Physical Activity Among Rural Older Adults With Diabetes

PURPOSE: This analysis describes physical activity levels and factors associated with physical activity in an ethnically diverse (African American, Native American, white) sample of rural older adults with diabetes. METHOD: Data were collected using a population-based, cross-sectional stratified random sample survey of 701 community-dwelling elders with diabetes completed in 2 rural North Carolina counties. Outcome measures were as follows: first, physical activity in the past year, and second, days physically active in the prior week (0-7). Potential correlates included personal and health characteristics and were evaluated for statistical significance using logistic regression models. FINDINGS: About half (52.5%) of the participants stated that they had engaged in physical activity in the past year. Among those, 42.5% stated that they had no days with at least 30 minutes of continuous physical activity in the prior week, while 21.5% reported daily physical activity. Common activities were walking and housework. Correlates of physical activity in the past year and days active in the prior week included measures of physical health and mobility. CONCLUSIONS: Physical activity in this ethnically diverse sample of rural elders with diabetes is limited. Effort must be invested to increase physical activity in these groups.     

Views on Exercise and Physical Activity Among Rural-Dwelling Senior Citizens

CONTEXT: This study was conducted with senior citizens in the 2 rural communities of Ada and Lindsay, Oklahoma. These communities are both predominantly white, with the largest minority population being American Indian. Both communities are more than 60 miles from a metropolitan area and have a history of farming and ranching. PURPOSE: The purpose of this study was to explore contextual factors related to physical activity among senior citizens living in rural communities. METHODS: Two focus groups were conducted. The groups were conducted in mixed-sex sessions and were audiotaped and transcribed verbatim for the purpose of analysis. FINDINGS: Themes from the focus groups included the following: (1) the types of daily activities engaged in by seniors; (2) the meaning and connotation of the words exercise and physical activity, with physical activity connotating for some the negative imagery of physical labor; and (3) the availability and suitability of settings for physical activity. For seniors living in rural settings in Oklahoma, the lack of indoor facilities and the sometimes extreme climatic conditions serve as significant barriers to physical activity. CONCLUSION: This study suggests that programs seeking to encourage physical activity among seniors in rural areas could benefit from an assessment of resources and settings for physical activity and the avoidance of language that may have negative connotations for this population.     

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.     

Pilot of a Diabetes Primary Prevention Program in a Hard-to-Reach,Low-Income,Immigrant Hispanic Population

An immigrant Hispanic population in the Texas-Mexico border region urgently requested assistance with diabetes. The project team implemented an exploratory pilot intervention to prevent type 2 diabetes in the general population through enhanced nutrition and physical activity. Social networks in low-income rural areas (colonias) participated in an adaptation of the Diabetes Empowerment Education Program. The program had a pre-post-test design with a comparison group. The intervention had a small but significant effect in lowering body mass index, the biological outcome variable. The process evaluation shows that the participants valued the pilot project and found it culturally and economically appropriate. This program was the first primary prevention program in diabetes to address a general population successfully. The study shows that low-income, rural Mexican American families will take ownership of a program that is participatory and tailored to their culture and economic situation.     

Expanding the role of nurse practitioners: effects on rural access to care for injured workers.

CONTEXT: A 3-year pilot program to expand the role of nurse practitioners (NPs) in the Washington State workers' compensation system was implemented in 2004 (SHB 1691), amid concern about disparities in access to health care for injured workers in rural areas. SHB 1691 authorized NPs to independently perform most functions of an attending physician. PURPOSE: The aims of this study were to (1) describe the contribution by NPs to Washington's workers' compensation provider workforce, (2) evaluate change in provider availability attributable to SHB 1691, and (3) evaluate the effect of SHB 1691 on timely accident report filing. METHODS: Administrative data were used to evaluate this natural experiment, using a pre-post design with primary care physicians (PCPs) as a nonequivalent comparison group. FINDINGS: NPs served injured workers with characteristics similar to those served by PCPs, but 22.0% of NPs were rural, compared with 17.3% of PCPs. Of claimants with NPs as their attending provider, 53.3% were injured in a rural county, compared with 24.7% for those with PCP attending providers. The number of NPs participating in the workers' compensation system rose after SHB 1691 implementation, more so in rural areas. SHB 1691 implementation was associated with a 16 percentage point improvement in timely accident report filing by NPs in both rural and urban areas. CONCLUSIONS: Authorizing NPs to function as attending providers for injured workers may improve provider availability (especially in rural areas) and timely accident report filing, which in turn may improve worker outcomes and system costs.     

