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Brandy S. Cowell, Christine A. Rosenbloom, Robert Skinner and Stephanie H. Summers

Iron deficiency is the most prevalent nutritional deficiency in the United States. This condition has been reported to affect 60% of female athletes. The Centers for Disease Control and Prevention emphasize screening for anemia in women of childbearing age. The purpose of this study was to determine the number of National Collegiate Athletic Association (NCAA) Division I-A schools that implement screening for iron deficiency in female athletes as well as the screening policies for those who do. A link to an online survey was sent to 94 NCAA Division I-A schools to determine current practices concerning screening and treating female athletes for iron deficiency. There was a 58% response rate. Frequencies for each response were computed. Forty-three percent of responding institutions report screening female athletes for iron deficiency. This study suggests that screening for iron deficiency in female athletes at NCAA Division I-A schools is not a routine procedure and, for those who do screen, variability exists in the criteria for diagnosis, as well as in treatment protocols. Standard protocols for assessment and treatment of iron deficiency in female athletes need to be developed and implemented.

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Ariane Bélanger-Gravel, Lise Gauvin, Daniel Fuller and Louis Drouin

Background:

Favorable public opinion and support for policies are essential to favor the sustainability of environmental interventions. This study examined public perceptions and support for active living policies associated with implementing a public bicycle share program (PBSP).

Methods:

Two cross-sectional population-based telephone surveys were conducted in 2009 and 2010 among 5011 adults in Montréal, Canada. Difference-in-differences analyses tested the impact of the PBSP on negative perceptions of the impact of the PBSP on the image of the city, road safety, ease of traveling, active transportation, health, and resistance to policies.

Results:

People living closer to docking stations were less likely to have negative perceptions of the effect of the PBSP on the image of the city (OR = 0.5; 95% CI, 0.4−0.8) and to be resistant to policies (OR = 0.8; 95% CI, 0.6−1.0). The likelihood of perceiving negative effects on road safety increased across time (OR = 1.4; 95% CI, 1.2−1.8). Significant interactions were observed for perceptions of ease of traveling (OR = 0.5; 95% CI, 0.4−0.8), active transportation (OR = 0.6; 95% CI, 0.4−1.0), and health (OR = 0.6; 95% CI, 0.4−0.8): likelihood of negative perceptions decreased across time among people exposed.

Conclusion:

Findings indicate that negative perceptions were more likely to abate among those living closer to the PBSP.

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Jacqueline Kerr, James F. Sallis, Neville Owen, Ilse De Bourdeaudhuij, Ester Cerin, Takemi Sugiyama, Rodrigo Reis, Olga Sarmiento, Karel Frömel, Josef Mitáš, Jens Troelsen, Lars Breum Christiansen, Duncan Macfarlane, Deborah Salvo, Grant Schofield, Hannah Badland, Francisco Guillen-Grima, Ines Aguinaga-Ontoso, Rachel Davey, Adrian Bauman, Brian Saelens, Chris Riddoch, Barbara Ainsworth, Michael Pratt, Tom Schmidt, Lawrence Frank, Marc Adams, Terry Conway, Kelli Cain, Delfien Van Dyck and Nicole Bracy

Background:

National and international strategies to increase physical activity emphasize environmental and policy changes that can have widespread and long-lasting impact. Evidence from multiple countries using comparable methods is required to strengthen the evidence base for such initiatives. Because some environment and policy changes could have generalizable effects and others may depend on each country’s context, only international studies using comparable methods can identify the relevant differences.

Methods:

Currently 12 countries are participating in the International Physical Activity and the Environment Network (IPEN) study. The IPEN Adult study design involves recruiting adult participants from neighborhoods with wide variations in environmental walkability attributes and socioeconomic status (SES).

Results:

Eleven of twelve countries are providing accelerometer data and 11 are providing GIS data. Current projections indicate that 14,119 participants will provide survey data on built environments and physical activity and 7145 are likely to provide objective data on both the independent and dependent variables. Though studies are highly comparable, some adaptations are required based on the local context.

Conclusions:

This study was designed to inform evidence-based international and country-specific physical activity policies and interventions to help prevent obesity and other chronic diseases that are high in developed countries and growing rapidly in developing countries.

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Thomas Quarmby and Katie Pickering

Background:

It is argued that regular engagement in physical activity (PA) has the potential to mitigate the negative health and educational outcomes that disadvantaged children living in care frequently face. However, little is currently known about children in care’s participation in PA. This scoping review primarily aimed to identify barriers and facilitators to PA participation for children in care.

Methods:

The main phases of the scoping review were 1) identifying relevant studies; 2) selecting studies based on predefined inclusion criteria; 3) charting the data; and 4) collating, summarizing, and reporting the results. All relevant studies were included in the review regardless of methodological quality and design.

Results:

The 7 articles that met the inclusion criteria were published between 1998 and 2013 and conducted in the USA (3), England (2), and Norway (2). A social ecological model was incorporated to map results against levels of influence.

