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Background: Organizational adoption is a key but understudied step in translating evidence-based interventions into practice. The purpose of this study was to report recruitment strategies and factors associated with church enrollment and intervention adoption in a national implementation study of the Faith, Activity, and Nutrition (FAN) program. Methods: We worked with partners using multiple strategies to disseminate intervention availability. Interested churches completed an online form. To enroll, the church coordinator (FAN coordinator) and pastor completed baseline surveys and then received intervention online training access. We compared enrolled vs. non-enrolled churches on how they heard about the study and church characteristics. We compared intervention-adopting vs. non-adopting churches on Consolidated Framework for Implementation Research (CFIR) constructs using Fisher's exact tests, χ2, or independent sample t-tests and reported differences where p < 0.10, d≥|0.35|, or the difference in percentage points was ≥ 10. Results: We received 226 interest forms; 107 churches enrolled, and 85 churches adopted the intervention. Faith-based sources were the most, and paid media the least, effective in reaching churches, which were largely from the southeast with a Methodist or Baptist tradition (no differences by enrollment status). Enrolled churches were less likely to have 500 + worshipers and more likely to have attended a study information session than non-enrolled churches. Church (CFIR inner setting) and FAN coordinator characteristics, but not intervention characteristics, were related to intervention adoption. Conclusion: Partnerships, relationships, and "face time" are important for enrolling churches in evidence-based interventions. Church and church coordinator characteristics are related to intervention adoption. Further work on adoption conceptualization and operationalization is needed. [ABSTRACT FROM AUTHOR]

This study compared marginal and conditional modeling approaches for identifying individual, park and neighborhood park use predictors. Data were derived from the ParkIndex study, which occurred in 128 block groups in Brooklyn (New York), Seattle (Washington), Raleigh (North Carolina), and Greenville (South Carolina). Survey respondents (n = 320) indicated parks within one half-mile of their block group used within the past month. Parks (n = 263) were audited using the Community Park Audit Tool. Measures were collected at the individual (park visitation, physical activity, sociodemographic characteristics), park (distance, quality, size), and block group (park count, population density, age structure, racial composition, walkability) levels. Generalized linear mixed models and generalized estimating equations were used. Ten-fold cross validation compared predictive performance of models. Conditional and marginal models identified common park use predictors: participant race, participant education, distance to parks, park quality, and population >65yrs. Additionally, the conditional mode identified park size as a park use predictor. The conditional model exhibited superior predictive value compared to the marginal model, and they exhibited similar generalizability. Future research should consider conditional and marginal approaches for analyzing health behavior data and employ cross-validation techniques to identify instances where marginal models display superior or comparable performance. [ABSTRACT FROM AUTHOR]

Background: Neighborhood parks are recognized as important spaces for facilitating physical activity (PA); however, it remains unclear how the frequency of park use is associated with PA. The purpose of this study was to examine associations between minutes of moderate to vigorous PA and multiple park use indicators: (1) use of a neighborhood park, (2) unique number of neighborhood parks used, and (3) frequency of neighborhood park use. Methods: Adults were surveyed from 4 US cities (Brooklyn, NY; Greenville County, SC; Raleigh, NC; and Seattle, WA). Using a map-based survey platform, participants indicated all neighborhood parks they used and the frequency of use in the past 30 days. Participants self-reported their weekly moderate to vigorous PA. Quantile regression was used to examine associations between PA and park use indicators. Results: Of all respondents (N = 360), 60% indicated visiting a neighborhood park in the past 30 days, with an average of about 13 total neighborhood park visits (SD = 17.5). Significant, positive associations were found between moderate to vigorous PA and both unique neighborhood park visits and total number of neighborhood parks visits. Conclusions: Frequency of park visitation is associated with PA among US adults. Ensuring equitable and safe access to neighborhood parks has the potential for population-level PA health benefits. [ABSTRACT FROM AUTHOR]

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be "just right" and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability. [ABSTRACT FROM AUTHOR]

Background: Research is needed that identifies environmental resource disparities and applies multiple rural definitions. Therefore, this study aims to examine urban‐rural differences in food and physical activity (PA) environment resource availability by applying several commonly used rural definitions. We also examine differences in resource availability within urban‐rural categories that are typically aggregated. Methods: Six food environment variables (access to grocery/superstores, farmers' markets, fast food, full‐service restaurants, convenience stores, and breastfeeding‐friendly facilities) and 4 PA environment variables (access to exercise opportunities and schools, walkability, and violent crimes) were included in the childhood obesogenic environment index (COEI). Total COEI, PA environment, and food environment index scores were generated by calculating the average percentile for related variables. US Department of Agriculture Urban Influence Codes, Office of Management and Budget codes, Rural‐Urban Continuum Codes, Census Bureau Population Estimates for percent rural, and Rural Urban Commuting Area Codes were used. One‐way ANOVA was used to detect urban‐rural differences. Results: The greatest urban‐rural disparities in COEI (F=310.2, P<.0001) and PA environment (F=562.5, P<.0001) were seen using RUCC codes. For food environments, the greatest urban‐rural disparities were seen using Census Bureau percent rural categories (food: F=24.9, P<.0001). Comparing remote rural categories, differences were seen for food environments (F=3.1, P=.0270) and PA environments (F=10.2, P<.0001). Comparing metro‐adjacent rural categories, differences were seen for PA environment (F=4.7, P=.0090). Conclusion: Findings inform future research on urban and rural environments by outlining major differences between urban‐rural classifications in identifying disparities in access to health‐promoting resources. [ABSTRACT FROM AUTHOR]

