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World Cancer Research Fund/American Institute for Cancer Research. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: a.

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Presentation on theme: "World Cancer Research Fund/American Institute for Cancer Research. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: a."— Presentation transcript:

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2 World Cancer Research Fund/American Institute for Cancer Research. Policy and Action for Cancer Prevention. Food, Nutrition, and Physical Activity: a Global Perspective. Washington DC: AICR; 2009.

3 Ward BW, Schiller JS, Freeman G. Early release of selected estimates based on data from the January–September 2013 National Health Interview Survey. National Center for Health Statistics. March Available from:

4 ADULTS 18 AND OVER BY SEXADULTS 18 AND OVER BY RACE/ETHNICITY Ward BW, Schiller JS, Freeman G. Early release of selected estimates based on data from the January–September 2013 National Health Interview Survey. National Center for Health Statistics. March Available from:

5 Physical Activity Public Policy local, state and national laws and policies Environmental Factors access to recreational facilities, walkable communities, sidewalks and bicycle lanes, worksite programs and policies, school-based programs Interpersonal Relationships social networks and support systems, including family, friends, co-workers Intrapersonal Factors individual characteristics, such as age, sex, gender, beliefs, motivation, self-concept, etc. Model adapted from: King AC, Sallis JF. Why and how to improve physical activity promotion: Lessons from behavioral science and related fields. Preventive Medicine. 2009; 49: ; McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education & Behavior. 1988;15:

6 Social Support Physical Activity Intrapersonal Factors Cognition Beliefs Motivation Intrapersonal Factors Cognition Beliefs Motivation

7  Interpersonal relationships  Social support  Social networks  Social inequalities  Socioeconomic position and income inequality  Racial discrimination  Neighborhood and community characteristics  Social cohesion and social capital  Neighborhood factors McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:

8  Social support  Resources provided by other persons  Social networks  Collective structure of social relationships that surround an individual  Provide information on how an individual is integrated with others McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:

9 Constrains the adoption of health promoting behaviors Enables the adoption of health promoting behaviors Provides access to resources & material goods Provides individual & community coping responses Buffers negative health outcomes Restricts contact to infectious disease McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:

10  Whitehall studies (1984) showed health gradients based on occupational class  3 fold increase in mortality between lowest and highest employment grades  Gradient persists after controlling for smoking Marmot MG, Shipley MJ, Rose G. Inequalities in death—specific explanation of a general pattern? Lancet. 1984;1(8384):

11  Your place in the social hierarchy  Indicators include  Individual income  Educational attainment  Occupational or job status McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:

12 Socioeconomic Position ↑ Biological Stress ↓ Health ↓ Accumulation of and Access to Material Resources that Protect against Stress

13 Gilson D, Perot C. It’s the Inequality, Stupid. March/April

14 McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63: Income Inequality Disinvestment in Social Capital ↓ Social Cohesion ↓ Social Spending on Programs and Services ↑ Negative Psychosocial Conditions

15  Differential treatment  Interpersonal ▪ Occurs between individuals  Institutionalized ▪ Discriminatory policies or practices ▪ Results in differential access to resources and societal opportunities ▪ Restricted access to types of physical activity (e.g. baseball) ▪ Restricted access to physical activity venues (e.g. golf clubs, swimming pools) McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:

16 Emple H. Documenting Discrimination in Local Rental Markets. May ; Frey WH. America’s Diverse Future: Initial Glimpses at the U.S. Child Population from the 2010 Census. Washington, DC: Brookings;

17 McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63: Racial Discrimination ↑ Economic and Social Deprivation ↑ Exposure to Harmful Substances ↑ Psychological Trauma

18 PEOPLE  Individual factors that influence health  Income and education  Physical and mental health  Knowledge, attitudes and beliefs about health-related behaviors  Perceptions of interpersonal bias or discrimination PLACE  Characteristics of the place where you live  Social cohesion  Social capital  Neighborhood socioeconomic position  Influence health-related behaviors directly and indirectly McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:

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20 Social Cohesion and Social Capital Reinforces Group and Social Norms Provides Tangible Support ↑ Health Behaviors

21  Neighborhood socioeconomic position  Deprivation  Home ownership  Presence/lack of neighborhood resources  Supermarkets/grocery stores  Parks, fitness and community centers  Perception of crime McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63: ; Figure adapted from Table 2 in Sundquist J, Malmstrom M, Johansson S. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol. 1999;28(5):841-5.

