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Müller C, Paulsen L, Bucksch J, Wallmann-Sperlich B. Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review. Int J Behav Nutr Phys Act 2024; 21:52. [PMID: 38702772 PMCID: PMC11067138 DOI: 10.1186/s12966-024-01598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking. METHODS We searched five databases and included studies for adults (18-65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results. RESULTS Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting). CONCLUSIONS Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults. TRIAL REGISTRATION PROSPERO: CRD42021283508.
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Affiliation(s)
- Christina Müller
- Institute of Sport Science, University of Würzburg, Judenbühlweg 11, 97082, Würzburg, Germany.
| | - Lisa Paulsen
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
| | - Jens Bucksch
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
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MacMillan Uribe AL, Demment M, Graham ML, Szeszulski J, Rethorst CD, Githinji P, Nelson ME, Strogatz D, Folta SC, Bailey RL, Davis JN, Seguin-Fowler RA. Improvements in dietary intake, behaviors, and psychosocial measures in a community-randomized cardiovascular disease risk reduction intervention: Strong Hearts, Healthy Communities 2.0. Am J Clin Nutr 2023; 118:1055-1066. [PMID: 37717638 PMCID: PMC10636233 DOI: 10.1016/j.ajcnut.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) prevalence has disproportionately risen among midlife and older female adults of rural communities, partly due to poor diet and diet-related behaviors and psychosocial factors that impede healthy eating. OBJECTIVES This study aimed to evaluate the impact of Strong Hearts Healthy Communities 2.0 (SHHC-2.0) on secondary diet-related outcomes between intervention and control participants that align with the dietary goal and behavioral aims of the SHHC-2.0, a CVD risk reduction program. METHODS A community-randomized controlled trial was conducted in rural, medically underserved communities. Participants were female adults ≥40 y who were classified as obese or both overweight and sedentary. Communities were randomized to SHHC-2.0 intervention (n = 5 communities; n = 87 participants) or control (with delayed intervention) (n = 6 communities; n = 95 participants). SHHC-2.0 consisted of 24 wk of twice-weekly experiential nutrition education and group-based physical activity classes led by local health educators. Changes between baseline and end point (24 wk) in dietary intake (24-h recalls), dietary behaviors (e.g., Rapid Eating Assessment for Participants-Short Version [REAP-S] scores) and diet-related psychosocial measures (e.g., Three Factor Eating questionnaire) between groups were analyzed using linear mixed-effects multilevel models. RESULTS At 24 wk, participants from the 5 intervention communities, compared with controls, consumed fewer calories (mean difference [MD]= -211 kcal, 95% CI: -412, -110, P = 0.039), improved overall dietary patterns measured by REAP-S scores (MD: 3.9; 95% CI: 2.26, 5.6; P < 0.001), and improved psychosocial measures (healthy eating attitudes, uncontrolled eating, cognitive restraint, and emotional eating). CONCLUSIONS SHHC-2.0 has strong potential to improve diet patterns and diet-related psychosocial wellbeing consistent with improved cardiovascular health. This trial was registered at www. CLINICALTRIALS gov as NCT03059472.
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Affiliation(s)
| | - Margaret Demment
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Meredith L Graham
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Jacob Szeszulski
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Chad D Rethorst
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Phrashiah Githinji
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Miriam E Nelson
- Tufts University, Friedman School of Nutrition, Boston, MA, United States
| | - David Strogatz
- Bassett Research Institute, Cooperstown, NY, United States
| | - Sara C Folta
- Tufts University, Friedman School of Nutrition, Boston, MA, United States
| | - Regan L Bailey
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Jaimie N Davis
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, United States
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Randall NL, Sanders CE, Lamm AJ, Berg AC. Qualitative Exploration of Cultural Influence on a Rural Health-Promotion Initiative. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:255-265. [PMID: 36670027 DOI: 10.1016/j.jneb.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To develop a conceptualization of cultural influence on perceptions of a rural food and physical activity policy, systems, and environmental (PSE) change project to inform public health research and practice. DESIGN Basic qualitative research design, semistructured phone interviews with community health coalition members. SETTING Five rural Southern counties (obesity prevalence > 40%). PARTICIPANTS Thirty-nine community coalition members. INTERVENTION The Centers for Disease Control and Prevention High Obesity Program. PSE initiatives to increase access to healthy food and physical activity opportunities through a community coalition model. PHENOMENON OF INTEREST Social norms and cultural influences surrounding community members' food preferences, physical activity behavior, and future hopes for community development. ANALYSIS Abductive content analysis. RESULTS Major categories on food social norms (subcategories: physical health, eating habits, and food preference), race relations, generational factors, physical activity social norms, and hopes for the community (subcategories: increased engagement, health, awareness, cohesion, and inspiration) were discussed in relation to the progress of PSE initiatives. CONCLUSIONS AND IMPLICATIONS Because of community member perceptions, PSE initiatives became associated with factors beyond food and fitness, such as race relations, generational differences, and community cohesion. A focus on increased youth and church involvement, community values, relationship building, and input from diverse voices can be foundational to culturally-appropriate PSE efforts in rural settings.
