Erica G. Soltero

Using the RE-AIM framework to evaluate physical activity public health programs in México

BackgroundPhysical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program’s funding source.MethodsPublic health programs promoting PA were systematically identified during 2008–2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites.ResultsIn addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M = 10, SD = 3.1) and programs that were partially or wholly privately or corporately supported (M = 12.0, SD = 4.4).ConclusionWhile reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established.

Does social support mediate the relationship among neighborhood disadvantage, incivilities, crime and physical activity?

OBJECTIVE Neighborhood disadvantage (ND), incivilities, and crime disproportionately impact minority women, discouraging physical activity (PA). Social support (SS) is a cultural tool promoting PA in minority women. Socially supportive environments may promote PA in disadvantaged neighborhoods, yet few studies have investigated the mediating role of social support among minority women. This study examined SS as a mediator among ND, incivilities, crime, and PA. METHODS The Health Is Power study aimed to increase PA in African American and Hispanic Latina women (N=410) in Houston and Austin, TX. ND and crime data were taken from the National Neighborhood Crime Study. Incivilities were measured using the Pedestrian Environment Data Scan (PEDS). SS was measured using the Family and Friend Support for Exercise Habits scale and physical activity was measured using the International Physical Activity Questionnaire. Linear regression analysis was used to examine SS as a mediator following the Baron and Kenny method. RESULTS ND was negatively associated with PA and SS. SS was not a mediator as it was not significantly associated with ND, crime, and incivilities (F(3,264)=2.02, p>.05) or PA (F(1,266)=3.8 p=.052). CONCLUSION ND significantly discourages PA and limits SS. Future research should focus on developing strategies to overcoming these negative environmental factors.

Contribution of Neighborhood Income and Access to Quality Physical Activity Resources to Physical Activity in Ethnic Minority Women over Time

Purpose. To create and test an index to indicate both availability and quality of physical activity (PA) resources (PARs), to examine associations between access to quality PARs and changes in PA, and to determine whether this association differed in lower- and higher-income neighborhoods. Design. Longitudinal, 6-month intervention. Setting. Houston and Austin, Texas. Subjects. African-American and Hispanic or Latina women. Measures. Women (N = 410) completed a questionnaire and accelerometry to measure PA. Neighborhoods (N = 163) were classified as lower- or higher-income by median household income at the census-tract level. PARs were audited using the PARA (physical activity resource assessment). Access to quality PARs was determined by a composite index (QPAR) of features, amenities, and incivilities. Analysis. Repeated measures analyses of variance were used to examine changes in PA by (1) neighborhood income (lower/higher) and QPAR (lower/higher) groups, and (2) neighborhood income (lower/higher) and number of PARs (lower/higher) groups, adjusting for ethnicity, household income, and body mass index. Results. Women in neighborhoods with lower QPAR scores had small increases in self-reported vigorous PA (M Δ = 327.8 metabolic equivalent of task [MET]-min/wk) and decreases in accelerometer PA (M = −3.4 min/d), compared to those with higher QPAR scores who had larger increases in self-reported vigorous PA (M Δ = 709.8 MET-min/wk) and increased accelerometer PA (M = 3.9 min/d). There was a significant interaction between changes in leisure-time PA, QPAR score, and number of PARs (p = .049). Women with both more PARs and higher QPAR scores reported greater increases in leisure-time PA than women with fewer PARs and lower QPAR scores. Conclusion. Access to higher-quality PARs can help increase or maintain PA over time regardless of neighborhood income. PAR quality is a separate and distinct, important determinant of PA in ethnic minority women.

Associations between objective and self-report measures of traffic and crime safety in Latino parents of preschool children

Differences in subjective and objective safety may be explained by moderators that shape parental perceptions of the environment. This study examined associations between subjective and objective measures of traffic and crime safety in preschool parents (N = 240) and potential moderators. Community cohesion, social control, and physical activity parenting practices were measured. Objective measures of crime and traffic were measured at the block-group level. Linear models revealed perceived traffic was negatively associated with the traffic hazards (b = −0.03; 95 % CI: −0.05, −0.01; p = .041). Acculturation moderated the relationship between perceptions of disorder and crime (b = 0.001; 95 % CI: 0.000, 0.003; p = .044). Poor community cohesion moderated the relationship between perceptions of disorder and crime (b = 0.0015; 95 % CI: 0.0002, 0.0028; p = .028). Perceived traffic safety was associated with the traffic hazard index in parents of boys (b = −0.04; 95 % CI: −0.07, −0.01; p = .027). Acculturation and community cohesion can be used to align misperceptions of safety to actual safety to promote outdoor play.

Association of Discrimination and Stress With Cardiometabolic Risk Factors in Ethnic Minority Women

Psychological stressors can contribute to adverse health outcomes and lead to health disparities. To examine associations among psychological stressors, coping, blood pressure, body mass index, and body fat in ethnic minority women, we conducted a secondary analysis using data from 178 African American and Hispanic/Latina women who completed measures of perceived racial discrimination and stress, coping, blood pressure, and body composition. The mean age of participants was 45.3 (±9.3 years), and most were obese (74.2%) and had prehypertensive systolic blood pressure (125.7 ± 14.6 mmHg). Hierarchical multiple regression models indicated a significant negative relationship between racial discrimination and percent body fat, and positive associations between stress and blood pressure. Coping did not moderate the association between racial discrimination and blood pressure or body composition. Health care providers should consider psychological stressors as underlying causes for hypertension and address tailored stress-reduction coping strategies when treating African American and Hispanic/Latina women with hypertension.

