title: A multilevel ecological approach to promoting walking in rural communities.
abstract: BACKGROUND
  Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This study's purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking.
  
  
  METHODS
  A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003-2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week.
  
  
  RESULTS
  At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking.
  
  
  CONCLUSIONS
  Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.
authors.affiliation: Prevention Research Center, Saint Louis University School of Public Health, Salus Center Room 469, 3545 Lafayette Avenue, St. Louis, MO 63104, USA. brownson@slu.edu
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
authors.forename: Laura
authors.initials: L
authors.lastname: Hagood
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Lovegreen
authors.forename: Betty
authors.initials: B
authors.lastname: Britton
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Caito
authors.forename: Michael B
authors.initials: MB
authors.lastname: Elliott
authors.forename: Jennifer
authors.initials: J
authors.lastname: Emery
authors.forename: Debra
authors.initials: D
authors.lastname: Haire-Joshu
authors.forename: Dawn
authors.initials: D
authors.lastname: Hicks
authors.forename: Brenda
authors.initials: B
authors.lastname: Johnson
authors.forename: Janet B
authors.initials: JB
authors.lastname: McGill
authors.forename: Sandra
authors.initials: S
authors.lastname: Morton
authors.forename: Gary
authors.initials: G
authors.lastname: Rhodes
authors.forename: Tammy
authors.initials: T
authors.lastname: Thurman
authors.forename: Debra
authors.initials: D
authors.lastname: Tune
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001131:Arkansas; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D012424:Rural Population; D013714:Tennessee; D016138:Walking