Upstream Policy Changes to Improve Population Health and Health Equity: A Priority Agenda.

Policy Points Upstream factors-social structures/systems, cultural factors, and public policy-are primary forces that drive downstream patterns and inequities in health that are observed across race and locations. A public policy agenda that aims to address inequities related to the well-being of children, creation and perpetuation of residential segregation, and racial segregation can address upstream factors. Past successes and failures provide a blueprint for addressing upstream health issues and inhibit health equity.

Sociodemographic and Environmental Determinants of Indoor Versus Outdoor Active Play Among Children Living in the Washington, DC Area.

BACKGROUND: Sociodemographic and environmental factors play important roles in determining both indoor and outdoor play activities in children. METHODS: The Built Environment and Active Play Study assessed neighborhood playability for children (7-12 y), based on parental report of their children's active play behaviors, neighborhood characteristics, and geographic locations. Simple logistic regression modeling tested the associations between sociodemographic characteristics and the frequency of and access to venues for indoor and outdoor play. RESULTS: Children of higher socioeconomic status were almost 3 times more likely to live more than a 30-minute walk from indoor recreational facilities compared with their less affluent peers (odds ratio [OR] = 2.9; 95% confidence interval [CI], 1.2-6.8). Non-Hispanic black children were less likely to live more than 30 minutes from indoor facilities (OR = 0.21; 95% CI, 0.08-0.57) and more were likely to engage in indoor activity (OR = 3.40; 95% CI, 1.17-9.88) than were white children. Boys were substantially more likely to play outdoors at a playing fields compared with girls (OR = 5.37; 95% CI, 2.10-13.69). CONCLUSIONS: Findings from this study could be used to enhance indoor and outdoor activity spaces for children and to reduce disparities in access to such spaces.

Between Privilege and Oppression: An Intersectional Analysis of Active Transportation Experiences Among Washington D.C. Area Youth.

The use of active transportation (AT), such as walking, cycling, or even public transit, as a means of transport offers an opportunity to increase youth physical activity and improve health. Despite the well-known benefits of AT, there are environmental and social variables that converge on the AT experiences of low-income youth and youth of color (YOC) that have yet to be fully uncovered. This study uses an intersectional framework, largely focusing on the race-gender-class trinity, to examine youth AT within a context of transportation inequity. Theoretically guided by the Ecological Model of Active Transportation, focus groups were completed with two groups of girls (15 participants) and two groups of boys (nine participants) ranging between the ages of 12-15 years who lived within the Washington D.C. area. This research found race, gender, and class to be inhibitors of AT for both boys and girls, but with more pronounced negative influences on girls.

Do Not Forget About Public Transportation: Analysis of the Association of Active Transportation to School Among Washington, DC Area Children With Parental Perceived Built Environment Measures.

BACKGROUND: Although the active transportation (AT) indicator received an F grade on the 2016 US Report Card on Physical Activity for Children and Youth, this AT assessment excluded public transportation. An objective of the Built Environment and Active Play Study was to assess youth AT, including public transportation, among Washington, DC area children in relation to parental perceptions of neighborhood built environment (BE) variables. METHODS: Questionnaires were mailed to 2000 parents of children aged 7-12 years. AT to school (ATS) was assessed with the question: "In an average school week, how many days does your child use each of the following ways to get to and from school? (a) Walk; (b) Bike; (c) Car; (d) Bus or Metro." Parental perceived BE data were obtained through questionnaire items, and logistic regression was conducted to determine if BE variables were associated with youth ATS. RESULTS: The sample included 144 children (50% female; average age 9.7 years; 56.3% white; 23.7% African American; 10.4% Asian American). Over 30% used ATS-public transportation 5 days per week, and nearly 13% used ATS-walking daily. Parental perceived BE variables significantly predicted youth ATS-walking and ATS-public transportation. CONCLUSIONS: ATS-public transportation is common among Washington, DC area youth, and parental perceptions of BE can significantly predict ATS.

The Influence of Family Dog Ownership and Parental Perceived Built Environment Measures on Children's Physical Activity within the Washington, DC Area.

Sedentary behavior and physical inactivity are significant contributors to youth obesity in the United States. Neighborhood dog walking is an outlet for physical activity (PA). Therefore, understanding the relationship between built environment, dog ownership, and youth PA is essential. This study examined the influence of dog ownership and parental built environment perceptions on children's PA in the Washington, D.C. area. In 2014, questionnaires were mailed to 2000 parents to assess family dog ownership; children's outdoor dog walking or playing; and parental perceived built environment measures. Chi-square analyses examined differences in parental perceived built environment measures between children with and without family dogs. The sample included 144 children (50% female; average-age 9.7 years; 56.3% White; 23.7% African-American; 10.4% Asian-American; 29.9% owned dog). Only 13% and 5.6% of the children walked or played outdoors with the dog daily, respectively. A significantly greater proportion (p-value < 0.05) of parents who owned dogs recognized and observed some home built environment measures (e.g., traffic speed on most streets is 30 mph or less) that were PA -promoting for their children. Findings suggest that dog ownership may provide more positive parental perceptions of the neighborhood built environment, which supports children's outdoor PA through dog walking and playing.

