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Wende ME, Umstattd Meyer MR, Perry C, Prochnow T, Hamilton CNB, Abildso CG, Porter KMP. Implementation characteristics that may promote sustainability of a rural physical activity initiative: examination of Play Streets through the lens of community implementers. Implement Sci Commun 2024; 5:48. [PMID: 38698464 PMCID: PMC11064337 DOI: 10.1186/s43058-024-00571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 03/14/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Play Streets, which are community-based environmental initiatives where public spaces/streets are temporarily closed to create safe, low-cost physical activity opportunities, have demonstrated feasibility and physical activity benefit in rural US areas. Yet, information is needed to identify implementation characteristics that may promote sustainability. This study examined rural Play Streets implementation characteristics that could impact sustainability from local partners' perspectives. METHODS Sixteen Play Streets implementation team members in rural Maryland, North Carolina, Oklahoma, and Texas, USA, participated in interviews. Semi-structured in-person individual and group interviews were conducted in the fall of 2018 (after Play Streets implementation in 2017 and 2018), recorded, and transcribed verbatim. Transcripts were analyzed using iterative, content analyses. Coding frameworks were based on the Public Health Program Capacity for Sustainability Framework, and emergent themes were also identified. RESULTS Interviewees' perceived characteristics for facilitating Play Streets implementation aligned with the Public Health Program Capacity for Sustainability Framework: funding stability, political support, partnerships, organizational capacity, program adaption, and communication. Interviewees also noted the importance of cultural alignment/support and the reciprocal impact of community connectedness/engagement. CONCLUSIONS Future research should examine the reciprocal role of public health impacts, as both outcomes and factors which may influence sustainability.
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Affiliation(s)
- Marilyn E Wende
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, USA.
| | - M Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, USA.
| | - Cynthia Perry
- School of Nursing, Oregon Health & Science University, Portland, USA
| | - Tyler Prochnow
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, USA
| | | | - Christiaan G Abildso
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, USA
| | - Keshia M Pollack Porter
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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Bridges Hamilton CN, Ylitalo KR, Wende ME, Sharkey JR, Umstattd Meyer MR. Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth. Fam Community Health 2024; 47:20-31. [PMID: 37747840 DOI: 10.1097/fch.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.
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Affiliation(s)
- Christina N Bridges Hamilton
- Department of Kinesiology, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas (Dr Bridges Hamilton); Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas (Drs Ylitalo, Wende, and Umstattd Meyer); and Professor Emeritus, Texas A&M University, College Station, Texas (Dr Sharkey)
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Prochnow T, Umstattd Meyer MR, Bridges Hamilton CN, Wilkins E, Pollack Porter KM. Real-Time Video Scan Method for Community Partner Use to Inform Play Streets Implementation. Health Promot Pract 2022; 23:944-949. [PMID: 33969724 DOI: 10.1177/15248399211009789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
System for Observing Play and Recreation in Communities (SOPARC) can provide accurate assessment of physical activity; however, the skills, time, and human resources necessary to collect/interpret SOPARC data can be challenging for community organizations. This article describes a more accessible adaptation of SOPARC using video recordings for community organizations to obtain physical activity feedback at Play Streets. Narrated panoramic video scans occurred every 30 minutes at each Play Street using an iPad. Videographers narrated: (1) sex, (2) age group (child, teen, adult, senior), and (3) activity level (sedentary, walking, vigorous) for everyone recorded. SOPARC video scans, in-person iSOPARC observations, and interviews were conducted with Play Streets implementors to determine validity and feasibility. Validity was examined using Lin's concordance correlation coefficient (CCC). In-person and video scans showed near perfect agreement for sedentary individuals (CCC = .95) and substantial agreement for active individuals (CCC = .72). Overall, community partners felt that they "could see how [the scans] could be useful" and "help[ed] see a bit more clearly what's happening." The method described here is a more accessible systematic observation approach to measure physical activity for communities implementing Play Streets. Further, this method can be used without research training while still providing valuable activity feedback.
