world cancer research fund/american institute for cancer research. policy and action for cancer...

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


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


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


Socioeconomic position


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.

http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

Income inequality


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)


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.

http://assets.newamerica.net/blogposts/2013/documenting_discrimination_in_local_rental_markets-83254

http://assets.newamerica.net/blogposts/2013/documenting_discrimination_in_local_rental_markets-83254

http://www.brookings.edu/~/media/research/files/papers/2011/4/06%20census%20diversity%20frey/0406_census_diversity_frey.pdf

http://www.brookings.edu/~/media/research/files/papers/2011/4/06%20census%20diversity%20frey/0406_census_diversity_frey.pdf

Racial discrimination


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


Social cohesion and social capital

Social cohesion and social capital


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


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


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


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


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


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


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


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


Promoting physical activity among women


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


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


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)


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


Thank you for your attention!Scherezade K. Mama, DrPHPostdoctoral FellowDepartment of Health Disparities ResearchThe University of Texas M.D. Anderson Cancer CenterHouston, Texas

Email: [email protected] Phone: 713-563-7546

world cancer research fund/american institute for cancer research. policy and action for cancer...

Documents

social environment

social science medicine

social support resources

social hierarchy indicators

stress slide

physical activity promotion

physical activity venues

types of physical activity