Physical Activity Disparities:
Socio-demographic Dimensions
Aviva Must, Ph.D.
Tufts University
How social disadvantage limits PA
• Lack of material resources
• Stressful environments
• Segregated neighborhoods
• Reduced access to primary
care
Key Dimensions of Disparity
…and disability
Prevalence of obesity across the lifecourse
(NHANES)
45
40
Males
Females
2-5
6-11
Percent (%)
35
30
25
20
15
10
5
0
12-19
20-39
BMI > 95th percentile
Age (years)
40-59
60+
BMI > 30
Ogden et al.,2014.
Prevalence of obesity by race/ethnicity and sex (NHANES)
60
Males
Females
Adults 20+
50
Children
Kids 2-19
2-19
40
30
20
10
0
Racial/Ethnic Group
Ogden et al. (2014)
MVPA minutes in youth by age, sex, and race/ethnicity
(NHANES)
Average number of Mintues in MVPA
100
90
80
70
60
50
40
30
20
10
0
Belcher et al., 2010
Percent of adults meeting aerobic and muscle
strengthening guidelines*: by race/ethnicity (BRFSS 2013)
30
Percent (%)
25
20
15
10
5
0
*at least 150 min/wk of moderate aerobic physical activity or 75 min/wk of vigorous aerobic physical activity
and engage in muscle-strengthening activities on 2+days a week
BRFSS (2013)
Percent of adults who engage in no leisure time physical
activity by race/ethnicity (BRFSS 2013)
35
30
Percent (%)
25
20
15
10
5
0
BRFSS (2013)
Prevalence of obesity among racial/ethnic groups
and people with disabilities (BRFSS)
40
35
Percent (%)
30
25
20
15
10
5
0
Disability Black
Asian
AI/AN Hispanic White
Institute on Disability Report (2011).
Prevalence of obesity among children with
disabilities (NSCH)
25
Percent (%)
20
15
10
5
0
Chen et al., 2009
*adjusted for age, sex, race/ethnicity, income, parental education, family structure, and region
Time in activity for adults with and without mobility
disability (NHANES)
600
Mean/proportion (min/day)
No Disability
Mobility Disability
500
400
300
200
100
0
Sedentary
Light
MVPA
Loprinzi et al., 2014
Prevalence of adult obesity by years of residence in US (NHIS)
30
Percent (%)
25
20
15
10
5
0
<1
1-5
5-9
10-14
15+
US Born
Years in US
Singh et al. (2011).
Prevalence of regular PA and lack of sports participation
among immigrant and US-born children 6-17 years (NSCH)
80
Regular PA
No Sports Participation
70
Percent (%)
60
50
40
30
20
10
0
Foreign-born, 2
US-born, 2
immigrant parents immigrant parents
US-born, 1
immigrant parent
US-born, US
parents
Singh et al., 2008
Prevalence of obesity by income for women (NHANES)
60
Non-Hisp White
Non-Hisp Black
Mexican American
Percent (%)
50
40
30
20
10
0
0-1
>1-2
>2-4
Poverty Income Ratio
richer
>4
Chang & Lauderdale (2005).
Prevalence of obesity by income for men (NHANES)
60
Non-Hisp White
Non-Hisp Black
Mexican American
Percent (%)
50
40
30
20
10
0
0-1
>1-2
>2-4
Poverty Income Ratio
>4
richer
Chang & Lauderdale (2005).
Percent of adults meeting aerobic and muscle
strengthening guidelines*: by income (BRFSS 2013)
30
Percent (%)
25
20
15
10
5
0
*at least 150 min/wk of moderate aerobic physical activity or 75 min/wk of vigorous aerobic physical activity
and engage in muscle-strengthening activities on 2+days a week
BRFSS (2013)
Access to “some” recess varies by race/ethnicity and
income (ECLS-K)
80
70
Percent (%)
60
50
40
30
20
10
0
Race
Income
Barros R et al. (2009)
Prevalence of obesity among adults by state and territory
(BRFSS)
WA
MT
ME
ND
MN
VT
OR
ID
SD
WI
IA
NE
PA
IL
UT
OH
IN
CO
CA
AZ
MO
NC
TN
AR
SC
MS
TX
AK
AL
GA
LA
FL
HI
PR
GUAM
15%–<20%
20%–<25%
25%–<30%
MD
VA
KY
OK
NM
30%–<35%
≥35%
CT
NJ
DE
WV
KS
MA
RI
MI
WY
NV
NY
NH
DC
Percent of adults meeting aerobic and muscle
strengthening guidelines* (BRFSS 2013)
*at least 150 min/wk of moderate aerobic physical activity or 75 min/wk of vigorous aerobic physical activity
and engage in muscle-strengthening activities on 2+days a week
Prevalence of obesity among adults by urbanization level
(NHIS)
45
Males
Females
40
Percent (%)
35
30
25
20
15
10
5
0
Large central
Large fringe
Metropolitan Counties
Rural Health Policy and Research Center
Small metro
Micropolitan
Non-core
Non-Metropolitan Counties
Prevalence of no leisure time PA among adults
by sex and urbanization level (NHIS)
45
Males
Females
Large central Large fringe
Small metro
40
Percent (%)
35
30
25
20
15
10
5
0
Metropolitan Counties
Micropolitan
Non-core
Non-Metropolitan Counties
Availability of PA Facilities and PA/Overweight
(Add Health)
1.5
Odds of having 5 or more
bouts of MVPA
Odds Ratio
1.25
1.26
referent
1
Odds of being overweight
0.75
0.68
0.5
One
Gordon-Larsen et al (2006)
Two
Three Four
Five
Six
Seven
Number of PA facilities per block group
Achieving PA Equity
• Addressing root causes
• Through intervention at all
levels
• Through environmental
change
• Through policies and
supporting resources