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Background and Purpose. The American Heart Association recommends community-based research on shared use of physical activity (PA) spaces. Pasadena, a community in southeast Houston, Texas with lower socioeconomic status and racial/ethnic diversity, was the setting for our study. Efforts to increase access to PA in Pasadena include building the evidence on PA resources. The purpose of this research was to utilize survey data in a community setting to inform and target efforts around sharing PA spaces. Method. An online survey was administered to K-12 school ( n = 25) and park ( n = 30) administrators, church leaders ( n = 10), community organizations ( n = 2), a health care center, and a local business. Results. Park facilities in Pasadena shared by agreement with two high schools and three baseball/softball leagues were ballfields, tennis courts, and jogging paths. No park facilities were shared with faith-based organizations. Four parks communicated daily, and five schools communicated with parks quarterly about providing opportunities for PA. Key facilitators to sharing facilities were building relationships and collaboration, service to the community, and improving health. Key barriers were cost, maintenance, staffing, and prioritizing use with limited time, facilities, and resources. Conclusions. This study is the first of its kind to address shared use at the community level and suggests opportunities to improve communication and partnerships between parks, schools, and churches. This research will inform ongoing efforts to promote access by identifying barriers and motivators among stakeholder groups to help facilitate shared use agreements.

Introduction The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic. Method We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression. Results A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7–48.1, I2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9–39.4, I2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups. Conclusion South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia., COVID-19; Mental health; Anxiety; Depression; South Asia; Afghanistan; Bangladesh; Bhutan; India; Maldives; Nepal; Pakistan; Sri Lanka; Psychiatry; Epidemiology.

This study examined metropolitan and rural differences regarding concerns about opioid misuse and support for different strategies to reduce opioid use disorder risk in areas not designated as high-risk. This study used cross-sectional data from a regional community health assessment, which was collected in 2019 using a combination of stratified random sampling and clinic-based purposive sampling in Central Texas. The secondary data included 430 and 270 respondents from metropolitan and rural (not metropolitan) counties, respectively. The primary outcomes were perceived concern about the opioid crisis, perceived likelihood of getting addiction treatment, and support for strategies to reduce opioid use disorder risks. Multiple multivariable regression models were used to examine metropolitan and rural differences in the outcome variables after adjusting for age, sex, ethnicity, race, marital status, education, and household income. Respondents were about 58 years old on average. A majority were female (60%), non-Hispanic (88%), and White (83%). About 60% of rural and metropolitan respondents were concerned about opioid use and misuse in their community. After adjusting for respondents' demographic characteristics, rural respondents were significantly less likely to perceive that individuals are getting the needed opioid use disorder treatment (aOR = 0.69

Sharing of physical activity spaces is supported by the American Heart Association and other leading public health authorities as one strategy to increase access to physical activity. The purpose of this study was to identify facilities within Pasadena, TX, that currently provide opportunities for active recreation, sport, and other forms of physical activity and analyze community access to these spaces from a geospatial perspective. Geospatial analysis was used to identify physical activity spaces and issues relevant to access. Using a community-based approach, the research team worked with partners to create a list of individuals responsible for each of the physical activity spaces. These “facility administrators” were contacted by email and then phone for a total of four attempts. Respondents were asked to complete an online shared use survey. An asset map was created from both local geospatial data (Pasadena, TX) and data from a facility access and shared use survey. Of the 39 facility administrators, 23 responded to the survey and consisted of the park director, school principals, lead pastors and clergy, and business owners. A total of 53 facilities were identified within the priority zip codes, including 30 parks, 25 schools, 9 faith-based organizations, and 4 others (a business, a nonprofit health care center, and two community-based organizations). Overall, there were 131 total amenities, and playgrounds, outdoor basketball courts, and ball fields were the most common types. Some facilities had multiple amenities at their location, including many of the parks and schools. Additionally, respondents noted other types of amenities where activity took place such as parking lots, grassy areas, classrooms, and other indoor areas. Many of the amenities, 102, were open to the general public and 28 were found to be in good condition. Findings suggest that there is inadequate access to physical activity spaces in this underserved community. There is a need for additional play spaces in Northern Pasadena and for future research bridging community health and geospatial mapping.

