Child's play: community solutions for increasing youth physical activity in distinct safety contexts

2013·2.1 MB·English

by  Phibbs, Stephanie L.

CHILD’S PLAY: COMMUNITY SOLUTIONS FOR INCREASING
YOUTH PHYSICAL ACTIVITY IN DISTINCT SAFETY CONTEXTS
by
Stephanie L. Phibbs
B.A., University of Redlands, CA, 1993
M.P.H., University of Nottingham, England, 1995

A thesis submitted to the
Faculty of the Graduate School of the
University of Colorado in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Health and Behavioral Sciences Program
2013
© 2013
STEPHANIE L. PHIBBS
ALL RIGHTS RESERVED
This thesis for the Doctor of Philosophy degree by
Stephanie L. Phibbs
has been approved for the
Health and Behavioral Sciences Program
by

Deborah S. Main, Dissertation Chair
Ronica N. Rooks, Chair of Examination Committee
L. Miriam Dickinson
Richard Allen Miech
Jean N. Scandlyn

April 19, 2013
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Phibbs, Stephanie, L. (Ph.D., Health and Behavioral Sciences)
Child’s Play: Community Solutions for Increasing Youth Physical Activity in Distinct
Safety Contexts
Thesis directed by Professor Deborah S. Main.

ABSTRACT
Amid the uniformly low physical activity rates among children in the United
States, combined with epidemic rates of childhood obesity, practical solutions for
increasing physical activity (PA) are needed. Whether interventions to increase PA need to
account for individual demographic characteristics or safety context is unknown.
Methods:
Study Design: This community based participatory research project used mixed
methods, including secondary data analyses and concept mapping.
Setting: Five demographically diverse, geographically contiguous, urban
neighborhoods in Colorado, including one of the largest redevelopments in the United
States designed for active living.
Measures: Secondary data identified neighborhood safety contexts. Concept
mapping participants identified, sorted and rated interventions to increase youth PA.
Population: Participants were purposefully sampled households, including equal
numbers of black, white and Latino adults from each safety context, and their 10-14 year-
old children.
Analysis: Cluster analysis using measures of social cohesion, incivilities,
discrimination, and fear of crime and traffic safety identified homogenous safety
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subgroups. ANOVA, multivariable analyses and concept mapping pattern matching were
used to compare ratings within and between safety contexts and demographic groups.
Results:
Cluster analyses identified three distinct safety contexts. Concept mapping
elicited 330 ideas, 100 of which were randomly selected for participants to sort and rate.
Three intervention groupings were identified: 1) activity interventions, 2) safety
interventions, and 3) infrastructure/access interventions. Participants residing in less
safe contexts, and black and Latino adults, rated all interventions as more needed than
participants from the safest context and white adults. Adults residing in the safest context
thought infrastructure/access interventions were most needed, while adults from less safe
contexts rated safety interventions as most needed. Youth across all contexts thought
safety interventions were least needed; activity and infrastructure/access interventions
were rated as most needed. Community-led analyses identified that all youth across all
contexts wanted fun, free and safe physical activity opportunities.
Discussion:
Safety context is an indicator of community need for youth physical activity
interventions. Communities recommend framing and implementing interventions that are
simultaneously fun, free and safe, rather than focusing exclusively on safety intervention
needs that stigmatize neighborhoods. Top intervention needs are consistent with
nationally recommended interventions and also suggest a role for grassroots participants.

