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Active travel to school is one way youth can incorporate physical activity into their daily schedule. It is unclear the extent to which active travel to school is systematically monitored at local, state, or national levels. To determine the extent of active travel to school surveillance in North America and catalog the types of measures captured, we conducted a systematic review of peer-reviewed literature documenting active travel to school surveillance published from 2004 to February 2018. A study was included if it addressed children’s school travel mode across two or more time-periods in North America. Criteria were applied to determine whether a data source was considered an active travel to school surveillance system. We identified 15 unique data sources; 4 of these met our surveillance system criteria. One system is conducted in the US, is nationally representative, and occurs every 5-8 years. Three are conducted in Canada, are limited geographically to regions and provinces, and are administered with greater frequency (e.g., 2-year cycles). School travel mode was the primary measure assessed, most commonly through parent report. None of the systems collected data on school policies or program supports related to active travel to school. We conclude that incorporating questions related to active travel to school behaviors into existing surveillance systems, and maintaining them over time, would enable more consistent monitoring. Concurrently capturing behavioral information along with related environmental, policy, and program supports may inform efforts to promote active travel to school.

Background: Assessing awareness and knowledge of the Physical Activity Guidelines for Americans, 2nd edition (Guidelines), released in 2018, is important for monitoring factors that contribute to increasing physical activity. Methods: We estimated prevalence of awareness and knowledge of the adult aerobic guideline (≥150 min/wk of moderate-intensity equivalent aerobic physical activity preferably spread out over a week) among adults (n = 3471) and of the youth aerobic guideline (≥60 min/d of mostly moderate- to vigorous-intensity aerobic physical activity) among a subset of parents (n = 744) from a nationwide sample of US adults in the 2019 FallStyles survey. We estimated odds ratios using logistic regression, adjusting for demographic and other characteristics. Results: Approximately 1 in 10 US adults and parents reported being aware of the Guidelines. Only 3% of adults knew the correct adult aerobic guideline. The most common responses were “don’t know/not sure” (44%) and “30 minutes a day, 5 or more days a week” (28%). Among parents, 15% knew the youth aerobic guideline. Awareness and knowledge tended to be lower with lower education and income. Conclusions: Limited awareness and knowledge of the Guidelines suggest communication about the Guidelines could be strengthened, especially among adults with low income or education.

Background: Surveillance is a core function of public health, and approaches to national surveillance of physical activity and sedentary behavior have evolved over the past 2 decades. The purpose of this paper is to provide an overview of surveillance of physical activity and sedentary behavior in the United States over the past 2 decades, along with related challenges and emerging opportunities. Methods: The authors reviewed key national surveillance systems for the assessment of physical activity and sedentary behavior among youth and adults in the United States between 2000 and 2019. Results: Over the past 20 years, 8 surveillance systems have assessed physical activity, and 5 of those have assessed sedentary behavior. Three of the 8 originated in nonpublic health agencies. Most systems have assessed physical activity and sedentary behavior via surveys. However, survey questions varied over time within and also across systems, resulting in a wide array of available data. Conclusion: The evolving nature of physical activity surveillance in the United States has resulted in both broad challenges (eg, balancing content with survey space; providing data at the national, state, and local level; adapting traditional physical activity measures and survey designs; and addressing variation across surveillance systems) and related opportunities.

Background Physical activity (PA) provides numerous health benefits relevant to the COVID-19 pandemic. However, concerns exist that PA levels may have decreased during the pandemic thus exacerbating health disparities. This study aims to determine changes in and locations for PA and reasons for decreased PA during the pandemic. Methods Reported percentage of changes in and locations for PA and reasons for decreased PA were examined in 3829 US adults who completed the 2020 SummerStyles survey. Results Overall, 30% reported less PA, and 50% reported no change or no activity during the pandemic; percentages varied across subgroups. Adults who were non-Hispanic Black (Black) or Hispanic (vs. non-Hispanic White, (White)) reported less PA. Fewer Black adults (vs. White) reported doing most PA in their neighborhood. Concern about exposure to the virus (39%) was the most common reason adults were less active. Conclusions In June 2020, nearly one-third of US adults reported decreased PA; 20% reported increased PA. Decreased activity was higher among Black and Hispanic compared to White adults; these two groups have experienced disproportionate COVID-19 impacts. Continued efforts are needed to ensure everyone has access to supports that allow them to participate in PA while still following guidance to prevent COVID-19 transmission.

