Physical activity provides a variety of both short- and long-term health benefits for all individuals. For adults, regular physical activity lowers the risk of all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, dementia, depression, and some cancers.1 It also improves cognition, sleep, weight status, bone health, and physical function.1 Since 2008, the U.S. Department of Health and Human Services (HHS) has issued federal guidance on physical activity, including recommendations for the amount and types of physical activity needed for substantial health benefits. The Physical Activity Guidelines for Americans (Guidelines), 2nd edition, released in 2018, recommends that adults get a mix of aerobic and muscle strengthening physical activity each week.1 To attain the most health benefits from physical activity, adults need at least 150 to 300 minutes of moderate-intensity aerobic physical activity per week and muscle strengthening activities on 2 or more days per week, a recommendation that has remained unchanged since 2008.1 Despite efforts to encourage Americans to meet these recommendations, in 2018, only 24% of US adults met both the aerobic and muscle strengthening guidelines, and about 25% of US adults reported doing no leisure-time physical activity of any kind.2
The low percentage of US adults who are meeting the Guidelines is consistent with the low levels of awareness of the Guidelines and limited knowledge of the recommended amount of physical activity or dosage.3–5 In a national sample, only 36.1% of US adults reported awareness of the Guidelines.4 Awareness was even lower in a sample of 2050 adults who were not meeting the Guidelines with only 22% of adults reporting awareness of the Guidelines.5 In addition, awareness of the Guidelines does not necessarily translate to knowledge of the recommended dosage. Estimates of US adults’ knowledge of the dosage from national surveys have ranged from 0.56% to 2.50%.3,4 Multiple behavioral theories, such as the transtheoretical model and the precaution adoption process, characterize awareness and knowledge as prerequisites to behavior change.6,7 Individuals in the precontemplation stage of the transtheoretical model are often defined as resistant to change or unaware that their current behavior is problematic, suggesting that increased awareness of the Guidelines and targeted messages could be a factor in moving individuals from the precontemplation phase to the contemplation phase.6 Similarly, the precaution adoption process suggests that individuals will not initiate a behavior change without recognizing their behavior as unhealthy.7 Thus, awareness of the Guidelines and knowledge of the dosage could be important targets within broader population-level efforts to increase physical activity in adults.
Although supported by theory, in practice, studies conducted outside of the United States have resulted in mixed evidence on whether awareness of national physical activity recommendations facilitates behavior change, warranting both further research on the topic and additional research with the US population.8–11 Since the release of the second edition of the Guidelines in November 2018, there has been limited research on how Americans are hearing about and responding to the Guidelines. Disseminating messages to a target audience via multiple unique communication channels can increase impact,12 and social marketing campaigns using multiple communication channels have had favorable physical activity-related outcomes.13–15 However, the use of different communication channels has not been examined as it relates to dissemination of the Guidelines. As the federal government works to disseminate the Guidelines and promote physical activity, understanding which dissemination channels will help reach the US population and improve overall physical activity levels is essential.
Using a nationally representative sample of US adults, this study explored the reported response (increase physical activity, decrease physical activity, look for more information, change type of activity, and no change) to hearing about the Guidelines and various information sources reported for hearing about the Guidelines (health professional/doctor, social media/internet, TV, and magazine). This study had 2 aims: (1) to characterize the population of US adults that heard about the Guidelines and describe the reported responses and (2) to describe how US adults heard about the Guidelines and examine associations between the reported response(s) to the Guidelines and the information source and number of sources reported. The findings from this research can help inform future efforts to promote and communicate the Guidelines to the public at both the federal and local levels.