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Prochnow T, Patterson MS, Bridges Hamilton CN, Umstattd Meyer MR. Summer Friends and Physical Activity: Social Network Effects on Child Self-Reported Physical Activity at Summer Care Programs. Health Educ Behav 2022; 49:10901981221076399. [PMID: 35227130 DOI: 10.1177/10901981221076399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Summer is a time of reduced physical activity (PA) for children; however, summer care programs (SCPs) can provide opportunities for children to be active and foster friendships. This study investigated associations between PA and friendship formation at SCPs. Children (ages 8-12 years) from two SCPs reported demographics, PA, and up to five friends at the program. Exponential random graph modeling determined significant factors associated with connections at each time point and between time points. PA was a significant factor in sending and maintaining friendship connections. A further understanding of the social dynamics which assist in the maintenance of PA behaviors during summer may improve the odds children engage in the recommended amounts of PA during this crucial time.
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Umstattd Meyer MR, Prochnow T, Pickett AC, Perry CK, Bridges Hamilton CN, Abildso CG, Pollack Porter KM. The Effects of Play Streets on Social and Community Connectedness in Rural Communities. Int J Environ Res Public Health 2021; 18:9976. [PMID: 34639278 PMCID: PMC8508026 DOI: 10.3390/ijerph18199976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Promoting physical activity (PA) is a long-standing public health initiative to improve overall health and wellbeing. Innovative strategies such as Play Streets, temporary activation of public spaces to provide safe places for active play, are being adopted in urban and rural communities to increase PA among children. As part of these strategies, aspects of social and community connectedness may be strengthened. This study analyzes focus groups and interviews from rural Play Street implementation team members (n = 14) as well as adults (n = 7) and children (n = 25) who attended Play Streets hosted in rural North Carolina, Maryland, Oklahoma, and Texas to better understand the added benefits of Play Streets in community connectedness. Overall, elements of social support and social cohesion are mentioned most frequently with instrumental and conditional support; however, concepts of social capital, collective-efficacy, and social identification are also presented. Participants expressed that Play Streets provided more than just PA; they provided opportunities to access and share resources, build perceptions of safety and trust in the community, and develop relationships with others. Fostering community connection through Play Streets may reduce health inequities in rural communities by building community resilience. Community-based PA programming that enhance and capitalize on community connectedness could be effective ways to improving the overall health and wellbeing of residents.
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Affiliation(s)
- M. Renée Umstattd Meyer
- Department of Public Health, Baylor University Robbins College of Health and Human Sciences, Waco, TX 78628, USA; (T.P.); (C.N.B.H.)
| | - Tyler Prochnow
- Department of Public Health, Baylor University Robbins College of Health and Human Sciences, Waco, TX 78628, USA; (T.P.); (C.N.B.H.)
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Andrew C. Pickett
- Division of Kinesiology & Sport Management, School of Education Research Center, University of South Dakota, Vermillion, SD 57069, USA;
| | - Cynthia K. Perry
- School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Christina N. Bridges Hamilton
- Department of Public Health, Baylor University Robbins College of Health and Human Sciences, Waco, TX 78628, USA; (T.P.); (C.N.B.H.)
- Department of Public Health & Health Education, SUNY Brockport, Brockport, NY 14420, USA
| | - Christiaan G. Abildso
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV 25606, USA;
| | - Keshia M. Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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McClendon ME, Umstattd Meyer MR, Prochnow T, Ylitalo KR, Meyer AR, Bridges Hamilton CN, Sharkey JR. ¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families. Int J Environ Res Public Health 2021; 18:ijerph18168618. [PMID: 34444366 PMCID: PMC8393545 DOI: 10.3390/ijerph18168618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children’s PA.
