| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
RESEARCH |
The authors are with the Psychology Department, University of Texas at El Paso.
Correspondence: Requests for reprints should be sent to Karen J. Coleman, PhD, Psychology Department, 500 W University Ave, University of Texas at El Paso, El Paso, TX 79968-0553 (e-mail: kcoleman{at}utep.edu).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
Objectives. This study sought to determine whether a culturally relevant health message would promote stair use in a predominantly Hispanic community.
Methods. Observations of stair, elevator, and escalator use were collected over a 6-month period at 4 sites throughout the city of El Paso, Tex. The efficacy of individual and family health promotion signs was tested.
Results. Stair use increased in response to both individual and family promotion health messages, and use varied widely by intervention site.
Conclusions. These results underscore the importance of considering the physical characteristics of the environments targeted for health promotion campaigns.
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
This is especially the case in the El Paso, Tex, border region, which has some of the highest rates of obesity (50% of adults older than 45 years), type 2 diabetes (16%), and inactivity (70%) in the nation.11,13 Stair use is a lifestyle change that can increase physical activity and thereby improve health.17–19 Communitywide interventions have most often used signs to promote stair use.20–23 This study investigated the use of signs depicting "familismo" (the importance of family)24–27 to promote stair use in a predominantly Hispanic population.
|
METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
). The individual promotion sign was modeled on that of Brownell et al.22 The culturally appropriate family promotion sign was created in Spanish first, and both signs were translated and back translated by a team of 6 bilingual speakers, 3 of whom were native Spanish speakers.
|
Design
At all of the sites, an initial baseline phase (phase 1) was followed by an intervention phase (phase 2) and, finally, a postintervention phase (phase 3) without a sign. To control for the effects of site, we included a second intervention phase (phase 4) at 2 buildings to test the effects of a sign posted opposite that in phase 2. This was followed by a second postintervention phase (phase 5) without a sign. Phase 3 was used as a "washout" period and as a baseline for phases 4 and 5. Each phase of the study, which was conducted throughout 1999, lasted 1 month.
Procedures
Two observers were inconspicuously stationed at each site. One person recorded men and women taking the stairs, and the other person recorded men and women taking elevators or escalators. People carrying heavy loads, children, or items larger than a backpack, purse, or briefcase and those who were physically handicapped were counted and coded as having luggage or being otherwise impaired. One observer at the airport used a third counter to assess the number of such individuals taking the escalators or elevators.
Reliability was determined at the beginning of each experimental phase and whenever new observers joined the study. The overall reliability rate (r) for the observation categories was 0.99. Observation periods were chosen randomly each day (Monday through Friday) for at least 4 days per week. An attempt was made to observe at least 2 mornings and afternoons a week. Observation periods lasted 30 to 60 minutes.
Patrons and Employees
El Paso's population is 51.2% female and 75% Hispanic (primarily of Mexican descent). UTEP is 53.6% female and 67.4% Hispanic (also primarily of Mexican descent). The study was approved by the UTEP institutional review board.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
. The individual promotion message posted at the bank was significantly associated with increased stair use among both men (
21 = 276.25, P < .001) and women (21 = 117.81, P < .001), and these increases persisted during phase 3 (men: 21 = 40.02, P < .001; women: 21 = 12.15, P < .001). The individual promotion sign displayed at the airport was also significantly associated with increased stair use among men (c21 = 11.36, P < .001) and women (21 = 35.51, P < .001) relative to phase 3. Among men, stair use during phase 5 returned to phase 3 levels. However, women's stair use remained elevated during phase 5 relative to phase 3 (c21 = 57.40, P < .001).
|
21 = 25.50, P < .001); it did not result in changes in rates of use among women relative to phase 3. The decline in men's stair use persisted into phase 5 (21 = 22.27, P < .001), while women's stair use continued to remain constant.
Family Promotional Message
The family promotion sign posted at the office building was significantly associated with decreased stair use among men (21 = 34.67, P < .001) but had no effect on stair use among women. Men's stair use continued to decline during phase 3 (21 = 13.47, P < .001), while women's stair use increased relative to baseline during phase 3 (21 = 22.52, P < .001).
At the airport, the family promotion sign was significantly associated with increased stair use among both men (21 = 288.00, P < .001) and women (21 = 84.01, P < .001). During phase 3, men's stair use returned to baseline levels, while women's stair use remained elevated (c21 = 33.82, P < .001).
Finally, at the UTEP library, the family promotion sign was significantly associated with decreased stair use among men (21 = 38.55, P < .001) and increased use among women (21 = 83.64, P < .001). Men's lower levels of stair use persisted into phase 3 (21 = 17.53, P < .001), while stair use among women remained elevated during phase 3 (21 = 33.82, P < .001).
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
Our findings are similar to the changes in stair use reported in other studies.20–23 Andersen et al.28 recently reported that having an African American character depicted on signs substantially increased stair use among African Americans. This would seem to support cultural tailoring of health-related messages. However, Andersen et al. did not compare this intervention with a general health promotion message, and stair use increased significantly among Caucasian people as well.
Other investigations have shown variations in stair use across different intervention sites.22 There are several reasons why we might have found effects for our intervention at some buildings and not others. The airport and bank evidenced the greatest increases in stair use. Baseline stair use rates were very low at these sites, leaving substantial room for improvement. In addition, most people did not have time to read the signs fully unless they stopped to do so.
Both the library and the office building evidenced high baseline rates of stair use, indicating a possible ceiling effect in the amount of stair use at these locations. Most people read the promotional signs at the library and office building while waiting for the elevator. It is possible that this extra contemplative time resulted in very different behavioral choices than those made quickly without much thought as to the full content of the message (such as at the bank and the airport).
