Assessing the Environment for Support of Youth Physical Activity In Rural Communities SOCIETY FOR NUTRITION EDUCATION AND BEHAVIOR WEBINAR April 3, 2017 1
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. 2
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. 3
Project Overview • 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 4
Rationale • Obesity is a health concern • More than 1/3 of US children and adolescents overweight and obese • Causes are complex and are multifactorial – Behavioral – Biological – Environmental* 5
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 6
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) 7
Urban vs. Rural • Significant differences between urban and rural communities – Climate and natural landscape – Built environment design http://blog.krrb.com/2011/06/24/keeping-it-real-nabewise-founder-ann-montgomery-talks- neighborhood/ – Transportation infrastructure – Societal culture and norms • Most assessment tools were designed for urban community structure and urban city design • Literature review identified 30 tools 8 http://scenicdakotas.com/southdakota/scotland/scotland-neighborhood.jpg
Built Environment Assessment Tools Systematic Pedestrian St. Louis Irvine-Minnesota Walking and Pedestrian and Environment Data University Inventory (IMI) Bicycling Cycling Scan (PEDS) Analytic Audit Suitability Environmental Tool (SLU) Assessment Scan (SPACES) (WABSA) Walk Friendly Physical Activity Senior Walking Neighborhood Physical Activity Communities Neighborhood Environmental Environment Resource (WFC) Community Environment Audit Tool Walkability Scale Assessment Assessment Tool Survey (PANES) (SWEAT-R) (NEWS) (PARA) Community Active Block Neighborhood Residential Healthy Living Neighborhood Environment Active Living Environment Index (CHLI) Checklist (ANC) Inventory (BEI) Potential (NALP) Assessment tool (REAT) 9
Built Environment Assessment Tools Environmental Community Neighborhood PIN3 Built Environment Supports for Health Brief Observation Neighborhood Site Survey Physical Activity Assessment aNd Tool Audit Instrument Checklist (BESSC) Questionnaire Group Evaluation (ESPAQ) (CHANGE) Environmental Healthy China Urban Built PhotoVoice Rural Active Living Nutrition and Environments Environment Scan Assessment Activity Partnership Tool (CUBEST) (RALA ) Community Tool Neighborhood (ENACT) Observational Checklist (NOC) Rural Active Living Environmental Bedimo-Rung The Path Core Measures of Perceived Assessment of Assessment Tools Environment Trail Use Environmental Public Recreation – Direct Audit Tool (PEAT) Support Scale Spaces (EAPRS) Observation (RALPESS) (BRAT-DO) Instrument 10
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, obesity, and obesity-related disease (Umstattd et al., 2012) 11 http://www.prainc.com/sequential-intercept-mapping-urban-vs-rural-communities/
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- 12 keeping-watchful-eye-children-tv-programmes-n3936
Significance • Gap in the literature in correlating environmental assessment data, environmental perceptions, and weight status • Unfavorable perceptions of the physical environment linked with increased obesity (Powell-Wiley et al., 2013) • Unclear whether perceptions of individuals in rural communities match objective measures 13
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 objective results obtained from the built environment assessments 14
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 6 th -8 th grade youth served as study participants 15
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 16
• PARA and ANC • Tools and training available from the BEAT Institute • http://www.med.upenn.edu/beat/ 17
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 18 http://massbike.org/resourcesnew/pathstrails/
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 19 http://www.city-data.com/picfilesc/picc9868.php
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 20
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 21
Behavior and Perception • Questionnaire – 5 questions – Sourced from previously validated tools – Cognitively tested for content, organization, and comprehension – Administered to consenting students 22
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