Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
Growing Healthy Communities Initiative:
Transforming the Built Environment to Combat Obesity
Janea Snyder 1, Amar Kanekar 1, and Bennie Prince 1
1
University of Arkansas
Abstract
A contributing factor to the U.S. national obesity epidemic is the built environment-the physical aspects of
a community in which we live, work and engage in our everyday activities. Therefore, modifying the built
environment can be a solution to address the epidemic. Such an example is the Arkansas Coalition for
Obesity Prevention (ArCOP) Growing Healthy Communities (GHC) initiative. The GHC initiative
encourages community health workers, health education specialists, government officials and other
stakeholders to embrace community collaboration in efforts to improve built environments by equipping
them with resources that increase community access to healthy foods and physical activities to help combat
obesity. ArCOP to date has funded 100+ GHC communities in Arkansas. One of the five communities
being highlighted by the authors for their GHC efforts includes: the University of Arkansas at Little Rock
University District community, in which the authors have contributed to implementing various GHC
projects for the residents of this community. The GHC, a state initiative, has implications for national and
global use, and it is emerging as an exemplary best practice model. It provides communities with effective
strategies to help address the health inequities of obesity, through prevention and intervention measures to
improve health behaviors.
© 2018 Californian Journal of Health Promotion. All rights reserved.
Keywords: obesity, built environment, healthy communities, community collaboration
Introduction
indicate that the prevalence of obesity in the
United States currently remains higher than the
Healthy People 2020 goals of 14.5% among
youth and 30.5% among adults (Healthy People
2020, 2018).
There is no consensus on the precise causes of the
obesity epidemic, more likely culprits are
changes in societal and environmental conditions
that have led to changes in diet and physical
activity (Havranek, Mujahid, Barr, Blair, Cohen,
Cruz-Flores, & Rosal, 2015). This makes it
extremely important for action to take place in
assessing the health of our communities’ built
environments. The built environment includes the
physical makeup of where we live, learn, work,
our homes, schools, businesses, streets and
sidewalks, open spaces, and transportation
options; it can influence the overall community
health and individual behaviors such as physical
activity and healthy eating (Centers for Disease
Control and Prevention (CDC), 2017). Data from
the National Center for Health Statistics (NCHS)
National Health Examination Survey revealed the
prevalence of obesity was 39.8% among adults
and 18.5% among youth in the United States in
2015–2016 (CDC, 2017). These statistics
Healthy environments, particularly ‘built
environments and healthy neighborhoods' are
among the five key areas included in the approach
towards meeting Healthy People 2020 goals of
‘creating physical and social environments that
promote good health for all' (Healthy People,
2020). At the national level, Centers for Disease
Control and Prevention's ‘Built Environment and
Health Initiative', the only existing federal
program has the noble purpose of improving the
health of all Americans through evidence-based
changes in the built environment. The key tenets
of the CDC’s Built Environment and Health
Initiative revolve around factors such as support
towards health impact assessments, forging
57
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
environment. Obese persons are often blamed for
their weight, with common perceptions that
weight stigmatization is justifiable and may
motivate individuals to adopt healthier behaviors
(Puhl & Heuer, 2010). However, these
perceptions must change in order to recognize
that the threat of obesity and its comorbidities are
affecting communities throughout the world.
relationships with local governments, providing
scientific expertise and training to local officials
and monitoring various environmental indicators
(Centers for Disease Control and Prevention,
2015). In models such as ecological model and
structural model of health behaviors`, the role of
environments, such as food environment,
physical environment and recently the built
environment contribute largely towards healthy
outcomes across the population health spectrum
(Cameron et al., 2012; Diclemente, Salazar &
Crosby, 2013). Food environment, particularly in
the
socio-economically
disadvantaged
populations, can influence chronic diseases such
as obesity and other non-communicable diseases
(Pessoa, Mendes, Gomes, Martins, & VelasquezMelendez, 2015). Built environments such as
parks, pavements, buildings, walkability are
important determinants for risk of being obese
and creating an obesogenic environment along
with unhealthy diets, physical inactivity and
gene-lifestyle interactions (Hruby et al., 2016).