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Affiliation(s)
- Nekeisha L Randall
- Department of Lifelong Education, Administration, and Policy, Mary Frances Early College of Education, University of Georgia, Athens, GA; Department of Agricultural Leadership, Education, and Communication, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA
| | - Catherine E Sanders
- Department of Agricultural Leadership, Education, and Communication, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA.
| | - Alexa J Lamm
- Department of Agricultural Leadership, Education, and Communication, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA
| | - Alison C Berg
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA
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Galbraith N, Rose C, Rose P. The roles of motivational interviewing and self-efficacy on outcomes and cost-effectiveness of a community-based exercise intervention for inactive middle-older aged adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1048-e1060. [PMID: 34260782 DOI: 10.1111/hsc.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Increasing physical activity (PA) among inactive middle-older aged adults in rural communities is challenging. This study investigates the efficacy of a PA intervention supporting inactive adults in rural/semirural communities. Inactive participants enrolled on either a single signposting session (n =427) or a multisession pathway combining signposting with motivational interviewing (MI; n = 478). Pre-post outcomes data assessed activity levels (International Physical Activity Questionnaire-Short Form; Single Item Sport England Measure), self-efficacy (New General Self-Efficacy scale [NGSE]) and well-being (five-item World Health Organization Well-Being Index [WHO-5]). Measures were repeated at longitudinal time points (26, 52 weeks) for the MI pathway. Outcomes were contrasted with results from an unmatched comparison group receiving treatment as usual (TAU). Cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) were estimated for short (5 years), medium (10 years) and long (25 years) time horizons. Both pathways significantly increased participants' PA. The MI pathway resulted in significantly greater increases in PA than signposting-only and TAU. Improvements in psychological outcomes (NGSE; WHO-5) were significantly greater in the MI pathway than TAU. Longitudinal results indicated MI pathway participants sustained increases in light-intensity PA at 52 weeks (p < 0.001; ηp2 = 0.16). Regression analyses found baseline self-efficacy predicted increased PA at 52 weeks, while baseline well-being did not. The relationship between self-efficacy and PA increased successively across time points. However, magnitude of participants' increased self-efficacy did not predict PA at any time point. Both pathways were cost-effective and cost -saving for participants aged ≥61 years from the short time horizon, with the MI pathway having greater ROI estimates. Overall, MI increased efficacy of a signposting PA intervention and was cost-saving for older adults.
