{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:40:18Z","timestamp":1777664418087,"version":"3.51.4"},"reference-count":50,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100001163","name":"Healthcare Georgia Foundation","doi-asserted-by":"publisher","award":["3152"],"award-info":[{"award-number":["3152"]}],"id":[{"id":"10.13039\/100001163","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Educ Behav"],"abstract":"<jats:p>\n                    Rural communities have assets that can be leveraged to address health disparities, particularly through complex policy, systems and environment (PSE) change approaches. Eleven rural community coalitions across Georgia participated in The Two Georgias Initiative, a 5-year health equity project from 2017 to 2022 designed to address rural\u2013urban health disparities. The coalitions addressed community health concerns through implementing county-specific PSE and programmatic strategies tracked through a Community Change Tracking Tool. This mixed-methods analysis assessed the variation in strategies implemented across domain- and PSE-type. In total, 141 strategies were implemented across 12 domains, ranging from three to 35 per coalition. The coalitions continued to work through the COVID-19 pandemic, pivoting to address emerging needs. Food access, health care access and healthy lifestyle education were the most common domains; and implemented strategies were distributed across policy (17.0%), system (28.4%), environment (29.8%) and programmatic (24.8%) approaches. While many strategies were designed to make changes accessible to whole communities, some focused on priority populations including low-income residents, youth and seniors. Key informant interviews (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 121) revealed that implementation barriers included challenges with staff and partner transitions, and lack of capacity and resources. Staff engagement, community rapport and partner-provided resources facilitated the implementation of strategies across several coalitions, highlighting the important role partnerships and community buy-in have with community-based PSE implementation approaches. At Year 5, among nine coalitions who provided sustainment data, a higher percentage of PSE strategies (95.6%) were sustained compared to programmatic strategies (42.9%), demonstrating the importance of PSE change approaches in community health equity efforts.\n                  <\/jats:p>","DOI":"10.1177\/10901981261442368","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T09:14:44Z","timestamp":1776762884000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Community Coalitions Implementing and Sustaining Policy, Systems and Environment Strategies for Rural Health Equity"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2403-4569","authenticated-orcid":false,"given":"Lauren M.","family":"Bigger","sequence":"first","affiliation":[{"name":"Emory University, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5676-6468","authenticated-orcid":false,"given":"April","family":"Hermstad","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5470-9352","authenticated-orcid":false,"given":"Regine","family":"Haard\u00f6rfer","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly Jacob","family":"Arriola","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelley","family":"Ditzel","sequence":"additional","affiliation":[{"name":"Equitable Impact Solutions, Warner Robins, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4898-5454","authenticated-orcid":false,"given":"Michelle C.","family":"Kegler","sequence":"additional","affiliation":[{"name":"Emory University, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Abildso