Where the Rubber Meets the Road: Promoting Active Transportation in Rural Areas is a round table discussion from 2012 that I listened to. This discussion promoting active transportation tied in well with our class discussion from a few weeks ago about community walkability and street-scale design. Proper planning makes active transportation much easier, safer, and increases the chances for people to walk/bicycle, instead of drive. Topics covered included; limitations specific to rural environments, the Complete-Streets initiative, community design including sidewalks and bike lanes, safe routes to schools, and suggestions related to active transportation for all individuals moving forward.

From what we covered in class, we know that “local” stores, schools, and jobs are sometimes located very far from homes, which makes it very difficult to commute without a well-functioning car. Many rural environments usually lack pedestrian amenities, like crosswalks with lights, sidewalks, and bicycle lanes, which makes active transportation more of an inconvenience. Back in 2012, all five public-health experts in this discussion agreed that active living was gaining momentum in every region of the country, and since then it appears that we have made a true effort to move forward by updating recreation facilities, parks, connecting sidewalks, and bicycle lanes.

Bicycling to school and work is something that has become more popular since this discussion and this helps you save money, as well as reach your weekly active minutes. Many renovations, like adding bicycle lanes, still needs to be made in order for these number to continue to rise. Having a separate lane for people on bicycles is much safer and inviting than having to share the road with cars. This discussion was tied into the Complete Streets initiative.

Jennifer Rice, from the Humboldt Area Foundation, followed with the point that the US lack methods and tradition for engaging communities in solving transportation problems. State officials say they are doing something for the community, in that community, but not working with the community. Ronald Cossman, from the Social Science Research Center, made the point that local officials need to notify and educate state officials, by showing proof of why and what kind of assistance they need. This requires local officials to spend time listening to better understand and connect with the community, but can lead to better results for all.

Mark Duncan, from Starkville in Motion, said that local officials need proof in order to get a grant in rural communities. Tracy Hadden Loh, from California, made a point that it is important to market towards parents. The opportunity to reduce transportation cost with a safe and healthier option is a great way to engage communities. In rural communities, having a school bus dropoff near the school and have a walking school bus was an option to help reduce congestion. Another takeaway moving forward from this discussion was to educate everyone (walkers, bicyclers, & drivers) on how to share the road properly and keep safety in mind.

The webinar “Streets as Places: An LQC Approach to Making Streets Vibrant and Active” focused on the new concept of Lighter, Quicker, Cheaper (LQC) interventions to change the built environment to promote physical activity. These interventions are based on the idea of placemaking, or creating public spaces where people want to be. In the U.S., historically we have not done a great job of making these kinds of spaces. The idea behind placemaking is that people will often spend more time in a place that offers them things to do, comfortable places to sit or do other activities, and that provide a sense of community. These characteristics also help to improve the built environment for physical activity in such spaces. LQC interventions are currently being used across the country for their placemaking abilities.

As previously mentioned, LQC interventions are not necessarily permanent changes to an environment, but rather a temporary change that allows the community to see the potential in its public spaces. These interventions can be extremely simple in nature such as marking a bike lane with decorative cones, making parklets, reducing street crossing distances using paint, and creating hay bale roundabouts. In general, a public space lends itself to an LQC intervention if there are 10 things to do, such as: sit and relax, read a book, take a walk, window shop, ride a bike, etc. By implementing “light” changes such as adding benches or greenery, slowing vehicle speeds, and adding temporary crosswalks or bike lanes, people begin to see the street as a place to gather and spend time together, rather than just a road for automobiles. In the grand scheme of placemaking, these LQC experiments act as part of a greater feedback loop which allows for reactions from the community to improve upon the existing environment.

Cathy Costakis of Montana State University is an expert in working to improve physical activity and the built environment in rural communities. She explains that while many people think it is difficult to increase physical activity in rural areas, the small nature of the towns is ideal for promoting walking and bicycling. While there are some challenges such as reduced capacity, cultural norms of using automobiles, and reduced funding, the opportunities for change in these communities are large given the strong leadership and close-knit nature of such places. For the past 5 years, Montana’s Building Active Communities Initiative has provided training and a guided action institute for communities who want to learn more about improving the built environment to promote physical activity. In it’s most recent version, the Institute has focused on increasing community involvement and engagement through the use of LQC interventions. These interventions have taken off in many communities in the form of temporary crosswalks, pop-up bike lanes, parklets, and a bike to school day.

