Analysis Grid For Environments Linked To Obesity Research Articles

Impact of the COVID-19 pandemic on the adaptability and resiliency of school food programs across Canada.

Following the sudden closure of schools due to the pandemic in 2020, many school food program (SFP) operators lost their operating venues and had to innovate to continue distributing meals to children. Our objective was to assess the impact of the COVID-19 pandemic on the delivery, adaptability, and resiliency of school food programs across Canada by conducting a systematic rapid review. Systematic literature searches identified newspaper articles and social media sources related to the adaptations and challenges faced by school food programs across Canada in response to the COVID-19 pandemic. Included sources were assessed and thematically categorized according to the dimensions of the Analysis Grid for Environments Linked to Obesity (ANGELO) and Getting To Equity (GTE) frameworks to identify factors impacting the delivery, adaptability, and resiliency of school food programs in Canada. School food programs in Canada made various efforts to meet existing and new challenges associated with the delivery of these programs to keep feeding school children, particularly those most vulnerable, during the pandemic. Distribution of food kits, prepared meals and gift cards/coupons were successful pathways in ensuring support for food accessibility to students and their families. Increased collaborations between community members and organizations/stakeholders to help maintain food delivery or collectively offer new modes to deliver foods were most frequently cited as key to facilitating school food programming. However, maintenance and sustainability related to operating costs and funding were identified as key challenges to successful school food programming. Our study highlights the swift and substantial transformation school food programs,, underwent in response to the pandemic, driven by the urgent need to ensure that students still had access to nutritious meals and the importance of policy and resource support to bolster the adaptability and resiliency of these programs. Findings on facilitators and challenges to school food programs during the early months of the COVID-19 pandemic can inform development of guidelines to design a robust national Canadian school food program and help make existing programs more sustainable, adaptable, and resilient.

Scanning for Obesogenicity of Primary School Environments in Tshwane, Gauteng, South Africa.

The purpose of this study was to scan for the obesogenicity of primary school environments in Tshwane, Gauteng, South Africa. This study was carried out in ten public primary schools in the Tshwane West district of the Gauteng province. An observational design was used to collect the data. Data collection was conducted using an observational checklist guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The findings revealed that although a nutrition policy was available in most schools, few schools were communicating the policy. Despite all the schools having sports fields, children were not exercising. Most schools also had a school nutrition programme. Most primary schoolchildren's lunchboxes contained sweets, sugar-sweetened beverages, and snacks. A few lunchboxes contained fruits and vegetables. Primary schools in Tshwane West did not comply with most aspects of the school mapping environment, indicating that the school environments were obesogenic. It is therefore essential to scan for obesogenicity in all South African schools so that tailor-made interventions can be implemented to rectify and further prevent obesogenic school environments.

The role of the perceived environment for recreational walking among adults in socioeconomically disadvantaged situations: A study using walk-along interviews

BackgroundPersons in socioeconomically disadvantaged situations (PSEDS) are generally less likely to engage in recreational walking (RW) compared to higher socioeconomic groups and are often more dependent on their local environment. Studies on RW have primarily focused on the role of the built environment for the general adult population and the older population in urban areas. The aim of this study is to qualitatively identify the perceived environmental factors affecting RW among PSEDS in peri-urban areas. MethodsIn two peri-urban municipalities in Belgium, walk-along interviews were conducted until data saturation with a purposeful convenience sampling of 38 PSEDS (25-65y/o) to identify local environmental factors affecting RW. A subsample of 22 participants joined a focus group (n = 4) to categorize the identified factors into environmental types (physical, sociocultural, political, and economic) of the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The interviews were transcribed and analyzed thematically using Maxqda 2022.0. ResultsThe information environment (dissemination, retrieving and understanding of information) was added to the ANGELO framework, highlighting the importance of digital literacy. Availability and accessibility of well-maintained walking surfaces, toilets, street lighting and seating options (physical environment), social support, dog-ownership, stigmatization, social isolation, and a sense of belonging (sociocultural environment) and indirect costs (economic environment) were identified as important environmental factors in RW among PSEDS. The identified political and economic factors are intertwined with the other environments. ConclusionsPerceived environmental factors affect RW among PSEDS and peri-urban settings offer specific challenges. Local governments should incorporate citizen perception into decision-making processes to create supportive environments that have the potential to promote RW among PSEDS in a peri-urban setting.

Examining the New Zealand school food environment: what needs to change?