Background: Public parks hold promise for promoting population-level PA, but studies show a significant portion of park use is sedentary. Past research has documented the effectiveness of message-based strategies for influencing diverse behaviors in park settings and for increasing PA in nonpark contexts. Therefore, to inform message-based interventions (eg, point-ofdecision prompts) to increase park-based PA, the purpose of this study was to elicit insights about key attitudes, perceived norms, and personal agency that affect park use and park-based PA in low-income urban neighborhoods. Methods: This study used 6 focus groups with youth and adults (n = 41) from low-income urban areas in Kansas City, MO, to examine perceptions of key attitudinal outcomes and motivations, perceived norms, key referents, and personal agency facilitators and constraints that affect park use and park-based PA. Results: Participant attitudes reflected the importance of parks for mental and physical health, with social interaction and solitude cited as key motivations. Of 10 themes regarding perceived norms, influential others reflected participants' ethnic makeup but little consensus emerged among groups. Social and safety themes were cited as both facilitators and constraints, along with park offerings and setting. Conclusions: Information about attitudes, perceived norms, and personal agency can increase understanding of theoretically derived factors that influence park-based PA and help park and health professionals create communication strategies to promote PA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop and evaluate the reliability and validity of self-efficacy and intentions measures for time spent in nature (TSN). TSN is related to improvement in psychological well-being and health, yet most American adults spend very little time in such settings. Theory-based interventions have been effective in increasing physical activity, a related behavior, and may be one mechanism to increase TSN. Self-efficacy and intentions have been shown to be strong predictors of health behaviors and are used across several theories. However, scales to measure these factors have not yet been developed and are needed to facilitate effective interventions. Methods: TSN self-efficacy and intentions scales were developed using a sequential nine-step procedure: identification of the domain and item generation; content validity; pre-testing of questions; sampling and survey administration; item reduction; extraction of factors; tests of dimensionality; tests of reliability; and tests of validity. The 14-member multidisciplinary, researcher and practitioner investigative team generated 50 unique items for self-efficacy and 24 unique items for intentions. After subjecting items to content validity and pre-testing, item sets were reduced to 21 assessing self-efficacy and nine assessing intentions. A nationwide sample of 2109 adult participants (49.7% female, Mean Age = 58.1; 59.8% White, 18.4% Hispanic, 13.3% Black) answered these items via an on-line survey. Results: Using split-half measures, principal components analysis indicated a one-factor solution for both scales. The factor structure was upheld in confirmatory factor analyses and had high internal consistency (α =.93 self-efficacy;.91 intentions). The scales were moderately correlated with each other (r =.56, p <.001) and were strongly related to TSN with large effect sizes (eta2 >.20). Conclusions: The study resulted in reliable and valid self-efficacy (14 items) and intentions (8 items) scales that can be used to develop future theory-based interventions to increase TSN and thereby improve population health. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the impact of ecological health promotion interventions on organizational practices over time, especially in faith-based settings. This statewide dissemination and implementation study examined change in organizational practices and their predictors across a 24-month period, as well as maintenance of change. Methods: Using a pre-post quasi-experimental design, church coordinators from 92 United Methodist Churches in South Carolina (42% predominantly African American congregations) completed surveys at baseline, and immediate, 12-, and 24-months post-training regarding physical activity (PA) and healthy eating (HE) organizational practices consistent with the Faith, Activity, and Nutrition (FAN) program (opportunities, policies, pastor support, messages) and possible predictors. The study was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR). Mixed model repeated measures analyses examined change in organizational practices over time. Regression models examined CFIR predictors of 24-month PA and HE organizational practices, controlling for baseline practices. Churches were also classified as maintainers (implemented at 12 and 24 months), non-sustained implementers (implemented at 12 but not 24 months), delayed implementers (implemented at 24 but not 12 months), and low implementers (implemented at neither 12 nor 24 months) for each FAN component. Results: PA and HE organizational practices increased over time (p <.0001). CFIR domains (and constructs within) of intervention characteristics (adaptability, relative advantage, cost/time), inner setting (relative priority, organizational rewards, readiness, congregant needs), characteristics of the implementer (self-efficacy, perceived benefits), and implementation process (engaging opinion leaders, engaging champions) were important predictors of 24-month PA and HE organizational practices. Over half of churches implementing PA policies, PA messages, HE policies, and HE opportunities at 12 months were maintainers at 24 months, and one-third were maintainers for PA opportunities, HE messages, and PA and HE pastor support. Furthermore, 16% of 12-month non-implementers were delayed implementers at 24 months for PA policies and 31% were delayed implementers for HE policies. Conclusions: This study makes important contributions to the faith-based health promotion literature by including a large sample of churches, testing an ecological intervention approach, and assessing organizational practices over a 24-month period. Study findings can guide technical assistance and program adaptations over time. Trial registration: This study was registered in clinicaltrials.gov NCT02868866 on August 16, 2016. [ABSTRACT FROM AUTHOR]

