Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States.

STUDY OBJECTIVES: Few studies have analysed the rates and correlates of physical activity in economically and geographically diverse populations. Objectives were to examine: (1) urban-rural differences in physical activity by several demographic, geographical, environmental, and psychosocial variables, (2) patterns in environmental and policy factors across urban-rural setting and socioeconomic groups, (3) socioeconomic differences in physical activity across the same set of variables, and (4) possible correlations of these patterns with meeting of physical activity recommendations. DESIGN: A cross sectional study with an over sampling of lower income adults was conducted in 1999-2000. SETTING: United States. PARTICIPANTS: 1818 United States adults. MAIN RESULTS: Lower income residents were less likely than higher income residents to meet physical activity recommendations. Rural residents were least likely to meet recommendations; suburban residents were most likely to meet recommendations. Suburban, higher income residents were more than twice as likely to meet recommendations than rural, lower income residents. Significant differences across income levels and urban/rural areas were found for those reporting neighbourhood streets, parks, and malls as places to exercise; fear of injury, being in poor health, or dislike as barriers to exercise and those reporting encouragement from relatives as social support for exercise. Evidence of a positive dose-response relation emerged between number of places to exercise and likelihood to meet recommendations for physical activity. CONCLUSIONS: Both income level and urban rural status were important predictors of adults' likelihood to meet physical activity recommendations. In addition, environmental variables vary in importance across socioeconomic status and urban-rural areas.

Environmental and policy determinants of physical activity in the United States.

OBJECTIVES: This study examined (1) descriptive patterns in perceived environmental and policy determinants of physical activity and (2) associations between these factors and behavior. METHODS: A cross-sectional study was conducted from 1999 to 2000 among US adults; individuals at lower income levels were oversampled. RESULTS: Availability of areas for physical activity was generally higher among men than among women. The 4 most commonly reported personal barriers were lack of time, feeling too tired, obtaining enough exercise at one's job, and no motivation to exercise. Neighborhood characteristics, including the presence of sidewalks, enjoyable scenery, heavy traffic, and hills, were positively associated with physical activity. There was a high level of support for health policy-related measures. Up to one third of individuals who had used environmental supports reported an increase in physical activity. CONCLUSIONS: An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions.

Promoting physical activity in rural communities: walking trail access, use, and effects.

INTRODUCTION: Environmental and policy approaches to promote physical activity, such as walking trail construction and promotion, are being widely recommended, yet sparse data exist on their effectiveness. In conjunction with ongoing community-intervention projects in Missouri, walking trails are being built, promoted, and evaluated. Objectives include determining: (1) patterns and correlates of walking, (2) the availability of places to walk and perform other forms of physical activity, (3) the extent of walking trail use and possible effects on rates of physical activity, and (4) attitudes toward the trails and their uses. METHODS: In 12 rural counties in Missouri we used a cross-s ectional telephone survey to ask a population-based sample of residents aged >18 years (n=1269) some standard and specially developed questions about walking behaviors, knowledge, and attitudes. RESULTS: Only 19.5% of respondents were classified as regular walkers. About one third of respondents (36.5%) reported having access to walking trails in their area, and 50.3% reported having access to indoor facilities for exercise. Among persons with access to walking trails, 38.8% had used the trails. Groups who were more likely to have used the walking trails included women, persons with more education, those making $35,000 or more per year, and regular walkers. Among persons who had used the trails, 55.2% reported they had increased their amount of walking since they began using the trail. Women and persons with a high school education or less were more than twice as likely to have increased the amount of walking since they began using the walking trails. CONCLUSIONS: Walking trails may be beneficial in promoting physical activity among segments of the population at highest risk for inactivity, in particular women and persons in lower socioeconomic groups.

Prevalence and correlates of physician advice for prevention: impact of type of insurance and regular source of care.

Although managed care penetration continues to grow, little is known about the relationship between managed care and the provision of preventive health services. In this paper the "behavioral model of health services utilization" is used to conceptualize and explore this relationship, and to examine: (1) the prevalence of physician advice for prevention of cardiovascular disease, (2) the relationship between predisposing, enabling, and need characteristics and physician advice, and (3) the impact of insurance type and regular source of care on receipt of physician advice.