In a very recent international study, which
assessed the role of built environment
characteristics and their relation to physical
activity with varying socioeconomic status,
significant differences were found in terms of
playground/play areas, public open spaces,
marked road crossings across various
neighborhoods (Brazdova et al., 2015). Yang,
Spears, Zhang, Lee & Himler (2012) assessed the
relationship between multiple built environment
factors and individual characteristics of people on
long-term physical activity, results revealed that
no long-term physical activity was significantly
associated with individual factors including:
older age, less education, lower income, being
obesity, and low life satisfaction. No long-term
physical activity was also significantly associated
with the following community factors: more
commute time, higher crime rate, urban
residence, higher population density, but not for
distance to recreation facilities. Although this
was a good cross-sectional study, it suggested
future use of spatial analyses for improved
understanding of the relationship between
population health and built environmental
characteristics (Yang, Spears, Zhang, Lee, &
Himler, 2012). A deeper understanding of the
relationship between built environments and
physical activity was studied using latent profile
analyses of seven GIS (geographic information
system) measured built environment features.
This study concluded that walkability along with
transit and recreation access did contribute to
healthy aging among older populations (Todd et
al., 2016).
Obesity is not just a public health concern in the
United States; it is a global issue. The worldwide
prevalence of obesity more than doubled between
1980 and 2014 (World Health Organization
(WHO), 2016). According to Blumenthal &
Levin (2017) “Every country included in the
World Health Organization’s data repository
experienced an increase in adult obesity rates
from 2010 to 2014. None of these nations’ obesity
rates stayed the same or declined during this time
period” (p. 1). Many of the indicators found by
these authors that played major roles in the
increase of obesity-included lack of education,
eating more processed foods, and physical
inactivity. Obesity is a serious concern because it
is often associated with poorer mental health
outcomes, reduced quality of life, and the leading
causes of death (chronic diseases e.g. heart
disease, diabetes, and some types of cancer) in the
United States and worldwide (CDC, 2018).
Role of Built Environment and Positive Health
Outcomes
Nationally, there is a consensus on the need to
help combat the obesity epidemic. According to
Caballero (2007), we still tend to regard obesity
as a disorder of individual behavior, rather than
highly conditioned by the socioeconomic built
Although the above literature suggests that built
environment contributes largely to positive health
outcomes and positive health behaviors, recent
studies show a mixed picture particularly due to
variations in study designs and heterogeneous
reporting of results (Schule & Bolte, 2015). The
58
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
members to embrace positive health behaviors
are of extreme importance. Reshaping people's
economic, physical, social, and service
environments can help ensure opportunities for
health and support healthy behaviors (Rudolph,
Caplan, Ben-Moshe, & Dillion, 2013).
Collaborating with community partners will help
make change happen at a greater scale, as no one
entity can be as impactful alone in addressing this
obesity epidemic. This has been the focus of the
Arkansas Coalition for Obesity Prevention
(ArCOP) Growing Healthy Communities (GHC)
initiative. This grant-funded project, (GHC) was
established in 2009 and has contributed to
helping ArCOP increase access to physical
activity and healthy foods, and implement
environmental and policy changes to support
combating obesity among diverse communities in
Arkansas.
current challenges to derive any significant
correlation, or, for that matter, inference to a
causal pathway between built physical
environments and positive health outcomes do
exist. They point to intermediary variables such
as associations between diet, physical activity
and built environments (Drewnowski et al.,
2016), high income vs. middle income countries
(Blay, Schulz, & Mentz, 2015), younger
populations vs. older populations (Siu, Lambert,
Fu, Hillier, Bosworth, & Michael, 2012). Hence,
it has become extremely important that in
addition to choosing specific built environment
variables, better tools need to be designed and
implemented which could assess large amounts
of spatial data covering wider geographic extent
(Kroeger, Messer, Edwards, & Miranda, 2012).
Such actions will help align best approaches to
improving the built environments to foster
positive health outcomes.
Arkansas Coalition for Obesity Prevention
The Arkansas Coalition for Obesity Prevention
was established in 2008. The coalition has been
supported with secured funding from the Blue &
You Foundation for a Healthier Arkansas, the
Arkansas Department of Health, and the
University of Alabama at Birmingham Midsouth
Transdisciplinary Collaborative Center for
Health Disparities Research (ArCOP, 2017). This
financial support has contributed to efforts and
the success of the coalition for over a decade and
helping local Arkansas communities contribute to
combating obesity within the state. In 2003,
Arkansas Act 1220 became the first law in the
nation with comprehensive multi-pronged
approaches that bring families, schools, and
communities together to combat the epidemic of
obesity (ArCOP, 2017).
