Whole-of-Community Systems Intervention for Youth Population Physical Activity

青年人生活的基本条件与人口健康结果有关， 社区面临的挑战研究不足。青少年体力活动（PA），一个关键的风险因素与后来 癌症的发生，是社会条件的结果。拟议的工作将解决一个关键的公众 通过评估整个社区多层次适应性系统干预的影响， 实施社区变革和青年人口方案。我们的干预，井景，是基于一个 层次斑块动力学范式，鉴于社区是“健康景观”的空间， 异质地理区域，其特征是相互作用的组织和活动的拼凑 设置.干预措施将建立一个多层次的系统基础设施（社区中心、组织 健康团队、活动设置/领导者），并为人口健康质量提供培训和支持 针对两个循证实践（EBP）的改进周期过程：（1）堆叠时间段， 组织日常工作中的PA事件，以及（2）提高PA事件的质量（%时间 PA）。我们的综合假设是，干预社区（加上组织和领导者嵌套在） 将具有实施EBP的协同作用和能力，适应不断变化的本地系统驱动因素， 创建一个全社区生态系统，为青少年提供多样化和公平的公共广播机会。建立在当地 卫生部的合作伙伴关系，我们将进行两波交错启动社区随机试验， 四个志愿者农村社区（每个社区都有嵌套学校，课后，童子军/4-H俱乐部，青年体育 组织）随机分配到干预或标准公共卫生实践。基线和 干预年，秋季（3天）和春季（3天）每月一天，组织活动设置 (e.g.,教室，团队），容纳480名儿童在第三至第六年级将进行评估，导致 观察到的社区状况数据、PA加速度计数据和设置范围数据（儿童出勤率， 性别、种族、免费/减少午餐状态和等级）。我们还将获得人口水平PA的估计值 使用经校准的青年活动概况以及社区系统定性数据。具体 目标是：（1）确定干预措施对多层次社区系统结果的影响;（2） 确定多层次青年人口PA的实施制度驱动因素。我们将利用“大数据”多- 层次建模方法，这种有效性，实现混合设计，因为有一个双重重点， 测试执行战略，同时评估巴勒斯坦权力机构对青年人口的影响。研究 是重要的，因为它评估了改善人口健康的方法，基于理论的系统， 低资源农村社区的行为变化过程。这项研究是新颖的，因为 适应性斑块动力学方法为公平合作和EBP实施建立能力 跨多个本地系统，这些系统是单独的和共同的，动态的和不可预测的。 !

The underlying conditions where youth live are associated with population health outcomes, with rural communities facing under-studied challenges. Youth physical activity (PA), a key risk factor linked to later cancer occurrence, is an outcome of community conditions. The proposed work will address a critical public health need by evaluating the impact of a whole-of-community multi-level adaptive systems intervention on implementation of community change and youth population PA. Our intervention, Wellscapes, is based on a hierarchical patch dynamics paradigm, given that communities are “wellness landscapes” of spatially heterogeneous geographic areas, characterized by a patchwork of interacting organization and activity settings. The intervention will establish a multi-level system infrastructure (Community Hub, Organization Wellness Teams, Activity Setting/Leaders) and provide training and support for population health quality improvement cycle processes targeting two evidence-based practices (EBPs): (1) stacking time segments of PA episodes within an organization’s daily routine, and (2) improving the quality of PA episodes (% time in PA). Our omnibus hypothesis is that intervention communities (plus organizations and leaders nested within) will have synergy and capacity to implement EBPs, adapting to continuously changing local system drivers to create a whole-of-community ecosystem of diverse and equitable youth PA opportunities. Building on local health department partnerships, we will conduct a two-wave staggered-start community randomized trial with four volunteer rural communities (each having nested school, after-school, scouting/4-H club, youth sport organizations) randomly assigned to intervention or standard public health practice. For baseline and intervention years, one day per month in the fall (3 days) and spring (3 days), organization activity settings (e.g., classrooms, teams) that house 480 children in 3rd through 6th grades will be assessed, resulting in observed community condition data, PA accelerometer data, and setting reach data (children % attendance by gender, ethnicity, free/reduced lunch status, and grade). We will also obtain estimates of population level PA with the use of the calibrated Youth Activity Profile, as well as community system qualitative data. The specific aims are to: (1) Determine the impact of the intervention on multi-level community system outcomes; and (2) Determine the implementation system drivers of multi-level youth population PA. We will use “big data” multi- level modeling methods for this effectiveness-implementation hybrid design, because there is a dual focus on testing an implementation strategy while simultaneously evaluating youth population PA impact. The research is significant because it evaluates a method for improving population health, theory-based systems, and behavior change processes in low-resource rural communities. The proposed research is novel because the adaptive patch dynamics approach builds capacity for both equitable collaboration and EBPs implementation across multiple local systems that are individually and collectively, dynamic and unpredictable. !