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Affiliation(s)
- Megan E. McClendon
- Texas A&M AgriLife Extension Service, Texas A&M University, College Station, TX 77843, USA;
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
| | - M. Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
- Correspondence:
| | - Tyler Prochnow
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Kelly R. Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
| | - Andrew R. Meyer
- Department of Health, Human Performance & Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA;
| | - Christina N. Bridges Hamilton
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
- Department of Public Health & Health Education, SUNY Brockport, Brockport, NY 14420, USA
| | - Joseph R. Sharkey
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA;
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Prochnow T, Umstattd Meyer MR, Bridges Hamilton CN, Pollack Porter KM. Differences in Child Physical Activity Levels at Rural Play Streets Due to Activity Type and Sex. J Healthy Eat Act Living 2020; 1:16-26. [PMID: 37790134 PMCID: PMC10544929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Children are significantly less active during summer months, and rural children may face unique barriers to engaging in physical activity. Play Streets is a low-cost way communities can provide safe play opportunities by activating public spaces. Four low-income rural communities received mini-grants to implement four three-hour Play Streets throughout summer 2017 for a total of 16 Play Streets. System for Observing Play and Recreation in Communities (SOPARC) and iSOPARC were used to assess physical activity. Chi-square tests of homogeneity determined significant differences in the proportion of children observed as active based on sex and target area type. Binomial logistic regression was used to determine if target area characteristics (i.e., type, equipped, supervised, organized) and presence of other active children or adults increased the odds of observing a child as active. In total, 1,750 children were observed across all 16 Play Streets; roughly half of all children (48.6% of boys, 48.7% of girls) were observed as active. There was no significant difference in proportion of children observed as active based on sex of the child (OR = 0.99, 95% CI:0.82-1.20). Significant differences in the proportion of active children were found between target area categories. Boys were significantly more likely to be observed as active in areas which were equipped or organized. All children were significantly more likely to be active if there was another active child present in the same area. These results add to the growing literature surrounding successful implementation of Play Streets in rural settings, social influence, and active play.
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Prochnow T, Patterson MS, Bridges Hamilton CN, Delgado H, Craig S, Umstattd Meyer MR. Network Autocorrelation of Perceived Physical Activity Skill Competence Among Adolescents at a Summer Care Program: A Pilot Study. Am J Health Promot 2020; 35:430-433. [PMID: 32929978 DOI: 10.1177/0890117120958544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study investigates the possible association between adolescent friendship networks and perceived physical activity skill competence in a summer care program. DESIGN Adolescents participated in researcher-administered surveys at the start (T1) and end (T2) of summer. SETTING Adolescents at a Boys & Girls Club were sampled. SAMPLE Adolescents (age 8-12) completed researcher-administered surveys at T1 (n = 100; µ age = 9.9 years; 47% male; 55% Black) and T2 (n = 77; µ age = 9.8 years; 51% male; 49% Black). MEASURES Perceived skill competence was measured by asking adolescents to rate how good they felt they were at physical activity at the club. Adolescents were also asked to provide names of up to 5 peers whom they hung around with, talked to, and did things with the most while at the club. ANALYSIS Linear network autocorrelation models were used to determine network effects or clustering of perceived physical activity skill competence within the club. RESULTS There were significant network effects for adolescent perceived skill competency scores at T1 (β = 0.05, p < 0.01) and T2 (β = 0.05, p = 0.02), indicating adolescent perceived skill competence scores were associated with those of their friends. CONCLUSIONS Practitioners may wish to encourage the use of group or collaborative skill competency improvement activities as well as possibly pairing adolescents with differing skill competencies to foster improvement and possible diffusion of perceived skill competency.
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Affiliation(s)
| | | | | | | | - Sam Craig
- 4224Carthage College, Kenosha, WI, USA
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Pollack Porter KM, Bridges Hamilton CN, Umstattd Meyer MR. Implementing Play Streets in Low-Income Rural Communities in the United States. Health Promot Pract 2020; 23:372-374. [PMID: 32917112 DOI: 10.1177/1524839920957228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Play streets involve the temporary closure of streets that for a specified time create a safe place for active play. Play streets have been implemented primarily in cities; it is unknown if they could be adapted and implemented in rural areas. To learn about implementation, core components of play streets and inform adaptation, we conducted systematic peer-reviewed and grey literature searches and interviews with a purposive sample of key informants. Data were analyzed by theme and used to inform implementation of play streets by four community organizations in low-income rural areas of Maryland, North Carolina, Oklahoma, and Texas from June to September 2017. Core elements of play streets in urban areas were present in rural settings-the content (e.g., activities offered), delivery of the intervention in partnership with community members and local organizations, and reoccurrence of play streets at a single location. There were three key adaptations relating to delivery and context to consider uniquely when implementing play streets in rural areas (1) using locations other than streets, (2) varying locations to account for geographic dispersion, and (3) maximizing participation and resources by coupling play streets with community events. Play streets can be successfully implemented in rural settings with these modifications, which support feasibility, reach, and access. Play streets in rural areas should include activities for active play that are age-appropriate and fun, without necessarily tailoring content for rural areas.
