Sandy Slater

Context & Objective: Written a decade ago, the 2015 Rural Active Living: A Call to Action (published in 2016) described rural-specific efforts in the fields of active living and physical activity (PA) and identified 8 recommendations to guide rural active living research and practice. Given that rural populations continue to experience a higher burden of PA-related chronic health conditions, the objective of this review was to revisit the 8 Rural Active Living Calls to Action, reassess the evidence base, summarize advances in each area, and identify emerging areas that warrant examination or further study. Methods: We leveraged expertise from researchers and practitioners within the CDC-funded Physical Activity Policy Research and Evaluation Network Rural Active Living Workgroup and reviewed literature published since the original call to action. Teams were formed for each of the original 8 calls to action. Each team reviewed the literature, synthesized findings, and developed recommendations for future research. Results: Academic and practice-based progress was evident across multiple of the original calls to action. Despite these findings, the need persists for rural-specific national surveillance data scaled to small geographies (census tract and block group) that accounts for differences within and across rural communities, various forms of rural governance, and how these factors interplay with active living opportunities. Six emerging areas of research (best practices, social issues, COVID-19 effects, collaboration, implementation science, and implications of rural health-related funding changes) are discussed and warrant further study. Conclusions: In summarizing progress since the original Call to Action, we recommend strategies to continue advancing rural active living and identify emerging focus areas.

Context: Despite evidence supporting the role of the built environment in promoting physical activity, there is limited guidance on how to implement recommended built environment changes at the local level. Objectives: The objective of this project was to develop a compilation of implementation strategies that hold promise for aiding communities in implementing built environment changes that support active transportation and leisure-time physical activity, titled “Expert Consensus for Local Implementation of Physical Activity Policy, Systems, and Environment (ECLIPPSE).” Design: A modified Delphi Technique using 3 web-based survey rounds was conducted from 2024 to 2025. Setting: A multidisciplinary national expert panel was recruited to participate in this online panel. Participants: The panel consisted of 23 professionals with expertise in the implementation of built environment changes to support physical activity at the local level. Main Outcome Measure: The Round 1 and 2 surveys utilized a rating process to establish a compilation of potentially promising strategies for aiding communities in implementing physical activity-supportive built environment changes. The Round 3 survey involved rating these strategies on potential feasibility and impact and endorsing the final compilation. Results: Fifty-five strategies emerged in 2 broad domains. The first domain, “Get Ready,” included 4 categories: (1) Partnerships and collaboration (5 strategies); (2) staffing (5 strategies); (3) training and education (4 strategies), and (4) interactive assistance (2 strategies). The second domain, “Take Action,” included 6 categories: (1) Data and community informed prioritization (6 strategies); (2) evaluative (8 strategies); (3) community awareness and demand (8 strategies); (4) engagement with decision-making processes (5 strategies); (5) funding (7 strategies); and (6) pilots or demonstration projects (5 strategies). The final compilation was endorsed by 95% of respondents. Conclusions: The ECLIPPSE strategies can be used to aid implementation of built environment changes at the local level to support physical activity.

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.

Background: In April 2016, the City of Chicago implemented an ordinance restricting the sale of all flavored (including menthol) tobacco products (FTPs), including electronic cigarettes, at retailers located within 500 feet of any public, private, or alternative elementary, middle (“primary”), or high (“secondary”) school. We examined changes in retail availability of FTPs from before to after policy implementation among policy-affected retailers compared with retailers not subject to the policy. Method: Observational data were collected in June to September 2015 (Wave 1; pre-policy) and November to December 2016 (Wave 2; post-policy) from a panel of 194 randomly selected policy-area stores (located within 500 feet of a school), and a panel of 199 randomly selected comparison-area stores (located more than 500 feet from a school). Using generalized estimation equation regression, we assessed differences in FTP availability changes across study areas. Results: We observed a statistically significant policy effect on FTP availability (Area × Wave interaction, p < .05); however, more than half of policy-area retailers continued to display at least one FTP after policy implementation (87.11% at Wave 1, 57.73% at Wave 2, p < .05). Similar reductions were seen for the availability of flavored cigarillos/little cigars and menthol cigarettes, while policy effects varied across store types. Discussion: FTP availability reductions appear to be associated with policy implementation, but FTPs remained readily available at retailers subject to the policy. This study contributes to the evidence base indicating that policies with exclusions or exemptions for certain flavors, products, store types, or retailer locations have a limited effect on retail availability of FTPs.

This commentary highlights a number of health disparities associated with neighborhood built environments, an important public health social determinant of health. Based on the background information provided in the article many of the issues current...

Background: Head Start serves over 1 million diverse low-income preschool children and is an ideal setting for developing and implementing obesity prevention efforts, which is expected to have positive impacts on behavior as youth age. This study examined how regional- and state-level Head Start offices have supported implementation of the recently updated physical activity (PA) requirement within the teaching and learning environment Head Start Program Performance Standard (1302.31). Methods: Key informant telephone interviews were conducted with 8 regional- and 36 state-level Head Start representatives. Interviews were recorded and professionally transcribed. Data were coded and analyzed using constant comparative methods in ATLAS.ti (version 8). Audit trails were maintained, and disagreements in codes were discussed and resolved among coders. Results: The following 3 overarching themes emerged: communication, resources and technical assistance, and challenges. Results showed variation in respondent knowledge regarding the Standards. Although regional contacts provide technical assistance, state-level contacts have many information sharing strategies for programs. Implementation challenges included the need for frequent professional development opportunities given staff turnover and low PA competency, and additional PA curricula. Conclusion: Findings can help identify existing or potential strategies that could be adopted more widely or developed to assist Head Start programs incorporate PA into daily activities.

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.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Introduction: Pedestrian-oriented zoning and land use policies are being used by local jurisdictions as tools to implement population-level built environmental changes to create more walkable communities. There is a paucity of evidence examining whether these policies lead to actual changes in the built environment. We used Google Street View (GSV), an established, less expensive, alternative built environment data collection method, to conduct an exploratory pilot study of 19 jurisdictions to examine associations between variations in the presence of these adopted zoning policies and their corresponding specific street-level built environment features. Methods: Samples of 10 large and 9 small jurisdictions (18 municipalities and 1 county) were purposively selected on the basis of the presence of activity-friendly zoning policy provisions (sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, trails/paths, bike lanes, bike parking, and other items). Corresponding activity-friendly street-level built environment measures were constructed using GSV. Street segments in these jurisdictions were sampled using ArcGIS and stratified by type (residential and arterial) and income (high, medium, and low). Results: A total of 4363 street segments were audited across the 19 sampled jurisdictions. Results show significant differences in the presence of activity-friendly street features when the corresponding zoning policy element was addressed in New Urbanist zones/districts in the site's zoning code (eg, crosswalks, 24.48% vs 16.18%; and bike lanes, 12.60% vs 7.14%). Street segments in the middle- and high-income block groups were less likely to have activity-friendly features than low-income segments, except bike lanes. Conclusions: Results show that having activity-friendly policy provisions embedded in a jurisdiction's (municipality/county) zoning codes was associated with a greater presence of the corresponding built environmental street feature on the ground. Results suggest that the methods tested in this article may be a useful policy tool for local governments to identify high need areas that should be prioritized for built environment improvements.