BACKGROUND AND OBJECTIVES:The aims of this study were to (1) Examine how families access health information; (2) Explore community perceptions of the role, purpose, and expectations of health agencies; and (3) Assess the perceptions of how well local public and private agencies make services accessible to diverse families. METHODS:We evaluated families' perceptions of public health programs and services through 25 semi-structured interviews that were conducted in October 2022. Inductive thematic coding was used to analyze the interviews. RESULTS:We identified the following themes: Objective 1- Families wanted more personalized sources of information, less fragmentation of information, and increased promotion of health information in family friendly spaces (e.g. libraries, schools, and churches); Objective 2- families were unsure of the different roles and responsibilities of the health department and nonprofits; Objective 3- participants felt that both sectors could increase their awareness of different family structures as well as cultural values of minorities by increasing staff cultural competency and creating culturally sensitive environments. CONCLUSIONS:This study emphasizes the importance of tailoring health information to families, promoting in family friendly spaces, alleviating the impact of fragmented information, improving resource accessibility, and developing culturally sensitive environments for all families to feel seen.

Fear of crime can influence our view of and experience with the world around us. This can be problematic for individuals seeking physical activity, including from walk commuting. Prior work shows fear is especially evident among women, who report fear of rape and sexual abuse by men as a primary concern. We present the results of a cross-sectional survey (n = 571) where participants were shown images from college campus (n = 4 campuses) depicting different lighting (daytime, nighttime), and entrapment levels (high, low; i.e., able to easily escape if needed, with high entrapment being difficult and low being easy), and using the Qualtrics heat map tool, selected features that stood out to them most. Data were segregated by gender and analyzed to determine similarity of heat maps for the same base image. Heat map images were analyzed using canonical correlation (Rc) to determine the relationship between the two groups; dispersion testing to decipher spatial uniformity within the images; the Structural Similarity Index (SSIM) to characterize the nature of image patterns differences; and, the Breslow-Day Test to specify pattern locations within images. Several heat map images are also presented in the results. Overall, female and male participants appear to "see" different things when imagining walk-commuting (as seen by poor Rc values) and the nature of what they were looking at were different (as seen by poor SSIM values). Female participants tended to focus on areas outside the walking path, such as bushes and dark areas, whereas men's focus was on the path ahead [χ2(1) = 4.29, p = 0.04]. Furthermore, women were more likely to select areas outside the walking path during high entrapment settings [χ2(1) = 15.49, p < 0.001] and at nighttime [χ2(1) = 4.98, p = 0.02]. Our study demonstrates point-of-view differences in female-male walking space assessments. Viewing walking safety through the lens of lived experience could be productive for holistic community walking safety.

Background While the social determinants of health (SDOH) have a greater impact on individual health outcomes than the healthcare services a person receives, healthcare providers face barriers to addressing these factors in clinical settings. Previous studies have shown that providers often lack the necessary knowledge and resources to adequately screen for and otherwise assist patients with unmet social needs. This study explores the perceptions and behaviors related to SDOH among healthcare providers in the United States (US). Methods This cross-sectional study analyzed data from a 22-item online survey using Reaction Data’s research platform of healthcare professionals in the US. Survey items included demographic questions as well as Likert scale questions about healthcare providers’ perceptions and behaviors related to SDOH. Descriptive statistics were calculated, and further analyses were conducted using t-tests and analysis of variance. Results A total of 563 respondents completed the survey, with the majority being male (72.6%), White (81%), and located in urban areas (82.2%). In terms of perceptions, most providers agreed or strongly agreed that SDOH affect the health outcomes of all patients (68.5%), while only 24.1% agreed or strongly agreed that their healthcare setting was set up to address SDOH. In terms of behavior, fewer than half currently screened for SDOH (48.6%) or addressed (42.7%) SDOH in other ways. Most providers (55.7%) wanted additional resources to focus on SDOH. Statistical analyses showed significant differences by gender, with females being more likely than males to prioritize SDOH, and by specialty, with psychiatrists, pediatricians, and family/general medicine practitioners being more likely to prioritize SDOH. Conclusion Most healthcare providers understand the connection between unmet social needs and their patients’ health, but they also feel limited in their ability to address these issues. Ongoing efforts to improve medical education and shift the healthcare system to allow for payment and delivery of more holistic care that considers SDOH will likely provide new opportunities for healthcare providers. In addition to what they can do at the institutional and patient levels, providers have the potential to advocate for policy and system changes at the societal level that can better address the root causes of social issues.

