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Randomized Controlled Trial
. 2021 Oct 23;11(10):1839-1848.
doi: 10.1093/tbm/ibaa138.

Physical activity and healthy eating behavior changes among rural women: an exploratory mediation analysis of a randomized multilevel intervention trial

Brian K Lo  1 , Meredith L Graham  2 , Sara C Folta  3 , David Strogatz  4 , Stephen A Parry  5 , Rebecca A Seguin-Fowler  2
Affiliations
Randomized Controlled Trial

Physical activity and healthy eating behavior changes among rural women: an exploratory mediation analysis of a randomized multilevel intervention trial

Brian K Lo et al. Transl Behav Med. .

Abstract

Rural women experience disproportionately higher levels of obesity in comparison to their non-rural counterparts. The present exploratory mediation analysis sought to identify mechanisms that might have contributed to rural women's physical activity and diet changes after participating in a 6-month multilevel community-randomized trial: Strong Hearts, Healthy Communities (SHHC). SHHC was conducted in 16 rural towns in Montana and New York, between 2015 and 2016; 194 overweight, sedentary midlife, and older women (mean age 59; 26.8% overweight; 73.2% obese) participated. Participants in eight towns received the SHHC intervention (n = 101), which focused on healthy behavior change at the individual level as well as creating supportive social and built environments for physical activity and healthy eating. Participants in the other eight towns received an education-only control intervention (n = 93). We investigated the direct and indirect effects of the SHHC intervention through changes to self-efficacy, social support, and built environment perception, on changes in participants' physical activity and diet. Compared to the controls, SHHC intervention participants increased their social support from friends for physical activity (p = 0.009) and healthy eating (p = 0.032). Participants' improved social support from friends marginally mediated the intervention effects for walking metabolic equivalent minutes per week, explaining 40.5% of the total effect (indirect effect = +45.24, 95% CI: -1.51, +91.99; p = 0.059). Increasing social support from friends appears to be helpful in encouraging rural women to become more active. Further investigations are needed to better understand how multilevel interventions work in rural communities.

Keywords: Mediation analysis; Nutrition; Physical activity; Rural; Social support.

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Figures

Fig 1
Fig 1
| CONSORT flowchart describing participant flow through Strong Hearts, Healthy Communities (SHHC). IPAQ, International Physical Activity Questionnaire; MT, Montana; NY, New York.
Fig 2
Fig 2
| Strong Hearts, Healthy Communities (SHHC) mediation analysis conceptual model.
See this image and copyright information in PMC

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References

    1. Ward BW, Clarke TC, Nugent CN, Schiller JS.. Early release of selected estimates based on data from the 2015 National Health Interview Survey [Internet]. Hyattsville, MD: National; Center for Health Statistics; May 2016. Available at: https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605.pdf. Date accessed 12 December 2019.
    1. Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in state-specific adult fruit and vegetable consumption—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(45):1241–1247. - PMC - PubMed
    1. Reis JP, Bowles HR, Ainsworth BE, Dubose KD, Smith S, Laditka JN. Nonoccupational physical activity by degree of urbanization and US geographic region. Med Sci Sports Exerc. 2004;36(12):2093–2098. - PubMed
    1. Matthews KA, Croft JB, Liu Y, et al. Health-related behaviors by urban-rural county classification—United States, 2013. MMWR Surveill Summ. 2017;66(5):1–8. - PMC - PubMed
    1. Trivedi T, Liu J, Probst J, Merchant A, Jhones S, Martin AB. Obesity and obesity-related behaviors among rural and urban adults in the USA. Rural Remote Health. 2015;15(4):3267. - PubMed

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