing) were related to staff skills (eg, the ability to describe the causes of inequities [82%]). Low agreement was reported for multiple items, indicating the lack of systems for tracking progress on health equity (32%), the lack of hiring of staff members who represent disadvantaged communities (33%), and limited use of principles for community engagement (eg, sharing decision-making authority with partners [34%]). Qualitative data provided tangible examples showing how practitioners and their agencies are turning an array of health equity concepts into actions.

CONCLUSIONS

There is urgency in addressing health equity and our data suggest considerable room for enhancing health equity practices in state and territorial public health. To support these activities, our findings provide some of the first information on areas of progress, gaps in practice, and where to target technical assistance, capacity building efforts, and accreditation planning.

Developing Priorities to Alleviate the Long-Term Impact of the COVID-19 Pandemic on Women Engaged in Diabetes Research, Education, and Care: A Concept Mapping Study

Objective

The aim of this study was to develop priorities through stakeholder engagement to alleviate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the professional careers of women engaged in diabetes research, education, and care.

Research Design and Methods

This study used concept mapping, a mixed-methods, multistep process, to generate a conceptual map of recommendations through the following steps: 1) identify stakeholders and develop the focus prompt, 2) generate ideas through brainstorming, 3) structure ideas through sorting and rating on priority and likelihood, 4) analyze the data and create a cluster map, and 5) interpret and use results.

Results

Fifty-two participants completed the brainstorming phase, and 24 participated in sorting and rating. The final concept map included seven clusters. Those rated as highest priority were to ensure supportive workplace culture (μ = 4.43); promote practices to achieve gender parity in hiring, workload, and promotion (μ = 4.37); and increase funding opportunities and allow extensions (μ = 4.36).

Conclusion

This study identified recommendations for institutions to better support women engaged in diabetes-related work to alleviate the long-term impact of the COVID-19 pandemic on their careers. Some areas were rated as high in priority and high in likelihood, such as ensuring a supportive workplace culture. In contrast, family-friendly benefits and policies were rated as high in priority but low in likelihood of being implemented; these may take more effort to address, including coordinated efforts within institutions (e.g., women's academic networks) and professional societies to promote standards and programs that advance gender equity in medicine.

An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses

Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses- major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.

Municipal officials' perspectives on policymaking for addressing obesity and health equity

Background

Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces.

Aims and objectives

This study investigated key factors affecting municipal officials' policymaking for obesity and related health disparities.

Methods

Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021.

Findings

Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviors, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take, limitations based on the scope of government, challenges with intergovernmental collaboration or across government levels, ability of policymakers and government employees to understand the problem, and the challenge of framing health disparities given the social-political context.

Discussion and conclusion

Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.

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.

Long-Term Evaluation of a Course on Evidence-Based Public Health in the U.S. and Europe

The evidence-based public health course equips public health professionals with skills and tools for applying evidence-based frameworks and processes in public health practice. To date, training has included participants from all the 50 U.S. states, 2 U.S. territories, and multiple other countries besides the U.S. This study pooled follow-up efforts (5 surveys, with 723 course participants, 2005-2019) to explore the benefits, application, and barriers to applying the evidence-based public health course content. All analyses were completed in 2020. The most common benefits (reported by >80% of all participants) were identifying ways to apply knowledge in their work, acquiring new knowledge, and becoming a better leader who promotes evidence-based approaches. Participants most frequently applied course content to searching the scientific literature (72.9%) and least frequently to writing grants (42.7%). Lack of funds for continued training (35.3%), not having enough time to implement evidence-based public health approaches (33.8%), and not having coworkers trained in evidence-based public health (33.1%) were common barriers to applying the content from the course. Mean scores were calculated for benefits, application, and barriers to explore subgroup differences. European participants generally reported higher benefits from the course (mean difference=0.12, 95% CI=0.00, 0.23) and higher frequency of application of the course content to their job (mean difference=0.17, 95% CI=0.06, 0.28) than U.S. participants. Participants from later cohorts (2012-2019) reported more overall barriers to applying course content in their work (mean difference=0.15, 95% CI=0.05, 0.24). The evidence-based public health course represents an important strategy for increasing the capacity (individual skills) for evidence-based processes within public health practice. Organization-level methods are also needed to scale up and sustain capacity-building efforts.

Parent Perceptions of Changes in Child Physical Activity During COVID-19 Stay-At-Home Orders

Purpose: The purpose of this study was to explore parent perceptions of changes in child physical activity during COVID-19 stay-at-home orders. Design: A cross-sectional study. Setting: The research team used social media, relevant organizations, and neighborhood groups to distribute the survey link in May and June of 2020. Subjects: A convenience sample of parents of children aged 5-12. Measures: Survey to assess parental perceptions of changes in children's physical activity before and during stay-at-home orders, and environmental and social barriers to physical activity. Analysis: Results were analyzed using descriptive statistics, bivariate comparisons, and multinomial-logistic regression models with covariates of environmental factors, social factors, and frequency of factors as barriers on association with perceived physical activity change. Results: Data from 245 parents were analyzed. A majority (63.7%) of parents reported a decrease in children's physical activity during stay-at-home orders. More parents indicated social barriers (e.g., lack of access to playmates) than environmental barriers (e.g., lack of access to neighborhood play spaces) to children's physical activity. In multivariate analyses, the odds of parents reporting decreased physical activity was greater for those reporting lack of playmates (OR = 4.72; 95% CI: 1.99-11.17) and lack of adult supervision (OR = 11.82; 95% CI: 2.48-56.28) as barriers. No environmental barriers were significantly associated with decreased children's physical activity. Conclusion: The unique aspects of the COVID-19 pandemic provide a natural experiment for developing social and environmental strategies to improve children's overall physical activity. Assessing parental perceptions is a way to inform these future efforts.