Healthy Communities
Healthy communities result from healthy choices
and environments that support shared
responsibility (Norris & Pittman 2000). Not
everyone who resides in a community has an
interest in wanting to contribute to the work in
making it healthier. However, a few may be
willing to collaborate with others to work toward
making positive change happen. Efforts of Drs.
Len Duhl and Trevor Hancock were instrumental
to the development of the initial Healthy
Communities movement that began in the mid1980s, and first implemented via the Healthy
Cities initiative spearheaded by the World Health
Organization. Since that time, the movement has
spread to more than 3,000 communities in more
than 50 countries on every continent (Norris &
Pittman, 2000). There is no known evidence that
this initial movement has contributed to the
development of the Arkansas Coalition of
Obesity Prevention (ArCOP) Growing Healthy
Communities (GHC) initiative. Yet, its existence
has helped increase the awareness of the
importance of improving the health of our
communities.
The coalition’s mission is focused on helping
community residents increase their physical
activity and improve their consumption of
healthier foods with an overarching goal of
combating obesity among Arkansans. This
collaborative coalition consists of diverse
partners but not limited to: stakeholders of local
communities, government agencies, community
health workers, health educators, non-profit
organizations, businesses, and advocates for
schools. The coalition has made concentrated
efforts in working towards its vision of improving
Prevention is key to combating obesity and as
community health workers our roles and
responsibilities in helping to promote, increase
awareness and encourage fellow community
59
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
effective policy and environmental changes. Each
community is provided assistance in creating a
work plan to address the specific weaknesses of
their community. Upon agreement of the work
plan, each GHC team is granted a 12-month cycle
to work toward the implementation of their
community projects. There is a mid-year report
that is due within the initial 6-month period that
requires a summary from each GHC team about
the GHC projects their team implemented to date
and detailed outcomes. At the conclusion of the
12-month cycle, an end of the year report is due,
that also requires a summary about the GHC
projects implemented to date and detailed
outcomes along with the submission of photos
capturing project activities. This grants
communities’ the opportunity to self reflect and
evaluate their GHC efforts. However, there is a
need for ArCOP to take additional measures to
evaluate the effectiveness and overall impact of
these efforts.
lifestyles of Arkansans by helping communities
increase access to physical activity and healthy
foods as a way to help combat and prevent
obesity. With secured funding, the coalition has
been able to provide financial support in the mode
of grants to communities that submit successful
proposals. In 2009, ArCOP collaborated with
community partners which included: the Blue &
You Foundation for a Healthier Arkansas, the
Arkansas Department of Health’s CDC
Cooperative Agreement, UAMS Partners for
Inclusive Communities, UAMS College of Public
Health, and the Winthrop Rockefeller Institute.
The collaboration helped launch the Growing
Healthy Communities project that has been very
impactful in growing healthier Arkansas
communities as a way to help combat obesity for
the past nine years. These positive GHC initiative
outcomes have included yet not limited to:
increased access to physical activity and healthy
foods, and the implementation of environmental
and policy changes. The GHC initiative efforts
alter the built environment in communities for
possible successes in obesity prevention. It is
emerging as a best practice model.
Sustainability of GHC Communities
After the initial year of funding GHC teams are
invited and encouraged to attend an ArCOP
annual regional state training summit usually
hosted in a funded GHC community. The
summits provide additional training opportunities
for GHC teams, which allows them to learn more
about sustaining their current GHC projects as
well as learn about new projects that could be
implemented within their communities. The
summit consists of various training topics not
limited to: (e.g. farmers market, Cooking Matters
cooking classes, grant writing, and community
gardening). For example, a GHC team could
attend a farmers’ market training session and be
educated on how to develop and manage a
farmers’ market. In addition, for attending the
farmers’ market training session they would be
eligible to submit a grant proposal to ArCOP for
funding based on their proposed plan they
developed after attending the training. This
allows for GHC team members to stay active in
sustaining or implementing new projects to
continue to improve their community.