Air pollution causes more damage to health and economy than previously understood, contributing to approximately one in six deaths globally. However, pollution reduction policies remain controversial even when proven effective and cost negative, partially because of misunderstanding and growing mistrust in science. We used an expert assessment to bridge these research–policy divides in the State of Utah, USA, combining quantitative estimates from 23 local researchers and specialists on the human health and economic costs of air pollution. Experts estimated that air pollution in Utah causes 2480 to 8000 premature deaths annually (90% confidence interval) and decreases the median life expectancy by 1.1 to 3.6 years. Economic costs of air pollution in Utah totaled $0.75 to $3.3 billion annually, up to 1.7% of the state’s gross domestic product. Though these results were generally in line with available estimates from downscaled national studies, they were met with surprise in the state legislature, where there had been an almost complete absence of quantitative health and economic cost estimates. We discuss the legislative and personal responses of Utah policy makers to these results and present a framework for increasing the assimilation of data into decision making via regional expert assessment. In conclusion, combining quantitative assessments from local experts is a responsive and cost-effective tool to increase trust and information uptake during time-sensitive policy windows.

Public health remains dedicated to the mission of prolonging life, promoting health, and preventing disease, and with what some may consider theological connections to assisting the poor and needy. The connection of public health and theology derives from the historical role and training of clergy taking care of the marginalized and underserved worldwide. Today, Brigham Young University (BYU), a university founded and supported by The Church of Jesus Christ of Latter-Day Saints (LDS), along with other faith-based universities try to tie student academic experience to a strong university mission. Consequently, BYU develops program curricula with the university mission and aims as guiding principles within each offered course. Innate in the mission and aims of BYU is the effort to help students achieve academic excellence and realize their human potential. This article presents a way to explore critical reflection within the academic training of future public health professionals using religious topics, as it relates to the university mission, for classroom discussion. Reflection in the classroom setting is used to promote character and career development for public health students. Through instructor-led discussion, students are encouraged to expand their abilities to internalize public health related information while cultivating innovative thinking and connections to fellow students. Suggestions for reflection activity application with instructor-led discussion are provided while exploring different settings and topics in which the recommended reflection practice can be developed and applied within private and public academic settings.

Electric scooters (e-scooters) are an increasingly popular form of transportation in urban areas. While research on this topic has focused primarily on injuries, there are multiple mechanisms by which e-scooter share programs may impact health. The aim of this study is to explore the health-related behaviors of e-scooter users and to discuss their implications for public health. Data were collected using an online survey emailed to registered e-scooter users. A total of 1070 users completed the survey. Descriptive variable statistics and chi-squared analysis were performed to determine variable dependent relationships and equality of proportions. The most common destinations reported were “just riding around for fun”, home, and dining/shopping. The two most common modes of transportation that would have been used if e-scooters were not available were walking (43.5%) and using a personal vehicle (28.5%). Riding behavior was equally mixed between on the street, on the sidewalk, and equal amounts of both. e-Scooters in Provo are likely having both positive (e.g., air pollution) and negative impacts on health (e.g., injuries, physical inactivity). Future research should further explore patterns of e-scooter use and explicitly examine the linkages between e-scooters and areas of health beyond just injuries.