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Umstattd Meyer MR, Bridges Hamilton CN, Prochnow T, McClendon ME, Arnold KT, Wilkins E, Benavidez G, Williams TD, Abildso CG, Pollack Porter KM. Come together, play, be active: Physical activity engagement of school-age children at Play Streets in four diverse rural communities in the U.S. Prev Med 2019; 129:105869. [PMID: 31654727 DOI: 10.1016/j.ypmed.2019.105869] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/24/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
Across the U.S., Play Streets - temporary street closures creating safe places for play for a few hours- are being implemented in urban areas during summer. Play Streets have never been implemented or evaluated in rural communities but have the potential to address challenges residents face accessing safe physical activity opportunities in these areas. Community organizations in four diverse low-income rural communities (selected to represent African American, American Indian, Latino, or White, non-Hispanic populations) received mini-grants in 2017 to implement four, three-hour Play Streets during the summer focusing on school-aged children in elementary-to-middle school. Physical activity was measured using Digi-walker (Yamax-SW200) pedometers and the System for Observing Play and Recreation in Communities (SOPARC/iSOPARC). Sixteen Play Streets were implemented in rural Maryland, North Carolina, Oklahoma, and Texas communities during June-September 2017. A total of 370 children (mean age = 8.81 years [SD = 2.75]; 55.0% female) wore pedometers across all 16 Play Streets (μ = 23.13 [SD = 8.59] children/Play Street). School-aged children with complete data (n = 353) wore pedometers for an average of 92.97 min (SD = 60.12) and accrued a mean of 42.08 steps/min (SD = 17.27), with no significant differences between boys (μ = 43.82, SD = 15.76) and girls (μ = 40.66, SD = 18.34). iSOPARC observations revealed no significant differences in child activity by sex; however, male teens were more active than female teens. Most adults were sedentary during Play Streets according to pedometer and iSOPARC data. Children in diverse rural communities are physically active at Play Streets. Play Streets are a promising intervention for promoting active play among children that lack safe opportunities to be active.
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Affiliation(s)
- M Renée Umstattd Meyer
- Baylor University, Department of Public Health, One Bear Place #97343, Waco, TX 76798, USA.
| | | | - T Prochnow
- Baylor University, College of Health and Human Sciences, One Bear Place #97311, Waco, TX 76798, USA
| | - Megan E McClendon
- Baylor University, College of Health and Human Sciences, One Bear Place #97311, Waco, TX 76798, USA; Texas State University, USA
| | - Kimberly T Arnold
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Hampton House 380A, Baltimore, MD 21205, USA; University of Pennsylvania, USA
| | - Emily Wilkins
- Baylor University, Department of Public Health, One Bear Place #97343, Waco, TX 76798, USA
| | - Gabriel Benavidez
- Baylor University, Department of Public Health, One Bear Place #97343, Waco, TX 76798, USA
| | - Tiffany D Williams
- Gramercy Research Group, 7990 North Point Boulevard, Suite 108, Winston-Salem, NC 27106, USA
| | - Christiaan G Abildso
- West Virginia University School of Public Health, PO Box 9190, Morgantown, WV 26506-9190, USA
| | - Keshia M Pollack Porter
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Hampton House 380A, Baltimore, MD 21205, USA
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Pollack Porter KM, Prochnow T, Mahoney P, Delgado H, Bridges Hamilton CN, Wilkins E, Umstattd Meyer MR. Transforming City Streets To Promote Physical Activity And Health Equity. Health Aff (Millwood) 2019; 38:1475-1483. [DOI: 10.1377/hlthaff.2019.00454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Keshia M. Pollack Porter
- Keshia M. Pollack Porter is a professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Tyler Prochnow
- Tyler Prochnow is a doctoral student and research assistant in the Department of Health, Human Performance, and Recreation, Baylor University, in Waco, Texas
| | - Patricia Mahoney
- Patricia Mahoney is a research data analyst in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Haley Delgado
- Haley Delgado is a graduate student and a research assistant in the Department of Public Health, Baylor University
| | - Christina N. Bridges Hamilton
- Christina N. Bridges Hamilton is a doctoral candidate and a teaching and research assistant in the Department of Health, Human Performance, and Recreation, Baylor University
| | - Emily Wilkins
- Emily Wilkins is a graduate student and a research assistant in the Department of Public Health, Baylor University
| | - M. Renée Umstattd Meyer
- M. Renée Umstattd Meyer is an associate professor in the Department of Public Health, Baylor University
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