The Model Aquatic Health Code (MAHC) from the Centers for Disease Control and Prevention (CDC) provides scientifically based recommendations that state, tribal, local, and territorial (STLT) public health partners can use to ensure healthy and safe experiences in public aquatic venues. Our study aimed to characterize MAHC use and implementation and identify facilitators and barriers to MAHC use across STLT jurisdictions. A mixed-methods approach was used, combining a web-based survey with virtual focus groups that included public health professionals from STLT health departments working on aquatic venue safety, regulation, and inspection. In total, 88 participants from 35 STLT health departments completed the survey that was distributed to 13,887 recipients via CDC-administered and nongovernmental listservs. In total, 47 (53%) respondents reported using the MAHC to justify existing code, 34 (39%) to provide guidance for sections not covered in their code, and 31 (35%) to grant code exceptions. Further, 13 (15%) respondents reported they frequently incorporate or have adopted the MAHC in full, and 34 (39%) reported they do not incorporate the MAHC but are considering incorporating the MAHC into code. Facilitators to MAHC use included the need for updated regulations, political will, and collaboration. Barriers included slow regulatory processes, resource constraints, and insufficient staff training. MAHC users indicated that an up-to-date MAHC provides flexibility for jurisdictions to adopt or reference it to best fit jurisdictional needs. Overall, MAHC use varies, and a multifactorial approach beyond code adoption might be needed to measure MAHC use. Moreover, implementation and adoption tracking support could improve MAHC use. Respondents generally agreed that the MAHC should be kept up-to-date, but that future update cycles could extend beyond every 3 years.

Background: Cleaning practices and hand hygiene are important behaviors to prevent and control the spread of infectious disease, especially in congregate settings. This project explored hygiene- and cleaning-related experiences in shelters serving people experiencing homelessness (PEH) during May–June 2020 of the COVID-19 pandemic. Methods: We conducted qualitative, in-depth interviews by phone with 22 staff from six shelters in Atlanta, Georgia. The interview guide included questions about cleaning routines, cleaning barriers and facilitators, cleaning promotion, hand hygiene promotion, and hand hygiene barriers and facilitators. We analyzed interview transcripts using thematic analysis. Results: Multiple individuals, such as shelter individuals (clients), volunteers, and staff, played a role in shelter cleaning. Staff reported engaging in frequent hand hygiene and cleaning practices. Barriers to cleaning included staffing shortages and access to cleaning supplies. Staff reported barriers (e.g., differing perceptions of cleanliness) for clients who were often involved in cleaning activities. Barriers to hand hygiene included limited time to wash hands, forgetting, and inconvenient handwashing facilities. Specific guidance about when and how to clean, and what supplies to use, were requested. Conclusion: During the early months of the COVID-19 pandemic, shelters serving PEH in the Atlanta-metro area needed resources and support to ensure sufficient staffing and supplies for cleaning activities. As part of future pandemic planning and outbreak prevention efforts, shelters serving PEH could benefit from specific guidance and training materials on cleaning and hand hygiene practices.

Objective: Each year, an estimated 12.5 million children under age 5 utilize early childhood education (ECE) facilities. States have developed licensing regulations to ensure the safe operation of facilities, including requirements related to sanitation and hygiene practices. This study aimed to evaluate sanitation- and hygiene-related practices included in ECE regulations to assess their alignment with best practices outlined in Caring for Our Children National Health and Safety Performance Standards (CFOC). Methods: CFOC standards were reviewed, and 42 sanitation- and hygiene-related practices were identified. These recommended practices fell into five categories: toileting, diapering, cleaning, hand hygiene, and general hygiene. State regulations for all 50 US states were compared with recommended best practices from CFOC. Using a standardized codebook, two coders independently reviewed each state regulation and assessed how well it aligned with recommended best practices from CFOC using a 4-point Likert Scale (1 – Not addressed, 2 – Somewhat addressed, 3 – Mostly addressed, 4 – Fully addressed). Results: Across all sanitation and hygiene standards evaluated, 64% of standards were scored somewhat, mostly, or fully addressed in state ECE regulations, with 7% of standards scored as fully addressed. Standards in the diapering, toileting, and cleaning category were scored somewhat, mostly, or fully addressed more often compared to standards in the general hygiene and hand hygiene category. Conclusions: Few state ECE regulations fully addressed recommended sanitation and hygiene practices. As state regulations are updated, future studies can compare and evaluate licensing regulations alignment to recommended best practices for safe and hygienic operation of facilities.

