Perceived Environmental, Social, and Policy Determinants of Physical Activity in Rural Iowan AdultsMatthew Chrisman, MS; Faryle Nothwehr, PhD, MPH; Kathleen Janz, EdD; Jingzhen Yang, PhD, MPH; Jacob Oleson, PhD; Joe Coulter, PhD

University of Iowa

• Physical activity (PA) occurs in multiple domains (home care, active living, work, and sport), and determinants of PA may be specific to each domain. Thus, specificity is needed when studying determinants of PA

• Rural adults are less likely to meet PA recommendations to achieve health benefits than their urban or suburban counterparts1

• The aim of this study is to identify environmental, social,

and policy-related determinants of PA by domain in this understudied population. Findings will be useful in better understanding health disparities and informing public health interventions

Methods

• Secondary data analysis of cross-sectional survey conducted in 2003 among 407 adults from two rural Iowan towns

• Multiple regression models were used to examine the relationships of determinants and PA, controlling for age, gender, BMI, marital status, and education Model selection was done using stepwise regression.

Conclusions

References

Introduction

• 232 (57%) were female, 308(76%) were married, and 240 (59%) had at least some college education

• 306 (76%) were overweight or obese (BMI >25)• 346 (85%) reported having access to places to exercise, and over

half (n=214; 53%) reported walking as their most common form of exercise

Results

Home care/Work

Active Living

PA Summary Score

• Environmental , social, and policy factors are associated with PA in active living and sport

• Traditional factors are not associated with home care and work, perhaps due to their utilitarian nature

• Findings offer support for examining PA by domain

when studying determinants of this behavior

This work was supported by the Centers for Disease Control and Prevention Cooperative Agreement Number 1-U48-DP-001902. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention

1. Patterson, PD, Moore, CG, Probst, JC, & Shinogle, JA . Obesity and physical inactivity in rural America. The Journal of Rural Health. 2004; 20(2), 151-159.

2. Ainsworth BE, Sternfeld B, Richardson MT, Jackson K. Evaluation of the Kaiser Physical Activity Survey in women. Med Sci Sports Exerc 2000 Jul;32(7):1327-38.

3. Brownson, R. C., Baker, E. A., Housemann, R. A., Brennan, L. K., and Bacak, S. J. (2001). Environmental and policy determinants of physical activity in the United States. American Journal of Public Health, 91(12), 1995-2003

Sport

• No environmental determinants were associated with PA in home care or work

PA in active living was positively associated with:• Positive attitude towards using government funds for biking

trails (F-value = 10.25; p = 0.0016);• Neighborhood characteristics (F-value = 7.12; p = 0.0081)PA in active living was negatively associated with :• Barriers to exercise (F-value = 17.49; p < 0.0001)

PA in sport was positively associated with:• Friends encouraging exercise (F-value = 3.71; p = 0.0056)

PA in sport was negatively associated with :• Barriers to exercise (F-value = 41.01; p < 0.0001)

Overall PA was positively associated with:• Supporting Physical Education in the schools (p = 0.03)• Workplace incentives to exercise (F-value = 19.72;

p=0.0001)• Interaction between Age and having a Positive attitude

towards using government funds for biking trails (F-value = 6.85; p = 0.0014); younger adults had more positive attitudes

PA in active living was negatively associated with :• Barriers to exercise (F-value = 8.33; p = 0.0044)

Measures

Variable Scoring Environment typeAccess to places to exercise Indoor/outdoor, indoor only,

outdoor only, noPhysical

Barriers summary score Numerical value (0-13) Physical

Neighborhood characteristics summary score (facilitators)

Numerical value (0-13) Physical

Information about exercise Nominal responses (doctor, friend, TV, etc.)

Social

Someone to exercise with Strongly agree – strongly disagree

Social

Friends encourage exercise Strongly agree – strongly disagree

Social

At least one friend would commit to exercise

Strongly agree – strongly disagree

Social

Relatives encourage exercise Strongly agree – strongly disagree

Social

At least one relative would commit to exercise

Strongly agree – strongly disagree

Social

Neighborhood safety Extremely safe- not at all safe Physical

Employers provide time for exercise Yes-no Policy

Workplace provide incentives Yes-no Policy

Schools require PE Yes-no PolicyGov’t funds used for exercise Yes-no Policy

Zoning regulations include walk/bike paths

Yes-no Policy

• PA was measured using the Kaiser PA survey2 – a self-administered survey measuring PA in four domains

• Determinants of PA were measured using the Perceived Environmental and Policy Determinants of Physical Activity in Communities questionnaire3 (see Table 1)

Table 1: