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Background The COVID-19 pandemic resulted in public health and policy measures to reduce in-person contact and the transmission of the virus. These measures impacted daily life and mental well-being (MWB). The aims of this study were to explore the MWB impacts of COVID-19 on children and assess the associations among perceived changes in physical activity (PA) and sedentary behaviors (SB), with perceived MWB changes, using a mixed-methods approach. Methods A convergent parallel mixed-methods design consisting of an online survey with a convenience sample and interviews was conducted from May through July 2020 with parents/caregivers of kindergarten through 5th graders in the St. Louis region. Survey domains assessed included child MWB, PA, and SB. Interviews were recorded, transcribed, and qualitatively analyzed using a code book developed to elicit themes. Survey data was analyzed with chi-squared tests and logistic regressions. The dependent variable was perceived change in child MWB due to the impact of COVID-19. Independent variables included perceived changes in PA, SB, and child concerns about COVID-19. Results Sample size consisted of 144 surveys and 16 interviews. Most parents reported a perceived decrease in child MWB (74%), a decrease in child PA (61%), and an increase in child SB (91%). Discontentment with stay-at-home orders and concern about COVID-19 were associated with a perceived decrease in MWB. Children whose PA decreased were 53% less likely to have the same or better MWB (OR 0.47) and children whose outside PA decreased were 72% less likely to have the same or better MWB (OR 0.28). Common qualitative themes included difficulty in adjusting to COVID-19 restrictions due to school closures and lack of socializing, child concerns about family getting sick, and PA benefits for improving MWB. Conclusions Based on parent perceptions, MWB decreased with COVID-19. Maintained or increased child PA improved the chances MWB would remain the same or improve. Parent interviews provide context to these findings by showing how COVID-19 impacted MWB and the associations between PA and MWB. Understanding protective factors for child MWB during COVID-19 is important to offset negative long-term health outcomes from this ongoing pandemic.

Background Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. Methods Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. Results Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. Conclusions Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health. Registration Not registered

Physical activity has many health benefits, yet a large portion of our population is not meeting recommendations. Using accelerometry and global positioning systems (GPS) to accurately measure where people are active and to identify barriers and facilitators of activity across various settings will inform evidence-based policies and interventions to improve activity levels. Criteria for sufficient accelerometry data (e.g., number of days, minimum hours in a day) to accurately monitor free-living physical activity in adults and children have been widely studied, implemented, and reported by researchers. However, few best practice recommendations for researchers using GPS have been established. Therefore, this paper examined the impact of three co-wear criteria of varying stringency among a sample of children aged 10 to 16 years in Baton Rouge, Louisiana. Overall and location-based physical activity was consistent across the samples even within sociodemographic subgroups. Despite the lack of significant subgroup-specific mean differences in physical activity across the three samples, associations between sociodemographics and weight status and physical activity were significantly different depending on the device time-matching “co-wear” criteria applied. These differences demonstrate the critical impact co-wear criteria may have on conclusions drawn from research examining health disparities. There is a need for additional research and understanding of ideal co-wear criteria that reduce bias and accurately estimate free-living location-based physical activity across diverse populations.

