Based on these findings, we recommend that future research include more diverse groups of women and evaluate modifiable factors, such as psychological, interpersonal, and environmental correlates. Future research also should include more intervention and longitudinal studies.

The results of our review suggest that policy and environmental strategies may promote physical activity and good nutrition. Based on the experimental and quasi-experimental studies in this review, the following interventions provide the strongest evidence for influencing these behaviors: prompts to increase stair use (N = 5); access to places and opportunities for physical activity (N = 6); school-based physical education (PE) with better-trained PE teachers, and increased length of time students are physically active (N = 7); comprehensive work-site approaches, including education, employee and peer support for physical activity, incentives, and access to exercise facilities (N = 5); the availability of nutritious foods (N = 33), point-of-purchase strategies (N = 29); and systematic officer reminders and training of health care providers to provide nutritional counseling (N = 4). Further research is needed to determine the long-term effectiveness of different policy and environmental interventions with various populations and to identify the steps necessary to successfully implement these types of interventions.

Ethnic minority and low-income populations have the highest rates of cardiovascular disease and the lowest rates of leisure-time physical activity. Because physical activity reduces the risk of premature death and disability from cardiovascular disease, researching correlates to such activity in these populations is an important aspect of health promotion in the US. To identify environmental, policy, and cultural barriers to physical activity in women, The Women's Cardiovascular Health Network Project conducted focus groups with White, African American, Latina, and American Indian women aged 20-50 years. The focus groups were audiotaped, transcribed, and analyzed with QSR NUD*IST qualitative software using a set of codes developed a priori by the research team. Family priorities were a main barrier to physical activity in all the groups. Having multiple roles as wife, mother, daughter, and as an active community member was mentioned as time-consuming and difficult, leaving little time or energy for exercise. Cultural barriers, which varied among the groups, included acculturation issues, lack of community support, and lack of past experience with exercise. Physical activity interventions suggested involved work programs, family-friendly programs, increased social support, and the availability of safer places to exercise such as parks, well-lit walking trails, and recreation centers. Many of the barriers were common to all groups (e.g., family priority) while some were unique (e.g., lack of community support). Assessing and addressing the issues raised should be considered when planning physical activity interventions for these populations.Physical activity is an important part of health promotion and disease prevention (USDHHS, 1996). Reducing disparities in health and increasing physical activity levels in all populations is paramount to the future health of our nation. For physical activity interventions to be effective, however, they must adequately address barriers to activity and promote factors that enable it. As indicated by our projects in this series, these barriers and enablers are both common and unique across race/ethnicity. Common barriers, such as lack of time, have been cited in

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Ethnic minority and low-income populations have some of the highest rates of cardiovascular disease (CVD) and the highest rates of physical inactivity, an independent risk factor for CVD. Ethnic minority and low-income women are especially at risk. Because programs designed to increase physical activity have the potential to reduce CVD rates in specific populations, research in this area is expanding. As part of the Women's Cardiovascular Health Network funded by the Centers for Disease Control and Prevention, the goal of this multi-site project is to identify factors, particularly environmental, policy, and cultural factors, that may influence physical activity among ethnic minority and low-income women ages 20-50 years. To achieve this goal, 42 focus groups were conducted in various locations throughout the United States with African American, American Indian, Latina and White women. Groups represented both urban and rural living environments. This article explains the basis for this project and the methodology used. Other articles in this series explain the results from the focus groups in detail.

Purpose: We investigated the impact of elements of a workplace culture of health (COH) on employees’ perceptions of employer support for health and lifestyle risk. Design: We used 2013 and 2015 survey data from the National Healthy Worksite Program, a Centers for Disease Control and Prevention (CDC)-led initiative to help workplaces implement health-promoting interventions. Setting: Forty-one employers completed the CDC Worksite Health Scorecard to document organizational changes. Participants: Eight hundred twenty-five employees provided data to evaluate changes in their health and attitudes. Measures: We defined elements of a COH as environmental, policy, and programmatic supports; leadership and coworker support; employee engagement (motivational interventions); and strategic communication. Outcomes included scores of employees’ perceptions of employer support for health and lifestyle risk derived from self-reported physical activity, nutrition, and tobacco use. Analysis: We estimated effects using multilevel regression models. Results: At the employee level and across time, regression coefficients show positive associations between leadership support, coworker support, employee engagement, and perceived support for health (P < .05). Coefficients suggest a marginally significant negative association between lifestyle risk and the presence of environmental and policy supports (P < .10) and significant associations with leadership support in 2015 only (P < .05). Conclusion: Relational elements of COH (leadership and coworker support) tend to be associated with perceived support for health, while workplace elements (environmental and policy supports) are more associated with lifestyle risk. Employers need to confront relational and workplace elements together to build a COH.

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The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.