Bill Reger-Nash

Health benefits of cycling: a systematic review

The purpose of this study was to update the evidence on the health benefits of cycling. A systematic review of the literature resulted in 16 cycling‐specific studies. Cross‐sectional and longitudinal studies showed a clear positive relationship between cycling and cardiorespiratory fitness in youths. Prospective observational studies demonstrated a strong inverse relationship between commuter cycling and all‐cause mortality, cancer mortality, and cancer morbidity among middle‐aged to elderly subjects. Intervention studies among working‐age adults indicated consistent improvements in cardiovascular fitness and some improvements in cardiovascular risk factors due to commuting cycling. Six studies showed a consistent positive dose–response gradient between the amount of cycling and the health benefits. Systematic assessment of the quality of the studies showed most of them to be of moderate to high quality. According to standard criteria used primarily for the assessment of clinical studies, the strength of this evidence was strong for fitness benefits, moderate for benefits in cardiovascular risk factors, and inconclusive for all‐cause mortality, coronary heart disease morbidity and mortality, cancer risk, and overweight and obesity. While more intervention research is needed to build a solid knowledge base of the health benefits of cycling, the existing evidence reinforces the current efforts to promote cycling as an important contributor for better population health.

Testing a hierarchy-of-effects model: pathways from awareness to outcomes in the VERB campaign 2002-2003.

BACKGROUND The McGuire hierarchy-of-effects (HOE) model, used extensively in mass-media interventions to describe the mechanisms for understanding effects, has not been tested in physical activity campaigns. DESIGN Data collected at baseline (2002) and follow-up (2003) surveys in the VERB evaluation were used in structural equation modeling to test pathways and hierarchies of campaign effects. SETTING/PARTICIPANTS Population-based cohort of youth aged 9-13 years (N=2364) for whom complete baseline and follow-up data were available. MAIN OUTCOME MEASURES Awareness of the VERB campaign, understanding of the VERB message, attitude toward being active, outcome expectations, and physical activity participation. RESULTS Among youth aged 9-13 years (tweens) in the study cohort, significant paths were identified between awareness and understanding (0.72, p<0.001) and between understanding and being physically active (0.11, p<0.05). At baseline there was a high prevalence of positive attitudes and outcome expectations, and these were not influenced by change in understanding or awareness. Among inactive tweens only, the same paths were identified except that, in this subgroup, attitude was related to physical activity (0.13, p<0.05), and awareness was more strongly related to physical activity than it was for the whole sample (0.14, p<0.01). CONCLUSIONS These findings provided limited support for the HOE model and suggest that increased awareness and understanding were the key proximal effects that led to behavior change. A distinct sequence of effects, which bypassed attitudes and outcome expectations, was found for these U.S. young people. The findings could inform the design of future campaigns to address youth physical activity.

Wheeling walks: evaluation of a media-based community intervention.

Mass media community-wide physical activity intervention to promote and sustain changes in walking was assessed using a 2-community longitudinal design. The intervention targeted sedentary 50- to 65-year-old residents of Wheeling, West Virginia. Telephone surveys of a probability sample followed cohorts at baseline and at 3-, 6-, and 12-month post-intervention with comparison communities. The intervention, consisting of paid advertisements, public relations, and community participatory planning, attained high levels of awareness and effected significant sustained population-wide changes among the most sedentary in Wheeling.

Formative Research to Develop a Mass Media Campaign to Increase Physical Activity and Nutrition in a Multiethnic State

Poor nutrition and physical inactivity are the second leading causes of preventable morbidity and mortality in the United States. Mass media campaigns have tremendous promise for reaching large segments of the population to influence these behaviors. There is still insufficient evidence in the literature, however, to recommend mass marketing campaigns for physical activity and nutrition. Successful mass media campaigns should have a formative research base that includes conducting preproduction research with the target audience, using theory as a conceptual foundation of the campaign, segmenting the audience into meaningful subgroups, and using a message approach that is targeted to and likely will be effective with the audience segment. In this study, these formative research steps were addressed to develop a mass media campaign based on the Theory of Planned Behavior to increase physical activity and fruit and vegetable consumption in 35–55-year-old adults in the state of Hawaii. For the walking campaign, our results identified time, a control belief, as the major barrier. For fruits and vegetable, the data suggested social norm (if others around me ate them) and control (if they were available). These data then were used to develop a mass media campaign based on these principals.

Testing the hierarchy of effects model: ParticipACTION's serial mass communication campaigns on physical activity in Canada

The hierarchy of effects (HOE) model is often used in planning mass-reach communication campaigns to promote health, but has rarely been empirically tested. This paper examines Canadas 30 year ParticipACTION campaign to promote physical activity (PA). A cohort from the nationally representative 1981 Canada Fitness Survey was followed up in 1988 and 2002-2004. Modelling of these data tested whether the mechanisms of campaign effects followed the theoretical framework proposed in the HOE. Campaign awareness was measured in 1981. Outcome expectancy, attitudes, decision balance and future intention were asked in 1988. PA was assessed at all time points. Logistic regression was used to sequentially test mediating and moderating variables adjusting for age, sex and education. No selection bias was observed; however, relatively fewer respondents than non-respondents smoked or were underweight at baseline. Among those inactive at baseline, campaign awareness predicted outcome expectancy which in turn predicted positive attitude to PA. Positive attitudes predicted high decision balance, which predicted future intention. Future intention mediated the relationship between decision balance and sufficient activity. Among those sufficiently active at baseline, awareness was unrelated to outcome expectancy and inversely related to positive attitude. These results lend support to the HOE model, in that the effects of ParticipACTIONs serial mass media campaigns were consistent with the sequential rollout of its messages, which in turn was associated with achieving an active lifestyle among those initially insufficiently active. This provides support to an often-used theoretical framework for designing health promotion media campaigns.

