CONTEXT. Environmental factors are suggested to play a major role in physical activity (PA) and other obesity-related behaviors, yet there is no national research on the relationship between disparity in access to recreational facilities and additional impact on PA and overweight patterns in US adolescents. 

OBJECTIVE. In a nationally representative cohort, we sought to assess the geographic and social distribution of PA facilities and how disparity in access might underlie population-level PA and overweight patterns. 

DESIGN, SETTING, AND PARTICIPANTS. Residential locations of US adolescents in wave I (1994–1995) of the National Longitudinal Study of Adolescent Health (N = 20745) were geocoded, and a 8.05-km buffer around each residence was drawn (N = 42857 census-block groups [19% of US block groups]). PA facilities, measured by national databases and satellite data, were linked with Geographic Information Systems technology to each respondent. Logistic-regression analyses tested the relationship of PA-related facilities with block-group socioeconomic status (SES) (at the community level) and the subsequent association of facilities with overweight and PA (at the individual level), controlling for population density. 

MAIN OUTCOME MEASURES. Outcome measures were overweight (BMI ≥ 95th percentile of the Centers for Disease Control and Prevention/National Center for Health Statistics growth curves) and achievement of ≥5 bouts per week of moderate-vigorous PA. 

RESULTS. Higher-SES block groups had a significantly greater relative odds of having 1 or more facilities. Low-SES and high-minority block groups were less likely to have facilities. Relative to zero facilities per block group, an increasing number of facilities was associated with decreased overweight and increased relative odds of achieving ≥5 bouts per week of moderate-vigorous PA. 

CONCLUSIONS. Lower-SES and high-minority block groups had reduced access to facilities, which in turn was associated with decreased PA and increased overweight. Inequality in availability of PA facilities may contribute to ethnic and SES disparities in PA and overweight patterns.

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Inequality in the Built Environment Underlies Key Health Disparities in Physical Activity and Obesity

Objective The goal of this review was to determine the direction of associations between SES and health behaviors during the period of adolescence. Method We searched the PsychInfo and Pubmed databases for studies that measured the association between SES and cigarette smoking, alcohol consumption, marijuana use, diet, and physical activity in adolescents between 10- and 21-years old. Results Associations between SES and health behaviors conformed to two patterns. First, low SES was associated with poorer diets, less physical activity, and greater cigarette smoking. Second, there was no clear pattern of associations between SES and alcohol consumption or marijuana use. Conclusion Results from this review indicate that, although some associations between SES and health behaviors exist during adolescence, the associations are not as robust as those in adulthood. Efforts to curb poor diet, inactivity, and smoking behaviors should target low SES adolescents, whereas efforts to curb teen drinking and marijuana use may be useful across the SES spectrum.

Socioeconomic status and health behaviors in adolescence: a review of the literature.

Approximately 79 400 000 American adults, or 1 in 3, have cardiovascular disease (CVD).1 CVD accounts for 36.3% or 1 of every 2.8 deaths in the United States and is the leading cause of death among both men and women in the United States, killing an average of 1 American every 37 seconds.1 Older adults, some ethnic minority populations, and socioeconomically disadvantaged individuals have an increased prevalence of CVD and vascular/metabolic risk factors such as hypertension, dyslipidemia, and diabetes; are more likely to have ≥2 risk factors; and are at increased risk of being sedentary, overweight or obese, and having unhealthy dietary habits.2–10 Black and Hispanic immigrants are initially at lower risk for vascular/metabolic risk factors and CVD than US-born black and Hispanic individuals,2 but as they adapt to the diet and activity habits of this country, the prevalence of vascular/metabolic risk factors increases.3 Each of these issues emphasizes the importance of interventions to promote physical activity (PA) and healthy diets in all American adults.

Even modest sustained lifestyle changes can substantially reduce CVD morbidity and mortality. Because many of the beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits. Interventions targeting dietary patterns, weight reduction, and new PA habits often result in impressive rates of initial behavior changes, but frequently are not translated into long-term behavioral maintenance.4 Both adoption and maintenance of new cardiovascular risk-reducing behaviors pose challenges for many individuals. According to the National Center for Health Statistics, life expectancy could increase by almost 7 years if all forms of major CVD were eliminated.5 Improvements in morbidity and quality of life would also be substantial. In order to achieve these goals, healthcare providers must focus on reducing CVD risk factors such as overweight and obesity, …

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Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults A Scientific Statement From the American Heart Association

Summary Over the past forty years various changes in the U.S. “built environment” have promoted sedentary lifestyles and less healthful diets. James Sallis and Karen Glanz investigate whether these changes have had a direct effect on childhood obesity and whether improvements to encourage more physical activity and more healthful diets are likely to lower rates of childhood obesity. Researchers, say Sallis and Glanz, have found many links between the built environment and children’s physical activity, but they have yet to find conclusive evidence that aspects of the built environment promote obesity. For example, certain development patterns, such as a lack of sidewalks, long distances to schools, and the need to cross busy streets, discourage walking and biking to school. Eliminating such barriers can increase rates of active commuting. But researchers cannot yet prove that more active commuting would reduce rates of obesity. Sallis and Glanz note that recent changes in the nutrition environment, including greater reliance on convenience foods and fast foods, a lack of access to fruits and vegetables, and expanding portion sizes, are also widely believed to contribute to the epidemic of childhood obesity. But again, conclusive evidence that changes in the nutrition environment will reduce rates of obesity does not yet exist. Research into the link between the built environment and childhood obesity is still in its infancy. Analysts do not know whether changes in the built environment have increased rates of obesity or whether improvements to the built environment will decrease them. Nevertheless, say Sallis and Glanz, the policy implications are clear. People who have access to safe places to be active, neighborhoods that are walkable, and local markets that offer healthful food are likely to be more active and to eat more healthful food—two types of behavior that can lead to good health and may help avoid obesity.

