Introduction to the Active Living Research Reference List January – July 2008


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(2008). Active living in diverse and disadvantaged communities. Proceedings of the Fourth Annual Active Living Research Conference. February 22-24, 2007. Coronado, California, USA. Am J Prev Med. 34, 271-372.

(2008). Practicing What We Preach: A Look at Healthy Active Living Policy and Practice in Canadian Pediatric Hospitals. Clinical Journal of Sport Medicine. 18, 187.

An abstract of the article "Practicing What We Preach: A Look at Healthy Active Living Policy and Practice in Canadian Pediatric Hospitals," by Ziad Solh, Jennica L. Plan, Kristi B. Adamo, Erin Boyd, Elaine Orrbine and Elizabeth Cummings is presented.

S. Adler, N. Dobson, K. P. Fox and L. Weigand. (2008). Advocating for active living on the rural-urban fringe: A case study of planning in the Portland, Oregon, metropolitan area. Journal Of Health Politics Policy And Law. 33, 525-558.

This case study is about the politics of incorporating active-living elements into a concept plan for a new community of about 68,000 people on the edge of the Portland, Oregon, metropolitan area. Development on the rural-urban fringe is ongoing in metropolitan areas around the United States. In this article, we evaluate the product of the concept-planning process from the standpoint of the extent to which environmental elements conducive to active living were included. We also analyze four issues in which challenges to the incorporation of active-living features surfaced: choices related to transportation facilities, the design and location of retail stores, the location of schools and parks, and the location of a new town center. Overall, the Damascus/Boring Concept Plan positions the area well to promote active living. Analyses of the challenges that emerged yielded lessons for advocates regarding ways to deal with conflicts between facilitating active living and local economic development and related tax-base concerns and between active-living elements and school-district planning autonomy as well as the need for advocates to have the capacity to present alternatives to the usual financial and design approaches taken by private- and public-sector investors.

S. Ahrentzen. (2008). Sustaining active-living communities over the decades: Lessons from a 1930s greenbelt town. Journal Of Health Politics Policy And Law. 33, 429-453.

Greendale, Wisconsin, was intentionally created with many of the design and planning principles that active-living advocates promote today. This case study examines the processes behind sustaining these particular planning and design principles over time in light of economic and regional challenges that have faced not just Greendale but most town centers over the last fifty years. Despite these challenges, the walkable nature of Greendale's center remains strong today, in terms of both activity and community identity. While many circumstances are specific to this particular town, useful lessons can be drawn for those new urbanist (NU) communities being developed in greenfields and suburbs today, many of which are strikingly similar to Greendale - relatively small, low density, and located within metropolitan areas. Greendale's success resulted from (1) attending to the retail/commercial product mix; (2) attracting nonresidents to use the community's retail and public space; and (3) capitalizing on community investment not simply from residents' organizing efforts but, more important in this case, from corporate community involvement by a Greendale business firm whose interests and values coincided with those of the community.

S. A. Aytur, D. A. Rodriguez, K. R. Evenson and D. J. Catellier. (2008). Urban containment policies and physical activity: A time-series analysis of metropolitan areas, 1990-2002. American Journal Of Preventive Medicine. 34, 320-332.

Background: Urban containment policies attempt to manage the location, character, and timing of growth to support a variety of goals such as compact development, preservation of greenspace, and efficient use of infrastructure. Despite prior research evaluating the effects of urban containment policies on land use, housing, and transportation outcomes, the public health implications of these policies remain unexplored. This ecologic study examines relationships among urban containment policies, state adoption of growthmanagement legislation, and population levels of leisure and transportation-related physical activity in 63 large metropolitan statistical areas from 1990 to 2002. Methods: Multiple data sources were combined, including surveys of urban containment policies, the Behavioral Risk Factor Surveillance System, the U.S. Census of Population, the National Resources Inventory, and the Texas Transportation Institute Urban Mobility Study. Mixed models were used to examine whether urban containment policies and state adoption of growth-management legislation were associated with population levels of leisure-time physical activity (LTPA) and walking/bicycling to work over time. Results: Strong urban containment policies were associated with higher population levels of LTPA and walking/bicycling to work during the study period. Additionally, residents of states with legislation mandating urban growth boundaries reported significantly more minutes of LTPA/week compared to residents of states without such policies. Weak urban containment policies showed inconsistent relationships with physical activity. Conclusions: This study provides preliminary evidence that strong urban containment policies are associated with higher population levels of LTPA and active commuting. Future research should examine potential synergies among state, metropolitan, and local policy processes that may strengthen these relationships.

A. Baumann, M. Hunsberger, J. Blythe and M. Crea. (2008). Sustainability of the workforce: government policies and the rural fit. Health Policy. 85, 372-9.

