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Background: Effective physical activity (PA) interventions are needed to counter the insufficient and declining levels of PA in youth. These require an updated, comprehensive planning framework that consolidates recent decades of progress in promoting PA in young children, children, and adolescents. Effective PA interventions require program planning and conceptual model development that target a coordinated and multilevel set of age-specific PA determinants. Accordingly, this paper presents a comprehensive planning framework that researchers can use to design intervention research to promote PA in youth. Methods: The first author conducted targeted searches through Google Scholar to compile PA models/frameworks/guides applicable to youth, a comprehensive set of PA determinants, and determinant-linked strategies to promote PA focusing on review articles. The information was summarized in tables, synthesized, and used to create a planning framework, all of which were reviewed by coauthors. Results: The APPLE Framework for Planning PA Opportunities for Youth (APPLE = Age, PA focus, Place and time, Leverage relevant influences and strategies, and ensure Enjoyable PA opportunities) incorporated all core elements from targeted reviews to create a comprehensive planning framework. The APPLE Planning Framework has a set of questions/prompts that guide the intervention planning process and conceptual model templates to organize planning efforts for designing intervention research. Conclusions: The APPLE Framework for Planning PA Opportunities for Youth will enable researchers to develop comprehensive conceptual models to guide the design of PA interventions for youth. Future research should refine the model and its components to enable PA intervention research in youth to move forward. [ABSTRACT FROM AUTHOR]

Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools.

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

The purposes of this study are to describe a process of structuring a tool (later named LAST letter), present my personal experiences by using it, and examine its meaning and utility. The LAST letter structure was grounded in my heartfelt desire to communicate with my deceased father. Its components are consistent with concepts in the literature for narrative writing for grief, including writing letters to the deceased. I examined the LAST letter I wrote to my deceased father considering previously published writing interventions and the meaning reconstruction model, and I explored how writing it helped resolve my bereavement-related regrets, strengthened continuing bonds, and facilitated meaning-making and personal growth. Few studies have focused on bereavement in an older adult and reflected on how the death of a loved one in the social context of a nursing home influenced the grieving process, with special attention to the challenges of providing eldercare and end-of-life planning. The novel, flexibly structured LAST letter tool has the potential to resolve bereavement-related regrets and facilitate meaning-making and continuing bonds for the bereaved. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to characterize the temporal, social, and physical contexts for physical activities commonly reported in a diverse cohort of 753 boys and girls from fifth to seventh grade. Methods: Data were obtained from a multilevel longitudinal study, the Transitions and Activity Changes in Kids. The Physical Activity Choices instrument assessed previous 5-day participation in specific physical activities and their temporal, social, and physical contexts. Mixed model repeated measure analyses of variance and multinomial analyses examined sex differences and change over time. Results: Fifth grade boys and girls reported participation in similar activities at similar frequencies, which declined significantly by seventh grade. One temporal pattern, playing with younger children, changed over time from "both inside/outside" to "outside" school. Boys and females reported more activities performed in class/team groups over time. Most activities took place primarily at home for all participants in both grades. Conclusions: Boys and girls reported declines in the variety and frequency of activities from fifth to seventh grade. There were sex-specific patterns in physical activities and groups; however, all participants reported home as the primary location and a shift to class/team groups over time. Schools are well-positioned to provide additional physical activity opportunities.

This study investigated the utility of the Study of Health and Activity in Preschool Environments (SHAPES) conceptual model, which targeted physical activity (PA) behavior in preschool children, by examining the relationship between implementation monitoring data and child PA during the school day. We monitored implementation completeness and fidelity based on multiple elements identified in the conceptual model. Comparing high-implementing, low-implementing, and control groups revealed no association between implementation and outcomes. We performed post hoc analyses, using process data, to refine our conceptual model's depiction of an effective preschool PA-promoting environment. Results suggest that a single component of the original four-component conceptual model, providing opportunities for moderate-to-vigorous physical activity through recess for 4-year-old children in preschool settings, may be a good starting place for increasing moderate-to-vigorous physical activity. Interventions that are implemented with optimal levels of completeness and fidelity are more likely to achieve behavior change if they are based on accurate conceptual models. Examining the mechanisms through which an intervention produces its effects, as articulated in the conceptual model that guides it, is particularly important for environmentally focused interventions because they are guided by emerging frameworks. The results of this study underscore the utility of using implementation monitoring data to examine the conceptual model on which the intervention is based.

Background: The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. Aims: (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. Method: HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework (Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Results: Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p = 0.001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p = 0.01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Conclusions: Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Examining factors that influence implementation of key program components that underlie an intervention's success provides important information to inform the development of effective dissemination strategies. We examined direct and indirect effects of preschool capacity, quality of prevention support system and teacher characteristics on implementation levels of a component, called Move Outside (i.e., preschool classroom teachers to provide at least 40 min of outdoor recess per day), that was fundamental to the success of a preschool-based physical activity intervention. Level of implementation, defined as the percent of daily goal met for the Move Outside component, was assessed via direct observation. Items assessing preschool capacity, quality of prevention support system and teacher characteristics were selected from surveys and an environmental checklist completed by preschool directors and teachers. Preschool classroom was used as the unit of analysis (Year 1: n = 19; Year 2: n = 17). Results from Bayesian path analyses showed that the three factors were not significantly associated with level of implementation in Year 1, but preschool capacity was directly associated with level of implementation in Year 2 (ß= 0.528, 95% CI: 0.134, 0.827). The current findings suggest that factors that influence level of implementation appear to differ as an intervention evolved over time.

