1
|
Jiang Y, Wu Y, Hu Y, Li S, Ren L, Wang J, Yu M, Yang R, Liu Z, Zhang N, Hu K, Zhang Y, Livingston G, Zhang JJ, Zeng Y, Chen H, Yao Y. Bi-directional association between outdoor or social activities and cognitive function: do the PM 2.5 exposure catalyze the detrimental inactivity-poor cognition cycle? ENVIRONMENTAL RESEARCH 2024; 252:118868. [PMID: 38580003 DOI: 10.1016/j.envres.2024.118868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Previous research has shown that lack of leisure activities, either outdoor or social activities, impedes cognitive function. However, the interrelationship between poor cognition and deficient activities is understudied. In addition, whether exposure to air pollution, such as PM2.5, can accelerate the detrimental 'inactivity-poor cognition' cycle, is worthy of investigation. METHODS We used data from the 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We assessed the frequency of outdoor or social activities at each wave. The cognitive function was examined using a China-Modified Mini-mental State Examination. We estimated the residential exposure to fine particular matter (PM2.5) via a satellite-based model. We applied cross-lagged panel (CLP) model to examine the bi-directional relationship between outdoor or social activities and cognitive function. We then examined the effect of PM2.5 exposure with sequent cognitive function and activities using generalized estimation equation (GEE) model. FINDINGS Overall, we observed significant bi-directional associations between outdoor or social activities and cognitive function. Participants with better cognitive function in the last wave were more likely to engage in outdoor or social activities in the following wave (outdoor activities: β = 0.37, 95% CI [0.27,0.48], P < 0.01; social activities: β = 0.05, 95% CI [0.02,0.09] P < 0.01). Meanwhile, higher engagement in outdoor or social activities in the last wave was associated with more favorable cognitive function in the following wave (outdoor activities: β = 0.06, 95% CI [0.03,0.09], P < 0.01; social activities: β = 0.10, 95% CI [0.03,0.18], P < 0.01). Notably, an increase in PM2.5 exposure during the preceding year was significantly associated with a declining cognitive function (β = -0.05, 95% CI [-0.08,-0.03], P < 0.01), outdoor activities (β = -0.02, 95% CI [-0.04, -0.01], P < 0.01) and social activities (β = -0.02, 95% CI [-0.02, -0.01], P < 0.01) in the current year; the lagged effects of the PM2.5 exposure in the past year of the last wave on activities and cognitive function of the following wave were also observed. INTERPRETATION Our findings not only indicate the bi-directional links between the frequency of outdoor or social activities and cognitive function, but also report that PM2.5 exposure plays a role in catalyzing the detrimental inactivity-poor cognition cycle. Future research should investigate whether the policy-driven interventions, such as clean air policies, can break the unfavorable activity-cognition cycle, and thereby promoting health from the dual gains in leisure activities and cognition.
Collapse
Affiliation(s)
- Yuling Jiang
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Yifei Wu
- School of Public Health, Peking University, Beijing, China
| | - Yang Hu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Shaojie Li
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Longbin Ren
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jingjing Wang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Mingzhi Yu
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Rui Yang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Zhouwei Liu
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Nan Zhang
- Manchester Urban Ageing Research Group (MUARG), The University of Manchester, Manchester, UK
| | - Kejia Hu
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, and Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Junfeng Jim Zhang
- Global Health Institute and the Nicholas School of Environment, Duke University, Durham, NC, USA
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China; Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, USA
| | - Huashuai Chen
- Business School of Xiangtan University, Xiangtan, China.
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.
| |
Collapse
|
2
|
Kelly MA, Puddy RW, Siddiqi SM, Nelson C, Ntazinda AH, Kucik JE, Hall D, Murray CT, Tomoaia-Cotisel A. Distilling the Fundamentals of Evidence-Based Public Health Policy. Public Health Rep 2024:333549241256751. [PMID: 38910545 DOI: 10.1177/00333549241256751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Public health policy interventions are associated with many important public health achievements. To provide public health practitioners and decision makers with practical approaches for examining and employing evidence-based public health (EBPH) policy interventions, we describe the characteristics and benefits that distinguish EBPH policy interventions from programmatic interventions. These characteristics include focusing on health at a population level, focusing on upstream drivers of health, and involving less individual action than programmatic interventions. The benefits of EBPH policy interventions include more sustained effects on health than many programs and an enhanced ability to address health inequities. Early childhood education and universal preschool provide a case example that illustrates the distinction between EBPH policy and programmatic interventions. This review serves as the foundation for 3 concepts that support the effective use of public health policy interventions: applying core component thinking to understand the population health effects of EBPH policy interventions; understanding the influence of existing policies, policy supports, and the context in which a particular policy is implemented on the effectiveness of that policy; and employing a systems thinking approach to identify leverage points where policy implementation can have a meaningful effect.
Collapse
Affiliation(s)
- Megan A Kelly
- Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard W Puddy
- Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sameer M Siddiqi
- RAND Corporation, Arlington, VA, USA
- Amazon Web Services, Amazon.com, Inc, Seattle, WA, USA
| | - Christopher Nelson
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Alexandra H Ntazinda
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - James E Kucik
- Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Office of the Director, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane Hall
- Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Office of Rural Health, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christian T Murray
- Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
3
|
Grice-Jackson T, Rogers I, Ford E, Dickinson R, Frere-Smith K, Goddard K, Silver L, Topham C, Nahar P, Musinguzi G, Bastiaens H, Van Marwijk H. A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project. FRONTIERS IN HEALTH SERVICES 2024; 4:1152410. [PMID: 38784704 PMCID: PMC11113076 DOI: 10.3389/frhs.2024.1152410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/20/2024] [Indexed: 05/25/2024]
Abstract
Background This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. Methods A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Results Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Conclusion Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.
Collapse
Affiliation(s)
- Thomas Grice-Jackson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Robert Dickinson
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Kat Frere-Smith
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Katie Goddard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Linda Silver
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Catherine Topham
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Papreen Nahar
- Department of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Central Region, Uganda
| | - Hilde Bastiaens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| |
Collapse
|
4
|
Velarde C, Landrau-Cribbs E, Soleimani M, Cruz TH. Measuring Policy, Systems, and Environmental Changes at Elementary Schools Involved in SNAP-Ed New Mexico Programming, 2018-2022. Prev Chronic Dis 2024; 21:E04. [PMID: 38237171 PMCID: PMC10805274 DOI: 10.5888/pcd21.230221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Introduction In 2018, the New Mexico Supplemental Nutrition Assistance Program-Education (SNAP-Ed NM) incorporated policy, systems, and environmental (PSE) strategies into the state plan to increase healthy eating and physical activity. Studies of multiple PSE strategies in elementary schools are lacking. Methods We conducted assessments of physical activity and nutrition environments at 11 elementary schools in New Mexico before and after schools were given school-specific PSE recommendations and technical assistance. Baseline data were collected in 2018 by using the School Physical Activity and Nutrition Environment Tool (SPAN-ET), which measures policy, situational, and physical environments in elementary schools. PSE scores were calculated as the proportion of criteria met within and across 27 areas of interest. Implementation of evidence-based PSE interventions began in 2019. COVID-19 school closures delayed follow-up assessments until 2022. We analyzed descriptive data to examine changes in PSE scores over time. Results Overall mean PSE scores increased significantly from baseline (53.6%) to follow-up (62.7%). Nutrition PSE scores significantly increased by 17.6 percentage points; the policy environment showed the largest improvement (+26.0 percentage points), followed by the situational environment (+13.8 percentage points), and physical environment (+9.1 percentage points). We found a nonsignificant increase in the overall average physical activity score (+2.7 percentage points). Conclusion Use of a standardized instrument for assessing implementation of PSE strategies across multiple schools showed significant overall improvement in nutrition scores and nonsignificant increases in physical activity scores. Providing school-specific recommendations combined with technical assistance may be an effective approach to implementing evidence-based nutrition and physical activity PSE strategies.
