COMMENTARIES
13. Owen CG, Martin RM, W incup PH,
Smith GD, Cook DG. Effect of infant feeding
on the risk of obesity across the life course:
a quantitative review of published evidence.
Pediatrics. 2005;1 15(5):1367-1377.
14. New York City Department of
Health and Mental Hygiene. Pregnancy
Risk Assessment Monitoring System.
Available at: http://ww w .nyc.gov/htm l/
doh/htm l/data/m s-pram s.shtm l.
Accessed D ecember 16, 2013.
15. Besculides M, Grigoiyan K, Laraque
F. Increasing breastfeeding rates in New
York City, 1 9 8 9 -2 0 0 0 . ] Urban Health.
2005;82(2):19 8 -2 0 6 .
P r o m o tin g P h y s ic a l A c tiv ity T h ro u g h t h e S h a re d U s e o f S c h o o l R e c r e a tio n a l
S p a c e s : A P o lic y S t a t e m e n t F ro m t h e A m e ric a n H e a r t A s s o c ia tio n
M o s t A m e ric a n s are n o t
s u ffic ie n tly p h y s ic a lly active,
even th o u g h re g u la r physical
a c tiv ity im p ro v e s h e a lth and
re d u c e s th e ris k o f m a n y
c h ro n ic d ise a ses. T h o s e liv ­
in g in ru ra l, n o n -W h ite , and
lo w e r- in c o m e c o m m u n itie s
o fte n have in s u ffic ie n t access
to p laces to be a ctive , w h ic h
can c o n trib u te to th e ir lo w e r
level o f p h y s ic a l a c tiv ity .
T h e s h a re d use o f s c h o o l
recreational fa cilitie s can p ro ­
v id e safe and a ffo rd a b le p la ­
ces fo r c o m m u n itie s . S tudies
s u g g e s t th a t c h a lle n g e s to
shared use in clu d e add ition a l
cost, lia b ility pro te ctio n , c o m ­
m u n ic a tio n a m o n g c o n s tit­
u e n c ie s interested in sharing
space, a n d d e c is io n -m a k in g
a b o u t s c h e d u lin g a nd space
a llo c a tio n .
T his A m e rica n Heart A sso ­
ciation p o lic y s ta te m e n t has
p ro vid e d re co m m e n d a tio n s
fo r fe d e ra l, s ta te , a n d lo ca l
d e c is io n -m a k e rs to s u p p o rt
and expand o p p o rtu n itie s
fo r p h y s ic a l a c tiv ity in c o m ­
m u n itie s th ro u g h th e shared
use o f s c h o o l spaces. [A m J
P u b lic Health. 2 0 1 4 ;1 0 4 ;
1583-1588. doi:10.2105/AJPH.
2013.301461)
S e p te m b e r 2 0 1 4 , Vol 1 0 4 , No. 9 | A m erica n Journal o f P ublic H ealth
16. Ford CN, Slining MM, Popkin BM.
Trends in dietary intake among US 2- to
6-year-old children, 1989-2008. ] Acad
Nutr Diet. 2 013;113(1):35—42.
17. B an y CL, Jarlenski M, Grob R,
Schlesinger M, Gollust SE. News media
framing of childhood obesity in the
United States from 2 0 0 0 to 20 0 9 . Pedi­
atrics. 2 0 1 1 ;128(1):132-145.
18. W arn er KE, Sexton DW, Gillespie
BW, Levy DT, Chaloupka FJ. Impact
o f tobacco control on adult per capita
cigarette consum ption in the United
States. A m J Public Health. 2 0 1 4 ;1 0 4
(1):83—89.
| D e b o r a h R. Y o u n g , P h D , J o h n 0 . S p e n g le r , J D , P h D , N a ta s h a F r o s t, J D , K e lly R. E v e n s o n , P h D ,
J e ff r e y M . V in c e n t , P h D , a n d L a u r ie W h it s e l, P h D
REGULAR PHYSICAL ACTIVITY
is an important behavior for gen­
eral health and to reduce the risk
of coronary heart disease, stroke,
hypertension, obesity, and some
types of cancers.1 Unfortunately,
the vast majority of youths and
adults are not sufficiently physi­
cally active. Depending on the
population of study and the phys­
ical activity assessment used, be­
tween 53°/o2 and 95% 3 of adults
and between 50°/o4 and 90% 3
of adolescents are found to not
participate in physical activity at
levels recommended by the US
governm ent5 African Americans
and Latinos are less physically
active2,4 than are th eir W hite
counterparts. All Americans
should have a variety of com­
munity resources that provide
an opportunity to be physically
active.
Public schools are located in
all communities and often have
physical activity facilities and spaces
that can be shared with community
members. The American Heart
Association supports policies that
enable schools to share their
19. Surgeon General’s Advisory Com­
mittee on Smoking and Health. Smoking
and Health: Report o f the Advisory Com­
mittee to the Surgeon General o f the United
States. Washington, DC: US Government
Printing Office; 1964. Public Health Ser­
vice Publication No. 1103. Available at:
http://profiles.nlm.nih.gov/ps/access/
NNBBMRpdf. Aooessed December 12,2013.
20. W arner KE. 50 years since the first
Surgeon General’s Report on Smoking
and Health: a happy anniversary? A m ]
Public Health. 2014; 104( 1):5-8.
21. Centers for Disease Control and Pre­
vention. Cigarette smoking among adults—
physical activity spaces with indi­
viduals and community groups.
This is in direct agreement with the
American Heart Association 2020
Strategic Impact Goal to improve
the cardiovascular health of the
nation by 20°/o.6 Sharing school
spaces is also a strategy of the US
National Physical Activity Plan,7 an
objective of Healthy People 2020,8
and a recommendation of the
2 0 1 0 White House Task Force on
Childhood Obesity,9 and it is in line
with recommendations of leading
public health authorities.10-12 How­
ever, policy recommendations and
tools are needed to facilitate and
encourage the shared use of school
resources. W e have identified the
benefits and challenges of shared
use, provided policy recommenda­
tions to support and expand shared
use, and highlighted areas for
needed additional research.
DEFINITION OF SHARED
USE
Opening school buildings and
grounds during non-school hours
for community use is often referred
Young e t al. \ P eer Reviewed | C o m m e n ta rie s | 1 5 8 3
United States, 2006. M M W R Morb Mortal
Wkly Rep. 2007; 56(44):1157-1161.
22. Sanders-Jackson A, Gonzalez M,
Zerbe B, Song AV, Glantz SA. The pattern
of indoor smoking restriction law transi­
tions, 1 9 7 0 -2 0 0 9 : laws are sticky. A m J
Public Health. 2013;103(8):e44-e51.
23. Dowell D, Farley TA. Prevention of
non-communicable diseases in New York
City. Lancet 2012;380(9855):1787-1789.
24. Johnson W, Soloway LE, Erickson D,
et al. A changing pattern of childhood BM1
growth during the 20th century: 70 y of
data from the Fels Longitudinal Study. A m ]
Clin Nutr. 2012;95(5):1136-1143.
to as “shared use” or “joint use”:
public schools sharing their facili­
ties that are conducive to physical
activity with individual community
members, community groups, or
school or public agencies during
non-school hours. Facilities in­
clude both indoor and outdoor
physical activity spaces. Shared use
includes individual community
members’ informal use for un­
structured, unsupervised use and
supervised, community-sponsored
activities, such as team sports
and supervised open gym.
Shared use may occur through
an informal arrangement or may
involve a formal written contract
(i.e., shared use agreement or
joint use agreement) between
a school district and another en­
tity, such as a municipality, county,
or nonprofit organization. The
contract defines the rights and re­
sponsibilities of the parties on
issues such as cost, liability, main­
tenance, and staffing. Model
shared use agreement resources
are available from many sources,
including the National Policy
and Legal Analysis Network.13
 COMMENTARIES