Growing Healthy Communities (GHC)
Initiative: An Emerging Best Practice Model
The Arkansas Coalition for Obesity Prevention
has been extremely ambitious in encouraging
communities to apply for coalition grant funding
to become a selected GHC. Such funding allows
them to plan and implement community projects
not limited to (e.g. farmers markets, walking/bike
trails, community health fairs, physical activity
programs at local elementary schools, healthy
cooking classes, complete street projects, and
joint use agreements) that will benefit their
communities. Funded communities are then
required to participate in a 3-day immersion
training that includes the participation of the
mayor and other community stakeholders from
each GHC community team. A representative(s)
of each GHC team presents a photovoice
presentation; this presentation highlights the
strengths and weaknesses of the selected
community, which serves as a catalyst for the
work plan each team develops. Throughout the
training, community work teams develop,
network, and participate in lecture presentations
from state, local, and national leaders about
Communities are often acknowledged annually
for their efforts in helping to improve their
communities. For the GHC projects conducted
each year, ArCOP extends a request for GHC
60
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
the built environment that affect health,
especially walking, biking, and other types of
physical activity. The five core features assessed
in the BE Tool includes the built environment
infrastructure: such as road types, intersections,
crosswalks, and public transportation. The
second core feature is walkability: access to safe,
attractive sidewalks and paths. The third core
feature is bikeability: the presence of bike lanes
or bike paths. The fourth core feature is
recreational sites. The fifth core feature is the
food environment: such as access to grocery
stores and farmers markets (CDC, 2017). GHC
communities are recognized for their built
environment efforts that mirror improving such
measures as indicated by the CDC’s (BE Tool).
The authors have been active in such measures,
and details the success of their GHC efforts of
implementation for the UA Little Rock
University District community, and highlights the
GHC efforts of four other Arkansas communities:
Bryant, Hot Springs, and Southside Bee Branch.
teams to complete a recognition application after
their initial year. This application requests
highlights, a summary of activities the GHC
teams implemented throughout the year including
policy changes, environmental changes, research
conducted, and evaluations. ArCOP’s president
at the annual GHC celebration recognizes
successes of the GHC teams’ efforts as well
shares statistical data about how the GHC efforts
are impacting the state’s obesity rates.
The following descriptions highlight the three
levels of recognition that communities can strive
to be.
An “Emerging Community” is a
community within the phase of one to three years,
building a foundation, and recruiting and
converting stakeholders to the cause for life
through
education
and
awareness.
A
“Blossoming Community” is a community within
the phase of five or more years. It is transitioning
into a strategic action plan, setting reachable
goals and implementing projects, engaging GHC
team members and utilizing their skills, network,
and available resources. Last, a “Thriving
Community” is a community beyond six years
and is keeping community excited and engaged
by celebrating each completed project, sustaining
projects, and implementing environmental and
policy changes, and tracking improvements with
data collection (ArCOP, 2017). ArCOP provides
this recognition at an annual conference
celebration that GHC teams are invited to attend
to be recognized and celebrated.
Growing Healthy Communities Successes
The Arkansas Coalition for Obesity Prevention
has recognized the city of Hot Springs, Arkansas
as a “Thriving community”. Hot Springs has
been successful in increasing access to healthy
affordable fruits and vegetables. This city has
developed two community gardens and is
currently participating in a farmers’ market
nutrition assistance program, with a doubling
incentive for customers who are recipients of the
Supplemental Nutrition Assistance Program
(SNAP). SNAP provides nutrition assistance to
millions of eligible, low-income individuals and
families and serves as the largest program in the
domestic hunger safety net (United States
Department of Agriculture, 2017).
This
supported GHC nutrition assistance project saw a
tremendous increase in SNAP customer
participation. According to ArCOP (2017) in
2014, there were 61 transactions with total sales
of $732.05 in 13 weeks and in 2015, there were
377 SNAP transactions with total SNAP sales of
$4,743.28 in 24 weeks. This project has helped
increase access and consumption of healthy
whole foods to community members as a way to
help combat obesity.
