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Background: Green space has been linked with cardiovascular (CV) health. Nature access and quality may have significant impact on CV risk factors and health. Objectives: The authors aimed to investigate the relationship between NatureScore, a composite score for natural environment exposure and quality of green spaces, with CV risk factors and atherosclerotic cardiovascular diseases (ASCVD). Methods: A cross-sectional study including one million adult patients from the Houston Methodist Learning Health System Outpatient Registry (2016-2022). NatureScore is a composite measure of natural environment exposure and quality (0-100) calculated for each patient based on residential address. NatureScores was divided into 4 categories: nature deficient/light (0-39), nature adequate (40-59), nature rich (60-79), and nature utopia (80-100). CV risk factors included hypertension, diabetes, dyslipidemia, and obesity. Results: Among 1.07 million included patients (mean age 52 years, female 59%, Hispanic 16%, Non-Hispanic Black 14%), median NatureScore was 69.4. After adjusting for neighborhood walkability, patients living in highest NatureScore neighborhoods had lower prevalence of CV risk factors (OR: 0.91, 95% CI: 0.90-0.93) and ASCVD (OR: 0.96, 95% CI: 0.93-0.98) than those in lowest NatureScore neighborhoods. A significant interaction existed between NatureScore and Walkability (P

Introduction: Time spent in nature provides myriad physical and mental health benefits for both adults and children. Despite these benefits, most people spend too little time in nature to realize the maximal effect. Different types of childhood experiences may have differential influence on adult time in nature. This study assessed the influences of different kinds of childhood outdoor experiences on time spent in nature as an adult. The first aim was to utilize 20 childhood nature experience items to construct summative scales. The second aim was to examine the influence of each scale and other factors on adult time in nature. Methods: A 2-factor scale measuring wild and domesticated childhood nature experiences was developed using principal and confirmatory factor analyses. An online study of 2,109 American adults was conducted. Multiple linear regression examined the influences of the 2 childhood nature experiences scales, attitude and self-efficacy scales, and sex and age covariates on adult time spent in nature. Results: Significant predictors of adult time in nature were wild childhood nature experiences (β=0.279, p

Abstract Background There has been limited research on college campus’ green spaces and their benefits to students. This study aimed to identify relationships between a Texas campus’s green spaces and students’ knowledge of their health benefits and their perception of their health compared to the campus’ indoor built environments. Methods Photovoice was utilized to answer this study’s research questions. Participants were instructed to take a photograph inside a building on campus and one outdoors anywhere on campus. Participants answered a questionnaire containing health-related questions, demographics, and nature relationship questions. Additionally, there was an in-class analysis and discussion to characterize overarching themes, knowledge, and evoked emotions. Frequencies, percentages, and a paired t-test were utilized to investigate the hypothesis that through the application of photovoice, participants would display more knowledge of nature’s health benefits and a better perception of areas providing emotional, mental, physical, and social health benefits when in these green spaces compared to the indoor built environments on campus. Results 122 students took photographs and answered the questionnaire. 91 students participated in the in-class discussion. Most students felt more positive (80%) and perceived better health with their outdoor location compared to their indoor. They also responded higher to having more positive overall health benefits (63%) outdoors than indoors. Conclusions These findings further solidified nature improves overall mood, there is a positive relationship between health and nature, and people are aware of it. Future studies should attempt to identify barriers accessing campus green spaces and develop interventions to encourage students to utilize these spaces.