A C C E S S TO S P A C E S Programs Study, conducted in community resource. There are more widespread implementation
A N D TH E P R O S P E C T 2000 and 2006, found that vir­ intrinsic benefits from providing of shared use. Below are five
OF S H A R E D U SE tually all schools reported at least a clean, safe place for community prominent challenges.28
one outdoor physical activity fa­ members to be active and building
1. Providing adequate funding
In many communities, oppor­ cility and that most elementary relationships with community
for costs associated with
tunities exist for physical activity. schools had playground equip­ groups.22 The case study described
greater facility utilization.28"31
Most local governments provide ment.18 The most common out­ in the box on this page exemplifies
Costs associated with the use
public parks and recreation cen­ door facilities were general use how schools and communities can
of facilities include mainte­
ters, and commercially available fields, baseball or softball fields, benefit from a successful partner­
nance, cleanup, and repair;
sports and fitness facilities are basketball courts, and soccer or ship. By contributing community
staff supervising activities or
sometimes available. However, football fields; common indoor assets to nearby residents, schools
providing security; and costs of
many rural, non-White, and facilities were gymnasiums and can generate the community
lighting and other utilities.
lower-income communities often weight rooms. goodwill needed to support tax
2. Establishing effective dia­
do not have the same density Several studies have found that revenue, capital building proj­
logue between the multiple
of community recreational facili­ opening school grounds to the ects, and other fund-raising
users of school spaces.28,30"32
ties14"16 as do those living in community results in increased initiatives. This is especially im­
The diversity of constituen­
higher-income neighborhoods. physical activity in those com­ portant in areas with low or
cies interested in sharing
Privately owned commercial munities.20'21 Adolescents sur­ declining numbers of children—
school spaces range from in­
facilities typically require mem­ veyed in Boston, Massachusetts; places in which households may
not be invested in school im­ dividuals and local sports
berships or fees that limit the Cincinnati, Ohio; and San Diego,
provement projects. Because organizations to state and
accessibility for lower-income California, were more likely to be
only about 45% of households federal legislatures.33 These
populations. Therefore, it is im­ physically active when they had
have children younger than 18 groups can have difficulty
portant to have convenient access to fields and play areas
after school.20 A study con­ years,25 maintaining community communicating relevant is­
access to affordable physical ac­
ducted in two lower-income New goodwill is an ongoing pursuit for sues because of different
tivity spaces in all communities.
Orleans, Louisiana, communities many schools. Finally, regular meanings of common terms.
Public school facilities have
found that when a previously physical activity may be associ­ 3. Designing school spaces to
emerged as an area of public
locked schoolyard was opened ated with higher academic per­ facilitate shared use.28
health advocate attention be­
and supervised, the number of formance.26,27 Schools that open Schools without sufficient
cause of their great availability in
US communities and their im­ children who were physically their grounds for physical activ­ facilities conducive to physi­
portance as a place for physical active outdoors was 84% higher ity indirectly promote being cal activity are limited in
activity. It is estimated that public than was the number in a com­ physically active and, consequently, what they can share with
schools total 6.6 billion indoor munity with closed school- youths’ academic performance. individuals and community
square feet and more than 1.0 yards.21 These studies exemplify organizations.
million acres of land.17 These how when school grounds are IM P L E M E N T A T IO N OF 4. Ensuring protection from
schools have spaces, including made available, they can be S H A R E D USE liability, crime, vandalism,
ball fields, courts, gymnasiums, and successfully used for physical and other physical incivil­
playgrounds, that the broader activity. Researchers and advocates ities.28,30"32,34 School offi­
community can use.18,19 The Schools benefit from shared have identified a set of challenges cials across the nation are
School Health Policies and use through being a valuable that must be addressed to foster highly concerned about

