world cancer research fund/american institute for cancer research. policy and action for cancer...
Post on 01-Apr-2015
224 Views
Preview:
TRANSCRIPT
Physical Activity and Social Support:Do you think you’re better off alone?
Scherezade K. Mama, DrPHPostdoctoral FellowDepartment of Health Disparities ResearchThe University of Texas M.D. Anderson Cancer Center
Preventability estimate by cancer site
Oesophag
us
Pancre
ase
Gallblad
der
Colorectum
Breast
Endometrium
Kidney0
102030405060708090
100
Physical activity Obesity
Perc
ent P
reve
ntab
le
World Cancer Research Fund/American Institute for Cancer Research. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: a Global Perspective. Washington DC: AICR; 2009.
Percentage of adults who met physical activity guidelines for aerobic activity in the U.S.
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
20130
10
20
30
40
50
60
43.6 43.2 42.247.5
49.8
Crud
e Pe
rcen
t
Ward BW, Schiller JS, Freeman G. Early release of selected estimates based on data from the January–September 2013 National Health Interview Survey. National Center for Health Statistics. March 2014. Available from: http://www.cdc.gov/nchs/nhis.htm.
Percentage of adults who met physical activity guidelines for aerobic activity in the U.S.
ADULTS 18 AND OVER BY SEX
Total Men Women40
42
44
46
48
50
52
54
56
50.3
54.7
46.2Perc
ent
ADULTS 18 AND OVER BY RACE/ETHNICITY
White Black Hispanic/Latino
0
10
20
30
40
50
6053.9
41.7 42.7
Perc
ent
Ward BW, Schiller JS, Freeman G. Early release of selected estimates based on data from the January–September 2013 National Health Interview Survey. National Center for Health Statistics. March 2014. Available from: http://www.cdc.gov/nchs/nhis.htm.
Ecologic framework
Physical Activity
Public Policylocal, state and national laws and policies
Environmental Factorsaccess to recreational facilities, walkable communities, sidewalks
and bicycle lanes, worksite programs and policies, school-based programs
Interpersonal Relationshipssocial networks and support systems, including family, friends, co-workers
Intrapersonal Factorsindividual characteristics, such as age, sex, gender, beliefs,
motivation, self-concept, etc.
Model adapted from: King AC, Sallis JF. Why and how to improve physical activity promotion: Lessons from behavioral science and related fields. Preventive Medicine. 2009; 49:286-88.; McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education & Behavior. 1988;15:351-77.
Direct and indirect influences on physical activity
Social Support Physical Activity
Intrapersonal Factors• Cognition• Beliefs• Motivation
Social environment categories
Interpersonal relationships Social support Social networks
Social inequalities Socioeconomic position and income inequality Racial discrimination
Neighborhood and community characteristics Social cohesion and social capital Neighborhood factors
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Interpersonal relationships
Social support Resources provided by
other persons Social networks
Collective structure of social relationships that surround an individual
Provide information on how an individual is integrated with others
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Social support and social networks
Constrains the adoption of health promoting
behaviors
Enables the adoption of health promoting behaviors
Provides access to resources & material goodsProvides individual & community coping
responsesBuffers negative health outcomes
Restricts contact to infectious disease
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Social inequalities
Whitehall studies (1984) showed health gradients based on occupational class 3 fold increase in
mortality between lowest and highest employment grades
Gradient persists after controlling for smoking
Marmot MG, Shipley MJ, Rose G. Inequalities in death—specific explanation of a general pattern? Lancet. 1984;1(8384):1003-6.
Socioeconomic position
Your place in the social hierarchy
Indicators include Individual income Educational attainment Occupational or job
status
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Socioeconomic position
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Socioeconomic Position ↑ Biological Stress ↓ Health
↓ Accumulation of and Access to
Material Resources that Protect against
Stress
Income inequalities
Gilson D, Perot C. It’s the Inequality, Stupid. March/April 2011. http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph.
