American Journal of Health Promotion

To examine the effect of a mail-mediated intervention, based on self-determination theory, on adults' exercise behavior.

The study was a randomized control trial conducted over a 2-month period. Of the initial 185 volunteer participants, 126 (68.1%) completed questionnaires at baseline, 1 month, and 2 months. Participants in intervention-only and intervention-plus-booster groups received a mail-delivered packet containing strategies designed to promote perceptions of autonomy, competence, and relatedness regarding exercise. Those in a control group received an American Heart Association physical-activity facts packet. After 1 month, those in the intervention-plus-booster group received a booster postcard, reiterating the main points of the initial intervention packet. Exercise behavior was the primary outcome variable. Perceptions of autonomy, competence, and relatedness were evaluated as mediating variables.

Separate 3 (group) × 3 (time) repeated measures analyses of variance conducted for men and women revealed that for women, all three groups significantly increased exercise levels over the 2-month period. No significant interactions were found regarding the influence of the intervention on the mediating variables. A process evaluation indicated a lack of compliance regarding completing intervention-packet worksheets.

Findings suggested that more intensive interventions and greater fidelity of treatment may be needed to evidence change in exercise behavior.

To determine the relationships between delivery agents' physical activity characteristics and subsequent adoption of a physical activity promotion program for community implementation.

Agents responsible for county health promotion in Kansas (n = 91; 94.5% women; mean age = 43.0 ± 11) completed interviews that assessed physical activity self-efficacy, value, and participation. Subsequent implementation of a physical activity program was monitored. The response rate was 100%.

Fifty-five percent of the agents met Centers for Disease Control and Prevention (CDC) recommendations for physical activity, 35% were active but did not meet CDC recommendations, and 10% were inactive. On the basis of logistic regression analysis (Wald statistic = 7.63; p < .05), agents who met recommendations were more likely to adopt the program for their county (69%) than were agents who were less active (41%) and inactive (11%).

The data suggest that increasing the proportion of delivery agents who meet the CDC recommendations for physical activity could be related with a higher proportion of communities implementing physical activity programs.

Health Belief Model (HBM) and Transtheoretical Model concepts were used to investigate possible differences in perceptions of physical activity among African-American college women categorized by their stage of physical activity behavior.

A survey was administered to 233 participants to assess their stage of physical activity behavior and HBM perceptions. Analysis of variance was used to investigate possible differences among HBM constructs for each behavior stage.

Perceived barriers were significantly higher (p < .05), and perceived severity, cues to action, and self-efficacy were significantly lower in the inactive group than in the active group. For example, perceived barriers were significantly higher in the inactive (mean = 2.3) stage than in the preparation (mean = 2.1), action (mean = 1.9), and maintenance (mean = 1.7) stages of physical activity behavior.

The results suggest that many perceptions of physical activity differ significantly among stages of behavior in this sample of African-American college women. A limitation was that some scales were modified specifically for this population and were not validated.

This study describes the prevalence and patterns of environmental tobacco smoke (ETS) exposure in a large, well-defined cohort of professional, female school employees in California.

This is a cross-sectional study based on survey responses from members of the California Teachers Study (CTS) cohort.

The analyses focused on lifetime nonsmokers (N = 61,899) in the CTS cohort who responded to detailed questions on lifetime ETS exposures in the home, workplace, and other social settings.

Demographic characteristics, smoking status, and ETS exposure were based on self-reported data from two mailed surveys. Prevalence estimates within the cohort were compared with those from the California Behavioral Risk Factor Survey and the California Adult Tobacco Survey.

ETS exposures were highest for never smokers born in the 1930s (78% in the home, 66% in the workplace, and 48% in other social settings) and steadily declined among participants born in later years. ETS exposure from spousal smoking peaked during the 1950s (37%). In the 1980s, the workplace (28%) replaced the household (19%) as the primary exposure setting.

Consideration of these patterns in the prevalence of ETS exposures is important in the interpretation and design of tobacco-related health studies.

To test whether a mailing describing new coverage for smoking cessation medications increases benefit knowledge, utilization, and quitting.

This randomized controlled trial assigned participants to benefit communication via (1) standard contract changes or (2) enhanced communication with direct-to-member postcards. A sample of 1930 self-identified smokers from two Minnesota health plans took surveys before and 1 year after the benefit's introduction. The follow-up response rate was 80%. A multilevel logistic estimator tested for differences in benefit knowledge and smoking behavior from baseline.

More enhanced than standard communication respondents knew about the benefit (39.0% vs. 22.2%, p < .0001) at follow-up. Groups did not differ on bupropion utilization (24.6% vs. 23.1%, p = .92); nicotine replacement therapy utilization (26.9% vs. 25.9%, p = .26), or cessation (12.8% vs. 15.6%, p = .32).

