barrier to considering PA in community design and layout. 19 The development of collaborations is a cornerstone of the Community Health Improvement Plan (CHIP) process, which represents a promising long-term strategic health planning approach to address complex public health issues such as physical
Meera Sreedhara, Karin Valentine Goins, Christine Frisard, Milagros C. Rosal and Stephenie C. Lemon
Mikihiro Sato, James Du and Yuhei Inoue
Although previous studies supported the health benefits of physical activity, these studies were limited to individual-level research designs. Building upon a social-ecological model, we examined the relationship between physical activity and community health—the health status of a defined group of people—while accounting for the potential endogeneity of physical activity to health.
We obtained U.S. county-level data from the 2012 Behavioral Risk Factor Surveillance System survey and the 2014 County Health Ranking Database. We first conducted an ordinary least squares (OLS) regression analysis to examine the relationship between the rate of physical activity and community health measured by the average perceived health score for each county. We then conducted a 2-stage least squares (2SLS) regression analysis to investigate this relationship after accounting for potential endogeneity.
Results from the OLS analysis indicated that the rate of physical activity was positively associated with community health. Results from the 2SLS analysis confirmed that the physical activity rate remained positively associated with community health.
In line with the social-ecological model, our findings provide the first evidence for the health benefits of county-level physical activity. Our results support extant research that has shown relationships between physical activity and individual-level, health-related outcomes.
Sara Wilcox, Deborah Parra-Medina, Gwen M. Felton, Mary Beth Poston and Amanda McClain
Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers.
Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity.
Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered.
A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.
Alex Antonio Florindo, Evelyn Fabiana Costa, Thiago Herick Sa, Taynã Ishii dos Santos, Marília Velardi and Douglas Roque Andrade
The aim of this study was to describe a methodology for training to provide counseling on physical activity among community health workers working within primary healthcare in Brazil.
This was an intervention study conducted with 65 community health workers in the Ermelino Matarazzo district in the São Paulo, Brazil (30 in intervention group). The intervention group received a course of 12 hours (with 4 meetings of 3 hours each in 1 month) that aimed to improve their knowledge and be autonomous with regard to promoting physical activity. For data analysis, focus groups and questionnaires on knowledge and perceptions regarding physical activity were used.
The average attendance for the 4 meetings was 29 workers (93% of total). There was an improvement in knowledge on physical activity recommendations in comparison with the control (P = .03), and qualitative results revealed that the professionals appreciated the learned content, valued its application based on knowledge construction and felt secure about promoting physical activity. This was seen through high adherence levels and construction collective of proposal for home visits for physical activity promotion.
The training was effective in improving knowledge and attitudes toward counseling on physical activity among community health workers.
Elizabeth Vásquez, Garrett Strizich, Linda Gallo, Simon J. Marshall, Gina C. Merchant, Rosenda Murillo, Frank J. Penedo, Christian Salazar, Daniela Sotres-Alvarez, Benjamin A. Shaw and Carmen R. Isasi
Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.
Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders.
Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant.
Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches.
Chad D. Rethorst, Ashley E. Moncrieft, Marc D. Gellman, Elva M. Arredondo, Christina Buelna, Shelia F. Castañeda, Martha L. Daviglus, Unab I. Khan, Krista M. Perreira, Daniela Sotres-Alvarez and Mark Stoutenberg
The burden of depression among Hispanics/Latinos indicates the need to identify factors related to depressive symptoms. This paper examines the relationship of physical activity (PA) and sedentary behavior (SB) with depressive symptoms in Hispanic/Latinos.
The Hispanic Community Health Study / Study of Latinos (HCHS/SOL) is a population-based, cohort study of Hispanic/Latinos in 4 United States metropolitan areas. Objectively measured PA was coded into: sedentary behavior (SB), light-intensity (LPA), moderate-intensity (MPA), and vigorous-intensity (VPA); and the Center for Epidemiological Studies Depression Scale-10 assessed depressive symptoms. Multiple regression analysis utilizing isotemporal substitution, adjusted for relevant covariates, examined PA as predictors of depressive symptoms.
Substitution of 1 hour of SB with VPA resulted in a significant decrease in depressive symptoms (β = –1.215, P = .021). Similar decreases were observed when VPA replaced LPA (β = –1.212, P = .021) and MPA (β = –1.50 P = .034). MPA and LPA were not associated with lower depressive symptoms.
Previous research has focused on the relationship of MVPA on depressive symptoms. Our results suggest these constructs should be examined separately as they may have unique relationships with depressive symptoms. The association of SB with greater depressive symptoms confirms previous reports.
Maggie Evans, Kelly J. Rohan, Alan Howard, Sheau-Yan Ho, Patricia M. Dubbert and Barbara A. Stetson
This prospective, naturalistic study examined the relationship between different exercise dimensions (i.e., frequency, intensity, duration, and omissions of planned exercise) and psychological well-being among community adults participating in self-selected exercise. For at least 2 months, participants kept daily exercise diaries and provided weekly ratings for depressed mood, anxiety, sleep quality, concentration, alertness, confidence, weight satisfaction, physical fitness, appetite, satisfaction with physical shape and appearance, and stress experienced. Linear mixed model analyses revealed positive associations between exercise frequency, intensity, and duration across a broad range of psychological and mood-related outcomes. In contrast, omissions of planned exercise were associated with a global and detrimental effect on psychological health. A main effect of age and a moderating effect of gender was observed in many of the models. This work contributes to literature on exercise dimensions and psychological constructs and informs future research that is needed to develop physical activity recommendations for improved mental health.
Sofia W. Manta, Paula F. Sandreschi, Thiago S. Matias, Camila Tomicki and Tânia R.B. Benedetti
.420). The data were collected in 2012, 2014, 2016, and 2017 at 14 community health centers (CHCs) ( n = 52) in Florianopolis in the state of Santa Catarina, Brazil. The study was approved by the ethics committee of the local Institutional Review Board (blinded for review). Written informed consent was
Iris Buder, Cathleen Zick, Norman Waitzman, Sara Simonsen, Grant Sunada and Kathleen Digre
Reviews of these interventions have suggested those targeted at minority populations should be culturally sensitive in design. 14 , 16 , 17 Utilization of community health workers to promote healthy behaviors can be an effective way to make interventions culturally sensitive, and thus improve healthy
JooYong Park, Aesun Shin, Miyoung Lee, Jaesung Choi, Minkyo Song, Yeonjung Kim, Jong-koo Lee, Daehee Kang and Ji-Yeob Choi
systems, the Korea National Health and Nutrition Examination Survey (KNHANES) and the Korea Community Health Survey (KCHS), have reported PA prevalence and trends annually based on an International Physical Activity Questionnaire (IPAQ). 11 – 13 The KNHANES, which is a nationwide surveillance system that