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Affiliation(s)
- Niall Galbraith
- Department of Psychology, Institute of Human Sciences, University of Wolverhampton, Wolverhampton, UK
| | | | - Peter Rose
- Tiller Research Ltd., Worcestershire, UK
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White MJ, Holliday KM, Hoover S, Robinson-Ezekwe N, Corbie-Smith G, Williams A, Bess K, Frerichs L. The significant places of African American adults and their perceived influence on cardiovascular disease risk behaviors. BMC Public Health 2021; 21:2018. [PMID: 34740336 PMCID: PMC8570769 DOI: 10.1186/s12889-021-12022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AA living in rural areas of the southeastern U.S. experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality. Neighborhood environmental factors contribute to this disparity and may decrease the effectiveness of lifestyle interventions aimed at preventing CVD. Furthermore, the influence of neighborhood factors on AA CVD risk behaviors (i.e. physical activity) may be obscured by the use of researcher-defined neighborhoods and researcher-defined healthy and unhealthy places. The objective of this study was to elucidate the effects of neighborhood environments on AA CVD risk behaviors among AA adults who recently completed a lifestyle intervention. We specifically sought to identify AA adults' self-perceived places of significance and their perceptions of how these places impact CVD risk behaviors including diet, physical activity and smoking. METHODS We conducted semi-structured interviews with AA adults (N = 26) living in two rural North Carolina counties (Edgecombe and Nash, North Carolina, USA). Participants were recruited from a community-based behavioral CVD risk reduction intervention. All had at least one risk factor for CVD. Participants identified significant places including where they spent the most time, meaningful places, and healthy and unhealthy places on local maps. Using these maps as a reference, participants described the impact of each location on their CVD risk behaviors. Data were transcribed verbatim and coded using NVivo 12. RESULTS The average age of participants was 63 (SD = 10) and 92% were female. Places participants defined as meaningful and places where they spent the most time included churches and relatives' homes. Healthy places included gyms and parks. Unhealthy places included fast food restaurants and relatives' homes where unhealthy food was served. Place influenced CVD risk behaviors in multiple ways including through degree of perceived control over the environment, emotional attachment and loneliness, caretaking responsibilities, social pressures and social support. CONCLUSIONS As we seek to improve cardiovascular interventions for rural AA in the American South, it will be important to further assess the effect of significant places beyond place of residence. Strategies which leverage or modify behavioral influences within person-defined significant places may improve the reach and effectiveness of behavioral lifestyle interventions.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics, Duke University School of Medicine, DUMC 102376, 2301 Erwin Rd, Durham, NC, 27705, USA.
| | - Katelyn M Holliday
- Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914, Durham, NC, 27710, USA
| | - Stephanie Hoover
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, 323 MacNider Hall, CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Nicole Robinson-Ezekwe
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, 323 MacNider Hall, CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Giselle Corbie-Smith
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, 323 MacNider Hall, CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Anissa Williams
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, 323 MacNider Hall, CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Kiana Bess
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Leah Frerichs
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, 323 MacNider Hall, CB #7240, Chapel Hill, NC, 27599-7240, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Roseneau Hall, CB #7400, Chapel Hill, NC, 27599-7400, USA
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Maternal Perceptions of Physical Activity Spaces for Children in Texas Border colonias. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2021. [DOI: 10.1177/07399863211044887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined differences in mother-reported physical activity (PA) and screen time (ST) based on child sex and mothers’ perceptions of PA resources for Mexican-heritage (MH) children residing in Texas-Mexico border colonias. Mothers with children 8 to 10 years old ( n = 335) from colonias in south Texas reported if there were places for their child to be physically active and their child’s hours of PA and ST per day during the week and weekend. Two-way ANCOVAs examined differences in child PA and ST based on presence of PA places and child sex. Only 46.0% of mothers ( n = 159) reported places for their child to be physically active; with no significant difference based on sex. Mothers’ perceptions of a place to play was differentially beneficial for girls’ weekday PA and ST. Findings suggest a need to increase perceived and/or actual access to PA places in colonias communities, particularly for girls.
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Timlin D, Giannantoni B, McCormack JM, Polito A, Ciarapica D, Azzini E, Giles M, Simpson EEA. Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy. BMC Public Health 2021; 21:265. [PMID: 33530965 PMCID: PMC7852355 DOI: 10.1186/s12889-021-10307-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life. Methods This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years. Results Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only. Conclusions Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.