The U.S. COVID-19 vaccination program began in December 2020, and ensuring equitable COVID-19 vaccine access remains a national priority.* COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administra-tion to those who have been most affected by COVID-19 disease) is an important goal. The CDC social vulnerability index (SVI) uses 15 indicators grouped into four themes that comprise an overall SVI measure, resulting in 20 metrics, each of which has national and state-specific county rankings. The 20 metric-specific rankings were each divided into lowest to highest tertiles to categorize counties as low, moderate, or high social vulnerability counties. These tertiles were combined with vaccine administration data for 49,264,338 U.S. residents in 49 states and the District of Columbia (DC) who received at least one COVID-19 vaccine dose during December 14, 2020-March 1, 2021. Nationally, for the overall SVI measure, vaccination coverage was higher (15.8%) in low social vulnerability counties than in high social vulnerability counties (13.9%), with the largest coverage disparity in the socioeconomic status theme (2.5 percentage points higher coverage in low than in high vulnerability counties). Wide state variations in equity across SVI metrics were found. Whereas in the majority of states, vaccination coverage was higher in low vulnerability counties, some states had equitable coverage at the county level. CDC, state, and local jurisdictions should continue to monitor vaccination coverage by SVI metrics to focus public health interventions to achieve equitable coverage with COVID-19 vaccine.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel† and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities§ initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3).

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 6,786,352 cases and 199,024 deaths in the United States.* Health care personnel (HCP) are essential workers at risk for exposure to patients or infectious materials (1). The impact of COVID-19 on U.S. HCP was first described using national case surveillance data in April 2020 (2). Since then, the number of reported HCP with COVID-19 has increased tenfold. This update describes demographic characteristics, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions, stratified by vital status, among 100,570 HCP with COVID-19 reported to CDC during February 12-July 16, 2020. HCP occupation type and job setting are newly reported. HCP status was available for 571,708 (22%) of 2,633,585 cases reported to CDC. Most HCP with COVID-19 were female (79%), aged 16-44 years (57%), not hospitalized (92%), and lacked all 10 underlying medical conditions specified on the case report form† (56%). Of HCP with COVID-19, 641 died. Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% versus 22%), persons aged ≥65 years (44% versus 4%), non-Hispanic Asians (Asians) (20% versus 9%), non-Hispanic Blacks (Blacks) (32% versus 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% versus 41%). From a subset of jurisdictions reporting occupation type or job setting for HCP with COVID-19, nurses were the most frequently identified single occupation type (30%), and nursing and residential care facilities were the most common job setting (67%). Ensuring access to personal protective equipment (PPE) and training, and practices such as universal use of face masks at work, wearing masks in the community, and observing social distancing remain critical strategies to protect HCP and those they serve.

Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12-April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31-April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31-April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). As of November 13, 2019, 49 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands) have reported 2,172 EVALI cases to CDC, including 42 (1.9%) EVALI-associated deaths. To inform EVALI surveillance, including during the 2019-20 influenza season, case report information supplied by states for hospitalized and nonhospitalized patients with EVALI were analyzed using data collected as of November 5, 2019. Among 2,016 EVALI patients with available data on hospitalization status, 1,906 (95%) were hospitalized, and 110 (5%) were not hospitalized. Demographic characteristics of hospitalized and nonhospitalized patients were similar; most were male (68% of hospitalized versus 65% of nonhospitalized patients), and most were aged