Children's Physical Activity and Screen Time during COVID-19 Pandemic: A Qualitative Exploration of Parent Perceptions

OBJECTIVE

In this study, we explore parent perception of children's physical activity and screen time during COVID-19 stay-at-home orders.

METHODS

We interviewed 16 parents of children ages 5-12 years in the St. Louis, Missouri region using snowball sampling. We sampled from rural, urban, and suburban areas. The interviews were recorded, transcribed, and analyzed using a priori and emergent codes.

RESULTS

The transition to virtual school and work transformed daily activities. Physical education requirements varied, generally perceived as not contributing to overall physical activity. Parents perceived the amount of physical activity as the same or increased but reported an increase in screen time. The physical environment of the home, yard, and neighborhood emerged as a theme as did the social environment for physical activity.

CONCLUSIONS

COVID-19 stay-at-home orders created challenges for children's physical activity. Results can be used to inform more generalizable studies and serve as a basis for creating better parent resources to support their children's physical activity outside of ordinary school, sport, and community activity opportunities.

Disparities in Text Messaging Interventions to Improve Diabetes Management in the United States

Substantial progress has been made in the development of evidence-based interventions to facilitate the management of type 2 diabetes. The increase in ownership of mobile phones has made short messaging services (SMS, or text messaging) a feasible way to enhance information delivery. The goals of this study were to 1) summarize characteristics of diabetes SMS interventions implemented in the United States and 2) identify the extent to which disadvantaged populations are represented in SMS-based diabetes management intervention studies. We conducted a literature search to identify published studies of type 2 diabetes self-management SMS interventions conducted with adults in the United States. Of the 792 articles retrieved, only 9 met inclusion criteria. We systematically extracted data on the theoretical basis, recruitment, incentives, inclusion/exclusion criteria, strategies toward ensuring a racially/ethnically or income-diverse sample, text message delivery, and study duration. Sixty-three percent of the participants across the nine studies were non-white. Only two studies reported participants' education level, and four captured non-English-speaking status. Interventions varied in offering one-way, two-way, or a combination of messaging strategies. Five studies did not describe cultural adaptations or report results separately for different cultural groups. None of the studies provided cell phones, and not having texting capability was an exclusion criterion for six studies. There is a dearth of published research on type 2 diabetes management interventions using text messaging among racially/ethnically or income-diverse populations. Future interventions should be better tailored to these target populations and include the collection of complete sociodemographic data and cell phone/smartphone availability, thereby ensuring cultural appropriateness.

Diversify the syllabi: Underrepresentation of female authors in college course readings

Emerging evidence demonstrates that female-authored publications are not well represented in course readings in some fields, resulting in a syllabi gender gap. Lack of representation may decrease student awareness of opportunities in professional fields and disadvantage the career success of female academics. We contribute to the evidence on the syllabi gender gap by: 1) quantifying the extent to which female authors are represented in assigned course readings; 2) examining representation of female authors by gender of instructor and discipline; and 3) comparing female representation in syllabi with the workforce and with representation as authors of peer-reviewed journal articles. From a list of courses offered in 2018-2019 at Washington University in St. Louis, we selected a stratified random sample of course syllabi from four disciplines (humanities; social science; science, technology, engineering, and mathematics; and other). We coded the gender of course instructors and course reading authors using the genderize application programming interface. We examined representation of female authors at the reading, course, and discipline level using descriptive statistics and data visualization. The final sample included 2435 readings from 129 unique courses. The mean percentage of female authors per reading was 34.1%; 822 (33.8%) of readings were female-led (i.e., a female first or sole author). Female authorship varied by discipline, with the highest percentage of female-led readings in social science (40%). Female instructors assigned a higher percentage of readings with female first authors and readings with higher percentages of females on authorship teams. The representation of female authors on syllabi was lower than representation of females as authors in the peer-reviewed literature or in workforce. Adding to evidence of the syllabi gender gap, we found that female authors were underrepresented as sole and first authors and as members of authorship teams. Since assigned readings promote academic scholarship and influence workforce diversity, we recommend several strategies to diversify the syllabi through increasing awareness of the gap and improving access to female-authored publications.

