Transcript Basic Principals of Epidemiology and PH--8/96

Health Disparities in Physical Activity:
Patterns and Implications
Ross C. Brownson
Prevention Research Center
Saint Louis University School of Public Health
http://prc.slu.edu
Learning Objectives
1. To understand the importance of physical activity
as a public health issue
2. To understand the descriptive patterns in physical
activity, related health conditions, and macro
factors (e.g., demographics)
3. To review the gaps and implications for health
disparities research and practice.
Definitions: Behaviors
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Physical Activity: “any bodily movement
produced by skeletal muscles that results in
energy expenditure.”
– Occupational, household, exercise, sports, play
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Exercise: “planned, structured, and repetitive
bodily movement done to improve or maintain
one or more components of physical fitness.”
– Running, aerobic dance, bicycling, calisthenics
Caspersen C, et al, Public Health Reports 1985; 100(2)126-131.
The Benefits of Physical Activity
Health Benefits
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Lowers risk for heart disease
Reduces risk for certain cancers
Lowers blood pressure
Improves lipid profile
Prevents obesity
Prevents diabetes
Builds healthy bones
Enhances immune function
Relieves stress and improves
mood
Promotes self-esteem
Fitness Benefits
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Increases aerobic capacity
Increases strength
Increases flexibility
Improves balance and
coordination
Increases functional Health:
Allows us to do the
things we need to do
and want to do with
ease and enjoyment!
Physical Activity and Health (Dose-Response)
Prevention of Weight Gain
Diabetes Mellitus
CHD
Stroke
Musculoskeletal Injury
Physical Activity
Functional Health Status
The
Obesity
Epidemic
Fit or fat evidence?
Puzzle is not so simple…
Fit or Fat?
CVD Mortality, % Body Fat, and Fitness
Adj RR*
*adj for age,
exam year,
smoking,
alcohol, &
fam history
Fit
Unfit
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Lean
<16%
Normal
16-<25%
Body Fat
Obese
25%
Lee CD et al. Am J Clin Nutr 1999.
The Chronic Disease Epidemic:
Changing Environment
Acting upon Pre-existing Genes
Phenotype = Genotype x Environment
Unhealthy
Gene
Expression
No Change
in past 100
Years
Large Change
in past 100 Years
*Physical Inactivity
Diet
Pollution, etc.
CDC/ACSM recommendations on the types and
amounts of physical activity needed for health
promotion and disease prevention:
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Every US adult should accumulate 30 minutes or
more of moderate-intensity physical activity on
most, preferably all, days of the week.
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Moderate-intensity - Activity performed at 3 to 6
times the resting metabolic rate.
– Equivalent to brisk walking 2 miles at 3 to 4 mph (15 to 20
minutes/mile) for healthy adults
Accumulating Physical Activity?