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

A Scoping Review of Policies Related to the Prevention and Control of Overweight and Obesity in Africa.

To address the issue of obesity, the World Health Organization (WHO) recommends a set of comprehensive programmes aimed at changing the obesogenic environments to provide opportunities for healthy food options and increased physical activity in the school, home, and at the population level. The objectives of this study were to examine the nature and range of policies related to overweight and obesity prevention in Africa, and to assess how they align with international guidelines. An existing methodological framework was adapted for this scoping review. A search of publicly available national documents on overweight/obesity, general health, and non-communicable diseases (NCDs) was undertaken from relevant websites, including WHO, ministries, and Google Scholar. Additional requests were sent to key contacts at relevant ministries about existing policy documents. The documents were reviewed, and the policies were categorised, using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The framework categorises the environmental drivers of obesity into four domains (physical, economic, legislative, and socio-cultural) and two scales: macro (national, regional, sectors, food industries, media, etc.) and micro (household, institutional, and community). This review included documents from 41 African countries. The policy initiatives to prevent overweight/obesity target the school, family and community settings, and macro environments, and broadly align with global recommendations. The NCD documents were in the majority, with only two on obesity. The majority of the documents detailed strategies and key interventions on unhealthy diets and physical inactivity. The physical, legislative, and sociocultural domains were largely featured, with less emphasis on the economic domain. Additionally, nutrition- and diet-related policies were in the majority. Overlaps and interactions of policies were observed in the application of the ANGELO framework. This study has provided information on national policies and programmes in Africa and can be useful as a first point of call for policymakers. The overlapping and interaction in the initiatives demonstrate the importance of multi-sectoral partnerships in providing supportive environments for healthy behaviours.

Food environment interactions after migration: a scoping review on low- and middle-income country immigrants in high-income countries.

To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries. A scoping review was carried out following the framework outlined by Arksey and O’Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A ‘Best fit’ framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. High-income countries. Immigrants from low- and middle-income countries. A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children’s demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired. This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.

HomeSTEAD's physical activity and screen media practices and beliefs survey: Instrument development and integrated conceptual model.

The home environment has a significant influence on children’s physical activity and obesity risk. Our understanding of this environment is limited by current measurement tools. The Home Self-administered Tool for Environmental assessment of Activity and Diet addresses this gap. This paper describes the development and psychometric testing of its family physical activity and screen media practices and beliefs survey. Methods: Survey development was guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework and informed by a literature review, expert opinion, and cognitive interviews. Parents of children ages 3–12 years (n = 129) completed the HomeSTEAD survey three times over 12–18 days. Additionally, parents reported on child behaviors and trained staff measured parent and child height and weight. Five exploratory factor analyses were conducted after categorizing items into: control of physical activity, control of screen media, explicit modeling, implicit modeling, and perceived barriers and facilitators. Scales with 3 or more items underwent scale reduction. Psychometric testing evaluated internal consistency (Chronbach’s alphas), test-retest reliability (analysis of variance and intraclass correlations (ICC)), and construct validity (correlations with child BMI, physical activity, screen time). An integrated conceptual model of parent physical activity and screen media practices and beliefs was developed based on recent literature to aid in the identification and naming of constructs. Results: Final scales demonstrated good internal consistency (median Cronbach’s alpha = 0.81, IQR = 0.74–0.85), test-retest reliability (median ICC = 0.70, IQR = 0.66–0.78), and construct validity (with correlations between scale score and children’s behaviors generally in the expected direction). Comparison with the integrated conceptual model showed that most identified constructs were captured. Conclusions: The family physical activity and screen media practices survey advances the measurement of the home environment related to children’s physical activity, screen time, and weight. The integrated conceptual model provides a useful framework for researchers studying both physical activity and screen media parenting practices.

Eat, play, learn well-a novel approach to co-production and analysis grid for environments linked to obesity to engage local communities in a child healthy weight action plan.

