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Burge AT, Holland AE, McDonald CF, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahhama A, Gillies R, Mahald A. "Willingness to Pay": The Value Attributed to Program Location by Pulmonary Rehabilitation Participants. COPD 2021; 18:281-287. [PMID: 34060968 DOI: 10.1080/15412555.2021.1924127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The "contingent valuation" method is used to quantify the value of services not available in traditional markets, by assessing the monetary value an individual ascribes to the benefit provided by an intervention. The aim of this study was to determine preferences for home or center-based pulmonary rehabilitation for participants with chronic obstructive pulmonary disease (COPD) using the "willingness to pay" (WTP) approach, the most widely used technique to elicit strengths of individual preferences. This is a secondary analysis of a randomized controlled equivalence trial comparing center-based and home-based pulmonary rehabilitation. At their final session, participants were asked to nominate the maximum that they would be willing to pay to undertake home-based pulmonary rehabilitation in preference to a center-based program. Regression analyses were used to investigate relationships between participant features and WTP values. Data were available for 141/163 eligible study participants (mean age 69 [SD 10] years, n = 82 female). In order to undertake home-based pulmonary rehabilitation in preference to a conventional center-based program, participants were willing to pay was mean $AUD176 (SD 255) (median $83 [IQR 0 to 244]). No significant difference for WTP values was observed between groups (p = 0.98). A WTP value above zero was related to home ownership (odds ratio [OR] 2.95, p = 0.02) and worse baseline SF-36 physical component score (OR 0.94, p = 0.02). This preliminary evidence for WTP in the context of pulmonary rehabilitation indicated the need for further exploration of preferences for treatment location in people with COPD to inform new models of service delivery.
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Affiliation(s)
- Angela T Burge
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Narelle S Cox
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
| | | | - Caroline Nicolson
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Aroub Lahhama
- Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Rebecca Gillies
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Ajay Mahald
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Abstract
BACKGROUND Promotion of physical activity (PA) among populations is a global health investment. However, evidence on economic aspects of PA is sparse and scattered in low-income and middle-income countries (LMICs). OBJECTIVE The objective of this study was to summarise the available evidence on economics of PA in LMICs, identify potential target variables for policy and report gaps in the existing economic evidence alongside research recommendations. DATA SOURCES A systematic review of the electronic databases (Scopus, Web of Science and SPORTDiscus) and grey literature. STUDY ELIGIBILITY CRITERIA Cost-of-illness studies, economic evaluations, interventions and descriptive studies on economic factors associated with PA using preset eligibility criteria. STUDY APPRAISAL AND SYNTHESIS OF METHODS Screening, study selection and quality appraisal based on standard checklists performed by two reviewers with consensus of a third reviewer. Descriptive synthesis of data was performed. RESULTS The majority of the studies were from upper-middle-income countries (n=16, 88.8%) and mainly from Brazil (n=9, 50%). Only one economic evaluation study was found. The focus of the reviewed literature spanned the economic burden of physical inactivity (n=4, 22%), relationship between PA and costs (n=6, 46%) and socioeconomic determinants of PA (n=7, 39%). The findings showed a considerable economic burden due to insufficient PA, with LMICs accounting for 75% of disability-adjusted life years (DALYs) globally due to insufficient PA. Socioeconomic correlates of PA were identified, and inverse relationship of PA with the cost of chronic diseases was established. Regular PA along with drug treatment as a treatment scheme for chronic diseases showed advantages with a cost-utility ratio of US$3.21/quality-adjusted life year (QALY) compared with the drug treatment-only group (US$3.92/QALY) by the only economic evaluation conducted in the LMIC, Brazil. LIMITATIONS Meta-analysis was not performed due to heterogeneity of the studies. CONCLUSIONS AND RECOMMENDATIONS Economic evaluation studies for PA promotion interventions/strategies and local research from low-income countries are grossly inadequate. Setting economic research agenda in LMICs ought to be prioritised in those areas. PROSPERO REGISTRATION NUMBER CRD42018099856.
