Community Usage and Physical Activity on a School Shared Use Path: Impact of Promotion, Programming, and Renovations

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Description
Ensuring access to safe and affordable recreational spaces is vital for promoting well-being, especially in underserved communities facing barriers to physical activity. Shared use agreements, where school facilities are open for public use, offer a promising solution; yet limited research…

Ensuring access to safe and affordable recreational spaces is vital for promoting well-being, especially in underserved communities facing barriers to physical activity. Shared use agreements, where school facilities are open for public use, offer a promising solution; yet limited research has examined how to maximize usage of these spaces. Framed under Social Cognitive Theory in a socioecological model, this dissertation comprises three studies contributing to this knowledge base to foster active, healthy communities. The first study was a scoping review of usage and physical activity behavior in school shared use spaces, highlighting the potential of shared use agreements to promote physical activity, especially when they included organized activities or space renovations. The study underscores the need for robust evaluations, gender- and population-sensitive interventions, and community engagement to maximize impact. The second study, adopting a pre/post, cross-sectional approach, assessed the impact of a multicomponent intervention on perceptions and usage of a school shared use path in South Phoenix (AZ). No statistically significant changes in usage were observed over time; however, access was a significant predictor of usage. Gender (female, negative) and safety perceptions (positive) were also identified as salient predictors of usage. The findings highlight the critical role of awareness (i.e., perceived access) in enhancing usage of school shared use spaces. The third study was a longitudinal natural experiment, with observational assessments of usage and related physical activity on one school shared use path over 12 months at an elementary school in South Phoenix (AZ). Moderate increases in usage over time were attributed to promotional efforts, social programming, and environmental modifications. Most users (>70%) of the path were observed walking, and were male, Hispanic, and adult. The study suggests that demographic disparities may exist. Implementing broader engagement strategies and understanding safety perceptions may facilitate more representative usage. Collectively, this dissertation provides a comprehensive evaluation of the potential of school shared use spaces to promote physical activity, while underscoring the importance of understanding complex factors influencing the usage of these spaces. Ultimately, the findings contribute knowledge to enhancing the usage of school shared use spaces, adding to the literature on their significance in promoting physical activity and community health, particularly in underserved regions.
Date Created
2024
Agent

Association between Community Eligibility Provision and Student Weight Outcomes: A Longitudinal Analysis

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Description
The U.S. Department of Agriculture’s (USDA) National School Lunch Program and School Breakfast Program provide nutritious meals to school-age children. USDA’s Community Eligibility Provision (CEP) is designed to extend the reach of these programs by allowing schools in low-income areas…

The U.S. Department of Agriculture’s (USDA) National School Lunch Program and School Breakfast Program provide nutritious meals to school-age children. USDA’s Community Eligibility Provision (CEP) is designed to extend the reach of these programs by allowing schools in low-income areas to provide free school meals to all students at no cost to families. CEP has been shown to increase school meal participation, nutritional intake, academic achievement, and attendance in previous research studies. This study aims to examine the impact of long-term CEP participation on student weight outcomes. Nurse-measured height and weight data for school years 2013-14 to 2019-20 were collected from 141 K-12 public schools in four low-income cities. School-level prevalence of obesity was calculated from students’ heights and weights using the Centers for Disease Control and Prevention protocol. CEP participation for each school year was obtained from the state Department of Education. Schools in the sample began participating in CEP at different times yielding varying numbers of years of CEP exposure over the study period. Multivariable analyses examined the relationship between school CEP exposure and the prevalence of obesity, controlling for school-level covariates. Multivariable analyses showed that for every additional year of CEP participation, the school-level prevalence of obesity was 0.4% lower (p=0.018). The regression-adjusted obesity prevalence for schools that never participated in CEP was 28.0%, while the obesity prevalence for schools with 6 years of CEP participation was 25.4%. The lower prevalence of obesity in CEP-participating schools was primarily driven by elementary schools. These results suggest that the benefits of CEP participation can cumulate over time, significantly reducing school-level obesity prevalence over time.
Date Created
2024
Agent

FINDING-Food: Frequent Informational Nudges Directing Individuals to Needed Goods. A Food Insecurity Intervention.

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Description
Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often…

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food, which may include inadequate finances, transportation, skills, and information. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of hunger, nutritional deficiencies, and chronic disease among vulnerable populations. This dissertation tested a novel food insecurity intervention using informational nudges to promote food security through the elimination of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity. The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group. Qualitative findings revealed how the intervention group found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.
Date Created
2023
Agent

Dual Participation in SNAP and WIC: Household Characteristics and Barriers and Facilitators to Participation

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Description

In 2020, approximately 55% of households facing food insecurity participated in one or more of the three largest federal nutrition assistance programs. Food insecurity rates have been relatively unchanged since 2019 but federal nutrition assistance programs have continued to see…

In 2020, approximately 55% of households facing food insecurity participated in one or more of the three largest federal nutrition assistance programs. Food insecurity rates have been relatively unchanged since 2019 but federal nutrition assistance programs have continued to see a decline in participation. Many families meet the income guidelines to participate in both the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) programs, yet almost half of those participants are not utilizing WIC. The WIC program is an essential safety net for low-income families to combat food insecurity and improve diet quality. The purpose of this study was to examine differences in household characteristics among families participating in SNAP only and households participating in both SNAP and WIC. Additionally, we examined potential barriers and facilitators to participating in WIC among WIC-eligible SNAP participants. Hispanics made up 40% of SNAP Only households and about 65% of SNAP and WIC. Households with a larger number of beneficiaries and those with an infant in the household were more likely to participate in both SNAP and WIC. The main barriers identified by respondents previously enrolled in WIC were a lack of knowledge regarding WIC eligibility and issues with appointments. The two most common misconceptions regarding WIC eligibility were being unaware that simultaneous enrollment in both programs was allowable, and being unaware that household members were still eligible for WIC services. For the facilitators toward WIC enrollment, more than half of respondents knew to enroll in WIC when they needed nutrition or breastfeeding assistance. Results from this study suggest the need for targeted outreach campaigns that highlight the possibility and benefits of dual participation in SNAP and WIC. Understanding how SNAP can increase enrollment in WIC demonstrates to policymakers the benefits of streamlining the certification process.