Japanese encephalitis in a U.S. traveler returning from Thailand, 2004

Japanese encephalitis (JE) virus is a mosquito-borne flavivirus that is closely related to the West Nile and St. Louis encephalitis viruses endemic to North America. JE virus is a leading cause of viral encephalitis in Asia but is rarely reported among travelers to countries where JE is endemic. This report describes a case of an unvaccinated Washington resident who had JE after traveling to northern Thailand. The Advisory Committee on Immunization Practices (ACIP) recommends JE vaccine for travelers to JE-endemic areas of Asia during the transmission season, especially those spending > or =1 month in those areas and whose travel itineraries include rural settings. JE vaccine should also be considered for travelers visiting areas with epidemic transmission or those engaging in extensive outdoor activity in rural settings in areas where JE is endemic, regardless of the duration of their visit. In addition, health-care providers and organized international travel programs should ensure that travelers obtain appropriate preventive health guidance before travel.     

Characteristics of physical activity levels among trail users in a U.S. national sample

BACKGROUND: The Task Force on Community Preventive Services strongly recommends environmental interventions that include enhanced access to opportunities for physical activity, such as walking and cycling trails. Although accumulating evidence indicates that trails can be effective in increasing physical activity, little is known about trail users. METHODS: Cross-sectional analysis of a national sample of 3717 adults from the HealthStyles and ConsumerStyles surveys using logistic regression to determine physical activity patterns and sociodemographic correlates related to trail use, and to identify support regarding trail development policies. RESULTS: Almost 13% (12.7%) of the sample reported using trails at least once a month and 24.3% at least once a week. People who reported using trails at least once a week were twice as likely than people who reported rarely or never using trails to meet physical activity recommendations (odds ratio=2.3, 95% confidence interval=1.9-2.8). Nearly half (43.6%) of the non-trail users supported expanded public spaces for people to exercise, and 36.4% of the non-trail users reported that they would be willing to pay more taxes to build more parks and trails in their community. CONCLUSIONS: Community trails facilitate physical activity, and almost half of frequent trail users report that access to trails and other green space is important in choosing a place to live. These results support the need for prospective research on whether newly built trails promote physical activity in previously inactive people.     

Physical Activity Among Cambodian Americans: An Exploratory Study

Available data indicate that Asian Americans as a group have lower levels of physical activity than non-Latino whites. However, few studies have focused on physical activity among Asian American sub-groups. Our objectives were to describe levels of physical activity, as well as individual and environmental correlates of physical activity among Cambodian Americans. We conducted a telephone survey of Cambodians living in three geographic areas (Central California, Northern California, and the Pacific Northwest) during 2010. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short version. Survey items addressed demographic characteristics, knowledge about the health benefits of physical activity, social norms and supports with respect to physical activity, the availability of neighbourhood recreational facilities, and neighbourhood characteristics. Our study group included 222 individuals. Only 12% of the study group reported low levels of physical activity, 40% reported moderate levels, and 48% reported high levels. Physical activity was strongly associated with the availability of neighborhood recreational facilities such as parks, but not with neighborhood characteristics such as heavy traffic. Our results suggest that a majority of Cambodian Americans are adherent to current physical activity guidelines. Neighborhood recreational facilities that provide opportunities for leisure-time physical activity are associated with higher levels of physical activity in Cambodian communities. Future research should assess the reliability and validity of the IPAQ in a Cambodian American study group.     