OBJECTIVES: Critical workforce issues among health care workers have raised public concerns about the ability of health care systems to provide adequate service. Services, however, are influenced by geographical and social factors. One important source of variation is rurality. This study evaluated the perception of the applicability of health human resource policies for rural areas. METHODS: An exploratory design was used. Twenty-one nurse administrators and 44 staff nurses from a sampling of 19 rural health care settings were interviewed. Hospitals with less than 100 beds were targeted. RESULTS: The government policies most frequently mentioned by study participants were the goal of 70% full-time employment, the new graduate policy and the late career initiative. Each presented challenges to managers attempting implementation. Urban bias is apparent in health care policy including health human resource policies. Little data is available about rural health care workers because health care statistics tend to be reported regionally. CONCLUSION: Rural institutions have difficulty accessing government funding intended to build sustainable workforces. Policies meant to be broadly implemented across jurisdictions may not fit the needs of rural institutions and their clients. Health care databases should include a rural variable to enhance understanding about this population.

W. Bemelmans, P. van Baal, W. Wendel-Vos, J. Schuit, E. Feskens, A. Ament and R. Hoogenveen. (2008). The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action. Prev Med. 46, 127-32.

OBJECTIVES: To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive lifestyle program (applied to 10% of overweight adults), and costs and cost-effectiveness were assessed. METHODS: Costs and effects were based on two Dutch projects and verified by similar international projects. A markov-type simulation model estimated long-term health benefits, health care costs and cost-effectiveness. RESULTS: Combined implementation of the interventions--at the above mentioned scale--reduces prevalence rates of overweight by approximately 3 percentage points and of physical inactivity by 2 percentage points after 5 years, at a cost of 7 euros per adult capita per year. The cost-effectiveness ratio of combined implementation amounts to euro 6000 per life-year gained and euro 5700 per QALY gained (including costs of unrelated diseases in life years gained). Sensitivity analyses showed that these ratios are quite robust. CONCLUSIONS: A realistic policy target is a decrease in overweight prevalence of three percentage points, compared to a situation with no interventions. In reality, large scale implementation of the interventions may not counteract the expected upward trends in The Netherlands completely. Nonetheless, implementation of the interventions is cost-effective.

S. E. Benjamin, A. Cradock, E. M. Walker, M. Slining and M. W. Gillman. (2008). Obesity prevention in child care: A review of US state regulations. Bmc Public Health. 8,

Objective: To describe and contrast individual state nutrition and physical activity regulations related to childhood obesity for child care centers and family child care homes in the United States. Methods: We conducted a review of regulations for child care facilities for all 50 states and the District of Columbia. We examined state regulations and recorded key nutrition and physical activity items that may contribute to childhood obesity. Items included in this review were: 1) Water is freely available; 2) Sugar-sweetened beverages are limited; 3) Foods of low nutritional value are limited; 4) Children are not forced to eat; 5) Food is not used as a reward; 6) Support is provided for breastfeeding and provision of breast milk; 7) Screen time is limited; and 8) Physical activity is required daily. Results: Considerable variation exists among state nutrition and physical activity regulations related to obesity. Tennessee had six of the eight regulations for child care centers, and Delaware, Georgia, Indiana, and Nevada had five of the eight regulations. Conversely, the District of Columbia, Idaho, Nebraska and Washington had none of the eight regulations. For family child care homes, Georgia and Nevada had five of the eight regulations; Arizona, Mississippi, North Carolina, Oregon, Tennessee, Texas, Vermont, and West Virginia had four of the eight regulations. California, the District of Columbia, Idaho, Iowa, Kansas, and Nebraska did not have any of the regulations related to obesity for family child care homes. Conclusion: Many states lack specific nutrition and physical activity regulations related to childhood obesity for child care facilities. If widely implemented, enhancing state regulations could help address the obesity epidemic in young children in the United States.

T. K. Boehmer, D. A. Luke, D. L. Haire-Joshu, H. S. Bates and R. C. Brownson. (2008). Preventing childhood obesity through state policy. Predictors of bill enactment. Am J Prev Med. 34, 333-40.

BACKGROUND: To address the epidemic of childhood obesity, health professionals are examining policies that address obesogenic environments; however, there has been little systematic examination of state legislative efforts in childhood obesity prevention. Using a policy research framework, this study sought to identify factors that predict successful enactment of childhood obesity prevention in all 50 states. METHODS: A legislative scan of bills introduced during 2003-2005 in all 50 states identified 717 bills related to childhood obesity prevention. Multilevel logistic regression modeling was performed in 2006 to identify bill-level (procedure, composition, and content) and state-level (sociodemographic, political, economic, and industrial) factors associated with bill enactment. RESULTS: Seventeen percent of bills were enacted. Bill-level factors associated with increased likelihood of enactment included having more than one sponsor; bipartisan sponsorship; introduction in the state senate; budget proposals; and content areas related to safe routes to school, walking/biking trails, model school policies, statewide initiatives, and task forces and studies. State-level political factors, including 2-year legislative session and Democratic control of both chambers, increased enactment. An indicator of state socioeconomic status was inversely associated with bill enactment; economic and industrial variables were not significantly related to bill enactment. CONCLUSIONS: In general, bill-level factors were more influential in their effect on policy enactment than state-level factors. This study provides policymakers, practitioners, and advocacy groups with strategies to develop more politically feasible childhood obesity prevention policies, including the identification of several modifiable bill characteristics that might improve bill enactment.

