Umstattd Meyer M Renée, Perry Cynthia K, Sumrall Jasmin C, Patterson Megan S, Walsh Shana M, Clendennen Stephanie C, Hooker Steven P, Evenson Kelly R, Goins Karin V, Heinrich Katie M, O'Hara Tompkins Nancy, Eyler Amy A, Jones Sydney, Tabak Rachel, Valko Cheryl
Baylor University, Robbins College of Health and Human Sciences, Department of Health, Human Performance and Recreation, One Bear Place No. 97313, Waco, TX 76798. Email:
School of Nursing Oregon Health & Science University, Portland, Oregon.
Prev Chronic Dis. 2016 Jan 7;13:E03. doi: 10.5888/pcd13.150406.
Health 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.
A 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.
Of 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.
Seven 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.
农村和城市居民之间存在健康差异；特别是农村居民患慢性病和肥胖症的比例更高。有证据支持政策和环境策略在预防肥胖和促进健康公平方面的有效性。2009年，疾病控制与预防中心推荐了24项政策和环境策略供当地社区使用：预防肥胖的共同社区措施（COCOMO）；其中12项策略侧重于身体活动。本综述旨在综合有关农村社区预防肥胖的与身体活动相关的政策和环境策略的实施、相关性和有效性的证据。
在PubMed、PsycINFO、Web of Science、CINHAL和PAIS数据库中进行文献检索，查找2002年至2013年5月发表的报告在美国或加拿大进行的与身体活动相关的政策或环境干预研究结果的文章。每篇文章由2名研究人员独立提取。
在2002篇文章中，有30篇文章代表26项不同的研究符合纳入标准。学校是最常见的场所（n = 18项研究）。22项研究在农村社区应用了COCOMO策略；最常见的2项COCOMO策略是“加强支持步行的基础设施”（n = 11）和“增加课外体育活动机会”（n = 9）。大多数研究（n = 21）应用了8项非COCOMO策略中的至少一项；最常见的是增加体育课之外在学校的身体活动机会（n = 8）。只有14项研究测量或报告了身体活动结果（10项研究仅使用自我报告）；10项报告了积极变化。
12项与COCOMO身体活动相关的策略中有7项在2项或更多研究中成功实施，这表明这7项策略在农村社区具有相关性，而其他5项可能在农村社区不太适用。需要使用强有力的研究设计和测量方法进行进一步研究，以更好地确定COCOMO和非COCOMO策略在农村社区的实施成功情况和有效性。
