Suojin Wang

Perceived barriers to children’s active commuting to school: a systematic review of empirical, methodological and theoretical evidence

Active commuting to school (ACS) may increase children’s daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children’s ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children’s ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child’s ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers’ awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.

Effects of Funding Allocation for Safe Routes to School Programs on Active Commuting to School and Related Behavioral, Knowledge, and Psychosocial Outcomes Results From the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) Study

Few controlled evaluations of Safe Routes to School (SRTS) initiatives have been conducted. The Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) study included three conditions: schools awarded infrastructure (I) projects (n = 23), schools awarded noninfrastructure (NI) projects (n = 21), and matched comparison (C) schools (n = 34). Fourth-grade children completed tallies to determine transport to/from schools. Serial cross-sectional surveys were collected from students and parents at baseline (2009) and follow-up (2012). Data were analyzed using mixed linear regression and growth curve models. Morning percent active commuting to school (ACS) in I and NI schools were higher than C schools (p = .024, p = .013, respectively). Afternoon percent ACS in NI schools decreased more over time compared with C schools (p = .009). I and NI school students had higher ACS self-efficacy; similar results were noted for parents in I schools. Policies that provide cost-reimbursement funding for SRTS achieve modest short-term ACS outcomes, with few differences between types of funding allocations.

Programmatic influences on outcomes of an evidence-based fall prevention program for older adults: a translational assessment

ABSTRACTInvestigating the implementation and dissemination of evidence-based health-promotion programs to reach large numbers of diverse older adults is needed. The purpose of this study is to examine relationships between class size and session attendance and assess differences in intervention outcomes based on these community-based fall prevention program characteristics. Pre-post data were analyzed from 2,056 falls prevention program participants. PROC MIXED for repeated measures and ordinary least squares regressions were employed. Approximately 32% of participants enrolled in recommended class sizes (eight to 12 participants) and 76.4% of enrolled seniors attended more than five of eight sessions. Enrolling in smaller class sizes was associated with higher class attendance (X2 = 43.43, p < 0.001). Recommended class sizes and those with 13–20 participants reported significant improvements in falls efficacy and physical activity. Perfect attendance was associated with improvements in falls efficacy (t = 2.52, p < 0.05) and activity limitation (t = −2.66, p < 0.01). Findings can inform fall prevention program developers and lay leader deliverers about ideal class sizes relative to maximum intervention benefits and cost efficiency.

Children’s active commuting to school: an interplay of self-efficacy, social economic disadvantage, and environmental characteristics

BackgroundActive commuting to school (ACS) can promote children’s physical activity and may help prevent childhood obesity. Previous researchers in various disciplines, e.g., health, urban planning, and transportation, have identified various predictors of ACS. However, little research has been carried out into investigating the effect of self-efficacy on ACS. The purpose of this study is to investigate the roles of children’s and parents’ self-efficacy in children’s ACS, controlling for sociodemographic and objective environmental characteristics.MethodsThis study is part of the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, which includes data from 857 parent/child pairs from 74 schools who lived within two miles of school in Texas. Measures included children’s usual modes of commuting to school, participants’ sociodemographics, perceived self-efficacy toward ACS, sources of children’s self-efficacy, school settings, and objective environmental constraints. Multilevel structural equation modeling (SEM) was employed to test the hypothesized pathways using Mplus 7.0.ResultsAround 18% of the children were active commuters. Two sources of children’s self-efficacy were identified, i.e., emotional states (β = 0.36, p < 0.001) and social modeling (β = 0.28, p < 0.01). Compared with children’s self-efficacy (β = 0.16, p < 0.001), parents’ self-efficacy (β = 0.63, p < 0.001) had a stronger influence on children’s ACS. Participants’ social economic disadvantage (β = 0.40, p < 0.001), environmental constraints (β = −0.49, p < 0.001), and school setting (β = −0.17, p = 0.029) all had statistically significant direct effects on children’s ACS.ConclusionsFuture initiatives should consider both parents’ and children’s self-efficacy in developing strategies for promoting children’s ACS. Social disadvantage and environmental constraints also need to be addressed for effective interventions. The work reported here provides support for the continuing exploration of the role of self-efficacy in children’s ACS.

Food-shopping environment disparities in Texas WIC vendors: a pilot study.

OBJECTIVE To identify differences in food-shopping environments of Texas WIC vendors using a culturally adapted instrument. METHODS A survey tool was developed for measuring food availability, accessibility, and affordability in 111 WIC vendors in Texas. Two-tailed t-tests and Mann-Whitney tests were used for rural/urban and Texas-Mexico border/non-border area comparisons. RESULTS Prices were higher in rural areas than in urban areas for 2 key foods, fruits (p = .024) and milk (p = .007); non-border vendors had overall better food availability than border vendors; non-border vendors had better accessibility for fruits (p = .007) than border vendors. CONCLUSION In Texas, disparities in food-shopping environments are evident and can be assessed using a culturally adapted survey tool.