IntroductionWhile the popularity of pedal-assist electric bikes (eBikes) generally is growing, electric-mountain bikes (eMTB) have not received a warm welcome by many within the mountain biking community. Anecdotally, a variety of concerns have been raised concerning eMTB use, including trail damage, trail conflict, decreased trail access, and the perception that eMTB use is not "real" mountain biking or is "cheating."MethodThis qualitative study involved extracting and thematically analyzing discussion thread comments about eMTBs among nine mountain biking Facebook pages,ResultsThree predominant themes emerged: What is an eMTB?, Trails, and How should eMTBs be used? There was general confusion about the features and capabilities of eMTBs except by those who had previously used one. Commenters expressed concern over a variety of trail-related issues, including that eMTBs will damage trails similar to the way motorized vehicles do and that they could cause restricted access to some trail systems. There were inconsistent opinions on the use of eMTBs, where some comments saw riding mountain bikes as a "rite of passage" and that using an eMTB was "cheating". There was some level of acknowledgement that eMTBs may be useful for promoting exercise, but this was mediated by the "rite of passage" belief.DiscussionThese findings confirm general attitudes around eMTBs including fears, concerns, and prejudices. This study includes insights that will be useful in efforts to promote eMTBs for recreation, a tool to increase levels of physical activity, and in discussing potential conflicts about trail use.

BACKGROUND:Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding.OBJECTIVE:This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB?METHODS:A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other.RESULTS:The average heart rate during eMTB use was 94% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires.CONCLUSIONS:Despite the measured benefit, participants' perceived exertion while riding the eMTB was low.

Soft-surface exercise infrastructure (ie off-road, mountain, and dirt trails) has been a particularly valuable community asset in mountainous, urban municipalities. This off-road, trail infrastructure can encourage individuals to engage in green exercise (ie physical activity done outside while in nature, for example, mountainous trails and near waterways). Green exercise can be helpful for encouraging individuals to participate in exercise who otherwise may not; it is especially helpful for promoting mental well-being and a sense of being connected to the environment. This study characterizes trail access and predictors among urban, mountainous municipalities in the Utah Wasatch Front region. Access was determined using two-standard deviation ellipses (2SDE) activity space analysis, and predictors were identified using multiple linear regression. About 42% municipalities had no trailhead access (ie no trailhead within its corresponding activity space). Trail density and trailheads were significantly correlated (r = 0.49, P = .004). There was a significant trail density cluster in the southern area of the study region, centered all over the city of Alpine. Reduced-model regression yielded trailheads and home income as being significant predictors of trail density, and trail density and elevation as being significant predictors for trailheads. Results demonstrate patterns of access to green exercise trails that align with socioeconomic and municipal elevation. The results of this research should be insightful for those who work in exercise promotion and urban planners.

Background: Social capital is a construct of interaction and social trust in one’s fellow community members. These interactions can provide a safety net for individuals in terms of information, social support, and adherence to social norms. While a number of studies have previously examined the relationship between social capital and health outcomes, few have examined the theparallel relationship of social capital and geographic "place" with respect to health outcomes. Methods: Considering social capital as facilitated by specific structures, we evaluate the relationship between neighborhood-level social capital and disability rates in a major Southern US city. Disability rates were collected through neighborhood-level data via the AmericanCommunity Survey (ACS) and compared to a geocoded map of neighborhood-level social capital measures during spring, 2016. Results: Higher social capital within a neighborhood coincided with lower disability rates in that neighborhood (r=-0.14, P=0.016) when compared to random assortment models. Conclusion: Findings from this research add evidence to the value of the built environment, not only providing resources and shaping choices, but for facilitating important social relationships.

