Background:
Longitudinal studies of midlife women’s health indicate that African American (AA) women have more symptoms of depressed mood than Caucasian women and that this disparity is amplified in disadvantaged neighborhoods. Although reductions in depressive symptoms with physical activity have been demonstrated in Caucasian adults, the mental health benefits of physical activity have not been examined in AA women either in the context of an intervention or in the context of their neighborhood environments. Further, it is unknown whether increasing physical activity can lessen the impact of adverse environments on depressive symptoms.

Objectives:
In a sample of AA women, the objectives of this study were to (a) compare the effects of aspects of the neighborhood built and social environment and walking adherence on depressive symptoms and (b) examine the moderating effect of walking adherence on the relationship between environmental features and depressive symptoms.

Methods:
Two-hundred and seventy eight AA women participated in the home-based, 24-week moderate-intensity walking intervention. Either a minimal or enhanced version of the intervention was randomly assigned to one of two community health centers located in low- and moderate-income predominately AA neighborhoods in Chicago with additional recruitment to 77 urban and suburban zip codes occurring via networking among participants. Both treatment groups received a prescription for walking based on their aerobic fitness level, health and safety information, and self-monitoring instructions. The enhanced treatment group also received four workshops and motivational telephone calls. Women were encouraged to incorporate planned moderate-intensity walking into everyday life for transport and leisure.

We included both objective and perceived measures of the neighborhood built and social environment including physical deterioration (objective: mean of standardized scores for % vacant houses and % net land area with abandoned buildings; perceived: rating of abandoned buildings as a problem on 3-point scale), safety (objective: annual number of violent crimes; perceived: sum of ratings on seven problems with crime, single item on safety from crime), social problems [perceived: sum of ratings on seven items (e.g., gangs, unemployment)], service problems [perceived: sum of ratings on five items (e.g., police, schools)], and socioeconomic status (objective: poverty rate). Objective measures were based on a 1-mile buffer of each woman's geocoded home address. Adherence to walking 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. Depression was measured with the Center for Epidemiologic Studies Depression (CES-D) scale at baseline and 24 weeks.

Results:
The mean age of women enrolled in the study was 48.5 years, 88% had children, 60% were currently unpartnered, 36% were college graduates, and 40% lived in moderately poor census tracts (20% or more residents in poverty). The mean score on the CES-D was 11.2 at baseline and 10.3 at 24-weeks. At baseline and 24 weeks there were significant positive correlations between the CES-D and perceived physical deterioration (rho=0.17, 0.22), perceived crime problems (r=0.24, 0.26), perceived safety from crime (r=0.14, 0.28), perceived social problems (r=0.21, 0.23), and perceived service problems (r=0.19, 0.26). Preliminary regression analysis showed, adjusting for individual age, education, income, and depressive symptoms at baseline, a significant negative effect of adherence (p=0.01) on depression at 24 weeks. Also, there were significant effects of perceived neighborhood safety from crime (p=0.01), perceptions of abandoned buildings as a big problem in the neighborhood (p=0.005), and perceived problems with neighborhood services (p=0.08) on depressive symptoms at 24 weeks. There was no evidence that adherence to walking moderated the effects of perceived or objective environmental features on depressive symptoms at 24-weeks.

Conclusions:
Findings suggest that adverse neighborhood conditions contribute to depressive symptoms among AA women, but that increased physical activity reduces depressive symptoms. The positive influence of increased physical activity was independent of the environmental factors examined; however, it did not appear to lessen the impact of negative aspects of the environment. In addition to supporting active lifestyles - as suggested by prior research -- improving neighborhood conditions may also promote mental health among midlife AA women.

Support:
Robert Wood Johnson Foundation via Active Living Research; NIH NINR RO1 NRO4234.