Background: High levels of sedentary behavior and physical inactivity increase the risk of premature mortality and several chronic diseases. Monitoring national trends and correlates of sedentary behavior and physical inactivity can help identify patterns of risk in the population over time. Methods: The authors used self-reported data from the National Health and Nutrition Examination Surveys (2007/2008–2017/2018) to estimate trends in US adults’ mean daily sitting time, overall, and stratified by levels of leisure-time and multidomain physical activity, and in the joint prevalence of high sitting time (>8 h/d) and physical inactivity. Trends were tested using orthogonal polynomial contrasts. Results: Overall, mean daily sitting time increased by 19 minutes from 2007/2008 (332 min/d) to 2017/2018 (351 min/d) (Plinear Pquadratic Plinear Conclusions: Sitting time among adults increased over the study period but decreased in recent years.

Background: Understanding how participation is changing across domains of physical activity is important for monitoring progress and informing promotion efforts. The authors examined changes in physical activity participation in the National Health and Nutrition Examination Survey 2007/2008 to 2017/2018. Methods: The prevalence of inactivity, insufficient activity, and meeting the aerobic physical activity guideline in multidomain physical activity and each domain (leisure time, occupational/household, and transportation) was estimated for each cycle and stratified by selected characteristics. The authors tested trends over time and overall changes (2017/2018 vs 2007/2008). Results: For multidomain physical activity, the prevalence of inactivity decreased linearly; meeting the aerobic guideline increased nonmonotonically, and the 2017/2018 prevalence (68.1%) was higher than 2007/2008 (64.1%). Similar findings were observed for adults aged ≥65 years, non-Hispanic Blacks, Hispanics, high school graduates, and adults with obesity. Domain-specific results varied, but decreasing trends in inactivity and increasing trends in meeting the guideline were consistently observed across subgroups for occupational/household activity. Meeting the guideline through transportation activity was rare. Conclusions: Increases in meeting the guideline and decreases in inactivity in multidomain activity and selected domains are encouraging results, especially among subgroups historically reporting low activity participation. Activity promotion efforts are important to maintain progress, and the transportation domain may be an underutilized source of physical activity.

Park planning documents may be valuable tools in order to promote policies and direct resources toward parks. However, the prevalence of such planning documents and policies specific to parks across municipal characteristics is not well known. This study compares the presence of parks and recreation plans and policies that address park safety and maintenance by municipality characteristics. Nationally representative data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living were analyzed (n=2005, response rate: 45%). About 7 out of 10 U.S. municipalities with a population of at least 1,000 reported having a parks and recreation plan. Prevalence of specific park or outdoor recreation policies was 78% for lighting, 85% for patrols by police and security, and 87% for maintenance of green space and equipment. The prevalence of a parks and recreation plan and of specific park or outdoor recreation policies were significantly lower in the smaller communities examined in this study. Most communities with at least 1,000 residents have park planning documents and policies, and opportunities may exist for practitioners to leverage the planning process to better engage residents. Future studies could investigate the role and importance of using planning documents, policies, or budget provisions to address park access and quality in less populous municipalities.Subscribe to JPRA

The importance of physical activity and community-level promotion strategies are well established, but little is known about adult perception of the importance of physical activity. In a nationwide sample of US adults, we examined self-reported importance of regular physical activity and the importance of living in walkable neighborhoods. About 55% of adults strongly agreed that regular physical activity is important, 40% strongly agreed that living in a walkable neighborhood is important, and 31% strongly agreed that both are important. Separately for each measure, estimates were lower among adults with lower education levels and who did not meet the aerobic physical activity guideline. Opportunities exist to improve the perception of the importance of physical activity and the importance of walkable neighborhoods.