This study examined spatial patterns of obesogenic environments for US counties. We mapped the geographic dispersion of food and physical activity (PA) environments, assessed spatial clustering, and identified food and PA environment differences across U.S. regions and rurality categories. Substantial low food score clusters were located in the South and high score clusters in the Midwest and West. Low PA score clusters were located in the South and high score clusters in the Northeast and Midwest (p <.0001). For region, the South had significantly lower food and PA environment scores. For rurality, rural counties had significantly higher food environment scores and metropolitan counties had significantly higher PA environment scores (p <.0001). This study highlights geographic clustering and disparities in food and PA access nationwide. State and region-wide environmental inequalities may be targeted using structural interventions and policy initiatives to improve food and PA access. [ABSTRACT FROM AUTHOR]

Although research traction is increasing, intangible social impacts are still difficult to measure and relatively under-researched compared to their tangible economic counterparts. Thus, the current study examines the question: what were the associations between hosting the 2010 Vancouver Olympic Games, social wellbeing (i.e. sense of belonging), and subjective wellbeing (i.e. life satisfaction) among Canadian youth? Using data from the Canadian Community Health Survey (n > 1,000,000), a time series analysis of youths' (aged 12–19) reports of perceived sense of belonging to their community and perceived life satisfaction across four time points before and after the Vancouver Winter Olympic and Paralympic Games at the national, provincial, and regional levels was conducted. The number of youths who reported a strong sense of belonging to their community significantly increased in the host region of North Shore after the Games concluded (2011–2012 to 2013–2014). The number of youths who reported a strong sense of belonging to their community and high life satisfaction significantly increased from 2007–2008 (pre-event) to 2009–2010 in the host region of Richmond. This study provides preliminary evidence that mega-sport events might positively affect wellbeing of youth living in regions that house venues for the event. The study also demonstrates the temporary nature of positive social impacts. Suggestions for how to help create situations where positive social impacts are more likely, and to help maintain the wellbeing benefits of mega-sport events for youth populations are offered. [ABSTRACT FROM AUTHOR]

Local-level childhood overweight and obesity data are often used to implement and evaluate community programs, as well as allocate resources to combat overweight and obesity. The most current substate estimates of US childhood obesity use data collected in 2007. Using a spatial multilevel model and the 2016 National Survey of Children's Health, we estimated childhood overweight and obesity prevalence rates at the Census regional division, state, and county levels using small-area estimation with poststratification. A sample of 24,162 children aged 10–17 years was used to estimate a national overweight and obesity rate of 30.7% (95% confidence interval: 27.0%, 34.9%). There was substantial county-to-county variability (range, 7.0% to 80.9%), with 31 out of 3,143 counties having an overweight and obesity rate significantly different from the national rate. Estimates from counties located in the Pacific region had higher uncertainty than other regions, driven by a higher proportion of underrepresented sociodemographic groups. Child-level overweight and obesity was related to race/ethnicity, sex, parental highest education (P  < 0.01 for all), county-level walkability (P  = 0.03), and urban/rural designation (P  = 0.02). Overweight and obesity remains a vital issue for US youth, with substantial area-level variability. The additional uncertainty for underrepresented groups shows surveys need to better target diverse samples. [ABSTRACT FROM AUTHOR]

Background Pregnancy can be a stressful time for many women; however, it is unclear if higher stress and depressive symptoms are associated with poorer diet quality during pregnancy. Objective The aims for this narrative review were to (1) synthesize findings of original, peer-reviewed studies that examined associations of stress and/or depressive symptoms with diet quality during pregnancy; (2) review the measurement tools used to assess stress, depressive symptoms, and diet quality; (3) identify current gaps in the extant literature; and (4) offer recommendations for future research. Methods A search strategy was used to identify peer-reviewed manuscripts published between January 1997 and October 2018, using the following databases: PubMed, CINAHL Complete, PsycINFO, Academic Search Complete, and Psychology & Behavioral Sciences Collection. The search was updated December 2019. Two reviewers independently assessed title, abstract, and full-text of the studies that met the inclusion criteria. Data were extracted and a quality assessment was conducted. Results Twenty-seven observational studies were identified in this review (21 cross-sectional and 6 longitudinal). In 22 studies, higher stress and/or depressive symptoms were associated with poorer diet quality or unhealthy dietary patterns; 5 studies found no association. Findings are mixed and inconclusive regarding the relationship among stress, depressive symptoms, and food groups related to diet quality and frequency of fast-food consumption. Conclusions The current data suggest stress and depressive symptoms may be a barrier to proper diet quality during pregnancy; however, variability in the assessment tools, timing of assessments, and use of covariates likely contribute to the inconsistency in study findings. Gaps in the literature include limited use of longitudinal study designs, limited use of comprehensive diet-quality indices, underrepresentation of minority women, and lack of multilevel theoretical frameworks. Studies should address these factors to better assess associations of stress and/or depressive symptoms with diet quality during pregnancy. [ABSTRACT FROM AUTHOR]

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting. [ABSTRACT FROM AUTHOR]