Collapse
Affiliation(s)
- Camille Velarde
- University of New Mexico Prevention Research Center, 2703 Frontier Ave NE, Ste 120, Albuquerque, NM 87131
| | | | - Mahtab Soleimani
- University of New Mexico Prevention Research Center, Albuquerque
| | - Theresa H Cruz
- University of New Mexico Prevention Research Center, Albuquerque
| |
Collapse
|
5
|
Sadeh M, Fulman N, Agay N, Levy I, Ziv A, Chudnovsky A, Brauer M, Dankner R. Residential Greenness and Long-term Mortality Among Patients Who Underwent Coronary Artery Bypass Graft Surgery. Epidemiology 2024; 35:41-50. [PMID: 37820249 DOI: 10.1097/ede.0000000000001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Studies have reported inverse associations between exposure to residential greenness and mortality. Greenness has also been associated with better surgical recovery. However, studies have had small sample sizes and have been restricted to clinical settings. We investigated the association between exposure to residential greenness and all-cause mortality among a cohort of cardiac patients who underwent coronary artery bypass graft (CABG) surgery. METHODS We studied this cohort of 3,128 CABG patients between 2004 and 2009 at seven cardiothoracic departments in Israel and followed patients until death or 1st May 2021. We collected covariate information at the time of surgery and calculated the patient-level average normalized difference vegetation index (NDVI) over the entire follow-up in a 300 m buffer from the home address. We used Cox proportional hazards regression models to estimate associations between greenness and death, adjusting for age, sex, origin, socioeconomic status, type of hospital admission, peripherality, air pollution, and distance from the sea. RESULTS Mean age at surgery was 63.8 ± 10.6 for men and 69.5 ± 10.0 for women. During an average of 12.1 years of follow-up (37,912 person-years), 1,442 (46%) patients died. A fully adjusted Cox proportional hazards model estimated a 7% lower risk of mortality (HR: 0.93, 95% CI = [0.85, 1.00]) per 1 interquartile range width increase (0.04) in NDVI. Results were robust to the use of different buffer sizes (100 m-1,250 m from the home) and to the use of average NDVI exposure during the first versus the last 2 years of follow-up. CONCLUSIONS Residential greenness was associated with lower risk of mortality in CABG patients.
Collapse
Affiliation(s)
- Maya Sadeh
- From the Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Fulman
- GIScience Research Group, Institute of Geography, Heidelberg University, Heidelberg, Germany
| | - Nirit Agay
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Levy
- Air Quality Division, Israel Ministry of Environmental Protection
| | - Arnona Ziv
- Unit for Data Management and Computerization, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Alexandra Chudnovsky
- AIR-O Lab, Porter School of Environment and Geosciences, Faculty of Exact Sciences, Department of Geography and Human Environment, Tel Aviv University, Israel
| | - Michael Brauer
- School of Population & Public Health, University of British Columbia, Canada
| | - Rachel Dankner
- From the Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
6
|
Ilango SD, Leary CS, Ritchie E, Semmens EO, Park C, Fitzpatrick AL, Kaufman JD, Hajat A. An Examination of the Joint Effect of the Social Environment and Air Pollution on Dementia Among US Older Adults. Environ Epidemiol 2023; 7:e250. [PMID: 37304341 PMCID: PMC10256342 DOI: 10.1097/ee9.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Abstract
Evidence suggests exposure to air pollution increases the risk of dementia. Cognitively stimulating activities and social interactions, made available through the social environment, may slow cognitive decline. We examined whether the social environment buffers the adverse effect of air pollution on dementia in a cohort of older adults. Methods This study draws from the Ginkgo Evaluation of Memory Study. Participants aged 75 years and older were enrolled between 2000 and 2002 and evaluated for dementia semi-annually through 2008. Long-term exposure to particulate matter and nitrogen dioxide was assigned from spatial and spatiotemporal models. Census tract-level measures of the social environment and individual measures of social activity were used as measures of the social environment. We generated Cox proportional hazard models with census tract as a random effect and adjusted for demographic and study visit characteristics. Relative excess risk due to interaction was estimated as a qualitative measure of additive interaction. Results This study included 2,564 individuals. We observed associations between increased risk of dementia and fine particulate matter (µg/m3), coarse particulate matter (µg/m3), and nitrogen dioxide (ppb); HRs per 5 unit increase were 1.55 (1.01, 2.18), 1.31 (1.07, 1.60), and 1.18 (1.02, 1.37), respectively. We found no evidence of additive interaction between air pollution and the neighborhood social environment. Conclusions We found no consistent evidence to suggest a synergistic effect between exposure to air pollution and measures of the social environment. Given the many qualities of the social environment that may reduce dementia pathology, further examination is encouraged.
Collapse
Affiliation(s)
- Sindana D Ilango
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Cindy S Leary
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Emily Ritchie
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Erin O Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Christina Park
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Family Medicine and Global Health, University of Washington, Seattle, Washington, USA
| | - Joel D Kaufman
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
7
|
Haynes A, Bayly M, Dixon H, McAleese A, Martin J, Chen YJM, Wakefield M. Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia. Health Promot Int 2022; 37:6827736. [DOI: 10.1093/heapro/daac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Summary
Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016–18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.
Collapse
Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
- Melbourne School of Psychological Sciences, The University of Melbourne , Parkville, VIC , Australia
| | - Megan Bayly
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
- Melbourne School of Psychological Sciences, The University of Melbourne , Parkville, VIC , Australia
| | - Alison McAleese
- Prevention Division, Cancer Council Victoria , Melbourne, VIC , Australia
| | - Jane Martin
- Obesity Policy Coalition, Cancer Council Victoria , Melbourne, VIC , Australia
| | - Yan Jun Michelle Chen
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria , 615 St Kilda Rd, Melbourne, VIC 3004 , Australia
- Melbourne School of Psychological Sciences, The University of Melbourne , Parkville, VIC , Australia
| |
Collapse
|
8
|
Hadley J, Sablan E. Lessons from the Field: The Traditional Monarch of Kitti in Pohnpei Addresses the High Rates of Non-Communicable Diseases through Local Policy. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:6-9. [PMID: 32596670 PMCID: PMC7311939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Almost a quarter of Pohnpei's population is overweight or obese, a major factor influencing a 2010 non-communicable diseases (NCD) emergency declaration. The Racial and Ethnic Approaches to Community Health (REACH) project in Pohnpei is implementing a culturally tailored policy, systems, and environmental (PSE) intervention to reduce NCDs through healthy nutrition projects. Through collaboration with traditional leaders and using traditional protocols, REACH succeeded in soliciting formal approval from a Traditional Monarch to serve only healthy beverages during events at all traditional houses in the municipality. The Governor, in turn, also supported this initiative. This project cultivated relationships with traditional and government leaders to implement a culturally appropriate healthy nutrition PSE change intervention.
Collapse
Affiliation(s)
- Johnny Hadley
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JH, ES)
| | - Evonne Sablan
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JH, ES)
| |
Collapse
|
9
|
Kim EJ, Kim J, Kim H. Neighborhood Walkability and Active Transportation: A Correlation Study in Leisure and Shopping Purposes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072178. [PMID: 32218233 PMCID: PMC7177876 DOI: 10.3390/ijerph17072178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022]
Abstract
A walkable environment is a crucial factor for promoting active transportation. The purpose of this study is to examine the association between neighborhood walkability and active transportation for noncommuting purposes (leisure and shopping) in Seoul, Korea. The Walkability Score is used as a measure of walkability, and a multilevel logistic regression model is employed to measure the odds of active transportation (i.e., walking and cycling; nonmotorized trips) at two levels: individual (level 1) and neighborhood (level 2). The results of the study showed that the Walkability Score was significantly correlated with higher odds of active transportation in shopping models. Specifically, every one-point increase in the Walkability Score was associated with 1.5%–1.8% higher odds of active transportation in shopping models. However, there was no significant correlation between the two in leisure models. Meanwhile, individual characteristics associated with the odds of active transportation differed in the leisure and shopping models. Older age was positively correlated with the odds of active transportation in the leisure model, while females showed a positive correlation in the shopping model. Based on the study, urban and transportation planners can recommend urban policies to promote active transportation in an urban setting.
Collapse
Affiliation(s)
- Eun Jung Kim
- Department of Urban Planning, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea; (E.J.K.); (J.K.)
| | - Jiyeong Kim
- Department of Urban Planning, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea; (E.J.K.); (J.K.)
| | - Hyunjung Kim
- Department of Civil and Environmental Engineering, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea
- Correspondence: ; Tel.: +82-2-880-8903
| |
Collapse
|
10
|
Leser KA, Liu ST, Smathers CA, Graffagnino CL, Pirie PL. Adoption, Sustainability, and Dissemination of Chronic Disease Prevention Policies in Community-Based Organizations. Health Promot Pract 2019; 22:72-81. [PMID: 31155948 DOI: 10.1177/1524839919850757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Despite increasing interest in structural (policy, systems, and environmental) changes to improve health, little attention has focused on the adoption, implementation, sustainability, and potential for dissemination of these changes among local community-based organizations. Method. A mixed methods approach was used for this process evaluation. Representatives of nine community-based organizations were surveyed using closed-ended questions and in-depth qualitative interviews to describe 32 policy changes. Diffusion of Innovation theory was used to inform the development of survey questions and the interview guide. Results. Policies adopted by local community-based organizations concerned types of food/beverages provided to staff/clients, methods to encourage physical activity, breastfeeding support, and tobacco control. The majority of the policies were either fully (66%) or partially (31%) implemented 1 year after their initial adoption. In general, participants somewhat/strongly agreed that policies had characteristics that predict sustainability/diffusion (relative advantage, compatibility, complexity, trialability, observability). In-depth interview responses described a generally smooth process for policy adoption and high levels of optimism for continued sustainability but revealed few efforts to disseminate the policies beyond the original organization. Conclusions. Structural changes in community-based organizations are a valuable tool for encouraging healthy changes in communities and have great potential to be adopted, sustained, and diffused.