Creating Built Environments That Expand Active Transportation and Active Living Across the United States: A Policy Statement From the American Heart Association

Physical activity is vital for the health and well-being of youth and adults, although the prevalence of physical activity continues to be low. Promoting active transportation or human-powered transportation through policy, systems, and environmental change is one of the leading evidence-based strategies to increase physical activity regardless of age, income, racial/ethnic background, ability, or disability. Initiatives often require coordination across federal, state, and local agencies. To maximize the effectiveness of all types of interventions, it is imperative to establish strong and broad partnerships across professional disciplines, community members, and advocacy groups. Health organizations can play important roles in facilitating these partnerships. This policy statement provides recommendations and resources that can improve transportation systems, enhance land use design, and provide education to support policies and environments to promote active travel. The American Heart Association supports safe, equitable active transportation policies in communities across the country that incorporate consistent implementation evaluation. Ultimately, to promote large increases in active transportation, policies need to be created, enforced, and funded across multiple sectors in a coordinated and equitable fashion. Active transportation policies should operate at 3 levels: the macroscale of land use, the mesoscale of pedestrian and bicycle networks and infrastructure such as Complete Streets policies and Safe Routes to School initiatives, and the microscale of design interventions and placemaking such as building orientation and access, street furnishings, and safety and traffic calming measures. Health professionals and organizations are encouraged to become involved in advocating for active transportation policies at all levels of government.

Actual Causes of Death in Relation to Media, Policy, and Funding Attention: Examining Public Health Priorities

Despite numerous public health advancements over the last century, we continue to under-invest in prevention and public health efforts. As a result, one of the most challenging aspects of public health is prioritizing the use of limited resources. Building on the foundation of previous researchers, the goal of this exploratory study was to provide current estimates for the actual causes of death, media attention, policy focus, and research funding in the United States. In addition, we sought to calculate and compare media attention, policy attention, and research funding trends to better assess the nation's prioritization of health issues. Using a systematic approach, we searched available databases, including Media Cloud, Nexis Uni, Congress.gov, and the Department of Health and Human Services Tracking Accountability in Government Grants System from January 1, 2010-December 31, 2019 and compared how the actual causes of death in the United States align with health-related media attention, policy attention, and federal spending. Overall, our findings suggest that our priorities are not well-aligned with the actual causes of death. Certain actual causes appear to be consistently misaligned across media, legislative, and financial sectors (e.g., tobacco). This work highlights the importance of multiple strategies-media coverage, national legislation, and government spending-as indicators of public health attention and priorities. These results may inform discussions about how to best allocate U.S. public health resources to better align with the actual causes of death.

Adherence to Updated Childcare Nutrition Regulations in Colorado, United States

Background: Preschool years are an important time for shaping healthy eating behaviors. Childcare centers can be a venue for policy change for broad and sustained positive impact on healthy eating environment. The objectives of this study were to assess how self-reported current practices align with updated statewide childcare center licensing regulations in Colorado, US, and to explore correlates of adherence. Methods: Using a post-test only study design, a survey was sent to all full-day, licensed childcare centers in Colorado (N = 1,398) with a valid street or email address. The survey included questions on allowable food and beverages, mealtime practices, and perceptions of the updated regulations. Frequencies were calculated and logistic regression models computed for a composite score of each of these factors. Results: Respondents (N = 344) were mostly center directors, with over 8 years of experience, from urban areas. Compliance was high for most food and beverage criteria (over 90%) and all meal practices. One third participated in the federal Child and Adult Care Food Program (CACFP), and were more likely to comply with the state meal regulations than non-CACFP centers. Conclusion: Although our results show high self-reported compliance, a more thorough study of the policy process would provide comprehensive evidence on effective development, enactment, and implementation of these regulations.

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

BACKGROUND

Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs.

METHODS

Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo.

RESULTS

Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM.

CONCLUSIONS

Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.

Using mixed methods to understand women's parenting practices related to their child's outdoor play and physical activity among families living in diverse neighborhood environments

A convergent parallel mixed methods design was used to understand parenting practices for outdoor play, their influence on adolescent's physical activity and outdoor play and the role of the neighborhood and child's sex. Adolescents (n = 263) and their parents completed questionnaires and wore accelerometers. Parents (n = 30) participated in in-depth interviews. Parenting practices were examined by neighborhood disadvantage and child's sex in quantitative (Chi-square and T-tests) and qualitative (comparative thematic analysis) samples. Multi-level linear mixed models examined the associations between parenting practices and two adolescent outcomes: physical activity and outdoor play. Parents in high disadvantage neighborhoods and of female adolescents imposed more restrictions on outdoor play. Restrictive parenting practices were negatively associated with outdoor play, but not physical activity. Policy and environment change that improves neighborhood conditions may be necessary to reduce parents' fear and lessen restrictions on outdoor play.

