In-Depth Interviews With State Public Health Practitioners On The United States National Physical Activity Plan

Abstract Background The United States National Physical Activity Plan (NPAP; 2010), the country’s first national plan for physical activity, provides strategies to increase population-level physical activity to complement the 2008 physical activity guidelines. This study examined state public health practitioner awareness, dissemination, use, challenges, and recommendations for the NPAP. Methods In 2011–2012, we interviewed 27 state practitioners from 25 states. Interviews were recorded and transcribed verbatim. Transcripts were coded using a standard protocol, verified and reconciled by an independent coder, and input into qualitative software to facilitate development of common themes. Results NPAP awareness was high among state practitioners; dissemination to local constituents varied. Development of state-level strategies and goals was the most frequently reported use of the NPAP. Some respondents noted the usefulness of the NPAP for coalitions and local practitioners. Challenges to the plan included implementation cost, complexity, and consistency with other policies. The most frequent recommendation made was to directly link examples of implementation activities to the plan. Conclusions These results provide early evidence of NPAP dissemination and use, along with challenges encountered and suggestions for future iterations. Public health is one of eight sectors in the NPAP. Further efforts are needed to understand uptake and use by other sectors, as well as to monitor long-term relevance, progress, and collaboration across sectors

Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways

IntroductionMultimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity–HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use.Materials and methodsLatent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 (N = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity–HRQoL relationship.ResultsLCA revealed four profiles, including a Relatively Healthy class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Compared to the Relatively Healthy class, Vascular-Inflammatory class membership was associated with lower physical functioning (β = −5.5; p < 0.001); membership in Vascular-Inflammatory (β = −1.7; p < 0.05), and Respiratory (β = −2.5; p < 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for Vascular-Inflammatory (p < 0.05) and Respiratory (p < 0.05) classes.ConclusionSpecific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services

The Relationships between Park Quality, Park Usage, and Levels of Physical Activity in Low-Income, African American Neighborhoods

Parks can be an important, low-cost neighborhood resource to increase physical activity and reduce overweight and obesity. The quality of parks, however, may impact use. This study used observational data to examine the relationships between park quality, park usage and levels of physical activity among users in 31 parks within low-income, African American neighborhoods. Relationships between park use and park characteristics (signs of disorder, attractiveness, and number of activity settings) varied by gender and user activity level. No variables of interest were significant for overall number of male users; whereas, disorder and attractiveness were significant for overall number of female users. Parks with signs of disorder were associated with 49% fewer female users (IRR = 0.51, 95% CI = (0.34–0.77)) and attractive parks with 146% more female users (IRR = 2.46, 95% CI = (1.39–4.33)). Similar significant relationships were found among active but not sedentary female users. Communities may consider increasing park maintenance and addressing attractiveness in existing parks as a relatively low-cost environmental strategy to encourage park use, increase physical activity, and reduce the burden of obesity, especially among women in low-income, African-American communities

Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets

Background: Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce. Methods: A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects. Results: In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips. Conclusion: The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce

Patterns of Cyclist and Pedestrian Street Crossing Behavior and Safety on an Urban Greenway

Greenways are linear open spaces, which are often used as trails for pedestrians and cyclists, but junctions with roads are a safety concern and act as a potential impediment to active transportation. This study evaluated crossing behavior patterns and safety at greenway–road junctions in New Orleans, LA. Crossing behaviors, safety and motor vehicle behavior were collected using direct observation methods. Intercept surveys were conducted to assess greenway use and safety perceptions. Logistic and negative binomial regression were used to assess the relationships between crossing signal (rectangular rapid flash beacon) activation and motor vehicle behavior. Fewer unsafe crossings occurred when the crossing signals were activated for cyclists and pedestrians (p-values of 0.001 and 0.01, respectively). There was no association between pedestrian use of crossing signals and motor vehicle stopping behavior but cyclists had significantly higher odds of motor vehicles failing to stop when the signal was activated (OR 5.12, 95% CI 2.86–9.16). The activation of rectangular rapid flash beacons at urban greenway junctions with roads did not influence motor vehicle behavior. Differences in crossing safety by signal use cannot be attributed to the signal’s influence on motor vehicle stopping behavior

Association of Symptons of Depression and Obesity With Hypertension: The Bogalusa Heart Study

Background: There is growing evidence that symptoms of depression influence the development of cardiovascular disease. The objective of this study was to evaluate the direct and indirect relationships between symptoms of depression, body mass index (BMI), and hypertension in a biracial (African American–white) rural population. Methods: This is a cross-sectional study with 1017 study participants (aged 12 to 62 years, 60% white, and 52% women) from 561 families of the Bogalusa Heart Study. A two-stage modeling approach was used to evaluate the relationship between symptoms of depression, BMI, and hypertension. Generalized estimating equation methods (GEE) were used to account for within family correlations. Adjusted coefficients (95% confidence interval [CI]) and odds ratios (OR) were used to explore relationships. Results: Mean ( SE) BMI of the study population was 28 (7). Thirty-two percent of those studied had presumptive depression and 13.4% had hypertension. The indirect effect of a 5 unit higher symptoms of depression score was associated with a 14% (OR: 1.14; 95% CI: 1.01–1.28; P .02) higher likelihood of being hypertensive due to presence of a higher level of BMI in both whites and African Americans. The direct effect of a 5 unit higher symptoms of depression score was found to be nonsignificant (OR: 1.05; 95% CI: 0.92–1.20; P .22) in whites and significant (OR: 0.81; 95% CI: 0.68–0.95; P .004) in African Americans. Conclusions: The presence of a significant indirect effect of symptoms of depression (mediated through higher level of BMI) in both whites and African Americans suggests that BMI can be an intermediate variable linking symptoms of depression and hypertension

Safe streets for some: A review of local active transportation responses across the U.S. during the COVID-19 pandemic.