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Affiliation(s)
- Priyanga Diloshini Ranasinghe
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
- Ministry of Health, Nutrition, Indegenous Medicine, Colombo 10, Sri Lanka
| | - Subhash Pokhrel
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
| | - Nana Kwame Anokye
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
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3
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Suminski RR, Robson S, Turner J, Plautz E. Promoting Small Business Support of Youth Physical Activity in Low-Income, Minority Neighborhoods: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13141. [PMID: 31364602 PMCID: PMC6691677 DOI: 10.2196/13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023] Open
Abstract
Background An unacceptably high percentage of our nation’s low-income, minority youth (age<18 years) are not regularly physically active. One reason for this could be their lack of access to quality youth physical activity opportunities (YPAOs). Our previous research found that small businesses (<500 employees), which represent over 99.64% (27.9/28.0 million businesses in United States) of all employers, are powerful resources for creating and improving YPAOs. In accordance with the socioecological model and established philanthropic principles, we developed an alpha version of an intervention (alpha-i) for increasing small businesses’ involvement with YPAOs. Objective The aims of this proposed study are to (1) create a beta version (beta-i) of the intervention and (2) conduct a pilot study of its impact on small business support for YPAOs and YPAO utilization by the youth in low-income, minority neighborhoods. Methods The alpha-i will be refined using information from focus groups and surveys conducted with small business owners and managers, YPAO providers, and parents and guardians of the youths from low-income, predominantly minority neighborhoods. A cluster randomized controlled trial will then be conducted for 1 year to examine the effects of the refined intervention (beta-i) on small business support for YPAOs in 10 low-income, minority neighborhoods. The control group of neighborhoods (n=10) will be provided with a standard practice intervention. The primary outcome for aim 2 will be the percentage of small businesses not supporting YPAOs at baseline that subsequently provide support for YPAOs at follow-up. We also will consider the US dollar equivalent of all types of support (monetary, goods/services, and time) donated for YPAOs by small businesses. In addition, we will examine the impact of the increased small business support for YPAOs on YPAO utilization by the youth. Results As of May 1, 2019, all YPAOs and small businesses in the study neighborhoods have been identified, and surveys have begun with these groups. In addition, 9 focus groups were completed, and the data have been transcribed. We anticipate that manuscripts regarding these aspects of the study will be submitted in fall 2019. Conclusions The proposed study is significant because it will provide evidence that an easily replicated approach can be used to increase small business support for YPAOs and that this support results in greater use of the YPAOs by youth. A logical next step will be to determine if YPAO changes resulting from increased small business support positively influence youth physical activity levels. ClinicalTrial ClinicalTrials.gov NCT03936582; https://clinicaltrials.gov/ct2/show/NCT03936582. International Registered Report Identifier (IRRID) DERR1-10.2196/13141
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Affiliation(s)
- Richard Robert Suminski
- Center for Innovative Health Research, Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, United States
| | - Shannon Robson
- Center for Innovative Health Research, Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, United States
| | - Jennie Turner
- Center for Innovative Health Research, Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, United States
| | - Eric Plautz
- Center for Innovative Health Research, Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, United States
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Kjær T, Højgaard B, Gyrd-Hansen D. Physical exercise versus shorter life expectancy? An investigation into preferences for physical activity using a stated preference approach. Health Policy 2019; 123:790-796. [PMID: 31200947 DOI: 10.1016/j.healthpol.2019.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/18/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
The positive life-prolonging effect of physical activity is often used as a promotion argument to motivate people to change their behaviour. Yet the decision of investing in health by exercising depends not only on the potential health effect but also on the costs of physical activity including time costs and the individual's (dis)utility of performing physical activity. The objective of this study was to investigate the trade-off between costs and benefits of engaging in physical activity. A web-based stated preference experiment was conducted to elicit individual preferences for physical activity among a representative sample of the Danish population, 18-60 years of age, categorised as moderately physically active or physically inactive. The results of the study suggest that perceived negative quality of life impact of physical activity is an important predictor of the choice of not attending physical activity, and hence should be acknowledged as a barrier to engaging in physical activity. Furthermore, we find time costs to have a significant impact on stated uptake. For individuals categorised as moderately active, the marginal health effect of physical activity is significant but minor. For inactive individuals, this effect is insignificant suggesting that information on long-term health effects does not work as motivation for engaging in exercise for this group. Instead, focus should be on reducing the perceived disutility of physical activity.
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Affiliation(s)
- Trine Kjær
- DaCHE - Danish Center for Health Economic Research, Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 1., 5230 Odense M, Denmark.
| | - Betina Højgaard
- VIVE, Danish Institute of Applied Social Science, Herluf Trolles Gade 11, 1052 København K, Denmark.
| | - Dorte Gyrd-Hansen
- DaCHE - Danish Center for Health Economic Research, Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 1., 5230 Odense M, Denmark.