Collapse
|
11
|
McIsaac JLD, Spencer R, Chiasson K, Kontak J, Kirk SFL. Factors Influencing the Implementation of Nutrition Policies in Schools: A Scoping Review. HEALTH EDUCATION & BEHAVIOR 2018; 46:224-250. [PMID: 30173576 DOI: 10.1177/1090198118796891] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although school nutrition policies (SNPs) have been highlighted as an important intervention to support childhood nutrition, their implementation and maintenance within real-word settings is complex. There is a need to understand the factors that influence implementation by consolidating existing research and identifying commonalities and differences. AIMS The purpose of this review is to determine what is known about the influence of broad and local system factors on the implementation of SNPs internationally. METHOD This scoping review involved identifying and selecting relevant literature that related SNP implementation in primary and secondary schools. Following the search process, 2,368 articles were screened and 59 articles were synthesized and charted and emerging themes were identified. RESULTS Across the final studies identified, factors emerged as barriers and facilitators to the implementation of SNPs, with system implications that related to five areas to support policy action: providing macro-level support may encourage policy implementation; addressing the financial implications of healthy food access; aligning nutrition and core school priorities; developing a common purpose and responsibility among stakeholders; recognition of school and community characteristics. DISCUSSION While SNPs can help to support childhood nutrition, strategies to address issues related to policy implementation need to be taken to help schools overcome persistent challenges. CONCLUSION The results of this review provide opportunities for action across multiple system levels to ensure synergy and coordinated action toward SNP goals to foster the creation supportive nutrition environments for children.
Collapse
Affiliation(s)
- Jessie-Lee D McIsaac
- 1 Dalhousie University, Halifax, Nova Scotia, Canada.,2 Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | | | | | - Julia Kontak
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara F L Kirk
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
12
|
Furtado KS, Brownson C, Fershteyn Z, Macchi M, Eyler A, Valko C, Brownson RC. Health Departments With A Commitment To Health Equity: A More Skilled Workforce And Higher-Quality Collaborations. Health Aff (Millwood) 2018; 37:38-46. [PMID: 29309233 PMCID: PMC5975259 DOI: 10.1377/hlthaff.2017.1173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health equity is a public health priority, yet little is known about commitment to health equity in health departments, especially among practitioners whose work addresses chronic disease prevention. Their work places them at the forefront of battling the top contributors to disparities in morbidity and mortality. A random sample of 537 chronic disease practitioners working in state health departments was surveyed on health equity commitments, partnerships, and needed skills. A small percentage of respondents (2 percent) worked primarily on health equity, and a larger group (9 percent) included health equity as one of their multiple work areas. People who rated their work unit's commitment to health equity as high were more likely to engage with sectors outside of health and rate their leaders as high quality, and less likely to identify skills gaps in their work unit. Opportunities exist to more fully address health equity in state public health practice through organizational, institutional, and governmental policies, including those regarding resource allocation and staff training.
Collapse
Affiliation(s)
- Karishma S Furtado
- Karishma S. Furtado ( ) is a PhD student at the Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, in Missouri
| | - Carol Brownson
- Carol Brownson is a consultant at the National Association of Chronic Disease Directors, in Atlanta, Georgia, and at the Prevention Research Center in St. Louis
| | - Zarina Fershteyn
- Zarina Fershteyn is director of program evaluation at the National Association of Chronic Disease Directors
| | - Marti Macchi
- Marti Macchi is senior director of programs at the National Association of Chronic Disease Directors
| | - Amy Eyler
- Amy Eyler is an associate professor at the Prevention Research Center in St. Louis
| | - Cheryl Valko
- Cheryl Valko is center manager at the Prevention Research Center in St. Louis
| | - Ross C Brownson
- Ross C. Brownson is the Bernard Becker Professor of Public Health at the Prevention Research Center in St. Louis and the Department of Surgery (Division of Public Health Sciences) and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine
| |
Collapse
|
13
|
Lau CJ, Pisinger C, Husemoen LLN, Jacobsen RK, Linneberg A, Jørgensen T, Glümer C. Reply to "Is diabetes preventable in the general population?". Prev Med 2017; 96:158-159. [PMID: 28043829 DOI: 10.1016/j.ypmed.2016.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Cathrine J Lau
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark.
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lise Lotte N Husemoen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Department of Clinical Experimental Research, Rigshospitalet, 2600 Glostrup, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Centre for Health, The Capital Region of Denmark Rigshospitalet - Glostrup, 2600 Glostrup, Denmark; Faculty of Medicine, Aalborg University, 9229 Aalborg East, Denmark
| |
Collapse
|
14
|
Cauchi D, Glonti K, Petticrew M, Knai C. Environmental components of childhood obesity prevention interventions: an overview of systematic reviews. Obes Rev 2016; 17:1116-1130. [PMID: 27432025 DOI: 10.1111/obr.12441] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 02/05/2023]
Abstract
Childhood obesity has a complex multi-factorial aetiology grounded in environmental and individual level factors that affect behaviour and outcomes. An ecological, systems-based approach to addressing childhood obesity is increasingly being advocated. The primary aim of this review is to summarize the evidence reported in systematic reviews on the effectiveness of population-level childhood obesity prevention interventions that have an environmental component. We conducted a systematic review of reviews published since 1995, employing a standardized search strategy in nine databases. Inclusion criteria required that reviews be systematic and evaluated at least one population-level, environmental intervention in any setting aimed at preventing or reducing obesity in children (5-18 years). Sixty-three reviews were included, ten of which were of high quality. Results show modest impact of a broad range of environmental strategies on anthropometric outcomes. Systematic reviews vary in methodological quality, and not all relevant primary studies may be included in each review. To ensure relevance of our findings to practice, we also report on relevant underlying primary studies, providing policy-relevant recommendations based on the evidence reviewed. Greater standardization of review methods and reporting structures will benefit policymakers and public health professionals seeking informed decision-making.
Collapse
Affiliation(s)
- D Cauchi
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - K Glonti
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M Petticrew
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Knai
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
15
|
Eriksson C. Review Article: Learning and knowledge-production for public health: a review of approaches to evidence-based public health. Scand J Public Health 2016. [DOI: 10.1177/14034948000280040101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Public health needs to be evidence-based if it is to be done correctly, which means that learning and knowledge-production for public health must be comprehensive and include knowledge from four different domains: distribution of health, determinants or causal web, consequences, and intervention methods. Specification of development trends in cardiovascular prevention points at four generations of preventive programs; these include a clinical, a bioepidemiological, a socioepidemiological, and an environmental and policy-oriented generation. Generations differ in focus and strategy, in knowledge base - the art of making an impact - and evaluation. Comprehensive public health programs often comprise components from different generations, leading to the need for an expanded model for research and evaluation. There is an urgent need for learning and knowledge-production using both quantitative and qualitative approaches for developing the evidence base for public health action. In addition, epidemiological knowledge is necessary for making appropriate priorities.
Collapse
Affiliation(s)
- Charli Eriksson
- Department of Community Medicine and Public Health, Regional Medical Center, Örebro, Sweden
| |
Collapse
|
16
|
Ewing R, Schmid T, Killingsworth R, Zlot A, Raudenbush S. Relationship between Urban Sprawl and Physical Activity, Obesity, and Morbidity. Am J Health Promot 2016; 18:47-57. [PMID: 13677962 DOI: 10.4278/0890-1171-18.1.47] [Citation(s) in RCA: 801] [Impact Index Per Article: 100.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To determine the relationship between urban sprawl, health, and health-related behaviors. Design. Cross-sectional analysis using hierarchical modeling to relate characteristics of individuals and places to levels of physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease. Setting. U.S. counties (448) and metropolitan areas (83). Subjects. Adults (n = 206,992) from pooled 1998, 1999, and 2000 Behavioral Risk Factor Surveillance System (BRFSS). Measures. Sprawl indices, derived with principal components analysis from census and other data, served as independent variables. Self-reported behavior and health status from BRFSS served as dependent variables. Results. After controlling for demographic and behavioral covariates, the county sprawl index had small but significant associations with minutes walked ( p = .004), obesity ( p < .001), BMI ( p = .005), and hypertension ( p = .018). Residents of sprawling counties were likely to walk less during leisure time, weigh more, and have greater prevalence of hypertension than residents of compact counties. At the metropolitan level, sprawl was similarly associated with minutes walked ( p = .04) but not with the other variables. Conclusion. This ecologic study reveals that urban form could be significantly associated with some forms of physical activity and some health outcomes. More research is needed to refine measures of urban form, improve measures of physical activity, and control for other individual and environmental influences on physical activity, obesity, and related health outcomes.