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The role of built environments in physical activity, eating, and obesity in childhood

The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.

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RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review

The purpose of this study was to determine whether the availability and accessibility of physical activity resources differed by neighborhood socioeconomic status (SES) in a small U.S. city (population = 133,046). U.S. census tracts (N = 32) were used to represent neighborhoods and categorized into high, medium, or low SES on the basis of the percentage of unemployed individuals, per capita income, and percentage of the population below the poverty threshold. We developed a geographic information system to generate a comprehensive list of physical activity resources available within each census tract in the city. We identified 112 parks, 33 sport facilities, 15 fitness clubs, 11 community centers, and 5 walking/biking trails. The total number of physical activity resources varied by neighborhood SES (p > .05); low-SES (M = 4.5±2.3) and medium-SES (M = 4.9±2.6) neighborhoods had significantly fewer resources than high-SES (M = 8.4±3.5) neighborhoods. Low-, medium-, and high-SES neighborhoods did not differ on the number of pay-for-use facilities; however, low-SES (M = 3.1±1.5) and medium-SES (M = 3.8±1.6) neighborhoods had significantly fewer free-for-use resources than high- (M = 6.1±2.4) SES neighborhoods (p > .01). Data suggest that individuals from lower SES neighborhoods may have limited ability to control their physical activity in the face of inaccessible environments. Community research and promotion efforts should include assessment and targeting of available and accessible physical activity resources.

https://staff.washington.edu/kwolf/Archive/Classes/ESRM304_SocSci/304%20Soc%20Sci%20Lab%20Articles/Estabrooks_2003.pdf

Resources for physical activity participation: Does availability and accessibility differ by neighborhood socioeconomic status?

Evaluating the impact of behavioral interventions that target physical activity: issues of generalizability and public health.

The purpose of the study was to examine the relationship between perceptions of self-efficacy, proxy efficacy, and exercise class attendance of participants involved in a 10-week structured group fitness program. At week 3, 127 females completed measures of self-efficacy and proxy efficacy and their class attendance was monitored for the subsequent four weeks. Self-efficacy was assessed through measures of exercise, scheduling, and barrier self-efficacy. Proxy efficacy was assessed through a measure of fitness instructor efficacy defined as participants' confidence in their fitness instructors' communication, teaching, and motivating capabilities. Results revealed positive correlations between self-efficacy variables and proxy efficacy. Hierarchical multiple regression analyses indicated that among those who were classified as exercise initiates (n = 33), self-efficacy and proxy efficacy accounted for 34 percent of the variance in exercise class attendance with the latter variable explaining a unique 12 percent. Consistent with theorizing, these preliminary findings indicate that for instructor-led, group physical activities such as aerobics classes, proxy efficacy perceptions are related to self-efficacy and may also be an important predictor of exercise behavior.

An Exploratory Investigation of the Relationship between Proxy Efficacy, Self-efficacy and Exercise Attendance.

The purpose of this study was to determine whether a theory-based framework could be used to deductively identify and understand the characteristics of motivational leaders of physical activity groups for older adults. Participants were 23 older adults (mean age = 78.5 ± 8.0 years, 65% women). An interview-guide approach was employed to elicit older adults’ thoughts on important characteristics of physical activity group leaders. The data suggested that effective leaders are those whom the participants feel are properly qualified, are able to develop a personal bond with participants, and can use their knowledge and the group to demonstrate collective accomplishments. It was concluded that the findings could be used to extend the leadership activities beyond the traditional technical performance and individual feedback to include activities of social integration. Furthermore, the conceptual framework identified can serve as a valuable tool in guiding future researchers in their examination of leadership i...

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Leadership in physical activity groups for older adults: A qualitative analysis

Objective

To examine whether aquatic exercise–related goals, task self-efficacy, and scheduling self-efficacy are predictive of aquatic exercise attendance in individuals with arthritis A secondary objective was to determine whether high attendees differed from low attendees on goals and self-efficacy



Methods

The sample comprised 216 adults with arthritis (mean age 6921 years) Measures included exercise-related goal difficulty and specificity, task and scheduling self-efficacy, and 8-week aquatic exercise attendance



Results

Results of a multiple hierarchical regression analysis were significant (P < 001) Goal difficulty, specificity, and task self-efficacy were independent predictors of attendance (P < 005) A significant multivariate analysis of variance (P < 001) indicated that high attendees had higher task and scheduling self-efficacy and lower goal difficulty than did low attendees (P < 005)



Conclusion

Support for the importance of exercise-related goal setting and self-efficacy was demonstrated Implications pertain to the design of interventions to impact aquatic exercise

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.11123

Nancy C. Gyurcsik

Papers

Resources for physical activity participation: Does availability and accessibility differ by neighborhood socioeconomic status?

Evaluating the impact of behavioral interventions that target physical activity: issues of generalizability and public health.

An Exploratory Investigation of the Relationship between Proxy Efficacy, Self-efficacy and Exercise Attendance.

Leadership in physical activity groups for older adults: A qualitative analysis

Exercise-related goals and self-efficacy as correlates of aquatic exercise in individuals with arthritis