Habitual physical activity reduces the risk of chronic disease, including obesity, cardiovascular disease, diabetes mellitus, and several types of cancer (25). Despite these health benefits, the majority of adults in the United States do not meet the physical activity recommendations to achieve them (5,6). Hispanics are the largest minority group in the United States and account for 12.5% of the general population, including the subpopulations of Mexican (7.4%), Puerto Rican (1.2%), Cuban (0.4%), and other Hispanics (3.8%) (16,22). The Hispanic population has more than doubled in size from 1980 to 2000, and it is estimated that Hispanics will account for 24.4% of the United States population by 2050. Hispanics are among the least physically active ethnic or racial groups in the United States, with Hispanic women (33.9%) in particular less likely than non-Hispanic white women (25.9%) to engage in leisure time physical activity (6).
Hispanics incur a disproportionate burden of disease partially attributed to sedentary lifestyle behaviors. This disease burden includes a greater prevalence of obesity, diabetes mellitus, cardiovascular disease, and certain types of cancer than in non-Hispanic whites (4). Despite this disease burden, Hispanics are underserved by the healthcare system and are less likely than non-Hispanics to have healthcare coverage and receive preventive services (4). Efforts to increase physical activity levels would serve to reduce the disparities in disease prevalence that currently exist among Hispanics.
The Hispanic population is made up of people from about 20 countries (29). The research examining factors that influence the physical activity levels of Hispanics residing in the United States focuses on Mexican Americans (14,19-21,27,28), the largest Hispanic subgroup, accounting for 67% of the Hispanic population who live primarily in the western and southern United States (22). Puerto Ricans are the second largest Latino subgroup in the United States, accounting for 9% of the Hispanic population who mainly live in the Northeast. Marquez et al. (19-21) have emphasized the importance of Latino heterogeneity as a moderator of health behavior among this diverse ethnic group. However, there has been minimal investigation on the determinants of habitual physical activity among Puerto Rican women.
Demographic, social, and physical environmental factors and acculturation have been identified as correlates of physical activity in diverse groups of women (14,15,19-21,27,28). The purpose of this study was to explore interpersonal and ecological factors that may influence the habitual physical activity levels of a convenience sample of Puerto Rican women residing in the urban northeastern United States. The Women and Physical Activity Survey (7,11,13) was used to examine which personal (i.e., income, education, age, marital status, and self-efficacy) and social (i.e., social roles, social issues, and sense of community), and environmental factors (i.e., physical environment) related to the physical activity levels of these women. It was hypothesized that all 3 factors (i.e., personal, social, and physical environment) would influence physical activity, with the greatest associations observed with the social and physical environmental factors.
Experimental Approach to the Problem
Two trained and bilingual female investigators administered the Women and Physical Activity Survey by telephone interview to a convenience sample of Puerto Rican women (n = 28) residing in the urban northeastern United States. The survey was developed as part of the Women's Cardiovascular Health Network Project to identify interpersonal, behavioral, and ecological determinants of physical activity (7,11,13). Participants for this study were recruited via word of mouth through local community centers and businesses. Interviews lasted approximately 20 minutes. Volunteers self-identified themselves as Puerto Rican and completed the survey in their language of preference (i.e., English or Spanish). That only 3 participants requested the Spanish version indicated a high degree of acculturation in the study sample (9). Due to the survey nature of the study design, this investigation was exempted from review by the University of Connecticut Internal Review Board. No incentive for participation was offered.
A majority of the 28 Puerto Rican women respondents were college-educated (64.3%) and reported an annual income of more than $35,000 (75%), with a mean age of 36.3 ± 10.5 years. Half of the women were married, and more than half of the sample had at least 1 child (53.6%). Most of the women perceived their general health to be good, very good, or excellent (78.6%).
The survey instrument used in this study was the Women and Physical Activity Survey, which was developed as part of the Women's Cardiovascular Health Network Project (7,11,13). The Women's Cardiovascular Health Network Project was a 3-year multisite project designed to identify interpersonal, behavioral, and ecological factors influencing physical activity among diverse racial and ethnic groups, totaling approximately 6000 women between the ages of 20 and 50 years (7,11,13). The Women and Physical Activity Survey includes questions accessing the physical environment, sense of community, social issues, social roles, and self-efficacy, with 3 to 12 questions listed under each of these categories as well as demographics, general health, and physical activity levels.
