Understanding the environmental correlates of physical activity for adults (20 to 65 years) in a Mexican city (Cuernavaca) Open Access

Salvo Dominguez, Deborah (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/ft848q872?locale=en
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Abstract

Physical inactivity has been defined as a pandemic. It is a known risk factor for obesity and several chronic diseases. Seven out of ten Mexican adults are either overweight or obese, and type II diabetes and cardiovascular diseases constitute the first causes of death in the country. The association of physical activity with the built environment is well established. The environmental correlates of physical activity have been extensively studied in countries such as the US, Australia, Canada, the UK and Belgium, but few studies from lower-to-middle income countries are available. The aim of this dissertation was to conduct the first study in Mexico to identify the environmental correlates of physical activity among adults in an urban setting (Cuernavaca). The study is part of the International Physical Activity Environment Network study, that uses data from twelve countries. A cross sectional study design was used and data were collected for a representative sample of adults (n=677) from Cuernavaca. Physical activity was measured objectively (accelerometry) and subjectively (International Physical Activity Questionnaire). Perception of the environment was measured through the Neighborhood Environment Walkability Scale, and Geographic Information Systems were used to obtain objective environmental data. Our findings show many variations from what is known for certain high income countries. We report the results of four analyses (including a preliminary analysis for Brazilian data) in this dissertation. Among the main findings, we saw that the accepted definition of walkability derived from evidence of standard US cities was inversely associated to PA among Mexican adults, while motor vehicle ownership is one of the strongest correlates (inverse) for PA among Mexicans. Our findings also highlight the importance of examining intensity and domain-specific PA instead of a compound variable for total to moderate physical activity. The data collected for this study will enable many future analyses that will be instrumental to elucidate the relationships of PA with sociodemographic, psychosocial and environmental variables among Mexicans. This is the first study of its kind for Mexico and will provide valuable information to guide interventions and policies in Mexico.

Table of Contents

Table of Contents

1.Introduction............................................................................................................................................................

2. Aims and Objectives................................................................................................................................................

2.1 Primary Aim.........................................................................................................................................................

2.2 Study I................................................................................................................................................................

2.3 Study II...............................................................................................................................................................

2.4 Study III .............................................................................................................................................................

2.5 Study IV..............................................................................................................................................................

3.Background............................................................................................................................................................

4. Preliminary Data.....................................................................................................................................................

5.Hypotheses............................................................................................................................................................

6. IPEN-Mexico Study Methods....................................................................................................................................

6.1 Overview of IPEN study.........................................................................................................................................

6.2 Collaboration with IPEN-Colombia and IPEN-Brazil.....................................................................................................

6.3 Collaboration with the Mexican National Institute of Public Health...............................................................................

6.4 Study site: Cuernavaca, Mexico..............................................................................................................................

6.5 Study design and sampling....................................................................................................................................

6.5.1 Stratification by the walkability index...................................................................................................................

6.5.2 Stratification by census tract level socioeconomic status.........................................................................................

6.5.3 Sampling.........................................................................................................................................................

6.6 Inclusion and exclusion criteria..............................................................................................................................

6.7 Instruments........................................................................................................................................................

6.7.1 Objective measurement of physical activity: Accelerometers...................................................................................

6.7.2 Self reported physical activity: International Physical Activity Questionnaire..............................................................

6.7.3 Objective measurement of the built environment: GIS............................................................................................

6.7.4 Perceived built environment: ANEWS....................................................................................................................

6.7.5 Survey to assess psychosocial measures...............................................................................................................

6.7.6 General information questionnaire for demographic information................................................................................

6.7.7 Data collection instruments for Body Mass Index estimation.....................................................................................

6.7.8 Home characteristics and assets survey................................................................................................................

6.7.9 Block level environmental audit tool.....................................................................................................................

6.7.10 Audit tool for spaces for physical activity for Latin American urban sites..................................................................

6.8 Data collection procedures.....................................................................................................................................

6.8.1 Training...........................................................................................................................................................

6.8.2 Recruitment and data collection...........................................................................................................................