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Affiliation(s)
| | - Barbara Giannantoni
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | | | - Angela Polito
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | - Donatella Ciarapica
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | - Elena Azzini
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | - Melanie Giles
- Psychology Research Institute, Ulster University, Coleraine, UK
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Umstattd Meyer MR, Ylitalo KR, Prochnow T, Gómez LA, Sharkey JR. Physical Activity Space Methodology for Assessment and Prioritization (PASMAP): Combining systematic observations with community perceptions to identify community physical activity resource priorities. Health Place 2020; 66:102443. [PMID: 33010660 DOI: 10.1016/j.healthplace.2020.102443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
Despite benefits of physical activity (PA), most Americans are not regularly active, with notable disparities for residents of low-income communities. PA is positively correlated with resource availability and quality, which can be measured and quantified by PA resource assessment tools. However, community members' perceptions are often not considered. This study incorporates community perceptions with systematic environmental observations to identify community PA resource priorities. The PA Space Methodology for Assessment and Prioritization (PASMAP) includes three phases. Phase 1: Promotora-researchers completed 57 PA Resource Assessments (PARAs) in colonias along the Texas-Mexico border assessing quantity and quality of features, amenities, and incivilities. Characteristics were ranked using average PARA scores from all PA spaces. Phase 2: community advisory board (CAB) members (n = 36 from 3 CABs) ranked the importance of each feature, amenity, and incivility respectively; rankings were averaged and ordered. Phase 3: differences between phases 1 and 2 were calculated. Large differences indicated high discordance between systematic observations and perceived importance. Phase 1: highest ranked PARA characteristics were sidewalks, non-street lighting, and noise. Phase 2: CAB members ranked trails/paths, sidewalks, play equipment, bathrooms, drinking fountains, substance abuse evidence, and litter most important. Phase 3: multiple characteristics had high discordance: trails/paths, fenced-in open fields (features), drinking fountains (amenity), and litter (incivility); low quantity/poor quality yet perceived as highly important. Discordant characteristics identified through PASMAP provide evidence-based, community-valued recommendations on PA resource priorities for planning and advocacy. Future work should incorporate perceptions from additional community members and apply PASMAP methods to other environmental assessments.
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Affiliation(s)
- M Renée Umstattd Meyer
- Baylor University, Robbins College of Health and Human Sciences, One Bear Place #97303, Waco, TX, 76798, USA.
| | - Kelly R Ylitalo
- Baylor University, Department of Public Health, One Bear Place #97343, Waco, TX, 76798, USA.
| | - Tyler Prochnow
- Baylor University, Robbins College of Health and Human Sciences, One Bear Place #97303, Waco, TX, 76798, USA.
| | - Luis A Gómez
- Texas A&M University School of Public Health, College Station, TX, 77843, USA.
| | - Joseph R Sharkey
- Texas A&M University School of Public Health, College Station, TX, 77843, USA.
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Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet). Public Health Nutr 2020; 24:1657-1670. [PMID: 32799963 PMCID: PMC8094434 DOI: 10.1017/s1368980020001445] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40-55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life. DESIGN This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet. SETTING Northern Ireland. PARTICIPANTS Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face. RESULTS Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food. CONCLUSIONS This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.
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Rodríguez-Pérez R, Correa-Matos N, Valdés-Valderrama A, Rodríguez-Cruz LA, Rodríguez MC. A Qualitative Study of Puerto Rican Parent and ChildPerceptions Regarding Eating Patterns. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:608-615. [PMID: 30509552 DOI: 10.1016/j.jneb.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify barriers that prevent healthy eating practices in Puerto Rican early adolescents (EAs). DESIGN Qualitative data collected via focus groups. A total of 7 focus groups were conducted: 5 with EAs and 2 with parents and caregivers (PCs). SETTING Urban and rural Puerto Rico. PARTICIPANTS Early adolescents aged 12-14years (n = 52) and PCs (n = 17). PHENOMENON OF INTEREST Factors that prevent healthy eating behavior in EAs in Puerto Rico. ANALYSIS Verbatim transcripts from focus group interviews were coded for concept frequency, extension, and content analysis. RESULTS The 3 main factors that influenced participants' eating habits, according to EAs' and PCs' answers, were stores that sold less healthful foods on or near school and the community, parental influence in the development of unhealthy eating habits, and the low cost of unhealthy foods. CONCLUSIONS AND IMPLICATIONS When EAs chose what to eat, primary food choices were based on taste preferences, physical access, economic cost, and influence of PCs, whereas health effects had little consideration. Nutrition education programs have to meet taste preferences and provide eating options that are affordable, accessible, and easy to prepare to achieve healthy food practices among EAs.