Income inequality
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Income Inequality
Disinvestment in Social Capital ↓ Social Cohesion
↓ Social Spending on Programs and
Services
↑ Negative Psychosocial Conditions
Racial discrimination
Differential treatment Interpersonal▪ Occurs between individuals
Institutionalized ▪ Discriminatory policies or practices▪ Results in differential access to resources and societal
opportunities▪ Restricted access to types of physical activity (e.g. baseball)▪ Restricted access to physical activity venues (e.g. golf clubs,
swimming pools)
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Racial discrimination operating through residential segregation
Emple H. Documenting Discrimination in Local Rental Markets. May 2013. http://assets.newamerica.net/blogposts/2013/documenting_discrimination_in_local_rental_markets-83254.; Frey WH. America’s Diverse Future: Initial Glimpses at the U.S. Child Population from the 2010 Census. Washington, DC: Brookings; 2011. http://www.brookings.edu/~/media/research/files/papers/2011/4/06%20census%20diversity%20frey/0406_census_diversity_frey.pdf.
Racial discrimination
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Racial Discrimination
↑ Economic and Social Deprivation
↑ Exposure to Harmful Substances
↑ Psychological Trauma
Neighborhood and community characteristics
PEOPLE
Individual factors that influence health Income and education Physical and mental health Knowledge, attitudes and
beliefs about health-related behaviors
Perceptions of interpersonal bias or discrimination
PLACE
Characteristics of the place where you live Social cohesion Social capital Neighborhood socioeconomic
position Influence health-related
behaviors directly and indirectly
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Social cohesion and social capital
Social cohesion and social capital
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Social Cohesion and Social Capital
Reinforces Group and Social Norms
Provides Tangible Support
↑ Health Behaviors
Neighborhood factors
Neighborhood socioeconomic position
Deprivation Home ownership Presence/lack of
neighborhood resources Supermarkets/grocery
stores Parks, fitness and
community centers Perception of crime Most affluent Most deprived
0
5
10
15
20
25
No PA by Neighborhood Deprivation and Educa-
tional AttainmentLow Middle High
% w
ith n
o ph
ysic
al a
ctivi
ty
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.; Figure adapted from Table 2 in Sundquist J, Malmstrom M, Johansson S. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol. 1999;28(5):841-5.
Neighborhood factors
Neighborhood Factors
Elements of the physical environment
Historical and Cultural Features
Availability of Support Services
McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.
Smog, poor air quality
Lack of recreation facilities, reduced PE in schools, limited
trash pick up
Social and cultural norms for physical activity
Social-environmental influences in women
We know that Physical inactivity is a problem. The social environment plays an important role on
behavior.
BUT…Do the frameworks we have fit women? …who are less physically active than men? …have different social and cultural norms?
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
The social environment
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Social support and social networks
Most studied and understood construct Consistently positively correlated with physical
activity among women 79.1% of studies addressed this 55.8% of these studies included ethnic
minorities 3 major types
Emotional Tangible Informational
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Emotional support
Ethnic minority women with low physical activity support are more likely to be sedentary
Women with high support were more likely to Meet leisure-time physical activity
recommendations (≥150 min/week) Lead a physically active lifestyle (~300 min/week)
Support from family and friends predicts exercise adherence
Eyler AA, Brownson RC, Donatelle RJ, King AC, Brown D, Sallis JF. Physical activity social support and middle- and older-aged minority women: results from a US survey. Soc Sci Med. 1999;46(6):781-9.; Oka R, King AC, Young D. Sources of social support as predictors of exercise adherence in women and men ages 50 to 65 years. Womens Health. 1995;1(2):161-75.
Tangible support
Miller YD, Trost SG, Brown WJ. Mediators of physical activity behavior change among women with young children. Am J Prev Med. 2002;23(2 Suppl 1):98-103.
