Tuesday, September 08, 2009
Abstract and Introduction
Abstract This review discusses evidence-based perspectives on promoting physical activity in minority populations. Future directions for inquiry and empirically driven public policy initiatives also are addressed.
IntroductionOver the past decade, considerable attention has focused on the nation's physical inactivity epidemic. Notwithstanding myriad public health mandates propped up by a welter of initiatives reminding Americans about exercise's broad-spectrum benefits and prompting them to "get active," too many remain sedentary. Regrettably, ethnic and cultural minorities disproportionately bear the brunt of this health-zapping lifestyle.[–]
Powered by recognition of its threat-multiplying potential for underserved populations already burdened by health disparities, physical inactivity has become a high-value intervention target. Yet, despite some noteworthy strides, resetting sedentary lifestyles remains challenging.[–]
To be sure, minority-focused research has only just begun to explore the complex dynamic of biopsychosocial factors that shape activity habits and crimp efforts to unwind them. Nevertheless, although many details remain sketchy, converging evidence increasingly high-lights the corrosive role of social disadvantage as one prime suspect at or near the epicenter of disproportionate minority risk.
Social Disadvantage as an Activity-relevant Risk FactorRecent research has provided tantalizing clues to the tangled web of activity-relevant processes in which socioeconomic status (SES) is inextricably inter-twined at the biological, psychological, and social levels. For instance, poverty may set limits on potential activity trajectories by taking a toll on optimal physiological maturation and brain development, raising both near-and long-term risks for cascading adversities (eg, growth delays and cognitive problems) that can tamp down intellectual and self-regulatory capabilities.[–]
Social disadvantage also profoundly affects psychological mediators of active lifestyles, magnifying risks for activity barriers such as negative attributional style (eg, feelings of low self-efficacy, diminished perceptions of control) and activity-hindering emotions (eg, depressed and/ or anxious mood).[–] Minority girls, for example, have reported low exercise self-efficacy (including discouragement at initial signs of perceived exertion, high anxiety, and feelings of low self-esteem during activity training) that deters exercise participation. Other evidence similarly highlights the robust relationship between negative emotions (eg, depressed mood, perceived hopelessness) and health risk behaviors, especially among urban minority youth. Accordingly, attention to such psychological stumbling blocks may be crucial to fostering exercise readiness in underserved populations. Indeed, these preparatory steps toward action would seem well worth the effort considering the psychological and physical benefits that accrue to ethnic and cultural minorities who regularly participate in leisure-time activity.[––]
At the sociocultural level, physical activity can be foiled by numerous SES-related processes that constrain educational opportunities, health literacy, and resource access, thereby limiting exposure to contexts in which habitual exercise is modeled and encouraged. For instance, attitudes about physical activity often are rooted in broader social and cultural traditions that may or may not coincide with professional health ecommendations. These commonsense models wield considerable leverage on activity preferences and practices.[––]
To cite but one of many possible examples, acculturation has been associated with physical activity across diverse groups. As a case in point, Anglo-acculturated Latinas (ie, those acculturated toward the US mainstream) have reported being more physically active than their more traditional Mexican-acculturated counterparts. These findings parallel those based on other minority participants (eg, American-Indian, African-American) in demonstrating the influence of culturally driven schema on activity habits.[–] Results such as these emphasize the importance of exploring exercise-relevant conceptualizations as a prelude to activity interventions.[––]
As indicated above, social disadvantage limits social capital, one especially relevant form of which is activity-linked social support. That is to say, although loved ones' unconditional positive regard offers numerous benefits, its sheer noncontingency typically renders it suboptimal for promoting exercise. Indeed, significant others' generic support for beloved kin (regardless of lifestyle) often is counterproductive to healthful behavior change. It is this activity-specific encouragement that may be hampered by SES-related processes.[–]
Along these lines, research has underscored the activity-enhancing advantages of social encouragement (ie, accentuating activity benefits) over social constraint (ie, emphasizing sedentariness hazards). Unfortunately, because underserved patients typically access health care on an emergent (versus preventive) basis, they may be most likely to receive lifestyle modification advice in the form of social constraint during crisis-oriented, teachable moments.
Even when effectively delivered, professional admonitions may be offset by pervasive, health-detrimental media messages. In response to media's well-documented adverse consequences (eg, from both observing media models of unhealthful habits and sitting motion-less during hours of passive viewing), professionals now urge parents to limit youngsters' screen time.[–] Unfortunately, children from socially disadvantaged families may be especially vulnerable to harmful media influences.
