Promoting Small Business Support of Youth Physical Activity in Low-Income, Minority Neighborhoods: Protocol for a Randomized Controlled Trial

Background An unacceptably high percentage of our nation’s low-income, minority youth (age<18 years) are not regularly physically active. One reason for this could be their lack of access to quality youth physical activity opportunities (YPAOs). Our previous research found that small businesses (<500 employees), which represent over 99.64% (27.9/28.0 million businesses in United States) of all employers, are powerful resources for creating and improving YPAOs. In accordance with the socioecological model and established philanthropic principles, we developed an alpha version of an intervention (alpha-i) for increasing small businesses’ involvement with YPAOs. Objective The aims of this proposed study are to (1) create a beta version (beta-i) of the intervention and (2) conduct a pilot study of its impact on small business support for YPAOs and YPAO utilization by the youth in low-income, minority neighborhoods. Methods The alpha-i will be refined using information from focus groups and surveys conducted with small business owners and managers, YPAO providers, and parents and guardians of the youths from low-income, predominantly minority neighborhoods. A cluster randomized controlled trial will then be conducted for 1 year to examine the effects of the refined intervention (beta-i) on small business support for YPAOs in 10 low-income, minority neighborhoods. The control group of neighborhoods (n=10) will be provided with a standard practice intervention. The primary outcome for aim 2 will be the percentage of small businesses not supporting YPAOs at baseline that subsequently provide support for YPAOs at follow-up. We also will consider the US dollar equivalent of all types of support (monetary, goods/services, and time) donated for YPAOs by small businesses. In addition, we will examine the impact of the increased small business support for YPAOs on YPAO utilization by the youth. Results As of May 1, 2019, all YPAOs and small businesses in the study neighborhoods have been identified, and surveys have begun with these groups. In addition, 9 focus groups were completed, and the data have been transcribed. We anticipate that manuscripts regarding these aspects of the study will be submitted in fall 2019. Conclusions The proposed study is significant because it will provide evidence that an easily replicated approach can be used to increase small business support for YPAOs and that this support results in greater use of the YPAOs by youth. A logical next step will be to determine if YPAO changes resulting from increased small business support positively influence youth physical activity levels. ClinicalTrial ClinicalTrials.gov NCT03936582; https://clinicaltrials.gov/ct2/show/NCT03936582. International Registered Report Identifier (IRRID) DERR1-10.2196/13141

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Promoting small business support of youth physical activity in low-income, minority neighborhoods (Preprint)

10.2196/preprints.13141 ◽

2018 ◽

Author(s):

Richard Suminski ◽

Shannon Robson ◽

Eric Plautz

Keyword(s):

Physical Activity ◽

Small Business ◽

Low Income ◽

Small Businesses ◽

Primary Outcome ◽

Activity Levels ◽

Physically Active ◽

Business Support ◽

Youth Physical Activity

BACKGROUND An unacceptably high percentage of our nation’s low-income, minority youth (< 18 years of age) are not regularly physically active. This contributes to extreme health disparities such as obesity rates nearly two-fold higher than those seen in white youth and greater risk for diabetes and related cardiometabolic disorders. The presence of quality youth physical activity opportunities (YPAO) enables and encourages physically active lifestyles. Unfortunately, quality YPAOs often are lacking in places where minority youth live, resulting in low activity levels and subsequent health issues that represent significant disparities in our society. Our previous research found that small businesses (< 500 employees), which represent over 99% of all employers, are powerful resources for creating and improving YPAOs. In accordance with the Socioecological Model and established philanthropic principles, we developed an alpha version of an intervention (alpha-i) for increasing small businesses’ involvement with YPAOs. OBJECTIVE The objectives of the proposed study is to create a beta version (beta-i) of the intervention and conduct a pilot study of its impact on small business support for YPAOs and YPAO utilization by youth in low-income, minority neighborhoods. METHODS We will complete three aims to meet our study objectives. Aim 1: Refine alpha-i components by completing focus groups with small business owners, YPAO providers, and parents/guardians of youth from low-income, predominantly minority neighborhoods. Results of the qualitative analysis will inform final tailoring of the intervention to create the beta-i which will be tested in Aim 2. Aim 2: Determine the effect of the beta-i on small business support for YPAOs in low-income, minority neighborhoods by conducting a plot cluster randomized-control trial with randomization at the neighborhood level. Intervention neighborhoods (n=10) will receive the beta-i while control neighborhoods (n=10) will be provided a standard practice intervention for a period of one year. The primary outcome for aim 2 will be the percentage of small businesses not supporting YPAOs at baseline that subsequently provide support for YPAOs at follow-up. We also will consider the U.S. dollar equivalent of all types of support (monetary, goods/services and time) donated for YPAOs by small businesses. Aim 3: Examine the impact of the increased small business support for YPAOs on YPAO utilization by youth. The primary outcome will be the percent change in the number of youth participating in YPAOs from baseline and follow-up in the treatment and control neighborhoods. RESULTS Outcomes from this study are pending; however, preliminary studies we’ve conducted supporting the research protocol indicate that 62% of businesses not supporting community physical activity initiatives thought they should support such initiatives and that businesses supporting YPAOs did so to give back to the neighborhood, improve children's health, provide athletic experiences, and/or increase customers/revenue. In a six-month pilot study of a developmental approach to encourage small business support of physical activity in their neighborhood, we observed a 27% increase in the number of businesses supporting local physical activity programs. CONCLUSIONS The proposed study is significant because it will provide evidence that an easily replicated approach can be used to increase small business support for YPAOs and that this support results in greater use of the YPAOs by youth. Our next step will be to determine if YPAO changes resulting from increased small business support positively influence youth physical activity levels as measured by accelerometry. Our long-term goals are to create a nationally implementable practice for increasing support for YPAOs and strengthen the science of addressing health disparities in socially disadvantaged populations.