Abstract Background The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). Methods Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin ‘top 10’ lists of the most important research needs. Results From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. Conclusions Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Background: Pakistan, Bangladesh, and India are all facing challenges related to large, growing populations with low levels of contraception. While, Bangladesh has the highest CPR (62%), close to the world’s CPR of 64%, India stands at 58%, followed by the lowest for Pakistan at 35%. Objective: To analyze the differences in the socio-economic determinants of modern contraception use in Pakistan, India, and Bangladesh. Methods: This study uses data from the latest rounds of Demographic and Health Surveys for Pakistan (2017-2018), Bangladesh (2017-2018), and India (2015-16) to examine the socioeconomic determinants of traditional, modern, and the most popular method of contraception among married women across the three countries by employing logistic regressions. The sample consists of currently married and fecund women only (Bangladesh=10,738; India=224,070; Pakistan=4,255). Results: In Bangladesh, Oral contraception Pills (OCPs) are the most popular method of contraception (44%), followed by the use of other modern contraception(38%) and traditional contraception(18%). In India, 60% of women using contraception, reported using female sterilization, 27% uses other forms of modern contraception, and 13% reported using traditional methods. For Pakistan, 29% of the women reported using condoms as a source of contraception, 43% of women reporting using other modern methods, and 29% of women reported using traditional methods of contraception. Logistic regressions in Bangladesh and Pakistan show that female educational attainment level is positively associated with the use of modern methods and the country’s most popular method of contraception but negatively associated with female sterilization, the most popular contraception method in India. Additionally, the socioeconomic status of the household is positively associated with the use of the most popular method of contraception in Pakistan but negatively associated with other modern methods. Contraception decision making if done by women in Bangladesh is positively associated with the use of both the most popular methods as well as modern methods of contraception. In India, the household’s socioeconomic status and women’s age are positively associated with the use of modern contraception. Conclusion: For these countries to lower the population growth rate, achieve replacement-level fertility, and increase the use of modern contraception, they need to focus on relevant determinants that would help them achieve the desired results.

Abstract Background Rural residents generally lack adequate physical activity to benefit health and reduce disparities in chronic diseases, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between individual, social, and community factors. Community group-based walking programs and civic engagement interventions aimed at enhancing physical activity have been successful in rural communities but have not targeted all three socioecological levels. Public libraries can act as innovative public health partners in rural communities. However, challenges remain because rural libraries often lack the capacity to implement evidence-based health promotion programming. The goals of this study are (1) build the capacity for rural libraries to implement evidence-based health promotion programs, (2) compare changes in physical activity between a group-based walking program and a combined group-based walking and civic engagement program with rural residents, and (3) conduct an implementation evaluation. Methods We will conduct a comparative effectiveness study of a group-based walking (standard approach) versus a group-based walking plus civic engagement program (combined approach) aimed at enhancing walkability to increase physical activity among rural adults. Key mediators between the program effects and change in outcomes will also be identified. Finally, we will evaluate program implementation, conduct a cost effectiveness evaluation, and use a positive deviance analysis to understand experiences of high and low changers on key outcomes. Twenty towns will be matched and randomized to one of the two conditions and our aim is to enroll a total of 350–400 rural residents (15–20 per town). Study outcomes will be assessed at baseline, and 6, 12, and 24 months. Discussion This study will build the capacity of rural libraries to implement evidence-based walking programs as well as other health promotion programs in their communities. The study results will answer questions regarding the relative effectiveness and cost effectiveness of two multilevel physical activity interventions targeting rural communities. We will learn what works and how these multilevel interventions can be implemented in rural populations. Trial Registration ClinicalTrials.gov Identifier: NCT05677906.

Abstract Background Physical inactivity is a risk factor for numerous adverse health conditions and outcomes, including all-cause mortality. Aging rural women are at particular risk for physical inactivity based on environmental, sociocultural, and psychosocial factors. This study reports on changes in physical activity and associated factors from a multicomponent community-engaged intervention trial. Methods Strong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cluster (community) randomized controlled trial building on the results from the previous trial of SHHC-1.0. Rural women (n = 182) aged 40 and over living in 11 rural communities in upstate New York were recruited. The intervention consisted of twice-weekly experiential classes focused on exercise, nutrition, and civic engagement. Physical activity outcomes included accelerometry and self-report as well as related psychosocial measures at midpoint (12 weeks) and post-intervention (24 weeks). Data were analyzed using multilevel linear regression models with the community as the random effect. Results Compared to participants from the control communities, participants in the intervention communities showed a significant increase in objectively measured moderate to vigorous intensity physical activity: at 12 weeks (increase of 8.1 min per day, P

