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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, 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

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  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Direct and indirect influences on physical activity • Intrapersonal Factors • Cognition • Beliefs • Motivation Social Support Physical Activity

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. Social cohesion and social capital

  20. 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.

  21. 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.

  22. 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.

  23. 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.

  24. 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.

  25. 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.

  26. 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.

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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.

  32. 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.

  33. 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.

  34. 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.

  35. 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.

  36. 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.

  37. 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.

  38. 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.

  39. 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.

  40. 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.

  41. 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.

  42. 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

  43. 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.

  44. 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.

  45. 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.

  46. 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.

  47. 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.

  48. 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: skmama@mdanderson.org Phone: 713-563-7546

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