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Affiliation(s)
- Robinson Rodríguez-Pérez
- Department of Agricultural Economics and Rural Sociology, College of Agricultural Sciences,University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico.
| | - Nancy Correa-Matos
- Nutrition and Dietetics Program, College of Natural Sciences, University of Puerto Rico, Río Piedras Campus, Río Piedras, Puerto Rico
| | - Angélica Valdés-Valderrama
- Department of Agricultural Economics and Rural Sociology, College of Agricultural Sciences,University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| | - Luis Alexis Rodríguez-Cruz
- Department of Food Science and Technology, College of Agricultural Sciences, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| | - María C Rodríguez
- Department of Agricultural Education, College of Agricultural Sciences, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
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Sriram U, Sandreuter K, Graham M, Folta S, Pullyblank K, Paul L, Seguin R. Process Evaluation of Strong Hearts, Healthy Communities: A Rural Community-Based Cardiovascular Disease Prevention Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:138-149. [PMID: 30738562 PMCID: PMC6422156 DOI: 10.1016/j.jneb.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). DESIGN Mixed-methods process evaluation. SETTING/PARTICIPANTS A total of 101 women from 8 rural towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were aged ≥40 years, sedentary, and overweight or obese. Local health educators (n = 15) served as program leaders within each town. OUTCOME MEASURES Reach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. ANALYSIS Descriptive statistics, chi-square tests of independence, and thematic analysis were employed. RESULTS Intervention sites reported high levels of fidelity (82%) and dose delivered (84%). Overall reach was 2.6% and program classes were rated as effective (3.9/5). Participants were satisfied with their experience and reported benefits such as camaraderie and awareness of healthy eating and exercise strategies. Common recommendations included increasing class time and enhancing group discussion. CONCLUSIONS AND IMPLICATIONS Implementation was good in terms of fidelity, dose delivered, and satisfaction, although low reach. Findings from this research have informed a second round of implementation and evaluation of the SHHC program in rural communities.
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Affiliation(s)
- Urshila Sriram
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Meredith Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Sara Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Lynn Paul
- College of Education, Health and Development, Montana State University, Bozeman, MT
| | - Rebecca Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
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Sriram U, Morgan EH, Graham ML, Folta SC, Seguin RA. Support and Sabotage: A Qualitative Study of Social Influences on Health Behaviors Among Rural Adults. J Rural Health 2017; 34:88-97. [PMID: 28045193 DOI: 10.1111/jrh.12232] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/11/2016] [Accepted: 11/30/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Social environments exert an important influence on health behaviors, yet evidence from rural-specific contexts is limited. This study explored how social relationships influence health-related behaviors among midlife and older rural adults at increased risk of chronic disease. METHODS Seventeen focus groups were conducted with 125 sedentary, overweight/obese adults (aged 40-91 years) residing in "medically underserved" rural Montana towns in 2014. Groups were stratified by age (40-64 and ≥65) and gender. Transcripts were examined thematically using NVivo software according to social influences on diet, physical activity, and tobacco use. Analyses were conducted in 2015-2016. RESULTS Attitudes and actions of family members and friends were key influences on health behaviors, in both health-promoting and health-damaging ways. In these small, isolated communities, support from and accountability to family and friends were common facilitators of behavior change and maintenance. However, expectations to conform to social norms and traditional gender roles (eg, caregiving duties) often hindered healthy lifestyle changes. CONCLUSIONS These findings suggest that health behavior interventions targeting adults in rural settings need to consider and, if possible, integrate strategies to address the impact of social relationships in both supporting and sabotaging behavior change and maintenance.
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Affiliation(s)
- Urshila Sriram
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Emily H Morgan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
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Comstock C, Kattelmann K, Zastrow M, McCormack L, Lindshield E, Li Y, Muturi N, Adhikari K, Kidd T. Assessing the Environment for Support of Youth Physical Activity in Rural Communities. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:234-41.e1. [PMID: 26852867 DOI: 10.1016/j.jneb.2015.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Assess environmental support of physical activity (PA) in rural areas and determine whether there is a correlation between the measured environment for PA and participant perceptions of the environment for PA. DESIGN The PA environment was assessed using the Active Neighborhood Checklist (ANC) and the Physical Activity Resource Assessment (PARA). Youth behavior and perceptions related to PA and the local environment were assessed using 5 questions from previously validated tools. SETTING Four rural low-income communities in South Dakota and Kansas. PARTICIPANTS Sixth- through eighth-grade youth. VARIABLES MEASURED Physical Activity Resource Assessment, ANC, behavior, and perception. ANALYSIS The authors used ANOVA to determine whether there were differences in ANC, PARA, and Perception of the Environment scores among communities. Pearson correlations were used to assess associations between ANC and student perception of the environment and PARA and student perception of the environment. RESULTS There were no differences in total ANC or total PARA among communities. Perception was weakly correlated with total ANC (multivariate coefficient, 0.016; P = .026; n = 308) but not total PARA. CONCLUSIONS AND IMPLICATIONS Perception of PA in rural communities may not match objective measures. Future research should work toward refining and improving existing environmental audit tools and developing new, comprehensive, location-specific tools.
