Physical Activity Interventions With African American or Latino Men: A Systematic Review

Identifying Factors That Influence Physical Activity and Healthy Aging Among Older Latino Adults

BACKGROUND

For older Latinos, some benefits of leisure-time physical activity (LTPA) include enhanced cognitive functioning, decreased loneliness, and reduced premature mortality. Despite LTPA benefits, adults ≥50 years are one of the most inactive age groups in the United States.

METHODS

This qualitative study aimed to add to the limited evidence of LTPA in older Latino adults by exploring the barriers and facilitators for fitness class uptake and park use. Guided by a Social-Ecological Model of Health and Social Determinants of Health theoretical and a phenomenological research design, qualitative research data were collected via 27 personal interviews with Latino adults using a semistructured interview guide. Participants were recruited using purposive sampling strategies in collaboration with community partners. Bicultural data collectors conducted the semistructured interviews over Zoom. Thematic analysis was performed using Dedoose, following an inductive and deductive approach.

RESULTS

The main barriers to fitness class attendance and park use were family and/or work commitments, perceived safety, and perceived discrimination. Conversely, the critical facilitators for participation were socialization into a group, social connectedness with group members, fitness instructor characteristics, and exercise history.

CONCLUSIONS

Findings from this study hold important implications for the design of fitness programming and park-based recreation, including the need to increase the cultural diversity of recreation staff and culturally relevant programming. Future research is needed on time poverty related to family/work commitments and whether discriminatory practices at fitness centers, like ageism and race/ethnicity, influence physical activity behavior.

Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

INTRODUCTION

Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts.

METHODS

The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria.

RESULTS

Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised.

DISCUSSION

CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.

Gym lifestyle factors and male reproductive health: a study into young adult usage and perceptions

RESEARCH QUESTION

What level of awareness do young adults have regarding the potential impacts of gym lifestyle factors and supplementation on male infertility?

DESIGN

Between February and March 2023 a questionnaire (n = 153) was employed to gauge attitudes to and awareness of the effects of male reproductive health and gym lifestyles on male fertility. Two semi-structured focus groups (n = 10 total), stratified by sex assigned at birth, were conducted using a set of discussion topics.

RESULTS

The survey revealed a statistically significant difference between male and female awareness of the potential impacts of some forms of high-intensity exercise and protein supplementation on male reproductive health (P = 0.045). Many men do not think about fertility unprompted; the survey revealed that fewer men have thought about their fertility compared with those who are curious about their fertility (P = 4.7  ×  10-5) and those who believe their personal fertility is important to them (P = 8.1  ×  10-6). Men were more likely to make a change in their behaviour if it had a long-term compared with a short-term effect on their fertility (P < 10-5). Five focus group themes surrounding awareness of male reproductive health were extracted.

CONCLUSIONS

This work has shown that there is a significant lack of awareness and information surrounding the effects of gym lifestyles on male infertility in a young adult UK population. Crucially, levels of awareness differ significantly between men and women. Men have a potentially alarming lack of concern over their own fertility and how factors such as gym supplements can have negative long-term impacts.

Change in Nutrition Behavior After Participating in an Obesity-Related Cancer Education Program in El Paso, Texas

BACKGROUND

Roughly 25% of the U.S- Border city, El Paso, Texas is obese. Obesity is a major risk factor for 13 cancers. Cancer is the leading cause of death in El Paso. Therefore, there is a growing urgency to implement evidence-based programs that support behavioral change that helps curb the impact of obesity in El Paso and the U.S.-Mexico border region.

PURPOSE

This study aimed to assess the effectiveness of an obesity-related cancer prevention program (Pasos Para Prevenir Cancer (PPPC) on changes in participant nutrition behaviors.

METHODS

Culturally tailored, theory-based education was provided to adults through the PPPC program. A total of 256 PPPC participants agreed to take part in our program evaluation. Participants were asked to complete a survey at baseline and 6 months after they completed the program. Session included topics on obesity-related cancers, assessing your obesity risk, measuring body fat, SMART goal setting, and how to find the right type of physical activity. For this report we used the Food Frequency Questionnaire (FFQ) data to assess changes between baseline and six months. We also used perceived dietary barriers as moderators on the relationship between program participation and nutrition behaviors.

