domingo, 12 de julio de 2015

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013–2014

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Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013–2014



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Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013–2014

Rebecca A. Seguin, PhD; Emily H. Morgan, PhD; Leah M. Connor, MPH; Jennifer A. Garner; Abby C. King, PhD; Jylana L. Sheats, PhD; Sandra J. Winter, PhD; Matthew P. Buman, PhD

Suggested citation for this article: Seguin RA, Morgan EH, Connor LM, Garner JA, King AC, Sheats JL, et al. Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013–2014. Prev Chronic Dis 2015;12:150147. DOI: http://dx.doi.org/10.5888/pcd12.150147.
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Abstract

Introduction
A community’s built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement.
Methods
Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change.
Results
Twenty-four adults (mean age, 69.4 y (standard deviation, 13.2 y), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use.
Conclusion
An electronic tablet–based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.
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Introduction

Physical inactivity and poor diet are 2 major modifiable risk factors for chronic disease and premature death in the United States (1), yet most Americans are not meeting national guidelines in these important health areas (2,3). A growing body of evidence emphasizes the importance of the built environment in shaping physical activity and diet (4–9). Built environment features that have been associated with physical activity include proximity to parks, access to trails and recreational facilities, mixed land use, walkability, bikeability, accessible destinations, and opportunities for active transit (4,6–8,10,11). Studies examining the food environment have focused on availability of healthy foods in a community, most often measured by access to grocery stores or the density of fast-food restaurants as influences on dietary consumption (9).
Rural populations suffer a disproportionate burden of chronic disease (12).They also tend to have less healthy diets and are more sedentary than their urban counterparts (13,14). With fewer places within easy walking distance, rural residents are more dependent on cars (15) and walk less (16). Most research examining the relationship between built environment and health have focused on nonrural settings. In addition, there are few assessment tools designed for rural settings (6).
This article reports on the use of and results from an electronic tablet-based community assessment tool, the Stanford Healthy Neighborhood Discovery Tool (hereafter referred to as the Discovery Tool), to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living in a rural context. The second objective was to understand resident perspectives on community features and opportunities for improvement.

Acknowledgments

The work was supported by the Cornell University Bronfenbrenner Center for Translational Research through the Bronfenbrenner Center Innovative Pilot Studies Program.
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Author Information

Corresponding Author: Rebecca A. Seguin, PhD, CSCS, Division of Nutritional Sciences, Cornell University, 412 Savage Hall, Ithaca, NY 14853. Telephone: 607-255-8250. Email:rs946@cornell.edu.
Author Affiliations: Emily H. Morgan, Leah M. Connor, Jennifer A. Garner, Division of Nutritional Sciences, Cornell University, Ithaca, New York; Abby C. King, Department of Health Research and Policy and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California; Jylana L. Sheats, Sandra J. Winter, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California; Matthew P. Buman, School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona.
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