In 1999, the Centers for Disease Control and Prevention (CDC) funded Play Across Boston (PAB), a collaborative project of local stakeholders, the Harvard School of Public Health Prevention Research Center (HPRC), and Northeastern University's Center for the Study of Sport in Society (Sport in Society) to address the following four aims in Boston, Mass:

Inner-city youth sports and physical activity programs may provide a mechanism for reducing disparities in chronic disease outcomes related to sex, race and ethnicity, and socioeconomic level. Physical activity among children and adolescents is important because of the related health benefits (e.g., cardiorespiratory function, blood pressure control, weight management) and because a physically active lifestyle adopted early in life may continue into adulthood (1). Insufficient levels of physical activity may contribute to the current epidemic of childhood overweight and associated health risks. National data indicate that the percentage of young people who are overweight has more than doubled in the last 20 years. Of children and adolescents aged 6 to 19 years, 16% are considered overweight (2).

Boston youths may be underserved by youth physical activity opportunities compared with other communities in Massachusetts, and girls in Boston are particularly underserved, according to an unpublished pilot study conducted in 1997 by Sport in Society. In 1999, fewer high school students in Boston reported participating in team sports than did their statewide counterparts on the 2001 Massachusetts Youth Risk Behavior Survey (MYRBS) (3). In 1999, 51% of Massachusetts' female and 61% of male high school students reported participating in one or more sports teams in the previous 12 months, whereas in Boston, 36% of female students and 53% of male students reported participating in sports teams (3).

The HPRC is part of CDC's Prevention Research Center program, a network of academic centers, public health agencies, and community partners that conduct applied research in disease prevention and control (4). Our mission is to work with local partners to develop, implement, and evaluate methodologies and interventions to improve nutrition and physical activity and reduce overweight and chronic disease risk among youths. The HPRC uses community-based participatory research methods (5) to involve nonacademic stakeholders in the design, implementation, and use of data to generate solutions and promote the sustainability of program improvements. Sport in Society is an intermediary organization that promotes the health and well-being of urban youths through sport, physical activity, and healthy development initiatives.

This article describes how local stakeholders worked with the HPRC and Sport in Society to improve opportunities for youth physical activity through the creation of facility and program censuses and dissemination of results.

Boston is a densely populated city; 589,141 residents were reported in the 2000 census (6). Fifteen percent of families live below the federal poverty level. Of the 95,251 school-age youths (aged 5 to 18 years), 37% are black, 27% are white, 23% are Hispanic, 7% are Asian, and 7% identified as another race or ethnicity (7). More than half (51%) of Boston youths live in four of the 16 neighborhoods in Boston. Two thirds of Boston school-age youths attend one of 131 public schools (8).

In 1997, Boston Mayor Thomas M. Menino convened a national conference on urban youth sports; the national conference was followed by a citywide Boston Youth Sports Congress (BYSC) in 1997 and in 1998 to examine after-school sporting opportunities for Boston youths. More than 600 coaches, parents, elected officials, corporations, members of Boston's professional sports teams, and directors of community centers, Boys & Girls Clubs, and YMCAs participated in the BYSC events. After the 1997 event, a pilot needs assessment conducted by Sport in Society, one of the organizers of the BYSC, estimated that Boston youths had one third the number of sports opportunities of suburban youths and identified possible sex disparities and likely barriers to participation (J. McDevitt, unpublished data, November 1997). Although these data suggest a lack of opportunity for sports programs among Boston youths compared with their suburban peers, policy makers and program providers decided that a comprehensive needs assessment would strengthen their ability to allocate funds, develop programs in areas of need, and add appropriate staffing.

Following the 1998 BYSC, the HPRC submitted a proposal to CDC as part of a Prevention Research Initiative to collaborate with Sport in Society and community partners to address disparities in access to physical activity facilities and after-school programs in Boston. The proposal was funded in October 1999, and PAB was created. As an outgrowth of the BYSC, PAB was envisioned as a study to assess community need and provide information to inform coordination and programming decisions in the community-based programs over which BYSC members had oversight and influence. Thus, the focus of PAB was limited to after-school physical activity programming.

PAB provided baseline data that has proven useful as a focus for interventions and as a source of advocacy for programmatic efforts. Although Boston has a substantial sports and recreational infrastructure, the ratio of youths to facilities in low-income Boston neighborhoods was twice the ratio found in the medium- and high-income suburban comparison communities (Table). The low-income suburban comparison community had the highest number of youths per recreational facility with 137 youths per facility, followed by Boston with 117 youths per facility. We found 63 youths per facility in the medium-income community and 64 youths per facility in the high-income community. The Figure shows how the ratio of youths to facilities also differed among Boston neighborhoods. Neighborhoods with a low density of facilities also had lower median income and larger minority populations. Boston playgrounds also varied in quality across the city, and lower-income neighborhoods and neighborhoods with more ethnic minority populations had poorer quality playgrounds (9).