The details of the Women and Physical Activity Survey development and the test-retest reliability for the questions included in the survey for the Women's Cardiovascular Health Network Project are described elsewhere (7,11-15,27,28). In brief, the overall intraclass correlation coefficient for questions in the various sections of the survey was 0.75 (95% confidence interval [CI], 0.68-0.80) for physical environment, 0.79 (95% CI, 0.74-0.83) for sense of community, 0.68 (95% CI, 0.61-0.74) for social issues, and 0.64 (95% CI, 0.56-0.71) for social roles. The 3-item measure for moderate (i.e., activities causing small increases in breathing or heart rate) and vigorous (i.e., causing large increases in breathing or heart rate) intensity physical activity had an intraclass correlation coefficient of 0.68 (95% CI, 0.4-0.9).
Descriptive statistics and frequencies were determined on all study variables to determine patterns of response. Consistent with recommendations from the Centers for Disease Control and Prevention, respondents were categorized as physically active if they participated in moderate-intensity physical activity for at least 30 minutes a day at least 5 days a week or vigorous-intensity physical activity for at least 20 minutes a day at least 3 days a week (6,11). If the women reported that they did not engage in any physical activity or did not meet these criteria, they were categorized as physically inactive.
Chi-square testing revealed whether the physically active and physically inactive women differed in response to questions from the Women and Physical Activity Survey. Survey items with scaled responses (i.e., strongly agree, agree, disagree, and strongly disagree) were recoded as agree (i.e., strongly agree and agree) or disagree (i.e., disagree and strongly disagree) for purposes of comparison of the physical activity groups. A mean score was calculated for the social roles, social issues, and sense of community responses following published guidelines, such that lower scores indicated less favorable associations with physical activity (11); these mean scores were also compared between physical activity groups. Responses to the open-ended questions pertaining to motivation and self-efficacy and suggested interventions were categorized by the similarity of response. Statistical analyses were performed with the Statistical Package for Social Sciences version 11.5 (SPSS, Inc., Chicago, IL). Significance was determined to be at p ≤ 0.05.
Prevalence of Physical Activity
The sample had a mean age of 36.3 ± 10.5 years. The majority of Puerto Rican women stated that they were physically active (67.9%), as defined by the study criteria denoted by the Centers for Disease Control and Prevention (3,6). Of the physically inactive group (32.1%), 1 woman (3.6%) was sedentary and 8 women (28.6%) were insufficiently physically active. The physically active women were significantly more likely to engage in vigorous-intensity physical activity than in moderate-intensity physical activity (p = 0.015).
Table 1 displays the demographic and general health characteristics of the physically active and inactive Puerto Rican women. Annual income was the only statistically significant demographic correlate of physical activity. The physically active women were more likely to have an annual household income of more than $35,000 than the inactive women were (p = 0.01). Although not achieving statistical significance, the different responses to several of the demographic questions between the physical activity groups are worthy of note. Nearly three-fourths of the physically active women were college-educated versus less than half of the physically inactive women. The majority of physically active women were married with children, while the majority of physically inactive women were unmarried without children. The physically active women more frequently rated their general health as good to excellent compared to the physically inactive women.
Social Environmental Factors
The physically active Puerto Rican women were more likely to belong to community groups (42.1% versus 0%), live in communities where people exercise (94.7% versus 11.1%), and feel their community was good for their family (100% versus 66.7%) compared to the inactive women, respectively (p < 0.05). In addition, the mean scored response for sense of community tended to be greater for the physically active (3.2) than for the inactive (2.6) women and indicated a stronger sense of community among the physically active women (p = 0.095).
The majority of the women (92.9%) indicated that they were very to somewhat confident that they could exercise more if they wanted to, independent of physical activity level. The women reported health (75.0%), weight (46.4%), and looking better (28.6%) as the 3 main reasons women exercise, whereas the major personal reasons they were not exercising more was time (50.0%) and self-motivation or will power (17.9%), regardless of physical activity level.
