title: A community-based approach to promoting walking in rural areas.
abstract: BACKGROUND
  Ecologic models are often recommended to promote physical activity, yet sparse data exist on their effectiveness.
  
  
  METHODS
  A quasi-experimental design examined changes in walking behavior in six rural intervention communities in the Missouri "bootheel" region and in six comparison communities in Arkansas and Tennessee.
  
  
  METHODS
  The communities ranged in population from 2399 to 17,642; interventions focused on adults aged >/=18 years.
  
  
  METHODS
  Interventions were developed with community input and included individually tailored newsletters, interpersonal activities that stressed social support, and community-wide events such as walk-a-thons.
  
  
  METHODS
  Primary outcomes were rates of walking-trail use, total number of minutes walked in the past week, and total minutes walked for exercise.
  
  
  RESULTS
  Among persons who used trails at baseline (16.9% of the total population), 32.1% reported increases in physical activity since they began using the trail. From community-wide samples, two subgroups indicated a positive net change in rates of 7-day total walking: people with high school degrees or less and people living in households with annual incomes of <==$20,000. However, no studied group showed a statistically significant net intervention effect.
  
  
  CONCLUSIONS
  Although there was an increase in the rate of walking-trail use, a community-wide change in walking rates in rural communities was not documented. Results of this study should provide guidance for future projects.
authors.affiliation: Department of Community Health and Prevention Research Center, School of Public Health, Saint Louis University, St. Louis, Missouri, USA. brownson@slu.edu
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Baker
authors.forename: Rutha L
authors.initials: RL
authors.lastname: Boyd
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Caito
authors.forename: Katie
authors.initials: K
authors.lastname: Duggan
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Housemann
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Kreuter
authors.forename: Tonya
authors.initials: T
authors.lastname: Mitchell
authors.forename: Freda
authors.initials: F
authors.lastname: Motton
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pulley
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Schmid
authors.forename: Dorothy
authors.initials: D
authors.lastname: Walton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012424:Rural Population; D012959:Socioeconomic Factors; D014481:United States; D016138:Walking