Physical activity occurs in 4 domains (leisure, occupational, household, and transportation), but US surveillance often focuses on leisure-time only. We compared estimates of self-reported leisure-time physical activity and estimates of all-domain activity among adults in the National Health and Nutrition Examination Survey for 2011–2016. During the study period, 38.6% met the aerobic physical activity guideline in leisure-time, 58.5% in leisure-time and occupational/household activity, and 63.7% in all domains. Differences within most subgroups when using all domains were similar to differences when using leisure-time activity only, except that we observed no urban/rural differences in the multidomain assessment. Assessment of multiple domains of activity instead of leisure-time–only activity affects prevalence estimates to a greater extent than it affects subgroup differences.

We used 2012-2015 data from the Colorado Pregnancy Risk Assessment Monitoring System to describe changes in self-reported physical activity (PA) before and during pregnancy and used logistic regression to examine factors associated with regular PA. The prevalence of regular PA (ie, 30 or more minutes per day on 5 or more days per week) was 19.1% before pregnancy and decreased to 10.2% during pregnancy. At both times, adjusted odds of regular PA were lower among women who were overweight or had obesity before pregnancy than among those with normal weight. Findings suggest that most women with a recent live birth in Colorado, particularly those who are overweight or have obesity, are not obtaining many health benefits of PA either before or during pregnancy.

Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected ≤7 days after illness onset, Real-Time Reverse Transcriptase Polymerase Chain Reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 RT-PCR) diagnostic results were 95.2% concordant. However, NP swab cycle threshold values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect the amount of SARS-CoV-2.

The updated Physical Activity Guidelines for Americans (2nd edition) removes the requirement that physical activity should occur in bouts lasting 10 minutes or more to count toward the minimum aerobic guideline. Using self-reported data from the 2017 Behavioral Risk Factor Surveillance System (N = 386,960), we examined differences in national physical activity estimates with and without this requirement. Overall, 1.9% of adults reported activities in short bouts (

Introduction Walking can serve many purposes, such as transportation (to get some place) or leisure (for fun, relaxation, or exercise); therefore, it provides many opportunities for people to be physically active. This study examines geographic and urban–rural differences in walking in the U.S. Methods Adult respondents (aged ≥18 years) to the 2015 National Health Interview Survey reported participation in and time spent (minutes per week) walking for transportation and leisure in the past week. In 2017, prevalence and time spent walking (among walkers) for any, leisure, and transportation walking were estimated by nine expanded regions and urban–rural designation. Results Prevalence of any walking ranged from 50.8% (East South Central) to 72.4% (Pacific); for leisure walking 43.9% (East South Central) to 60.6% (Pacific); and transportation walking 17.8% (East South Central) to 43.5% (New England). Among walkers, mean minutes spent walking per week ranged from 77.4 (East South Central) to 101.6 (Pacific); for leisure walking 70.5 (West South Central) to 85.9 (Mountain); and for transportation walking 47.4 (East South Central) to 66.4 (Middle Atlantic). Overall, there were urban–rural differences in prevalence of walking; however, differences depended on walking purpose and expanded region. Time spent walking was similar in urban and rural areas. Conclusions Regional differences in walking prevalence and time spent walking exist. Urban–rural differences in prevalence of walking differ based on region and purpose; however, rural areas had a lower prevalence of walking than urban areas regardless of purpose in southern regions. Opportunities exist to improve walking, particularly among southern regions with a focus on rural areas.

Promotion of walking is a promising strategy for increasing physical activity levels in the U.S. The proportion of adults who report walking for either transportation or leisure has increased in recent years, but evidence on trends in walking for specific purposes is limited.The 2005, 2010, and 2015 National Health Interview Survey assessed self-reported participation in and volume (minutes/week) of walking for transportation and leisure in the past week among adults aged ≥18 years. Linear and quadratic trends in the prevalence and mean volume of walking for each purpose were evaluated using logistic and linear regression. Analyses were performed in 2017.The prevalence of transportation walking increased from 28.4% (2005) to 31.7% (2015) (linear trend: p0.05). Leisure walking prevalence increased from 42.1% (2005) to 52.1% (2015), but the increased stalled from 2010 to 2015 with only a 2.3 percentage point increase (linear and quadratic trends: p0.05). Across purposes, the mean walking volume decreased from 2005 to 2015, with no significant changes between 2010 and 2015 (linear and quadratic trends: p0.05). The proportion of adults who walked for both transportation and leisure in the past week increased steadily (linear trend: p0.05), and this group reported the greatest total volume of walking.Although the prevalence of self-reported transportation and leisure walking increased during the last decade, the time spent walking decreased. Strategies that encourage walking for multiple purposes may present an opportunity for increasing both participation in walking and the amount of time spent walking.

