Introduction to the Active Living Research Reference List January – July 2008


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A. Batnitzky. (2008). Obesity and household roles: gender and social class in Morocco. Sociol Health Illn. 30, 445-62.

Often referred to as the developing world's new burden of disease, obesity constitutes a major and growing health epidemic in Morocco, in particular for women (22% of women versus 8% of men). Through an analysis of qualitative data, I demonstrate how gender roles influence obesity risk in the Moroccan context. Current social and economic theories, including the nutrition transition theory, are inadequate in explaining the persistent gender differentials in health status across time and place. I suggest that Moroccan women's higher prevalence of obesity is predominantly the outcome of different risks acquired from their distinct roles. In the Moroccan context, we can gain insight into how men and women divide household labour and how the overall non-egalitarian nature of social roles may deleteriously affect women's health. I hypothesise that marital status, age and socioeconomic status determine Moroccan women's household roles and help to explain why women are more likely to be obese than men. The main findings support this hypothesis and demonstrate the interactive relationship between culture and structure in influencing obesity risk.

L. N. Burgoyne, C. Woods, R. Coleman and I. J. Perry. (2008). Neighbourhood perceptions of physical activity: a qualitative study. Bmc Public Health. 8,

Background: Effective promotion of physical activity in low income communities is essential given the high prevalence of inactivity in this sector. Methods: This study explored determinants of engaging in physical activity in two Irish city based neighbourhoods using a series of six focus groups and twenty five interviews with adult residents. Data were analysed using constant comparison methods with a grounded theory approach. Results: Study findings centred on the concept of 'community contentment'. Physical activity was related to the degree of contentment/comfort within the 'self' and how the 'self' interacts within the neighbourhood. Contemporary focus on outer bodily appearance and pressure to comply with societal expectations influenced participants' sense of confidence and competence. Social interaction, involvement, and provision of adequate social supports were viewed as positive and motivating. However normative expectations appeared to affect participants' ability to engage in physical activity, which may reflect the 'close knit' culture of the study neighbourhoods. Access to suitable local facilities and amenities such as structured and pleasant walking routes was regarded as essential. Indeed participants considered walking to be their preferred form of physical activity which may relate to the minimal skill requirement, ease of access and low financial costs incurred. Conclusion: In the context of physical activity, health promoters need to be conscious of the difficulties that individuals feel in relation to bodily appearance and the pressure to comply with societal standards. This may be particularly relevant in low income settings where insufficient allocation of resources and social supports means that individuals have less opportunity to attend to physical activity than individuals living in higher income settings.

M. W. Chang, S. Nitzke, E. Guilford, C. H. Adair and D. L. Hazard. (2008). Motivators and barriers to healthful eating and physical activity among low-income overweight and obese mothers. Journal Of The American Dietetic Association. 108, 1023-1028.

Low-income women who are overweight and obese are at high risk for long-term retention of weight gain during pregnancy, in part because they may have poor diets and inadequate physical activity, both of which may be exacerbated by stressful situations. This study identified motivators and barriers to healthful eating and physical activity among low-income overweight and obese non-Hispanic black and non-Hispanic white mothers. Qualitative data were collected via eight focus group interviews. Eighty low-income overweight and obese non-Hispanic black (n=41) and non-Hispanic white (n=39) mothers, age 18 to 35 years, were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children sites in six counties in Michigan. Personal appearance, fit in clothes, inability to play with their children, and social support were motivating factors for healthful eating and physical activity. Stressful experiences triggered emotional eating and reduced participants' ability to practice these behaviors. Other factors-for example, wanting quick weightloss results-made it difficult for these mothers to follow recommended healthful lifestyle practices. Nutrition educators can address these concerns by including information about ways to deal with stress and emotional eating and emphasizing the benefits of healthful eating and physical activity in their program plans.

H. Cutt, B. Giles-Corti, M. Knuiman, A. Timperio and F. Bull. (2008). Understanding Dog Owners' Increased Levels of Physical Activity: Results From RESIDE. American Journal of Public Health. 98, 66.