Background: Too much sitting, including time spent sitting in cars, is associated with poor health outcomes. Identifying the built-environment attributes that may reduce vehicular sitting time can inform future initiatives linking the public health, urban design, and transportation sectors. Methods: Data collected in 2003-2004 from adult residents (n = 2521) of Adelaide, Australia were used. Logistic regression analyses examined associations of prolonged time spent sitting in cars during leisure time (30 min/ day or more) with neighborhood walkability and its components (dwelling density; intersection density; land use mix; net retail area ratio). Results: Lower overall walkability was significantly associated with a higher odds (OR = 1.43, 95% CI: 1.21-1.70) of spending prolonged time in cars. For analyses with walkability components, lower net retail area ratio, lower residential density, and lower intersection density were significantly associated with prolonged sitting in cars. Conclusion: This study found that residents of high walkable neighborhoods tended to spend less time sitting in cars. In particular, higher net retail area ratio, an indicator of tightly spaced commercial areas, was strongly associated with less time in cars. Policy and planning initiatives to reduce car use require further evidence, particularly on the influence of neighborhood retail areas. [ABSTRACT FROM AUTHOR]

Objective: This study examined the separate relationships between socio-economic disadvantage and the density of multiple types of food outlets, and relationships between socio-economic disadvantage and composite food environment indices.Design: Cross-sectional data were analysed using geospatial kernel density techniques. Food outlet data included convenience stores, discount stores, fast-food and fast casual restaurants, and grocery stores. Controlling for urbanicity and race/ethnicity, multivariate linear regression was used to examine the relationships between socio-economic disadvantage and density of food outlets.Setting: This study occurred in a large Southeastern US county containing 255 census block groups with a total population of 474 266, of which 77·1 % was Non-Hispanic White, the median household income was $48 886 and 15·0 % of residents lived below 125 % of the federal poverty line.Participants: The unit of analysis was block groups; all data about neighbourhood socio-economic disadvantage and food outlets were publicly available.Results: As block group socio-economic disadvantage increased, so too did access to all types of food outlets. The total food environment index, calculated as the ratio of unhealthy food outlets to all food outlets, decreased as block group disadvantage increased.Conclusions: Those who reside in more disadvantaged block groups have greater access to both healthy and unhealthy food outlets. The density of unhealthy establishments was greater in more disadvantaged areas; however, because of having greater access to grocery stores, disadvantaged populations have less obesogenic total food environments. Structural changes are needed to reduce access to unhealthy food outlets to ensure environmental injustice and reduce obesity risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: In Spartanburg County, SC, nearly 33.7% of children are overweight or obese. The purpose of this study was to investigate differences in eating behavior of youth by race/ethnicity and socioeconomic status. METHODS: Students (N = 997) in 4th to 5th grades completed the School Nutrition and Physical Activity Survey. School databases categorized students as either White or racial/ethnic minority and free/reduced or full paid lunch status. Dietary behaviors included 13 composite measures: unhealthy proteins, healthy proteins, dairy, refined grains, whole grains, vegetables, fruit, fried snacks, sugar‐sweetened beverages, sweets, and consumption of a breakfast, evening, and/or restaurant meal. Logistic regression, controlling for sex, was used to analyze differences in consumption for each nutrition variable. RESULTS: Minority youth were less likely to consume healthy proteins (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.55‐0.92) and more likely to eat at a restaurant (OR = 1.32, 95% CI = 1.02‐1.70) compared to white youth. Lower socioeconomic status youth were less likely to eat an evening meal compared to higher socioeconomic status youth (OR = 0.59, 95% CI = 0.39‐0.89). CONCLUSIONS: Differences in dietary behaviors may result from food accessibility and insecurity in minority and/or low‐income neighborhoods. Future research should explore policy strategies that can help ensure all youth maintain healthy eating habits and weight status. [ABSTRACT FROM AUTHOR]

Parks benefit communities by supporting the physical, mental, and social health of their residents. This is especially important in urban areas, where parks provide essential access to green space, and especially among low-income populations who may lack alternative venues for outdoor recreation. However, although urban parks may ostensibly be accessible, their use can be influenced by factors including perceptions and realities of safety. This qualitative study explored the issue of safety as it relates to park use and park-based physical activity from six focus groups with 41 total participants in urban Kansas City, Missouri. As a facilitator to safety, participants described social interactions and structural environment factors. Safety constraints emerged along five main themes: violence, concerning behavior, lack of maintenance, lack of lighting, and traffic/busy roads. This study adds to the literature establishing safety as a complex and multidimensional factor influencing park usage and physical activity. [ABSTRACT FROM AUTHOR]

Background: Diverse environmental factors are associated with physical activity (PA) and healthy eating (HE) among youth. However, no study has created a comprehensive obesogenic environment index for children that can be applied at a large geographic scale. The purpose of this study was to describe the development of a childhood obesogenic environment index (COEI) at the county level across the United States. Methods: A comprehensive search of review articles (n = 20) and input from experts (n = 12) were used to identify community-level variables associated with youth PA, HE, or overweight/obesity for potential inclusion in the index. Based on strength of associations in the literature, expert ratings, expertise of team members, and data source availability, 10 key variables were identified – six related to HE (# per 1000 residents for grocery/superstores, farmers markets, fast food restaurants, full-service restaurants, and convenience stores; as well as percentage of births at baby (breastfeeding)-friendly facilities) and four related to PA (percentage of population living close to exercise opportunities, percentage of population < 1 mile from a school, a composite walkability index, and number of violent crimes per 1000 residents). Data for each variable for all counties in the U.S. (n = 3142) were collected from publicly available sources. For each variable, all counties were ranked and assigned percentiles ranging from 0 to 100. Positive environmental variables (e.g., grocery stores, exercise opportunities) were reverse scored such that higher values for all variables indicated a more obesogenic environment. Finally, for each county, a total obesogenic environment index score was generated by calculating the average percentile for all 10 variables. Results: The average COEI percentile ranged from 24.5–81.0 (M = 50.02,s.d. = 9.01) across US counties and was depicted spatially on a choropleth map. Obesogenic counties were more prevalent (F = 130.43,p <.0001) in the South region of the U.S. (M = 53.0,s.d. = 8.3) compared to the Northeast (M = 43.2,s.d. = 6.9), Midwest (M = 48.1,s.d. = 8.5), and West (M = 48.4,s.d. = 9.8). When examined by rurality, there were also significant differences (F = 175.86,p <.0001) between metropolitan (M = 46.5,s.d. = 8.4), micropolitan (M = 50.3,s.d. = 8.1), and rural counties (M = 52.9,s.d. = 8.8) across the U.S. Conclusion: The COEI can be applied to benchmark obesogenic environments and identify geographic disparities and intervention targets. Future research can examine associations with obesity and other health outcomes. [ABSTRACT FROM AUTHOR]

