Developing the Active Communities Tool to Implement the Community Guide's Built Environment Recommendation for Increasing Physical Activity.

Physical activity is higher in communities that include supportive features for walking and bicycling. In 2016, the Community Preventive Services Task Force released a systematic review of built environment approaches to increase physical activity. The results of the review recommended approaches that combine interventions to improve pedestrian and bicycle transportation systems with land use and environmental design strategies. Because the recommendation was multifaceted, the Centers for Disease Control and Prevention determined that communities could benefit from an assessment tool to address the breadth of the Task Force recommendations. The purpose of this article is to describe the systematic approach used to develop the Active Communities Tool. First, we created and refined a logic model and community theory of change for tool development. Second, we reviewed existing community-based tools and abstracted key elements (item domains, advantages, disadvantages, updates, costs, permissions to use, and psychometrics) from 42 tools. The review indicated that no tool encompassed the breadth of the Community Guide recommendations for communities. Third, we developed a new tool and pilot tested its use with 9 diverse teams with public health and planning expertise. Final revisions followed from pilot team and expert input. The Active Communities Tool comprises 6 modules addressing all 8 interventions recommended by the Task Force. The tool is designed to help cross-sector teams create an action plan for improving community built environments that promote physical activity and may help to monitor progress toward achieving community conditions known to promote physical activity.

HKHC Community Dashboard: design, development, and function of a Web-based performance monitoring system.

BACKGROUND: As part of Robert Wood Johnson Foundation's Healthy Kids, Healthy Communities (HKHC) national grant program, a technical assistance team designed the HKHC Community Dashboard, an online progress documentation and networking system. The Dashboard was central to HKHC's multimethod program evaluation and became a communication interface for grantees and technical assistance providers. METHODS: The Dashboard was designed through an iterative process of identifying needs and priorities; designing the user experience, technical development, and usability testing; and applying visual design. The system was created with an open-source content management system and support for building an online community of users. The site developer trained technical assistance providers at the national program office and evaluators, who subsequently trained all 49 grantees. Evaluators provided support for Dashboard users and populated the site with the bulk of its uploaded tools and resource documents. The system tracked progress through an interactive work plan template, regular documentation by local staff and partners, and data coding and analysis by the evaluation team. Other features included the ability to broadcast information to Dashboard users via e-mail, event calendars, discussion forums, private messaging, a resource clearinghouse, a technical assistance diary, and real-time progress reports. RESULTS: The average number of Dashboard posts was 694 per grantee during the grant period. Technical assistance providers and grantees uploaded a total of 1304 resource documents. The Dashboard functions with the highest grantee satisfaction were its interfaces for sharing and progress documentation. A majority of Dashboard users (69%) indicated a preference for continued access to the Dashboard's uploaded resource documents. CONCLUSIONS: The Dashboard was a useful and innovative tool for participatory evaluation of a large national grant program. While progress documentation added some burden to local project staff, the system proved to be a useful resource-sharing technology.

Collaborating to support Healthy Kids, Healthy Communities partnerships.

The Robert Wood Johnson Foundation (RWJF) (http://www.rwjf.org/en.html) launched Healthy Kids, Healthy Communities (HKHC) in 2008, with a $33.4 million commitment to help reverse the childhood obesity epidemic by 2015. With grant funding and technical assistance, HKHC supported 50 diverse community partnerships focusing on populations at greatest risk for obesity. Active Living By Design served as the national program office, and St. Louis-based Transtria conducted the evaluation. Collaboration fundamentally shaped HKHC's national program design and strategy, the grantee selection process, technical assistance, the HKHC learning network, and evaluation. This article describes the ways in which the concept of collaboration was defined and practiced among the Robert Wood Johnson Foundation, Active Living By Design, Transtria, and other national partners, and how it shaped the evolving vision for and expectations from HKHC grantees. Collaboration contributed to HKHC grantees' success, helped build the healthy communities movement, and influenced philanthropic practices.

Capturing community change: Active Living by Design's progress reporting system.