Collapse
Affiliation(s)
- Reid Ewing
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, USA
| | | | | | | | | |
Collapse
|
17
|
Flanagan SV, Spayd SE, Procopio NA, Chillrud SN, Braman S, Zheng Y. Arsenic in private well water part 1 of 3: Impact of the New Jersey Private Well Testing Act on household testing and mitigation behavior. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 562:999-1009. [PMID: 27118151 PMCID: PMC5204457 DOI: 10.1016/j.scitotenv.2016.03.196] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 05/23/2023]
Abstract
Regularly ingesting water with elevated arsenic increases adverse health risks. Since September 2002, the NJ Private Well Testing Act (PWTA) has required testing untreated well water for arsenic during real estate transactions in 12 counties. Its implementation provides an opportunity to investigate the effects of policy intervention on well testing and treatment behavior. Here we analyze results of a survey mailed to 1943 random addresses (37% response), including responses from 502 private well households who purchased their homes prior to PWTA commencement and 168 who purchased after. We find the PWTA has significantly increased arsenic testing rates in an area where 21% of wells contain arsenic above the 5μg/L NJ drinking water standard. The PWTA has allowed identification of more wells with arsenic (20% of post-PWTA vs. 4% of pre-PWTA households) and more treatment for arsenic (19% of post-PWTA vs. 3% of pre-PWTA households). Such an Act is a partial answer to significant socioeconomic disparities in testing observed among households for whom it is not required. Additionally residents purchasing homes since 2002 are younger and disproportionately more likely to have children in their household (60% vs. 32%), a priority group given their particular vulnerability to effects of arsenic. Despite more wells tested under the PWTA, post-PWTA well owners forget or misremember arsenic test results more often, are more likely to report not knowing what kind of treatment they are using, and are not reporting better maintenance or monitoring of their treatment systems than pre-PWTA households. This suggests serious challenges to reducing arsenic exposure remain even when testing is a requirement. Furthermore, only a fraction of wells have been tested under the PWTA due to the slow pace of housing turnover. We recommend more public resources be made available to support private well testing among socially and biologically vulnerable groups.
Collapse
Affiliation(s)
- Sara V Flanagan
- Columbia University, Lamont-Doherty Earth Observatory, 61 Route 9W, Palisades, NY 10964, USA; Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th Street, New York, NY 10027, USA; New Jersey Department of Environmental Protection, P.O. Box 420, Trenton, NJ 08625-0420, USA.
| | - Steven E Spayd
- New Jersey Department of Environmental Protection, P.O. Box 420, Trenton, NJ 08625-0420, USA.
| | - Nicholas A Procopio
- New Jersey Department of Environmental Protection, P.O. Box 420, Trenton, NJ 08625-0420, USA.
| | - Steven N Chillrud
- Columbia University, Lamont-Doherty Earth Observatory, 61 Route 9W, Palisades, NY 10964, USA.
| | - Stuart Braman
- Columbia University, Lamont-Doherty Earth Observatory, 61 Route 9W, Palisades, NY 10964, USA.
| | - Yan Zheng
- Columbia University, Lamont-Doherty Earth Observatory, 61 Route 9W, Palisades, NY 10964, USA; Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th Street, New York, NY 10027, USA; Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY 11367, USA.
| |
Collapse
|
18
|
Brennan LK, Baker EA, Haire-Joshu D, Brownson RC. Linking Perceptions of the Community to Behavior: Are Protective Social Factors Associated with Physical Activity? HEALTH EDUCATION & BEHAVIOR 2016; 30:740-55. [PMID: 14655867 DOI: 10.1177/1090198103255375] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the relationship of psychosocial factors to physical activity has been explored, there is increased interest in how perceptions of the community environment influence behavior.However, few methodological studies have incorporated perceptions of the social and community environment (protective social factors) or addressed key measurement issues.Computer-assisted telephone interviews were administered to a national sample of 1, 818 U.S.adults.Unadjusted and multivariate-adjusted odds ratios were calculated to compare active and inactive participants by Protective Social Factors (PSF) scores and selected sociodemographics. Confirmatory factor analysis and reliability analysis suggested strong PSF scale psychometric properties (• =. 92). After adjustment for potential confounders, a 10-point rise in the PSF score resulted in a 12% increased likelihood of meeting Centers for Disease Control and Prevention/American College of Sports Medicine recommendations. Additional analyses indicated that greater perceived PSFs were associated with meeting these recommendations among Whites but not among African Americans.
Collapse
Affiliation(s)
- Laura K Brennan
- Department of Community Health and Prevention Research Center, Saint Louis University, School of Public Health, St. Louis, Missouri 63104-1314, USA.
| | | | | | | |
Collapse
|
19
|
Is Physical Activity Self-Efficacy for Patients With End-Stage Renal Disease Meaningful? JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2016. [DOI: 10.1097/jat.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Dodson EA, Geary NA, Brownson RC. State legislators' sources and use of information: bridging the gap between research and policy. HEALTH EDUCATION RESEARCH 2015; 30:840-8. [PMID: 26464418 PMCID: PMC4769321 DOI: 10.1093/her/cyv044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 09/11/2015] [Indexed: 05/10/2023]
Abstract
Research can inform policymakers of public health issues and shape policy decisions, hopefully benefiting public health; thus, improving dissemination of research to policymakers is important for developing effective public health policies that improve health and health equity. However, the utilization of research among policymakers is often not fully realized. This study builds upon current knowledge about what types of information legislators seek when working on health issues and where they go for information. Further, it explores what kinds of information legislators find most helpful and if there are ways researchers could better provide this evidence. Key-informant interviews were conducted with 25 U.S. state legislators holding health committee leadership positions between July and November, 2010. Regarding types of information sought, most legislators discussed their desire for data and statistics when working on health-related issues. When asked about their most trusted sources of information, participants mentioned government sources as well as advocacy, lobby and industry groups. A few mentioned universities and healthcare professionals. Results from this study offer public health researchers and practitioners' insights into the types of information that may be most helpful to policymakers. Insights gathered may improve the dissemination of research and bridge the gap between knowledge users and knowledge producers.
Collapse
Affiliation(s)
- Elizabeth A Dodson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA,
| | - Nora A Geary
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, GA 30329, USA and
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA, Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
| |
Collapse
|
21
|
Tabak RG, Eyler AA, Dodson EA, Brownson RC. Accessing evidence to inform public health policy: a study to enhance advocacy. Public Health 2015; 129:698-704. [PMID: 25795018 DOI: 10.1016/j.puhe.2015.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Improving population health often involves policy changes that are the result of complex advocacy efforts. Information exchanges among researchers, advocates, and policymakers is paramount to policy interventions to improve health outcomes. This information may include evidence on what works well for whom and cost-effective strategies to improve outcomes of interest. However, this information is not always readily available or easily communicated. The purposes of this paper are to describe ways advocates seek information for health policy advocacy and to compare advocate demographics. STUDY DESIGN Cross-sectional telephone survey. METHODS Seventy-seven state-level advocates were asked about the desirable characteristics of policy-relevant information including methods of obtaining information, what makes it useful, and what sources make evidence most reliable/trustworthy. Responses were explored for the full sample and variety of subsamples (i.e. gender, age, and position on social and fiscal issues). Differences between groups were tested using t-tests and one-way analysis of variance. RESULTS On average, advocates rated frequency of seeking research information as 4.3 out of five. Overall, advocates rated the Internet as the top source, rated unbiased research and research with relevancy to their organization as the most important characteristics, and considered information from their organization as most reliable/believable. When ratings were examined by subgroup, the two characteristics most important for each question in the total sample (listed above) emerged as most important for nearly all subgroups. CONCLUSIONS Advocates are a resource to policymakers on health topics in the policy process. This study, among the first of its kind, found that advocates seek research information, but have a need for evidence that is unbiased and relevant to their organizations and report that university-based information is reliable. Researchers and advocates should partner so research is useful in advocating for evidence-based policy change.
Collapse
Affiliation(s)
- R G Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, 621 Skinker Boulevard, St Louis, MO 63130, USA.
| | - A A Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, 621 Skinker Boulevard, St Louis, MO 63130, USA
| | - E A Dodson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, 621 Skinker Boulevard, St Louis, MO 63130, USA
| | - R C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, 621 Skinker Boulevard, St Louis, MO 63130, USA; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
22
|
Shrivastav R, Nazar GP, Stigler MH, Arora M. Health promotion for primordial prevention of tobacco use. Glob Heart 2015; 7:143-50. [PMID: 25691311 DOI: 10.1016/j.gheart.2012.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/11/2012] [Indexed: 11/16/2022] Open
Abstract
Prevention of tobacco use is critical for primordial prevention of cardiovascular diseases. Low- and middle-income countries such as India face a burgeoning burden of tobacco-related cardiovascular diseases. A focus on adolescents and young people is consistent with a primordial approach to cardiovascular disease prevention and appropriate given the natural history of tobacco use, in regards to its onset and progression. The primordial prevention approach is feasible, because it attempts to bring about behavior change (sustained abstinence for nonusers) at the population level. This paper reviews effective strategies for population-based tobacco control among adolescents including settings-based interventions at school, at home, and in the community, as well as policy and media interventions. It goes on to briefly touch on the pivotal role that medical professionals, particularly cardiologists, play in fortifying such interventions and summarizes some key recommendations based on review of evidence on the effectiveness of these interventions.