To describe the process of combining Analysis Grid for Environments Linked to Obesity (ANGELO) with community engagement, qualitative and co-production methods to promote local strategies around child healthy weight (CHW) and to highlight steps taken to engage local people in developing a community CHW action plan around two school communities in Dundee, Scotland. The Eat, Play, Learn Well (Learn Well) approach applied an action-oriented research approach, using qualitative methods. Focus group discussions (FGDs), a co-production approach, and ANGELO were linked by applying a novel three-step process. FGDs were recorded by scribe and following face-to-face interview's key themes were identified using a novel, predefined five-step process, and ANGELO grids were populated. Prioritization events allowed local people to rank most important health statements, with community conversations offering further insights to help create a local CHW action plan. Three FGDs were conducted with parents (n=24) and two with workers (n=15). Eighty-seven attended a prioritization event at school B (41 adults), 59 attended at school A (35 adults), where each school community chose its top four priorities from 11 health statements developed. Two further community conversations then took place and led to the creation of a CHW action plan with five overarching themes. The Learn Well test approach helped gain important insights into local environments linked to obesity and production of a pragmatic, step-by-step process suitable for real-life public health practice that can enable local people to identify key early intervention and prevention priorities, in a tangible way.

Truckies and health promotion: using the ANGELO framework to understand the workplace’s role

Purpose Workplaces are challenging environments which place workers at the risk of obesity. This is particularly true for Australian road transport industry workplaces. The Analysis Grid for Environments Linked to Obesity (ANGELO) framework is a public health tool which can be used to conceptualise obesogenic environments. It suggests that workplaces have a variety of roles (in the physical, economic, political and sociocultural domains) in responding to obesity in transport industry workplaces. The purpose of this paper is to present the findings which explore this idea. Design/methodology/approach The project used a mixed-methods approach located within a participatory action research framework, to engage workplace managers and truck drivers in the implementation and evaluation of workplace health promotion strategies. The project involved six transport industry workplaces in Queensland, Australia. Findings This study found that transport industry workplaces perceive themselves to have an important role in addressing the physical, economic, political and sociocultural aspects of obesity, as per the ANGELO framework. However, transport industry employees – specifically, truck drivers – do not perceive workplaces to have a major role in health; rather, they consider health to be an area of personal responsibility. Practical implications Balancing the competing perceptions of truck drivers and workplace managers about the workplace’s role in health promotion is an important consideration for future health promotion activities in this hard-to-reach, at-risk population. Originality/value The use of the ANGELO framework allows the conceptualisation of obesity in a novel workplace context.

Individual and contextual correlates of obesity-related behaviours and obesity: the SPOTLIGHT project.

Individual and contextual correlates of obesity-related behaviours and obesity: the SPOTLIGHT project.

Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community-driven health programmes in an Indigenous community in Canada.

Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes.

It's not as Easy as just Saying 20 Minutes a Day': Exploring Teacher and Principal Experiences Implementing a Provincial Physical Activity Policy

In 2005, the Ontario Ministry of Education implemented the Daily Physical Activity (DPA) Policy to provide every elementary student with at least 20 minutes of sustained moderate to vigorous intensity physical activity each day. This exploratory research sought to understand the factors shaping DPA implementation in schools and classrooms, from the perspective of elementary school teachers and principals. Semi-structured interviews were conducted with Ontario grade 1-8 teachers (n=14) and elementary school principals (n=5) regarding DPA implementation, facilitators, barriers, perceived outcomes, and suggestions for change. The majority of participants stated that students were not meeting the requirements daily. However, participants shared activities and techniques for incorporating physical activity into instructional time. Facilitators and barriers to implementation were organized using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework in order to identify factors acting at four environmental levels. The facilitators and barriers identified indicate that staff and resources within individual schools strongly influence implementation. Although many positive outcomes for students were identified, increased fitness was not mentioned, highlighting additional benefits above physical health. The findings suggest DPA is not being implemented as intended, as school staff are finding it difficult to meet the time and intensity requirements. Policy makers must consider the local school environment and the roles of school staff when designing school-based health policies.

How community environment shapes physical activity: Perceptions revealed through the PhotoVoice method

A growing body of evidence shows that community environment plays an important role in individuals' physical activity engagement. However, while attributes of the physical environment are widely investigated, sociocultural, political, and economic aspects of the environment are often neglected. This article helps to fill these knowledge gaps by providing a more comprehensive understanding of multiple dimensions of the community environment relative to physical activity. The purpose of this study was to qualitatively explore how people's experiences and perceptions of their community environments affect their abilities to engage in physical activity. A PhotoVoice method was used to identify barriers to and opportunities for physical activity among residents in four communities in the province of Alberta, Canada, in 2009. After taking pictures, the thirty-five participants shared their perceptions of those opportunities and barriers in their community environments during individual interviews. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, themes emerging from these photo-elicited interviews were organized in four environment types: physical, sociocultural, economic, and political. The data show that themes linked to the physical (56.6%) and sociocultural (31.4%) environments were discussed more frequently than the themes of the economic (5.9%) and political (6.1%) environments. Participants identified nuanced barriers and opportunities for physical activity, which are illustrated by their quotes and photographs. The findings suggest that a myriad of factors from physical, sociocultural, economic, and political environments influence people's abilities to be physically active in their communities. Therefore, adoption of a broad, ecological perspective is needed to address the barriers and build upon the opportunities described by participants to make communities more healthy and active.

