Environmental, policy, and cultural factors related to physical activity in sedentary American Indian women

Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review

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.

Socioeconomic Determinants of Health and Cardiovascular Outcomes in Women: JACC Review Topic of the Week

Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials. These barriers can be mitigated by optimizing care access via policy change and improving physical access to care in women with geographic or transportation limitations. Addressing structural racism through policy change and bolstering structured community support systems will be key to reducing adverse cardiovascular outcomes among women of racial and ethnic minorities. Diversification of the cardiology workforce to more closely represent the patients we serve will be beneficial to all women.

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens

BACKGROUND

American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population.

OBJECTIVE

To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes.

DESIGN

Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes.

RESULTS

Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma.

CONCLUSIONS

Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.

Cardiovascular Health among U.S. Indigenous Peoples: A Holistic and Sex-Specific Systematic Review

PURPOSE

The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples.

METHODS

A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n= 15; Sociocultural, n =17; Behavioral/Physical, n =19).

RESULTS

This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment-including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors.

DISCUSSION

Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.

Social Support and Physical Activity Among American Indians in Oklahoma: Results From a Community-based Participatory Research Study

PURPOSE

Little is known about the contribution of social support to physical activity (PA) behavior among American Indians (AIs). This community-based participatory research study examined the prevalence of and associations between different types of PA social support and PA among AIs in rural Oklahoma.

METHODS

Our tribal-academic partnership surveyed AI adults (N = 513) living within the tribal jurisdictional areas of 2 tribal nations. We used the Physical Activity Social Support (PASS) scale to assess 3 types of PA social support and Poisson regression to investigate associations between PASS types and self-reported PA behavior.

FINDINGS

Over a third of participants perceived high levels of PA social support from friends (37%), family (35%), and overall (34%), yet only 29% reported regular PA (ie, 150 minutes or more weekly). Participants who exercised with pets/other were significantly more likely to achieve regular PA than those who exercised alone (PR 2.0, 95% CI: 1.4-2.9). Although not significant, compared with those reporting no/low support, participants with high friend PASS (PR 1.2, 95%: CI 0.9-1.6), medium family PASS (PR 1.2, 95% CI: 0.9-1.7), and overall PASS (PR 1.1, 95% CI: 0.8-1.6) were more likely to report regular PA.

CONCLUSIONS

The majority of participants did not meet current recommendations for PA behavior, which underscores the ongoing need for PA effective interventions among AIs living in rural areas. Results suggest that exercising with pets/other could be an important factor for future intervention. Further research is needed to elucidate determinants of PA and test interventions to increase PA among AIs.

Work, worksites, and wellbeing among North American Indian women: a qualitative study

The purpose of this study was to understand what factors influenced work-family balance and related health behaviors among a sample of rural North American Indian women. We interviewed 89 women through both in-depth interviews and focus groups across four tribal communities in the American Southwest and Upper Midwest between July 2010 and August 2011. Interviews were transcribed, coded, and analyzed for emerging themes related to work- family demands placed on women and resources available to cope with those demands. Three prominent themes emerged: structural characteristics (the context of rural reservation life), role stressors (women's multiple and conflicting roles) and the influence of social support (communal nature of care in the family and institutional support in the workplace). We found that women in participating rural reservation communities often acted as primary caregivers for both immediate and extended family, and often placed the needs of others before themselves. The context of rural reservations, with high rates of unemployment, poverty, and chronic illnesses associated with the collective trauma of colonization, placed high demands on female caregivers. Social support from within the workplace, family, and cultural traditions helped some female caregivers balance the demands of home and work. Tribal worksites could be a resource for promoting health and work-life balance by being responsive to the particular demands placed on women that often interfere with engaging in positive health behaviors in general and tribal wellness programs in particular.

Cigarette smoking and risk of albuminuria in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies

BACKGROUND

The aim of this study was to assess the effects of smoking on albuminuria risk in adults with type 2 diabetes mellitus (T2DM).