The form and content of this abstract are approved. I recommend its publication.
Approved: Deborah S. Main
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ACKNOWLEDGEMENTS
This project would not have been possible without the work and support of
numerous people. Debbi Main took the initiative to start Taking Neighborhood
Health to Heart, finding excellent community organizers such as Charlene Barrientos
Ortiz, Patricia Iwataki Iwasaki and Alicia Brown to bring and keep community
members together. The chair of Taking Neighborhood Health to Heart, George Ware,
has dedicated countless hours to maintaining this CBPR effort through the years. The
Society of the Youth, a working group of TNH2H, included beautiful people
dedicating time each month making this dissertation part of a social change project,
where research played one part. Adult leaders of that group included LaShonn
Billingsley, Carmen Miranda, Francisco Subiadur, Olga Martinez, Cat Santos and
Daniel Armijo. These adults were extremely generous, sharing so much to create a
true community. Many youth brought fun and vitality to the group as well. Silvia
Gutiérrez Raghunath, Rebecca Slaughter, Heather Kennedy, Nicole Tuitt, Ira
Gorman, Rosario Montoya, Kate Walker and Samuel Wood all contributed
significantly to various phases of the project. Thank you all!
My family has been incredibly supportive, really understanding and loving me
even in my constant busyness, supporting me in believing that together we can make
a difference. I am also very grateful for my supportive colleagues at Denver Health.
This study would not have been possible without the generous funding from the
Active Living Research Program of The Robert Wood Johnson Foundation. Results
would not have become actions without the funding of The Denver Foundation.
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TABLE OF CONTENTS
CHAPTER
I. INTRODUCTION........................................................................................................1
Project Significance................................................................................................8
Study Aims............................................................................................................10
II. LITERATURE AND THEORY REVIEW................................................................11
Understanding Physical Activity among Youth through a Social Ecological
Approach...............................................................................................................11
Combining CBPR and Recommended Interventions for Action..........................14
Rationale for Safety Construct Selection..............................................................16
Understanding Racial and Ethnic Disparities.......................................................21
A View from a Broad Theoretical Lens................................................................24
Chapter Summary.................................................................................................29
III. METHODOLOGY.....................................................................................................30
Research Design....................................................................................................30
Research Setting....................................................................................................30
Aim 1 Methods.....................................................................................................32
Measures...................................................................................................33
Cluster Analytic Methods Used to Identify Unique Safety Contexts.......34
Aim 2 Methods.....................................................................................................35
Concept Mapping Sampling and Recruitment Methods...........................36
Steps in Concept Mapping........................................................................37
Concept Mapping Data Analysis..............................................................41
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IV. RESULTS...................................................................................................................44
Aim 1 Results........................................................................................................44
Aim 2 Results........................................................................................................46
CBPR and the Community-Advisory Counsel.........................................46
Concept Mapping Recruitment Efforts.....................................................50
Participant-Suggested Interventions.........................................................52
Concept Map of Suggested Interventions.................................................54
Multivariable Analyses to Evaluate How Ratings by Different
Demographic Subgroups Vary within and between Safety Contexts.......58
Comparisons of Safety Intervention Needs..................................59
Comparisons of Infrastructure/Access Intervention Needs..........60
Comparison of Activity Intervention Needs.................................61
Summary of Multivariable Analyses............................................62
Concept Mapping Analyses......................................................................62
Concept Maps by Context and Demographic Groups..................62
Comparing Intervention Needs among Adults within and between
Safety Contexts.............................................................................64
Comparing Intervention Needs among Youths within and between
Safety Contexts.............................................................................67
Comparing Intervention Needs among Ethnic Groups within and
between Safety Contexts...............................................................70
Summary of Concept Mapping Need Analysis Comparisons......76
Concept Mapping Adult Possibility Comparisons........................76
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Community-Generated Analyses for Action........................................................81
V. DISCUSSION.............................................................................................................85
Review of Study Findings.....................................................................................85
Interpretation of Study Aim 1 Findings................................................................88
Interpretation of Study Aim 2 Findings................................................................91
Revised Socio-Ecological Framework......................................................91
Perceived Needs Influenced by Individual Factors..................................95
CBPR as a Social Change Project.............................................................98
Correspondence of Study Intervention Recommendations with National Efforts
.............................................................................................................................102
Reflections..........................................................................................................107
Limitations..........................................................................................................109
Limitations of Study Aim 1....................................................................109
Limitations for Aim 2.............................................................................109
Conclusions and Implications for Future Research............................................112
REFERENCES...............................................................................................................115
APPENDICES................................................................................................................134
1: Participant Recruitment Flyer.........................................................................135
2: CAC Facilitation Training Materials..............................................................137
3: Brainstorming Protocol and Packet................................................................153
4: Sorting Protocols.............................................................................................167
5: Rating Protocols..............................................................................................174
6: Community Fair Flyers...................................................................................181
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7: Comprehensive List of Intervention Suggestions...........................................187
8: Pattern Match: Similar Ratings among Context 2 and Context 3 Adults.......195
9: Community Feedback Presentation................................................................197
10: Physical Education Policy Brief...................................................................208

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