Suchergebnisse

Reversing the Obesogenic Environment describes the factors that contribute to an environment that leads to obesity, including public policy, the built environment, food supply and distribution, family and cultural influences, technology, and the media. It also offers tools that help professionals start to reverse the obesity epidemic

Background. Obesity prevalence is higher among those who live in impoverished environments. This investigation identified obesogenic factors in urban neighborhoods surrounding public housing developments (HDs). Design. Cross-sectional quantitative survey data from 14 HD neighborhoods and qualitative interviews of the HD managers. Setting. Kansas City, Kansas, and Kansas City, Missouri. Subjects. Environmental data were collected from HDs and surrounding neighborhoods, an area enclosed by an 800-m radius line drawn from the HD centroid. Qualitative data were collected from all 14 HD managers. Measures. HDs were rated by a brief environmental audit. HD managers were assessed in a structured 45- to 60-minute interview about neighborhood factors influencing resident obesity. Results. The properties were typically modern and well maintained; however, there were few physical activity (PA) resources and food sources on site. Most HD managers cited the availability of PA resources near the HD; however, there was wide variability in the type and accessibility of the resources. Only two HDs had a store that sold groceries within one block. Interviews identified fast food restaurants as common food sources, with few other food sources available. Discussion. Data suggested that although strides have been made to increase safety and comfort in public housing, there remains poor access to PA resources and healthful food sources. Interventions and policies should consider access to PA resources and food sources.

Purpose. Access and quality of physical activity resources (PARs) influence physical activity (PA) participation. This study examined the type, size, accessibility, features, amenities, and incivilities of PARs in two cities. Design. Researchers identified all PARs within an 800-meter radius of the homes of participants from a larger study. Each PAR was evaluated by a trained assessor. Setting. PARs were evaluated in Houston and Austin, Texas. Patients. The final sample included 1326 PARs in Houston and 297 in Austin, Texas. Measures. The 2010 Physical Activity Resource Assessment (PARA), a direct-observation audit tool, was used to assess the type, size, accessibility, features, amenities, and incivilities of a PAR. Analysis. Both t-tests and analyses of variance were used to determine differences in features, amenities, and incivilities by city, type, and accessibility. Results. Houston PARs had greater amenities (t[421] = 4.445; p < .001) and fewer incivilities (t[371] = −6.89; p < .001) than Austin PARs. Combination resources had the highest score for features (M = 9.94; standard deviation [SD] = 5.62); fitness clubs had the highest score for amenities (M = 17.06; SD = 5.27); and trails had the most incivilities (M = 4.23; SD = 4.88). Free PARs had greater features (F[3, 1509] = 16.87; p < .001), amenities (F[3, 1500] = 3.13; p = .025), and incivilities (F[3, 1540] = 21.97; p < .001) than pay for use PARs. Conclusion. Improvements to quality and maintenance of existing free PARs may be an economical strategy to increase PA.

Purpose. To create and test an index to indicate both availability and quality of physical activity (PA) resources (PARs), to examine associations between access to quality PARs and changes in PA, and to determine whether this association differed in lower- and higher-income neighborhoods. Design. Longitudinal, 6-month intervention. Setting. Houston and Austin, Texas. Subjects. African-American and Hispanic or Latina women. Measures. Women (N = 410) completed a questionnaire and accelerometry to measure PA. Neighborhoods (N = 163) were classified as lower- or higher-income by median household income at the census-tract level. PARs were audited using the PARA (physical activity resource assessment). Access to quality PARs was determined by a composite index (QPAR) of features, amenities, and incivilities. Analysis. Repeated measures analyses of variance were used to examine changes in PA by (1) neighborhood income (lower/higher) and QPAR (lower/higher) groups, and (2) neighborhood income (lower/higher) and number of PARs (lower/higher) groups, adjusting for ethnicity, household income, and body mass index. Results. Women in neighborhoods with lower QPAR scores had small increases in self-reported vigorous PA (M Δ = 327.8 metabolic equivalent of task [MET]-min/wk) and decreases in accelerometer PA (M = −3.4 min/d), compared to those with higher QPAR scores who had larger increases in self-reported vigorous PA (M Δ = 709.8 MET-min/wk) and increased accelerometer PA (M = 3.9 min/d). There was a significant interaction between changes in leisure-time PA, QPAR score, and number of PARs (p = .049). Women with both more PARs and higher QPAR scores reported greater increases in leisure-time PA than women with fewer PARs and lower QPAR scores. Conclusion. Access to higher-quality PARs can help increase or maintain PA over time regardless of neighborhood income. PAR quality is a separate and distinct, important determinant of PA in ethnic minority women.

