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Physical Activity and Social Support: Do you think you’re better off alone? Scherezade K. Mama, DrPH Postdoctoral Fellow Department of Health Disparities Research The University of Texas M.D. Anderson Cancer Center. Preventability estimate by cancer site.

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Preventability estimate by cancer site

Physical Activity and Social Support:Do you think you’re better off alone?Scherezade K. Mama, DrPHPostdoctoral FellowDepartment of Health Disparities ResearchThe University of Texas M.D. Anderson Cancer Center


Preventability estimate by cancer site

Preventability estimate by cancer site

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.


Percentage of adults who met physical activity guidelines for aerobic activity in the u s

Percentage of adults who met physical activity guidelines for aerobic activity in the U.S.

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 2014. Available from: http://www.cdc.gov/nchs/nhis.htm.


Percentage of adults who met physical activity guidelines for aerobic activity in the u s1

Percentage of adults who met physical activity guidelines for aerobic activity in the U.S.

Adults 18 and over by sex

Adults 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 2014. Available from: http://www.cdc.gov/nchs/nhis.htm.


Ecologic framework

Ecologic framework

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.

Physical Activity

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; 49:286-88.; McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education & Behavior. 1988;15:351-77.


Direct and indirect influences on physical activity

Direct and indirect influences on physical activity

  • Intrapersonal Factors

    • Cognition

    • Beliefs

    • Motivation

Social Support

Physical Activity


Social environment categories

Social environment categories

  • 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;63:1011-22.


Interpersonal relationships

Interpersonal relationships

  • 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;63:1011-22.


Social support and social networks

Social support and social networks

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Social inequalities

Social inequalities

  • 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):1003-6.


Socioeconomic position

Socioeconomic position

  • 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;63:1011-22.


Socioeconomic position1

Socioeconomic position

↓ Accumulation of and Access to Material Resources that Protect against Stress

Socioeconomic Position

↑ Biological Stress

↓ Health

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Income inequalities

Income inequalities

Gilson D, Perot C. It’s the Inequality, Stupid. March/April 2011. http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph.


Income inequality

Income inequality

Disinvestment in Social Capital

↓ Social Cohesion

Income Inequality

↓ Social Spending on Programs and Services

↑ Negative Psychosocial Conditions

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Racial discrimination

Racial discrimination

  • 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;63:1011-22.


Racial discrimination operating through residential segregation

Racial discrimination operating through residential segregation

Emple H. Documenting Discrimination in Local Rental Markets. May 2013. http://assets.newamerica.net/blogposts/2013/documenting_discrimination_in_local_rental_markets-83254.; Frey WH. America’s Diverse Future: Initial Glimpses at the U.S. Child Population from the 2010 Census. Washington, DC: Brookings; 2011. http://www.brookings.edu/~/media/research/files/papers/2011/4/06%20census%20diversity%20frey/0406_census_diversity_frey.pdf.


Racial discrimination1

Racial discrimination

↑ Economic and Social Deprivation

Racial Discrimination

↑ Exposure to Harmful Substances

↑ Psychological Trauma

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Neighborhood and community characteristics

Neighborhood and community characteristics

PEOPLE

PLACE

Characteristics of the place where you live

Social cohesion

Social capital

Neighborhood socioeconomic position

Influence health-related behaviors directly and indirectly

  • 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

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Social cohesion and social capital

Social cohesion and social capital


Social cohesion and social capital1

Social cohesion and social capital

Reinforces Group and Social Norms

Social Cohesion and Social Capital

↑ Health Behaviors

Provides Tangible Support

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Neighborhood factors

Neighborhood factors

  • 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;63:1011-22.; 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.


Neighborhood factors1

Neighborhood factors

Smog, poor air quality

Social and cultural norms for physical activity

Lack of recreation facilities, reduced PE in schools, limited trash pick up

McNeill LH, Kreuter MW, Subramanian SV. Social environment and physical activity: A review of concepts and evidence. Social Science & Medicine. 2006;63:1011-22.


Social environmental influences in women

Social-environmental influences in women

  • 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.


The social environment

The social environment

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.


Social support and social networks1

Social support and social networks

  • 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.


Emotional support

Emotional support

  • 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. SocSci 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):161-75.


Tangible support

Tangible support

Print+Community Development Intervention

Women with increased partner support were 2.29 times more likely to meet PA guidelines

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):98-103.


Informational support

Informational support

  • 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;15:220-31.


Life transitions and multiple roles

Life transitions and multiple roles

Life transitions

Multiple roles

Wife

Mother

Employee

Caretaker

Head of household

  • Marriage

  • Parenthood

  • Employment

  • 53.5% of studies addressed this

  • 60.9% of these studies included ethnic minority women

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.


Increasing responsibilities

Increasing responsibilities

  • 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.


Reduced discretionary time and low priority of physical activity

Reduced discretionary time and low priority of physical activity

  • 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 EducBehav. 1998;25(5):640-52.


Beliefs about being active

Beliefs about being 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.; Sternfeld B, Ainsworth BE, Quesenbury CP. Physical activity patterns in a diverse population of women. Prev Med. 1999;28(3):313-23.


Beliefs about being active1

Beliefs about being active

  • 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.

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.


Cultural standards gender roles

Cultural Standards & Gender Roles

  • 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.


Acceptance of physical activity

Acceptance of physical activity

  • 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 usualfamily 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):894-904.


Cultural appropriateness of physical activity for adult women

Cultural appropriateness of physical activity for adult women

  • Gender-role expectations

  • Social and cultural pressureto

    • 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.


Lack of physically active adult female role models

Lack of physically active, adult, female role models

  • 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.


Promoting physical activity among women

Promoting physical activity among women

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.


Microsystem intervention strategies

Microsystem 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.


Mesosystem intervention strategies

Mesosystem 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.


Macrosystem intervention strategies

Macrosystem 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.


Longitudinal results microsystem

Longitudinal results: Microsystem

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 10.1007/s10865-013-9534-5


Longitudinal results mesosystem

Longitudinal results: Mesosystem

Completers

Noncompleters

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)368-78.


Longitudinal results mesosystem1

Longitudinal results: Mesosystem

  • “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)368-78.


Longitudinal results macrosystem

Longitudinal results: Macrosystem

  • 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, KirtaniaU, Lasater TM. SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women. Int J BehavNutrPhys Act. 2013;10:141.


Longitudinal results macrosystem1

Longitudinal results: Macrosystem

Risica PM, Gans KM, Kumanyika S, KirtaniaU, Lasater TM. SisterTalk: final results of a culturally tailored cable television delivered weight control program for Black women. Int J BehavNutrPhys Act. 2013;10:141.


But for the biggest bang for your

But for the biggest bang for your $...

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.


Thank you for your attention

Thank you for your attention!

Scherezade K. Mama, DrPH

Postdoctoral Fellow

Department of Health Disparities Research

The University of Texas M.D. Anderson Cancer Center

Houston, Texas

Email: [email protected]

Phone: 713-563-7546


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