Physical activity social support and middle- and older-aged minority women: results from a US survey

Can physical activity prevent physical and cognitive decline in postmenopausal women? A systematic review of the literature

BACKGROUND

Participation in regular physical activity is among the most promising and cost effective strategies to reduce physical and cognitive decline and premature death. However, confusion remains about the amount, frequency, and duration of physical activity that is likely to provide maximum benefit as well as the way in which interventions should be delivered.

AIMS

This paper aimed to review research on the impact of leisure-time and general physical activity levels on physical and cognitive decline in postmenopausal women. In a systematic review of the literature, empirical literature from 2009 to 2013 is reviewed to explore the potential impact of either commencing or sustaining physical activity on older women's health.

RESULTS

All studies found that physical activity was associated with lower rates of cognitive and physical decline and a significant reduction in all-cause mortality. In this review we found that exercise interventions (or lifestyle activities) that improved cardiorespiratory exercise capacity showed the most positive impact on physical health.

CONCLUSIONS

Findings suggest that programs should facilitate and support women to participate in regular exercise by embedding physical activity programs in public health initiatives, by developing home-based exercise programs that require few resources and by creating interventions that can incorporate physical activity within a healthy lifestyle. The review also suggests that clinicians should consider prescribing exercise in a tailored manner for older women to ensure that it is of a high enough intensity to obtain the positive sustained effects of exercise.

Predictors of Weight Loss for African-American Women in the Faith, Activity, and Nutrition (FAN) Study

BACKGROUND

Understanding predictors of weight loss can assist in developing targeted evidence-based programs to reduce obesity in faith-based settings. The purpose of this study was to examine predictors of weight loss for a sample of African-American women taking part in in a church-based study.

METHODS

Participants (N = 350) completed physical assessments and comprehensive surveys at baseline and 15 months later. Analyses examined baseline variables and change in variables from baseline to posttest, as predictors of ≥ 5% weight loss at posttest. Demographic, health-related, and behavioral variables were examined.

RESULTS

Lower baseline stress predicted greater likelihood of weight loss. Increased leisure-time physical activity (LTPA) from baseline to posttest was predictive of greater weight loss. The odds of ≥ 5% weight loss was 38% lower for every 1-point increase in baseline stress (OR = 0.62, CI = 0.39, 0.98, P = .04) and 6% greater for every 1-hour increase in posttest LTPA (OR = 1.06, CI = 1.0, 1.12, P = .049).

CONCLUSIONS

Increased LTPA appears to be an independent predictor of modest but meaningful reductions in weight among African-American women. African-American women reporting higher levels of stress at baseline may require more intense strategies emphasizing increased LTPA to lose weight.

Correlates of 15-year maintenance of physical activity in middle-aged women

BACKGROUND

Interventions to increase sustained physical activity are needed and should be based on proven theories.

PURPOSE

To gain a better understanding of the correlates of sustained physical activity in midlife women, we used longitudinal epidemiologic data to investigate links between sustained physical activity and constructs advocated by three basic behavioral and social science theories: (1) self-determination, (2) social cognitive, and (3) social networks. A random sample of 90 midlife women, stratified by level of physical activity over 15 years, was selected from the Chicago cohort of the Longitudinal Study of Women's Health Across the Nation (SWAN).

METHODS

Using data on self-reported physical activity collected over 15 years, women were categorized into consistently active, sporadically active, and sedentary. New data were collected on theory-relevant constructs, i.e., autonomous motivation (assessed by the Treatment Self-Regulation Questionnaire) and self-efficacy (assessed by the Self-Efficacy and Exercise Habits Survey). Every SWAN woman identified a close female friend who also completed the physical activity questionnaire.

RESULTS

SWAN women with higher autonomous motivation (p = 0.002) and higher self-efficacy (p < 0.001) were more likely to be consistently physically active in analyses adjusted for age, race, and socioeconomic status. Sixty-one percent of SWAN women with a history of consistent physical activity had a friend who is currently highly active, versus 38 and 23 % for sporadically active and sedentary women, respectively (test for trend p = 0.008).

CONCLUSION

In midlife women, constructs advocated by basic behavioral and social science theories were consistent with long-term patterns of physical activity behavior. Special focus should be given to these basic theories in the design of interventions to promote sustained physical activity in mid-life women.

Daily spousal influence on physical activity in knee osteoarthritis

BACKGROUND

Physical activity is critical for the management of knee osteoarthritis, and the spouse may play a role in encouraging or discouraging physical activity.

PURPOSE

The purpose of this study was to examine four types of spousal influence-spouses' daily activity, autonomy support, pressure, and persuasion-on the daily physical activity of adults living with knee osteoarthritis.

METHODS

A total of 141 couples reported their daily experiences for 22 days using a handheld computer and wore an accelerometer to measure moderate activity and steps.

RESULTS

Spouses' autonomy support for patient physical activity, as well as their own level of activity, was concurrently associated with patients' greater daily moderate activity and steps. In addition, on days when male patients perceived that spouses exerted more pressure to be active, they spent less time in moderate activity.

CONCLUSIONS

Couple-oriented interventions for knee osteoarthritis should target physical activity in both partners and spousal strategies for helping patients stay active.

Process evaluation methods, implementation fidelity results and relationship to physical activity and healthy eating in the Faith, Activity, and Nutrition (FAN) study

Faith, Activity and Nutrition (FAN), a community-based participatory research project in African American churches, aimed to increase congregant physical activity and healthy eating. The Health-Promoting Church framework, developed collaboratively with faith-based partners, guided the intervention and a comprehensive process evaluation. The Health-Promoting Church components related to healthy eating and physical activity were getting the message out, opportunities, pastor support, and organizational policy. There was no evidence for sequential mediation for any of the healthy eating components. These results illustrate the complexity of systems change within organizational settings and the importance of conducting process evaluation. The FAN intervention resulted in increased implementation for all physical activity and most healthy eating components. Mediation analyses revealed no direct association between implementation and increased physical activity; rather, sequential mediation analysis showed that implementation of physical activity messages was associated with improved self-efficacy at the church level, which was associated with increased physical activity.

Factors influencing adherence to regular exercise in middle-aged women: a qualitative study to inform clinical practice

BACKGROUND

About half of women decrease their regular exercise during middle age. Concurrently, they experience a reduction in basal metabolic rate and loss of lean muscle as they transition to menopause. The combined effects place these women at increased risk for body weight gain and associated co-morbidities. Further research is required to better assess their barriers to regular exercise and to develop more applied knowledge aimed to improve the applicability of clinical interventions aimed at this population. The main aim of this study was to identify enablers and barriers influencing adherence to regular exercise in middle-aged women who exercise.