RESULTS

Most participants (92.2%) identified as being of Mexican American descent, were between the ages of 41-75 years of age (n = 165) and identified as females (n = 225). 48.1% of the participants were born in Mexico while 50.4% were born in the U.S. Approximately 35-51% of participants improved and sustained their intake of healthier foods at 6 month follow up. Specifically, there was a statistically significant shift from higher fat and sugar content foods to light and low-fat foods, and fruits and vegetables. Participants also increased their consumption of ground chicken, lean red meat, and seafood. A key modifier in this relationship is perceived health risk.

CONCLUSION

Latinos on the U.S.-Mexico border ascribe to a healthy living mindset. In general, they frequently eat fruits and vegetables. Participation in PPPC increased perceived barriers to healthy living around cost and convenience and enhanced decision-making around healthier options. Participants responded to our adapted evidence-based program resulting in sustained changes in nutrition behaviors. Using adapted evidence-based strategies developed outside of the U.S.-Mexico border region is a feasible approach to address persist health disparities.

Tailor Made: A Pilot Virtual Weight Loss Intervention Individually Tailored for African American Men

This study tests the acceptability and feasibility of the first virtual weight loss study individually tailored for middle-aged African American men. Tailor Made is a 3-month randomized controlled pilot of a weight loss intervention that included 58 overweight or obese African American men (mean age of 50.4; SD = 7.9). Control group participants received a Fitbit activity tracker and Bluetooth-enabled scale and copies of the self-led Tailor Made curriculum. Intervention group participants received the same Fitbit, Bluetooth-enabled scale, and curriculum and also participated in weekly, 45-minute virtual small group, professional-led education sessions using the Tailor Made curriculum and received three SMS text messages weekly: (a) a message individually tailored on African American Manhood that links men's values, goals, and motivation to health-promoting behavior; (b) a goal-tracking message to monitor physical activity, healthier eating, and lifestyle changes; and (c) a reminder 24 hours before their session. Participation rates in weekly small group sessions, randomization, and attendance at the assessments suggest that Tailor Made was feasible and acceptable. Only among intervention group participants, we found a small and significant decrease in BMI between baseline and final. In addition, active minutes of physical activity decreased for the control group while active minutes for the intervention group remained steady throughout the intervention. In sum, we demonstrated that a virtual, individually tailored weight loss intervention is feasible and acceptable to African American men. Participants valued the convenience of a virtual intervention, but there were a number of ways we may be able to enhance the potential benefits of this approach.

A descriptive study of physical function and performance in older black men with low back pain

The purpose of this paper is to describe physical function and performance scores and examine the relationships between measures of physical performance in older Black men with low back pain. The Mobility, Aging, Pain, and Disparities study used a cross-sectional, observational design to objectively measure physical performance on the Short Physical Performance Battery (SPPB), the Back Performance Scale (BPS), and the 400-meter Walk Test along with subjective ratings of pain intensity in the past 24 hours. Sixty community-based Black men aged 61-87 (x̄= 70 ± 6) years had an average BPS score of 7.0 ± 4 and total score on the SPPB 8.5 ± 2.1. Average 400-meter Walk time was 6.3 ± 3.1 minutes. Men's average pain intensity in the past 24 hours was 5.7 ± 2, indicating moderate pain. In conclusion, older Black men with low back pain demonstrated low physical function scores and a higher level of disability.