Neighborhood Influences on Women's Parenting Practices for Adolescents' Outdoor Play: A Qualitative Study

Understanding factors that influence parenting decisions for outdoor play is necessary to promote physical activity during critical years for adolescent adjustment. This study explored physical and social environmental influences on parenting decisions and rules for their child's outdoor play using semistructured in-depth interviews with parents (n = 30, 29 of whom were mothers) of adolescents. Mothers from low- (n = 16) and high-disadvantage (n = 13) neighborhood environments were recruited to identify environmental factors that resulted in parenting decisions that either promoted or hindered outdoor play and identify differences across neighborhood types. Data were analyzed using a grounded theory approach. Mothers limit their child's independent play, as well as the location and time of outdoor play, due to both social and physical aspects of their neighborhood. Seven themes (safety, social norms, sense of control, social cohesion and neighborhood composition, walkability, and access to safe places for activity) were identified as influencers of parenting practices. Mothers in high-disadvantage neighborhoods reported facing greater neighborhood barriers to letting their child play outside without supervision. Physical and social neighborhood factors interact and differ in low- and high-disadvantage neighborhoods to influence parenting practices for adolescent's outdoor play. Community-level interventions should target both physical and social environmental factors and be tailored to the neighborhood and target population, in order to attenuate parental constraints on safe outdoor play and ultimately increase physical activity and facilitate adolescent adjustment among developing youth.

Adjusting the Equity Lens: Gaps in Addressing Health Equity in State Chronic Disease Prevention

Purpose: Chronic diseases cause a significant proportion of mortality and morbidity in the United States, although risk factors and prevalence rates vary by population subgroups. State chronic disease prevention practitioners are positioned to address these issues, yet little is known about how health equity is being incorporated into their work. The purpose of this study was to explore perceptions of health equity in a sample of state chronic disease practitioners.

Methods: Participants were selected in conjunction with a related evaluation of the National Association of Chronic Disease Directors (NACDD) capacity-building and evidence-based efforts. Four states were chosen for study based on variance in capacity. Directors in each of the states were interviewed and using snowball sampling, 8–12 practitioner interviews were conducted in each state, digitally audio recorded and transcribed. Using a comparative coding technique, themes and analyses were developed.

Results: Comments from the practitioners fell into three main and inter-related categories. First, they discussed the varying degrees of integration of health equity in their work. The second theme was collaboration and the importance of working within and outside of departments, as well as with the community. The third theme related to measurement and the need for better data that can be used to garner support and measure impact.

Conclusion: Chronic disease practitioners can play an important role in achieving health equity. Integrating this work more fully into chronic disease prevention and health promotion, developing strategic partnerships, tracking efforts, and measuring impact will improve practice and ultimately population health.

Network influences on the development and implementation of active transportation policies in six U.S. cities

Many communities have prioritized policy and built environment changes to promote active transportation (AT). However, limited information exists on the partnerships and processes necessary to develop and implement such policy and environmental changes, particularly among organizations in non-health sectors. Within the transportation sector, metropolitan planning organizations (MPOs) are increasingly recognized as organizations that can support AT policies. This study examined inter-organizational relationships among MPOs and their partners working to advance AT policies in six U.S. cities. In fall 2015, an average of 22 organizations in each city participated in an online survey about partnerships with MPOs and other organizations developing and implementing AT policies. Measures included organizational characteristics and relational attributes including: level of AT policy collaboration, information transmission, resource sharing, and perceived decisional power. Descriptive network analysis and exponential random graph modeling were used to examine organizational attributes and relational predictors associated with inter-organizational collaboration in each network. MPOs served as collaborative intermediaries, connecting other organizations around AT policies, in half of the cities examined. Organizations in each city were more likely to collaborate around AT policies when partners communicated at least quarterly. In half of the cities, the probability of AT policy collaboration was higher when two agencies exchanged resources and when organizations had perceived decisional authority. Network analysis helped identify factors likely to improve partnerships around AT policies. Results may contribute to best practices for collaboration among researchers, practitioners, policymakers, and advocates across diverse sectors seeking to promote population-level physical activity.

Perspectives on High School "Pay to Play" Sports Fee Policies: A Qualitative Study

BACKGROUND

Participation in high school athletics is associated with many physical and psychosocial benefits. School budget cuts and increased program costs have resulted in policies requiring student athletes to pay fees for sports participation. The purpose of this study was to explore the implementation and perception of these policies among state and district key informants.

METHODS

We conducted an Internet search to compile a list of state and district athletic directors for study recruitment to participate in qualitative interviews. Twelve key informants were interviewed via telephone, digitally audio-recorded, and the conversations transcribed verbatim. Two team members coded transcripts and themes were identified and summarized.

RESULTS

The main reasons for implementing fee policies were increasing program costs, revenue loss or decreased school budget, and unsuccessful levy passage. The policies varied in fee structure, and were reported by sport, by athlete, by year, or by family. Participants discussed fee waivers as a strategy to assist athletes unable to pay the sports participation fees. Waivers were most likely linked with federal poverty qualifications.

CONCLUSION

The results from these interviews provided insight into sports participation policies in US high schools. More information is needed to explore the consequences of these policies on high school sports participation as well as longer-term outcomes.

