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

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.

A Qualitative Study for Understanding Family and Peer Influences on Obesity-Related Health Behaviors in Low-Income African-American Adolescents

“…Participants in the present study (see table 1) were recruited from communities participating in the Positive Action for today's Health (PAtH) trial, which examined the effect of an environmental intervention on improving access and safety for PA in high-crime communities 54 (see ref. 54 for details).…”

Neighborhood Social Predictors of Weight-related Measures in Underserved African-Americans in the PATH Trial

“…16,17 Data for our study were assessed at baseline and included height, weight, blood pressure and physical activity. Additionally, psychosocial and demographic data (age, sex, education status, annual income, occupational status, and marital status) were obtained by trained research staff.…”

“…Data were collected from 417 African American adults who resided in one of three low-income communities that took part in the PATH randomized trial, which tested the efficacy of a walking program on PA. 16 The three communities were matched on poverty rates, crime rates, and PA levels. Inclusion criteria included being: 1) African American (three of four grandparents of African American heritage); 2) aged >18 years; 3) having no plans to move during the 2-year study period; 4) having no medical condition limiting participation in moderate intensity exercise; 5) residing in one of three censusspecified communities; and 6) having controlled blood pressure (systolic < 180 mm Hg and diastolic < 110 mm Hg) and blood sugar levels (nonfasting < 300 mg/dL and fasting ≤ 250 mg/dL).…”

“…The Places for Walking and Cycling subscale measured infrastructure for walking and access to services based on evidence that neighborhood 16,17 about safety, 11,12 or because of not having access to workout facilities. 13 Fish et al 14 found that individuals who rated their neighborhoods as unsafe had a 2.81 times higher BMI than those who perceived their neighborhoods as more safe.…”

“…16,17 Specifically, our study expands on past literature by evaluating the associations of neighborhood factors (places to walk and bike, neighborhood satisfaction, perception of safety, and neighborhood social interaction) and peer support on body mass index (BMI) in African American adults. Based on previous research, it was hypothesized that neighborhood social and environmental factors would be significantly predictive of BMI in our study.…”