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Physical Activity Promotion for Reducing Health Disparities in Rural Communities

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 50911

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Assoc. Prof. Dr. Cynthia Perry

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Guest Editor

School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA
Interests: community-based participatory research; physical activity promotion in rural communities to promote health equity, dissemination and implementation of evidence-based programs in rural communities

Assoc. Prof. Dr. Christiaan Abildso

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Assistant Guest Editor

School of Public Health, West Virginia University, Morgantown, WV, 25606, USA
Interests: theory-based health promotion program evaluation; social ecological determinants of physical activity, especially in rural areas; pedestrian and bicyclist safety

Prof. Dr. M. Renée Umstattd Meyer

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Assistant Guest Editor

Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
Interests: promoting health and health equity through an active living lens; using mixed method approaches to understand cultural context and advance approaches and policies to foster healthy and active opportunities and lifestyles for all people; partnering with underserved rural communities and families

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the socio-ecological factors associated with physical activity and physical activity promotion in rural communities as a way to address health disparities.

Rural residents are not physically active enough to receive the health benefits from physical activity and they suffer disparities in chronic illness and cancers associated with physical inactivity. The socio-ecological model describes multiple interacting domains that impact physical activity, including individual, social/intrapersonal, community/environment (built and natural), and policy. Rural communities are diverse and experience challenges to promoting physical activity across all the socio-ecological domains. While there is a growing body of research examining the influences on physical activity and the impact on interventions designed to increase physical activity within and across these domains, more is needed to understand the effective approaches to promote physical activity and improve rural health and health disparities.

In this Special Issue, we invite researchers to submit high-quality empirical papers or systematical reviews related to the socio-ecological factors associated with physical activity and physical activity promotion, including multi-level interventions, in rural communities.

Prof. Dr. Cynthia Perry
Prof. Dr. Christiaan Abildso
Prof. Dr. M. Renée Umstattd Meyer
Guest Editors

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Keywords

physical activity
rural
socio-ecological model
interventions
health equity
policy
built environment

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Published Papers (12 papers)

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9 pages, 655 KiB

Open AccessCommunication

Implementation of Physical Activity Programs for Rural Cancer Survivors: Challenges and Opportunities

by Kelly A. Hirko, Joan M. Dorn, James W. Dearing, Catherine M. Alfano, Annemarie Wigton and Kathryn H. Schmitz

Int. J. Environ. Res. Public Health 2021, 18(24), 12909; https://doi.org/10.3390/ijerph182412909 - 7 Dec 2021

Cited by 7 | Viewed by 2899

Abstract

Physical activity after cancer diagnosis has been consistently associated with improvements in quality of life and prognosis. However, few cancer survivors meet physical activity recommendations, and adherence is even lower among those living in rural settings. The purpose of this quasi-experimental study was to evaluate the implementation of a clinic-based physical activity program for cancer survivors at a rural community oncology setting. We also examined changes in quality-of-life measures among 24 cancer survivors participating in the physical activity program and described challenges and opportunities to optimize future implementation efforts in rural settings. Significant pre- to post-program improvements in fatigue (5.5 to 6.8; p = 0.03), constipation (7.7 to 9.0; p = 0.02), pain (6.7 to 8.0; p = 0.007), and sleep quality (p = 0.008) were observed. Participants also reported improved nausea, stamina, depression, stress, and overall physical health after participation in the physical activity program, although the differences were not statistically significant (all p-values > 0.13). However, the reach of the physical activity program was limited, with only 0.59% of cancer survivors participating. Fidelity to the physical activity program was relatively high, with 72.7% of survivors participating in at least five classes. Our findings suggest that physical activity programs in oncological settings may need tailoring to effectively reach rural cancer survivors. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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25 pages, 798 KiB

Open AccessArticle

Do State Comprehensive Planning Statutes Address Physical Activity?: Implications for Rural Communities

by Lisa M. Charron, Chloe Milstein, Samantha I. Moyers, Christiaan G. Abildso and Jamie F. Chriqui

