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The importance of engaging in any type of physical activity regularly, for both physical and mental health, is well established, and may be particularly beneficial in protecting the body and limiting the damage caused by the coronavirus disease 2019 (COVID-19). Exposure to nature or green space also has positive physical and mental health benefits. Closures of parks and green spaces during the COVID-19 pandemic has limited the options for physical activity and may affect vulnerable populations more than others. We provide both short-term and long-term recommendations to encourage access to green space for people while allowing for physical distancing.

Children's physical activity, especially play, is important for healthy physical, social, and psychological development. Playgrounds are public spaces for children, but not all playgrounds are conducive to play and physical activity. We examined \"playability,\" the ability of a space to promote active play, and associations with moderate-to-vigorous physical activity (MVPA) and energy expenditure. This cross-sectional study assessed playground features with the Play Space Audit Tool; we calculated playability scores from audit data, overall and by domain (general amenities, surface, path, and play structure), from playgrounds in 70 parks in Chicago, Illinois, in 2017. We observed 2,712 individuals during the audits and used the System for Observing Play and Recreation in Communities tool to assess MVPA and energy expenditure. We used generalized estimating equation negative binomial regression to calculate incidence rate ratios for MVPA and mixed effects models to calculate energy expenditure (in kcal/kg/min) associated with playability scores. General amenities and play structure scores were associated with 1.28 (95% CI, 1.08-1.52) and 1.15 (95% CI, 1.00-1.31) times as many individuals (any age) engaged in MVPA, respectively. The general amenities score was significantly associated with 0.51 (95% CI, 0.24-0.79) and 0.42 (95% CI, 0.15-0.68) higher energy expenditure in renovated playgrounds and in all playgrounds, respectively. Overall, general amenities and play structure scores were associated with MVPA and were robust to adjustment for weather, neighborhood socioeconomic characteristics, and crime. These playground playability indices may strengthen future evaluations of community infrastructure for children's physical activity.

Case investigation and contact tracing is a case-based communicable disease mitigation strategy that has been used by public health departments for decades and is being scaled up across the nation to combat the spread of COVID-19.1 Examples of other communicable diseases that are traced include sexually transmitted infections, tuberculosis, measles, and Ebola, among others. Case investigation involves contacting a confirmed case and helping them recall everyone they have been in contact with recently.2 Then exposed individuals are contacted to confidentially warn them of the potential exposure. Contacts are also provided with education, information, and support to understand risks and to know what to do. Case investigation and contact tracing require specialized training, including knowledge about the disease as well as interviewing and interpersonal skills.2,3 These trained professionals are also known as disease intervention (or investigator) specialists.2,3 Before COVID-19, there were 2200 disease intervention specialists employed throughout the country. The current disease intervention specialist workforce primarily comprises public health staff and not necessarily clinical health care professionals.

Objectives. We examined associations between neighborhood demographic characteristics and the availability of commercial physical activity–related outlets by zip code across the United States. Methods. Multivariate analyses were conducted to assess the availability of 4 types of outlets: (1) physical fitness facilities, (2) membership sports and recreation clubs, (3) dance facilities, and (4) public golf courses. Commercial outlet data were linked by zip code to US Census Bureau population and socioeconomic data. Results. Results showed that commercial physical activity–related facilities were less likely to be present in lower-income neighborhoods and in neighborhoods with higher proportions of African American residents, residents with His-panic ethnicity, and residents of other racial minority backgrounds. In addition, these neighborhoods had fewer such facilities available. Conclusions. Lack of availability of facilities that enable and promote physical activity may, in part, underpin the lower levels of activity observed among populations of low socioeconomic status and minority backgrounds.