We examined the influence of dog ownership on physical activity, independent of demographic, intrapersonal, and perceived environmental factors, in a cross-sectional survey of 1813 adults. Although only 23% of the dog owners walked their dogs 5 or more times per week, the adjusted odds of achieving sufficient physical activity and walking were 57% to 77% higher among dog owners compared with those not owning dogs (P<.05). Dog ownership was independently associated with physical activity and walking. Actively encouraging more dog walking may increase community physical activity levels. (Am J Public Health. 2008; 98: 66-69. doi: 10. 2105/AJPH. 2006. 103499)

H. E. Cutt, M. W. Knuiman and B. Giles-Corti. (2008). Does getting a dog increase recreational walking? International Journal Of Behavioral Nutrition And Physical Activity. 5,

Background: This study examines changes in socio-demographic, environmental and intrapersonal factors associated with dog acquisition in non-dog owners at baseline to 12-months follow-up and the effect of dog acquisition on minutes per week of recreational walking. Methods: RESIDE study participants completed self-administered questionnaires (baseline and 12-months follow-up) measuring physical activity, dog ownership, dog walking behavior as well as environmental, intrapersonal and socio-demographic factors. Analysis was restricted to 'Continuing non-owners' (i.e., non-owners at both baseline and follow-up; n = 681) and 'New dog owners' (i.e., non-owners who acquired a dog by follow-up; n = 92). Results: Overall, 12% of baseline non-owners had acquired a dog at follow-up. Dog acquisition was associated with working and having children at home. Those who changed from single to couple marital status were also more likely to acquire a dog. The increase in minutes of walking for recreation within the neighborhood from baseline to follow-up was 48 minutes/week for new dog owners compared with 12 minutes/week for continuing non-owners (p < 0.05). After adjusting for baseline variables the effect of dog acquisition on the increase in minutes of recreational walking within the neighborhood was 31 minutes (95% CI: 7.39, 54.22; p < 0.01). However, this reduced to 22 minutes (95% CI: -1.53, 45.42; p > 0.05) after further adjustment for change in baseline to follow-up variables. Increase in intention to walk was the main factor contributing to attenuation of the effect of dog acquisition on recreational walking. Conclusion: This study used a large representative sample of non-owners to examine the relationship between dog acquisition and recreational walking and provides evidence to suggest that dog acquisition leads to an increase in walking. The most likely mechanism through which dog acquisition facilitates increased physical activity is through behavioral intention via the dog's positive effect on owner's cognitive beliefs about walking, and through the provision of motivation and social support for walking. The results suggest that behavioral intention mediates the relationship between dog acquisition and walking and that dogs may have a significant role in the maintenance of owner walking behavior.

G. M. Fletcher, T. K. Behrens and L. Domina. (2008). Barriers and Enabling Factors for Work- Site Physical Activity Programs: A Qualitative Examination. Journal of Physical Activity & Health. 5, 418.

Background: Work sites offer a productive setting for physical activity (PA) promoting interventions. Still, PA participation remains low. Thus, the purpose of this study was to examine the reasoning behind commonly reported barriers and enabling factors to participation in PA programs in a work-site setting. Methods: Employees from a large city government were recruited to participate in focus groups, stratified by white- and blue-collar occupations. Responses from open-ended questions about factors influencing participation in PA programs were audio recorded and transcribed verbatim. Resulting data were analyzed with open and axial coding. Results: The sample consisted of 60 employees composing 9 focus groups. Although time was the most common barrier between both groups, white-collars workers responded that scheduling and work conflicts were the most common barrier concerning time. Blue-collar workers indicated shift work as their most common barrier. In addition, health was a significant enabling factor for both occupational categories. White-collar workers were much more concerned with appearances and were more highly motivated by weight loss and the hopefulness of quick results than were blue-collar workers. Conclusions: These findings are important in the understanding of PA as it relates to the reasoning behind participation in work-site programs in regard to occupational status.

A. Heraclides, D. Witte and E. J. Brunner. (2008). The association between father's social class and adult obesity is not explained by educational attainment and an unhealthy lifestyle in adulthood. European Journal Of Epidemiology. 23, 573-579.

