Background Observational audits are commonly used in public health research to collect data on built environment characteristics that affect health-related behaviors and outcomes, including physical activity and weight status. However, implementing in-person field audits can be expensive if observations are needed over large or geographically dispersed areas or at multiple points in time. A reliable and more efficient method for observational audits could facilitate extendibility (i.e., expanded geographic and temporal scope) and lead to more standardized assessment that strengthens the ability to compare results across different regions and studies. Purpose To evaluate the degree of agreement between field audits and audits derived from interpretation of three types of omnidirectional imagery. Methods Street segments from St. Louis and Indianapolis were geographically stratified to ensure representation of neighborhoods with different socioeconomic characteristics in both cities. Audits were conducted in 2008 and 2009 using four methods: field audits, and interpretation of archived imagery, new imagery, and Google Street View imagery. Agreement between field audits and image-based audits was assessed using observed agreement and the prevalence-adjusted bias-adjusted kappa statistic (PABAK). Data analysis was conducted in 2010. Results When measuring the agreement between field audits and audits from the different sources of imagery, the mean PABAK statistic for all items on the instrument was 0.78 (archived), 0.80 (new) and 0.81 (Street View imagery), indicating substantial to nearly perfect agreement among methods. Conclusions Image-based audits represent a reliable method that can be used in place of field audits to measure several key characteristics of the built environment important to public health research.

Background Afterschool programs (ASPs) are an important setting in which to promote children’s physical activity. This study examines the association of environmental and policy characteristics on the moderate-to-vigorous physical activity (MVPA) and sedentary behavior of children attending ASPs. Methods A total of 1,302 children attending 20 ASPs across South Carolina wore accelerometers (ActiGraph GT3X+) for up to 4 non-consecutive days. Policy-level characteristics were evaluated using the Healthy Afterschool Program Index-Physical Activity (HAPI-PA) scale. Physical activity space was measured using a measuring wheel (indoor, ft2) and GIS (outdoor, acres). The structure (free-play or organized) of activity opportunities, was evaluated via direct observation. Time spent in MVPA and sedentary, both indoors and outdoors, was estimated using accelerometry. Results For every 5000ft2 of utilized indoor activity space an additional 2.4 and 3.3 minutes/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 minutes/day and 10.0 minutes/day, respectively). For every one acre of outdoor activity space used, an additional 2.7 minutes/day of MVPA was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor MVPA for boys and girls (4.4 and 3.4 minutes/day increase, respectively). Policy characteristics were unrelated to MVPA levels and time spent sedentary. Conclusion Findings indicate that policies and the size of activity space had limited influence on MVPA and sedentary behavior, suggesting that programmatic structure may be a more effective option to improve MVPA levels of children attending ASPs.

To date, few studies have examined the relationship between cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) in populations at high risk for developing cardiovascular disease (CVD).PurposeTo examine the association between objectively measured CRF and physical and mental components of HRQoL in a Uruguayan cohort at risk for developing CVD.MethodsPatient data records from 2002–2012 at the Calidad de Vida Center were examined. To assess CRF, participants performed a submaximal exercise test. During the evaluation, participants also completed the SF-36, a HRQoL measure comprised of eight dimensions that are summarized by physical and mental component scores (PCS and MCS, respectively). ANCOVA was used to examine the relationship between HRQoL dimensions and CRF. Logistic regression was then used to compare the odds of having a HRQoL component score above the norm across CRF. All analyses were performed separately for males and females with additional stratified analyses across age and BMI conducted among significant trends.ResultsA total of 2,302 subjects were included in the analysis. Among females, a significant relationship was observed between CRF and vitality, physical functioning, physical role, bodily pain, and general health dimensions. However, for males the only dimension found to be significantly associated with CRF was physical health. After adjusting for potential confounders, a significant linear trend (p<0.001) for PCS scores above the norm across CRF levels was observed for females only.ConclusionAmong females with one or more risk factors for developing CVD, higher levels of CRF were positively associated with the vitality and physical dimensions of HRQoL, as well as the overall PCS. However, among males the only dimension associated with CRF was physical functioning. Future studies should examine this relationship among populations at risk for developing CVD in more detail and over time.

Background: In order to improve our understanding of the relationship between the built environment and physical activity, it is important to identify associations between specific geographic characteristics and physical activity behaviors.Purpose: Examine relationships between observed physical activity behavior and measures of the built environment collected on 291 street segments in Indianapolis and St. Louis.Methods: Street segments were selected using a stratified geographic sampling design to ensure representation of neighborhoods with different land use and socioeconomic characteristics. Characteristics of the built environment on-street segments were audited using two methods: in-person field audits and audits based on interpretation of Google Street View imagery with each method blinded to results from the other. Segments were dichotomized as having a particular characteristic (e.g., sidewalk present or not) based on the two auditing methods separately. Counts of individuals engaged in different forms of physical activity on each segment were assessed using direct observation. Non-parametric statistics were used to compare counts of physically active individuals on each segment with built environment characteristic.Results: Counts of individuals engaged in physical activity were significantly higher on segments with mixed land use or all non-residential land use, and on segments with pedestrian infrastructure (e.g., crosswalks and sidewalks) and public transit.Conclusion: Several micro-level built environment characteristics were associated with physical activity. These data provide support for theories that suggest changing the built environment and related policies may encourage more physical activity.

The impact of policies, systems, and environments on physical activity behavior, and subsequently fitness and health, has been clearly established. Advocacy efforts aimed at active living policies, systems, and environmental changes to improve population health often fail. However, advocating for active living policies to improve national security may prove more promising, particularly with legislators. Results from this study demonstrate how certain states, previously identified for their disproportionate public health burden, are also disproportionately burdensome for military readiness and national security.