Michael Kanters

Increasing prevalence of overweight and obesity in the U.S. remains a significant public health concern. Being overweight or obese is associated with increased risk for diabetes, heart disease and a range of other chronic diseases. Research shows that minority and low-income populations are disproportionately affected by obesity compared to the general population. This project, ����������������A Multi-Level Approach to Prevent Obesity: Extension and Engagement in Four North Carolina Counties���������������, identifies several strategies to prevent obesity in four counties in North Carolina: Lee, Edgecombe, Halifax, and Northampton. By partnering with local Extension offices, health departments, parks and recreation departments, schools, and faith communities, we aim to: 1) increase opportunities for individual education around healthy eating and physical activity, drawing on research-based Extension programming such as EFNEP, SNAP-Education and Faithful Families Eating Smart and Moving More; 2) increase partnerships and supporting coalitions that are focused on increasing access to healthy foods and places to be active; 3) increase the number of organizations (faith communities and schools) and food retail establishments (corner stores and farmers������������������ markets) that implement healthy food standards or increase access to fresh and local foods; and 4) increase the availability of places to be active through Active Routes to School programs, shared use practices in community organizations, and standards that encourage physical activity in Afterschool setting. Through a comprehensive approach, based on the socio-ecological model, we aim to better understand the role Extension can play in preventing obesity, particularly in low-income and minority communities in North Carolina.

Inefficiencies in the U.S. health care system create barriers to providing the highest quality of prevention and treatment services, particularly for vulnerable communities. What the U.S. spends for health care relative to improvements in population health highlights symptoms of a failing system. Physical activity (PA) has been identified as one of four key modifiable risk behaviors contributing to chronic diseases. Despite evidence that increased PA reduces preventable chronic diseases, health care professionals including primary care doctors may lack knowledge to effectively counsel patients on activity and program options for PA. Community parks and recreation services can play a much larger role in providing both prevention and treatment, offering an alternative and a more cost effective and efficient preventive medical approach. Park Rx programs seek to strengthen the connection between the healthcare system and parks and recreation services. In such programs, physicians and other healthcare providers prescribe to patients������������������ use of parks and recreation services for prevention and treatment for a range of chronic diseases. This project is a collaborative effort between NC State, two to four Federally Qualified Health Centers, and the NC Division of Public Health (NCDPH), Chronic Disease and Injury Section. We will also engage two key partners: North Carolina Parks and Recreation Association (NCRPA) and Recreation Resources Service (RRS), a state-level technical assistance program that supports public parks and recreation department in all 100 NC counties. These two organizations could potentially coordinate partnerships between parks and recreation departments in the project counties and the volunteer focus group participants. This project will develop an app that would allow FQHC staff and their patients to identify opportunities for physical activity programs and facilities in the patient's community that matches their interest, physical abilities/disabilities, and leisure skills.

The purpose of this project is to create a public facing tool to assess the relative health benefits and risks of playing the most commonly offered sports. The Healthy Sport Index will collect physical activity data for the 10 sports most commonly played by adolescents as determined by the most recent High School Athletics Participation Survey. High school sports were selected because they represent a regulated sport environment with fairly consistent structure and delivery across the nation; they also offer the richest available research and data sets for youth athletes. Specific scope of work activities for this contract include: ��������������� Collect data for physical activity measures in Raleigh-Durham and New York City high schools. A minimum of 400 high school athletes in 10 boys sports and 10 girls sports will be evaluated. ��������������� Train and manage data collection observers at both locations. ��������������� Organize and analyze data for physical activity measures. ��������������� Participate in meetings, as a member of the Healthy Sport Index Advisory Group, with travel costs covered by the Institute. Travel costs will also be provided to attend the 2017 and 2018 Project Play Summits. ��������������� Participate in regular calls with Institute staff and Advisory Group members. ��������������� Produce an academic journal article related to the physical activity findings from the Healthy Sport Index project. ��������������� Coordinate with Institute staff to capture psychological insights from the teams being measured about the role of sport in contributing to their motivation to remain active.

Inefficiencies in the U.S. health care system create barriers to providing the highest quality of prevention and treatment services, particularly for vulnerable communities. What the U.S. spends for health care relative to improvements in population health highlights symptoms of a failing system. Physical activity (PA) has been identified as one of four key modifiable risk behaviors contributing to chronic diseases. Despite evidence that increased PA reduces preventable chronic diseases, health care professionals including primary care doctors may lack knowledge to effectively counsel patients on activity and program options for PA. Community parks and recreation services can play a much larger role in providing both prevention and treatment, offering an alternative and a more cost effective and efficient preventive medical approach. Park Rx programs seek to strengthen the connection between the healthcare system and parks and recreation services. In such programs, physicians and other healthcare providers prescribe to patients������������������ use of parks and recreation services for prevention and treatment for a range of chronic diseases. This project is a collaborative effort between NC State, two to four Federally Qualified Health Centers, and the NC Division of Public Health (NCDPH), Chronic Disease and Injury Section. We will also engage two key partners: North Carolina Parks and Recreation Association (NCRPA) and Recreation Resources Service (RRS), a state-level technical assistance program that supports public parks and recreation department in all 100 NC counties. These two organizations could potentially coordinate partnerships between parks and recreation departments in the project counties and the volunteer focus group participants. This project will develop an app that would allow FQHC staff and their patients to identify opportunities for physical activity programs and facilities in the patient's community that matches their interest, physical abilities/disabilities, and leisure skills.

