Ecological Correlates of Physical Inactivity

1
Ecological Correlates of Physical Inactivity

• Carlos J. Crespo, DrPH, MS, FACSM
• University at Buffalo
• State University of New York
• Department of Social and Preventive Medicine
• April 28, 2003
• University of Wisconsin

2
Major points

• To describe the prevalence of physical inactivity
  and obesity in US
• To examine the distribution of sedentary
  lifestyles in different segments of the US
  population
• To study ecological correlates of physical
  inactivity in the United States

3
Data sources

• Behavioral Risk Factor Surveillance System
• National Health Interview Survey
• National Health and Nutrition Examination Survey
• Youth Risk Behavioral Surveillance System
• Substance Abuse and Mental Health Administration
• U.S. Census Bureau
• U.S. Agency for Health Care Research (AHCPR)

4
Limitations

• Ecological fallacy
• Stateunit of measurement
• Other correlates
• parks and recreations
• community organizations, advocacy groups
• policy makers
• secular trends

5
First bicycles, then roller skates. Theyre
turning everything I used to do for fun and
turning it into exercise
6
Leisure Time Physical Activity

• Outside of work, recreationally
• exercise
• sports (except professional athletes)
• physical education
• play, games, active hobbies
• no LTPAlack of any of the above
• Other forms of physical activity
• occupational
• transportation
• incidental

7
Prevalence of no leisure-time physical activity
by race/ethnicity in U.S. adults, 20 years and
older
Source Crespo et al., Arch Int Med, 1996
Crespo et al., Am J Prev Med 2000 (NHANES III)
8
Age-specific prevalence of no leisure-time
physical activity by race/ethnicity in men.
years of age
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
9
Age-specific prevalence of no leisure-time
physical activity by race/ethnicity in women.
years of age
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
10
Percent of adults physically inactive during
leisure-time
Behavioral Risk Factor Surveillance System, 1996
11
The 10 most inactive states

• Delaware 35.8
• Arkansas 36.4
• Oklahoma 37.1
• Mississippi 38.9
• Tennessee 39.9
• North Carolina 40.4
• West Virginia 41.5
• Ohio 42.9
• Kentucky 44.6
• Georgia 51.1

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The 10 least inactive states (more active)

• Utah 17.5
• Washington 18.8
• Oregon 19.2
• Montana 20
• Wyoming 20.3
• Idaho 20.4
• Hawaii 20.7
• Colorado 20.9
• Wisconsin 21.2
• Vermont 21.4

13
Lack of enrollment in physical education class
among high school students by state, U.S., 1995
R.43 p0.016
Youth Risk Behavioral Surveillance System, 1995
14
Prevalence of obesity in children according to
hours of television watching, U.S. children 8-16
years, 1988-1994
Crespo et al., Archives of Pediatric and
Adolescent Medicine, 2001 155360-5
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(No Transcript)
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Energy intake in children according to hours of
television watching, U.S. children 8-16 years,
1988-1994
Boys
Boys
Girls
PCrespo et al., Archives of Pediatric and
Adolescent Medicine, 2001 155360-5
18
Left base or Third field?
19
Prevalence of no leisure-time physical
activityby region in persons aged 55 years and
over
Morbidity and Mortality Weekly Report, Dec. 17,
1999
20
No leisure-time physical activity and degree of
urbanization

• The difference in the prevalence (metro vs rural
  . . .was greater for men (12.0) than women
  (6.7).