METHODS

An interpretive description qualitative study was conducted using individual interviews. The two key questions were focused on planning to engage in physical activity and succeeding or planning to engage in physical activity and not succeeding. Inductive content analysis was used.

RESULTS

Fifty-three women interviewed were aged 40-62 years and experiencing mild to moderate menopausal symptoms. Six broad themes influencing adhering to regular exercise were: routine, intrinsic motivation, biophysical issues, psychosocial commitments, environmental factors, and resources. Common sub-themes were identified as enabling factors: daily structure that incorporated physical activity (broad theme routine), anticipated positive feelings associated with physical activity (intrinsic), and accountability to others (psychosocial). Other common sub-themes identified as barriers were disruptions in daily structure (routine), competing demands (routine) and self-sacrifice (psychosocial).

CONCLUSIONS

The most common barrier middle-aged women describe as interfering with adhering to regular exercise was attributable to the demands of this life stage at home and with others. Lack of time and menopausal symptoms were not identified as the common barriers. To support women to adhere to regular exercise, healthcare professionals should consider a narrative approach to assessing barriers and focus on enablers to overcoming identified barriers.

Barriers to Physical Activity in Women

Despite the clear benefits of physical activity for women, few women obtain the recommended levels of physical activity. To address adherence to physical activity in this group, it is important to understand the barriers to physical activity that affect women. These barriers may include lack of time; anticipated lack of enjoyment; self-consciousness about body size, shape, and physical activity ability; and urinary incontinence. By addressing barriers to physical activity, health care providers may experience greater success in their efforts to increase physical activity in their female patients.

Social support may buffer the effect of intrafamilial stressors on preschool children's television viewing time in low-income families

BACKGROUND

Excessive television (TV) viewing in preschool children has been linked to negative outcomes during childhood, including childhood obesity. In a sample of low-income families, this study examined associations between intrafamilial factors and preschool children's TV-viewing time and the moderating effect of social support from nonfamily members on this association.

METHODS

In 2010, 129 mothers/female guardians of 2- to 5-year-old children enrolled at five Head Start centers in Rensselaer County, New York, completed a self-report survey. The survey assessed child TV-viewing time (including TV, DVDs, and videos) and intrafamilial risk factors, including maternal perceived stress, depressive symptoms, TV viewing, leisure-time physical activity (inactivity), and family functioning. Social support from nonfamily members (nonfamily social support) was also measured and examined as an effect modifier.

RESULTS

Children watched TV an average of 160 minutes per day. Moderate depressive symptoms (Personal Health Questionnaire depression scale scores ≥10), higher perceived stress, poorer family functioning, and higher maternal TV-viewing were significantly and independently associated with greater minutes of child TV viewing, controlling for covariates. In all instances, nonfamily social support moderated these associations, such that negative experiences within the family environment were linked with higher child TV-viewing time under conditions of low nonfamily social support, but not high nonfamily support.

CONCLUSIONS

Social support from nonfamily members may buffer potentially negative effects of intrafamilial factors on preschool children's TV-viewing time.

Direct social support and long-term health among middle-aged and older adults with type 2 diabetes mellitus

OBJECTIVES

This study examined whether or not direct social support is associated with long-term health among middle-aged and older adults with diabetes mellitus.

METHOD

Direct social support was assessed at baseline (2003) for 1,099 adults with type 2 diabetes mellitus from the Health and Retirement Study. Self-reported health status was examined at baseline and in 4 biennial survey waves (2003-2010). A series of ordinal logistic regression models examined whether or not the 7-item Diabetes Care Profile scale was associated with a subsequent change in health status over time. Additional analyses examined whether or not individual components of direct social support were associated with health status change.

RESULTS

After adjusting for baseline covariates, greater direct social support as measured by the Diabetes Care Profile was associated with improved health outcomes over time; however, this trend was not significant (p = .06). The direct social support measures that were associated with improved health over follow-up were support for taking medicines (odds ratio [OR] = 1.22), physical activity (OR = 1.26), and going to health care providers (OR = 1.22; all p < .05).

DISCUSSION

Interventions that specifically target improving specific aspects of diabetes social support may be more effective in improving long-term health than less targeted efforts.

Effectiveness of Start to Run, a 6-week training program for novice runners, on increasing health-enhancing physical activity: a controlled study

Background

The use of the organized sports sector as a setting for health-promotion is a relatively new strategy. In the past few years, different countries have been investing resources in the organized sports sector for promoting health-enhancing physical activity. In the Netherlands, National Sports Federations were funded to develop and implement “easily accessible” sporting programs, aimed at the least active population groups. Start to Run, a 6-week training program for novice runners, developed by the Dutch Athletics Organization, is one of these programs. In this study, the effects of Start to Run on health-enhancing physical activity were investigated.

Methods

Physical activity levels of Start to Run participants were assessed by means of the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH) at baseline, immediately after completing the program and six months after baseline. A control group, matched for age and sex, was assessed at baseline and after six months. Compliance with the Dutch physical activity guidelines was the primary outcome measure. Secondary outcome measures were the total time spent in physical activity and the time spent in each physical activity intensity category and domain. Changes in physical activity within groups were tested with paired t-tests and McNemar tests. Changes between groups were examined with multiple linear and logistic regression analyses.

Results

In the Start to Run group, the percentage of people who met the Dutch Norm for Health-enhancing Physical Activity, Fit-norm and Combi-norm increased significantly, both in the short- and longer-term. In the control group, no significant changes in physical activity were observed. When comparing results between groups, significantly more Start to Run participants compared with control group participants were meeting the Fit-norm and Combi-norm after six months. The differences in physical activity between groups in favor of the Start to Run group could be explained by an increase in the time spent in vigorous-intensity activities and sports activities.

Conclusions

Start to Run positively influences levels of health-enhancing physical activity of participants, both in the short- and longer-term. Based on these results, the use of the organized sports sector as a setting to promote health-enhancing physical activity seems promising.

Predictors of change in fruit and vegetable consumption in a faith-based intervention with African American adults

A majority of African American adults do not eat the recommended daily amount of fruit and vegetables. This study examined baseline demographic, health-related, and psychosocial variables as predictors of change in fruit and vegetable consumption from baseline to postprogram in a sample of church members taking part in a 15-month intervention. Participants who had a greater waist circumference, greater baseline fruit and vegetable consumption, greater leisure time physical activity, higher levels of social support, greater attendance at worship service, were obese, and did not have diabetes at baseline showed higher posttest fruit and vegetable consumption.

