Assessing the Environment for Support of Youth Physical Activity In - - PowerPoint PPT Presentation

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

SOCIETY FOR NUTRITION EDUCATION AND BEHAVIOR WEBINAR April 3, 2017

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Authors

Kendra Kattelmann, PhD, RDN, LN, FAND, is a Distinguished Professor and Director, Didactic Program of Dietetics in the Health and Nutritional Sciences Department, South Dakota State University. Her research focuses on obesity prevention through behavioral and environmental programs. Christopher Comstock, MS, RDN, is lecturer in the Health and Nutritional Sciences Department, South Dakota State University and was a graduate student at the time the research was collected. Lacey McCormack, PhD, MPH, RD, EP-C is an Assistant Professor in the Health and Nutritional Sciences Department, South Dakota State University. Her research focuses on how the environment shapes diet and physical activity behaviors in rural populations. Tandalayo Kidd, PhD, RD, LPN, is Associate Professor and Extension Specialist in the Food, Nutrition, Dietetics and Health Department, Kansas State University. She is the principal investigator of the USDA/NIFA/AFRI grant that funded this research.

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Objectives

• To describe the tools used to assess rural environmental support for

physical activity.

• To report the environmental support of physical activity in rural

areas.

• To discuss the relationship between the measured environment for

physical activity and the perceptions of physical activity support in sixth- to eighth-grade youth in rural communities.

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Project Overview

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• Ignite: Sparking Youth to Create Healthy Communities

– Create an environment in selected low-income ethnic communities to prevent overweight and obesity in 6th-8th grade youth – Assess the environment to identify barriers to healthy behaviors associated with fruit and vegetable intake and physical activity

• BONUS COMPONENT

– Youth Empowerment! Research design used tenets of the CBPR model to provide decision-making opportunities for youth

Rationale

• Obesity is a health concern
• More than 1/3 of US children and adolescents overweight and
• bese
• Causes are complex and are multifactorial

– Behavioral – Biological – Environmental*

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Rationale

• Physical environment has role in influencing physical activity behavior

– Urban – Land use – Transportation systems

• Benchmarking the environment for supporting healthfulness assists in

focusing on the necessary changes.

• However, protocols for assessing the environments are relatively new

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Assessing the Built Environment

• Environmental audits are essential for identifying environmental features

linked to obesogenic behaviors (Gasevic et al., 2011)

• Protocols are relatively new (Lytle, 2009)

– Direct assessments – In-person audits (Booth et al, 2005) – Intermediate assessments – Perceived environmental measures, regional land use data, local databases (Booth et al, 2005) – Indirect assessments – Census data, GIS, street network data (Booth et al, 2005)

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Urban vs. Rural

• Significant differences between urban

and rural communities

– Climate and natural landscape – Built environment design – Transportation infrastructure – Societal culture and norms

• Most assessment tools were designed

for urban community structure and urban city design

• Literature review identified 30 tools

http://blog.krrb.com/2011/06/24/keeping-it-real-nabewise-founder-ann-montgomery-talks- neighborhood/ http://scenicdakotas.com/southdakota/scotland/scotland-neighborhood.jpg

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Built Environment Assessment Tools

Systematic Pedestrian and Cycling Environmental Scan (SPACES) Pedestrian Environment Data Scan (PEDS)

• St. Louis

University Analytic Audit Tool (SLU) Irvine-Minnesota Inventory (IMI) Walking and Bicycling Suitability Assessment (WABSA) Walk Friendly Communities (WFC) Community Assessment Tool Physical Activity Neighborhood Environment Survey (PANES) Senior Walking Environmental Audit Tool (SWEAT-R) Neighborhood Environment Walkability Scale (NEWS) Physical Activity Resource Assessment (PARA) Community Healthy Living Index (CHLI) Active Neighborhood Checklist (ANC) Block Environment Inventory (BEI) Neighborhood Active Living Potential (NALP) Residential Environment Assessment tool (REAT)

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Built Environment Assessment Tools

Environmental Supports for Physical Activity Questionnaire (ESPAQ) Community Health Assessment aNd Group Evaluation (CHANGE) Neighborhood Brief Observation Tool PIN3 Neighborhood Audit Instrument Built Environment Site Survey Checklist (BESSC) Environmental Nutrition and Activity Community Tool (ENACT) Healthy Environments Partnership Neighborhood Observational Checklist (NOC) China Urban Built Environment Scan Tool (CUBEST) PhotoVoice Rural Active Living Assessment (RALA) Rural Active Living Perceived Environmental Support Scale (RALPESS) Environmental Assessment of Public Recreation Spaces (EAPRS) Bedimo-Rung Assessment Tools – Direct Observation (BRAT-DO) Instrument The Path Environment Audit Tool (PEAT) Core Measures of Trail Use