C. G. Bias T. K. Coffman J. (2019). Adoption and Reach of a statewide policy systems and environment intervention to increase access to fresh fruits and vegetables in West Virginia. Translational Behavioral Medicine 9(5) 847\u2013856. https:\/\/doi.org\/10.1093\/tbm\/ibz095","DOI":"10.1093\/tbm\/ibz095"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Allen P. Walsh-Bailey C. Hunleth J. Carothers B. J. Brownson R. C. (2022). Facilitators of multisector collaboration for delivering cancer control interventions in rural communities: A descriptive qualitative study. Preventing Chronic Disease 19 210450. https:\/\/doi.org\/10.5888\/pcd19.210450","DOI":"10.5888\/pcd19.210450"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Backman C. Rome C. Ryser L. Sero R. A. Hansen D. (2022). A new lens: Using the policy systems and environmental framework to guide community development. Journal of Extension 60(2). https:\/\/doi.org\/10.34068\/JOE.60.02.21","DOI":"10.34068\/joe.60.02.21"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Berman M. Bozsik F. Shook R. P. Meissen-Sebelius E. Markenson D. Summar S. DeWit E. Carlson J. A. (2018). Evaluation of the healthy lifestyles initiative for improving community capacity for childhood obesity prevention. Preventing Chronic Disease 15 170306. https:\/\/doi.org\/10.5888\/pcd15.170306","DOI":"10.5888\/pcd15.170306"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Betancourt K. Ridgway A. Rockenbach J. Eady S. Thompson J. Bateman L. B. Fouad M. N. Schoenberger Y.-M. M. (2017). Empowering one community at a time for policy system and environmental changes to impact obesity. Ethnicity & Disease 27(Suppl. 1) 347\u2013354. https:\/\/doi.org\/10.18865\/ed.27.S1.347","DOI":"10.18865\/ed.27.S1.347"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Bowen D. J. Barrington W. E. Beresford S. A. A. (2015). Identifying the effects of environmental and policy change interventions on healthy eating. Annual Review of Public Health 36(aba 8006431) 289\u2013306. https:\/\/doi.org\/10.1146\/annurev-publhealth-032013-182516","DOI":"10.1146\/annurev-publhealth-032013-182516"},{"key":"e_1_3_3_8_1","unstructured":"Braveman P. Acker J. Arkin E. Badger K. Holm N. (2022). Advancing health equity in rural America. https:\/\/www.rwjf.org\/en\/insights\/our-research\/2022\/06\/advancing-health-equity-in-rural-america.html"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Brennan L. K. Brownson R. C. Hovmand P. (2012). Evaluation of active living by design: Implementation patterns across communities. American Journal of Preventive Medicine Evaluation of Active Living by Design 43(5 Suppl. 4) S351\u2013S366. https:\/\/doi.org\/10.1016\/j.amepre.2012.07.007","DOI":"10.1016\/j.amepre.2012.07.007"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Bronfenbrenner U. (1999). Environments in developmental perspective: Theoretical and operational models. In Measuring environment across the life span: Emerging methods and concepts (pp. 3\u201328). American Psychological Association. https:\/\/doi.org\/10.1037\/10317-001","DOI":"10.1037\/10317-001"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Bunnell R. O\u2019Neil D. Soler R. Payne R. Giles W. H. Collins J. Bauer U. & Communities Putting Prevention to Work Program Group. (2012). Fifty communities putting prevention to work: Accelerating chronic disease prevention through policy systems and environmental change. Journal of Community Health 37(5) 1081\u20131090. https:\/\/doi.org\/10.1007\/s10900-012-9542-3","DOI":"10.1007\/s10900-012-9542-3"},{"key":"e_1_3_3_12_1","unstructured":"CDC & ACS. (2022). PSE-in-CCC-Guide_FINAL.pdf. https:\/\/www.acs4ccc.org\/wp-content\/uploads\/2022\/02\/PSE-in-CCC-Guide_FINAL.pdf"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Cheadle