BACKGROUND:Shigellosis is diarrheal disease caused by highly infectious Shigella bacteria. Shigella can spread in multiple ways, including sexual contact. Gay, bisexual, and other men who have sex with men are particularly at risk for shigellosis. METHODS:To evaluate the acceptability of 3 Centers for Disease Control and Prevention-developed behavioral recommendations for the prevention of sexually transmitted shigellosis, virtual in-depth interviews were conducted among 26 gay or bisexual men in March to May 2021. RESULTS:Participants had a median age of 25 years; 65% were non-Hispanic White, 12% were Hispanic White, 12% Asian, 4% Hispanic Black, and 8% multiracial/other. Respondents indicated willingness to engage in certain prevention behaviors (e.g., washing hands, genitals, and anus before and after sex), but were less willing to engage in behaviors that were viewed as outside social norms or difficult to practice (e.g., dental dams for oral-anal contact; latex gloves for fingering or fisting). Respondents thought recommendations may be more feasible if knowledge of shigellosis was greater; however, some perceived that the severity of shigellosis is low and did not warrant the effort of engaging in prevention behaviors. CONCLUSIONS:Educational efforts to increase awareness of shigellosis and other enteric diseases spread through sexual contact are needed and public health practitioners should consider the acceptability of how realistic it is for individuals to engage in certain prevention behaviors. Rather than recommending behaviors that do not have buy-in, it may be more efficacious to focus recommendations on adopting behaviors reported as acceptable to the target audience.

We identified fifty-one peer-reviewed studies that geospatially analyzed the relationship between the community nutrition environment (CNE) and obesity. Eighty percent of studies found at least one significant association between the CNE and obesity. However we calculated the proportion of studies that found at least one significant association between the CNE and obesity in the expected direction for each food store type and measurement technique, and the proportion across the different store types and measurement techniques was just 32 %. Different methods for classifying, locating, and analyzing food stores produced mixed results and challenged direct study level comparison.

Background: Despite the continued growth of Health Impact Assessment (HIA) in the US, there is little research on HIA capacity-building. A comprehensive study of longer-term training outcomes may reveal opportunities for improving capacity building activities and HIA practice.Methods: We conducted in-depth interviews with HIA trainees in-the United States to assess their outcomes and needs. Using a training evaluation framework, we measured outcomes across a spectrum of reaction, learning, behavior and results.Results: From 2006 to 2012, four organizations trained over 2200 people in at least 75 in-person HIA trainings in 29 states. We interviewed 48 trainees, selected both randomly and purposefully. The mean duration between training and interview was 3.4 years. Trainees reported that their training objectives were met, especially when relevant case-studies were used. They established new collaborations at the trainings and maintained them. Training appeared to catalyze more holistic thinking and practice, including a range of HIA-related activities. Many trainees disseminated what they learned and engaged in components of HIA, even without dedicated funding. Going forward, trainees need assistance with quantitative methods, project management, community engagement, framing recommendations, and evaluation.Conclusions: The research revealed opportunities fora range of HIA stakeholders to refine and coordinate training resources, apply a competency framework and leverage complimentary workforce development efforts, and sensitize and build the capacity of communities. Published by Elsevier Inc.

Many people fail to achieve recommended levels of physical activity. Neighborhood parks serve as locations in which physical activity often occurs, and walking to parks provides added opportunity for leisure-time activity. The authors examine environmental characteristics of shortest pedestrian routes to parks to determine how route walkability affects park use. Using an objective environmental audit, the authors found that routes of park users were measurably more walkable than those of nonpark users and that each unit increase in total walkability score associated with a 20% increase in the likelihood of walking to the park, controlling for education and route length (odds ratio = 1.20; 95% confidence interval = [1.07, 1.34]). The most significant elements measured included route distance, traffic, neighborhood maintenance, street maintenance, safety, and aesthetics. Pedestrian scale environmental characteristics are associated with individuals’ use of neighborhoods for physical activity. Understanding these relationships can contribute to evidence-based design interventions to increase physical activity.

Let's go to the park today! This familiar phrase is heard routinely throughout the year in many U.S. households. Access to parks, trails, open spaces, and recreational facilities not only provides increased opportunities for children and adults to play and be physically active, but these venues also influence other behaviors. As the health and wellbeing of our children are impacted by the daily environment in which they live, learn, and play, the use of parks and other recreation spaces as a healthful venue is important to consider in a comprehensive view of childhood and family obesity prevention. This article briefly summarizes some of the obesity-related benefits of parks across the local, state, and national park systems and highlights specific initiatives as examples of the commitment by park agencies to benefit the public's health and play a role in obesity and chronic disease prevention.