Int. J. Environ. Res. Public Health 2021, 18(22), 12190; https://doi.org/10.3390/ijerph182212190 - 20 Nov 2021

Cited by 4 | Viewed by 3445

Abstract

Less than one-quarter of U.S. adults meet physical activity (PA) recommendations, with rural residents less likely to be active than urban residents. The built environment has been identified as a potential facilitator of PA and local comprehensive plans are a foundational tool for guiding the development of the built environment. The purpose of this study was therefore to understand the current landscape of comprehensive planning state statutes related to PA and rural communities. We used primary legal research methods to identify, compile, and evaluate all 50 state comprehensive planning statutes for items related to PA and conditional mandates based on population size of local jurisdictions. The presence of population-conditional planning mandates and the inclusion of PA-related items was analyzed by state-level rurality using Fisher’s exact tests. Our analyses demonstrated that (1) broader PA-related items were addressed in state statutes more often than more specific PA-related items; (2) when PA-related items were addressed, they were most likely to be mandated, subsumed elements; (3) several PA-related items were less likely to be addressed in the most rural states and/or conditionally mandated for jurisdictions meeting minimum population requirements; and (4) only two states addressed PA directly and explicitly in their comprehensive planning statutes. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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21 pages, 721 KiB

Open AccessArticle

What Sets Physically Active Rural Communities Apart from Less Active Ones? A Comparative Case Study of Three US Counties

by Christiaan G. Abildso, Cynthia K. Perry, Lauren Jacobs, M. Renée Umstattd Meyer, Megan McClendon, Michael B. Edwards, James N. Roemmich, Zachary Ramsey and Margaret Stout

Int. J. Environ. Res. Public Health 2021, 18(20), 10574; https://doi.org/10.3390/ijerph182010574 - 9 Oct 2021

Cited by 3 | Viewed by 4133

Abstract

Background: Rural US communities experience health disparities, including a lower prevalence of physical activity (PA). However, “Positive Deviants”—rural communities with greater PA than their peers—exist. The purpose of this study was to identify the factors that help create physically active rural US communities. Methods: Stakeholder interviews, on-site intercept interviews, and in-person observations were used to form a comparative case study of two rural counties with high PA prevalence (HPAs) and one with low PA prevalence (LPA) from a southern US state, selected based on rurality and adult PA prevalence. Interview transcripts were inductively coded by three readers, resulting in a thematic structure that aligned with a Community Capital Framework, which was then used for deductive coding and analysis. Results: Fifteen stakeholder interviews, nine intercept interviews, and on-site observations were conducted. Human and Organizational Capital differed between the HPAs and LPA, manifesting as Social, Built, Financial, and Political Capital differences and a possible “spiraling-up” or cyclical effect through increasing PA and health (Human Capital), highlighting a potential causal model for future study. Conclusions: Multi-organizational PA coalitions may hold promise for rural PA by directly influencing Human and Organizational Capital in the short term and the other forms of capital in the long term. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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15 pages, 382 KiB

Open AccessArticle

The Effects of Play Streets on Social and Community Connectedness in Rural Communities

by M. Renée Umstattd Meyer, Tyler Prochnow, Andrew C. Pickett, Cynthia K. Perry, Christina N. Bridges Hamilton, Christiaan G. Abildso and Keshia M. Pollack Porter

Int. J. Environ. Res. Public Health 2021, 18(19), 9976; https://doi.org/10.3390/ijerph18199976 - 23 Sep 2021