METHODS

A literature search was conducted using MEDLINE, EMBASE, and China National Knowledge Infrastructure from the established date to October 2017. Summary relative risks (SRR) and 95% confidence intervals (CI) were computed utilizing a random effect inverse variance method.

RESULTS

This meta-analysis included a total of 19 relevant observational studies (four prospective cohort, seven case-control, and eight cross-sectional studies), reporting 105,031 participants and 23,366 albuminuria events. Compared with never-smokers with T2DM, the SRRs of albuminuria were 1.43 (95% CIs 1.27-1.61) for ever-smokers, 2.61 (95% CIs 1.86-3.64) for current smokers, and 1.86 (95% CIs 1.37-2.52) for former smokers. Considerable heterogeneity was observed among these studies, and study design was a significant modifier for this association. There were significantly elevated risk associations for microalbuminuria (SRRs = 1.24, 95% CIs 1.05-1.46) and for macroalbuminuria (SRRs = 1.65, 95% CIs 1.03-2.66), respectively.

CONCLUSIONS

Our systematic review and meta-analysis indicates that cigarette smoking might be a potential factor for the development of albuminuria in adults with T2DM. Future studies are required to investigate the association between smoking cessation and intensity and incident albuminuria in adults with T2DM.

Physical activity levels of community-dwelling older adults are influenced by winter weather variables

Winter weather conditions may negatively influence participation of older adults in daily physical activity (PA).

OBJECTIVE

Assess the influence of winter meteorological variables, day-time peak ambient temperature, windchill, humidity, and snow accumulation on the ground to accelerometer measured PA values in older adults.

METHODS

50 community-dwelling older adults (77.4±4.7yrs; range 71-89; 12 females) living in Southwestern Ontario (Latitude 42.9°N Longitude 81.2° W) Canada, wore a waist-borne accelerometer during active waking hours (12h) for 7 consecutive days between February and April 2007. Hourly temperature, windchill, humidity, and snowfall accumulation were obtained from meteorological records and time locked to hourly accelerometer PA values.

CONCLUSIONS

Regression analysis revealed significant relationships between time of day, ambient daytime high temperature and a humidity for participation in PA. Windchill temperature added no additional influence over PA acclamation already influenced by ambient day-time temperature and the observed variability in PA patterns relative to snow accumulation over the study period was too great to warrant its inclusion in the model. Most PA was completed in the morning hours and increased as the winter month's transitioned to spring (February through April).

PRACTICE

An equation was developed to adjust for winter weather conditions using temperature, humidity and time of day.

IMPLICATIONS

Accurate PA assessment during the winter months must account for the ambient daytime high temperatures, humidity, and time of day. These older adults were more physically active during the morning hours and became more active as the winter season transitioned to spring.

Effect of bilirubin concentration on the risk of diabetic complications: A meta-analysis of epidemiologic studies

Diabetes can affect many parts of the body and is associated with serious complications. Oxidative stress is a major contributor in the pathogenesis of diabetic complications and bilirubin has been shown to have antioxidant effects. The number of studies on the effect of bilirubin on the risk of diabetic complications has increased, but the results are inconsistent. Thus, we performed a meta-analysis to determine the relationship between bilirubin concentration and the risk of diabetic complications, and to investigate if there was a dose-response relationship. We carried out an extensive search in multiple databases. A fixed or random-effects model was used to calculate the pooled estimates. We conducted a dose-response meta-analysis to analyze the association between these estimates. A total of 132,240 subjects from 27 included studies were analyzed in our meta-analysis. A negative nonlinear association between bilirubin concentration and the risk of diabetic complications was identified (OR: 0.77, 95% CI: 0.73-0.81), with a nonlinear association. We also found that there was a negative association between bilirubin concentration and the risk of diabetic nephropathy, diabetic retinopathy and diabetic neuropathy. The results of our meta-analysis indicate that bilirubin may play a protective role in the occurrence of diabetic complications.

Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives

Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.

Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes

OBJECTIVE

To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes.

METHOD

We examined the relationship between access to care and diabetes management, as measured by HbA_1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA_1c levels.

RESULTS

In bivariate analyses, out-of-pocket costs were associated with higher HbA_1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models.

DISCUSSION

Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.

Built Environments and Active Living in Rural and Remote Areas: a Review of the Literature

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.

Sick of sitting

Sitting too much kills. Epidemiological, physiological and molecular data suggest that sedentary lifestyle can explain, in part, how modernity is associated with obesity, more than 30 chronic diseases and conditions and high healthcare costs. Excessive sitting--sitting disease--is not innate to the human condition. People were designed to be bipedal and, before the industrial revolution, people moved substantially more throughout the day than they do presently. It is encouraging that solutions exist to reverse sitting disease. Work environments, schools, communities and cities can be re-imagined and re-invented as walking spaces, and people thereby offered more active, happier, healthier and more productive lives.

Diabetes and Kidney Disease in American Indians: Potential Role of Sugar-Sweetened Beverages

Since the early 20th century, a marked increase in obesity, diabetes, and chronic kidney disease has occurred in the American Indian population, especially the Pima Indians of the Southwest. Here, we review the current epidemic and attempt to identify remediable causes. A search was performed using PubMed and the search terms American Indian and obesity, American Indian and diabetes, American Indian and chronic kidney disease, and American Indian and sugar or fructose, Native American, Alaska Native, First Nations, Aboriginal, Amerind, and Amerindian for American Indian for articles linking American Indians with diabetes, obesity, chronic kidney disease, and sugar; additional references were identified in these publications traced to 1900 and articles were reviewed if they were directly discussing these topics. Multiple factors are involved in the increased risk for diabetes and kidney disease in the American Indian population, including poverty, overnutrition, poor health care, high intake of sugar, and genetic mechanisms. Genetic factors may be especially important in the Pima, as historical records suggest that this group was predisposed to obesity before exposure to Western culture and diet. Exposure to sugar-sweetened beverages may also be involved in the increased risk for chronic kidney disease. In these small populations in severe health crisis, we recommend further studies to investigate the role of excess added sugar, especially sugar-sweetened beverages, as a potentially remediable risk factor.

Eating Habits and Lifestyles among a Sample of Obese Working Egyptian Women

BACKGROUND:

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.

AIM:

To figure out food habits and different lifestyle pattern among a sample of Egyptian females working at the National Research Centre.

METHODS:

A cross-sectional, descriptive study, including 138 overweight and obese Egyptian females (BMI ≥ 25 Kg/m²); working at the National Research Centre; was done. A specific questionnaire was used to gather information regarding lifestyle including dietary habits, physical activity and sedentary behaviour.

RESULTS:

The prevalence of overweight among the studied subjects was 27%, while that of obesity was 38%. Missing and or infrequent intake of breakfast at home, frequent consumption of snacks, low serving per day of fruits and vegetables with frequent consumption of sweets, fried food, eating while watching TV and sedentary behaviour were all predictors of obesity and overweight among the current sample.

CONCLUSION:

The present study identified several lifestyle factors and improper dietary habits associated with overweight and obesity among Egyptian females. There is a great need to change these habits to avoid the increasing risk of obesity. A national plan of action to overcome obesity is urgently needed to reduce its economic and health burden.

Barriers and facilitators to being physically active on a rural U.S. Northern Plains American Indian reservation

The objective of the present study was to identify barriers to and facilitators of physical activity among American Indian adults living on a rural, U.S. Northern Plains reservation using the nominal group technique (NGT). NGT is a method of data generation and interpretation that combines aspects of qualitative (free generation of responses) and quantitative (systematic ranking of responses) methodologies. Adults participated in one of two NGT sessions asking about either barriers to (n = 6), or facilitators of (n = 5), being physically active. Participants nominated and ranked 21 barriers and 18 facilitators. Barriers indicated lack of knowledge of how to fit physical activity into a daily schedule, work, caring for family members, and prioritizing sedentary pursuits. Other responses included environmental barriers such as lack of access and transportation to a gym, unsafe walking conditions, and inclement weather. Facilitators to following recommendations included knowledge of health benefits of physical activity and the perception of physical activity as enjoyable, including feeling good when working out. Environmental facilitators included being outdoors walking and biking as well as parks and exercise facilities. Responses provided direction for locally designed community-based programs to promote facilitators and decrease barriers to individual's engagement in physical activity.