Physical activity in Latinas: social and environmental influences

Latinas are the largest, fastest growing female ethnic minority group in the USA, and also report the lowest levels of physical activity. Following the framework of the social ecological model, this review examines unique social and environmental factors that influence physical activity in Latinas. Research shows that Latinas receive little social support for activity despite having large, close-knit social networks. Interventions incorporating social support components are generally efficacious. Latinas also face many environmental barriers, including crime, heat, traffic, lack of facilities and a fear of immigration enforcement, and there have been few attempts to address environmental barriers in Latino communities. Successful future interventions will need to consider unique social and environmental barriers affecting Latinas, and help Latinas learn to incorporate social networks into physical activity participation.

Social capital, health behaviours and health: a population-based associational study

Background

Social capital is associated with health behaviours and health. Our objective was to explore how different dimensions of social capital and health-related behaviours are associated, and whether health behaviours mediate this association between social capital and self-rated health and psychological well-being.

Methods

We used data from the Health 2000 Survey (n=8028) of the adult population in Finland. The response rate varied between 87% (interview) and 77% (the last self-administered questionnaire). Due to item non-response, missing values were replaced using multiple imputation. The associations between three dimensions of social capital (social support, social participation and networks, trust and reciprocity) and five health behaviours (smoking, alcohol use, physical activity, vegetable consumption, sleep) were examined by using logistic regression and controlling for age, gender, education, income and living arrangements. The possible mediating role of health behaviours in the association between social capital and self-rated health and psychological well-being was also analysed with a logistic regression model.

Results

Social participation and networks were associated with all of the health behaviours. High levels of trust and reciprocity were associated with non-smoking and adequate duration of sleep, and high levels of social support with adequate duration of sleep and daily consumption of vegetables. Social support and trust and reciprocity were independently associated with self-rated health and psychological well-being. Part of the association between social participation and networks and health was explained by physical activity.

Conclusions

Irrespective of their social status, people with higher levels of social capital – especially in terms of social participation and networks – engage in healthier behaviours and feel healthier both physically and psychologically.

Social capital, health behaviours and health: a population-based associational study

BACKGROUND

Social capital is associated with health behaviours and health. Our objective was to explore how different dimensions of social capital and health-related behaviours are associated, and whether health behaviours mediate this association between social capital and self-rated health and psychological well-being.

METHODS

We used data from the Health 2000 Survey (n=8028) of the adult population in Finland. The response rate varied between 87% (interview) and 77% (the last self-administered questionnaire). Due to item non-response, missing values were replaced using multiple imputation. The associations between three dimensions of social capital (social support, social participation and networks, trust and reciprocity) and five health behaviours (smoking, alcohol use, physical activity, vegetable consumption, sleep) were examined by using logistic regression and controlling for age, gender, education, income and living arrangements. The possible mediating role of health behaviours in the association between social capital and self-rated health and psychological well-being was also analysed with a logistic regression model.

RESULTS

Social participation and networks were associated with all of the health behaviours. High levels of trust and reciprocity were associated with non-smoking and adequate duration of sleep, and high levels of social support with adequate duration of sleep and daily consumption of vegetables. Social support and trust and reciprocity were independently associated with self-rated health and psychological well-being. Part of the association between social participation and networks and health was explained by physical activity.

CONCLUSIONS

Irrespective of their social status, people with higher levels of social capital - especially in terms of social participation and networks - engage in healthier behaviours and feel healthier both physically and psychologically.

Physical activity as a mediator linking neighborhood environmental supports and obesity in African Americans in the path trial

OBJECTIVE

African Americans have the highest rates of obesity in the United States. Engaging in recommended levels of physical activity (PA) reduces risk for obesity. Social and environmental supports for PA may be important to increase PA. This study hypothesized that PA would mediate the effects of neighborhood and social supports for PA on body mass index (BMI).

METHOD

Baseline data were collected from 434 underserved African American adults in the Positive Action for Today's Health (PATH) trial. Features of the neighborhood environment (i.e., infrastructure for walking, access to services, and crime) and peer social support were measured with validated surveys. Moderate-to-vigorous PA (MVPA) was assessed based on 7-day accelerometry estimates (in minutes per day), and self-reported walking and exercise were obtained using the Four-Week Physical Activity History questionnaire.

RESULTS

The sample was predominantly female (63%) and obese (MBMI = 30.88 kg/m², SD = 8.43). Neither crime nor social support was significantly associated with either PA or BMI; thus, they were excluded from the final models. Infrastructure for walking predicted MVPA (B = 4.06, p = .01) and self-reported walking (B = 7.39, p = .03). A positive association between access to services and MVPA approached significance (B = 2.27, p = .06). MVPA (B = -0.07, p < .001) and self-reported walking (B = -0.02, p = .01) predicted BMI, but only MVPA mediated the effect of infrastructure for walking on BMI (B = -0.03, p = .04). No significant direct or indirect effects of predictors were found for self-reported exercise.

CONCLUSION

Findings suggest that MVPA is a mediator linking infrastructure for walking and BMI in underserved communities.

What might work? Exploring the perceived feasibility of strategies to promote physical activity among women living in socioeconomically disadvantaged neighbourhoods

This study aimed to investigate preferences for, perceived feasibility of and barriers to uptake of hypothetical physical activity promotion strategies among women from socioeconomically disadvantaged neighbourhoods. Semi-structured interviews were conducted with 20 purposively recruited women (18-45 years) living in socioeconomically disadvantaged urban and rural areas of Victoria, Australia. Participants indicated the most and least appealing of nine hypothetical strategies, strategies most likely to use and strategies most likely to increase physical activity. Interviews were digitally recorded and transcribed verbatim. Thematic and interpretive content analyses were used to identify emergent common and contrasting themes. A community centre-based program with free childcare, the provision of a cleaner while physical activity is undertaken and a neighbourhood-based program were the three most popular strategies. Mobile-telephone-delivered text messages, an online interactive diary and subsidized gym memberships were considered least useful. Irrespective of the strategy, components of importance commonly identified were social support; being accountable to someone; having the option of a structured or flexible attendance design; integration of multiple strategies and financial considerations. Issues around trust and privacy and weight loss also emerged as important. The findings provide important insights for the development of physical activity programs targeting socioeconomically disadvantaged women.