In a vivid illustration conducted at preschools for low-income children, Robinson and colleagues recently examined the effects of fast-food branding on taste preferences. Results revealed that -to -year-old ethnically and culturally diverse children preferred food and drinks (including items such as carrots and milk) they believed were from McDonald's. Central to the point of the present discussion, however, this branding effect was moderated by the number of television sets at home and the frequency of McDonald's food consumption, reinforcing the covariation of risk behaviors that frequently has been observed throughout the health hazards literature.[––]
Social disadvantage also undermines physical activity through ecological and environmental inputs such as exercisethwarting social policies and features of the built environment such as the lack of recreation facilities (eg, absence of walking trails and bike paths), neighborhood walkability (eg, few sidewalks, unattractive surroundings), and safety (eg, presence of stray dogs, high crime). In short, disadvantaged neighborhoods are unlikely to provide an optimal context for infusing habitual activity into daily life.[–––]]
Promoting Active LifestylesConsidering activity's biopsychosocial influences, the fight against sedentary lifestyles must engage on many fronts simultaneously,[–] reaching beyond traditional providers and medical settings to include indigenous mediators and venues tailored to ethnic and cultural considerations.[–] Despite the seemingly fitful progress to date, evidence of incremental victories are beginning to dapple the scientific landscape. Leveraging these stepwise achievements into sustainable lifestyle gains will be challenging but, given the potential benefits, are well worth the effort.
- Terre L. Exercise for primary care. Am J Lifestyle Med. 2008;2:290–.
- Terre L, Poston W, Foreyt J. Overview and the future of obesity treatment. In: Goldstein D, ed. The Management of Eating Disorders and Obesity. Totowa, NJ: Humana Press; 2005;–.
- Albright C, Pruitt L, Castro C, et al. Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) Project. Ann Behav Med. 2005;30:191–.
- Bush C, Shadston P, McKay S, et al. Park-based obesity intervention program for inner-city minority children. J Pediatr. 2007;15:513–.
- Frierson G, Williams D, Dunsiger S, et al. Recruitment of a racially and ethnically diverse sample into a physical activity efficacy trial. Clin Trials. 2008;5:504–.
- Kumanyika S. Environmental influences on childhood obesity: ethnic and cultural influences in context. Physiol Behav. 2008;94:61–.
- Kumanyika S, Grier S. Targeting interventions for ethnic minority and low-income populations. Future Child. 2006;16:187–.
- Kumanyika S, Obarzanek E, Stettler N, et al. Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance. A scientific statement from the American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the Expert Panel on Population and Prevention Science). Circulation. 2008;118:428–.
- Pekmezi D, Jennings E. Interventions to promote physical activity among African Americans. Am J Lifestyle Med. 2009;():–.
- Resnick B, Luisi D, Vogel A. Testing the Senior Exercise Self-Efficacy Project (SESEP) for use with urban dwelling minority older adults. Public Health Nurs. 2008;25:221–.
- Schrop S, Pendleton B, McCord G, et al. The medically underserved: who is likely to exercise and why? J Health Care Poor Underserved. 2006;17:276–.
- Dornelas E, Stepnowski R, Fischer E, et al. Urban ethnic minority women's attendance at health clinic vs. church based exercise programs. J Cross Cult Gerontol. 2007;22:129–.
- Eakin E, Bull S, Riley K, et al. Recruitment and retention of Latinos in a primary care-based physical activity and diet trial: the Resources for Health study. Health Ed Res. 2007;22:361–.
- Tandon S, Phillips K, Bordeaux B, et al. A vision for progress in community health partnerships. Prog Community Health Partnersh. 2007;1:11–.
- Yancey A. Building capacity to prevent and control chronic disease in underserved communities: expanding the wisdom of WISEWOMAN in intervening at the environ-mental level. J Women Health. 2004;13:644–.
- Yang J, Kagawa-Singer M. Increasing access to care for cultural and linguistic minorities: ethnicity-specific health care organizations and infrastructure. J Health Care Poor Underserved. 2007;18:532–.
- Zoellner J, Connell C, Santell R, et al. Fit for life steps: results of a community walking intervention in the rural Mississippi Delta. Prog Community Health Partnersh. 2007; Spring. pchp.press. jhu. edu. Accessed October 20, 2008.
- Genel M, McCaffree M, Hendricks K, et al. A national agenda for America's children and adolescents in 2008: recommendations from the 15th Annual Public Policy Plenary Symposium, Annual Meeting of the Pediatric Academic Societies, May 3, 2008. Pediatrics. 2008;122:843–.
- Lemmon C, Ludwig D, Howe C, et al. Correlates of adherence to a physical activity program in young African-American girls. Obesity. 2007;15:695–.
- Terre L. Children's nutritional health: running on empty? Am J Lifestyle Med. 2009:2; –.
- Gallo L, Matthews K. Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull. 2003;129:10–.
- Hill-Briggs F, Gary T, Yen H, et al. Association of social problem solving with glycemic control in a sample of urban African Americans with type diabetes. J Behav Med. 2006;29:69–.
- Marquez D, McAuley E. Social cognitive correlates of leisure time physical activity among Latinos. J Behav Med. 2006;29:281–.