Collapse
Affiliation(s)
- Radhika Shrivastav
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
| | - Gaurang P Nazar
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
| | - Melissa H Stigler
- Michael and Susan Dell Center for Healthy Living, School of Public Health, University of Texas, Austin Regional Campus, Austin, TX, USA
| | - Monika Arora
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India; Public Health Foundation of India (PHFI), New Delhi, India
| |
Collapse
|
23
|
Raine KD, Sosa Hernandez C, Nykiforuk CIJ, Reed S, Montemurro G, Lytvyak E, MacLellan-Wright MF. Measuring the progress of capacity building in the Alberta Policy Coalition for Cancer Prevention. Health Promot Pract 2013; 15:496-505. [PMID: 24334541 DOI: 10.1177/1524839913511627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Alberta Policy Coalition for Cancer Prevention (APCCP) represents practitioners, policy makers, researchers, and community organizations working together to coordinate efforts and advocate for policy change to reduce chronic diseases. The aim of this research was to capture changes in the APCCP's capacity to advance its goals over the course of its operation. We adapted the Public Health Agency of Canada's validated Community Capacity-Building Tool to capture policy work. All members of the APCCP were invited to complete the tool in 2010 and 2011. Responses were analyzed using descriptive statistics and t tests. Qualitative comments were analyzed using thematic content analysis. A group process for reaching consensus provided context to the survey responses and contributed to a participatory analysis. Significant improvement was observed in eight out of nine capacity domains. Lessons learned highlight the importance of balancing volume and diversity of intersectoral representation to ensure effective participation, as well as aligning professional and economic resources. Defining involvement and roles within a coalition can be a challenging activity contingent on the interests of each sector represented. The participatory analysis enabled the group to reflect on progress made and future directions for policy advocacy.
Collapse
Affiliation(s)
- Kim D Raine
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Shandy Reed
- Alberta Policy Coalition for Chronic Disease Prevention, Edmonton, Alberta, Canada
| | | | | | | |
Collapse
|
24
|
Kansas legislators prioritize obesity but overlook nutrition and physical activity issues. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:139-45. [PMID: 23358292 DOI: 10.1097/phh.0b013e318254cc57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION State-level policymakers play an important role in the fight against obesity because of their ability to create policies that influence opportunities for physical activity and nutrition. OBJECTIVE In 2011, we investigated how Kansas policymakers regarded obesity, nutrition, and physical activity in comparison to other issues. DESIGN This study used a cross-sectional design. SETTING This study was conducted in Kansas, a predominately rural and Republican Midwestern state. PARTICIPANTS All 181 state-level policymakers in Kansas were mailed a cover letter and survey. MAIN OUTCOME MEASURES Policymakers were asked to identify and rate the importance of issues or problems in need of attention for Kansas. The 2011 state legislative report was content analyzed and coded to match the survey. Comparisons were made by political party. RESULTS Of the 49 policymakers who completed a survey, 37 were Republicans and 43 were elected to their position. Although obesity-related issues were rated second highest after jobs, physical activity- and nutrition-related issues were not seen as important problems; moreover, little corresponding legislation was introduced. Other key issues identified by policymakers included budget/spending/taxes, education, jobs/economy, and drug abuse, with more legislation reflecting these problems. The Democrats ranked 11 issues as more significant problems than did the Republicans: quality of public education, poverty, access to health care, lack of affordable housing, ethics in government, lack of public health training, access to healthy groceries, lack of pedestrian walkways/crosswalks/sidewalks, pedestrian safety, air pollution, and global warming (P < .05). CONCLUSIONS There is a need to provide more public health education on the relationship between nutrition and physical activity issues and obesity for Kansas policymakers. Issues identified may be similar for other predominately rural and Republican states.
Collapse
|
25
|
Dodson EA, Stamatakis KA, Chalifour S, Haire-Joshu D, McBride T, Brownson RC. State legislators' work on public health-related issues: what influences priorities? JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:25-9. [PMID: 23169400 DOI: 10.1097/phh.0b013e318246475c] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Policies are an effective way to influence population health and prevent disease. Unfortunately, public health research is often not well translated for policy audiences. Furthermore, researchers seeking to influence policy face an incomplete understanding of what influences legislators' decisions regarding which issues will receive their limited time and focus. OBJECTIVE The objective of this analysis was to examine various factors that may influence state legislators' decisions about which health issues they address. DESIGN Cross-sectional analysis of data collected from a randomized trial. SETTING State legislatures. PARTICIPANTS State-level legislators. MAIN OUTCOME MEASURE(S) Measures included a rating of the influence of various factors on health policy priorities. A 7-point scale was used to measure political ideology on social and fiscal issues. Standard demographic questions were included on age, gender, and level of education. RESULTS Seventy-five legislators completed surveys. Sixty-three percent were aged 55 years or older, and 76% male. When they were asked to rate factors according to importance in determining what health issues to work on, the top-rated factor was constituents' needs or opinions followed by evidence of scientific effectiveness. Ratings were also examined by subgroups. CONCLUSIONS These findings point to several important applications for public health practitioners and researchers. Because legislators value constituents' opinions, it is critical to inform and educate constituents about public health issues as well as policy options that may be effective in addressing problems. The results also highlight the importance of public health researchers and practitioners improving dissemination efforts to ensure that evidence-based scientific information is shared with policymakers in an effective and timely manner.
Collapse
Affiliation(s)
- Elizabeth A Dodson
- Prevention Research Center in St. Louis, and Brown School, Washington University in St. Louis, St Louis, Missouri 63110, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Allen P, Sequeira S, Jacob RR, Hino AAF, Stamatakis KA, Harris JK, Elliott L, Kerner JF, Jones E, Dobbins M, Baker EA, Brownson RC. Promoting state health department evidence-based cancer and chronic disease prevention: a multi-phase dissemination study with a cluster randomized trial component. Implement Sci 2013; 8:141. [PMID: 24330729 PMCID: PMC3878781 DOI: 10.1186/1748-5908-8-141] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/09/2013] [Indexed: 11/25/2022] Open
Abstract
Background Cancer and other chronic diseases reduce quality and length of life and productivity, and represent a significant financial burden to society. Evidence-based public health approaches to prevent cancer and other chronic diseases have been identified in recent decades and have the potential for high impact. Yet, barriers to implement prevention approaches persist as a result of multiple factors including lack of organizational support, limited resources, competing emerging priorities and crises, and limited skill among the public health workforce. The purpose of this study is to learn how best to promote the adoption of evidence based public health practice related to chronic disease prevention. Methods/design This paper describes the methods for a multi-phase dissemination study with a cluster randomized trial component that will evaluate the dissemination of public health knowledge about evidence-based prevention of cancer and other chronic diseases. Phase one involves development of measures of practitioner views on and organizational supports for evidence-based public health and data collection using a national online survey involving state health department chronic disease practitioners. In phase two, a cluster randomized trial design will be conducted to test receptivity and usefulness of dissemination strategies directed toward state health department chronic disease practitioners to enhance capacity and organizational support for evidence-based chronic disease prevention. Twelve state health department chronic disease units will be randomly selected and assigned to intervention or control. State health department staff and the university-based study team will jointly identify, refine, and select dissemination strategies within intervention units. Intervention (dissemination) strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include pre-post surveys, structured qualitative phone interviews, and abstraction of state-level chronic disease prevention program plans and progress reports. Trial registration clinicaltrials.gov:
NCT01978054.
Collapse
Affiliation(s)
- Peg Allen
- Prevention Research Center in St, Louis, Brown School, Washington University in St, Louis, 621 Skinker Blvd,, St, Louis, MO 63130-4838, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Process Evaluation of a Worksite Social and Physical Environmental Intervention. J Occup Environ Med 2013; 55:1409-20. [DOI: 10.1097/jom.0b013e3182a50053] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Lessons in promoting active living: the collaborative perspective. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:S58-64. [PMID: 23529057 DOI: 10.1097/phh.0b013e318284b3c6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT 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. OBJECTIVE The objective of this analysis is to explore successes and challenges of collaborative groups in promoting active living in their communities. DESIGN/SETTING One-time, structured telephone interviews were conducted to assess the composition tactics and activities and approaches used by collaboratives to promote active living. PARTICIPANTS 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. MAIN OUTCOME MEASURE(S) 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. RESULTS 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. CONCLUSIONS 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.