LQC interventions are an extremely effective way to begin improving the built environment to support physical activity. These experiments allow communities to re-imagine their streets as places for people, not just cars.

This webinar features four speakers Rachel Bennett, MPH, MURP, Maria Sipin, Nate Storring, and Jennifer S. Vey, who are from the Brookings Institution, Prevention Institute and Project for Public Spaces, that have combined to form the Bass Initiative on Innovation and Peacemaking.  Their hopes are to address the roots of gentrification, particularly innovation economic development and investments and walkability quality places can promote economic opportunity.

The speakers begin by discussing what gentrification is, where does change come from and who drives it.  They highlight that communities can drive change by focusing on three outcomes:

-Prevent negative outcomes from externally driven change

– Guide potentially positive outcomes from externally driven change

– Empower internally driven change

Their primary focus is on the innovation of economy, which is driven by innovation processes that increasingly demand collaboration. The importance of this collaboration is that it changes the spatial geography of innovation such that the hyper local is increasing valued.  The hyper local refers to an area of a well-defined small comminuted that focuses on the matters that are directed towards the concerns of that population.  This can create innovation, arts and creative districts and food markets.  This brings together diversity and new opportunity to connect people to the economy.

I found this webinar very interesting, because when observing any improvements within communities, I am wary whether these initiatives actually reduces or increases displacement.  Mr. Storring highlights that community engagement is key and even though it takes time to build trust, it is a necessary component in order to make sure the community has a say in improving their community and creating an ownership element, thereby avoiding gentrification.  Ms. Bennett further discussed how to contribute to build healthy communities without contributing to gentrification.  They support grassroots organizing, research and policy advocacy to prevent displacement.  In building healthy communities as well as maintaining affordable housing, from a public heath standpoint, the focus is on health equity.  This is defined as “every person, regardless of who they are – the color of their skin, their level of education, their gender or sexual identify, whether or not they have a disability, the job that they have, or the neighborhood that they live in – has an equal opportunity to achieve optimal health.” Braveman, et al., 2011.

In closing, Ms. Sipin discusses the process of boosting community power for mobility justice.  Multicultural Communities for Mobility (MCM) is an organization made of team members who are active transportation advocates who stand up against racism and discrimination, evictions, rent increase, police violence and harassment, just to name a few areas interest.

This institute provides a great guideline for tackling the major issue at hand.

This CNN article (1) begins by focusing on summarizing a recent study from the journal of Nature Communications, “Fructose-1, 6-bisphophate couples glycolytic flux to activation of Ras” by Peeters et al. (2) to ask in essence, if sugar leads to cancer and suggests that the research project may influence personal medicine and dies for cancer patients.

The article by Peeters et al., examined yeast and cancer cells as they share a yeast mutation to identify the molecular connection between glucose fermentation and the activation of RAS.  They conclude that the Warburg effect creates a vicious cycle through Fru1,6bisP activation of Ras, by which enhanced fermentation stimulates oncogenic potency.

The CNN article further references other studies that that may leads to the linkage of eating excess sugar can lead to weight gain.  Thereby increasing risk for obesity, which in turn, is linked to a higher risk of some cancer.

When examining whether media outlets accurately report what is presenting in scholarly articles, it is important to scrutinize if certain circumstances or false pretenses may be occurring:

• Did the journalist accurately translate the technical jargon of the article?
• Did the journalist make causal or audacious conclusions?
• Are multiple studies cited without accounting for shortcoming’s and differences in individual studies?
• Are the significant finding reporting’s over or under inflated?

