Abstract
Background
Little research has examined gender differences in the association of seeing others engage in exercise, in the neighborhood context, with physical activity, particularly for diverse racial/ethnic groups. We examined gender differences in the association between frequency of seeing people walk and aerobic activity among Latinos.
Methods
We used cross-sectional 2015 National Health Interview Survey data on Latino participants ≥18 years (n=5147). Multinomial logistic regression models estimated the association between seeing people walk and aerobic physical activity.
Results
Men reporting seeing people walk every 2–3 days, and every day were more likely to meet the aerobic activity recommendation (OR:2.02; 95%CI:1.05–3.89, and OR:1.96; 95%CI:1.23–3.14, respectively). Among women, those seeing people walk every day and every 2–3 days were likely to engage in some aerobic activity (OR:1.88; 95%CI:1.26–2.80 and OR:2.16, 95%CI:1.23–3.18, respectively) and meet the recommendation (OR:1.73; 95%CI:1.24–2.42 and OR:1.66, 95%CI:1.03–2.67, respectively). Women seeing people walk about once a week were also likely to engage in some activity (OR:3.06; 95%CI:1.59–5.89).
Conclusions
Among Latino men and women, seeing people walk is associated with meeting the aerobic activity guideline. Results suggest adoption of physical activity may in part be driven by neighborhood-level behavioral norms, and by inference characteristics of the neighborhood that support walking.
Keywords: built environment, epidemiology, health disparities, exercise
INTRODUCTION
Meeting the aerobic physical activity (PA) guideline has been linked to positive health outcomes such as decreased risk of coronary heart disease, colon cancer, and diabetes.1 However, Latino adults are less likely to meet aerobic PA guidelines compared with non-Latino adults.1,2 Specifically, only 33.4% of Latinos meet guidelines compared to 47.6% of non-Latino whites.2 Furthermore, Latino men tend to engage in more moderate to vigorous aerobic physical activity than Latina women, with 51.1% of men and 31.3% of women engaging in ≥ 150 minutes per week of moderate to vigorous physical activity.3 Examining factors that contribute to meeting aerobic physical activity guidelines among Latinos may help inform physical activity promotion and identify factors that lead to gender disparities within the Latino population.
A vast amount of research has shown that attributes of the neighborhood environment contribute to aerobic physical activity.4 Moreover, seeing people walk, as an indirect measure of neighborhood walkability, has been associated with aerobic physical activity. For example, previous research has shown that having neighbors that are physically active is associated with an increase in walking.5 Previous findings have also shown that individuals who see others exercise or engage in physical activity in their neighborhood are significantly more likely to engage in increased leisure time physical activity6–8 and are more likely to engage in recommended levels of physical activity.9 This may in part be explained by observational learning, a construct of the social cognitive theory and defined as the acquisition of attitudes, values, and styles of thinking through the observation of others, influencing whether an individual engages in a particular behavior.10 Further, previous research has suggested that women are more likely than men to report seeing people engage in physical activity in their neighborhood 11, and women seeing people being active engage in higher levels of physical activity 9,11,12. Further research is warranted to obtain insight into how frequency of seeing people walk within sight of the home may be related to physical activity disparities.
Despite abundant literature indicating that individuals are more likely to engage in exercise if they see others around them engage in this behavior, little is known about how the frequency of seeing people exercise or walk is related to aerobic physical activity among Latinos. A few studies have included or been conducted among Latinas and have suggested that seeing people walk or exercise contributes to the performance of aerobic physical activity.13–15 For example, previous research has indicated that Latinas who report rarely seeing people exercise have said it constrains their LTPA much or very much.16 However, none of these studies have included Latino men, and have been primarily limited to community-based samples. Further, no study of which we are aware has examined the association between seeing people walk and meeting the current aerobic activity guideline in a nationally representative diverse sample of Latino adults. Therefore, given the prior evidence that suggests that seeing people walk is differentially reported by women and that Latinas engage in lower physical activity levels, further research is warranted examining the association between seeing people walk and physical activity by gender among Latinos.
Using data from a nationally representative sample of US adults, we examined the association between the frequency of seeing people walk within sight of home and aerobic physical activity among Latino men and women. We hypothesized that the association between frequency of seeing people walk would be associated with meeting aerobic physical activity guidelines in both men and women, with a strong association among women.