Treadmill desks: A 1-year prospective trial

OBJECTIVE

Sedentariness is associated with weight gain and obesity. A treadmill desk is the combination of a standing desk and a treadmill that allow employees to work while walking at low speed.

DESIGN AND METHODS

The hypothesis was that a 1-year intervention with treadmill desks is associated with an increase in employee daily physical activity (summation of all activity per minute) and a decrease in daily sedentary time (zero activity). Employees (n = 36; 25 women, 11 men) with sedentary jobs (87 ± 27 kg, BMI 29 ± 7 kg/m(2) , n = 10 Lean BMI < 25 kg/m(2) , n = 15 Overweight 25 < BMI < 30 kg/m(2) , n = 11 Obese BMI > 30 kg/m(2) ) volunteered to have their traditional desk replaced with a treadmill desk to promote physical activity for 1 year.

RESULTS

Daily physical activity (using accelerometers), work performance, body composition, and blood variables were measured at Baseline and 6 and 12 months after the treadmill desk intervention. Subjects who used the treadmill desk increased daily physical activity from baseline 3,353 ± 1,802 activity units (AU)/day to, at 6 months, 4,460 ± 2,376 AU/day (P < 0.001), and at 12 months, 4,205 ± 2,238 AU/day (P < 0.001). Access to the treadmill desks was associated with significant decreases in daily sedentary time (zero activity) from at baseline 1,020 ± 75 min/day to, at 6 months, 929 ± 84 min/day (P < 0.001), and at 12 months, 978 ± 95 min/day (P < 0.001). For the whole group, weight loss averaged 1.4 ± 3.3 kg (P < 0.05). Weight loss for obese subjects was 2.3 ± 3.5 kg (P < 0.03). Access to the treadmill desks was associated with increased daily physical activity compared to traditional chair-based desks; their deployment was not associated with altered performance. For the 36 participants, fat mass did not change significantly, however, those who lost weight (n = 22) lost 3.4 ± 5.4 kg (P < 0.001) of fat mass. Weight loss was greatest in people with obesity.

CONCLUSIONS

Access to treadmill desks may improve the health of office workers without affecting work performance.

Physically active families - de-bunking the myth? A qualitative study of family participation in physical activity

BACKGROUND

The benefits of physical activity for reducing obesity and related chronic diseases are well known. The need for more family-based interventions to increase physical activity is frequently cited in the literature; however, little is known about if and how families are physically active together, and what factors might influence family-based participation in regular physical activity. This study examined the types of activities (physical and sedentary) engaged in as a family and explored parents' perceptions of the importance, frequency, nature and barriers to family physical activity.

METHODS

Semi-structured telephone interviews were conducted with 30 parents (26 female, four male) of 10- to 11-year-old schoolchildren who attended either low, middle or high socio-economic status schools in Bristol, UK. Interviews were transcribed verbatim, anonymized and analysed using conventional content analysis.

RESULTS

The majority of parents rated family engagement in physical activity as important, and identified benefits such as increased parent-child communication, spending time together, enjoyment, enhanced mental health, weight control and physical fitness. Despite these benefits most parents reported their families did little or no physical activity together as a family unit during the week, and any activities performed together were usually sedentary in nature. They reported increased family physical activity on the weekends but rarely including the full family unit simultaneously. Parents in two-parent households commonly paired off with one or more children because of complexities of schedules. Commonly reported barriers were busy lifestyles, diverse ages and interests of children and adults, bad weather, and lack of access to facilities, transportation and money to support activities.