Mighty Men: A Pilot Test of the Feasibility and Acceptability of a Faith-Based, Individually Tailored, Cluster-Randomized Weight Loss Trial for Middle-Aged and Older African American Men

Two in five African American men have obesity, but they are underrepresented in community-based weight loss interventions. This pilot effectiveness trial examines the acceptability and feasibility of the first weight loss study for African American men that includes randomization and individual tailoring. Using a community-based, cluster-randomized, longitudinal parallel group design, four churches were randomized to a control condition or a weight loss condition. Each church received physical activity equipment, a coordinator, and small group physical activity sessions. A total of 71 African American men (mean age: 58.5) enrolled and received a Fitbit, Bluetooth-enabled scale, a t-shirt, gift cards for participation, and 45 min of small group physical activity led by a certified personal trainer. Men in the weight loss condition also received 45 min of health education and individually tailored SMS text messages. Multiple metrics suggest that Mighty Men was feasible, yet the acceptability of the intervention components was mixed. Participants in both the weight loss and control conditions lost weight between zero and 6 months (p < .001), but body fat (p = .005) and visceral fat percentage (p = .001) of men in the weight loss condition decreased while men in the control condition did not (p < .05). An increase in physical activity was seen among men in the weight loss condition (p = .030) but not among men in the control condition (p < .05). It is acceptable and feasible to conduct a 6-month weight loss intervention with African American men that includes randomization and individually tailored text messages.

Population-based physical activity promotion with a focus on health equity: a review of reviews

BACKGROUND

The extent to which people are physically active is dependent upon social gradients. Numerous studies have shown that especially people with social disadvantages do not meet the physical activity (PA) recommendations. A promising strategy to alleviate this issue are approaches that promote PA in the general population. In addition, several researchers have raised concerns that population-based health interventions may increase health inequities. The aim of the current review of reviews was therefore to identify successful population-based PA promotion approaches with a particular focus on health equity.

METHODS

Six electronic databases were examined for systematic reviews on population-based PA promotion for the period 2015 to 2021. A reference list and grey literature search were also conducted. Two independent reviewers used inclusion/exclusion criteria to screen titles and abstracts of the potentially relevant literature and conducted a quality assessment for each identified review. All included reviews of population-based approaches for PA promotion with a focus on disadvantaged populations and/or health equity were narratively summarized.

RESULTS

Our search resulted in 4,411 hits. After a systematic review process, six reviews met the inclusion criteria and were included after they were all rated as high quality. We identified that mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches can promote PA in the general population. Across populations with social disadvantages mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective as long as they are tailored. Regarding environmental approaches, the results are inconsistent. None of the reviews on community-based multi-component approaches provided evidence on health equity.

CONCLUSION

There are several effective approaches to promote PA in the general population but evidence regarding health equity is still sparse. Future studies should therefore pay more attention to this missing focus. Furthermore, there is a lack of evidence regarding the type of tailoring and the long-term impact of population-based approaches to PA promotion. However, this requires appropriate funding programmes, complex study designs and evaluation methods.

Mexican and Puerto Rican Men's Preferences Regarding a Healthy Eating, Physical Activity and Body Image Intervention

This study examined the logistical, practical, and cultural preferences of Latinos regarding the design of a healthy eating, physical activity, and body image intervention. Puerto Rican and Mexican men (n = 203) completed an interview as part of an NIH-funded study. Overall, 66.5% preferred the intervention to be in Spanish only or both Spanish and English; 88.67% said it was moderately, very or extremely important for the intervention leader to be bilingual; and 66.01% considered it moderately to extremely important for the leader to be Hispanic or Latino. Most participants (83.74%) reported they would be willing to attend an intervention that met twice per week and 74.38% said they would be willing to attend an intervention that met for 1.5 to 2 h, twice weekly. Overall, the majority said they would be moderately to extremely interested in attending an exercise program if it consisted of aerobics with Latin or salsa movements (74.88%) and if it consisted of aerobics with Latin or salsa music (70.44%). Some participants were moderately to extremely interested in attending an intervention if it included dichos (Latino sayings) (65.02%) and cuentos (folktales or stories) (69.46%). The findings have implications for lifestyle and body image interventions aimed at preventing cardiometabolic diseases.

Resistance training for Black men with depressive symptoms: a pilot randomized controlled trial to assess acceptability, feasibility, and preliminary efficacy

BACKGROUND

Depression is under-recognized in Black men, who are less likely to seek or have access to psychiatric treatment. Resistance training (RT; i.e., weight lifting) can improve depressive symptoms and may be more acceptable to Black men, but its effects have not been examined for Black men with depressive symptoms.

