Do Neighborhood Demographics Modify Walking Group Intervention Effectiveness in Urban Neighborhoods?

OBJECTIVES: We assessed the effects of neighborhood composition on effectiveness of the Walk Your Heart to Health (WYHH) intervention in promoting physical activity and reducing cardiovascular risk (CVR) in low-to-moderate-income, predominantly non-Latino Black (NLB) and Latino communities. METHOD: Multilevel models assessed modifying effects of neighborhood composition on (1) WYHH adherence/participation at 8 weeks and 32 weeks, (2) associations between participation and steps, and (3) associations between steps and CVR. RESULTS: Approximately 90% of participants were women. Neither neighborhood poverty nor racial composition modified intervention participation at 8 weeks. At 32 weeks, residents of high percentage-NLB neighborhoods that also had high poverty rates had reduced participation. Neighborhood composition did not modify associations between participation and steps or between steps and CVR. Neighborhood percentage poverty and NLB were positively associated with CVR. CONCLUSION: Positive associations between participation in the WYHH program and physical activity, and CVR did not differ by neighborhood composition. Efforts to address challenges to long-term participation are warranted for residents of racially segregated, high-poverty neighborhoods. Residents of racially segregated neighborhoods with high concentrations of poverty experience disproportionately high risk for cardiovascular disease and can benefit from interventions such as WYHH that increase physical activity and reduce CVR.

Longitudinal Associations Between Observed and Perceived Neighborhood Food Availability and Body Mass Index in a Multiethnic Urban Sample.

INTRODUCTION: Blacks, Hispanics, and women of lower socioeconomic status tend to have a higher risk of obesity. Numerous studies over the past decade examined the role of the neighborhood food environment in body weight. However, few were longitudinal. PURPOSE: This longitudinal study examined whether multiple measures of neighborhood food availability were associated with body mass index (BMI) in a predominately Black and Hispanic adult sample living in low- to moderate-income urban neighborhoods. METHOD: This longitudinal study used two waves of data (2002, 2008), including interviewer-measured height and weight, from a community survey of adults ( n = 219). In both 2002 and 2008, multiple measures characterized neighborhood food availability: GIS-derived availability of retail food outlets (large grocery store, small grocery store, convenience store, liquor stores), observed fruit and vegetable availability (count of stores selling 10 or more fresh fruit or vegetable varieties), and perceived fruit and vegetable access. Random intercept models estimated multivariable associations, controlling for individual-level demographics and neighborhood median household income. RESULTS: Small grocery store availability was associated with 1.22-unit increase in BMI ( p = .047), while each unit increase in perceived fruit and vegetable access was associated with a 0.69-unit decrease in BMI ( p = .055). BMI was not associated with large grocery store, convenience store, or liquor store availability, or with observed fruit and vegetable availability. CONCLUSIONS: Findings suggest that improving the neighborhood food environment, particularly at small grocery stores, may help urban residents living in low- to moderate-income neighborhoods achieve healthier body weights over time.

Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012. METHOD: WYHH was a 32-week community health promoter-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers. RESULTS: Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (ß = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks. CONCLUSION: The WYHH community health promoter-facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.

Associations between socioeconomic status and allostatic load: effects of neighborhood poverty and tests of mediating pathways.

OBJECTIVES: We examined relationships between neighborhood poverty and allostatic load in a low- to moderate-income multiracial urban community. We tested the hypothesis that neighborhood poverty is associated with allostatic load, controlling for household poverty. We also examined the hypotheses that this association was mediated by psychosocial stress and health-related behaviors. METHODS: We conducted multilevel analyses using cross-sectional data from a probability sample survey in Detroit, Michigan (n = 919) and the 2000 US Census. The outcome measure was allostatic load. Independent variables included neighborhood and household poverty, psychosocial stress, and health-related behaviors. Covariates included neighborhood and individual demographic characteristics. RESULTS: Neighborhood poverty was positively associated with allostatic load (P < .05), independent of household poverty and controlling for potential confounders. Relationships between neighborhood poverty were mediated by self-reported neighborhood environment stress but not by health-related behaviors. CONCLUSIONS: Neighborhood poverty is associated with wear and tear on physiological systems, and this relationship is mediated through psychosocial stress. These relationships are evident after accounting for household poverty levels. Efforts to promote health equity should focus on neighborhood poverty, associated stressful environmental conditions, and household poverty.

A community-based participatory planning process and multilevel intervention design: toward eliminating cardiovascular health inequities.

The elimination of persistent health inequities requires the engagement of multiple perspectives, resources, and skills. Community-based participatory research (CBPR) is one approach to developing action strategies that promote health equity by addressing contextual as well as individual-level factors, and that can contribute to addressing more fundamental factors linked to health inequity. Yet many questions remain about how to implement participatory processes that engage local insights and expertise, are informed by the existing public health knowledge base, and build support across multiple sectors to implement solutions. This article describes a CBPR approach used to conduct a community assessment and action planning process, culminating in development of a multilevel intervention to address inequalities in cardiovascular disease in Detroit, Michigan. The authors consider implications for future efforts to engage communities in developing strategies toward eliminating health inequities.