title: Individual and contextual correlates of physical activity among a clinical sample of United States Veterans.
abstract: BACKGROUND
  Veterans, especially those using U.S. Department of Veterans Affairs (VA) healthcare, have poorer health than the general population. In addition, Veterans using VA services are more likely than non-VA users to be physically inactive. Little is known about physical activity correlates among Veterans. To identify targets for health promotion interventions, understanding barriers to and facilitators of physical activity in this population is critical.
  
  
  METHODS
  This study examined individual-, social-, and perceived neighborhood-level associations of meeting weekly physical activity recommendations (150 min/week of combined leisure and transportation activity) based on the International Physical Activity Questionnaire (IPAQ) among N = 717 patients from VA Puget Sound, Seattle Division using a mailed survey sent 2012-2013 (response rate = 40%). Independent associations were identified with direct estimation of relative risks using generalized linear models (dichotomous outcome), and linear regression (continuous outcome), including variables associated in bivariate tests (p < .05).
  
  
  RESULTS
  Most participants were male, Caucasian, and unemployed, and had an annual income ≤$40,000. Over two-thirds (69.9%) reported meeting physical activity recommendations. Fewer days of limitations due to physical or mental health (Relative Risk (RR) = 0.99 per day; 95% Confidence Interval (CI) = 0.98, 0.99; p = .01), others doing physical activity with the Veteran (RR = 1.18; 95% CI = 1.04, 1.33; p = .01), receiving ideas from others regarding physical activity (RR = 1.14; 95% CI = 1.01, 1.29; p = .03) and better perceived neighborhood aesthetics (RR = 1.14; 95% CI = 1.06, 1.24; p = .001) were associated with meeting physical activity recommendations. Findings were comparable for total weekly physical activity, but lower depression symptom severity was also associated with increased physical activity.
  
  
  CONCLUSIONS
  This study identified individual and contextual correlates of physical activity among VA-using Veterans. Targeting these factors will be important in promoting physical activity in order to address the disproportionate disease burden facing U.S. Veterans. Existing VA interventions targeting physical activity may need to be adapted to account for the influence of contextual factors.
authors: VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, United States. Electronic address: Katherine.Hoerster@va.gov.
authors: Katherine D
authors: KD
authors: Hoerster
authors: VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, United States; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, United States.
authors: Rachel A
authors: RA
authors: Millstein
authors: Durham Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, United States; Duke University, Department of Medicine, United States.
authors: Katherine S
authors: KS
authors: Hall
authors: VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, United States; University of Washington School of Public Health, Department of Health Services, United States.
authors: Kristen E
authors: KE
authors: Gray
authors: VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, United States; University of Washington School of Public Health, Department of Health Services, United States; University of Washington School of Public Health, Department of Epidemiology, United States.
authors: Gayle E
authors: GE
authors: Reiber
authors: VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, Department of Medicine, United States.
authors: Karin M
authors: KM
authors: Nelson
authors: University of Washington, Department of Psychiatry and Behavioral Sciences, United States; Seattle Children's Research Institute, United States.
authors: Brian E
authors: BE
authors: Saelens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression; D015444:Exercise / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012111:Residence Characteristics; D012944:Social Support; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans / Q000523:psychology; D014861:Washington
keywords: Neighborhood; Physical activity; Social support; Veterans