Purpose. To measure the concordance of directly and indirectly measured neighborhood attributes and to determine the correlates of the concordance between directly and indirectly measured built environment attributes. Design. Environmental cross-sectional design. Setting. Urban and suburban neighborhoods within Harris County, Houston, and Travis County, Austin, Texas. Subjects. Community-dwelling African-American and Hispanic or Latina women. Measures. Physical activity resource accessibility, path maintenance, and pedestrian and bicycle facilities were measured directly and indirectly. Directly or objectively measured neighborhood attributes were measured by the Physical Activity Resource Assessment and Pedestrian Environmental Data Scan instruments. Indirectly measured or self-reported neighborhood attributes were measured by the International Physical Activity Prevalence Study environmental survey module. Analysis. Logistic regression was used to measure the concordance between directly and indirectly measured neighborhood attributes with ethnicity as a covariate. Residual values were calculated to determine the strength and direction of concordance. Results. Participants' (N = 409) average body mass index (BMI) was classified as obese (MBMI = 34.5 kg/m2, SD = 7.9), and the mean body fat percentage was 42.8% (SD = 7.1). The correlates BMI, body fat percentage, physical activity, and ethnicity were not significantly associated with any built environment attribute or concordance value, and none of our models significantly predicted indirectly measured built environment attributes. Conclusion. Being less familiar with certain built environment attributes may not be associated with weight status or physical activity levels among African-American and Hispanic or Latina women.

Abstract Background Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program's funding source. Methods Public health programs promoting PA were systematically identified during 2008–2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites. Results In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported ( M = 10, SD = 3.1) and programs that were partially or wholly privately or corporately supported ( M = 12.0, SD = 4.4). Conclusion While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established.

Background Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the programs funding source. Methods Public health programs promoting PA were systematically identified during 20082013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites. Results In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M=10, SD=3.1) and programs that were partially or wholly privately or corporately supported (M=12.0, SD=4.4). Conclusion While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established. ; Published version

Promoting outdoor play and participation in sports and organized physical activities in children may depend on neighborhood characteristics. This study investigated associations between neighborhood streets and physical activities among Mexican children ( N = 1,509, 6-11 years). Child sociodemographic characteristics and physical activity were measured in schools in Guadalajara ( n = 10), Mexico City ( n = 13), and Puerto Vallarta ( n = 3), Mexico, in 2012. Street segments within an 800 m radius around each school were measured using the Pedestrian Environment Data Scan. Most (75.8%) played outdoors; 47.4% participated in sports and 40% in organized physical activities. Fewer path obstructions and more pedestrian amenities were associated positively with outdoor play. Greater street cleanliness, more pedestrian amenities, and more path obstructions were associated with less participation in sports or organized activities. Walkability was negatively associated with all physical activities. Fostering safe and appealing streets may help promote outdoor play time, but not sports participation, for Mexican children.

Purpose. This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments. Design. Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods. Setting. Pathways to Health interviewed housing development residents and Understanding Neighborhood Determinants of Obesity assessed built environment factors in the surrounding neighborhoods (i.e., 800–m radius from center of housing development). Subjects. Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0% women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity resources were identified and assessed. Measures. Demographics and measured weights and heights were obtained for participants. The Physical Activity Resource Assessment measured the type, accessibility, features, amenities, qualities, and incivilities of neighborhood physical activity resources. Neighborhood street connectivity was also measured. Results. Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of residents obese. High negative correlations were found between BMI and street connectivity (p = .05) and between obesity prevalence and resource accessibility (p = .09), number of amenities (p = .04), and amenity quality (p = .04). Higher resource accessibility, feature quality, number of amenities, and fewer incivilities per resource accounted for 71% of obesity variance (p < .05). Male gender and higher feature quality, F(11, 407)37.19 and 12.66, p < .001, predicted lower BMI among residents. Conclusion. Supportive neighborhood environments were related to lower obesity prevalence and lower BMI among residents.

Purpose. To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention. Design. Longitudinal design. Setting. Harris County and Travis County, Texas. Participants. Community-dwelling African-American and Hispanic or Latina women. Intervention. Three hundred ten women were randomized to a PA (n = 204) or VF (n = 106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption. Measures. Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention. Analyses. The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis. Results. Women were middle aged (mean = 44.4 years) and overweight or obese (mean body mass index = 34.0 kg/m2). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p <. 05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes. Conclusions. Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.