The original article is extremely technical, but from my understanding of the study, the science writer for CNN does not deviate much from the content outlined in the publication.  The title, however is misleading.  As most writers must do, they created an attention-grabbing headline, in order to draw readers in.  Where this becomes a problem is when individuals run off with just the headline(s) and potentially spread inaccurate information.  As professionals, we should be aware of this issue, especially when working with patients who may skim news outlets as a primary source of information.  We should make efforts to thoroughly inform our patients and make them away of some of these possible misrepresentations.  It would be more beneficial to refer our clients and /or patients to reputable sources and explain that one study is not enough to substantiate its findings; readings reviews and meta-analyses are more helpful.

• http://www.cnn.com/2017/10/27/health/sugar-cancer-relationship-study/index.html
• Peeters, K., Van Leemputte, F., Fischer, B., Bonini, B. M., Quezada, H., Tsytlonok, M., & … Thevelein, J. M. (2017). Fructose-1,6-bisphosphate couples glycolytic flux to activation of Ras. Nature Communications, 8(1), 922. doi:10.1038/s41467-017-01019-z

Research suggests that Idaho’s population has a higher aging rate than the national average. Older adults are a vulnerable population , and physical, mental, and emotional age-related changes can severely impact lifestyle and quality of life. Falls are the major cause of unintentional injury and deaths among older adults, and fall prevention is considered to be a public health priority.

While there are plenty of evidence based fall prevention programs to choose from, the team ultimately selected this one due to:

– the setting being in Idaho with rural geography

– lack of funds and infrastructure

– transportation being limited and time-consuming

– health professional shortages

The classes last 45-60 minutes and meet 2-3 times per week. Each session runs for 10 weeks, and each of the 117 sites must hold 3 sessions per year. In these classes, volunteer leaders and coaches to teach various topics, including the benefits of physical activity on fall prevention, fitness basics, and injury prevention. Participants of the program ranged from those with functional limitations to triathletes, and the program had a 85% retention rate.

Program results:

– Participants reported improved physical, mental and social health and wellness, along with increased stability, strength, energy, and confidence

– The volunteer leaders enjoyed opportunities for personal growth

– Hosting a site promoted community growth

The program is volunteer-led with a “train the trainer” model. The classes take place in a variety of areas wherever older adults gather, including churches, libraries, hospitals, . This type of learning environment is great because the volunteers are there because they want to be there. Both the participants and the volunteer leaders thoroughly enjoyed the program because of the socializing and group learning that brought them back week after week. Everyone worked on improving their balance, flexibility, and strength, but took so much more out of the program. Improving the self-efficacy of these older adults changed their lives.

Evaluation methods:

120 participants were recruited from 10 sites, coming from approximately 50% rural and 50% urban settings. The data was collected over two 10-week session with a baseline measure. Measurement methods included the use of demographic surveys, SF-36v2 (quality of life questionnaire), and the 8-foot Timed Up-and-Go (TUG).

Results of the evaluation include:

– 68% of participants reported improvements in physical function and ability

– 72% of participants reported improvements in mental health

– 85% of participants significantly increased in social functioning

– 72% of participants reported an increase in energy levels

Advantages of the program include long-term financial sustainability in a variety of community settings and safe physical activity and education opportunities for older adults in rural communities. However, limitations of the evaluation include lack of detailed medical and medication histories, no tracking of falls, and self report data.

Next steps would be to consider community partners for age-friendly parks and walkability in the community.

Human trafficking is a growing problem both globally, as well as nationally throughout the United States. The Hospitals in Pursuit of Excellence has recognized this, and organized a webinar for health care providers on the key role they could play in fixing this problem. The presenters for this webinar included Roy Ahn, Associate Director of Public Health at the University of Chicago, Laura Krausa, System’s Director st catholic health initiatives, and Dr. Wendy Macias from Massachusetts General Hospital.

To best address this problem, it’s imprtortant to know what all constitutes human trafficking. It can be defined as any of the following: sexual slavery, forced labor, forced begging, debt bondage, child soilders, or forced marriages,  child soilders being the only one not seen in the United States. Approximately 21 million indisdviudsls are forced into labor trafficking alone globally as of 2016. Its difficult to tell exactly how many are in the United States, but in 2016, 26727 calls were made to the us trwfficking hotline.