Print+Community Development Intervention
Women with increased partner support were 2.29
times more likely to meet PA guidelines
Informational support
Must be tailored and include Benefits of physical activity
for women Strategies to incorporate
into women’s lives
Increases exercise adherence
More valuable from health professionals
Duncan T, Duncan S, McAuley E. The role of domain and gender specific provisions of social relations in adherence to a prescribed exercise regimen. J Sport Exerc Psychol. 1993;15:220-31.
Life transitions and multiple roles
LIFE TRANSITIONS
Marriage Parenthood Employment
MULTIPLE ROLES
Wife Mother Employee Caretaker Head of household
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
53.5% of studies addressed this 60.9% of these studies included ethnic minority women
Increasing responsibilities
Women were more likely to be “inactive” if they reported Getting married (OR=1.46) Giving birth to a first (OR=2.27) or subsequent
child (OR=2.06) Becoming a single parent (OR=1.32) Beginning work (OR=1.15)
Brown WJ, Trost SG. Life transitions and changing physical activity patterns in young women. Am J Prev Med. 2003;25(2):140-3.
Reduced discretionary time and low priority of physical activity
Related to increasing responsibilities
Lack of time is #1 barrier Family responsibilities are
a priority▪ Require a lot of time▪ Physically demanding
Household and caregiving responsibilities limit leisure-time/physical activity
“I think aerobics, like [doing an] aerobics tape is a waste of time. You stand there doin‘ that, you're not accomplishing anything. If you were dusting, and carpet sweeping the floor, or vacuuming, you're doing something.”
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.; Eyler AA, Baker E, Cromer L, King AC, Brownson RC, Donatelle RJ. Physical activity and minority women: a qualitative study. Health Educ Behav. 1998;25(5):640-52.
Beliefs about being active
Social roles and
responsibilities
Busy schedules
Physical activity Married 1 Child 2+ Children Employed High
Support0
2
4
6
8
10
12
2.79
5.66
10.43
1.29 1.27
3.052.13
Sports/ExerciseActive LivingHousehold/CaregivingOccupational
Odd
s Ra
tio
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.; Sternfeld B, Ainsworth BE, Quesenbury CP. Physical activity patterns in a diverse population of women. Prev Med. 1999;28(3):313-23.
Beliefs about being active
Women think they are doing enough physical activity because they are busy.
May not be enough to benefit their health, but not willing to add more to their schedule.
Social roles and responsibilities Busy schedules Physical activity Too tired to
exercise
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Cultural Standards & Gender Roles
Most complex aspects of the social environment
Least understood and studies 39.5% of studies looked at this 76.5% of these studies included ethnic minorities
Key issues Acceptance of physical activity Cultural appropriateness of physical activity for adult
women Lack of role models
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Acceptance of physical activity
Need spouse to give consent or allow them time to do physical activity Especially true among
Hispanics Lack of acceptance
leads to feeling guilty or selfish
“Unless it fits into the usual family life pattern, PA does not happen.”
“I think that’s probably the biggest obstacle is getting out of the house. To even do it. And the support is where it comes in.”
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.; Berg J, Cromwell S, Arnett M. Physical activity: perspectives of Mexican American and Ango American midlife women. Health Care Women Int. 2002;23(8):894-904.
