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Background: COVID-19 restrictions and alterations to daily living (e.g. working from home, caregiving responsibilities) necessitated changes in physical activity (PA) behavior. Purpose: The purpose of this study is to understand how PA within specific domains and behavior settings changed during the COVID-19 pandemic. Methods: An e-survey, conducted April-June 2020, examined changes in PA across domains and settings in a national sample of adults (N=805; M age=38.7 ± 14.9 yrs; 78.0% female). Results: Respondents reported domain-specific increases in household and recreational PA, but decreases in active transportation, occupational PA, and public transportation use. Weekly minutes of PA changed significantly across all behavior settings, with reported increases in home-based, neighborhood, parks/trails, and total PA, and decreases in PA through recreational sports and fitness facilities. Total weekly PA minutes increased by 10.6% (Z= 4.428, p < .000). Those with caregiving responsibilities reported increases in household PA (2=9.82, p=0.007) and PA frequency (2=8.21, p=0.02). Those without caregiving responsibilities were more likely to report increases in sitting (2=20.55, p

The health benefits of physical activity and spending time in nature are well established. However, children and adults in the United States are not participating in sufficient levels of physical activity and are not spending much time outdoors. Recently, increased access to nature for the health and wellness of all populations has seen growing public health attention, though a specific focus on nature-based physical activity has been limited. The purpose of this scoping review is to operationalize the health benefits of nature-based physical activity to provide guidance to program administrators, advocates, and researchers for nature-based physical activity to facilitate collaborations. Peer-reviewed literature was searched in PubMed, Medline, Web of Science, and Google Scholar as well as in published reviews of the literature. The literature was divided into three categories of: 1) amount and location of nature-based components and physical activity; 2) added health benefits of exposure to nature-based components and physical activity; and 3) nature-based components and physical activity effect on non-white, marginalized, and vulnerable populations. This review supports and encourages multiple strategies to increase nature-based physical activity as this provides even greater benefit to health and wellness than exposure to nature or physical activity alone. Although many of the physical and mental health benefits of nature and physical activity are well established, additional research is needed to better understand the relationship between exposure to nature and nature-based physical activity. However, the existing information justifies the promotion of nature-based physical activities in public health initiatives.

Background Small island Caribbean countries such as Jamaica are now facing an epidemic of obesity and decreased physical activity (PA) levels. Public parks have been shown to be important resources for PA that also provide psychological and social benefits associated with increased PA. There are no studies that document PA in parks in the Caribbean. Methods This study utilized a mixed method approach by using the System for Observing Play and Recreation in Communities (SOPARC) to obtain baseline data on park usage patterns in Emancipation Park, a large urban public park in Jamaica. In addition, in-depth interviews were conducted to gain additional insights on the park’s use for PA. Results The park was used mostly by females, in the evenings and by persons 18–64 years old. Females had significantly lower mean energy expenditure (EE) than males (0.078 versus 0.080 kcal/kg/min, p

BACKGROUND: Dementia and late-life cognitive decline are leading causes of death and disability in the United States. Prevention of these diseases, by maintaining brain health throughout the life course, is essential. Diet and lifestyle changes are the chief strategies aimed at primary prevention for many of the risk factors of cognitive decline. OBJECTIVE: The aim of this study was to examine the potential impact of dietary factors on cognitive function. METHODS: This prospective cohort study followed 516 young adults through midlife. The Youth/Adolescent Questionnaire was used to collect habitual nutrition data (mean age: 32.03 ± 5.96 y) at baseline. Scores from a neurocognitive battery were used to assess cognitive function (mean age: 49.03 ± 4.86 y) at follow-up and were transformed to z scores. Separate multivariable-adjusted linear regression models were fitted. The trend across quintiles for each dietary variable was assessed. RESULTS: Vitamin B-6, whole grains, processed meats, and foods fried at home all displayed significant linear trends in their relation with cognitive function. Dietary intake of vitamin B-6 and whole grains was directly associated with better cognitive function after adjustment for age, race, sex, and total calorie intake (β coefficient from linear regression and SE: 1.755 ± 0.621, P = 0.005, and 0.001 ± 0.000, P = 0.018, respectively). Processed meat and foods fried at home consistently displayed inverse associations with cognitive function across crude and adjusted models (linear trend P values were 0.05 and

INTRODUCTION A neighborhood's built environment is associated with physical activity among its residents, and physical activity is associated with depression. Our study aimed to determine whether the built environment was associated with depression among residents of the rural South and whether observed associations were mediated by physical activity. METHODS We selected 2,000 participants from the Bogalusa Heart Study who had a valid residential address, self-reported physical activity (minutes/week), and a complete Center for Epidemiologic Study-Depression (CES-D) scale assessment from 1 or more study visits between 1998 and 2013. We assessed the built environment with the Rural Active Living Assessment street segment audit tool and developed built environment scores. The association between built environment scores and depression (CES-D ≥16) in geographic buffers of various radii were evaluated by using modified Poisson regression, and mediation by physical activity was evaluated with mixed-effects models. RESULTS Depression was observed in 37% of study participants at the first study visit. One-point higher physical security and aesthetic scores for the street segment of residence were associated with 1.07 times higher (95% CI, 1.02-1.11) and 0.96 times lower (95% CI, 0.92-1.00) baseline depression prevalence. One-point higher destination scores (ie, more commercial and civic facilities) in radius buffers of 0.25 miles or more were associated with 1.06 times (95% CI, 1.00-1.13) the risk of depression during follow-up. Neighborhood poverty (defined as percentage of residents with incomes below the federal poverty level and dichotomized at 28.3%) modified cross-sectional and longitudinal associations. Associations were not mediated by physical activity. CONCLUSION The built environment was associated with prevalence and risk of depression, and associations were stronger in high-poverty neighborhoods. Built environment improvements to promote physical activity should take neighborhood context into consideration to minimize negative side effects on mental health in high-poverty communities.

