Matthew Chrisman

Environmental Influences on Physical Activity in Rural Midwestern Adults: A Qualitative Approach

Qualitative research can be used to examine multiple factors associated with physical activity and help practitioners identify language used by the rural adult population when discussing this behavior. Three focus groups were conducted among 19 residents of multiple towns in a rural Midwestern county to examine the language and influences on rural physical activity. Focus group members were asked to define physical activity, exercise, community, and neighborhood. They were asked about the activities they engaged in and facilitators and barriers to those activities. A guidebook was developed to capture major themes and common patterns that emerged in the responses to the topics discussed. The data were reviewed for repeated statements and points that were agreed on by multiple participants. Important factors associated with physical activity include the importance of social support and modeling physical activity behavior. Also, the influence of pets and children was important for engaging these adults in physical activity. The focus group members engaged in walking and bicycling in their neighborhood streets and community trails, and desired to see community buildings be open to the public for exercise. This study revealed contextual issues and culturally relevant language for practitioners to use in tailoring physical activity measurement tools or designing interventions for a rural adult population. Social support (specifically, seeing others being active and using pets as motivators for being active) and policy attitudes may be targeted for interventions to increase physical activity in rural adults.

Cohort Profile: The Mexican American Mano a Mano Cohort

Hispanic Americans comprise the largest and fastest-growing ethnic minority in the USA. In Houston, Texas, 44% of the population is of Hispanic descent, with the majority being Mexican Americans (78%). This population is under-represented in health-related research despite their high prevalence of obesity and diabetes, which may predispose them to cancer and other chronic conditions. Recognizing the need for a greater research effort into the health risks of Hispanic Americans, the population-based Mexican American (Mano a Mano) Cohort study was launched in 2001. This is an open cohort with enrolment ongoing to 2019, and as of 30 June 2014, 23 606 adult participants from over 16 600 households were enrolled. Bilingual interviewers elicit information in person on demographics, acculturation, lifestyle, occupation, medical history, family cancer history, self-reported and measured height and weight, and other exposures. Urine, blood and saliva samples have been collected at baseline from 43%, 56% and 63% of participants, respectively. DNA samples are available for about 90% of participants. Incident cancers and other chronic diseases are ascertained through annual telephone re-contact and linkage to the Texas Cancer Registry and/or medical records. Molecular data such as genetic ancestry markers, blood telomere length and HbA1c, a marker of impaired glucose tolerance, are available for a substantial proportion of the participants. Data access is provided on request [manoamano@mdanderson.org]. For further information please visit [www.mano-mano.us].

Perceived Correlates of Domain-Specific Physical Activity in Rural Adults in the Midwest

PURPOSE In response to calls for more specificity when measuring physical activity, this study examined perceived correlates of this behavior in rural adults separately by the domain in which this behavior occurs (ie, home care, work, active living, and sport). METHODS A cross-sectional survey was completed by 407 adults from 2 rural towns in the Midwest. The questionnaire assessed the perceived social and physical environment, including neighborhood characteristics, as well as barriers to being active. The Kaiser Physical Activity Survey captured domain-specific activity levels. The response rate was 25%. Multiple regression analyses were conducted to examine the associations between social and physical environment factors and domain-specific physical activity. FINDINGS Having a favorable attitude toward using government funds for exercise and activity-friendly neighborhood characteristic were positively associated with active living. Friends encouraging exercise was positively associated with participation in sport. Barriers were inversely associated with active living and sport. Total physical activity was positively associated with workplace incentives for exercise, favorable policy attitudes toward supporting physical education in schools and supporting the use of government funds for biking trails, and it was inversely associated with barriers. There were no factors associated with physical activity in the domains of work or home care. CONCLUSIONS Correlates of physical activity are unique to the domain in which this behavior occurs. Programs to increase physical activity in rural adults should target policy attitudes, neighborhood characteristics, and social support from friends while also working to decrease personal barriers to exercise.