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5
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Ranasinghe PD, Pokhrel S, Anokye NK. The economics of physical activity in low-income and middle-income countries: protocol for a systematic review. BMJ Open 2019; 9:e022686. [PMID: 30659037 PMCID: PMC6340626 DOI: 10.1136/bmjopen-2018-022686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/09/2018] [Accepted: 11/23/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Evidence on the economic costs of physical inactivity and the cost-effectiveness of physical activity interventions in low-income and middle-income countries (LMICs) is sparse, and fragmented where they are available. This is the first review aimed to summarise available evidence on economics of physical activity in LMICs, identify potential target variables for policy, and identify and report gaps in the current knowledge on economics of physical activity in LMICs. METHODS AND ANALYSIS Peer-reviewed journal articles of observational, experimental, quasi-experimental and mixed-method studies on economics of physical activity in LMICs will be identified by a search of electronic databases; Scopus, Web of Science and SPORTDiscus. Websites of WHO, the National Institute for Health and Care Excellence international, World Bank and reference lists of included studies will be searched for relevant studies. The study selection process will be a two-stage approach; title and abstract screen for inclusion, followed by a review of selected full-text articles by two independent reviewers. Disagreements will be resolved by consensus and discussion with a third reviewer. Data will be extracted using standardised piloted data extraction forms. Risk of bias will be critically appraised using standard checklists based on study designs. Descriptive synthesis of data is planned. Where relevant, summaries of studies will be classified according to type of economic analysis, country or country category, population, intervention, comparator, outcome and study design. Meta-analysis will be performed where appropriate. This protocol for systematic review is prepared according to the Preferred Reporting Items for Systematic review and Meta-analysis for Protocols -2015 statement. ETHICS AND DISSEMINATION Ethical approval is not obtained as original data will not be collected as part of this review. The completed review will be submitted for publication in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42018099856.
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Affiliation(s)
- Priyanga Diloshini Ranasinghe
- Department of Health, Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
- Division of Health Sciences, Department of Clinical Sciences, Collage of Health and Life Sciences, Brunel University, London, UK
| | - Subhash Pokhrel
- Health Economics Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Nana Kwame Anokye
- Health Economics Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
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6
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Ulijaszek S. Physical activity and the human body in the (increasingly smart) built environment. Obes Rev 2018; 19 Suppl 1:84-93. [PMID: 30511510 DOI: 10.1111/obr.12790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022]
Abstract
Physical activity in the built environment of high income countries may be changing faster than at any time prior to the 2000s, with the engagement of social media, smart devices and increasing urban smartness that has come with the Internet of Things. This article describes the most salient features of built environments that have facilitated physical activity between the 1980s and 2000s (most importantly walkability and active transport with bicycles). It goes on to use the anthropological three bodies framework in association with that of forms of capital, to explore how the use of smart devices and increasing incorporation of smartness and performativity into architecture and urban planning since the 2000s might influence physical activity. Smartness and use of smart devices in the built environment should favour increased physical activity through new types of sociality that they facilitate. In turn, engagement with such technologies offers an important opportunity for the empowerment of the individual body-self and the social body towards increased physical activity.
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Affiliation(s)
- S Ulijaszek
- Unit for Biocultural Variation and Obesity, School of Anthropology, University of Oxford, Oxford, UK
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7
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Kruger J, Yore MM, Bauer DR, Kohl HW. Selected Barriers and Incentives for Worksite Health Promotion Services and Policies. Am J Health Promot 2016; 21:439-47. [PMID: 17515009 DOI: 10.4278/0890-1171-21.5.439] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To assess employees' attitudes toward potential barriers to and incentives for their likely use of worksite health promotion services. Methods. Data from the 2004 HealthStyles Survey, a volunteer mail survey, were used to examine selected barriers to, incentives for, and potential use of worksite health promotion programs among adults employed full-time or part-time outside the home (n = 2337). Results. Respondents were 72.7% white and 52.1% female; 36.5% were college graduates, 30.7% had a body mass index of at least 30, and 35.6% were regularly active. The most common reported barriers to use of worksite services were no time during the workday (42.5%) and no time before or after work (39.4%). More than 70% of employees responded that the following incentives would promote their interest in participating in a free worksite wellness program: convenient time, convenient location, and employer-provided paid time off during the workday. Preferred health promotion services reported by respondents were fitness centers (80.6%), weight loss programs (67.1%), and on-site exercise classes (55.2%). Policy practices of paid time to exercise at work and healthy vending or cafeteria food choices were preferred by almost 80% of employees. Conclusions. These HealthStyles Survey data, in combination with needs data from an employer's own workforce, may help employers design wellness programs to include features that attract employees.
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Affiliation(s)
- Judy Kruger
- Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-46, Atlanta, GA 30341-3717, USA.