Examining local-level factors shaping school nutrition policy implementation in Ontario, Canada.

Increasing numbers of overweight and obese youth draw attention to the school as an important setting for targeted nutrition interventions, given that it is where they spend a majority of their waking time. The objective of the present study was to explore local-level factors shaping the implementation of a school nutrition policy. In-depth, semi-structured interviews were conducted in person or via the telephone (a maximum of 60 min). An interview guide was informed by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, research objectives and literature. Key themes centred on policy implementation, including facilitators and barriers (i.e. resources, capacity), user satisfaction (i.e. students) and communication strategies. Secondary schools in Ontario, Canada. Twenty-two participants from local agencies supporting school nutrition programming (n 8) and secondary-school principals, vice principals and teachers (n 14) from nine schools across three Ontario school boards. Results are organized according to environments outlined in the ANGELO framework. The cost of healthy food for sale, revenue loss (economic), proximity of schools to off-site food outlets (physical), the restrictive nature of policy, the role of key stakeholders (political), the role of stigma and school culture (sociocultural) act as local-level barriers to policy implementation. Gaps in policy implementation include the high cost of food for sale and subsequent revenue generation, the close proximity of internal and external food environments, the need for consultation and communication between stakeholders, and strategies to reduce stigma and improve the school nutrition culture.

Dissecting the Obesogenic Environment of a Psychiatric Setting: Client Perspectives

This qualitative study asked individuals with schizophrenia to identify environmental factors in a psychiatric facility that influence their diet, physical activity, and ultimately weight. Participants took photographs of environmental elements they perceived to be obesogenic within the hospital and then participated in a semi-structured interview during which they were asked about the identified environmental elements. The Analysis Grid for Environments Linked to Obesity (ANGELO) framework was used for the analysis of data. Participants recommended individual and environmental approaches to address obesity. The ANGELO framework is a useful tool for identifying obesogenic factors, a process that can inform environmental interventions in psychiatric settings.

Exploring the School Nutrition Policy Environment in Canada Using the ANGELO Framework

Excess body weight has become a major public health issue. Given the link between poor nutrition, obesity, and chronic disease in youth, increasing attention is being paid to the school as an ideal setting for promoting nutritious eating practices. Informed by the ANGELO (Analysis Grid for Environments Linked to Obesity) framework, we employ a documentary analysis to investigate the context of school nutrition in Canada, particularly the relationship between regional- and upper-level policies. In doing so, we examine policy documents and technical reports across three levels. We used mixed methods to analyze relevant English language policy documents and technical reports across Canada (n = 58), published between 1989 and 2011. Results reveal distinct differences across federal, provincial, and regional levels. The availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels. Federal and provincial priorities are guided by a health promotion framework and adopting a partnership approach to policy implementation. Gaps in regional-level policy include incorporating nutrition education in the curriculum and making the link between nutrition and obesity. Policy implications are provided, in addition to future research opportunities to explore the connections between these environments at the local level.

Community Action To Prevent Childhood Obesity: Lessons from Three US Case Studies

A 2005 Institute of Medicine report argues that "prevention of obesity in children and youth is, ultimately, about community," yet the literature lacks empirical research on what communities are doing to prevent childhood obesity. This research helps fill this gap and highlights promising practices. This research entailed exploratory analysis of three descriptive case studies of community efforts to prevent childhood obesity in the northeastern United States: Shape Up Somerville in Massachusetts, MA (urban), Whole Community Project in New York, NY (semiurban), and Eat Well Play Hard Chemung in NY (semirural). Data included stakeholder interviews (n=23), participant observation (n ≥ 7 events and meetings/case), and document analysis (n≈100/case) from project inceptions until March, 2010. Meeting participation was tracked. Data were coded for actions and strategies. Actions were mapped to an adapted version of the ANalysis Grid for Environments Linked to Obesity (ANGELO) framework. These three projects were successful in changing physical environments for food and activity through program and event offerings. The projects were less active in generating policy and economic change. The scale and scope of actions related to project longevity. Demographics of key project stakeholders may have hinged on individual and institutional identities of project facilitators and on intentionality of inclusion strategies. Such projects could likely generate greater scope and scale of environmental changes to prevent childhood obesity if funding agencies provided long-term financial support and technical assistance, even if at lower levels. Diversity of participation would also benefit from stable support and from dispersal of decision-making powers, including through distributed funding.