Methods
Data Source
This study used data from the National Cancer Institute’s Health Information National Trends Survey (HINTS), a nationally representative survey of noninstitutionalized US adults ages 18 years and older. Since 2003, HINTS has collected nationally representative data through multiple cross-sectional survey iterations and data collection cycles. Data used in this study were from HINTS 5 Cycle 3, which was conducted from January to April, 2019. Data collection occurred through either a mailed self-administered questionnaire or a web-based pilot version. Web-based participants were randomly assigned to either the (1) web option group wherein respondents were offered a choice between responding via paper or web or (2) web bonus group wherein respondents were offered a choice between responding via paper or web with an additional $10 incentive for those responding via web. A total of 5438 respondents (29.6%–31.5% response rate across survey modalities) completed the survey. Contradictory responses (7.9%, n = 391), described further in the “Measures” section, were excluded from the sample prior to analysis, leaving an overall analytical sample of 5047 respondents. Further information about sampling procedures and survey modality has been published16 and can also be found on the study website (https://hints.cancer.gov/) along with the publicly available data set. The Westat Institutional Review Board approved the administration of HINTS.16
Measures
Information Source
Information sources for hearing about the Guidelines were measured using the question, “The Federal Government publishes the Physical Activity Guidelines for Americans, which provide recommendations for how much physical activity to get to be healthy. In the past 6 months, have you heard about government recommendations for physical activity from any of the following sources?” Participants were asked to select all that applied of the following options: (1) health professional or doctor, (2) social media or internet, (3) television, and (4) magazine. Each source was treated independently with a dichotomous (selected/not selected) response.
Number of Sources
The number of sources was defined as the number of information sources that respondents selected for hearing about the Guidelines. A composite total source variable was derived as the sum of sources selected, ranging from 0 to 4.
Response to Guidelines and Awareness
Responses to the Guidelines were measured using the question, “Think about the last time you heard a new government recommendation about physical activity or exercise. Which of the following best describe what you did in response to the new recommendation?” Participants were asked to select all that applied of the following options: (1) I increased the amount of physical activity/exercise that I do, (2) I decreased the amount of physical activity/exercise that I do, (3) I changed the type of physical activity that I do, (4) I looked for more information about the recommendation, (5) I did not change what I do, and (6) I have not heard any government recommendations about physical activity or exercise. Each individual response item was treated dichotomously (selected/not selected). Awareness of the Guidelines was operationalized using reported responses to the Guidelines (Figure 1). Those who selected options 1 to 5 were coded as “Aware of the Guidelines” and those who selected response option 6 were coded as “Not Aware of the Guidelines.”
—Measuring awareness of the Guidelines. HINTS indicates Health Information National Trends Survey.
Citation: Journal of Physical Activity and Health 18, 11; 10.1123/jpah.2021-0136
Characteristics of the Sample
Variables representing meeting the aerobic guidelines, muscle strengthening guidelines, and combined overall guidelines were calculated as follows.
Aerobic guidelines: Meeting aerobic physical activity guidelines was defined as reporting at least 150 minutes of moderate-intensity physical activity per week. An indicator variable for meeting aerobic physical activity guidelines was derived from 2 questions. First, participants were asked, “In a typical week, how many days do you do any physical activity or exercise of at least moderate intensity, such as brisk walking, bicycling at a regular pace, and swimming at a regular pace (do not include weightlifting)?” Answer choices were “None” to “7 days per week.” Participants who selected a response other than “None” were asked, “On the days that you do any physical activity or exercise of at least moderate intensity, how long do you typically do these activities?” Answers were open response using the units of minutes per day. Days per week were multiplied by duration of activity for a total summary score. Participants who reported at least 150 minutes of moderate-intensity physical activity per week were coded as “Meeting aerobic guidelines.”
Muscle strengthening guidelines: Meeting the muscle strengthening physical activity guidelines was defined as reporting at least 2 days of muscle strengthening activity per week. An indicator for meeting muscle strengthening physical activity guidelines was derived from the question, “In a typical week, outside of your job or work around the house, how many days do you do leisure-time physical activities specifically designed to strengthen your muscles such as lifting weights or circuit training (do not include cardio exercise such as walking, biking, or swimming)?” Answer choices were “None” to “7 days per week.” Participants who answered 2 or more days per week were coded as “Meeting muscle strengthening guidelines.”