Case Study: Turning Some Elementary School Fitness Parks Into Community Fitness Parks: San Antonio, TX, 2 0 1 2

On April 1 2 , 2 0 1 2 , th e S an A n to n io City C ou ncil ap p ro ved a p a rtn e rs h ip w ith S an A nton io S p o rts SPARK parks to ex p a n d scho ol playgro un ds to in c lu d e sp o rts fie ld s an d w a lk in g tra ils . T h e p a rks will

b e o p en to th e co m m u n ity a fte r 3 p .m . Th ey w ill b e p la n n e d using th e local resou rces o f a rc h ite c tu re s tu d e n ts a t th e U niversity o f Texas, S an A nton io . The p ro g ra m is s ta rtin g w ith o n e ele m e n ta ry

sch o o l, Sky H arb or. T h e p rin cip al o f th e scho ol, M a rin a Avila, n o ted th a t m a n y local res id en ts d o n o t have a sa fe p la c e to w alk; th u s , th e p ro gram is p a rtic u la rly b e n e ficia l to th e co m m u n ity . S an

A n to n io S p o rts SPARK is a n in itia tiv e w ith S an A nton io S po rts, a n o n p ro fit sp orts co m m iss io n , a n d th e City o f S an A nton io an d th e U niversity o f Texas a t S an A nton io C ollege o f A rch itec tu re. The

p ro g ra m 's g o al is to b u ild 1 0 0 new sch o o l p a rks in B exar C ounty, TX, over a 1 0 -y e a r p e rio d . The SPARK S cho ol P ark P rogram w as c re a te d in 1 9 8 3 a n d is a n o n p ro fit o rg an iz atio n o p e ra tin g o u t of

th e city o f H o u sto n 's m ayor's office.