L. D. Brown and M. K. Kraft. (2008). Active living as an institutional challenge: Lessons from the Robert Wood Johnson Foundation's "Celebrate Fitness" program. Journal Of Health Politics Policy And Law. 33, 497-523.

Native American youth suffer disproportionately from a range of adverse health conditions. Empowering youth leaders to work on community-based solutions has proved effective in reducing tobacco use and gun violence and is now emerging as a promising approach to improving fitness and health. This article, based on direct observation and interviews with key informants, examines the implementation of a Robert Wood Johnson Foundation - funded project that gave tribal youth councils minigrants to design and run diverse projects that encourage physical activity in their communities. The article highlights the institutional challenges that confront health-promotion strategies for disadvantaged populations. Unless they take proper account of organizational, political, environmental, and cultural forces, funders' interventions have limited chances for success and sustainability.

R. C. Brownson, C. M. Kelly, A. A. Eyler, C. Carnoske, L. Grost, S. L. Handy, J. E. Maddock, D. Pluto, B. A. Ritacco, J. F. Sallis and T. L. Schmid. (2008). Environmental and Policy Approaches for Promoting Physical Activity in the United States: A Research Agenda. Journal of Physical Activity & Health. 5, 488.

Background: Environmental and policy approaches are promising strategies to raise population-wide rates of physical activity; yet, little attention has been paid to the development and prioritization of a research agenda on these topics that will have relevance for both researchers and practitioners. Methods: Using input from hundreds of researchers and practitioners, a research agenda was developed for promoting physical activity through environmental and policy interventions. Concept mapping was used to develop the agenda. Results: Among those who brainstormed ideas, 42% were researchers and 33% were practitioners. The data formed a concept map with 9 distinct clusters. Based on ratings by both researchers and practitioners, the policy research cluster on city planning and design emerged as the most important, with economic evaluation second. Conclusions: Our research agenda sets the stage for new inquiries to better understand the environmental and policy influences on physical activity.

J. Cawley and L. Feng. (2008). Correlates of State Legislative Action to Prevent Childhood Obesity. Obesity (19307381). 16, 162.

The article discusses a study which aims to determine the factors associated with state legislatures to prevent childhood obesity in the U.S. Based on the results, the trend toward the introduction of bills and enactment of laws to address childhood obesity occurred from 2003 to 2005. The results also showed that states with Democratic governors and state legislatures not controlled by Republicans are associated with greater policy actions against obesity.

J. C. Cogan, J. P. Smith and M. D. Maine. (2008). The risks of a quick fix: a case against mandatory body mass index reporting laws. Eat Disord. 16, 2-13.

As the United States addresses obesity, a number of state legislatures are considering laws that require schools to track and report students' body mass index (BMI), a measurement of body weight (weight/height2). This article describes the state level activity on mandatory BMI reporting, offers numerous arguments against this practice, and suggests an alternative approach to promoting health in youth. Mandatory BMI reporting laws place a new and inappropriate responsibility on the schools. Proponents of such laws imply that BMI reporting will have positive outcomes, yet there is virtually no independent research to support this assumption. The authors argue that these laws could do significant harm, including an increased risk for children to develop eating disorder symptoms.

D. Cohen, A. Sehgal, S. Williamson, D. Golinelli, T. L. McKenzie, P. Capone-Newton and N. Lurie. (2008). Impact of a new bicycle path on physical activity. Prev Med. 46, 80-1.

