BACKGROUND
Increasing physical activity among African-American women may help to reduce obesity and excess morbidity and mortality. Interventions to increase physical activity have had limited success across all population subgroups including African-American women. Most intervention studies have focused on how intrapersonal (e.g., motivation) and interpersonal (e.g., social support) factors are associated with adherence to exercise regimens. Yet, because of race-based residential segregation, many African-American women face significant environmental barriers to being physically active, which may affect adherence.
OBJECTIVES
The purpose of this study is to examine relationships between aspects of the built and social environments and adherence during the adoption phase of a home-based walking intervention among African-American women living in diverse environments in metropolitan Chicago. Two-hundred and seventy-eight midlife African-American women from 70 zip codes participated in the Women’s Walking Program, a home-based, moderate-intensity walking study. A standard or an enhanced version of the intervention was randomly assigned to one of two community health care centers located in predominately African American communities of Chicago. The standard treatment group received a prescription for walking based on their aerobic fitness level, health information, and self-monitoring instructions, while the enhanced treatment group received the standard treatment augmented with four workshops and motivational telephone calls. Women were encouraged to incorporate planned moderate-intensity walking into everyday life during leisure time and for transport.
METHODS
We measured several aspects of the built environment within a one-mile radius of women’s homes: walkability (e.g., percent commercial land use, housing unit density, mean block area, ratio of four-way to all intersections, number of public transit stops), aesthetics (e.g., density of vacant housing, percent industrial land use, percent green space, percent rubble lots or abandoned buildings, presence of interstate), and spatial access to facilities for walking (e.g., number of and distance to indoor shopping malls, public recreation facilities, schools, parks). We also measured aspects of the neighborhood (census block group) social environment: poverty rate and median family income. The dependent variable was adherence to walking during the first 24 weeks, or adoption phase. Adherence was measured as percentage of prescribed frequency of walking (68 walks over 24 weeks) obtained via heart rate monitor, walking log, and an automated telephone-response system. We used ordinary least squares (OLS) regression to examine associations between the environmental measures and adherence, adjusting for individual sociodemographics (age, household income, education) and participation in the intervention vs. control group.
RESULTS
The mean age of women enrolled into the study was 48.5 years, 88% had children, 60% were currently unpartnered, and 36% were college graduates. Preliminary regression analyses showed the percentage of the net land area that was included abandoned buildings or rubble lots was negatively associated with walking adherence (p=0.08). Contrary to our expectations, we found negative associations between number of parks, public transit stops, and schools in the neighborhood and adherence (ps<0.05).
CONCLUSIONS
Preliminary findings indicate that the presence of abandoned buildings and even parks may deter walking adherence. These sites may be havens for drug and gang activity, as well as violence and prostitution. Neighborhoods with more public transit stops may have heavier vehicular traffic. Indeed, safety may be the overriding factor in the environment influencing leisure and utilitarian walking for African-American women. Thus, as part of next steps in this study, we will incorporate objective measures of neighborhood safety: crime (e.g., aggravated assault, homicide, gunshots fired), pedestrian accidents, and presence of liquor establishments.