6.9 Protection to human subjects.................................................................................................................................

6.10 Accelerometry data scoring..................................................................................................................................

6.11 Variables for analysis..........................................................................................................................................

6.11.1 Physical activity outcome variables....................................................................................................................

6.11.2 Built environment (independent) variables..........................................................................................................

6.12 Statistical analysis..............................................................................................................................................

6.12.1 Weights..........................................................................................................................................................

6.12.2 Descriptive analysis..........................................................................................................................................

6.12.3 Correlation analysis..........................................................................................................................................

6.12.4 Modeling strategy.............................................................................................................................................

6.12.5 Statistical software...........................................................................................................................................

6.13 Final sample for analysis .....................................................................................................................................

7. Study I.................................................................................................................................................................

7.1 Title page............................................................................................................................................................

7.2 Abstract...............................................................................................................................................................

7.3 Background.........................................................................................................................................................

7.4 Methods..............................................................................................................................................................

7.5 Results................................................................................................................................................................

7.6 Discussion...........................................................................................................................................................

7.7 Acknowledgements...............................................................................................................................................

7.8 List of Tables and Figures......................................................................................................................................

7.9 References..........................................................................................................................................................

8. Study II................................................................................................................................................................

8.1 Title page............................................................................................................................................................

8.2 Abstract..............................................................................................................................................................

8.3 Introduction........................................................................................................................................................

8.4 Methods.............................................................................................................................................................

8.5 Results...............................................................................................................................................................

8.6 Discussion...........................................................................................................................................................

8.7 Conclusion...........................................................................................................................................................

8.8 Acknowledgements...............................................................................................................................................

8.9 List of Tables and Figures......................................................................................................................................

8.10 References.........................................................................................................................................................

9. Study III...............................................................................................................................................................

9.1 Title page............................................................................................................................................................

9.2 Abstract..............................................................................................................................................................

9.3 Introduction .......................................................................................................................................................

9.4 Methods.............................................................................................................................................................

9.5 Results...............................................................................................................................................................

9.6 Discussion...........................................................................................................................................................

9.7 Conclusion...........................................................................................................................................................

9.8 Acknowledgements...............................................................................................................................................

9.9 List of Tables and Figures......................................................................................................................................

9.10 References.........................................................................................................................................................

10. Study IV..............................................................................................................................................................

10.1 Title page..........................................................................................................................................................

10.2 Abstract............................................................................................................................................................

10.3 Introduction.......................................................................................................................................................

10.4 Methods............................................................................................................................................................

10.5 Results.............................................................................................................................................................

10.6 Discussion.........................................................................................................................................................

10.7 Conclusion.........................................................................................................................................................

10.8 Acknowledgements.............................................................................................................................................

10.9 List of Tables and Figures....................................................................................................................................

10.10 References.......................................................................................................................................................

11. Discussion...........................................................................................................................................................

11.1 Novel approach to understand the association of combinations of environmental variables on physical activity outcomes

11.2 Importance of studying intensity-specific physical activity outcomes..........................................................................

11.3 First study to address the sociodemographic and environmental correlates of physical activity in Mexico........................

11.4 Inverse association of "walkability index" and its components to physical activity among Mexican adults........................

11.5 No association of socioeconomic status with physical activity....................................................................................

11.6 Role of safety from crime for physical activity.........................................................................................................

11.7 Motor vehicle ownership and public transit routes: inverse associations to physical activity among Mexican adults...........

11.8 Self reported versus objectively measured physical activity......................................................................................

11.9 Physical activity as a continuous variable...............................................................................................................

11.10 Bout analysis for accelerometer-based physical activity..........................................................................................

11.11 Limitations of using GIS data.............................................................................................................................

11.12 Challenges of conducting this type of research in Latin America (Mexico)..................................................................

11.13 Further studies with our dataset.........................................................................................................................

11.14 Future studies beyond the scope of our dataset....................................................................................................

11.15 Policy implications............................................................................................................................................

12. Conclusion..........................................................................................................................................................

13. Bibliography........................................................................................................................................................

Appendices...............................................................................................................................................................

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