Background Non-communicable disease (NCD) multimorbidity is associated with impaired functioning, lower quality of life and higher mortality. Susceptibility to accumulation of multiple NCDs is rooted in social, economic and cultural contexts, with important differences in the burden, patterns, and determinants of multimorbidity across settings. Despite high prevalence of individual NCDs within the Caribbean region, exploration of the social epidemiology of multimorbidity remains sparse. This study aimed to examine the social determinants of NCD multimorbidity in Jamaica, to better inform prevention and intervention strategies. Methods Latent class analysis (LCA) was used to examine social determinants of identified multimorbidity patterns in a sample of 2551 respondents aged 15–74 years, from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008. Multimorbidity measurement was based on self-reported presence/absence of 11 chronic conditions. Selection of social determinants of health (SDH) was informed by the World Health Organization’s Commission on SDH framework. Multinomial logistic regression models were used to estimate the association between individual-level SDH and class membership. Results Approximately one-quarter of the sample (24.05%) were multimorbid. LCA revealed four distinct profiles: a Relatively Healthy class (52.70%), with a single or no morbidity; and three additional classes, characterized by varying degrees and patterns of multimorbidity, labelled Metabolic (30.88%), Vascular-Inflammatory (12.21%), and Respiratory (4.20%). Upon controlling for all SDH (Model 3), advancing age and recent healthcare visits remained significant predictors of all three multimorbidity patterns (p p p Metabolic class while being female was a significant independent predictor of Vascular-Inflammatory class membership (RRR = 2.54; p Conclusion This study provides a nuanced understanding of the social patterning of multimorbidity in Jamaica, identifying biological, health system, and structural determinants as key factors associated with specific multimorbidity profiles. Future research using longitudinal designs would aid understanding of disease trajectories and clarify the role of SDH in mitigating risk of accumulation of diseases.

Background Insufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies. Methods Participants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations. Results Participants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics. Conclusions Significant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.

The importance of engaging in any type of physical activity regularly, for both physical and mental health, is well established, and may be particularly beneficial in protecting the body and limiting the damage caused by the coronavirus disease 2019 (COVID-19). Exposure to nature or green space also has positive physical and mental health benefits. Closures of parks and green spaces during the COVID-19 pandemic has limited the options for physical activity and may affect vulnerable populations more than others. We provide both short-term and long-term recommendations to encourage access to green space for people while allowing for physical distancing.

Relationships of the built environment (BE) with physical activity (PA) and health outcomes have been reported, though data is limited in rural settings. This study was conducted to assess relationships between BE around the residence and death from chronic disease in rural residents. We hypothesized that BE more conducive to PA would be associated with lower odds of chronic disease death. Participants in the Bogalusa Heart Study, a long-running cohort study in rural Louisiana, with a valid address of residence and either deceased of a chronic disease (cases) or observed (controls) since 1998 were included (N=2,052). Cases were identified in the National Death Index (N=111). BE features on the street segment of residence were assessed with the Rural Active Living Assessment tool and Google Street View. Scores for walkability, overall and in domains (including path features, aesthetics, land use), were calculated for street segments and in buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations of BE scores with chronic disease death were assessed with generalized estimating equations logistic regression models that accommodated clustering in street segments and census tracts, and were adjusted for age, sex, race, census tract population density and percent living in poverty. Cases were of similar age (45 at death vs 44 at last visit), more likely to be male (59 vs 43%) and less likely to be white (52 vs 66%) than controls. Significant associations were observed between scores for path features, aesthetics and land use and odds of chronic disease death in buffers of 0.25, 0.50, 1.00 and 1.50 miles. In 0.25 mile buffers, 1-point higher scores for path features, aesthetics and land use were associated with 1.12 (95% CI 1.02, 1.23), 0.66 (95% CI 0.53, 0.82) and 0.49 (95% CI 0.32,0.76) times the odds of chronic disease death, respectively. Significant associations highlight the importance of land use development conducive to PA (i.e. higher density and better condition residential settlement) and improved community aesthetics (i.e. greenspace presence and maintenance) to improved health in rural populations. More research is needed to identify a mechanism for the unexpected association between path features (i.e. presence of a path) and increased odds of chronic disease death. Rural BE improvements face barriers (lower population density), and these reported associations may guide feasible approaches to improved rural health.

Background: New licensing regulations require Louisiana early care and education centers (ECEs) to limit children's screen time and increase physical activity. A community– academic partnership involving academic, community, government, and ECE stakeholders launched two initiatives: (1) an evaluation of the implementation of licensing regulations at the local level and (2) a statewide effort to develop technical assistance for ECE directors. Objectives: To describe the methods and lessons learned and to establish recommendations based on this ongoing participatory action research. Methods: A case study approach was used to identify the lessons learned and recommendations thus far, based on partners' perspectives and ECE directors' participation. Lessons Learned: Recommendations include to share power and funding among stakeholders, to engage directors as partners to overcome recruitment challenges, and to start with the end in mind to ensure meaningful community engagement. Conclusions: This participatory action approach is leading to innovative, feasible strategies to increase children's physical activity.