METHODS

Fifty Black men with depressive symptoms were randomized to either (a) 12 weeks of RT (coupled with Behavioral Activation techniques to promote adherence) or (b) an attention-control group (Health, Wellness, and Education; HWE). Both groups met twice/week for 12 weeks, and follow-up assessments were done at end-of-treatment (EOT) and 6 months after enrollment. Changes in physical activity and muscular strength were collected as a manipulation check. The primary outcome was interviewer assessed symptoms of depression using the Quick Inventory of Depression Symptomology (QIDS). Secondary outcomes included self-reported depressive symptoms, anxiety, and stress. The association between change in QIDS from baseline to EOT and concurrent changes in physical activity and muscular strength in the RT group were explored as an initial assessment of mechanism. Longitudinal mixed effects regression models with subject-specific intercepts were used to examine intervention effects.

RESULTS

A sample with high rates of medical comorbidities (e.g., 44% HIV positive), substance use (e.g., 34% smoking), and negative social determinates of health (e.g., 50% unemployed) was enrolled. Recruitment, engagement, and retention data indicate that the intervention and design were feasible. The RT group showed greater gains in self-reported exercise (b = 270.94, SE = 105.69, p = .01) and muscular strength (b = 11.71, SE = 4.23, p = .01 for upper body and b = 4.24, SE = 2.02, p = .04 for lower body) than the HWE group. The RT group had greater reductions in QIDS scores at both EOT (b = -3.00, SE = 1.34, p = .01) and 6 months (b = -2.63, SE = 1.81, p = .04). The RT group showed a greater reduction in anxiety at EOT (b = -2.67, SE = 1.06, p = .02). Findings regarding self-reported depressive symptoms and stress were non-significant, but in the expected direction with effect sizes in the small to medium range. In the RT group, improvement on the QIDS between baseline and EOT was associated with concurrent improvements in physical activity (b = 21.03, SE = 11.16, p = .02) and muscular strength (b = 1.27, SE = .44, p = .03 for upper body and b = .75, SE = .14, p = .03 for lower body).

CONCLUSIONS

Results suggest that RT is feasible and may be efficacious for reducing depressive symptoms among underserved urban Black men.

TRIAL REGISTRATION

ClinicalTrial.gov #: NCT03107039 (Registered 11/04/2017).

Recruiting African American parents of school-aged children in a physical activity study: Lessons learned

OBJECTIVES

To describe the recruitment strategies and lessons learned when enrolling African American parents/caregivers of school-aged children (ages 6-12 years) in an online survey of physical activity. With physical activity serving as a modifiable behavioral risk factor for several chronic diseases (obesity and cardiovascular diseases), little is understood regarding the influences on African Americans' physical activity participation to develop culturally appropriate physical activity interventions. Gaining a better understanding of physical activity influences is possible through research, yet recruiting and enrolling African Americans in health research is a challenge.

METHODS

Over a three-month period, a multidimensional approach (distribution of flyers, community partnerships, network sampling, African American researcher, effective communication, and data collection procedures) was used for study recruitment.

RESULTS

We exceeded our recruitment goal of 105 participants. A total of 127 African American parent/caregivers of school-aged children enrolled, which included both females/mothers (n = 87, 69%) and males/fathers (n = 40, 31%). Network sampling was the single most effective recruitment strategy for reaching this population. Lessons learned in this study includes considering participant burden and their comfort with technology, as well as gaining community trust.

DISCUSSION

Lessons learned in recruiting African American parents provides a guide for future research. Efforts are needed to further increase the representation of African American males in health research.