Objectives: To investigate the effect of father's social class on central and general obesity in adulthood. To test the role of educational attainment and adult health behaviours as mediators in this association. Methods: BMI, Waist-hip-ratio, smoking status, alcohol consumption, leisure-time physical activity and dietary intake (semi-quantitative food-frequency questionnaire) were assessed at phase 5 (1997-1998) of the Whitehall II cohort study. We used retrospective data on educational attainment and father's social class. Our study sample was 4598 participants (3364 men, 1234 women) aged 44-69, with a valid obesity measure and information on father's social class and educational attainment. Results: Father's social class was inversely associated with adult life central (Waist-hip-ratio) and general (BMI) obesity in women but not in men. For example, mean BMI difference between the highest and lowest childhood social class was 2.04 kg/m(2) (95% confidence intervals: 0.90; 3.18). These associations remained robust to adjustment for adult life socioeconomic position. Adjusting for educational attainment resulted in a reduction of 10-15% in the difference in mean obesity measures between lowest and highest father's social class. In our fully adjusted model, adult life health behaviours did not provide further attenuation of the effect of father's social class on adult obesity. Conclusion: We provide evidence for an independent effect of father's social class on adult central and general obesity in women, which is not explained by educational attainment and an unhealthy lifestyle in adulthood. Policies aiming at reducing inequalities in obesity should tackle the problem of social inequality early in life.

B. Hickerson, A. Moore, L. Oakleaf, M. Edwards, P. A. James, J. Swanson and A. H. Karla. (2008). The Role of a Senior Center in Promoting Physical Activity for Older Adults. Journal of Park & Recreation Administration. 26, 22.

The health of citizens in communities is a paramount concern of parks and recreation professionals. Although opportunities for physical activity have been ubiquitous in public recreation programs, their potential is more important today than ever before for all ages, including older adults. The purpose of this paper is to explore the roles of a community senior center (CSC) in promoting physical activity among older adults. People are living longer, and the number of older people is growing rapidly. Therefore, examining how physical activity can be facilitated has implications that can lead to healthier older adults and communities. Health and well-being are influenced by multiple facets within the individual as well as in physical and social environments. Health behaviors such as physical activity are influenced not only by motivations but also by the structures, opportunities, and policies that exist in communities. We conducted research for this case study over a period of three months in the spring of 2007. Data were gathered through the triangulation of field observations, focus groups, and in-depth interviews. The focus was not on the CSC in general but specifically on the programs that facilitated physical activity, which were defined as activities that involved large muscle movement. Four major themes related to physical activity participation at the CSC emerged from the analysis: organizational resources, personal capital, relational capital and social structure, and physical activity and enjoyment. The idea of capital as the sum of assets that make a phenomenon work was a way to examine how these themes could be theorized to understand the possible role of a senior center in facilitating physical activity for and with older adults. This study further confirms for managers the importance of a social ecological approach to health promotion through parks and recreation. Although most recreation programs are based on the idea that many factors can.

C. B. Kamphuis, F. J. Van Lenthe, K. Giskes, M. Huisman, J. Brug and J. P. Mackenbach. (2008). Socioeconomic status, environmental and individual factors, and sports participation. Med Sci Sports Exerc. 40, 71-81.

PURPOSE: To examine the contribution of neighborhood, household, and individual factors to socioeconomic inequalities in sports participation in a multilevel design. METHODS: Data were obtained by a large-scale postal survey among a stratified sample of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response rate 64.4%). Multilevel logistic regression analyses were performed with sports participation as a binary outcome (no vs yes); that is, respondents not doing any moderate- or high-intensity sports at least once a week were classified as nonparticipants. RESULTS: Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small social network), household factors (material and social deprivation), and individual physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were significantly associated with doing no sports and were reported more frequently among lower socioeconomic groups. Taking these factors into account reduced the odds ratios of doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.99-5.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from 3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). CONCLUSIONS: A combination of neighborhood, household, and individual factors can explain socioeconomic inequalities in sports participation to a large extent. Interventions and policies should focus on all three groups of factors simultaneously to yield a maximal reduction of socioeconomic inequalities in sports participation.