Disentangling Associations of Neighborhood Street Scale Elements With Physical Activity in Mexican School Children

Promoting outdoor play and participation in sports and organized physical activities in children may depend on neighborhood characteristics. This study investigated associations between neighborhood streets and physical activities among Mexican children (N = 1,509, 6-11 years). Child sociodemographic characteristics and physical activity were measured in schools in Guadalajara (n = 10), Mexico City (n = 13), and Puerto Vallarta (n = 3), Mexico, in 2012. Street segments within an 800 m radius around each school were measured using the Pedestrian Environment Data Scan. Most (75.8%) played outdoors; 47.4% participated in sports and 40% in organized physical activities. Fewer path obstructions and more pedestrian amenities were associated positively with outdoor play. Greater street cleanliness, more pedestrian amenities, and more path obstructions were associated with less participation in sports or organized activities. Walkability was negatively associated with all physical activities. Fostering safe and appealing streets may help promote outdoor play time, but not sports participation, for Mexican children.

Developing a transcultural academic-community partnership to arrest obesity

Innovative and empirically tested strategies are needed to define and understand obesity prevention and reduction in a transcultural society. This manuscript describes the development of Science & Community, a partnership developed over a 3-year period with the end goal of implementing a community-based participatory research (CBPR) trial to reduce and prevent obesity. Outreach strategies focused on promoting the project via existing and new channels and identifying and contacting potential partners using established strategies. Science & Community developed and fostered partnerships by hosting a series of interactive meetings, including three Opportunity Receptions, four Community Open Forum Symposia, and quarterly Community Advisory Board (CAB) meetings. Opportunity Reception (N = 62) and Symposia attendees (N = 103) represented the diversity of the community, and participants reported high satisfaction with content and programming. From these events, the CAB was formed and was comprised of 13 community representatives. From these meetings, a Partnership representing 34 organizations and 614 individuals emerged that has helped to guide the development of future proposals and strategies to reduce obesity in Houston/Harris County.

Researching Those Who Have the Most to Gain: Focused Physical Activity Promotion in Lower Socioeconomic Populations

Physical inactivity is among the most pressing public health challenges facing industrialized nations, and low socioeconomic status (SES) populations report lower rates of physical activity than high SES populations. The Ecologic Model of Physical Activity (EMPA) accounts for individual, social and environmental factors that contribute to physical activity, and can be used to demonstrate possible pathways by which SES may influence physical activity, illuminating strategies for intervention. This review examines current approaches to physical activity promotion in low SES populations couched within the EMPA. Findings suggest that limitations and challenges remain for physical activity promotion in low SES populations. Coordinated and consistent physical activity promotion efforts, targeting multiple levels of influence and a range of settings, including political, corporate and community support, are needed to prevent and treat the disparity in physical activity in this vulnerable population.

A Multisite Study of Environmental Correlates of Active Commuting to School in Mexican Children.

BACKGROUND Mexican children often use active commuting to school (ACS). In order to maintain high levels of ACS it is important to understand correlates of ACS in this population. However, most evidence comes from high-income countries (HICs). We examined multilevel correlates of ACS in children attending public schools in 3 Mexican cities. METHODS Information on 1191 children (grades 3 to 5) attending 26 schools was retrieved from questionnaires, neighborhood audits, and geographic information systems data. Multilevel logistic modeling was used to explore individual and environmental correlates of ACS at 400-m and 800-m buffers surrounding schools. RESULTS Individual positive correlates for ACS included age (6-8 years vs 9-11 years, odds ratio [OR] = 1.5; 6-8 years vs ≥12 years: OR = 2.1) and ≥ 6 adults at home (OR = 2.0). At the 400-m buffer, more ACS was associated with lower walkability (OR = 0.87), presence of posted speed limits (< 6% vs > 12%: OR = 0.36) and crossing aids (< 6% vs 6-20%: OR = 0.25; > 20%: OR = 0.26), as well as higher sidewalk availability (< 70% vs > 90%: OR = 4.5). Similar relationships with speed limits and crossing aids were observed at the 800m buffer. CONCLUSIONS Findings contrast with those reported in HICs, underscoring the importance of considering the local context when developing strategies to promote ACS. Future studies are needed to replicate these relationships and investigate the longitudinal impact of improving active transportation infrastructure and policies.

Feasibility and Acceptability of Adapting the Eating in the Absence of Hunger Assessment for Preschoolers in the Classroom Setting.

Eating in the Absence of Hunger (EAH) represents a failure to self-regulate intake leading to overconsumption. Existing research on EAH has come from the clinical setting, limiting our understanding of this behavior. The purpose of this study was to describe the adaptation of the clinical EAH paradigm for preschoolers to the classroom setting and evaluate the feasibility and acceptability of measuring EAH in the classroom. The adapted protocol was implemented in childcare centers in Houston, Texas (N=4) and Phoenix, Arizona (N=2). The protocol was feasible, economical, and time efficient, eliminating previously identified barriers to administering the EAH assessment such as limited resources and the time constraint of delivering the assessment to participants individually. Implementation challenges included difficulty in choosing palatable test snacks that were in compliance with childcare center food regulations and the limited control over the meal that was administered prior to the assessment. The adapted protocol will allow for broader use of the EAH assessment and encourage researchers to incorporate the assessment into longitudinal studies in order to further our understanding of the causes and emergence of EAH.