Co-producing an action-oriented framework for community-based Physical Activity Promotion in Germany

German National Recommendations for Physical Activity (PA) and PA Promotion recommend community-based approaches to promote PA at the local level with a focus on health equity. In addition, the German Federal Prevention Act addresses health equity and strengthens setting-based health promotion in communities. However, the implementation of both in the local context remains a challenge. This article describes Phase 1 of the KOMBINE project that aims to co-produce an action-oriented framework for community-based PA promotion focusing on structural change and health equity. (i) In a series of workshops, key stakeholders and researchers discussed facilitators, barriers and needs of community-based PA promotion focusing on health equity. (ii) The research team used an inductive approach to cluster all findings and to identify key components and then (iii) compared the key components with updated literature. (iv) Key components were discussed and incorporated into a gradually co-produced framework by the participants. The first result of the co-production process was a catalog of nine key components regarding PA-related health promotion in German communities. The comparison of key components with scientific evidence showed a high overlap. Finally, a six-phase action-oriented framework including key components for community-based PA promotion was co-produced. The six-phase action-oriented framework integrates practice-based and scientific evidence on PA-related health promotion and health equity. It represents a shared vision for the implementation of National Recommendations for PA and PA Promotion in Germany. The extent to which structural changes and health equity can be achieved is currently being investigated in pilot-studies.

Better Together? A Pilot Study of Romantic Partner Influence on Exercise Adherence and Cardiometabolic Risk in African-American Couples

BACKGROUND

African-Americans (AAs) have higher rates of inactivity, obesity, and cardiometabolic risk compared to other races/ethnicities. Romantic partners can positively influence health habits, yet whether or not couples have to exercise together in order to adopt regular exercise remains unclear. This study examined whether exercising together influences exercise adherence and cardiometabolic risk in AA couples.

METHODS

Nine AA romantic couples (age 62.8 ± 7.7 years; body mass index 31.0 ± 4.4 kg/m2; 6105 ± 1689 average steps/day) completed a 12-week walking (≥ 30 min, 3 days/week) plus resistance training (RT; 2 days/week) pilot intervention. Couples were randomized to either exercise together (ET) or separately (ES). Waist and hip circumferences, iDXA-measured body composition, blood pressure, and blood biomarkers (glucose, hemoglobin A1c (HbA1c), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, and fibrinogen) were assessed pre- and post-intervention. Independent-sample t tests and generalized linear mixed models, controlling for gender, were used to analyze data. Significance was accepted at P < 0.05.

RESULTS

There were no significant group × time interactions for any outcome. However, ET trended toward more walking (86.5 ± 57.7 min/week) than ES (66.1 ± 31.7 min/week). There were also significant overall time effects for waist circumference (P < 0.001), body fat (P = 0.020), fat mass (P = 0.007), gynoid fat (P = 0.041), HbA1c (P = 0.020), and HDL (P = 0.047), where all variables decreased.

CONCLUSIONS

Trends showed exercising together may promote walking prescription adherence, although more research is needed in a larger sample. This intervention may also improve cardiometabolic risk factors in this population. These pilot data will inform the current investigators' future exercise intervention research in AA adult dyads.

Examining current physical activity interventions in Black school-age children and parents: A systematic review

Obesity is prevalent in Black children and adults; increasing physical activity (PA) can aid in reducing childhood obesity in both age groups. The purpose of this systematic review is to examine current research on PA interventions in school-age Black children. Adhering to PRISMA guidelines, a systematic search was conducted in six databases for PA interventions in Black children. A total of 13 articles met inclusion criteria (n = 7 randomized controlled trial, n = 5 quasi-experimental, n = 1 cross-sectional). The majority of the articles were on a combination of diet and PA programs (n = 9). Four articles targeted PA and parental role modeling of PA as the outcome showing positive intervention effects. Nine additional studies included PA as an outcome variable along with at least one additional obesity-related predictor. PA interventions for Black school-age children typically use a parent-child dyadic approach (n = 13), are guided by theory (n = 11) and are high quality. However, continued investigation is warranted to draw definitive conclusions and determine how to best involve parents within the PA interventions. Theory-driven higher quality trials that clearly describe the structured PA component and outcomes among Black parent-child dyads are needed.

A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial

Background

Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men.

Objective

To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables.

Methods

Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization.