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Affiliation(s)
- Christopher Comstock
- Health and Nutritional Sciences Department, South Dakota State University, Brookings, SD
| | - Kendra Kattelmann
- Health and Nutritional Sciences Department, South Dakota State University, Brookings, SD.
| | - Marjorie Zastrow
- South Dakota State University Extension Services, South Dakota State University, Brookings, SD
| | - Lacey McCormack
- Health and Nutritional Sciences Department, South Dakota State University, Brookings, SD
| | - Erika Lindshield
- Department of Human Nutrition, Kansas State University, Manhattan, KS
| | - Yijing Li
- Department of Human Nutrition, Kansas State University, Manhattan, KS
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, Kansas State University, Manhattan, KS
| | - Koushik Adhikari
- Department of Food Science and Technology, University of Georgia, Athens, GA
| | - Tandalayo Kidd
- Department of Human Nutrition, Kansas State University, Manhattan, KS
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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15
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Belon AP, Nieuwendyk LM, Vallianatos H, Nykiforuk CIJ. Community Lenses Revealing the Role of Sociocultural Environment on Physical Activity. Am J Health Promot 2016; 30:e92-100. [PMID: 25973966 PMCID: PMC4945163 DOI: 10.4278/ajhp.140428-qual-169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify perceptions of how sociocultural environment enabled and hindered physical activity (PA) participation. DESIGN Community-based participatory research. SETTING Two semirural and two urban communities located in Alberta, Canada. PARTICIPANTS Thirty-five people (74.3% females, 71.4% aged 25-64 years) across the four communities. METHOD PhotoVoice activities occurred over 3 months during the spring of 2009. Participants were asked to document perceived environmental attributes that might foster or inhibit PA in their community. Photographs and narratives were shared in one-on-one interviews. Line-by-line coding of the transcripts was independently conducted by two researchers using an inductive approach. Codes were arranged into themes and subthemes, which were then organized into the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. RESULTS Six main themes (accompanied by subthemes) emerged: sociocultural aesthetics, safety, social involvement, PA motivation, cultural ideas of recreation, and car culture. Representative quotes and photographs illustrate enablers and obstacles identified by participants. CONCLUSION This PhotoVoice study revealed how aspects of participants' sociocultural environments shaped their decisions to be physically active. Providing more PA resources is only one step in the promotion of supportive environments. Strategies should also account for the beautification and maintenance of communities, increasing feelings of safety, enhancement of social support among community members, popularization of PA, and mitigating car culture, among others.
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16
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Assessing Heavy Metal and PCB Exposure from Tap Water by Measuring Levels in Plasma from Sporadic Breast Cancer Patients, a Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15683-91. [PMID: 26690196 PMCID: PMC4690949 DOI: 10.3390/ijerph121215013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/19/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022]
Abstract
Breast cancer (BrCA) is the most common cancer affecting women around the world. However, it does not arise from the same causative agent among all women. Genetic markers have been associated with heritable or familial breast cancers, which may or may not be confounded by environmental factors, whereas sporadic breast cancer cases are more likely attributable to environmental exposures. Approximately 85% of women diagnosed with BrCA have no family history of the disease. Given this overwhelming bias, more plausible etiologic mechanisms should be investigated to accurately assess a woman’s risk of acquiring breast cancer. It is known that breast cancer risk is highly influenced by exogenous environmental cues altering cancer genes either by genotoxic mechanisms (DNA mutations) or otherwise. Risk assessment should comprehensively incorporate exposures to exogenous factors that are linked to a woman’s individual susceptibility. However, the exact role that some environmental agents (EA) play in tumor formation and/or cancer gene regulation is unclear. In this pilot project, we begin a multi-disciplinary approach to investigate the intersection of environmental exposures, cancer gene response, and BrCA risk. Here, we present data that show environmental exposure to heavy metals and PCBs in drinking water, heavy metal presence in plasma of nine patients with sporadic BrCA, and Toxic Release Inventory and geological data for a metal of concern, uranium, in Northeast Georgia.
