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Onufrak S, Saelee R, Zaganjor I, Miyamoto Y, Koyama AK, Xu F, Pavkov ME. Physical Activity According to Diabetes and Metropolitan Status, U.S., 2020 and 2022. Am J Prev Med 2024; 66:1008-1016. [PMID: 38331113 PMCID: PMC11284528 DOI: 10.1016/j.amepre.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Physical activity can reduce morbidity and mortality among adults with diabetes. Although rural disparities in physical activity exist among the general population, it is not known how these disparities manifest among adults with diabetes. METHODS Data from the 2020 and 2022 National Health Interview Survey were analyzed in 2023 to assess the prevalence of meeting aerobic and muscle-strengthening recommendations according to the 2018 Physical Activity Guidelines for Americans during leisure time. Physical activity prevalence was computed by diabetes status, type of physical activity, and urban/rural residence (large central metropolitan, large fringe metropolitan, medium/small metropolitan, and nonmetropolitan). Logistic regression models were used to estimate prevalence and prevalence ratios of meeting physical activity recommendations by urban/rural residence across diabetes status. RESULTS Among adults with diabetes in nonmetropolitan counties, only 23.8% met aerobic, 10.9% met muscle-strengthening, and 6.2% met both physical activity recommendations. By contrast, among adults with diabetes in large fringe metropolitan counties, 32.1% met aerobic, 19.7% met strengthening, and 12.0% met both guidelines. Multivariable adjusted prevalence of meeting muscle-strengthening recommendations was higher among participants with diabetes in large fringe metropolitan than among large central metropolitan counties (prevalence ratio=1.27; 95% CI=1.03, 1.56). Among those without diabetes, adjusted prevalence of meeting each recommendation or both was lower in nonmetropolitan and small/medium metropolitan than in large central metropolitan counties. CONCLUSIONS Adults with diabetes are less likely to meet the physical activity recommendations than those without, and differences exist according to urban/rural status. Improving physical activity among rural residents with diabetes may mitigate disparities in diabetes-related mortality.
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Affiliation(s)
- Stephen Onufrak
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Ryan Saelee
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ibrahim Zaganjor
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yoshihisa Miyamoto
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alain K Koyama
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fang Xu
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meda E Pavkov
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Müller C, Paulsen L, Bucksch J, Wallmann-Sperlich B. Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review. Int J Behav Nutr Phys Act 2024; 21:52. [PMID: 38702772 PMCID: PMC11067138 DOI: 10.1186/s12966-024-01598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking. METHODS We searched five databases and included studies for adults (18-65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results. RESULTS Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting). CONCLUSIONS Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults. TRIAL REGISTRATION PROSPERO: CRD42021283508.
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Affiliation(s)
- Christina Müller
- Institute of Sport Science, University of Würzburg, Judenbühlweg 11, 97082, Würzburg, Germany.
| | - Lisa Paulsen
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
| | - Jens Bucksch
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
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DeBolt CL, Popovich JJ, Widere JC, Wibberly KH, Harris D. Rurality as a Risk Factor for Pulmonary Health Disparities. Clin Chest Med 2023; 44:501-508. [PMID: 37517830 DOI: 10.1016/j.ccm.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Rural populations experience significant pulmonary health disparities compared with urban populations. Patients in rural communities experience health determinants including high smoking prevalence, worse nutrition, lower educational attainment, specific occupational exposures, decreased health-care access, as well as unique cultural and political drivers of health. This article describes social determinants of pulmonary health relevant in rural communities, describes examples of existing pulmonary disparities in rural populations, and highlights health policies with potential to mitigate disparities.
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Affiliation(s)
| | - John J Popovich
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J Christian Widere
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Katharine Hsu Wibberly
- Mid-Atlantic Telehealth Resource Center, University of Virginia, Charlottesville, VA, USA
| | - Drew Harris
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Rio CJ, Saligan LN. Understanding physical activity from a cultural-contextual lens. Front Public Health 2023; 11:1223919. [PMID: 37601221 PMCID: PMC10436229 DOI: 10.3389/fpubh.2023.1223919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
This paper aims to emphasize the need to acknowledge unique cultural and contextual meanings of physical activity to improve health outcomes in different communities. Leininger's Sunrise Model was used as the theoretical base to understand the complex cultural and contextual factors that influence physical activity. Beliefs and practices surrounding physical activity are influenced by a variety of cultural and contextual factors. Providing culturally relevant contexts to the meaning of physical activity allows opportunities for improving policies or programs that would engage individuals and communities in physical activity in culturally meaningful ways. Incorporating cultural and contextual factors is critical to promote physical activity, especially in minority and vulnerable communities.