CONCLUSIONS

Family-based interventions might be more effective if they are designed to accommodate the complex demands and needs of two-parent and single-parent families and provide affordable, diverse activities appealing to a wide range of interests.

Obesity in minority women: calories, commerce, and culture

Obesity is increasing at epidemic rates in all women, but especially in minority women and children. Factors that contribute to this include changes in caloric intake and expenditure (calories), cost and ease of acquiring food along with pressures from the marketplace and media (commerce) and the community response to the increasing prevalence of obesity and sedentary lifestyle (culture).

An Overview and Proposed Framework of Social-Environmental Influences on the Physical-Activity Behavior of Women

Objective.

The primary purposes of this review were to identify key social-environmental influences on the physical-activity behavior of women and to propose an organizing framework of these influences in the social environment.

Data Sources.

Computerized searches of MEDLINE, Science Direct, and CINAHL were conducted to identify relevant research.

Study Inclusion and Exclusion Criteria.

Studies were included if they used a sample of adult women or included gender-specific analysis, identified or measured some aspect of the social environment in relation to physical activity, and were published in English within the last two decades.

Data Extraction.

Characteristics of study design, sample population, and identified social-environmental variables were extracted.

Data Synthesis.

Through an iterative review of the data by several researchers, common influences and themes were identified and organized into a social environment framework, which included the following components: social support/social networks, life transitions/multiple roles, and cultural standards/gender role expectations.

Results.

Women are exposed to societal messages that indicate physical activity is not a priority and may be inappropriate; they may also lack the social support necessary to adopt and maintain physical activity.

Conclusions.

This review reveals the complex range of factors in the social environment that influence women, and it provides support for the importance of the social environment on physical-activity behavior in women. A social-environmental framework related to Bronfenbrenner's social ecological model is proposed along with recommended strategies to apply in interventions targeting women.

Factors That Contribute to Levels of Independent Activity Functioning Among a Group of Navajo Elders

The purpose of this study was to examine factors that contribute to levels of independent activity functioning among a group of elder Navajos. Data were collected from a sample of Navajo elders from Tuba City, Arizona, and a health assessment survey was administered. Multiple regression analysis was used to examine the effects of social support and demographic factors on levels of independent activity functioning, such as bathing, toileting, dressing, eating, walking, and getting in and out of bed. The results indicated that assistive devices, marital status, the frequency of visits to Tuba City, and visits to the elders significantly affected independent activity functioning. Although other factors of social support were not significant, it appeared that visiting Tuba City and visits to the elders in their homes were important factors in maintaining higher levels of independent activity functioning among elder Navajos. Implications for practice, policy, and future research are discussed.

Meteorological conditions are associated with physical activities performed in open-air settings

Meteorological conditions (MC) are believed to modify physical activity. However, studies in this area are limited and none have looked at the associations between MC and physical activity in open-air settings. Therefore, we examined the relationships between MC and physical activities performed on sidewalks/streets and outdoor oval tracks. Observation techniques were used to count individuals walking to school, exercising on oval tracks and walking/jogging/biking on sidewalks/streets. Meteorological conditions were obtained from an Automated Surface Observing System located at a nearby airport for the same time periods physical activities were observed. On weekdays, fewer children were seen walking to school and more bicyclists were observed on sidewalks/streets as wind speed increased (p < 0.05). Ambient and apparent temperatures were positively (p < 0.05) and humidity and barometric pressure negatively (p < 0.005) related to the number of individuals walking on the track. Meteorological conditions were not significantly associated with physical activities observed on weekends. Multiple linear regression analyses showed that apparent temperature (+), barometric pressure (-) and dew point (-) accounted for 58.0% of the variance in the number of walkers on the track. A significant proportion of the variance (>30%) in the number of joggers and the length of time they jogged was accounted for by apparent temperature (+) and dew point (-). We found that meteorological conditions are related to physical activity in open-air settings. The results embellish the context in which environmental-physical activity relationships should be interpreted and provide important information for researchers applying the observation method in open-air settings.

