Association of Food Access, Recreational Opportunities, and Natural Amenities with Engagement in the Veterans MOVE! Weight Management Program.

OBJECTIVE: The aim of this study was to examine the association of county-level food access, recreational opportunities, and natural amenities with participant engagement in a weight management program. METHODS: In this cohort study, participants in the Veterans Health Administration MOVE! weight management program between October 1, 2007, and September 30, 2013, were observed for 12 months after enrollment. Engagement was measured as the number of program visits per year at 12 months. Cross-sectional analysis and spatial regression were used to examine county characteristics associated with greater participant engagement at 12 months. RESULTS: A total of 321,624 participants in 2,708 counties were included. Greater engagement was associated with older age, female sex, white race, being married, and being retired. After accounting for similarities between nearby communities, engagement at 12 months was 3.1 visits higher for each additional farmers' market per 1,000 population (P = 0.01). Engagement was highest for participants living in counties with the most natural amenities (P < 0.001). Recreational opportunities had only a small effect on engagement in the program (ß = 0.02 visits at 12 months; P = 0.002). CONCLUSIONS: Consideration of a participant's county characteristics in addition to other known demographics and program factors may help to explain variation in engagement in weight management programs.

Associations between neighborhood socioeconomic environment and physical activity in Cuban immigrants.

Physical inactivity is a major public health concern because it is a determinant of obesity and obesity-related chronic diseases. Few longitudinal studies have examined the association between neighborhood socioeconomic (SES) environment and change in physical activity behaviors. Additionally, few studies have examined this association in immigrant groups or Hispanic subgroups such as Cubans. This research aimed to determine if neighborhood SES is associated with longitudinal change in moderate-to-vigorous physical activity (MVPA) among Cuban immigrants who participate in the Cuban Health Study in Miami, Florida. Data on 280 participants [mean age: 37.4 (± 4.6), 48.9% women, mean body mass index: 25.0 (± 2.5)] collected at baseline, 12 months and 24 months were analyzed. Minutes of MVPA were objectively measured during each data collection period using accelerometers. A neighborhood SES score was calculated for each participant's residential census tract from American Community Survey data on median household income, median housing value, educational attainment and occupation. The neighborhood SES score was grouped into tertiles, reflecting low, moderate and high neighborhood SES environment. Multilevel linear models were used to examine the relationship between neighborhood SES and change in MVPA over 24 months. At baseline, 94 (33.6%), 108 (38.6%) and 78 (27.9%) participants resided in low, moderate, and high SES neighborhoods, respectively. After adjusting for age, sex, and body mass index, no difference in average change in MVPA over time was observed between participants residing in low and moderate SES neighborhoods (p=0.48) or low and high SES neighborhoods (p=0.62). In Cuban immigrants, longitudinal change in MVPA may not vary by neighborhood socioeconomic environment.

Walking and proximity to the urban growth boundary and central business district.

BACKGROUND: Planners have relied on the urban development boundary (UDB)/urban growth boundary (UGB) and central business district (CBD) to encourage contiguous urban development and conserve infrastructure. However, no studies have specifically examined the relationship between proximity to the UDB/UGB and CBD and walking behavior. PURPOSE: To examine the relationship between UDB and CBD distance and walking in a sample of recent Cuban immigrants, who report little choice in where they live after arrival to the U.S. METHODS: Data were collected in 2008-2010 from 391 healthy, recent Cuban immigrants recruited and assessed within 90 days of arrival to the U.S. who resided throughout Miami-Dade County FL. Analyses in 2012-2013 examined the relationship between UDB and CBD distances for each participant's residential address and purposive walking, controlling for key sociodemographics. Follow-up analyses examined whether Walk Score(®), a built-environment walkability metric based on distance to amenities such as stores and parks, mediated the relationship between purposive walking and each of UDB and CBD distance. RESULTS: Each one-mile increase in distance from the UDB corresponded to an 11% increase in the number of minutes of purposive walking, whereas each one-mile increase from the CBD corresponded to a 5% decrease in the amount of purposive walking. Moreover, Walk Score mediated the relationship between walking and each of UDB and CBD distance. CONCLUSIONS: Given the lack of walking and walkable destinations observed in proximity to the UDB/UGB boundary, a sprawl repair approach could be implemented, which strategically introduces mixed-use zoning to encourage walking throughout the boundary's zone.