Introduction: Coalitions are often composed of member organizations. Member involvement is thought to be associated with coalition success. No instrument currently exists for evaluating organizational member involvement in physical activity coalitions. This study aimed to develop a survey instrument for evaluating organizational member involvement in physical activity coalitions. The study was carried out in three phases: (a) developing a draft survey, (b) assessing the content validity of the draft survey, and (c) assessing the underlying factor structure, reliability, and validity of the survey. Method: A cross-sectional design was employed. In Phase 1, a team of experts in survey development produced a draft survey. In Phase 2, the content validity of the draft survey was evaluated by a panel of individuals with expertise in physical activity coalitions. In Phase 3, the survey was administered to 120 individuals on local-, state-, and national-level physical activity coalitions. Responses were subjected to an exploratory factor analysis in order to determine the survey's underlying factor structure, reliability, and validity. Results: Phases 1 and 2 yielded a survey instrument with demonstrated content validity. Phase 3 yielded a three-factor model with three subscales: Strategic Alignment, Organizational Alignment, and Providing Input. Each subscale demonstrated high internal consistency reliability and construct validity. Discussion: The survey instrument developed here demonstrated sound psychometric properties and provides new insight into organizational member involvement in physical activity coalitions. This instrument may be an important tool in developing a more complete picture of coalition functioning in physical activity coalitions specifically and health-based coalitions overall.

Background: The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children's physical activity, though the term "physical activity desert" has not come into wide use. Methods: This exploratory study operationalized the term "physical activity desert" and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities. Results: Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children. Conclusion: Children living in a "no park" zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of "physical activity desert." Future studies of physical activity deserts should be undertaken in larger and more diverse samples. [ABSTRACT FROM AUTHOR]

Background: Churches are an appealing setting for implementing health-related behavior change programs. Purpose: The objective of the study was to examine the relationship between perceived environmental church support for physical activity (PA) and PA behaviors. Method: Black church members from South Carolina ("n" = 309) wore an Actigraph accelerometer prior to the initiation of an intervention. Relationships between moderate to vigorous PA (MVPA; counts = 1,952), light PA (LPA; counts 100-1951), sedentary behavior (counts < 100), and perceived environmental church support for PA (total, spoken informational, written informational, instrumental) were examined. Support x Gender interactions examined whether relationships differed by gender. Results: The mean age was 54.0 ± 12.3 years and mean body mass index was 32.9 ± 7.2 kg/m[superscript 2]. On average, participants engaged in 14.4 ± 13.7 minutes/day of MVPA, 289.8 ± 82.4 minutes/day of LPA, and were sedentary 548.9 ± 102.2 minutes/day. Total, spoken informational, and written informational church support were significantly related to higher levels of LPA and lower levels of sedentary behavior in men but not women. The relationship between written informational support and MVPA approached significance for men but not women. Instrumental church support was not associated with PA behaviors. Conclusion: The church environment may have an important influence on Black church members' PA behavior, particularly men's, and thus should be targeted in interventions.

Background: Interventions promoting physical activity (PA) in youth have had limited success, in part because studies with methodological challenges have yielded an incomplete understanding of personal, social, and environmental influences on PA. This study described changes in these factors for subgroups of youth with initially high PA that decreased (Active-Decline) compared with children with initially low PA that decreased (Inactive-Decline) from fifth to ninth grades. Methods: Observational, prospective cohort design. Participants (n = 625) were fifth-grade children recruited in 2 school districts and followed from elementary to high school. Students and their parents responded to questionnaires to assess personal, social, and perceived physical environmental factors in the fifth (mean age = 10.5 [.5] y) and ninth (mean age = 14.7 [.6] y) grades. Analyses included a mixed-model 2-way repeated analysis of variances. Results: Children in the Active-Decline compared with those in the Inactive-Decline group showed a more favorable profile in 6 of 8 personal variables (perceived barriers, self-efficacy, selfschema, enjoyment, competence, and fitness motives) and 4 of 6 social variables (friend support, parent encouragement, parent support, and parent-reported support). Conclusions: The results suggest efforts to promote PA should target selected personal, social, and perceived environmental factors beginning before age 10 and continuing through adolescence. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) provides important health benefits to children, and a large percentage of children's PA occurs at home. The purpose of this study was to examine the associations between psychosocial, home, and neighborhood environmental factors and children's reported PA at home and in the neighborhood, during the transition from elementary to high school. Methods: A total of 555 participants (44% boys) were recruited in grade 5 and followed through grades 6, 7, and 9. Children self-reported PA in 3 locations--at home, in the neighborhood, and on the street. Children reported parent support and neighborhood environment, parents reported PA equipment, and a windshield survey assessed incivilities and outside PA equipment. Longitudinal Poisson models evaluated the relationships between environmental variables and 3 self-reported PA variables, adjusting for gender, race/ethnicity, and parent education. Results: Parent support and PA equipment were significant positive predictors of home PA. Child's perceived environment (positive) and incivilities (negative) were significant predictors of neighborhood PA. Parental support, perceived environment, and outside PA equipment were positive significant predictors of street PA. Conclusions: This study supports the need for both family and community/neighborhood PA interventions that encourage parents to support child PA and for communities to reduce incivilities. [ABSTRACT FROM AUTHOR]