Results

This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing.

Conclusions

We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial.

Trial Registration

Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570

International Registered Report Identifier (IRRID)

DERR1-10.2196/23690

Reasoned Action Approach Correlates of Physical Activity Among African American Men Living With HIV: A Cross-Sectional Study

ABSTRACT

Physical activity (PA) is associated with a reduced incidence of chronic diseases. However, little is known about the predictors of PA among African American men living with HIV. We report secondary analyses examining the strength of the relationships between the reasoned action approach constructs, attitude, subjective norm, descriptive norm, and self-efficacy and intention to exercise and self-reported adherence to Department of Health and Human Services PA guidelines using baseline data from a trial of a PA intervention with 302 African American men, between 40 and 88 years of age (M = 53.9; SD = 7.2) living with HIV. Multiple regression revealed that attitude, subjective norm, and self-efficacy were positively associated with intention. Logistic regression revealed higher odds of meeting PA guidelines as self-efficacy increased. Self-efficacy and descriptive norm predicted meeting the aerobic guideline. Self-efficacy predicted meeting the muscle-strengthening guideline. Interventions targeting reasoned action approach variables may contribute to efforts to improve PA among African American men living with HIV.

Overcoming barriers to physical activity in underserved populations

There is compelling evidence suggesting underserved populations, including racial/ethnic minorities and individuals with low socioeconomic status, are less likely to partake in sufficient amounts of physical activity (PA) at recommended levels. Communities of color and low-income individuals face institutional, societal, and environmental barriers that may prevent them from achieving adequate levels of PA. However, these communities also possess a wealth of knowledge, assets, and support that can be harnessed to help individuals meet PA guidelines. This paper outlines the barriers to PA and explores how to overcome them, drawing from case studies of successful, evidence-based interventions that use culturally- and linguistically- appropriate approaches to increase PA in underserved populations.

Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study

BACKGROUND

A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample.

METHODS

We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health.

RESULTS

Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency.

IMPLICATIONS

Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

Randomized Trial of a Physical Activity Intervention for Latino Men: Activo

INTRODUCTION

Latino men experience disproportionately high rates of diseases related to low physical activity, yet they are poorly represented in physical activity intervention trials. Efforts to promote physical activity in Latina women show promising results, yet such interventions are yet to be extended to Latino men. This study tested a computer expert system‒tailored, text messaging-supported physical activity intervention for underactive Spanish-speaking Latino men compared with a control group matched for contact time. Potential predictors of intervention success were also explored.

STUDY DESIGN

Randomized trial. Participants were randomized to receive a Tailored Physical Activity Intervention (Intervention) or a Wellness Control (Control). Data were collected in 2015-2017 and analyzed in 2018-2019.

SETTING/PARTICIPANTS

Insufficiently active Latino men (n=46).

INTERVENTION

Intervention participants received a baseline counseling session and then, individually tailored print materials and text messages on a tapered schedule for 6 months. Control participants received printed wellness materials and text messages on the same schedule.

MAIN OUTCOME MEASURES

Primary outcome was a change in weekly moderate to vigorous physical activity from baseline to 6 months measured by accelerometers. Self-reported moderate to vigorous physical activity measured by the 7-day Physical Activity Recall Interview was a secondary outcome.

RESULTS

For Intervention participants, median accelerometer-measured moderate to vigorous physical activity increased from 10.0 minutes/week at baseline to 57.5 minutes/week at 6 months, whereas for Control participants, it increased from 21.0 minutes/week at baseline to 23.0 minutes/week at 6 months (p<0.05). Similar results were found for self-reported moderate to vigorous physical activity. At 6 months, 47% of Intervention participants met national guidelines of 150 minutes/week versus 25% of Control participants (p=0.15, not significant).

CONCLUSIONS

Findings suggest that an individually tailored intervention can successfully increase moderate to vigorous physical activity in underactive Latino men. Such technology-supported interventions have the potential for broad dissemination.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02512419.

Confidence in Understanding Health Insurance and Challenges Paying Medical Bills Among Men in the United States

Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.