Objective. To determine the associations between household motor vehicle ownership and weight status among Colombian adults.Methods. Secondary analysis of data from the 2005 Demographic and HealthSurvey of Colombia. Height, weight and waist circumference were objectively measured in 49,079 adults, ages 18 to 64 that resided in urban settings. Abdominal obesity was defined as a waist circumference >80 cm in women and >90 cm in men.Results. Prevalence was 19.9% for motor vehicle ownership in household, 33.1% for BMI between 25 and 29.9 kg/m(2), 14.4% for BMI>30 kg/m(2), and 46% for abdominal obesity. Males reporting any household motor vehicle ownership were more likely to be overweight or obese, and to have abdominal obesity (p for gender*exposure variables interaction=<0.001).Conclusions. Household motor vehicle ownership is associated with overweight, obesity, and abdominal obesity among Colombian men but not women. (C) 2009 Elsevier Inc. All rights reserved.

Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions. We identified 14 randomized controlled trials, which tested interventions specifically targeting and assessing walking behavior. Results show that among self-selected samples, intensive interventions can increase walking behavior relative to controls. Brief telephone prompts appear to be as effective as more substantial telephone counseling. Although more research is needed, individual studies support prescriptions to walk 5-7 versus 3-5 d.wk and at a moderate (vs vigorous) intensity pace, with no differences in total walking minutes when single or multiple daily walking bouts are prescribed. Mediated interventions delivering physical activity promotion materials through non-face-to-face channels may be ideal for delivering walking promotion interventions and have shown efficacy in promoting overall physical activity, especially when theory-based and individually tailored. Mass media campaigns targeting broader audiences, including those who may not intend to increase their physical activity, have been successful at increasing knowledge and awareness about physical activity but are often too diffuse to successfully impact individual behavior change. Incorporating individually tailored programs into broader mass media campaigns may be an important next step, and the Internet could be a useful vehicle.

In Brief • This commentary describes model programs that can be disseminated across the country to assist in improving public health by enhancing the positive impacts and reducing the negative impacts of the built environment.

BACKGROUND:In this article, we examine the possibility of reducing time to conduct traffic volume audits through (1) reducing time for manual traffic counting and (2) using Department of Transportation (DOT) information. METHODS:In audits of 824 road segments in 2 West Virginia (WV) communities, manual traffic counts were recorded for 1, 2, and 5 min in duration. Annual Average Daily Traffic (AADT) was calculated from counts. Available AADT from DOT was also collected. Percent agreement and a weighted kappa were calculated between 5-min count and 1- and 2-min count AADT categories and between 5-min count and DOT AADT categories. RESULTS:One- and 2-min counts produced identical AADT categories as 5-min counts in 93.4% and 95.0% of segments, respectively. Weighted kappa was 0.79 (95% CI = 0.74-0.85) and 0.85 (95% CI = 0.80-0.89), respectively. Forty-two segments (5.1%) had DOT data. CONCLUSIONS:DOT AADT was available for a small percentage of road segments assessed. The high agreement between AADT categories produced by 1- and 2-min counts and 5-min counts makes it reasonable to consider using 1- or 2-min manual traffic counts if time or staffing constraints make it necessary. Possible generalizability of this methodology to other communities, particularly larger urban and suburban areas, will require further research.

OBJECTIVES:To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions.METHODS:Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999-2007. Key characteristics of each HIA were abstracted from published and unpublished sources.RESULTS:Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented.CONCLUSIONS:These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.

Background:This study examined if the environmental variables related to transportation walking were related to leisure-time walking.Methods:The sample (N = 452) was 71% female, 79% Hispanic, age 42 ± 17 y, and moderately acculturated. The data was analyzed with multiple stepwise regression.Results:For the entire sample, total time spent walking was related to higher socioeconomic status (SES) (P = 0.02; R2 = 0.06), walking frequency was related to fewer barriers (P = 0.03; R2 = 0.07), and walking duration was related to higher SES (P = 0.02), better health (P = 0.40), fewer barriers (P = 0.02), and living in a residential area (P = 0.04; R2 = 0.08). Among regular walkers, total time spent walking was related to older age (P = 0.03) and fewer physical activity facilities (P = 0.04; R2 = 0.11). Walking frequency was related to older age (P = 0.02), fewer facilities (P = 0.04), and living in a commercial neighborhood (P = 0.02; R2 = 0.11).Conclusions:Most of the variables that influence transportation walking were not related to leisure-time walking. Land use had differential impacts on walking depending on the sample examined.

OBJECTIVE:The current study examined the relationships among built environment, physical activity, and body mass index (BMI) in a primarily Hispanic border community in El Paso, TX. METHODS:Data from a 2001 community-wide health survey were matched to environmental data using geocoding techniques in ARC VIEW software. A total of 996 adults were surveyed by phone and 452 were successfully geocoded. RESULTS:The sample was 71% female, 79% Hispanic, 42 +/- 17 years old, moderately acculturated, and had socioeconomic status (SES) levels of semi-skilled workers. Increasing BMI was related to less moderate intensity physical activity (P = 0.05), higher SES (P = 0.0003), worse overall health (P = 0.0004), and living in areas with greater land-use mix (less residential; P = 0.03). The relationship between overall health and BMI was in part mediated by higher numbers of barriers to physical activity in those with poor health, which lead to a decrease in moderate physical activity. These variables explained 20% of the variance in BMI. CONCLUSIONS:This is one of the first studies to find a positive relationship between land-use mix and BMI in a predominantly Hispanic, low-income community. The positive association between BMI and land-use mix may be due to the inclusion of individual SES as a controlling variable in the analyses, suggesting that SES may have a differential effect on how the built environment influences BMI in low- to moderate-income minority communities.