Introduction The Guide to Community Preventive Services recommends combined built environment approaches to increase physical activity, including new or enhanced transportation infrastructure (e.g., sidewalks) and land use and environmental design interventions (e.g., close proximity of local destinations). The aim of this brief report is to provide nationally representative estimates of two types of built environment supports for physical activity: near-home walkable infrastructure and destinations, from the 2015 National Health Interview Survey. Methods Adults ( n =30,453) reported the near-home presence of walkable transportation infrastructure (roads, sidewalks, paths, or trails where you can walk; and whether most streets have sidewalks) and four walkable destination types (shops, stores, or markets; bus or transit stops; movies, libraries, or churches; and places that help you relax, clear your mind, and reduce stress). The prevalence of each, and the count of destination types, was calculated (in 2017) and stratified by demographic characteristics. Results Overall, 85.1% reported roads, sidewalks, paths, or trails on which to walk, and 62.6% reported sidewalks on most streets. Among destinations, 71.8% reported walkable places to relax; followed by shops (58.0%); transit stops (53.2%); and movies, libraries, or churches (47.5%). For most design elements, prevalence was similar among adults aged 18–24 and 25–34 years, but decreased with age >35 years. Adults in the South reported a lower prevalence of all elements compared with those in other Census regions. Conclusions Many U.S. adults report walkable built environment elements near their home; future efforts might target areas with many older adult residents or those living in the South.

Since the release of the 2008 Physical Activity Guidelines for Americans (https://health.gov/paguidelines/2008/pdf/paguide.pdf), the age-adjusted percentage of adults meeting the combined aerobic and muscle-strengthening guidelines increased from 18.2% to 24.3% in 2017 (1). Trends in urban and rural areas, across demographic subgroups, and among subgroups within urban and rural areas have not been reported. CDC analyzed 2008-2017 National Health Interview Survey (NHIS) data to examine trends in the age-standardized prevalence of meeting physical activity guidelines among adults aged ≥18 years living in urban and rural areas. Among urban and rural residents, prevalence increased from 19.4% to 25.3% and from 13.3% to 19.6%, respectively. Nationally, all demographic subgroups and regions experienced increases over this period; increases for several groups were not consistent year-to-year. Among urban residents, the prevalence was higher during 2016-2017 than during 2008-2009 for all demographic subgroups and regions. During the same period, prevalence was higher across all rural-dwelling subgroups except Hispanics, adults with a college education, and those living in the South U.S. Census region. Urban and rural communities can implement evidence-based approaches, including improved community design, improved access to indoor and outdoor recreation facilities, social support programs, and community-wide campaigns to make physical activity the safe and easy choice for persons of all ages and abilities (2-4). Incorporating culturally appropriate strategies into local programs might help address differences across subgroups.