The purpose of this contract is to evaluate the impact of joint use agreements (JUA) on physical activity, especially within low-income and/or rural populations and to formulate strategies for expanding successful and sustainable JUA. The specific aims are to (1) assess the impact of JUA on physical activity in a sample of communities selected from findings of the year one audit of the 10 community transformation grant (CTG) collaborative regions. All 98 CTG Project counties in North Carolina were included in an initial baseline audit of JUA. Subsequent evaluations of JUA impact on physical activity of adults and children and assessment of factors contributing to successful and sustainable JUA and/or barriers to JUA formation will be conducted at a sample of 20 public schools with JUA and include low-income and/or rural communities.

The purpose of this contract is to evaluate the extent of JUA in North Carolina in an effort to determine their impact on physical activity, especially within low-income and/or rural populations and to formulate strategies for expanding successful and sustainable JUA. The specific aims are to (1) conduct an initial audit within the 10 community transformation collaborative regions established for the North Carolina Community Transformation Project; (2) identify factors associated with success in developing JUA and their sustainability; and (3) assess their impact on physical activity in a sample of communities. All 98 CTG Project counties in North Carolina will be included in an initial baseline audit of JUA. Subsequent evaluations of JUA impact on physical activity of adults and children and assessment of factors contributing to successful and sustainable JUA and/or barriers to JUA formation will be conducted and include low-income and/or rural communities.

The purpose of this proposed study is to develop and validate measures and a methodology to assess and document selected outcomes of USA Hockey's model for youth sport development. The following program outcome areas will guide measurement development: (1) Participant physical activity (duration & intensity) during ADM practices commonly defined as sedentary, moderate, or vigorous; and (2) Practice context time (e.g., how players and coaches spend their time and how instructional time is used).

The goal of this project is to communicate the results of our past active living research projects on Middle School Sport Delivery Models and Middle School Sport Facility Use to specific audiences who are likely to use it to improve practices or policies relevant to active living and childhood obesity prevention. Products and activities included in this proposed project will include: repackaging results into toolkits, briefs, Web sites, policy briefs, workshops, and webinars tailored to target audiences.

The impact of sport on childrens? achievement of recommended levels of daily physical activity can be viewed as a function of Reach (the # of participants impacted) x Efficacy (the amount of physical activity achieved during those activities). For example, results of our research on sport participation in Middle Schools has indicated that more students participate in intramurals than interscholastic sports (Reach) yet interscholastic sports are more frequently offered in NC Middle schools. Our study also found that intramural sports generated more activity during participation than interscholastic sport among certain demographic groups (Efficacy). Furthermore, our research examining Middle school joint-use policies indicates that facilities designated for physical activity (i.e., athletic fields) are underutilized due to policies that restrict community access. This further limits the potential Reach of public Middle school resources for physical activity particularly among low-income and rural communities with limited community resources (Edwards et al., in press). The purpose of our commissioned analysis would be to examine the potential impact of policy changes that would increase both the Reach and Efficacy of Middle school resources for physical activity. Using data from our previous research on Middle School Athletics and Facility use (e.g., ALR CFP 7, ALR CFP 9, ALR Dissertation Rd 8) in combination with available data sets (i.e., NCYRBS, SHPPS, NCDENR) we plan to analyze the impact of various policy change simulations that would increase both the Reach and Efficacy of Middle school programs for physical activity and their athletic facilities.

There is also little, if any research that examines the cost and benefits of school athletic facilities. Policies that restrict school sports to highly competitive interscholastic sports and limit facility use to only the gifted athletes within a school does not appear to be the most efficient use of limited financial resources. The CDC recommends that school policies for extracurricular activities should include physical activity programs that meet the needs and interests of all students. It is unclear however, what type and quantity of school sport facilities would yield the greatest impact on physical activity patterns. Creative school administrators can develop excellent programs leveraging community partnerships while contemporary high quality facilities may not ensure widespread impacts on student and community physical activity patterns (Wechsler et al., 2000). The purpose of this study is to examine the impact of public middle school policies for facility use and access on the following outcome measures: 1) percentage of school population participation in school sports, and amount & type of physical activity during participation in school sports; 2) total student physical activity facilitated by school athletic facilities and programs; 3) community structured and unstructured physical activity participation on school sport facilities during non-school hours; 4) total community (non-student) physical activity on school sport facilities; and 5) cost of school sport facility construction & maintenance.