The Active Living by Design (ALbD) National Program Office (NPO) developed an evaluation system to track progress of 25 community partnerships, funded by the Robert Wood Johnson Foundation (RWJF). Between June 2004 and October 2008, partnerships documented their actions and accomplishments through ALbD's online Progress Reporting System (PRS) database. All entries were verified and analyzed by the NPO. Results from the PRS suggest that the ALbD partnerships were successful fundraisers, leveraging $256 million from grants, policy decisions, in-kind and direct sources. The partnerships also documented newspaper coverage, TV, and radio air time and they developed physical activity programs such as exercise clubs and "walking school buses." Partnerships were adept at influencing decision makers to create or rewrite policies and improve built environments. Selected policy examples included, but were not limited to, approvals for capital improvements, street design standards, and development ordinances. Partnerships also contributed to the completion and approval of influential planning products, such as comprehensive land use, neighborhood, and roadway corridor plans. The most common built-environment changes were street improvements for safer pedestrian and bicycle travel, including new crosswalks, bicycle facilities, and sidewalks. The ALbD community partnerships' accomplishments and challenges contribute to knowledge and best practices in the active living field. Five years after their grant began, RWJF's initial investment showed substantial and measurable results.

Assessment for active living: harnessing the power of data-driven planning and action.

BACKGROUND: Robert Wood Johnson Foundation's Active Living by Design (ALbD) grant program funded 25 communities across the U.S. The ALbD National Program Office (NPO) supported grantee community partnerships with technical assistance for assessment, planning, and implementation activities intended to increase population levels of physical activity. PURPOSE: This paper analyzes and summarizes the range of assessments conducted to identify local barriers and opportunities for active living as important elements of a thorough intervention planning process. METHODS: Evaluation of the partnerships focused on documenting community changes and strategies used to produce those changes. With support from NPO staff and external evaluators, partnerships tracked and summarized their community assessment approaches as well as strengths and challenges in conducting assessments. RESULTS: The partnerships documented a range of assessment strategies and methods. Partnerships used several qualitative methods, including focus groups, individual and group interviews, and public meetings. Quantitative methods included surveys, audits, observations, and analysis of existing data, among others. The environmental audit was the most common assessment method used by the partnerships. Assessment processes and findings were used for not only intervention planning but also community engagement and direct advocacy. Assessment data collectors varied from professional staff to community volunteers. CONCLUSIONS: Assessments were essential to the identification of local barriers and assets related to active living, which in turn helped ALbD partnerships prioritize and refine their action strategies. Assessment processes were also valuable in building relationships with new partners, community members, and local officials.

Strategies proposed by Healthy Kids, Healthy Communities partnerships to prevent childhood obesity.

INTRODUCTION: Healthy Kids, Healthy Communities (HKHC) is an initiative of the Robert Wood Johnson Foundation to prevent obesity among high-risk children by changing local policies, systems, and environments. In 2009, 105 community partnerships applied for funding from HKHC. Later that year, the Centers for Disease Control and Prevention (CDC) released recommended community strategies to prevent obesity by changing environments and policies. The objective of this analysis was to describe the strategies proposed by the 41 HKHC partnerships that received funding and compare them to the CDC recommendations. METHODS: We analyzed the funded proposals to assess the types and prevalence of the strategies proposed and mapped them onto the CDC recommendations. RESULTS: The most prevalent strategies proposed by HKHC-funded partnerships were providing incentives to retailers to locate and serve healthier foods in underserved areas, improving mechanisms for purchasing food from farms, enhancing infrastructure that supports walking and cycling, and improving access to outdoor recreational facilities. CONCLUSION: The strategies proposed by HKHC partnerships were well aligned with the CDC recommendations. The popular strategies proposed by HKHC partnerships were those for which there were existing examples of successful implementation. Our analysis provides an example of how information from communities, obtained through grant-writing efforts, can be used to assess the status of the field, guide future research, and provide direction for future investments.

A tale of two trails: exploring different paths to success.

BACKGROUND: This comparative case study investigates 2 successful community trail initiatives, using the Active Living By Design (ALBD) Community Action Model as an analytical framework. The model includes 5 strategies: preparation, promotion, programs, policy, and physical projects. METHODS: Key stakeholders at 2 sites participated in in-depth interviews (N=14). Data were analyzed for content using Atlas Ti and grouped according to the 5 strategies. RESULTS: PREPARATION: Securing trail resources was challenging, but shared responsibilities facilitated trail development. PROMOTIONS: The initiatives demonstrated minimal physical activity encouragement strategies. PROGRAMS: Community stakeholders did not coordinate programmatic opportunities for routine physical activity. POLICY: Trails' inclusion in regional greenway master plans contributed to trail funding and development. Policies that were formally institutionalized and enforced led to more consistent trail construction and safer conditions for users. PHYSICAL PROJECTS: Consistent standards for wayfinding signage and design safety features enhanced trail usability and safety. CONCLUSIONS: Communities with different levels of government support contributed unique lessons to inform best practices of trail initiatives. This study revealed a disparity between trail development and use-encouragement strategies, which may limit trails' impact on physical activity. The ALBD Community Action Model provided a viable framework to structure cross-disciplinary community trail initiatives.