A. Atiedu A. Rauzon S. Schwartz P. M. Keene L. Davoudi M. Spring R. Molina M. Lee L. Boyle K. Williamson D. Steimberg C. Tinajero R. Ravel J. Nudelman J. Azuma A. M. Kuo E. S. Solomon L. (2018). A community-level initiative to prevent obesity: Results from Kaiser Permanente\u2019s healthy eating active living zones initiative in California. American Journal of Preventive Medicine Building Thriving Communities through Comprehensive Community Health Initiatives: Evaluations from 10 Years of Kaiser Permanente\u2019s Community Health Initiative to Promote Healthy Eating and Active Living 54(5 Suppl. 2) S150\u2013S159. https:\/\/doi.org\/10.1016\/j.amepre.2018.01.024","DOI":"10.1016\/j.amepre.2018.01.024"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Choy L. B. Maddock J. E. Brody B. Richards K. L. Braun K. L. (2016). Examining the role of a community coalition in facilitating policy and environmental changes to promote physical activity: The case of Get Fit Kaua\u2019i. Translational Behavioral Medicine 6(4) 638\u2013647. https:\/\/doi.org\/10.1007\/s13142-015-0379-z","DOI":"10.1007\/s13142-015-0379-z"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Cloutier C. Ravasi D. (2021). Using tables to enhance trustworthiness in qualitative research. Strategic Organization 19(1) 113\u2013133. https:\/\/doi.org\/10.1177\/1476127020979329","DOI":"10.1177\/1476127020979329"},{"key":"e_1_3_3_16_1","unstructured":"Community Commons. (n.d.). An introduction to policy systems and environmental (PSE) change. https:\/\/www.communitycommons.org\/collections\/An-Introduction-to-Policy-Systems-and-Environmental-PSE-Change"},{"key":"e_1_3_3_17_1","unstructured":"Comprehensive Cancer Control National Partnership. (2015). Policies systems and environmental change resource guide. https:\/\/www.acs4ccc.org\/wp-content\/uploads\/2020\/06\/PSE_Resource_Guide_FINAL_05.15.15.pdf"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Crespo R. Shrewsberry M. Cornelius-Averhart D. King H. B. (2011). Appalachian regional model for organizing and sustaining county-level diabetes coalitions. Health Promotion Practice 12(4) 544\u2013550. https:\/\/doi.org\/10.1177\/1524839910377965","DOI":"10.1177\/1524839910377965"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Crowder S. J. Tanner A. L. Dawson M. A. Felsman I. C. Hassmiller S. B. Miller L. C. Reinhard S. C. Toney D. A. (2022). Better together: Coalitions committed to advancing health equity. Nursing Outlook 70(6) S48\u2013S58. https:\/\/doi.org\/10.1016\/j.outlook.2022.02.013","DOI":"10.1016\/j.outlook.2022.02.013"},{"key":"e_1_3_3_20_1","doi-asserted-by":"crossref","unstructured":"Cunningham-Sabo L. Tagtow A. Mi S. Engelken J. Johnston K. Herman D. R. (2022). Partnerships and community engagement key to policy systems and environmental achievements for healthy eating and active living: A systematic mapping review. Preventing Chronic Disease 19 210466. https:\/\/doi.org\/10.5888\/pcd19.210466","DOI":"10.5888\/pcd19.210466"},{"key":"e_1_3_3_21_1","unstructured":"EPRC. (2023). The Two Georgias Initiative: Cross site evaluation. https:\/\/emoryrsphmain.widen.net\/view\/pdf\/koisynqxbk\/2ga-final-evaluation-report_july2023.pdf"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Fleischhacker S. Parks C. A. Yaroch A. L. (2019). Addressing food insecurity in the United States: The role of policy systems changes and environmental supports. Translational Behavioral Medicine 9(5) 827\u2013836. https:\/\/doi.org\/10.1093\/tbm\/ibz131","DOI":"10.1093\/tbm\/ibz131"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"Frieden T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health 100(4) 590\u2013595. https:\/\/doi.org\/10.2105\/AJPH.2009.185652","DOI":"10.2105\/AJPH.2009.185652"},{"key":"e_1_3_3_24_1","doi-asserted-by":"crossref","unstructured":"Gabbert K. D. Tompkins N. O. Murphy E. (2023). Addressing the gap between academic research and grassroots public health practice: Supporting policy systems and environmental changes in rural communities. Health Promotion Practice 24(Suppl. 