METHODS
Data
We used data from the 2015 National Health Interview Survey (NHIS), a cross-sectional survey conducted annually that employs a multistage probability sample survey design to obtain a nationally representative sample of the non-institutionalized US civilian population. The NHIS gathers information related to health and demographics from all family members. An adult (age ≥18 years old) within each family is randomly selected and interviewed to collect additional information, such as information regarding physical activity. Additional NHIS survey details can be found elsewhere.17
Of the 5,316 Latino participants who were 18 years of age and older, participants with missing data on education, acculturation proxies, aerobic physical activity, or seeing people walk were excluded (n=142). Therefore, analyses included data from 5,147 Latino adults with complete data on the variables of interest.
Measures
Seeing people walk
Participants were asked, “How often are there people walking within sight of your home?” Response options included every day, every 2–3 days, about once a week, and less than once a week, and were reverse coded.
Aerobic Activity
Participants were asked how often during their leisure time they participated, for ≥ 10 min at a time, in 1) vigorous activity that caused heavy sweating or large increases in their breathing or heart rate; and 2) light or moderate activity that caused light sweating or slight to moderate increases in their breathing or heart rate. Participants reported both frequency of their activity (in days, weeks, months or year) and the duration of each session (in minutes or hours). Using criteria from the 2018 Physical Activity Guidelines for Americans,1 individuals were classified as meeting the aerobic activity guideline if they reported engaging in ≥ 150 min of moderate-intensity activity per week, ≥ 75 min of vigorous-intensity activity per week, or ≥ 150 min of an equivalent combination of moderate-and vigorous-intensity activity per week. The following categories were created: met recommendation (≥150 min of moderate-vigorous physical activity or ≥75 min of vigorous physical activity or 150 min of moderate physical activity/week); some activity (>0 min/week of activity but less than the recommendation); none (0 min/week). Based on the recommendations from the 2018 Physical Activity Guidelines for Americans,1 minutes of vigorous-intensity activity were allotted twice the credit of minutes of moderate-intensity activity to calculate an equivalent combination.
Covariates
Multivariable models included age, gender, education and acculturation proxies. Age was modeled continuously and educational attainment was categorized into four education levels (i.e., less than high school, high school graduate, some college or college graduate). For acculturation proxies, we used self-reported nativity (foreign-born, US-born) and length of residence in the US to create acculturation proxy measures. Based on a combination of nativity and years living in the US, we categorized participants as foreign-born with <10 years of residence in the US, foreign-born with ≥10 years in the US, and US-born.
Statistical Analysis
We computed unadjusted means or frequencies and standard errors of participant characteristics, frequency of seeing people walk within sight of home, and level of aerobic physical activity by gender. Multinomial logistic regression models were used to estimate the adjusted odds ratios (OR) of the likelihood of engaging in some aerobic activity or meeting the aerobic activity recommendation, relative to none, and their associations with the frequency of seeing people walk within sight of home. In tables 2 and 3, estimates for Model 1 were unadjusted, and estimates for Model 2 were adjusted for age, education, and acculturation proxies.
To account for the complex sampling design of NHIS and survey weights, we used SAS 9.4 survey procedures (SAS Institute Inc., Cary, NC) in all of our analyses.
RESULTS
Table 1 displays the distribution of demographics, frequency of seeing people walk, and aerobic physical activity by gender. Among both men and women, about 63% of individuals reported being Mexican/Mexican-American (63.2% and 63.8%, respectively). About half of both men and women reported being foreign-born and living in the US less than 10 years (48.9% and 50.2%, respectively). Approximately 76.4% of men and 74.3% of women reported seeing people walk within sight of their home every day. A slightly higher proportion of men met the aerobic activity recommendation (47.2%), compared with women (42.1%, respectively).
Table 1.