Cited by 8 | Viewed by 5666

Abstract

Promoting physical activity (PA) is a long-standing public health initiative to improve overall health and wellbeing. Innovative strategies such as Play Streets, temporary activation of public spaces to provide safe places for active play, are being adopted in urban and rural communities to increase PA among children. As part of these strategies, aspects of social and community connectedness may be strengthened. This study analyzes focus groups and interviews from rural Play Street implementation team members (n = 14) as well as adults (n = 7) and children (n = 25) who attended Play Streets hosted in rural North Carolina, Maryland, Oklahoma, and Texas to better understand the added benefits of Play Streets in community connectedness. Overall, elements of social support and social cohesion are mentioned most frequently with instrumental and conditional support; however, concepts of social capital, collective-efficacy, and social identification are also presented. Participants expressed that Play Streets provided more than just PA; they provided opportunities to access and share resources, build perceptions of safety and trust in the community, and develop relationships with others. Fostering community connection through Play Streets may reduce health inequities in rural communities by building community resilience. Community-based PA programming that enhance and capitalize on community connectedness could be effective ways to improving the overall health and wellbeing of residents. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

15 pages, 363 KiB

Open AccessArticle

“You’re Going to Have to Think a Little Bit Different” Barriers and Facilitators to Using mHealth to Increase Physical Activity among Older, Rural Cancer Survivors

by Tamar Ginossar, Heidi Rishel Brakey, Andrew L. Sussman, Brittany Price, Miria Kano, Sally Davis and Cindy K. Blair

Int. J. Environ. Res. Public Health 2021, 18(17), 8929; https://doi.org/10.3390/ijerph18178929 - 25 Aug 2021

Cited by 6 | Viewed by 3645

Abstract

Wearable activity trackers (WATs) hold great promise in increasing physical activity among older cancer survivors. However, older cancer survivors who reside in rural regions are at increased risk of being digitally marginalized. The goal of this study was to learn about WATs adoption motivation and needs of rural older cancer survivors who live in New Mexico, one of the most rural states with the lowest broadband Internet connectivity in the United States. We conducted six key informant interviews and recruited 31 older cancer survivors from rural counties statewide who participated in interviews and focus groups. Our results show great interest in using WATs as part of an intervention to alleviate barriers associated with the digital divide. Participants were offered diverse modalities to support them in adoption of the trackers. These results will be used to inform future interventions and policies focusing on increasing physical activity in older cancer survivors who reside in rural communities. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

16 pages, 1848 KiB

Open AccessArticle

Trail Conditions and Community Use: Utilizing Geospatial Video to Guide the Adoption of a Spatial-Temporal Trail Audit Tool (STAT)

by Carissa Smock, Naomi Carlson and Chelsey Kirkland

Int. J. Environ. Res. Public Health 2021, 18(16), 8741; https://doi.org/10.3390/ijerph18168741 - 19 Aug 2021

Viewed by 3455

Abstract

Physical activity (PA), associated with all-cause mortality, morbidity, and healthcare costs, improves vitamin D absorption, immune response, and stress when completed outdoors. Rural communities, which experience PA inequities, rely on trails to meet PA guidelines. However, current trail audit methods could be more efficient and accurate, which geospatial video may support. Therefore, the study purpose was (1) to identify and adopt validated instruments for trail audit evaluations using geospatial video and a composite score and (2) to determine if geospatial video and a composite score motivate (influence the decision to use) specific trail selection among current trail users. Phase 1 used a mixed-method exploratory sequential core design using qualitative data, then quantitative data for the development of the Spatial-temporal Trail Audit Tool (STAT). Geospatial videos of two Northeast Ohio trails were collected using a bicycle-mounted spatial video camera and video analysis software. The creation of STAT was integrated from Neighborhood Environment Walkability Scale (NEWS), Walk Score, and Path Environment Audit Tool (PEAT) audit tools based on four constructs: trail accessibility, conditions, amenities, and safety. Scoring was determined by three independent reviewers. Phase 2 included a mixed-method convergent core design to test the applicability of STAT for trail participant motivation. STAT has 20 items in 4 content areas computing a composite score and was found to increase trail quality and motivation for use. STAT can evaluate trails for PA using geospatial video and a composite score which may spur PA through increased motivation to select and use trails. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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10 pages, 363 KiB

Open AccessArticle

¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families

by Megan E. McClendon, M. Renée Umstattd Meyer, Tyler Prochnow, Kelly R. Ylitalo, Andrew R. Meyer, Christina N. Bridges Hamilton and Joseph R. Sharkey