Although perceptions and uses vary, nature-based health interventions (NBHIs) help facilitate the additional health benefits of physical activity (PA) experienced in nature, thereby reducing all-cause morbidity and mortality. The purpose of this mixed-methods, cross-sectional study was to better understand perceptions, terminology, and participation in NBHIs. A questionnaire was developed by reviewing validated instruments and gauging expert experience with stakeholders. Distributed electronically, a community partner listserv promoting active living served as the population. Quantitative questionnaire measures assessed familiarity with NBHI terms, concepts, experience, how NBHI should be used, and the importance of NBHI components. Qualitative themes included the strengths and weaknesses of NBHIs. Participants (n = 53) were familiar with the terms nature play (82%), forest bathing (78%), and park and nature prescriptions (74%) and moderately familiar with NBHIs (5-point Likert scale, M = 3.27, SD = 1.17). Most thought NBHIs could be useful in treating physical (96%) and mental health conditions (100%) and would follow or write one (80%). The location was reported as the most important component, followed by access, social comfort, dosage, and ongoing support. This study suggests stakeholders are familiar with and support NBHIs conceptually; however, policies, support, and funding opportunities are needed to operationalize components to increase use of NBHIs.

Between 2013 and 2016, the Chicago Park District renovated 327 playgrounds in need of repair across Chicago through a $44 million investment. This study evaluated whether short-term and longer-term impacts of renovations on park use and park-based moderate-to-vigorous physical activity (MVPA) differed by neighborhood income level and neighborhood concentration of Black residents. A total of 39 parks with renovated playgrounds and 39 matched comparison parks with playgrounds that needed repair but not selected for renovation in year 1 were studied. Three waves of observational data were collected at each park: baseline, 12 months post-renovation, and 24 months post-renovation. Difference-in-differences mixed-effects Poisson regression models estimated renovation effects. The effects of renovations differed by the income level and concentration of Black residents in the neighborhoods where parks were located. In low-income neighborhoods, renovations were associated with reductions in park use and park-based MVPA over the longer term. In contrast, renovations were associated with short- and longer-term increases in park use and park-based MVPA in medium-income neighborhoods and with longer-term increases in MVPA in high-income neighborhoods. Renovations were generally not associated with any changes in park use or park-based MVPA in high-percent Black neighborhoods, but they were associated with increased park use and park-based MVPA in low-percent Black neighborhoods. This study suggests playground renovations in Chicago may have had unintended consequences, increasing neighborhood income and racial disparities in park use and park-based MVPA. Future playground renovation efforts may need to allocate more resources for renovating the broader park where in disrepair, more intensely involve neighborhood residents, and employ complementary strategies such as additional park programming to ensure renovations benefit all neighborhoods.

In 2017 the National Recreation and Park Association launched an initiative entitled “Meet Me at the Park: Transforming Parks and Improving Access to Play Spaces.” The purpose of this grant opportunity was to fund innovative and scalable projects that transform parks and improve access to play spaces for kids of all abilities (aged 3-11) and their families in underserved communities. To date, there have been three funding cycles. Each cycle funded a total of 25 park projects (Sample N=75) that were tasked with providing access to renovated play spaces to increase physical activity in the most underserved communities using innovative and scalable solutions. A sample of 24 parks (8 per cycle) were selected for an in-depth evaluation using a pre-post study design. Two primary data collection activities were conducted: 1) collecting systematic observations of play and recreation in communities (SOPARC) pre- and post-renovation of play spaces; and 2) collecting intercept surveys from 32 adults pre- and post-renovation of play spaces. SOPARC results showed significant increases in daily park use (20 vs. 37 visitors on average per day at baseline compared to post-renovation), and a 31.5% increase (p<0.001) in the number of people engaged in moderate to vigorous physical activity (MVPA). Intercept survey results showed a 17.54 percentage point increase in the number of survey participants visiting the park for the first time. There was a 26.73 percentage point increase in the number of respondents stating that the park gave the kids a chance to experience something new and a 19.32 percentage point increase in respondents stating that the child they were with played more since using the park post-renovation. Results of the evaluation show that the investments in play space renovations were positively associated with increased park use, MVPA, and children’s park-based play. This information is important for park and recreation agencies, park and recreation advocates and elected officials to show that high quality, well-maintained parks are essential to improve public health outcomes and use of park spaces.