Associations among environmental supports, physical activity, and blood pressure in African-American adults in the PATH trial

High blood pressure disproportionately affects African-American adults and is a leading cause of stroke and heart attack. Engaging in recommended levels of physical activity reduces blood pressure, and social and physical environmental supports for physical activity may increase engagement in physical activity. Based on social cognitive theory within a bioecological framework, the present study tested hypotheses that perceived peer social support for physical activity and neighborhood walkability would be positively associated with physical activity, and that physical activity would mediate their relation with blood pressure. Baseline data were collected with 434 African-American adults in underserved communities (low income, high crime) participating in the Positive Action for Today's Health (PATH) trial. Perceived peer social support for physical activity and neighborhood walkability were measured with validated surveys. Physical activity was assessed with 7-day accelerometry (moderate-to-vigorous physical activity, min/day) and with a 4-week recall of walking. Three blood pressure assessments were taken by trained staff using standard protocols, with values from the second and third assessments averaged. The sample was predominantly female (63%), overweight (mean body mass index = 30.9, SD = 8.4), and had slightly elevated blood pressures with a mean systolic blood pressure of 132.4 (SD = 17.9) and a mean diastolic blood pressure of 81.4 (SD = 11.0). Results demonstrated that peer social support for physical activity (B = 2.43, p = .02) and neighborhood walkability (B = 2.40, p = .046) were significantly related to average daily moderate-to-vigorous physical activity. Neighborhood walkability was also significantly associated with self-reported average daily walking (B = 8.86, p = .02). Physical activity did not mediate their relation with blood pressure and no significant direct effects of these variables on blood pressure were found. The positive influence of social and physical environmental supports on physical activity in underserved African-American communities may guide intervention efforts and contribute to our understanding of physical activity and related health outcomes.

Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis

Physical activity is important for preventing weight gain and obesity, but women experiencing socioeconomic disadvantage are at high risk of inactivity. This study aimed to determine the effectiveness of interventions to increase physical activity among women experiencing disadvantage, and the intervention factors (i.e. physical activity measure, delivery mode, delivery channel, setting, duration, use of theory, behavioural techniques, participant age, risk of bias) associated with effectiveness. We conducted a meta-analysis of controlled trials using random-effects models and meta-regression. Seven databases were searched for trials among healthy women (18-64 years), which included a physical activity intervention, any control group, and statistical analyses of a physical activity outcome at baseline and post-intervention. Nineteen studies were included (n = 6,339). Because of substantial statistical heterogeneity (χ(2) = 53.61, df = 18, P < 0.0001, I(2) = 66%), an overall pooled effect is not reported. In subgroup analyses, between-group differences were evident for delivery mode, which modestly reduced heterogeneity (to 54%). Studies with a group delivery component had a standardized mean difference of 0.38 greater than either individual or community-based delivery. Programs with a group delivery mode significantly increase physical activity among women experiencing disadvantage, and group delivery should be considered an essential element of physical activity promotion programs targeting this population group.

Cost-utility analysis of a dance intervention for adolescent girls with internalizing problems

BACKGROUND

The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular form of exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of this study was to assess the cost-effectiveness of a dance intervention in addition to usual school health services for adolescent girls with internalizing problems, compared with usual school health services alone.

METHODS

A cost-utility analysis from a societal perspective based on a randomized controlled intervention trial was performed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13-18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n = 59) or control (n = 53) group. The intervention comprised dance twice weekly during eight months in addition to usual school health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs were considered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measured with the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs for the intervention group compared with the control group. Likelihood of cost-effectiveness was calculated.

RESULTS

At 20 months, quality of life had increased by 0.08 units more in the intervention group than in the control group (P = .04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALY and the likelihood of cost-effectiveness was 95%.

CONCLUSIONS

Intervention with dance twice weekly in addition to usual school health services may be considered cost-effective compared with usual school health services alone, for adolescent girls with internalizing problems.

TRIAL REGISTRATION

Name of the trial registry: "Influencing Adolescent Girls' With Creative Dance Twice Weekly"

TRIAL REGISTRATION NUMBER

NCT01523561.

Contextualizing nativity status, Latino social ties, and ethnic enclaves: an examination of the 'immigrant social ties hypothesis'

OBJECTIVES

Researchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their US-born counterparts, may be the strength of social ties and social support among immigrants.

METHODS

We examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study's Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used ordinary least squares (OLS) regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed-effects regression models, we estimated the association between Latino/immigrant neighborhood composition and our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants' length of time in the USA.

RESULTS

After controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their US-born counterparts for all the outcomes, except informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for US-born Latinos than for immigrant Latinos. US-born Latinos maintained a significant social ties advantage over immigrants - regardless of length of time in the USA - for informal social integration, network diversity, and network size.

CONCLUSION

At the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their US-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.

Cross-border ties and self-rated health status for young Latino adults in Southern California

At the same time that health researchers have mostly ignored the cross-border nature of immigrant social networks, scholars of immigrant "transnationalism" have left health largely unexamined. This paper addresses this gap by analyzing the relationship between cross-border ties and self-rated health status for young Latino adults living in the greater Los Angeles area (n = 1268). Findings based on an ordered logistic regression analysis suggest that cross-border relationships may have both protective and adverse effects on overall health status. Specifically, those reporting a period of extended parental cross-border separation during childhood have lower odds of reporting better categories of self-rated health, all else equal. Conversely, a significant positive association was found between having a close relative living abroad and self-rated health status for foreign-born respondents when interacted with immigrant generation (foreign versus U.S.-born). Given the findings of significant negative and positive relationships between cross-border ties and self-rated general health status, I discuss the implications for future research on the social determinants of immigrant health.

Social-emotional support, life satisfaction, and mental health on reproductive age women's health utilization, US, 2009

To examine the associations among social-emotional support, life satisfaction, and mental health with not having a routine checkup among women of reproductive age in the US, data from the 2009 Behavioral Risk Factor Surveillance System, a population-based telephone survey of health behaviors, were analyzed among reproductive aged (18-44 years) women in the US. Prevalence estimates were calculated for not having a routine checkup in the past year with measures of social-emotional support, life satisfaction, and mental distress. Independent multivariable logistic regressions for each measure assessed not having a routine checkup within the past year with adjustment for age, race/ethnicity, education level, and health care coverage. Among women of reproductive age, 33.7 % (95 % CI 33.0-34.4) did not have a routine checkup within the past year. Factors associated with not having a routine checkup included: having social-emotional support most of the time (AOR = 1.29, 95 % CI 1.20-1.38) or sometimes or less (AOR = 1.47, 95 % CI 1.34-1.61) compared to those who reported always having the social-emotional support they need; reporting life satisfaction as being satisfied (AOR = 1.27, 95 % CI 1.19-1.36) or dissatisfied (AOR = 1.65, 95 % CI 1.43-1.91) compared to being very satisfied; and frequent mental distress (AOR = 1.19, 95 % CI 1.09-1.30) compared to those without. Women who report lower levels of social-emotional support, less life satisfaction, and frequent mental distress are less likely to see a doctor for a routine checkup. Targeted outreach that provides appropriate support are needed so these women can access clinical services to increase exposure to preventive health opportunities and improve overall health.

