Biomedical subjects

R C Brownson

Publications and source records attributed to R C Brownson.

At least 37 records · Page 2Linked to original sources

PubMed2000

Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women.

Personal, program-based, and environmental barriers to physical activity were explored among a U.S. population-derived sample of 2,912 women 40 years of age and older. Factors significantly associated with inactivity included American Indian ethnicity, older age, less education, lack of energy, lack of hills in one's neighborhood, absence of enjoyable scenery, and infrequent observation of others exercising in one's neighborhood. For all ethnic subgroups, caregiving duties and lacking energy to exercise ranked among the top 4 most frequently reported barriers. Approximately 62% of respondents rated exercise on one's own with instruction as more appealing than undertaking exercise in an instructor-led group, regardless of ethnicity or current physical activity levels. The results underscore the importance of a multifaceted approach to understanding physical activity determinants in this understudied, high-risk population segment.

Activities of Daily Living↗

PubMed2000

Measuring physical activity with the behavioral risk factor surveillance system.

PURPOSE AND METHODS: Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity. RESULTS: Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)). CONCLUSIONS: Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.

Adolescent↗

PubMed2000

Data uses, benefits, and barriers for the behavioral risk factor surveillance system: a qualitative study of users.

The purpose of this study was to describe data use, benefits, and barriers among BRFSS users. A trained facilitator conducted eight focus groups of eight to 12 state health department employees. NUD*IST qualitative software was used to code responses. Users viewed the BRFSS as an invaluable data set. Data were used most frequently for public education, trend analyses, planning, policy support, and program evaluation. Common barriers to data use included limited availability of regional and subgroup data, lack of data analysis skills, and inadequate staff resources. Users described the BRFSS as a beneficial data source, but some barriers impede its usefulness.

Attitude of Health Personnel↗

PubMed2000

Disability and health status: ethnic differences among women in the United States.

STUDY OBJECTIVES: There are few data describing disability and health status for ethnic groups. The disablement process involves social influences, which may include minority status. Cross sectional data were examined to investigate the relation of ethnicity to disability. DESIGN: A stratified random digit dialled sample of women aged 40 and older. Disability and health status were measured as functional and activity limitations, work disability, and days of poor physical and mental health. SETTING: United States. PARTICIPANTS: Women interviewed by telephone included 774 white, 749 African-American, 660 Hispanic, and 739 Native American women. MAIN RESULTS: The prevalence of disability was higher among minority women when classified by general health status, and the need for personal care assistance. There was a striking excess of work disability: 3.5% of white women compared with 7.1% to 10.3% for minority women. The differences were reduced when adjusted for other risk factors and socioeconomic status. White and minority women reported more similar disability when it was defined by poor mental and physical health days. CONCLUSIONS: Disability is correlated with social and demographic characteristics as well as medical diagnoses. Ethnicity also is associated with disability and may be part of a social context for disablement. Future research should concentrate on the temporal sequence of disability. Consistent definitions of disability will facilitate this research.

Adult↗

PubMed2000

Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States.

STUDY OBJECTIVE: Determinants of leisure time physical activity (LTPA) in rural middle aged and older women of diverse racial and ethnic groups are not well understood. This study examined: (1) urban-rural differences in LTPA by sociodemographic factors, (2) urban-rural differences in LTPA determinants, and (3) the pattern of relations between LTPA determinants and LTPA. DESIGN: A modified version of the sampling plan of the Behavioral Risk Factor Surveillance Survey (BRFSS) was used. Zip codes were selected with 20% or more of each of the following race/ethnic groups: African American, American Indian/Alaskan Native (AI/AN), and Hispanic. A comparison group of white women were also surveyed using standard BRFSS techniques. PARTICIPANTS: Rural (n=1242) and urban (n=1096) women aged 40 years and older from the US Women's Determinants Study. MAIN RESULTS: Rural women, especially Southern and less educated women, were more sedentary than urban women. Rural women reported more personal barriers to LTPA, cited caregiving duties as their top barrier (compared with lack of time for urban women), and had greater body mass indices. Rural women were less likely to report sidewalks, streetlights, high crime, access to facilities, and frequently seeing others exercise in their neighbourhood. Multivariate correlates of sedentary behaviour in rural women were AI/AN and African American race, older age, less education, lack of enjoyable scenery, not frequently seeing others exercise, greater barriers, and less social support (p<0.05); and in urban women, older age, greater barriers, less social support (p<0.05), and less education (p<0.09). CONCLUSIONS: Rural and urban women seem to face different barriers and enablers to LTPA, and have a different pattern of determinants, thus providing useful information for designing more targeted interventions.