The Active Living by Design national program: community initiatives and lessons learned.

Public health advocates have increasingly highlighted the importance of implementing comprehensive physical activity interventions that use an ecologic framework. Such a framework can broadly address physical activity barriers, such as the lack of opportunities, social support, policies, built environments, and community awareness. The Active Living by Design (ALbD) was a community grant program of the Robert Wood Johnson Foundation (RWJF), which was established to help 25 communities create environments that support active living. Each funded site established a multidisciplinary community partnership and implemented the 5P strategies: preparation, promotions, programs, policy, and physical projects. The community partnerships worked within neighborhoods, schools, worksites, and other organizations to increase physical and social supports for physical activity. Ten community examples illustrate the 5Ps. Throughout the 5-year grant, the ALbD national program office provided community partnerships with group and individualized learning opportunities. Technical assistance and peer-to-peer learning was facilitated by ALbD project officers, who also coached each community partnership via site visits, regular phone calls, and electronic communications. The ALbD grant program provided valuable lessons for communities, technical assistance organizations, and funders. Community partnerships experienced success in a variety of settings and their collaborative approaches encouraged multiple organizations, including funders, to participate in improving conditions for active living. Strong local leadership was a key to success and community partnerships benefited considerably from peer-to-peer learning. The 5P model, while challenging to implement comprehensively, proved to be a useful model for community change.

Indicators of activity-friendly communities: an evidence-based consensus process.

BACKGROUND: Regular physical activity, even at modest intensities, is associated with many health benefits. Most Americans, however, do not engage in the recommended levels. As practitioners seek ways to increase population rates of physical activity, interventions and advocacy efforts are being targeted to the community level. Yet, advocates, community leaders, and researchers lack the tools needed to assess local barriers to and opportunities for more active, healthy lifestyles. Investigators used a systematic review process to identify key indicators of activity-friendly communities that can assess and improve opportunities for regular physical activity. METHODS: Investigators conducted a comprehensive literature review of both peer-reviewed literature and fugitive information (e.g., reports and websites) to generate an initial list of indicators for review (n=230). The review included a three-tiered, modified Delphi consensus-development process that incorporated input of international, national, state, and local researchers and practitioners from academic institutions, federal and state government agencies, nonprofit organizations, and funding agencies in public health, transportation, urban planning, parks and recreation, and public policy. RESULTS: Ten promising indicators of activity-friendly communities were identified: land use environment, access to exercise facilities, transportation environment, aesthetics, travel patterns, social environment, land use economics, transportation economics, institutional and organizational policies, and promotion. CONCLUSIONS: Collaborative, multidisciplinary approaches are underway to test, refine, and expand this initial list of indicators and to develop measures that communities, community leaders, and policymakers can use to design more activity-friendly community environments.

Change in the prevalence of leisure activity with the number of activities recalled.

PURPOSE: The purpose of this study was to examine how the estimated prevalence of leisure activity changed when respondents self-reported up to four activities, compared with using information only from the respondent's one, two, and three most commonly performed leisure activities. METHODS: Information on leisure activities, sociodemographics, and body mass index (BMI) categories was collected in the year 2000 during a telephone interview of 1813 randomly selected adults living in six North Carolina counties. Recommended activity was defined as moderate leisure activity > or =5x wk(-1) for > or =30 min per session or vigorous leisure activity > or =3x wk(-1) for > or =20 min per session. RESULTS: Among respondents, 32.1% reported participation in no leisure activity, 41.7% reported one activity, 21.5% reported two activities, 3.8% reported three activities, and 0.9% reported four activities during the past month. The largest change in prevalence occurred when using two activities compared with one activity for recommended activity, overall and by sociodemographic and BMI categories. The prevalence of recommended activity determined by using 1, 2, 3, or 4 activities was 21.0%, 26.0%, 26.5%, and 26.7%, respectively. CONCLUSION: In this study, collecting information on two leisure activities was the most efficient balance for population specific accuracy of recommended activity.

Neighborhood environment, access to places for activity, and leisure-time physical activity in a diverse North Carolina population.