Cultural appropriateness of physical activity for adult women
Gender-role expectations Social and cultural pressure
to Conform to role as mothers Conform to role as primary
caretakers/caregivers Put family obligations and
relationships ahead of their own needs
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Lack of physically active, adult, female role models
Lack of role models adds to perceived lack of community and social support
Role models would Make physical activity
more socially acceptable Make women feel
comfortable and confident about being physically active
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Promoting physical activity among women
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Microsystem intervention strategies
Potential Targets Intervention Strategies
Individual women Educational programs emphasizing importance of PA for women*Programs to develop communication and support-seeking skillsPrograms with culturally appropriate options and instructions for exercise
Key individuals (e.g. spouse, partner, family member)
Programs teaching family members skills for providing support (e.g. sharing duties)Programs involving key individuals in PA
Health care providers Programs to develop emotional and informational support skillsEducational materials to give to women
*Applicable to all potential targets
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Mesosystem intervention strategiesPotential Targets Intervention Strategies
Leaders in workplace, clubs, churches, or other social settings
Programs targeting key leaders to enhance acceptance of PA for womenRecognition of leaders who support PA through advocacy, policies and modeling
Organization or group Programs to strengthen existing support networks for PAPrograms to develop new networks for PA
Creation of worksite policies that enhance PA (e.g. childcare, flexible schedule)Organization provides additional PA opportunities and support services
Community-wide Provide childcare support services
Provide programs allowing women to trade time with other mothers for PA timeCreate or recognize active role models
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Macrosystem intervention strategies
Potential Targets Intervention Strategies
Community campaigns targeting key individuals, key leaders and organizations, and health care providers
Media and social marketing interventions to • Change norms for PA in women• Increase acceptance of PA• Provide positive, active role models• Develop health communication
messages that emphasize the importance of PA to women’s health
Advocacy and public policy campaigns Organize and support efforts to create acceptable and appropriate opportunities for women to be physically active (e.g. women-friendly facilities)
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Longitudinal results: Microsystem
Cavallo DN, Brown JD, Tate DF, DeVellis RF, Zimmer C, Ammerman AS. The role of companionship, esteem, and informational support in explaining physical activity among young women in an online social network intervention. J Behav Med. 2013; In press. DOI 10.1007/s10865-013-9534-5
Longitudinal results: Mesosystem
COMPLETERS
Baseline 1-year follow-up0
2
4
6
8
10
12
Total Leisure-timeOccupational
Phys
ical
acti
vity
(hou
rs/w
eek)
NONCOMPLETERS
Baseline 1-year follow-up0
2
4
6
8
10
12
14
Total Leisure-timeOccupational
Phys
ical
acti
vity
(hou
rs/w
eek)
Huberty JL, Ehlers D, Coleman J, Gao Y, Elavsky S. Women Bound to be Active: Differences in long-term physical activity between completers and noncompleters of a book club intervention. J Phys Act Health. 2013;10(3)368-78.
Longitudinal results: Mesosystem
“The interaction with women [in WBA] was very rewarding.”
“They [WBA women] were great as an initial ‘get going,’ but then I kinda went on my own and family became more of my support.”
“I learned this skill…of reaching out and asking for support or looking for support…that has stayed with me since the program.”
Huberty JL, Ehlers D, Coleman J, Gao Y, Elavsky S. Women Bound to be Active: Differences in long-term physical activity between completers and noncompleters of a book club intervention. J Phys Act Health. 2013;10(3)368-78.
Longitudinal results: Macrosystem
SisterTalk 12 one-hour weekly programs Mailed corresponding print material Goals to “eat better, move more and feel great”
Risica PM, Gans KM, Kumanyika S, Kirtania U, Lasater TM. SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women. Int J Behav Nutr Phys Act. 2013;10:141.
Longitudinal results: Macrosystem
Baseline 3-months 8-months 12-months40
45
50
55
60
65
70
75
80
Δ4.62Δ1.47 Δ0.49
Δ-2.75Δ-0.40 Δ-1.07
InterventionControl
Tota
l Lei
sure
Acti
vity
Sco
re
Risica PM, Gans KM, Kumanyika S, Kirtania U, Lasater TM. SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women. Int J Behav Nutr Phys Act. 2013;10:141.
But for the biggest bang for your $...
Microsystem
MesosystemMacrosystem
Multilevel intervention str
ategies
Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.
Thank you for your attention!Scherezade K. Mama, DrPHPostdoctoral FellowDepartment of Health Disparities ResearchThe University of Texas M.D. Anderson Cancer CenterHouston, Texas
Email: skmama@mdanderson.org Phone: 713-563-7546
top related