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8
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Romé ÅS, Persson U, Ekdahl C, Gard G. Costs and outcomes of an exercise referral programme – A 1-year follow-up study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.3109/21679169.2014.886291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Songer T, Glazner J, Coombs LP, Cuttler L, Daniel M, Estrada S, Klingensmith G, Kriska A, Laffel L, Zhang P. Examining the economic costs related to lifestyle and pharmacological interventions in youth with Type 2 diabetes. Expert Rev Pharmacoecon Outcomes Res 2014; 6:315-324. [PMID: 19774104 DOI: 10.1586/14737167.6.3.315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The best treatment option for children with Type 2 diabetes has not yet been established. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study is currently testing the efficacy of three therapies: metformin, metformin plus rosiglitazone and metformin plus an intensive lifestyle intervention. The relative cost-effectiveness of these therapies is also being examined. This review discusses the rationale for the design and methods applied in the economic analysis. The design of the economic analysis in the TODAY study was influenced by the existing literature and two primary study parameters: the nature of the interventions and the participants' age. The lifestyle intervention is an intensive behavioral intervention comprising diet and physical activity. Since economic factors influence both diet and physical activity, the analytical plan includes measurement of food and exercise-related purchases. Due to the young age of the participants, the impact of the intervention on adult caregivers is also included in the analysis. This analysis focuses on the time spent by the caregivers in both medical treatment and nutrition- and activity-related activities, and the value of this time relative to usual activities. Important methodological questions include how and when to collect information, not only on medical costs, but also on the impact of caregiver time, travel, food and equipment purchases. In the TODAY study, these latter resources are being measured by regularly administered surveys completed by the caregivers. The approach to the cost-effectiveness assessment undertaken by the TODAY study is one of the first in diabetes research to focus on youth and to include a societal perspective, regular and prospective assessment of clinician and caregiver time, and a comprehensive assessment of the costs associated with lifestyle behaviors. It can serve as a model for future studies of diabetes treatments.
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Affiliation(s)
- Thomas Songer
- University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, 3512 Fifth Avenue, Room 205, Pittsburgh, PA 15213, USA, Tel.: +1 412 802 6499, ,
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10
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Kuvaja-Köllner V, Valtonen H, Komulainen P, Hassinen M, Rauramaa R. The impact of time cost of physical exercise on health outcomes by older adults: the DR's EXTRA Study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:471-479. [PMID: 22532236 DOI: 10.1007/s10198-012-0390-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 03/22/2012] [Indexed: 05/31/2023]
Abstract
When the motivation for exercise is high and people are retired, the cost of time used for physical exercise may be lower and individuals may exercise more compared to individuals with a low motivational level and in working life. The aim was to study the effect of time cost of physical exercise on the amount of physical exercise and on health-related quality of life. We used 2-year data (n = 1,292) from a 4-year randomised controlled trial in a population-based sample of Eastern Finnish men and women, 57-78 years of age at baseline, in 2005-2006. In the statistical analysis, physical exercise and health outcomes were assumed to be endogenous variables explained with a set of exogenous variables. The statistical modelling was done by panel data instrumental variable regressions. Health-related quality of life was evaluated by the RAND 36-item survey and motives for exercise with a questionnaire. Joy as the motivation for physical exercise and retirement increased the amount of physical exercise per week (p < 0.001). A higher amount of exercise was associated with physical (p < 0.001) and mental (p < 0.001) components of quality of life. Moreover, a higher amount of physical exercise decreased the metabolic risk factor score (p < 0.001). The motivation and extra time, i.e. retirement, have a significant impact on the time spent on physical exercise (p < 0.001). Our data agree with the theory that high motivation and retirement lower the time cost of physical exercise. The results emphasise that motivation and the labour market position are important in determining the cost of physical exercise.
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Affiliation(s)
- Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
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11
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Abstract
Objective: The effects of contingency management to induce physical activity levels were examined in seven non-obese physically inactive undergraduate students by providing monetary payments using a multiple baseline, changing-criterion procedure. Methods: Participants attended a baseline phase, a subsequent intervention phase consisting of three exercise sessions per week for 4 weeks, and a follow-up session 2 weeks post intervention. A total of $145 was available for attendance and exercise contingency payments. Results: Results indicate that all participants significantly increased exercise during intervention from inactivity at baseline to exercising three 30-minute sessions per week. Participants maintained some gains during follow-up. Limitations: The study employed a small and homogenous sample size and required participants to exercise in a lab setting thus limiting external validity. Conclusions: These findings suggest that incentive-based interventions are an effective and viable means for inducing exercise.
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Abstract
The rise of obesity in the United States over the past 25 years has resulted in an increase in the number of research studies published related to the causes, consequences, and possible solutions to the problem. Most would agree that obesity is a multi-dimensional problem that requires a range of solutions related to individual diet and activity, food and built environment, and public policy. Examination of complex relationships between food choice, time use patterns, sociodemographic characteristics and obesity has been limited by data availability and disciplinary focus. Using the theory of the production of health capital, this paper links empirical data from the Consumer Expenditure, Current Population, and American Time Use Surveys to provide estimates of the impacts of food expenditure and time use patterns on obesity in single female headed households of 31-50 years of age.
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Affiliation(s)
- Jane M Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, Vermont, USA.