Int. J. Environ. Res. Public Health 2021, 18(16), 8618; https://doi.org/10.3390/ijerph18168618 - 15 Aug 2021

Cited by 3 | Viewed by 2890

Abstract

Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children’s PA. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

12 pages, 382 KiB

Open AccessArticle

Environmental Factors Associated with Physical Activity in Rural U.S. Counties

by Christiaan G. Abildso, Shay M. Daily, M. Renée Umstattd Meyer, Michael B. Edwards, Lauren Jacobs, Megan McClendon, Cynthia K. Perry and James N. Roemmich

Int. J. Environ. Res. Public Health 2021, 18(14), 7688; https://doi.org/10.3390/ijerph18147688 - 20 Jul 2021

Cited by 8 | Viewed by 4463

Abstract

Background: Rural U.S. adults’ prevalence of meeting physical activity (PA) guidelines is lower than urban adults, yet rural-urban differences in environmental influences of adults’ PA are largely unknown. The study’s objective was to identify rural-urban variations in environmental factors associated with the prevalence of adults meeting PA guidelines. Methods: County-level data for non-frontier counties (n = 2697) were used. A five-category rurality variable was created using the percentage of a county’s population living in a rural area. Factor scores from Factor Analyses (FA) were used in subsequent Multiple Linear Regression (MLR) analyses stratified by rurality to identify associations between environmental factor scores and the prevalence of males and females meeting PA guidelines. Results: FA revealed a 13-variable, four-factor structure of natural, social, recreation, and transportation environments. MLR revealed that natural, social, and recreation environments were associated with PA for males and females, with variation by sex for social environment. The natural environment was associated with PA in all but urban counties; the recreation environment was associated with PA in the urban counties and the two most rural counties. Conclusions: Variations across the rural-urban continuum in environmental factors associated with adults’ PA, highlight the uniqueness of rural PA and the need to further study what succeeds in creating active rural places. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

12 pages, 569 KiB

Open AccessArticle

Physical Activity Barriers and Assets in Rural Appalachian Kentucky: A Mixed-Methods Study

by Natalie Jones, Deirdre Dlugonski, Rachel Gillespie, Emily DeWitt, Joann Lianekhammy, Stacey Slone and Kathryn M. Cardarelli

Int. J. Environ. Res. Public Health 2021, 18(14), 7646; https://doi.org/10.3390/ijerph18147646 - 19 Jul 2021

Cited by 10 | Viewed by 4333

Abstract

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five focus groups with elected community leaders, community residents, members, and key stakeholders to assess perspectives on physical activity barriers and resources within the county. The cohort survey sample (N = 152) reported a median of 6 barriers (range 0–13) to participating in at least 30 min of physical activity daily. The qualitative analysis yielded three overarching themes related to physical activity participation: lack of motivation, physical environment, and cultural barriers. This mixed-methods study revealed the challenges and perceptions among rural residents across the socioecological model when assessing physical inactivity. Findings can be used to tailor future interventions focused on expanding social support, designing infrastructure, and creating policies that promote physical activity. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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9 pages, 324 KiB

Open AccessArticle

A Cross-Sectional Comparison of Physical Activity during COVID-19 in a Sample of Rural and Non-Rural Participants in the US

by Alan M. Beck, Amanda S. Gilbert, Dixie D. Duncan and Eric M. Wiedenman

Int. J. Environ. Res. Public Health 2021, 18(9), 4991; https://doi.org/10.3390/ijerph18094991 - 8 May 2021

