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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.
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.
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.
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.
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.
ClinicalTrials.gov NCT03936582; https://clinicaltrials.gov/ct2/show/NCT03936582.
DERR1-10.2196/13141
Health benefits can be gained by the youths (age<18 years) who regularly participate in physical activity; for example, physical activity reduces the incidence of overweight, obesity, and chronic diseases [
The socioecological model has been used to explain why the youth are not more physically active. Briefly, the model suggests physical activity behavior is determined by intrapersonal (eg, self-motivation), interpersonal (eg, social support), and environmental (eg, availability of programs) factors [
Perhaps the strongest and the most influential environmental determinants of youth physical activity are the availability and adequacy of youth physical activity opportunities (YPAOs). They have been defined as programs and places available to the youth with components/amenities that typically require/involve physical activity [
YPAOs assume added importance if they are in one’s local environment or neighborhood. Walking by the youth (aged 5-20 years) is positively associated with having access to nearby (<1 km distance from home) recreation or open spaces [
Small businesses (<500 employees) represent 99.64% (27.9/28.0 million) of all businesses operating in the United States. Total revenues typically exceed US $1 trillion annually and over half a million new businesses start each month [
The strong preference by small businesses for sponsoring local programs sets up a powerful force that, if utilized effectively, would have a dramatic and lasting impact on the quantity and quality of YPAOs and, ultimately, physical activity and health in low-income, minority neighborhoods. Supporting this contention are findings from our preliminary study showing that although a majority of small businesses do not currently support YPAOs (~60%), a large percentage (88%) of these non-YPAO supporters believe they should [
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. We are now poised to create a beta version (beta-i) and conduct a pilot study of its
The timeline of activities completed in aim 1 is given in
We used a multistep process recommended for use in urban health research to identify 27 distinct neighborhoods in New Castle, Delaware (mainly Wilmington, the largest city in the state) meeting our inclusion criteria requiring a minority concentration greater than 50%, median household yearly income in the lower third of all neighborhoods in these areas, and a land use mix that is at least 30% residential and at least 15% retail/commercial [
During November and December 2018, we identified all small businesses and YPAOs in the study neighborhoods using various approaches and sources we had used in previous studies (registries, internet/phone books, media, community tours, and community members) [
Focus groups allowed us to obtain unique perspectives from neighborhood stakeholders, which were used to refine alpha-i components to better meet the needs/resources of the treatment neighborhoods. Participants were asked to consider components, provide recommendations, and suggest modifications. We specifically looked for input on our strategy for increasing support for YPAOs, how to efficiently handle administrative tasks, promoting YPAO provider fund use, ways to reduce barriers to using YPAOs, and long-term sustainability.
Between January and March 2019, we conducted 9 focus groups and analyzed the data. Each focus group was comprised 6 to 8 members recruited from the 27 low-income, minority neighborhoods that had met our inclusion criteria as outlined above. Participation was solicited from small business owners (3 focus groups), YPAO providers (3 focus groups), and parents and guardians of the youth (3 focus groups), using our personal contacts, referrals, flyers, and ads in local publications. Incentives (eg, food/drink, $20 gift card) were used to encourage participation and all group sessions were held in one of the study neighborhoods. The number of groups we used was adequate for ensuring saturation, providing us with a comprehensive picture of the domains and helping achieve focus group goals [
Each focus group lasted about 90 min and was moderated by a research team member with extensive training in qualitative methodology. The moderator was assisted by a second scientist who documented focus group proceedings and other process data (eg, nonverbal behaviors) [
The final activities that were completed in aim 1 involved the refinement of alpha-i components by the local advisory board, mainly using focus group and survey outcomes, and the formation of the beta-i. We also prepared for baseline data acquisition and developed the tracking mechanism that will be used to monitor donations to the fund and the distribution of donations. This will allow us to closely examine the cost of fund administration. We will be interested in the costs to solicit, maintain, and track donations, offer recognition (process and materials), identify YPAO providers, and distribute funds to YPAO providers. Information from donors and YPAO providers will include name, location, contact information, and a detailed description of the donation (given or received). Because donations could be monetary (US dollars) and nonmonetary (goods/services and time), we will use the Statement of Financial Accounting Standards 157, Fair Value Measurements guide, to properly determine the US dollar value of all donation types. By the end of May 2019, the development of the beta-i was complete.
The timeline of activities involved in aim 2 is presented in
We developed the small business policy survey to capture the presence and development of small business support for YPAOs [
In-person interviews were conducted by trained personnel with a randomly selected sample of 44 YPAO providers. Our reliable YPAO survey was used to gather detailed information on the YPAO including the number of youth participants, descriptions of all features and amenities, programmatic information (eg, fees, operating times, and sessions per week), personnel qualifications, and start-up and operating costs including how costs were covered [
As stated previously, the treatment intervention (beta-i) will be a derivative of the alpha-i intervention components given in
Data for aim 3 will be collected at baseline and follow-up as per the measures described under aim 2 as well as additional measures described below and used to address our aim 3 hypothesis. These additional measures will be conducted at baseline and follow-up.
The system for observing play and recreation in communities (SOPARC) will be used according to the established protocols to count the number of youths using public YPAOs [
Trained field coders will use the Physical Activity Resource Assessment (PARA) to conduct concise (10-30 min) audits of YPAOs where surveys and SOPARCs were completed. The PARA is a reliable (ρ >.77) instrument for assessing characteristics of publicly available physical activity resources including YPAO [
Interviewers were trained according to the guidelines developed by The Gallop Organization [
Process outcomes will inform us of intervention challenges and lessons learned. They will be derived from meeting minutes, debriefing sessions, study records (eg, budgets), small business surveys, YPAO provider reports, adult local advisory board member reports, liaisons, and study team evaluations. The primary process outcomes will be related to the local advisory board (eg, attendance), cost of fund administration and logistics of tracking donations and providing recognition, user satisfaction with donating methods, logistics of using electronic messaging (eg, span blockers), and recruitment/retention of liaisons. This information will be used to inform planning of future implementations of the intervention and when interpreting/discussing outcomes from this study.
An iterative, 2-phase thematic analysis will be conducted to capture the meaning behind the transcribed text with an overall purpose of creating an increasingly sophisticated and rich description about small business involvement with YPAOs. First, researchers will review the transcribed documents to develop a familiarity with the text and search for the patterns and the themes that occur frequently in a single session or are common across sessions. The data will then be coded by identifying passages that exemplify key concepts or ideas related to the major patterns and themes. The use of multiple reviewers will help establish construct validity and interrater reliability of the coding scheme and identified codes. During the second phase, a computer-assisted qualitative data analysis program (NVivo qualitative data analysis software; QSR International Pty Ltd. Version 12, 2018) will be used to check the rigor of the manual coding, help organize the large volume of data, analyze data, and provide a means for generating reports. Qualitative data analysis is typically iterative, recursive, and dynamic; therefore, we will move between the manual and the electronic process until we are satisfied that the coding scheme and results are representative of the participants’ perspectives. Furthermore, themes identified will be compared with the extant literature on the topic to further validate the findings [
The detailed information collected about YPAOs will be used to estimate the relative contributions made by small businesses toward their total yearly costs. Total yearly costs will be defined as all costs in the cost model incurred for the YPAO during the past 12 months (
Our power analysis was based on the percent change in the proportion of small businesses supporting YPAOs at baseline that subsequently provided support for YPAOs during the intervention. Data to construct the primary outcome will be derived from tracking donations and small business surveys. Power formulas accounted for experimental condition, number of neighborhoods, number of businesses/neighborhoods surveyed, variance estimates of the outcome measure from preliminary studies, and a conservative estimate of the intraclass correlation coefficient (ICC). In our previous research, a 27% versus 8.0% increase in support for community physical activity initiatives by small businesses not supporting them at baseline was observed in the treatment and the control neighborhoods, respectively [
