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Robinson SA, Bamonti P, Richardson CR, Kadri R, Moy ML. Rural disparities impact response to a web-based physical activity self-management intervention in COPD: A secondary analysis. J Rural Health 2024; 40:140-150. [PMID: 37166231 DOI: 10.1111/jrh.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/04/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE This secondary exploratory analysis examined rural-urban differences in response to a web-based physical activity self-management intervention for chronic obstructive pulmonary disease (COPD). METHODS Participants with COPD (N = 239 US Veterans) were randomized to either a multicomponent web-based intervention (goal setting, iterative feedback of daily step counts, motivational and educational information, and an online community forum) or waitlist-control for 4 months with a 12-month follow-up. General linear modeling estimated the impact of rural/urban status (using Rural-Urban Commuting Area [RUCA] codes) on (1) 4- and 12-month daily step-count change compared to waitlist-control, and (2) intervention engagement (weekly logons and participant feedback). FINDINGS Rural (n = 108) and urban (n = 131) participants' mean age was 66.7±8.8 years. Rural/urban status significantly moderated 4-month change in daily step counts between randomization groups (p = 0.041). Specifically, among urban participants, intervention participants improved by 1500 daily steps more than waitlist-control participants (p = 0.001). There was no difference among rural participants. In the intervention group, rural participants engaged less with the step-count graphs on the website than urban participants at 4 months (p = 0.019); this difference dissipated at 12 months. More frequent logons were associated with greater change in daily step counts (p = 0.004); this association was not moderated by rural/urban status. CONCLUSIONS The web-based intervention was effective for urban, but not rural, participants at 4 months. Rural participants were also less engaged at 4 months, which may explain differences in effectiveness. Technology-based interventions can help address urban-rural disparities in patients with COPD, but may also contribute to them unless resources are available to support engagement with the technology.
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Affiliation(s)
- Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia Bamonti
- Department of Research & Development, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Reema Kadri
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Abstract
Purpose of Review Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities. Recent Findings The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted. Summary Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.
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Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI USA
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Sasaki S, Nakamura K, Ukawa S, Okada E, Amagasa S, Inoue S, Kimura T, Yoshimura A, Tanaka A, Nakagawa T, Imae A, Tamakoshi A. Association of accelerometer-measured physical activity with kidney function in a Japanese population: the DOSANCO Health Study. BMC Nephrol 2022; 23:7. [PMID: 34979979 PMCID: PMC8722077 DOI: 10.1186/s12882-021-02635-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/09/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sedentary behavior and decreased physical activity are associated with reduced kidney function, yet most evidence is based on self-reported physical activity. This study investigated the association between accelerometer-based physical activity level and kidney function in a general Japanese population. METHODS A cross-sectional study was conducted in 440 community-dwelling Japanese participants, aged 35-79 years. Time (min/d) was assessed for the following types of physical activity: sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Kidney function was assessed using estimated glomerular filtration rate (eGFR). A linear regression model was employed to calculate the β coefficient of eGFR for a 60-min/d increase in sedentary behavior and LPA and a 10-min/d increase in MVPA. A logistic regression model was used to calculate the odds ratio for low eGFR (< 60 versus ≥60 mL/min/1.73m2) for a 60-min/d or 10-min/d increase in each physical activity type. RESULTS MVPA time and eGFR were positively associated in both men and women, after adjusting for age, body mass index, and other clinical characteristics (Men: β, 0.91; P = 0.021; Women: β, 0.70; P = 0.034). In women, sedentary behavior and eGFR were inversely associated after adjusting for the same factors (β, - 1.06; P = 0.048). The odds ratio (95% confidence interval) for low eGFR associated with a 60-min increase in sedentary behavior was 1.65 (1.07-2.55) after adjusting for the same factors in women. CONCLUSION Longer sedentary behavior and shorter MVPA time were associated with lower kidney function in the Japanese population.
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Affiliation(s)
- Sachiko Sasaki
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.,Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, 5-196-1 Kogane-chuo, Eniwa, 061-1449, Japan
| | - Koshi Nakamura
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan. .,Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Shigekazu Ukawa
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.,Research Unit of Advanced Interdisciplinary Care Science, Osaka City University Graduate School of Human Life Science, Sugimoto 3-3-138, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Emiko Okada
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.,Department of Nutritional Epidemiology, National Institute of Biomedical Innovation, Health and Nutrition, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Shiho Amagasa
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Aya Yoshimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Aya Tanaka
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takafumi Nakagawa
- The Hokkaido Centre for Family Medicine, 1-18, Kita 41, Higashi 15, Higashi-ku, Sapporo, 007-0841, Japan
| | - Akihiro Imae
- Suttu Municipal Clinic, 72-2, Utoshima-Cho, Suttu-Cho, Suttu-Gun, Hokkaido, 048-0406, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Ramakreshnan L, Fong CS, Sulaiman NM, Aghamohammadi N. Motivations and built environment factors associated with campus walkability in the tropical settings. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141457. [PMID: 33370890 DOI: 10.1016/j.scitotenv.2020.141457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/27/2020] [Accepted: 08/01/2020] [Indexed: 06/12/2023]
Abstract
Recognizing and mainstreaming pertinent walkability elements into the university campus planning is crucial to materialise green mandates of the campus, while enhancing social and economic sustainability. In one of such attempts, this transverse study investigated the walking motivations, built environment factors associated with campus walkability and the relative importance of the studied built environment factors in reference to the sociodemographic attributes from the viewpoint of the campus community in a tropical university campus in Kuala Lumpur, Malaysia. An online survey using a structured questionnaire was conducted between May and September 2019. The built environment factors associated with campus walkability were expressed and ranked as adjusted scores (AS). Meanwhile, multivariable logistic regression was deployed to examine the relative importance of the studied built environment factors in reference to the sociodemographic attributes of the campus community. Among 504 total responses acquired, proximity between complementary land uses (90.7%) was reported as the main motivation for walking. On the other hand, street connectivity and accessibility (AS: 97.62%) was described as the most opted built environment factor, followed by land use (AS: 96.76%), pedestrian infrastructure (AS: 94.25%), walking experience (AS: 87.07%), traffic safety (AS: 85.28%) and campus neighbourhood (AS: 59.62%), respectively. Among the sociodemographic attributes, no regular monthly income (OR = 3.162; 95% CI = 1.165-8.379; p < 0.05) and willingness to walk more than 60 min inside the campus per day (OR = 0.418; 95% CI = 0.243-0.720; p < 0.05) were significantly associated with the expression of higher importance towards the reported built environment factors in the multivariate analysis. In brief, the findings of this study were envisaged to elicit valuable empirical evidence for informed interventions and strengthening campus sustainable mobility policies.
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Affiliation(s)
- Logaraj Ramakreshnan
- Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Institute for Advanced Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chng Saun Fong
- Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Institute for Advanced Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nik Meriam Sulaiman
- Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nasrin Aghamohammadi
- Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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