The role of physical activity enjoyment in the pathways from the social and physical environments to physical activity of early adolescent girls

Most girls experience a notable decline in physical activity (PA) in early adolescence, increasing their risk for harmful health outcomes. Enjoyment for PA (i.e., positive feelings toward PA) is a determinant of PA among girls during adolescence and sustained PA throughout adulthood. Previous studies recommended increasing girls' PA enjoyment in order to increase their PA, but did not include environmental-level strategies for how families, schools, or communities do this. To gain insight on such strategies, this study examines the role of PA enjoyment as a mediator of social and physical environments to moderate-to-vigorous intensity PA of early adolescent girls. Cross-sectional, secondary analyses, using structural equation modeling, were conducted on a U.S. national dataset of 1721 sixth grade girls from the Trial of Activity for Adolescent Girls in 2003. Mediation model fit parameters included χ2 (292, N = 1721) = 947.73 p < 0.001, CFI = 0.95, RMSEA = 0.04 (90% CI = 0.03, 0.04), and SRMR = 0.037 suggesting overall good fit. There were no indirect effects on PA through PA enjoyment from the social or physical environmental factors. To PA, there were significant direct effects only from social support from friends (β = 0.15, CI = 0.09, 0.22). To PA enjoyment, there were significant direct effects from social support from family (β = 0.15, CI = 0.08, 0.23), school climate (teachers β = 0.15, CI = 0.10, 0.21 and boys β = 0.15, CI = 0.09, 0.20), and neighborhood environment (β = 0.10, CI = 0.04, 0.17). The findings of this study identified several direct effects of the social and physical environment on PA enjoyment that can begin to inform environmental-level strategies for increasing PA enjoyment among early adolescent girls.

Administrative Evidence-based Practices in State Chronic Disease Practitioners

INTRODUCTION

Research and lessons from community implementation have informed evidence-based practices that can improve the effectiveness of health initiatives. Administrative evidence-based practices (A-EBPs) facilitate the role of public health departments in implementing the most effective programs and policies. The purpose of this study is to describe A-EBPs in relation to characteristics of chronic disease practitioners in state health departments.

METHODS

Randomly selected chronic disease practitioners who worked in state health departments were invited to complete an online survey in 2016. The survey included questions on five domains of A-EBPs: workforce development, leadership, culture and climate, relationships and partners, and financial practices. State-level variables that could potentially affect the use of A-EBPs were collected and used in a regression model.

RESULTS

Analysis was conducted in 2016 on data from 571 respondents. Mean percentages of those who strongly agreed/agreed were lowest for financial practices (41.49%) and leadership (42.33%) with higher means for culture and climate (54.52%) and relationships and partners (58.71%). State poverty level was the only significant predictor of A-EBP scores after adjusting for other covariates in a regression model.

CONCLUSIONS

These results show several areas of high agreement with A-EBP within the domains measured as well as opportunities for improvement. Highlighting the importance of A-EBPs to public health leadership level may enhance practice. There is also need for developing plans for an aging workforce and cultivating partnerships with health care and other sectors. Findings can be used to target training for enhancement of A-EBPs within state health departments.

"Can we walk?" Environmental supports for physical activity in India

India is currently facing a non-communicable disease epidemic. Physical activity (PA) is a preventative factor for non-communicable diseases. Understanding the role of the built environment (BE) to facilitate or constrain PA is essential for public health interventions to increase population PA. The objective of this study was to understand BEs associations with PA occurring in two major life domains or life areas-travel and leisure-in urban India. Between December 2014 and April 2015, in-person surveys were conducted with participants (N=370; female=47.2%) in Chennai, India. Perceived BE characteristics regarding residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking and bicycling, aesthetics, traffic safety, and safety from crime were measured using the adapted Neighborhood Environment Walkability Scale-India (NEWS-India). Self-reported PA was measured the International Physical Activity Questionnaire. High residential density was associated with greater odds of travel PA (aOR=1.9, 95% CI=1.2, 3.2). Land use mix-diversity was positively related to travel PA (aOR=2.1, 95%CI=1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score predicted a two-fold increase in odds of travel PA (aOR=1.9, 95% CI=1.1, 3.1) and a 40% decrease in odds of leisure PA (aOR=0.6, 95% CI=0.4, 1.0). However, the association of the aggregated score with leisure PA was not significant. Results suggest that relationships between BE and PA in low-and-middle income countries may be context-specific, and may differ markedly from higher income countries. Findings have public health implications for India suggesting that caution should be taken when translating evidence across countries.

Opportunities for Promoting Physical Activity in Rural Communities by Understanding the Interests and Values of Community Members

PURPOSE

Physical activity (PA) has well-established health benefits, but most Americans do not meet national guidelines. In southeastern Missouri, trails have been developed to increase rates of PA. Although this has had success, broad-scale interventions will be needed to improve rates further. In this study, we surveyed residents of southeastern Missouri to identify ways to improve rates of PA.

METHODS

We conducted a telephone survey in 2015 of adults (n = 524) from eight rural Missouri towns that had walking trails, regarding their activities and interests.

FINDINGS

Forty percent of respondents reported both walking and meeting PA recommendations, 29% reported walking but not meeting PA recommendations, and the remainder did not walk or did not answer. Respondents who used the trails were significantly more likely to meet PA recommendations (odds ratio = 2.7; 95% confidence interval = 1.7, 4.5). Certain values and interests that may encourage PA or draw people to trails were common.