Purpose: To assess predictors of stated support for policies promoting physically active transportation. Design: Cross-sectional. Setting: US counties selected on county-level physical activity and obesity health status. Participants: Participants completing random-digit dialed telephone survey (n = 906). Measures: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle–pedestrian projects. Analysis: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. Results: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs $1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (Conclusion: Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.

BackgroundEvidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques.MethodsLatent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15-74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA).ResultsNearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ≥2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; pConclusionThis first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.

Research indicates that sleep duration and quality are inter-related factors that contribute to obesity, but few studies have focused on sleep chronotype, representing an individual's circadian proclivity, nor assessed these factors in racially diverse middle-aged samples. We examined the associations between chronotype and obesity among black and white men and women participating in the Bogalusa Heart Study (BHS).Body mass index (BMI) and sleep data were available for 1,197 middle-aged men and women (mean age 48.2 ± 5.3 years) who participated in the BHS 2013-2016. Based on the reduced Morningness-Eveningness Questionnaire's cutoff values for chronotypes, we combined 'definitely morning' and 'moderately morning' types into 'morning' type, 'definitely evening' and 'moderately evening' types into 'evening' type and kept those who were "neither" type in a separate group. We used 'morning' type as the referent group. Obesity was defined as a BMI ≥ 30. Multivariable logistic regression models were used to examine associations adjusting for sex, age, education, smoking, alcohol use and drug use, depression, shift work, physical activity and sleep duration.Evening chronotype, reported by 11.1% of participants, was associated with obesity after multi-variable adjustment, including shift work, physical activity and sleep duration (OR 1.67, 95% CI: 1.08-2.56). However, once stratified by race (black/white), this association was found only among white participants (OR = 1.91, 95% CI = 1.12-3.25) after full adjustment.In our biracial, community-based population, evening chronotype was independently associated with obesity, specifically among white participants. Further research is needed to identify behavioral, endocrine, nutritional and genetic pathways which underlie these associations.

Objective To prospectively assess the association of habitual glucosamine use with risk of cardiovascular disease (CVD) events. Design Prospective cohort study. Setting UK Biobank. Participants 466 039 participants without CVD at baseline who completed a questionnaire on supplement use, which included glucosamine. These participants were enrolled from 2006 to 2010 and were followed up to 2016. Main outcome measures Incident CVD events, including CVD death, coronary heart disease, and stroke. Results During a median follow-up of seven years, there were 10 204 incident CVD events, 3060 CVD deaths, 5745 coronary heart disease events, and 3263 stroke events. After adjustment for age, sex, body mass index, race, lifestyle factors, dietary intakes, drug use, and other supplement use, glucosamine use was associated with a significantly lower risk of total CVD events (hazard ratio 0.85, 95% confidence interval 0.80 to 0.90), CVD death (0.78, 0.70 to 0.87), coronary heart disease (0.82, 0.76 to 0.88), and stroke (0.91, 0.83 to 1.00). Conclusion Habitual use of glucosamine supplement to relieve osteoarthritis pain might also be related to lower risks of CVD events.

Although the adverse effects of elevated glucose on cognitive function have been well-documented, most cognitive evidence comes from older adults. In this study, we make use of repeated measurements across five decades of the Bogalusa Heart Study and latent class methodology to examine the association of glucose from childhood through early adulthood on cognitive function in middle age. From our cohort of n=1,298 adults, after adjustment for age, sex, race, BMI, diabetic status, smoking, physical activity, and depressive symptoms, we identified four trajectory classes of glucose over the life course: (1) “healthy and stable;” (2) “healthy but slightly increasing;” (3) “decreasing;” and (4) “sharply increasing” (Figure). The distributions of trajectory class membership were modeled with a relative cognitive z-score, computed from a battery of tests covering major neuropsychological domains. Mean z-scores, where higher indicates better relative cognitive function, for classes 1-4 were 1.04, 0.85, 0.19, and -6.69, respectively. Parameter estimates were positive for classes 1-3, and negative for class 4 (p Disclosure P. Stuchlik: None. O. Carmichael: None. E. Harville: None. H. He: None. M. Romero: None. J. Gustat: None. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis. L.A. Bazzano: None.

BACKGROUND: Short sleep duration has been consistently associated with obesity. However, few studies in adults have assessed whether this association varies by sex and race. METHODS: In the 2013–2016 examination of 1,116 participants from the biracial Bogalusa Heart Study, habitual sleep duration was measured in categories ( 8 hours) using self-report. Anthropometry was performed and adiposity was assessed using body mass index (BMI) and waist circumference. Linear regression models estimated the relationship between sleep duration and adiposity adjusting for age, education, employment, bed partner status, depressive symptoms, smoking status, physical activity, and the use of alcohol and sleeping pills. Effect modification by sex and race was examined using cross-product terms in the models and marginal means were reported. RESULTS: Of 1,116 participants (mean age 48.2 years), 58.3% were female, and 31.7% were black. In adjusted analyses, women sleeping < 6 hours had a 3.2 (95% CI 1.4, 5.0) kg/m2 greater BMI and 6.1 (1.8, 10.4) cm greater waist circumference compared to women sleeping 7–8 hours. In contrast, men had similar BMIs and waist circumferences regardless of sleep duration (p’s for interaction = 0.04 & 0.11). There was no effect modification by race. CONCLUSIONS: In this sample, lower habitual sleep duration was associated with greater adiposity among women compared to men. Further research is needed to understand the potential mechanisms of the adverse metabolic effects of short sleep in women.