1) 161S\u2013169S. https:\/\/doi.org\/10.1177\/15248399221115452","DOI":"10.1177\/15248399221115452"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Galuska D. A. (2024). Data for decision makers: Finding policy systems and environmental solutions for public health problems. Preventing Chronic Disease 21. https:\/\/doi.org\/10.5888\/pcd21.240165","DOI":"10.5888\/pcd21.240165"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"George B. Ravola M. (2024). The evolution of SNAP-Ed: Policy systems and environment (PSE) interventions to enhance nutrition security and health equity in the United States. Nutrition & Food Science 55(2) 402\u2013422. https:\/\/doi.org\/10.1108\/NFS-08-2024-0278","DOI":"10.1108\/NFS-08-2024-0278"},{"key":"e_1_3_3_27_1","doi-asserted-by":"crossref","unstructured":"Holston D. (2020). Implementing policy systems and environmental change through community coalitions and extension partnerships to address obesity in rural Louisiana. Preventing Chronic Disease 17. https:\/\/doi.org\/10.5888\/pcd17.190284","DOI":"10.5888\/pcd17.190284"},{"key":"e_1_3_3_28_1","doi-asserted-by":"crossref","unstructured":"Honeycutt S. (2015). Evaluating policy systems and environmental change interventions: Lessons learned from CDC\u2019s prevention research centers. Preventing Chronic Disease 12. https:\/\/doi.org\/10.5888\/pcd12.150281","DOI":"10.5888\/pcd12.150281"},{"key":"e_1_3_3_29_1","doi-asserted-by":"crossref","unstructured":"Jilcott Pitts S. B. Keyserling T. C. Johnston L. Smith T. W. McGuirt J. T. Evenson K. R. Rafferty A. P. Gizlice Z. Garcia B. A. Ammerman A. S. (2015). Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake physical activity and support for obesity prevention polices among rural adults. Journal of Community Health 40(2) Article 2. https:\/\/doi.org\/10.1007\/s10900-014-9927-6","DOI":"10.1007\/s10900-014-9927-6"},{"key":"e_1_3_3_30_1","doi-asserted-by":"crossref","unstructured":"Kegler M. C. Hermstad A. Bigger L. Smith T. A. Line M. G. Goldson A. Smith A. J. Haard\u00f6rfer R. (2025). A mixed methods analysis of community capacity to address health equity in the rural Southern U.S. International Journal for Equity in Health 24(1) 223. https:\/\/doi.org\/10.1186\/s12939-025-02589-x","DOI":"10.1186\/s12939-025-02589-x"},{"key":"e_1_3_3_31_1","doi-asserted-by":"crossref","unstructured":"Kegler M. C. Hermstad A. Haard\u00f6rfer R. Arriola K. J. Gauthreaux N. Tucker S. Nelson G. (2022). Evaluation design for the two Georgias initiative: Assessing progress toward health equity in the rural south. Health Education & Behavior 10901981211060330. https:\/\/doi.org\/10.1177\/10901981211060330","DOI":"10.1177\/10901981211060330"},{"key":"e_1_3_3_32_1","doi-asserted-by":"crossref","unstructured":"Kelly C. Clennin M. N. Barela B. A. Wagner A. (2021). Practice-based evidence supporting healthy eating and active living policy and environmental changes. Journal of Public Health Management and Practice 27(2) 166. https:\/\/doi.org\/10.1097\/PHH.0000000000001099","DOI":"10.1097\/PHH.0000000000001099"},{"key":"e_1_3_3_33_1","doi-asserted-by":"crossref","unstructured":"Kemper K. A. Pate S. P. Powers A. R. Fair M. (2018). Promoting healthy environments in afterschool settings: The Livewell Greenville afterschool initiative. Preventing Chronic Disease 15 Article