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© 2001 American Public Health Association
RESEARCH |
The authors are with the Psychology Department, University of Texas at El Paso.
Correspondence: Requests for reprints should be sent to Karen J. Coleman, PhD, Psychology Department, 500 W University Ave, University of Texas at El Paso, El Paso, TX 79968-0553 (e-mail: kcoleman{at}utep.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Objectives. This study sought to determine whether a culturally relevant health message would promote stair use in a predominantly Hispanic community.
Methods. Observations of stair, elevator, and escalator use were collected over a 6-month period at 4 sites throughout the city of El Paso, Tex. The efficacy of individual and family health promotion signs was tested.
Results. Stair use increased in response to both individual and family promotion health messages, and use varied widely by intervention site.
Conclusions. These results underscore the importance of considering the physical characteristics of the environments targeted for health promotion campaigns.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Millions of Americans suffer from illnesses that can be prevented or improved through regular physical activity.1–7 Recent epidemiologic reports have made it clear that minorities suffer disproportionately from lifestyle diseases such as diabetes and obesity.8–10 Also, Hispanic adults, especially women, represent one of the most sedentary groups in the United States.11–16 Therefore, increasing physical activity in Hispanic communities is a public health priority.16
This is especially the case in the El Paso, Tex, border region, which has some of the highest rates of obesity (50% of adults older than 45 years), type 2 diabetes (16%), and inactivity (70%) in the nation.11,13 Stair use is a lifestyle change that can increase physical activity and thereby improve health.17–19 Communitywide interventions have most often used signs to promote stair use.20–23 This study investigated the use of signs depicting "familismo" (the importance of family)24–27 to promote stair use in a predominantly Hispanic population.
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Signs
All signs measured 2 ft x 2 ft (60 cm x 60 cm) and were professionally mounted; each sign's message appeared in both English and Spanish (Figure 1
). The individual promotion sign was modeled on that of Brownell et al.22 The culturally appropriate family promotion sign was created in Spanish first, and both signs were translated and back translated by a team of 6 bilingual speakers, 3 of whom were native Spanish speakers.
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Settings
Four intervention sites were chosen: 3 community locations (an airport, a bank, and an office building) and 1 campus location (the University of Texas at El Paso [UTEP] library). All buildings had open area staircases. At the airport and the bank, stairs and the adjacent escalators represented the only access to the second floor. At the office building (3 floors) and the library (6 floors), the stairs and elevators were within sight of each other; there were no escalators in either building.
Design
At all of the sites, an initial baseline phase (phase 1) was followed by an intervention phase (phase 2) and, finally, a postintervention phase (phase 3) without a sign. To control for the effects of site, we included a second intervention phase (phase 4) at 2 buildings to test the effects of a sign posted opposite that in phase 2. This was followed by a second postintervention phase (phase 5) without a sign. Phase 3 was used as a "washout" period and as a baseline for phases 4 and 5. Each phase of the study, which was conducted throughout 1999, lasted 1 month.
Procedures
Two observers were inconspicuously stationed at each site. One person recorded men and women taking the stairs, and the other person recorded men and women taking elevators or escalators. People carrying heavy loads, children, or items larger than a backpack, purse, or briefcase and those who were physically handicapped were counted and coded as having luggage or being otherwise impaired. One observer at the airport used a third counter to assess the number of such individuals taking the escalators or elevators.
Reliability was determined at the beginning of each experimental phase and whenever new observers joined the study. The overall reliability rate (r) for the observation categories was 0.99. Observation periods were chosen randomly each day (Monday through Friday) for at least 4 days per week. An attempt was made to observe at least 2 mornings and afternoons a week. Observation periods lasted 30 to 60 minutes.
