Perspectives on healthy behaviors among low-income Latino and non-Latino adults in two rural counties.

OBJECTIVES: Rural populations and individuals with low incomes are less likely than the general population to achieve recommended levels of physical activity and fruit and vegetable consumption. The purpose of this study was to describe the perspectives of low-income adults in 2 rural Wisconsin counties on the factors that influence physical activity and healthy eating. DESIGN AND SAMPLE: A qualitative descriptive study was conducted using 4 focus groups: 2 in English and 2 in Spanish. A convenience sample (N=20) was recruited. MEASURES: Focus group questions and data analysis were based on an ecological framework. A team of 3 researchers performed content analysis of focus group transcripts. RESULTS: Participants reported individual, social, and community influences on health behaviors. Individual barriers included lack of motivation and lack of knowledge. Participants described the importance of family, friends, and the community social climate for health behaviors. Latinos emphasized the need for resources such as community gardens and public spaces for physical activity, while non-Latinos recommended community education related to healthy eating. CONCLUSIONS: The results suggest that relevant health promotion strategies in rural, low-income populations include multilevel approaches, the development of schools as health promotion resources, and strategies to build social connections among community residents.

Perceived influences on physical activity and diet in low-income adults from two rural counties.

BACKGROUND: Despite the increased use of ecological models in health behavior research, multilevel influences on health behaviors in rural, low-income people, an aggregate at high risk for sedentary behavior and inadequate diets, have been examined in few studies. OBJECTIVE: The purpose of this study was to describe influences on physical activity and diet in low-income, rural adults. METHOD: A cross-sectional survey was conducted using face-to-face interviews in a convenience sample of 137 low-income Anglo and Latino adults recruited from two rural Wisconsin counties. The survey included questions on health behaviors, self-efficacy, barriers, social support, and community environments. Self-report data on physical activity and fruit and vegetable intake were categorized into outcome variables of meets recommendation or does not meet recommendation. Latent class cluster analysis was used to identify clusters of participants with similar influences on health behaviors, and cluster membership was used as an independent variable in logistic regression of physical activity and diet outcomes. RESULTS: Fifty-two percent of participants met a recommendation for physical activity, but only 8% met their MyPyramid recommendation for fruit and vegetable intake. Participants in the moderate self-efficacy/high safety cluster were significantly more likely than those in the low self-efficacy/moderate safety cluster to meet a recommendation for physical activity (odds ratio = 2.65). For healthy diet, participants in the low barriers cluster were significantly more likely to eat more fruits and vegetables (odds ratio = 4.13) than those in the high barriers cluster. DISCUSSION: People with healthier behaviors were distinguished from those with less healthy behaviors by higher levels of intrapersonal, interpersonal, and community supports. Results support the importance of multilevel approaches to promoting healthy lifestyles in rural, low-income adults.

Cancer prevention services and physician consensus in primary care group practices.

BACKGROUND: We conducted a randomized clinical trial of interventions to achieve physician consensus, practice changes, and patient activation designed to help primary care group practices enhance the delivery of cancer prevention and screening services. METHODS: In each of 42 primary care practices in 1991 to 1994, we studied approximately 60 patients per physician who were between the ages 53 and 64. Data sources included patient and physician questionnaires, medical record audits of consenting patients for evidence of 11 cancer prevention services during the previous 3 years, and telephone interviews with key practice personnel. RESULTS: None of the interventions was associated with significant changes in frequency of services or procedures received or provided. Increased frequencies of services overall and of specific activities were associated with HMO membership or insurance coverage for six screening procedures. Patient reports of clinic staff recommendations to have each of six screening procedures were specifically associated with higher frequencies of services (P = 0.001). CONCLUSIONS: Demonstration of intervention impact may have been limited because the rates of prevention services were significantly higher in this study than have been reported elsewhere. These results might be explained by selection biases inherent in studying patients with a regular provider, overall practice trends for changes in provision of the studied services, and the study methods.

A participatory assessment of environmental health concerns in an Ojibwa community.

This research employed a participatory approach to explore environmental health (EH) concerns among Lac Courte Oreilles (LCO) Ojibwa Indians in Sawyer County, Wisconsin. The project was grounded in a broad ecological conceptualization of EH and in principles of health promotion and community participation. Community participation was accomplished through a steering committee that consisted of the primary author and LCO College faculty and community members. The selected assessment methodology was a self-administered survey mailed to LCO members in Sawyer County. Concern for environmental issues was high in this tribal community, especially for future generations. Concern was higher among older members and tribal members living on rather than off the reservation. Local environmental issues of concern were motorized water vehicles, effects from global warming, aging septic systems on waterways, unsafe driving, and contaminated lakes/streams. The LCO community can use survey results to inform further data needs and program development.