SummaryBackground Obese adults have a higher risk of obstructive sleep apnoea (OSA); however, the relationship between childhood obesity and adult OSA risk is unclear. Objectives This study aimed to examine overweight/obesity (OW) in childhood and risk of OSA in middle age. Methods Childhood OW status was classified as never OW, weight cycling, persistent OW and incident OW. After 35 years of follow-up, high risk for OSA was determined by a positive score in ≥2 domains on the Berlin Questionnaire with obesity removed from scoring. Results At initial assessment, mean (SD) age was 9.9 (2.9) years, and 23.9% were OW. Overall, 25.7% had scores indicating a high risk for OSA. Compared with participants who were never OW, those with persistent OW and incident OW were 1.36 (95%CI: 1.04–1.77) and 1.47 (1.11–1.96) times more likely to be high risk for OSA, after adjustment for multiple risk factors and adult OW status. Participants with an OW duration of 1–4 years, 5–8 years, and 8+ years were 0.96 (0.44–2.09), 1.20 (0.70–2.04) and 1.52 (1.22–1.90) times more likely to be high risk for OSA compared with those who were never OW (P for trend: 0.0002). Conclusions These results suggest that childhood OW is associated with a high risk of OSA in middle age.

Background: Glucosamine is a common supplement for treating osteoarthritis, while its effectiveness on osteoarthritis and joint pain continues to be debated. Recently emerging evidence from animal studies and cross-sectional studies in humans suggest that glucosamine may have potential benefits on reduction of cardiovascular disease (CVD) and mortality; however, evidence from prospective studies is lacking. Methods: In the UK biobank cohort study, a total of 466,039 participants without CVD at baseline completed the questionnaire on supplement use, including glucosamine, were analyzed in this study. These participants were enrolled from 2006 to 2010 and followed up to 2016. Cox proportional hazards models were used to compare hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD events in participants who did and did not use glucosamine. Findings: During a median of 7·0 years of follow-up, we documented 10,204 incident cases of CVD events, 3,060 cases of CVD death, 5,745 cases of CHD and 3,263 cases of stroke. After adjustment for age, sex, body mass index, race, lifestyle factors, dietary intakes, medication use and other supplements use, glucosamine use was associated with significantly reduced risks of total CVD events (HR: 0·85: 95% confidence interval [CI], 0·80-0·90), CVD death (HR: 0·78: 95% [CI], 0·70-0·87), CHD (HR: 0·82: 95% [CI], 0·76-0·88) and stroke (HR: 0·91: 95% [CI], 0·83-1·00). In addition, the associations of glucosamine use with risks of total CVD events and CHD were more pronounced in smokers than non-smokers (P-interaction=0·018 and 0·004, respectively). Interpretation: Beyond its original use for treating osteoarthritis, habitual use of glucosamine supplement was associated with significantly reduced risks of CVD events, especially among smokers. Further investigations in both prospective cohorts and clinical trials are warranted to verify our findings. Funding: The study was supported by grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383, DK078616). Declaration of Interest: We declare no competing interests. Ethical Approval: All participants provided written informed consent and the study was approved by the NHS National Research Ethics Service. The present analysis was approved by the Tulane University (New Orleans, Louisiana) Institutional Review Board. Data from 502, 616 participants were available for our study.

209 The 2010 National Physical Activity Plan (NPAP) includes a wide-ranging set of policies, programs, and initiatives directed at increasing physical activity across the United States (US).1 It is the first comprehensive, national planning tool devoted entirely to supporting physical activity in the US. The NPAP brings together 8 disciplines in the pursuit of a multi-sector approach to promoting physical activity: public health; health care; education; mass media; business and industry; volunteer and non-profit organizations; parks, recreation, fitness, and sports; and transportation, land use, and community design.2 A companion guide for implementing the NPAP, entitled Make the Move, was developed by the National Coalition for Promoting Physical Activity.3 It includes resources, anecdotal success narratives, and sets short-term goals related to championing physical activity through the NPAP. The document provides physical activity practitioners with measurable outcomes and objectives for change as they work through the NPAP by showcasing successful examples of implementation strategies from around the US. Currently, Texas is one of only a few states to develop a state-level plan devoted entirely to physical activity planning and promotion. Most other states include physical activity as part of a chronic disease or obesity plan.4 The physical activity plan in Texas is in addition to its state-level obesity plan.5,6 Active Texas 2020 is the product of collaboration among the Governor’s Council on Physical Fitness, the University of Texas Health Science Center at Houston, the Michael and Susan Dell Center for Advancement of Healthy Living, the University of Texas at Austin, and the Austin Mayor’s Fitness Council. Like the NPAP, it is a multi-sector plan designed to incorporate stakeholders from a diverse group of community sectors.7-15

Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana. A crosssectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household’s main grocery shopper. All participants were in the New Orleans metro area and were surveyed in 2011. Participants were 2,834 residents identified as the households’ main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older. Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, selfreported health, and frequency of grocery shopping. Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p