Overall guidelines: Meeting the overall physical activity guidelines was defined as meeting both the aerobic and muscle strengthening guidelines. Respondents who met both the aerobic and muscle strengthening guidelines were coded as “Meeting overall guidelines,” and those that met one or neither guideline were coded as “Not meeting overall guidelines.”
Sociodemographic factors: Sociodemographic factors explored as potential covariates in the analyses included self-reported gender (male and female), race/ethnicity (non-Hispanic white, Hispanic, non-Hispanic black or African American, non-Hispanic Asian, and non-Hispanic other), education (less than high school, 12 y or completed high school, some college, college graduate, or higher), age group (18–34 y, 35–49 y, 50–64 y, and 65 y and older), US region (Northeast, Midwest, South, and West), and urbanicity (large metro, large fringe metro, medium metro, and small metro/micropolitan/noncore).
Health-related variables: Health-related variables explored as potential covariates in the analyses included self-reported chronic disease status (diabetes, high blood pressure, heart condition, lung disease, depression, and cancer), health information seeking (yes and no), and body mass index (underweight, normal weight, overweight, and obese).
Statistical Analyses
All statistical analyses were performed using SAS software (version 9.4; SAS Institute Inc, Cary, NC) and applying jackknife weighting procedures due to the complex survey design. Prior to analyses, contradictory responses to survey items were examined to mitigate potential error. Contradictory responses were defined as respondents who selected responses that were not plausible (ie, indicating having heard about the Guidelines through a specific source and then subsequently selecting “I have not heard any government recommendations about physical activity or exercise”). A total of 7.9% (391/5438) respondents were coded as contradictory. All responses coded as contradictory were excluded from analysis (n = 391), leaving the overall analytical sample size of N = 5047. In addition, potential differences in the dependent variable(s) by data collection modality (mail, web option, and web bonus) were examined. No statistical differences across survey modalities were found, so mode was not controlled for in the models.
Descriptive statistics, including frequencies, weighted percentages, and chi-square statistics, were used to describe characteristics of the overall sample. First, chi-square tests were used to examine potential differences in sample characteristics among those who were and were not aware of the Guidelines. Then, those who were not aware of the Guidelines (n = 1543) and those who had missing data for the question (n = 205) were excluded from further analyses (n = 1748) and a series of binary logistic regressions were performed. First, behavioral responses to the Guidelines (dependent variables—increased, looked for more information, changed type, no change; referent—not selected) by information source (independent variables—health professional/doctor, social media/internet, TV, magazine; referent—not selected) were modeled. Responses to the Guidelines by number of sources (independent variables—zero, one, multiple; referent—one source selected) were also examined. Regressions were run separately for each behavioral response while controlling for respondent characteristics (gender, race/ethnicity, education, and age) and the other sources. In addition, logistic regressions were stratified by meeting overall physical activity guidelines (Supplemental Table S1 [available online]). However, these findings should be interpreted with caution due to the low sample size. No significant findings were found for the health-related variables; therefore, they were not included in the models. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported for all models. Survey weights were used to provide nationally representative estimates.
Results
AIM 1
Characteristics of the Sample
Weighted prevalence estimates of the sample (N = 5047) are presented in Table 1, overall and stratified by awareness of the Guidelines. The majority of the sample was Non-Hispanic white and had at least some college or higher. Over two-thirds of the sample had overweight or obesity. In the overall sample of adults, 37.4% met aerobic guidelines, 36.3% met muscle strengthening guidelines, and 22.3% met the overall physical activity guidelines. A total of 64.8% of the sample (n = 3299) were aware of the Guidelines. There was a significant difference in the prevalence of meeting overall, aerobic, and muscle strengthening guidelines in those who were aware of the Guidelines (40.4%, 39.7%, and 25.0%) compared with those who were not aware of the Guidelines (32.9%, 31.3%, and 18.5%).