S o u rc e. K E N S 523 a n d S an A nton io S p o rts .24

1 5 8 4 | Commentaries | Peer Reviewed | Young e t al. American Journal of Public Health | September 2 0 1 4 , Vol 104, No. 9

liability should someone be
injured while participating in
recreational or sport activities
while on school property.35
5. Determining decision­
making processes for allo­
cating space.28,30"32 If
school districts or individual
schools do not have a system
in place to identify eligible
users and eligible activities
and to manage scheduling,
use can become ad hoc,
which may exclude some
individuals or groups.
POLICY
R ECO M M ENDATIO NS FOR
SHARED USE
State and local policy tools are
needed to make it easier to sup­
port and expand shared use. As
of 2010, only eight states require
schools to be available for com­
munity use (Alabama, California,
Hawaii, Indiana, Maryland, Mas­
sachusetts, Ohio, and Utah), 37
states and the District of Columbia
allow community use of schools,
and five do not address the issue
in legislation (Illinois, Michigan,
New Hampshire, Rhode Island,
and Wyoming)36 State policies in
the form of legislation or regula­
tion are particularly important in
enabling, incentivizing, and, in
some cases, mandating shared use.
Opportunities also exist for stake­
holders to pursue policies at the
federal and local levels. Depend­
ing on the unique legal and polit­
ical context of each state, there are
several ways to incorporate these
recommendations into existing or
new policies. Some recommenda­
tions may lead states to consider
creating or clarifying legislation.
Others can be addressed through
state departmental regulation
or policy change. Finally, some
policy recommendations can be
pursued through working with
Septem ber 2 0 1 4 , Vol 10 4, No. 9 | American Journal o f Public Health
COMMENTARIES
nongovernmental entities that
guide school action, such as state-
level school board associations or
associations of school administra­
tors. The box on this page displays
a case study of how Mississippi
implemented best practice legisla­
tion. Rather than list all the states
that have enacted similar policies,
where applicable, we have illus­
trated policies with examples. Ta­
ble 1 displays a particular policy
recommendation and which of the
shared use implementation chal­
lenges are addressed. We propose
the following 11 recommendations.
• Encourage or require school
districts to provide community
recreational use of school prop­
erty. California and Utah have
designated public schools as
“civic centers,” requiring school
districts to make their facilities
and grounds available for public
access.38'39 Other states have
language in legislation that en­
courages schools to allow com­
munity access, such as Alaska’s
law stating a school district
“may” allow the community to
use school property.36'40 State
agency regulations and policies
can also accomplish this policy
recommendation. Education
associations are a critical part­
ner and often create model
school district policies. For ex­
ample, in Wisconsin, stake­
holders are in discussions
with the state’s school board as­
sociation to develop sample
shared use polity to be distributed
to the association’s members.41
• Require school board policy to
address shared use. States can
set requirements for what must
be contained in local school
district shared use and wellness
policies. Mississippi legislation
requires that school districts ad­
dress community recreational
use of school property in con­
sultation with the school health
council.6
• Clarify or provide liability
protection for schools for recre­
ational use of properties. States
should have clear laws that pro­
vide appropriate legal protec­
tions for school districts. For
example, Minnesota added lan­
guage in its immunity statute
protecting governmental entities
from “any claim for a loss or
injury arising from the use of
school property or a school fa­
cility made available for public
recreational activity.”42
• Authorize school districts to
enter into contracts to shared
facilities and set specific re­
quirements for what is included
in the contracts. States can au­
thorize school districts to enter
into shared use agreements and
require key provisions, such as
language to address safety and
liability. Wisconsin requires that
shared use agreements outline
the time, place, eligibility, and
type of recreational activity; the
supervision of the activity; and
a statement outlining the partic­
ipant’s assumption of risk.41
• Require proof of insurance for
groups using school property.
Some states have policies that
require schools to ensure that
community groups have insur­
ance before entering into
a shared use agreement. Louisi­
ana policy states that schools
“shall require in the agreement
that the other entity maintain
and provide proof of adequate
liability and accident insurance
coverage as determined by in­
dustry standards.”43 A Tennes­
see policy strongly encourages
local school boards to set this
requirement.44
• Support full and dedicated
funding of the Land and Water
Conservation Fund. The
schools can use Land and Wa­
Young e t al. | Peer Reviewed | Com m entaries | 15 85
ter Conservation Fund State
and Local Assistance funds to
acquire, develop, and share
public outdoor recreation fa­
cilities. Stakeholders can work
with state and local govern­
ment representatives to sup­
port ongoing funding of the
Land and W ater Conservation
Fund.
• Incorporate community recrea­
tional use of school property as
a Statewide Comprehensive Out­
door Recreation Plan priority.
For schools to be eligible for
Land and Water Conservation
Fund funding, states must include
recreational use of school prop­
erty as a Statewide Comprehen­
sive Outdoor Recreation Plan
priority.45 Wisconsin’s Statewide
Comprehensive Outdoor Recrea­
tion Plan does so by identifying
school parks as potentially being
available as neighborhood parks,
youth athletic fields, and a loca­
tion for recreational classes; the
plan additionally comments on
how school districts and park sys­
tems can benefit from the shared
use of facilities and land.46
• Provide incentives for shared
use in school construction. State
policies can incentivize school
districts to consider shared use
concepts when renovating or
building schools. Washington
State convened a group to ad­
dress how shared use worked in
the school construction assistance
program. The resulting report
provided recommendations for
the state’s School Construction
Assistance Program and Commu­
nity Schools that addressed bar­
riers to promote shared use.47
• Outline joint powers’ concepts
and opportunities. Joint powers
are specific laws that authorize
local governmental entities
to work together to share facili­
ties and resources. Minnesota
law authorizes “joint powers
 COMMENTARIES