Although limited by the low intervention intensity and potential social desirability bias, information about new coverage alone does not appear to increase quitting behaviors.

To identify factors associated with receipt of physician advice on diet and exercise, including patient sociodemographic characteristics, health-related needs, and health care access, using Andersen's model of health care utilization.

A cross-sectional analysis was performed using data from the 2000 National Health Interview Survey (NHIS).

NHIS data were collected through personal household interviews by Census interviewers. The overall response rate for the 2000 NHIS adult sample was 82.6%.

Subjects were a representative sample of the American civilian, noninstitutionalized population aged 18 and older. After eliminating missing data and respondents who reported they did not see a doctor in the past 12 months, sample sizes for physician advice on diet and exercise were n = 26,255 and n = 26,158, respectively.

Using the 2000 NHIS, the prevalence of receipt of physician advice on diet and exercise was assessed. Multiple logistic regression analyses were performed to examine the associations between receipt of physician advice on diet and exercise and potential predictors, adjusting for all covariates.

By self-report, 21.3% and 24.5% of respondents received physician advice on diet and exercise, respectively. Being middle-aged (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI], 1.0–1.29 for diet; AOR = 1.55, 95% CI = 1.33–1.79 for exercise) and having a baccalaureate degree or higher (AOR = 1.78, 95% CI = 1.52–2.08 for diet; AOR = 1.75, 95% CI = 1.47–2.07) were associated with a higher likelihood of receiving physician advice on diet and exercise. African-Americans (AOR = .78, 95% CI = .67–.92) and foreign-born immigrants (AOR = .57, 95% CI = .38–.86) were less likely to receive physician advice on exercise. The prevalence of physician advice was higher for persons who chose hospital outpatient departments as a usual source for care (AOR = 2.36, 95% CI = 1.66–3.36 for diet; AOR = 2.39, 95% CI = 1.68–3.4 for exercise) than for adults with other types of usual care sites. Poorer self-rated health status (AOR = 5.2, 95% CI = 4.12–6.57 for diet; AOR = 2.63, 95% CI = 2.04–3.38 for exercise) and obesity (AOR = 2.32, 95% CI = 2.02–2.66 for diet; AOR = 3.01, 95% CI = 2.46–3.69 for exercise) was positively associated with the likelihood of receiving physician advice on diet and exercise.

Effective strategies to increase receipt of physician advice should include efforts to improve access to regular source of care and patient-physician communication. Sociodemographic factors remain independent and important predictors of who obtains such advice.

Lack of physical activity is associated with increased risk of overweight and cardiovascular disease, conditions associated with lower socioeconomic status (SES). Associations between activity levels of urban youth and limited access to safe recreation areas in their neighborhoods of residence were investigated.

Analyses of data from the Project on Human Development in Chicago Neighborhoods, a multilevel longitudinal study of families and communities, are reported.

Chicago, Illinois.

Individual-level data were obtained from 1378 youth 11 to 16 years old and caregivers living in 80 neighborhood clusters. Neighborhood-level data were collected from 8782 community residents and videotapes of 15,141 block faces.

Parental estimates of hours youth spent in recreational programming were used to estimate physical activity. A scale of residents' assessment of neighborhood safety for children's play was created; disorder measures came from videotaped observations.

Physical activity averaged 2.7 hours/week (SD = 5.0), varying significantly across neighborhoods. Using hierarchical linear regression, SES, age, and male gender, but not body mass index, were independently associated with physical activity. Lower neighborhood safety and social disorder were significantly associated with less activity, controlling for demographics.

One mechanism for reduced physical activity among youth may be the influence of unsafe neighborhoods. Neighborhood interventions to increase safety and reduce disorder may be efficacious in increasing physical activity, thereby reducing risk of overweight and cardiovascular disease.

The purpose of this study was to investigate the proportion of short trips made by walking among Michigan adults and barriers to walking for transportation.

Four questions on walking for transportation were asked of 3808 respondents to the Michigan Behavioral Risk Factor Surveillance System (BRFSS) between January and December 2001.

Three quarters (74.3%) of Michigan adults were estimated to have made at least one short trip (.25–1 mile) in the previous week; however, only 36.2% of them walked even one of these trips. The mean proportion of short trips walked was 21.4%; less than 10% of all respondents walked five or more trips per week.

Our results provide a Michigan-specific baseline for Healthy People 2010 Objective 22-14 (i.e., increase the proportion of trips made by walking) and suggest the potential for these questions to be used to monitor active transportation via the BRFSS.