Stepping Up Active Transportation in Community Health Improvement Plans: Findings From a National Probability Survey of Local Health Departments

Abstract

Background: Local health departments (LHDs) are increasingly involved in Community Health Improvement Plans (CHIPs), a collaborative planning process that represents an opportunity for prioritizing physical activity. We determined the proportion of LHDs reporting active transportation strategies in CHIPs and associations between LHD characteristics and such strategies. Methods: A national probability survey of US LHDs (<500,000 residents; 30.2% response rate) was conducted in 2017 (n = 162). LHDs reported the inclusion of 8 active transportation strategies in a CHIP. We calculated the proportion of LHDs reporting each strategy. Multivariate logistic regression models determined the associations between LHD characteristics and inclusion of strategies in a CHIP. Inverse probability weights were applied for each stratum. Results: 45.6% of US LHDs reported participating in a CHIP with ≥1 active transportation strategy. Proportions for specific strategies ranged from 22.3% (Safe Routes to School) to 4.1% (Transit-Oriented Development). Achieving national accreditation (odds ratio [OR] = 3.67; 95% confidence interval [CI], 1.11–12.05), pursuing accreditation (OR = 3.40; 95% CI, 1.25–9.22), using credible resources (OR = 5.25; 95% CI, 1.77–15.56), and collaborating on a Community Health Assessment (OR = 4.48; 95% CI, 1.23–16.29) were associated with including a strategy in a CHIP after adjusting for covariates. Conclusions: CHIPs are untapped tools, but national accreditation, using credible resources, and Community Health Assessment collaboration may support strategic planning efforts to improve physical activity.

United States local health department engagement in activities that support active transportation considerations in land use and transportation policies: Results of a national survey

“…Survey weights were applied to all analyses to account for the stratified simple random sampling design, differential response rates among strata, and analysis of surveys with complete data. A detailed description of survey weight construction is published elsewhere (Sreedhara et al, 2019). We performed analyses using Stata/MP 14.2 (StataCorp College Station, TX).…”

“…We followed a standardized reminder protocol. Additional details about survey administration have been previously published (Sreedhara et al, 2019).…”

Healthy Eating and Physical Activity Policy, Systems, and Environmental Strategies: A Content Analysis of Community Health Improvement Plans

“…A convenience sample of CHIPs was selected from communities represented by respondents to a 2017 probability survey of United States (US) LHDs serving fewer than 500,000 residents (response rate 30%, n = 209) (20). Among respondents, 93 (44%) LHDs reported participating in a CHIP within the past 5 years that included one or more of 13 HE policy strategies or eight strategies supportive of active transportation.…”

“…Characteristics of LHDs were collected during the previous survey (20). Characteristics included: US census geographic region (South, West, Northeast, Midwest), population size served (<25,000, 25,000-49,999, 50,000-99,999, 100,000-499,999 residents), structure (municipal, county or city-county, other), state and LHD governance (decentralized or centralized/shared/mixed) and Public Health Accreditation Board (PHAB) status (not accredited, achieved accreditation, or accreditation in progress or planned).…”

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“…Communities and LHDs are increasingly engaging in population health activities, including health improvement planning, potentially due to benefits such as reductions in diabetes and cardiovascular disease mortality (15,16). Although most CHIPs generally address nutrition and PA, emerging evidence suggests that strategic health improvement plans underutilize PSE strategies to address HE and PA (17)(18)(19)(20).…”