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Guidelines allow for the accumulation of moderateintensity physical activity over the course of a day
Five recent studies compared the traditional 30
minutes of continuous activity vs. shorter (5- to 15minute) bouts of activity spread throughout the day
Shorter bouts resulted in comparable improvements in
cardiorespiratory fitness and health
Multiple short bouts of physical activity also appear to
increase participation and adherence
The Lifestyle Approach
Noon-time jog
10
Sedentary
Structured Exercise
Lifestyle Activity
8
6
After-dinner walk
Walk to bus stop
4
2
0
0
2
4
6
8
10
12
14
16
Blair et al. Med Exerc Nutri Hlth
1:54, 1992
Time (hours)
18
20
22
24
Physical Activity Levels Survey Measures
Recommended level
Moderate-intensity activity 5 times per week for 30
minutes each time,
Vigorous-intensity 3 times per week for 20 minutes
each time, or
 Both
 Insufficient
Some activity but not enough to be classified as
moderate or vigorous
 Inactive
No leisure-time physical activity during the preceding
month
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Possible Domains of Physical
Activity
Leisure/recreational
 Occupational
 Transportation
 Household chores
 Gardening/yardwork
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Completely sedentary activities
(e.g., watching television)
Descriptive Epidemiology
1. Person
2. Place
3. Time
Physical Activity, U.S. Adults
(2003 BRFSS, Age-Adjusted)
Recommended
46%
Insufficient
54%
Classify
PERSON
age
race
sex
ses
occupational
marital status
migrants
family
blood type
personality traits
Physical Activity by Race/Ethnicity
(2003 BRFSS, Age-Adjusted)
80
70
60
50
40
30
20
10
0
Recommended
White
Insufficient
Black
Latino
Physical Activity by Income Group
(2003 BRFSS, Age-Adjusted)
60
50
40
30
20
10
0
Recommended, moderate
Less than $15K
$15K - <$25K
$25K - < $50K
$50K+
Physical Activity by Income Group
(2003 BRFSS, Age-Adjusted)
60
50
40
30
20
10
0
Recommended, vigorous
Less than $15K
$15K - <$25K
$25K - <$35K
$35K - < $$50K
Moderate Physical Activity for Adults by
Disability and Arthritis Status
Age-adjusted percent
60
1997
2002*
2010 Target
50
40
30
20
10
0
With
Without
Disabilities
With
Without
Arthritis
Physical Activity in Ethnically Diverse Women 40 and older
80
70
60
50
40
30
20
10
0
Regular
Occupational
Caucasian
Black
Housework
Am. Indian
Composite
Hispanic
Brownson RC et al. Am J Public Health 1999.
Vigorous Physical Activity for
Adolescents by Grade Level: 2001
Percent
100
80
60
40
20
0
9th
10th
11th
12th
Classify
PLACE
natural boundaries
political subdivisions
urban-rural differences
weather variations
Prevalence of No Leisure-Time Activity, 2000
45
40
35
30
25
Men
Women
20
15
10
5
0
Alabama
Colorado
Indiana
Kentucky
South
Carolina
Utah
No Physical Activity for Adults by State,
2003
Age-adjusted
percent
(Quartiles)
15.0 - 20.0
20.5 - 22.4
23.0 - 26.2
26.4 - 30.2
Age-adjusted heart disease mortality, Missouri, 1992-98
Classify
TIME
secular trends
declining rates
cyclicity-seasonality
periodicity
clusters in time or place
Age-adjusted colon cancer incidence by gender and race
Age-adjusted breast cancer incidence by race
Other important macro
patterns & trends in the United
States that are likely to affect
health disparities and the
burden of physical inactivity
Population Trends
Aging of the Population
– 65+ the most rapidly growing US segment
– Projected increases 65+:
• 1990, 31 million
• 2010, 40 million
• 2030, 70 million
– Large impacts on public health and health
care systems
Population Trends
Changing Racial/Ethnic Makeup
– Non-Hispanic Whites
• 1992, 191 million to 202 million in 2050
– African American
• 1992, 32 million to 62 million in 2050
– Asian/Pacific Islander
• 1992, 9 million to 41 million in 2050
– Distinguish counts from percentages
– Large potential effects on disease burden
– Issues of cultural competence
Car ownership, walking & biking
Percent by Walking or Biking
40
35
Highest Income
30
Lowest Income
25
20
15
10
5
0
No Car
1 Car
2 Cars
3 Cars
Miles per person per day
Vehicle miles traveled by automobile
30
25
20
15
10
5
0
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Hours per household per day
Ave. daily television viewing
8
7
6
5
4
3
2
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Knowledge Gaps
Do correlates differ between majority and
minority populations?
 What data are lacking (for both descriptive and
analytic epidemiology)?
 How generalizable are various, tested
interventions?
 How do we do a better job in assessing
context for intervention among population
subgroups?
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Acknowledgments
Certain slides were provided by Dr. Greg
Heath (Centers for Disease Control and
Prevention) and Dr. Steve Blair (Cooper
Institute)