This dissertation was guided by the Ecological Model of Physical Activity and Ecological Model of Obesity and sought to determine the relationship between active transportation (AT), physical activity, and cardiometabolic health among adults and ethnic minority women. Chapter 2 presents an investigation into the relationship between walking for AT and cardiometabolic health among adults through systematic review. Chapter 3 presents an exploration of the cross-sectional relationships of AT and moderate-to-vigorous physical activity (MVPA) with cardiometabolic health among African American (AA) and Hispanic/Latina (HL) women from Texas. Chapter 4 presents an investigation into the cross-sectional relationship of AT on cardiometabolic health and physical activity among primarily HL women.

In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.

High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.

Advances in health care have resulted in an increase in life expectancy causing a rapid growth in the number of older adults at a global level. At the same time, socioeconomic development is transitioning family structures and social relationships. With reduced family engagement, many older adults are more at risk for physical and psychological health issues including loneliness, which is considered a public health issue affecting their quality of life and well-being. This descriptive, exploratory study aims to describe the significance of loneliness in three northern regions of the Sultanate of Oman. The purpose of this study is to examine the prevalence and correlates of loneliness and the relationship of loneliness to health statuses among older Omani adults aged 60 years and above. A demographic data questionnaire, the UCLA loneliness scale, and SF-12-v-1 health status instruments were used for data collection. The sample includes 113 Omani older adults, male (n = 36) and female (n = 77), who experienced a mixture from low to high and severe levels of loneliness. Among these older adults, 34.5% perceived low level, 34.5% moderate level, 22.1% high, and 8.8% were severely lonely. The main demographic factors that were associated with the older adults level of loneliness were female gender, older age 80 years and above, living with others who were not a family member, and being unemployed. When controlling for demographic and environmental factors loneliness was a significant predictor (p < .001) for lower mental health status but not for physical health status (p > .05).

The purpose of this study was to determine if a relationship existed between acculturative stress and cardiovascular disease risk factors in Korean immigrants residing in the United States. This is a secondary analysis of existing data that was collected for a cross-sectional, descriptive study of 104 Korean American adults in a large Southwestern city in the U.S. Descriptive statistics, t-test, and analysis of variance were used to analyze data on demographics, acculturative stress, and biomarkers indicative of cardiovascular risk, such as body mass index (BMI), blood pressure (BP), and total cholesterol (TC). Most participants were women (66.3%), with a mean age of 53.59 (SD = 10.42), who were married (89.4%), educated at a college level or above (graduate) level (85.6%), employed full/part-time (64.4%), and had an annual household income of $50,000 or more (62.5%). The average length of residence in the U.S. was 22.04 years (SD = 11.89), Half of the study sample were overweight or obese (BMI > 23 kg/m2), 65.4% with high SBP (≥ 120 mmHg), 75.9% with high DBP (≥ 80 mmHg), and 75% with high TC (≥ 170 mg/dL). Acculturative stress was significantly associated with age, length of residence, and family annual income. Cardiovascular risk factors were significantly different by age, gender, marital status, education level, or employment status. However, the relationship between acculturative stress and cardiovascular risk indicators was not statistically significant. The study findings provide useful information about demographic characteristics, acculturative stress, and cardiovascular health of Korean immigrants in the United States. In order to prevent and manage cardiovascular health of the population, healthcare professionals should consider that cardiovascular risk factors may vary according to demographic characteristics in Korean immigrants.

Introduction: This study used social network theory to explore the role of social support and social networks in health information–seeking behavior among Korean American (KA) adults.

Methods: A descriptive qualitative study using a web-based online survey was conducted from January 2013 to April 2013 in the U.S. The survey included open-ended questions about health information–seeking experiences in personal social networks and their importance in KA adults. Themes emerging from a constant comparative analysis of the narrative comments by 129 of the 202 respondents were analyzed.

Results: The sample consisted of 129 KA adults, 64.7% female, with a mean age of 33.2 (SD = 7.7). Friends, church members, and family members were the important network connections for KAs to obtain health information. KAs looked for a broad range of health information from social network members, from recommendations and reviews of hospitals/doctors to specific diseases or health conditions. These social networks were regarded as important for KAs because there were no language barriers, social network members had experiences similar to those of other KAs, they felt a sense of belonging with those in their networks, the network connections promoted increased understanding of different health care systems of the U.S. system, and communication with these network connections helped enhance feelings of being physically and mentally healthy.

