Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association.

Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association's My Life Check - Life's Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association's 2020 Impact Goals.

A commercially available crime index may be a reliable alternative to actual census-tract crime in an urban area.

Health research on the effects of crime has been hampered by a lack of small-scale, reliable crime data. Our objective is to assess the accuracy of a set of commercially available crime indices for use in health research. The 2016 release of Applied Geographic Solutions' (AGS) crime indices are based on data from 2010 to 2014 and provide tract-level information on crime. We use crime rates for 1069 tracts of the Los Angeles Police Department (LAPD) jurisdiction for the same years to assess (1) Spearman Correlations of major crime categories, and (2) accuracy of AGS indices in predicting falling above/below the median and into the highest/lowest quartile of LAPD crime. We also test if adding variables from the American Community Survey (ACS) to regression analyses can help to reduce measurement bias. We found that five of ten AGS indices correlated moderately well with LAPD crime. In unadjusted regressions, robbery, homicide, aggravated assault, motor-vehicle theft and personal crime achieved c-statistics from 0.81 to 0.90. C-statistics improved up to 0.13 points after adding ACS variables. Some AGS crime indices may be reliable proxies for crime in an urban area. The AGS index for total crime, most commonly used in prior research, performed poorly.

Sensitizing Black Adult and Youth Consumers to Targeted Food Marketing Tactics in Their Environments.

Food marketing environments of Black American consumers are heavily affected by ethnically-targeted marketing of sugar sweetened beverages, fast foods, and other products that may contribute to caloric overconsumption. This qualitative study assessed Black consumers' responses to targeted marketing. Black adults (2 mixed gender groups; total n = 30) and youth (2 gender specific groups; total n = 35) from two U.S. communities participated before and after a sensitization procedure-a critical practice used to understand social justice concerns. Pre-sensitization focus groups elicited responses to scenarios about various targeted marketing tactics. Participants were then given an informational booklet about targeted marketing to Black Americans, and all returned for the second (post-sensitization) focus group one week later. Conventional qualitative content analysis of transcripts identified several salient themes: seeing the marketer's perspective ("it's about demand"; "consumers choose"), respect for community ("marketers are setting us up for failure"; "making wrong assumptions"), and food environments as a social justice issue ("no one is watching the door"; "I didn't realize"). Effects of sensitization were reflected in participants' stated reactions to the information in the booklet, and also in the relative occurrence of marketer-oriented themes and social justice-oriented themes, respectively, less and more after sensitization.

Personal, social, and environmental correlates of physical activity in urban African-American women.

BACKGROUND: African-American women are at risk of chronic diseases for which regular physical activity can provide benefits. This group, however, remains predominantly sedentary. Little research has been undertaken to elucidate the multiple factors that influence their physical activity levels. This study was designed to determine associations among personal, social environmental, and physical environmental factors with physical activity level in urban African-American women. METHODS: The Women and Physical Activity Survey, an interviewer-administered survey consisting of demographic, personal, and social and physical environmental factors, was given to 234 African-American women living in Baltimore, Maryland. Physical activity level was determined from the Behavioral Risk Factor Surveillance System survey. Women were divided into three groups: meeting current recommendations for moderate or vigorous physical activity, insufficiently active, and inactive. Comparisons were made between the group of women that met recommendations versus women who did not, and women who reported any activity versus women who were inactive. RESULTS: Twenty-one percent (48) of women met recommendations for physical activity, 61% (143) were insufficiently active, and 18% (43) were inactive. Women who had a partner or who had no children were less likely to engage in some physical activity. Inactive women were more likely than women who participated in some physical activity to know people who exercised. Women who belonged to community groups were more likely to be inactive than women who met current recommendations for physical activity. Women with fewer social roles were more likely to meet current recommendations. Physical environment factors were not associated with physical activity level. CONCLUSIONS: Further exploration is needed to determine how personal and social environmental and physical environmental factors relate to physical activity in African-American women.

Personal, social, and physical environmental correlates of physical activity levels in urban Latinas.