22 Neighborhood Factors Elements of the physical environment Historical and Cultural Features Availability of Support Services McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63: Smog, poor air quality Lack of recreation facilities, reduced PE in schools, limited trash pick up Social and cultural norms for physical activity

23  We know that  Physical inactivity is a problem.  The social environment plays an important role on behavior.  BUT…Do the frameworks we have fit women?  …who are less physically active than men?  …have different social and cultural norms? Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

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25  Most studied and understood construct  Consistently positively correlated with physical activity among women  79.1% of studies addressed this  55.8% of these studies included ethnic minorities  3 major types  Emotional  Tangible  Informational Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

26  Ethnic minority women with low physical activity support are more likely to be sedentary  Women with high support were more likely to  Meet leisure-time physical activity recommendations (≥150 min/week)  Lead a physically active lifestyle (~300 min/week)  Support from family and friends predicts exercise adherence Eyler AA, Brownson RC, Donatelle RJ, King AC, Brown D, Sallis JF. Physical activity social support and middle- and older-aged minority women: results from a US survey. Soc Sci Med. 1999;46(6):781-9.; Oka R, King AC, Young D. Sources of social support as predictors of exercise adherence in women and men ages 50 to 65 years. Womens Health. 1995;1(2):

27 Miller YD, Trost SG, Brown WJ. Mediators of physical activity behavior change among women with young children. Am J Prev Med. 2002;23(2 Suppl 1): Print+Community Development Intervention Women with increased partner support were 2.29 times more likely to meet PA guidelines Print+Community Development Intervention Women with increased partner support were 2.29 times more likely to meet PA guidelines

28  Must be tailored and include  Benefits of physical activity for women  Strategies to incorporate into women’s lives  Increases exercise adherence  More valuable from health professionals Duncan T, Duncan S, McAuley E. The role of domain and gender specific provisions of social relations in adherence to a prescribed exercise regimen. J Sport Exerc Psychol. 1993;15:

29 LIFE TRANSITIONS  Marriage  Parenthood  Employment MULTIPLE ROLES  Wife  Mother  Employee  Caretaker  Head of household Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.  53.5% of studies addressed this  60.9% of these studies included ethnic minority women

30  Women were more likely to be “inactive” if they reported  Getting married (OR=1.46)  Giving birth to a first (OR=2.27) or subsequent child (OR=2.06)  Becoming a single parent (OR=1.32)  Beginning work (OR=1.15) Brown WJ, Trost SG. Life transitions and changing physical activity patterns in young women. Am J Prev Med. 2003;25(2):140-3.

31  Related to increasing responsibilities  Lack of time is #1 barrier  Family responsibilities are a priority ▪ Require a lot of time ▪ Physically demanding  Household and caregiving responsibilities limit leisure-time/physical activity “I think aerobics, like [doing an] aerobics tape is a waste of time. You stand there doin‘ that, you're not accomplishing anything. If you were dusting, and carpet sweeping the floor, or vacuuming, you're doing something.” Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.; Eyler AA, Baker E, Cromer L, King AC, Brownson RC, Donatelle RJ. Physical activity and minority women: a qualitative study. Health Educ Behav. 1998;25(5):

32 Social roles and responsibilities Busy schedules Physical activity Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.; Sternfeld B, Ainsworth BE, Quesenbury CP. Physical activity patterns in a diverse population of women. Prev Med. 1999;28(3):

33  Women think they are doing enough physical activity because they are busy.  May not be enough to benefit their health, but not willing to add more to their schedule. Social roles and responsibilities Busy schedulesPhysical activity Too tired to exercise Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

