Does the neighborhood built environment moderate the effectiveness of a weight-loss intervention for mothers with overweight or obesity? Findings from the Healthy Eating and Active Living Taught at Home (HEALTH) study.

BACKGROUND: Women of childbearing age are vulnerable to weight gain and experience a high prevalence of obesity due to pregnancy and stressors of parenthood. Lifestyle interventions such as the Healthy Eating and Active Living Taught at Home (HEALTH) study have been effective for weight loss; however, little is known about how the built environment (parks, transit, grocery stores, fast food, walkability etc.), where participants live might modify intervention effectiveness. This study examined whether characteristics of the neighborhood built environment modified effectiveness of the HEALTH study on weight loss.  METHODS: Secondary data analysis was conducted using data from HEALTH. Using GIS, buffers were built around participant addresses to capture distance to and availability of food (grocery store, convenience store, fast food) and urban design and transit (parks, street connectivity, transit) built environment characteristics. Built environment characteristics were dichotomized into low and high density and distance. Likelihood ratio tests for interaction were conducted to determine if built environment characteristics modified intervention effectiveness on Body mass index (BMI) and waist circumference (WC). Mixed effects linear regression models were then run to estimate the effect of the HEALTH intervention on weight outcomes at 24-months across both strata of built environment characteristics.  RESULTS: The analytic sample (n = 151) had baseline mean BMI 34.9 (SD = 5.8) and mean WC 46.0 cm (SD4.9). All urban design and transit and all food environment characteristics modified HEALTH effectiveness on one or both weight outcomes. The built environment modified the HEALTH intervention such that it was mostly effective for mothers residing in neighborhoods with low transit access, low street connectivity, high park access, and low access to grocery stores, convenience stores, and fast food. CONCLUSIONS: Result show the HEALTH was most effective for women residing neighborhoods with built environment characteristics suggestive of suburban neighborhood typology. To maximize impact for mothers residing in all types of neighborhoods, future research should explore scaling up HEALTH in suburban settings, while adapting HEALTH to maximize effectiveness in compact neighborhoods most likely, urban core neighborhoods.

How Do Perceived Changes in Child and Adolescent Activities Relate to Perceptions of Health during COVID-19? Exploring Heterogeneity during the Pandemic.

COVID-19 affected child/adolescent activities (e.g., extra-curricular, screen time), along with physical health (PH) and mental health (MH); however, less is known about the relationship between changes in activities and PH and MH in the United States and how these relationships vary by race/ethnicity. To address this gap, data were used from a national survey (Socio-Economic Impacts of COVID-19 Survey) administered May-June 2021 (n = 853). Multinomial logistic regression explored changes in outdoor, school, extracurricular, friend, and screen time activities with changes in PH and MH; interactions explored moderation by race/ethnicity. Results showed increases in outdoor (RRR 2.36, p = 0.003), school (RRR 3.07, p < 0.001), and extracurricular activities (RRR 3.05, p < 0.001), which were associated with increases in chances of better PH. Better MH was more likely for children/adolescents where friend activities (RRR 3.34, p < 0.001) and extracurriculars (RRR 4.48, p < 0.001) increased. Except for extracurriculars, heterogeneous relationships were observed (e.g., increases and decreases in activities were simultaneously related to better and worse health). The relationship between outdoor activities and screen time with health were moderated by race/ethnicity. Findings support facilitating outdoor, school, extracurricular, and friend activities, which were positively related to health. Given heterogeneity and variation by race/ethnicity, more research is needed to understand the complex relationship between activities and health during COVID-19.

