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JoAnn Kuo, MPH, Carolyn C. Voorhees, PhD, Jennifer A. Haythornthwaite, PhD and Deborah Rohm Young, PhD

JoAnn Kuo and Deborah Rohm Young are with the Department of Kinesiology, University of Maryland, College Park. Carolyn C. Voorhees is with the Department of Public and Community Health, University of Maryland, College Park. Jennifer A. Haythornthwaite is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Md.

Correspondence: Requests for reprints should be sent to JoAnn Kuo, MPH, Department of Kinesiology, University of Maryland, 2351 Health and Human Performance Building, College Park, MD 20742-2611 (e-mail: jkuo1{at}umd.edu).

	ABSTRACT

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We examined the association between various dimensions of the family environment, including family intimacy and involvement in activities, family support for physical activity, and neighborhood violence (perceived and objective) and physical activity among urban, predominantly African American, ninth-grade girls in Balti-more, Md. Greater family intimacy (P = .05) and support (P = .01), but not neighborhood violence, was associated with physical activity. Family factors, including family intimacy and support, are potential targets in physical activity interventions for urban high-school girls.

	INTRODUCTION

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Regular physical activity is a health-protecting behavior¹ that declines dramatically during adolescence.² According to the social–ecological model, health behaviors are influenced on 5 levels: intrapersonal, interpersonal, institutional, community, and public policy.³ Physical and social environments interact with individual behavior to support or hinder physical activity, as does neighborhood safety.^4,5 Although parental support is consistently associated with adolescent physical activity,⁶ little attention has been given to other aspects of the family environment, such as family intimacy, that are associated with other adolescent health risk behaviors, including condom and drug use.⁷ This is the first study we know of to examine the relationship between the broader family environment—including neighborhood violence and family intimacy and involvement in social and recreational activities—and physical activity among urban adolescent girls.

	METHODS

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We analyzed baseline data collected from 2000 to 2002 for Project Heart, a comprehensive physical activity randomized trial in an all-girl, citywide, urban high school in Baltimore, Md. In Project Heart, ninth-grade girls were recruited to participate in physical education class; approximately 50% agreed to participate.

We used reliable and validated instruments to assess physical activity and environmental factors.^8–12 After 7 days had passed, a physical activity recall was used to assess total daily energy expenditure, following the methodology of Sallis et al.⁸ Perceived threatened or actual violence in the past year was assessed using an exposure-to-violence subscale.⁹ Closeness and emotional sharing among family members were assessed using a family intimacy subscale.¹⁰ Family involvement in social and recreational activities¹¹ and family support for exercise¹² also were assessed using respective subscales.

We obtained the number of violent crimes (i.e., aggravated assault, murder, rape, and robbery) reported citywide in 2000 from the Vital Signs for Baltimore Neighborhoods Report and calculated the rate of violent crime per 1000 residents.¹³ Violent crime counts were obtained by occurrence within a community statistical area (defined as a neighborhood cluster created along boundaries of census tracts with similar demographics, income, and education). We used a girl’s home address to determine her community statistical area. Each community statistical area had an average of 4691 households. Because neighborhoods are more recognizable to community groups, police, and residents, this approach to measuring crime data may be more amenable to intervention.

Analyses indicated that physical activity and perceived neighborhood violence were skewed, so we performed regression analyses with and without logarithmically transformed data. Final analyses used the transformed physical activity variable and the original violence variable. We examined associations between physical activity and family environmental characteristics after we controlled for mother’s education. The results were not affected after we controlled for which parent participants lived with and race/ethnicity; these variables were not included in the final models. We used similar models to compare the association of physical activity to perceived violence (model 1) and violent crime rate (model 2). We used a mixed models approach to construct models with girls nested within community statistical areas (SAS, version 9.1; SAS Institute Inc, Cary, NC).

	RESULTS

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Participants (N = 221) resided in 48 of the 55 community statistical areas in Baltimore. Table 1 presents participant characteristics. Table 2 shows participant responses regarding physical activity for each environmental subscale, as well as the results of the regression analyses. We estimated that a nonactive participant (one who averages 8 hours of sleep and performs no moderate or greater activities per day) would have a total daily energy expenditure of 7.6 kJ/kg/day (32 kcal/kg/day). We found that on average, participants could be classified as nonactive, with a total daily expenditure of 8.3 ± 0.71 kJ/kg/day (34.7 ± 2.96 kcal/kg/day). Family scales correlated significantly with each other (r_s = 0.34–0.42; P < .001). Physical activity correlated significantly with family involvement in activities (r_s = 0.17; P < .05), family support (r_s = 0.18; P < .01), and perceived neighborhood violence (r_s = 0.14, P < .05). Perceived neighborhood violence was positively related to rate of violent crime (r_s = 0.23; P = .01).