Background Investigating the association of the neighborhood social environment on physical activity is complex. A systematic scoping review was performed to (1) provide an inventory of studies assessing the influence of the neighborhood social environment on physical activity since 2006; (2) describe methodologies employed; and (3) formulate recommendations for the field. Methods Two databases were searched using terms related to ‘physical activity,’ ‘neighborhood,’ and ‘social environment’ in January 2017. Eligibility criteria included: 1) physical activity as an outcome; 2) neighborhood social environment as a predictor; 3) healthy population (without diagnosed clinical condition or special population); 4) observational or experimental design. Of 1352 studies identified, 181 were included. Textual data relevant to the social environment measurement and analysis were extracted from each article into qualitative software (MAXQDA) and coded to identify social environmental constructs, measurement methods, level of measurement (individual vs. aggregated to neighborhood), and whether authors explicitly recognized the construct as the social environment. The following measures were generated for each construct: number of unique measurements; % of times measured at an aggregate level; % of times authors referred to the construct as the social environment. Social environmental constructs were then grouped into larger descriptive dimensions. Results/findings Fifty-nine social environmental constructs were identified and grouped into 9 dimensions: Crime & Safety (n = 133 studies; included in 73% of studies); Economic & Social Disadvantage (n = 55, 33%); Social Cohesion & Capital (n = 47, 26%); Social Relationships (n = 22, 12%); Social Environment (n = 16, 9%); Disorder & Incivilities (n = 15, 8%); Sense of Place/Belonging (n = 8, 4%); Discrimination/Segregation (n = 3, 2%); Civic Participation & Engagement (n = 2, 1%). Across all articles, the social environment was measured using 176 different methods, was measured at an aggregate-level 38% of the time, and referred to as the social environment 23% of the time. Conclusions Inconsistent terminology, definitions, and measurement of the social environment and the lack of explicit language identifying constructs as the social environment make it challenging to compare results across studies and draw conclusions. Improvements are needed to increase our understanding of social environmental correlates and/or determinants of physical activity and facilitate cross-disciplinary conversations necessary to effectively intervene to promote physical activity. Trial registration PROSPERO CRD42017059580.

Purpose: The purpose of this study was to explore parent perceptions of changes in child physical activity during COVID-19 stay-at-home orders.Design: A cross-sectional study.Setting: The research team used social media, relevant organizations, and neighborhood groups to distribute the survey link in May and June of 2020.Subjects: A convenience sample of parents of children aged 5–12.Measures: Survey to assess parental perceptions of changes in children's physical activity before and during stay-at-home orders, and environmental and social barriers to physical activity.Analysis: Results were analyzed using descriptive statistics, bivariate comparisons, and multinomial-logistic regression models with covariates of environmental factors, social factors, and frequency of factors as barriers on association with perceived physical activity change.Results: Data from 245 parents were analyzed. A majority (63.7%) of parents reported a decrease in children's physical activity during stay-at-home orders. More parents indicated social barriers (e.g., lack of access to playmates) than environmental barriers (e.g., lack of access to neighborhood play spaces) to children's physical activity. In multivariate analyses, the odds of parents reporting decreased physical activity was greater for those reporting lack of playmates (OR = 4.72; 95% CI: 1.99–11.17) and lack of adult supervision (OR = 11.82; 95% CI: 2.48–56.28) as barriers. No environmental barriers were significantly associated with decreased children's physical activity.Conclusion: The unique aspects of the COVID-19 pandemic provide a natural experiment for developing social and environmental strategies to improve children's overall physical activity. Assessing parental perceptions is a way to inform these future efforts.

Background: New licensing regulations require Louisiana early care and education centers (ECEs) to limit children's screen time and increase physical activity. A community– academic partnership involving academic, community, government, and ECE stakeholders launched two initiatives: (1) an evaluation of the implementation of licensing regulations at the local level and (2) a statewide effort to develop technical assistance for ECE directors. Objectives: To describe the methods and lessons learned and to establish recommendations based on this ongoing participatory action research. Methods: A case study approach was used to identify the lessons learned and recommendations thus far, based on partners' perspectives and ECE directors' participation. Lessons Learned: Recommendations include to share power and funding among stakeholders, to engage directors as partners to overcome recruitment challenges, and to start with the end in mind to ensure meaningful community engagement. Conclusions: This participatory action approach is leading to innovative, feasible strategies to increase children's physical activity.

Understanding factors that influence parenting decisions for outdoor play is necessary to promote physical activity during critical years for adolescent adjustment. This study explored physical and social environmental influences on parenting decisions and rules for their child&rsquo, s outdoor play using semistructured in-depth interviews with parents (n = 30, 29 of whom were mothers) of adolescents. Mothers from low- (n = 16) and high-disadvantage (n = 13) neighborhood environments were recruited to identify environmental factors that resulted in parenting decisions that either promoted or hindered outdoor play and identify differences across neighborhood types. Data were analyzed using a grounded theory approach. Mothers limit their child&rsquo, s independent play, as well as the location and time of outdoor play, due to both social and physical aspects of their neighborhood. Seven themes (safety, social norms, sense of control, social cohesion and neighborhood composition, walkability, and access to safe places for activity) were identified as influencers of parenting practices. Mothers in high-disadvantage neighborhoods reported facing greater neighborhood barriers to letting their child play outside without supervision. Physical and social neighborhood factors interact and differ in low- and high-disadvantage neighborhoods to influence parenting practices for adolescent&rsquo, s outdoor play. Community-level interventions should target both physical and social environmental factors and be tailored to the neighborhood and target population, in order to attenuate parental constraints on safe outdoor play and ultimately increase physical activity and facilitate adolescent adjustment among developing youth.