Acculturation, sociodemographic and lifestyle factors associated with compliance with physical activity recommendations in the Mexican- American Mano A Mano cohort

Objectives Being physically active is important for health, and few Mexican-Americans meet national US physical activity recommendations. The aim of this study was to investigate sociodemographic, acculturation and lifestyle factors that were associated with meeting physical activity recommendations in this group. Design and setting A cross-sectional analysis of a large population-based cohort study in southern Texas, USA. Participants Between 2001 and 2011, 21 551 adult members of the Mexican-American Mano A Mano cohort completed baseline questionnaires on physical activity and other lifestyle factors. Outcomes Meeting US physical activity recommendations was defined as participating in 150 min of moderate, or 75 min of vigorous, activity per week. Factors contributing to the likelihood of meeting physical activity recommendations were examined by sex and country of birth in multivariate logistic regression models. Results Less than half of all men and less than a quarter of all women met US physical activity recommendations. Having some college education, greater acculturation and current alcohol use were each associated with greater odds of meeting physical activity recommendations in all groups except US-born men. Higher body mass index was associated with lower odds of meeting recommendations in US-born and Mexico-born women. Conclusions Results demonstrate that factors associated with meeting physical activity recommendations differ by sex and country of birth. Tailored interventions to increase Mexican-Americans’ activity levels to achieve health benefits should consider education, acculturation and alcohol use.

Perceived resources and environmental correlates of domain-specific physical activity in rural midwestern adults

BACKGROUND Rural adults participate in lower levels of physical activity (PA) than urban or suburban adults. Due to known effects of the environment on PA participation, this study examined perceived ecological correlates (social, environmental, and policy) of domain- and intensity-specific PA in rural adults. METHODS A cross-sectional survey was completed by 143 individuals residing in the rural Midwest. PA was measured using the International Physical Activity Questionnaire; correlates of PA were measured using a modified version of the PA in Communities Questionnaire. Multiple regression analyses were conducted using general linear modeling. RESULTS Predictors of PA included: employers providing time for exercise (P = .0003); available shopping malls (P = .0032); activity-friendly community aspects (P = .0048); favorable policy attitudes (P = .0018): participation in sports (P < .0001); encouragement from friends (P = .0136); awareness (P = .0015) and use (P = .0113) of community resources; and having hills (P = .0371). CONCLUSIONS Correlates of PA in various domains and intensities in rural adults are multifactorial and occur at different levels of the environment. Findings from this study can be used to tailor PA interventions in rural adults, with respect to specific domains and intensity in which the PA occurs.

Effects of school-based point-of- testing counselling on health status variables among rural adolescents

Objective: Rural areas may suffer from a lack of access to health care and programmes to promote behaviours such as healthy eating and physical activity. Point-of-testing counselling is a method of promoting a healthy lifestyle during an individual’s most ‘teachable moment’. Design/Setting: This longitudinal study examined the effects of school-based nutrition education and point-of-testing counselling on nutrition knowledge, weight, blood lipid profile and blood pressure over a 3-year period (2005–2008) among junior high and high school students from a rural community in the Southern USA. Methods: Screening for health variables, followed by point-of-testing counselling sessions, was offered every 6 months, along with nutrition education once a week for 12 weeks. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS). T-tests and analysis of variance (ANOVA) were conducted to analyse changes in health outcomes over the course of the study. Results: A total of 233 rural students participated in this longitudinal community-based study. Students who attended at least four sessions (n = 52) were analysed for changes in health outcomes. High-density lipoprotein levels significantly increased between the second and fourth visits. Attending the intervention at least four times stabilised or improved blood values and anthropometric measurements. Significant nutrition knowledge increases were documented among 7th and 8th graders; 6th, 9th and 10th graders also showed modest improvements. Conclusion: Using point-of-testing counselling may be an effective strategy in delaying or preventing the onset of risk factors for obesity and related chronic diseases during adolescence.

Fostering Healthy Lifestyles in the African American Population

Approximately 8.3% of the U.S. population (25.8 million people) is affected by type 2 diabetes. The burden of diabetes is disproportionately greater in the African American community. Compared with non-Hispanic Caucasian adults, the risk of diagnosed type 2 diabetes was 77% higher among non-Hispanic Blacks, who are 27% more likely to die of diabetes complications than either Caucasians or Hispanics. The purpose of this longitudinal community intervention was to promote healthy lifestyles among African American participants through multiple channels, including individualized point-of-testing counseling, and weekly exercise and nutrition classes led by trained community health mentors. Data collection procedures were guided by the World Health Organization’s STEPS approach, which includes gathering demographic and health information, collecting anthropometric measurements, and analyzing biochemical blood work. Changes in body mass index were assessed from in-person measurements and changes in blood lipids and glucose were examined by biochemical analyses. A total of 157 individuals participated in this study. Results showed that weight gain during the intervention was prevented, glucose levels decreased (−10.88 mg/dL), and low-density lipoprotein cholesterol decreased (−8.8 mg/dL), while high-density lipoprotein increased (+3.2 mg/dL). Lifestyle interventions and point-of-testing counseling can be successful in reducing risk factors for type 2 diabetes among the African American population. The results of this intervention indicate that the use of community health mentors and point-of-testing counseling may be effective in fostering healthy lifestyle changes, which can halt the progression of type 2 diabetes among non-Hispanic Black populations.