Adult↗

PubMed2000

Patterns and correlates of physical activity among US women 40 years and older.

OBJECTIVES: This study describes the patterns of physical activity among minority women by using a variety of definitions and determines sociodemographic and behavioral correlates of physical activity in this population. METHODS: A cross-sectional study was conducted in 1996 and 1997 among US women 40 years and older (n = 2912) of the following racial/ethnic groups: African American, American Indian/Alaskan Native, Hispanic, and White. RESULTS: Physical activity was lowest among African Americans and American Indians/Alaskan Natives (adjusted odds ratios [ORs] for no leisure-time activity were 1.35 [95% confidence interval (CI) = 1.08, 1.68] and 1.65 [95% CI = 1.33, 2.06], respectively). A much higher proportion of women were classified as being physically active when occupational activity rather than more traditional assessments of leisure activity were used to determine level of physical activity. On the basis of a composite definition of physical activity, 72% of respondents reported being physically active. Women living in rural regions (OR = 1.33; 95% CI = 1.12, 1.58) were more likely than urban inhabitants to be completely inactive during leisure time. CONCLUSIONS: Minority women are among the least active subgroups in American society, although not all groups are less active than White women when all domains of physical activity are taken into account.

Adult↗

PubMed2000

Uses of Behavioral Risk Factor Surveillance System data, 1993-1997.

OBJECTIVES: The purpose of this study was to document and describe Behavioral Risk Factor Surveillance System (BRFSS) data use patterns, benefits, and barriers from 1993 to 1997. METHODS: Data use information was gathered via a Medline database search and a telephone survey of BRFSS program directors (n = 54). RESULTS: The database search uncovered 109 BRFSS-based reports. Program directors indicated that BRFSS data frequently were used to support health policies regarding diabetes, physical activity, and smoking. Frequent data use barriers included insufficient special population data, insufficient city- or county-specific data, and insufficient staff. CONCLUSIONS: Use of BRFSS data, which aid several state health activities, increased from 1993 to 1997.

Data Interpretation, Statistical↗

PubMed1999

Reliability of information on physical activity and other chronic disease risk factors among US women aged 40 years or older.

Data on chronic disease risk behaviors and related variables, including barriers to and attitudes toward physical activity, are lacking for women of some racial/ethnic groups. A test-retest study was conducted from July 1996 through June 1997 among US women (n = 199) aged 40 years or more who were white, black, American Indian/Alaska Native, or Hispanic. The sample was selected and interviews were conducted using a modified version of the methods of the Behavioral Risk Factor Surveillance System. For behavioral risk factors such as physical inactivity, smoking, and low fruit and vegetable consumption, group prevalences were generally similar between interviews 1 and 2. However, kappa values for selected physical activity variables ranged from 0.26 to 0.51 and tended to be lower for black women. Discordance was low for variables on cigarette smoking and exposure to environmental tobacco smoke (kappa = 0.64-0.92). Discordance was high (kappa = 0.33) for low consumption of fruits and vegetables. Additional variables for barriers to and access to exercise ranged widely across racial/ethnic groups and in terms of measures of agreement. These methods illustrate an efficient way to sample and assess the reliability of data collected from women of racial/ethnic minority groups.

Adult↗

PubMed1999

Physical activity social support and middle- and older-aged minority women: results from a US survey.

BACKGROUND: Many American adults remain sedentary despite many known health benefits. Research on the determinants of physical activity have indicated that social support is one of the strongest correlates, but little is known about this relation in important subgroups of middle and older-aged women. OBJECTIVE: The purpose of this study was to assess the association of physical activity-related social support on several measures of physical activity in a national sample of minority women. A unique aspect of these measures is the inclusion of vigorous household tasks and occupational physical activities. METHODS: The US Women's Determinants Study was conducted in 1996-1997. The survey was a modified-random sample, telephone survey of 2912 Black, Hispanic, American Indian/Alaskan Native, and White women age 40 and older. A composite score of physical activity social support (PASS) was analyzed as the independent variable in logistic regression analyses. Four measures of physical activity levels served as the dependent variables. A separate analysis was done to distinguish PASS from friends versus PASS from relatives. The potential confounding effect of race/ethnicity, marital status, age, income and education were evaluated and adjusted in the models. RESULTS: Hispanic women were more likely to have high PASS scores than the other racial/ethnic groups. Odds ratios indicate that subjects with high levels of PASS were significantly less likely to be sedentary than those with low support, even after adjusting for race/ethnicity. While there were significant associations among levels of social support and physical activity, this was not true for the measure of "regular exercise." There was no significant difference between the contribution of "friend" support versus "family" support on all four measures on physical activity. DISCUSSION: Based on our results, enhancing social support may be an important aspect of interventions aimed at increasing physical activity in a population of sedentary women of various racial/ethnic backgrounds. Also, "regular exercisers" in this population appear to be less reliant social support to maintain their behavior.

