M. Renée Umstattd Meyer

Built Environments and Active Living in Rural and Remote Areas: a Review of the Literature

Rural children and adults are more likely to have obesity than their urban counterparts even after adjustment for individual-level behaviors, suggesting that rural environments may promote obesity. The rural built environment may be an important area of research that can help us understand rural–urban disparities in obesity. The purpose of this review is to summarize the rural built environment and active living literature, and to address key issues, gaps, and observations in the field. A literature review was conducted in spring 2015 to identify research published from 2000 to 2015. Our review suggests that limited active living built environments in rural communities and unique rural barriers to physical activity may contribute to a higher prevalence of obesity compared to urban populations. More empirical research is needed to build the evidence-base for the association between rural built environments, active living, and obesity. School- and community-based policies that expand active living opportunities in rural areas should also be closely examined.

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

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.

Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: A descriptive study

BackgroundThe increasing numbers of colonias along the U.S.-Mexico border are characterized by disproportionately poor families of Mexican-origin, limited access to resources and health services, and heightened risk for obesity and diabetes. Despite consistent evidence supporting physical activity (PA) in prevention of chronic diseases, many individuals of Mexican-origin, including children, fail to meet PA recommendations. Environmental influences on PA, founded in ecological and social cognitive perspectives, have not been examined among children living in colonias. The purpose of this study was to identify and better understand (1) household and neighborhood environmental PA resources/supports, (2) perceived barriers to engaging in PA, and (3) PA offerings, locations, and transportation characteristics for Mexican-origin children living in colonias.MethodsData for this study were collected by promotora-researchers (indigenous community health workers trained in research methods) using face-to-face interviews conducted in Spanish. The sample consists of 94 mother-child dyads from Texas border colonias in Hidalgo County. Interviews included questionnaire items addressing PA barriers, household and neighborhood environmental support assessments conducted with each dyad, and open-ended questions that were coded to identify availability and locations of PA opportunities and transportation options. Descriptive statistics were calculated and differences between genders, birth countries, and BMI categories of children were determined using chi-square tests.ResultsAll children were of Mexican-origin. The most frequently reported barriers were unleashed dogs in the street, heat, bad weather, traffic, no streetlights, and no place like a park to exercise. Prominent locations for current PA included schools, home, and parks. Common PA options for children were exercise equipment, running, playing, and sports. Environmental assessments identified exercise equipment (bicycles/tricycles, balls, etc.…), paved/good streets, yard/patio space, and social norms as the most frequent household or neighborhood resources within these colonias. Differences in PA barriers, options, and environmental resources for genders, birth countries, and BMI categories were detected.ConclusionsThis study suggests that PA environmental resources, barriers, and opportunities for colonias children are similar to previous studies and distinctively unique. As expected, built resources in these communities are limited and barriers exist; however, knowledge of PA opportunities and available PA resources within colonias households and neighborhoods offers insight to help guide future research, policy, and PA initiatives.

Walk@Work: an automated intervention to increase walking in university employees not achieving 10,000 daily steps

OBJECTIVE This study assessed the workday step counts of lower active (<10,000 daily steps) university employees using an automated, web-based walking intervention (Walk@Work). METHODS Academic and administrative staff (n=390; 45.6±10.8years; BMI 27.2±5.5kg/m(2); 290 women) at five campuses (Australia [x2], Canada, Northern Ireland and the United States), were given a pedometer, access to the website program (2010-11) and tasked with increasing workday walking by 1000 daily steps above baseline, every two weeks, over a six week period. Step count changes at four weeks post intervention were evaluated relative to campus and baseline walking. RESULTS Across the sample, step counts significantly increased from baseline to post-intervention (1477 daily steps; p=0.001). Variations in increases were evident between campuses (largest difference of 870 daily steps; p=0.04) and for baseline activity status. Those least active at baseline (<5000 daily steps; n=125) increased step counts the most (1837 daily steps; p=0.001), whereas those most active (7500-9999 daily steps; n=79) increased the least (929 daily steps; p=0.001). CONCLUSIONS Walk@Work increased workday walking by 25% in this sample overall. Increases occurred through an automated program, at campuses in different countries, and were most evident for those most in need of intervention.

Rural Active Living: A Call to Action

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.