Improving Rural Newspaper Coverage of Nutrition Stories: An Educational Assessment of Editors’ Attitudes and Learning Needs

Local newspapers are an important source of information for rural residents but often lack accurate or helpful nutrition-related information. To improve the quantity and quality of nutrition stories in rural, local newspapers, it is important to understand the perspective of editors. An online survey of 51 rural Midwest editors was conducted to assess attitudes toward writing nutrition stories, sources of information, perceived challenges, and interest in learning more about writing such stories. Of respondents, 49% were female, and 63% had at least a 4-year college degree. Through a mix of closed- and open-ended questions, the majority indicated positive attitudes toward nutrition stories, were confident in their abilities to write them, and expressed interest in learning more. Challenges cited include lack of print space, small staff, lack of specific requests from readers for nutrition stories, and the need to avoid offending local agricultural businesses. Results should be useful in planning an educational intervention for editors. Meanwhile, public health practitioners should provide concise press releases to their local newspapers about their activities. Also, greater expressions of appreciation from public health professionals and other readers may lead to higher prioritization of nutrition-related stories, and ultimately to an environment more supportive of healthy eating.

Associations between language acculturation, age of immigration, and obesity in the Mexican American Mano A Mano cohort

INTRODUCTION As Mexican immigrants to the U.S. become acculturated, they face worsening health outcomes such as obesity. The role of language acculturation in the development of obesity has not been thoroughly examined. METHODS To examine associations between language acculturation and obesity, data were drawn from the Mexican-American Mano A Mano cohort study. Participants aged 20 years and over (n=18,298) completed baseline questionnaires on socio-demographic and behavioural factors, including physical activity and sitting time. The Bi-dimensional Acculturation Scale for Hispanics assessed language acculturation. Multivariate-adjusted logistic regression was conducted to investigate associations between language acculturation, immigration age, and obesity, and whether sitting time and physical activity mediated these associations. RESULTS Individuals with obesity were more linguistically acculturated than individuals who were normal weight or overweight (P<0.001); however, this relationship differed by gender and nativity. Among Mexico-born women, language acculturation score was inversely related to BMI (P<0.001). Language acculturation was associated with higher risk of obesity (OR=1.35, 95% CI: 1.12-1.62) in U.S.-born participants and lower risk in Mexico-born participants (OR=0.90, 95%CI=0.81-1.00). For Mexico-born participants, arrival in the U.S. as an adult (≥20years old) was associated with a reduced obesity risk (OR=0.74, 95% CI: 0.67-0.80). Sitting time mediated the association between language acculturation and obesity. CONCLUSIONS Language acculturation may influence obesity development among the U.S.-born Mexican Americans in this cohort, but not their Mexico-born counterparts. Sitting time could be targeted in obesity prevention efforts in this population.

Mobile Phone Use and its Association With Sitting Time and Meeting Physical Activity Recommendations in a Mexican American Cohort.

Background The benefits of physical activity (PA) are well-documented. Mobile phones influence PA by promoting screen-based sedentary time, providing prompts or reminders to be active, aiding in tracking and monitoring PA, or providing entertainment during PA. It is not known how mobile phone use is associated with PA and sitting time in Mexican Americans, and how mobile phone users may differ from nonusers. Objective To determine the associations between mobile phone use, PA, and sitting time and how these behaviors differ from mobile phone nonusers in a sample of 2982 Mexican-American adults from the Mano a Mano cohort. Methods Differences in meeting PA recommendations and sitting time between mobile phone users and nonusers were examined using chi-square and analysis of variance tests. Logistic regression was used to examine associations between mobile phone use, PA, and sitting. Results Mobile phone users were more likely to be obese by body mass index criteria (≥30 kg/m2), younger, born in the United States and lived there longer, more educated, and sit more hours per day but more likely to meet PA recommendations than nonusers. Males (odds ratio [OR] 1.42, 95% CI 1.16-1.74), use of text messaging (OR 1.26, 95% CI 1.03-1.56), and having a higher acculturation score (OR 1.27, 95% CI 1.07-1.52) were associated with higher odds of meeting PA recommendations. Sitting more hours per day was associated with being male, obese, born in the United States, a former alcohol drinker, and having at least a high school education. Among nonusers, being born in the United States was associated with higher odds of more sitting time, and being married was associated with higher odds of meeting PA recommendations. Conclusions Mobile phone interventions using text messages could be tailored to promote PA in less acculturated and female Mexican American mobile phone users.