Faith-based settings have the potential to improve health in underresourced communities, but little research has quantified and compared health-promoting elements in church environments. This study examines the number of potential indoor and outdoor physical activity opportunities, healthy eating opportunities, healthy living media, and total environmental resources present in churches (n = 54) in a rural, southeastern US county and the relationship between these resources and neighborhood income. In our sample, most churches offered potential indoor and outdoor opportunities for physical activity and healthy eating opportunities, with more variability in the number of healthy living media items on display compared to other environmental components. Common potential opportunities present in churches for physical activity included a fellowship hall and green/open space, while potential opportunities for healthy eating frequently included a refrigerator and sink. Compared to those in medium- and high-income neighborhoods, churches in low-income neighborhoods scored higher on measures of potential outdoor physical activity opportunities and lower on measures of total potential environment resources, healthy eating opportunities, healthy living media, and indoor physical activity opportunities, though only indoor physical activity opportunities reached statistical significance. Potential opportunities for using existing resources in and around churches for health promotion should be investigated further, particularly in rural areas. [ABSTRACT FROM AUTHOR]

Objectives: Few social ecological studies have considered the joint effects of intrapersonal and environmental influences on physical activity. This study investigated the interaction of self-efficacy and perceived neighborhood walkability in predicting neighborhood-based physical activity and how this relationship varied by gender and body mass index. Methods: Data were derived from a cross-sectional investigation of environmental and psychosocial correlates of physical activity among adults (n = 585). Participants completed a detailed 7-day physical activity log booklet, along with a questionnaire that included measures of neighborhood walkability, self-efficacy, and several sociodemographic items. Factorial analysis of variance tests were used to examine the main effects of and interaction between walkability and self-efficacy. Results: In predicting neighborhood-based physical activity, significant interactions were observed between self-efficacy and neighborhood walkability for females (but not for males) and for overweight/obese participants (but not for healthy weight individuals). Women and overweight/obese individuals with low self-efficacy demonstrated substantially greater physical activity when living in a high walkable neighborhood. Conclusions: Physical activity research and promotion efforts should take into account both environmental and personal factors and the interrelationships between them that influence active living. [ABSTRACT FROM AUTHOR]

Background: Parks are important settings for physical activity (PA), but few studies have documented the actual behaviors of park users. The purpose of this study was to examine the individual and joint effects of various park user demographic characteristics on observed PA intensity levels. Methods: Four parks were observed using the System for Observing Play and Recreation in Communities. Observers recorded the age group, gender, race, and intensity level of all park users in 83 activity areas over two weekends at each park. Logistic regression examined whether male/White, female/White, and male/non-White users were more likely than female/non-White users to be observed engaging in moderate-to-vigorous PA (MVPA) rather than sedentary activity across 4 age groups. Results: In total, 8612 users were observed during the study. In the child age group, male/White users were significantly more likely to be observed in MVPA than female/non-White users. For teens, female/White and male/White users were less likely to engage in MVPA. For both adults and seniors, female/White and male/White users were snore likely to be observed in MVPA. Conclusion: Observations revealed significant differences in intensity levels across gender, age, and race groups. Future interventions should emphasize park design that promotes increased MVPA among diverse groups. [ABSTRACT FROM AUTHOR]

Background: Parks are important settings for physical activity (PA), but few studies have documented the actual behaviors of park users. The purpose of this study was to examine the individual and joint effects of various park user demographic characteristics on observed PA intensity levels. Methods: Four parks were observed using the System for Observing Play and Recreation in Communities. Observers recorded the age group, gender, race, and intensity level of all park users in 83 activity areas over two weekends at each park. Logistic regression examined whether male/White, female/White, and male/non-White users were more likely than female/non-White users to be observed engaging in moderate-to-vigorous PA (MVPA) rather than sedentary activity across 4 age groups. Results: In total, 8612 users were observed during the study. In the child age group, male/White users were significantly more likely to be observed in MVPA than female/non-White users. For teens, female/White and male/White users were less likely to engage in MVPA. For both adults and seniors, female/White and male/White users were more likely to be observed in MVPA. Conclusion: Observations revealed significant differences in intensity levels across gender, age, and race groups. Future interventions should emphasize park design that promotes increased MVPA among diverse groups. [ABSTRACT FROM AUTHOR]

