Built environment in programs to promote physical activity among Latino children and youth living in the United States and in Latin America

Summary To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA‐promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA‐promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA‐promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context‐specific priorities and exchanging lessons learned.

mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA-promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context-specific priorities and exchanging lessons learned. Currently, there are over 12 million Latino youth aged 6-17 years living in the United States. 4 This population is more likely to live in poverty and have insufficient access to trails, recreational facilities, and parks compared with other racial/ethnic minority groups. 5 In LAC, there are over 158 million children and adolescents aged 5-19 years. 6 This region is characterized by being one of the most urbanized, dense, unequal, and violent in the world, with over 30% of the population living in poverty. 5 These contextual conditions provide a challenging backdrop for advancing programs promoting PA among Latino youth in the United States and youth in LAC.
It is necessary to understand the complex interplay of BE and PA to ensure supportive environments that promote PA. This requires a comprehensive interdisciplinary research focus to explore the similarities as well as differences in BE-PA associations in different cultures and regions of the Americas. 7,8 From a socioecological perspective, youth's PA is shaped by a constellation of psychological, sociocultural, family, school, and environmental factors. 9,10 Specifically, a supportive BE provides children and families with opportunities and infrastructure for free play, structured and unstructured outdoor PA, and active transport-related behaviors. 11 Based on this understanding, strategies have been initiated globally to promote PA behaviors among youth through interventions in three primary domains: (1) youth-oriented, nonschool, outdoor activities in residential neighborhoods; (2)   we defined specific indicators that should be documented when considering BE and PA among Latino and Latin American youth: urban form and landscape, school built environment, parks and green spaces accessibility, mobility patterns, crime and safety, and children's perspectives on affordances-always acknowledging the context of socioeconomic inequalities in the United States and LAC.
The experts also underscored the importance of a complex methodological approach using interdisciplinary mixed methods, such as social network analysis and citizen science, to advance BE and PA interventions among youth. These approaches can lead to a clearer understanding of the interactions between activity-enhancing or activity-limiting places and PA behaviors, and its cultural-related aspects. 9 PA levels are affected by social norms and context-specific factors (e.g., gender norms, safety perceptions, parental rules, and socioeconomic disparities), making it critical to advance research at the intersection of infrastructure (i.e., the physical built environment aspects) and agents (i.e., the people and communities using and interacting in the BE). 13 We reviewed published systematic reviews and conducted an expert consultation with members of the Network of Ciclovía of the Americas and program coordinators for the availability of programs that have been implemented in the United States and LAC to promote PA among youth in the three primary domains: (1) nonschool outdoor activities (play streets), (2) active travel patterns to and from school, and (3) school setting interventions. Applying the socioecological perspective, we identified at each level (individual, interpersonal, and community) the intervention targets and aspects to further evaluate (Table 1). We identified one case study per type of program and region and conducted in-depth interviews with academic researchers and practitioners who have been part of the reviewed case studies.