CONCLUSIONS

The group that walked but did not meet PA recommendations would be the ideal group to target for intervention, which could focus on their reported values and interests (e.g., personal relationships, being outdoors). Use of walking trails was associated with meeting PA recommendations.

The Impact of the Physical Activity Policy Research Network

INTRODUCTION

Lack of physical activity is one of the greatest challenges of the 21st century. The Physical Activity Policy Research Network (PAPRN) is a thematic network established in 2004 to identify determinants, implementation, and outcomes of policies that are effective in increasing physical activity. The purpose of this study is to describe the products of PAPRN and make recommendations for future research and best practices.

METHODS

A mixed methods approach was used to obtain both quantitative and qualitative data on the network. First, in 2014, PAPRN's dissemination products from 2004 to 2014 were extracted and reviewed, including 57 publications and 56 presentations. Next, semi-structured qualitative interviews were conducted with 25 key network participants from 17 locations around the U.S. The transcripts were transcribed and coded.

RESULTS

The results of the interviews indicated that the research network addressed several components of its mission, including the identification of physical activity policies, determinants of these policies, and the process of policy implementation. However, research focusing on physical activity policy outcomes was limited. Best practices included collaboration between researchers and practitioners and involvement of practitioners in research design, data collection, and dissemination of results.

CONCLUSIONS

PAPRN is an example of a productive research network and has contributed to both the process and content of physical activity policy research over the past decade. Future research should emphasize physical activity policy outcomes. Additionally, increased partnerships with practitioners for collaborative, cross-sectoral physical activity policy research should be developed.

State Legislation Related to Increasing Physical Activity: 2006-2012

BACKGROUND

Strategies to improve physical activity prevalence often include policy and environmental changes. State-level policies can be influential in supporting access and opportunities for physical activity in schools and communities. The purpose of this study was to explore the prevalence of state legislation related to physical activity and identify the correlates of enactment of this legislation.

METHODS

An online legislative database was used to collect bills from 50 states in the U.S. from 2006 to 2012 for 1010 topics related to physical activity. Bills were coded for content and compiled into a database with state-level variables (eg, obesity prevalence). With enactment status as the outcome, bivariate and multivariate analyses were conducted.

RESULTS

Of the 1,542 bills related to physical activity introduced, 30% (N = 460) were enacted. Bills on public transportation and trails were more likely to be enacted than those without these topics. Primary sponsorship by the Republican Party, bipartisan sponsorship, and mention of specific funding amounts were also correlates of enactment.

CONCLUSION

Policy surveillance of bills and correlates of enactment are important for understanding patterns in legislative support for physical activity. This information can be used to prioritize advocacy efforts and identify ways for research to better inform policy.

Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013

INTRODUCTION

Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity-related policy and environmental strategies for obesity prevention in rural communities.

METHODS

A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity-related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.

RESULTS

Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were "enhance infrastructure supporting walking" (n = 11) and "increase opportunities for extracurricular physical activity" (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.

CONCLUSION

Seven of the 12 COCOMO physical activity-related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.

Appraising the evidence for public health policy components using the quality and impact of component evidence assessment

An essential strategy expected to reduce the global burden of chronic and cardiovascular disease is evidence-based policy. However, it is often unknown what specific components should constitute an evidence-based policy intervention. We have developed an expedient method to appraise and compare the strengths of the evidence bases suggesting that individual components of a policy intervention will contribute to the positive public health impact of that intervention. Using a new definition of "best available evidence," the Quality and Impact of Component (QuIC) Evidence Assessment analyzes dimensions of evidence quality and evidence of public health impact to categorize multiple policy component evidence bases along a continuum of "emerging," "promising impact," "promising quality," and "best." QuIC was recently applied to components from 2 policy interventions to prevent and improve the outcomes of cardiovascular disease: public-access defibrillation and community health workers. Results illustrate QuIC's utility in international policy practice and research.

Governors' priorities for public health and chronic disease prevention: a qualitative analysis of State of the State addresses

Governors use State of the State speeches to publicly outline state status, progress, and policy priorities. The purpose of this study was to qualitatively analyze the public health content of State of the State addresses from 2009 to 2013. Speech transcripts were collected and uploaded into NVivo10. Speeches were coded using a priori, general thematic codes followed by detailed sub-coding of public health text. Data was organized by emergent thematic patterns. From 2009 to 2013, 48 governors presented 72 speeches with public health messages. Framing current public health problems and outlining strategies were two of the three main themes that emerged. Problems were often framed using data or emphasizing economic costs. Governors outlined prevention strategies on tobacco, nutrition, or physical activity through increased funding, policies, or partnerships. Speech content provides information on priorities and trends and can be used to inform advocacy efforts. Future research should link these priorities to outcomes of legislation.