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Hansen AY, Umstattd Meyer MR, Lenardson JD, Hartley D. Built Environments and Active Living in Rural and Remote Areas: a Review of the Literature. Curr Obes Rep 2015; 4:484-93. [PMID: 26364307 DOI: 10.1007/s13679-015-0180-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rural children and adults are more likely to have obesity than their urban counterparts even after adjustment for individual-level behaviors, suggesting that rural environments may promote obesity. The rural built environment may be an important area of research that can help us understand rural-urban disparities in obesity. The purpose of this review is to summarize the rural built environment and active living literature, and to address key issues, gaps, and observations in the field. A literature review was conducted in spring 2015 to identify research published from 2000 to 2015. Our review suggests that limited active living built environments in rural communities and unique rural barriers to physical activity may contribute to a higher prevalence of obesity compared to urban populations. More empirical research is needed to build the evidence-base for the association between rural built environments, active living, and obesity. School- and community-based policies that expand active living opportunities in rural areas should also be closely examined.
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Affiliation(s)
- Anush Yousefian Hansen
- Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - M Renée Umstattd Meyer
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, One Bear Place, #97313, Waco, TX, 76798, USA.
| | - Jennifer D Lenardson
- Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - David Hartley
- Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
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Abstract
Within most developed countries, rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities. This review will describe the rural community, home, and individual food environments and what is known about their roles in healthy eating.
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Affiliation(s)
- Jennifer D Lenardson
- Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - Anush Y Hansen
- Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - David Hartley
- Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
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19
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Seguin R, Connor L, Nelson M, LaCroix A, Eldridge G. Understanding barriers and facilitators to healthy eating and active living in rural communities. J Nutr Metab 2014; 2014:146502. [PMID: 25574386 PMCID: PMC4276670 DOI: 10.1155/2014/146502] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/07/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022] Open
Abstract
Objective. Studies demonstrate that people's food and physical activity (PA) environments influence behavior, yet research examining this in rural communities is limited. Methods. Focus groups of 8-15 women were conducted in rural communities in seven US states. Questions were designed to identify factors within residents' food and PA environments they felt helped or hindered them from eating healthfully and being physically active. Results. Participants were aged 30-84 years; mean (SD) = 61 (14) (N = 95). On average, communities had fewer than 5,000 residents. Limited time, social norms, and distances from or lack of exercise facilities were common PA barriers. Facilitators for PA included social support, dog walking, and availability of affordable facilities. Healthy eating barriers included the perception that healthy foods were too expensive; calorically dense large portion sizes served at family meals; and frequency of eating foods away from home, which were perceived as generally unhealthy. Healthy eating supports included culture/value around local food gathering (e.g., hunting and gardening) and preservation (e.g., canning and smoking). Friends and family were frequently identified as key influencers of eating and PA behavior. Conclusions. Targeting both social and built environment factors, particularly those unique to rural locales, may enhance support for healthy eating and PA behavior change interventions.
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Affiliation(s)
- Rebecca Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Leah Connor
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Miriam Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Redefining racial residential segregation and its association with physical activity among African Americans 50 years and older: a mixed methods approach. J Aging Phys Act 2014; 23:237-46. [PMID: 24812201 DOI: 10.1123/japa.2013-0069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Physical inactivity is one of the factors contributing to disproportionate disease rates among older African Americans. Previous literature indicates that older African Americans are more likely to live in racially segregated neighborhoods and that racial residential segregation is associated with limited opportunities for physical activity. A cross-sectional mixed methods study was conducted guided by the concept of therapeutic landscapes. Multilevel regression analyses demonstrated that racial residential segregation was associated with more minutes of physical activity and greater odds of meeting physical activity recommendations. Qualitative interviews revealed the following physical activity related themes: aging of the neighborhood, knowing your neighbors, feeling of safety, and neighborhood racial identity. Perceptions of social cohesion enhanced participants' physical activity, offering a plausible explanation to the higher rates of physical activity found in this population. Understanding how social cohesion operates within racially segregated neighborhoods can help to inform the design of effective interventions for this population.
