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Meghan McGurk and Jay Maddock

Background:

Obesity and lack of physical activity are major public health problems in the United States. Well-designed, active living communities (ALCs) can help support physically active lifestyles. This study assessed attitudes of Hawaii decision makers in 2007 and 2013 to determine if priorities toward ALCs changed.

Methods:

Elected and appointed state and county officials were mailed surveys both years. Respondents rated the importance of 23 specified problems, which included 1 obesity variable and 5 ALC variables.

Results:

The survey was completed by 126 (70.4%) respondents in 2007 and 117 (60.9%) in 2013. Among the specific problems, only obesity increased in rank from 14th to ninth place. Three variables fell more than 2 places: increasing traffic (fifth to seventh place), poorly planned development and sprawl (seventh to 11th place) and pedestrian safety (12th to 17th place). The other 2 stayed relatively the same: lack of pedestrian walkways, sidewalks, and crosswalks (16th to 15th place) and lack of recreational activities (22nd to 23rd place).

Conclusions:

Across years, obesity concerns have increased but do not appear to be tied to increases in concern for ALC variables. More education for policymakers on the link between obesity, physical activity, and the built environment is necessary.

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Katie M. Heinrich, Jay Maddock and Adrian Bauman

Background:

Despite clear health benefits of physical activity, previous research has been limited in linking knowledge of physical activity recommendations to actual behavior.

Methods:

Using Expectancy Theory, we examined whether an individual’s health outcome expectancies from physical activity might provide the missing link between knowledge and behavior. With data from a cross-sectional survey, we assessed differences between how much moderate physical activity people thought they needed for health benefits compared with what they thought experts recommended and the relationship of these differences to physical activity behaviors.

Results:

Our hypothesis that people with positive health outcome expectancies would report more minutes of physical activity than those with neutral or negative health outcome expectancies was supported for all self-reported physical activity behaviors (P < .001).

Conclusions:

It appears that the health outcome expectancy of needing more physical activity than recommended by experts is correlated with achieving more physical activity, regardless of type. Future research should address health outcome expectancies as a way to impact physical activity.

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Opal Vanessa Buchthal, Nicole Taniguchi, Livia Iskandar and Jay Maddock

Background:

Physical inactivity is a growing problem in the United States, one that is being addressed through the development of active living communities. However, active living promotion requires collaboration among organizations that may not have previously shared goals.

Methods:

A network analysis was conducted to assess Hawaii’s active living promotion network. Twenty-six organizations playing a significant role in promoting active living in Hawaii were identified and surveyed about their frequency of contact, level of collaboration, and funding flow with other agencies.

Results:

A communication network was identified linking all agencies. This network had many long pathways, impeding information flow. The Department of Health (DOH) and the State Nutrition and Physical Activity Coalition (NPAC) were central nodes, but DOH connected state agencies while NPAC linked county and voluntary organizations. Within the network, information sharing was common, but collaboration and formal partnership were low. Linkages between county and state agencies, between counties, and between state agencies with different core agendas were particularly low.

Conclusions:

Results suggest that in the early stages of development, active living networks may be divided by geography and core missions, requiring work to bridge these divides. Network mapping appears helpful in identifying areas for network development.

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Jay E. Maddock, Bill Reger-Nash, Katie Heinrich, Kevin M. Leyden and Thomas K. Bias

Background:

The U.S. Community Guide to Preventive Services strongly recommends changes in urban design, land use and accessibility to increase physical activity. To achieve these goals, policy change is often needed. This study assessed attitudes of decision makers in Hawaii to determine if physical activity related issues are among their priorities.

Methods:

State and county officials (n = 179) were mailed surveys. Respondents listed the three most important problems (open-ended) in Hawaii and rated the importance of 23 specified problems, of which six directly related to physical activity.

Results:

The survey was completed by 126 (70.4%) respondents. The most frequently mentioned categories for the open-ended questions were affordable housing, environment/sustainability, sprawl/traffic/population growth, and healthcare. Among the closed-ended physical activity related items, increasing traffic was ranked highest (43.9%) and fourth overall. Less than 12% of decision makers rated other physical activity issues as important.

Conclusions:

Future work is needed to increase the visibility and importance of physical activity related issues among policymakers.

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Katie M. Heinrich, Nancee N. Aki, Heidi Hansen-Smith, Mark Fenton and Jay Maddock

Background:

Policy changes were needed to reshape the built environment for active transportation.

Methods:

Using the social ecological model as a framework, the Healthy Hawaii Initiative worked with a contractor to develop a series of meetings, planning sessions, and workshops. Activities spanned 22 months between 2007 and 2009, and involved multiple stakeholders, including educational outreach for legislators and collaborative planning sessions with advocates.

Results:

Ultimately, with the help of the contractor to initiate the process, Complete Streets and Safe Routes to School (SRTS) legislation were introduced January 2009. Advocacy groups monitored bill progress, testified at hearings, and assisted in rewording the bills. The SRTS statute required the Department of Transportation (DOT) to administer the federal SRTS funds and the complete streets law tasked the state and county DOTs to adopt complete streets policies and review existing highway design standards and guidelines. Both bills were signed into law June 2009.

Conclusions:

Focusing efforts at multiple levels of the social ecological model involving champions and key stakeholders led to the successful passage of legislation supporting active transportation. Tracking policy implementation and evaluation over time will help determine actual impact on active transportation behaviors across Hawaii.

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Amy Eyler, Jamie Chriqui, Jay Maddock, Angie Cradock, Kelly R. Evenson, Jeanette Gustat, Steven Hooker, Rodney Lyn, Michelle Segar, Nancy O’Hara Tompkins and Susan G. Zieff

Background:

In the United States, health promotion efforts often begin with state-level strategic plans. Many states have obesity, nutrition, or other topic-related plans that include physical activity (PA). The purpose of this study was to assess PA content in these state plans and make recommendations for future plan development.

Methods:

Publically available plans were collected in 2010. A content analysis tool was developed based on the United States National PA Plan and included contextual information and plan content. All plans were double coded for reliability and analyzed using SPSS.

Results:

Forty-three states had a statewide plan adopted between 2002 and 2010, none of which focused solely on PA. Over 80% of PA-specific strategies included policy or environmental changes. Most plans also included traditional strategies to increase PA (eg, physical education, worksite). Few plans included a specific focus on land use/community design, parks/recreation, or transportation. Less than one-half of plans included transportation or land use/community design partners in plan development.

Conclusions:

Though the majority of states had a PA-oriented plan, comprehensiveness varied by state. Most plans lacked overarching objectives on the built environment, transportation, and land use/community design. Opportunities exist for plan revision and alignment with the National PA Plan sectors and strategies.

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Ross C. Brownson, Cheryl M. Kelly, Amy A. Eyler, Cheryl Carnoske, Lisa Grost, Susan L. Handy, Jay E. Maddock, Delores Pluto, Brian A. Ritacco, James F. Sallis and Thomas L. Schmid

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.