Outside the exam room: policies for connecting clinic to community in diabetes prevention and treatment

The public health burden and racial/ethnic, sex, and socioeconomic disparities in obesity and in diabetes require a population-level approach that goes beyond provision of high-quality clinical care. The Robert Wood Johnson Foundation’s Commission to Build a Healthier America recommended 3 strategies for improving the nation’s health: 1) invest in the foundations of lifelong physical and mental well-being in our youngest children; 2) create communities that foster health-promoting behaviors; and 3) broaden health care to promote health outside the medical system. We present an overview of evidence supporting these approaches in the context of diabetes and suggest policies to increase investments in 1) adequate nutrition through breastfeeding and other supports in early childhood, 2) community and economic development that includes health-promoting features of the physical, food, and social environments, and 3) evidence-based interventions that reach beyond the clinical setting to enlist community members in diabetes prevention and management.

Enhancing workplace wellness efforts to reduce obesity: a qualitative study of low-wage workers in St Louis, Missouri, 2013-2014

INTRODUCTION

The objective of this study was to examine workplace determinants of obesity and participation in employer-sponsored wellness programs among low-wage workers.

METHODS

We conducted key informant interviews and focus groups with 2 partner organizations: a health care employer and a union representing retail workers. Interviews and focus groups discussed worksite factors that support or constrain healthy eating and physical activity and barriers that reduce participation in workplace wellness programs. Focus group discussions were transcribed and coded to identify main themes related to healthy eating, physical activity, and workplace factors that affect health.

RESULTS

Although the union informants recognized the need for workplace wellness programs, very few programs were offered because informants did not know how to reach their widespread and diverse membership. Informants from the health care organization described various programs available to employees but noted several barriers to effective implementation. Workers discussed how their job characteristics contributed to their weight; irregular schedules, shift work, short breaks, physical job demands, and food options at work were among the most commonly discussed contributors to poor eating and exercise behaviors. Workers also described several general factors such as motivation, time, money, and conflicting responsibilities.

CONCLUSION

The workplace offers unique opportunities for obesity interventions that go beyond traditional approaches. Our results suggest that modifying the physical and social work environment by using participatory or integrated health and safety approaches may improve eating and physical activity behaviors. However, more research is needed about the methods best suited to the needs of low-wage workers.

Physical activity and food environment assessments: implications for practice

There is growing interest in the use of physical activity and nutrition environmental measures by both researchers and practitioners. Built environment assessment methods and tools range from simple to complex and encompass perceived, observed, and geographic data collection. Even though challenges in tool selection and use may exist for non-researchers, there are opportunities to incorporate these measures into practice. The aims of this paper are to (1) describe examples of built environment assessment methods and tools in the practice context; (2) present case studies that outline successful approaches for the use of built environment assessment tools and data among practitioners; and (3) make recommendations for both research and practice. As part of the Built Environment Assessment Training Think Tank meeting in July 2013, experts who work with community partners gathered to provide input on conceptualizing recommendations for collecting and analyzing built environment data in practice and research. The methods were summarized in terms of perceived environment measures, observational measures, and geographic measures for physical activity and food environment assessment. Challenges are outlined and case study examples of successful use of assessments in practice are described. Built environment assessment tools and measures are important outside the research setting. There is a need for improved collaboration between research and practice in forming partnerships for developing tools, collecting and analyzing data, and using the results to work toward positive environmental changes.

Accessing evidence to inform public health policy: a study to enhance advocacy

OBJECTIVES

Improving population health often involves policy changes that are the result of complex advocacy efforts. Information exchanges among researchers, advocates, and policymakers is paramount to policy interventions to improve health outcomes. This information may include evidence on what works well for whom and cost-effective strategies to improve outcomes of interest. However, this information is not always readily available or easily communicated. The purposes of this paper are to describe ways advocates seek information for health policy advocacy and to compare advocate demographics.

STUDY DESIGN

Cross-sectional telephone survey.

METHODS

Seventy-seven state-level advocates were asked about the desirable characteristics of policy-relevant information including methods of obtaining information, what makes it useful, and what sources make evidence most reliable/trustworthy. Responses were explored for the full sample and variety of subsamples (i.e. gender, age, and position on social and fiscal issues). Differences between groups were tested using t-tests and one-way analysis of variance.

RESULTS

On average, advocates rated frequency of seeking research information as 4.3 out of five. Overall, advocates rated the Internet as the top source, rated unbiased research and research with relevancy to their organization as the most important characteristics, and considered information from their organization as most reliable/believable. When ratings were examined by subgroup, the two characteristics most important for each question in the total sample (listed above) emerged as most important for nearly all subgroups.

CONCLUSIONS

Advocates are a resource to policymakers on health topics in the policy process. This study, among the first of its kind, found that advocates seek research information, but have a need for evidence that is unbiased and relevant to their organizations and report that university-based information is reliable. Researchers and advocates should partner so research is useful in advocating for evidence-based policy change.

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.

Moving the Barricades to Physical Activity: A Qualitative Analysis of Open Streets Initiatives Across the United States

PURPOSE

Ciclovía, or Open Streets initiatives, are events where streets are opened for physical activity and closed to motorized traffic. Although the initiatives are gaining popularity in the United States, little is known about planning and implementing them. The goals of this paper are to explore the development and implementation of Open Streets initiatives and make recommendations for increasing the capacity of organizers to enhance initiative success.