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Abstract
The presence of youth physical activity opportunities is one of the strongest environmental correlates of youth physical activity. More detailed information about such opportunities is needed to maximize their contributions to physical activity promotion especially in under resourced, lower income areas. The objectives of this study were to construct a comprehensive profile of youth physical activity opportunities and contrast profile characteristics between lower and higher income neighborhoods. Youth physical activity opportunities in eight lower (median household income <$36,000) and eight higher (>$36,000) income neighborhoods were identified and described using interviews, neighborhood tours, site visits, and systematic searches of various sources (e.g., Internet). Lower income neighborhoods had a greater number of locations offering youth physical activity opportunities but similar quantities of amenities. Lower income neighborhoods had more faith-based locations and court, trail/path, event, and water-type amenities. Higher income neighborhoods had significantly more for-profit businesses offering youth physical activity opportunities. Funding for youth physical activity opportunities in lower income neighborhoods was more likely to come from donations and government revenue (e.g., taxes), whereas the majority of youth physical activity opportunities in the higher income neighborhoods were supported by for-profit business revenue. Differences between lower and higher income neighborhoods in the type and amenities of youth physical activity opportunities may be driven by funding sources. Attention to these differences could help create more effective and efficient strategies for promoting physical activity among youth.
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Safeer R, Rothenstein MM. Creating a Physically Active Society: The Next Great Challenge. Am J Health Promot 2011; 25:291-3. [DOI: 10.4278/ajhp.100513-cit-152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Richard Safeer
- Richard Safeer, MD, FAAFP, is with CareFirst BlueCross BlueShield, Department of Prevention and Disease Management, Baltimore, Maryland. Meg M. Rothenstein, MPH, CHES, is a freelance health promotion specialist
| | - Meg M. Rothenstein
- Richard Safeer, MD, FAAFP, is with CareFirst BlueCross BlueShield, Department of Prevention and Disease Management, Baltimore, Maryland. Meg M. Rothenstein, MPH, CHES, is a freelance health promotion specialist
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Spence JC, Holt NL, Dutove JK, Carson V. Uptake and effectiveness of the Children's Fitness Tax Credit in Canada: the rich get richer. BMC Public Health 2010; 10:356. [PMID: 20565963 PMCID: PMC2908091 DOI: 10.1186/1471-2458-10-356] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 06/21/2010] [Indexed: 11/18/2022] Open
Abstract
Background The Government of Canada implemented a Children's Fitness Tax Credit (CFTC) in 2007 which allows a non-refundable tax credit of up to $500 to register a child in an eligible physical activity (PA) program. The purposes of this study were to assess whether the awareness, uptake, and perceived effectiveness of this tax credit varied by household income among Canadian parents. Methods An internet-based panel survey was conducted in March 2009 with a representative sample of 2135 Canadians. Of those, parents with children aged 2 to 18 years of age (n = 1004) were asked if their child was involved in organized PA programs (including dance and sports), the associated costs to register their child in these programs, awareness of the CFTC, if they had claimed the CFTC for the tax year 2007, and whether they planned to claim it in the upcoming year. Parents were also asked if they believed the CFTC has lead to their child being more involved in PA programs. Results Among parents, 54.4% stated their child was in organized PA and 55.5% were aware of the CFTC. Parents in the lowest income quartile were significantly less aware and less likely to claim the CFTC than other income groups. Among parents who had claimed the CFTC, few (15.6%) believed it had increased their child's participation in PA programs. Conclusions More than half of Canadian parents with children have claimed the CFTC. However, the tax credit appears to benefit the wealthier families in Canada.
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Affiliation(s)
- John C Spence
- Faculty of Physical Education & Recreation, University of Alberta, Edmonton, Alberta, Canada.
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16
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Romé A, Persson U, Ekdahl C, Gard G. Willingness to pay for health improvements of physical activity on prescription. Scand J Public Health 2010; 38:151-9. [PMID: 20064920 DOI: 10.1177/1403494809357099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To estimate the willingness to pay for health improvements among participants in the programme ''Physical Activity on Prescription''. The objective was also to examine predictors such as income, education level, health status, activity level and BMI, differences for long- and short-term health effects of physical activity and differences between a high- and low-intensity activity group. METHODS Willingness to pay (WTP) data were collected alongside a randomized, controlled trial in Sweden 2007, and 128 sedentary individuals, 20-80 years old (intervention/high-intensity group n = 71, control/low-intensity group n = 57), with lifestyle-related health problems answered open-ended questions in this contingent valuation study. RESULTS The highest mean WTP (59/SEK 552) was stated for an immediate health improvement, but no significant differences compared with long-term health improvements. The high-intensity group showed higher WTP-values for all health improvements, but without significant differences compared with a low-intensity group. Regression analyses show strong associations between a higher level of education and the WTP for improved well-being and improved health, and also between income and the WTP for improved well-being. There are significant correlations between the WTP and the variables BMI, income and education level, as expected from economic theories. CONCLUSIONS The willingness to pay for the health improvements of exercise is influenced by a higher education level, income and BMI. The highest WTP for a health outcome of physical activity is for an immediate health improvement. The results of this randomized controlled trial in primary health care may be of interest to decision makers when evaluating different approaches to promoting physical activity among people who are sedentary.