Developing a "Tailor-Made" Precision Lifestyle Medicine Intervention for Weight Control among Middle-aged Latino Men

Objective

To identify what is important to middle-aged Latino men and their personal goals and values as foundations for a future precision lifestyle medicine intervention that is rooted in Self-Determination Theory.

Design

We used a phenomenological, thematic approach to analyze data from 20 semi-structured, individual interviews with Latino men aged 35-60 years.

Setting

Community-based settings between November 2017 and May 2018 in South Florida.

Participants

Latino or Hispanic men who were aged 35-60 years. The mean age of the men was 49.8 years.

Results

Two key themes emerged: a) the characteristics that these men say define what it means to be a man; and b) the characteristics that these men say define what is important to them. "What defines a man" includes three primary subthemes: a) the attributes, characteristics and behaviors that participants understood to be ideals that a man should embody and the roles he should fulfill; b) lessons learned growing up about what it means to be a man; and c) how Latino men relate to the ideal of machismo. "What defines me" includes the subthemes: a) comparing themselves with the ideal of machismo; b) caring for family and others; and c) supporting and modeling positive behavior for their children.

Conclusions

We found key candidate mechanisms that may be novel yet critical foundations on which to build a precision lifestyle medicine intervention for Latino men. We identified actionable psychosocial factors that map onto motivational constructs that can shape behaviors that are essential for weight control and be a useful foundation for improving the health of middle-aged Latino men.

Mighty men: A faith-based weight loss intervention to reduce cancer risk in African American men

According to the American Cancer Society's guidelines on nutrition and physical activity for cancer prevention, weight control, eating practices and physical activity are second only to tobacco use as modifiable determinants of cancer risk. However, no evidence-based interventions have been targeted to African American men or tailored to individual African American men's preferences, needs or identities. The goal of this chapter is to describe the rationale for the components, aims and setting of Mighty Men: A Faith-Based Weight Loss Intervention for African American Men. We begin by discussing the rationale for focusing on weight loss in the context of cancer prevention, and argue that obesity and obesogenic behaviors are important yet modifiable determinants of cancer risk. Next, we briefly review the scarce literature on interventions to promote healthy eating, physical activity and weight loss in our population of interest, and then discuss the rationale for conducting the intervention in faith- based organizations rather than other common settings for recruiting African American men. We conclude with a discussion of the conceptual foundations and components of Mighty Men, and discuss our focus and goals in the context of the larger literature in this area.

Physical activity change after a promotora-led intervention in low-income Mexican American women residing in South Texas

BACKGROUND

The purpose of this study was to determine physical activity (PA) preferences associated with increases in moderate-to-vigorous physical activity (MVPA) and decrease in sedentary time in Mexican American (MA) women participating in a Promotora (community health worker)-led intervention on the U.S.-Mexico border.

METHODS

Enlace ('to link' in Spanish) was a randomized clinical trial to increase PA in low-income, MA women living in South Texas on the U.S.-Mexico border. A total of 620 participants were recruited into the study. The primary outcome was increase in moderate to vigorous physical activity (MVPA) using the Actigraph GT3X 16 Mb accelerometer. A modified version of the Community Health Activities Model Program for Seniors Physical Activity (CHAMPS) instrument was used to predict MVPA. Adjusted and unadjusted logistic regression models predicted change in MVPA by change in CHAMPS activities. ANOVA analysis determined the variance explained in change in MVPA by change in time engaged in activity. Individual effect sizes were then calculated for significant activity type change on MVPA increase.

RESULTS

There were significant increases in all CHAMPS activities except aerobic machines and errand walking. An increase in leisure walking (O.R. = 2.76, p = .046), errand (O.R. = 3.53, p = .051), and brisk walking (O.R. = 4.74, p = .011), dance (O.R. = 8.22, p = .003), aerobics class (O.R. = 32.7, p = .001), and light housework (O.R. = 6.75, p = .000), were associated with a decrease in sedentary time. Significant effect sizes for MVPA were observed for jogging (1.2, p = .050), general exercise (1.6, p = .024), and other exercise not specified (2.6, p = .003). Significant effect sizes for sedentary time were detected for leisure time (.031, p = .036), errands (.017, p = .022), brisk walking (.022, p = .003), dance (.042, p = .005), and aerobics class (.013, p = .009).

