UrbanRural and IncomeRelated Variations in Correlates of Physical

Urban/Rural- and Income-Related Variations in Correlates of Physical Activity in U. S. Adults Sharon E. Parks Robyn Housemann Ph. D, Ross Brownson Ph. D Prevention Research Center at Saint Louis University

Introduction n Importance of physical activity to chronic disease u link to heart disease, colon cancer, NIDDM, osteoporosis u link to 14% (over 250, 000) of premature U. S deaths/year t Mc. Ginnis and Foege, 1993. Much research on racial and gender differences in physical activity Recent foci: environment, SES, intra-personal and interpersonal factors and urban/rural dwelling

Introduction Wilcox et. al 2000 u Analyzed urban/rural differences in physical activity for ethnically diverse, women, ages 40 and older u Significant findings: t Urban- age, barriers, social support t Rural- age, barriers, social support, race, education, enjoyable scenery, not seeing others exercise n Will these differ depending upon SES and in a sample containing men? n

Methods-Sampling n National Physical Activity Survey u Cross-sectional u Random-digit dialing u Modified BRFSS sampling u Over-sampled lower income zip codes u Included 1, 818 men and women

Methods- Instrumentation n Questionnaire ascertained: u Environmental characteristics u Social support u Personal barriers u Participation in physical activity

Methods- Analyses Dependent variable - meets/doesn’t meet recommendations for P. A. based on new BRFSS questions n U. S. Census categories - urban, suburban, rural n Income breaks - less than $20 K (lower) and $20 K or more (higher) n Multivariate-adjusted (age, gender, education, race) ORs and 95% CIs calculated n

Results-Overall

Results-Overall Urban/Rural Patterns n Large urban/rural and income variations found in participants reporting u Places to exercise: neighborhood streets, parks, shopping malls u Personal barriers: fear of injury, being in poor health, disliking exercise u Social support: encouragement from relatives important for P. A

Results-Environment/Access Associations n Places to exercise strongly related to P. A. among urban, higher income and suburban, lower income participants n Parks increased likelihood of lower income, suburban participants to meet recommendations 14. 5 times n Access to an indoor gym was related to P. A. for suburban residents (OR~5. 0)

Results-Environment/Access Associations n Evidence of a “dose-response” relationship between number of places to exercise and likelihood to meet recommendations for all u For example, ORs for urban, higher income t 0 places=1. 00 t 1 place =1. 14 t 2 places=2. 11 t 3 places=3. 87 t 4 places=5. 63

Results-Social Support Associations n Encouragement from friends related to P. A. among urban and suburban lower income and rural, higher income participants n Encouragement from relatives related to P. A. among suburban higher income participants

Results-Personal Barriers Associations n Evidence of a “dose-response” between number or barriers reported and likelihood to meet recommendations u For example, ORs for urban, lower and higher income combined t 0 barriers=1. 00 t 1 barrier = 0. 66 t 2 barriers=0. 42 t 3 barriers=0. 38

Limitations Cross-sectional data n Data collected via telephone survey n Survey conducted only in English n Some survey questions not examined for validity and reliability n

Conclusions n Income level is probably more important than urban/rural dwelling in predicting adults’ likelihood to be physically active n Many significant relationships that emerged here were not previously examined among urban and rural residents

Implications Areas of emphasis for community-based physical activity research and intervention design u For example, enablers and barriers may differ substantially between lower and higher income urban and rural areas n Issues in research likely to show variation between specific communities n

Future Work Longitudinal studies needed u Determine influence of dwelling/income related differences in determinants on adoption and maintenance of physical activity n For the full article see: n Parks SE, Housemann RA, Brownson RC. Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. Journal of Epidemiology and Community Health 2003; 57: 29 -35.