'We need a safe, walkable way to connect our sisters and brothers': a qualitative study of opportunities and challenges for neighborhood-based physical activity among residents of low-income African-American communities

Motivation for Physical Activity in Low-Income Adults: An Integrative Literature Review

AIM

To explore, review and assess the literature on motivation for physical activity in low-income adults to inform future research and clinical interventions.

DESIGN

An integrative review of the literature on motivation for physical activity in low-income adults.

METHODS

Whittemore and Knaul's five-stage methodological approach for integrative reviews was utilised. Studies written in English that focused primarily on low-income adults discussed physical activity and included a component of motivation or drive were included. The Johns Hopkins Evidence Level and Quality Guide was used to assess the quality of the studies.

DATA SOURCES

PubMed, CINAHL, PsycINFO, SPORTDiscuss and Google Scholar from 1 January 2018 - 23 August 2024.

RESULTS

A total of 20 studies met the inclusion criteria. Three main categories of factors impacting physical activity in low-income adults were identified: (1) motivators for physical activity, (2) barriers for physical activity (3) and items that were both a motivator and a barrier. Despite the key role nurses play in promoting health and wellness, studies conducted by nurses or employing nursing interventions were notably absent.

CONCLUSION

This integrative literature review highlights the need for more information about what motivates low-income adults to be more physically active.

IMPLICATIONS FOR THE PROFESSION

Understanding the experience of low-income adults with physical activity is integral to meeting their needs and facilitating increased physical activity. Future research should utilise nursing theories and interventions to improve physical activity levels among low-income adults.

IMPACT

This study addressed physical inactivity in low-income adults. More information is needed about motivation for physical activity. This information will impact researchers and clinicians.

REPORTING METHOD

The search strategy and reporting method were consistent with PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Neighborhood Disadvantage and Prostate Tumor Aggressiveness among African American and European American Men

BACKGROUND

Studies have identified associations between neighborhood disadvantage (ND), which is more likely to affect African American (AA) individuals, and aggressive prostate cancer. Thus, ND may contribute to prostate cancer disparities. However, it is unknown what ND components drive aggressive disease and whether associations vary by race.

METHODS

We evaluated associations between aggressive prostate cancer and four ND metrics-Area Deprivation Index (ADI), validated Bayesian Neighborhood Deprivation Index (NDI), racial isolation (RI) index, and historical redlining, and whether these factors interacted with race, among men with prostate cancer treated at the University of Maryland Greenebaum Comprehensive Cancer Center (2004-2021).

RESULTS

We included 1,458 men (698 European American and 760 AA). AA men were more likely to experience ND. In adjusted models, the ADI, RI, and redlining were significantly associated with aggressive versus nonaggressive prostate cancer overall [ADI, OR for one SD increase = 1.14, 95% confidence interval (CI), 1.00-1.30; RI, OR = 1.27, CI, 1.07-1.51; redlining, OR = 1.77; CI, 1.23-2.56] and among AA men. The NDI was associated with aggressive prostate cancer among AA men (OR = 1.32, 95% credible interval: 1.13-1.57); percent in poverty received the largest importance weight. The ADI (P heterogeneity = 0.002) and NDI (exceedance probability heterogeneity = 98.1%) significantly interacted with race, such that associations were significantly stronger for AA men.

CONCLUSIONS

We identified novel significant positive associations for racial segregation and historical redlining with aggressive prostate cancer and significant interactions between ND indices and race.

IMPACT

Findings inform specific ND components that are associated with aggressive prostate cancer and suggest the ND effect is stronger for AA men, which has implications for interventions to reduce disparities.

Outdoor Time in Childhood: A Mixed Methods Approach to Identify Barriers and Opportunities for Intervention in a Racially and Ethnically Mixed Population

A growing body of literature suggests that outdoor time is beneficial for physical and mental health in childhood. Profound disparities exist in access to outdoor spaces (and the health benefits thereof) for children in communities of color. The objectives of this research were to: (1) identify challenges and solutions to outdoor time for children; (2) assess the importance of outdoor time for children; and (3) evaluate results stratified by race/ethnicity. Using a convergent mixed methods approach, we conducted a thematic analysis from 14 focus groups (n = 50) with outdoor educators, parents with children attending outdoor preschools, and community members with children. In addition, 49 participants completed a survey to identify challenges and solutions, perceived importance, and culturally relevant perspectives of outdoor time. The main challenges identified for outdoor time were safety concerns, inclement weather, lack of access to outdoor spaces, and parent work schedules. The primary proposed solution was integrating outdoor time into the school day. Nearly all participants, independent of racial identity, reported that outdoor time improved physical and mental health. Overall outdoor time was lower in participants from communities of color (~8 h/week) compared to their White counterparts (~10 h/week). While 50% of people of color (POC) reported that outdoor time was an important cultural value, only 18% reported that people in their respective culture spent time outside. This work contributes to accumulating knowledge that unique barriers to outdoor time exist for communities of color, and the children that live, learn, and play in these communities. Increasing outdoor time in school settings offers a potential solution to reduce identified barriers and to promote health equity in childhood.

Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review

One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.