BACKGROUND Hand tremor and blood pressure (BP) are both increased by adrenergic stimulation and reduced by β-blockade, indicating that they may share a common underlying pathophysiology. METHODS We prospectively examined the relationship between postural hand tremor and incident hypertension in a community-based cohort of 715 (184 blacks and 531 whites) adults without hypertension and not using medications to control tremor (e.g. β-blockers). At baseline, tremor was measured with participants holding a laser pointer aimed at a sheet of Polaroid film 8 feet away with arm outstretched for 8 s in a darkened room, and characterized by the width of the circle diameter encompassing all exposures and enumeration of exposure dots in the same area. Incident hypertension was defined as new elevation of BP (SBP ≥ 140 or DBP ≥ 90 mmHg, based on an average of six readings over two visits) or antihypertensive medication use. RESULTS During a median follow-up of 6.4 years, 198 (69 blacks and 129 whites) participants developed hypertension. Tremor measurements (by quartile) were positively associated with incident hypertension after adjustment for baseline demographics, lifestyle characteristics, and BP. There was significant interaction by race (P = 0.01). Among whites, tremor was positively associated with incident hypertension [hazard ratio highest vs. lowest quartile: 2.50 (95% confidence interval: 1.40-4.48) dot method and 3.24 (1.78-5.90) circular method; both P trend

Purpose To examine the relationship of metabolic syndrome with corrected QT interval duration. Methods In a cross-sectional analysis of NHANES III, a representative sample of the adult US population, 3,495 individuals aged ≥40 years were categorized as having metabolic syndrome and not having metabolic syndrome as defined by ATP III. QT interval was measured from the standard 12-lead electrocardiogram. Results A weighted multi-linear regression analysis adjusted for age, gender, serum calcium, and potassium showed that metabolic syndrome was significantly associated with a corrected QT interval in milliseconds. The adjusted Beta coefficient and its corresponding standard error were (4.48 milliseconds, 0.95 milliseconds, P < 0.01). Conclusion These data indicate that metabolic syndrome is independently associated with a corrected QT interval duration. This study calls for careful ECG monitoring among persons with metabolic syndrome for early detection of a long corrected QT interval in order to prevent severe and often fatal arrhythmias.

Few epidemiologic studies have examined the association between depressive symptoms and atherosclerosis in subjects aged ≥65 years. Most of these studies were cross sectional and could not determine the temporality between depressive symptoms and the development of abnormal common carotid artery (CCA) intima-media thickness (CCA-IMT). To investigate the association between depressive symptoms and CCA atherosclerosis in subjects aged ≥65 years, data from 3,781 participants aged ≥65 years from the Cardiovascular Health Study were analyzed. The presence of depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale, while CCA-IMT as an indicator of CCA atherosclerosis was measured by B-mode carotid ultrasonography. Multivariate generalized estimation equations adjusted for age, gender, race, alcohol intake, blood glucose status, body mass index, and time showed that subjects aged ≥65 years with depressive symptoms had larger CCA-IMTs than those who did not have such symptoms (β = 18.26 μm, SE 8.06, p = 0.03). Using 1,000 and 1,140 μm as cut-off points to exclude participants who had abnormal CCA-IMTs at baseline, the adjusted relative risks and the corresponding 95% confidence intervals of developing abnormal CCA-IMT over 3 years were 1.30 (95% confidence interval 1.10 to 1.44) and 1.21 (95% confidence interval 1.00 to 1.46), respectively. Similar results were obtained after excluding participants with prevalent cardiovascular disease at baseline. In conclusion, these data indicate that depressive symptoms are associated with the development of atherosclerosis in subjects aged ≥65 years.

Background: There is growing evidence that symptoms of depression influence the development of cardiovascular disease. The objective of this study was to evaluate the direct and indirect relationships between symptoms of depression, body mass index (BMI), and hypertension in a biracial (African American–white) rural population. Methods: This is a cross-sectional study with 1017 study participants (aged 12 to 62 years, 60% white, and 52% women) from 561 families of the Bogalusa Heart Study. A two-stage modeling approach was used to evaluate the relationship between symptoms of depression, BMI, and hypertension. Generalized estimating equation methods (GEE) were used to account for within family correlations. Adjusted coefficients (95% confidence interval [CI]) and odds ratios (OR) were used to explore relationships. Results: Mean ( SE) BMI of the study population was 28 (7). Thirty-two percent of those studied had presumptive depression and 13.4% had hypertension. The indirect effect of a 5 unit higher symptoms of depression score was associated with a 14% (OR: 1.14; 95% CI: 1.01–1.28; P .02) higher likelihood of being hypertensive due to presence of a higher level of BMI in both whites and African Americans. The direct effect of a 5 unit higher symptoms of depression score was found to be nonsignificant (OR: 1.05; 95% CI: 0.92–1.20; P .22) in whites and significant (OR: 0.81; 95% CI: 0.68–0.95; P .004) in African Americans. Conclusions: The presence of a significant indirect effect of symptoms of depression (mediated through higher level of BMI) in both whites and African Americans suggests that BMI can be an intermediate variable linking symptoms of depression and hypertension.

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.

The relation of self-rated measures of physical activity to multiple risk factors of insulin resistance syndrome (IRS) was examined in African American (n = 409) and white (n = 1,011) young adults aged 20 to 38 years enrolled in the Bogalusa Heart Study. Physical activity was assessed in terms of work activity, leisure-time activity, television watching, and video game playing by a questionnaire. Waist circumference, blood pressure, total to high-density lipoprotein cholesterol ratio, and insulin resistance index showed a consistent inverse trend with leisure-time activity (P 75th percentile for age, race, and sex) (P or =3 risk factors (P < 0.05); conversely, excess hours of inactivity increased the relative risk (P < 0.05). Thus, leisure-time activity and hours of inactivity are important predictors of multiple cardiovascular risk variables of IRS in young adults.

