This report addresses three important issues around active living and how planning, health and governmental agencies are addressing active living in their spheres of influence. Initially the report uses a literature review to determine if research shows that characteristics of the physical environment influence active lifestyle choices and behaviors. This review also includes whether state and local governments and non-profit agencies are incorporating active lifestyle goals in important planning and policy decisions affecting the local physical and natural environment. The literature review supports links between the physical environment and active living but does not establish a causal link. Regarding the question of whether state and local governments and non-profit agencies are incorporating active lifestyle goals in important planning and policy decisions, the research reveals that there is a low level of inclusion of health goals within planning efforts. The body of work in this report is focused on understanding the level of knowledge and the degree of cooperation among local actors around active living issues in Texas. The report explores this question through a survey targeted at public and non-profit organizations that have the potential to influence conditions supporting active lifestyles in Texas communities. While this survey and results focus on Texas communities, given the breadth of the responses, the results are likely applicable outside Texas. The research found collaboration around active living in Texas was widespread among the departments and organizations represented by the survey. Many communities have implemented active living programs or projects, however, most communities have not completed active living assessments to prioritize active living needs. Funding was the most important factor in addressing barriers to active living. Other important factors in addressing these barriers included education, sample policies and programs, best practices and case studies, and access to local experts and community groups. Strong community support and local government leadership were the most important factors in creating an environment that supports active learning. / text

The Pedestrian is compromised in the majority of our built landscapes. Today's dominant fixture is the automobile. Pedestrian and automobile efficiency are in direct competition with each other; to facilitate one is to inhibit the other. Pedestrian functionality depends on the presence of walkable destinations, commonly referred to as multi-use areas. Pedestrian functionality is an important issue because sprawl, the current development norm, is reaching the physical limits of the countryside. Density is the positive alternative to issues we encounter as a result of low density such as increased runoff, pollution, congestion, obesity, physical inactivity, and road rage. â The alternative to sprawl is simple and timely: neighborhoods of housing, parks and schools placed within walking distance of shops, civic services, jobs and transit — a modern version of the traditional town.â 1 Improving pedestrian functionality has the ability to impact multiple aspects of our lives and improve the quality of life we experience. â We need communities that are occupied full time and that provide a world of opportunity for kids, communities that support women and men in their efforts to weave together an ever more complex life of home and work.â 2 1 Calthorpe, Peter, p. 16 2 Duany, Andres, p. 25 / Master of Landscape Architecture

Purpose To describe outcomes of community partnerships for promoting healthy active living among families with young children in the ReadNPlay for a Bright Future Project. Methods ReadNPlay for a Bright Future was developed through grant support from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee AAP Chapter. ReadNPlay is a coordinated, multi-level, multi-component initiative promoting healthy active living among families with young children during infant-toddler health supervision visits and in childcare and other community settings. The project site is located in rural southern Appalachia, an area of the country with a high prevalence of obesity. Materials and messages developed by the project team were finalized during a community forum with stakeholders held in Northeast Tennessee in fall 2012. Four themes emerged as a focus for the initiative: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. Partnerships with the regional children's hospital, childcare providers, health department, public libraries, and farmers' markets were supported through on-going communication via email, social media, and individual meetings. Availability of two $750 pediatric resident mini-grants and structure afforded by the residency program's existing community pediatrics rotation facilitated development and implementation of community initiatives for this project. Results Project posters displayed in community settings, use of social media, and periodic community events are reinforcing efforts to promote healthy active living in the clinical setting. A new event for families with infants/toddlers was added to the children's hospital annual Kids Run, involving over 120 families during the first year. Walk N' Rollers received free Reach Out and Read books and were surprised at the sugar content of juice and other beverages displayed in sippy cups as part of a “Sugar Quiz.” Information disseminated through regional child care centers will promote participation in a summer Walk N' Roll program in addition to this annual event. At a regional childcare provider conference, ReadNPlay workshops with over 100 infant-toddler teachers and 40 families were conducted and information on Tennessee's “Gold Sneaker” designation for compliance with state nutrition and physical activity policies was shared (only 6% of local centers are designated). During summer 2013, 75 families are being provided with $10 farmers' market vouchers at their 12-15 month well child visit to encourage consumption of fruits and vegetables. 18-month statistics on social media reach, walking program participation, new Gold Sneaker designations, and farmers' market program participation will be presented. Conclusion This presentation will illustrate how pediatric residency programs and practitioners may partner with existing community organizations and initiatives to promote healthy active living in families with young children.