BACKGROUND: Nationwide, Hispanic women report low levels of physical activity and bear excess health risk associated with inactivity. This study investigated the relationship between physical activity levels and sociodemographic, social environmental, and physical environmental factors. DESIGN: A cross-sectional, community-based convenience sample of 285 Hispanic/Latino women completed a face-to-face survey administered in Spanish. MAIN OUTCOME MEASURES: The following categories of physical activity were used in analyses: "meets current national recommendations," which includes women who reported engaging in moderate activity at least 5 days per week for at least 30 minutes or who engaged in vigorous activity at least 3 days per week for at least 20 minutes; "insufficiently active" for women not meeting moderate or vigorous objectives; and "inactive" for women who report no moderate or vigorous physical activity. RESULTS: The majority of women (46%) were aged 20 to 29 years, 48% have less than or equal to a high school education, 72% are employed, 43% speak Spanish, and 76% are from Central or South America. A total of 37% of the women met physical activity recommendations, 23% were inactive, and 40% were insufficiently active. Personal and physical environmental factors were not statistically significant correlates of activity level comparison groups; however, most indicated trends in the hypothesized direction. Social environmental factors that showed statistically significant relationships with various physical activity comparison groups included the following: Women were significantly less likely to be active if they reported knowing people who exercise (odds ratio [OR]=0.42; 95% confidence interval [CI], 0.23-0.76), reported that there are people in the neighborhood who exercise (adjusted OR=0.19; 95% CI, 0.09-0.42), belonged to community groups (OR=0.32; 95% CI, 0.15-0.69), or attended religious services (OR=0.41; 95% CI, 0.41-0.72). CONCLUSION: Social environmental factors appeared to be the most important factors related to physical activity in this group of Latino women. Physical environment and personal factors, although not statistically significant, showed trends in expected directions and should be explored further.

Quantitative study of correlates of physical activity in women from diverse racial/ethnic groups: Women's Cardiovascular Health Network Project--introduction and methodology.

BACKGROUND: Physical activity is an important aspect of cardiovascular disease prevention. However, data show a high prevalence of physical inactivity among women and ethnic minority and low-income populations. The purpose of this introduction is to describe the Women's Cardiovascular Health Network Project and implementation of the Women and Physical Activity Survey. The goal of the survey was to identify personal, social environmental, and physical environmental factors that are associated with physical activity status among diverse groups of women. METHODS: Seven universities were funded to study factors that influence physical activity among African-American, Native American, Latina, and white women residing in rural, suburban, and urban living environments. An ecologic model was used to design a quantitative questionnaire that was implemented by telephone or face-to-face interviews in seven sites across the United States. RESULTS: The survey was completed by a total 4122 women, with group totals ranging from 300 to 1000. Results from each site are presented in individual articles in this issue. A summary of results that compare and contrast the groups is presented in an additional report. CONCLUSION: This study provides important information on the assessment of physical activity among women. Results can be used to help improve assessments and to develop more effective policies and interventions for unique groups of women.

Weight status in US youth: the role of activity, diet, and sedentary behaviors.

OBJECTIVES: To assess associations of physical activity, diet, and sedentary behaviors with overweight and obesity. METHODS: Analyses of the NHANES 2003-06 were conducted among 2368 US adolescents, ages 12-19. Self-reported diet and sedentary behavior measures were used; physical activity was assessed using accelerometers. RESULTS: Television/video viewing (OR=1.84; CI=1.24, 2.69), physical activity (OR=0.75; CI=0.59, 0.95), and fiber intake (OR=0.96; CI=0.92, 0.99) were associated with obesity whereas television/video viewing was a risk factor for overweight (OR=1.57; CI=1.1, 2.63). CONCLUSIONS: Findings using accelerometer-measured physical activity are consistent with results from other studies using self-reported measurements. No interactions with ethnicity and gender were found.

Correlates of physical activity among women from diverse racial/ethnic groups.

OBJECTIVE: Women have lower rates of participation in leisure time physical activity than men and have been studied to a lesser extent than men. Because physical activity plays a vital role in overall health, it is important to identify factors than can help increase physical activity rates for women. METHODS: Defining and understanding correlates of physical activity is critical for at-risk populations and for planning effective interventions. This paper reviews research conducted in the past two decades on correlates of physical activity in women. An ecological model with an added physical environment component was used to organize the correlates. Studies conducted among adult white, black, American Indian, Asian, and Hispanic women are included. A total of 91 studies were reviewed. Many studies included white women, fewer studies included black and Hispanic women, and even fewer included American Indian women, and only 3 studies included Asian women. RESULTS: The correlates most studied are sociodemographic variables, with nonwhite race, lower educational levels, and older age most consistently associated with lower levels of physical activity. Few studies focused on environmental and policy correlates. Social support was an overwhelmingly positive determinant of physical activity for all groups of women. CONCLUSIONS: Based on these findings, we recommend that future research include more diverse groups of women and evaluate modifiable factors, such as psychological, interpersonal, and environmental correlates. Future research also should include more intervention and longitudinal studies.