Problems with the current study include not using focus groups to develop and test our "culturally tailored" intervention, not having specific information about the people who were using the stairs at each building, and the observed decreases in men's stair use at certain locations that could not be explained. Future studies would benefit from pretesting health promotion messages with Hispanic men and women of different levels of acculturation, in different socioeconomic categories, and at different geographic locations across the country.
|
Acknowledgments |
|---|
We would like to thank those students who contributed to the completion of this project, including Sherrine Stone, Oscar Esparza, Kelly Chase, Rudy Acuna, Brad Davis, Doris Gonzalez, Susana Rojo, Mario Parada, Delia Hernandez, Kimberly Janssen, Candace Rutt, and Imelda Alcala.
|
Footnotes |
|---|
Accepted for publication December 13, 2000.
|
References |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
2. Aaron DJ, LaPorte RE. Physical activity, adolescence and health: an epidemiological perspective. Exerc Sport Sci Rev. 1998;26:391–405.
3. Schulz LO, Weidensee RC. Glucose tolerance and physical activity in a Mexican indigenous population. Diabetes Care. 1995;18:1274–1276.[Abstract]
4. Soukup JT, Kovaleski JE. A review of the effects of resistance training for individuals with diabetes mellitus. Diabetes Educator. 1993;19:307–312.
5. Sowers M, Villalpando CG, Stern MP, Fox C, Mitchell BD. Relationships between physical activity, insulin levels and lipids in non-diabetic low income residents of Mexico City: the Mexico City Diabetes Study. Arch Med Res. 1995;26:133–140.[Medline]
6. Wei M, Kampert JB, Barlow CE, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight and obese men. JAMA. 1999;282:1547–1553.
7. Wing RR, Epstein LH, Paternostro-Bayles M, Kriska A, Nowalk MP, Gooding W. Exercise in a behavioural weight control programme for obese patients with type 2 (non-insulin-dependent) diabetes. Diabetologia. 1988;31:902–909.[Medline]
8. Carter JS, Pugh JA, Monterrosa A. Non-insulindependent diabetes mellitus in minorities in the United States. Ann Intern Med. 1996;125:221–232.
9. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes. 1998;22:39–47.[Medline]
10. Winkleby MA, Robinson TN, Sundquist J, Kraemer HC. Ethnic variation in cardiovascular risk factors among children and young adults: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. JAMA. 1999;281:1006–1013.
11. Condon KW, Pauli A, Price V, Fry B, Kaigh W, Kaigh G. El Paso Health Report 1996: Executive Summary. El Paso, Tex: Paso del Norte Health Foundation; 1997:1–13.
12. Crespo CH, Keteyian SJ, Heath GW, Sempos CT. Leisure-time physical activity among US adults: results from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 1996;156:93–98.[Abstract]
13. Diabetes Awareness and Education in the Community: Summary Report April 2000. El Paso, Tex: El Paso Diabetes Association; 2000:1–10.
14. Jones DA, Ainsworth BE, Croft JB, Macera CA, Lloyd EE, Yusuf HR. Moderate leisure-time physical activity: who is meeting the public health recommendations? A national cross-sectional study. Arch Fam Med. 2000;7:285–289.
15. Kriska AM, Rexroad AR. The role of physical activity in minority populations. Womens Health Issues. 1998;8:98–103.[Medline]
16. Healthy People 2010: Understanding and Improving Health. Washington, DC: US Dept of Health and Human Services; 2000.
17. Andersen RE, Wadden TA, Bartlett SJ, Zemel B, Verde TJ, Franckowiak SC. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA. 1999;281:335–340.
18. Blair SN, Kohl HW III, Gordon NF. Physical activity and health: a lifestyle approach. Med Exerc Nutr Health. 1992;1:54–57.
19. Paffenbarger RS Jr, Olsen E. LifeFit: An Effective Exercise Program for Optimal Health and a Longer Life. Champaign, Ill: Human Kinetics; 1996.
20. Andersen RE, Franckowiak SC, Snyder J, Bartlett SJ, Fontaine KR. Can inexpensive signs encourage the use of stairs? Results from a community intervention. Ann Intern Med. 1998;129:363–369.
21. Blamey A, Mutrie N, Aitchison T. Health promotion by encouraged use of stairs. BMJ. 1995;311:289–290.
22. Brownell KD, Stunkard AJ, Albuam JM. Evaluation and modification of exercise patterns in the natural environment. Am J Psychiatry. 1980;137:1540–1545.
23. Boutelle KN, Jeffery RW, Schmitz KH. The use of music and artwork to promote daily physical activity. Ann Behav Med. 1999;21(suppl):S206.
24. Huerta EE, Macario E. Communicating health risk to ethnic groups: reaching Hispanics as a case study. J Natl Cancer Inst Monogr. 1999;25:23–26.
25. Naranjo LE, Dirksen SR. The recruitment and participation of Hispanic women in nursing research: a learning process. Public Health Nurs. 1998;15:25–29.[Medline]
26. Sabogal F, Marin G, Otero-Sabogal R, Marin BV, Per Stable EJ. Hispanic familism and acculturation: what changes and what doesn't? Hispanic J Behav Sci. 1987;9:397–412.[Abstract]
27. Vera MI. Health care of Latina women: sociocultural factors. J Fla Med Assoc. 1996;83:494–497.
28. Andersen RE, Franckowiak SC, Zuzak KB, Cummings ES, Crespo CJ. Community intervention to encourage stair use among African-American commuters. Med Sci Sports Exerc. 2000;32(suppl):S38.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
