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.

1

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

3

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

4

Theoretical Approach• Social ecological framework

• Social cognitive theory

• Environment � Behaviors � Health Outcomes

5

Bronfenbrenner, 1979, MacKinnon & Luecken, 2008; Sallis et al., 2006; Tu & Ko, 2008

6

Mediated Effect = a*b

7

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)

8

9

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

10

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

11

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)

12

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

13

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

14

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

15

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

16

17

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

18

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

19

THANK YOUcoulon@mailbox.sc.edu

20