Introduction Cardiovascular disease (CVD) is the leading cause of death in the United States, and increasing physical activity can help prevent and manage disease. Walking is an easy way for most adults to be more active and may help people at risk for CVD avoid inactivity, increase their physical activity levels, and improve their cardiovascular health. To guide efforts that promote walking for CVD prevention and management, we estimated the prevalence of walking among US adults by CVD risk status. Methods Nationally representative data on walking from participants (N = 29,742) in the 2015 National Health Interview Survey Cancer Control Supplement were analyzed. We estimated prevalence of walking (ie, any, transportation, and leisure) overall and by CVD status. We defined CVD status as either not having CVD and not at risk for CVD; being at risk for CVD (overweight or having obesity plus 1 or more additional risk factors); or having CVD. We defined additional risk factors as diabetes, high cholesterol, or hypertension. Odds ratios were estimated by using logistic regression models adjusted for respondent characteristics. Results Prevalence of any walking decreased with increasing CVD risk (no CVD/not at risk, 66.6%; at risk: overweight or has obesity with 1 risk factor, 63.0%; with 2 risk factors, 59.5%; with 3 risk factors, 53.6%; has CVD, 50.2%). After adjusting for respondent characteristics, the odds of any walking and leisure walking decreased with increasing CVD risk. However, CVD risk was not associated with walking for transportation. Conclusions Promoting walking may be a way to help adults avoid inactivity and encourage an active lifestyle for CVD prevention and management.

Background Physical inactivity is a public health concern in the US Virgin Islands (USVI). A contributing factor may be a lack of pedestrian infrastructure and other environmental supports for walking. In this manuscript, we describe the methods used to conduct a walkability audit of environmental features related to physical activity in the USVI. Methods In 2016, volunteer auditors conducted the audit using a modified version of the Microscale Audit of Pedestrian Streetscapes tool. A two-stage sampling method was developed using publicly available census data to select a sample of estates (n=46) and street segments (n=1550; 99.2 km) across the USVI. A subset of segments was audited by two independent auditors, and inter-rater reliability was assessed using Cohen's kappa and percent agreement. Results Audits were completed on 1114 segments (94.6 km), and estimates were weighted to represent accessible public street length in the study area (1155.9 km). Most items on the audit tool (62.7%) demonstrated good to excellent reliability. We found that it was feasible to conduct a reliable audit of environmental features related to physical activity across a large sample of streets in the USVI. Conclusions These methods can be replicated in other settings to collect comprehensive data that can be used to guide strategies to improve the walkability of communities.

Built environments that provide activity-friendly routes (e.g., sidewalks) to everyday destinations (e.g., shops) can increase physical activity. Surveillance of supports and destinations is important, and identifying which are associated with walking could prioritize surveillance questions. Our purpose was to identify the significant associations between supports and destinations with walking among a nationally-representative sample of urban- and rural-dwelling adults. Participants in the 2015 National Health Interview Survey, Cancer Control Supplement (n = 29,925) reported the near-home presence of walkable supports (roads, sidewalks, paths, or trails; sidewalks on most streets), destinations (shops; transit; movies, libraries, or churches; relaxing places), and past-week walking for leisure or transportation. We used stepwise logistic regression to quantify associations between supports and destinations and walking, including by urban/rural residence. We calculated the prevalence of walking across counts of reported elements by urban/rural residence. Among all participants, roads, sidewalks, paths, or trails and relaxing destinations were associated with leisure walking. Among urban residents, sidewalks on most streets and all four destination types were associated with transportation walking; among rural residents, roads, sidewalks, paths, or trails; movies, libraries, or churches; and relaxing destinations were associated with transportation walking. Walking was more common when more environmental elements were reported. To improve efficiency, communities may match surveillance priorities to behavioral priorities (i.e., leisure versus transportation walking) and environmental context (i.e., urban/rural areas). Surveillance of environments supporting leisure walking might focus on recreation-oriented spaces. Surveillance of environments supporting transportation walking might differ for urban and rural areas, and assessing destinations may be particularly important.

Objectives. To determine the prevalence of community and street-scale design features that promote walking across the US Virgin Islands (USVI). Methods. In May 2016, the USVI Department of Health, with technical assistance from the Centers for Disease Control and Prevention, conducted a territory-wide audit with a validated tool. We selected street segments (n = 1114) via a 2-stage sampling method, and estimates were weighted to be representative of publicly accessible street length. Results. Overall, 10.7% of the street length contained a transit stop, 11.3% had sidewalks, 21.7% had at least 1 destination (e.g., stores, restaurants), 27.4% had a traffic calming feature (e.g., speed humps), and 53.2% had at least some street lighting. Several features were less prevalent on residential streets compared with commercial streets, including transit stops, sidewalks, destinations, and street lighting (P Conclusions. Across the USVI, community and street-scale features supportive of walking were uncommon. Improving community and street-scale design in the USVI, particularly in residential areas, could increase physical activity by enhancing walkability and therefore improve public health. These data can be used to inform community planning in the USVI.