Purpose To describe: (1) development of ReadNPlay for a Bright Future with community stakeholders, (2) integration of a novel communicative tool, the ReadNPlay Baby Book, into infant-toddler well child visits, and (3) use of a quality improvement approach to monitor progress in promoting healthy active living in families with young children. Methods ReadNPlay for a Bright Future is funded by a grant from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee Chapter of the AAP. The setting for this project is in rural southern Appalachia, a U.S. region with a disproportionately high prevalence of obesity. During a community forum held in Northeast Tennessee in fall 2012, community stakeholders provided feedback to help finalize project materials and messages developed by the project team around four themes: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. A behavioral health consultant (BHC) assisted with provider training in brief motivational interviewing and behavioral counseling and project implementation in the clinic. An anonymous mothers' survey was designed to identify opportunities for improving behaviors and monitor progress in promoting healthy active living during well child visits. Process measures and feedback will be obtained from provider surveys and focus groups with parents and providers. Results As of February 2013, the ReadNPlay Baby Book is being provided to families starting at the newborn visit. The book contains age-appropriate guidance and areas for parents to record their baby's growth, milestones, eating habits, favorite books, and activities between birth and 18 months. Families are receiving small incentives for bringing it to each well child visit. A companion Healthy Active Living Tips booklet encourages healthy behaviors in the whole family. Use of social media, posters, and periodic community events provide reinforcement. A total of 80 mothers with infants 9-24 months of age are completing anonymous surveys during well child visits every 4-6 months (mostly Caucasian, 70% WIC recipients). Baseline surveys with mothers of younger infants (9-12 months of age) suggest: 60% of mothers are reading or looking at books with their infants on most days of the week; 80% of infants watch at least 30 minutes of television and 48.7% drink juice on a typical day; 82% of infants were ever-breastfed; 20% of mothers had sought care for their infants due to an injury; and 13.2% of infants routinely bed-share. Over 80% of all mothers wished that they themselves could get more exercise. Conclusion ReadNPlay for a Bright Future is using novel communication tools, community partnerships, and quality improvement methodology to encourage healthy active living during infant-toddler well child visits

Studies have shown that the rising rate of adverse physical, social and mental conditions are tightly related to a lack of physical activity, poor eating habits, and the lack of social interaction. Unlike health problems centuries ago which were often caused by lethal diseases, the contemporary health problems in the United States relate to peoples' lifestyles and built environments. Vehicle-oriented community design has caused limited physical activity and unhealthful eating habits that increase obesity and other related health problems. Modern built environments often unintentionally discourage social interactions and present unintended obstacles to physical activities which causes social and mental health problems. This thesis is an attempt to address some of the issues related to improving community design for better community health outcomes via a better design on the built environment. Specifically, this thesis is a case study in the Burlington neighborhood, a low income urban area in Knoxville, Tennessee. I test how design may the issues mentioned above. Following the WHO's definition of health, which is ``a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.'' This thesis therefore addresses the issue of human health by focusing upon two things. The first thing is to improve the physical health. This includes providing access for pedestrians and bicyclists, access to healthy food and places to exercise. The second focus is to improve social and mental health by providing recreation areas for socialization and refreshing mental health. Unlike the traditional public health approach that relies upon medical interventions, this thesis posits the preventive efforts by utilizing spaces close to people's dwelling places.