Statewide Implementation of the 1% or Less Campaign:

The 1% or Less Campaign is an effective research-tested program for reducing saturated fat intake by encouraging individuals to switch to low-fat milk. All published studies have been conducted in small communities with mostly White populations. The 6-week intervention included a media campaign, public relations, and taste tests. Campaign effectiveness was measured using sales data and cross-sectional telephone surveys. Survey results showed a significant increase in low-fat milk consumption from 30.2% to 40.8% of milk drinkers (p < .001) with a reduced yet sustained increase at 3 months. This translates to approximately 65,000 people switching to low-fat milk during the campaign with a sustained effect of approximately 32,000 people three months postcampaign. Sales data show an increase of low-fat milk sales from 32.7% to 39.9%. Results are similar to smaller community initiatives, indicating the program is effective in promoting population behavior change but may need booster sessions for sustained effects.

The importance of being parsimonious: reliability of a brief community walkability assessment instrument.

This research presents the Leyden Walkability Instrument (LWI), a brief survey checklist designed to measure the perceived walkability of a neighborhood or community where a respondent lives. The reliability of this instrument was tested using the intra-class correlation and found to be moderately substantially reliable (Landis-Koch rating) in every survey item (ranging from .54 to .76 and ranging in observed agreement from 72.8% to 93.9% with an overall instrument score of .71 and an observed agreement of 81.6%). The LWI is discussed in the context of other survey instruments designed to measure perceived walkability and found to be a useful addition because of its brevity and ease of use.

Does the Environment Moderate the Impact of a Mass Media Campaign to Promote Walking

Purpose. To examine if a mass media campaign influenced walking differently in people in different physical environments. Design. Quasi-experimental study. Setting. Wheeling, West Virginia. Participants. Random sample of adults age 50 to 65 years, response rate: 72.1% (n = 719 in intervention community, n = 753 in comparison community). Intervention. Mass media campaign. Measures. Self-reported measures were used in before and after telephone surveys for walking and the physical environment. Measures included 11 environmental walkability items, from which two subscales (i.e., usable sidewalks/aesthetics and facilities) were extracted. Analysis. Multiple linear regression. Results. Overall, walking increased by 2.7 minutes per week (standard deviation [SD] = 231.1, not significant [NS]). When confined to those insufficiently active at baseline (i.e., <30 minutes per day) the minutes walked increased by 92.1 minutes (SD = 152.9, p < .001). For the insufficiently active at baseline in the top half of the environmental factor of usable sidewalks, walking increased by 19 minutes more than in the bottom half (NS). For the factor of aesthetics and facilities, people in the more walkable environment increased walking by 87 minutes more than those in the bottom half (p < .001). Conclusion. In this community-wide physical activity, intervention changes in walking after the campaign were significantly moderated by some environmental attributes. This contributes to the limited evidence on the impact of the environment in enhancing community physical activity interventions. This finding needs to be replicated in other community interventions with greater environmental variation.

Health Educator Believability and College Student Self-rated Health

Abstract Objective: To evaluate the self-rated health (SRH) status among college students who reported receiving the majority of their health-related information from health educators. Participants: Students (n = 49,921) who completed the 2006 National College Health Association survey. Methods: Bivariate associations between SRH and the believability of health information received were analyzed. Multiple logistic regression tested the relationship after covariate adjustment. Results: Although a modest correlation (r = .06, p < .0001) existed between the variables, SRH declined as the believability of health information received from health educators ratings became increasingly unfavorable (χ2 = 110.96, p < .0001). After covariate adjustment, the relationship persisted with increased odds of reporting fair/poor health for those who reported the health information received from health educators as “neutral” (odds ratio [OR] = 1.31) or “unbelievable” (OR = 2.25) when compared to those who reported the health information received as “believable” (p < .0001). Conclusions: The field of health education, and health educators, may positively influence college student SRH.

Motivated to walk but nowhere to walk to: Differential effect of a mass media campaign by mix of local destinations

Objective Built environment attributes are associated with walking but little is known about how the impact of walking campaigns varies across different environments. The objective of this study was to compare the impact of a campaign on changes in walking between respondents with a high versus low mix of local destinations. Methods Pre- and post-campaign data from a quasi-experimental study were used to compare changes in walking for residents aged 40–65 with high and low destination mix in a West Virginia community campaign (March–May 2005). Results Overall samples consisted of 777 intervention community respondents and 388 comparison community respondents with pre- and post-campaign data. Among insufficiently active intervention respondents, those with high destination mix increased their walking by 0.64 days more than those with low mix (p < 0.05). No significant differences were observed among the comparison community. Conclusion The walking response to campaigns in those insufficiently active may be influenced by neighborhood attributes.