Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013

Citation: Meyer, M. R. U., Perry, C. K., Sumrall, J. C., Patterson, M. S., Walsh, S. M., Clendennen, S. C., . . . Valko, C. (2016). Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013. Preventing Chronic Disease, 13, 24. doi:10.5888/pcd13.150406Additional Authors: Valko, C.Introduction Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity-related policy and environmental strategies for obesity prevention in rural communities. Methods A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity-related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers. Results Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were "enhance infrastructure supporting walking" (n = 11) and " increase opportunities for extracurricular physical activity" (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes. Conclusion Seven of the 12 COCOMO physical activity-related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities

Food for thought : a social cognitive approach to assessing children’s food environments.

The objective of this study was to describe the process of developing and piloting a Social Cognitive Theory (SCT)-based assessment tool to capture the interaction between environmental and social determinants of child fruit and vegetable (F/V) intake. A three-stage process facilitated development of the 64-item Food For Thought questionnaire: (1) initial item selection and improvement; (2) expert panel review for improvement and establishing content and face validity, comprehensiveness, and cultural equivalence; and (3) refinement from a pilot test and focus group. Instrument modifications determined from these processes were described in detail. Children ages 8-12 (n=42) of ethnically diverse and low-income households were administered the computer-based questionnaire during after-school programming at local community centers. Scale response means and bivariate correlations were calculated. Overall mean F/V intake met the daily recommendation of five servings (M=5.17; SD=3.43). Self-efficacy for eating, preparing, and asking for F/V was the SCT construct most strongly associated with F/V consumption (M=2.44; SD=0.41; r=0.50; p=0.01). Future research should be designedto validate the SCT-based scales included in the Food For Thought questionnaire to provide a more robust, theoretically comprehensive assessment of factors of children’s F/V intake

Food for thought : a social cognitive approach to assessing children’s food environments.

The objective of this study was to describe the process of developing and piloting a Social Cognitive Theory (SCT)-based assessment tool to capture the interaction between environmental and social determinants of child fruit and vegetable (F/V) intake. A three-stage process facilitated development of the 64-item Food For Thought questionnaire: (1) initial item selection and improvement; (2) expert panel review for improvement and establishing content and face validity, comprehensiveness, and cultural equivalence; and (3) refinement from a pilot test and focus group. Instrument modifications determined from these processes were described in detail. Children ages 8-12 (n=42) of ethnically diverse and low-income households were administered the computer-based questionnaire during after-school programming at local community centers. Scale response means and bivariate correlations were calculated. Overall mean F/V intake met the daily recommendation of five servings (M=5.17; SD=3.43). Self-efficacy for eating, preparing, and asking for F/V was the SCT construct most strongly associated with F/V consumption (M=2.44; SD=0.41; r=0.50; p=0.01). Future research should be designedto validate the SCT-based scales included in the Food For Thought questionnaire to provide a more robust, theoretically comprehensive assessment of factors of children’s F/V intake