Most Canadian adults do not meet recommended levels of physical activity; this phenomenon has persisted for many years and is associated with health concerns and chronic disease. These trends appear to affect Canadian Armed Forces (CAF) personnel who have heightened mandates around physical activity. CAF operational mandates combined with these trends highlight the importance of addressing divides between expectation and reality. Traditionally the CAF has used approaches targeted to individuals to manage activity levels; however, there have been no studies exploring the relationship between the environment and activity levels among CAF personnel which has the potential to affect far more people. This dissertation examined built environments where CAF personnel live and explored the relationship between the built environment and active living among CAF personnel. There are two studies in this work. The first study developed a scale with and for the CAF and used this to examine the built environments where CAF personnel live. The results indicated a factor solution and demonstrated good-to-strong psychometric properties. Among the environments, it highlighted areas of strength and potential areas of improvement. These findings contribute to a better understanding of the built environments where CAF personnel live. The second study used data from several sources at individual and neighbourhood levels to conduct a hierarchical linear model analysis to explore the relationship between the built environment and physical activity among CAF personnel. The findings revealed information about the different relationships between active living (measured by physical activity level) of CAF personnel and individual and neighbourhood characteristics. The findings in this dissertation provide novel evidence about the relationship of the built environment and active living among CAF personnel. The aim of this research was to provide evidence and information to decisionmakers that serves to meaningfully contribute to the pursuit of the overall health and wellbeing of CAF members. The findings provided meaningful information to help guide and inform Canadian Forces Morale and Welfare Services (CFMWS) policy, programming, and resource decisions that affect CAF personnel.

Indiana University-Purdue University Indianapolis (IUPUI) / Research on the association between health and the built environment often delineates environmental exposure using different spatial forms and distances surrounding points of interest, such as residences or schools. Examples from the literature include Euclidian and network buffers, administrative and census boundaries, and other arbitrary geographies, such as grid cells. There is a lack, however, of reports that describe the justifications or implications for using different methods. This research compares different forms and distances for measuring environmental variables surrounding residential locations in the context of adult walking behavior in Marion County, Indiana. Walkability index and vegetation greenness variables were evaluated within 400-meter, 1-kilometer, and 2-kilometer Euclidian and network buffers, census block groups and tracts, and 805- X 805-meter grid cells. Results of analyses using each of these methods to test walkability and greenness as correlates of self-reported walking behavior were compared. Significant differences were observed in measurements of environmental variables as a function of both size and form. There were also significant differences between spatial measure methods when measuring components of walkability and NDVI. Census geographies, widely used in the public health literature, yielded environmental variable measurements differently than did similarly-sized residence-based measure methods. In logistic regressions, the walkability index did not exhibit a significant relationship with self-reported walking behavior. NDVI exhibited a negative relationship with self-reported walking, although the relationship was reversed and significant when stratifying by residential density.

Purpose To describe: (1) development of ReadNPlay for a Bright Future with community stakeholders, (2) integration of a novel communicative tool, the ReadNPlay Baby Book, into infant-toddler well child visits, and (3) use of a quality improvement approach to monitor progress in promoting healthy active living in families with young children. Methods ReadNPlay for a Bright Future is funded by a grant from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee Chapter of the AAP. The setting for this project is in rural southern Appalachia, a U.S. region with a disproportionately high prevalence of obesity. During a community forum held in Northeast Tennessee in fall 2012, community stakeholders provided feedback to help finalize project materials and messages developed by the project team around four themes: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. A behavioral health consultant (BHC) assisted with provider training in brief motivational interviewing and behavioral counseling and project implementation in the clinic. An anonymous mothers’ survey was designed to identify opportunities for improving behaviors and monitor progress in promoting healthy active living during well child visits. Process measures and feedback will be obtained from provider surveys and focus groups with parents and providers. Results As of February 2013, the ReadNPlay Baby Book is being provided to families starting at the newborn visit. The book contains age-appropriate guidance and areas for parents to record their baby’s growth, milestones, eating habits, favorite books, and activities between birth and 18 months. Families are receiving small incentives for bringing it to each well child visit. A companion Healthy Active Living Tips booklet encourages healthy behaviors in the whole family. Use of social media, posters, and periodic community events provide reinforcement. A total of 80 mothers with infants 9-24 months of age are completing anonymous surveys during well child visits every 4-6 months (mostly Caucasian, 70% WIC recipients). Baseline surveys with mothers of younger infants (9-12 months of age) suggest: 60% of mothers are reading or looking at books with their infants on most days of the week; 80% of infants watch at least 30 minutes of television and 48.7% drink juice on a typical day; 82% of infants were ever-breastfed; 20% of mothers had sought care for their infants due to an injury; and 13.2% of infants routinely bed-share. Over 80% of all mothers wished that they themselves could get more exercise. Conclusion ReadNPlay for a Bright Future is using novel communication tools, community partnerships, and quality improvement methodology to encourage healthy active living during infant-toddler well child visits.