DISCUSSION

Participants who engaged in walking and aerobic activities through this intervention significantly increased their engagement in MVPA and decreased their sedentary time. These findings are novel, since preferences have not been examined in relation to MVPA or sedentary time in MA women.

CONCLUSION

PA preferences need to be considered when aiming to promote activities that reduce sedentary time and increase PA participation among marginalized groups, such as MA women.

TRIAL REGISTRATION

NCT02046343 .

Perceptions of Chronic Illnesses and Preventive Behaviors Among Hispanic/Latino men

INTRODUCTION

Although Latinos represent the largest minority group, their health needs continue to be poorly understood, especially regarding Latino men. The purpose of this study was to assess perceptions of chronic illnesses and preventing behaviors among Latino men residing in Pennsylvania.

METHOD

Qualitative in-depth interviews were conducted with 30 men, older than 40 years.

RESULTS

Findings from the content analysis were that several factors influenced these men, including their perceptions about the severity of chronic illnesses, their level of concerns, views about health and prevention, and when to go to see a primary care provider. In addition, cultural factors such as family, machismo, lack of preventive culture, religious beliefs, present time orientation, and sympathy and respect influence whether these men engage in preventive behaviors. Most men would like to receive information about chronic illnesses, risk factors, and screenings.

CONCLUSION

The results provide some insight into the perceptions about chronic illnesses, health screening, and preventive behaviors, and could help in the development of a health promotion and disease prevention programs targeting Latino men.

Correlates of Moderate-to-Vigorous Physical Activity and Exercise Motivation in Underserved African American Men

Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today’s Health (PATH) trial. African American men (n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA (B = 1.15, SE = .41, p = .006). Exercise attitudes (B = .16, SE = .07, p = .037), exercise self-concept (B = .28, SE = .06, p < .001), exercise support from friends (B = .12, SE = .06, p = .048), and places for walking and cycling (B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men.

ClinicalTrials.gov # NCT01025726

Romain J, Jerrod T, Griffith DM, Myers V. Development of a mobile phone app to maintain physical activity in African American men: MobileMen

BACKGROUND

African American men experience health disparities across a number of chronic diseases. mHealth technology is widely utilized to address lifestyle factors that contribute to these conditions. Participation of African American men in qualitative and quantitative studies of mHealth is low. Therefore, little is known regarding the acceptability of mHealth interventions and few interventions have been specifically developed for this population. The purpose of the current study is to describe the development of a smartphone application, MobileMen, to promote the maintenance of physical activity (PA) in African American men and to report on app feasibility when applied to the target population.

METHODS

We used a mixed methods study design including formative research, user-centered design, and a feasibility study. Focus groups (n=26) were conducted to inform the acceptability of the app and desired features. Lab usability (n=19) was used to develop the app through an iterative process. A feasibility study was conducted to assess utilization of the app over a 1-month timeframe. Measures of usability and user-friendliness were collected during lab usability sessions. Satisfaction and app usage were collected following the feasibility study.

RESULTS

The focus groups revealed that African American men use smartphone apps and that they are willing to utilize an app to maintain PA habits. The MobileMen app was subsequently developed and contained a dashboard, rewards, a learning component, a prompting system, and activity tracking. Scores increased between the first and last lab sessions for usability [5.0 (0.0) vs. 4.3 (1.0)] and user-friendliness [74.2 (17.0) vs. 70.6 (12.4)]. Participants reported acceptable satisfaction (mean values >3.5 on a 1-5 Likert scale) with most app components.

CONCLUSIONS

African American men are willing to utilize mHealth to improve their health behavior, including PA. An initial version of the MobileMen app has been developed that is acceptable and user-friendly. However, there are several components requested by African American men could not be included in the current app but warrant future app development.