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Affiliation(s)
| | - Leorey N. Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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Brown NI, Stewart L, Rogers LQ, Anne Powell M, Hardy CM, Baskin ML, Oster RA, Pisu M, Demark-Wahnefried W, Pekmezi D. Assessing the built environment, programs, and policies that support physical activity opportunities in the rural Deep South. Prev Med Rep 2023; 33:102223. [PMID: 37223566 PMCID: PMC10201820 DOI: 10.1016/j.pmedr.2023.102223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
Disparities in physical activity (PA) exist in rural regions and prior research suggests environmental features and community resources likely contribute. It is important to identify the opportunities and barriers that influence activity to appropriately inform PA interventions in such areas. Thus, we assessed the built environment, programs and policies related to PA opportunity in six rural Alabama counties that were purposively selected to inform a PA randomized controlled trial. Assessments were conducted August 2020-May 2021 using the Rural Active Living Assessment. Town characteristics and recreational amenities were captured using the Town Wide Assessment (TWA). PA programs and policies were examined with the Program and Policy Assessment. Walkability was evaluated using the Street Segment Assessment (SSA). Using the scoring system (0-100), the overall TWA score was 49.67 (range: 22-73), indicating few schools within walking distance (≤5 miles of the town's center) and town-wide amenities (e.g., trails, water/recreational activities) for PA. The Program and Policy Assessment showed a paucity of programming and guidelines to support activity (overall average score of 24.67, [range: 22-73]). Only one county had a policy requiring walkways/bikeways in new public infrastructure projects. During assessment of 96 street segments, few pedestrian-friendly safety features [sidewalks (32%), crosswalks (19%), crossing signals (2%), and public lighting (21%)] were observed. Limited opportunities for PA (parks and playgrounds) were identified. Barriers such as few policies and safety features (crossing signals, speed bumps) were indicated as factors that should be addressed when developing PA interventions and informing future policy efforts.
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Affiliation(s)
- Nashira I. Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Stewart
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q. Rogers
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Anne Powell
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claudia M. Hardy
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L. Baskin
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Oster
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Zhang X, Warner ME. Linking Urban Planning, Community Environment, and Physical Activity: A Socio-Ecological Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2944. [PMID: 36833640 PMCID: PMC9956976 DOI: 10.3390/ijerph20042944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 05/31/2023]
Abstract
Lack of physical activity is a growing concern among public health advocates and urban planners. Our socio-ecological model incorporates urban planning and World Health Organization actions on physical activity to identify key factors related to leisure-time physical activity at the community level. Our 2019 nationwide US survey of 1312 communities enables examination of the influence of individual, community, and policy levels on physical activity. Individual factors-poverty, aging, minority population, and longer commuting time-result in lower physical activity. Community-level factors have both positive and negative effects. Physical activity is lower in rural and suburban communities, but higher in communities with more transportation services, recreation and social activities, and safety. Communities with mixed-use neighborhoods and complete streets also show higher levels of physical activity. At the policy level, zoning and cross-agency collaboration have an indirect effect on physical activity by increasing these community-level factors. This suggests an alternative approach to promoting physical activity. Local governments can promote transportation, recreation and safety, especially in rural and minority communities lacking active-friendly built environments and facing challenges from aging population, poverty, and longer commuting time. This socio-ecological approach can assess multilevel factors related to physical activity in other countries.
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Affiliation(s)
- Xue Zhang
- Lerner Center for Public Health Promotion and Population Health, Center for Policy Research, Syracuse University, Syracuse, NY 13244, USA
| | - Mildred E. Warner
- Department of City and Regional Planning, Cornell University, Ithaca, NY 14853, USA
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Norman-Burgdolf H, DeWitt E, Gillespie R, Cardarelli KM, Slone S, Gustafson A. Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022. Front Public Health 2023; 11:1142478. [PMID: 37124781 PMCID: PMC10140309 DOI: 10.3389/fpubh.2023.1142478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.