Objective: The purpose of this review is to uncover some best practices for increasing access to physical activity opportunities by examining efforts used within low income and diverse communities. The theoretical lens used is from the Active Living by Design (ALbD) Community Action Model, with a focus on the 6 essential practices (health equity focus, community engagement, facilitative leadership, sustainable thinking, culture of learning, and strategic communication) describing how partnerships can guide and sustain meaningful change in a community. Methods: A 2-step process guided the literature search. In step 1, 4 databases (PubMed, Psych INFO, Social Science Citation Index, and Cochrane Library) were searched using Boolean connections and variations in the key terms. Step 2 assessed articles by title, abstract, and full text to determine whether the studies met the inclusion and exclusion criteria guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Additionally, included articles were compared against the 6 essential practices outlined by the ecological framework, ALbD. Results: Of 1775 total articles, 14 studies met inclusion criteria. Most of the studies were case studies located in the United States using several different approaches including, changes in the built environment, implementation of a community-based physical activity program, creating partnerships to leverage resources, and policy change. This review compared the 14 studies against the 6 essential practices of the ALbD model and found 2 studies that met all 6 criteria, and only a few studies meeting more than 2 criteria. Conclusions: Overall, the conclusions are 2-fold, (1) only 14 cases demonstrate success in increasing access to physical activity opportunities, suggesting that more can be done to address inequalities. (2) Of the existing efforts, few utilize crucial components to create a sustainable change in the community. Future research should take into consideration the ALbD ecological framework, the best existing theory for this type of work, to guide the creation and implementation of a sustainable community access effort.

Young children asked to pretend to use a series of absent objects typically pantomime by using a body part as the object (BPO) rather than by acting as if using an imaginary object (IO). This replication of Lyons's work (1983, 1986) examines whether different pretend contexts when requesting pantomimes influence children's use of IO and BPO pantomimes. Forty-three children aged 3;6 to 6;6 were asked to pretend to use 8 objects in 1 of 3 contexts: request, request after participating in an experimenter-provided imaginary context, and request after seeing the adult model the requested pretend action. The experimenter used IO pantomimes in the last 2 contexts. Children produced, on average, the most IO pantomimes in the modeling context, fewer in the imaginary context, and the fewest in the request context. Older children overall produced more IO pantomimes than did younger children; however, when pretend contexts were examined separately, ontogenetic differences in IO pantomimes were present for the request...

Background : Following a community health assessment the Brazos Valley Health Partnership (BVHP) organized to address fragmentation of services and local health needs. This regional partnership employs the fundamental principles of community-based participatory research, fostering an equitable partnership with the aim of building community capacity to address local health issues. Objectives : This article describes changes in relationships as a result of capacity building efforts in a community-academic partnership. Growth in network structure among organizations is hypothesized to be indicative of less fragmentation of services for residents and increased capacity of the BVHP to collectively address local health issues. Methods : Each of the participant organizations responded to a series of questions regarding its relationships with other organizations. Each organization was asked about information sharing, joint planning, resource sharing, and formal agreements with other organizations. The network survey has been administered 3 times between 2004 and 2009. Results : Network density increased for sharing information and jointly planning events. Growth in the complexity of relationships was reported for sharing tangible resources and formal agreements. The average number of ties between organizations as well as the strength of relationships increased. Conclusion : This study provides evidence that the community capacity building efforts within these communities have contributed to beneficial changes in interorganizational relationships. Results from this analysis are useful for understanding how a community partnership’s efforts to address access to care can strengthen a community’s capacity for future action. Increased collaboration also leads to new assets, resources, and the transfer of knowledge and skills.

Compared with their urban counterparts, rural populations face substantial disparities in terms of health care and health outcomes, particularly with regard to access to health services. To address ongoing inequities, community perspectives are increasingly important in identifying health issues and developing local solutions that are effective and sustainable. This article has been developed by both academic and community representatives and presents a brief case study of the evolution of a regional community of solution (COS) servicing a 7-county region called the Brazos Valley, Texas. The regional COS gave rise to multiple, more localized COSs that implemented similar strategies designed to address access to care within rural communities. The regional COS, known as the Brazos Valley Health Partnership, was a result of a 2002 health status assessment that revealed that rural residents face poorer access to health services and their care is often fragmented. Their localized strategy, called a health resource center, was created as a "one-stop shop" where multiple health and social service providers could be housed to deliver services to rural residents. Initially piloted in Madison County, the resource center model was expanded into Burleson, Grimes, and Leon Counties because of community buy-in at each of these sites. The resource center concept allowed service providers, who previously were able to offer services only in more populous areas, to expand into the rural communities because of reduced overhead costs. The services provided at the health resource centers include transportation, information and referral, and case management along with others, depending on the location. To ensure successful ongoing operations and future planning of the resource centers, local oversight bodies known as health resource commissions were organized within each of the rural communities to represent local COSs. Through collaboration with local entities, these partnerships have been successful in continuing to expand services and initiating health improvements within their rural communities.

Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process.

Background Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours. Methods A review of recent literature regarding child-feeding behaviours and child weight. Results Parents report using a wide range of child-feeding behaviours, including monitoring, pressure to eat and restriction. Restriction of children's eating has most frequently and consistently been associated with child weight gain. Furthermore, there is substantial evidence for a causal relationship between parental restriction and childhood overweight. Conclusions Parents may inadvertently promote excess weight gain in childhood by using inappropriate child-feeding behaviours. We recommend the development of interventions to increase awareness of the possible consequences of inappropriate child-feeding behaviours. Parents who are concerned about their child's weight will also require guidance and support in order to adopt more appropriate child-feeding behaviours.