Participant Characteristics by Sex: National Health Interview Survey 2015
| Total Sample (n=5147) | Men (n=2252) | Women (n=2895) | |
|---|---|---|---|
| Mean or % (SE) | Mean or % (SE) | Mean or % (SE) | |
| Demographics | |||
| Age, years (mean) | 41.04 (0.29) | 40.43 (.43) | 41.64 (0.42) |
| Male, % | 49.92 (0.91) | - | - |
| Education | |||
| Less than high school, % | 32.71 (0.83) | 33.14 (1.25) | 32.27 (1.14) |
| High school graduate, % | 28.30 (.90) | 29.09 (1.26) | 27.50 (1.21) |
| Some college, % | 25.40 (0.86) | 25.08 (1.32) | 25.72 (1.13) |
| College graduate, % | 13.60 (0.69) | 12.68 (1.00) | 14.51 (0.90) |
| Latino Subgroup | |||
| Mexican/Mexican-American, % | 63.50 (1.08) | 63.16 (1.56) | 63.84 (1.29) |
| Puerto Rican, % | 10.24 (0.53) | 9.43 (0.86) | 11.04 (0.67) |
| Cuban/Cuban American, % | 4.70 (0.37) | 5.47 (0.60) | 3.92 (0.48) |
| Dominican, % | 2.99 (0.29) | 2.40 (0.27) | 3.57 (0.45) |
| Central or South American, % | 18.58 (0.84) | 19.54 (1.21) | 17.63 (0.96) |
| Acculturation | |||
| US-born, % | 41.69 (1.03) | 42.05 (1.54) | 41.34 (1.15) |
| Foreign-born living in US ≥10 years, % | 49.58 (1.01) | 48.94 (1.52) | 50.21 (1.21) |
| Foreign-born living in US <10 years, % | 8.73 (0.56) | 9.01 (0.83) | 8.45 (0.63) |
| Frequency of people walking within sight of home | |||
| Every day, % | 75.34 (0.96) | 76.37 (1.29) | 74.29 (1.14) |
| Every 2–3 days, % | 9.28 (0.53) | 9.22 (0.76) | 9.35 (0.74) |
| About once a week, % | 5.53 (0.46) | 5.80 (0.65) | 5.27 (0.59) |
| Less than once a week, % | 9.84 (0.61) | 8.61 (0.78) | 11.08 (0.76) |
| Aerobic physical activity | |||
| None, % | 37.60 (0.96) | 37.49 (1.48) | 37.70 (1.13) |
| Somea, % | 17.74 (0.67) | 15.30 (0.92) | 20.18 (1.01) |
| Met recommendationb, % | 44.66 (0.93) | 47.21 (1.41) | 42.12 (1.17) |
Some: >0 minutes of activity but less than recommendation.
Met recommendation: engaged in ≥150 min of moderate physical activity, ≥75 min of vigorous physical activity, or 150 mins of combination of moderate or vigorous physical activity per week. SE=standard error.
Table 2 presents the results from the multinomial logistic regression analyses examining the association between frequency of seeing people walk within sight of home and aerobic physical activity among men. In the adjusted models (model 2), men that reported seeing people walk every 2–3 days within sight of their home were significantly more likely to meet the aerobic activity recommendation (OR: 2.02; 95% Confidence Interval (CI): 1.05–3.89). Similarly, men that reported seeing people walk every day within sight of their home were also significantly more likely to meet the aerobic activity recommendation (OR: 1.96; 95% CI: 1.23–3.14).
Table 2.
Associations of Frequency of Seeing People Walking Within Sight of Home with Aerobic Physical Activity Among Men: National Health Interview Survey 2015
| Model 1 |
Model 2 |
|||
|---|---|---|---|---|
| None vs. Somea | None vs. Met Recommendationb | None vs. Somea | None vs. Met Recommendationb | |
| OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
| Frequency of People Walking Within Sight of Home | ||||
| Every day | 1.24 (0.74–2.07) | 2.12 (1.36–3.32) | 1.19 (0.72–1.97) | 1.96 (1.23–3.14) |
| Every 2–3 days | 1.46 (0.72–2.96) | 2.07 (1.10–3.91) | 1.49 (0.74–3.02) | 2.02 (1.05–3.89) |
| About once a week | 1.32 (0.60–2.94) | 1.92 (1.06–3.50) | 1.27 (0.57–2.86) | 1.68 (0.92–3.09) |
| Less than once a week | 1.00 | 1.00 | 1.00 | 1.00 |
| Age | - | - | 1.01 (1.00–1.01) | 0.98 (0.98–0.99) |
| Education | ||||
| Less than high school | - | - | 1.00 | 1.00 |
| High school graduate | - | - | 0.99 (0.64–1.53) | 1.37 (1.00–1.88) |
| Some college | - | - | 1.23 (0.76–1.99) | 2.00 (1.39–2.89) |
| College graduate | - | - | 2.22 (1.30–3.77) | 4.23 (2.83–6.32) |
| Latino Subgroup | ||||
| Mexican/Mexican-Americans | - | - | 1.00 | 1.00 |
| Puerto Ricans | - | - | 0.69 (0.36–1.32) | 0.85 (0.56–1.29) |
| Cuban/Cuban Americans | - | - | 0.69 (0.24–1.99) | 0.91 (0.52–1.59) |
| Dominicans | - | - | 0.34 (0.12–0.96) | 0.71 (0.33–1.53) |
| Central or South Americans | - | - | 1.33 (0.86–2.06) | 1.43 (0.98–2.08) |
| Acculturation | ||||
| US-born | - | - | 1.00 | 1.00 |
| Foreign-born living in US ≥10 years | - | - | 0.80 (0.46–1.39) | 0.54 (0.34–0.87) |
| Foreign-born living in US <10 years | - | - | 0.81 (0.55–1.18) | 0.70 (0.53–0.93) |
Some: >0 minutes of activity but less than recommendation.
