title: Multi-level support for physical activity and healthy eating.
abstract: OBJECTIVE
  This paper reports a study evaluating the relationship between social and community level supports and physical activity and dietary behaviours among a low-income Latino population with multiple chronic conditions.
  
  
  BACKGROUND
  With consistently lower physical activity than whites and documented nutritional deficiencies, Latinos in the United States of America represent a disproportionate share of the population with chronic illness. This pattern of health disparities is seen across countries, where there is a struggle to raise the health status of low-income, immigrant and aboriginal communities. Social-ecological theories of health behaviour stress the importance of considering social and community support for health behaviour, and represent a useful framework for considering ways to improve physical activity and nutrition for immigrant and aboriginal groups.
  
  
  METHODS
  We report here on data from a baseline assessment of 200 patients from a health clinic in the United States of America serving a low-income, primarily Latino population. Participants were enrolled in Resources for Health, a randomized controlled trial to promote multi-level support for chronic illness self-management. Measures included self-reported physical activity, dietary behaviour and multi-level support for chronic illness management as well as demographic data. Baseline data reported on here were collected between February 2002 and September 2003.
  
  
  RESULTS
  Use of multi-level supports (e.g. family, individual and healthcare provider) was statistically significantly associated with meeting physical activity guidelines and better dietary behaviours. Being female and having multiple chronic conditions were also associated with better dietary behaviour. These variables explained 20% of the variance in dietary behaviour.
  
  
  CONCLUSIONS
  Results support a social-ecological approach for promoting healthy behaviour in this low-income, primarily Latino sample with multiple chronic conditions. Addressing multiple levels of support for healthy behaviour is important in interventions to improve physical activity and diet, and nurses may be particularly well placed to address such issues for low-income, aboriginal and immigrant patients with chronic conditions.
authors.affiliation: Associate Professor, Health Outcomes, University of Colorado, Aurora, 80045, USA. sheana.bull@uchsc.edu
authors.forename: Sheana
authors.initials: S
authors.lastname: Bull
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Eakin
authors.forename: Marina
authors.initials: M
authors.lastname: Reeves
authors.forename: Riley
authors.initials: R
authors.lastname: Kimberly
mesh_terms: D002908:Chronic Disease; D003152:Community Health Nursing / Q000379:methods*; D004032:Diet; D015444:Exercise; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D010353:Patient Education as Topic; D011203:Poverty; D012944:Social Support; D014481:United States