Another "Thriving
Community" that has been recognized by the
Arkansas Coalition for Obesity for Prevention for
ArCOP’s GHC initiative compliments the efforts
of the World Health Organization (WHO) in
increasing awareness about obesity and the
importance of collaboratively striving to combat
it. Supportive environments and communities are
fundamental in shaping people’s choices, by
making the choice of healthier foods and regular
physical activity the easiest choice (the choice
that is the most accessible, available and
affordable), and therefore preventing overweight
and obesity (WHO, 2016). There are several
GHC communities in the state of Arkansas that
are proactive in such efforts.
These GHC efforts often align with the CDC’s
Built Environment Assessment Tool (BE Tool)
that measures the core features and qualities of
61
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
The Arkansas Coalition for Obesity Prevention
has recognized the Southside Bee Branch (SSBB)
School District community that resides in Bee
Branch, Arkansas as an “Emerging Community”.
According to ArCOP (2017), this community's
GHC efforts have included: (1) the Southside Bee
Branch Wellness Committee, (2) recognizing a
need for local healthcare services in the Bee
Branch area, and (3) the SSBB School Board
approving the use of district funds to renovate the
superintendent's former house into a schoolbased health center (Hornet Health Care) for the
community members to utilize for services. Such
GHC efforts of this community and the many
others will continue to help grow healthier
communities. The Arkansas Coalition for Obesity
Prevention efforts in supporting the growth and
successes of over 100 Growing Healthy
Communities will continue to be a great
reinforcer that communities need to sustain their
efforts (e.g. community gardens, farmers
markets, healthy eating cooking classes,
increased access to physical activity, and
environmental and policy changes) in striving to
combat obesity.
Conclusion
its GHC success is the city of Bryant, Arkansas
for implementing community projects focused on
increasing access to engagement in physical
activity as a way to help combat obesity. These
have included the city having roads painted to
encompass bike lanes as well as the creation of
natural mulch trails at community parks to
increase community access to physical activity
resources (ArCOP, 2017). There have been other
communities also praised for their efforts in
growing healthier communities.
The School District of Lamar, Arkansas has been
recognized as a "Blossoming Community"
because of their efforts in helping to cultivate an
environment that is focused on making the whole
child healthy. With funding from ArCOP, they
have contributed to the establishment of school
gardens. The school district has also been a
recipient of 6 Joint Use Agreement grants to offer
the school and community more options to get
physical activity. The district is also involved
with the Farm to School program and has
partnered with a community farmer who grows
peaches and offers fresh locally grown peaches to
students during lunchtime (ArCOP, 2017).
Environmental factors are crucial in impacting
overall quality of healthy life and the Healthy
Communities movement is transforming
communities across the nation. Its goal is
ambitious: to achieve radical, measurable
improvements in health status and long-term
quality of life. By many measures of health and
well-being it’s working (Norris & Pittman, 2000).
A high percentage of studies have identified a
beneficial relationship between the built
environment and physical activity or obesity.
Furthermore, studies that included populations
from the South had similar positive findings
(Ferdinand, Sen, Rahurkar, Engler, &
Menachemi, 2012). These studies complement
the Arkansas Coalition for Obesity Prevention
GHC built environment improvement efforts in
growing healthy communities: encouraging
community partners to collaboratively work for
the purpose of combating the obesity epidemic.
The University of Arkansas at Little Rock
University District Community, which is located
in Little Rock, Arkansas is also considered a
"Blossoming Community". This is the
community in which the authors have been
involved. This GHC team has collaborated with
local community partners for the past seven years
to help sustain their GHC project efforts. These
projects have included: annual gardening classes
that granted raised bed gardens to over one
hundred residents homes, annual community
wellness fairs to grant residents free annual gym
memberships to the UA Little Rock campus
fitness center to increase residents access to
physical activity. Other projects have included:
Garden to Grill cooking classes in which class
participants are granted a free stovetop grill pan
to help reinforce healthy cooking and eating at
home, and community farmers market days
(University of Arkansas at Little Rock, 2016). A
newly selected GHC community has been
rewarded by ArCOP for its' emerging efforts to
grow a healthier community.