R. D. Edwards. (2008). Public transit, obesity, and medical costs: assessing the magnitudes. Prev Med. 46, 14-21.

OBJECTIVE: This paper assesses the potential benefits of increased walking and reduced obesity associated with taking public transit in terms of dollars of medical costs saved and disability avoided. METHODS: I conduct a new analysis of a nationally representative U.S. transportation survey to gauge the net increase in walking associated with public transit usage. I translate minutes spent walking into energy expenditures and reductions in obesity prevalence, estimating the present value of costs and disability that may be avoided. RESULTS: Taking public transit is associated with walking 8.3 more minutes per day on average, or an additional 25.7-39.0 kcal. Hill et al. [Hill, J.O., Wyatt, H.R., Reed, G.W., Peters, J.C., 2003. Obesity and the environment: Where do we go from here? Science 299 (5608), 853-855] estimate that an increase in net expenditure of 100 kcal/day can stop the increase in obesity in 90% of the population. Additional walking associated with public transit could save $5500 per person in present value by reducing obesity-related medical costs. Savings in quality-adjusted life years could be even higher. CONCLUSIONS: While no silver bullet, walking associated with public transit can have a substantial impact on obesity, costs, and well-being. Further research is warranted on the net impact of transit usage on all behaviors, including caloric intake and other types of exercise, and on whether policies can promote transit usage at acceptable cost.
M. F. Floyd, C. J. Crespo and J. F. Sallis. (2008). Active living research in diverse and disadvantaged communities stimulating dialogue and policy solutions. Am J Prev Med. 34, 271-4.

G. D. Foster, S. Sherman, K. E. Borradaile, K. M. Grundy, S. S. Vander Veur, J. Nachmani, A. Karpyn, S. Kumanyika and J. Shults. (2008). A policy-based school intervention to prevent overweight and obesity. Pediatrics. 121, e794-802.

BACKGROUND: The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity. OBJECTIVE: The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (> 95.0th percentile) among children in grades 4 through 6 over a 2-year period. METHODS: Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with > or = 50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach. RESULTS: The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years. CONCLUSION: A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.
B. Giles-Corti, M. Knuiman, A. Timperio, K. Van Niel, T. J. Pikora, F. C. L. Bull, T. Shilton and M. Bulsara. (2008). Evaluation of the implementation of a state government community design policy aimed at increasing local walking: Design issues and baseline results from RESIDE, Perth Western Australia. Preventive Medicine. 46, 46-54.

Objectives. To describe the design and baseline results of an evaluation of the Western Australian government's pedestrian-friendly subdivision design code (Liveable Neighborhood (LN) Guidelines). Methods. Baseline results (2003-2005) from a longitudinal study of people (n=1813) moving into new housing developments: 18 Liveable, 11 Hybrid and 45 Conventional (i.e., LDs, HDs and CDs respectively) are presented including usual recreational and transport-related walking undertaken within and outside the neighborhood, and 7-day pedometer steps. Results. At baseline, more participants walked for recreation and transport within the neighborhood (52.6%; 36.1% respectively), than outside the neighborhood (17.7%; 13.2% respectively). Notably, only 20% of average total duration of walking (128.4 min/week (SD159.8)) was transport related and within the neighborhood. There were few differences between the groups' demographic, psychosocial and perceived neighborhood environmental characteristics, pedometer steps, or the type, amount and location of self-reported walking (p>0.05). However, asked what factors influenced their choice of housing development, more participants moving into LDs reported aspects of their new neighborhood's walkability as important (p<0.05). Conclusions. The baseline results underscore the desirability of incorporating behavior and context-specific measures and value of longitudinal designs to enable changes in behavior, attitudes, and urban form to be monitored, while adjusting for baseline residential location preferences.

R. Hanson and G. Young. (2008). Active living and biking: Tracing the evolution of a biking system in Arlington, Virginia. Journal Of Health Politics Policy And Law. 33, 387-406.

In Arlington, Virginia, a steady evolutionary change in biking policy during the last three decades has yielded some of the nation's best biking assets. It has a comprehensive, well-connected, highly integrated, well-mapped, and well-signed system of shared-use paved trails, bike lanes, bike routes, and other biking assets, such as workplace showers. Understanding the conditions that led to Arlington's current biking system can provide lessons in the strategy and tactics of active-living politics. One potentially effective political strategy that was successful in Arlington is for activists to pressure elected officials to select professional managers who see bikeways as crucial to the overall transportation system. Then it is important to formalize the government-citizen relationship through an advisory panel. Also, in Arlington, the incremental creation of biking assets helped create demand for more and better facilities. In turn, this created political support for expanding and upgrading. Finally, Arlington used potentially negative circumstances (e. g., the building of highway corridors, the introduction of the Metro) as opportunities to change the built environment in ways that have encouraged more active living.

J. Harrington, S. Friel, C. Thunhurst, A. Kirby and B. McElroy. (2008). Obesogenic island: the financial burden of private transport on low-income households. Journal Of Public Health. 30, 38-44.

Background The physical and social environment influences access to a healthy lifestyle, of which transport is one determining factor. This paper estimates the cost of transport on the island of Ireland. Methods Budget standards were developed on the basis of costs of baskets of core goods and services required for daily living. The transport budget was based on the needs of an urban living family. Financial capacity of the family relative to transport basket costs was determined. Results Transport costs vary depending on family type and car ownership. The motoring costs for a family with two unemployed adults, with a weekly financial capacity of 388.28(sic) and 427.70(sic), respectively, for the Republic of Ireland and Northern Ireland, amount to 94.78(sic) and 74.68(sic), representing 18 and 10% of the family's weekly income. Conclusion The prohibitive costs of private transport present an opportunity for policy makers to consider creating supportive environments incorporating the more cost-effective and environmentally friendly options of public transport. Without such measures, dependence on private transport will exacerbate the incidence of food poverty and the health inequalities consequent upon it.