Adult↗

PubMed1999

Measuring the impact of prevention research on public health practice.

CONTEXT: Prevention research involves the translation of established and promising methods of disease prevention and health promotion to communities. Despite its importance, relatively little attention has been paid to systematic approaches to determining the impact of prevention research on public health practice. Evaluation of these effects is challenging, particularly in light of multi-factor causation, long time periods between exposure and disease occurrence, and difficulties in determining costs and benefits. OBJECTIVE: To develop a framework that allows the prospective or retrospective evaluation of the effects and effectiveness of prevention research. RESULTS: The proposed framework allows assessment of prevention research in five areas of public health practice: surveillance and disease investigation, program delivery, policies and regulations, recommendations to the public, and public health education and training. A brief case study of environmental tobacco smoke illustrates the public health impact of prevention research. CONCLUSIONS: Greater translation of prevention research findings is needed to accomplish public health goals--efforts are enhanced by academic-practice partnerships. The relevance and utility of the current framework needs additional testing with a variety of public health issues.

Cost-Benefit Analysis↗

PubMed1999

Physical activity patterns of Chippewa and Menominee Indians: the Inter-Tribal Heart Project.

INTRODUCTION: Leisure-time (LTPA), occupational, transportation, and household physical activity were evaluated among participants in the Inter-Tribal Heart Project (ITHP). METHODS: Age-stratified random samples of persons aged > or =25 years were drawn from three communities of Chippewa and Menominee Indians in Minnesota and Wisconsin. Participants (843 women and 501 men) completed an interviewer-administered questionnaire. Logistic regression analyses were performed to assess age-adjusted associations between no reported LTPA and potential correlates. RESULTS: During leisure time, 12% of women and 17% of men were active 7-12 months in the past year; 33% of women and 21% of men reported no LTPA. During a typical workday for employed persons, approximately 90% of both genders walked > or =20 minutes, for carrying/lifting moderate to heavy objects the median value for men was 1 hour and women 0 hours. The median value of weekly household activity for men was 3 hours compared to 10 hours for women. Little transportation activity was reported by either gender. Age, household income, smoking, and poor/fair self-perceived health were associated with leisure-time inactivity in women (p < 0.05). Age, poor/fair self-perceived health, and smoking were associated with leisure-time inactivity in men (p < 0.05). Walking was the most prevalent activity in the population. CONCLUSIONS: Prevalence of leisure-time inactivity is higher than the national health objective of 15%, however, ITHP participants obtain a substantial amount of occupational and household activity that may lower risks of chronic diseases. Health promotion efforts to increase LTPA may lead not only to reduced chronic disease risk, but to additional benefits of enjoyment and improved psychological well-being.

Adult↗

PubMed1999

Predictors of compliance with recommended cervical cancer screening schedule: a population-based study.

BACKGROUND: The prevalence of routine cervical cancer screening and compliance with screening schedules are low compared to the Year 2000 objectives. Identifying predictors of routine screening and screening schedule compliance will help achieve these objectives. METHODS: We analyzed data from probability samples of 1,609 Missouri women responding to both the 1994 Behavioral Risk Factor Surveillance System (BRFSS) and the Missouri Enhanced Survey (ES). We generated prevalence odds ratios to identify predictors of non-compliance to cervical cancer screening guidelines. Also, among a sample of women reporting a reason for last Pap test, we estimated the relative odds of a screening v. diagnostic exam. RESULTS: In the combined probability sample, compliance with screening schedule was likely among women younger than 50 years of age and women who had either a recent mammography or a clinical breast exam. Being African-American, not experiencing a cost barrier when seeking medical care, having at least a high-school education and health coverage were each associated with an increased compliance with a screening schedule in the combined probability sample. Among women in the combined probability sample, whites, those who experienced no cost barrier to seeking medical care, the non-obese, and those who had a recent mammography were each more likely to have had a screening as opposed to a diagnostic exam. DISCUSSION: Cancer control and cardiovascular (CVD) prevention programs should consider jointly targeting those at high risk for cervical cancer and CVD because of aging and associated high-risk behavior such as non-compliance with cervical cancer screening, smoking, and obesity. Also, further research is needed to examine whether the increased compliance with cervical cancer screening guidelines among African American women may be in part due to higher occurrence of diagnostic Pap smears.

