Assessing the Environment for Support of Youth Physical Activity in Rural Communities

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

BACKGROUND

Obesity levels are higher in rural versus urban children. Multi-level community-based interventions can be effective in promoting healthy child weight, but few of such interventions have focused on rural children. This formative study assessed barriers, facilitators, and opportunities to promote healthy child weight in two rural communities.

METHODS

Multiple data collection methods were used concurrently in two rural communities in Indiana and North Carolina. Focus groups and interviews were conducted with participants, including parents of children aged 2-5 years (n = 41), childcare providers (n = 13), and stakeholders from 23 community organizations. Observational audits were conducted at 19 food outlets (grocery stores) and 50 publicly-accessible physical activity resources. Focus groups/interviews were analyzed thematically. Surveys were analyzed using descriptive statistics, Fisher's exact test, and t-tests.

RESULTS

Family level barriers included limited financial resources and competing priorities, whereas parental role-modeling was perceived as a facilitator of healthy weight behaviors. At the organizational level, childcare providers and community stakeholders cited limited funding and poor parental engagement in health promotion programs as barriers. Childcare providers explained that they were required to comply with strict nutrition and physical activity guidelines, but expressed concerns that similar messages were not reinforced at home. Facilitators at the organizational level included healthy meals provided at no cost at childcare programs, and health promotion programs offered through community organizations. At the community level, lack of public transportation, and limited access to healthy food outlets and physical activity-promoting resources posed barriers, whereas existing physical activity resources (e.g., parks) and some ongoing investment to improve physical activity resources in the community were assets. In designing/implementing a potential child obesity prevention intervention, participants discussed the need to garner community trust, emphasize wellness instead of obesity prevention, establish community partnerships, and leverage existing community resources.

CONCLUSIONS

Rural areas experience multiple challenges that make it difficult for children/families to engage in healthy weight behaviors. This study highlights several assets (existing programs/resources, expertise within communities) that can be leveraged as facilitators. Findings will guide the study team in developing a child obesity prevention intervention for the two rural communities.

The iCook 4-H Study: Report on Physical Activity and Sedentary Time in Youth Participating in a Multicomponent Program Promoting Family Cooking, Eating, and Playing Together

OBJECTIVE

To report physical activity and sedentary time outcomes of youth in iCook 4-H.

STUDY DESIGN AND SETTING

iCook 4-H was a 5-state, randomized, control-treatment, family-based childhood obesity prevention intervention promoting cooking, eating, and playing together.

PARTICIPANTS AND INTERVENTION

Youth aged 9-10 years and the main preparer of their meals participated in the 12-week program followed by monthly newsletters and biyearly booster sessions until 24 months.

MAIN OUTCOME MEASURE(S)

A total of 155 youth were fitted with an Actigraph GT3X+ accelerometer, which they wore for 7 days at baseline and 4, 12, and 24 months to measure mean daily minutes per hour of waking wear time for sedentary time (ST), light physical activity (PA) (LPA), moderate PA, vigorous PA, and moderate to vigorous PA. Self-reported PA was assessed using the Block Kids Physical Activity Screener and additional questions querying for the program goal of the frequency of family actively playing together. Linear mixed models were used to determine differences from baseline to 24 months. Significance was set at P ≤ .05.

RESULTS

There was a significant (P < .05) group × time interaction for LPA (adjusted interaction B estimate, 95% confidence interval; 0.18 [0.05, 0.30]) and ST (-0.15 [-0.26, -0.04]); ST increased and LPA decreased in the treatment group. There were no differences in other accelerometer-derived PA measures, self-report Block Kids Physical Activity Screener measures, or frequency of family actively playing together at any time point.

CONCLUSIONS AND IMPLICATIONS

iCook 4-H was a multicomponent program observing youth aged 9-10 years for 24 months that focused on enhancing cooking skills, mealtime behavior and conversation, and PA through daily family activities. Greater emphasis on developing PA skills, changing environmental factors, and increasing PA both in and after school may be needed.