E144. https:\/\/doi.org\/10.5888\/pcd15.180164","DOI":"10.5888\/pcd15.180164"},{"key":"e_1_3_3_34_1","unstructured":"Kretzman J. P. McKnight J. (1993). Building communities from the inside out: A path toward finding and mobilizing a community\u2019s assets. https:\/\/www.semanticscholar.org\/paper\/Building-Communities-from-the-Inside-Out%3A-A-Path-a-Kretzman-McKnight\/c204c88d1409cbdd878db131384166dcd8f26348"},{"key":"e_1_3_3_35_1","doi-asserted-by":"crossref","unstructured":"Lee J. P. Lipperman-Kreda S. Saephan S. Kirkpatrick S. (2012). Youth-led tobacco prevention: Lessons learned for engaging Southeast Asian American youth. Progress in Community Health Partnerships: Research Education and Action 6(2) 187\u2013194. https:\/\/doi.org\/10.1353\/cpr.2012.0022","DOI":"10.1353\/cpr.2012.0022"},{"key":"e_1_3_3_36_1","doi-asserted-by":"crossref","unstructured":"Lenardson J. D. Hansen A. Y. Hartley D. (2015). Rural and remote food environments and obesity. Current Obesity Reports 4(1) Article 1. https:\/\/doi.org\/10.1007\/s13679-014-0136-5","DOI":"10.1007\/s13679-014-0136-5"},{"key":"e_1_3_3_37_1","unstructured":"Mabli J. (2013). Measuring the effect of supplemental nutrition assistance program (SNAP) participation on food security. Prepared by Mathematica Policy Research for the U.S. Department of Agriculture Food and Nutrition Service. https:\/\/www.fns.usda.gov\/research\/snap\/measuring-effect-snap-food-security"},{"key":"e_1_3_3_38_1","doi-asserted-by":"crossref","unstructured":"Meit M. Knudson A. (2020). Leveraging rural strengths to overcome population health challenges. American Journal of Public Health 110(9) 1281\u20131282. https:\/\/doi.org\/10.2105\/AJPH.2020.305641","DOI":"10.2105\/AJPH.2020.305641"},{"key":"e_1_3_3_39_1","doi-asserted-by":"crossref","unstructured":"Moore A. Villalobos A. Gardner A. L. Staples C. Shafir S. (2019). Leveraging the strength of comprehensive cancer control coalitions to support policy systems and environmental change. Cancer Causes & Control 30(10) 1033\u20131044. https:\/\/doi.org\/10.1007\/s10552-019-01215-w","DOI":"10.1007\/s10552-019-01215-w"},{"key":"e_1_3_3_40_1","unstructured":"NORC. (2018 February). Exploring strategies to improve health and equity in rural communities. NORC Walsh Center for Rural Health Analysis. https:\/\/www.norc.org\/content\/dam\/norc-org\/pdfs\/Rural%20Assets%20Final%20Report%20Feb%2018.pdf"},{"key":"e_1_3_3_41_1","doi-asserted-by":"crossref","unstructured":"Okobi O. E. Ajayi O. O. Okobi T. J. Anaya I. C. Fasehun O. O. Diala C. S. Evbayekha E. O. Ajibowo A. O. Olateju I. V. Ekabua J. J. Nkongho M. B. Amanze I. O. Taiwo A. Okorare O. Ojinnaka U. S. Ogbeifun O. E. Chukwuma N. Nebuwa E. J. Omole J. A. . . .Okobi R. K. (2021). The burden of obesity in the rural adult population of America. Cureus 13(6) Article e15770. https:\/\/doi.org\/10.7759\/cureus.15770","DOI":"10.7759\/cureus.15770"},{"key":"e_1_3_3_42_1","doi-asserted-by":"crossref","unstructured":"Parker M. A. Weinberger A. H. Eggers E. M. Parker E. S. Villanti A. C. (2022). Trends in rural and urban cigarette smoking quit ratios in the US from 2010 to 2020. JAMA Network Open 5(8) Article e2225326. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.25326","DOI":"10.1001\/jamanetworkopen.2022.25326"},{"key":"e_1_3_3_43_1","doi-asserted-by":"crossref","unstructured":"Richman L. Pearson J. Beasley C. Stanifer J. (2019). Addressing health inequalities in diverse rural communities: An unmet need. SSM\u2013Population Health 7 100398. https:\/\/doi.org\/10.1016\/j.ssmph.2019.100398","DOI":"10.1016\/j.ssmph.2019.100398"},{"key":"e_1_3_3_44_1","doi-asserted-by":"crossref","unstructured":"Rohan E. A. Chovnick G. Rose J. Townsend J. S. Young M. Moore A. R. (2019). Prioritizing