Introduction Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual applications can reliably capture social determinants of health at the smallest geographic resolution (parcel level) remains uncertain. This paper presents a novel, parcel-level SSO methodology and assesses whether this new method can be collected reliably using Google Street View and is feasible. Methods Multiple raters (N=5) observed 42 neighborhoods. In 2016, inter-rater reliability (observed agreement and kappa coefficient) was compared for four SSO methods: (1) street-level in person; (2) street-level virtual; (3) parcel-level in person; and (4) parcel-level virtual. Intra-rater reliability (observed agreement and kappa coefficient) was calculated to determine whether parcel-level methods produce results comparable to traditional street-level observation. Results Substantial levels of inter-rater agreement were documented across all four methods; all methods had >70% of items with at least substantial agreement. Only physical decay showed higher levels of agreement (83% of items with >75% agreement) for direct versus virtual rating source. Intra-rater agreement comparing street- versus parcel-level methods resulted in observed agreement >75% for all but one item (90%). Conclusions Results support the use of Google Street View as a reliable, feasible tool for performing SSO at the smallest geographic resolution. Validation of a new parcel-level method collected virtually may improve the assessment of social determinants contributing to disparities in health behaviors and outcomes.

A convergent parallel mixed methods design was used to understand parenting practices for outdoor play, their influence on adolescent's physical activity and outdoor play and the role of the neighborhood and child's sex. Adolescents (n = 263) and their parents completed questionnaires and wore accelerometers. Parents (n = 30) participated in in-depth interviews. Parenting practices were examined by neighborhood disadvantage and child's sex in quantitative (Chi-square and T-tests) and qualitative (comparative thematic analysis) samples. Multi-level linear mixed models examined the associations between parenting practices and two adolescent outcomes: physical activity and outdoor play. Parents in high disadvantage neighborhoods and of female adolescents imposed more restrictions on outdoor play. Restrictive parenting practices were negatively associated with outdoor play, but not physical activity. Policy and environment change that improves neighborhood conditions may be necessary to reduce parents' fear and lessen restrictions on outdoor play.

Background: The current study examined relationships between the neighborhood social environment (parental perceived collective efficacy (PCE)), constrained behaviors (e.g., avoidance or defensive behaviors) and adolescent offspring neighborhood physical activity in low- versus high-incivility neighborhoods. Methods: Adolescents (n = 71; 11–18 years (14.2, SD ± 1.6); male = 37 (52%); non-white = 24 (33.8%); low-income = 20 (29%); overweight/obese = 40 (56%)) and their parents/guardians enrolled in the Molecular and Social Determinants of Obesity in Developing Youth study were included in the current study. Questionnaires measured parents’/guardians’ PCE, constrained outdoor play practices and offspring neighborhood physical activity. Systematic social observation performed at the parcel-level using Google Street View assessed neighborhood incivilities. t-tests and chi-square tests determined differences by incivilities. Multilevel regression models examined relationships between PCE and: (1) constrained behaviors; and (2) neighborhood physical activity. The Hayes (2013) macro determined the mediating role of constrained behaviors. Results: Parents who had higher PCE reported lower levels of avoidance (p = 0.04) and defensive (p = 0.05) behaviors. However, demographic variables (i.e., gender, race and annual household income) limited these results. The direct relationship between PCE and parent-reported neighborhood physical activity was statistically significant in high-incivility neighborhoods only. Neither avoidance nor defensive behavior mediated the relationship between PCE and neighborhood physical activity. Conclusions: PCE influences parenting behaviors related to youth physical activity. Community-based programs that seek to facilitate social cohesion and control may be needed to increase adolescents’ physical activity.