Change in Neighborhood Socioeconomic Status and Adherence to the Cancer Prevention Lifestyle Guidelines in Hispanic/Latino Adults: Results from the HCHS/SOL Study

Neighborhood conditions are dynamic; the association of changing neighborhood socioeconomic factors with cancer preventive behaviors remains unclear. We examined associations of neighborhood socioeconomic deprivation, gentrification, and change in income inequality with adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The HCHS/SOL enrolled 16,415 adults, ages 18–74 years, at baseline (2008–2011), from communities in the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA. Geocoded baseline addresses were linked to the 2000 decennial Census and 5-year American Community Survey (2005–2009 and 2012–2016) tracts to operationalize neighborhood deprivation index (NDI), gentrification, and income inequality. Complex survey multinominal logistic regression models estimated the relative risk ratio (RRR) with overall guideline adherence level (low, moderate, high) and by components—diet, physical activity, body mass index (BMI), and alcohol intake. Overall, 14%, 60%, and 26% of the population had low, moderate, and high ACS guideline adherence, respectively. NDI was negatively associated with risk of high (vs. low) guideline adherence [RRR = 0.87, 95% confidence interval (CI) = 0.78–0.98], although attenuated after controlling for individual socioeconomic status (SES; RRR = 0.89, 95% CI = 0.80–1.00), and associated with lower adherence to BMI recommendations (low vs. moderate RRR = 0.90, 95% CI = 0.84–0.97; high RRR = 0.86, 95% CI = 0.77–0.97). Gentrification was associated with higher likelihood of meeting the dietary recommendations (low vs. moderate RRR = 1.04, 95% CI = 1.01–1.07), but not with overall adherence or individual components. Change in income inequality was not associated with outcomes. Neighborhood deprivation may be negatively associated with ACS guideline adherence among Hispanic/Latino adults.

SIGNIFICANCE

This study provides new evidence on the link between neighborhood gentrification, changing income inequality and adoption and maintenance of cancer preventive behaviors in an understudied population in cancer research. We observed that while neighborhood deprivation may deter from healthy lifestyle behaviors, positive changes in neighborhood SES via the process of gentrification, may not influence lifestyle guideline adherence among Hispanic/Latino adults.

Alzheimer disease in African American individuals: increased incidence or not enough data?

Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous progress has been made over the past two decades in our understanding of the neurobiological substrates of AD. However, owing to well-documented challenges of study participant recruitment and a persistent lack of biological data in the African American population, knowledge of the drivers of these racial disparities has lagged behind. Therapeutic targets and effective interventions for AD are increasingly sought, but without a better understanding of the disease in African American individuals, any identified treatments and/or cures will evade this rapidly growing at-risk population. In this Perspective, I introduce three key obstacles to progress in understanding racial differences in AD: uncertainty about diagnostic criteria, disparate cross-sectional and longitudinal findings; and a dearth of neuropathological data. I also highlight evidence-informed strategies to move the field forward.

In this Perspective, Barnes introduces three key obstacles to progress in our understanding of racial differences in Alzheimer disease and highlights evidence-informed strategies that can move the field forward.

Factors Associated with COVID-Related Mortality: the Case of Texas

Background

Texas ranks 2nd in the count of COVID cases. Pre-existing disparities in healthcare may be intersecting with COVID-19 outcomes.

Objectives

To explore the relationship between county-level race/ethnic composition and COVID-19 mortality in the state of Texas and determine whether county-level health factors, healthcare access measures, and other demographic characteristics explain this relationship.

Methods

This retrospective study uses county-level case and fatality data obtained from the Texas Department of State Health Services and merged with the 2020 Robert Wood Johnson foundation (RWJF) county health rankings data. The outcome variables were fatalities per 100,000 population. A two-part/hurdle model examined (1) the probability of having a COVID-19 fatality and (2) fatalities per 100,000 population in counties with 1+ fatalities. For both parts of the hurdle model, we examined the impacts of racial and ethnic composition, adjusting for county characteristics and health factors.

Results

The odds of having a COVID-19 fatality decreased with a unit increase in the rate of primary care physicians in a county (OR = 0.93; 95% CI = 0.89, 0.99). In the second part of the model, there was a statistically significant increase in COVID-19 fatalities/100,000 population with every 1 % increase in the proportion of Hispanics (β = 5.41; p = 0.03) and African Americans (β = 5.08; p value = 0.04).

Conclusion

Counties with higher rates of minorities, specifically Hispanics and African Americans, have a higher COVID-19 fatality burden. Targeted interventions are needed to raise awareness of preventive measures in these communities.

Intrapersonal and Environmental Barriers to Physical Activity Among Blacks and Latinos

OBJECTIVE

To understand perceived barriers and facilitators to physical activity (PA) among at-risk African American and Hispanic adolescents and adults in a low-income community.

DESIGN

Qualitative research was conducted in 2014-2015 using focus groups and a sociodemographic survey.

SETTING

Three high schools in South Los Angeles, California.

PARTICIPANTS

Eight high school-aged adolescent focus groups (n = 64) and 8 adult focus groups (n = 47).

PHENOMENON OF INTEREST

Perceived barriers and facilitators to PA among predominantly obese and overweight African American and Hispanic adolescents and adults.

ANALYSIS

Groups were audio recorded, transcribed, coded, and analyzed using an inductive approach.

RESULTS

Participants reported that PA resources were available on school campuses (eg, sports teams) and in the community (eg, sidewalks, local parks, fitness classes). Key barriers to PA were intrapersonal (lack of motivation and time constraints) and environmental (safety concerns), whereas facilitators included interpersonal factors (social support). Participants provided valuable insights, including recommendations to increase noncompetitive programs at schools, develop shared-use agreements, and address safety concerns at local parks and public recreational spaces.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that future efforts to promote PA among at-risk minority groups should address intrapersonal and social environmental factors. Community-based programmatic and policy recommendations are provided.