Health and psychosocial outcomes in U.S. adult patients with diabetes from diverse ethnicities

Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.

Correlates and determinants of physical activity in persons with spinal cord injury: A review using the International Classification of Functioning, Disability and Health as reference framework

BACKGROUND

Participation in physical activity (PA) decreases after the onset of a spinal cord injury (SCI) and is generally low in persons with SCI.

OBJECTIVE

To provide an overview of findings on correlates/determinants of PA in persons with SCI applying the International Classification of Functioning, Disability and Health (ICF) to analyze and report results.

METHODS

A systematic literature review using the databases MEDLINE, PsycINFO, SSCI, and CINHAL was conducted. Independent variables were extracted and linked to ICF codes. Quality of evidence was rated using internationally accepted standards.

RESULTS

Overall, evidence quality of the 25 included studies is low. Environmental Factors were consistently found as correlates of PA, whereas Personal Factors (socio-demographics and psychological constructs) were weakly associated with PA in the SCI population. Associations with Body Functions, Body Structures, Activities and Participation and Health Conditions were less frequently studied.

CONCLUSION

Although quality of evidence of reviewed literature is low, results indicate that rather environmental barriers than the 'classical' socio-demographic factors known from social epidemiology correlate with PA in persons with SCI. There is insufficient evidence to draw conclusions concerning the association of Body Functions and Structures and Activity and Participation with PA. Future research is encouraged to better understand the interplay between functioning, contextual factors, health conditions and PA in SCI to establish a sound basis for intervention planning in this special needs population. In addition, our experience showed that linking study results to the ICF facilitates data analysis and reporting.

Social marketing: approach to cultural and contextual relevance in a community-based physical activity intervention

We report the social marketing strategies used for the design, recruitment and retention of participants in a community-based physical activity (PA) intervention, Madres para la Salud (Mothers for Health). The study example used to illustrate the use of social marketing is a 48-week prescribed walking program, Madres para la Salud (Mothers for Health), which tests a social support intervention to explore the effectiveness of a culturally specific program using 'bouts' of PA to effect the changes in body fat, fat tissue inflammation and postpartum depression symptoms in sedentary Hispanic women. Using the guidelines from the National Benchmark Criteria, we developed intervention, recruitment and retention strategies that reflect efforts to draw on community values, traditions and customs in intervention design, through partnership with community members. Most of the women enrolled in Madres para la Salud were born in Mexico, largely never or unemployed and resided among the highest crime neighborhoods with poor access to resources. We developed recruitment and retention strategies that characterized social marketing strategies that employed a culturally relevant, consumer driven and problem-specific design. Cost and benefit of program participation, consumer-derived motivation and segmentation strategies considered the development transition of the young Latinas as well as cultural and neighborhood barriers that impacted retention are described.

Relationships between Social Resources and Healthful Behaviors across the Age Spectrum

Background. We examined cross-sectional relationships of social resources with health behaviors in adults ages 18–93 years. Methods. Baseline data from a 2009 risk behavior intervention trial were used to measure social resources, physical activity, and fruit and vegetable intake in 2,440 adults. To evaluate associations overall and within 4 age groups (18–34, 35–49, 50–64, and 65–93 y), we used multivariable regression. Results. Mean (SD) age was 49.4 (15) years, physical activity was 346 (304) minutes/week, and fruit and vegetable intake was 3.4 (2.4) servings/day. Mean social resource score was 1.2 (0–4 scale) in 18–34 year olds, 1.1 in all other age groups (P = 0.04). In multivariable models, for each one-point increment in social resource score, the odds ratio for getting 150–959 minutes of physical activity/wk (compared to <150 min/wk) was 3.7 (95% CI 3.0–4.6). Each one-point increment in score was also associated with 29% (95% CI: 23–35%) more servings of fruit and vegetables. We did not observe effect modification by age group. Conclusions. Although younger adults reported slightly higher resources than older adults, the magnitude of association between social resources and healthful behaviors did not differ between them.

Perceived social support and preventive health behavioral outcomes among older women

Although research has documented that social support is a positive pathway to healthpromoting behavioral practices, very few longitudinal studies have assessed the relationship between social support and health-promoting behaviors among older, diverse women. Three waves of data from the Americans' Changing Lives (ACL) survey assessed whether or not changes in perceived social support influenced behavioral outcomes among 671 African American women and non-Hispanic white women aged 60 years and older. Positive social support from friends was the most successful in predicting physical activity across the life span while positive spousal support, positive support from children, and health behavior-specific support were insignificant determinants of physical activity. The results suggest that social support from friends may be an important predictive factor in engaging older women in physical activity during the aging process.

"ASUKI Step" pedometer intervention in university staff: rationale and design

BACKGROUND

We describe the study design and methods used in a 9-month pedometer-based worksite intervention called "ASUKI Step" conducted at the Karolinska Institutet (KI) in Stockholm, Sweden and Arizona State University (ASU) in the greater Phoenix area, Arizona.

METHODS/DESIGN

"ASUKI Step" was based on the theory of social support and a quasi-experimental design was used for evaluation. Participants included 2,118 faculty, staff, and graduate students from ASU (n = 712) and KI (n = 1,406) who participated in teams of 3-4 persons. The intervention required participants to accumulate 10,000 steps each day for six months, with a 3-month follow-up period. Steps were recorded onto a study-specific website. Participants completed a website-delivered questionnaire four times to identify socio-demographic, health, psychosocial and environmental correlates of study participation. One person from each team at each university location was randomly selected to complete physical fitness testing to determine their anthropometric and cardiovascular health and to wear an accelerometer for one week. Study aims were: 1) to have a minimum of 400 employee participants from each university site reach a level of 10,000 steps per day on at least 100 days (3.5 months) during the trial period; 2) to have 70% of the employee participants from each university site maintain two or fewer inactive days per week, defined as a level of less than 3,000 steps per day; 3) to describe the socio-demographic, psychosocial, environmental and health-related determinants of success in the intervention; and 4) to evaluate the effects of a pedometer-based walking intervention in a university setting on changes in self-perceived health and stress level, sleep patterns, anthropometric measures and fitness.Incentives were given for compliance to the study protocol that included weekly raffles for participation prizes and a grand finale trip to Arizona or Sweden for teams with most days over 10,000 steps.