Abstract Background Prior studies demonstrate associations between risk factors for obesity and related chronic diseases (e.g., cardiovascular disease) and features of the built environment. This is particularly true for rural populations, who have higher rates of obesity, cancer, and other chronic diseases than urban residents. There is also evidence linking health behaviors and outcomes to social factors such as social support, opposition, and norms. Thus, overlapping social networks that have a high degree of social capital and community cohesion, such as those found in rural communities, may be effective targets for introducing and maintaining healthy behaviors. Methods This study will evaluate the effectiveness of the Change Club (CC) intervention, a civic engagement intervention for built environment change to improve health behaviors and outcomes for residents of rural communities. The CC intervention provides small groups of community residents (approximately 10–14 people) with nutrition and physical activity lessons and stepwise built environment change planning workshops delivered by trained extension educators via in-person, virtual, or hybrid methods. We will conduct process, multilevel outcome, and cost evaluations of implementation of the CC intervention in a cluster randomized controlled trial in 10 communities across two states using a two-arm parallel design. Change in the primary outcome, American Heart Association’s Life’s Simple 7 composite cardiovascular health score, will be evaluated among CC members, their friends and family members, and other community residents and compared to comparable samples in control communities. We will also evaluate changes at the social/collective level (e.g., social cohesion, social trust) and examine costs as well as barriers and facilitators to implementation. Discussion Our central hypothesis is the CC intervention will improve health behaviors and outcomes among engaged citizens and their family and friends within 24 months. Furthermore, we hypothesize that positive changes will catalyze critical steps in the pathway to improving longer-term health among community residents through improved healthy eating and physical activity opportunities. This study also represents a unique opportunity to evaluate process and cost-related data, which will provide key insights into the viability of this approach for widespread dissemination. Trial registration ClinicalTrials.gov: NCT05002660 , Registered 12 August 2021.

Abstract 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 .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 Background Workplace violence against healthcare workers is a global issue that is on the rise, with Chinese healthcare workers facing growing challenges with hospital violence. Attacks on medical staff have increased in recent years with no clear resolution. Prior research focused on policies to improve the doctor-patient relationship and better protect clinicians, but few studies addressed the patient perspective. This paper examines patients’ choices when facing a medical dispute and identifies groups who are more likely to respond to conflict with violence or other serious actions. Methods Patient survey responses were collected in 12 leading public hospitals in five Chinese provinces with 5556 participants. The survey asked sociodemographic information, patients’ attitudes (e.g., general optimism, trust in their physicians, perceived healthcare quality), and their primary response to a medical dispute. From least to most severe, the options range from “complaining within the family” to “violence.” We used t-tests and Chi-square tests to explore the relationships between reactions and patient characteristics. We also performed multivariable logistic regressions to determine the impact of sociodemographics and provider trust on the seriousness of responses. Results The primary response of a third of respondents was complaining to hospital or health department officials (32.5%). Seeking legal help (26.3%) and direct negotiation with doctors (19.6%) were other frequent responses. More serious responses included 83 stating violence (1.5%), 9.7% expressing a desire to expose the issue to the news media, and 7.4% resorting to seeking third-party assistance. Patients who were more likely to report “violence” were male (OR = 1.81, p

Rural communities are at higher risk for physical inactivity, poor dietary behaviors, and related chronic diseases and obesity. These disparities are largely driven by built environment, socioeconomic, and social factors. A community-based cluster randomized controlled trial of an intervention, the Change Club, aims to address some of these disparities via civic engagement for built environment change. Baseline data collection began in February 2020, only to be paused by the COVID-19 pandemic. In this context, the investigators evaluated multiple approaches for collecting data when the study resumed, focusing on Life’s Simple 7, and additional anthropometric, physiologic, and behavioral outcomes in rural and micropolitan (

Purpose COVID-19 is largely spread through close contact with infected people in indoor spaces. Avoiding these spaces is one of the most effective ways to slow the spread. This study assessed who had engaged in risky travel and leisure behaviors before the availability of vaccines. Design National cross-sectional on-line survey collected in November and December 2020. Setting: United States; Participants: 2589 adults representative by gender and race/ethnicity to the US population; Measures: The survey assessed if people had resumed 11 risky behaviors during the pandemic, prior to vaccines. Independent variables included age, race/ethnicity, region of the country, education, income, preexisting conditions, perceived severity and susceptibility, positive COVID diagnosis, and political ideology. Analysis Univariate analysis and logistic regressions were used to assess demographic and psychological factors of those resuming these behaviors. Results: Most (60.3%) of people had resumed at least 1 behavior with eating inside of restaurants (33.2%) and visiting family and friends (37.5%) being the most prevalent. In the multivariate analyses, perceived susceptibility was significant across all behaviors. Young people, fiscal conservatives, and people with higher perceived severity were more likely to perform several of the behaviors. Preexisting conditions did not predict any of the behaviors. Conclusions Travel and leisure behaviors vary by type of risk and may need specific tailored, prevention messages to promote risk reduction during future pandemics.

