Brian L Cole’s research while affiliated with Department of Public Health - Los Angeles County and other places

Background: HIA is defined as "a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population" (1). This project examined the potential health outcomes related to redeveloping a dangerous highway. Methods: The study area included 14,000 individuals (60.0% male, 49.8% Hispanic, 51.3% without a high school education, 61.1% foreign born, and 15.8% live in poverty) living along 2.37 miles of Buford Highway in Atlanta, GA. Quantitative and qualitative methods were used to estimate potential health impacts. Results: We estimated that individuals will walk approximately 124 additional minutes per week after redevelopment (range 64 to 220 min/week). A 91% (range: 89%-94%) reduction in pedestrian accidents is expected resulting in 6.1 (6.0-6.3) fewer injuries and 1.6 (1.5-1.7) fewer fatalities per year. A 60% (range: 39%-65%) reduction is expected for automobile accidents resulting in 73.8 (48.0-80.0) fewer injuries per year. We also expect no changes in regional air pollution levels, a small decrease in noise pollution and automobile level of service, and an increase in gentrification which will have mixed effects on safety and social capital. Conclusions: Data gaps precluded quantitative analysis for many of the health-related outcomes suggesting that more research is needed. Nonetheless, important decisions will be made regarding projects and policies, and the purpose of HIA - even if the data is imperfect - is to use the best data available to allow health to be appropriately factored into complex decisions.

Background: Few young people walk or bike to school; most rely upon non-active forms of transportation, primarily automobiles and buses. Walk-to-school programs have generated substantial interest as a potential opportunity for increasing physical activity and promoting an active lifestyle among youth. We assessed the health impacts of promoting walking to school as part of a comprehensive health impact assessment (HIA) of the Sacramento Safe Routes to School program. While the HIA examined a wide range of potential health-related impacts including, air pollution, pedestrian safety, neighborhood safety and social capital, this article focuses on a single area of the analysis-physical activity and associated changes in body mass index (BMI). Methods: After constructing a logic framework specifying potential impacts and their causal pathways, a thorough literature review was conducted describing each pathway and impact. A spreadsheet-based, quantitative model was created to predict potential changes in physical activity and body mass index for different scenarios. Results: We estimated that, if fully implemented, the program would increase the percent of students walking to school from 24% to 39% at participating schools, providing an additional 35 minutes of physical activity each school day for those who had previously commuted to school by automobile or bus, thus increasing the percentage of students with at least 30 minutes of daily physical activity from 12.8% to 21.4%. Among students with a body mass index (BMI) > 85th percentile, this additional physical activity would reduce their BMI by an average of 0.09 kg/m2/year. Conclusion: Walking to school can provide a number of potential health benefits. Although walking to school alone is unlikely by itself to provide children with the recommended daily amount of physical activity, it is an opportunity for children to increase daily activity and establish habits of an active lifestyle. Using the model we developed, health advocates can vary the inputs of the model we developed to understand how to maximize the potential benefits from a program such as this one.

There is comparatively little commercial mass marketing for physical activity. Even targeted marketing of tennis rackets, golf resorts, therapy balls, and personal trainers is limited to upscale venues and vehicles, e.g., in-flight airline magazines, affluent neighborhoods, university alumni magazines, and TV shows catering to high income demographics. The marketing of sedentary pursuits, on the other hand, is pursued aggressively, especially to lower income communities and African Americans and Latinos, but pales in comparison to the $33 billion annual marketing tally of the food industry. This chapter summarizes the sparse literature on the marketing of physical activity and sedentary behavior in mass media. We chronicle the commercial and social marketing of physical activity, from the Jack LaLanne era of the 1950s to the recent successes of CDC’s VERB, Kaiser Permanente’s Thrive, and First Lady Michelle Obama’s Let’s Move media campaigns. We then identify opportunities for population physical activity promotion exploiting modern innovations in information technology and social media. An understanding of behavioral economics, human physiology, and evolutionary biology grounds this discussion. Finally, we present the development and dissemination of Instant Recess® as a case study of this model. We will share some of the steps, missteps, and adaptations of the initial concept that transpired between its introduction as the Lift Off! 13 years ago and its current penetration across the US, especially in schools and workplaces.

Background California law has standards for physical education (PE) instruction in K-12 public schools; audits found that the Los Angeles Unified School District did not enforce the standards. In 2009, the district adopted a PE policy to comply with these standards. Purpose This study aimed to evaluate the outcomes of the PE policy in district schools. Methods PE class observations were conducted using the System for Observing Fitness Instruction Time in the 2010–2011 and 2011–2012 school years in an income-stratified random sample of 34 elementary, middle, and high schools to assess changes in PE class size, class duration, and time students spent in moderate to vigorous physical activity. Results PE class duration increased in high-income elementary schools. Mean class size decreased in low-income middle schools. Conclusions There was limited implementation of the PE policy 2 years after passage. Opportunities exist to continue monitoring and improving PE quantity and quality.

