The influence of rural home and neighborhood environments on healthy eating, physical activity, and weight.

Despite the recognition that environments play a role in shaping physical activity and healthy eating behaviors, relatively little research has focused on rural homes and neighborhoods as important settings for obesity prevention. This study, conducted through community-based participatory research, used a social ecological model to examine how home and neighborhood food and physical activity environments were associated with weight status among rural-dwelling adults. Data were from a cross-sectional survey of White and African American adults (n = 513) aged 40-70 years living in rural southwest Georgia. Data were analyzed using measured variable path analysis, a form of structural equation modeling. The results support a social ecological approach to obesity prevention. Physical activity had a direct effect on BMI; self-efficacy, family support for physical activity, and household inventory of physical activity equipment also had direct effects on physical activity. Neighborhood walkability had an indirect effect on physical activity through self-efficacy and family social support. Although neither fruit and vegetable intake nor fat intake had direct effects on BMI, self-efficacy and household food inventories had direct effects on dietary behavior. Perceived access to healthy foods in the neighborhood had an indirect effect on healthy eating and a direct effect on weight; neighborhood cohesion had an indirect effect on healthy eating through self-efficacy. Overall, individual factors and home environments tended to exhibit direct effects on behavior, and neighborhood variables more often exhibited an indirect effect.

Youth understanding of healthy eating and obesity: a focus group study.

INTRODUCTION: Given the high prevalence of childhood obesity in the United States, we aimed to investigate youth's understanding of obesity and to investigate gaps between their nutritional knowledge, dietary habits, and perceived susceptibility to obesity and its co-morbidities. METHODS: A marketing firm contracted by Children's Healthcare of Atlanta facilitated a series of focus group discussions (FGD) to test potential concepts and sample ads for the development of an obesity awareness campaign. Data were collected in August and September of 2010 with both overweight and healthy weight 4th-5th grade and 7th-8th grade students. We conducted a secondary analysis of the qualitative FGD transcripts using inductive thematic coding to identify key themes related to youth reports of family eating habits (including food preparation, meal frequency, and eating environment), perceived facilitators and barriers of healthy diet, and knowledge about obesity and its complications. RESULTS: Across focus group discussions, mixed attitudes about healthy eating, low perceived risk of being or becoming obese, and limited knowledge about the health consequences of obesity may contribute to the rising prevalence of obesity among youth in Georgia. Most youth were aware that obesity was a problem; yet most overweight youth felt that their weight was healthy and attributed overweight to genetics or slow metabolism. CONCLUSIONS: Our analysis suggests that urban youth in Georgia commonly recognize obesity as a problem, but there is less understanding of the link to lifestyle choices or the connection to future morbidities, suggesting a need for education to connect lifestyle behaviors to development of obesity.

Reliability of gestational weight gain reported postpartum: a comparison to the birth certificate.

Gestational weight gain (GWG) is an important predictor of short- and long-term adverse maternal and child outcomes. As interest in long-term outcomes increases, utilization of maternal postpartum report is likely to also increase. There is little data available examining the reliability and identifying predictors of bias in GWG recalled by mothers postpartum. We used data from the Early Childhood Longitudinal Study-Birth Cohort, a national study of U.S. children born in 2001, to compare GWG recalled by mothers approximately 10 months postpartum to GWG recorded on the birth certificate, among 5,650 records. On average, the postpartum estimates were 2.1 lbs higher (standard error, 0.2 lbs.) than the birth certificate report; 54.7% were within 5 lbs, 27.2% were overreported by more than 5 lbs, and 18.2% were underreported by more than 5 lbs. The difference between the two sources increased with GWG reported postpartum and was significantly greater among mothers who were obese prior to pregnancy, had inadequate prenatal care, or were multiparous. Bias also differed by birth outcome, indicating the potential for recall bias. When categorized by adequacy of the 2009 Institute of Medicine GWG recommendations, 70% of women were similarly categorized, and associations between GWG adequacy and small- and large-birthweight-for-gestational-age did not differ meaningfully by source of GWG data. These results suggest that for future studies, mothers' estimates of their GWG, obtained within approximately 1 year postpartum, may be a reliable substitute when birth certificate GWG data are unavailable.