Background: Built environments are associated with physical activity (PA), but most studies to date have employed acontextual PA outcome measures. The purposes of this study were to examine the proportion of PA that occurred within participants' neighborhoods and associations between neighborhood walkability attributes and different intensities and purposes of PA episodes occurring specifically within neighborhoods. Methods: 384 community residents completed 7 subscales of the Neighborhood Environment Walkability Scale (NEWS) and a detailed 7-day PA log-booklet that included the duration, intensity, and purpose of all episodes. Results: Only one-third of reported PA episodes occurred in participants' neighborhoods. Higher ratings for 5 of the 7 walkability variables were associated with an increased likelihood of engaging in at least some moderate-intensity neighborhood PA (versus none), but were not significantly associated with engaging in greater levels of neighborhood PA (150+ versus 1-149 minutes). Land use mix access, street connectivity, and aesthetics were significant predictors of transportation-related neighborhood PA, but only aesthetics was significantly associated with neighborhood recreational PA. Conclusions: Improving neighborhood walkability may be a stimulus for increased neighborhood PA, especially among largely sedentary individuals, but different attributes are associated with transportation-related and recreational activity. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to review reported associations between parks and recreation settings (PRSs) as features of the built environment and various functions and intensities of physical activity (PA). Methods: By searching 4 major databases for the years 1998 to 2005, 50 articles were uncovered that reported quantitative relationships between PRSs and PA. Results: Most articles showed some significant positive relationships between PRSs and PA. PRSs were more likely to be positively associated with PA for exercise or utilitarian functions than for recreational PA. Mixed results were observed for the associations between PRSs and both moderate and vigorous PA, but PRSs were commonly associated with walking. Conclusions: The studies indicated links between PRSs and PA and provided evidence for the contributions parks and recreation makes as part of the "health care" system within communities. Because of the ubiquity of PRSs and their potential contributions to active living, these relationships merit further exploration. [ABSTRACT FROM AUTHOR]

Faith-based settings offer opportunities for reaching populations at risk for chronic conditions and are optimal settings for dissemination and implementation (D&I) research. Faith, Activity, and Nutrition (FAN) is an evidence-based program designed to promote physical activity (PA) and healthy eating (HE) through church policy, systems, and environmental change. We report implementation fidelity for Phase 1 of the FAN D&I project, a countywide effort. The group randomized study included pre- and postintervention assessments of core PA and HE components. We compared implementation in early intervention (n = 35) versus delayed intervention (control, n = 19) churches; assessed individual church implementation; and examined the effects of level of implementation on church member outcomes. Implementation assessments were conducted with the FAN coordinator via telephone survey. Study outcomes were assessed with church members 8 to 12 months following baseline assessment via self-administered surveys. We found significantly higher levels of implementation for PA opportunities, PA and HE guidelines, PA and HE messages, and PA and HE pastor support in intervention versus control churches and showed church-level variation in PA and HE implementation. PA self-efficacy varied by level of implementation; high and low implementers did not differ in proportion of church members physically inactive, although low implementers had fewer members inactive than controls. The high level of implementation in intervention churches shows promise for broader dissemination of FAN. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to explore perceptions of the benefits of and influencing factors for neighborhood-based physical activity (PA), and elicit suggestions for increasing neighborhood-based PA among primarily Black residents living in lower income neighborhoods. Design: Eight focus groups were conducted in low-income, predominantly Black neighborhoods (n = 8) in Greenville, SC during Spring 2014. Using a semi-structured focus group guide with open-ended questions, residents were asked to describe benefits of PA, neighborhood factors associated with PA, and ways to increase PA within their neighborhoods. Trained research assistants transcribed audio recordings verbatim. Using grounded theory and an ecological perspective, emergent coding was employed to generate initial categories with open and axial coding used to achieve consensus on themes. Results: Primarily Black (95%), female (72%), and older (M = 61.5 years) residents (N = 76) participated in the study. Seven themes were identified across the three main focus group topics: physical and mental health benefits of neighborhood PA, safety/hazards and social factors as influencing neighborhood PA, and improving safety, structural opportunities, and programing support to improve neighborhood PA. Most participants reported walking within their communities, despite describing several community-level barriers (e.g. drugs, safety). Residents desired structured neighborhood-based opportunities for increasing PA, including walking tracks and walking groups, and reported social benefits to being active, including increased awareness within the community and trust. Participants conveyed that walking strengthened the social environment of their community as well as the health of residents. Conclusion: Few studies of contextual factors and PA have focused on African-American, low-income neighborhoods. Despite diverse environmental constraints, residents reported walking within their communities as part of a healthy lifestyle. Social ecological interventions tailored to promote PA and reduce health disparities among residents of low-income communities should highlight neighborhood-based opportunities for PA, focusing on personal and collective social benefits of neighborhood walking. [ABSTRACT FROM AUTHOR]

