Iris Alcantara

A qualitative examination of home and neighborhood environments for obesity prevention in rural adults.

BackgroundThe home and neighborhood environments may be important in obesity prevention by virtue of food availability, food preparation, cues and opportunities for physical activity, and family support. To date, little research has examined how home and neighborhood environments in rural communities may support or hinder healthy eating and physical activity. This paper reports characteristics of rural homes and neighborhoods related to physical activity environments, availability of healthy foods, and family support for physical activity and maintaining an ideal body weight.MethodsIn-depth interviews were conducted with 60 African American and White adults over 50 years of age in two rural counties in Southwest Georgia. Interviews were transcribed verbatim and coded independently by two members of the research team using standard methods of qualitative analysis. Themes were then identified and data matrices were used to identify patterns by gender or race.ResultsNeighborhood features that supported physical activity were plenty of land, minimal traffic and living in a safe and friendly neighborhood. The major barrier was lack of recreational facilities. The majority of participants were not physically active with their family members due to schedule conflicts and lack of time. Family member-initiated efforts to encourage physical activity met with mixed results, with refusals, procrastination, and increased activity all reported. Participants generally reported it was easy to get healthy foods, although cost barriers and the need to drive to a larger town for a supermarket with good variety were noted as obstacles. Family conversations about weight had occurred for about half of the participants, with reactions ranging from agreement about the need to lose weight to frustration.ConclusionThis study suggests that successful environmental change strategies to promote physical activity and healthy eating in rural neighborhoods may differ from those used in urban neighborhoods. The findings also provide insight into the complexities of family support for physical activity and maintaining a healthy weight. Addressing socio-ecologic factors has the potential to increase healthy behaviors and decrease the prevalence of obesity among rural residents.

Results From an Intervention to Improve Rural Home Food and Physical Activity Environments

Background: Ecological models of healthy eating and physical activity emphasize the influence of behavioral settings such as homes and worksites in shaping behavior. Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating.Objective: Using a community-based participatory research (CBPR) approach, the Emory Prevention Research Center (EPRC), Cancer Coalition of South Georgia, and the EPRCs Community Advisory Board (CAB) designed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults.Methods: The 6-week intervention consisted of a tailored home environment profile, goal-setting, and behavioral contracting delivered through two home visits and two telephone calls. The study used a quasi-experimental design with data collected via telephone interviews at baseline, 2 and 4 months post-baseline. Ninety households (n = 90) completed all three telephone interviews.Results: Multilevel models indicated that intervention households reported significant improvements in household food inventories, purchasing of fruit and vegetables, healthier meal preparation, meals with the TV off, and family support for healthy eating, relative to comparison households. Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households. Percent of fat intake decreased significantly, but no changes were observed for fruit and vegetable intake, physical activity, or weight among intervention relative to comparison households, although trends were generally in a positive direction.Conclusion: Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults.

The influence of home food environments on eating behaviors of overweight and obese women.

OBJECTIVE To describe home food environments and examine which aspects are associated with fruit and vegetable intake and percent calories from fat among overweight and obese women. DESIGN Baseline data from a weight gain prevention trial collected through telephone interviews. SETTING Participants were recruited from 3 federally qualified health centers in rural Georgia. PARTICIPANTS Overweight and obese patients (n = 319) were referred by their providers if they had a body mass index (BMI) > 25 and lived with at least 1 other person. Participants were primarily African American (83.7%), with a mean BMI of 38.4. MAIN OUTCOME MEASURES Fruit and vegetable intake and percent calories from fat. ANALYSIS Descriptive statistics and multiple regression. RESULTS Participants reported a large variety of both fruits and vegetables and unhealthy foods in their homes, and an average of 2.6 family meals from non-home sources per week. Eating family meals with the television on was common. Availability of fruits and vegetables in the home (P < .001) and frequency of fruit shopping (P = .01) were associated with fruit and vegetable intake. The number of unhealthy foods in the home (P = .01) and food preparation methods (P = .01) were associated with percent calories from fat. CONCLUSIONS AND IMPLICATIONS Home food environments may be effective intervention targets for nutrition programs designed for overweight and obese women.

Impact of Improving Home Environments on Energy Intake and Physical Activity: A Randomized Controlled Trial.