Weighted Population Estimates for Participants Characteristics, HINTS 5 Cycle 3 (N = 5047)
| Overall sample, weighted % (n) (N = 5047) | Aware of the Guidelines, weighted % (n) (n = 3299) | Not aware of the Guidelines, weighted % (n) (n = 1543) | P | |
|---|---|---|---|---|
| Gender | .815 | |||
| Male | 48.8 (2080) | 48.6 (1354) | 49.3 (664) | |
| Female | 51.2 (2849) | 51.4 (1900) | 50.6 (867) | |
| Race/ethnicity | .140 | |||
| Non-Hispanic white | 65.3 (2907) | 63.7 (1868) | 68.9 (978) | |
| Hispanic | 15.8 (648) | 15.7 (436) | 15.7 (194) | |
| Non-Hispanic black or African American | 10.8 (609) | 11.4 (438) | 9.2 (148) | |
| Non-Hispanic Asian | 5.0 (198) | 5.5 (131) | 4.2 (65) | |
| Non-Hispanic other | 3.0 (155) | 3.6 (102) | 2.1 (48) | |
| Education | .526 | |||
| College graduate or higher | 30.8 (2301) | 31.7 (1528) | 30.2 (734) | |
| Some college | 40.6 (845) | 39.5 (976) | 42.7 (443) | |
| 12 y or completed high school | 21.9 (845) | 22.0 (551) | 21.7 (260) | |
| Less than high school | 6.6 (291) | 6.8 (190) | 5.4 (81) | |
| Household income | .747 | |||
| $75,000 or more | 40.3 (1710) | 41.3 (1140) | 39.3 (544) | |
| $50,000 to < $75,000 | 17.3 (794) | 16.6 (518) | 19.1 (264) | |
| $35,000 to < $50,000 | 13.3 (581) | 14.0 (403) | 12.5 (164) | |
| $20,000 to < $35,000 | 10.9 (564) | 10.5 (370) | 11.2 (174) | |
| <$20,000 | 18.2 (805) | 17.6 (520) | 17.9 (242) | |
| Age group, y | .003 | |||
| 18–34 | 24.5 (645) | 23.3 (390) | 27.8 (234) | |
| 35–49 | 24.6 (914) | 25.0 (582) | 24.0 (308) | |
| 50–64 | 31.1 (1545) | 30.0 (1023) | 32.0 (471) | |
| 65+ | 19.9 (1801) | 21.7 (1227) | 16.3 (504) | |
| US region | .216 | |||
| Northeast | 17.7 (738) | 17.7 (492) | 18.3 (218) | |
| Midwest | 21.0 (895) | 20.2 (600) | 22.2 (260) | |
| South | 38.7 (2180) | 37.9 (1407) | 39.9 (680) | |
| West | 22.7 (1234) | 24.2 (800) | 19.6 (385) | |
| Urban/rural | .057 | |||
| Large metro | 30.9 (1831) | 32.9 (1228) | 27.0 (534) | |
| Large fringe metro | 24.9 (1191) | 23.7 (769) | 27.4 (381) | |
| Medium metro | 21.9 (1049) | 21.9 (689) | 22.2 (310) | |
| Small metro/micropolitan/noncore | 22.4 (976) | 21.4 (613) | 23.4 (318) | |
| Chronic disease(s)a | .679 | |||
| None | 40.2 (1572) | 39.4 (999) | 41.5 (538) | |
| 1 condition | 31.9 (1512) | 33.1 (1008) | 30.9 (476) | |
| 2+ conditions | 27.9 (1685) | 27.6 (1147) | 27.6 (481) | |
| BMI category, kg/m2 | .129 | |||
| Underweight (<18.5) | 1.8 (78) | 1.3 (51) | 2.6 (24) | |
| Normal weight (18.5–24.9) | 30.5 (1484) | 32.4 (1003) | 27.1 (439) | |
| Overweight (25–29.9) | 34.8 (1695) | 33.3 (1097) | 37.1 (545) | |
| Obese (>30) | 32.9 (1623) | 33.0 (1063) | 33.2 (502) | |
| Ever looked for information about health topics | .491 | |||
| No | 20.3 (923) | 19.0 (576) | 20.6 (288) | |
| Yes | 79.7 (4040) | 81.0 (2670) | 79.4 (1235) | |
| Meeting physical activity guidelines | ||||
| Overall | .007 | |||
| No | 77.7 (3835) | 75.0 (2485) | 81.5 (1249) | |
| Yes | 22.3 (1001) | 25.0 (726) | 18.5 (268) | |
| Aerobic | .006 | |||
| No | 62.6 (3117) | 59.6 (2010) | 67.1 (1014) | |
| Yes | 37.4 (1760) | 40.4 (1226) | 32.9 (506) | |
| Muscle strengthening | .003 | |||
| No | 63.7 (3183) | 60.3 (2018) | 68.7 (1074) | |
| Yes | 36.3 (1732) | 39.7 (1245) | 31.3 (464) | |
Abbreviations: BMI, body mass index; HINTS, Health Information National Trends Survey.