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Promoting Small Business Support of Youth Physical Activity in Low-income, Minority Neighborhoods

Case Medical Research ◽

10.31525/ct1-nct03936582 ◽

2019 ◽

Author(s):

Keyword(s):

Physical Activity ◽

Small Business ◽

Low Income ◽

Business Support ◽

Youth Physical Activity

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Abstract 070: Community-based, Cluster Randomized Controlled Trial Increases Physical Activity In Diverse, Low Income Older Adults Over 2-year Period

Circulation ◽

10.1161/circ.143.suppl_1.070 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Katie Crist ◽

Fatima Tuz Zahra ◽

Kelsie M Full ◽

Marta M Jankowska ◽

Loki Natarajan

Keyword(s):

Physical Activity ◽

Older Adults ◽

Randomized Controlled Trial ◽

Depressive Symptoms ◽

Low Income ◽

Controlled Trial ◽

Community Based ◽

Randomized Controlled ◽

Income Status ◽

Cluster Randomized

Objective: Older adults are the least active population group in the U.S. Low income and ethnically diverse communities have fewer physical activity (PA) related resources and facilities, which contributes to lower PA levels and disparities in cardiovascular (CVD) risk factors and disease outcomes. This study assessed the hypothesis that low income and diverse older adults participating in the multilevel Peer Empowerment Program 4 Physical Activity (PEP4PA) would increase moderate-to-vigorous PA (MVPA), improve blood pressure (BP), perceived quality of life (PQoL), and depressive symptoms to a greater extent than older adults receiving usual senior center programming. Methods: In a cluster-randomized controlled trial (RCT) in 12 senior centers, 476 older adults (mean age 71.4 years, 76% female, 60% low income, 38% minority) were assigned to a PA intervention (n=267) or control (n=209) condition. The peer-led intervention included individual self-monitoring and counseling, group walks and social support, and community advocacy to improve walking conditions. Outcomes included minutes of MVPA per day (7-day accelerometer), systolic and diastolic BP (automatic cuff), PQoL (PQoL-20) and depressive symptoms (CES-D 10) at baseline, 6, 12, 18 and 24 months. To account for multiple measurement days and clustering of participants within senior centers, mixed effects regression models with random effects estimated the intervention effects on all outcomes between groups over time. Models were adjusted for imbalanced baseline covariates. A three-way interaction term assessed whether intervention effects differed by income status. Results: Compared to the control group, intervention participants significantly increased MVPA from baseline at 6, 12, 18 and 24 months by 8, 11, 9 and 9 minutes/day respectively (p<0.001), with increases remaining statistically significant across the 2-year period. The intervention group significantly increased mean PQoL scores from 7.2 at baseline to 7.6 (p<0.001), 7.8 (p=0.008) and 7.7 (p<0.001) at 12, 18 and 24 months, compared to control participants. No significant effects were observed for BP or depressive symptoms. Low income participants decreased minutes of MVPA, compared to higher income participants, at 12 and 24 months (β=-7.9, p=0.008 and β=-10.8, p=0.001). Conclusions: The multilevel RCT achieved sustained increases in MVPA and QoL in a diverse cohort of older adults across 2 years of follow up. The peer-led, community-based intervention provides a sustainable model to improve health behaviors related to CVD in an at-risk and often difficult to reach aging population. Further exploration is needed to understand what components of the intervention may be modified to address the differential effects by income status.

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