DISCUSSION

"ASUKI Step" is designed to increase the number of days employees walk 10,000 steps and to reduce the number of days employees spend being inactive. The study also evaluates the intra- and interpersonal determinants for success in the intervention and in a sub-sample of the study, changes in physical fitness and body composition during the study.

TRIAL REGISTRATION

Current Controlled Trials NCT01537939.

Environmental Factors Associated With Active Living in Retirement Village Residents

This exploratory enquiry employs qualitative methods to advance knowledge and understanding of physical environmental attributes related to active living among residents of Australian retirement villages. Six focus groups ( n = 51 residents) were held and participants described how their current, and subsequently ideal, retirement village and neighborhood supported active lifestyles. Thematic analysis revealed three key environmental factors associated with active living: a positive social environment within the village; services and facilities provided in the village and wider neighborhood; and the presence of suitable pedestrian infrastructure. The unique discovery that environmental factors of both the retirement village and the surrounding neighborhood were associated with residents’ active living raises many questions for study. Findings informed the development of a survey instrument, and further understanding in this area has the potential to contribute to the design and siting practices of senior housing complexes within neighborhoods.

"Convivência" groups: building active and healthy communities of older adults in Brazil

In old age, social groups can be a crucial component for health and well-being. In 2009-2010, a follow-up survey was carried out in Florianópolis, Brazil to understand the impact of a variety of programs established since 2002 that were designed to enhance social activities among the older adult population. This study employed two surveys within the population of older adults in Florianópolis. The first survey interviewed a total of 875 older adults in 2002, and the second survey involved 1,705 older adults between 2009 and 2010. By 2010, many new programs were offered in the community and the enrollment of older adults in social programs followed similar trends. “Convivência” groups stood out as extremely popular social groups among this population. This paper discusses some of the potential outcomes associated with participation in “convivência” groups.

Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study

BACKGROUND

As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations.

METHODS

This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final.

RESULTS

In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final.

CONCLUSION

These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.

Long-term effectiveness and mediators of a need-supportive physical activity coaching among Flemish sedentary employees

This study examined the long-term and mediation effects of a need-supportive coaching programme on physical activity. Sedentary employees (n = 92) of the university of Leuven received 4 months of physical activity coaching, based on the self-determination theory, by coaches with a bachelor's degree in kinesiology who are specializing in health-related physical activity (n = 30). The programme consisted of a limited number of individual contact moments (i.e. an intake session, three follow-up contacts and an out-take session), either face-to-face, by phone or by e-mail. Self-reported physical activity, social support, self-efficacy and autonomous motivation were assessed in the coaching group (n = 92) and a control group (n = 34) at three moments: before the intervention (i.e. pre-test), after the intervention (i.e. post-test) and 1 year after pre-test measurements (i.e. follow-up test). Results revealed significant 3 (time) × 2 (groups) interaction effects on strenuous and total physical activity. Moreover, whereas the control group remained stable from pre- to post-test, the coaching group increased significantly in moderate, strenuous and total physical activity. Additionally, the coaching group increased significantly in mild, moderate, strenuous and total physical activity from pre- to follow-up tests, whereas the control group did not change. Bootstrapping analyses indicated that self-efficacy and autonomous motivation significantly mediated the intervention effect on physical activity from pre- to post-test, while social support significantly mediated the long-term effect. This study provides evidence for the long-term effectiveness of a need-supportive physical activity programme that might be efficient at the community level.

Contribution of individual and environmental factors to physical activity level among Spanish adults

Background

Lack of physical activity (PA) is a major risk for chronic disease and obesity. The main aims of the present study were to identify individual and environmental factors independently associated with PA and examine the relative contribution of these factors to PA level in Spanish adults.

Methodology/Principal Findings

A population-based cross-sectional sample of 3,000 adults (18–75 years old) from Gran Canaria (Spain) was selected using a multistage stratified random sampling method. The participants were interviewed at home using a validated questionnaire to assess PA as well as individual and environmental factors. The data were analyzed using bivariate and multivariate logistic regression. One demographic variable (education), two cognitive (self-efficacy and perceived barriers), and one social environmental (organized format) were independently associated with PA in both genders. Odds ratios ranged between 1.76–2.07 in men and 1.35–2.50 in women (both p<0.05). Individual and environmental factors explained about one-third of the variance in PA level.

Conclusions/Significance

Self-efficacy and perceived barriers were the most significant factors to meet an adequate level of PA. The risk of insufficient PA was twofold greater in men with primary or lesser studies and who are employed. In women, living in rural environments increased the risk of insufficient PA. The promotion of organized PA may be an efficient way to increase the level of PA in the general population. Improvement in the access to sport facilities and places for PA is a prerequisite that may be insufficient and should be combined with strategies to improve self-efficacy and overcome perceived barriers in adulthood.

The impact of an after-school physical activity program on health-related fitness of mother/daughter pairs: CASPIAN study

OBJECTIVE

To examine the effectiveness of parental support and involvement in a low-cost intervention for the improvement of health-related fitness of high school girls through an after-school physical activity (PA) program.

METHODS

This multi-site study was conducted in 2006-2007 in 7 provinces in Iran. The study population comprised of two groups of children. The first group consisted of 206 children who were randomly selected from female students (7th-10th grade) and their mothers (n=204). Another 60 children (without their mothers) were randomly selected as the control group. Overall, during 12 weeks, 24 sessions of after-school aerobic exercise were held. Health-related fitness data were collected pre- and post-intervention.

RESULTS

The findings are based on 470 participants. The after-school PA significantly improved body mass index, resting heart rate, cardiorespiratory fitness, flexibility and muscle strength and endurance in children in both groups, and in mothers. Improvement in the physiological measures of the children in the mother/daughter group was significantly better than the control group.

CONCLUSION

The findings suggest that after-school PA may provide an effective model for improving the health-related fitness of high school girls and their mothers. Our data show that family support, including mother's participation, contributes to enhanced health-related achievements in adolescent girls.