The mean scored responses for social roles (3.1 versus 3.1) and issues (3.1 versus 2.8) were not different between the physically active and inactive women, respectively (p ≥ 0.05). The physically inactive women, however, tended to report that social roles and issues were a greater barrier to being physically active than did the physically active women. Although not achieving statistical significance (p ≥ 0.05), more physically inactive women (44.4%) agreed with the statement, “When I see a women exercising, it makes me feel guilty,” than did the active women (15.8%). In response to the statement, “If you wanted to exercise, childcare responsibilities would get in the way,” 37.5% of physically inactive women agreed versus 13.3% of physically active women. Interestingly, all women disagreed with the statements, “If you wanted to exercise, what your partner or husband might think about you would get in the way” and “When I see a women exercising, I think she is selfish.”
Physical Environmental Factors
The physically active and inactive women did not differ on their responses to physical environmental factors that influenced physical activity (p ≥ 0.05). Nevertheless, as seen in Table 2, the physically active women tended to be more likely to report the presence of exercise facilities (p = 0.084) and well-maintained sidewalks in their communities (p = 0.087) as more important for exercise accessibility than did the inactive women. More physically active women reported living in neighborhoods with very good or good street lighting (52.6% versus 33.3%) and classified their neighborhood as extremely or somewhat safe (78.9% versus 55.6%) than did the inactive women, respectively, but these differences did not achieve statistical significance (p ≥ 0.05).
Table 3 summarizes the suggestions of the respondents who were asked what changes in their neighborhood and work place would increase their levels of physical activity. The most common recommendation given by both the physically active and the inactive women was to increase the number of gyms and exercise facilities and to improve access to facilities by decreasing cost. The second most frequent community improvement cited by the physically active women involved measures to increase social support networks, while the inactive women more frequently cited the need for improved neighborhood safety to foster physical activity.
The Women and Physical Activity Survey, which was developed as part of the Women's Cardiovascular Health Network Project (7,11,13), was administered to examine personal, social, and physical environmental factors that could influence the physical activity levels of a convenience sample of Puerto Rican women residing in urban areas in the northeastern United States. The majority of the women surveyed were regularly physically active according to the Centers for Disease Control and Prevention criteria (3,6), were college-educated, had an annual income of more than $35,000, and were married with children (Table 1). Due to the exploratory nature of this study in a small, select sample of urban Puerto Rican women, the findings should be regarded as preliminary. Nonetheless, since most research examining physical activity determinants among Hispanics involves Mexican Americans and Puerto Ricans are the second largest Hispanic group in the United States, the results indicate a need to examine these issues further among a larger, more socioeconomically diverse sample of Puerto Rican women.
The major findings from this study were that sense of community and annual income were the most important factors influencing the physical activity levels of these Puerto Rican women. The physically active Puerto Rican women were more likely than the inactive women to belong to community groups, live in communities where people exercise, and feel their community was good for their family. In addition, certain aspects of the physical environment pertaining to exercise accessibility were more important to the physically active than to the inactive women, namely the presence of exercise facilities and sidewalks. The findings among Puerto Rican women residing in urban northeastern United States extend upon those from other studies involving Hispanic women from other regions of the United States, who were predominately Mexican emigrants (8,9,19-21,24,28) and those involving other diverse racial and ethnic groups of women (12,14).
Income was positively correlated with physical activity in this sample of Puerto Rican women, whereas Voorhees and Young (27), Evenson et al. (8,9), and Wilbur et al. (28) did not find income to be a significant predictor of physical activity. The most likely reason for the discrepancies between these studies and the current study is the varying degree of acculturation of the samples surveyed (7,19,21,24). Despite self-identifying themselves as Latinas, the annual income of the Puerto Rican women was greater; they were more highly educated and physically active; and their preferred language appeared to be English in contrast to the Mexican American women in the other studies. These differences indicated a greater degree of acculturation of the Puerto Rican women than the Mexican women (19,21-23).
Although there were tendencies for education and marital status to be associated with physical activity levels, no other personal factors were found to statistically correlate with physical activity in the current study or those of the other investigators from the Women's Cardiovascular Health Network Project that involved Hispanic women (8,9,14,27,28). In other investigations involving diverse racial and ethnic groups of women, the findings regarding associations among income, education, and physical activity have been mixed (12,14). Collectively, these inconsistencies reflect the challenges in collecting health information on Hispanics and reinforce the notion that Hispanic subgroups should be examined versus reporting aggregate data on diverse racial and ethnic groups of women (19,21,29).