C. Lu, J. Sylvestre, N. Melnychuk and J. Li. (2008). East meets West: Chinese-Canadians' perspectives on health and fitness. Can J Public Health. 99, 22-5.

BACKGROUND: Chinese-Canadians comprise one of Canada's largest and fastest-growing ethnocultural groups. This exploratory qualitative study examined how Chinese-Canadians' views of health and fitness, and their understanding of mainstream Western health care and fitness programs, influence their health behaviours, health beliefs, and use of health care services. This issue is explored against the backdrop of immigration and processes of integration to understand how this immigrant population reconciles conceptions of health acquired in their originating cultures with their experiences in Western society. METHODS: Semi-structured interviews were conducted with 10 first-generation Chinese-Canadians to elicit their views and experiences with the concepts of health and fitness. Interview transcripts were analyzed using an inductive analytic approach involving constant comparison of emerging themes to the data. RESULTS: The analysis revealed that participants had integrated some Canadian health and fitness practices in their daily lives, particularly in their diet and use of health care services. Nonetheless, Chinese-Canadians retained their view of the superiority of Eastern conceptions of health and health practices. Both positive and negative changes in their health practices attributed to their immigration experiences. INTERPRETATION: The integration of some Western health and fitness practices does not appear to be based on changes in values and beliefs. The evolution and pattern of Chinese-Canadians' practice of health and fitness is complex over the course of immigration and acculturation. The findings of this study suggest the importance of attending to actual practices as a way of understanding how immigration may affect health behaviour and health status.

F. I. Matheson, R. Moineddin and R. H. Glazier. (2008). The weight of place: a multilevel analysis of gender, neighborhood material deprivation, and body mass index among Canadian adults. Soc Sci Med. 66, 675-90.

This study examined the impact of neighborhood material deprivation on gender differences in body mass index (BMI) for urban Canadians. Data from a national health survey of adults (Canadian Community Health Survey Cycles 1.1/2.1) were combined with census tract-level neighborhood data from the 2001 census. Using multilevel analysis we found that living in neighborhoods with higher material deprivation was associated with higher BMI. Compared to women living in the most affluent neighborhoods, women living in the most deprived neighborhoods had a BMI score 1.8 points higher. For women 1.65 m in height (5'4'' inches), this translated into a 4.8 kg or 11 lb difference. For men, living in affluent neighborhoods was associated with higher BMI (7 lb) relative to men living in deprived neighborhoods. The relative disadvantage for men living in pockets of affluence and women living in pockets of poverty persisted after adjusting for age, married and visible minority status, educational level, self-perceived stress, sense of belonging, and lifestyle factors, including smoking, exercise, diet, and chronic health conditions. The implication of these disparate findings for men and women is that interventions that lead to healthy weight control may need to be gender responsive. Our findings also suggest that what we traditionally have thought to be triggering factors for weight gain and maintenance of unhealthy BMI-lifestyle and behavioral factors-are not sufficient explanations. Indeed, these factors account for only a portion of the explanation of why neighborhood stress is associated with BMI. Cultural attitudes about the body that pressure women to meet the thin ideal which can lead to an unhealthy cycle of dieting and, subsequent weight gain, and the general acceptability of the heavier male need to be challenged. Education and intervention within a public health framework remain important targets for producing healthy weight.

N. C. McDonald. (2008). The effect of objectively measured crime on walking in minority adults. American Journal Of Health Promotion. 22, 433-436.

Purpose. Evaluate the relationship between neighborhood crime and the amount of daily walking by minority adults. Design. This was a cross-sectional study of minority adult walking behavior and crime. Setting. Oakland, California was chosen as the study area because of the substantial spatial variation in levels of criminal activity combined with detailed, information on walking trips. Participants. The study was restricted to minority adults who responded to the 2000 Bay Area Travel Survey and lived in Oakland, California (n = 359). Method. Data on leisure and utilitarian walking were collected through the 2000 Bay Area Travel Survey and combined with crime data from the Oakland Police Department. A negative binomial model was used to test if violent, Property, or quality of life crimes had significant associations with daily minutes walked, controlling for individual and neighborhood covariates. Results. The model showed a significant negative association between violent crime and minutes walked per day (b = -.07; p =.016). Neither property nor quality of life crimes were correlated with amount of walking. Conclusions. Reductions in violent crime may increase opportunities for minority residents in urban areas to participate in physical activity such as walking, thereby providing another reason to pursue anticrime measures. Urban designers' efforts to increase physical activity by improving neighborhood walkability may consider violent crime prevention in their designs.