Left ventricular (LV) hypertrophy increases the risk of future cardiovascular events. The relationship between obesity in young adulthood and later LV geometry is unknown. We examined the association between long-term changes in measures of adiposity and subsequent LV geometry among 1073 young adults from the Bogalusa Heart Study.Echocardiography-measured LV geometry was classified into normal (N = 796), concentric remodeling (N = 124), eccentric hypertrophy (N = 99), and concentric hypertrophy (N = 54) by integrating relative wall thickness and LV mass index. The mean age of our population was 38 years when the LV geometry was measured. Body mass index (BMI) increased by a mean of 4.9 kg/m(2) over a median of 20 years, waist circumference (WC) by 10.9 cm over 17 years, waist/hip ratio by 0.02 over 10 years, waist/height ratio by 0.06 over 17 years, abdominal height by 0.9 cm over 10 years, body fat (BF) percentage by 12.7% over 20 years, and Visceral Adiposity Index by 0.30 over 17 years. In polytomous logistic regression models corrected for multiple comparisons, participants with one-standard-deviation increases in BMI, WC, waist/height ratio, and BF had 2.00 (95% confidence interval (CI): 1.53-2.61), 1.33 (1.06-1.68), 1.35 (1.07-1.70), and 1.60 (1.26-2.03) times the risk of eccentric hypertrophy, respectively, after adjustment for demographic, lifestyle, metabolic risk factors, and follow-up time. Likewise, the rates of change in BMI, WC, waist/height ratio, and BF were associated with eccentric hypertrophy. There was no association with concentric remodeling or concentric hypertrophy.Our findings suggest that increases in BMI, WC, waist/height ratio, and BF were strong predictors of eccentric hypertrophy in middle age.

Background: Patients with obesity have high risk of obstructive sleep apnea (OSA); however, the relationship between childhood obesity and later OSA risk is unknown. Methods: We prospectively examined the association between changes in overweight/obesity status in childhood and subsequent OSA in 823 middle-aged adults free of cardiovascular diseases at baseline and who had at least 2 measures of body mass index (BMI) between 4 and 18 yrs old (1974-) and responded to the Berlin Questionnaire in 2010. Childhood overweight/obesity was defined as age and gender specific BMI ≥85 th percentile based on 2000 CDC Growth Charts. Four groups were generated based on change in obesity status from the earliest to most recent visit in childhood: persistent normal weight, incident overweight (from normal to overweight), weight loss (from overweight to normal), and persistent overweight. Based on Berlin Questionnaire, high-risk OSA was defined as any 2 of the following: obesity or hypertension, persistent snoring symptoms, and persistent daytime sleepiness. Persistent snoring was defined as snoring on ≥3 nights/week, snoring louder than talking or very loud, and breathing pauses on ≥3 nights/week; and persistent daytime sleepiness was defined as feeling tired ≥3 days/week after sleeping, feeling tired during time awake ≥3 days/week, and falling asleep while driving. Results: Mean age was 42 yrs and mean BMI was 31.0 kg/m 2 in adulthood. Of the total, 43% were male, and 34% were African-American. There were 604, 68, 39, and 112 persons in the persistent normal weight, incident overweight, weight loss, and persistent overweight groups, respectively. Median time between measures of BMI in childhood was 5 yrs (IQR: 5 yrs) across the 4 groups. Over an average of 35 years follow-up from childhood to adulthood (IQR: 1 yr), 326 (38%) participants had high-risk of OSA. In multivariate log-linear regression models, compared to participants in persistent normal weight group, those in persistent overweight, incident overweight, and weight loss groups had 1.80 (95% CI: 1.48, 2.19), 1.61 (1.22, 2.12), and 1.28 (0.89, 1.87) times higher risk of OSA, after adjustment for age, gender, race, educational level, leisure-time physical activity, regular drinking, and current smoking. The persistent overweight group had significantly higher risk of persistent snoring symptoms than persistent normal group (RR: 1.39; 95% CI: 1.12, 1.73). Results were not statistically significant for persistent daytime sleepiness among the groups. Conclusions: Persistent overweight or change from normal weight to overweight in childhood was associated with a higher risk of OSA in middle age, while weight loss during childhood did not have higher risk of OSA in adulthood compared to their counterparts in the persistent normal weight group.

Obesity and fat patterns are important predictors of coronary heart disease risk. The relations of abdominal height (sagittal diameter) and various obesity measures to coronary heart disease risk factors were examined in a community-based sample of 409 Blacks and 1,011 Whites aged 20-38 years in Bogalusa, Louisiana (1995-1996). Obesity measures used included weight, waist circumference, waist:hip ratio, waist:height ratio, abdominal height, triceps and subscapular skinfold thicknesses, body mass index, and conicity index. Abdominal height was highly correlated with other obesity measures, especially waist circumference (0.937-0.944, p < 0.001), and was least correlated with height. In multivariate analysis, abdominal height was an independent predictor of levels of total cholesterol, triglycerides, very low density lipoprotein cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, glucose, and insulin and of systolic and diastolic blood pressures (p < 0.05 to p < 0.001), with total R 2 values ranging from 0.13 to 0.52. Abdominal height contributed more to the prediction of blood pressure than did other measures of central obesity. In canonical analysis, abdominal height was correlated more strongly with the coronary disease risk factor variables as a group than were other obesity measures. These results suggest that abdominal height adds another dimension to measures of obesity in that it may help to assess a component of visceral fat that other measures miss.