Associations of physical activity and sedentary behaviors with child mental well-being during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic resulted in public health and policy measures to reduce in-person contact and the transmission of the virus. These measures impacted daily life and mental well-being (MWB). The aims of this study were to explore the MWB impacts of COVID-19 on children and assess the associations among perceived changes in physical activity (PA) and sedentary behaviors (SB), with perceived MWB changes, using a mixed-methods approach. METHODS: A convergent parallel mixed-methods design consisting of an online survey with a convenience sample and interviews was conducted from May through July 2020 with parents/caregivers of kindergarten through 5th graders in the St. Louis region. Survey domains assessed included child MWB, PA, and SB. Interviews were recorded, transcribed, and qualitatively analyzed using a code book developed to elicit themes. Survey data was analyzed with chi-squared tests and logistic regressions. The dependent variable was perceived change in child MWB due to the impact of COVID-19. Independent variables included perceived changes in PA, SB, and child concerns about COVID-19. RESULTS: Sample size consisted of 144 surveys and 16 interviews. Most parents reported a perceived decrease in child MWB (74%), a decrease in child PA (61%), and an increase in child SB (91%). Discontentment with stay-at-home orders and concern about COVID-19 were associated with a perceived decrease in MWB. Children whose PA decreased were 53% less likely to have the same or better MWB (OR 0.47) and children whose outside PA decreased were 72% less likely to have the same or better MWB (OR 0.28). Common qualitative themes included difficulty in adjusting to COVID-19 restrictions due to school closures and lack of socializing, child concerns about family getting sick, and PA benefits for improving MWB. CONCLUSIONS: Based on parent perceptions, MWB decreased with COVID-19. Maintained or increased child PA improved the chances MWB would remain the same or improve. Parent interviews provide context to these findings by showing how COVID-19 impacted MWB and the associations between PA and MWB. Understanding protective factors for child MWB during COVID-19 is important to offset negative long-term health outcomes from this ongoing pandemic.

A Cross-Sectional Comparison of Physical Activity during COVID-19 in a Sample of Rural and Non-Rural Participants in the US.

Physical activity (PA) pre-COVID-19 was lower in rural areas compared to non-rural areas. The purpose of this study was to determine COVID-19's impact on PA in rural and non-rural residents. A cross-sectional study consisting of a convenience sample of 278 participants (50% rural, 50% non-rural) from 25 states completed an online survey describing their PA behaviors and perceptions during COVID-19. The global physical activity questionnaire was used to determine PA in various domains and summed to determine if the participant met the PA guidelines. Rural participants had a significantly higher body mass index, lower income, and a lower educational attainment. Conversely, non-rural participants reported more barriers to PA. There was no difference in the perception of COVID-19's impact on PA, specifically; however, rural participants were significantly less likely to meet cardiorespiratory PA recommendations compared to non-rural participants. Conclusions: This study demonstrates the continued disparity in PA between rural and non-rural residents, despite the supposition of COVID-19 being less impactful in rural areas due to sparse populations. Efforts should be pursued to close the PA gap between rural and non-rural residents.

A Qualitative Study Identifying Barriers and Facilitators of Physical Activity in Rural Communities.

Background: Physical activity (PA) rates are lower in rural populations, compared to urban and suburban counterparts. Since PA is shown to decrease the risk of cancers and chronic diseases, increasing PA in rural environments is an important disease-prevention strategy. However, in order to develop effective interventions for rural populations, more research is needed. The purpose of the study was to elicit rural residents' thoughts and perceptions related to PA and walking trail use. Methods: Key informant interviews were conducted via telephone, with 62 adults, living in six rural communities in southeast Missouri, who identified as stakeholders, walking trail users, and nontrail users. Participants were recruited through word of mouth and snowball sampling. Interviews were digitally audio-recorded, transcribed, and qualitatively analyzed. Findings: Analysis revealed variation within the rural population, with each town unique in what constituted barriers and facilitators to PA. Life priorities other than physical health were found to be important motivators to PA and also influenced how PA was obtained. Community size was found to impact community resources and infrastructure, although this was mitigated by poverty rates. Conclusion: Rural communities are distinct from one another with different views and approaches to PA. Future interventions designed to increase PA should be mindful of differences at the individual and town levels and avoid a one-size-fits-all approach. Interventions would benefit from insight and support from community members and stakeholders, to facilitate a tailored approach to increase PA.

A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial.

BACKGROUND: Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents. METHODS/DESIGN: Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments. DISCUSSION: This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations. TRIAL REGISTRATION: Clinical Trials NCT03683173 , September 25, 2018.