Background Personal (i.e. egocentric) network characteristics are associated with health outcomes, including overweight and obesity. Previous research suggests educational attainment may interact with network characteristics to buffer these relationships. Limited research has examined the personal network characteristics of Black Americans, who have increased risk of overweight and obesity. The purpose of the current study was to examine associations between network characteristics and body mass index (BMI), and whether educational attainment modified these associations among Black Americans. Methods In 2014, using respondent-driven sampling, we recruited 430 adult residents of eight low-income neighborhoods in Greenville, SC. Self-administered questionnaires assessed structural and compositional characteristics (i.e. size, density) of respondents' personal networks, socio-demographic characteristics, and health-related behaviors and conditions. Multilevel regression models with robust sandwich estimation accounted for clustering within respondent chains. Results Among Black adults overall, network density—the number of connections among network members—was positively associated with BMI. Higher education moderated this relationship; among Black adults with a college degree, higher network density was inversely associated with BMI. Conclusions Our data suggest low educational attainment may reflect more homogenous and less resourceful networks. Multiple pathways are discussed for how education interacts with network density on BMI among Black Americans. [ABSTRACT FROM AUTHOR]

In America, the average house size has increased from 1660 to 2596 ft2 from 1973 to 2013 with home prices rising to more than nine times the average price in 1970. Additionally, the increase in urban sprawl and city dwelling has caused a 50% increase in the negative environmental impact of housing since the 1950s. Given these concerns, many people have reevaluated their needs and desires leading to the tiny house movement. Therefore, the purposes of this study were to examine tiny house dwellers' motivations and understanding whether they are correlated to tiny house satisfaction. The Tiny House Community Survey was an online survey to assesses tiny house residents' motivations for living tiny through seven diverse items (e.g., simpler life, sustainability, cost, etc.). Overall tiny house satisfaction was also measured by asking if the respondent was satisfied with his or her tiny house, captured on a five-point scale. Descriptive and multivariate analyses within SPSS 22.0 compared the motivations of tiny house dwellers according to a variety of socio-demographic and structural factors (e.g., gender, location, house size). Decreased costs, a simplified lifestyle, and increased freedom were salient motivations for more than half of the surveyed population. In examining the association between motivations and housing satisfaction, a simplified lifestyle was the only motivation held by respondents with significant relationship. Increased knowledge regarding tiny homes and their impact could help overcome some of the challenges faced by the tiny house community such as lack of awareness, legality concerns, and financing opportunities. [ABSTRACT FROM AUTHOR]

The relationship between park availability, physical activity, and positive health outcomes has been documented across the globe. However, studying how people access parks and why they use the parks is difficult due to a lack of consensus with respect to measurement approaches and assessment of park environments. Establishing a parsimonious method and tool for quantifying both park availability and park quality represents a major step that could advance park and physical activity research and practice. This paper describes phase one of the effort to develop such a measurement tool, known as ParkIndex. ParkIndex is a two-year National Institutes of Health (NIH)- funded study to create an evidence-based tool that will assist citizens and professionals in understanding and using information regarding community park access and use. Phase one consisted of key informant interviews conducted with research and practice leaders to inform development and provide insight on the essential foundations of ParkIndex. Twelve professionals from practice and academia, including parks and recreation, landscape design, and public health sectors, were interviewed in fall 2016. Key informants were interviewed on four topics concerning the content, value, feasibility, and dissemination of ParkIndex. Trained research assistants employed double, emergent, open, and axial coding methods to develop key themes and concepts to guide phase 2 and further development of ParkIndex. Key themes throughout the interviews included measures for park use, including distance, safety, neighborhood characteristics, route and travel mode to park, and overall park characteristics. Park elements discussed included quality of, and availability of, amenities, activity spaces, programming, and park management, as well as the context of the park and the engagement of the local community. Respondents determined that ParkIndex could benefit park planning and community development and provide for a standardized method for evaluating park access. Interviews and themes offer parks and public health practitioners and researchers--and this specific ParkIndex development teamthe opportunity to refine and evaluate measures to be included in a comprehensive park access and use tool. Key informants repeatedly referenced the need, especially within parks and recreation management, for consistent, reliable, and valid measures of park access and use, such as ParkIndex seeks to provide. We believe a well-conceived, integrated index will at the very least allow for greater comparison between parks and park systems and at best will facilitate the many park stakeholders to best design, maintain, program, research, and advocate for their local parks. [ABSTRACT FROM AUTHOR]

BACKGROUND Evidence consistently shows children in the United States gain 3 to 5 times more weight during summer vacation (∼2.5 months) compared to the 9‐month school year. The purpose of this study is to examine within‐child differences in 4 obesogenic behaviors (physical activity [PA], sedentary/screen‐time, diet, and sleep) during school versus summer. METHODS: We used a repeated‐measures within‐subjects design. Children (N = 30 mean age = 8.2 years; 57% female; 37% overweight/obese; 100% African American) wore accelerometers on the nondominant wrist for 24 hr/d over 9 consecutive days during school and summer of 2016 to capture PA, sedentary time, and sleep. Parents completed a daily diary to report bed/wake times, diet, and screen‐time of their child each day. Mixed‐effect models compared summer and school behaviors. RESULTS: Children spent more time sedentary (69% vs 67% of wake wear time), less time in light PA (25% vs 23% of wake wear time), had higher screen‐time (242 vs 123 minutes/day), slept longer (428 vs 413 minutes/night), and consumed more sugar‐based foods (6 days vs 2.5 days/week) and fruit (7 days vs 4.7 days/week) during summer compared to school (p <.05). CONCLUSION: Initial evidence suggests children are displaying multiple unfavorable obesogenic behaviors during summer compared to school that may contribute to accelerated weight gain during summer. [ABSTRACT FROM AUTHOR]