Collaborative groups are integral in health promotion and disease prevention and use an ecological approach to address complex health conditions in community settings. Little is known about collaborative efforts to promote active living.The objective of this analysis is to explore successes and challenges of collaborative groups in promoting active living in their communities.One-time, structured telephone interviews were conducted to assess the composition tactics and activities and approaches used by collaboratives to promote active living.Collaborative groups were referred by Physical Activity Policy Research Network members or found through online searches. Interviews were conducted with coordinators of 59 collaborative groups.Analysis focused on successes and challenges of collaborative groups' policies, programs, and/or projects as described by collaborative group coordinators. We used the Grounded Theory method approach to code and abstract themes from 2 open-ended response sets.Collaboratives' most successful projects centered on strategies using environmental (41%) or policy (31%) approaches to promote active living. While 80% of groups reported that their most successful project was funded, funding was also identified as a primary challenge for 71% of the collaboratives. Personnel issues were a common challenge for 54%. Opposition to successful projects ranged from community issues to collaborative member issues, although more than half the groups experienced no opposition.Groups that aligned goals, strategies, and funding to advance changes to the built environment were likely to identify their projects as successful. Perceptions of opposition and attitudes toward success may be important precursors to project outcomes of active living collaboratives and warrant further investigation. Lessons from these active living collaborative groups can provide guidance for other groups planning for environmental and policy change.

INTRODUCTION: Changing the built environment to promote active lifestyles requires collaboration among diverse sectors. Multisectoral collaborative groups in the United States promote active lifestyles through environmental and policy changes. The objective of this study was to examine the characteristics of these collaborative groups and the extent to which they have achieved change. METHODS: We identified, recruited, and interviewed the coordinators of active living collaborative groups in the United States. We used descriptive statistics to characterize groups by composition, stakeholder engagement, and the extent of environmental and policy change in 8 strategic areas. RESULTS: Fifty-nine groups from 22 states participated in the study. Most groups had a diverse set of partners and used a range of activities to advance their agendas. Most groups achieved some form of environmental or policy change. On average, groups reported working on 5 strategy areas; parks and recreation (86%) and Safe Routes to School (85%) were named most frequently. More than half of groups reported their environmental initiatives as either in progress or completed. Groups reported the most success in changing policy for public plazas, street improvements, streetscaping, and parks, open space, and recreation. Complete Streets policy and zoning ordinances were the most frequently cited policy types. Engaging in media activities and the policy-making process in addition to engaging stakeholders appear to influence success in achieving change. CONCLUSION: Although many groups successfully worked on parks and recreation improvements, opportunities remain in other areas, including transit and infill and redevelopment. Additional time and resources may be critical to realizing these types of changes. KW: SW2S Language: en

Introduction Obesity is a public health problem that is due in part to low levels of physical activity. Physical activity levels are influenced by the built environment. We examined how changes in the built environment affected residents' physical activity levels in a low-income, primarily African American neighborhood in New Orleans.

Studies involving dietary patterns (DP) and their association with diseases have several benefits over the conventional approach, which has focused largely on the effects of single nutrients or individual foods(1,2). As the measurement of diet is complex, and foods are typically consumed in combinations, the combined effect of nutrients and foods can be observed only when DP are examined(1,2). Moreover, results from DP analyses are more helpful in disseminating diet-related messages to consumers that they may be more likely to adhere to rather than those related to single foods or nutrients(3). DP have also been related to selected biomarkers of dietary exposure(1,2) and have been reported to contribute in the development or prevention of CHD and type 2 diabetes mellitus (T2DM)(4). Recent focus has been on the occurrence of metabolic syndrome (MetS), a constellation of metabolic abnormalities including central obesity, elevated blood levels of CHD-promoting lipids, hypertension, insulin resistance and hyperglycaemia(5). In adults, MetS increases the risk of CHD by two-fold and the risk for T2DM by five-fold(5–7). The age-adjusted prevalence of MetS in US adults (≥20 years) participating in the 2003–2006(8) National Health and Nutrition Examination Survey (NHANES) was 34 % v. 29·2 % reported in the 1988–1994 NHANES(9). Among young adults (20–39 years), the prevalence of MetS has increased from 10·8 % (in 1988–1994)(9) to 15·6 % (in 2003–2006) in females(8), and from 15·7 % (in 1988–1994)(9) to 20·3 % (in 2003–2006)(8) in males. Young adulthood is an important period of transition from adolescence into adulthood, when individuals begin to live an independent life. Pressures of independence, hurried lifestyles and providing support for new families may lead to shifts in their dietary and lifestyle patterns. Consequently, unhealthy dietary habits such as skipping breakfast(10), relying on fast food(11) and eating outside home(12) are prevalent among young adults. Moreover, individuals from rural and semi-rural US communities tend to have poorer dietary and health habits because of their lower socio-economic status (SES)(13–15). It is therefore critical to examine the DP of young adults and their relation to risk factors for chronic diseases in order to administer effective dietary and lifestyle prevention and treatment programmes for metabolic disorders such as the MetS, in this age group. Despite the rising prevalence of MetS, few recent studies have examined the role of DP and their relationship with MetS(16–20); their results, in general, showed that healthy DP were inversely associated with the occurrence of MetS in adults(16–20). However, to date only one Bogalusa Heart Study (BHS)(21) has examined the relationship of diet with MetS in young adults, and showed that lower fruit and vegetable consumption and higher sweetened beverage consumption were independently associated with one to two risk factors for MetS(21). Yet, the above-mentioned BHS explored the association of only single food groups rather than DP with MetS. The present study, although an extension of the previous BHS(21), had two additional objectives. First, it aimed to identify various DP among young adults and to examine the association of these DP with the risk factors of MetS. Second, because food consumption differs by SES and demographic factors such as gender and ethnicity(13), and the occurrence of MetS is related to lifestyle factors such as physical inactivity, smoking and alcohol consumption(22), the present study also assessed SES, and demographic and lifestyle differences among the DP in these young adults.