Mujeres en accion: design and baseline data

The majority of programs designed to promote physical activity in older Hispanic women includes few innovative theory-based interventions that address cultural relevant strategies. The purpose of this report is to describe the design and baseline data for Mujeres en Accion, a physical activity intervention to increase regular physical activity, and cardiovascular health outcomes among older Hispanic women. Mujeres en Accion [Women in Action for Health], a 12 month randomized controlled trial to evaluate the effectiveness of a social support physical activity intervention in midlife and older Hispanic women. This study tests an innovative intervention, Mujeres en Accion, and includes the use of a theory-driven approach to intervention, explores social support as a theoretical mediating variable, use of a Promotora model and a Community Advisory group to incorporate cultural and social approaches and resources, and use of objective measures of physical activity in Hispanic women.

Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach

BACKGROUND

Immigrant and refugee populations arrive to the U.S. healthier than the general population, but the longer they reside, the more they approximate the cardiovascular risk profiles of the country. Among women, these declines are partly mediated by less physical activity and lower dietary quality upon immigration. Given the complex forces that influence these behaviors, a community-based participatory research (CBPR) approach is appropriate. Therefore, a socioculturally responsive physical activity and nutrition program was created with and for immigrant and refugee women in Rochester, Minnesota, through a CBPR approach.

METHODS

Focus groups informed program content and revealed principles for designing the sessions. A 6-week program with two, 90-minute classes per week was conducted among 45 women (Hispanic, Somali, Cambodian, and non-immigrant African American). Average attendance was 22.5 women per class; 34 women completed the evaluation.

RESULTS

Evaluation revealed high acceptability (average overall score of 4.85 out of 5 on the Physical Activity Class Satisfaction Questionnaire). After the intervention, participants were more likely to exercise regularly (p ≤ .001). They reported higher health-related quality of life (p ≤ .001) and self-efficacy for diet (p = .36) and exercise (p = .10). Likewise, there were trends for weight loss (87 vs 83.4 kg; p = .65), decreased waist circumference (99.6 vs 95.5 cm; p = .35), and lower blood pressure (125/80 vs 122/76 mm/Hg; p = .27).

CONCLUSION

A CBPR approach to design and implement a socioculturally responsive fitness program was highly acceptable to immigrant and refugee women and demonstrated promising outcomes. Further testing of physical activity and nutrition interventions that arise organically from target communities are needed.

Instrument selection for randomized controlled trials: why this and not that?

A fundamental linchpin for obtaining rigorous findings in quantitative research involves the selection of survey instruments. Psychometric recommendations are available for the processes for scale development and testing and guidance for selection of established scales. These processes are necessary to address the validity link between the phenomena under investigation, the empirical measures and, ultimately, the theoretical ties between these and the world views of the participants. Detailed information is most often provided about study design and protocols, but far less frequently is a detailed theoretical explanation provided for why specific instruments are chosen. Guidance to inform choices is often difficult to find when scales are needed for specific cultural, ethnic, or racial groups. This paper details the rationale underlying instrument selection for measurement of the major processes (intervention, mediator and moderator variables, outcome variables) in an ongoing study of postpartum Latinas, Madres para la Salud [Mothers for Health]. The rationale underpinning our choices includes a discussion of alternatives, when appropriate. These exemplars may provide direction for other intervention researchers who are working with specific cultural, racial, or ethnic groups or for other investigators who are seeking to select the 'best' instrument. Thoughtful consideration of measurement and articulation of the rationale underlying our choices facilitates the maintenance of rigor within the study design and improves our ability to assess study outcomes.

Understanding exercise uptake and adherence for people with chronic conditions: a new model demonstrating the importance of exercise identity, benefits of attending and support

Understanding the factors influencing uptake and adherence to exercise for people with chronic conditions from different ages, genders and ethnicities is important for planning exercise services. This paper presents evidence supporting a new model of exercise uptake and adherence applicable to people with chronic conditions from diverse socio-demographic backgrounds. The study is based on 130 semi-structured interviews with people with chronic conditions, including both those who did and those who did not attend exercise services, and supporters of those who attended. Analysis followed the guidelines of 'framework analysis'. Results show that three factors were particularly important in influencing adherence behavior: (i) exercise identity, (ii) support and (iii) perceived benefits of attending. Social and cultural identities impacted on willingness to exercise, importance of exercise and perceived appropriateness of exercising. Having at least one supporter providing different types of support was associated with high levels of attendance. Those people who valued the social and psychological benefits of attending were more likely to be high attenders. The new model illustrates interaction between these three factors and discusses how these can be taken into account when planning exercise services for people with chronic conditions drawn from diverse socio-demographic groups.

Consistent behavior development: is a personal-rule or a deliberation-based strategy more effective?

The development of consistent health behaviors is important for chronic illness prevention and management. The current study experimentally compared two strategies--a personal-rule and a deliberation strategy--designed to help participants consistently perform their intended behaviors over a 7-week period in a real-world setting. Although the personal-rule strategy had theoretical support from behavioral economics and empirical support from both animal and human lab experiments, the deliberation strategy group was significantly more successful than the personal-rule strategy group, both initially (time to first violation, p < .01, Cohen's d = .51) and over the entire 7-week period (overall success, p < .05, Cohen's d = .18). These effects were significant even after controlling for known predictors of behavioral success, including individual-difference variables, person-behavior factors, and resolution-related factors.

Synergistic effect of social support and self-efficacy on physical exercise in older adults

The purpose of the current study was to examine whether the effects of social support on physical exercise in older adults depend on individual perceptions of self-efficacy. Three hundred nine older German adults (age 65-85) were assessed at 3 points in time (3 months apart). In hierarchical-regression analyses, support received from friends and exercise self-efficacy were specified as predictors of exercise frequency while baseline exercise, sex, age, and physical functioning were controlled for. Besides main effects of self-efficacy and social support, an interaction between social support and self-efficacy emerged. People with low self-efficacy were less likely to be active in spite of having social support. People with low support were less likely to be active even if they were high in self-efficacy. This points to the importance of both social support and self-efficacy and implies that these resources could be targets of interventions to increase older adults' exercise.

Validity and reliability of a physical activity social support assessment scale

OBJECTIVE

To assess the validity and reliability of the Brazilian version of the physical activity social support scale for adults.

