[Show abstract][Hide abstract] ABSTRACT: To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention.
Harris County and Travis County, Texas.
Community-dwelling African-American and Hispanic or Latina women.
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.
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.
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.
Women were middle aged (mean = 44.4 years) and overweight or obese (mean body mass index = 34.0 kg/m(2)). 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.
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.
American journal of health promotion: AJHP 03/2012; 26(4):e116-25. · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Estimates of lifetime prevalence of depression for African Americans (AA) (16%) are similar to rates of prevalence among whites in the United States. However, evidence of lower diagnosis and treatment rates continue to persist among minority groups. Health disparities in diagnosis and treatment lead to greater burden of morbidity for African Americans. This paper is to describe the prevalence of depression among participants in Project CHURCH, a 1462-person church-based cohort study to examine the role of lifestyle/behavioral, social, and environmental factors on minority health. AA men (n=370) and women (n=1092), between the ages of 18-87 years (M=45.23, SD=12.84), completed the Center for Epidemiological Studies-Depression Scale (CES-D) via a computer based survey. The results indicated that the observed proportion for individuals who were at risk for depression (P=.188) was significantly greater than the expected proportion (P=.16) of individuals who were not at risk for depression, χ2(1, N=1462) = 8.59, p<.05. While not significant, more AA women (20.0%) reported depressive symptoms than AA men (15.4%), χ2(1, N=1462) = 3.76, p=.053. Participants, who were younger (p=.039), reported high school or less education (p=.013) and income less than 40,000 (p<.001) were of higher risk of depression. In this study, there was a higher risk of depression among African Americans. Implementing routine depression screenings for this group may increase the rate of individuals referred for further psychological evaluation and subsequent exposure to health information for preventive measures and available depression treatment.
139st APHA Annual Meeting and Exposition 2011; 11/2011
[Show abstract][Hide abstract] ABSTRACT: Minority men are less likely to engage in leisure time physical activity (LTPA) than their white counterparts. Little is known about barriers to LTPA among sedentary African American (AA) and Hispanic/Latino (HL) men. This qualitative study seeks to understand the strengths and limitations associated with gender,culture,and LPTA among AA and HL men between 2560 years, who were not physically active (< 90 minutes of PA per week). Focus groups (FG) were conducted with AA (n=17; M=47 (SD=±8.2)) men and indepthindividual interviews with HL men (n=6; M=41 (SD=±8.1)) . Participants were recruited from churches, clinics, and community organizations. FG and interviews lasted 90120 minutes. Recordings were transcribed verbatim and coded based on apriori themes (PA benefits, barriers, preferences, and social support (SS)); however, also coded for emerging themes. AAs reported enjoying group competitive sports, whereas HLs reported a preference for individual LTPA activities. Men preferred LTPAs congruent with gender expectations of strength, endurance, and physical ability. AA men reported physical appearance as personal motivation for PA, while HL men endorsed commitment to family. Men reported low levels of SS, but acknowledged past LTPA successes were sustained by family members and friends' SS. The men struggled to identify cultural limitations and strengths to LTPA, but upon further query AA and HL noted their respective cultures undervalue LTPA. In conclusion, there are cultural and gender specific differences associated with LTPA between AA and HL men. Future research is needed to determine the best approaches to increasing PA among minority men.
