Associations of Neighborhood Supports with Physical Activity and Blood Pressure in African American Adults in the PATH
Trial
Sandra M. Coulon, M.A., Dawn K. Wilson, Ph.D., and Brent Egan, M.D.
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Grant Funding and Investigators
• This project is funded through an NIDDK grant #R01DK067615 (PI: Dawn K. Wilson, Ph.D.)
• Co-Investigators:• Abe Wandersman, Ph.D.
• M. Lee Van Horn, Ph.D
• Sarah Griffin, Ph.D.• Brent Egan, Ph.D
• Melinda Forthofer, Ph.D.
• Heather Kitzman-Ulrich, Ph.D
• This project is funded in part by from NIA training grant #F31AG039930 and NIGMS training grant #T32GM081740 (Sandra M. Coulon, M.A.)
Background• CVD mortality and high BP disparity
• PA linked to BP; 4 mmHg and greater for African Americans
• Social support for PA linked to PA
• Neighborhood walkability linked to PA
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Ainsworth et al., 2003; Collins & Winkleby, 2002; Cutler et al., 2008; Eyler et al., 2002; King et al., 2006; Lloyd-Jones, et al., 2009; Luke et al., 2005; Roger et al., 2012; Saelens et al., 2003; Sallis et al., 1987; Sallis et al., 2009; Sharma et al., 2005; Wilcox et al.,
2009; Wilson et al., 2004; Whelton et al., 2002
Mediation• Statistical method, potential mechanisms
• Residential Environment & CORonary heart Disease Study Chaix, et al., 2008; Chaix, et al., 2010 • Individual SES, Neighborhood SES – PA – BP*
• Neighborhood Education Level, Urbanicity – BMI, Waist – SBP
• The NHLBI Family Intervention Trial for Heart Health Fischer Aggarwal, et al. 2008• Social Support – PA – HDL, not BP
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Theoretical Approach• Social ecological framework
• Social cognitive theory
• Environment � Behaviors � Health Outcomes
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Bronfenbrenner, 1979, MacKinnon & Luecken, 2008; Sallis et al., 2006; Tu & Ko, 2008
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Mediated Effect = a*b
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Peer Social Support for PA
Neighborhood Walkability
Physical Activity
Systolic BP
Diastolic BP
a b
c’
+ -
-
Participants• Positive Action for Today’s Health (PATH)
• Three matched communities
• Environmental PA intervention
• Baseline PATH measures
• 434 African American adults
• Excluded for BP or BS or moderate to vigorous PA (MVPA)
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Measures• Social Support for Exercise Habits Scale; peers
• NEWS; walking & cycling subscale
• Accelerometry; intensity, frequency of movement
• FWH; interview-reported PA
• Automated BP; three assessments; RN
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Adams et al.; Ainsworth, Richardson, Jacobs, & Leon, 1993; Bassett et al., 2008; Cerin et al., 2006; Esliger & Tremblay2009; Kayes et al., 2009; Kriska, Caspersen, & Periera, 1997; Saelens et al., 2003; Sallis et al., 1987; Sharma et al., 2005
Demographics
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Demographic Variable Total (%)N (%) 434GenderMaleFemale
162 (37)272 (63)
AgeMean (SD)18-2425-4445-6465+
51.19 (15.68)33 (8)
102 (24)207 (48)92 (21)
EmploymentWorking UnemployedRetiredDisabledOtherNo Response
169 (39)85 (20)94 (22)36 (8)49 (11)2 (1)
Demographic Variable Total (%)
Marital StatusMarriedSeparatedDivorcedWidowedNever MarriedUnmarried CoupleNo Response
100 (23)59 (14)49 (11)81 (19)111 (26)31 (7)3 (1)
Income$40 KNo Response
125 (29)145 (33)77 (18)63 (15)24 (6)
Health FactorsBMI Mean (SD)< 2525-30>30
30.88 (8.43)112 (26)105 (24)211 (49)
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VariablePeer
Support Walka-bility
PA SBP DBP Age Female BMI BPMed Rep. Walk
Rep. Ex
Peer Support 1.00
Walkability .21** 1.00
MVPA .08 .14** 1.00
SBP -.04 -.07 -.19** 1.00
DBP .01 .01 .05 .69** 1.00
Age -.12* -.16** -.44** .29** .03 1.00
Female -.04 -.07 -.39** -.01 -.11* .15** 1.00
BMI -.01 -.03 -.27** .15** .01 .07 .33** 1.00
BP Med -.08 -.11* -.37** .22** .02 .53** .27** .22** 1.00
Rep Walk .12* .12* .11* -.04 .07 -.09 -.03 -.02 -.07 1.00
Rep Ex .09 .04 .12* -.02 -.00 -.02 -.10* -.01 -.02 .10* 1.00
Correlations
*p
Primary AnalysesVariable B SE t p LCL UCL R2
MVPA on Control Variables, Peer Support, and Walkabi lity
Age -.369 .095 -6.027 .000** -.546 -.176
.329
Sex -19.322 2.987 -6.468 .000** -25.137 -13.542
BP Med -3.028 2.651 -1.142 .253 -8.168 2.238
BMI -.540 .121 -4.451 .000** -.782 -.314
Community 1.681 1.519 1.107 .269 -1.155 4.764
Peer Support 2.396 1.060 2.261 .024* .217 4.465
Walkability 2.433 1.220 1.994 .046* .019 4.791
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Fritz & MacKinnon, 2007; Gulliford et al., 1999; Hannan et al., 1994; Li et al., 2005; MacKinnon et al., 1998; MacKinnon & Luecken, 2008; MacKinnon, 2008
Primary Analyses
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Variable B SE t p LCL UCL R2
SBP on MVPA, and Peer Support and Walkability with C ovariates
Age .276 .065 4.235 .000** .142 .393
.122
Sex -4.308 2.022 -2.130 .033* -8.408 -.495
BP Med 3.303 2.311 1.429 .153* -1.200 7.931
BMI .282 .113 2.490 .013* .073 .507
Community -.534 1.088 -.491 .623 -2.598 1.650
MVPA -.029 .042 -.684 .494 -.109 .054
Peer Support -.327 .813 -.402 .688 -1.913 1.226
Walkability -.144 .977 -.148 .883 -2.046 1.814
Primary Analyses
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Variable B SE t p LCL UCL R2
DBP on MVPA, and Peer Support and Walkability with Covariates
Age .016 .044 .373 .709 -.071 .098
.022
Sex -2.399 1.336 -1.796 .072 -5.086 .310
BP Med .696 1.448 .480 .631 -2.092 3.466
BMI .035 .067 .517 .605 -.089 .172
Community -1.271 .684 -1.859 .063 -2.560 .169
MVPA -.009 .028 -.326 .744 -.065 .046
Peer Support -.062 .527 -.117 .907 -1.141 .981
Walkability .180 .635 .283 .777 -1.047 1.411
Secondary Analyses• Additional measures of PA
• Walkability and reported walking (B=7.881, p=.045), not reported exercise
• Peer support and reported walking (B=5.475, p=.082)
• Neither reported walking or exercise predicted BP
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Mediated Effect = a*b
ConclusionsStrengths
• Theory-driven design & hypotheses
• Large sample of at-risk African Americans
• Two measures of PA; objective PA
Limitations
• Absence of temporal precedence- bias
• Low levels of PA and PA variability
• Sample size and power
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Future Directions• Application within a longitudinal design
• Investigation of additional health outcomes (BMI)
• Incorporation of GIS data and multi-level designs
• Incorporation of stress biomarkers
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THANK [email protected]
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