- Poulton R, Caspi A. Commentary: how does socioeconomic disadvantage during child-hood damage health in adulthood? Testing psychosocial pathways. Int J Epidemiol. 2005;34:344–.
- Robbins L, Pender N, Ronis D, et al. Physical activity, self-efficacy, and perceived exertion among adolescents. Res Nurs Health. 2004;27:435–.
- DiClemente R, Wingood G, Lang D, et al. Adverse health consequences that co-occur with depression: a longitudinal study of black adolescent females. Pediatrics. 2005;116:78–.
- Valadez-Meltzer A, Silber T, Meltzer A, et al. Will I be alive in 2005? Adolescent level of involvement in risk behaviors and belief in near-future death. Pediatrics. 2005;116:24–.
- Goldfinger J, Arniella G, Wylie-Rosett J, et al. Project HEAL: peer education leads to weight loss in Harlem. J Health Care Poor Underserved. 2008;19:180–.
- Horowitz C, Goldfinger J, Muller S, et al. A model for using community-based participatory research to address the diabetes epidemic in East Harlem. Mount Sinai J Med. 2008;75:13–.
- Miller D, Gilman R, Martens M. Wellness promotion in the schools: enhancing students' mental and physical health. Psychol Sch. 2008;45:5–.
- Wise L, Adams-Campbell L, Palmer J, et al. Leisure time physical activity in relation to depressive symptoms in the Black Women's Health Study. Ann Behav Med. 2006;32:68–.
- Levanthal H, Levanthal E, Cameron L. Representations, procedures, and affect in illness self-regulation: a perceptual-cognitive model. In: Baum A, Revenson T, Singer J, eds. Handbook of Health Psychology. Mahwah NJ: Erlbaum; 2001:19–.
- Levanthal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman S, ed. Contributions to Medical Psychology. New York, NY: Pergamon; 1980:7–.
- Adams A, Harvey H, Brown D. Constructs of health and environment inform child obesity prevention in American Indian communities. Obesity. 2008;16:311–.
- Adams A, Quinn R, Prince R. Low recognition of childhood overweight and disease risk among Native-American caregivers. Obes Res. 2005;12:146–.
- Hekler E, Lambert J, Leventhal E, et al. Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans. J Behav Med. 2008;31:391–.
- Gordon-Larsen P, Nelson M, Page P, et al. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117:417–.
- McDonald N. The effect of objectively measured crime on walking in minority adults. Am J Health Promot. 2008;22:433–.
- Pichon L, Arredondo E, Roesch S, et al. The relation of acculturation to Latinas' perceived neighborhood safety and physical activity: a structural equation analysis. Ann Behav Med. 2007;34:295–.
- Gabriele J, Walker M, Gill D, et al. Differentiated roles of social encouragement and social constraint on physical activity behavior. Ann Behav Med. 2005;29:210–.
- Connor S. Food-related advertising on preschool television: building brand recognition in young viewers. Pediatrics. 2006;118:1478–.
- Escobar-Chaves S, Anderson C. Media and risky behaviors. Future Child.2008;18:147–.
- Evans W. Social marketing campaigns and children's media use. Future Child. 2008;18:181–.
- Wilcox B, Kunkel D, Cantor J, et al. Report of the APA Task Force on Advertising and Children. www.apa.org. Retrieved November 2008.
- Robinson T, Borzekowski D, Matheson D, et al. Effects of fast food branding on young children's taste preferences. Arch Pediatr Adolesc Med. 2007;161:792–.
- Collins J. Addressing racial and ethnic disparities: lessons from the REACH 2010 communities. J Health Care Poor Underserved. 2006;17:1–.
- Sallis J, King A, Sirard J, et al. Perceived environmental predictors of physical activity over months in adults: Activity Counseling Trial. Health Psychol. 2007;26:701–.
- Sloane D, Nascimento L, Flynn G, et al. Assessing resource environments to tar-get prevention interventions in community chronic disease control. J Health Care Poor Underserved. 2006;17:146–.
- Stafford M, Cummins S, Ellaway E, et al. Pathways to obesity: identifying local, modifiable determinants of physical activity and diet. Soc Sci Med. 2007;65:1882–.
- Fort J, McClellan L. REACH-Meharry community-campus partnership: developing culturally competent health care providers. J Health Care Poor Underserved. 2006;17:78–.
- Farmer D, Jackson S, Camacho F, et al. Attitudes of African American and low socioeconomic status white women toward medical research. J Health Care Poor Underserved. 2007;18:85–.
- Winett R, Anderson E, Wojcik J, et al. Guide to health: nutrition and physical activity out-comes of a group-randomized trial of an internet-based intervention in churches. Ann Behav Med. 2007;33:251–.
Lisa Terre, PhD, Department of Psychology, University of Missouri–Kansas City, Troost Building, Suite , Kansas City, MO 64110-2499; e-mail: email@example.com.
Am J Lifestyle Med. 2009;():195-197. © 2009 Sage Publications, Inc.