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Affiliation(s)
- Asa Romé
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
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Bleich SN, Sturm R. Developing policy solutions for a more active nation: Integrating economic and public health perspectives. Prev Med 2009; 49:306-8. [PMID: 19616575 DOI: 10.1016/j.ypmed.2009.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 07/08/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
Both economic and public health/medical perspectives play an important role in the policy process but often approach policy questions in an incompatible way. Harnessing any synergy requires an understanding of the other perspective. We begin by comparing and contrasting the economic and public health perspectives, including introducing relevant economic concepts. We next identify economic considerations for the development of environmental incentives that promote physical activity. We then assess features of the political environment which could impact the success of policy alternatives aimed at increasing physical activity. We conclude with several policy levers that may promote active living. Throughout the manuscript, we use the term economics to refer to classical economics and utility maximization rather than behavioral economics. In addition, we focus mostly on normative economics (which offers prescriptions for what should be done) rather than positive economics (which offers predictions of economic outcomes conditional on various hypothetical scenarios).
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Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 451, Baltimore, MD 21205, USA.
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Yancey AK. The meta-volition model: organizational leadership is the key ingredient in getting society moving, literally! Prev Med 2009; 49:342-51. [PMID: 19744510 DOI: 10.1016/j.ypmed.2009.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 10/20/2022]
Abstract
This paper argues that substantive and sustainable population-wide improvements in physical activity can be achieved only through the large scale adoption and implementation of policies and practices that make being active the default choice and remaining inactive difficult. Meta-volition refers to the volition and collective agency of early adopter leaders who implement such changes in their own organizations to drive productivity and health improvements. Leaders, themselves, are motivated by strong incentives to accomplish their organizational missions. The meta-volition model (MVM) specifies a cascade of changes that may be sparked by structural integration of brief activity bouts into organizational routine across sectors and types of organizations. MVM builds upon inter-disciplinary social ecological change models and frameworks such as diffusion of innovations, social learning and social marketing. MVM is dynamic rather than static, integrating biological influences with psychological factors, and socio-cultural influences with organizational processes. The model proposes six levels of dissemination triggered by organizational marketing to early adopter leaders carried out by "sparkplugs," boisterous leaders in population physical activity promotion: initiating (leader-leader), catalyzing (organizational-individual), viral marketing (individual-organizational), accelerating (organizational-organizational), anchoring (organizational-community) and institutionalizing (community-individual). MVM embodies public-private partnership principles, a collective investment in the high cost of achieving and maintaining active lifestyles.
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Affiliation(s)
- Antronette K Yancey
- Department of Health Services, Center to Eliminate Health Disparities, Center for Health Policy Research, UCLA School of Public Health, 31-235 CHS, 650 Charles Young Drive South, Los Angeles, CA 90095, USA.
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Zick CD, Smith KR, Fan JX, Brown BB, Yamada I, Kowaleski-Jones L. Running to the store? The relationship between neighborhood environments and the risk of obesity. Soc Sci Med 2009; 69:1493-500. [PMID: 19766372 DOI: 10.1016/j.socscimed.2009.08.032] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Indexed: 11/29/2022]
Abstract
We expand the search for modifiable features of neighborhood environments that alter obesity risk in two ways. First, we examine residents' access to neighborhood retail food options in combination with neighborhood features that facilitate physical activity. Second, we evaluate neighborhood features for both low income and non-low income neighborhoods (bottom quartile of median neighborhood income versus the top three quartiles). Our analyses use data from the Utah Population Database merged with U.S. Census data and Dun & Bradstreet business data for Salt Lake County, Utah. Linear regressions for BMI and logistic regressions for the likelihood of being obese are estimated using various measures of the individual's neighborhood food options and walkability features. As expected, walkability indicators of older neighborhoods and neighborhoods where a higher fraction of the population walks to work is related to a lower BMI/obesity risk, although the strength of the effects varies by neighborhood income. Surprisingly, the walkability indicator of neighborhoods with higher intersection density was linked to higher BMI/obesity risk. The expected inverse relationship between the walkability indicator of population density and BMI/obesity risk is found only in low income neighborhoods. We find a strong association between neighborhood retail food options and BMI/obesity risk with the magnitude of the effects again varying by neighborhood income. For individuals living in non-low income neighborhoods, having one or more convenience stores, full-service restaurants, or fast food restaurants is associated with reduced BMI/obesity risk, compared to having no neighborhood food outlets. The presence of at least one healthy grocery option in low income neighborhoods is also associated with a reduction in BMI/obesity risk relative to no food outlets. Finally, multiple food options within a neighborhood reduce BMI/obesity risk, relative to no food options, for individuals living in either low-income or non-low neighborhoods.