Crime prevention and active living

This paper addresses the question of whether crime is a barrier to active living and if it is, what can be done about it? The authors introduce a theoretical model that addresses how crime might influence physical activity behavior. The core components of the model are: situational characteristics, crime and disorder, fear of crime or disorder, and physical activity. These variables are thought to be moderated through psychological, demographic, environmental and other factors. Research questions that derive from the model are featured.

Relationship between objective measures of physical activity and weather: a longitudinal study

BACKGROUND

The weather may be a barrier to physical activity but objective assessment of this hypothesis is lacking. Therefore we evaluated the effect of temperature, rain or snow, and wind speed on the daily physical activity of adults.

METHODS

This report contains data from 25 males (BMI (mean +/- SD): 28.7 +/- 3.83 kg/m2) and 177 females (BMI: 29.2 +/- 5.92 kg/m2) enrolled in an intervention to increase physical activity. Steps/day of the participants was measured by pedometer. Weather data were obtained from Environment Canada. A total of 8,125 observations were included in a mixed linear model analysis.

RESULTS

Significant weather related variables (at the 5% level) impacting steps/day included: seasonal effects related to the interaction between weekday and month; mean temperature, total rainfall, interactions between gender, BMI and total snow, interactions between maximum wind speed and BMI, and the amount of snow on the ground. The estimated magnitudes for the various effects were modest, ranging from approximately 1% to approximately 20%. Thus for an average individual taking approximately 10,000 steps/day, weather-dependent changes in physical activity could reach 2,000 steps/day.

CONCLUSION

We conclude that weather had modest effects on physical activity of participants in an intervention to increase their activity. It should be stressed that these effects may be different for less or more motivated people. With this in mind, we suggest that the effect of weather on physical activity in the general population needs to be objectively assessed to better understand the barrier it poses, especially as it relates to outdoor recreation or work activities.

Physical activity and Native Americans: a review

The physical activity behaviors of Native-American populations in the United States and Canada have received little attention in the health literature. The purpose of this review was to unite the literature regarding the physical activity behaviors of Native Americans. A majority of the literature was obtained using online databases. Reference lists were also reviewed to gain further access to the literature. Key-word searches included various combinations of Aboriginal, Native Indian, American Indian, Native American, First Nation, Métis, or Alaska Native with physical activity, exercise, and health behavior. Articles included were those published in English-language, peer-reviewed journals from 1990 until November 2005 that focused on participants aged 18 years and older. This review is organized according to ecologic models of health behavior, which take into account several correlates to explain human behavior, including demographic, personal health, environmental, and psychosocial. Correlates were included if they appeared at least three times in the literature. As a result of these inclusion criteria, the number of reviewed articles includes 28 quantitative, 4 qualitative, and 3 intervention studies. Results indicate that age, gender, and social support are important factors associated with physical activity. The remaining correlates show inconsistent or indeterminate results due in part to the paucity of research. It is suggested that an increase in the number of studies, especially those using longitudinal designs, is needed. Further, the application of psychosocial models to understand physical activity motivations as well as culturally appropriate and validated measurement tools are largely absent in the Native-American physical activity literature.

Body-related emotional experiences of young aboriginal women

Concerns related to the body are associated with health-compromising behaviors, and although research has indicated that young Aboriginal women are dissatisfied with their bodies, their voices have typically been absent from the literature. The purpose of this case study was to provide insight into the body-related emotional experiences of young, Canadian, urban Aboriginal women. Four young women participated; 3 identified themselves as Aboriginal (one 14-year-old, two 18-year-olds) and 1 as non-Aboriginal (18 years old). Multiple methods (focus group, one-on-one interviews, and artwork) provided the authors the opportunity to listen to the young women's stories. Five themes emerged: (a) conflicting cultures, (b) need to belong, (c) the beauty of difference, (d) journey to acceptance of the body, and (e) the body affects everything. This research highlights the complexity of young Aboriginal women's body-related emotional experiences and indicates that their experiences might not be as negative as previous research has led us to believe.