aIncludes diabetes, high blood pressure, heart condition, lung disease, depression, and cancer.
Response to the Guidelines
Of those who were aware of the Guidelines, a total of 71.1% (n = 2389/3299) reported not changing their behavior upon hearing about the Guidelines. The remaining 28.9% (n = 910/3299) reported at least one behavioral response. Of those, about half (490/910 = 54.2%) reported increasing their activity, followed by looking for more information (391/910 = 41.5%), changing their type of activity (311/910 = 35.2%), and decreasing their activity (31/910 = 3.5%). About 30% (297/910) selected multiple responses, which tended to include changing activity type (72.6%), increasing activity (69.2%), and looking for more information (65.5%).
AIM 2
Information Source and Number of Sources
In those aware of the Guidelines (n = 3299), weighted prevalence estimates for the information source and number of source(s) are presented in Figures 2 and 3, respectively. Among the information sources reported, television (43.5%) was selected with the highest frequency, followed by social media or internet (38.0%), health professional or doctor (31.5%), and magazine (23.9%) (Figure 2). In addition, 36.5% of respondents selected zero of the 4 listed sources, 21.7% selected one source, and 41.7% selected 2 or more sources (Figure 3).
—Weighted frequency and 95% confidence intervals by information source among participants reporting awareness of Guidelines (N = 3299).
Citation: Journal of Physical Activity and Health 18, 11; 10.1123/jpah.2021-0136
—Weighted frequency and 95% confidence intervals for total number of sources among participants reporting awareness of Guidelines (N = 3299).
Citation: Journal of Physical Activity and Health 18, 11; 10.1123/jpah.2021-0136
Information Source and Response to Guidelines
In those aware of the Guidelines (n = 3299), binary logistic regression models revealed several associations between the information source and response to hearing about the Guidelines (Table 2). Compared with those who heard from other sources, individuals who heard about the Guidelines from a health professional had higher odds of reporting increasing their physical activity (AOR = 2.30; 95% CI, 1.45–3.65) and looking for more information (AOR = 1.67; 95% CI, 1.01–2.75) and lower odds of reporting no change (AOR = 0.43; 95% CI, 0.29–0.63). Similarly, those who heard about the Guidelines through social media or internet had higher odds of reporting increasing their activity (AOR = 1.89; 95% CI, 1.20–2.96) and looking for more information (AOR = 1.87; 95% CI, 1.28–2.73) and lower odds of reporting no change (AOR = 0.56; 95% CI, 0.40–0.78). Those who heard about the Guidelines from a magazine had higher odds of reporting looking for more information (AOR = 1.66; 95% CI, 1.05–2.62) and changing the type of activity (AOR = 2.31; 95% CI, 1.22–4.39) and lower odds of reporting no change (AOR = 0.61; 95% CI, 0.43–0.88). Despite television being the most frequently reported source for hearing about the Guidelines, when compared with other sources, television was the only source that had no significant differences for reporting a behavioral response. All models were mutually adjusted for all other communication sources and gender, race/ethnicity, education, and age. Associations with decreasing activity are not provided due to the low number of participants selecting this response (n = 31).