The State of Obesity (2018) recommends that
federal, state and local governments should
provide sufficient resources to support policies
62
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
complexity of the obesity epidemic, prevention
strategies and policies across multiple levels are
needed in order to have a measurable effect. Such
policies and prevention strategies could help
influence the adoption and increased engagement
of healthy behaviors among Americans, in which
such actions could help foster combating the
obesity epidemic within our communities.
and programs that support healthy communities,
including obesity and chronic disease prevention
programs;
transportation,
housing
and
community development policies that support
active living; and nutrition assistance programs to
ensure all Americans have access to affordable,
healthy food. Authors Malik, Willett & Hu
(2013) agree stating that due to the scope and
References
Arkansas Coalition for Obesity Prevention (ArCOP). (2016). Who we are. Retrieved from
http://arkansasobesity.org/who-we-are/mission.html
Arkansas Coalition for Obesity Prevention (ArCOP). (2017). Hot Springs. Retrieved from
http://arkansasobesity.org/news-events/ghc-success-stories/hot-springs.html
Arkansas Coalition for Obesity Prevention (ArCOP). (2017). City of Bryant. Retrieved from
http://arkansasobesity.org/news-events/ghc-success-stories/city-of-bryant.html
Arkansas Coalition for Obesity Prevention (ArCOP). (2017). Southside bee branch. Retrieved from
http://arkansasobesity.org/news-events/ghc-success-stories/southside-bee-branch.html
Arkansas Coalition for Obesity Prevention (ArCOP). (2017). Lamar school district.Retrieved from
http://arkansasobesity.org/news-events/ghc-success-stories/lamar-school-district.
Blay, S. L., Schulz, A. J., & Mentz, G. (2015). The relationship of built environment to health-related
behaviors and health outcomes in elderly community residents in a middle income country.
Journal Of Public Health Research, 4(2), 135-141. doi:10.4081/jphr.2015.548
Blumenthal, M.D. & Levin, S. (2017). Global Obesity: A Growing Epidemic, The Huffington Post,
retrieved from http://www.huffingtonpost.com/susan-blumentahl/global 9139554 on 2/9/2017
Brazdova, Z.D., Klimusova, H., Hruska, D., Prokopova, A., Burjanek, A., Wulff, K.R.S. (2015).
Assessment of environmental determinants of physical activity: A study of built
environment indicators in Brno, Czech Republic. Central European Journal of Public Health, 23,
sup S23-29.
Caballero, B. (2007). The global epidemic of obesity: an overview. Epidemiol Rev 2007; 29 (1):
1-5.
doi: 10.1093/epirev/mxm012
Cameron, C.M., Scuffham, P.A., Spinks, A., Scott, R., Sipe, N., Ng, S., Wilson, A., Searle, J.,
Lyons,
R.A., Kendall, E., Halford, K., Griffiths, L.R., Homel, R., & Mcclure, R.J. (2012).
Environments for Healthy Living (EFHL) Griffith birth cohort study: Background and Methods.
Maternal and Childhealth Journal, 16, 1896-1905.
Centers for Disease Control and Prevention. (2015). CDC’s built environment and health initiative.
Retreived from https://www.cdc.gov/nceh/information/built_environment.htm
Centers for Disease Control and Prevention. (2018). Prevalence of obesity among adults and youth:
United States, 2015–2016. Retrieved from
https://www.cdc.gov/nchs/products/databriefs/db288.htm
Centers for Disease Control and Prevention. (2018). Adult causes and consequences. Retrieved from
https://www.cdc.gov/obesity/adult/causes.html
Centers for Disease Control and Prevention. (2017). Built environment assessment tool.
Retrieved from https://www.cdc.gov/nccdphp/dnpao/state-local-programs/built-environmentassessment/
DiClemente, R.J., Salazar, L.F., & Crosby, R.A. (2013). Health behavior theory for public health:
Principles, foundations and applications. Burlington, MA: Jones and Bartlett.
63
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
Drewnowski, A., Aggarwal, A., Tang, W., Hurvitz, P. M., Scully, J., Stewart, O., & Moudon, A. V.
(2016). Obesity, diet quality, physical activity, and the built environment: the need for behavioral
pathways. BMC Public Health, 161-12. doi:10.1186/s12889-016-3798-y.
Ferdinand, A., Sen, B., Rahurkar, S., Engler, S., & Menachemi, N. (2012). The Relationship Between
Built Environments and Physical Activity: A Systematic Review. American Journal of Public
Health, 102(10), e7–e13. http://doi.org/10.2105/AJPH.2012.300740
Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., & Rosal, M.