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20
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Sari N. Physical inactivity and its impact on healthcare utilization. HEALTH ECONOMICS 2009; 18:885-901. [PMID: 18792089 DOI: 10.1002/hec.1408] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Physically inactive people are expected to use more healthcare services than active people. This inactivity imposes costs on the collectively funded health insurance programs. In this paper, excess utilization of healthcare services due to physical inactivity is examined using count data models and the Canadian Community Health Survey. The aim of the paper is to estimate utilization of healthcare services associated with inactivity and to estimate its impact on the Canadian healthcare system. The results suggest that physical inactivity increases hospital stays, and use of physician and nurse services. On average, an inactive person spends 38% more days in hospital than an active person. S/he also uses 5.5% more family physician visits, 13% more specialist services, and 12% more nurse visits than an active individual. The subsequent social cost of inactivity for the healthcare system is substantial.
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Affiliation(s)
- Nazmi Sari
- Department of Economics & SPHERU, University of Saskatchewan, Saskatoon, Sask., Canada.
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Cobiac LJ, Vos T, Barendregt JJ. Cost-effectiveness of interventions to promote physical activity: a modelling study. PLoS Med 2009; 6:e1000110. [PMID: 19597537 PMCID: PMC2700960 DOI: 10.1371/journal.pmed.1000110] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Accepted: 06/04/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity. METHODS AND FINDINGS From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered. CONCLUSIONS Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector. Please see later in the article for Editors' Summary.
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Affiliation(s)
- Linda J Cobiac
- Centre for Burden of Disease and Cost-Effectiveness, School of Population Health, The University of Queensland, Herston, Queensland, Australia.
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22
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Zintz T. Les organisations sportives nationales sont-elles des acteurs économiques de la santé ? Sci Sports 2009. [DOI: 10.1016/j.scispo.2007.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Active Living Research program: six years of grantmaking. Am J Prev Med 2009; 36:S10-21. [PMID: 19147053 DOI: 10.1016/j.amepre.2008.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 10/06/2008] [Accepted: 10/06/2008] [Indexed: 11/20/2022]
Abstract
Changes in policies and built environments are advocated as part of efforts to increase physical activity, but in 2001 the knowledge base to inform these changes was limited. The Robert Wood Johnson Foundation addressed this deficit by initiating Active Living Research (ALR). The mission of ALR was to stimulate and support research that could guide the improvement of environments, policies, and practices to promote active living. The program's goals were to (1) build the evidence base about environmental and policy factors related to physical activity, (2) build the capacity of researchers in multiple fields to collaborate, and (3) inform and facilitate policy change. To build the evidence base, 121 grants were supported with $12.5 million. Efforts were made to support new investigators, fund investigators from numerous disciplines, and increase the demographic diversity of researchers. Activities to build capacity to conduct collaborative research included annual conferences, journal supplements, seminars for multiple disciplines, and the posting of environmental measures. Coordination with Active Living Leadership was a primary means of communicating research to policymakers. Other activities to facilitate the application of research included research summaries written for nonresearchers, collaborations with Active Living by Design, several components of the website (www.activelivingresearch.org), and using policy relevance as a funding criterion. Two independent evaluations were accomplished, and they concluded that ALR made progress on all three goals. ALR has been renewed through 2012. The new mission is to use a $15.4 million research budget to contribute to reversing the childhood obesity epidemic, especially among youth in the highest-risk groups.
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Romé Å, Persson U, Ekdahl C, Gard G. Physical activity on prescription (PAP): costs and consequences of a randomized, controlled trial in primary healthcare. Scand J Prim Health Care 2009; 27:216-22. [PMID: 19929183 PMCID: PMC3413913 DOI: 10.3109/02813430903438734] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse costs and consequences of changing physical activity behaviour due to the "Physical Activity on Prescription" (PAP) programme. DESIGN A randomized controlled trial with a four-month intervention, with comparison between intervention and control group. Intervention. The PAP programme, with exercise twice a week, education, and motivational counselling. SUBJECTS 525 sedentary individuals, 20-80 years (intervention group n = 268, control group n = 257), with lifestyle-related health problems. A total of 245 returned for the four-month assessment. MAIN OUTCOME MEASURE Programme costs based on intention-to-treat estimations, direct and indirect costs of inactivity, and physical activity behaviour analysed with IPAQ (International Physical Activity Questionnaire), self-reported physical activity, and measures of functional capacity. RESULTS The intention-to-treat programme costs for the four-month programme period was SEK (Swedish Kronor) 6475 (euro [Euro] 684) for the intervention group and SEK 3038 (euro 321) for the control group. Of this, healthcare providers' costs were 24% in the intervention group, and 31% in the control group. The physical activity behaviour was significantly improved in both groups, but no differences were found between the groups. Implications. The largest share of the PAP programme costs was the participants' costs. Significant improvements were shown in physical activity behaviour in both groups, but no differences were found between the intervention and control groups. Due to many non-completers, the potential for improvements of the motivating assignment with sedentary individuals in primary healthcare is obvious. Long-term follow-up can determine the sustainability of the results, and can be used in a future cost-effectiveness analysis.