| BE and PA among Latino and Latin American youth
Even with considerable evidence on the associations between BE and PA from the last two decades, [14][15][16] mainly coming from high-income countries, there is limited evidence from Latino U.S. youth 10,15-17 and from LAC. 15,16 The common themes emerging from this line of research include (i) perceived access to recreational opportunities for PA in one's neighborhood or community and (ii) the importance of PA at or en route to school. 16 With respect to recreational PA opportunities, geographical areas in the United States with predominantly Latino populations have shown a lower probability of having parks and recreational facilities. 18,19 Parents of Latino children have consistently reported limited availability of parks, facilities for PA, and clean, safe places as barriers to their children's PA. 18,[20][21][22] Importantly, perceived neighborhood access to parks, playgrounds, and gyms typically has shown a stronger effect on promoting PA among Latino youth than objective measures of park access. 23 This suggest the relevance of addressing both availability and perceptions of BE features to influence active behaviors among Latino youth.
Similarly, the limited evidence from LAC shows that parents' perceptions of neighborhood BE attributes are associated with children's use of parks and unstructured open spaces for PA. 24 Regarding objective BE data, in Mexico, sidewalk availability was positively associated with PA behaviors among youth, 25 while in Brazil, mix land use (i.e., a range of land uses including residential, commercial, and industrial to be co-located in an integrated way to support PA), recreational facilities or venues along the route (e.g., parks), and residential density were factors associated with youth PA. 26 Additionally, evidence from Mexico revealed that participation in school-based sports and organized PA was higher in children living in unsafe neighborhoods and with more path obstructions, whereas the participation in unstructured types of outdoor PA was higher in neighborhoods with more pedestrian amenities, greater cleanliness, and low traffic volume. 27 This evidence regarding the relationship between the safety conditions of the neighborhoods and unstructured outdoor play suggests similarities in the United States and LAC regarding parents' perceived BE availability and context-specific differences regarding BE features and PA among Latino youth.
With respect to youth PA occurring en route to or at school, active commuting to school or unstructured outdoor PA in the school setting 25,27,28 have been associated with school surroundings, including speed limits, crossing guards or other intersection crossing aids, and the presence of sidewalks in both the United States and LAC. Unfortunately, in the United States, there has been a rapid decline in the rates of active travel to school over the past five decades, with a decrease nationally from a 40.7% prevalence in 1969 to 10.7% in 2017. 29,30 Importantly, Latino youth are more likely to bike or walk to school compared with their White or Black youth counterparts. 31 Evidence from LAC highlights that this behavior constitutes a major source of PA among youth, with considerably higher prevalence overall in LAC, ranging from 23.0% to 70.8%, although substantial variations by country have been reported. 26,[32][33][34][35][36] Most LAC studies on the correlates of active travel to school support that in this region, this is a necessity-driven mobility behavior (i.e., high socioeconomic status and having the means to use a private vehicle are inversely associated with such active travel). In terms of BE features, no consistent characteristic has been associated with active travel to school across the LAC region. Additionally, associations between BE and active travel to school have not been explored for public and private schools.
Underscoring the importance of the social environment when studying the BE, evidence from Mexico showed that youth with more neighborhood social ties (defined as interactions among residents) reported more PA during the week, and the number of social ties had a stronger positive association with PA than perceived neighborhood safety. 23 In fact, studies exploring safety, crime, with PA in youth in Argentina, 24 Brazil, 37 Colombia, 37 and Mexico 25,38 have shown inconsistent associations. 39 Meanwhile, concerns about crime, gangs, and unsafe neighborhoods have emerged as barriers to PA frequently reported among children of Latino parents living in the United States. [40][41][42] Together, the limited research on BE and PA among Latino U.S. youth and LAC youth reveals the need for further research to better define what "activity-friendly" environments actually mean in these different regions.

| Built environment indicators affecting PA behaviors
The expert group underscored the need to develop indicators within the following topics to advance the understanding of BE and PA among Latino and Latin American youth: urban landscape and street design, parks and green areas, mobility patterns and activity places, crime and safety, and children's perspectives on affordances.

| Urban landscape and street design
The spatial configuration and composition of urban environments can affect PA behaviors. As cities where Latino and Latin American youth live continue to expand and densify, quantifying their spatial configuration and accurately projecting their future dynamics becomes critical for PA and obesity prevention. Within the spatial configuration, the urban landscape domain measures how urban development is configured within each city and includes variables like fragmentation, isolation, shape of developed urban areas, and city density that could provide proxy measurements of compact cities versus urban sprawl. 43 The street design domain typically includes street connectivity, street length, and directness, which can provide proxy walkability measurements. Advances in geospatial analyses and remote sensing offer a unique opportunity for comparable urban landscape and street design metrics. 43 where standardized geographic scales have been applied and could be linked to survey data. However, to our knowledge, there are no studies on the association of these indicators and PA among Latino youth.

| Parks and green areas
Parks are vital components of communities, offering opportunities for groups, families, and individuals to enjoy outdoor activities together and alone, including PA. Parks and green spaces are measured on dimensions of quantity, the absolute number or space devoted to them, and the quality of the features and amenities of the park. 45,46 Also, the physical characteristics of parks and other greenspaces are defined as elements that people use for PA, such as sport or recreation fields, trails, or courts. 47 Features may also include shared areas including plazas or pavilions that might be used for civic events or to host activities, such as dancing or group exercise classes. 47 Other physical elements include park amenities, such as water fountains, restrooms, lighting, or benches. 47 Having more features and better amenities is usually associated with more PA, particularly when parks or greenspaces are well maintained and safe. 47 Parks with a large number of incivilities such as broken glass, trash, tagging/graffiti or other nuisances can discourage their use for physical activities and may be perceived as unsafe. 47 Of note, systematic differences in neighborhood park quantity and quality along ethnic or socioeconomic status lines have not been consistently observed in the United States and may depend less on socioeconomic differences and more on local policy or civic involvement. 48 Recent research on green space has used a satellite-based measure of green space, the normalized difference vegetation index, which is a proxy measure of neighborhood greenness or availability of green space. 43  Latino youth. 54,55 The use of such technologies to explore multilevel influences of PA will provide a better understanding of mobility patterns and activity places in Latino and Latin American youth.