Before developing statistical models, an examination of the univariate distribution of variables will be conducted (eg, scatter plots). Statistics, such as means or proportions, standard errors, ranges, and estimates of skewness and kurtosis will be derived for the overall samples and stratified by condition and characteristics of small businesses and YPAOs using SAS 9.4 and used as guidelines in the application of both bivariate and multivariate analyses [
The primary outcome for aim 3 will be the percent increase in youth participants from baseline to follow-up. We hypothesize that the increase will be significantly greater at YPAOs in the treatment neighborhoods receiving support from small businesses than at YPAOs in the control neighborhoods. Previously in low-income, minority neighborhoods, we found an average of 46.7 (SD 37) youths participating in YPAOs [
Over the past 2 decades, our research team has developed methods to ensure low rates of missing data in our projects. One aspect of this study most likely to result in missing data is the longitudinal assessment of businesses/YPAOs. We will attempt to minimize missing data by maintaining contact with study businesses/YPAO providers and if dropout does occur, we will attempt to determine the reasons why and how much of their study participation was affected. We will examine characteristics associated with attrition and adjust models for attrition and/or baseline group differences.
We have been successful in the past in obtaining information from small businesses and soliciting their support for community physical activity initiatives. In the proposed study, we expect to elicit significant increases in support for YPAOs from small businesses in the treatment neighborhoods because the intervention contains numerous components that stimulate donations from small businesses.
We do not foresee a problem recruiting YPAO providers to participate in the study. We were successful at obtaining detailed information from YPAO providers in a previous study and, in the proposed study, they will receive compensation for their participation and have the opportunity to receive donated funds [
The study protocol was approved by our institutional review board on July 13, 2018. All preparatory activities (eg, hiring, training, and data collection procedures finalized) were completed on 31 October 2018. In addition, 20 study neighborhoods comprising 53 US census block groups meeting the inclusion criteria were identified and randomly assigned to treatment or control conditions (
In December 2018, a database containing the names, addresses, and geolocations (eg, US census block group) of the 87,982 businesses currently licensed in Delaware was obtained from the Delaware Department of Finance: Division of Revenue. The database was edited to include only small businesses with a physical, nonresidential address located in 1 of our 20 study neighborhoods. During May and June, 2019, baseline surveys were completed with 244 owners and managers of small businesses in the study neighborhoods. Data from small businesses will be analyzed in July 2019 and results will be disseminated in August 2019. In addition, a total of 96 YPAOs were identified in the 20 study neighborhoods, and interviews have been conducted with 35 nonpark YPAOs from May 6 to June, 2019. The park YPAOs (n=27) were examined in June, 2019 using the SOPARC and PARA methods to determine usages and presence/absence of amenities.
We are 10 months into this study and have achieved the milestones set forth in the proposal. Preparation activities, including the identification of study neighborhoods and small businesses and YPAOs in these neighborhoods, and focus groups have been completed. The focus group data are currently being analyzed and we have just completed (June 2019) baseline surveying of small business owners and managers and YPAO providers. It is anticipated that findings will be disseminated in the fall of 2019.
Research in this area has typically been on policies targeting employee wellness programs at large corporations [
Aim 1 activities.
Intervention alpha components.
Aim 2 activities.
Description of treatment and control interventions.
Cost model.
Characteristics of study neighborhoods [means (standard deviations)].
alpha version of intervention
beta version of intervention
intraclass correlation coefficient
moderate to vigorous physical activity
Physical Activity Resource Assessment
physical education
system for observing play and recreation in communities
youth physical activity opportunity
This study was funded on August 20, 2018, by the National Institute of Nursing Research, National Institutes of Health (1 R21 NR017267-01A1).
None declared.