N. C. McDonald. (2008). The effect of objectively measured crime on walking in minority adults. American Journal of Health Promotion. 22, 433-436.

A. P. McGinn, K. R. Evenson, A. H. Herring, S. L. Huston and D. A. Rodriguez. (2008). The Association of Perceived and Objectively Measured Crime With Physical Activity: A Cross-Sectional Analysis. Journal of Physical Activity & Health. 5, 117.

Background: Crime is one aspect of the environment that can act as a barrier to physical activity. The goals of this study were to (1) compare measures of perceived crime with observed crime and (2) examine the association between the independent and combined effects of objective and perceived crime on physical activity. Methods: Perceived crime and physical activity were assessed in 1659 persons via telephone survey. Crime was objectively measured in a subset of 303 survey participants. Results: For all types of crime, there was low agreement between objective and perceived measures. Both perceived and objectively measured crime were independently associated with leisure activities. Conclusions: This study suggests that perceptions and objective measures of crime are both important correlates of leisure physical activity. Evaluating both measures is necessary when examining the relationship between crime and physical activity to develop interventions that will most influence leisure physical activity levels.

W. K. Mummery, W. Lauder, G. Schofield and C. Caperchione. (2008). Associations between physical inactivity and a measure of social capital in a sample of Queensland adults. Journal Of Science And Medicine In Sport. 11, 308-315.

How social capital is related to an increasingly important disease risk-physical inactivity has not yet been investigated. In the present study the associations between social capital and physical inactivity were investigated in a sample of Queensland (Australia) adults. Data was collected from 1278 persons by means of a computer-assisted-telephone-interview survey. The association between the social capital variables and physical inactivity was studied using logistical regression. Multivariate analysis adjusted for the effects of selected socio-demographic factors in the investigation of the association between physical inactivity and quartile groupings of social capital scores. Physical inactivity was negatively associated with the measure of social capital. Individuals in the top two quartiles of social capital were significantly less likely to be physically inactive than those in the two lowest quartiles. In summary, low social capital was associated with physical inactivity. The results offer implications for health promotion programs aimed at increasing levels of physical activity at the community or population level.

L. M. Neufeld, S. Hernandez-Cordero, L. C. Fernald and U. Ramakrishnan. (2008). Overweight and obesity doubled over a 6-year period in young women living in poverty in Mexico. Obesity (Silver Spring). 16, 714-7.

OBJECTIVE: To document the changes in BMI and the prevalence of overweight and obesity in young women living in poverty in a semi-urban community in Mexico. METHODS AND PROCEDURES: Women who had previously participated in a longitudinal research study (1997-2000) were re-assessed in 2005. Anthropometric measurements were obtained using standard procedures, and socio-demographic questionnaires were administered. Total and annual rate of change in BMI and change in the prevalence of overweight and obesity (BMI > or = 25.0 and > or =30.0) were estimated. RESULTS: Mean age in 2005 was 30.0 +/- 5.7 years (n = 683) and time between recruitment and follow-up was 6.4 +/- 1.0 years. Mean change in BMI was +3.6 +/- 2.7 (range -8.2 to +14.6). In 2005, 500 (73.2%) women were overweight, up from 263 (38.5%) in the original assessment. The prevalence of obesity tripled over the follow-up period (from 9.8% to 30.3%). The mean annual rate of change in BMI was +0.6 (+/-0.4). After adjustment for age and parity at baseline, an annual rate of change of BMI above the sample median (>0.5) was associated with lower levels of formal education. DISCUSSION: The annual increase in the prevalence of overweight and obesity in this sample is double that which was reported at a national level in Mexico. An understanding of the determinants of this rapid increase among the women living in poverty in Mexico is urgently needed.