Of the 235 programs, nine YMCAs, seven Boys & Girls Clubs, and 44 city-operated community centers were identified. Other programs offered were Pop Warner Little Scholars football and cheerleading, Little League baseball, lacrosse, softball, soccer, tennis, dance, and martial arts, among others. Some Boston public middle and high schools hosted intramural and competitive sports teams. During the summer, the Boston Centers for Youth & Families provided golf, swimming, basketball, track and field games, and summer camps at its community centers. Of the 235 programs offered to Boston's youths, more than half cost less than $20 per session to participate; 65% of programs were free. There were no costs for using the facilities.

On average during the school year, approximately 67% of program participants were boys, and 33% were girls. Boys and whites were overrepresented among participants; girls, blacks, and Hispanics were underrepresented. We calculated the ratio of the total number of male and female participants to the youth census population and found ratios of 1.33 for boys and 0.69 for girls. For racial and ethnic groups, the ratios were 1.23 for white non-Hispanics, 1.05 for Asians, 0.84 for Hispanics, and 0.83 for blacks. The highest reported levels of participation were for youths attending middle school (aged 11 to 14 years) (7). Similar to findings on facilities, participants in neighborhoods with higher median incomes had more favorable outcomes.    

The table shows that, compared with the three suburban comparison communities, Boston overall had the lowest ratio of participants to youths (1.02), and Boston's median income ($39,629) was closest to the median income of the low-income comparison community ($45,654). The high-income community had the greatest ratio of participants to youths (2.00). Lower participation rates among girls than boys in each community indicated a consistent sex disparity.

PAB successfully developed and implemented a rigorous needs assessment with local relevance and important implications for public health research on physical activity and the environment. In December 2002, Mayor Menino hosted a community press conference to release the key findings report (7). City officials, program providers, parents, and youths attended. He applauded PAB's data, calling the report a "playbook" for future sports and recreation planning by the city of Boston and its partners and stating, "For several years we have only had anecdotal information about the need to get more of Boston's young people involved in physical activity. PAB gives us scientific evidence that we have more work to do" (10). To date, more than 300 copies of the report have been distributed both locally and nationally. PAB also produced Active Facts online (11), a series of neighborhood-specific briefs, to provide information on programs and facilities.

Several local initiatives have incorporated findings to improve programming and resource allocation. Sport in Society uses PAB data as they address disparities in participation by increasing the number of sporting opportunities available. Boston Steps (12), a U.S. Department of Health and Humans Services initiative at the Boston Public Health Commission, is adapting PAB methodologies to examine adult recreation. Jump Up & Go (13), a project of Blue Cross Blue Shield of Massachusetts, and the Boston Youth Sports Network (14), a project designed to connect resources for local programs through a youth sports coordinator, have used the data to prioritize neighborhood resource allocation. As a result of the documented sex disparities in PAB, a group of foundations began working with the Women's Sports Foundation in 2003 to award more than $600,000 to Boston organizations to create and expand youth sports programs for girls from 2004 through 2007 (14). In a change that required no outside funding, the Shelburne Community Center in Roxbury, Mass, implemented biweekly mother-and-daughter aerobics classes as a result. In addition, researchers at HPRC, along with the Women's Law Foundation, cowrote a report on Title IX in Massachusetts (15). In addition, one of the comparison communities used in this study prepared a report for its own city's health alliance for internal planning use.

The city of Boston lists participating PAB programs in The Mayor's Youthline (16), a database of resources for Boston youth and their parents created by Boston teenagers; the Boston Youth Zone (17), a Web-based resource for teenagers and their parents; and the Boston Guide to Youth Services (18), a print resource. These resources help educate parents, teachers, community advocates, pediatricians, and youth about which sports and physical activities are available near where they live.

PAB benefited from strong and creative partners and stakeholders dedicated to improving Boston's after-school resources for youths and their families. The project and its partners continue to be committed to the findings and the process of developing a culture of colearning through the use of community-based participatory research. A hallmark of a genuine participatory process is that the shape and focus of research over time may change as participants refocus their understanding about what is happening in the community and what is really important to them (19).

Because PAB focused on youth physical activity opportunities outside of school programming, future assessments might also include school-based programs and examine more closely program quality (e.g., staff qualifications, staff-to-participant ratios). Additionally, other factors that may limit access to programs (e.g., costs, hours of operation) and strategies that may produce more reliable estimates of unique numbers of participants and their demographic characteristics (e.g., using standard intake forms for all youth programs, voluntary reporting standards for programs) could potentially improve the assessment protocol. These areas were not fully assessed by our PAB methodology but could be important factors, depending on community interests and needs.   

Following the summary report (7), the PAB group continued to work with local municipal, educational, and city planners to address Healthy People 2010 goals on increasing time spent in physical activity and reducing time spent in inactivity and watching television. Current initiatives with Sport in Society, Boston Centers for Youth & Families, and Boston Steps focus on developing a sustainable monitoring system for physical activity resources. Planned uses of PAB data include analyzing facility over- and underuse with the Boston Parks and Recreation Department and improving access to school physical activity spaces and facilities for all people during nonschool hours.

Sparked by the enthusiasm of the BYSC, the energy in Boston was rich for PAB. Communities dedicated to the health of young people and interested in using a community-focused approach to reduce disparities in access to physical activity may benefit from PAB's inclusive participatory methods.