C ase Study: S tate -L e v e l Im p le m e n ta tio n of B est P ra c tic e Legislation to P rom ote Shared Use: M ississipp i, 2 0 1 2

The American Heart Association and the Public Health Law Center developed sam ple policy language to assist stakeholders in exploring state-level policy change to prom ote com m unity recreational

use o f school property. In the 20 12 legislative session, Mississippi used th is language to create a com prehensive state law th a t incorporated many o f these policy recom m endations. The Mississippi

law does the following:

1. Specifically authorizes a school d istrict to ad o p t a policy fo r shared use

2. Lim its lia b ility fo r injuries th a t occur during recreational use o f school property during nonschool hours

3. Encourages school districts to enter into shared use agreements

4. Authorizes local governments to expend funds to pursue shared use agreements

5. Requires th e departm ent o f education to create a shared use to o lk it

6. Requires the departm ent of education to m aintain a Web site to prom ote inform ation sharing by the school districts

7. Requires each school d istrict to address com m unity recreational use of school property _________

S o u rc e . Public Health Law Center a t W illiam M itchell College o f Law.37

agreements” to build and main­
tain recreational facilities, en­
abling collaboration between
school districts and city park and
recreation departments.48
• Require state-level toolkits
and plans for dissemination to
local communities. Mississippi
legislation requires a toolkit,
stating, “The State Department
of Education, in consultation with
the State Department of Health,
shall develop a best practices tool
kit relating to shared use agree­
ments for school districts."49 The
statute outlines the key compo­
nents of the toolkit and sets
a timeframe for how often the
toolkit must be updated. Missis­
sippi also requires a W eb site to
encourage information sharing
among school districts.
• Commission studies through
state workgroups to assess
barriers and determine solu­
tions. States have the power to
commission studies. Vermont
commissioned such a report in
2010, which identified liability
concerns as a barrier to shared
use, and recommended “statu­
tory protection from liability,
to encourage schools to open
their facilities to the public
under appropriate condi­
tions.”50 W ashington’s report
identified policy solutions to
financial barriers in school
c o n stru ctio n 47
RESEARCH NEEDED FOR
SHARED USE
Existing research has only be­
gun to document the prevalence of
shared use, to identify and exam­
ine the perceived barriers and
motivators to shared use, and to
understand the policies being uti­
lized to enact shared use. This
work needs to expand across
states and local communities to
increase its generalizabilify and
should include evaluation mea­
sures of both the process and the
outcomes of shared use. W e have
described specific research rec­
ommendations and categorized
them into recommendations on
the influence of shared use on
health outcomes and understand­
ing policy implementation.
In flu ence of Shared Use on
Physical A c tiv ity
• Conduct longitudinal observa­
tional and experimental studies
to measure users’ physical

TABLE 1 —Policy R ecom m en dation s to Prom ote and Fa c ilita te Shared Use T h a t Address S h a red Use C hallenges

Shared Use Challenges Addressed by the Recom mendation

Policy Recom mendation to Promote and Facilitate Shared Use Funding School Design Com m unication Liability Decision-M aking

Encourage or require school districts to provide com m unity recreational use of school property.