INTRODUCTION & RESEARCH OBJECTIVES: The COVID-19 pandemic significantly disrupted daily travel. This paper contrasts 51 US cities responses, namely street reallocation criteria and messaging related to physical activity (PA) and active transportation (AT) during the early months of the pandemic. This study can be utilized by cities for aiding in the creation of locally responsive policies that acknowledge and remedy a lack of safe active transportation. METHODS: A content analysis review was conducted of city orders and documents related to PA or AT for the largest city by population in all 50 US states and the District of Columbia. Authoritative documents issued from each citys public health declaration (ca. March 2020) to September 2020 were reviewed. The study obtained documents from two crowdsourced datasets and municipal websites. Descriptive statistics were used to compare policies and strategies, with a focus on reallocation of street space. RESULTS: A total of 631 documents were coded. Considerable variation existed in city responses to COVID-19 that impacted PA and AT. Most cities stay-at-home orders explicitly permitted outdoor PA (63%) and many encouraged PA (47%). As the pandemic continued, 23 cities (45%) had pilot programs that reallocated street space for non-motorized road users to recreate and travel. Most cities explicitly mentioned a rationale for the programs (e.g., to provide space for exercise (96%) and to alleviate crowding or provide safe AT routes (57%)). Cities used public feedback to guide placement decisions (35%) and several welcomed public input to adjust initial actions. Geographic equity was a criterion in 35% of programs and 57% considered inadequately sized infrastructure in decision-making. CONCLUSIONS: If cities want to emphasize AT and the health of their citizens, safe access to dedicated infrastructure needs to be prioritized. More than half of study cities did not instate new programs within the first 6 months of the pandemic. Cities should study peer responses and innovations to inform and create locally responsive policies that can acknowledge and remedy a lack of safe AT

Physical distancing [is not equal to] physical inactivity

During this time of global health crisis, physical distancing, along with mask wearing, has emerged as the sine qua non social practice to protect ourselves and others from COVID-19. But as physical distancing ensues and all eyes remain fixed on the novel coronavirus, another, albeit careworn, pandemic rages on. Physical inactivity, the world\u27s fourth leading cause of death, may indeed be exacerbated by physical distancing measures, such as sheltering at home and closing or limiting access to recreation and exercise facilities. The purpose of this paper is to urge public health and medical professionals not to forget the importance of physical activity to whole-person health, recognize the importance of physical activity as a potential COVID-19 mitigation strategy and to serve as advocates for promoting active lifestyles. It is imperative that the national call for physical distancing not be interpreted as a call for physical inactivity

Diet Quality and Sleep Characteristics in Midlife: The Bogalusa Heart Study

Background: Sleep and diet contribute to cardiometabolic disease, but evidence is sparse for the association between these behaviors. This study analyzed the cross-sectional relationship between diet quality and multiple sleep outcomes in the Bogalusa Heart Study (BHS). Methods: Diet and sleep characteristics, including insomnia and sleep apnea symptoms, were measured with validated questionnaires. Poisson regression using generalized estimating equations with a log link estimated prevalence rate ratios (PRR) of sleep outcomes by dietary pattern scores (quintile (Q) and per SD). Models were adjusted for body mass index (BMI), multi-level socioeconomic factors, physical activity, depressive symptoms, and other potential confounders. Results: In 824 participants, higher diet quality, measured by the Alternate Healthy Eating Index-2010, was associated with lower sleep apnea risk score after adjustment (PRR [95% confidence interval (CI)] Q5 vs. Q1: 0.59 [0.44, 0.79], per SD increase: 0.88 [0.81, 0.95], p-trend < 0.0001). There were no statistically significant associations with the Healthy Eating Index 2015 or the Alternate Mediterranean dietary patterns, or for insomnia symptoms or a healthy sleep score. Conclusions: Higher diet quality, after adjustment for BMI, was associated with a lower sleep apnea risk score in a cohort with substantial minority representation from a semi-rural, lower-income community

Support for physical activity policies and perceptions of work and neighborhood environments: variance by BMI and activity status at the county and individual levels

PURPOSE: To examine support for local policies encouraging physical activity and perceived neighborhood environment characteristics by physical activity and weight status of respondents across U.S. counties. DESIGN: We used a random-digit-dial, computer-assisted telephone interview (CATI) to conduct a cross-sectional telephone questionnaire in selected U.S. counties in 2011. SETTING: Counties with high prevalences of obesity and sedentary behavior (HH; n = 884) and counties with low prevalences of obesity and sedentary behavior (LL; n = 171) were selected nationally. SUBJECTS: Adult respondents from HH (n = 642) and LL (n = 566) counties. MEASURES: Questions were asked of respondents, pertaining to support for physical activity policies in various settings, neighborhood features, time spent in physical activity and sedentary behaviors, self-reported weight and height, and personal demographic information. ANALYSIS: Means and frequencies were calculated; bivariable and multivariable linear and logistic regression models, developed. Models were adjusted for individual characteristics and county HH/LL status. RESULTS: Respondents in LL counties perceived their neighborhood and work environments to be more supportive of healthy behaviors and were more supportive of local physical activity policies than respondents in HH counties (p \u3c .001 for all). Positive neighborhood environment perceptions were related to reduced body mass index, increased physical activity, and decreased sedentary behavior. CONCLUSION: Policy support and neighborhood environments are associated with behaviors. Results can inform targeting policy agendas to facilitate the improvement of environments (community, work, and school) to be more supportive of physical activity