M. H. Ochner, F. R. Salvail, E. S. Ford and U. Ajani. (2008). Obesity and self-reported general health, Hawaii BRFSS: Are polynesians at higher risk? Obesity. 16, 923-926.

objective: This study compared the relationship between fair/poor general health status among overweight and obese Polynesians with that among other overweight and obese persons in Hawaii. Methods and Procedures: Data were pooled from the 1998-2003 Hawaii Behavioral Risk Factor Surveillance System (BRFSS) and logistic regression used to examine the predictors of fair/poor health status. Results: Polynesians were significantly more likely to be obese than non-Polynesians; overweight Polynesians were more likely than other overweight individuals to report fair/poor health status. After adjusting for confounders, among Polynesians, being obese was no longer associated with fair/poor health. Non-Polynesians who were obese (odds ratio 1.9; 95% confidence interval: 1.4-2.6), older, less educated, smokers, diabetic, hypertensive, and physically inactive were more likely to report fair/ poor health. Discussion: Although Polynesians were significantly more obese than the rest of the Hawaii population, their weight was not independently associated with their odds for fair/ poor health as it was with non-Polynesians. The difference may be that, for Polynesians, hypertension and diabetes overrode the effect of obesity on general health status or this group maintains different cultural perceptions of body size. Regardless, these findings show a major health risk among Polynesians and suggest the need for culturally specific health interventions.

E. Regidor, J. L. Gutierrez-Fisac, E. Ronda, M. E. Calle, D. Martinez and V. Dominguez. (2008). Impact of cumulative area-based adverse socioeconomic environment on body mass index and overweight. Journal Of Epidemiology And Community Health. 62, 231-238.

Objective: Although the relationship between area socioeconomic environment and obesity is known, previous research has measured area socioeconomic environment at only one point in time. This study evaluates the relationship of cumulative area-based adverse socioeconomic environment with body mass index (BMI) and overweight. Design: Cross-sectional study. Setting: Spain. Participants: 17 917 subjects in 2001. Main outcome measure: Information from 1980, 1990 and 2000 was used for the percentage of the population with low educational achievement, gross domestic product per capita (GDPpc), and Gini coefficient to estimate BMI and prevalence of overweight by the number of times each province had an adverse exposure to each of these measures of socioeconomic environment. Results: After adjusting for individual variables and sports facilities in the area, the difference in BMI in residents of provinces with the highest percentage of population with low educational achievement in 1980, 1990 and 2000, compared with residents of provinces with no history of adverse socioeconomic environment based on this indicator, was 0.61 kg/m(2), whereas the prevalence of overweight was 1.46 times higher. Similar results were obtained for residents of provinces with cumulative low GDPpc versus residents of provinces that had never had low GDPpc. Neither BMI nor overweight were associated with cumulative income inequality based on the Gini coefficient. Conclusion: Cumulative adverse socioeconomic environment based on indicators of educational level or wealth, but not of income inequality, is positively associated with BMI and overweight. This association is not explained by individual characteristics or by the availability of sports facilities.

C. G. Roman and A. Chalfin. (2008). Fear of walking outdoors. A multilevel ecologic analysis of crime and disorder. Am J Prev Med. 34, 306-12.

BACKGROUND: Although a number of studies have tested ecologic models that postulate relationships among social networks, the built environment, and active living, few neighborhood-based studies have considered the role of crime and violence. This study investigates the degree to which individual-level demographic characteristics and neighborhood-level physical and social characteristics are associated with increased fear of crime. METHODS: Data were analyzed in 2007 from a 2005 survey of 901 randomly selected individuals living in 55 neighborhoods in Washington DC. Multilevel ordered logit regression was used to examine associations between individual-level and neighborhood-level characteristics and how often fear of crime prevents a respondent from walking outdoors. RESULTS: Age and female gender were associated with an increase in fear; the percentage of a resident's life spent in the same neighborhood was associated with a decrease in fear. Results of cross-level interactions showed that at the neighborhood level, women were more fearful than men in neighborhoods without violence, but that the difference in fear between men and women shrinks as neighborhood violence increases. Collective efficacy was found to increase fear among black respondents and had no effect on fear among nonblack respondents. CONCLUSIONS: If the study of neighborhoods and active living is to progress and contribute to both etiologic understanding and policy formation, it is essential that theoretical and empirical models consider the impact of violence and fear on walking. Efforts to increase active living in urban neighborhoods that do not account for the impact of crime and fear may fall short of their intended outcomes.