Date Created
2023
Agent

Examining Associations Between Participation in the Supplemental Nutrition Assistance Program (SNAP) and Dietary Behaviors: A Longitudinal Analysis

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Description
The Supplemental Nutrition Assistance Program (SNAP) participants have been shown to have worse dietary behaviors compared to eligible non-participants. It is suggested that individuals who self-select into SNAP have unhealthy diets prior to program participation. This study examined the association…

The Supplemental Nutrition Assistance Program (SNAP) participants have been shown to have worse dietary behaviors compared to eligible non-participants. It is suggested that individuals who self-select into SNAP have unhealthy diets prior to program participation. This study examined the association between low-income adults’ SNAP participation status and dietary behaviors over time. A sample of households from low-income high-minority cities were surveyed at baseline (T1) and 2-4 years later (T2). Analyses were restricted to adults with household income < 200% of the federal poverty line (n=338). Participants were grouped into the four following categories: Long-term (n=171): SNAP participation at T1 and T2; Previous (n=47): SNAP participation at T1 but not T2; Current (n=38): SNAP participation at T2 but not T1; and Never (n=132): no SNAP participation at T1 or T2. Self-reported daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and snacks were measured through self-reports. To observe dietary differences based on SNAP participation status, T2 behaviors of all groups were compared to those of the Never group. To observe dietary differences prior to SNAP participation, T1 behaviors were compared between Current and Never groups. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between Never and Current participants providing no evidence of self-selection of unhealthy households into SNAP. Only marginal differences were found between SNAP participation status and dietary behaviors at T2. Improvements in SNAP participants’ diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.
Date Created
2023
Agent

Macy Young Honors Thesis Defense.pdf

Date Created
2023-05
Agent

The Effect of the COVID-19 Pandemic on the Fertility of Women in Reproductive Ages:
Cross-sectional Study

Description

Background: Recent studies have shown a decline in birth rates in large metropolitan areas (after accounting for population), which can be possibly explained by barriers to reproduction associated with the COVID-19 pandemic and related lockdowns. Objective: This study’s objective was…

Background: Recent studies have shown a decline in birth rates in large metropolitan areas (after accounting for population), which can be possibly explained by barriers to reproduction associated with the COVID-19 pandemic and related lockdowns. Objective: This study’s objective was to investigate the impact of the COVID-19 pandemic and related lockdowns on the fertility rates of women in reproductive ages living in Greater Phoenix. Methods: The total number of inpatient births and people in both Maricopa and Pinal Counties during pre-COVID-19 years (2017-2019) were compared with those during the COVID-19 years (2021) among women in reproductive ages (15-49 years). To make age-specific comparisons, women in reproductive years were divided into eight distinct age group categories (15-17, 18-20, and then five year age group categories to age 49) from which age-specific, general, and total fertility rates were calculated. Results: Using a two-sample z-test for difference in proportions, findings revealed that the general fertility rate in Greater Phoenix had significantly declined from 48 to 46 per 1,000 population from the pre-COVID-19 period to COVID-19 period (P<0.001). Two sample z-tests were also used to compare age-specific fertility rates, which revealed a significant decline in the fertility rate in women ages 15-17 (from 8.0/1000 to 5.0/1000) (P<0.001), 18-20 (from 43.0/1000 to 35.0/1000) (P<0.001), and 21-24 (from 79.0/1000 to 68.0/1000) (P<0.001) from the pre-COVID-19 period to COVID-19 period, while no significant change was observed in the fertility rate in women ages 25-49. Conclusions: The observed general fertility decline in Greater Phoenix as a result of the COVID-19 pandemic poses significant implications for further research on barriers to reproduction brought upon by the COVID-19 pandemic and related lockdown measures. Another direction for further research involves possibly continuing this study to include years 2022 and 2023 in the COVID-19 period, as well as calculating age-specific fertility rates by race.

Date Created
2023-05
Agent

Healthy school meals for all in Arizona: A comprehensive assessment of benefits, cost scenarios, and community perspectives

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Description

We surveyed a diverse group of Arizona residents, including over 2,300 parents of school-age children and nearly 1,300 members of the school community, consisting of teachers, lunchroom staff, school administrators,and other school employees. Respondents represented a wide range of racial, economic, educational, and political backgrounds.

Agent

Healthy school meals for all in Arizona: A comprehensive assessment of benefits, cost scenarios, and community perspectives

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Description

We surveyed a diverse group of Arizona residents, including over 2,300 parents of school-age children and nearly 1,300 members of the school community, consisting of teachers, lunchroom staff, school administrators,and other school employees. Respondents represented a wide range of racial, economic, educational, and political backgrounds.

Agent
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