Intersectionality takes it to the streets: Mobilizing across diverse interests for the Women's March.

Can a diverse crowd of individuals whose interests focus on distinct issues related to racial identity, class, gender, and sexuality mobilize around a shared issue? If so, how does this process work in practice? To date, limited research has explored intersectionality as a mobilization tool for social movements. This paper unpacks how intersectionality influences the constituencies represented in one of the largest protests ever observed in the United States: the Women's March on Washington in January 2017. Analyzing a data set collected from a random sample of participants, we explore how social identities influenced participation in the Women's March. Our analysis demonstrates how individuals' motivations to participate represented an intersectional set of issues and how coalitions of issues emerge. We conclude by discussing how these coalitions enable us to understand and predict the future of the anti-Trump resistance.

Black people don't exercise in my neighborhood: Perceived racial composition and leisure-time physical activity among middle class blacks and whites.

Using a sample of middle class blacks and whites living in urban and suburban areas, this article focuses on how perceptions of the racial composition of neighborhoods influence leisure-time physical activity. Using an ordinal representation of an underlying continuous indication of the perceived percentage of blacks and whites within an egocentric neighborhood, the results show that black men are significantly less likely to be physically active in neighborhoods perceived as predominately white. Alternatively, they are more likely to be physically active in neighborhoods perceived as racially diverse and predominately black. Conversely, for black women, white women, and white men, physical activity increases as the perception of one's neighborhood becomes increasingly white. Black women are significantly less likely to engage in physical activity in neighborhoods perceived as predominately black and urban. Drawing upon the intersectionality framework, I discuss how perceptions of criminalization and safety lead to different levels of leisure-time physical activity for middle class black women and men relative to their white middle class counterparts.

Missed Opportunity? Leveraging Mobile Technology to Reduce Racial Health Disparities.

Blacks and Latinos are less likely than whites to access health insurance and utilize health care. One way to overcome some of these racial barriers to health equity may be through advances in technology that allow people to access and utilize health care in innovative ways. Yet, little research has focused on whether the racial gap that exists for health care utilization also exists for accessing health information online and through mobile technologies. Using data from the Health Information National Trends Survey (HINTS), we examine racial differences in obtaining health information online via mobile devices. We find that blacks and Latinos are more likely to trust online newspapers to get health information than whites. Minorities who have access to a mobile device are more likely to rely on the Internet for health information in a time of strong need. Federally insured individuals who are connected to mobile devices have the highest probability of reliance on the Internet as a go-to source of health information. We conclude by discussing the importance of mobile technologies for health policy, particularly related to developing health literacy, improving health outcomes, and contributing to reducing health disparities by race and health insurance status.

Electronic media time and sedentary behaviors in children: Findings from the Built Environment and Active Play Study in the Washington DC area.

An objective of the Built Environment and Active Play (BEAP) Study was to examine whether home built environment, bedroom electronic presence, parental rules and demographics predicted children's sedentary behavior (SB). In 2014, BEAP Study questionnaires were mailed to 2000 parents of children (7-12 years) within the Washington DC area. SB-Duration (hours/day) and SB-Frequency (days/week) were assessed by two questions with multiple subparts relating to SB activity type (e.g. car riding) and SB companionship (e.g. friends). Built environment, bedroom electronic presence, parental rules and demographic data were obtained through questionnaire items and ordered logistic regression models were used to examine whether these variables were associated with SB. Study sample included 144 children (female (50%); average age (9.7 years); White (56.3%); Black/African-American (23.7%); Asian-Americans (10.4%)). Nearly 40% of the sample reported daily solitary SB with car riding being the most frequently reported type of SB. Children living on streets without a dead-end/cul-de-sac exhibited a higher odds in SB-Duration using electric media [2.61 (CI: 1.31, 5.18)] and having no television in a child's bedroom was associated with a lower odds in SB-Frequency [0.048 (CI: 0.006, 0.393)] and SB-Duration [0.085 (CI: 0.018, 0.395)]. Non-Hispanic/Latino children were also found to have higher odds in solitary SB-Frequency when parental rules of electronic use were modeled [8.56 (CI: 1.11, 66.01)]. Based on results from this cross-sectional study, home neighborhood built environment, bedroom electronic presence and absence of parental rules can significantly predict children's SB.

Parental perceived built environment measures and active play in Washington DC metropolitan children.