Collapse
|
29
|
Pettibone KG, Friend KB, Nargiso JE, Florin P. Evaluating environmental change strategies: challenges and solutions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 51:217-21. [PMID: 23054168 PMCID: PMC5621596 DOI: 10.1007/s10464-012-9556-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In this introductory article we define environmental change strategies (ECS), summarize the primary challenges associated with evaluating ECS, and provide an overview of the methods researchers have employed to begin to address these challenges. This special issue provides a range of examples, from researchers and practitioners in the field, of different approaches for addressing these challenges. These articles present new methods to understand and test how ECS are implemented and propose methods to evaluate their implementation. The content of the articles covers multiple public health issues, including substance abuse prevention, tobacco control, HIV prevention, and obesity prevention. This special issue is intended to build the evidence base for effective ECS, generate compelling discussion, critical analyses, and spur future research that will help improve the implementation and evaluation of ECS.
Collapse
Affiliation(s)
- Kristianna G Pettibone
- National Institute of Environmental Health Sciences, National Institutes of Health, 530 Davis Dr., Morrisville, NC 27650, USA.
| | | | | | | |
Collapse
|
30
|
Booker L, Mullan B. Using the temporal self-regulation theory to examine the influence of environmental cues on maintaining a healthy lifestyle. Br J Health Psychol 2012; 18:745-62. [PMID: 23279265 DOI: 10.1111/bjhp.12015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the current study is to explore the predictive utility of the temporal self-regulation theory (TST) for maintaining a healthy lifestyle (Hall & Fong, 2007, Health Psychology Review, 1, 6). According to TST, the influence of intention, self-regulation, and behavioural prepotency differs depending on the environmental context in which the behaviour is performed. This study examined the influence of perceptions about the supportiveness of the environmental context on TST-related factors. DESIGN Temporal self-regulation theory was tested using a prospective design with a 1-week follow-up. METHODS One hundred and fifty-two undergraduates were administered three executive functioning tasks and an online questionnaire regarding their intentions to maintain a healthy lifestyle, environmental responsiveness, and previous behaviour. One week later, they completed a follow-up questionnaire. RESULTS Participants who were supported by the environment were significantly more likely to maintain a healthy lifestyle than those distracted by the environment. Behavioural prepotency was significantly predictive of behaviour performance for 'supported' participants. Behavioural prepotency, planning, and response inhibition were significantly predictive of 'unsupported' participants' behaviour. CONCLUSIONS These findings provided preliminary support for the use of TST for the prediction of healthy lifestyle behaviour. Importantly, this study provided support for the contention that the influence of TST-related factors would vary according to the perceived supportiveness of the environment. These findings suggest that environmental responsiveness may be an important determinant to close the intention-behaviour gap for maintaining a healthy lifestyle.
Collapse
Affiliation(s)
- Liesel Booker
- School of Psychology, University of Sydney, New South Wales, Australia
| | | |
Collapse
|
31
|
Claus JM, Dessauer M, Brennan LK. Programs and promotions: approaches by 25 Active Living by Design partnerships. Am J Prev Med 2012; 43:S320-8. [PMID: 23079264 DOI: 10.1016/j.amepre.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/24/2012] [Accepted: 07/02/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND From 2003 to 2008, a total of 25 community partnerships funded through Active Living by Design (ALbD) implemented physical activity programs and promotions as part of integrated approaches complementing policy and environment changes. PURPOSE This paper reviews the partnerships' efforts with respect to promotions and programs, the breadth and depth of these types of approaches, challenges, successes, and lessons learned. METHODS Through a mixed-methods approach, including interviews, focus groups, and web-based tracking, multiple sources of data were collected and analyzed from 2006 to 2010. Evaluators summarized quantitative data by counts or means and qualitative results using systematic coding procedures to identify themes, ideas, and concepts. RESULTS All 25 community partnerships were engaged in programs and promotions of varying degrees throughout the initiative. Programs were categorized as community walking and biking programs, school programs, afterschool programs, and worksite programs, among others. Promotional strategies were categorized as social marketing campaigns, media, events, and communications. The most common programs included Safe Routes to School, walking clubs, and Bike/Walk to School Day. Media efforts were undertaken by all 25 partnerships, totaling 2659 TV, newspaper, and radio hits. CONCLUSIONS Programs and promotions can be resource-intensive and have limited population impact when offered in isolation; however, these strategies help connect people to their environments (e.g., increase awareness of facilities, provide social support for use of facilities) in order to improve physical activity behaviors.
Collapse
Affiliation(s)
- Julie M Claus
- Active Living by Design, North Carolina Institute for Public Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|
32
|
Rationale and development of the Move More North Carolina: Recommended Standards for After-School Physical Activity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:359-66. [PMID: 20520375 DOI: 10.1097/phh.0b013e3181ca2634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this article is to describe the rationale and procedure employed in developing the Move More North Carolina: Recommended Standards for After-School Physical Activity, which was publicly released statewide in April 2009. The Standards outline evidenced-based best practices for after-school programs to implement in order to increase amount and quality of physical activity (PA) among program participants. The Standards can be applied in any after-school program and were developed to benefit the approximately 152,000 school-aged children who are served by NC after-school programs each year. These programs often serve children at high risk for physical inactivity, including children from racial/ethnic minorities, impoverished areas, with disabilities, and/or living in neighborhoods with limited PA opportunities. The rationale for developing standards for PA in after-school programs is threefold: (1) such programs can provide enjoyable, safe, and age-appropriate PA; (2) they can facilitate family involvement, community partnership, and increase access to PA resources; and (3) they serve children at risk for inactivity. Recommended best practices are included for the following categories: time/intensity, qualified staff/training, curriculum, program size, facilities, equipment, and evaluation. Methods used to inform The Standards included a planning team, on-line surveys, focus groups, a systematic literature review, a consensus panel, and external expert review. The impact of The Standards is yet to be seen, but the collaborative process used in their creation can serve as a model for the development of similar PA standards in other states.
Collapse
|
33
|
Yen IH, Anderson LA. Built environment and mobility of older adults: important policy and practice efforts. J Am Geriatr Soc 2012; 60:951-6. [PMID: 22568533 DOI: 10.1111/j.1532-5415.2012.03949.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As people age, they prefer to "age in place." The concept of aging in place refers to the ability to live in one's own home, wherever that might be, for as long as one can feel confident and comfortable. Where people live and whether these environments can support them are critical questions for public health and public policy, especially since the baby boomers began to turn 65 on January 1, 2011. Equally important for public policy, those aged 85 and older are the fastest growing population group in the United States. The Health and Aging Policy Fellows Program, with the Centers for Disease Control and Prevention Healthy Aging Program, has supported a project to determine how design features of the built environment can support the mobility of older adults. Mobility refers to physical activity, usually walking, but also encompasses the ability to stay connected to nearby community resources and services. The project's purpose is to investigate features that support mobility in built environments. This policy brief introduces the realist synthesis method used in the project and selected national initiatives and activities to place this work in a broader context. Given the importance of mobility concerns to older adults, it must be determined without delay which design features support mobility and how local areas can better prepare to support the health of their aging populations.
Collapse
Affiliation(s)
- Irene H Yen
- Department of Medicine, University of California at San Francisco, San Francisco, California 94118, USA.
| | | |
Collapse
|
34
|
Parrish AM, Yeatman H, Iverson D, Russell K. Using interviews and peer pairs to better understand how school environments affect young children's playground physical activity levels: a qualitative study. HEALTH EDUCATION RESEARCH 2012; 27:269-280. [PMID: 21712499 DOI: 10.1093/her/cyr049] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
School break times provide a daily opportunity for children to be active; however, research indicates this time is underutilized. Reasons for low children's playground activity levels have primarily focused on physical barriers. This research aimed to contribute to physical environmental findings affecting children's playground physical activity levels by identifying additional variables through the interview process. Thirteen public schools were included in the sample (total 2946 children). Physical activity and environmental data were collected over 3 days. Environmental variables were manually assessed at each of the 13 schools. Observational data were used to determine which three schools were the most and least active. The principal, three teachers and 20 students in Grades 4-6 from these six schools (four lower and two average socioeconomic status) were invited to participate in the interview process. Student interviews involved the paired interview technique. The main themes generated from the school interviews included the effect of non-fixed equipment (including balls), playground markings, playground aesthetics, activity preference, clothing, the amount of break time available for play, teacher playground involvement, gender, bullying, school policies, student confidence in break-time activity and fundamental movement skills. The effect of bullying on playground physical activity levels was concerning.