Connecting Public Health and Planning Professionals: Health Impact Assessment Candace D. Rutt, Michael Pratt, Andrew L. Dannenberg, and Brian L. Cole Over the last few years there has been a resurgence of interest in how the built environment affects people’s health. One potential tool for moving beyond theory in this area is health impact assessment (HIA). HIA can be used to evaluate the public-health impacts of a policy or project before it is implemented or built. One interesting aspect of the 2004 EDRA/Places award- winning project “Incremental Urbanism: The Auto and Pedestrian Reconsidered in Greyfield Reclamation” (Michael Gamble and W. Jude LeBlanc, Places, Vol. 16, No. 3, pp. 18-21) was its advocacy of public health as a salient reason to initiate redevelopment planning for a bypassed area of suburban Atlanta, Georgia — the Buford Highway Corridor. Taking this work a step further, the Centers for Disease Control and Prevention (CDC), along with the University of California at Los Angeles, the Robert Wood Johnson Foundation, and the Center for Quality Growth and Regional Development at the Geor- gia Institute of Technology, have begun a health impact assessment of the plan’s proposals. Among other things, the Buford Highway HIA aims to produce quantitative estimates of expected increases in physical activity and decreases in injury as a result of rede- velopment, as well as qualitative estimates of its effects on air and noise pollution, traffic, social capital, crime, safety, economic development, and gentrification. A cost-effec- tiveness analysis of redeveloping Buford Highway from a societal perspective is also being conducted by CDC and an actuarial firm. 1 Developments in the Field Recently, there has been a growing interest in the use of HIA in the U.S. The Robert Wood Johnson Foundation along with the CDC held an international conference in October 2004 to advance development of HIA methods. 2 In 2003, special issues of the American Journal of Public Health and the American Journal of Health Promotion were dedicated to exploring the interaction between the built environment and health. The American Planning Asso- ciation and the National Association of County and City Health Officials have also held a number of symposia and conferences on improving collaboration between their respective disciplines. Finally, the National Institutes of Health and the CDC have launched a major research fund- ing initiative on obesity and the built environment. 3 One potential benefit of HIA is to bring public-health issues to the attention of decision-makers in areas where they may not have been considered before. For instance, HIA could be incorporated during plan review for new developments; public-health officials evaluating traditional water and sewer concerns might make recommendations, such as for increased walkability, that could lead to in- creased physical activity and reductions in chronic diseases. 4 HIA also has the potential to involve community members in decisions concerning proposed projects and policies, and thus gain their support and help reduce the NIMBY (not-in-my-backyard) phenomenon. Similar to an EIA HIA is commonly defined as “a combination of pro- cedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” 5 In some ways, HIA may be thought of as similar to environmental impact assessment (EIA). However, EIA reports are mandated, and focus on defined outcomes such as air and water quality. By contrast, HIAs can be voluntary and focus on more wide-ranging concerns such as obesity, physical inactivity, asthma, injuries, and social equity. 6 Numerous HIAs have been performed in Europe, Canada and elsewhere. Several countries’ experiences with HIA have been documented in a new book, Health Impact Assessment. 7 Additional resources are available at the Health Impact Assessment Gateway. 8 So far, research indicates that HIAs can succeed in pro- moting health-related change to the built environment. Successful efforts include HIAs for the Finningley Airport, and for Edinburgh’s urban transportation strategy (reduc- ing air and noise pollution; reducing health disparities). 9 However, other HIAs, such as the “Health of Londoners Transportation Strategy,” have had little or no impact. 10 Several factors may influence the success of an HIA. Among these are involvement and interest of responsible decision-makers; involvement and political will of affected communities; timeliness; congruence between the health impacts examined and prevailing social and political con- cerns; and credibility and scientific objectivity of those completing the HIA. Applicability in the U.S. If HIAs are to become useful in the U.S., various chal- lenges will need to be addressed. Among the technical difficulties that may arise is a lack of data to make quantita- tive estimates and barriers to communicating across dis- ciplines. 11 HIAs may also encounter political resistance if they are presented late in the planning process, or if impor- tant decision-makers are unaware of them. There can also Rutt, Pratt, Dannenberg, Cole / Health Impact Assessment

Overall Discussion 10:50 AM - 11:00 AM