L. A. Hearn, M. R. Miller and R. Campbell-Pope. (2008). Review of evidence to guide primary health care policy and practice to prevent childhood obesity. Med J Aust. 188, S87-91.

OBJECTIVES: To identify key barriers to effective engagement of primary health care (PHC) providers and families in promoting healthy weight among children aged 2-6 years, and to examine promising interventions to identify policy goals to overcome these barriers. METHODS: We conducted a literature review of published and unpublished articles from January 1990 to February 2006 using keywords relating to childhood obesity, risk factors, prevention, populations and primary care provider interventions, constraints and models. We identified barriers to engagement by PHC providers. Appraisal of "promise" was based on best available evidence and consideration of strengths and weaknesses of interventions in specific contexts and settings. RESULTS: Of 982 interventions aimed at the primary prevention of overweight and obesity among children, few related to 2-6-year-olds, with only 45 interventions meeting the inclusion criteria and 11 ranking highly on key criteria. Areas of weakness were low-level engagement by PHC providers, focus on single risk factors rather than a multidimensional approach, and lack of a population focus. A range of administrative, attitudinal, knowledge, skills and training issues were identified as barriers to effective engagement of different PHC providers with parents and other early childhood service providers. CONCLUSIONS: Engagement of PHC providers in prevention of childhood obesity requires a systematic approach involving practice protocols, assessment tools, client support material and referral pathways, as well as adequate training and sufficient staff for implementation. A more comprehensive approach could be promoted by increased collaboration, agreed role delineation, consistent public health messages and better coordination between PHC providers and other service providers, facilitated at service policy and administration level.

K. M. Heinrich, C. B. Johnson, Y. Jokura, B. Nett and J. E. Maddock. (2008). A survey of policies and local ordinances supporting physical activity in Hawaii counties. Prev Chronic Dis. 5, A19.

BACKGROUND: Features of the built environment that influence physical activity behavior characterize Active Community Environments. CONTEXT: Whether Active Community Environments policies exist in the state of Hawaii's four counties is unknown. The purpose of this study was to provide a baseline assessment of these policies in Hawaii. METHODS: A survey assessing policies in six domains (i.e., sidewalks, bike lanes, greenways, recreational facilities, commercial buildings, and shared-use paths) was completed by employees of Hawaii planning departments. CONSEQUENCES: Honolulu County had the most policies (n = 13), followed by Maui County (n = 6), Kauai County (n = 2), and Hawaii County (n = 1). Written policies were most prevalent in Honolulu County (n = 15), followed by Kauai County (n = 14), Hawaii County, (n = 4), and Maui County (n = 3). Sidewalk policies were reported for Honolulu County, Maui County (no written policies were found for Maui County), and Kauai County. Bike lane and greenway policies were found for Honolulu County (reported and written) and Kauai County (written). Recreation facility and pedestrian shared-use path policies existed for all counties, although only Honolulu and Kauai counties had written policies for commercial buildings (Maui County reported having policies). Few policies directly addressed physical activity promotion. INTERPRETATION: The most populous county, Honolulu, had the most policies in place, although discrepancies existed between reported and written policies. This baseline measure of physical activity-related policies will help focus efforts of county coalitions to increase opportunities for physical activity. Additional policies should be tracked with population behavior surveillance.

W. P. T. James. (2008). The fundamental drivers of the obesity epidemic. Obesity Reviews. 9, 6-13.

Most policy makers do not yet understand that the obesity epidemic is a normal population response to the dramatic reduction in the demand for physical activity and the major changes in the food supply of countries over the last 40 years. A national focus on individual behaviour reflects a failure to confront the facts. Thus, the changes in food supply and physical environment are socioeconomically driven, and the health sector simply picks up the consequences. Urbanization alone in China has reduced daily energy expenditure by about 300-400 kcal d(-1) and cycling/bussing or going to work by car determines another variation of 200 kcal d(-1). Thus, energy demands may have dropped with additional TV/media, mechanization and computerized changes by 400-800 kcal d(-1), so weight gain and obesity are inevitable for most or all the population. Food intake should have fallen substantially despite the community's focus on the value of food after all the food crises of the past. Yet, Chinese fat and sugar intakes are escalating, and these policy-mediated features are amplified by the primeval biological drive for those commodities with specialized taste buds for fatty acids, meat, sugar and salt. Yet, traditionally, Chinese diets had negligible sugar, and 25-year-old data show that the optimum diet for Chinese contains 15% fat. Policies relating to food imports, agriculture, food quality standards, appropriate food traffic light labelling, price adjustments and controlled access to unhealthy foods are all within the grasp of the Chinese government. China has traditionally been far more responsive to the value of policies which limit inequalities and establish standards of care than many western governments, who have yet to recognize that the individualistic free-market approach to obesity prevention is guaranteed to fail. China could therefore lead the way: if it follows western approaches, the health and economic burden will become unsustainable.