C. N. Sawchuk, A. Bogart, S. Charles, J. Goldberg, R. Forquera, P. Roy-Byrne and D. Buchwald. (2008). Education is associated with physical activity among American Indian elders. American Indian And Alaska Native Mental Health Research. 15, 1-17.

Although educational attainment and physical activity levels tend to be positively associated in majority populations, this relationship has not been investigated in American Indian and Alaska Native (Al/AN) elders. This study examined the association between education and physical activity among Al/AN elders (N = 107) using self-report and behavioral outcomes. Regression models showed that higher education was significantly associated with total caloric expenditure for moderate-intensity physical activities and distance traveled during a 6-minute walk test of fitness. Additional research is needed to understand modifiable personal, social, and environmental physical activity barriers in these populations.

M. H. Shishehbor, P. Gordon-Larsen, C. I. Kiefe and D. Litaker. (2008). Association of neighborhood socioeconomic status with physical fitness in healthy young adults: The Coronary Artery Risk Development in Young Adults (CARDIA) study. American Heart Journal. 155, 699-705.

Background Impaired physical fitness, a contributor to obesity and cardiovascular disease, has been associated with both an individual's socioeconomic status (SES) and with residence in disadvantaged neighborhoods. The aim of the study was to examine the extent to which neighborhood socioeconomic status (SES) is associated with impaired fitness, independent of clinical characteristics and individual-level SES. Methods Two thousand five hundred five participants 25 to 42 years old examined in the CARDIA study from 1992 to 1993 underwent symptom-limited exercise stress testing. Physical fitness was considered impaired if metabolic equivalents were in the lowest sex-specific quintile. Neighborhood SES was determined for each census tract using 1990 census data. Generalized estimating equations assessed the association between neighborhood SES and physical fitness, before and after adjustments for individual SES, sociodemographic, and clinical characteristics, and accounted for clustering within census tracts. Results Individuals in disadvantaged neighborhoods had lower educational attainment and income, and were more likely unemployed, black, and uninsured. The odds ratio (95% CI) for impaired physical fitness in the lowest vs highest tertile of neighborhood SES was 5.8 (3.7-7.3). These became 3.9 (2.7-5:7) after adjusting for individuals' educational attainment, personal income, employment status, and ability to pay for basic needs; and 1.9 (1.2-2.9) after additional adjustment for other sociodemographic and clinical factors. Conclusions Features of one's neighborhood of residence are relevant to cardiovascular health. A health policy perspective that looks beyond an individual's characteristics may therefore be useful in identifying more effective interventions to reduce the prevalence of low physical fitness and its consequences in young adults.

K. Y. Wolin and G. G. Bennett. (2008). Interrelations of socioeconomic position and occupational and leisure-time physical activity in the National Health and Nutrition Examination Survey. J Phys Act Health. 5, 229-41.

BACKGROUND: The interrelations between various physical activity domains have received little empirical attention in the United States. Of particular interest, given the potential applicability to traditionally underserved communities, is the nature of the association between occupational physical activity (OPA) and leisure-time physical activity (LTPA). METHODS: 5448 adult men and women who participated in NHANES 1999-2000 were included in analyses. Linear regression was used to examine the bivariate and multivariable associations of OPA and education with LTPA. Generalized logit models were used to examine the association of education with OPA. RESULTS: We found no association between education and LTPA. OPA was significantly positively associated with LTPA (P <.001). The association between OPA and LTPA was not strongest among those with low education and held only for men in gender-stratified analysis. Education was inversely associated with OPA (P <.001) in multivariable analysis. CONCLUSIONS: Our findings lend preliminary support to the hypothesis that OPA is an important determinant of LTPA, particularly in men. This provides additional support to calls for assessment of OPA, particularly among individuals of low social class.

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