Examining Physical Activity Levels of Pregnant Women of Mexican Origin in Detroit, MI: A Socioecological Approach
Militzer, Maria
2019
Abstract
Low levels of physical activity (PA) during pregnancy are associated with detrimental health outcomes, not only for the mother but also for her child. Pregnant WMO are less likely to meet recommended PA (20-30 minutes/day), most days/week. They have higher overweight (76.9%) and obesity (45%) rates compared to the US population, and face increased risk for excessive GWG, GDM and T2DM. Nonetheless, most research available on PA during pregnancy has focused on NHW women. Employing a socioecological approach, this dissertation built on literature describing pathways between PA-related beliefs, attitudes, subjective norms and perceived behavioral control (individual level), social support (interpersonal level), and neighborhood poverty, social cohesion, safety, walkability, presence/condition of parks/playgrounds, and car/truck traffic (neighborhood level) and PA among pregnant and non-pregnant NHW, and racial and ethnically minority women, and the literature on interventions aimed at increasing PA. However, these pathways and interventions have not been examined among pregnant and postpartum WMO. The purpose of this dissertation is to examine pathways that individual, interpersonal and neighborhood factors may influence PA and assess the efficacy of a behavioral intervention to reduce PA declines among pregnant and early postpartum WMO. The Theories of Planned Behavior and Social Support grounded this research. Using a dataset from an RCT of a behavioral intervention, first I examined independent and joint relationships of individual-level factors and PA intention/behavior; and social support moderating effects. Findings suggest significant associations between attitude and PBC with PA intention but not PA behavior. PA-social support did not moderate relationships of PBC-PA intention nor PBC-PA behavior. Independent associations between social support and PA behavior were significant. Joint relationships between TPB constructs and social support, and PA accounted for 6.8% of the variance in regression models. Second, I examined relationships of neighborhood characteristics and PA. I found positive significant independent and joint associations between neighborhood social cohesion, walkability, and presence/condition of parks/playgrounds, and PA. Neighborhood poverty, safety and heavy car/truck traffic were not significantly associated with PA. Neighborhood safety perceptions moderated the neighborhood poverty-PA association. Associations of PA-Neighborhood characteristics accounted for 22% of the PA variance. Third, I examined the efficacy of a lifestyle intervention to reduce PA declines among pregnant and postpartum WMO. Findings suggested a significant PA decline from T0(baseline) to T1(follow up), and an increase from T1 to T2(postpartum), but still lower PA at T2 compared to T0. The PA- HLI group had significantly lower PA declines than the comparison group during pregnancy and early postpartum. Findings may inform public health interventions focusing on PA during pregnancy and postpartum, especially for WMO. This research provides quantitative evidence of associations between individual, interpersonal factors and neighborhood characteristics to be considered when designing interventions to address PA among pregnant and postpartum WMO. It provides evidence-based information to prenatal care providers, city planners, community leaders about the influence that these factors, and especially the neighborhood, may have on PA directly, and health outcomes indirectly. This study is a unique contribution to the literature on PA activity among WMO in the US. Further research on factors that may promote PA during pregnancy and the early postpartum, and testing additional intervention strategies for this population is needed. This research may contribute to ameliorating the increasing rates of low PA-associated metabolic diseases and improving the health of pregnant and postpartum WMO and their children.Subjects
Examining Physical Activity Levels of Pregnant Women of Mexican Origin in Detroit, MI: A Socio-Ecological Approach
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