S. K. Kumanyika. (2008). Global calorie counting: a fitting exercise for obese societies. Annu Rev Public Health. 29, 297-302.

Implementation of strategies to address obesity on a global scale has not yet begun in earnest. One key issue is uncertainty about the relative importance of taking aggressive action on the food vs. physical activity side of the energy balance equation, recognizing that interventions in both areas are critical. Using data on obesity prevalence, food availability, and selected economic and sociodemographic indicators from member countries of the Organization for Economic Cooperation and Development, an article in this volume of the Annual Review of Public Health provides estimates and projections to help resolve this uncertainty. The analyses presented support the authors' hypothesis that most of the recent rise in obesity is attributable to excess caloric intake. The implication that policies to curb overconsumption might include deliberate changes in the price structure of the food supply should stimulate debate about our current agricultural and trade paradigms, particularly because any such global policies would also affect the developing world.

J. M. Lee. (2008). Why young adults hold the key to assessing the obesity epidemic in children. Archives Of Pediatrics & Adolescent Medicine. 162, 682-687.

Despite significant increases in prevalence rates of childhood obesity in the United States during the past 2 decades, rates of type 2 diabetes mellitus among children at the population level have not followed a similar trajectory as those in adults. In this review, hypotheses for the contrasting findings in children compared with adults are explored, as are possible links between the trends in childhood obesity rates and increases in type 2 diabetes among young adults in the United States. This review concludes with observations about the profound policy implications from current patterns of type 2 diabetes among youth and particularly young adults and a proposed research agenda regarding childhood obesity and type 2 diabetes risk over the life course.

K. M. Leyden, B. Reger-Nash, A. Bauman and T. Bias. (2008). Changing the Hearts and Minds of Policy Makers: An Exploratory Study Associated With the West Virginia Walks Campaign. American Journal of Health Promotion. 22, 204.

Purpose. To pilot test whether West Virginia Walks changed local policy makers' awareness of walking-related issues. Design. A quasi-experimental design with preintervention and postintervention mail surveys. Setting. Morgantown, WV (intervention community), and Huntington, WV (comparison community). Subjects. One hundred thirty-three and 134 public officials in Morgantown and 120 and 116 public officials in Huntington at baseline and at follow-up, respectively. Intervention. An 8-week mass media social ecological campaign designed to encourage moderate-intensity walking among insufficiently active persons aged 40 to 65 years. Measures. Policy makers listed three problems they believed needed to be addressed in their community. They then rated the severity of several problems that many communities face using a Likert scale, with 1 representing "not a problem" and 5 representing "an extremely important problem." Analysis. Independent sample t-tests were used to examine differences in mean responses at baseline and at follow-up. Results. Statistically significant increases in the perceived importance of walking-related issues were observed among policy makers in Morgantown but not in the comparison community. Conclusions. Integrated communitywide health promotion campaigns designed to influence the public can also affect the perceptions of policy makers. Future research should examine this linkage and determine whether resource allocation and policy changes follow such interventions.

R. Lopez, R. Campbell and J. Jennings. (2008). The Boston Schoolyard Initiative: A public-private partnership for rebuilding urban play spaces. Journal Of Health Politics Policy And Law. 33, 617-638.

The Boston Schoolyard Initiative (BSI) is a policy effort to rebuild school yards in Boston through innovative citywide public-private partnerships. At the center of the initiative is a commitment to engage multiple stakeholders and utilize a bottom-up planning process to encourage meaningful change. Based on a case study of BSI, this article develops a framework to understand and analyze how different school and neighborhood sectors can partner to benefit neighborhood communities and utilize the built environment to encourage more active living and active learning. The article contributes to a literature that focuses on the effects of school yards and the role of physically active environments on learning. It expands on this literature by looking at the school-yard initiative as a way to build and expand relationships between teachers, parents, and the community at large. Finally, the study shows that even older schools in inner-city neighborhoods, previously considered blights, can be turned into community, educational, and political assets.

J. R. Morrow, J. E. Fulton, N. D. Brener and H. W. Kohl. (2008). Prevalence and correlates of physical fitness testing in US schools-2000. Research Quarterly For Exercise And Sport. 79, 141-148.