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Urban vs. Rural

• Lack of rural assessment tools

is concerning

• Rural children are 25% more

likely to be overweight (Lutfiyya et

al., 2007)

• Rural populations have higher

rates of physical inactivity,

• besity, and obesity-related

disease (Umstattd et al., 2012)

http://www.prainc.com/sequential-intercept-mapping-urban-vs-rural-communities/

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Environmental Perceptions and Physical Activity Behavior

• Studies have linked poor environmental

design to physical inactivity and obesity (Booth,

Pinkston, & Poston, 2005; Diez Roux & Mair, 2010)

• Observational audits fail to capture the

perception of the individual

• Reaction to environment depends on

situation (Belon et al., 2014)

– Cultural elements – Socioeconomic factors – Interpersonal relationships

https://www.migreat.co.uk/en/africans/london/news/let-kids- keeping-watchful-eye-children-tv-programmes-n3936

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Significance

• Gap in the literature in correlating environmental assessment data,

environmental perceptions, and weight status

• Unfavorable perceptions of the physical environment linked with increased
• besity (Powell-Wiley et al., 2013)
• Unclear whether perceptions of individuals in rural communities match
• bjective measures

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Purpose

• 1) Assess environmental support of physical activity in rural areas
• 2) Determine whether there is a correlation between the measured

physical environment and the physical activity perceptions of the study participants

Hypothesis

• Perceptions of the study participants will correlate with the
• bjective results obtained from the built environment assessments

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Community & Participant Selection

• Chosen based on protocols developed by the Ignite study
• Communities needed to meet:

– Low-income definition – Minority definition

• Four rural, low-income communities in South Dakota and Kansas

were chosen

• Consenting 6th-8th grade youth served as study participants

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Environmental Assessments

• Conducted by trained researchers
• Built environment audited with:

– Active Neighborhood Checklist (ANC)

(Hoehner et al., 2007)

– Physical Activity Resource Assessment (PARA) (Lee et al., 2005)

• Tools applicable to urban, rural and

frontier settings

http://cehi.snre.umich.edu/projects/cap

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• PARA and ANC
• Tools and training available from the BEAT Institute
• http://www.med.upenn.edu/beat/

Active Neighborhood Checklist

• Direct-observation tool
• Targets five areas within the community

– Land use – Places to walk and bicycle – Local street characteristics – Quality of the environment for a pedestrian – Transportation availability

• Scored from 0 to 59

http://massbike.org/resourcesnew/pathstrails/

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Active Neighborhood Checklist (ANC)

• Areas audited in SD

– Around schools and routes between the school and important local destinations – Routes/street segments chosen randomly – 10 in SD Community I – 19 in SD Community II

• Areas audited in KS

– Similar selection process followed – 5 in KS Community I – 3 In KS Community II

http://www.city-data.com/picfilesc/picc9868.php

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Physical Activity Resource Assessment

• One page observation tool
• Assesses schools, parks, churches, community centers, fitness

centers, indoor and outdoor athletic facilities, walking and bicycling paths, and local trails

• Scores resources based on type, location, cost, and quality
• Features, amenities, and incivilities scored from 0 to 3 (Lee et al., 2005)

– 0 = not present – 1 = poor – 2 = mediocre – 3 = good

• Scored from 0 to 79

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Physical Activity Resource Assessment (PARA)

• 29 locations audited
• Areas audited in SD

– 9 in SD Community I – 14 in SD Community II

• Areas audited in KS

– 2 in KS Community I – 4 in KS Community II

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Behavior and Perception

• Questionnaire

– 5 questions – Sourced from previously validated tools – Cognitively tested for content, organization, and comprehension – Administered to consenting students

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Assessment of PA Perception

• Survey questions ask about how much participants agree with the following

statements:

– I think there are plenty of opportunities to be physically active in my community; – It is difficult to be physically active in the local park/street near my home because there is not enough space in which to be active; – It is difficult to be physically active in the local park/street near my home because there are no choices for activities; – It is difficult to be physically active in the local park/street near my home because there is no equipment/facility; and – It is difficult to be physically active in the local park/street near my home because it is not safe (owing to crime or traffic). – Using a Likert scale, possible responses ranged from not at all agree to strongly agree; 1 = not at all agree and 5 = strongly agree. Each individual question was scored and a Total Perception of the Environment (TPE) score was computed by reverse-coding questions 2, 3, 4, and 5, summing the scores from all questions, and then dividing by 5.

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Assessment of PA

• The proportion of students who were physically active for ≥

60 minutes most days of the week was assessed by asking each student the following question (adapted from the Youth Risk Behavior Survey and the Active Living Research Adolescent Survey 1):

– “Over a typical or usual week, how many days did you do moderate to vigorous physical activity like brisk walking, dancing, aerobics, running, swimming, or competitive games (e.g. football, volleyball, basketball) for a TOTAL of at least 60 minutes per day?