Abstract Background The Healthy Hawai‘i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. Methods From interviews with key informants, we analyze two decades of the Healthy Hawai‘i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. Results The Healthy Hawai‘i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making “the healthy choice the easiest choice.” Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. Conclusions This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

Using a participatory approach, this multi-method case study compared bicyclists’ perceptions and physical indicators of bikeability on a college campus. Student focus groups discussed campus bikeability and mapped and graded common bicycle routes. Trained students conducted environmental audits with bicycle counts. In discussions, students expressed concerns about safe bicycle riding on campus, especially during peak times. Congestion with pedestrians, other bicyclists, and skateboarders created the potential for crashes. Five major routes were identified with map scores ranging from 21.4% to 70%. Audit scores ranged from 82.5% to 86.7%. Bicycle counts varied by time of day and ranged from 11 to 91 bicycles. Student perceptions of bikeability were poorer than objective assessments of routes. The audit tool did not differentiate enough between routes and did not capture conflict potential accurately. Specification is needed on audit tools to capture the potential for conflict between bicycling and other forms of active transport—especially in unique settings like college campuses. Campuses that have well-marked paths for pedestrians, bicyclists, and motor vehicles and that communicate the importance and ease of bicycling may see the most overall success when promoting active transport options.

The 2nd edition of the Physical Activity Guidelines for Americans was released in November of 2018. This document contained specific guidelines for young children, children and adolescents, adults, older adults, pregnant and postpartum women, and adults living with chronic conditions and disabilities as well as safety recommendations. Given the complexity of the recommendations, the aim of this study was to assess which of the guidelines were covered by both print and broadcast media in the three months following the release of the guidelines. LexisNexis was searched for print media as well as transcripts of broadcast media. YouTube was used to search for broadcast television news stories. All retrieved stories (n = 34) were coded independently by two raters on which of the elements of the guidelines were covered. On average, stories covered less than half of the guidelines. Most stories reported aerobic guidelines for adults, children and adolescents and young children. Muscle strengthening and vigorous exercise were covered less frequently. No stories mentioned guidelines for pregnant or postpartum women or adults with disabilities. Print (M = 6.4, sd = 2.7) covered more recommendations than broadcast media (M = 4.0, sd = 1.9, p

Human health behaviors are essential to reducing the spread and impact of pandemics. However, most behavioral scientists do not work in the area of pandemics given the infrequency of their occurrences. This editorial examines relevant health behavior theories, in particular the precaution adoption process model, and how these apply to the COVID-19 pandemic.

Physical inactivity is a growing issue in Chinese youth, but parks can facilitate traditional and non-traditional forms of physical activity for little to no cost. Despite this opportunity, very little is known regarding park use among Chinese youth. The purpose of this study was to conduct a cross-sectional observational study of park usage and physical activity of youth in municipal parks in Nanchang, China. Data were collected in June of 2014 in eight parks across Nanchang, Jiangxi a large city in southeast China. Physical activity was measured by a modified version of System for Observing Play and Recreation in Communities. Ordered hierarchic generalized linear models were estimated using a logit link function. The influence of the park was estimated using random effects, with fixed effects and park, environmental, and park user characteristics. Youth were most often seen active in the afternoon, on weekends, and during cooler times (≤29°C). Paradoxically, more children were active when air quality was poorer. Older boys were more active than younger boys, but no differences were observed in girls. More children were seen active in unstructured play compared to structured activities. The results suggest parks are an important setting for physical activity among Chinese youth, and that unstructured activities can play an important role in promoting greater youth physical activity. Keywords: Exercise, Adolescent, Recreation

Over the past century, advances in public health have led to longer, healthier, and more prosperous lives. However, this rising prosperity has led to increases in consumption contributing to loss of biodiversity, climate change, air pollution, ocean acidification, and deforestation. In his new book entitled, “Survival: One Health, One Planet, One Future,” George Lueddeke examines this paradox and what can be done to ensure a sustainable planet as well as healthy human and animal populations.