34  Most complex aspects of the social environment  Least understood and studies  39.5% of studies looked at this  76.5% of these studies included ethnic minorities  Key issues  Acceptance of physical activity  Cultural appropriateness of physical activity for adult women  Lack of role models Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

35  Need spouse to give consent or allow them time to do physical activity  Especially true among Hispanics  Lack of acceptance leads to feeling guilty or selfish “Unless it fits into the usual family life pattern, PA does not happen.” “I think that’s probably the biggest obstacle is getting out of the house. To even do it. And the support is where it comes in.” Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.; Berg J, Cromwell S, Arnett M. Physical activity: perspectives of Mexican American and Ango American midlife women. Health Care Women Int. 2002;23(8):

36  Gender-role expectations  Social and cultural pressure to  Conform to role as mothers  Conform to role as primary caretakers/caregivers  Put family obligations and relationships ahead of their own needs Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

37  Lack of role models adds to perceived lack of community and social support  Role models would  Make physical activity more socially acceptable  Make women feel comfortable and confident about being physically active Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

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39 Potential TargetsIntervention Strategies Individual womenEducational programs emphasizing importance of PA for women* Programs to develop communication and support-seeking skills Programs with culturally appropriate options and instructions for exercise Key individuals (e.g. spouse, partner, family member) Programs teaching family members skills for providing support (e.g. sharing duties) Programs involving key individuals in PA Health care providersPrograms to develop emotional and informational support skills Educational materials to give to women *Applicable to all potential targets Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

40 Potential TargetsIntervention Strategies Leaders in workplace, clubs, churches, or other social settings Programs targeting key leaders to enhance acceptance of PA for women Recognition of leaders who support PA through advocacy, policies and modeling Organization or groupPrograms to strengthen existing support networks for PA Programs to develop new networks for PA Creation of worksite policies that enhance PA (e.g. childcare, flexible schedule) Organization provides additional PA opportunities and support services Community-wideProvide childcare support services Provide programs allowing women to trade time with other mothers for PA time Create or recognize active role models Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

41 Potential TargetsIntervention Strategies Community campaigns targeting key individuals, key leaders and organizations, and health care providers Media and social marketing interventions to Change norms for PA in women Increase acceptance of PA Provide positive, active role models Develop health communication messages that emphasize the importance of PA to women’s health Advocacy and public policy campaignsOrganize and support efforts to create acceptable and appropriate opportunities for women to be physically active (e.g. women-friendly facilities) Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

42 Cavallo DN, Brown JD, Tate DF, DeVellis RF, Zimmer C, Ammerman AS. The role of companionship, esteem, and informational support in explaining physical activity among young women in an online social network intervention. J Behav Med. 2013; In press. DOI /s

43 COMPLETERSNONCOMPLETERS Huberty JL, Ehlers D, Coleman J, Gao Y, Elavsky S. Women Bound to be Active: Differences in long-term physical activity between completers and noncompleters of a book club intervention. J Phys Act Health. 2013;10(3)

44  “The interaction with women [in WBA] was very rewarding.”  “They [WBA women] were great as an initial ‘get going,’ but then I kinda went on my own and family became more of my support.”  “I learned this skill…of reaching out and asking for support or looking for support…that has stayed with me since the program.” Huberty JL, Ehlers D, Coleman J, Gao Y, Elavsky S. Women Bound to be Active: Differences in long-term physical activity between completers and noncompleters of a book club intervention. J Phys Act Health. 2013;10(3)

45  SisterTalk  12 one-hour weekly programs  Mailed corresponding print material  Goals to “eat better, move more and feel great” Risica PM, Gans KM, Kumanyika S, Kirtania U, Lasater TM. SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women. Int J Behav Nutr Phys Act. 2013;10:141.

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47 Microsystem MesosystemMacrosystem Multilevel intervention strategies Vrazel J, Saunders RP, Wilcox S. An overview and proposed framework of social-environmental influences on the physical-activity behavior of women. Am J Health Promot. 2008;23(1):2-12.

48 Scherezade K. Mama, DrPH Postdoctoral Fellow Department of Health Disparities Research The University of Texas M.D. Anderson Cancer Center Houston, Texas Phone:


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