Objective: To estimate the association of rural vs urban living in the United States (US) with incident cognitive impairment (ICI), and to assess confounding, mediation, and effect heterogeneity by demographic, social, behavioral, and clinical risk factors. Methods: REGARDS is a cohort of 30,239 adults aged 45+ in the 48 contiguous states. We analyzed 20,592 participants who at baseline (2003-2007) were cognitively intact with no history of stroke and had cognition assessed an average of 7.1 years later. We used Rural-Urban Commuting Area (RUCA) codes to classify participants as urban (n = 16,436), large city/town (n = 2,420), or small/isolated rural (n = 1,736) at baseline. We defined ICI as falling ≥1.5 SD below the mean on at least two of three cognitive tests administered during follow-up: word list learning, word list delayed recall, and animal naming. Using urban as the referent, we estimated odds ratios of ICI for rural and for large city/town. Results: ICI occurred in 1,291 participants (6.3%). Rural residents had 49% higher odds of ICI adjusted for confounding by demographics (Model 2 in Table, OR = 1.49 [95% CI: 1.19, 1.85]). After further adjusting for potential mediators (Models 3-6), odds of ICI remained 25% higher for rural vs urban (Model 6, OR = 1.25 [0.99, 1.56]). In assessing effect heterogeneity, we found synergism of rural dwelling with black race, physical inactivity, and low self-rated health (all P < 0.1; see ORs in Table), but not for other ICI risk factors. We found no difference in ICI for large city/town vs urban (demographics-adjusted OR = 1.08 [0.88, 1.33]; fully adjusted OR = 0.95 [0.77, 1.18]), and no effect heterogeneity of ICI risk factors by large city/town (all P > 0.2). Conclusion: Rural living is an important social determinant of cognitive health in the US. ICI was significantly more frequent among rural dwellers than urban dwellers, partly due to confounding or mediation by ICI risk factors. Odds of ICI were highest for rural dwelling combined with black race, physical inactivity, or low self-rated health.

We investigated university active transportation policies in the United States for commuter-skateboarding. Methods: Universities were selected from 12 categories (very small to large; non-residential to highly residential) via Carnegie Classification of Institutes of Higher Education (N = 360). Results: Skateboarding policies were present at 43.3% of universities. Among those, roughly one-fifth prohibited all skateboarding on campus. The remaining majority specified conditions under which skateboarding could be used (eg, places, times). Larger, more residential universities were more likely to have skateboarding policies. Reasons restricting skateboarding included potential property damage or injury to the skateboarder, with a notable view of skateboarding being "disruptive to the community." Environment and culture appear to influence these policies. Conclusion: Campus policymakers should consider the broader impact of commuting mode restrictions.

Traffic-related air pollution in urban areas contributes significantly to commuters’ daily PM2.5 exposures, but varies widely depending on mode of commuting. To date, studies show conflicting results for PM2.5 exposures based on mode of commuting, and few studies compare multiple modes of transportation simultaneously along a common route, making inter-modal comparisons difficult. In this study, we examined breathing zone PM2.5 exposures for six different modes of commuting (bicycle, walking, driving with windows open and closed, bus, and light-rail train) simultaneously on a single 2.7 km (1.68 mile) arterial urban route in Salt Lake City, Utah (USA) during peak “rush hour” times. Using previously published minute ventilation rates, we estimated the inhaled dose and exposure rate for each mode of commuting. Mean PM2.5 concentrations ranged from 5.20 μg/m3 for driving with windows closed to 15.21 μg/m3 for driving with windows open. The estimated inhaled doses over the 2.7 km route were 6.83 μg for walking, 2.78 μg for cycling, 1.28 μg for light-rail train, 1.24 μg for driving with windows open, 1.23 μg for bus, and 0.32 μg for driving with windows closed. Similarly, the exposure rates were highest for cycling (18.0 μg/hr) and walking (16.8 μg/hr), and lowest for driving with windows closed (3.7 μg/hr). Our findings support previous studies showing that active commuters receive a greater PM2.5 dose and have higher rates of exposure than commuters using automobiles or public transportation. Our findings also support previous studies showing that driving with windows closed is protective against traffic-related PM2.5 exposure.

This article provides a review of spatial analysis methods for use in health promotion and education research and practice. Spatial analysis seeks to describe or make inference about variables with respect to the places they occur. This includes geographic differences, proximity issues, and access to resources. This is important for understanding how health outcomes differ from place to place; and in terms of understanding some of the environmental underpinnings of health outcomes data by placing it in context of geographic location. This article seeks to promote spatial analysis as a viable tool for health promotion and education research and practice. Four more commonly used spatial analysis techniques are described in-text. An illustrative example of motor vehicle collisions in a large metropolitan city is presented using these techniques. The techniques discussed are as follows: descriptive mapping, global spatial autocorrelation, cluster detection, and identification and spatial regression analysis. This article provides useful information for health promotion and education researchers and practitioners seeking to examine research questions from a spatial perspective.

