Physical Activity–Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

Abstract

IntroductionHealth disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity–related policy and environmental strategies for obesity prevention in rural communities.MethodsA literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity–related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.ResultsOf 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were “enhance infrastructure supporting walking” (n = 11) and “increase opportunities for extracurricular physical activity” (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.ConclusionSeven of the 12 COCOMO physical activity–related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.

Prevalence of risk factors and programs for prevention of cardiovascular disease among the rural population

“…Большинство профилактиче-ских программ показали хорошие результаты в отноше-нии снижения распространенности большинства ФР ССЗ, за исключением избыточного ИМТ, ожирения и гликозилированного гемоглобина (HbA 1c ) U. Meyer и со-авт. [2] провели поиск и анализ результатов исследова-ний, оценивающих программы профилактики среди сельских жителей. В базах данных PubMed, PsycINFO, Web of Science, CINHAL и PAIS авторы выявили 2002 ста-тей, 30 из которых описывали стратегии профилактики ожирения и результаты их применения.…”

“…Многие авторы [2] отмечают, что большинство про-филактических программ недостаточно эффективны, и именно поэтому в мире ежегодно разрабатываются и внедряются все новые и новые стратегии, направлен-ные на борьбу с ФР ССЗ. Так, в США, по данным Centers for Disease Control and Prevention, рекомендова-но к применению на уровне первичного звена 24 стра-тегии профилактики ожирения (the Common Community Measures for Obesity Prevention, COCOMO) и 12 страте-гий, направленных на повышение уровня физической активности.…”

“…Сегодня опыт программы многофакторной профи-лактики ишемической болезни сердца (ИБС) оказывает неоценимую помощь при разработке и внедрении меро-приятий по профилактике неинфекционных заболеваний (НИЗ). Ряд отечественных и зарубежных исследователей [1][2][3] отмечают худшее состояние здоровья, более высо-кую распространенность ФР ССЗ и более высокую смерт-ность среди сельского населения.…”

An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education

“…Applications of BME technologies, such as bioinformatics, have illustrated divergent burden of disease across the United States, but more poignantly also uncovered disturbing and puzzling health disparities. For instance, rural Americans suffer disproportionately elevated obesity rates, 26 degenerative vision loss unduly affects residents of the Southern USA 17 and cardiovascular disease is more likely to result in death for American women than men. 24 For such US-based disparities, conventional biomedical interventions by specialized experts have begun to fail; simultaneously dismissed by residents as merely community-placed rather than community-based and raising the ire of biomedical professionals and the communities in which they live and/or serve.…”

“…These distinctions highlight the unique diversity of CCNY, whose comparable student enrollment from all major US demographic groups make the college an excellent pioneering site for the integration of health disparities into BME undergraduate education. 14,26 …”