Adjusted Binary Logistic Regression Models Examining the Association Between Information Source (Referent = Not Selected) and Response to Hearing About the Guidelines (n = 2883)
| Behavioral response | ||||
|---|---|---|---|---|
| Source | Increased physical activity, AOR (95% CI) | Looked for more information, AOR (95% CI) | Changed type of activity, AOR (95% CI) | Did not make a change, AOR (95% CI) |
| Health professional or doctor (selected vs not selected) | 2.30 (1.45–3.65)* | 1.67 (1.01–2.75)* | 1.45 (0.78–2.68) | 0.43 (0.29–0.63)* |
| Social media or Internet (selected vs not selected) | 1.89 (1.20–2.96)* | 1.87 (1.28–2.73)* | 0.96 (0.58–1.60) | 0.56 (0.40–0.78)* |
| Magazine (selected vs not selected) | 1.36 (0.85–1.87) | 1.66 (1.05–2.62)* | 2.31 (1.22–4.39)* | 0.61 (0.43–0.88)* |
| Television (selected vs not selected) | 1.05 (0.67–1.66) | 1.03 (0.60–1.75) | 1.58 (0.83–3.00) | 1.01 (0.68–1.50) |
Abbreviations: AOR, adjusted odds ratio; CI, confidence interval. Note: Models are mutually adjusted for all other communication sources and gender, race/ethnicity, education, and age category.
*Statistical significance (P < .05).
Number of Sources and Response to Guidelines
Binary logistic regression models also showed significant associations between the number of sources and response to the Guidelines (Table 3). Those who indicated hearing about the Guidelines through more than one of the listed sources (vs one) had higher odds of reporting increasing their activity (AOR = 1.97; 95% CI, 1.18–3.31) and changing their activity type (AOR = 2.16; 95% CI, 1.07–4.34) and had lower odds of selecting no change (AOR = 0.50; 95% CI, 0.33–0.77) after controlling for covariates. Those who did not select any of the provided sources (health professional/doctor, social media/internet, TV, or magazine), indicating they may have heard about the Guidelines from an unlisted source, had lower odds of looking for more information about the Guidelines (AOR = 0.34; 95% CI, 0.16–0.70) and higher odds of reporting no change (AOR = 1.95; 95% CI, 1.15–3.31). All models were adjusted for gender, race/ethnicity, education, and age.
Adjusted Binary Logistic Regression Models Examining the Association Between Number of Sources (Referent = 1 Source) and Response to Hearing About the Guidelines (n = 2883)
| Behavioral response | ||||
|---|---|---|---|---|
| Number of sources | Increased physical activity, AOR (95% CI) | Looked for more information, AOR (95% CI) | Changed type of activity, AOR (95% CI) | Did not make a change, AOR (95% CI) |
| 0 sources versus 1 source | 0.50 (0.24–1.03) | 0.34 (0.16–0.70)* | 0.71 (0.29–1.77) | 1.95 (1.15–3.31)* |
| Multiple sources versus 1 source | 1.97 (1.18–3.31)* | 1.55 (0.85–2.83) | 2.16 (1.07–4.34)* | 0.50 (0.33–0.77)* |
Abbreviations: AOR, adjusted odds ratio; CI, confidence interval. Note: All models are adjusted for gender, race/ethnicity, education, and age category.
*Statistical significance (P < .05).