The authors present the results of a media documentary, Weight of the Nation, disseminated in rural communities in the Brazos Valley region of east central Texas. Researchers relied on a community-based participatory research strategy to assure community participation in the implementation and evaluation of the media documentary in rural communities. To measure the short-term effects of the documentary, the research team used a mixed-methods approach of quantitative panel data from a pre/post survey, qualitative meeting notes, and observations from facilitated discussion groups. Results showed short-term increases in behavioral intention, as well as an increase in self and collective efficacy of participants to make healthy changes at individual and community levels to reduce obesity. The findings suggest that Weight of the Nation is a catalyst for increasing awareness about obesity and initiating changes in intention and efficacy perceptions.

Mountain marathons are 2-d, self-supported adventure races, during which competitors must carry all nutritional requirements to sustain athletic effort. This requires a compromise between the energy required to perform and the weight penalty of carrying it. We have undertaken a nutritional survey of event competitors in the UK using a questionnaire-based approach and have monitored dehydration during the event. We found that competitors in longer-distance classes (> 50 km) carry significantly less mass of food, which is more energy dense, but that the calorific value is lower than that of competitors in shorter classes. Carbohydrate and protein consumption both positively associated with performance. Competitors became progressively dehydrated throughout the event. Counterintuitively, the better-performing subjects became the most dehydrated. Competitors at all distances should make more effort to rehydrate during breaks in the event. Competitors at shorter distances could choose more energy-dense foods to reduce weight penalty.

Introduction: The field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention's (CDC's) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions. Methods: Seven Prevention Research Centers (PRCs) applied CDC's framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned. Results: Evaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences. Conclusion: Framework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors.

Community health development is a process by which a community identifies factors influencing population health, assesses available resources to build the capacity to plan and take action, and implement interventions to address identified needs. At its core, community health development targets structural change and infrastructure development to facilitate more efficient and effective health service delivery systems and environmental changes to support improvements in community health. One indicator of structural change and common measure of community capacity is the relationships among the network of organizations that comprise that system. The Brazos Valley has employed a community health development approach to population health improvement in partnership with the Center for Community Health Development. Changes in interorganizational networks illustrate progress in the Brazos Valley. Contextual factors provide some insight into how the process has unfolded.

Food risks have a special standing in people’s risk appraisals (Knox 2000) due to the central role which food plays in family life. Concern about food risks has steadily increased in the last few decades (Payson 1994). A survey conducted by the international market research company Ipsos-Reid (Tucker et al. 2006) found that the majority of respondents in 19 countries felt their food is less safe that it was ten years ago. In recent years consumers have become generally uncertain about the safety and quality of their food and their perceptions often differ substantially from that of experts (Verbeke et al. 2007). There is evidence to suggest that consumers expect all food to be intrinsically safe and would never knowingly purchase or consume unsafe food, and this is particularly evident in terms of protecting and nurturing the family. Nevertheless, although under normal conditions the majority of consumers are not worried about food safety, or at least accept the inherent low level risk, the occurrence of a food safety incident may result in consumer concern and anxiety (Verbeke et al. 2007).

adolescent depression conducted in a convenience sample of community pediatric offices with access to integrated behavioral health services. Interviews were audio-recorded, transcribed, and coded for key themes. Interview questions addressed parental barriers to uptake of care for depression within an integrated behavioral health system. Results: Several key themes emerged from the interviews. PCPs thought parental barriers were more salient to accessing care than teen barriers. Parents were seen as responsible for prioritizing depression care for the teen, and without this, teens would not have the means (e.g. transportation, finances, parental social support, etc.) to obtain care. PCPs reported some parents refused to accept the diagnosis, instead telling the child, especially boys, to deal with their problems on their own e even refusing care after the PCP, in a private conversation with the parent, exhorted the importance of treatment. One PCP described, “I’ve had parents look at me straight in the eye and be like, ‘No. They’re fine. See you later.’” PCPs described some parents who had difficulty identifying the presence of depressive symptoms and others who would attribute symptoms to normal adolescence or a situation such as a divorce. Some PCPs expressed frustration at parental skepticism about treatment. Other barriers identified by PCPs included parental inability to access care due to work requirements, lack of support, feeling overwhelmed, or having “chaotic” home situations including family discord or violence. PCPs often equated structural barriers like transportation with a parent not prioritizing care. PCPs contrasted this with examples of good family support they believed would enable adolescents to attend follow-up appointments and have a “life coach” at home who could help with monitoring for side effects and watching for increased suicidality when starting antidepressants. Conclusions: PCPs working in an environment with integrated behavioral health services reported that when adolescents do not access care it is often due to parental barriers. PCPs commonly noted attitudinal barriers such as not accepting the diagnosis and attributing symptoms to part of normal adolescent development as well as skepticism about treatment. PCPs believe these negative attitudes may also explain purported underlying structural barriers. Interventions which assist PCPs in eliciting and addressing parental barriers are needed to improve the uptake of adolescent depression care. Sources of Support: Agency for Healthcare Research and Quality T32HS019486-01.