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Affiliation(s)
- Heather Norman-Burgdolf
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
- *Correspondence: Heather Norman-Burgdolf,
| | - Emily DeWitt
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
| | - Rachel Gillespie
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Kathryn M. Cardarelli
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Stacey Slone
- Dr. Bing Zhang Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, KY, United States
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
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Dėdelė A, Chebotarova Y, Miškinytė A. Motivations and barriers towards optimal physical activity level: A community-based assessment of 28 EU countries. Prev Med 2022; 164:107336. [PMID: 36334682 DOI: 10.1016/j.ypmed.2022.107336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/18/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Regular physical activity (PA) is one of the most important determinants of a healthy lifestyle and improved physical and mental well-being. Despite the health benefits of regular PA, the studies show low levels of PA among European adolescents and adults. An increase in physical inactivity has been associated with different personal and environmental factors. This study aimed to investigate positive motivation and barriers to community-based PA. Face-to-face interviews were conducted to collect data on PA, positive motivation and barriers to PA, demographic, and socioeconomic factors. Moderate and vigorous levels of PA were assessed. Regression analysis was applied to estimate the associations for positive and negative reasons for meeting PA recommendations. Data were available for 28,031 adults with a mean age of 48.3 (SD = 18.8) and 51.8% women. Significant variations in individual characteristics were seen between different types of communities. The percentage of participants who reported achieving recommended levels of PA was the lowest in rural areas (44.3%). Regression models showed that most motivational factors had a strong positive association with meeting PA recommendations. We observed the effects of interactions between making acquaintances, having fun and the type of community on meeting PA recommendations. The effects of interactions between the type of community and barriers to PA such as price, risk of injury, disability / illness, and a lack of motivation on PA recommendations were observed. In conclusion, the motivational factors and barriers to PA are associated with the physical environment, and community-based programs and policies for encouraging PA participation are needed.
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Affiliation(s)
- Audrius Dėdelė
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Akademija 53361, Kaunas district, Lithuania
| | - Yevheniia Chebotarova
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Akademija 53361, Kaunas district, Lithuania
| | - Auksė Miškinytė
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Akademija 53361, Kaunas district, Lithuania.
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Sagoe D, Johnsen B, Lindblad B, Normann TAJ, Skogvoll V, Heierdal M, Lauritzen F. A Mixed-Method Evaluation of a Prison Anti-doping Intervention: The Hercules Prison Program. Front Sports Act Living 2022; 3:779218. [PMID: 35005620 PMCID: PMC8732770 DOI: 10.3389/fspor.2021.779218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
The Norwegian Offender Mental Health and Addiction study denotes the need for physical activity and anti-doping interventions in Norwegian prisons. We developed and evaluated the efficacy of such intervention—the Hercules prison program. The program combines theoretical anti-doping lessons with practical strength training. The study adopts a mixed-methods approach (pretest-posttest design) comprising a longitudinal survey, observation, informal conversations, and in-depth interviews. Survey respondents were 104 male prisoners aged 18–56 (M = 34.81, SD = 9.34) years from seven Norwegian prisons. Of these, 52 provided both baseline and posttest responses. Participants completed questionnaires including demographic, doping use, and psychophysical items/measures. At the end of the intervention, in-depth interviews were conducted with 11 of the survey respondents. The survey data were analyzed using descriptive statistics, as well as independent and paired samples t-tests. The qualitative data were analyzed using Interpretative Phenomenological Analysis. A total of 7.5% and 33.3% of participants were current and former AAS users respectively, whereas 86.1% personally knew at least one current or former AAS user. Consistent with our expectation, there were increases in self-rated physical strength (t = −4.1, p < 0.001, d = 0.46) and strength training self-efficacy (t = −8.33, p < 0.001, d = 1.36), and a decrease in moral disengagement in doping (t = −4.05, p < 0.001, d = 0.52) from baseline to posttest. These findings are supported by the qualitative data. Notable success factors are relationship-building, instructors' expertise and acceptability, and gatekeepers' navigation and co-creation. The program provides valuable evidence of the potential benefits of combining anti-doping education with practical strength training in doping prevention in correctional settings.
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Affiliation(s)
- Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Berit Johnsen
- University College of Norwegian Correctional Service (Kriminalomsorgens Høgskole og Utdanningssenter KRUS), Lillestrøm, Norway
| | - Bo Lindblad
- Department of Prevention and Public Health, Anti-doping Norway, Oslo, Norway
| | - Tom Are Jensen Normann
- University College of Norwegian Correctional Service (Kriminalomsorgens Høgskole og Utdanningssenter KRUS), Lillestrøm, Norway
| | - Vidar Skogvoll
- University College of Norwegian Correctional Service (Kriminalomsorgens Høgskole og Utdanningssenter KRUS), Lillestrøm, Norway
| | - Morten Heierdal
- Department of Prevention and Public Health, Anti-doping Norway, Oslo, Norway
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