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Show some college education or women with college degrees. Effects of Health Insurance Coverage Approximately 42% of uninsured persons engaged in regular vigorous exercise compared with 54% of insured persons. The results of logistic regression indicated that uninsured women with some college or higher education were less likely to participate in regular vigorous exercise than women with health insurance at the same level of education. Health insurance status had no influence on regular vigorous exercise among men. Summary and Discussion Sedentary lifestyle as a recognized risk factor for health outcomes is a relatively new concept (National Center for Health Statistics, 1997). Improving the understanding of physical activity in Utah is urgently needed in order to make local promotion endeavors more effective. As a part of the efforts and based on the available data, this article has presented a relatively comprehensive picture of physical activity in Utah. Utah is a relatively healthy state. However, the trend of sedentary lifestyle in Utah since the 1980s, identified by Study I, highlighted an area in which Utah adults can further improve their health. Since Utahns and residents in the Rocky Mountain states, on average, have a more active lifestyle than other parts of the nation, Utah with other Rocky Mountain states needs to develop specific strategies to increase physical activity. For example, strategies need to be introduced which will reduce the disparity between the awareness of the benefits of physical activity and the behavior of physical inactivity in Utah as reported in Study II. There are several possible explanations for the disparities between awareness and behavior regarding physical activity discussed in Study II. First, the small disparity on the issue of smoking versus the large disparity for exercise and diet could be the result of the long history of public health programs aimed at reducing smoking compared to those more recently developed toward the promotion of regular physical activity and a healthy diet. Second, although researchers demonstrated that physical activity and fitness can reduce the risk of heart disease (Sopko, Obarzanek, & Stone, 1992), an individual might not perceive that heart disease could be a risk for his/her own health and that exercise could directly impact on one's well- being. Heart disease has been the leading cause of deaths in Utah since the 1940s (Owens & Dandoy, 1987), yet only 38.4% of adult Utahns were aware of this fact (Larsen & Friedrichs, unpublished). Third, knowledge of the benefits of physical activity does not automatically translate to exercise behavior. In addition to believing that regular exercise is beneficial, the public needs to have increased opportunities for participation and skill development in this area. The findings from Study III suggest that public programs on physical activity should target promotion efforts on those Utah adults who have less education or income and who are employed. These recommendations are also supported by the results from a multiple logistic analysis on the combined 1985-1996 Utah BRFSS data, recently conducted by the Utah Bureau of Health Education (UBHE). The UBHE's study found that income, education, race, gender, employment status, and marital status have independent effects on sedentary lifestyle in Utah (Utah Bureau of Health Education, 1998). The findings also pointed out that non-Whites are more likely to be sedentary than Whites and that there is no statistically significant difference in physical activity between residents in urban and rural areas of Utah. Study IV further refines the target populations (lower SES group) defined in Study III. Study IV suggests that full-time employed men with low SES are more likely to have a sedentary lifestyle. Moreover, the authors encourage readers to consider the effects of family, individuals' multiple roles, religious networks, and health insurance status on physical activity, which have not been well-documented in current literature. The study showed that social environment or system setting plays a role in facilitating or hindering an individual's physical activity. Other adults in the household engaging in regular vigorous exercise had a consistent positive effect on one's exercise behavior across the six gender-education groups. This finding is also consistent with the results of a similar study based on the 1991 Utah Health Status Survey (Xu, Stinner, & Paita, 1992). Both researches suggest that public health messages on physical activity should include the family and household in the targeted audiences. Attention also needs to be given to the effects of multiple roles and religious networks on physical activity in Utah. Although, Xu and colleagues also discovered the statistically significant effects of multiple roles and religious affiliation and involvement on exercise, some of their findings (the results of statistical tests, the 40 |