Patrons and Employees
El Paso's population is 51.2% female and 75% Hispanic (primarily of Mexican descent). UTEP is 53.6% female and 67.4% Hispanic (also primarily of Mexican descent). The study was approved by the UTEP institutional review board.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Individual Promotional Message
Summary stair use data are presented in Table 1
. The individual promotion message posted at the bank was significantly associated with increased stair use among both men (
21 = 276.25, P < .001) and women (21 = 117.81, P < .001), and these increases persisted during phase 3 (men: 21 = 40.02, P < .001; women: 21 = 12.15, P < .001). The individual promotion sign displayed at the airport was also significantly associated with increased stair use among men (c21 = 11.36, P < .001) and women (21 = 35.51, P < .001) relative to phase 3. Among men, stair use during phase 5 returned to phase 3 levels. However, women's stair use remained elevated during phase 5 relative to phase 3 (c21 = 57.40, P < .001).
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Finally, the individual promotion sign at the library was significantly associated with decreased stair use among men (
21 = 25.50, P < .001); it did not result in changes in rates of use among women relative to phase 3. The decline in men's stair use persisted into phase 5 (21 = 22.27, P < .001), while women's stair use continued to remain constant.
Family Promotional Message
The family promotion sign posted at the office building was significantly associated with decreased stair use among men (21 = 34.67, P < .001) but had no effect on stair use among women. Men's stair use continued to decline during phase 3 (21 = 13.47, P < .001), while women's stair use increased relative to baseline during phase 3 (21 = 22.52, P < .001).
At the airport, the family promotion sign was significantly associated with increased stair use among both men (21 = 288.00, P < .001) and women (21 = 84.01, P < .001). During phase 3, men's stair use returned to baseline levels, while women's stair use remained elevated (c21 = 33.82, P < .001).
Finally, at the UTEP library, the family promotion sign was significantly associated with decreased stair use among men (21 = 38.55, P < .001) and increased use among women (21 = 83.64, P < .001). Men's lower levels of stair use persisted into phase 3 (21 = 17.53, P < .001), while stair use among women remained elevated during phase 3 (21 = 33.82, P < .001).
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Women's stair use increased at all intervention sites, while men's stair use increased at 2 of the 4 sites. In general, we did not find that a culturally tailored family promotion message was any more effective in regard to increasing stair use in a predominantly Hispanic community than a general individual promotion message. Although stair use increased by only 3% to 9%, a 4% increase at the airport alone would result in an additional 136 000 people using the stairs, roughly 22% of the population of El Paso.
Our findings are similar to the changes in stair use reported in other studies.20–23 Andersen et al.28 recently reported that having an African American character depicted on signs substantially increased stair use among African Americans. This would seem to support cultural tailoring of health-related messages. However, Andersen et al. did not compare this intervention with a general health promotion message, and stair use increased significantly among Caucasian people as well.
Other investigations have shown variations in stair use across different intervention sites.22 There are several reasons why we might have found effects for our intervention at some buildings and not others. The airport and bank evidenced the greatest increases in stair use. Baseline stair use rates were very low at these sites, leaving substantial room for improvement. In addition, most people did not have time to read the signs fully unless they stopped to do so.
Both the library and the office building evidenced high baseline rates of stair use, indicating a possible ceiling effect in the amount of stair use at these locations. Most people read the promotional signs at the library and office building while waiting for the elevator. It is possible that this extra contemplative time resulted in very different behavioral choices than those made quickly without much thought as to the full content of the message (such as at the bank and the airport).
Problems with the current study include not using focus groups to develop and test our "culturally tailored" intervention, not having specific information about the people who were using the stairs at each building, and the observed decreases in men's stair use at certain locations that could not be explained. Future studies would benefit from pretesting health promotion messages with Hispanic men and women of different levels of acculturation, in different socioeconomic categories, and at different geographic locations across the country.
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Acknowledgments |
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This study was funded in part by a Research Enhancement Fund award from the University of Texas at El Paso.
We would like to thank those students who contributed to the completion of this project, including Sherrine Stone, Oscar Esparza, Kelly Chase, Rudy Acuna, Brad Davis, Doris Gonzalez, Susana Rojo, Mario Parada, Delia Hernandez, Kimberly Janssen, Candace Rutt, and Imelda Alcala.
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Footnotes |
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K. J. Coleman and E. C. Gonzalez planned the study, collected the data, and wrote the paper. K. J. Coleman designed and conducted the analyses.
Accepted for publication December 13, 2000.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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