An overview of the “Positive Action for Today's Health” (PATH) trial for increasing walking in low income, ethnic minority communities

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Abstract

Background

Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities.

Design and setting

Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months.

Intervention

The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA.

Main hypotheses/outcomes

It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months.

Conclusions

Implications of this community-based trial are discussed.

Section snippets

Introduction and rationale for the PATH trial

The important influence of physical activity (PA) on reducing chronic disease, including obesity, has been well-established [1], [2]. National studies have demonstrated that moderate intensity activity equivalent to a brisk walk provides enough benefit to improve fitness and prevent poor health outcomes, including obesity, disability, and death [1], [2], [3]. National studies have also shown that PA may be associated with weight loss resulting in reductions in blood pressure, serum

Study design and recruitment

The PATH trial is designed to examine a 24-month environmental intervention designed to improve safety and access for PA and trail use in three underserved communities. Three communities have been identified and matched based on census tract level information (see Table 1). The three communities have been randomized to receive one of the three interventions: an intervention that combines a police-patrolled-walking program with a social marketing intervention, a police-patrolled-walking program

Integration of ecological and behavioral theories in the PATH intervention

The PATH intervention integrates principles from ecological and social marketing perspectives that highlight the promotion of a safe and accessible place to walk in the neighborhood on a regular basis. Social marketing has been defined as the design and implementation of programs to increase the acceptance of a new practice in a target group [35] to improve health or personal welfare [36]. McGuire [37] has developed an information-processing model that suggests the impact of persuasive

Approach to process evaluation

PATH uses FORECAST modeling to guide tracking and process evaluation of program implementation [39]. FORECAST is framed around four critical components: models, markers, measures and meaning. The model provides a visual of the nature of the problem and the proposed intervention actions. The PATH research model (see Fig. 1) illustrates the program elements that target specific mediating factors which collectively should impact the projects primary and secondary aims. A program model based on

Outcome measures and psychosocial mediators

PATH research staff conduct health screenings and measurement assessments in the community centers at baseline, 6, 12, 18, and 24 months. Health screenings are conducted simultaneously in all three communities to control for extraneous environmental factors. Measures include 7-day accelerometry estimates of PA, casual blood pressure, height, weight, blood sugar levels, waist circumference, medications use, psychosocial surveys, and a four week PA recall (see Table 4, Table 5). Trained and

Overview of data analyses

The primary aim of this study is to examine differences between communities in PA at 12 months following the start of the intervention and to examine the stability of these effects over the following year. While random effects for individuals over time are estimated, because treatment status and community overlap in this study with one community per treatment condition, random effects for community cannot be included in these analyses. Thus, the inferences which can be drawn from this study are

Baseline data

Demographic and baseline characteristics for the study sample are presented in Table 2. Participants were mostly women (63%) with a mean age of 51 years (SD = 16). The majority of participants were non-working (61%), not married (77%), had no children at home (63%), had obtained a high school diploma or less (67%), and were making less than $25,000/year (62%). The majority of participants (73%) were overweight or obese, with an average body mass index (BMI) of 30 (SD = 8). The average blood pressure

Study implications

Preliminary analyses of the baseline data reveal that, indeed, these underserved communities are at risk for diseases related to obesity, such as hypertension and diabetes. Furthermore, confirming results of our preliminary focus groups, perceptions of access to places for walking and safety from crime are poor for our participants. In other words, baseline data reflect a reality of poor health and lack of places for PA in these underserved neighborhoods.

Our study is the first that involves

Acknowledgements

Thanks to all our communities and to Shamika Robinson, Phil Watts, and Kaya Outen for their assistance with this project. In addition, we thank Klein Buendel Inc. for their assistance with the development of the social marketing intervention.

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    This article was supported by a grant (R01 DK067615) funded by the National Institutes of Diabetes, Digestive, and Kidney diseases to Dawn K. Wilson, Ph.D.

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