PURPOSE: To examine associations between perceived neighborhood characteristics, access to places for activity, and leisure-time physical activity. DESIGN: Cross-sectional telephone survey. SETTING: Cabarrus, Henderson, Pitt, Robeson, Surry, and Wake counties in North Carolina. SUBJECTS: Population-based sample of 1796 adults at least 18 years of age residing in the six counties. MEASURES: The 133-item questionnaire assessed self-reported leisure-time physical activity and perceptions of neighborhood characteristics (sidewalks, trails, heavy traffic, streetlights, unattended dogs, and safety from crime) and general access to places for physical activity. RESULTS: Trails, streetlights, and access to places were positively associated with engaging in any leisure activity: unadjusted odds ratio (OR) (95% confidence interval [CI]); 1.62 (1.09-2.41), 1.57 (1.14-2.17), and 2.94 (1.91-4.52), respectively. Trails and access to places were positively associated with engaging in the recommended amount of leisure activity: 1.49 (1.00-2.22), and 2.28 (1.30-4.00), respectively). In multivariable logistic regression modeling including environmental factors and demographics, access to places was associated with any activity (2.23 [1.44-3.44]) and recommended activity (2.15 [1.23-3.77]), and trails were associated with recommended activity (1.51 [1.00-2.28]). CONCLUSION: Certain neighborhood characteristics, particularly trails, and access to places for physical activity may be associated with leisure activity levels. In this study, perceived neighborhood environmental factors and access to places for physical activity were strongly associated with race, education, and income.

Reliability and validity of two instruments designed to assess the walking and bicycling suitability of sidewalks and roads.

PURPOSE: Public health professionals hypothesize that when community environments provide suitable walking and bicycling conditions, community members will be more active. Measurement indicators and assessment instruments are needed to evaluate suitability. This study determined the reliability and validity of two instruments to assess the suitability of sidewalks for walking and roads for bicycling. METHODS: Two data collectors used walking and bicycling suitability assessment instruments to collect data on 31 road segments. In addition, three transportation experts used a 7-point Likert response system to subjectively evaluate walking and bicycling conditions for the same segments. Intraclass correlations determined the reliability of each assessment instrument and the reliability of the Likert response system. Pearson correlations (research staff assessments with expert assessments) were calculated to determine the criterion-related validity of the suitability measures. RESULTS: Intercoder reliability (intraclass) correlations for the walking and bicycling assessment instruments were r = .79 and .90, respectively. Intercoder reliability of the experts' Likert response system was r = .73 for the walking form and r = .77 for the bicycling form. Criterion-related validity (Pearson) correlations for the walking and bicycling assessment instruments were r = .58 and .62, respectively. CONCLUSION: Although some variables have lower reliability and validity than is ideal, the walking and bicycling suitability assessment instruments appear promising as instruments for community members and professionals to systematically assess key aspects of the physical environment.

Statewide prevalence and correlates of walking and bicycling to school.

BACKGROUND: Travel to and from school can be an important and regular source of physical activity for youth. Few US studies have documented the prevalence and correlates of walking and bicycling to school. OBJECTIVE: To examine the prevalence and correlates of walking and bicycling to school among middle and high school youth. DESIGN: Cross-sectional survey. SETTING: Sixty middle schools and 62 high schools selected in North Carolina. PARTICIPANTS: Students in 6th through 8th grades (n = 2151) and in 9th through 12th grades (n = 2297) during the spring of 2001. MAIN OUTCOME MEASURES: Walking or bicycling to school in a usual week. RESULTS: Among middle school students, 9.4% usually walked to school and 4.1% usually bicycled to school at least 1 day per week. Among high school students, 4.9% usually walked to school and 2.8% usually bicycled to school at least 1 day per week. For middle school youth, walking or bicycling to school was more prevalent among boys and among nonwhites. For high school youth, walking or bicycling to school was also more prevalent among nonwhites. For middle school youth (but not high school youth), a higher body mass index (85th to less than 95th percentile) was associated with a reduced odds of walking to school. For high school youth (but not middle school youth), participating in physical education 1 to 4 days per week or never having an adult at home immediately after school was associated with walking or bicycling to school. Higher parental educational level was associated with a reduced odds of walking to school among high school youth. CONCLUSIONS: The descriptive information provided by this study broadens our limited understanding of the prevalence and correlates of walking and bicycling to school in the United States. Further qualitative and quantitative descriptive data are needed to develop successful interventions to increase walking and bicycling to school.