Morbidity and Mortality Weekly Report, Dec. 25,
1998
21
Annual household income and prevalence of no
leisure-time physical activity by race/ethnicity
in men.
Income, dollars
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
22
Annual household income and prevalence of no
leisure-time physical activity by race/ethnicity
in women
Income, dollars
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
23
The Time Crunch, Families and the Labor Market,
1969-1996.
Married with children
Husband
Single parent
Wife
Families with at least one child under age 18 y
Source The Washington Post, May 25, 1999,
Report from Council of Economic Advisers
24
Median household income by state, 1996
R-0.32 p.023
25
Leisure-time and hard occupational physical
activity 5hrs/day among employed U.S. adults,
1990
Source MMWR, May 19, 2000, National Health
Interview Survey, 1990
26
Occupation and prevalence of no leisure-time
physical activity by race/ethnicity in men
Occupation
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
27
Occupation and prevalence of no leisure-time
physical activity by race/ethnicity in women.
Occupation
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
28
Percent distribution of persons living in poverty
R.40 p0.0037
Health, United States, 1998, NCHS/CDC
29
Percent of adults without health care coverage
R.26 p0.06
US Bureau of the Census, Household Economic
Study, 1995, in Health, US 98
30
Percent of persons 60 years with a probable
physical activity-limiting chronic condition
congestive heart failure, chronic bronchitis or
COPD, emphysema, heart attack, arthritis, low
back pain, stroke or cancer
31
Prevalence of no LTPA according to selected
chronic diseases in US adults 20 y and older,
1988-1994
non-skin cancer
Crespo et al., J. Clin. Exercise Phys.
19991(2)68-73
32
Prevalence of no LTPA among persons 60 year and
older with physical activity-limiting chronic
condition
Crespo et al., J. Clin. Exercise Phys.
19991(2)68-73
33
Distribution of persons enrolled in health
maintenance organization
R-.35 p0.012
The InterStudy Edge Competitive Edge, 1994-1997,
in Health, US 98
34
Annual percent change in physician service
expenditures, 1990-1993
R-.14
Health Care Financing Administration, In Health,
United States, 1998
35
Annual percent change in hospital care
expenditures, 1990-1993
R.19
Health Care Financing Administration, In Health,
United States, 1998
36
Marital status and prevalence of no leisure-time
physical activity by race/ethnicity in men.
Marital status
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
37
Marital status and prevalence of no leisure-time
physical activity by race/ethnicity in women.
Marital status
Source Third National Health and Nutrition
Examination Survey, 1988-1994 Crespo et al., Am J
Prev Med 2000
38
What adults say are their top two or three
favorite leisure activities (per 100)
39
Percent of persons 60 years and older who engage
in different types of social contact with others
at least once a week
40
Unadjusted prevalence of no LTPA by numbers of
phone contacts with family, friends and neighbors
a week
41
Adjusted prevalence of no LTPA according to
social support among persons 60 years and older
No
Yes
Adjusted for race, sex, and presence of chronic
conditions.
42
Neighborhood safety and physical inactivity
Morbidity and Mortality Weekly Report, Feb 26,
1999, BRFSS selected states, C. Macera, APHA 98
43
Neighborhood safety and physical inactivity
Morbidity and Mortality Weekly Report, Feb 26,
1999, BRFSS selected states, C. Macera, APHA 98
44
Clients in treatment for both alcoholism and
drug abuse, 12 y
R.43 p0.001
Substance Abuse and Mental Health Services
Administration, 1992 and 1995
45
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Percent of adults who are overweight
R.38 p.005
Based on self-reported weight and height
Overweight for men27.8, women 27.3 Behavioral
Risk Factor Surveillance System, 1996
47
Physical activity among overweight adults by
geographic region
Morbidity and Mortality Weekly Report, April 21,
2000
48
Obesity Trends Among U.S. Adults BRFSS, 1991,
1995 and 2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI ? 30, or 30 lbs overweight for 54 woman)
52
Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI ? 30, or 30 lbs overweight for 54 woman)
53
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI ? 30, or 30 lbs overweight for 54 woman)
54
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI ? 30, or 30 lbs overweight for 54 woman)
55
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI ? 30, or 30 lbs overweight for 54 woman)
56
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI ? 30, or 30 lbs overweight for 54 woman)
57
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI ? 30, or 30 lbs overweight for 54 woman)
58
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI ? 30, or 30 lbs overweight for 54 woman)
59
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI ? 30, or 30 lbs overweight for 54 woman)
60
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI ? 30, or 30 lbs overweight for 54 woman)
62
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI ? 30, or 30 lbs overweight for 54 woman)
63
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI ? 30, or 30 lbs overweight for 54 woman)
64
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
65
Age-specific changes in obesity in men between
NHANES III and NHANES 2000
66
Race-specific changes in obesity between NHANES
III and NHANES 2000
67
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Percent of 17-20 years persons who weight more
than maximum allowable for Military Services,
Source Nolte, Franckowiak, Crespo and Andersen.
Am J Med, 2002113486
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Our Evolution...

• America, as a whole, has successfully achieved
  a high level of productivity, producing abundant
  food, effective medical treatment, and labor
  saving technology...

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Our Problem

• ...Yet, this success has produced unintended
  consequences that make it difficult for many
  individuals to maintain a healthy lifestyle

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Body Fat Mass
? Activity of daily living
? Work-related physical activity
High Fat, energy dense foods
? Sedendary behavior
EIn
EOut
Large Portion Sizes
Palatable, low-cost, easily available foods
72
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Spending in fast-food restaurants per person
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Where are we today?

• Transition from undernutrition to overnutrition
  long recognized as a problem
• Obesity is a marker of poor dietary and physical
  activity patterns
• The problem is getting worse

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What is Causing the Problem?

• Not biology
• Interaction of biology environment
• Constantly evolving society

78
Complexity of Factors Involved

• Issues within the individual
• Issues within the environment
• Broad societal issues

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How Do We Begin to Address the Complexities?

• A multi-dimensional problem requires a
  multi-dimensional solution...

80
Percent of adult who reported cigarette smoking
R.41 p0.002
Behavioral Risk Factor Surveillance System, 1996
81
Percent of adults physically inactive in
leisure-time
Behavioral Risk Factor Surveillance System, 1996
82
I developed a dependency on treadmills over the
winter
83
Monthly variations in no leisure-time physical
activity by race/ethnicity
Behavioral Risk Factor Surveillance System, 1994,
MMWR May 9, 1997
84
Monthly variations in no leisure-time physical
activity, gender differences
Behavioral Risk Factor Surveillance System, 1994,
MMWR May 9, 1997
85
Average winter temperatures, F
R.21
86
Average summer temperatures, F
R.16
87
Average fall temperatures, F
R.28 p0.04
88
Average spring temperatures, F
R.33 p0.01
89
Average days a year with precipitation
R.12
90
Multivariate logistic regression of no
leisure-time physical activity among 51 states

• Overweight (P0.01)
• Smoking (P0.03)
• Poverty (P0.03)
• In HMO (P0.10)
• Substance abuse (P0.04)
• No physical education (P0.0814) (N31)

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In Summary

• Differences in physical inactivity by state are
  multi-factorial
• Relationships were found with
• income/poverty
• substance abuse
• smoking
• health services provider
• and possibly obesity and lack of school PE

92
Conclusion

• Every state should promote physical activity
• Legislation should be implemented to secure the
  time, space and resources for all members of
  society to benefit from an active lifestyle
• Expand research to identify possible
  macro-determinants of physical activity
  participation