Exploring contextual differences in environment and policy strategies to promote physical activity in disadvantaged communities

The benefits of physical activity for health are far reaching, including the reduced risk of several chronic diseases. However, only about 24% of US adults meet recommended guidelines of physical activity, with traditionally disadvantaged populations such as rural residents and persons of color facing even lower rates. Ecological models of health behavior help to understand correlates of physical activity that impact population health, but may not be as useful in disadvantaged populations where the evidence base is either lacking or not as rigorous. Furthermore, measures and methods may be underdeveloped in disadvantaged populations and there is a lack of understanding of context (social-cultural, political, economic) in these settings. A health equity lens is needed to address some of these barriers and help equalize opportunities to be active and healthy. The present study seeks to contribute to health equity and the evidence base by addressing three aims in key disadvantaged populations: 1) Examine sub-population differences in the relationship between the perceived built environment and rural residents’ objectively assessed physical activity; 2) Assess how community development strategies influence the built and social-cultural environment to promote physical activity; and 3) Describe the impacts (benefits and consequences) of community development strategies for health promoting environments. Rural midwestern adults, particularly women, have disproportionately lower levels of physical activity, but there is evidence to suggest that increased self-efficacy for physical activity and recreational access (including walking trails) may help to promote physical activity in this group. However, a lack of clear associations between perceived environmental factors and physical activity, suggests the importance of gender in driving physical activity behaviors. Community development strategies that have traditionally focused on social and economic benefits for disadvantaged communities, may also benefit the health of communities by provding infrastructure and opportunities to be physically active. Neighborhood improvements such as the implementation of smart growth strategies and complete streets are shown to influence physical activity behaviors. However, successful community development that benefits all community members should also focus on capacity building for key stakeholders in the community (e.g., community members, public health practitioners, advocates) and community engagement. Public health practitioners and advocates should engage with community members, but also across sectors

Perspectives from public health practitioners and advocates on community development for active living: What are the lasting impacts?

PURPOSE: Evidence suggests differential impacts of community development, including gentrification and displacement. Public health practitioners and advocates are key stakeholders involved in the community development process related to active living, yet little is known about their perceptions of its impacts. We explored the perspectives of relevant leaders of public health departments and key community and advocacy organizations on community development, gentrification, and displacement. APPROACH: Purposive key informant interviews. SETTING: CDC State Physical Activity and Nutrition (SPAN) funding recipients. PARTICIPANTS: CDC SPAN recipient leadership (n = 10 of 16) and advocacy organizations they partnered with (n = 7 of 16). METHOD: Interviews were recorded, transcribed, coded, and thematically analyzed with direct quotes representing key themes. RESULTS: Both groups felt community development held important benefits, specifically by creating healthy living opportunities, but also potentially leading to the displacement of long-time residents. Practitioners reported the benefits were for all community members, whereas advocates noted the benefits were seen in those with privilege, and the consequences were disproportionately seen in disadvantaged communities. Both mentioned the importance and difficulty of getting diverse representation for community engagement. CONCLUSIONS: Learning how key stakeholders perceive and navigate the community development process can help inform recommendations for better equity in active living community improvements. More work is needed to further elucidate best practices for health and social equity in the community development process

Perspectives From Public Health Practitioners and Advocates on Community Development for Active Living: What are the Lasting Impacts?

Purpose Evidence suggests differential impacts of community development, including gentrification and displacement. Public health practitioners and advocates are key stakeholders involved in the community development process related to active living, yet little is known about their perceptions of its impacts. We explored the perspectives of relevant leaders of public health departments and key community and advocacy organizations on community development, gentrification, and displacement. Approach Purposive key informant interviews. Setting CDC State Physical Activity and Nutrition (SPAN) funding recipients. Participants CDC SPAN recipient leadership (n = 10 of 16) and advocacy organizations they partnered with (n = 7 of 16). Method Interviews were recorded, transcribed, coded, and thematically analyzed with direct quotes representing key themes. Results Both groups felt community development held important benefits, specifically by creating healthy living opportunities, but also potentially leading to the displacement of long-time residents. Practitioners reported the benefits were for all community members, whereas advocates noted the benefits were seen in those with privilege, and the consequences were disproportionately seen in disadvantaged communities. Both mentioned the importance and difficulty of getting diverse representation for community engagement. Conclusions Learning how key stakeholders perceive and navigate the community development process can help inform recommendations for better equity in active living community improvements. More work is needed to further elucidate best practices for health and social equity in the community development process