Purpose To describe outcomes of community partnerships for promoting healthy active living among families with young children in the ReadNPlay for a Bright Future Project. Methods ReadNPlay for a Bright Future was developed through grant support from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee AAP Chapter. ReadNPlay is a coordinated, multi-level, multi-component initiative promoting healthy active living among families with young children during infant-toddler health supervision visits and in childcare and other community settings. The project site is located in rural southern Appalachia, an area of the country with a high prevalence of obesity. Materials and messages developed by the project team were finalized during a community forum with stakeholders held in Northeast Tennessee in fall 2012. Four themes emerged as a focus for the initiative: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. Partnerships with the regional children's hospital, childcare providers, health department, public libraries, and farmers' markets were supported through on-going communication via email, social media, and individual meetings. Availability of two $750 pediatric resident mini-grants and structure afforded by the residency program's existing community pediatrics rotation facilitated development and implementation of community initiatives for this project. Results Project posters displayed in community settings, use of social media, and periodic community events are reinforcing efforts to promote healthy active living in the clinical setting. A new event for families with infants/toddlers was added to the children's hospital annual Kids Run, involving over 120 families during the first year. Walk N' Rollers received free Reach Out and Read books and were surprised at the sugar content of juice and other beverages displayed in sippy cups as part of a “Sugar Quiz.” Information disseminated through regional child care centers will promote participation in a summer Walk N' Roll program in addition to this annual event. At a regional childcare provider conference, ReadNPlay workshops with over 100 infant-toddler teachers and 40 families were conducted and information on Tennessee's “Gold Sneaker” designation for compliance with state nutrition and physical activity policies was shared (only 6% of local centers are designated). During summer 2013, 75 families are being provided with $10 farmers' market vouchers at their 12-15 month well child visit to encourage consumption of fruits and vegetables. 18-month statistics on social media reach, walking program participation, new Gold Sneaker designations, and farmers' market program participation will be presented. Conclusion This presentation will illustrate how pediatric residency programs and practitioners may partner with existing community organizations and initiatives to promote healthy active living in families with young children.

Canada’s obesogenic environment is host to the advironment, which bombards children with advertisements for soft drinks, fast foods, confectionary, cereals and savory snacks (‘the Big 5’). Television is the primary media outlet used by advertisers to promote the Big 5 to the widest range of Canadian children. A recent trend in commercial marketing is to portray the Big 5 products in a physical activity, exercise or sport context, described here as Healthy Active Living Marketing. This study was designed to explore the relationships between Healthy Active Living Marketing and children and caregivers’ eating and physical activity perceptions and behaviors. Four caregiver-child dyads from communities of York Region, Ontario consented to collect family food receipts, complete commercial activity worksheets, one-on-one interviews and a caregiver questionnaire. A combination of descriptive statistics, content analyses and thematic analyses revealed caregiver control plays a significant role in the appropriateness of eating perceptions and behaviours.