Require school board policy to address shared use.

Clarify o r provide lia b ility protection fo r schools when recreational use o f th e property is allowed.

Authorize school districts to enter into shared use agreements, and set specific requirem ents for

w hat is included in the agreements.

Require proof o f insurance fo r groups using school property.

S upport full and dedicated funding of the Land and W ater Conservation Fund.
Incorporate com m unity recreational use o f school property as a Statewide Comprehensive Outdoor

Recreation Plan priority.

Provide incentives for shared use in school construction.

O utline jo in t powers concepts and opportunities.

Require the creation of state-level to o lkits and local dissem ination plans to local com m unities.
Commission studies through state workgroups to assess barriers and determ ine solutions.

1 5 8 6 | Commentaries | Peer Reviewed | Young et at. American Journal o f Public Health | September 2 0 1 4 , Vol 10 4, No. 9

activity type, duration, and fre­
quency; sociodemographic
characteristics of users; and the
characteristics of the shared
school areas utilized (e.g., ball
fields, tennis courts) before
and after changes in shared
use.
• Identify program participation
rates and program characteris­
tics for activities that occur on
shared school space before and
after shared use.
• Determine the access and use of
shared school spaces of resi­
dents living in nearby neighbor­
hoods and any changes in their
physical activity or health
outcomes.
P o lic ie s a n d A p p ro a c h e s fo r
Im p le m e n ta tio n
• Examine the impact of state pol­
icies and identify barriers and
motivators to implementation.
• Identify best approaches
through case studies examining
characteristics of successful
schools, school districts, and
community groups.
• Identify successful long-term
practices and conduct replica­
tion studies to determine the
transferability of these practices.
• Examine the prevalence of
injuries that occur during
shared use activities and the
am ount of litigation resulting
from injury.
• Examine networks and links in
the greater community setting to
understand which groups are
natural shared use partners.
C O N C L U S IO N S
There are many benefits when
schools share recreational facilities
with their local communities.
These include increasing opportu­
nities for physical activity, garner­
ing community goodwill, and
Septem ber 2 0 1 4 , Vol 10 4, No. 9 | American Journal o f Public Health
COMMENTARIES
supporting the academic mission of
the schools. Challenges exist, which
include funding, communication,
decision-making authority,
adequate facilities, and liability
concerns, but they are not insur­
mountable. States, local govern­
ments, and other groups can
develop supportive policies to
minimize the challenges associated
with shared use. W e encourage
lawmakers and other stakeholders
to enact these recommendations in
ways that are amenable to the unique
context of their jurisdiction. ■
About the Authors
Deborah R. Young is with the Department
o f Research and Evaluation, Kaiser
Permanente Southern California, Pasadena.
John 0. Spengler is with the College o f
Health and Human Performance, University
o f Florida, Gainesville. Natasha Frost is
with the Public Law Center, William
Mitchell College o f Law, St. Paul, MN. Kelly
R. Evenson is with the Department of
Epidemiology, Gillings School o f Global
Public Health, University o f North Carolina,
Chapel Hill. Jeffrey M. Vincent is with the
Center fo r Cities and Schools, Institute o f
Urban and Regional Development,
University o f California, Berkeley. Laurie
Whitsel is with the American Heart
Association, Washington, DC.
Correspondence should be sent to Deborah
R. Young, PhD, Department o f Research
and Evaluation, Kaiser Permanente Southern
California, 100 S Los Robles, 2ndfloor,
Pasadena, CA 91 1 0 1 (e-mail: Deborah.R.
Young@kp.org). Reprints can be ordered at
http://www.ajph.org by clickingthe “Reprints"
link.
This commentary was accepted May
16, 2013.
Contributors
The authors contributed equally to the
article conceptualization, the literature
review, and the drafting of the article.
References
1. Lee IM, Shiroma EJ, Lobelo F, Puska P,
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critical issue o f
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v e te ra n suicide
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tiative. 20 1 0 . Available at: http://w w w . Health Conditions purchase this title
atg.state.vt.us/assets/files/Report%20of together with Veteran Suicide and save
% 20the0/o20Land% 20use% 20W orking
10%!
% 2 0Group.pdf. Accessed June 7, 2012.
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