Multilevel correlates of domain-specific physical activity among rural adults - A cross-sectional study

BACKGROUND: Increasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities. METHODS: Surveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19-96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire. RESULTS: Rural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA. CONCLUSIONS: PA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults

Shaping Policy and Practice: Analyzing the Reach of Highly Cited and High Altmetrics Publications for Broader Impact on Physical Activity

BACKGROUND: A significant gap remains between the availability of physical activity (PA) evidence-based interventions and their application in real-world settings in policy and practice areas. This study aims to describe highly cited and high altmetrics publications in PA research and explore their impact on PA policy and practice. METHODS: Mixed-methods sequential explanatory study including the identification and description of the top highly cited and high altmetrics PA publications from the last 10 years (including study design, population, type of PA study, number of citations, and altmetrics score), and interviews with key informants regarding research dissemination and implications on PA policy and practice. RESULTS: When considering publication type, the most frequent highly cited publications were health consequences (40%, altmetrics = 42%), measurement/trends (23%, altmetrics = 10%), and correlates/determinants (21%, altmetrics = 26%) studies. They were predominantly cross-sectional (50%, altmetrics = 28%), systematic reviews (38%, altmetrics = 18%), and longitudinal studies (8%, altmetrics = 37%). All authors who participated in the interviews agreed that the most important factors in disseminating findings and influencing PA policy and practice were the published peer-reviewed manuscript itself, the reputation of the journal, the communication strategy, and the use of online platforms. CONCLUSIONS: To have a real-world influence on PA policy and practice, it is not enough to publish the results in scientific journals and participate in media outreach. To successfully involve policymakers and communities in appropriating the evidence and evaluating the extent to which these findings affect policy and practice outcomes, it is critical to lead co-creation, co-dissemination, advocacy, and capacity building efforts

Sub-population differences in the relationship between the neighborhood environment and Latinas' daily walking and vehicle time.

BackgroundOver 60% of Latinas report not meeting moderate to vigorous physical activity (MVPA) guidelines of 150 minutes/week. Ecological models of health posit that intrapersonal and environmental factors interact with one another to influence physical activity. Understanding their interactions in relation to transportation behaviors may inform interventions to increase Latinas' physical activity.PurposeTo 1) objectively estimate walking and vehicle time in Latinas, 2) examine the association of, and interactions between, intrapersonal (socio-demographics and weight status) and neighborhood environmental correlates with objective daily walking and vehicle time.MethodsA subsample of Latinas (n=87) participating in a health intervention wore an accelerometer and GPS device for at least two valid wear days at baseline. The Personal Activity Location and Measurement System (PALMS) software estimated daily walking and vehicle time. Participants' anthropometrics were measured, and they completed a survey assessing socio-demographic characteristics and perceived neighborhood environment. Generalized linear mixed models examined main effects and interactions of four intrapersonal and five environmental factors on daily walking and vehicle time.ResultsOn average, participants walked 16 min/day and spent 69 min/day in a vehicle. Overweight/obesity was negatively associated with walking time (p=.04) and positively associated with vehicle time (p=0.01). Household income was positively associated with vehicle time (p=0.02). For daily walking time, two interactions were significant: perceived access to destinations X household income (p=0.01), and perceived sidewalk maintenance X acculturation (p= 0.01). For daily vehicle time, two interactions were significant: perceived access to destinations X weight status (p<0.001), and perceived safety from crime X education (p=0.01).ConclusionLatinas participated in relatively low walking time and high amounts of vehicle time. Findings suggest intrapersonal sub-group differences in the association of the neighborhood environment with walking and vehicle time. Improving neighborhood environments to promote walking and reduce vehicle time may help improve Latinas' overall physical activity

Two-year outcomes of Faith in Action/Fe en Acción: a randomized controlled trial of physical activity promotion in Latinas.

BackgroundLatina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas.MethodsThe study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference.ResultsAfter adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference.ConclusionsParticipants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits.Trial registrationNCT01776632 , Registered March 18, 2011

Fe en Acción: Promoting physical activity among churchgoing Latinas

Objectives. To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. Methods. We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. Results. Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. Conclusions. A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls