Inequities in Physical Activity Environments and Leisure-Time Physical Activity in Rural Communities

Experiences of Rural-Dwelling Children Wearing Physical Activity Trackers: An Exploratory Study

BACKGROUND/OBJECTIVES

Although there is a need for evidence-based physical activity programs in rural communities, evaluating such programs is often challenging due to access-related barriers and measurement tools that are not designed for rural contexts. This study aimed to explore and better understand the day-to-day experiences of rural-dwelling children using wrist-worn PA trackers as part of a study to develop a health promotion program.

METHODS

Ten caregivers and child dyads were enrolled (n = 20). The children wore accelerometers pre- and post-intervention. Semi-structured interviews were completed post-intervention and were audio recorded, transcribed, and summary reports were generated based on recurring themes.

RESULTS

The children had a mean age of 8.7 (SD = 1.4) years and the majority were male (80%). The caregivers were female, white, and had a mean age of 43.6 (SD = 8.5) years, with an annual income of ≥USD 40,000. Factors contributing to device wear times included low caregiver burden, device functioning as a watch, and device interactivity. The children reported that the devices were acceptable, but may have changed their physical activity behaviors, with children regularly checking their step count. The caregivers preferred devices that monitored the children's activity levels without sharing location data.

CONCLUSIONS

Identifying acceptable and feasible strategies to measure physical activity is vital to developing effective health promotion efforts. The lessons learned may help develop evaluation plans for implementing rural physical activity programming.

Grandparenting and Physical Activity

Objective: The aim of this study was to examine a continuum of grandparenting intensity and its association with physical activity using three perspectives: grandparents are active, the more constraints perspective, and the selection bias perspective. Method: We use 2014 data from the Health and Retirement Study (HRS), a nationally-representative panel study of the US population over the age of 50 and their spouses (n = 17,851). Results: We found that greater grandparenting intensity was inversely associated with physical activity, providing support for both the more constraints perspective and the selection bias perspective. Discussion: We discuss the implications of inequality in which the most advantaged with physical activity are those who were either not grandparents, or grandparents who provided less care.

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.

Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity

Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.

Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults

Purpose of Review

The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered.

Recent Findings

More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health.

Summary

Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.

Multilevel needs assessment of physical activity, sport, psychological needs, and nutrition in rural children and adults

Introduction

Physical activity yields significant benefits, yet fewer than 1 in 4 youth meet federal guidelines. Children in rural areas from low socioeconomic (SES) backgrounds face unique physical activity contextual challenges. In line with Stage 0 with the NIH Stage Model for Behavioral Intervention Development, the objective of the present study was to conduct a community-engaged needs assessment survey with middle school children and adults to identify perceptions, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition from a multi-level lens.

Methods

A cross-sectional survey data collection was conducted with children (n = 39) and adults (n = 63) from one middle school community in the Midwestern United States. The child sample was 33% 6th grade; 51% 7th grade and was 49% female. The adult sample was primarily between 30 and 39 years old (70%) and comprised predominantly of females (85%). Multi-level survey design was guided by the psychological needs mini-theory within self-determination theory and aimed to identify individual perceptions, barriers, and facilitators in line with the unique context of the community.

Results

At the individual level, 71.8% of children and 82.2% of the overall sample (children and adults) were interested in new physical activity/sport programming for their school. Likewise, 89.7% of children and 96.8% of adults agree that PA is good for physical health. For basic psychological needs in the overall sample, relatedness was significantly greater than the autonomy and competence subscales. Children's fruit and vegetable intake were below recommended levels, yet only 43.6% of children were interested in nutritional programming. Conversely, 61.5% indicated interest at increasing leadership skills. At the policy-systems-environmental level, the respondents' feedback indicated that the condition and availability of equipment are areas in need of improvement to encourage more physical activity. Qualitative responses are presented within for physical activity-related school policy changes.

Discussion

Interventions addressing children's physical activity lack sustainability, scalability, and impact due to limited stakeholder involvement and often neglect early behavioral intervention stages. The present study identified perspectives, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition in a multi-level context and forms the initial campus-community partnership between scientists and community stakeholders.

Validity and reliability of the physical activity and social support scale among Chinese established adults

Social support is a crucial factor that can facilitate regular engagement in physical activity. To assess the influence of social factors on the level of regular physical activity, the Physical Activity and Social Support Scale (PASSS) has been developed. However, the PASSS has yet to be validated in a Chinese sample of established adults. To address this gap in the literature, this study describes the development and psychometric evaluation of a Chinese version of the PASSS (PASSS-C) for established adults. PASSS-C was validated for a Chinese sample of adults aged between 30 and 45 years old (N = 1799). Structural validity was evaluated using confirmatory factor analysis (CFA) with Maximum Likelihood Method (MLM). Spearman's correlations between the PASSS-C and the International Physical Activity Questionnaire - Short Form (IPAQ-SF), the Social Support Rating Scale - Chinses Version (SSRS-C), and the Affective Exercise Experience Scale - Chinese Version (AFFEXX-C) were determined to examine the criterion validity. Cronbach's alpha coefficients and McDonald's omega coefficients were used to assess the internal consistency of the total scale and sub-scales of the PASSS-C. The results of the CFA suggest that the five-factor model had an acceptable fit (CFI = 0.99, GFI = 0.99, SRMR = 0.01, RMSEA = 0.02). Cronbach's alpha and McDonald's omega for the PASSS-C and its sub-scales ranged from 0.81 to 0.96. The results indicate that the PASSS-C has acceptable psychometric properties. Thus, the scale can be used to assess the levels of social support for physical activity in Chinese established adults.

Understanding Libraries as Part of the Rural Active Living Environment: Evidence From a Content Analysis of Library Facebook Posts Made in Summer 2022

As both public health and public libraries continue to evolve, there are opportunities for collaboration focused on building policies, systems, and environments that support communities making healthy choices easy choices. Given the health disparities related to physical inactivity, such as diabetes and heart disease in rural America, public libraries within rural communities are emerging as important settings for health promotion and disease prevention. This study sought to better understand how rural libraries promote physical activity opportunities on Facebook. Based on a content analysis of Facebook posts of a random sample of 118 libraries made during the Summer of 2022, 47 of the 118 had at least one post related to physical activity and 42 had multiple posts. The most frequent offering was events or classes; libraries also supported physical activity by lending equipment and making changes to the built environment. This study provides evidence that some rural libraries are offering physical activity opportunities through community health partnerships, particularly for youth and families. Considering this evidence, public health professionals are encouraged to collaborate with local libraries to promote physical activity and advance rural health equity. Researchers are invited to continue to develop the evidence base around promoting physical activity with rural libraries.

The Epidemiology of Domain-Specific Physical Activity in New Zealand Adults: A Nationally Representative Cross-Sectional Survey

BACKGROUND

Surveillance of domain-specific physical activity (PA) helps to target interventions to promote PA. We examined the sociodemographic correlates of domain-specific PA in New Zealand adults.

METHODS

A nationally representative sample of 13,887 adults completed the International PA Questionnaire-long form in 2019/20. Three measures of total and domain-specific (leisure, travel, home, and work) PA were calculated: (1) weekly participation, (2) mean weekly metabolic energy equivalent minutes (MET-min), and (3) median weekly MET-min among those who undertook PA. Results were weighted to the New Zealand adult population.

RESULTS

The average contribution of domain-specific activity to total PA was 37.5% for work activities (participation = 43.6%; median participating MET-min = 2790), 31.9% for home activities (participation = 82.2%; median participating MET-min = 1185), 19.4% for leisure activities (participation = 64.7%; median participating MET-min = 933), and 11.2% for travel activities (participation = 64.0%; median MET-min among participants = 495). Women accumulated more home PA and less work PA than men. Total PA was higher in middle-aged adults, with diverse patterns by age within domains. Māori accumulated less leisure PA than New Zealand Europeans but higher total PA. Asian groups reported lower PA across all domains. Higher area deprivation was negatively associated with leisure PA. Sociodemographic patterns varied by measure. For example, gender was not associated with total PA participation, but men accumulated higher MET-min when taking part in PA than women.

CONCLUSIONS

Inequalities in PA varied by domain and sociodemographic group. These results should be used to inform interventions to improve PA.

Using Convolutional Neural Networks to Derive Neighborhood Built Environments from Google Street View Images and Examine Their Associations with Health Outcomes

Built environment neighborhood characteristics are difficult to measure and assess on a large scale. Consequently, there is a lack of sufficient data that can help us investigate neighborhood characteristics as structural determinants of health on a national level. The objective of this study is to utilize publicly available Google Street View images as a data source for characterizing built environments and to examine the influence of built environments on chronic diseases and health behaviors in the United States. Data were collected by processing 164 million Google Street View images from November 2019 across the United States. Convolutional Neural Networks, a class of multi-layer deep neural networks, were used to extract features of the built environment. Validation analyses found accuracies of 82% or higher across neighborhood characteristics. In regression analyses controlling for census tract sociodemographics, we find that single-lane roads (an indicator of lower urban development) were linked with chronic conditions and worse mental health. Walkability and urbanicity indicators such as crosswalks, sidewalks, and two or more cars were associated with better health, including reduction in depression, obesity, high blood pressure, and high cholesterol. Street signs and streetlights were also found to be associated with decreased chronic conditions. Chain link fence (physical disorder indicator) was generally associated with poorer mental health. Living in neighborhoods with a built environment that supports social interaction and physical activity can lead to positive health outcomes. Computer vision models using manually annotated Google Street View images as a training dataset were able to accurately identify neighborhood built environment characteristics. These methods increases the feasibility, scale, and efficiency of neighborhood studies on health.