Background:Parks provide environments for physical activity, yet little is known about how natural disasters affect them or how these disasters alter physical activity. Our objectives were to (1) describe the development of an instrument to assess park conditions following a hurricane and (2) document the conditions of New Orleans’ parks 3 and 6 months after Hurricane Katrina.Methods:A Post-Hurricane Assessment (PHA) instrument was developed and implemented in 54 parks 3 and 6 months post-hurricane.Results:Summary scores of the Park Damage Index and the Neighborhood Damage Index showed improvement between 3 and 6 months of data collection. Parks and neighborhoods most affected by the hurricane were located in the most- and least-affluent areas of the city.Conclusion:The PHA proved to be a promising tool for assessing park conditions in a timely manner following a natural disaster and allowed for the creation of summary damage scores to correlate to community changes.

Background: The β2-adrenergic receptor (ADRB2) plays a major role in regulating energy expenditure by stimulating lipid metabolism in human adipose tissue. Polymorphisms in the ADRB2 gene have been associated with obesity and various weight-related traits in cross-sectional studies of adults, but little is known about the effects of the ADRB2 gene on childhood obesity or the propensity to gain weight over time. Objective: To assess the effects of a polymorphism in codon 16 (Arg16→Gly) of the ADRB2 gene, which has been associated with a decrease in β2-receptor density and efficiency, on longitudinal changes in obesity from childhood to young adulthood in a biracial cohort. Design: Seven cross-sectional screenings of children and five cross-sectional screenings of young adults who were previously examined as children produced longitudinal data from childhood to young adulthood. Methods: Height, weight and subscapular and triceps skinfolds were measured by trained examiners following identical protocols over the course of the study. Gender- and age-stratified analyses using random coefficients models were used to examine longitudinal genetic effects on obesity in 1151 African-American and Caucasian males and females who attended an average of six examinations over a 24 y period from childhood to young adulthood. Results: Age-stratified analyses showed no clear genetic relationships with changes in obesity measures over time in females, but an age-dependent association was observed in males, where the relationship between the Arg16Gly polymorphism and obesity became stronger with age. In males who were 4–9 y of age at the beginning of the study in 1973, body mass index (BMI) was 4% higher in Gly/Gly and Arg/Gly males compared to those with Arg/Arg by 26 y of age. Subscapular skinfold measurements in Gly/Gly males became significantly different from Arg/Arg males (20% higher) by age 20. In the oldest male cohort (10–14 y of age in 1973), BMI increased at a significantly greater rate (0.4%/y) in males carrying the Gly16 form of the receptor relative to Arg/Arg males. BMI was significantly different between homozygous genotypes by approximately 26 y of age, and reached 8% higher in Gly/Gly males by age 32. Subscapular skinfolds also increased at a significantly greater rate (2%/y) in Gly/Gly males compared to Arg/Arg males, becoming significantly different (27%) by approximately 22 y of age and reaching a maximum difference of 50% by age 32. Conclusions: Our data suggest that the β2-adrenergic receptor is associated with the propensity to gain weight from childhood to young adulthood in males. An increased understanding of genetic influences on the development of obesity may improve the effectiveness of interventions designed to reduce excess body weight and help define the role of genetic factors in diabetes and cardiovascular disease.

Background Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce. Methods A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects. Results In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips. Conclusion The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce., Highlights • This city-wide data set used distances calculated from the stores where people reported shopping. • Fresh fruit and vegetable consumption was mediated by the frequency of shopping trips per month. • Distance to the patronized store was not directly associated with consumption of produce. • Automobile access allowed consumers to shop more frequently but distance deterred it.

Background The United States National Physical Activity Plan (NPAP; 2010), the country’s first national plan for physical activity, provides strategies to increase population-level physical activity to complement the 2008 physical activity guidelines. This study examined state public health practitioner awareness, dissemination, use, challenges, and recommendations for the NPAP. Methods In 2011–2012, we interviewed 27 state practitioners from 25 states. Interviews were recorded and transcribed verbatim. Transcripts were coded using a standard protocol, verified and reconciled by an independent coder, and input into qualitative software to facilitate development of common themes. Results NPAP awareness was high among state practitioners; dissemination to local constituents varied. Development of state-level strategies and goals was the most frequently reported use of the NPAP. Some respondents noted the usefulness of the NPAP for coalitions and local practitioners. Challenges to the plan included implementation cost, complexity, and consistency with other policies. The most frequent recommendation made was to directly link examples of implementation activities to the plan. Conclusions These results provide early evidence of NPAP dissemination and use, along with challenges encountered and suggestions for future iterations. Public health is one of eight sectors in the NPAP. Further efforts are needed to understand uptake and use by other sectors, as well as to monitor long-term relevance, progress, and collaboration across sectors.