Correlates of recreational and transportation physical activity among adults in a New England community

BACKGROUND: Promotion of transportation-related physical activity is consistent with current national recommendations. However, few studies have simultaneously examined correlates of recreational and transportation physical activity. METHODS: Surveys were mailed to 1002 adults residing in a Massachusetts suburb. The survey included measures of self-reported recreational and transportation-related physical activity and demographic, cognitive, interpersonal, and environmental variables potentially correlated with activity. Multiple linear regression was used to examine the associations between environmental variables and the two outcomes. RESULTS: Respondents (n = 413) who averaged 51.2 +/- 16.8 years of age reported 132.3 +/- 140.5 min/week recreational physical activity and 142.1 +/- 180.9 min/week transportation activity. Sidewalks (P = 0.02) and traffic (P = 0.01) were each associated with higher levels of recreational physical activity in unadjusted analyses, but in models that controlled for age, self-efficacy for physical activity and family social support for physical activity, these environmental variables were nonsignificant. Three perceived environmental variables (enjoyable scenery, sidewalks, traffic) and one objective environmental variable (distance from home to a community rail-trail) each showed associations (P 相似文献   

Environmental perceptions and objective walking trail audits inform a community-based participatory research walking intervention

Background  

Given the documented physical activity disparities that exist among low-income minority communities and the increased focused on socio-ecological approaches to address physical inactivity, efforts aimed at understanding the built environment to support physical activity are needed. This community-based participatory research (CBPR) project investigates walking trails perceptions in a high minority southern community and objectively examines walking trails. The primary aim is to explore if perceived and objective audit variables predict meeting recommendations for walking and physical activity, MET/minutes/week of physical activity, and frequency of trail use.     

Assessment Of The Nutrition And Physical Activity Education Needs Of Low-Income,Rural Mothers: Can Technology Play A Role?

The purpose of this study was to examine the perceptions of low-income, rural mothers regarding their need for nutrition and physical activity education and the role of technology in addressing those needs. Quantitative and qualitative research was combined to examine the nature and scope of the issues faced by this target population. Women who were currently receiving food stamps and had children in nursery school to eighth grade were recruited through a state database to participate in a telephone survey (N = 146) and focus groups (N = 56). Low-income, rural mothers were aware of and practiced many health behaviors related to nutrition and physical activity, but they faced additional barriers due to their income level, rural place of residence, and having children. They reported controlling the fat content in the food they cooked and integrating fruits and vegetables but showed less interest in increasing fiber consumption. They reported knowing little about physical activity recommendations, and their reported activity patterns were likely inflated because of seeing housework and child care as exercise. To stretch their food budget, the majority reported practicing typical shopping and budgeting skills, and many reported skills particularly useful in rural areas: hunting, fishing, and canning. Over two-thirds of the survey respondents reported computer access and previous Internet use, and most of those not yet online intended to use the Internet in the future. Those working in rural communities need to consider technology as a way to reach traditionally underserved populations like low-income mothers.     

Trail User Demographics, Physical Activity Behaviors, and Perceptions of a Newly Constructed Greenway Trail

To better understand and promote physical activity on a newly constructed trail, the present study examined the demographic characteristics and physical activity behaviors of trail users; the demographic characteristics of trail users compared to the demographic profile Greenville County, South Carolina residents; trail users' purpose for using the trail; the distance trail users traveled to access the trail from their homes; channels through which trail users learned about the trail; and trail characteristics liked by trail users. Using a valid and reliable intercept survey, 1,148 trail users were interviewed. Trail users were mostly white (93.1%), male (59.1%) adults (84.2%) who reported using the trail for exercise (91%). Significant associations were identified between trail user demographic characteristics and how trail users learned about the trail and trail characteristics liked by trail users. The findings may contribute to the development of targeted health promotion efforts to promote physical activity on this and similar trails.     

Letter – Recruiting hard‐to‐reach populations: lessons from a study of women living in socioeconomically disadvantaged areas of Victoria,Australia

Women living in socioeconomically disadvantaged areas are at heightened risk for physical inactivity, an important modifiable risk factor for a number of preventable diseases. To best promote physical activity, we need to understand influences on physical activity and the feasibility of physical activity promotion strategies among this target group. However, those of lower socioeconomic position (SEP) are under‐represented in research studies. Limited literature detailing effective strategies for recruiting low SEP populations exists. This letter outlines the strategies we employed in an attempt to recruit 25 women aged 18–45 years living in socioeconomically disadvantaged urban and rural areas of Victoria, Australia, into a qualitative study involving participation in a 30–60 minute interview. We hope that this letter stimulates discussion and debate about methods for recruiting populations of low SEP.     

Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity

BACKGROUND: Information to judge both the internal and external validity of health behavior research conducted in healthcare settings is vital to translate research findings to practice. This paper reviews the extent to which this research has reported on elements of internal and external validity, with emphasis on the extent to which research has been conducted in representative settings with representative populations. METHODS: A comprehensive review was conducted of controlled interventions for dietary change, physical activity, or smoking cessation conducted in healthcare settings and published in 12 leading health behavior journals between 1996 and 2000. Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, the characteristics and results of these studies were summarized to document the extent to which intervention reach, adoption, implementation, and maintenance were reported and what has been learned about each of these dimensions. RESULTS: A total of 36 studies qualified for review. Participation rates among eligible patients were reported in 69% of studies and were generally quite high; in contrast, only 30% of studies reported on participation rates among either healthcare settings or providers. Implementation data were reported in 77% of the studies and these rates were generally high, with the caveat that intervention was often delivered by paid research staff. Long-term maintenance results were reported very consistently at the individual level, but program continuation was almost never reported at the setting level. CONCLUSIONS: We conclude that a much stronger emphasis needs to be placed on the representativeness of providers and settings that are studied. Examples of how this can be done and recommendations for future research are provided.     

Comparison of roles and professional development needs of nurse executives working in metropolitan,provincial, rural or remote settings in Queensland

ABSTRACT: This research provides a profile of nurse executives' roles, career opportunities and professional development needs across metropolitan, provincial, rural and remote settings in Queensland. A cross-sectional survey was posted to all Directors/Assistant Directors of Nursing in the Queensland Public Health Sector (n = 281 ), with a response rate of 52.3% (n = 147 ).
Findings indicated that the role of nursing executives has expanded and diversified, with multiple role responsibilities increasing with distance from the metropolitan area. Nurse executives in remote areas were less satisfied with the quality of supervision and mentorship they received, and least likely to participate in career enhancing activities. Metropolitan nursing executives utilised more of the career enhancing opportunities provided by the Queensland Public Health Sector than did provincial, rural or remote nursing executives. Provincial nurse executives were the group most likely to network, attend conferences and participate in informal educational activities. Professional development needs, although generally common to all groups, were more practice specific for those in rural and remote areas. Many nurse executives begin their careers in rural or remote areas where limited opportunities for career development may be detrimental to their future development.     

Biopsychosocial imperatives from the rural perspective

Rural health issues are examined within a biopsychosocial framework by addressing three questions: what is meant by ‘rural’? what are rural health needs? what factors must be considered in understanding and addressing these needs?Probably the single most important characteristic distinguishing rural from urban areas is low population density. This factor is particularly important in terms of its impact on (1) communication and transportation patterns, (2) one's ‘sense of community’ and (3) the availability of specialized services and complex organizations and institutions.For statistical purposes two different definitional dichotomies exist: rural-urban and metropolitan-nonmetropolitan. Although the rural and nonmetropolitan populations are not conterminous, approximately the same percentage of the nation's population is included in each of the two categories. A serious misconception is that of equating agriculture with rurality. While most farmers live and work in rural areas only a small fraction of rural Americans are engaged in agriculture.In terms of health needs, infant mortality tends to be higher in nonmetropolitan than in metropolitan areas; and limitation of activity due to chronic conditions is more likely to occur among the nonmetropolitan than the metropolitan population. Similarly, the percent of people who perceive their health as either ‘fair’ or ‘poor’ is higher for the nonmetropolitan population. On the other hand, the incidence of acute conditions and disability days per person per year are lower for the nonmetropolitan population than for the metropolitan population. Limited data on mental health suggest that the halcyon picture of country life may be grossly distorted.Understanding and addressing rural health needs involves a close look at the social, economic and medical systems operating in rural America. Income and employment levels, and their interrelationship to nutrition, housing and transportation generally find rural areas at a disadvantage. Although attitudes and values between rural and urban populations differ, it is all too easy to exaggerate these differences. The areas of sharpest differences have to do with issues of morality, religion and political philosophy. Problems in the availability and accessibility of medical services—especially specialized services—continue to plague rural areas.Recently, the most important dynamic in rural areas has been the rapid population growth associated with urban-to-rural migration. Another important characteristic of rural America is its diversity. Greater diversity likely exists among rural areas than among urban areas. For example, some rural areas have medical systems that are as sophisticated as those found in most urban areas.Failing to recognize and appreciate the diversity within the rural sector may be the greatest impediment to designing and implementing effective public policies for dealing with rural health needs. Considerable research, recent books, the creation of statewide offices of rural health and the work of national organizations have been helpful in alleviating the misunderstanding which surrounds rural America, its health care needs and the ways to best address those needs.     