Met recommendation: engaged in ≥150 min of moderate physical activity, ≥75 min of vigorous physical activity, or 150 mins of combination of moderate or vigorous physical activity per week.
OR=Odds Ratio. Boldface indicates statistical significance.
We also examined the association between frequency of seeing people walk within sight of home and aerobic activity among women (Table 3). In adjusted models, women who reported seeing people walk every day, every 2–3 days, and about once a week were significantly more likely to engage in at least some aerobic activity (OR: 1.88; 95% CI: 1.26–2.80, OR: 2.16; 95% CI: 1.23–3.81, and OR: 3.06; 95% CI: 1.59–5.89, respectively). Women who reported seeing people walk every day and every 2–3 days were also significantly more likely to meet the aerobic activity recommendation (OR: 1.73; 95% CI: 1.24–2.42 and OR: 1.66; 95% CI: 1.03–2.67, respectively).
Table 3.
Associations of Frequency of Seeing People Walking Within Sight of Home with Aerobic Physical Activity Among Women: National Health Interview Survey 2015
| Model 1 |
Model 2 |
|||
|---|---|---|---|---|
| None vs. Somea | None vs. Met Recommendationb | None vs. Somea | None vs. Met Recommendationb | |
| OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
| Frequency of People Walking Within Sight of Home | ||||
| Every day | 1.96 (1.27–3.02) | 1.90 (1.36–2.67) | 1.88 (1.26–2.80) | 1.73 (1.24–2.42) |
| Every 2–3 days | 2.20 (1.20–4.04) | 1.76 (1.10–2.82) | 2.16 (1.23–3.81) | 1.66 (1.03–2.67) |
| About once a week | 3.17 (1.61–6.25) | 1.19 (0.60–2.36) | 3.06 (1.59–5.89) | 1.12 (0.59–2.15) |
| Less than once a week | 1.00 | 1.00 | 1.00 | 1.00 |
| Age | - | - | 1.00 (0.99–1.00) | 0.99 (0.98–0.99) |
| Education | ||||
| Less than high school | - | - | 1.00 | 1.00 |
| High school graduate | - | - | 1.34 (0.93–1.92) | 1.45 (1.06–2.00) |
| Some college | - | - | 1.82 (1.30–2.55) | 2.19 (1.60–2.99) |
| College graduate | - | - | 1.87 (1.19–2.92) | 2.90 (2.00–4.22) |
| Latino Subgroup | ||||
| Mexican/Mexican-Americans | - | - | 1.00 | 1.00 |
| Puerto Ricans | - | - | 0.63 (0.43–0.91) | 0.65 (0.47–0.89) |
| Cuban/Cuban Americans | - | - | 0.41 (0.18–0.91) | 0.52 (0.24–1.09) |
| Dominicans | - | - | 0.85 (0.42–1.72) | 0.69 (0.40–1.20) |
| Central or South Americans | - | - | 0.93 (0.64–1.35) | 1.26 (0.91–1.75) |
| Acculturation | ||||
| US-born | - | - | 1.00 | 1.00 |
| Foreign-born living in US ≥10 years | - | - | 0.75 (0.48–1.18) | 0.50 (0.33–0.75) |
| Foreign-born living in US <10 years | - | - | 1.16 (0.88–1.52) | 0.89 (0.69–1.15) |
Some: >0 minutes of activity but less than recommendation.