‘The worst of the Bangladeshi and the worst of the British’: exploring eating patterns and practices among British Bangladeshi adolescents in East London

Objectives: This article examines how aspects of a specific locality, history and set of practices interact to produce an obesogenic environment. The Analysis Grid for Environments Linked to Obesity (ANGELO) framework and a biocultural approach are used to examine one obesogenic environment – that experienced by British Bangladeshi adolescents (ages 11–14 years old) in Tower Hamlets, East London. Interdisciplinary literature and methods explore how physical, economic, cultural, and political pressures in school, street, and home micro-environments influence eating patterns and practices. Design: This ethnographic research included living on a council estate and working as an assistant physical education teacher in two secondary schools in Tower Hamlets. Anthropometric and socioeconomic characteristics were collected from the young people whose physical education classes I assisted (n=447). Then interviews and questionnaires were completed with a subsample of participants (n=165) drawn from the first phase of research to understand the factors that influence eating patterns. Results: Among this group of adolescents, interwoven cultural and structural pressures encourage frequent consumption of energy-dense foods in their schools, streets, and homes. They were exposed to factors that have led to the widespread increase in the prevalence of overweight and obesity such as the increased availability and affordability of energy-dense foods. In addition, they faced cultural and structural pressures associated with being the adolescent children of immigrants from Bangladesh and living in an economically depressed neighborhood. Conclusion: To develop a comprehensive understanding of the factors that may lead to weight gain in different ethnic, geographic and socioeconomic contexts it is important to examine the pressures specific to that context that might influence the variety and frequency of food consumption. This type of research may lead to the identification of points of intervention that are specific to the pressures and sensitivities of particular environments.

Modifying the food supply at a community swimming pool: a case study

We report on a process evaluation of a project that aimed to replace energy-dense, nutrient-poor (EDNP) items at a community swimming pool kiosk. The analytic framework was the Analysis Grid for Environments Linked to Obesity (ANGELO). To contribute to health promotion practice in recreational settings, the process evaluation sought to determine the extent to which project'controversies' modified project objectives and strategies. The case study method captured the project narrative. The primary data were interviews with key project participants, supplemented with project records and media articles.These were analysed thematically. The socio-cultural and political environments, particularly the capacity to exercise choice in relation to ENDP products, had considerable influence on the project. In the face of two controversies -"I thought everyone was signed up to it"and "We can't deny the kiddies their ice-cream" it was necessary for the project partners to modify the objectives and strategies and substantially change the target. The setting is highly responsive to both the micro and macro socio-cultural and political aspects of the environment.

Active Living for Rural Children: Community Perspectives Using PhotoVOICE

Active living integrates physical activity into one's daily routine. Current understanding of active living among children and their families living in rural communities is limited. A community perspective is critical to understand the contextual factors that influence children's physical activity in rural areas. The purpose of this study was to identify the perceived environmental factors that support or hinder physical activity among rural children to develop testable hypotheses to inform future interventions for reducing unhealthy weight gain and preventing chronic diseases associated with physical inactivity. PhotoVOICE was used to explore active living opportunities and barriers for children living in four low-income, rural U.S. communities. In 2007, parents (n=99) and elementary school staff (n=17) received disposable cameras to document their perspective. Using their photographs and narratives, participants developed emergent themes during a facilitated group discussion. In 2008, study authors used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to categorize the themes. Microenvironment themes include physical (e.g., natural features, topography); sociocultural (e.g., isolation); policy (e.g., time for school recess); and economic (e.g., funding for physical activity programs). Macroenvironmental themes related to the built and natural environments and transportation infrastructure. This study identified rural environment elements that community members perceived as influencing children's physical activity patterns. Certain aspects were unique to rural areas, whereas other urban and suburban factors may be generalizable to rural settings. PhotoVOICE was a useful participatory research method to gain insight into perceived factors affecting rural children's physical activity behaviors.