Sense of community stood out as the social environmental factor that differentiated the physically active Puerto Rican women from those who were inactive. The physically active Puerto Rican women cited increased social support networks in the community as a necessary intervention to increase the exercise levels of women. Evenson et al. (9), Voorhees and Young (27), Wilbur et al. (28), and Marquez and McAuley (20) also found that the social environment and, in particular, sense of community were important determinants of the physical activity levels of Latinas.
Similarly, a lack of social networks and support has been shown to influence physical activity (14,24). King (17) and Evenson et al. (8) found discouragement from others about exercise, particularly from husbands and families, was negatively correlated with physical activity among Mexican American women. All of the Puerto Rican women in this study disagreed with the statement, “If you wanted to exercise, what your partner or husband might think about you would get in the way.” Furthermore, the social role scores among the Puerto Rican women were high and independent of physical activity level and indicated low social role strain. Perhaps low social role strain can be attributed to the large percentage of Puerto Rican women who are household heads or who grew up in a household headed by a woman (26). Growing up in a matriarchal society may have diminished the influence that multiple social roles has been reported to have on physical activity (2,12,14). The findings on social environmental determinants of physical activity among Puerto Rican women once again support the notion that subgroups should be examined when investigating determinants of health-related behaviors, such as physical activity in the general Hispanic population (19,21,29).
The neighborhood environment (e.g., sidewalks and street lighting) and perceptions of neighborhood safety are reported to be associated with physical activity (1,10,18). Consistent with the findings of Evenson et al. (8,9), Voorhees and Young (27), and Wilbur et al. (28), the current study found physical environmental factors not to be strongly related to the physical activity levels of Latina women, with the exception of exercise accessibility. Evenson et al. (9) reported that having access to indoor or outdoor places to exercise was positively associated with physical activity among rural Latina immigrants. The physically active Puerto Rican women in this study suggested increasing the number of exercise facilities and making membership costs affordable to enable physical activity, whereas the inactive women suggested improved neighborhood safety.
This study had several limitations. The small convenience sample of urban Puerto Rican women was more affluent, better educated, and more physically active than the general Hispanic population residing in the United States (22,23). Thus, the findings should be investigated further in a larger, more socioeconomically diverse sample of Puerto Rican women. Nonetheless, they demonstrate the importance of examining Hispanic subpopulations rather than the Hispanic population at large when attempting to identify determinants of health-related behaviors, such as physical activity (19,21,29). The Spanish translation of the Women and Physical Activity Survey from the Women's Cardiovascular Health Network Project was done by a Mexican American translator for Mexicans (11). The difference between the Spanish spoken by Puerto Ricans and that spoken by Mexicans became apparent when the word for sidewalk was not familiar to a respondent whose primary language was Spanish. Latinas are more likely to engage in physical activity related to work and household activities than to engage in leisure time physical activity, as was assessed with the Women and Physical Activity Survey in this study (11,19-21,24). Therefore, it is possible that the physical activity levels of the Puerto Rican women in this study were underestimated.
In conclusion, sense of community, income, and exercise accessibility were important determinants of the physical activity levels of urban Puerto Rican women residing in the northeastern United States. The findings demonstrate the importance of examining Hispanic subpopulations when attempting to identify correlates of physical activity. Due to the preliminary nature of this study, future work is warranted to explore factors that influence the physical activity levels among a larger, more diverse sample of Puerto Rican women so that targeted, culturally sensitive strategies can be developed to promote physically active lifestyles in this population.
The results show that sense of community, income, and exercise accessibility may be important determinants of physical activity among Puerto Rican women. Because Hispanic women are one of the most physically inactive gender and ethnic groups in the United States and because Puerto Ricans are the second largest Hispanic subgroup in the United States, these findings should be explored further in a more diverse population of Puerto Rican women. Findings from these larger studies could be used to develop environmental and behavioral strategies that are culturally appropriate to increase physical activity among a Hispanic subgroup that is predominately sedentary and continues to grow in the United States. The findings indicate these strategies could include promotion of community walkathons, keeping sidewalks maintained, and obtaining grant funds to equip apartment buildings with exercise equipment.
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