	DISCUSSION

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Family support for exercise, family involvement in activities, and general family intimacy may be important predictors of physical activity in adolescent girls. Family intimacy, although overlooked in previous adolescent physical activity research, may be an important factor to evaluate further given its association with adolescent health risk behaviors.¹⁴ Greater parent communication, monitoring, and warmth can affect adolescents’ attitudes and beliefs about risk behaviors.¹⁵ Parental monitoring and communication interventions may protect against adolescent risk behavior.¹⁶ Hence, although family intimacy explains a small percentage of the variance in physical activity, it benefits other adolescent behaviors without detrimental effects. Given the current attention to childhood obesity,¹⁷ this is a unique moment during which parents may be more receptive to adolescent physical activity interventions that have parenting components.

Studies on violence and physical activity are inconsistent. Perception of neighborhood crime was associated with less adult physical activity,^4,5 but objectively measured crime was associated with more adolescent physical activity.¹⁸ The neighborhood environment may influence adults and adolescents differently, possibly because environments outside the neighborhood are less accessible to adolescents.

It is not clear why neither perceived violence nor the objective violent crime rate predicted adolescent physical activity in this study. Perceived crime was expected to predict physical activity better than was objective crime because perceived crime reflects direct exposure to specific types of crime. Because community statistical areas are large, girls may not know about crimes that happened within their community statistical area if those crimes occurred too far from home. The objective crime measurement was made on the basis of reported crimes, which may have underestimated the actual number of crimes that were committed. The overall inactivity of the study population may explain why differences by crime were not detected.

This study had several limitations. Self-report measures could have been biased toward socially desirable responses and were subject to lack of recall. Interviewers used probes to improve girls’ recall of their activities, particularly those that were less vigorous in nature. Results may not be generalizable beyond a population of urban, predominantly African American girls.

Our results extend the adolescent physical activity literature and suggest an area for future investigation: the role of aspects of the family environment other than that of family social support, particularly family intimacy and involvement in activities, that also may influence physical activity. Future research should use crime data from smaller geographic levels (e.g., census tract) or weighted for distance from home. Other aspects of the neighborhood that contribute to safety, such as the presence of sidewalks or heavy traffic, may be important factors for adolescent physical activity level. Future research should continue to study additional aspects of the adolescent family and neighborhood environments as possible determinants of physical activity.

	Acknowledgments

 
This study was supported by National Institutes of Health (grant RO1 HL63861).

Human Participant Protection
This study was approved by the internal review boards at Johns Hopkins University and the University of Maryland.

	Footnotes

 
Peer Reviewed

Contributors
J. Kuo led the writing of the brief, performed the data analysis, interpreted the results, and collaborated on the study design. C.C. Voorhees participated in the writing of the brief and collaborated on the study design. J.A. Haythorn-thwaite helped obtain funding, assisted with interpretation of results, and participated in the writing of the brief. D. Rohm Young obtained funding, supervised the study, assisted with interpretation of results, participated in the writing of the brief, and collaborated on the study design.

Accepted for publication August 15, 2006.

	References

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1. Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

2. Kimm YS, Glynn NW, Kriska AM, et al. Decline in physical activity in black girls and white girls during adolescence. N Engl J Med. 2002;347:709–715.[Abstract/Free Full Text]

3. Sallis JF, Owen N. Ecological models of health behavior. In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. San Francisco, Calif: Jossey-Bass; 2002:462–484.

4. Centers for Disease Control and Prevention. Neighborhood safety and the prevalence of physical inactivity—selected states, 1996. MMWR Morb Mortal Wkly Rep. 1999;48:143–146.[Medline]

5. Brownson RC, Baker EA, Housemann RA, Brennan LK, Bacak SJ. Environmental and policy determinants of physical activity in the United States. Am J Public Health. 2001;91:1995–2003.[Abstract/Free Full Text]

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8. Sallis JF, Haskell WL, Wood PD, et al. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol. 1985;121:91–106.[Abstract/Free Full Text]

9. Ewart CK, Suchday S. Discovering how urban poverty and violence affect health: development and validation of a neighborhood stress index. Health Psychol. 2002;21:254–262.[CrossRef][Web of Science][Medline]

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13. Vital Signs for Baltimore Neighborhoods Report. Baltimore, Md: Baltimore Neighborhood Indicators Alliance, Jacob France Institute, University of Baltimore; 2002.

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This Article Abstract Full Text (PDF) All Versions of this Article: AJPH.2005.072348v1 97/1/101    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Kuo, J. Articles by Young, D. R. Search for Related Content PubMed PubMed Citation Articles by Kuo, J. Articles by Young, D. R. Related Collections Community Health Exercise/Physical Activity Adolescent Health African Americans/Blacks Minority Children Other Environment