APPROACH

Phenomenology with qualitative analysis of structured interviews was used.

SETTING

Study setting was urban and suburban communities in the United States.

PARTICIPANTS

Study participants were organizers of Open Streets initiatives in U.S. cities.

METHOD

Using a list of 47 events held in 2011, 27 lead organizers were interviewed by telephone about planning, implementation, and lessons learned. The interviews were digitally recorded and transcribed. A phenomenologic approach was used, an initial coding tool was developed after reviewing a sample of transcripts, and constant comparative coding methodology was applied. Themes and subthemes were generated from codes.

RESULTS

The most common reasons for initiation were to highlight or improve health and transportation. Most initiatives aimed to reach the general population, but some targeted families, children, or specific neighborhoods. Getting people to understand the concept of Open Streets was an important challenge. Other challenges included lack of funding and personnel, and complex logistics.

CONCLUSION

These initiatives democratize public space for citizens while promoting physical activity, social connectedness, and other broad agendas. There are opportunities for the research community to contribute to the expanse and sustainability of Open Streets, particularly in evaluation and dissemination.

Target population involvement in urban ciclovias: a preliminary evaluation of St. Louis open streets

Ciclovias are active street events when roads are open to walkers, cyclists, and families and closed to automobiles. Over 70 cities in the USA have implemented ciclovias to promote physical activity. The authors evaluated four events during 2010 to determine what activities participants perform and who is attending. For two ciclovia events in St. Louis, Missouri, observation reports of activities, gender, and age of 1,452 participants were collected, and 82 adults were interviewed via direct approach. The survey covered six domains: physical activity, travel to event, sense of community, marketing, economic impact, and demographics. Each event occurred within the city, along multiple streets. Domains were selected from Ciclovia Recreativa developed by Ciclovia Bogota, Pan American Health Organization, and CDC. Additional questions addressed city-specific goals and matched similar evaluations in other cities. Over 50 % of participants met CDC-defined weekly minute thresholds for physical activity. Participants, primarily (>80 %) middle class, college educated, and white, were not representative of the majority minority city population, which has high rates of poverty, and low percentage of college graduates. Cities must work with residents to increase low-income minority population participation in ciclovia-based physical activity.

Policies on worksite lactation support within states and organizations

BACKGROUND

The issue of workplace lactation support has intensified due to the Affordable Care Act of 2010 (ACA) amendment of the Fair Labor Standards Act (FLSA) obliging employers to provide a reasonable break time for nursing mothers.

OBJECTIVES

This objective of this study is to examine organizational policies on worksite lactation support as they relate to the new federal standards in state employees and within large state public and private universities.

METHODS

State laws were collected from National Conference of State Legislators. Policies for state employees and large public and private universities were collected via human resource or personnel administration websites. The policies were coded for content and compared to FLSA requirements. The presence of state law on lactation support and extent to which the organizational policies encompass FSLA were compared with state breastfeeding rates at 6 months.

RESULTS

After the ACA became effective in 2010, 33 state organizations, 36 state public universities, and 13 private universities issued the administrative notice and aligned their organizational policies with the federal requirements. Twenty-four states enacted worksite breastfeeding law prior to the 2010 federal law. Nineteen states with enacted worksite breastfeeding state laws also have lactation policies for state employees.

CONCLUSION

States and universities vary in the presence of a formal, written lactation support policy for state employees. There was a significant correlation between State law and 6 months exclusive breastfeeding rates. Future research should investigate whether the federal law serves as stronger catalyst for organizational policies than does state law. Additionally, other policies such as paid maternity leave may also contribute to achieving the desired breastfeeding rates.

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.

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.

The U.S. National Physical Activity Plan: dissemination and use by public health practitioners

BACKGROUND

The 2010 U.S. National Physical Activity Plan contains a comprehensive set of policies, programs, and initiatives to increase physical activity.

PURPOSE

To determine the early awareness, use, diffusion, and implementation of the plan among members of the National Society of Physical Activity Practitioners in Public Health.

METHODS

The web-based survey was conducted in 2011 and analyzed in 2011-2012. The survey was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Diffusion of Innovations theory. Of 492 professional members, 291 responded.

RESULTS

Overall, 79% reported awareness of the plan, with higher odds among state practitioners compared to other practitioners and among those with state partnerships to address physical activity compared to those without. Among those who were aware (n=230), 15% reported using the plan ≥6 times, whereas 28% had never used it. For those who referred to the plan at least once in their work (n=165), the most commonly reported uses were for brainstorming and discussion (73%); development and implementation of activities (55%); and state-level goal-setting (34%). Related to diffusion principles, many respondents reported that the plan fit their organization's goals (85%) and was easy to understand (81%), yet fewer agreed that changes made after the plan were easy to observe (32%); easy to implement (28%); and low-cost (25%).

CONCLUSIONS

This theory-based evaluation found that the National Physical Activity Plan has been broadly disseminated to physical activity practitioners working in public health. Opportunities exist for public health practitioners and others to more fully integrate the plan into their work.