Introduction: Increasing physical activity among adults at risk for or with cardiovascular disease (CVD) can help prevent and manage disease. Walking may present an opportunity for promoting physical activity among this high risk group. We hypothesized that in US adults the prevalence of self-reported walking would decrease with increasing CVD risk. Methods: Nationally representative data from the 2015 National Health Interview Survey Cancer Control Supplement (N=28,780) were analyzed. Analyses were repeated after excluding those needing assistance with walking (n=2,192). Walking was defined as engaging in at least one 10-minute bout of transportation or leisure walking in the past seven days. Prevalence estimates of walking (any, transportation, and leisure) are reported overall and by presence of risk factors (overweight or obesity and ≥1 of diabetes, high cholesterol, or hypertension) or CVD (myocardial infarction or stroke). Orthogonal polynomial contrasts were used to identify significant trends. Results: Overall, 64.9% (standard error, SE=0.5) of adults reported any walking (TABLE). This prevalence was highest among those with no CVD or risk factors (67.1%, SE=0.5), decreased with increasing number of risk factors (1 risk factor: 64.0%, SE=1.0; 2 risk factors: 60.3%, SE=1.3; 3 risk factors: 54.8%, SE=2.0), and the lowest was among those with CVD (51.9%, SE=1.7). Similar trends were observed for leisure and transportation walking. To ensure differences in prevalence of walking by risk factor or disease status was not due to functional limitations, repeated analyses that excluded those needing assistance with walking observed similar patterns. Conclusions: Prevalence of any and leisure walking decreased as the presence of CVD risk factors increased and was lowest among those with disease. Promoting walking, especially among adults at higher risk, may present an important opportunity for encouraging an active lifestyle for CVD prevention and management.

Barriers to safe walking may prevent people from being physically active, and previous reports have identified differences in barriers to safe walking across racial and ethnic groups. The purpose of this research was to determine the role demographic characteristics play on racial/ethnic differences in perceived barriers to safe walking and determine if racial/ethnic differences vary by urban/rural residence and Census region. Participants in the 2015 National Health Interview Survey Cancer Control Supplement (n = 31,433 adults ≥18 years) reported perceived barriers to safe walking (traffic, crime, and animals) and demographic characteristics. Urban/rural residence and Census region were based on home addresses. We calculated adjusted prevalence of barriers by race/ethnicity using logistic regression; geographic differences in barriers across racial/ethnic groups were examined via interaction terms. After adjustment for demographic characteristics, non-Hispanic blacks (blacks) and Hispanics reported crime and animals as barriers more frequently than non-Hispanic whites (whites) (crime: blacks, 22.2%; Hispanics, 16.7%; whites, 9.0%; animals: blacks, 18.0%; Hispanics, 12.4%; whites, 8.5%). Racial/ethnic differences in perceived crime as a barrier were more pronounced in the Northeast and Midwest than in the South and West. Urban-dwelling blacks (all regions) and Hispanics (Midwest and South) reported animals as barriers more frequently than whites. Racial/ethnic differences in perceived barriers to safe walking remained after adjusting for demographic characteristics and varied by geographic location. Addressing perceived crime and animals as barriers to walking could help reduce racial/ethnic differences in physical activity, and several barriers may need to be assessed to account for geographic variation.