139st APHA Annual Meeting and Exposition 2011; 11/2011
[Show abstract][Hide abstract] ABSTRACT: Retention of African American (AA) participants in health promotion studies is paramount to decrease health disparities among minority populations1. Retention challenges for AA participants have been attributed to participant satisfaction, historical mistrust of researchers and rigid study procedures (e.g. site location and appointment times)2,3. Project CHURCH, a 2 year pilot prospective cohort study, examined the role of behavioral, social, and environmental factors on minority health and cancer-related disparities among a church-based sample. This paper examines the retention strategies used to obtain African American participants in a health promotion study. Project CHURCH enrolled 1501 men (23.6%) and women (76.4%) between the ages of 1987 years (M=46.5±12.8 years) with 81% reportedly had some college education. Upon the completion of the first year of the study, Project CHURCH retained 95% of the participants. A commitment to the pastoral leadership and community advisory board (CAB), convenient on-site location, flexible appointment times, recurrent financial compensation and access to health information and educational liaison enhanced the retention of Project CHURCH participants. The CAB provided authentic and timely feedback regarding the type of study design most likely preferred by potential participants. Factors identified to enhance retention were linked to participant satisfaction with prompt responses to complaints, excellent customer service and multiple bidirectional communicative efforts such as newsletters and programs. Retention of AA participants in health promotion research is a significant challenge, however future studies should consider culturally competent strategies that increase participant satisfaction, and reduce historical mistrust in an effort to increase retention.
139st APHA Annual Meeting and Exposition 2011; 11/2011
[Show abstract][Hide abstract] ABSTRACT: Studies have shown a positive relationship between exercise selfefficacy (ESE), social support (SS), and physical activity (PA). However, this is a great need to understand these relationships among racial/ethnic minorities. Project CHURCH was a cohort study to examine the role of lifestyle/behavioral, social, and environmental factors on minority health. This study examined relationships among ESE, SS, and PA in African American (AA) adults between the ages of 1987 years (N=1375; female=76.4%; age=46.5±12.8 years). ESE, SS, and self-report PA (as measured by IPAQ-short), were obtained via computer-based survey. Multiple regression models, controlled for age, gender, and education, were performed to examine the effect of ESE and SS on PA (e.g. Vigorous Activity (VA); Moderate Activity (MA); Walking Activity (WA); and Total Activity (TA)). There were significant positive associations between ESE and all levels of PA (standardized coefficient, ΒVA =0.16**; ΒMA =0.12**; ΒWA=0.08*; ΒTA=0.15**), whereas SS predicted VA (Β=0.16**), MA (Β=0.05*) and TA (Β=0.06*). Mediation analyses indicated exercise self-efficacy was a mediator of the relationship between social support and all levels of PA. The mediated effect, point estimate (BCa95%CI), was stronger for PA Total Activity (TA=2.17(0.924.15)) compared to the mediator effect on PA for Vigorous Activity (VA = 0.75(0.251.5)), Moderate Activity (MA=0.74(0.281.45)), and Walking Activity (WA=0.58(0.141.31).This study demonstrated a relationship between SS, ESE, and PA in African-American adults. This finding provides additional evidence of the importance of ESE and SS for increasing physical activity among African-American adults. *p<0.05; **p<0.01
139st APHA Annual Meeting and Exposition 2011; 11/2011
[Show abstract][Hide abstract] ABSTRACT: Researchers and policymakers promote recreational trails for increasing physical activity (PA); however, we know little about how racial and ethnic minorities use recreational trails for PA promotion. Psychosocial and interpersonal factors, such as exercise self-efficacy (ESE), perceived barriers (PB), and social support (SS) are known to influence to PA. These factors may also influence trail use among racial/ethnic minority groups. The Walking Trails Study was a descriptive, cross-sectional study, conducted in a master-planned community intentionally designed to promote PA. African American (AA; n=62), white (n=56), Asian (n=40), and Latino (n=21) men and women were intercepted while walking on the trail and completed PA, ESE, SS, and PB questions. We used ANOVA to examine between group means on ESE, SS, and PB. Majority of participants used the trail for exercise (82%). Latinos preferred exercise with a partner (75%), and AA were more likely to use the trail alone (42%).ESE was significant for between group differences F(3,123)=4.21, p=.007 with AAs (M=20.63) reporting higher ESE than whites (M=19.17), Asians (M=15.97), and Latinos (M=17.80). Asians (M=35.32) reported significantly higher PB than AAs (M=29.08), whites (M=31.41), and Latinos (M=31.76), F(3,123)=3.80, p=0.01. SS from family F(3,121)=0.328, p=0.81 and friends F(3,121)=1.22, p=0.30 was not significantly different between groups. Planned and adequate PA resources like recreational trails may not solely determine PA participation among minority groups. The current study demonstrates that psychosocial factors differ among racial/ethnic groups and may contribute to trail use. Future studies should focus on the influence of ESE and PB on trail-based PA.