Background and Purpose: Formal training for health promotion practitioners often includes academic study in health education. Accreditation is an important quality assurance mechanism. One concern expressed during Council of Education for Public Health (CEPH) professional meetings is the capacity of stand-alone undergraduate programs in health education to meet the demands of accreditation. The purpose of this study was to determine the accreditation knowledge level among the program directors of stand-alone programs, and identify the perceived challenges, support for and value ascribed to accreditation among these programs operating without an affiliated graduate program. Methods: Thirtyfive undergraduate program coordinators identified via the 2009 American Association for Health Education (AAHE) directory completed a 21-item survey instrument. Results: Most program coordinators knew about undergraduate accreditation requirements (82.9%), but program coordinators of self-identified small programs had significantly more concerns about the availability of resources needed to successfully attain accreditation. Conclusion: It is important to consider and provide resources for successful attainment of accreditation among smaller undergraduate institutions. Information regarding this general concern will be important to both the CEPH and academic program coordinators as they move forward with the new stand-alone baccalaureate accreditation initiative.

Adolescent drug use is individually and socially harmful in terms of disrupting adolescent development and social cohesion. Prior research has identified populations at risk and risk factors for adolescent drug use. This research sought to contextualize adolescent drug use by examining this behavior from a geographic perspective. The specific objectives were to identify patterns, local clusters and excess spatial risk for 5-digit zip codes within the 5-county Cincinnati, Ohio region. Adolescents (n = 57,241) were recruited within local schools by the Coalition for a Drug-free Greater Cincinnati. Results of this research show spatial clusters for perceived safety of marijuana; peer approval of alcohol, tobacco and marijuana; and age of onset for other drugs. The location and nature of these clusters are discussed and displayed in-text. Further, zip codes that were in excess risk compared to the 5-county region were identified. The utility of this research is two-fold: (1) It identifies the geographic variability in adolescent drug use and correlated factors of use, and (2) It provides a methodological framework for future research in spatial epidemiology of drug use. (C) 2014 Elsevier Ltd. All rights reserved.

Physical inactivity poses concern for health risks among all groups in the United States. Active transportation (AT) (e.g., bicycling) is one way of being physically active and may be helpful in promoting physical activity. This study characterized active transportation behavior among college students using the Theory of Planned Behavior. This study sought to describe predictors, including Theory of Planned Behavior (TPB) constructs, of AT behavior among college students at a large Midwest university. Students were recruited through the university registrar's office and e-mailed an electronic survey. Differences among AT users were determined using t-tests, and predictors of AT were identified using regression analysis. Significant differences between AT users for all TPB constructs were observed. Regression analysis using only TPB constructs accounted for 11.58% explained variation in AT use. Other variables added to the model resulted in 44.44% explained variation in AT use. The final model included subjective norms, age, perceived behavioral control, and transportation type and destination. The results of this research are insightful in explaining AT behavior. Perceived norms and the level of control students had regarding their method of transportation were important contributions to AT use. These results may be applied to promoting physical activity in community health.

INTRODUCTION:Local environmental factors provide important contributions to bicycle safety. The purpose of this study was to characterize bicycle collisions by neighborhood in Cincinnati, Ohio.BACKGROUND:The majority of prior bicycle safety research has focused on helmet use, especially among youth. Studies that have considered the neighborhood have centered on the built environment and its facilitation of bicycling (e.g., connectivity of roads and road conditions). Other broad conditions may be associated with injury beyond the use of protective equipment and the physical environment.METHOD:This study sought to determine spatial clustering, local patterning, temporal differences (time of day and season of year), and significant neighborhood-level predictors of bicycle collisions. Bicycle collision data were obtained from the Cincinnati, Ohio Police Department.CONCLUSIONS:This study showed that collisions occur at higher rates in the south-central and southwest neighborhoods of Cincinnati, Ohio. There were seasonal and time-of-day differences with respect to collision rates with summer and afternoon being the most common collision times. Neighborhood ethnicity, population density and presence of public transportation were all significant predictors of bicycle collisions. These findings will be disseminated to local city authorities and bicycle advocacy groups.