METHODS

The scale was applied in conjunction with a face-to-face multi-dimensional questionnaire in 1,461 individuals aged between 18 and 79 years, living in Curitiba, Southeastern Brazil, between April and July 2009. The questionnaire was submitted to validity (factorial and construct) and reliability testing (internal consistency and reproducibility). Reliability was observed with the use of internal consistency, Cronbach's alpha, test-retest procedure with a one-week interval (n = 74) and intraclass correlation coefficient.

RESULTS

Factorial analysis resulted in four factors with eigenvalues between 4.29 and 1.39, which explained 82.8% of the total variance. Factors 1 and 2 included questions about social support from friends for moderate to vigorous physical activities and walking, respectively. Factors 3 and 4 were comprised of groups of social support from the family for moderate to vigorous physical activities and walking, respectively. Reproducibility showed an intraclass correlation coefficient between 0.63 and 0.80 and alpha internal consistency between 0.87 and 0.91. Construct validity was observed from the significant association (p < 0.005) between scores of social support for walking and moderate to vigorous physical activities.

CONCLUSIONS

The instrument tested showed psychometric characteristics that were adequate for use in adult Brazilians.

Social support and leisure-time physical activity: longitudinal evidence from the Brazilian Pró-Saúde cohort study

Background

Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA), multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up.

Methods

This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pró-Saúde study). LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group) and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS). To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group) and for those who had maintained LTPA since the beginning of the follow up (maintenance group).

Results

After adjusting for confounders, statistically significant associations (p < 0.05) between dimensions of social support and group LTPA were found in the engagement group. Also, the emotional/information dimension was associated with time spent on LTPA (OR = 2.01; 95% CI 1.2-3.9). In the maintenance group, material support was associated with group LTPA (OR = 1.80; 95% CI; 1.1-3.1) and the positive social interaction dimension was associated with time spent on LTPA (OR = 1.65; 95% CI; 1.1-2.7).

Conclusions

All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it suggests that maintenance of LTPA must be associated with other factors beyond the individual's level of social support, such as a suitable environment and social/health policies directed towards the practice of LTPA.

Leisure-time physical activities for community older people with chronic diseases

AIMS

(1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people.

BACKGROUND

Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively.

DESIGN

A cross-sectional design was used for this study.

METHODS

Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting.

RESULTS

The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity.

CONCLUSIONS

The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA.

RELEVANCE TO CLINICAL PRACTICE

An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individual's needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas.

H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among African Americans

BACKGROUND

Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes.

METHODS

The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking intervention, including a 6-month active intervention quasi experimental phase and 12-month maintenance randomized controlled trial phase to test dose effects of motivational interviewing. A community advisory board helped develop and execute the culturally-appropriate intervention components which included social support walking groups led by peer coaches, pedometer diary self-monitoring, monthly diet and physical activity education sessions, and individualized motivational interviewing sessions. Although the study is on-going, three month data is available and reported. Analyses include descriptive statistics and paired t tests.

RESULTS

Of 269 enrolled participants, most were African American (94%) females (85%) with a mean age of 43.8 (SD = 12.1) years. Across the 3 months, 90% of all possible pedometer diaries were submitted. Attendance at the monthly education sessions was approximately 33%. At the 3-month follow-up 227 (84%) participants were retained. From baseline to 3-months, systolic BP [126.0 (SD = 19.1) to 120.3 (SD = 17.9) mmHg; p < 0.001] and diastolic BP [83. 2 (SD = 12.3) to 80.2 (SD = 11.6) mmHg; p < 0.001] were significantly reduced.

CONCLUSIONS

This CBPR study highlights implementation factors and signifies the community's active participation in the development and execution of this study. Reach and representativeness of enrolled participants are discussed. Adherence to pedometer diary self-monitoring was better than education session participation. Significant decreases in the primary blood pressure outcomes demonstrate early effectiveness. Importantly, future analyses will evaluate long-term effectiveness of this CBPR behavioral intervention on health outcomes, and help inform the translational capabilities of CBPR efforts.

Disconnections of African American public housing residents: connections to physical activity, dietary habits and obesity

African American (AA) and low SES populations report poor health behaviors and outcomes. This study aimed to increase understanding of barriers to participating in healthful behaviors and programs in AA residents of public housing. Twenty two apparently healthy, AA residents (50% female, M = 43.9 years) completed in depth interviews, which were taped, transcribed and analyzed using a constant comparison approach. Residents demonstrated some awareness of health recommendations, but described limited adherence. Physical activity for recreation was reported as primarily for youth, with adults engaging in limited physical activity (primarily incidental to other activities). Barriers reported by residents were both personal and environmental. Few residents were aware of local neighborhood opportunities for physical activity or healthful eating. Future efforts should focus on increasing understanding of health promoting behaviors and awareness and efficacy of residents to connect with the resources of their surrounding communities.

Social cognitive theory as a predictor of dietary behavior and leisure time physical activity behavior in middle-aged Asian Indian women residing in United States

The purpose of the study was to determine to what extent expectations, self-control, and self-efficacy from the social cognitive theory account for variance in the dietary behaviors and leisure time physical activity of middle-aged Asian Indian women residing in Chicago. Dietary behavior was broken down into fruit and vegetable consumption and number of portions consumed. Data was collected from a sample of 200 participants in Chicago over a span of 1 month. Valid and reliable subscales were developed for the study. Descriptive statistics, stepwise multiple regressions, and Pearson correlations were used to analyze the data. Results indicated expectations for leisure time physical activity and self-control as predictive for leisure time physical activity (adjusted R² = 0.14). No relationships were seen with the constructs of the social cognitive theory with number of portions and fruit and vegetable consumption. Recommendations have been included for future studies.

Community health promotion: a framework to facilitate and evaluate supportive social environments for health

The evaluation of community health promotion designed to create supportive social environments for health is still in its infancy. There is a lack of consensus on concepts, a lack of information on interventions that bring about social change, and a lack of feasible methods and tools. Consequently, the effectiveness of community health promotion may not be evaluated under all relevant headings. Therefore, this study aims to contribute to the evaluation of change in the social environment by presenting a framework. On the basis of the relevant literature we describe the relation between social environment and health predicting mediators. We selected participation and collaboration as core concepts in moderating the social environment of health because these terms give insight into the actual dynamics of health promotion practice. We synthesize the results into a framework with operational variables and offer four guidelines on how to apply the framework: use the variables as a menu, set specific aims for social change processes, use an action research approach, and triangulate data. The framework and guidelines enable the start-up, facilitation and evaluation of social change and learning processes and provide common ground for researchers and practitioners to improve the practice of their professions.