So, how can healthcare providers make such an impact on this problem? Well, in the most recent study conducted in the survivors of human trafficking, 87.8% reported having an encounter with a healthcare provider while they were being trafficked, and it was unreported. To have such a high number seen by healthcare providers without being reported is astonishing. 63% of survivors seen were in emergency departments, of which it is estimated that only about 3% of providers have proper training on identifying those being trafficked. Primary care clinics saw about 22.5% of survivors, urgent clinics 21.4%, and planned parenthood at 29.6%. With all of these numbers in mind, it is clear that better education and planning need to take place in our healthcare systems.

While it may appear to be difficult to address such a hidden problem, there are many steps that could be taken in our hospitals and health  services to have an impact on this problem. First, is proper training. This includes training on positive indentifiers of those at risk, knowing the referral process for someone you suspect to be involved in human trafficking, and knowing the reporting guidelines. Next is having an impact on public policy. Many hospitals can push for policy changes, and they should always be advocating for positive change at the local, state and federal levels. Another slightly more obscure measure that can be taken is through contracting with outside organizations. All contracts should state that there is no child labor or trafficking involved. Most companies will probably not have a problem with this, but can lead to an increased awareness among different companies. Hospitals are also great resources for community initiatives, and should provide community education, develop partnerships, and push for government involvement. Hospitals can also invest responsibly. This can change corporate policies, and they can also focus on travel and hospitality settings, as these are the most common areas of human trafficking. Lastly, providing proper education through web based resources, printed resources, and clinical education will improve providers knowledge on the topic.

Human trafficking is a crime that has been committed across the globe for far too long. Our healthcare systems, as well as many other agencies need to take positive action in eliminating this problem from modern society,

LiveStories, a company that provides an integrated civic dats hub to health departments recently hosted a webinar on the growing opioid epidemic in the United States. The guest speakers for the webinar were Dr. Tina Kim, Cory Kendrick, and Jackie Pollard from LA County Public Health department, and Summit County health department in Ohio. It was interesting to see how this crisis is impacting different areas of the country, and what the public health departments are doing to combat the problem.

First,  Cory Kendrick and Jackie Pollard discussed the growth of opioid use in the summit county Ohio area. For this area specifically, there was a 400% increase in opioid overdose when fentanyl, and its derivatives such as carfentanyl, were introduced in the area. Jumping from 100 OD ER visits in June 2016 to over 400 visits in July 2016. But while this drastic increase just pushed the area over the edge, they discussed problems that have contributed over the last decade. First, the incorporation of pain as the “5th vital sign” for physicians. FDA approval of highly addictive pain killers, the intractable pain act of 1998, Medicare and Medicaid grading system, direct consuming advertising by pharmaceutical companies, and unregulated pain management clinics. With all of these factors contributing, Ohio has seen a 413% increase in OD death since 1999. Most recently, Ohio had 4050 OD deaths in 2016, 58.2% of which were caused by fentanyl or its derivatives.

With all of these stats in mind, it’s clear that this crisis is quickly becoming a major problem for many areas of the country. Additionally, many accidental overdoses have been reported throughout the United States by children, police, or any other bystander who just happens to touch the fentsnyl substance, Fentanyl is approximately 1000 times stronger than morphine, and carfentanyl is about 1000 times stronger than that, just touching the substance can cause absorption through the skin and lead to overdose in those who are not use to the substance. So what can be done to decrease the grip that opioids have on America? Ohio has taken many steps to address this. At the state level, they have increased penalties for trafficking fentanyl, restricted prescribing guidelines for physicians and emergency rooms (a person can only go 7 days without seeing a doctor for a refill on medication), strict licensing guidelines for pain management clinics, drug take back programs, approval of naloxone (narcan) friends, family, and law enforcement, and lastly mandatory school based opiate prevention program.

At the county level, summit county has also initiated specific initiatives to further combat the problem. Summit county has distributed over 40000 drug disposal bags to pharmacists, supplied naloxone to community jails and schools, created a task force to further advance the initiatives, expanded medication assisted treatment and residential treatment services, offers a syringe exchange program, and lastly stated a quick response team for overdoses specifically in the community.