Collapse
Affiliation(s)
- Anne-Maree Parrish
- School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, New South Wales 2522, Australia.
| | | | | | | |
Collapse
|
35
|
MacLellan D, Taylor J, Freeze C. Developing school nutrition policies: enabling and barrier factors. CAN J DIET PRACT RES 2011; 70:166-71. [PMID: 19958571 DOI: 10.3148/70.4.2009.166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The study was conducted to identify the enabling and barrier factors in the development of nutrition policies in Prince Edward Island elementary and consolidated schools. METHODS A document review and in-depth interviews were conducted with key stakeholders (n=12). RESULTS Principals were identified as important champions for change. Working group members created an interface between the school world and the nutrition world, and drew upon common philosophical ground to work together to lead the change process. Successfully navigating the process of policy development required building a case for change, testing policies in the real world, integrating healthy eating within school life, offering support to schools, engaging participants, and acknowledging the need to weigh the costs and benefits of the change. At times, external pressures on schools and available foods varied in the extent to which they enabled or challenged policy development. Finally, resource limitations, competing issues, and the use of unhealthy food as rewards were identified as the primary barriers. CONCLUSIONS The use of a consultative approach that engages key stakeholders early in the process is critical to the successful development of school nutrition policies. This approach also may be an important predictor of the long-term success of such initiatives.
Collapse
Affiliation(s)
- Debbie MacLellan
- Department of Family and Nutritional Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
| | | | | |
Collapse
|
36
|
Millstein RA, Sallis JF. Youth advocacy for obesity prevention: the next wave of social change for health. Transl Behav Med 2011; 1:497-505. [PMID: 24073069 PMCID: PMC3717625 DOI: 10.1007/s13142-011-0060-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recommended obesity prevention interventions target multiple levels. Effective advocacy is needed to influence factors at individual, social, environmental, and policy levels. This paper describes the rationale for engaging youth in obesity prevention advocacy efforts targeting environment and policy changes to improve nutrition and physical activity. Advocacy involves education, skill development, and behavior and attitude changes, with the goal of persuading others or taking action. Youth advocacy has been successfully used in substance use prevention, but it is relatively new in obesity prevention. A model is presented to guide intervention and evaluation in youth advocacy for obesity prevention. With youth advocacy as a central construct, the model outlines inputs and outcomes of advocacy at individual, social environment, built environment, and policy levels. The model can be used and refined in youth advocacy evaluation projects. By involving youth in their communities, advocacy can produce ownership, engagement, and future involvement yielding sustainable changes.
Collapse
Affiliation(s)
- Rachel A Millstein
- />SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 3900 Fifth Avenue, Suite 310, San Diego, CA 92103 USA
| | - James F Sallis
- />Department of Psychology, San Diego State University, 3900 Fifth Avenue, Suite 310, San Diego, CA 92103 USA
| |
Collapse
|
37
|
Brennan L, Castro S, Brownson RC, Claus J, Orleans CT. Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity. Annu Rev Public Health 2011; 32:199-223. [PMID: 21219169 DOI: 10.1146/annurev-publhealth-031210-101206] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The childhood obesity epidemic has stimulated the emergence of many policy and environmental strategies to increase healthy eating and active living, with relatively few research recommendations identifying the most effective and generalizable strategies. Yet, local, state, and national decision makers have an urgent need to take action, particularly with respect to lower-income and racial and ethnic populations at greatest risk. With the surge of promising and emerging policy and environmental strategies, this review provides a framework, criteria, and process modeled from existing expert classification systems to assess the strength of evidence for these strategies. Likewise, this review highlights evidence gaps and ways to increase the types and amount of evidence available to inform policy and environmental strategies. These priorities include documenting independent and interdependent effects, determining applicability to different populations and settings, assessing implementation fidelity and feasibility, identifying cumulative benefits and costs, ascertaining impacts on health equity, and tracking sustainability.
Collapse
|
38
|
Ford ES, Capewell S. Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care. Annu Rev Public Health 2011; 32:5-22. [PMID: 21417752 DOI: 10.1146/annurev-publhealth-031210-101211] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mortality rates from coronary heart disease (CHD), which had risen during the twentieth century in many countries, started declining in some countries during the 1960s. Once initial skepticism about the validity of the observed trends dissipated, researchers attempted to generate explanations about the events that had transpired using a variety of techniques, including ecological examinations of the trends in risk factors for CHD and changes in management of CHD, multivariate risk equations, and increasingly sophisticated modeling techniques. Improvements in risk factors as well as changes in cardiac treatments have both contributed to the reductions in CHD mortality, although estimates of their contributions have varied among countries. Models suggest that additional large reductions in CHD mortality are feasible by either improving the distribution of risk factors in the population or raising the percentage of patients receiving evidence-based treatments.
Collapse
Affiliation(s)
- Earl S Ford
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
| | | |
Collapse
|
39
|
Lv J, Chen Y, Wang S, Liu Q, Ren Y, Karrar S, Li L. A survey of nutrition labels and fats, sugars, and sodium ingredients in commercial packaged foods in Hangzhou, China. Public Health Rep 2011; 126:116-22. [PMID: 21337937 DOI: 10.1177/003335491112600116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
40
|
Jansen MW, van Oers HA, Kok G, de Vries NK. Public health: disconnections between policy, practice and research. Health Res Policy Syst 2010; 8:37. [PMID: 21194428 PMCID: PMC3022611 DOI: 10.1186/1478-4505-8-37] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/31/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Public health includes policy, practice and research but to sufficiently connect academic research, practice and public health policy appears to be difficult. Collaboration between policy, practice and research is imperative to obtaining more solid evidence in public health. However, the three domains do not easily work together because they emanate from three more or less independent 'niches'.Work cycles of each niche have the same successive steps: problem recognition, approach formulation, implementation, and evaluation, but are differently worked out. So far, the research has focused on agenda-setting which belongs to the first step, as expressed by Kingdon, and on the use of academic knowledge in policy makers' decision-making processes which belongs to the fourth step, as elaborated by Weiss. In addition, there are more steps in the policy-making process where exchange is needed. METHOD A qualitative descriptive research was conducted by literature search. We analyzed the four steps of the policy, practice and research work cycles. Next, we interpreted the main conflicting aspects as disconnections for each step. RESULTS There are some conspicuous differences that strengthen the niche character of each domain and hamper integration and collaboration. Disconnections ranged from formulating priorities in problem statements to power roles, appraisal of evidence, work attitudes, work pace, transparency of goals, evaluation and continuation strategies and public accountability. Creating awareness of these disconnections may result in more compatibility between researchers, policy makers and practitioners. CONCLUSION We provide an analysis that can be used by public health services-related researchers, practitioners and policy makers to be aware of the risk for disconnections. A synthesis of the social, practical and scientific relevance of public health problems should be the starting point for a dialogue that seeks to establish a joint approach. To overcome the above mentioned disconnections, face-to-face encounters consistently emerge as the most efficient way to transfer knowledge, achieve higher quality and acknowledge mutual dependence. We recommend practice and policy based research networks to establish strong links between researchers, policy makers and practitioners to improve public health.
Collapse
Affiliation(s)
- Maria Wj Jansen
- Academic Collaborative Centre of Public Health Limburg, Maastricht, the Netherlands.
| | | | | | | |
Collapse
|
41
|
Huybrechts I, De Bourdeaudhuij I, Buck C, De Henauw S. [Environmental factors. Opportunities and barriers for physical activity and healthy eating among children and adolescents]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:716-24. [PMID: 20631973 DOI: 10.1007/s00103-010-1085-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
While genetic factors play a role in the development of obesity, its dramatic increase in prevalence over the past few years strongly suggests an important environmental role. The results of a review on environmental opportunities and barriers for physical activity and dietary intake influencing the obesity epidemic among children and adolescents are presented. Although evidence clearly shows the impact of the environment on obesity-related lifestyle factors among children, evidence for effective strategies combating this obesogenic environment is scarce. Interventions aiming to change environmental factors to reduce childhood obesity may include providing extra sporting facilities and healthy foods/meals at school (e.g., provision of fruit), efforts to improve safety and accessibility of walking, cycling, and play areas, while at the same time attempting to influence social values attached to weight, food, or physical activity. Some level of institutionalization of systems that support the desired changes is required to sustain long-term environmental changes (e.g., ban of softdrinks at school). Better-designed and -conducted research on the true importance of environmental factors for obesogenic behavioral change is needed to achieve success of large-scale environmental change interventions.
Collapse
Affiliation(s)
- I Huybrechts
- Department of Public Health, Ghent University, Ghent University Hospital, 2 Blok A, De Pintelaan 185, 9000, Ghent, Belgien.
| | | | | | | |
Collapse
|
42
|
Troped PJ, Wilson JS, Matthews CE, Cromley EK, Melly SJ. The built environment and location-based physical activity. Am J Prev Med 2010; 38:429-38. [PMID: 20307812 PMCID: PMC3568665 DOI: 10.1016/j.amepre.2009.12.032] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 11/02/2009] [Accepted: 12/07/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies of the built environment and physical activity have implicitly assumed that a substantial amount of activity occurs near home, but in fact the location is unknown. PURPOSE This study aims to examine associations between built environment variables within home and work buffers and moderate-to-vigorous physical activity (MVPA) occurring within these locations. METHODS Adults (n=148) from Massachusetts wore an accelerometer and GPS unit for up to 4 days. Levels of MVPA were quantified within 50-m and 1-km home and work buffers. Multiple regression models were used to examine associations between five objective built environment variables within 1-km home and work buffers (intersection density, land use mix, population and housing unit density, vegetation index) and MVPA within those areas. RESULTS The mean daily minutes of MVPA accumulated in all locations=61.1+/-32.8, whereas duration within the 1-km home buffers=14.0+/-16.4 minutes. Intersection density, land use mix, and population and housing unit density within 1-km home buffers were positively associated with MVPA in the buffer, whereas a vegetation index showed an inverse relationship (all p<0.05). None of these variables showed associations with total MVPA. Within 1 km of work, only population and housing unit density were significantly associated with MVPA within the buffer. CONCLUSIONS Findings are consistent with studies showing that certain attributes of the built environment around homes are positively related to physical activity, but in this case only when the outcome was location-based. Simultaneous accelerometer-GPS monitoring shows promise as a method to improve understanding of how the built environment influences physical activity behaviors by allowing activity to be quantified in a range of physical contexts and thereby provide a more explicit link between physical activity outcomes and built environment exposures.