Using the social cognitive theory to understand physical activity among dialysis patients

PURPOSE/OBJECTIVE The purpose of this study was to use the social cognitive theory (SCT) constructs self-efficacy, outcome expectations, and self-regulation to better understand associations of physical activity (PA) behaviors among dialysis patients after controlling for demographic and health-related factors. RESEARCH METHOD/DESIGN This study was cross-sectional in design. Participants (N = 115; mean age = 61.51 years, SD = 14.01) completed self-report questionnaires during a regularly scheduled dialysis treatment session. Bivariate and hierarchical linear regression analyses were conducted to examine relationships among SCT constructs and PA. RESULTS Significant relationships between PA and self-efficacy (r = .336), self-regulation (r = .280), and outcome expectations (r = .265) were detected among people on dialysis in bivariate analyses. Hierarchical linear regression revealed significant increases in variance explained for the addition of self-efficacy, self-regulation, and covariates (p < .01). Younger age, self-efficacy, and self-regulation were associated (p < .10) with greater participation in physical activity in the final model (R² = .272). Conclusion/Implication: This research supports the use of SCT in understanding PA among people undergoing dialysis treatment. The findings of this study can help health educators and health care practitioners better understand PA and how to promote it among this population. Future research should further investigate which activities dialysis patients participate in across the life span of their disease. Future PA programs should focus on increasing a patients self-efficacy and self-regulation.

Using the Community Assessment for Public Health Emergency Response (CASPER) to assess barriers to healthy eating and active living in a low-income community.

Insufficient physical activity and unhealthy eating behaviors are major contributors to the obesity epidemic in the United States. Identifying health behaviors and disparities in underserved communities is needed to guide the development of targeted interventions. The Community Assessment for Public Health Emergency Response (CASPER) is a set of tools designed for public health emergencies, but the utility of CASPER in non-emergency settings has not been explored. The purpose of this study was to use CASPER to obtain information on household-based behaviors of and barriers to fruit/vegetable consumption and physical activity, and explore the utility of these methods for future health assessments. Cross-sectional survey data included households (n=100) in a low-income neighborhood. Half of adults did not meet recommendations for fruit/vegetable consumption and 20% reported no physical activity during the previous week. Cost was significantly associated with healthy eating and physical activity in our community. Four primary advantages of using CASPER methodology included a user-friendly CDC toolkit, yield of a representative community sample with a relatively low sample size, low-cost/low-tech requirements for implementation, and the strengthening of an academic-practice-community partnership. Our work demonstrates the utility of CASPER for assessing healthy living in a geographically-defined community where household health behaviors and barriers are unknown.

Physical and social environmental characteristics of physical activity for Mexican-origin children: examining differences between school year and summer perceptions

BackgroundColonias are substandard residential areas along the U.S.-Mexico border. Families of Mexican-origin living in colonias face health burdens characterized by environmental and socioeconomic hardships. Mexican Americans and low-income families, including colonias children, do not frequently participate in physical activity despite the known link to disease risk reduction. For colonias children, schools are the most commonly reported location for physical activity. School closures and extreme temperatures during summer months create a need to explore seasonal differences in environmental supports and barriers in this population. The purpose of this study was to examine the effect of seasonality on perceived environmental barriers, opportunities, and social support for physical activity among colonias children. As a secondary aim, mother-child discordance for each factor was analyzed.MethodsPromotora-researchers recruited mother-child dyads (n=101 dyads, n=202 participants) from colonias in Hidalgo County, Texas. Mothers and children were separately administered surveys at two time points to capture perceived barriers, opportunities, and social support for physical activity (school-year: February-May; summertime: July-August). Summative scores for each outcome were calculated and three multilevel longitudinal models for continuous outcomes were examined; children were nested within households. Mother-child discordance was measured using Cohen’s Kappa statistic.ResultsPhysical activity barriers and environmental opportunities (household and neighborhood) increased from school-year to summer by 1.16 and 2.83 points respectively (p≤0.01), after adjusting for covariates. Significant predictors of increased barriers included household income of >

Internal consistency, convergent validity, and structural validity of the Japanese version of the Physical Activity Self-Regulation scale (PASR-12) among Japanese workers: A validation study.

900/month and having more household members. Children of mothers with significant others who were employed part-time or full-time saw significant decreases in barriers. Mother-child agreement of barriers, environmental opportunities, and social support across seasons was slight to fair (range: median κ=0.047 to κ=0.262).ConclusionsThese results suggest a complex relationship between dimensions of economic hardship (employment status, household income, etc…) and perceived opportunities and barriers of children’s physical activity engagement during the school-year and summer. In this study, both barriers and opportunities increased from school-year to summer, further demonstrating that interactions among these characteristics need to be better understood and addressed when considering physical activity initiatives for colonias and other Mexican-American children, specifically during summer when school-based physical activity resources are unavailable.

Why Women Sit: Determinants of Leisure Sitting Time for Working Women

Self‐regulation for physical activity is considered as one of the most effective factors in promoting physical activity. However, there is no reliable and valid scale to measure it in Japanese. The purpose of this study was to investigate the internal consistency, convergent validity, and structural validity of the newly developed Japanese version of the 12‐item Physical Activity Self‐Regulation scale (PASR‐12) among Japanese workers.