Internationally, parks have been shown to be an important community asset for physical activity (PA), but little is known about the relationship between park usage and physical activity in China. The purpose of this study was to determine the association between park user characteristics and PA in Nanchang, China. In June 2014, 75,678 people were observed in eight parks over 12 days using SOPARC, a validated systematic observation tool. A logistic regression analysis was used to determine the association between PA and park user characteristics. Most park users were older adults (53.5%) or adults (34.6%). Overall, 55% of park users engaged in moderate-to-vigorous physical activity (MVPA). Fewer women were observed in parks than men, but were 66% more likely to be engaged in MVPA than men. Park users were more likely to be observed in MVPA between 6–9 am and when the temperature was below 30 °C. Chinese park users were more active (55%) than US studies in Tampa (30%), Chicago (49%), and Los Angeles (34%). More research is necessary to identify features of parks that are associated with greater PA so that effective interventions can be developed to promote active park use in Chinese citizens.

The purpose of the current study is to assess (1) health behavior researchers’ opinions on significant new foci emerging over the next 20 years, (2) disciplines that can serve as important partners, and (3) adjustments needed for doctoral training programs to prepare researchers for emerging trends. A two-wave modified Delphi procedure was employed to assess opinions and perspectives of current health behaviors researchers. Participants were recruited through email invitations sent to the membership listserv of the American Academy of Health Behavior. In Wave I, respondents generated up to three ideas for each of four prompts: (1) the biggest game changers in health behavior research, (2) the disciplines most important to partner with, and (3) what should be added or (4) removed from doctoral training programs. In Wave II, participants rated the importance of each of the responses generated in the first wave. 39 and 48 people completed Waves I and II, respectively. Wave I yielded 46 respondent-generated items for the new foci, and 28 different partner disciplines. Respondents identified 47 topics not currently covered in health behavior Ph.D. programs, and 8 topics that should be removed from current Ph.D. programs. Seven new foci were endorsed by 80% or more of the respondents, including studying cultures of illness and health, as well as better operationalization of social-ecological models. Seven disciplines were seen as essential partners by at least two-thirds of the respondents, including public health, biostatistics, and public policy. Five additions to doctoral programs were endorsed by 80% or more of the respondents, including stronger research skills, advanced statistical methods, writing, and evaluation. Years since earning a doctoral degree was negatively correlated with a number of suggested new foci, disciplines to partner with, and areas that should be added to health behavior Ph.D. programs. There was a high level of consensus about potential new foci in the field, focusing on population health, stronger scientific techniques, and more research training. There was less consensus on related disciplines’ potential, based on the respondents’ type of work and field. Overall, results have potential to shape doctoral training and preparation of future health behavior researchers.

Background: Local food environments influence fresh produce purchase and consumption, and previous research has found disparities in local food environments by income and ethnicity. Other existing studies have begun to quantify the distribution of food sources, but there has been limited attention to important features or types of healthful food that are available or their quality or cost. Two studies assessed the type, quantity, quality and cost of healthful food from two diverse urban cities, Kansas City, Kansas and Missouri and Honolulu, Hawaii, and evaluated differences by neighborhood income and ethnic composition. Method: A total of 343 food stores in urban neighborhoods were assessed using the one-page Understanding Neighborhood Determinants of Obesity (UNDO) Food Stores Assessment (FSA) measuring healthful foods. US Census data were used to define median household income and ethnic minority concentration. Results: In Study 1, most low socioeconomic status (SES), high ethnic minority neighborhoods had primarily convenience, liquor or small grocery stores. Quality of produce was typically lower, and prices of some foods were more than in comparison neighborhoods. In Study 2, low SES neighborhoods had more convenience and grocery stores. Farmers’ markets and supermarkets had the best produce availability and quality, and farmers’ markets and pharmacies had the lowest prices. Conclusions: Messages emphasizing eating more fruits and vegetables are not realistic in urban, low SES, high ethnic concentration neighborhoods. Farmers’ markets and supermarkets provided the best opportunities for fresh produce. Increasing access to farmers’ markets and supermarkets or reducing prices could improve the local food environment.

BackgroundTo increase levels of physical activity (PA), interventions that create or enhance access to places for PA are recommended. Establishing a joint use agreement is one way to increase access to existing PA and recreational facilities. The purpose of this article is to present a case study of In-Motion, a pilot joint use agreement project at one urban high school in Honolulu, Hawaii.ContextResidents of urban Honolulu are underserved by the amount of parkland and recreational facilities available for their use. The Honolulu County Department of Parks and Recreation sought to implement a joint use agreement to use the facilities of one urban high school for a recreational program. The high school selected for the pilot project has a student population primarily from low-income and ethnic minority backgrounds.MethodsAn assessment of the potential of 7 urban high schools to implement a joint use agreement was conducted to select the pilot site. In-Motion developed and implemented a joint use agreement. PA preferences of students, staff, and community members were assessed to guide recreational program offerings. Various recreational classes were offered free to the school community.ConsequencesSeveral barriers to implementing the joint use agreement and recreational program were encountered. However, participants were satisfied with the recreational classes they attended and said that the In-Motion program helped them to engage in more PA. Program awareness by high school students and staff was high.InterpretationIn-Motion has successfully modeled a pilot joint use agreement and provided new opportunities for PA to the high school’s students, teachers, and staff, and to community residents.