Adult↗

PubMed1999

Key informant surveys as a tool to implement and evaluate physical activity interventions in the community.

Key informant surveys are important tools for planning and evaluating community health programs. A survey was conducted to gather views on policies toward physical activity from four sets of key informants: physicians, church leaders, business leaders and civic leaders. Surveys were mailed to 797 key informants who were selected from 12 southeastern Missouri counties. For comparison, data from a telephone survey of 2106 persons in the general population were also analyzed. The majority (> 85%) in all four key informant groups were very supportive of required physical education in schools, but less supportive (< 69%) of government funding for places where community members can exercise. Physicians perceived community members as having somewhat greater access to places to exercise relative to the other key informant groups. Comparisons of the key informant surveys to the population survey indicated similar levels of support for physical activity policy. The information from this survey has been useful in identifying support for physical activity policy and gaining access to potential influences for community change. Since key informant research in the area of physical activity policy and cardiovascular disease prevention is sparse, there is a need for future studies.

Adult↗

PubMed1999

Evidence-based decision making in public health.

A stronger focus on evidence-based decision making in day-to-day public health practice is needed. This article describes the rationale for this need, including (1) the inter-relationships between evidence-based medicine and evidence-based public health (EBPH); (2) commonly used analytic tools and processes; (3) keys to when public health action is warranted; (4) a strategic, six-step approach to more analytic decision making; and (5) summary barriers and opportunities for widespread implementation of EBPH. The approach outlined is being tested through a series of courses for mid-level managers in the Missouri Department of Health--initial results from a pilot test are encouraging. It is hoped that the greater use of an evidence-based framework in public health will lead to more effective programs.

Decision Making↗

PubMed1999

Assessing excess deaths in St. Louis, Missouri: 1980 to 1994.

Excess deaths in the city of St. Louis from 1980 to 1994, their trends over time, and racial death patterns were assessed using the CDC's Wonder mortality database. Death rates in the city were compared with the three lowest statistically valid county death rates in the state of Missouri. The number and percent of preventable deaths in the city population also were estimated. Findings show that approximately 50 percent of city deaths from the nine leading causes may be preventable.

Adolescent↗

PubMed1999

The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States.

OBJECTIVES: This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. METHODS: Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. RESULTS: Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. CONCLUSIONS: If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.

Australia↗

PubMed1999

Residential radon exposure and risk of lung cancer in Missouri.

OBJECTIVES: This study investigated residential radon exposure and lung cancer risk, using both standard radon dosimetry and a new radon monitoring technology that, evidence suggests, is a better measure of cumulative radon exposure. METHODS: Missouri women (aged 30 to 84 years) newly diagnosed with primary lung cancer during the period January 1, 1993, to January 31, 1994, were invited to participate in this population-based case-control study. Both indoor air radon detectors and CR-39 alpha-particle detectors (surface monitors) were used. RESULTS: When surface monitors were used, a significant trend in lung cancer odds ratios was observed for 20-year time-weighted-average radon concentrations. CONCLUSIONS: When surface monitors were used, but not when standard radon dosimetry was used, a significant lung cancer risk was found for radon concentrations at and above the action level for mitigation of houses currently used in the United States (148 Bqm-3). The risk was below the action level used in Canada (750 Bqm-3) and many European countries (200-400 Bqm-3).

Adult↗

PubMed1999

Prevalence and correlates of physician advice for prevention: impact of type of insurance and regular source of care.

Although managed care penetration continues to grow, little is known about the relationship between managed care and the provision of preventive health services. In this paper the "behavioral model of health services utilization" is used to conceptualize and explore this relationship, and to examine: (1) the prevalence of physician advice for prevention of cardiovascular disease, (2) the relationship between predisposing, enabling, and need characteristics and physician advice, and (3) the impact of insurance type and regular source of care on receipt of physician advice.

Adolescent↗