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

This study assesses implementation of a district policy to improve physical education in the Los Angeles Unified School District (LAUSD). LAUSD serves 670,000 students, four-fifths of whom are Latino or African-American and three-quarters qualify for free-/reduced price meals. Formally adopted in the fall 2009 as a result of a community campaign to address inequities across the district, the plan aims to enforce existing requirements for minimum minutes of PE, PE content, class size caps, and teacher credentialing. A stratified random sample of 35 LAUSD schools (elementary, middle, and high) was drawn from the highest and lowest quintiles of schools based on percentage of students eligible for free-/reduced price meals (FRPM). Eighteen control schools with similar FRPM rates were randomly selected from other nearby districts. Primary data were collected using 1) the System for Observing Fitness Instruction Time (SOFIT) to determine amount of class time spent in moderate to vigorous physical activity (MVPA), 2) direct observation of PE class length, content and size, and 3) interviews with school personnel documenting PE curriculum used, frequency of classes, teacher credentials and awareness of the implementation plan. Analysis of outcomes compares LAUSD schools with controls, as well as high and low income schools. Preliminary results reveal that LAUSD schools are implementing PE requirements to varying degrees. This study provides much-needed evidence as to whether school districts can successfully implement a policy that positively impacts the provision of PE and improve the health and physical fitness of students.

Background: Physical education in schools can model and encourage healthy levels of physical activity. Particularly in disadvantaged areas, children may have a limited number of safe places to be active outside of school. The Healthy Eating, Active Communities program (HEAC), funded by The California Endowment, has partnered with school districts in six low-income communities throughout California to improve school physical education environments. Methods: Data were collected at several points in time over the course of five years using an observational tool to assess physical activity levels of students. In addition, data collectors made note of the duration of class time, whether the class was in- or outdoors, class size, and the types of activities in which students participated. Results: The HEAC schools have made many changes to their PE programs since baseline in 2005. Data collected indicated that the average level of moderate-to-vigorous physical activity (MVPA) changed throughout the initiative. The six communities used different methods to achieve positive changes in their PE programs. The presenter will highlight these findings, and tie in data related to school level, programming and equipment, and class size, duration, and location. Conclusions: Schools in disadvantaged communities are implementing policies and programming to improve their physical education environments for students. Challenges exist, such as diminishing budgets and persisting lack of buy-in, but these are being overcome. HEAC school districts are a model for schools in other areas hoping to improve the physical activity level of children.

This pilot study builds on efforts to develop evaluation methods to compare and contrast potential strategies designed to increase population physical activity generally, and to reduce disparities in activity levels more specifically. The study presents a user-friendly, semi-quantitative decision-support tool of intermediate complexity that may better enable quick, flexible first-pass "ballpark" decision making by state and local health agencies instead of traditional evidence-based scientific reviews. The tool produces a summary score from ratings on 18 criteria, adjusted by fixed or variable weights to incorporate salient community contextual factors. Stair use, workplace activity breaks, and school construction siting are presented as samples. This first iteration of the decision-support tool is intended to be refined empirically by the experiences and policy outcomes of agencies adopting the innovation. This decision-support tool may expand the capacity of public health practitioners to conduct first-pass assessments of policy options for physical activity promotion in underserved communities.

Using GPS devices and digital cameras, we surveyed outdoor advertisements in Austin, Los Angeles and Philadelphia. GIS and hot spot analysis revealed that unhealthy ads were clustered around child-serving institutions in Los Angeles and Philadelphia but not in Austin. Multivariate generalized least square (GLS) regression models showed that percent black (p<0.04) was a significant positive predictor of clustering in Philadelphia and percent white (p<0.06) was a marginally significant negative predictor of clustering in Los Angeles after controlling for several land use variables. The results emphasize the importance of zoning and land use regulations to protect children from exposure to unhealthy commercial messages, particularly in neighborhoods with significant racial/ethnic minority populations.

Introduction: School environments can model and encourage healthy levels of physical activity for children. Particularly in low-income communities, children may have a limited number of safe places to be active outside of school. Policy changes, made to improve the quality and duration of PE, can positively impact the health of students. Program design/methodology: The Healthy Eating, Active Communities program (HEAC), funded by The California Endowment, has partnered with school districts in six low-income communities throughout California to improve school physical education environments. This session will describe the extent to which implementation of policies and programming was able to change the physical education experience for students. Results: The HEAC schools have made many changes to their PE programs since baseline in 2005. Data collected at midpoint in 2008 indicated that the average level of moderate-to-vigorous physical activity (MVPA) had remained about the same. However, in comparing each school to itself from baseline to midpoint, over one-third of the schools had increased the amount of MVPA in PE classes. The presenter will highlight these findings, and tie in data related to school level, programming and equipment, and class size, duration, and location. Discussion: Schools in disadvantaged communities are implementing policies and programming to improve their physical education environments for students. Challenges exist, such as diminishing budgets and persisting lack of buy-in, but these are being overcome. HEAC school districts are a model for schools in other areas hoping to improve the physical activity level of children and prevent childhood overweight and obesity.