(2015). Social Determinants of Risk and Outcomes for Cardiovascular Disease. Circulation,
132(9), 873-898.
Healthy People 2020. (2018). Social determinants of health. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-ofhealth
Healthy People 2020. (2018). Nutrition and weight status. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weightstatus/objectives
Hruby, A., Manson, J.E., Qi, L., Malik, V.S., Rimm, E.B., Sun, Qi, Willett, W.C., & Hu, F.B. (2016).
Determinants and consequences of obesity. American Journal of Public Health, 106, supp 9,
1656-1662. doi 10.2105/AJPH.2016.303326.
Kroeger, G. L., Messer, L., Edwards, S. E., & Miranda, M. L. (2012). A novel tool for assessing
and summarizing the built environment. International Journal Of Health Geographics, 11(1), 46-58. doi:
10.1186/1476-072X-11-46
Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Global obesity: trends, risk factors and policy
implications. Nature Reviews Endocrinology, 9(1), 13-27
Norris, T., & Pittman, M. (2000). The healthy communities movement and the coalition for healthier
cities and communities. Public Health Reports, 115(2-3), 118–124.
Pessoa, M.C., Mendes, L.L., Gomes, C.S., Martins, P.A., & Velasquez-Melendez, G. (2015).
Food environment and fruit and vegetable intake in an urban population: A multilevel analysis. BMC
Public Health, 15, 1012 doi 10.1186/s12889-015-2277-1.
Puhl, R. M., Heuer C. A., (2010). Obesity stigma: Important considerations for public health, American
Journal of Public Health 100 (6), 1019-1028.doi: 10.2105/AJPH.2009.159491
Rudolph, L., Caplan, J., Ben-Moshe, K., & Dillon, L. (2013). Health in all policies: a guide for state and
local governments. Washington, DC and Oakland, CA: American Public Health Association and
Public Health Institute
Schüle, S. A., & Bolte, G. (2015). Interactive and independent associations between the socioeconomic
and objective built environment on the neighborhood level and individual Health: A systematic
review of multilevel studies. Plos ONE, 10(4), 1-31. doi:10.1371/journal.pone.0123456
Siu, V. W., Lambert, W. E., Fu, R., Hillier, T. A., Bosworth, M., & Michael, Y. L. (2012). Built
environment and its influences on walking among older women: Use of standardized geographic
units to define urban forms. Journal Of Environmental & Public Health, 1-9.
doi:10.1155/2012/203141
State of Obesity (2018). Recommendations: Invest in Community-Based Policies and Programs to
Improve Nutrition and Increase Physical Activity. Retrieved from
https://stateofobesity.org/policy/recommendations/introduction
Todd, M., Adams, M.A., Kurka, J., Conway, T.L., Cain, K.L., Burnan, M.P., Frank, L.D., Sallis, J.F., &
King, A.C. (2016). GIS-measured walkability, transit and recreation environmentsin relation to
older adults’ physical activity: A latent profile analysis. Preventive Medicine, 93, 57-63.
United States Department of Agriculture (USDA). (2017). Supplemental nutrition assistance program.
Retrieved from
https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap
University of Arkansas at Little Rock (UALR). (2016). University district recognized for
healthy community initiatives. Retrieved from
64
Snyder, J., Kanekar, A., Prince, B. / Californian Journal of Health Promotion 2018, Volume 16, Issue 2, Pages 57-65.
http://ualr.edu/news/2016/12/15/university-healthy- community-initiatives/#more65994 https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap
World Health Organization (WHO). (2014). Obesity. Retrieved from
http://www.wpro.who.int/mediacentre/factsheets/obesity/en/
Yang, W., Spears, K., Zhang, F. Lee, W., & Himler, H.L. (2012). Evaluation of personal and built
environment attributes to physical activity: A multilevel analysis on multiple population- based
data sources. Journal of Obesity, 1-9. doi:10.1155/2012/548910
Author Information
Janea Snyder Ph.D., CHES
Assistant Professor
Health Education & Promotion
University of Arkansas at Little Rock
College of Education & Health Professions
School of Counseling, Human Performance & Rehabilitation
Office: 501-683-7575
Fax: 501-569-3237
E-mail: jlsnyder@ualr.edu
65