Development, adaptation, and implementation of a cardiovascular health program for Alaska native women

Southcentral Foundation's Traditions of the Heart program is an innovative cardiovascular disease prevention program for women designed to build on the strengths of the Alaska Native culture as a way to support and encourage positive lifestyle behaviors that focus on healthy eating, active living, stress management, and tobacco cessation. After conducting assessments of existing intervention programs and formative data collection, we adapted two existing programs, Native Nutrition Circles and A New Leaf... Choices for Healthy Living, to develop the Traditions of the Heart program. We implemented and evaluated a pilot intervention study to determine the program's acceptance among Alaska Native women. We used the evaluation results to further refine our study protocol. This article describes the adaptation of these programs to the cultural needs and strengths of Alaska Native women and the results of the formative evaluation used to improve the program design. The complete pilot study outcomes will be published separately.

Correlates of Self-Efficacy for Physical Activity in African American Women

This study examined the correlates of self-efficacy for physical activity in African American women. In bivariate analyses, self-efficacy was higher among women reporting fewer social role constraints, more positive perceptions of physically active women, more positive sense of community, better perceived health, and higher levels of physical activity. In a simultaneous multivariate model, more positive perceived health status (p = .001), higher physical activity level (p = .007), and lower social role constraint (p = .02) were independently associated with higher self-efficacy. Thus, physical activity interventions for African-American women should include strategies to decrease social role constraint and offer safe activities for women with health conditions hindering physical activity.

Physical Activity and Obesity in Canadian Women

HEALTH ISSUE: Overweight and obesity have been recognized as major public health concern in Canada and throughout the world. Lack of physical activity, through its impact on energy balance, has been identified as an important modifiable risk factor for obesity. Physical activity and obesity are also important risk factors for a variety of chronic diseases. This chapter provides an overview of the current state of physical activity and overweight/obesity among Canadian women. KEY FINDINGS: For all ages combined more women (57%) than men (50%) are physically inactive (energy expenditure <1.5 KKD). Physical activity increases as income adequacy and educational level decrease. Physical inactivity also varies by ethnicity. The prevalence of both overweight (BMI 25.0 - 29.9 kg/m2) and obese (BMI >/= 30 kg/m2) Canadian women has increased 7% since 1985. Obesity increases with age and is highest among women reporting low and lower middle incomes and lower levels of education. The prevalence of obesity is highest among Aboriginal women and men (28% and 22% respectively). DATA GAPS AND RECOMMENDATIONS: There is currently no surveillance system in Canada to monitor the level of physical activity among children, those performing activity at work, at school or in the home. There is a gap in the knowledge surrounding socio-cultural and ecological determinants of physical activity and obesity and the associations of these to chronic disease among women and minority populations. Multi-sectoral policy interventions that act to decrease the broad systemic barriers to physical activity and healthy weights among all women are needed.

Environmental, policy, and cultural factors related to physical activity in well-educated urban African American women

The purpose of this qualitative study was to identify environmental, policy, and cultural predictors of physical activity in urban African American women living in Baltimore, MD. Thirty-nine mostly well-educated women participated in eight focus group discussions, five for women aged 36 to 50 years and three for women 20 to 35 years of age. Transcripts were analyzed using QSR NUD*IST qualitative software, and themes were identified. The discussions identified numerous opportunities and barriers for physical activity. The women reported being aware of physical activity resources and facilities available to them, but they lacked time and motivation to participate. Family responsibilities and duties unique to African American women were cited often. The results suggest that providing more environmental facilities may not be sufficient to increase physical activity in well-educated urban African American women. Intervention strategies that place value on family and cultural responsibilities should be considered.