139st APHA Annual Meeting and Exposition 2011; 10/2011
[Show abstract][Hide abstract] ABSTRACT: Perceived safety is associated with lower rates of physical activity (PA) among families who reside in low socioeconomic status (SES) neighborhoods. African Americans (AA) who reside in low-income neighborhoods are likely to report lower rates of PA, and are more likely to perceive their neighborhood as unsafe for their children. Therefore, it is essential to understand how neighborhood characteristics influence PA decision making among AAs living in lower-income neighborhoods. Family VOICE is a qualitative study designed to better understand environmental influences on PA among families residing in predominately AA, low-income public housing developments. We also examined the role of perceived neighborhood safety on PA participation. AA families recruited from six housing developments in Texas, participated in in-depth parent interviews (n=29) and youth focus groups (n=4). Families (n=14; one youth and one parent) also participated in a Photovoice project, a creative participatory research method to highlight communities' strengths and weaknesses through photography, to describe their views of the available neighborhood PA resources. Participants frequently perceived PA resources as dangerous and undesirable for children according to photographs and interviews. Perceived safety concerns included presence of transient populations, incivilities (e.g. stray dogs, litter, and abandoned properties), and drug/gang activity. Families endorsed policies and programs targeting community connectedness and sustainable programs as pathways to increase neighborhood safety. Future advocacy efforts should target policies of local governments, community organizations, and housing development resident councils to address neighborhood perceived safety and PA.
139st APHA Annual Meeting and Exposition 2011; 10/2011
[Show abstract][Hide abstract] ABSTRACT: Adherence to physical activity and dietary interventions is a common challenge. Interventions that use group cohesion strategies show promise for increasing adherence, but have not been tested among women of color. The purpose of this study was to determine whether dimensions of group cohesion mediate the association between intervention condition and attendance within a community physical activity program for women of color. African American and Hispanic or Latina women (N = 310) completed measurements at baseline and post-intervention and participated in a social cohesion intervention to improve physical activity and dietary habits. Women were assigned to a physical activity or fruit and vegetable intervention group. Social and task cohesion was measured using the Physical Activity Group Environment Questionnaire (PAGE-Q). Attendance was recorded at each of six intervention sessions. Women were generally middle-age (M age = 46.4 years, SD = 9.1) and obese (M BMI = 34.4 kg/m2, SD = 7.7). The estimate of the mediated effect was significant for all group cohesion constructs, indicating both task constructs-attraction to the group's task (SE = 0.096, CI: -0.599 to -0.221) and group integration around the task (SE = 0.060, CI: -0.092 to -0.328)-and social constructs-attraction to the group's social aspects (SE = 0.046, CI: -0.546 to -0.366) and group integration around social aspects (SE = 0.046, CI: -0.546 to -0.366)-significantly mediated the association between group assignment and attendance. Both task and social constructs are important to improve attendance in health promotion interventions for women of color.
[Show abstract][Hide abstract] ABSTRACT: Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. This manuscript describes the rationale, design and methodology of Health Is Power (HIP), a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity and improve dietary habits in African American and Hispanic or Latina women in Houston and Austin, Texas.
The intervention development was guided by group dynamics principles anchored within an ecologic model.
Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods - integrated into strategies to promote group cohesion - framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests.
Neighborhood contextual and environmental measures are described to test ecologic factors that may contribute to behavioral maintenance. Theoretically guided interventions that account for multiple levels of influence in behavior initiation and maintenance stand to improve health outcomes in vulnerable populations.