| Crime and perceived safety
Crime and safety-related factors of neighborhood environments strongly shape parents' restriction of their child's PA and independent mobility. However, most studies in this area have used isolated questions about the perception of safety or crimes and thus may not adequately capture this construct. Additionally, social and individual factors are potential moderators between perceived and objective measures of neighborhood safety, such as community cohesion, gender (of parent and child), child's age, education, and acculturation. 56 Perceived crime and traffic safety are typically measured using surveys aimed at reporting signs of physical and social disorder, stranger danger, and perceived levels of traffic hazards. 56 Meanwhile, objective measures of crime and traffic safety are assessed using in-person, context-specific observational audits, GIS, or available crime and safety databases. 56 It is important to use ecologic approaches that combine perceived and objective measures of neighborhood safety to capture more comprehensively factors at the individual, family/parent, and neighborhood levels.

| Affordances
Within a functional approach seeking to maximize BE potential to increase PA and outdoor play among youth, the concept of affordances becomes relevant. In the context of play, affordances are the functionally significant properties of the environment that satisfy children's needs, interests, motivations, or capabilities (i.e., flat surface and climbable elements). 57   The citizen science approach can be defined generally as engaging members of the public in research processes, such as data collection, analysis, and dissemination, to contribute to scientific advancements. 70     Play streets are community-based initiatives where residents work together to temporarily limit automobile traffic on a residential street so children and their families can safely play, socialize, and actively engage with their community. 81 They are aimed at addressing the inequality in opportunities for outdoor play for children from lower SES families that may not have a park, green space or safe shared play spaces in walking distance to their home. 82,83 Play streets differ in area size, schedule, number of participants, and type of activities depending on the decisions of the residents on and around a specific neighborhood block.

PlayFamilias:
Latino families activating streets in

Miami, Florida
Initiative promoted by partnered non-profit organizations engaged in the empowerment of communities. 86 It was implemented in 2017 to address the Little Havana neighborhood families' lack of safety to walk, ride bikes, or play outdoor games.
-Play streets is a BE context-specific malleable initiative that is adaptable to different sociocultural perspectives on play with the potential to foster intergenerational interactions and transform sedentary behaviors in parents, grandparents, and children.
-The sustainability of play streets requires a family-based approach to engage local residents in outdoor play. As an initiative relying on self-organized residents of local streets, the implementation of play streets requires tailoring processes to raise awareness among parents and local residents regarding the ultimate goals of this program.
-As low cost, easy to implement program, play streets are ideal for communities with limited green or public spaces and its contributions to a wide range of outcomes related to social and emotional well-being should be studied further.

Juega en tu Barrio:
Chilean intervention for outdoor play Research intervention conducted in 2014 in Santiago de Chile, the capital city of Chile.
It has been scaled up as a program funded by the Health Ministry. In the COVID19 pandemic it has received particular attention for reducing inequities in access to open areas in neighborhoods.
The intervention and non-play street control neighborhoods (total N = 2) were lowto-middle income neighborhoods with poor urban infrastructure and high traffic/stranger danger perceptions, presenting similar crime levels. 83 The intervention targeted all levels of the socioecological model and its results indicated that it was effective in increasing outside play and PA in children. 83 Fifty-three percent of children participated in more than 70% of the sessions, with more girls participating. In addition, parental safety concerns regarding outdoor play improved, as well as social cohesion among neighbors. 83 Active travel to school (ATS) are programs fostering the joy of safe walking and biking.
They often comprise multilevel socioecological actions, including both educational activities and BE changes as strategies to promote travel behavior change, including infrastructure improvements, safety education and enforcement, and incentives for participation.
Household SES and car ownership determine transportation options. In the United States, 90% of adults report using a private car to work, whereas in LAC it is 22%. 87 Children from low-to-middle income neighborhoods in LAC may not have the choice to access motorized travel to school and often are Safe Routes to School in the United States: Government-supported local engagement to active school travel Furthermore, future research will need to combine mixedmethods to more fully assess active behaviors among youth in advancing our understanding of the interactions between activity places and PA behaviors, as well as the culturally and socially related aspects of PA promotion (social network analysis, spatial analysis, systematic observation, and community-engaged citizen science).
Hearing the voices of youth might contribute to further implementation of gender-specific and age-appropriate interventions, while also empowering youth as agents of change responsible for co-creating healthy environments. In this manner, the Our Voice model may be useful as an advocacy training program to foster improvement, sustainability, and community "ownership" of the programs. Likewise, SNA might provide useful insight concerning the extent to which social capital and norms shape active behaviors, particularly in relation to age, gender, and cultural background. Using SNA in each intervention will help to promote the understanding of who the people are who enroll in the activity and how local and external stakeholders engage and maintain the initiative. 97