• Possible responses were 0–7 days. Responses were dichotomized

into not being physically active on most days (0–3) or being physically active on most days (4–7).

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Analyses

• One-way analysis of variance and post-hoc Bonferroni
• Total ANC and Total PARA scores transformed prior to comparison with TPE

scores

• Pearson’s correlations computed to assess relationship between:

– 1) TPE score and transformed Total ANC score – 2) TPE score and transformed Total PARA score

• SPSS version 22.0 (IBM Corp., Armonk, NY, 2013)
• Significance set at p≤0.05

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Results

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Higher scores are better for subscores and total ANC. Community location and number of routes/segments or activity resources were assessed. Subscores range from 0 to 6 for land use to 0 to 4 for public transportation, 0 to 7 for street characteristics, 0 to 12 for quality of the environment, and 0 to 30 for places to walk or bicycle. Total ANC score = land use + public transportation + street characteristics + quality of the environment + places to walk or bicycle. Scores range from 0 to 59.

Results

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For PARA scores, differences were determined with 1-way ANOVA and post hoc analysis with Bonferroni adjustment. No significant differences were found among the 4 communities at P ≤ .05. For features and amenities, higher scores are better. For incivilities, lower scores are better. Subscores range from 0 to 39 for features, and 0 to 36 for amenities and incivilities. Total PARA score = features + amenities–incivilities. Scores range from 0 to 75, with higher scores being better.

Rural Youth Perception of Environmental Support for Physical Activity

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Students were asked, “How much do you agree with the following statement?” Possible responses include 1 = not at all agree; 2 = slightly agree; 3 = somewhat agree; 4 = moderately agree; and 5 = strongly agree. Higher scores indicate greater agreement. Environmental perception questions 2– 5 were reverse-scored so that 1 = 5, 2 = 4, and 3 = 3. Questions 1–5 were totaled and averaged.

% of students at least 60 minutes PA most days

Community Kansas I Kansas II SD I SDII % of students 79% 78% 74% 61.5%

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Association of Perception with Measured Environment Scores

• Positive correlation between TPE scores and total ANC scores

(multivariate coefficient, 0.016, P = .026).

• No correlation between TPE scores and total PARA scores

(multivariate coefficient, 0.012; P = .056).

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Discussion

• Built Environment Assessments

– ANC - Public transportation, land use, street characteristics, quality of the environment for a pedestrian, and places to walk and bicycle – PARA - Schools, parks, churches, community centers, fitness centers, indoor and

• utdoor athletic facilities, walking and bicycling paths, and local trails

– All four communities scored near or less than the median in Total ANC and Total PARA – Indicates environment offers few physical activity resources

• Students had a positive perception of the environment
• Objective environmental assessments may not accurately reflect local

environmental perception

• Reported physical activity levels align with student perception

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Discussion – Social Ecological Model (SEM)

• SEM

– Conceptual framework – Understand relationship between social influences, environmental impacts, local policies, and active living – Health behaviors are influenced by intrapersonal, interpersonal,

• rganizational, community, and policy factors, and health promoting

interventions need to be directed toward each of these components (McLeroy et

al., 1988)

• Results support the need for a broader approach to obesity-prevention

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Discussion – Strengths and Limitations

• Strengths

– Provides insight into the environment of rural communities – Offers support for the development of more comprehensive obesity prevention strategies – Communities were ethnically diverse – Results provide a unique perspective on individual environmental perception – Findings indicate researchers should highlight and capitalize on available resources and work to improve perception

• Limitations

– Surveys were only distributed to 6th-8th grade youth – PARA and ANC were not originally designed for rural communities and environments

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Conclusions

• Perception may not always match objective measures
• Future research should improve existing environmental audit tools and

develop new, comprehensive, location-specific tools

• Why are rural specific tools needed?

– Outsiders may not recognize all resources being utilized – Children and adolescents are innovative and creative – Need to capture unique areas for physical activity – Incorporate ways to capture cultural components of physical activity as well as individual perception

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Implications

• Findings from this study indicate that when working on health and

wellness programming, researchers should determine what the youth (or any target population) view as physical activity resources.

• Individual perception may have a key role in physical activity

behaviors; if the environment is perceived in a positive manner, children and community members may be more likely to use local resources that are already available.

• Finding ways to capitalize on youth perception may be a useful

strategy for increasing physical activity, even if the overall measured environment does not appear conducive to physical activity.

• Better tools are needed to measure physical activity environments in

rural areas, and alternative opportunities for physical activity may need to be included in the measurements to provide a total picture of activity support.

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Implications

• Objective and subjective environmental assessments needed

– RALA and RALPESS

• High quality behavior and anthropometric data collection

methods

• Traditional suggestions for PA interventions may not be feasible

– i.e. joint use agreements, complete streets/sidewalks

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http://www.economist.com/blogs/democracyinamerica/2014/01/obesity-america

Questions?

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