[Show abstract][Hide abstract] ABSTRACT: Compared measures of physical activity and dietary habits used in the Health Is Power (HIP) study, and described the associations of physical activity and dietary habits among African American and Hispanic or Latino women, adjusted for weight status. Cross-sectional baseline data were compared for community dwelling, healthy African American (N = 262) and Hispanic or Latina women (N = 148) who participated in HIP. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) long form, the Check And Line Questionnaire (CALQ) log and accelerometry. Dietary habits were measured using NCI 24-h recall screeners, vegetable and fruit (VF) logs and the NCI Diet History Questionnaire (DHQ). Differences in physical activity and dietary habits were assessed using simultaneous 2 (ethnicity) × 3 (weight status) ANCOVAs adjusted for age and socioeconomic status. Women (M age = 44.4 ± 10.9 years) were obese (M = 34.0 ± 9.7 kg/m(2)), did not meet physical activity guidelines as measured by accelerometry (M = 19.4 ± 19.1 min MVPA/day) and ate few VF (M = 2.8 ± 2.7 servings/day). DHQ variables differed by weight status. IPAQ was associated with CALQ, and CALQ with accelerometry (P < .05). IPAQ was not associated with accelerometry. Regardless of ethnicity, normal weight women did more physical activity, reported more VF consumption, and consumed more fat calories than overweight and obese women (Ps < .05). African American women did more MVPA than Hispanic or Latino women (P < .001). Relationships between behaviors and weight status suggest accelerometry and DHQ are preferable, regardless of ethnicity; and studies may capture different domains of physical activity and dietary habits depending on measure used.
Journal of Community Health 04/2011; 36(6):1011-23. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obesity in African American (AA) and Hispanic or Latina (HL) women has been partly attributed to low physical activity (PA) and cultural influences on body image. The purpose of this study was to determine the relationship among body mass index (BMl=kg/m2), body image perception (perceived and desired) and PA.
The current study is a cross-sectional, secondary data analysis of the Health Is Power (HIP) project (1R01CA109403).
Women residing in Harris County, Houston and Travis County, Austin, Texas were recruited to participate in the study.
Over four hundred (N=410) AA (N=262) and HL (N=148) women participated in the HIP project and were included in the current study.
BMI, Pulvers' body image, PA and demographic data were collected from each participant.
Women (mean age=45.2 yrs) were educated (44% college graduates) and obese (mean BMI =34.6 kg/m2). Less than half perceived themselves correctly regardless of actual weight and ethnicity (P<.001). Nearly three-fourths of AA (73.9%) and less than half of HL (42.9%) women who were normal weight desired to be obese, and only 39.4% of AA and HL women desired to be normal weight. Women varied on measures of PA (P<.05). Regression analyses showed objectively measured PA was significantly associated with BMI and ethnicity (P<.01).
Results reveal dichotomous distortion in body images. Women need strategies to perceive normal weight as desirable for health and beauty, leading to increased PA and reducing obesity.
[Show abstract][Hide abstract] ABSTRACT: Local food environments influence fresh produce purchase and consumption, and previous research has found disparities in local food environments by income and ethnicity. Other existing studies have begun to quantify the distribution of food sources, but there has been limited attention to important features or types of healthful food that are available or their quality or cost. Two studies assessed the type, quantity, quality and cost of healthful food from two diverse urban cities, Kansas City, Kansas and Missouri and Honolulu, Hawaii, and evaluated differences by neighborhood income and ethnic composition.
A total of 343 food stores in urban neighborhoods were assessed using the one-page Understanding Neighborhood Determinants of Obesity (UNDO) Food Stores Assessment (FSA) measuring healthful foods. US Census data were used to define median household income and ethnic minority concentration.
In Study 1, most low socioeconomic status (SES), high ethnic minority neighborhoods had primarily convenience, liquor or small grocery stores. Quality of produce was typically lower, and prices of some foods were more than in comparison neighborhoods. In Study 2, low SES neighborhoods had more convenience and grocery stores. Farmers' markets and supermarkets had the best produce availability and quality, and farmers' markets and pharmacies had the lowest prices.