BackgroundFeatures of the built environment that influence physical activity behavior characterize Active Community Environments.ContextWhether Active Community Environments policies exist in the state of Hawaii’s four counties is unknown. The purpose of this study was to provide a baseline assessment of these policies in Hawaii.MethodsA survey assessing policies in six domains (i.e., sidewalks, bike lanes, greenways, recreational facilities, commercial buildings, and shared-use paths) was completed by employees of Hawaii planning departments.ConsequencesHonolulu County had the most policies (n = 13), followed by Maui County (n = 6), Kauai County (n = 2), and Hawaii County (n = 1). Written policies were most prevalent in Honolulu County (n = 15), followed by Kauai County (n = 14), Hawaii County, (n = 4), and Maui County (n = 3). Sidewalk policies were reported for Honolulu County, Maui County (no written policies were found for Maui County), and Kauai County. Bike lane and greenway policies were found for Honolulu County (reported and written) and Kauai County (written). Recreation facility and pedestrian shared-use path policies existed for all counties, although only Honolulu and Kauai counties had written policies for commercial buildings (Maui County reported having policies). Few policies directly addressed physical activity promotion.InterpretationThe most populous county, Honolulu, had the most policies in place, although discrepancies existed between reported and written policies. This baseline measure of physical activity–related policies will help focus efforts of county coalitions to increase opportunities for physical activity. Additional policies should be tracked with population behavior surveillance.

Background: With rapid economic development in China, traditional patterns of health behaviors are changing, concurrent with a rise in childhood obesity. While the home environment and parenting behaviors are modifiable factors that could be targeted for intervention, little is known about their relationship with children’s health behaviors. Therefore, the purpose of this study was to investigate the relationship between obesity and home and parenting factors in Chinese children. Methods: A cross-sectional survey was conducted in Nanchang, China in 2013 with caregivers (N = 470) of a child between the ages of 2-10 years. Regression analyses were conducted to determine risk factors for childhood obesity. Results: Obesity prevalence (21.7%) did not differ by demographic variables. Eight physical activity, nutrition, and sedentary variables had significant relationships to obesity status. Logistic regression analysis revealed three significant predictors of obesity: the number of days the family eats meals together (odds ratio = 0.84, 95% CI 0.73-0.96) and parental home computer use time (odds ratio = 0.83, 95% CI 0.72-0.96) were related to lower levels of obesity, while parental television time (odds ratio = 1.25 95% CI 1.07-1.47) was related to higher levels of obesity. Conclusions: The prevalence of obesity among children is high in Nanchang. Family and environmental risk factors are significantly related to obesity.

Legislation and regulation at the state and local level can often have a greater impact on the public’s health than individual-based approaches. Elected and appointed officials have an essential role in protecting and improving public health. Despite this important role, little systematic research has been done to assess the relative importance of public health issues compared to other policy issues in times of economic hardship. This study assessed attitudes of elected and appointed decision makers in Hawaii in 2007 and 2013 to determine if priorities differed before and after the economic recession. Methods: Elected and appointed state and county officials were mailed surveys at both time points. Respondents rated the importance of 23 specified problems, of which 9 asked about specific public health issues. Results: The survey was completed by 126 (70.4%) respondents in 2007 and 117(60.9%) in 2013. Among the public health issues, five saw significant mean decreases. These variables included: climate change, pedestrian safety, government response to natural disasters, access to healthcare, and pandemic influenza. Obesity was the only public health issue to increase in importance across the two time points. In terms of relative ranking across the time points, only drug abuse and obesity were among the top ten priorities. Lack of public health training, pandemic influenza, and government response to natural disasters were among the bottom five priorities. Conclusions: After the economic recession, many public health issues have a lower priority among Hawaii’s policy makers than before the downturn. Additional education and advocacy is needed to keep public health issues on the minds of decision makers during tough economic times.