Collapse
Affiliation(s)
- Philip J Troped
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana 47907-2046, USA.
| | | | | | | | | |
Collapse
|
43
|
Jolly DH, Wigfall PM, Scott SA, Richardson RC, Ray K. A Case Study in Teaching Tobacco Policy Advocacy at a Historically Black University. Health Promot Pract 2009; 10:527-36. [DOI: 10.1177/1524839908321485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policy advocacy is increasingly recognized as a crucial component of the training provided to health educators but relatively few universities offer advocacy training as part of their professional preparation programs for health educators. Historically Black colleges and universities (HBCUs) represent a natural setting for creating strong Black leaders in tobacco policy advocacy. This case study focuses on experiential education at an HBCU to develop advocacy skills around tobacco issues among Black college students. The authors describe the structure and content of two tobacco policy courses, their efforts to evaluate these courses, and the lessons they learned planning and conducting them. They believe their experience can prove useful to others developing curricula for teaching policy advocacy skills to health education students.
Collapse
Affiliation(s)
- David H. Jolly
- Department of Public Health Education at North Carolina
Central University in Durham, North Carolina,
| | - Patricia M. Wigfall
- Department of Public Administration at North Carolina
Central University in Durham, North Carolina
| | | | - Rosalind C. Richardson
- Department of Physical Education and Recreation at North
Carolina Central University in Durham, North Carolina
| | - Kenneth Ray
- Tobacco Use Prevention Program in the Georgia Department
of Human Resources, Atlanta, Georgia
| |
Collapse
|
44
|
Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health 2009; 99:1576-83. [PMID: 19608941 PMCID: PMC2724448 DOI: 10.2105/ajph.2008.156224] [Citation(s) in RCA: 342] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 11/04/2022]
Abstract
Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.
Collapse
Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St Louis, the George Warren Brown School of Social Work, MO, USA.
| | | | | |
Collapse
|
45
|
|
46
|
Kondo K, Lee JS, Kawakubo K, Kataoka Y, Asami Y, Mori K, Umezaki M, Yamauchi T, Takagi H, Sunagawa H, Akabayashi A. Association between daily physical activity and neighborhood environments. Environ Health Prev Med 2009; 14:196-206. [PMID: 19568848 DOI: 10.1007/s12199-009-0081-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 02/15/2009] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Previous studies on the association between physical activity (PA) and neighborhood environments (NE) focused on either objectively measuring the NE or the residents' perception of NE. Here, we investigate which actual or perceived NE is associated with residents' PA in Japan. METHODS Two regions with an objectively assessed high and low residential density, land use mix-diversity, and street connectivity, respectively, were identified in one city. The subjects were selected using a stratified random sampling method by sex and age in each region. The NE of the subjects was objectively measured using the Geographic Information System (GIS), and the subjects' perception of the NE was assessed using a questionnaire. The daily total number of walking steps was measured with an accelerometer, and walking and cycling time were assessed by a questionnaire. RESULTS For the female subjects, the mean cycling time, subjectively assessed as a means of transport, was significantly longer in the group with a high GIS score for the number of land use types, while the score for total number of walking steps was significantly higher among those who were aware of places to walk to, and cycling time for transport was longer for those who perceived an accessibility to post offices, banks/credit unions, gymnasiums/fitness facilities, and amusement facilities in their neighborhood. For the male subjects, the score for walking time for leisure was longer for those who perceived aesthetics and an accessibility to parks, and the score for total walking steps was significantly higher for those who perceived an accessibility to bookstores or rental video stores in their neighborhood. CONCLUSIONS The results to this study demonstrate that daily PA was high among female subjects living in a NE with land use mix-diversity, and who had an awareness of places to walk to and the accessibility to facilities for daily necessities in their neighborhood. For male subjects, daily PA was high among those who perceived the aesthetics of and accessibility to facilities for pleasure in their neighborhood. Further research is needed to determine the association between PA and NE on the basis of sex differences.
Collapse
Affiliation(s)
- Kanae Kondo
- Department of Health Promotion Science, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Buchner DM, Schmid T. Active Living Research and public health: natural partners in a new field. Am J Prev Med 2009; 36:S44-6. [PMID: 19147056 DOI: 10.1016/j.amepre.2008.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 11/03/2008] [Accepted: 11/05/2008] [Indexed: 11/18/2022]
Affiliation(s)
- David M Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | |
Collapse
|
48
|
Abstract
Over the past decade, the prevalence of type 2 diabetes mellitus has reached epidemic levels in the United States and other developed countries. With a concomitant rise in obesity levels in the United States and advances in the treatment of diabetes and its complications, the prevalence of diabetes is expected to continue to rise through the year 2050. Despite strong evidence that regular physical activity can prevent or delay the onset of diabetes, too many Americans are not meeting the recommended levels of regular physical activity. Although most physical activity interventions to date have been focused on characteristics of the individual, more-recent studies have considered how changing characteristics of the social and physical environment in which people live may ultimately have a greater impact on increasing population levels of physical activity. Policy interventions are a way to make sustainable changes in the physical environment of a community and thus provide support for other intrapersonal and interpersonal behavioral change interventions. Policy changes also can affect the social norms that shape behavior. The purposes of this perspective article are: (1) to describe the rationale for population approaches to primary prevention of type 2 diabetes, (2) to discuss how policy interventions can increase physical activity levels within populations, and (3) to provide recommendations for the role of physical therapists in interventions that can increase the level of physical activity in communities. Public health approaches to curb the diabetes epidemic are urgently needed. Policy interventions to increase population levels of physical activity show promise for diabetes prevention. Physical therapists are uniquely suited to influence primary prevention efforts for diabetes.
Collapse
|
49
|
Factors influencing implementation of local policies to promote physical activity: a case study of Montgomery County, Maryland. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2008; 14:280-8. [PMID: 18408553 DOI: 10.1097/01.phh.0000316487.57512.f6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Policy interventions such as zoning ordinances, school facility sitting guidelines, capital improvement programs, and park master plans hold particular promise for promoting physical activity, especially at the local level. Despite increasing attention to the relationship between built environment characteristics and physical activity, there is a paucity of research on the extent to which local policies can promote or hinder physical activity. Furthermore, the impact of local policies on physical activity should depend on how effectively the policies are implemented. Based on the policy implementation literature and using Montgomery County, Maryland, as a case study, this study identifies factors related to the successful implementation of local policies hypothesized to influence physical activity. For our study, we conducted an extensive policy review and 17 in-depth interviews with 26 individuals. The interviews were transcribed, coded, and analyzed to identify the relevant factors that affect policy implementation. Our findings suggest that knowledge and awareness, commitment and capacity, intergovernmental coordination, the presence of an advocate or champion, and conflict influence physical activity policy implementation at the local level. Those trying to increase physical activity through policy could focus on these implementation features to help make policy implementation more successful.
Collapse
|
50
|
Affiliation(s)
- Thomas Golaszewski
- Thomas Golaszewski Ed.D., Professor, Department of Health Science, SUNY at Brockport, Brockport, NY., Judd Allen PhD, President, Human Resources Institute, Burlington, VT and Dee Edington PhD, Director, Health Management Research Center, and Professor, Division of Kinesiology, The University of Michigan, Ann Arbor, MI
| | - Judd Allen
- Thomas Golaszewski Ed.D., Professor, Department of Health Science, SUNY at Brockport, Brockport, NY., Judd Allen PhD, President, Human Resources Institute, Burlington, VT and Dee Edington PhD, Director, Health Management Research Center, and Professor, Division of Kinesiology, The University of Michigan, Ann Arbor, MI
| | - Dee Edington
- Thomas Golaszewski Ed.D., Professor, Department of Health Science, SUNY at Brockport, Brockport, NY., Judd Allen PhD, President, Human Resources Institute, Burlington, VT and Dee Edington PhD, Director, Health Management Research Center, and Professor, Division of Kinesiology, The University of Michigan, Ann Arbor, MI
| |
Collapse
|