Objectives: In this paper, we describe development and reliability testing of a novel tool to evaluate the physical environment of faith-based settings pertaining to opportunities for physical activity (PA) and healthy eating (HE). Methods: Tool development was a multistage process including a review of similar tools, stakeholder review, expert feedback, and pilot testing. Final tool sections included indoor opportunities for PA, outdoor opportunities for PA, food preparation equipment, kitchen type, food for purchase, beverages for purchase, and media. Two independent audits were completed at 54 churches. Interrater reliability (IRR) was determined with Kappa and percent agreement. Results: Of 218 items, 102 were assessed for IRR and 116 could not be assessed because they were not present at enough churches. Percent agreement for all 102 items was over 80%. For 42 items, the sample was too homogeneous to assess Kappa. Fortysix of the remaining items had Kappas greater than 0.60 (25 items 0.80-1.00; 21 items 0.60-0.79), indicating substantial to almost perfect agreement. Conclusions: The tool proved reliable and efficient for assessing church environments and identifying potential intervention points. Future work can focus on applications within faith-based partnerships to understand how church environments influence diverse health outcomes. [ABSTRACT FROM AUTHOR]

Background: Little research has comprehensively explored how park features, quality indicators, and neighborhood environments are associated with observed park usage and physical activity (PA). This case study examined whether weekday park usage and PA differ by neighborhood type, across numerous categories of park features, and according to park feature condition and cleanliness.Methods: Direct observation was used to capture the number of users and PA levels within 143 park features in 6 parks (3 urban, 3 suburban) over the course of six weeks. Audits of park environments assessed the type, condition, and cleanliness of all features and amenities.Results: Urban parks experienced greater usage, but a higher proportion of sedentary users than suburban parks. Usage and PA levels differed across types of park features, with splash pads, pools, paths, and play structures having the greatest proportion of active users. Usage did not differ by park feature condition and cleanliness, but greater condition and cleanliness were generally associated with higher PA levels.Conclusions: Factors such as neighborhood context, types of park features, and condition and cleanliness can impact park usage and PA levels and should be targets for researchers and planners aiming to foster more user-friendly and active neighborhood park environments. [ABSTRACT FROM AUTHOR]

Background: Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential. Discussion: There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays. Conclusion: In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development. [ABSTRACT FROM AUTHOR]

Limited research has explored how specific elements of physical and social environments influence mental health indicators such as perceived stress, or whether such associations are moderated by gender. This study examined the relationship between selected neighborhood characteristics and perceived stress levels within a primarily low-income, older, African-American population in a mid-sized city in the Southeastern U.S. Residents ( n = 394; mean age=55.3 years, 70.9% female, 89.3% African American) from eight historically disadvantaged neighborhoods completed surveys measuring perceptions of neighborhood safety, social cohesion, aesthetics, and stress. Multivariate linear regression models examined the association between each of the three neighborhood characteristics and perceived stress. Greater perceived safety, improved neighborhood aesthetics, and social cohesion were significantly associated with lower perceived stress. These associations were not moderated by gender. These findings suggest that improving social attributes of neighborhoods may have positive impacts on stress and related benefits for population health. Future research should examine how neighborhood characteristics influence stress over time. [ABSTRACT FROM AUTHOR]

Parks are important venues for physical activity (PA), but research indicates that they are underutilized by youth. The purpose of this paper is to describe the development and preliminary evaluation of Park Hop, an innovative collaboration of seven parks and recreation agencies to create an incentivized passport-style program to increase awareness, visitation, and active use of parks among youth in Greenville County, South Carolina. Park Hop occurred in summer 2013. It was developed within a family recreation program planning framework as a free, summer-long scavenger hunt designed to encourage children and their families to visit 17 selected parks and recreation facilities and answer clues at each location. The four overarching goals of Park Hop were to 1) increase parks usage and discovery, 2) foster awareness and appreciation for the wealth of parks in Greenville County, 3) increase time spent in PA during park visits, and 4) establish an annual tradition for all to enjoy. The pilot evaluation used multiple methods to collect information about program accessibility, enjoyment, ease of participation, park awareness and visitation, perceived changes in park enjoyment, and park-based PA. A total of 231 youth submitted completed Passports (M=7.0 years). All but one youth (99.6%) indicated that they visited at least one park for the first time as part of the program, with an average of 7.0 new parks visited per youth. Survey results indicated that youth averaged 87.1 minutes of PA on their last park visit, and the majority of parents said their child enjoyed participating (98%) and that they would participate again next year (95.1%). Park Hop successfully influenced park awareness and visitation (especially to new parks) among youth and effectively translated park awareness research into a sustainable initiative that positively influenced youth park-based PA. Further, Park Hop exemplifies a successful collaboration of multiple recreation agencies across Greenville County. Such partnerships may be critical during times of budgetary constraints while cross-promotion of all area parks offers a wider variety of opportunities to citizens. Implications of this program include the utility of collaboration between multiple parks and recreation departments, the pooling of resources for common goals, and partnering with local health agencies to strengthen the view of parks as community health resources. Overall, this summer-long program provided fun opportunities for families to explore local parks and engage with multiple parks and recreation agencies. With continuous expansion and improvement, such initiatives have the potential to improve use of parks and open spaces in an effort to reduce obesity amongst youth nationwide. [ABSTRACT FROM AUTHOR]