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Justesen L, Mikkelsen BE, Gyimóthy S. Understanding hospital meal experiences by means of participant-driven-photo-elicitation. Appetite 2014; 75:30-9. [DOI: 10.1016/j.appet.2013.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/26/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022]
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McPhail D, Chapman GE, Beagan BL. The rural and the rotund? A critical interpretation of food deserts and rural adolescent obesity in the Canadian context. Health Place 2013; 22:132-9. [PMID: 23694820 DOI: 10.1016/j.healthplace.2013.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/25/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
Resting on the notion that rural spaces are "food deserts," rural adolescents are increasingly regarded as a "problem population" in Western obesity narratives. Using qualitative data gleaned from interviews with 51 teenage participants from rural areas across Canada, this paper focuses on the ways in which obesity is constructed as a rural disease in the Canadian context, demonstrating in particular how discourses of food deserts and related rural obesity rely on classist imaginings of obesity as a working-class embodiment. The paper will further question the understanding of the rural as a food desert, showing the ways in which rural teens acquire fresh, healthy foods in part through an informal economy of food growing and sharing.
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Affiliation(s)
- Deborah McPhail
- Community Health Sciences, Faculty of Medicine, University of Manitoba, S-113 750 Bannatyne Ave. Winnipeg, MB, Canada.
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DeGuzman PB, Kulbok PA. Changing health outcomes of vulnerable populations through nursing's influence on neighborhood built environment: a framework for nursing research. J Nurs Scholarsh 2012; 44:341-8. [PMID: 23062005 DOI: 10.1111/j.1547-5069.2012.01470.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this article is to present a framework for nurses to study the impact of built environment on health, particularly in vulnerable populations. ORGANIZING CONSTRUCT The framework is adapted from Social Determinants of Health and Environmental Health Promotion, a framework describing how physical and social environments interact to influence individual and population health and health disparities via macro, community-level, and interpersonal factors. METHODS The original framework was modified for public health nursing using nursing research evaluating built environment and health, and supplemented with Nightingale's theory of nursing and health. FINDINGS The built environment affects health through regional-, neighborhood-, and individual-level factors. Nursing can affect the health of patients by evaluating the neighborhood built environment where patients reside, and by advocating for changes to the built environment. CONCLUSIONS Through development of built environment research, nurses can provide valuable insight into the pathways linking built environment to health of vulnerable populations, providing evidence for public health nurses to advocate for these changes on a neighborhood, state, and federal level. CLINICAL RELEVANCE This framework can be used by public health clinicians to understand the pathways by which the built environment may be affecting the health of their patients, and by researchers to investigate the pathways, and to design and test community interventions.
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Michimi A, Wimberly MC. Natural Environments, Obesity, and Physical Activity in Nonmetropolitan Areas of the United States. J Rural Health 2012; 28:398-407. [DOI: 10.1111/j.1748-0361.2012.00413.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sobal J, Blake C, Jastran M, Lynch A, Bisogni CA, Devine CM. Eating Maps: Places, Times, and People in Eating Episodes. Ecol Food Nutr 2012; 51:247-64. [DOI: 10.1080/03670244.2012.674444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Litt JS, Soobader MJ, Turbin MS, Hale JW, Buchenau M, Marshall JA. The influence of social involvement, neighborhood aesthetics, and community garden participation on fruit and vegetable consumption. Am J Public Health 2011; 101:1466-73. [PMID: 21680931 DOI: 10.2105/ajph.2010.300111] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We considered the relationship between an urban adult population's fruit and vegetable consumption and several selected social and psychological processes, beneficial aesthetic experiences, and garden participation. METHODS We conducted a population-based survey representing 436 residents across 58 block groups in Denver, Colorado, from 2006 to 2007. We used multilevel statistical models to evaluate the survey data. RESULTS Neighborhood aesthetics, social involvement, and community garden participation were significantly associated with fruit and vegetable intake. Community gardeners consumed fruits and vegetables 5.7 times per day, compared with home gardeners (4.6 times per day) and nongardeners (3.9 times per day). Moreover, 56% of community gardeners met national recommendations to consume fruits and vegetables at least 5 times per day, compared with 37% of home gardeners and 25% of nongardeners. CONCLUSIONS Our study results shed light on neighborhood processes that affect food-related behaviors and provides insights about the potential of community gardens to affect these behaviors. The qualities intrinsic to community gardens make them a unique intervention that can narrow the divide between people and the places where food is grown and increase local opportunities to eat better.
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Affiliation(s)
- Jill S Litt
- Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO 80045, USA.
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