Discussion
This study aimed to understand how US adults respond to hearing about the Guidelines. The results showed that less than a quarter of American adults met the overall Guidelines, which is consistent with Healthy People data tracking of physical activity trends over time.17 About 65% of the sample were aware of the Guidelines. Of those, 28.9% reported making a behavior change (increased physical activity, decreased physical activity, looked for more information, and/or changed type of activity). Although 28.9% represents a minority of the sample, even small changes in physical activity levels in the population can have large public health implications. Lee et al18 found that reducing physical inactivity by 10% or 25% could prevent over 533,000 or 1.3 million deaths, respectively, each year. Still, among US adults who heard about the Guidelines, 71.1% reported making no changes, demonstrating a clear opportunity to better facilitate behavior change. This finding is consistent with previous research that suggests knowledge is just one component of behavior change and that promotion of the Guidelines should go beyond communication of the dosage.8 For example, communication of the Guidelines could include strategies for addressing common barriers.19–21 In addition, physical activity promotion could occur in conjunction with broader efforts to shift social norms and reduce environmental barriers to physical activity.19,22 Future research should consider how additional factors interact with different sources to affect behavior change, such as knowledge of the dosage, frequency of communication, and types of resources or messages provided when communicating about the Guidelines.
HHS released the first Physical Activity Guidelines for Americans in 2008 using a 3-fold communication strategy to promote the Guidelines to professionals and consumers: (1) the launch; (2) media outreach, including online, print, and television; and (3) partnerships.23 The Physical Activity Guidelines for Americans, 2nd edition, released in November 2018, utilized similar communication strategies. Although the updated Guidelines included new information and reflected an expanded evidence base, the dosage recommendation for adults was unchanged, meaning the US federal government has been promoting a consistent government physical activity recommendation since 2008. Of note, the data used in this analysis were collected shortly after the release of the second edition of the Guidelines, from January to April 2019; therefore, study participants may have been recently exposed to the promotional activities associated with the release of Physical Activity Guidelines for Americans, 2nd edition, which was shared extensively on social media and covered by 2190 stories in print, online, and broadcast media with over 2.9 billion impressions in the first 2 weeks, as measured by HHS.24 Notably, the second edition of the Guidelines was launched in partnership with the American Heart Association at Scientific Sessions, and several articles were published in medical journals when it was released, including 2 in JAMA, making it more likely that health professionals were exposed to information about the Guidelines during this time. This information provides context to the present findings, which show that about 42% of US adults who were aware of the Guidelines had heard about the Guidelines from more than one of the 4 examined sources.
The level of awareness of the Guidelines found in this analysis (64.8%) represents an increase in awareness from previous research, which reported US adults’ awareness at 36.1% in 2009.4 Furthermore, analysis of adults not meeting the Guidelines in 2017 showed awareness at 22%.5 These awareness estimates were derived from different surveys using different samples and measurements, making them difficult to compare. Nevertheless, the timing of these studies and notable changes over the decade suggests that awareness of the Guidelines may have been influenced by promotional activities associated with the release of the 2 editions and that additional efforts are required to sustain awareness over time. Of note, HHS developed and released the Move Your Way® campaign alongside the second edition of the Guidelines and has supported campaign promotion in 10 communities from 2019 through 2020.25,26 This consumer-focused multichannel communication campaign is targeted to individuals who are not yet meeting the Guidelines and provides information about the amount of activity people need as well as how to overcome common barriers.20
This study provides insight on 4 widely used dissemination channels and offers support for leveraging the health care setting in physical activity communication. Adults who heard about the Guidelines from their doctor or health professional were over 2 times more likely to report increasing their physical activity compared with those who heard about the Guidelines from other sources. The health care setting may be especially important for those not currently meeting the Guidelines—an important population to target (Supplemental Table S1 [available online]). These findings are consistent with existing research on the important role of health professionals as trusted sources of both health and physical activity information.20,27,28 Findings also support existing initiatives like Exercise is Medicine®, which aims to increase physical activity assessment and guidance in the clinical setting,29–32 and the Move Your Way® campaign, which offers resources for use in the health care setting based on formative research with medical professionals. Even with the rise of internet use for health information, doctors and health professionals remain highly trusted and continue to serve as the primary source of health information for some important populations, such as older adults.33,34 As such, doctors and health professionals can continue to be leveraged to support physical activity promotion.
