Objectives: To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviors (acquisition, preparation, and fruit and vegetable (FV) consumption) on youths’ primary caregivers. Design: B’more Healthy Communities for Kids (BHCK), group-randomized, controlled trial, promoted access to healthy food and food-related behaviors through wholesaler and small store strategies, peer-mentor led nutrition education aimed at youth, and social media and text messaging targeting their adult caregivers. Measures included caregivers’ (n=516) self-reported household food acquisition frequency for FV, snacks, and grocery items over 30 days, and usual consumption of FV in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical models assessed average-treatment-effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated the correlation between behavioral change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities. Setting: 30 Baltimore City low-income neighborhoods Subjects: Adult caregivers of youth ages 9–15 years. Results: 90.89% of caregivers were female, average 39.31(± 9.31) years. Baseline mean fruit intake (servings/day) was 1.30(± 1.69) and vegetable was 1.35(± 1.05). In ATE, no significant effect of the intervention was found on caregiver food-related behaviors. In TTE, for each point increase in the BHCK exposure score (range 0–6.9), caregivers increased daily consumption of fruits by 0.2 servings (0.24± 0.11; 95%CI 0.04; 0.47). Caregivers reporting greater exposure to social media tripled their daily fruit intake (3.16± 0.92; 95%CI 1.33; 4.99) and increased frequency of unhealthy food purchasing, compared to baseline. Conclusions: Child-focused community-based nutrition interventions may also benefit family members’ fruit intake. Child-focused interventions should involve adult caregivers and intervention effects on family members should be assessed. Future multilevel studies should consider using social media to improve reach and engage caregiver participants.

Little is known about the mechanisms through which neighborhood-level factors (e.g., social support, economic opportunity) relate to suboptimal availability of healthy foods in low-income urban communities. We engaged a diverse group of chain and local food outlet owners, residents, neighborhood organizations, and city agencies based in Baltimore, MD. Eighteen participants completed a series of exercises based on a set of pre-defined scripts through an interactive, iterative group model building process over a two-day community-based workshop. This process culminated in the development of causal loop diagrams, based on participants’ perspectives, illustrating the dynamic factors in an urban neighborhood food system. Synthesis of diagrams yielded 21 factors and their embedded feedback loops. Crime played a prominent role in several feedback loops within the neighborhood food system: contributing to healthy food being “risky food,” supporting unhealthy food stores, and severing social ties important for learning about healthy food. Findings shed light on a new framework for thinking about barriers related to healthy food access and pointed to potential new avenues for intervention, such as reducing neighborhood crime.

BackgroundActive play and physical activity are important for preventing childhood obesity, building healthy bones and muscles, reducing anxiety and stress, and increasing self-esteem. Unfortunately, safe and accessible play places are often lacking in under-resourced communities. Play Streets (temporary closure of streets) are an understudied intervention that provide safe places for children, adolescents, and their families to actively play. This systematic review examines how Play Streets impact opportunities for children and adolescents to engage in safe active play and physical activity, and for communities and neighborhoods. Methods for evaluating Play Streets were also examined.MethodsA systematic literature review was conducted in Academic Search Complete, CINHAL, PsycINFO, PubMED, Web of Science, and Google Scholar. Peer-reviewed intervention studies published worldwide were included if they were published in English, through December 2017 and documented free-to-access Play Streets or other temporary spaces that incorporated a designated area for children and/or adolescents to engage in active play. Systematic data extraction documented sample, implementation, and measurement characteristics and outcomes.ResultsOf 180 reviewed abstracts, 6 studies met inclusion criteria. Studies were conducted in five different countries (n = 2 in U.S.), using mostly cross-sectional study designs (n = 4). Physical activity outcomes were measured in half of the studies; one used observational and self-report measures, and two used device-based and self-report measures. In general, Play Streets provided safe places for child play, increased sense of community, and when measured, data suggest increased physical activity overall and during Play Streets.ConclusionsPlay Streets can create safe places for children to actively play, with promise of increasing physical activity and strengthening community. Given the popularity of Play Streets and the potential impact for active play, physical activity, and community level benefits, more rigorous evaluations and systematic reporting of Play Streets’ evaluations are needed.

Effective policy change is more likely to improve health when key principles are considered. We outline 4 principles

IMPORTANCE Rural, low-income, and historically underrepresented minority communities face substantial barriers to trauma care and experience high injury incidence and mortality rates. Characteristics of injury incident locations may contribute to poor injury outcomes. OBJECTIVE To examine the association of injury scene characteristics with injury mortality. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, data from trauma center and emergency medical services provided by emergency medical services companies and designated trauma centers in the state of Maryland from January 1, 2015, to December 31, 2015, were geocoded by injury incident locations and linked with injury scene characteristics. Participants included adults who experienced traumatic injury in Maryland and were transported to a designated trauma center or died while in emergency medical services care at the incident scene or in transit. EXPOSURES The primary exposures of interest were geographic characteristics of injury incident locations, including distance to the nearest trauma center, designation level and ownership status of the nearest trauma center, and land use, as well as community-level characteristics such as median age and per capita income. MAIN OUTCOMES AND MEASURES Odds of death were estimated with multilevel logistic regression, controlling for individual demographic measures and measures of injury and health. RESULTS Of the 16 082 patients included in this study, 8716 (52.4%) were white, and 5838 (36.3%) were African American. Most patients were male (10 582; 65.8%) and younger than 65 years (12 383; 77.0%). Odds of death increased by 8.0% for every 5-mile increase in distance to the nearest trauma center (OR, 1.08; 95% CI, 1.01-1.15; P = .03). Compared with privately owned level 1 or 2 centers, odds of death increased by 49.9% when the nearest trauma center was level 3 (OR, 1.50; 95% CI, 1.06-2.11; P = .02), and by 80.7% when the nearest trauma center was publicly owned (OR, 1.81; 95% CI, 1.39-2.34; P < .001). At the zip code tabulation area level, odds of death increased by 16.0% for every 5-year increase in median age (OR, 1.16; 95% CI, 1.03-1.30; P = .02), and decreased by 26.6% when the per capita income was greater than $25 000 (OR, 0.73; 95% CI, 0.54-0.99; P = .05). CONCLUSIONS AND RELEVANCE Injury scene characteristics are associated with injury mortality. Odds of death are highest for patients injured in communities with higher median age or lower per capita income and at locations farthest from level 1 or 2 trauma centers.