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Background: Policy changes were needed to reshape the built environment for active transportation. Methods: Using the social ecological model as a framework, the Healthy Hawaii Initiative worked with a contractor to develop a series of meetings, planning sessions, and workshops. Activities spanned 22 months between 2007 and 2009, and involved multiple stakeholders, including educational outreach for legislators and collaborative planning sessions with advocates. Results: Ultimately, with the help of the contractor to initiate the process, Complete Streets and Safe Routes to School (SRTS) legislation were introduced January 2009. Advocacy groups monitored bill progress, testified at hearings, and assisted in rewording the bills. The SRTS statute required the Department of Transportation (DOT) to administer the federal SRTS funds and the complete streets law tasked the state and county DOTs to adopt complete streets policies and review existing highway design standards and guidelines. Both bills were signed into law June 2009. Conclusions: Focusing efforts at multiple levels of the social ecological model involving champions and key stakeholders led to the successful passage of legislation supporting active transportation. Tracking policy implementation and evaluation over time will help determine actual impact on active transportation behaviors across Hawaii. [ABSTRACT FROM AUTHOR]

Introduction: Walking and bicycling are important but underused modes of transportation in the United States. Road design influences how much walking and bicycling takes place along streets and roads. Currently, numerous national policy initiatives, including Safe Routes to School and Complete Streets, are attempting to improve pedestrian and bicycling infrastructure and "friendliness." However, no state has completed a systematic assessment of its streets to determine how amenable they are to walking and bicycling. Our statewide study was undertaken to assess how accessible and friendly Hawaii roads are to these 2 activities., Methods: We randomly selected street segments in Hawaii's 4 counties and then completed objective assessments using the Pedestrian Environmental Data Scan. We audited 321 segments, and interrater reliability was adequate across all measures. Streets were coded as high (42.4%) or low capacity (57.6%) depending on how much vehicular traffic the street was designed to accommodate. Outcome measures included street accommodations (ie, sidewalks and crossing aids) and pedestrian and bicyclist use., Results: Most high-capacity streets had sidewalks (66%). These sidewalks were usually in good condition, contiguous, and had traffic control devices and pedestrian signals. Most low-capacity roads did not have sidewalks (63.4%). Bicycling facilities were limited (<10%) on both types of roads. Pedestrian and bicycle traffic was related to mixed use, including both residential and retail space, and to pedestrian and bicycling infrastructure., Conclusion: Road segments in Hawaii with more infrastructure and types of use, including single-family houses, apartment complexes, restaurants, office buildings, and industrial buildings, are used more by pedestrians and bicyclists.

Increasing active transportation to and from school may reduce childhood obesity rates in Hawai'i. A community partnership was formed to address this issue in Hawai'i's Opportunity for Active Living Advancement (HO'ĀLA), a quasi-experimental study of active transportation in Hawai'i County. The purpose of this study was to determine baseline rates for active transportation rates to and from school and to track changes related to macro-level (statewide) policy, locally-based Safe Routes to School (SRTS) programs and bicycle and pedestrian planning initiatives expected to improve the safety, comfort and ease of walking and bicycling to and from school. Measures included parent surveys, student travel tallies, traffic counts and safety observations. Assessments of the walking and biking environment around each school were made using the Pedestrian Environment Data Scan. Complete Streets and SRTS policy implementation was tracked through the activities of a state transportation-led Task Force and an advocacy-led coalition, respectively. Planning initiatives were tracked through citizen-based advisory committees. Thirteen volunteer schools participated as the intervention (n=8) or comparison (n=5) schools. The majority of students were Asian, Native Hawaiian, and Pacific Islander in schools located in under-resourced communities. Overall, few children walked or biked to school. The majority of children were driven to and from school by their parents. With the influence of HO'ĀLA staff members, two intervention schools were obligated SRTS project funding from the state, schools were identified as key areas in the pedestrian master plan, and one intervention school was slated for a bike plan priority project. As the SRTS programs are implemented in the next phase of the project, post-test data will be collected to ascertain if changes in active transportation rates occur.

In 2007, the State of Hawaii, Healthy Hawaii Initiative conducted a statewide social-marketing campaign promoting increased physical activity and nutrition. The campaign included substantial formative research to develop messages tailored for Hawaii's multiethnic Asian and Pacific Islander populations. The authors conducted a statewide random digital dialing telephone survey to assess the campaign's comparative reach among individuals with different ethnicities and different levels of education and income. This analysis suggests that the intervention was successful in reaching its target ethnic audiences. However, a knowledge gap related to the campaign appeared among individuals with incomes less than 130% of the poverty level and those with less than a high school education. These results varied significantly by message and the communication channel used. Recall of supermarket-based messages was significantly higher among individuals below 130% of the poverty level and those between 18 and 35 years of age, 2 groups that showed consistently lower recall of messages in other channels. Results suggest that cultural tailoring for ethnic audiences, although important, is insufficient for reaching low-income populations, and that broad-based social marketing campaigns should consider addressing socioeconomic status-related channel preferences in formative research and campaign design.

Support provided by the US Food Stamp Program (FSP) is intended to promote health. The objective of this qualitative study was to examine food security for low-income Hawaii residents. A sample of low-income Hawaii residents (n = 86) were recruited to participate in a series of focus group discussions. Most participants were female (73.5%), Native Hawaiian/Pacific Islander (61.6%), ages 18-39 (62.7%), high school educated (80.5%), low-income (50.6% < $10,000), used food stamps (73.5%), and had 4.07 +/- 2.89 persons per household. At 2 hour focus groups, participants received a healthy meal and a monetary incentive. Audio recordings were transcribed verbatim and analyzed using NVivo. Over 50% indicated FSP assistance was not enough. When this happened, most participants had alternatives including food banks, churches, friends and family members. Shopping strategies included budgeting, buying in bulk, or smarter shopping practices. Several participants were concerned about high living costs. Food insecurity should be addressed for FSP participants in Hawaii, with many residents not being able to meet nutritional and economic needs on their own.

Background: Features of the built environment that influence physical activity behavior characterize Active Community Environments., Context: Whether Active Community Environments policies exist in the state of Hawaii's four counties is unknown. The purpose of this study was to provide a baseline assessment of these policies in Hawaii., Methods: A survey assessing policies in six domains (i.e., sidewalks, bike lanes, greenways, recreational facilities, commercial buildings, and shared-use paths) was completed by employees of Hawaii planning departments., Consequences: Honolulu County had the most policies (n = 13), followed by Maui County (n = 6), Kauai County (n = 2), and Hawaii County (n = 1). Written policies were most prevalent in Honolulu County (n = 15), followed by Kauai County (n = 14), Hawaii County, (n = 4), and Maui County (n = 3). Sidewalk policies were reported for Honolulu County, Maui County (no written policies were found for Maui County), and Kauai County. Bike lane and greenway policies were found for Honolulu County (reported and written) and Kauai County (written). Recreation facility and pedestrian shared-use path policies existed for all counties, although only Honolulu and Kauai counties had written policies for commercial buildings (Maui County reported having policies). Few policies directly addressed physical activity promotion., Interpretation: The most populous county, Honolulu, had the most policies in place, although discrepancies existed between reported and written policies. This baseline measure of physical activity-related policies will help focus efforts of county coalitions to increase opportunities for physical activity. Additional policies should be tracked with population behavior surveillance.