Beyond the health care setting, other sources, such as social media and magazines, were also associated with reporting a behavior change in response to hearing about the Guidelines. These sources were particularly salient for those not meeting the Guidelines (Supplemental Table S1 [available online]). In addition, adults who heard about the Guidelines from more than one source (vs one source) were almost 2 times more likely to report increasing their physical activity in response to the Guidelines, highlighting the benefit of communicating through multiple channels. This finding is consistent with previous research and other national physical activity promotion initiatives that seek to disseminate messages via multiple sources.14,20,21,35 For example, the VERB™ campaign communicated messaging through a variety of sources, such as posters, print advertising, television, and radio spots.14 Similarly, the Move Your Way® campaign leverages printed materials (posters and fact sheets), video content, and social media messages and is designed for multifaceted implementation at the local level to ensure that members of the target audience are exposed through one or more preferred sources of information.20 The results from this study further support the importance of efforts like these and reinforce the value of utilizing multichannel communication strategies to communicate messages about physical activity. Since the present findings concentrate on individuals who are aware of the Guidelines, future research can focus on the population of US adults who are not aware of the Guidelines and explore dissemination strategies to better reach that population. This could include examining trust in different information sources by demographic group.
This study has numerous strengths. Using a large, nationally representative sample of US adults, this study expands the current literature by describing how US adults respond to hearing about the Guidelines, including reported changes in physical activity. Inclusion of sample weights and adjustment of the complex sampling procedures allowed for weighting of results to generate nationally representative estimates. In addition, this study measured a variety of communication channels that are frequently used in public health programming. The data from this study can be used to inform future marketing and health communication campaigns.
Limitations
There are several limitations to this research. First, respondents were prompted with the language, “The Federal Government publishes the Physical Activity Guidelines for Americans,” but it is possible that due to recall or social desirability bias, the respondents may have reported on recommendations other than the Guidelines. Despite this, any reported increase in physical activity in response to hearing recommendations, even at levels above or well below the Guidelines, is beneficial.1 Next, the 4 sources provided were not an exhaustive list of communication channels. About a third of respondents (36.5%) did not select any of the 4 sources, suggesting that they either heard from one of the listed sources outside of the past 6 months or heard about the Guidelines from an unlisted source, which could include friends or family.36 Nevertheless, a sensitivity analysis was conducted excluding those that did not select any of the 4 sources, and the findings for behavior change were consistent with the primary analysis. Further research could explore sources not examined in the present study and identify additional avenues to target messages and encourage behavior change. Another limitation to consider is the survey’s cross-sectional design, which limits causal inferences and the ability to track maintenance of any reported behavior change. Future research can consider methods to assess sustained behavior change. In addition, only reported behavior change was captured, and the self-report modality could lead to the overestimation of physical activity levels due to social desirability and recall bias.37 Specifically, respondents may have been more likely to report making a change in response to hearing a government recommendation about physical activity. Despite these, this study provides one of the first examinations of reported behavior change in response to hearing about the Guidelines in a representative US sample.
Conclusion
This research describes the potential health impact of promoting the Guidelines alongside broader efforts to change physical activity behavior. Approximately one-third of US adults reported changing their behavior in response to hearing about the Guidelines. This research also highlights opportunities to disseminate the Guidelines in ways that may increase the proportion of US adults who may make a behavioral change. Public health practitioners should leverage health professionals as important messengers of physical activity information, and efforts to disseminate the Guidelines should aim to use multiple communication channels, including but not limited to health professionals, social media, and magazines.
Acknowledgments
The authors would like to thank Frances Bevington (ODPHP) and Rick Troiano (NIH) for providing comments and suggestions during the writing process. The HINTS is funded by the NCI’s Division of Cancer Control and Population Sciences with contract support to Westat, Inc, Rockville, MD (contract number: HHSN26120120000291).
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