Excess gestational weight gain is associated with child adiposity among mothers with normal and overweight prepregnancy weight status.

There are inconsistencies in the literature regarding the association between gestational weight gain (GWG) and child adiposity. GWG is hypothesized to act on child adiposity directly through intrauterine programming and indirectly through birth weight. It is unclear if the relative importance of these pathways differs by prepregnancy BMI status. We analyzed data from 3600 participants of the nationally representative Early Childhood Longitudinal Study-Birth Cohort. Child BMI Z-score was calculated from height and weight measured at 5 y. Using linear regression, controlling for sociodemographics and family lifestyle, we examined prepregnancy BMI-specific associations between GWG and child BMI Z-score. There was a nonlinear association among normal (P < 0.001) and overweight mothers only (P = 0.013), such that GWG beyond the midpoint of the 2009 Institute of Medicine recommendations was associated with a significant increase in child BMI Z-score. After the addition of birth-weight-for-gestational-age and breastfeeding to the model, the association remained among normal-weight mothers (P = 0.005) and was slightly attenuated among overweight mothers (P = 0.09). No significant association was observed between GWG and child BMI Z-score among underweight or obese mothers. We used path analysis to decompose the total effect into direct and indirect effects. This indicated the presence of a stronger direct than indirect effect. In conclusion, low GWG is not associated with BMI Z-score among any prepregnancy BMI group. Excess GWG is associated with an increase in child BMI Z-score among normal and overweight mothers only. Prevention of excess GWG may be a strategy to prevent childhood obesity.

Environmental influences on physical activity in rural adults: the relative contributions of home, church and work settings.

BACKGROUND: This study examines the relative contribution of social (eg, social support) and physical (eg, programs and facilities) aspects of worksite, church, and home settings to physical activity levels among adults in rural communities. METHODS: Data are from a cross-sectional survey of 268 African American and Caucasian adults, ages 40-70, living in southwest Georgia. Separate regression models were developed for walking, moderate, vigorous, and total physical activity as measured in METs-minutes-per-week. RESULTS: Social support for physical activity was modest in all 3 settings (mean scores 1.5-1.9 on a 4-point scale). Participants reported limited (<1) programs and facilities for physical activity at their worksites and churches. An interaction of physical and social aspects of the home setting was observed for vigorous and moderate physical activity and total METs. There were also interactions between gender and social support at church for vigorous activity among women, and between race and the physical environment at church for moderate physical activity. A cross-over interaction was found between home and church settings for vigorous physical activity. Social support at church was associated with walking and total METs. CONCLUSIONS: Homes and churches may be important behavioral settings for physical activity among adults in rural communities.

Advancing coalition theory: the effect of coalition factors on community capacity mediated by member engagement.

Community coalitions have the potential to enhance a community's capacity to engage in effective problem solving for a range of community concerns. Although numerous studies have documented correlations between member engagement and coalition processes and structural characteristics, fewer have examined associations between coalition factors and community capacity outcomes. The current study uses data from an evaluation of the California Healthy Cities and Communities program to examine pathways between coalition factors (i.e. membership, processes), member engagement (i.e. participation, satisfaction) and community capacity as hypothesized by the Community Coalition Action Theory (CCAT). Surveys were completed by 231 members of 19 healthy cities and communities coalitions. Multilevel mediation analyses were used to examine possible mediating effects of member engagement on three community capacity indicators: new skills, sense of community and social capital. Results generally supported CCAT. Member engagement mediated the effects of leadership and staffing on community capacity outcomes. Results also showed that member engagement mediated several relationships between process variables (i.e. task focus, cohesion) and community capacity, but several unmediated direct effects were also observed. This suggests that although member engagement does explain some relationships, it alone is not sufficient to explain how coalition processes influence indicators of community capacity.

