Mary Maley

Perceptions of the Environment for Eating and Exercise in a Rural Community

OBJECTIVE To understand how members of a rural community perceive the effect of the built, natural, and social environments on their food choice and physical activity behaviors. METHODS A constructivist community environmental assessment was conducted including 17 individual qualitative interviews, 2 focus groups, and photo elicitation (n = 27) in a rural northeastern community where over 60% of the adult population is overweight or obese. RESULTS Participants described social, natural, and physical environmental factors that influenced their food choice and physical activity behaviors. Overweight and obesity were variably presented as an individual and/or a collective problem. Participants described conflicting goals for food choice and physical activity in the community, and an interrelationship between the social and physical environments. CONCLUSIONS AND IMPLICATIONS A community environmental assessment provides a view of the physical and social environments from the perspective of community residents that can serve as a foundation for locally tailored, community-based approaches to obesity prevention.

Small steps are easier together: A goal-based ecological intervention to increase walking by women in rural worksites

OBJECTIVE Small Steps Are Easier Together (SmStep) was a locally-instituted, ecologically based intervention to increase walking by women. METHODS Participants were recruited from 10 worksites in rural New York State in collaboration with worksite leaders and Cooperative Extension educators. Worksite leaders were oriented and chose site specific strategies. Participants used pedometers and personalized daily and weekly step goals. Participants reported steps on web logs and received weekly e-mail reports over 10 weeks in the spring of 2008. RESULTS Of 188 enrollees, 114 (61%) reported steps. Weekly goals were met by 53% of reporters. Intention to treat analysis revealed a mean increase of 1503 daily steps. Movement to a higher step zone over their baseline zone was found for: 52% of the sedentary (n=80); 29% of the low active (n=65); 13% of the somewhat active (n=28); and 18% of the active participants (n=10). This placed 36% of enrollees at the somewhat active or higher zones (23% at baseline, p<0.005). CONCLUSION Workers increased walking steps through a goal-based intervention in rural worksites. The SmStep intervention provides a model for a group-based, locally determined, ecological strategy to increase worksite walking supported by local community educators and remote messaging using email and a web site.

Evaluation of dietary energy intake and physical activity in dogs undergoing a controlled weight-loss program

OBJECTIVE To quantify physical activity and dietary energy intake in dogs enrolled in a controlled weight-loss program and assess relationships between energy intake and physical activity, sex, age, body weight, and body condition score (BCS). DESIGN Prospective clinical study. ANIMALS 35 client-owned obese dogs (BCS > 7/9). PROCEDURES Dogs were fed a therapeutic diet with energy intake restrictions to maintain weight loss of approximately 2%/wk. Collar-mounted pedometers were used to record the number of steps taken daily as a measure of activity. Body weight and BCS were assessed at the beginning of the weight-loss program and every 2 weeks thereafter throughout the study. Relationships between energy intake and sex, age, activity, BCS, and body weight at the end of the study were assessed via multivariable linear regression. Variables were compared among dogs stratified post hoc into inactive and active groups on the basis of mean number of steps taken (< or > 7,250 steps/d, respectively). RESULTS Mean ± SD daily energy intake per unit of metabolic body weight (kg(0.75)) of active dogs was significantly greater than that of inactive dogs (53.6 ± 15.2 kcal/kg(0.75) vs 42.2 ± 9.7 kcal/kg(0.75), respectively) while maintaining weight-loss goals. In regression analysis, only the number of steps per day was significantly associated with energy intake. CONCLUSIONS AND CLINICAL RELEVANCE Increased physical activity was associated with higher energy intake while maintaining weight-loss goals. Each 1,000-step interval was associated with a 1 kcal/kg(0.75) increase in energy intake.

Process evaluation of an environmental walking and healthy eating pilot in small rural worksites

Small Steps are Easier Together (SS) was a pilot environmental intervention in small rural worksites in Upstate New York in collaboration with Extension educators. Worksite leaders teamed with co-workers to select and implement environmental changes to increase walking steps over individual baseline and to choose healthy eating options over 10 weeks. Participants were 226 primarily white, women employees in 5 sites. A mixed methods process evaluation, conducted to identify determinants of intervention effectiveness and to explain differences in outcomes across worksites, included surveys, self-reports of walking and eating, interviews, focus groups, and an intervention log. The evaluation assessed reach, characteristics of recruited participants, dose delivered, dose received, and context and compared sites on walking and eating outcomes. Emergent elements of participant-reported dose received included: active leadership, visible environmental changes, critical mass of participants, public display of accomplishments, accountability to co-workers, and group decision making. Participants at sites with high reach and dose were significantly more likely than sites with low reach and dose to achieve intervention goals. Although this small pilot needs replication, these findings describe how these evaluation methods can be applied and analyzed in an environmental intervention and provide information on trends in the data.

Implementing Evidence-Based Programs: Lessons Learned from the Field.

Evidence-based programs (EBPs) are used in many health promotion efforts to ensure that the intended positive behavioral and health outcomes will be achieved. However, because EBPs are developed and tested in research settings, the contextual elements of real world implementation play an important role in their successful delivery in communities. As an intermediary charged with supporting the translation of research to practice for a statewide teen pregnancy prevention initiative, the ACT for Youth Center of Excellence conducted a mid-course evaluation to identify factors that contribute to the successful implementation of EBPs. The findings indicate that successful implementation involves systematic planning that addresses three critical contextual factors: community readiness, organizational capacity, and setting characteristics. By attending both to factors identified from local practice, and to theory and evidence identified through implementation science, practitioners can strengthen programming and enhance the quality of EBP delivery.