Conclusions: This study demonstrates the important role that social support and personal social networks perform in the dissemination of health information for a large ethnic population, KAs, who confront distinct cultural challenges when seeking health information in the U.S. Data from this study also illustrate the cultural factors that influence health information acquisition and access to social support for ethnic minorities. This study provides practical insights for professionals in health information services, namely, that social networks can be employed as a channel for disseminating health information to immigrants.

ABSTRACT

The purpose of this study was to investigate physical activity (PA) program characteristics preferred by low-income childbearing age Latinas and the relationship with the participants’ personal characteristics, cultural values, and acculturation. This was an exploratory study guided by the Preferences and Health Behavior Model (PaHBM), developed by this investigator. Recruitment occurred at three sites; two sites were located in Phoenix, AZ and one site was located in Houston, TX. Non pregnant Latinas between 18 to 35 years old were included (N=275). Latinas were excluded if they were pregnant, incarcerated, physically or mentally disabled, or had chronic diseases (e.g. cardiovascular disease). Quantitative data were collected using the Predictors and Preferences of Physical Activity Research Intervention Participation in an Underserved Latina Community Questionnaire, developed by this author, along with the Brief Acculturation Rating Scale for Mexican Americans, and the Mexican American Cultural Values Scale. The hypotheses were tested utilizing Chi-square, Pearson correlation and logistic regression. Annual family income, parity, country of origin, BMI and acculturation were the personal characteristics significantly associated with preferred PA program by this group of Latinas. Latino women were heterogeneous in their preferences. In general, sixty percent endorsed dancing as the type of activity preferred, 20% preferred PA education and 20% preferred walking. Major differences were found between the types of activity the Latino women were currently participating in compared to their preferred type of activity. Of the 124 who reported to be walking/jogging, almost half (49) preferred dancing, 22 preferred PA education and only 12 preferred walking. The study findings add to the existing knowledge by looking at factors that should be considered when developing PA interventions as well as when prescribing or recommending PA to this population. These results demonstrate the need to identify the preferred PA program characteristics of Latinas prior to developing interventions. Failure to know the patient’s preferred PA program characteristics may result in prescribing or recommending an undesired activity and decrease participation in PA interventions.



RESUMEN

El propósito de este estudio fue identificar las características preferidas en un programa de actividad física por una comunidad de mujeres Latinas de bajos recursos económicos y en edad fértil, así como la relación de esas características con sus propias características personales, sus valores culturales y su adaptación a la comunidad Anglosajona. Este fue un estudio exploratorio guiado por el “Modelo Preferencias y Comportamiento Saludables” (PaHBM), por sus siglas en Ingles, desarrollado por esta investigadora. El reclutamiento de las Latinas ocurrió en tres sedes: Una en Houston, TX y dos en Phoenix, AZ. Las mujeres Latinas fueron incluidas si tenían entre 18 y 35 años de edad. Se excluyeron mujeres que estaban embarazadas, estuvieran encarceladas, físicamente o mentalmente incapacitadas o que sufrieran alguna enfermedad crónica. Los datos cuantitativos fueron recolectados a través de una encuesta llamada “Predictores y preferencias de participación en un programa investigativo de actividad física”, desarrollada por la autora de este estudio, además utilizando la escala breve de aculturación para Mejicanos Americanos y la escala de valores culturales en Mejicanos Americanos. Las hipótesis fueron probadas utilizando el Chi-cuadrado, la correlación de Pearson, y la regresión lógica. Las características personales más asociadas con las características del programa preferido fueron el salario anual de la familia, el número de hijos, el país de origen, y el índice de masa corporal. En general, 60% prefirieron bailar, 20% clases de actividad física y 20% caminar. Mayores diferencias se encontraron en el tipo de actividad en las que las mujeres Latinas estaban participando, comparado con lo que ellas preferían. De 124 participantes que estaban caminando o trotando, 49 Latinas (39%) preferían bailar, 22 Latinas (17%) preferían clases de actividad física y solo 12 Latinas (10%) prefirieron caminar. Estos resultados demuestran la necesidad de identificar las características del programa de actividad física antes de crear dicho programa. Estos resultados son una adición a los conocimientos existentes, en los que se identificaron factores que deben ser considerados cuando se planea un programa así como cuando se prescribe o se recomienda actividad física a esta población. Sera un fracaso no conocer las preferencias de una paciente para mantenerse físicamente activa porque puede resultar en la prescripción o recomendación de actividades que la paciente no desea y esto se traducirá en reducción de la participación en programas de actividad física.