After this discussion, Dr. Tins Kim discussed the opioid crisis in LA county, and the number were very interesting, while overdoses have steadily risen in LA county recently, it has it been as drastic as most areas in the country, However, the health department knows that it could rise st anytime, and has stated to take action to prevent a drastic rise. LA county has started a prescription drug coalition to prevent the problem from expanding, the coalition consists of nine action teams, with 6 priorities, that possess 10 key objectives. Objectives include decreasing use, changing policy to prevent an influx of prescription drugs, and nary other objectives that are similar to the actions taken in Ohio.

It is clear that this crisis is a serious problem, as the United States population consists of 5% of the world population, but 80% of the world opioid abuse and 99% of hydrocodone use, strong changes need to be made to effectively change the course of this crisis.

Adopting a vegetarian diet has become more prevalent; the US Census Bureau reported that 3.3% of adults are vegetarian or vegan. There are many reasons cited for becoming a vegetarian: animal rights, sustainability, preventing chronic disease, and promoting weight management. Whatever the reason, becoming a vegetarian or vegan is a major lifestyle choice, and some planning is needed to make sure that the diet is nutritionally adequate. The Academy of Nutrition and Dietetics’ webinar provided their position on a healthy vegetarian diet and its potential benefits, which is a good starting guide for those wanting to become a vegetarian.

First, what are the benefits of becoming a vegetarian? Research suggests that a vegetarian diet can help to prevent many chronic diseases. It has been associated with reduced risk of cardiovascular disease, lower prevalence of hypertension, lower risk of type 2 diabetes, and lower risk of some cancers. For some individuals, a vegetarian diet can also be a way to promote a healthy weight.

Another thing to consider is what type of vegetarian to become. Vegetarian is actually a fluid term that can be used to describe many diet patterns. For example, one can become a lacto-ovo-vegetarian that still eats dairy products and eggs. You can also eliminate either dairy or eggs by becoming an ovo-vegetarian or a lacto-vegetarian, respectively. Vegan is a stricter diet that excludes all animal products and maybe honey. None of these choices are better than the other; each individual should choose the type of vegetarian diet that aligns best with their food preferences and beliefs.

If a vegetarian or vegan diet is adopted, a few key nutrients should be monitored to ensure adequate intake.

• Protein – The recommended intake can be easily met by a variety of plant foods, especially beans, peanuts, and soy products.
• Omega-3 fatty acids – These heart-healthy fats are typically associated with intake of fatty fish like salmon or tuna, but there are plenty of vegetarian/vegan sources like ground flax seeds, chia seeds, walnuts, or canola oil.
• Iron – It is generally not a concern for vegetarians, but remember that sources of vitamin C (fruits) can enhance absorption.
• Calcium – Vegetarians who eat dairy do not have to be too concerned about meeting their calcium needs, but vegans need to be more thoughtful about their sources. Calcium-fortified products and supplements may need to be added to the diet.
• Vitamin D – Look for fortified foods like cow’s milk, nondairy milks, fruit juices, cereals, margarine, and eggs. Vegans may need to take a supplement.
• B12 – This vitamin cannot be found in adequate amounts in plant foods, so choose fortified foods or a supplement to ensure you are getting enough.

These are just a few things to consider when deciding to become a vegetarian. While this diet pattern can provide many health benefits, it is also important to consider some nutrients you may be missing. For further questions about a nutritionally adequate diet, consult a registered dietitian nutritionist.

The webinar Let the Tots Play – Adventures in Early Childhood Physical Activity provided some interesting insight into improving physical activity in daycare centers. It focused on two states’ initiatives, New Hampshire and Texas. One topic that was covered in the webinar was particularly interesting – preventing obesity by design in childcare centers.

Modifying the built environment is a popular public health initiative. The idea is to design the environment and infrastructure in a way that promotes physical activity. Mixed-land use and aesthetically pleasing walking paths help to incorporate physical activity more naturally into the day. It was reported in the webinar that being outdoors is the strongest correlate of physical activity. Why not extend this idea to playgrounds at childcare centers? Young children are not going to exercise for thirty minutes at one time, so it is imperative that they have an environment that motivates them to be active. This was the idea of NC State College of Design, and they created the Natural Learning Initiative. It involved designing playgrounds or outdoor spaces in a way that promotes movement and richer play. Their idea worked – redesigning a playground caused 22% improvement in movement among the children. These new spaces, now called an Outdoor Learning Environments instead of playgrounds, provide plenty of space and appropriate activities for young children to play.

