Background: Diverse environmental factors are associated with physical activity (PA) and healthy eating (HE) among youth. However, no study has created a comprehensive obesogenic environment index for children that can be applied at a large geographic scale. The purpose of this study was to describe the development of a childhood obesogenic environment index (COEI) at the county level across the United States. Methods: A comprehensive search of review articles (n = 20) and input from experts (n = 12) were used to identify community-level variables associated with youth PA, HE, or overweight/obesity for potential inclusion in the index. Based on strength of associations in the literature, expert ratings, expertise of team members, and data source availability, 10 key variables were identifiedsix related to HE (# per 1000 residents for grocery/superstores, farmers markets, fast food restaurants, full-service restaurants, and convenience stores; as well as percentage of births at baby (breastfeeding)-friendly facilities) and four related to PA (percentage of population living close to exercise opportunities, percentage of population < 1 mile from a school, a composite walkability index, and number of violent crimes per 1000 residents). Data for each variable for all counties in the U.S. (n = 3142) were collected from publicly available sources. For each variable, all counties were ranked and assigned percentiles ranging from 0 to 100. Positive environmental variables (e.g., grocery stores, exercise opportunities) were reverse scored such that higher values for all variables indicated a more obesogenic environment. Finally, for each county, a total obesogenic environment index score was generated by calculating the average percentile for all 10 variables.

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Highlights Composite measures of park availability, features, and quality are lacking. Detailed park access and use data were collected in four diverse communities. Number of parks, total acreage, and average park quality were related to park use. Simulated addition and renovation of parks increased the probability of park use. ParkIndex has value for advancing public health and environmental justice.

Objective: This study examined the separate relationships between socio-economic disadvantage and the density of multiple types of food outlets, and relationships between socio-economic disadvantage and composite food environment indices. Design: Cross-sectional data were analysed using geospatial kernel density techniques. Food outlet data included convenience stores, discount stores, fast-food and fast casual restaurants, and grocery stores. Controlling for urbanicity and race/ethnicity, multivariate linear regression was used to examine the relationships between socio-economic disadvantage and density of food outlets. Setting: This study occurred in a large Southeastern US county containing 255 census block groups with a total population of 474 266, of which 77·1 % was Non-Hispanic White, the median household income was $48 886 and 15·0 % of residents lived below 125 % of the federal poverty line. Participants: The unit of analysis was block groups; all data about neighbourhood socio-economic disadvantage and food outlets were publicly available. Results: As block group socio-economic disadvantage increased, so too did access to all types of food outlets. The total food environment index, calculated as the ratio of unhealthy food outlets to all food outlets, decreased as block group disadvantage increased. Conclusions: Those who reside in more disadvantaged block groups have greater access to both healthy and unhealthy food outlets. The density of unhealthy establishments was greater in more disadvantaged areas; however, because of having greater access to grocery stores, disadvantaged populations have less obesogenic total food environments. Structural changes are needed to reduce access to unhealthy food outlets to ensure environmental injustice and reduce obesity risk.

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Background Few studies have examined secular trends in gestational weight gain (GWG) and findings are inconsistent. Parallel to increasing trends in pre‐pregnancy obesity, we hypothesised similar increasing GWG trends. Objectives The study examined trends in GWG in South Carolina (SC), using methods to reduce bias. We also examined whether the 12‐year trends in GWG varied according to race/ethnicity and pre‐pregnancy weight. Methods Data came from SC birth certificates, 2004 to 2015. We calculated standardised GWG z‐scores (GWGZ), using smoothed reference values to account for gestational age and pre‐pregnancy body mass index. Quantile regression was used to examine trends in GWGZ, adjusting for pre‐pregnancy weight status, race/ethnicity, parity, WIC participation, smoking during pregnancy, residence, age, and birth cohort. Results Among 615 093 women, the mean GWGZ was −0.4 (SD = 1.3), which increased from −0.4 in 2004‐2005 to −0.2 in 2014‐2015. GWGZ increased at the 5th, 10th, 25th, 50th, and 75th percentiles (ranging 0.04 to 0.73 units), with differential trends observed in sub‐groups by pre‐pregnancy weight and racial/ethnic group. Notably, non‐Hispanic White women showed larger increasing trends (0.89 units) compared to non‐Hispanic Black (0.55 units) and Hispanic (0.76 units) women in the 5th percentile. Decreasing trends were seen overall for the 90th (−0.02) and 95th percentile (−0.06 units) but positive trends were not seen among women experiencing obese class 1 (no change in 90th and 95th), and 2 (0.01 units in 90th, −0.02 units in 95th). Conclusions This study shows increasing GWGZ trends from the 5th to the 75th percentiles and decreasing trends in 90th and 95th percentiles in SC for the last decade. Racial/ethnic and pre‐pregnancy weight disparities did not improve over the study period. Future research is needed to confirm these findings in other states and to develop strategies to narrow racial and pre‐pregnancy weight disparities at the highest and lowest percentiles.

Background: Neighborhood parks are recognized as important spaces for facilitating physical activity (PA); however, it remains unclear how the frequency of park use is associated with PA. The purpose of this study was to examine associations between minutes of moderate to vigorous PA and multiple park use indicators: (1) use of a neighborhood park, (2) unique number of neighborhood parks used, and (3) frequency of neighborhood park use. Methods: Adults were surveyed from 4 US cities (Brooklyn, NY; Greenville County, SC; Raleigh, NC; and Seattle, WA). Using a map-based survey platform, participants indicated all neighborhood parks they used and the frequency of use in the past 30 days. Participants self-reported their weekly moderate to vigorous PA. Quantile regression was used to examine associations between PA and park use indicators. Results: Of all respondents (N = 360), 60% indicated visiting a neighborhood park in the past 30 days, with an average of about 13 total neighborhood park visits (SD = 17.5). Significant, positive associations were found between moderate to vigorous PA and both unique neighborhood park visits and total number of neighborhood parks visits. Conclusions: Frequency of park visitation is associated with PA among US adults. Ensuring equitable and safe access to neighborhood parks has the potential for population-level PA health benefits.