Messages emphasizing eating more fruits and vegetables are not realistic in urban, low SES, high ethnic concentration neighborhoods. Farmers' markets and supermarkets provided the best opportunities for fresh produce. Increasing access to farmers' markets and supermarkets or reducing prices could improve the local food environment.
[Show abstract][Hide abstract] ABSTRACT: public housing facilities play an important role in housing individuals with physical disabilities, including older adults, who are unable to afford private housing. This study assessed general features of physical access in the common use areas of 14 federally subsidized, urban public housing facilities.
fourteen public housing facilities were assessed by trained field assessors for 6 features of accessibility.
most housing facilities had at least 1 parking space designated with a vertical sign (86%), an entrance that was level or had a ramp (86%), and a 32-inch wide exterior door (71%). Half (50%) had a public restroom designated by signage as accessible, and most of these bathrooms had 32-inch-wide doorways and at least 1 grab bar near the toilet (86%). Most housing managers were able to identify building modifications that had been made to satisfy accessibility regulations.
the results suggest that relatively large proportions (14%-29%) of federally funded housing facilities are not complying with federal regulations. Better education and compliance are needed to ensure access for all in public housing facilities.
Disability and Health Journal 01/2008; 1(1):25-9. · 1.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments.
Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods.
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).
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.
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 physical activity resources. Neighborhood street connectivity was also measured.
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. CONDUSION: Supportive neighborhood environments were related to lower obesity prevalence and lower BMI among residents.
American journal of health promotion: AJHP 01/2008; 22(3):187-94. · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments.
Physical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis.
Participants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors.
These results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with fewincivilities, as well as, greater street connectivity, are more likely to be physically active.
International Journal of Behavioral Nutrition and Physical Activity 01/2007; 4:56. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obesity prevalence is higher among those who live in impoverished environments. This investigation identified obesogenic factors in urban neighborhoods surrounding public housing developments (HDs).
Cross-sectional quantitative survey data from 14 HD neighborhoods and qualitative interviews of the HD managers.
Kansas City, Kansas, and Kansas City, Missouri.
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.
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.
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.
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.
American journal of health promotion: AJHP 03/2006; 20(4):282-90. · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neighborhood environment factors may influence physical activity (PA). The purpose of this study was to develop and test a brief instrument to systematically document and describe the type, features, amenities, quality and incivilities of a variety of PA resources.
The one-page Physical Activity Resource Assessment (PARA) instrument was developed to assess all publicly available PA resources in thirteen urban lower income, high ethnic minority concentration neighborhoods that surrounded public housing developments (HDs) and four higher income, low ethnic minority concentration comparison neighborhoods. Neighborhoods had similar population density and connectivity. Trained field coders rated 97 PA resources (including parks, churches, schools, sports facilities, fitness centers, community centers, and trails) on location, type, cost, features, amenities, quality and incivilities. Assessments typically took about 10 minutes to complete.
HD neighborhoods had a mean of 4.9 PA resources (n = 73) with considerable variability in the type of resources available for each neighborhood. Comparison neighborhoods had a mean of 6 resources (n = 24). Most resources were accessible at no cost (82%). Resources in both types of neighborhoods typically had about 2 to 3 PA features and amenities, and the quality was usually mediocre to good in both types of neighborhoods. Incivilities at PA resources in HD neighborhoods were significantly more common than in comparison neighborhoods.
Although PA resources were similar in number, features and amenities, the overall appearance of the resources in HD neighborhoods was much worse as indicated by substantially worse incivilities ratings in HD neighborhoods. The more comprehensive assessment, including features, amenities and incivilities, provided by the PARA may be important to distinguish between PA resources in lower and higher deprivation areas.
International Journal of Behavioral Nutrition and Physical Activity 10/2005; 2:13. · 3.58 Impact Factor