Smoke-free policies at home, church, and work: smoking levels and recent quit attempts among a southeastern rural population, 2007.

OBJECTIVE: The objective of this study was to examine the cumulative effect of smoke-free policies and social support for smoking cessation in the home, at church, and at work on smoking levels and quit attempts in the context of a community-based study of rural African Americans and whites in the Southeast. METHODS: We conducted a baseline survey to assess sociodemographics, smoking behavior, level of social support for smoking cessation, and smoke-free policies at home, church, and work. We created a variable for a weighted "dose" of smoking restrictions on the basis of the existence of policies in the 3 settings and a weighted score for social support and used bivariate analyses and multivariate regression to analyze data. RESULTS: Of 134 survey participants, 18.7% had complete restrictions at home. Among church attendees, 39.4% had complete restrictions at church, and among those employed outside the home, 15.4% had complete restrictions at work. After controlling for age, sex, race, and education, the weighted dose of smoking restrictions was significantly related to having made a quit attempt in the past 12 months (odds ratio, 2.2; 95% confidence interval, 1.1-4.3) but not number of cigarettes smoked per day. Social support for cessation had no effect on recent quit attempts or number of cigarettes smoked per day. CONCLUSION: Smoke-free policies have a cumulative effect on smoking behavior. These findings may inform interventions aimed at promoting comprehensive community-wide smoke-free policies.

The role of hope in engaging in healthy behaviors among college students.

OBJECTIVES: To examine hope in relation to alcohol use, binge drinking, smoking, exercise, and limiting of dietary fat among college students. METHODS: Undergraduate students (N=2265) completed an online survey. RESULTS: Lower hope scores were related to binge drinking and smoking in the past month and more frequent drinking and binge drinking, controlling for sociodemographics. Higher hope scores were related to greater likelihood of and more frequent exercising and fat limitation in the past month. CONCLUSIONS: Interventions to improve college student health behaviors should target hope.

An initial attempt at operationalizing and testing the Community Coalition Action Theory.

The Community Coalition Action Theory (CCAT) blends practice wisdom with empirical data to explain how community coalitions achieve community change and community capacity outcomes. The current study uses data from an evaluation of 20 California Healthy Cities and Communities coalitions to test relationships between coalition factors and outcomes as predicted by CCAT in two stages of coalition development. Data are from two rounds of coalition member surveys, interviews with local coalition coordinators, and semiannual progress reports. Consistent with CCAT predictions and prior research, shared decision making and leadership were correlated with participation; staff competence, task focus, and cohesion were correlated with member satisfaction. Coalition size was associated with participation and dollars leveraged. Also, consistent with CCAT, diversity of funding sources was associated with new leadership opportunities and program expansion; dollars leveraged was correlated with new leadership opportunities and new partners. Findings provide preliminary support for many, but not all, of the relationships predicted by CCAT.

Individual and environmental correlates of dietary fat intake in rural communities: a structural equation model analysis.

Total dietary fat and saturated fat intake are associated with obesity, elevated cholesterol, and heart disease. This study tested a multi-group structural equation model to explore differences in the relative influence of individual, social, and physical environment factors on dietary fat intake amongst adults aged 40-70 years. Participants from four rural Georgia, U.S., counties (n=527) completed a cross-sectional survey that included questions about eating patterns and individual and social influences on healthy eating. Observational measures of nutrition environments in stores and restaurants in these counties also were completed. Models for both women and men found significant positive relationships between self-efficacy for healthy eating and perceived nutrition environments and family support for healthy eating. The association between self-efficacy for eating a low-fat diet and frequency of eating out and grocery shopping was negative for both genders. The home nutrition environment was associated with dietary fat intake for women but not men. The results indicate that the influence of individual and environmental factors on dietary fat intake differs for men and women, with the home environment playing a larger role for women in rural communities.