population approaches: A qualitative evaluation of policy systems and environmental change initiatives in cancer prevention and control. Population Health Management 22(3) 205\u2013212. https:\/\/doi.org\/10.1089\/pop.2018.0081","DOI":"10.1089\/pop.2018.0081"},{"key":"e_1_3_3_45_1","doi-asserted-by":"crossref","unstructured":"Seguin R. Connor L. Nelson M. LaCroix A. Eldridge G. (2014). Understanding barriers and facilitators to healthy eating and active living in rural communities. Journal of Nutrition and Metabolism 2014 1\u20138. https:\/\/doi.org\/10.1155\/2014\/146502","DOI":"10.1155\/2014\/146502"},{"key":"e_1_3_3_46_1","doi-asserted-by":"crossref","unstructured":"Townsend J. S. Sitaker M. Rose J. M. Rohan E. A. Gardner A. Moore A. R. (2019). Capacity building for and implementation of policy systems and environmental change: Results from a survey of the national comprehensive cancer control program. Population Health Management 22(4) 330\u2013338. https:\/\/doi.org\/10.1089\/pop.2018.0082","DOI":"10.1089\/pop.2018.0082"},{"key":"e_1_3_3_47_1","unstructured":"U.S. Department of Agriculture. (2015). Supplemental nutrition assistance program education guidance FY 2016 SNAP-Ed plan guidance. U.S. Department of Agriculture Food and Nutrition Service. https:\/\/snaped.fns.usda.gov\/library\/materials\/snap-ed-evaluation-framework-and-interpretive-guide"},{"key":"e_1_3_3_48_1","doi-asserted-by":"crossref","unstructured":"van den Berg A. Nielsen A. Akhavan N. Pulido C. L. Basu S. Hussaini A. Jovanovic C. Janda K. Denis L. Ranjit N. (2019). Design and evaluation of a coalition-led obesity initiative to promote healthy eating and physical activity in low-income ethnically diverse communities: The Go! Austin\/Vamos! Austin initiative. Archives of Public Health 77(1) 25. https:\/\/doi.org\/10.1186\/s13690-019-0350-4","DOI":"10.1186\/s13690-019-0350-4"},{"key":"e_1_3_3_49_1","doi-asserted-by":"crossref","unstructured":"Whitfield G. P. Carlson S. A. Ussery E. N. Fulton J. E. Galuska D. A. Petersen R. (2019). Trends in meeting physical activity guidelines among urban and rural dwelling adults\u2014United States 2008\u20132017. Morbidity and Mortality Weekly Report 68(23) 513\u2013518. https:\/\/doi.org\/10.15585\/mmwr.mm6823a1","DOI":"10.15585\/mmwr.mm6823a1"},{"key":"e_1_3_3_50_1","doi-asserted-by":"crossref","unstructured":"Wilcox S. Castro C. King A. C. Housemann R. Brownson R. C. (2000). Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States. Journal of Epidemiology and Community Health 54(9) 667\u2013672. https:\/\/doi.org\/10.1136\/jech.54.9.667","DOI":"10.1136\/jech.54.9.667"},{"key":"e_1_3_3_51_1","doi-asserted-by":"crossref","unstructured":"Yaroch A. L. Parks C. A. Story M. T. (2020). Leveraging community engaged policy systems and environmental (PSE) approaches to foster healthy eating in the United States. Journal of Healthy Eating and Active Living 1(1) 3\u20135.","DOI":"10.51250\/jheal.v1i1.9"}],"container-title":["Health Education &amp; Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10901981261442368","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10901981261442368","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10901981261442368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:36:03Z","timestamp":1777448163000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10901981261442368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":50,"alternative-id":["10.1177\/10901981261442368"],"URL":"https:\/\/doi.org\/10.1177\/10901981261442368","relation":{},"ISSN":["1090-1981","1552-6127"],"issn-type":[{"value":"1090-1981","type":"print"},{"value":"1552-6127","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]},"article-number":"10901981261442368"}}