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Affiliation(s)
- Åsa Romé
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund
| | - Ulf Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Charlotte Ekdahl
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund
| | - Gunvor Gard
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund
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25
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China's transition: the effect of rapid urbanization on adult occupational physical activity. Soc Sci Med 2006; 64:858-70. [PMID: 17125897 DOI: 10.1016/j.socscimed.2006.10.019] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Indexed: 12/13/2022]
Abstract
China has recently undergone rapid social and economic change. Increases in urbanization have led to equally rapid shifts toward more sedentary occupations through the acquisition of new technology and transitions away from a mostly agricultural economy. Our purpose was to utilize a detailed measure of urbanicity comprising 10 dimensions of urban services and infrastructure to examine its effects on the occupational physical activity patterns of Chinese adults. Longitudinal data were from individuals aged 18-55 from the years 1991-1997 of the China Health and Nutrition Survey (N=4376 men and 4384 women). Logistic multilevel regression analyses indicated that men had 68% greater odds, and women had 51% greater odds, of light versus heavy occupational activity given the mean change in urbanization over the 6-year period. Further, simulations showed that light occupational activity increased linearly with increasing urbanization. After controlling for individual-level predictors, community-level urbanization explained 54% and 40% of the variance in occupational activity for men and women, respectively. This study provides empirical evidence of the reduction in intensity of occupational activity with modernization. It is likely that urbanization will continue unabated in China and this is liable to lead to further transitions in the labor market resulting in additional reductions in work-related activity. Because occupational activity remains the major source of energy expenditure for adults, unless alternative forms are widely adopted, the Chinese population is at risk of dramatic increases in the numbers of overweight and obese individuals.
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Pierce JR, Denison AV, Arif AA, Rohrer JE. Living near a trail is associated with increased odds of walking among patients using community clinics. J Community Health 2006; 31:289-302. [PMID: 16894827 DOI: 10.1007/s10900-006-9014-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We tested the hypothesis that living near a walking or cycling trail was associated with greater odds of walking. This has been previously studied in healthy and unselected populations, but to our knowledge has not been studied in patients attending community clinics. A cross-sectional survey was completed by 1211 persons in five community clinics that serve poor populations. We performed univariate analysis and developed a multivariate logistic regression model for walking adjusting for 12 independent variables including self-rated health, frequent mental distress, lifestyle and demographic variables, and environmental characteristics of the neighborhood including perceived proximity to a walking or cycling trail. Compared to those who reported not living close to a trail, persons who reported living near a trail were more likely to meet recommended levels of walking of at least 30 minutes fives times per week (unadjusted odds ratio = 1.49, 95% confidence intervals = 1.04-2.13). In the multivariate model, male gender (unadjusted odds ratio = 1.63, 95% confidence intervals = 1.15-2.30), having three or more convenient destinations (unadjusted odds ratio = 1.78, 95% confidence intervals = 1.37-2.32), and living near a trail (unadjusted odds ratio = 1.45, 95% confidence intervals = 1.01-2.09) were positively associated with walking at statistically significant levels. The odds of walking were lower in non-Hispanic blacks (odds ratio = 0.59, 95% confidence intervals = 0.40-0.87) and current smokers (odds ratio = 0.66, 95% confidence intervals = 0.57-0.76). For patients attending community clinics, environmental strategies to encourage walking may include mixed-land-use neighborhoods and construction of trails.
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Affiliation(s)
- J Rush Pierce
- Amarillo Bi-City-County Health District, Amarillo, Texas, USA.
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Affiliation(s)
- James F Sallis
- Department of Psychology, San Diego State University, San Diego, CA 92103, USA.
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Affiliation(s)
- Richard J Jackson
- State Public Health Officer, California Department of Health Services, Sacramento, CA 95814, USA.
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Powell KE. Land use, the built environment, and physical activity: a public health mixture; a public health solution. Am J Prev Med 2005; 28:216-7. [PMID: 15694531 DOI: 10.1016/j.amepre.2004.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kenneth E Powell
- Georgia Department of Human Resources, Division of Public Health, Atlanta, GA 30303, USA.
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