Because of the perceived lack of youth physical fitness and/or concerns for increased obesity, physical education teachers are interested in youth fitness and physical activity levels. Statewide mandates are being developed that require school-based teachers to complete physical fitness testing. Data from the nationally representative School Health Policies and Programs Study 2000 were analyzed to investigate the prevalence of fitness testing and the professional characteristics of fitness test users. Data: were collected with teachers of either randomly selected classes in elementary schools and randomly selected required physical education courses in middle/junior high and senior high schools (N = 1,564). The prevalence of fitness test use is 65% across all school levels. Variables associated with physical fitness test usage., were professionally oriented. Results showed that teachers in secondary schools (odds ratio [OR] = 2.25, 95% confidence interval [CI] = 1.18-4.27), those with degrees in physical education/kinesiology-related disciplines (OR = 2.01, 95% CI = 1.11-3.63), and those who had completed staff development on physical fitness testing (OR = 3.22, 95% CI = 1.86-5.60) were more likely than respondents without these characteristics to engage in physical fitness testing. Results changed little when separate analyses were conducted for classes/courses in districts requiring versus not requiring fitness testing. Financial variables, including fitness-oriented facilities available, metropolitan location, and discretionary expenditures per student, were not associated with fitness test use. Results provided national prevalence of school-based physical fitness testing use in the U. S. and conveyed information about those who currently use physical fitness tests.

D. Penney. (2008). Playing a political game and playing for position: Policy and curriculum development in health and physical education. European Physical Education Review. 14, 33.

This paper addresses prospective policy relationships between health and physical education (HPE) and contemporary education policies. It specifically explores the opportunities and challenges that contemporary education discourses present for policy and curriculum development in HPE. Contemporary education discourses of lifelong learning, learning communities, personalized learning, inclusivity and excellence are critically analysed in relation to policy and curriculum development in HPE. It is contended that these discourses present a potentially strong focus for advocacy and that their adoption may be an astute political move for HPE. Recent curriculum development in senior physical education in Western Australia is used to illustrate the scope for the discourses to be embedded in curricula and for HPE to thereby be seen to firmly connect with key education agendas.

J. Pucher and R. Buehler. (2008). Making cycling irresistible: Lessons from the Netherlands, Denmark and Germany. Transport Reviews. 28, 495-528.

This article shows how the Netherlands, Denmark and Germany have made bicycling a safe, convenient and practical way to get around their cities. The analysis relies on national aggregate data as well as case studies of large and small cities in each country. The key to achieving high levels of cycling appears to be the provision of separate cycling facilities along heavily travelled roads and at intersections, combined with traffic calming of most residential neighbourhoods. Extensive cycling rights of way in the Netherlands, Denmark and Germany are complemented by ample bike parking, full integration with public transport, comprehensive traffic education and training of both cyclists and motorists, and a wide range of promotional events intended to generate enthusiasm and wide public support for cycling. In addition to their many pro-bike policies and programmes, the Netherlands, Denmark and Germany make driving expensive as well as inconvenient in central cities through a host of taxes and restrictions on car ownership, use and parking. Moreover, strict land-use policies foster compact, mixed-use developments that generate shorter and thus more bikeable trips. It is the coordinated implementation of this multi-faceted, mutually reinforcing set of policies that best explains the success of these three countries in promoting cycling. For comparison, the article portrays the marginal status of cycling in the UK and the USA, where only about 1% of trips are by bike.

J. A. Rye, N. O'Hara Tompkins, R. Eck and W. A. Neal. (2008). Promoting youth physical activity and healthy weight through schools. W V Med J. 104, 12-5.

The prevalence of overweight in youth has increased three- to four-fold in the United States since the 1960s. The school environment can play prominently in the mitigation of this epidemic by increasing physical activity opportunities/ levels, decreasing the availability of food/ beverage with added sugar, and enhancing students' scientific understandings about energy balance. The potential to increase energy expenditure goes beyond the school day to include safe routes for walking and biking to school (active transport) as well as the availability of school facilities as a community resource for physical activity outside of school hours. However, school consolidation and siting decisions have profound effects on active transport as well as the school as a community resource. Teachers and adolescents should not be overlooked as important partners in conceiving and carrying out programming that seeks to increase physical activity levels in youth and the broader community. As leaders and health care providers in their communities, physicians are postured to be effective advocates of, and to leverage in their own practice, school-based policies and practices towards promoting healthy weight in youth.

T. J. Ryley. (2008). The propensity for motorists to walk for short trips: Evidence from West Edinburgh. Transportation Research Part A-Policy And Practice. 42, 620-628.

The trade-offs individuals make between the motor car and walking for short trips are investigated, using data from a West Edinburgh household survey. Propensity to walk discrete choice models are estimated from a stated preference experiment within the survey questionnaire. This includes segmented models using socio-economic, spatial and attitudinal variables. The relative importance of the three attributes of journey time, petrol cost and parking cost are examined; value of time estimates are also generated. With all other factors remaining constant, for short trips motorists are more likely to walk in response to an increase in parking costs than a rise in petrol prices. The use of parking as a transport policy tool is discussed. (c) 2008 Elsevier Ltd. All rights reserved.