OBJECTIVE: Previous research identified associations between perceived built environment and adult physical activity; however, fewer studies have explored associations in children. The Built Environment and Active Play (BEAP) Study examined relationships between children's active play and parental perceptions of home neighborhood built environments within the Washington, DC metropolitan area (DMV). METHODS: With this cross-sectional study, a questionnaire was administered in 2014 to parents of children (7-12 years old) residing in the DMV. Data were collected on children's active play, home built environment parental perceptions, and demographics. Active play response data were dichotomized by whether the child did or did not meet the 60-min/day Physical Activity Guidelines for Americans (PAGAs) recommendation. Perceived home neighborhood built environment data were also dichotomized. Chi-square tests determined differences in parental perceived built environment measures between active and non-active child groups. Logistic regression assessed the association of parental perceived built environment variables with active play while adjusting for demographic variables. RESULTS: The BEAP Study population (n = 144) included a uniquely diverse population of children with 23.7% African Americans and 10.4% Asian Americans. A statistically significant greater proportion of active children's parents agreed with the importance of neighborhood esthetics, active play areas, walkability and safety as compared to the parents of non-active children. Fully adjusted logistic regression models demonstrated that some parental perceived built environment measures (e.g. access to play equipment) were predictors of their children meeting the 60-min/day PAGA recommendation. CONCLUSION: Our findings support the important role of home neighborhood built environment perceptions on childhood active play.

Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health.

Over the past two decades, there has been growing interest in improving black men's health and the health disparities affecting them. Yet, the health of black men consistently ranks lowest across nearly all groups in the United States. Evidence on the health and social causes of morbidity and mortality among black men has been narrowly concentrated on public health problems (e.g., violence, prostate cancer, and HIV/AIDS) and determinants of health (e.g., education and male gender socialization). This limited focus omits age-specific leading causes of death and other social determinants of health, such as discrimination, segregation, access to health care, employment, and income. This review discusses the leading causes of death for black men and the associated risk factors, as well as identifies gaps in the literature and presents a racialized and gendered framework to guide efforts to address the persistent inequities in health affecting black men.

Why Police Kill Black Males with Impunity: Applying Public Health Critical Race Praxis (PHCRP) to Address the Determinants of Policing Behaviors and "Justifiable" Homicides in the USA.

Widespread awareness of the recent deaths of several black males at the hands of police has revealed an unaddressed public health challenge-determining the root causes of excessive use of force by police applied to black males that may result in "justifiable homicides." The criminalization of black males has a long history in the USA, which has resulted in an increase in policing behaviors by legal authorities and created inequitable life chances for black males. Currently, the discipline of public health has not applied an intersectional approach that investigates the intersection of race and gender to understanding police behaviors that lead to "justifiable homicides" for black males. This article applies the core tenets and processes of Public Health Critical Race Praxis (PHCRP) to develop a framework that can improve research and interventions to address the disparities observed in recent trend analyses of "justifiable homicides." Accordingly, we use PHCRP to offer an alternative framework on the social, legal, and health implications of violence-related incidents. We aim to move the literature in this area forward to help scholars, policymakers, and activists build the capacity of communities to address the excessive use of force by police to reduce mortality rates from "justifiable homicides."

Built environment and active play among Washington DC metropolitan children: A protocol for a cross-sectional study.

BACKGROUND: Research has demonstrated that children who participate in active play are more likely to be physically active, thereby improving long-term health outcomes. Many adult studies have also shown that neighborhood built environments can encourage or discourage routine physical activity. Limited evidence has demonstrated that children who reside in neighborhoods with a built environment that is more inviting to active play exhibit lower overweight and obesity rates as well as an overall better state of well-being. This Built Environment and Active Play (BEAP) Study aims to develop a neighborhood playability rating system in the Washington, DC (DMV) area. Similar to walkability scores, these playability scores will estimate how affable a neighborhood is to active play. The BEAP Study will attempt to provide a broad view of factors influencing the level and type of active play among children. METHODS/DESIGN: Using a cross-sectional design, the BEAP Study will collect data using a mail questionnaire administered to the parents and/or guardians of 2000 children aged 7-12 years residing in select DMV areas in October of 2014. Questionnaire data, including information on active play, home and neighborhood characteristics, parental perceptions, and sociodemographic characteristics will be merged through a geographic information system (GIS) with objective built environment measures in the participants' neighborhoods. An ordered logit model will be used to regress an ordinal active play outcome on built environment exposure variables while adjusting for potential confounders. Upon the construction of the final model, predictor coefficients will be used as parameters in the scoring system to develop neighborhood playability scores. DISCUSSION: The BEAP Study intends to generate a neighborhood playability index by characterizing and quantifying children's active play using parent-reported physical activity data in children, GIS data and built environment measures in participant neighborhoods. The BEAP Study will improve our understanding of the built environment and childhood playability relationship while also contributing to the body of evidence-based built environment and physical activity research.