Met recommendation: engaged in ≥150 min of moderate physical activity, ≥75 min of vigorous physical activity, or 150 mins of combination of moderate or vigorous physical activity per week.
OR=Odds Ratio. Boldface indicates statistical significance.
DISCUSSION
Our study is one of the first to examine the association between frequency of seeing people walk within sight of home and aerobic physical activity among Latino men and women using a nationally representative sample of Latinos. Our study findings indicate that there are gender differences in the association between seeing people walk and aerobic activity among Latino adults. Specifically, among men, seeing people walk every day and every 2–3 days was associated with meeting the aerobic activity recommendation. Among women, seeing people walk every and every 2–3 days was associated with engaging in some aerobic activity and meeting the aerobic activity recommendation. Seeing people walk within sight of home about once a week was also associated with engaging in some aerobic activity among women.
Our findings indicate that among men, a higher frequency of seeing people walk was associated with aerobic activity guideline. This is one of the first studies to examine this association among Latino men. One other study suggested that neighborhood walkability, which included seeing people walk, contributed to physical activity among Latino men.18 These findings suggest that frequency of seeing people walk in the neighborhood context may be important for adoption of physical activity among Latino men. Future research should consider examining individual and neighborhood-level factors that may uniquely influence aerobic activity among Latino men to obtain a better understanding of the contributors to physical activity in this population. Although some research suggests that the factors that underlie physical activity performance among Latino men may differ from Latinas,19–21 facilitators and barriers to physical activity specific to Latino men are largely understudied.20
Our findings also show that among women, a higher frequency of seeing people walk was associated with engaging in at least some aerobic activity and meeting the aerobic activity guideline. Our findings are consistent with previous research that has also shown a significant association between higher frequency of seeing people walk and aerobic physical activity among Latinas.13,15 However, our study is the first to examine this association in large nationally representative sample of Latina women. Our findings show that the association between frequency of seeing people walk and aerobic activity was stronger among women than men. One possible explanation is that for women, seeing people walk or exercise in their neighborhood may have a greater impact than it does among men. For example, previous research has indicated that Latinas who report “rarely seeing Latino people exercise” said it constrained their LTPA much or very much.16 However, this has not been found among Latino men. Future research should consider examining perceptions associated with seeing people walk within sight of the home among Latino men and women to better understand the role of seeing people walk in physical activity performance.
The limitations of our study should be taken into consideration when assessing the study strengths. As a cross-sectional study, we were not able to determine if seeing others walk led to changes in adoption of aerobic physical activity over time. As a result, our study findings cannot be utilized to make causal inferences about the association between seeing people walk and meeting the aerobic activity guideline. Further, reverse causality is possible if those who exercise are outdoors and hence are seeing more people walk in their neighborhoods. However, this is not as likely since we assessed aerobic physical activity in general and not specifically if this was done in outdoor settings. Further, data collected by the NHIS is self-reported which can lead to information bias. Other studies have shown that the amount of physical activity that is self-reported is higher than when physical activity is directly measured using objective measures such as an accelerometer.22 Lastly, another limitation of our study was the lack of information on the type of community individuals lived in. For example, previous research has shown that among Latinos, residing in an immigrant enclave may influence physical activity, and could also have an impact on the type of people they are seeing walk in their neighborhood, which has been suggested to influence activity as well.23 Further, information on whether an individual resides in an urban versus rural setting could influence frequency of seeing people walk and influence activity,24–26 but was not included in our study.
Our study is one of the first to show that a higher frequency of seeing people walk, an indirect measure of neighborhood walkability, is associated with meeting the aerobic physical activity guideline among both Latino men and women. Particularly among women, seeing people walk contributes to engaging in any level of aerobic activity. Our findings provide further insight into factors that may contribute to aerobic physical activity disparities observed within the Latino population, and highlight the continued importance of neighborhood contexts to promote physical activity. In the development of future efforts to promote and intervene on aerobic physical activity among Latinos, neighborhood factors and how these factors may impact Latino men and women should be considered. Given the persistent physical activity disparities within the Latino population, and the contribution of physical activity to health, it remains critical to further understand the factors that contribute to physical activity among Latinos.
FUNDING SOURCE
Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under award number P20CA221697–01 and P20CA221696–01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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