Purpose: Authorities recommend that schools provide a variety of opportunities for students to obtain physical activity (PA) before, during, and after school. This study assessed the prevalence of several school PA practices - including measures of quantity and quality of physical education (PE) - in elementary schools and examined the associations of PA practices with school resources (PE staffing, training, and facilities). Method: Surveys were obtained from respondents in nationally representative samples of elementary schools from 2009-2010 to 2011-2012 (1,831 schools). Results: Few schools (20.8 percent) provided students with PE class every day, but most (76.3 percent) had an appropriate PE student-to-teacher ratio ((/= 25:1). Many schools (74.0 percent) offered 20 min of recess daily, but fewer than half offered organized opportunities for PA before or after school (e.g., sports). After controlling for demographics and school size, having a full-time PE teacher and requiring PE teachers to obtain PE-related continuing education (CE) were associated with PE practices such as offering )/= 150 min of PE per week (for 3rd-grade students) and testing PE knowledge, skills, and fitness. Required CE was also associated with a higher likelihood of offering PA during the school day (i.e., activity breaks and PA outside of PE class) and before or after the school day (i.e., afterschool PA programs). Conclusion: Few schools offer a broad array of PA programming. However, PE staffing and CE are positively associated with many PA practices including those outside of PE, possibly indicating that PE staff serve a crucial role in promoting a whole-school PA-supportive environment. Verf.-Referat.

Abstract Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce high rates of cardiometabolic conditions. Local zoning codes are a policy and planning tool to create more walkable and bikeable environments. This study evaluated relationships between active living-oriented zoning code environments and cardiometabolic conditions (body mass index, hyperlipidemia, hypertension). The study used county identifiers to link electronic health record and other administrative data for a sample of patients utilizing primary care services between 2012 and 2016 with county-aggregated zoning code data and built environment data. The analytic sample included 7,441,991 patients living in 292 counties in 44 states. Latent class analysis was used to summarize municipal- and unincorporated county-level data on seven zoning provisions (e.g., sidewalks, trails, street connectivity, mixed land use), resulting in classes that differed in strength of the zoning provisions. Based on the probability of class membership, counties were categorized as one of four classes. Linear and logistic regression models estimated cross-sectional associations with each cardiometabolic condition. Models were fit separately for youth (aged 5–19), adults (aged 20–59), and older adults (aged 60+). Little evidence was found that body mass index in youth, adults, or older adults or the odds of hyperlipidemia or hypertension in adults or older adults differed according to the strength of active living-oriented zoning. More research is needed to identify the health impacts of zoning codes and whether alterations to these codes would improve population health over the long term.

Abstract Background: With the continued threat of childhood obesity, many public health intervention efforts focus on school settings. The current study sought to document administrator attitudes regarding obesity and interest in improving relevant school practices (i.e., nutrition and physical activity) in elementary schools. Methods: Mail-back surveys were used to gather data from public and private elementary schools during the 2006–2007, 2007–2008, 2008–2009, and 2010–2011 school years. In each year, a different set of items pertaining to administrator attitudes was included. Numbers of responding schools annually ranged from 259 to 336 private schools, and from 578 to 748 public schools. Results: The vast majority of elementary school administrators (>90%) agreed that schools can play a role in addressing childhood obesity, physical education improves a variety of academic outcomes, and they were interested in improving practices at their school. Concern about childhood obesity and perceiving that schools can play a role in addressing obesity were both associated with more interest in improving school practices. However, only one-third of administrators agreed that parents were interested in participating in improving nutrition and physical activity practices, suggesting opportunities for efforts to improve collaboration. Conclusions: Administrators are generally very supportive of school-based efforts to improve nutrition and physical activity practices and see the value in doing so. Given the amount of time children spend in school, schools are an essential venue for efforts to address childhood obesity.