Cited by 11 | Viewed by 3802

Abstract

Physical activity (PA) pre-COVID-19 was lower in rural areas compared to non-rural areas. The purpose of this study was to determine COVID-19’s impact on PA in rural and non-rural residents. A cross-sectional study consisting of a convenience sample of 278 participants (50% rural, 50% non-rural) from 25 states completed an online survey describing their PA behaviors and perceptions during COVID-19. The global physical activity questionnaire was used to determine PA in various domains and summed to determine if the participant met the PA guidelines. Rural participants had a significantly higher body mass index, lower income, and a lower educational attainment. Conversely, non-rural participants reported more barriers to PA. There was no difference in the perception of COVID-19’s impact on PA, specifically; however, rural participants were significantly less likely to meet cardiorespiratory PA recommendations compared to non-rural participants. Conclusions: This study demonstrates the continued disparity in PA between rural and non-rural residents, despite the supposition of COVID-19 being less impactful in rural areas due to sparse populations. Efforts should be pursued to close the PA gap between rural and non-rural residents. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

13 pages, 553 KiB

Open AccessArticle

Papás Activos: Associations between Physical Activity, Sedentary Behavior and Personal Networks among Fathers Living in Texas Colonias

by Tyler Prochnow, M. Renée Umstattd Meyer, Megan S. Patterson, Megan E. McClendon, Luis Gómez, Stewart G. Trost and Joseph Sharkey

Int. J. Environ. Res. Public Health 2020, 17(24), 9243; https://doi.org/10.3390/ijerph17249243 - 10 Dec 2020

Cited by 9 | Viewed by 4023

Abstract

Despite growing health disparities in Latino populations related to lack of physical activity (PA), little is known regarding the impact of social networks on PA and sedentary behavior among a sample of Latino fathers residing in functionally rural colonias. Fathers wore accelerometers and responded to questions regarding their self-efficacy and characteristics of who they were active with most often. Fathers (n = 47) attained a mean of 73.3 min of moderate-to-vigorous PA (SD = 23.8) per day and were sedentary for a mean of 364.0 min (SD = 74.4) per day. In total, fathers reported 205 alters and significantly more family members (M = 3.60, SD = 1.64) than friends (M = 0.77, SD = 1.37). Sedentary time was positively associated with number of peers and inversely related to the number of children reported. Minutes of moderate-to-vigorous PA was significantly associated with greater self-efficacy and number of family members reported. This study contributes to the evidence by further examining PA correlates of Latino fathers from functionally rural colonia communities. Additionally, this study supported both family systems theory and the socio–ecological model as it details the interpersonal and familial influences of PA behavior. Thus, supports for family activity promotion and programs which impact familial norms and activity at the family level may be particularly useful. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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12 pages, 988 KiB

Open AccessProject Report

Get Outside! Promoting Adolescent Health through Outdoor After-School Activity

by Patricia Ann Barfield, Katelyn Ridder, Justin Hughes and Kelly Rice-McNeil

Int. J. Environ. Res. Public Health 2021, 18(14), 7223; https://doi.org/10.3390/ijerph18147223 - 6 Jul 2021

Cited by 10 | Viewed by 4857

Abstract

Background: The Get Outside: After School Activity Program (GO-ASAP) exemplifies how a rural community can utilize its natural resources and community partnerships to promote adolescent health. Methods: A qualitative descriptive inquiry was conducted using convenience sampling. Data were collected from students (n = 13/2018; n = 13/2019) via focus group and art-based method (2018 only) and parent (n = 6/2018) focus group. Data were analyzed via qualitative content analysis using the applied theoretical frameworks of Social Cognitive Theory and Social Determination Theory. Results: (1) Increasing Health-Related Competencies. Students increased their physical activity, improved their sleep, perceived less stress, and reported changes in dietary habits and electronic use. (2) Increasing Social Relatedness. Students made new friends, felt more connected, and spent less time home alone after school. (3) Increasing Autonomy and Intrinsic Motivation. Students recognized their emerging capabilities, and their increased confidence stimulated more action-oriented behavior. Parent-perceived changes support and mirror student reports. Conclusion: Outdoor, nature-based, activity programs are a novel upstream approach to promote adolescent health, especially in rural communities where natural resources often exceed health-service resources and community partnerships are a way of life. Full article

(This article belongs to the Special Issue Physical Activity Promotion for Reducing Health Disparities in Rural Communities)

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