Conclusions:

Various factors influence PA engagement for children in care. Barriers include low self-efficacy, instability of their social environment, which impacts on schooling and maintaining friendship groups, and, specific institutional practices and policies that may prevent access to PA. Before fully considering policy implications, further research with children in care is warranted in this area.

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Sonja Kahlmeier, Francesca Racioppi, Nick Cavill, Harry Rutter and Pekka Oja

Background:

There is growing interest in “Health in All Policies” approaches, aiming at promoting health through policies which are under the control of nonhealth sectors. While economic appraisal is an established practice in transport planning, health effects are rarely taken into account. An international project was carried out to develop guidance and tools for practitioners for quantifying the health effects of cycling and walking, supporting their full appraisal.

Development Process:

A systematic review of existing approaches was carried out. Then, the products were developed with an international expert panel through an extensive consensus finding process.

Products and Applications:

Methodological guidance was developed which addresses the main challenges practitioners encounter in the quantification of health effects from cycling and walking. A “Health Economic Assessment Tool (HEAT) for cycling” was developed which is being used in several countries.

Conclusions:

There is a need for a more consistent approach to the quantification of health benefits from cycling and walking. This project is providing guidance and an illustrative tool for cycling for practical application. Results show that substantial savings can be expected. Such tools illustrate the importance of considering health in transport policy and infrastructure planning, putting “Health in All Policies” into practice.

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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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Alfred Ruetten, Annika Frahsa, Luuk Engbers, Narcis Gusi, Jorge Mota, Rimantas Pacenka, Jens Troelsen, Jana Vasickova and Anne Vuillemin

Background:

A multilevel theoretical framework of physical activity (PA) promotion that addresses supportive environments, PA behavior, community action, and PA promoting policies is related to research and development in an international comparative study.

Methods:

Most-different and most-similar case selection was applied to data from 8 European Union Member States. Data from semistructured key informant qualitative interviews, focus group interviews with experts and policy-makers, as well as document analysis were linked to corresponding Eurobarometer data.

Results:

The framework on the interplay of environment, PA behavior, community action and policies appears to be working across most different countries. Comprehensive systems of PA infrastructures are interlinked with relatively high levels of PA prevalence. These countries implement comprehensive national policies on PA promotion and show a positive perception of related local governments’ engagement. Less comprehensive systems of infrastructures interplay with lower levels of PA prevalence, less community action and fewer policies. Differences between similar cases are linked to country-specific contexts.

Conclusions:

Framework application and comparative analysis indicates how to relate theory to empirical research and complex data sets. In-depth analysis of country-specific contexts and longitudinal observation on changes within and between countries might advise on how to integrate the framework into intervention research.

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Mary B. Waterman and Patience H. White

The Environmental and Policy Strategies to Increase Physical Activity Among Adults with Arthritis report focuses on the ways to make physical activity more convenient and accessible for adults with arthritis. The report is designed to engage 6 important sectors, which were adapted from the National Physical Activity Plan, as partners with a mutual interest in increasing physical activity among adults with arthritis using environmental and policy strategies. It serves as a call to action for each of these sectors to collaborate and focus more attention on helping people live well with arthritis and be a productive part of our society.

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Kelly R. Evenson, Fang Wen, Sarah M. Lee, Katie M. Heinrich and Amy Eyler

Background:

A Healthy People 2010 developmental objective (22-12) was set to increase the proportion of the nation's public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours. The purpose of this study was to describe the prevalence of indoor and outdoor facilities at schools and the availability of those facilities to the public in 2000 and 2006.

Methods:

In 2000 and 2006, the School Health Policies and Programs Study (SHPPS) was conducted in each state and in randomly selected districts, schools, and classrooms. This analysis focused on the school level questionnaire from a nationally representative sample of public and nonpublic elementary, middle, and high schools (n = 921 in 2000 and n = 984 in 2006).

Results:

No meaningful changes in the prevalence of access to school physical activity facilities were found from 2000 to 2006, for youth or adult community sports teams, classes, or open gym.

Conclusions:

These national data indicate a lack of progress from 2000 and 2006 toward increasing the proportion of the nation's public and private schools that provide access to their physical activity facilities for all persons outside of normal school hours.

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Ana Henderson and Christine R. Fry

Background:

Improving parks in low income and minority neighborhoods may be a key way to increase physical activity and decrease overweight and obesity prevalence among children at the greatest risk. To advocate effectively for improved recreation infrastructure, public health advocates must understand the legal and policy landscape in which public recreation decisions are made.

Methods:

In this descriptive legal analysis, we reviewed federal, state, and local laws to determine the authority of each level of government over parks. We then examined current practices and state laws regarding park administration in urban California and rural Texas.

Results:

We identified several themes through the analysis: (1) multiple levels of governments are often involved in parks offerings in a municipality, (2) state laws governing parks vary, (3) local authority may vary substantially within a state, and (4) state law may offer greater authority than local jurisdictions use.

Conclusions:

Public health advocates who want to improve parks need to (1) think strategically about which levels of government to engage; (2) identify parks law and funding from all levels of government, including those not typically associated with local parks; and (3) partner with advocates with similar interests, including those from active living and school communities.