What is the magic formula to creating a beautiful Outdoor Learning Environment? The Natural Learning Initiative developed several Best Practices that daycare centers or even parents can incorporate into their playgrounds and backyards to promote developmentally appropriate play. One of the major structural elements is a looping, curvy pathway. This provides a fun track for kids to use on foot or their tricycles, and adding curves to the path increases their activity time. They also recommend creating 10 or more learning settings, or different areas with activities to do. Smaller settings are commonly seen in indoor spaces of daycare centers, so why not bring it outside? Other large structural elements to include are a multipurpose lawn, designated vegetable garden, and an enclosed outdoor classroom space. If these changes are out of reach due to space and cost, small changes can be made. For instance, providing shady settings, trees (especially edible fruit trees), shrubs, vines, and ornamental grasses are little ways to perk up the space with natural elements. It Is also recommended to provide wheeled toys and natural, loose materials for children to play with.

While these Best Practices may seem simple, consider the playground that you had at your daycare or elementary school. Don’t these suggestions seem more inviting? Incorporating edible fruit trees and gardens can also promote nutrition and agriculture education. These types of initiatives targeting young children are exciting and important ways to combat childhood obesity.

To learn more about the Natural Learning Initiative, visit their website: https://naturalearning.org

Charlene Burgeson, Executive Director of the Active Schools, presented a National Physical Activity Society webinar on April 17, 2017 titled, “The Active Schools Movement: Strategic Plan for 2017-2020. This initiative was formally known as the Let’s Move! Active Schools, originally led by former first lady, Michelle Obama.

The purpose behind this initiative is to provide an evidence-based argument on how important it is to offer an active school environment for children and how important it is when compared to learning other subjects in the school day. Approximately 2 in 3 kids are not reaching their daily 60 minutes of physical activity, and 1 in 5 school aged kids (6-19 years) are considered obese. In efforts to combat these numbers, policy change is required.

So, why do schools insist that cuts to these programs are necessary to increase academic performance? Time? Money? What the policy makers and decision makers do not realize is that what they are doing is counter-productive. Cutting these programs will have detrimental effects on the very thing they want to improve! Michelle Obama says that we, as a nation, should try harder and come together for the future lives of our kids.

Research consistently suggests that participating in daily physical activity has numerous benefits, especially for children. Examples of benefits include increases in brain activity, grades, and performance on standardized tests, as well as decreases in wasted class time and behavior issues. Students tested better in reading, spelling, and math, and were likely to read above their grade level. These benefits help everyone, including the students, teachers, and parents, as well as administration.

Charlene presented a variety of statistics on children who had about 20 minutes of physical activity:

• 20% more likely to earn an A in math and English
• 6% increase in standardized test scores over three years
• 13% increase in student’s physical activity level for the week after 1 PA lesson
• 21% decrease in teachers’ time managing behavior issue

The program itself relies on these strategies:

• Improve supply
  • Influence current teacher practices by helping teachers with time management and the confidence to do so
  • Give teachers the information on how to incorporate physical activity into the classroom environment by showing the benefits (ex. increased performance and time students are on task/attentive)
• Increase demand
  • Repackage and enhance evidence base
  • Show parents that their children can become well-rounded
  • Convince administration that attendance and grades will increase
  • Communicate strategically with stakeholders/policy makers

In order to accomplish future goals of the program, it requires the assistance and involvement of various partners in a collaborative effort. CDC now funds Healthy School Programs in all 50 states in efforts to reduce childhood obesity. Approximately 23,000 K-12 school are currently enrolled in the program, which includes over 12 million students, along with 43 partnering organizations. Active Schools hopes to partner with more organizations to create a more substantial impact. Limitations include financial resources and dependent assistance from partnering organizations, as well as the current assumptions that academics should be valued more than health and alternative means of improving the learning process.