Evaluating the Influence of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Allocation Package on Healthy Food Availability, Accessibility, and Affordability in Texas

BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was implemented to improve the health of pregnant women and children of low socioeconomic status. In 2009, the program was revised to provide a wider variety of healthy food choices (eg, fresh fruits, vegetables, and whole-grain items). OBJECTIVES The purpose of this study was to evaluate (1) the impact of the revised WIC Nutrition Programs food allocation package on the availability, accessibility, and affordability of healthy foods in WIC-authorized grocery stores in Texas; and (2) how the impact of the policy change differed by store types and between rural and urban regions. DESIGN WIC-approved stores (n=105) across Texas were assessed using a validated instrument (88 items). Pre- (June-September 2009) and post-new WIC package implementation (June-September 2012) audits were conducted. Paired-sample t tests were conducted to compare the differences between pre- and post-implementation audits on shelf width and number of varieties (ie, availability), visibility (ie, accessibility), and inflation-adjusted price (ie, affordability). RESULTS Across the 105 stores, post-implementation audits showed increased availability in terms of shelf space for most key healthy food options, including fruit (P<0.001), vegetables (P<0.01), cereal (P<0.001), and varieties of vegetables (P<0.001). Food visibility increased for fresh juices (P<0.001). Visibility of WIC labeling improved for foods such as fruits (P<0.05), WIC cereal (P<0.05), and whole-grain or whole-wheat bread (P<0.01). Inflation-adjusted prices decreased only for bread (P<0.001) and dry grain beans (P<0.001). The positive effects of the policy change on food availability and visibility were observed in stores of different types and in different locations, although smaller or fewer effects were noted in small stores and stores in rural regions. CONCLUSIONS Implementation of the revised WIC food package has generally improved availability and accessibility, but not affordability, of healthy foods in WIC-authorized stores in Texas. Future studies are needed to explore the impact of the revised program on healthy food option purchases and consumption patterns among Texas WIC participants.

Correlates of Receiving a Recommendation for More Physical Activity From a Primary Care Provider

INTRODUCTION Primary care providers (PCPs) are strategically positioned to communicate with their overweight/obese patients about positive behavioral changes to improve health and functioning. Demographic and behavioral correlates of receiving a recommendation for more physical activity (PA) from a PCP by overweight/obese patients were assessed. METHODS Community-dwelling adults aged ≥50 years from four Texas cities who were seen by a family physician in a primary care clinic were surveyed from October 2013 to June 2014. Multivariate logistic regression predicted the likelihood of receiving a PA recommendation from a PCP, controlling for sociodemographic factors, health conditions, and walking behaviors. The analysis was conducted in 2016. RESULTS Of the total 388 participants (survey response rate, 6.8%), 30.1% were obese, 55.4% were female, and most were non-Hispanic white (82.9%), married (75.6%), or reported an annual household income of ≥

Determinants of Walking among Middle-Aged and Older Overweight and Obese Adults: Sociodemographic, Health, and Built Environmental Factors

50,000 (66.8%). Receipt of a PA recommendation from a PCP (n=151, 38.9%) was significantly correlated with reporting poor to fair health (OR=7.33, 95% CI=2.6, 20.32), obesity (OR=2.95, 95% CI=1.69, 5.14), having only a little or some difficulty walking for a quarter of a mile (OR=2.94, 95% CI=1.41, 5.88), not walking the recommended ≥150 minutes for any purpose (OR=2.60, 95% CI=1.25, 5.38), and being employed (OR=2.11, 95% CI=1.13. 3.94). CONCLUSIONS PCPs seem to be targeting obese, inactive individuals with poor to fair health, populations traditionally not encouraged to be more physically active. These findings are consistent with the current trend in medical care to recommend positive lifestyle changes to a broader range of the population.

Fear of Outdoor Falling Among Community-Dwelling Middle-Aged and Older Adults: The Role of Neighborhood Environments

Background This study examined the association between selected sociodemographic, health, and built environmental factors and walking behaviors of middle-aged and older overweight/obese adults. Methods Subjective data were obtained from surveys administered to community-dwelling overweight/obese adults aged ≥50 years residing in four Texas cities from October 2013 to June 2014, along with objective data on neighborhood walkability (Walk Score™). Multivariate logistic regression identified factors predicting the odds of walking the recommended ≥150 minutes per week for any purpose. Results Of 253 participants, the majority were non-Hispanic white (81.8%), married (74.5%), and male (53.4%) and reported an annual income of ≥

Using Walk Score™ and Neighborhood Perceptions to Assess Walking Among Middle-Aged and Older Adults

50,000 (65.5%). Approximately, half were employed (49.6%) or had at least a college degree (51.6%). Walking the recommended ≥150 minutes per week for any purpose (n = 57, 22.5%) was significantly associated with having at least a college degree (OR = 5.55, 95% CI = 1.79–17.25), having no difficulty walking a quarter of a mile (OR = 5.18, 95% CI = 1.30–20.83), and being unemployed (OR = 3.25, 95% CI = 1.18–8.93) as well as perceived presence of sidewalks/protected walkways (OR = 3.56, 95% CI = 1.10–11.50) and perceived absence of distracted drivers in the neighborhood (OR = 4.08, 95% CI = 1.47–11.36). Conclusion Addressing neighborhood conditions related to distracted drivers and pedestrian infrastructure may promote walking among middle-aged and older overweight/obese individuals.