D. Salvesen, K. R. Evenson, D. A. Rodriguez and A. Brown. (2008). Factors influencing implementation of local policies to promote physical activity: A case study of Montgomery County, Maryland. Journal Of Public Health Management And Practice. 14, 280-288.

Policy interventions such as zoning ordinances, school facility siting guidelines, capital improvement programs, and park master plans hold particular promise for promoting physical activity, especially at the local level. Despite increasing attention to the relationship between built environment characteristics and physical activity, there is a paucity of research on the extent to which local policies can promote or hinder physical activity. Furthermore, the impact of local policies on physical activity should depend on how effectively the policies are implemented. Based on the policy implementation literature and using Montgomery County, Maryland, as a case study, this study identifies factors related to the successful implementation of local policies hypothesized to influence physical activity. For our study, we conducted an extensive policy review and 17 in-depth interviews with 26 individuals. The interviews were transcribed, coded, and analyzed to identify the relevant factors that affect policy implementation. Our findings suggest that knowledge and awareness, commitment and capacity, intergovernmental coordination, the presence of an advocate or champion, and conflict influence physical activity policy implementation at the local level. Those trying to increase physical activity through policy could focus on these implementation features to help make policy implementation more successful.

J. Schilling and S. D. Keyes. (2008). The promise of Wisconsin's 1999 comprehensive planning law: Land-use policy reforms to support active living. Journal Of Health Politics Policy And Law. 33, 455-496.

Weaving together the disciplines of planning and policy change with the emerging research of active living, this article explores the competing interests and underlying political forces behind the design and passage of Wisconsin's Comprehensive Planning Law of 1999. While Wisconsin's law remains a work in progress, it illustrates the contemporary policy battles over land use and smart growth and the resurgence of the property-rights movement. It further highlights the influence of smart-growth coalitions and policy networks on planning reform. The authors suggest that planning practitioners and active-living proponents can adapt and transfer these policy lessons from Wisconsin to address the complex relationships of the built environment, physical activity, and the nation's current obesity problem through state and local planning reforms.

D. Siegel. (2008). Policies and Opportunities for Physical Activity in Middle Schools. JOPERD: The Journal of Physical Education, Recreation & Dance. 79, 8.

The article presents a study on policies and opportunities for physical activity in middle schools. It states that various interventions have been proposed to increase children's participation in physical activity. In this activity, school principals, department heads for physical education and health, and leaders of school-grounded physical activity programs from 36 schools participating in the Trial of Activity for Adolescent Girls (TAAG) were asked to determine the level of support for physical activity in their schools. The study identified that none of the schools received a perfect score for support of physical activity.

P. J. Spilchak, E. Denney-Wilson, L. King and L. A. Baur. (2008). Tertiary paediatric obesity services in Australia. J Paediatr Child Health. 44, 243-7.

AIM: To examine the nature and availability of paediatric obesity services in tertiary care settings across the states/territories of Australia. METHODS: Surveys were sent to all clinicians identified as offering obesity services to children and adolescents. Respondents were asked to identify other service providers in their area, who were also asked to complete the survey. RESULTS: Sixteen clinicians responded to the survey, from 20 requests. The clinicians who responded identified nine services in three of the eight states/territories of Australia. Existing services are limited to children and adolescents with severe obesity, with an average of 12 new referrals per service each month and an average waiting time of 5 months for an appointment. Most services involve a multidisciplinary approach, although the mix of staff varies considerably and emphasises nutrition rather than physical activity approaches. CONCLUSIONS: Despite the public attention devoted to paediatric obesity, tertiary services in Australia are inadequate to meet the increasing incidence and prevalence of this complex condition. The development of tertiary services as part of service delivery arrangements for paediatric obesity and its associated morbidities must become a priority within the health system.

J. W. Yang. (2008). Policy implications of excess commuting: Examining the impacts of changes in US metropolitan spatial structure. Urban Studies. 45, 391-405.

This article examines how changes in US metropolitan spatial structure lead to an increase in measurable excess commuting and a decrease in measurable transport-land use connections. Using Boston and Atlanta as two comparative regions, this research computes excess commuting with three-decade census data and then examines excess commuting in relation to the changes in metropolitan spatial structure. Empirical results suggest that the transport-land use connection appears weaker over the decades as the dispersion of jobs changes the dynamics of commuting and the selection of residential location follows patterns of average job location rather than that of the closest available job location. This decreasing transport-land use connection points to a spatial structure effect apart from individual preferences. It also suggests an alternative view of excess commuting for metropolitan transport policy-making.

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