Examining the role of youth empowerment in preventing adolescence obesity in low-income communities

INTRODUCTION

Youth empowerment programs have increasingly gained attention in public health as emphasis shifts on children and adolescents as decision makers in their health and well-being. Adolescence obesity is among the public health concerns that require more active engagement at individual and community level while empowering adolescents to take charge of their own health. This study examines the influence of youth empowerment on nutritional and physical activity factors associated with adolescence obesity.

METHODS

Data were gathered through a self-administered survey among adolescents (N = 410) ages 11-15 years in three U.S. States - Kansas, Ohio and South Dakota.

RESULTS

Findings show that youth empowerment significantly influences adolescents' self-efficacy, perceptions for healthy food choice, healthy eating, attitudes towards physical activity and the overall motivation for health. Gender differences exist in adolescents' self-efficacy for physical activity whereas ethnicity played a role in perceived youth empowerment and perceived barriers to healthy eating. Age was also a significant contributor in efficacy for healthy food choice and perception of healthy food availability.

CONCLUSIONS

This study suggests more focus on youth empowerment in interventions that seek to reduce obesity and improve adolescents' overall health by creating environments where they can play a more active decision-making role. With empowerment, adolescents are more likely to be motivated to adopt healthier dietary habits and engage more in physical activity. Further research would establish the impact of youth empowerment on obesity reduction and other public health problems that impact children across ages.

Childhood Obesity Declines Project: Highlights of Community Strategies and Policies

BACKGROUND

The social ecological model (SEM) is a framework for understanding the interactive effects of personal and environmental factors that determine behavior. The SEM has been used to examine childhood obesity interventions and identify factors at each level that impact behaviors. However, little is known about how those factors interact both within and across levels of the SEM.

METHODS

The Childhood Obesity Declines (COBD) project was exploratory, attempting to capture retrospectively policies and programs that occurred in four communities that reported small declines in childhood obesity. It also examined contextual factors that may have influenced initiatives, programs, or policies. Data collection included policy and program assessments, key informant interviews, and document reviews. These data were aggregated by the COBD project team to form a site report for each community (available at www.nccor.org/projects/obesity-declines ). These reports were used to develop site summaries that illustrate how policies, programs, and activities worked to address childhood obesity in each study site.

RESULTS/CONCLUSIONS

Site summaries for Anchorage, AK; Granville County, NC; Philadelphia, PA; and New York City, NY, describe those policies and programs implemented across the levels of the SEM to address childhood obesity and examine interactions both across and within levels of the model to better understand what factors appear important for implementation success.

Development and testing of a community audit tool to assess rural built environments: Inventories for Community Health Assessment in Rural Towns

Rural populations face unique challenges to physical activity that are largely driven by environmental conditions. However, research on rural built environments and physical activity is limited by a paucity of rural-specific environmental assessment tools. The aim of this paper is to describe the development and testing of a rural assessment tool: Inventories for Community Health Assessment in Rural Towns (iCHART). The iCHART tool was developed in 2013 through a multistep process consisting of an extensive literature search to identify existing tools, an expert panel review, and pilot testing in five rural US communities. Tool items represent rural built environment features that influence active living and physical activity: community design, transportation infrastructure, safety, aesthetics, and recreational facilities. To assess reliability, field testing was performed in 26 rural communities across five states between July and November of 2014. Reliability between the research team and community testers was high among all testing communities (average percent agreement = 77%). Agreement was also high for intra-rater reliability (average kappa = 0.72) and inter-rater reliability (average percent agreement = 84%) among community testers. Findings suggest that the iCHART tool provides a reliable assessment of rural built environment features and can be used to inform the development of contextually-appropriate physical activity opportunities in rural communities.

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Rural built environment research is limited by a lack of rural-specific tools.

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We developed and tested a rural assessment tool: iCHART

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Reliability between the research team and community testers was high.

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Intra- and inter-rater reliabilities were also high among community testers.

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Our tool can reliably and feasibly assess rural built environment features.