Participant Recruitment to a Randomized Trial of a Community-Based Behavioral Intervention for Pre- and Interconceptional Women: Findings From the Central Pennsylvania Women''s Health Study

BACKGROUND: Community-based health studies rely on the ability of researchers to successfully recruit and retain participants from target populations, rather than from clinical settings. Many prior women's health studies have recruited in urban and suburban areas, but rural populations pose specific challenges. We describe the recruitment strategies employed in the Central Pennsylvania Women's Health Study to recruit 692 women in 15 low-income rural communities to a randomized trial of a behavioral intervention for pre- and interconceptional women. METHODS: The organization of the project is described. Qualitative (e.g., focus groups of local project facilitators) and quantitative methods (e.g., surveys of participants) were used to assess the effectiveness of various recruitment techniques and the characteristics of the final enrolled sample. RESULTS: A triangular recruitment approach was used in 15 communities, which included partnering with local community organizations and use of both active and passive recruitment techniques. The most effective recruitment methods were (1) actively recruiting women in social service and childcare settings, (2) use of a toll-free project telephone number printed on all passive recruitment material, and (3) the combination of passive and active recruitment in educational settings. Together, these methods successfully achieved the recruitment goals: enrolling participants who were more likely to be rural, poor or near poor, non-white, and to have less access to health care than their counterparts residing in the target communities. CONCLUSIONS: Successful recruitment of typically hard-to-reach women, such as low-income rural women, is possible through implementation of a triangular recruitment approach in local communities.     

中国慢性病前瞻性研究: 10 个项目地区成人体力活动和休闲静坐时间特征差异的分析

目的 描述中国慢性病前瞻性研究(CKB)10个项目点健康人群体力活动和静坐行为特征的地区差异。方法 剔除自报患有冠心病、卒中和肿瘤等慢性疾病的个体后, 研究分析10个项目地区中486 514名30~79岁队列成员体力活动和每周休闲静坐时间的基线信息, 重点描述地区差异。结果 男性总体力活动水平(22.9 MET-h/d)高于女性(20.6 MET-h/d), 休闲静坐时间(3.1 h/d)多于女性(2.9 h/d)。浙江项目点个体每天总体力活动水平最高(男31.3 MET-h/d, 女 30.2 MET-h/d)且静坐时间最少(男2.0 h/d, 女 1.6 h/d)。工作相关活动所占比例, 男性以浙江(86.5%)和河南(85.2%)项目点最高, 海口(69.4%)最低;女性以浙江(74.8%)最高, 河南(40.9%)最低。甘肃项目点(男17.8%, 女18.1%)交通活动所占比例明显高于其他地区。家务活动所占比例, 男性以湖南项目点(18.0%)最高, 女性以河南(54.0%)和湖南(39.1%)最高。城市项目点的休闲相关活动所占比例高于农村, 其中柳州(男9.5%, 女10.4%)最高。甘肃(男36.8%, 女29.8%)、四川(男34.1%, 女33.8%)和浙江(男20.0%, 女19.2%)3个农村项目点的高强度活动所占比例明显高于其他项目点。结论 CKB 10个项目地区的研究人群在总体力活动水平、活动类型、活动强度和休闲静坐时间等特征上存在明显的地区差异。