OBJECTIVES We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia. METHODS We conducted a randomized controlled trial (n = 349) from 2011 to 2013, with follow-up at 6 and 12 months. Health coaches delivered the 16-week intervention by using tailored home environment profiles showing areas in need of improvement and positive aspects of the home environment, behavioral contracts for healthy actions, and mailed support materials. RESULTS Participants were mostly African American women (84.8%), with a mean age of 50.2 years and a mean body mass index (weight in kilograms divided by the square of height in meters) of 38.3. Daily energy intake decreased more for the intervention than control group at 6 (-274 vs -69 kcal) and 12 months (-195 vs -76 kcal). We observed no change for either objective or self-reported physical activity. At 12 months, 82.6% of intervention participants had not gained weight compared with 71.4% of control participants. CONCLUSIONS The intervention was effective in changing home environments and reducing energy intake.

Relative validation of fruit and vegetable intake and fat intake among overweight and obese African-American women

OBJECTIVE To compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women. DESIGN Three telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance Systems (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institutes (NCI) Percentage Energy from Fat Screener. SETTING Participants were recruited from three federally qualified health centres in south-west Georgia, USA. SUBJECTS Participants (n 260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49.6%) and 58.7% had a high-school education or less. Most were obese (88.5%), with 39.6% reporting a BMI ≥ 40.0 kg/m(2). RESULTS Mean fruit and vegetable intake reported from the 24 h dietary recall was 2.66 servings/d compared with 2.79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0.22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35.5% as reported from the 24 h dietary recall, compared with 33.0% as measured by the NCI fat screener. The deattenuated Pearson correlation was 0.38, also with notable variation by weight status, education level and age. CONCLUSIONS Validity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

Physical activity profiles of overweight and obese women in rural Georgia.

Physical Activity Profiles of Overweight and Obese Women in Rural Georgia The value of moderate and vigorous physical activity (PA) is wellknown and substantiated by a large body of research.1 In addition, research on the value of light activity and the negative effect of sedentary behavior is starting to accumulate.2,3 However, little is known about PA in relation to time spent sedentary and the frequency and length of interruptions in sedentary behavior in overweight and obese patients of safety-net primary care practices such as federally qualified health centers (FQHCs). This study investigated the PA profiles of overweight and obese women, focusing on light activity and breaks in sedentary behavior.

Differences in Perceptions of the Home Food and Physical Activity Environment Among Adult Dyads

Research has shown that microenvironments such as homes and neighborhoods are associated with dietary and physical activity behaviors. This study examines self-reports of home and neighborhood environments of adult dyads living in the same household (n = 83 dyads) and explores correlates of discrepant perceptions. Food and exercise equipment in the home and access to neighborhood recreational facilities were assessed. Agreement between pairs varied across measures, with dyads having less disagreement in reporting their physical activity environment compared with their food environment. Discrepancy indices were .20 for exercise equipment, .29 for neighborhood facilities, .25 for fruits, .26 for drinks, and .28 for vegetables and snacks/other foods. Differences in education, food shopping behavior, fat intake, BMI, and physical activity were associated with discordance in reporting among dyads. Results suggest that co-dwelling adults perceive their home and neighborhood environments differently. This has implications for how microenvironments are measured and how data are interpreted.

Home environments, physical activity, and energy expenditure among low-income overweight and obese women

ABSTRACT Ecologic models of physical activity identify multiple environmental domains that influence activity levels, including the home. This study examined aspects of the home environment associated with objective measures of physical activity in overweight and obese women. Study participants were recruited through three federally qualified health centers in rural southwest Georgia as part of a randomized controlled trial of a home-environment-focused weight gain prevention intervention. Data collected from February 2011 to December 2012 were from 301 participants who completed baseline interviews and wore accelerometers for 7 days. Most were African American (83.4%) and obese (50.5%) or morbidly obese with body mass index ≥40 (35.6%). Mean age was 50.6 years. Participants were highly sedentary, with 7.9 hours of non-sedentary time per week, primarily in light activity. In a multivariate model, exercise equipment (p = .03), family support (p = .02), and full-time employment (p = .03) were positively associated with non-sedentary time, whereas age (p = .003), living in a more rural area (p = .03), and having an exercise space (p = .01) were negatively associated. Home environments may be promising targets for programs aimed at increasing activity levels among overweight and obese women.