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Show strength and direction of relationships) are different from those reported in Study IV. These variations could be attributed to the changes that occurred during the five years between these two surveys as well as the difference in measuring regular vigorous exercise as well (see the Appendix). Therefore, it may be too soon to implement Study IVs findings on multiple roles and religious networks into the promotion of physical activity, unless a study, based on comparable measures, replicates the findings of Study IV. The factor of health insurance status in Study IV was conceptualized as a health system effect. Based on the available information, the authors cannot completely explain how having health insurance coverage affects exercise behavior, especially for women with some college education or higher. However, considering communication or information flow between managed care organizations (MCOs) and their enrollees has been expanded and increased with the penetration of MCOs in the 1990s, this study suggests that MCOs could be an influential partner in a community coalition to promote physical activity in Utah. The U.S. Surgeon General's report pointed out the most effective interventions occur on multiple levels (U.S. Department of Health and Human Services, 1996). Three system and community-based strategies affecting sedentary adults are recommended by HP2000: (a) to increase the proportion of worksites offering employer-sponsored physical activity and fitness programs; (b) to increase community availability and accessibility of physical activity facilities such as fitness trails, public swimming pools, park and recreation open space; and (c) to increase the proportion of primary care providers' counsel on physical activity (U.S. Department of Health and Human Services, Public Health Service, 1991). Utah public health agencies, voluntary organizations, and advocates have implemented some of these recommendations in the 1990s, including the Utah Governor's Council on Health and Physical Fitness annual worksite health promotion conference and the Eat Smart Move Smart Initiative. However, there has not yet been available data to evaluate these efforts. In sum, to change the trend of sedentary lifestyle in Utah, public health initiatives must be multifaceted, family- and community-focused, targeted to specific groups, as well as grounded in the research of health education, social sciences and behavior change, and effective social-marketing. Increased public attention to immediate and long-term benefits from physical activity could include campaigns highlighting the relationship between quality of life, risk factors, and chronic diseases . In addition, community-level allocation of resources promoting structural changes that create a supportive environment for active lifestyles, is also needed. These changes can occur through community initiatives which involve schools, employers, health insurance companies, and community and religious organizations. Utahns can become a healthier population if schools, government, and other social institutions act together to achieve this common goal. References Armitage, P. (1955). Tests for Linear Trends in Proportions and Frequencies. Biometrics, 11, 375-386. Bird, C. E. & Fremont, A. M. (1991). Gender, Time Use, and Health. Journal of Health and Social Behavior, 32, 114-129. Dwyer, J. W., Clarke, L. L., & Miller, M. K. (1990). The Effect of Religious Concentration and Affiliation on County Cancer Mortality Rates. Journal of Health and Social Behavior, 31, 185-202. Gardner, J. W. & Lyon, J. L. (1982). Cancer in Utah Mormon Women by Church Activity Level. American Journal of Epidemiology, 116, 243-257. Hochschild, A. R. (1989). The Second Shift: Working Parents and the Revolution at Home. New York: Viking. Idler, L.I. (1987). Religious Involvement and the Health of the Elderly: Some Hypotheses and an Initial Test. Social Forces, 66, 226-238. Larsen, L., & Friedrichs, M. (unpublished). What Do Utahns Know about Their Health Risks and What Do They Do about It? Salt Lake City: Utah Department of Health, Bureau of Chronic Disease Prevention and Control. McGinnis, J. M. (1992). The Public Health Burden of a Sedentary Lifestyle. Medicine and Science in Sports and Exercise, 24, S196-S200. National Center for Health Statistics. (1997). Healthy People 2000 Review, 1997. Hyattsville, MA: Public Health Service. 41 |