Physical activity confers considerable health benefits, but only half of U.S. adults report participating in levels of aerobic physical activity consistent with guidelines (1,2). Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities identified walking as an important public health strategy to increase physical activity levels (3). A previous report showed that the self-reported prevalence of walking for transportation or leisure increased by 6 percentage points from 2005 to 2010 (4), but it is unknown whether this increase has been sustained. CDC analyzed National Health Interview Survey (NHIS) data from 2005 (26,551 respondents), 2010 (23,313), and 2015 (28,877) to evaluate trends in the age-adjusted prevalence of self-reported walking among adults aged ≥18 years. The prevalence of walking increased steadily among women, from 57.3% in 2005, to 62.5% in 2010, and to 65.1% in 2015 (significant linear trend). Among men, a significant linear increase in reported walking was observed, from 54.3% in 2005, to 61.8% in 2010, and to 62.8% in 2015, although the increase stalled between 2010 and 2015 (significant linear and quadratic trends). Community design policies and practices that encourage pedestrian activity and programs tailored to the needs of specific population subgroups remain important strategies for promoting walking (3).

Creating environments that support all types of physical activity, including active transportation, is a public health priority (1). Public health surveillance that identifies the locations where community members walk and bicycle (i.e., engage in active transportation) can inform such efforts. Traditional population-representative active transportation surveillance incurs a considerable time lag between data collection and dissemination, and often lacks geographic specificity (2). Conversely, user-generated active transportation data from Global Positioning System (GPS)-based activity tracking devices and mobile applications can provide near real-time information, but might be subject to self-selection bias among users. CDC analyzed the association between GPS-based commuting data from a company that allows tracking of activity with a mobile application (Strava, Inc., San Francisco, California) and population-representative commuting data from the U.S. Census Bureau's American Community Survey (ACS) (3) for four U.S. cities. The level of analysis was the Census block group. The number of GPS-tracked commuters in Strava was associated with the number of ACS active commuters (Spearman's rho = 0.60), suggesting block groups were ranked similarly based on these distinct but related measurements. The correlation was higher in high population density areas. User-generated active transportation data might complement traditional surveillance systems by providing near real-time, location-specific information on where active transportation occurs.

Parks and recreation departments and public health organizations both work to improve the well-being of their communities. Measuring residential proximity to parks could be a specific area of shared interest, given that proximity to parks is needed for walking access, and the use of parks is, in turn, associated with many physical, social, and mental health benefits. The CDC’s publicly available National Environmental Public Health Tracking Network (NEPHTN) Access to Parks Indicator (API) focuses on one major component of access, residential proximity to parks. The API uses a commercial parks database and U.S. Census data to estimate the number and percentage of individuals in the U.S. that live within a half-mile of a park boundary, a measure commonly used to represent park proximity. The API is calculated at the state and county levels and is available for all states and counties in the U.S. Using estimates from the API, we examined the distribution of residential proximity to parks by geography and race/ethnicity. Additionally, we evaluated differences in park proximity by rural/urban status of counties. In 2010, 39% of the total U.S. population lived within a half-mile of a park. This percentage varied widely between states, ranging from 9% in West Virginia to 67% in Hawaii and 88% in the District of Columbia (DC). Park proximity was lowest among non-Hispanic whites (34.2%) and highest among individuals belonging to the non-Hispanic other race category (52.0%). Metropolitan counties had the highest percentage of residents living within a half-mile of a park (43.3%); the percentage was lower in non-metropolitan counties adjacent to a metropolitan county (15.0%) and non-metropolitan counties not adjacent to a metropolitan county (18.5%). Park proximity was higher in metropolitan counties with a larger population size and in non-metropolitan counties with a higher degree of urbanization. The NEPHTN Access to Parks Indicator provides an opportunity to understand park proximity in counties and states throughout the U.S., including identifying disparities that may exist between population subgroups and comparing geographic areas. Parks and recreational professionals can use this information to compare their county or state to other geographic areas and, in combination with local data on parks within their jurisdiction, inform decisions to improve the distribution of parks and the well-being of their communities.

This study uses 2015-2016 National Health and Nutrition Examination Survey data to assess prevalence of daily sitting time and weekly leisure-time physical activity among US adults.