Promoting physical activity in a low-income neighborhood of the Paris suburb of Saint-Denis: effects of a community-based intervention to increase physical activity

Abstract

BackgroundPhysical activity (PA) is a key factor for facing the increasing prevalence of obesity and overweight, and should be part of every public health programs. In this context, a community-based public health program promoting PA was developed in a low-income neighborhood of the city of Saint-Denis (France).MethodsThis work aimed at assessing the effectiveness of a 2-year PA promotion program.A quasi-experimental study was carried out using a pre/post design, with an assessment before (2013) and after (2015) the program. The interviewees were selected using a stratified random cluster sampling. The primary outcome was the proportion of participants practicing sufficient PA (WHO guidelines), and was measured using the RPAQ questionnaire. External interventions (on both neighborhood environment and inhabitants) were listed.ResultsWe collected 199 questionnaires at baseline and 217 in 2015. There was a majority of women in both samples: 64.3 % in 2013 and 58.2 % in 2015. The average age of participants was 38.1 years (+/−1.1) and 40.6 (+/−1.1) respectively. The proportion of people practicing sufficient PA was modified from 48.1 % in 2013 to 63.5 % in 2015 (p = 0.001). This was mainly driven by women whose level of PA, increased from 40.3 % to 60.3 % (p = 0.002), reaching the average national French estimation of PA level among adults (63.5 %).ConclusionsThis work showed a significant increase of the proportion of people practicing PA in a disadvantaged neighborhood where a community-based program promoting PA was developed. Simultaneous external interventions contributed to the results, showing the necessity of synergic interventions to reach efficiency.

Do multiple community-based interventions on health promotion tackle health inequalities?

“…partnership agreements, steering committees, school co-ordinator models) 4) Environmental change (e.g. healthy eating in schools, physical activity opportunities) Anthropometry; health-related behaviors; quality of life Few reduced inequalities (area level) Buscail et al, 2016 [ 17 ] Pre-post-test (no control group), France (n of adults in a low-income neighborhood: 199 and 217) 2 1) Social marketing (flyers and informative brochures on physical activity) 3) Networking/partnership (questioning residents on barriers) 4) Environmental change (offering and access to physical activity at community centers; pedestrian orientation paths) Physical activity behavior (WHO guidelines) Reduced inequalities (area level) Cummins et al, 2005 [ 18 ] Quasi-experimental, UK (n of men and women in a deprived community: 493 aged 16+; comparison group: 310) 3 1) Social marketing (advertisement) 4) Environmental change (provision of a new food supermarket) Fruit and vegetable consumption; self-reported health; psychological health No difference (area level) Egan et al, 2016 [ 19 ] Pre-post-test (no control group), UK (n of 14 differentially disadvantaged neighborhoods: 1006) 2 2) Individual or group education (anti-social behavior services/initiatives) 3) Networking/partnership (stakeholders’ consultation including residents) 4) Environmental change (complex housing improvements, demolition and new build) Self-reported mental and physical health Reduced inequalities by subgroups (lower income and higher investment groups respectively) Gans et al, 2018 [ 29 ] Cluster randomized controlled trial, USA (n in 8 intervention sites with low income: 837; 7 control sites: 760) 1 1) Social marketing (motivational campaigns, cooking demonstrations/taste-testing events) 2) Individual or group education (multi-component nutrition education) 4) Environmental change (discount prices, mobile fresh F&V markets) F&V intake Reduced inequalities (area level) Gautam et al, 2014 [ 34 ] Quasi-experimental, New Zealand (n in low-income area: 345; control area: 631) 3 1) Social marketing (biannual information campaign to retailers, wallet card, DVD) 5) Regulatory interventions (controlled purchase operations) 6) Sense of community (social artwork) Parental and retail supply of tobacco to minors No difference (area level) Goodman et al, 2013 [ 20 ...…”

“…Only one of the programs contained elements of all six strategies [ 16 ]. Six programs comprised five strategies [ 22 , 23 , 25 – 27 , 32 ], five consisted of four [ 21 , 23 , 25 , 28 , 37 ], six of three [ 17 , 19 , 29 , 33 , 34 , 36 ] and five of two strategies [ 18 , 20 , 28 , 30 , 36 ].…”

“…Of the 23 studies reviewed, ten studies were found to be of strong quality (43.8%) [23, 25, 26, 27, 28, 30, 31, 34, 36 39]. Nine studies (39.1%) were moderate in quality [ 16 , 17 , 19 – 21 , 23 , 32 , 34 , 37 ], and four studies (17.4%) were weak in quality [ 18 , 28 , 31 , 36 ]. 52.2% of all studies showed poor ratings or could not be evaluated regarding withdrawals and drop-outs.…”

“…Of these, 14 were set in Europe [16][17][18][19][20][21][22][23][24][25][26][27][28][29], five in North America [30][31][32][33][34], three in Australia/Oceania [35][36][37], and one study took place in a country in Central America [38] (see Table 2). The studies used various designs, including RCTs (n = 1) [38], cluster randomized trials (n = 3) [25,30,34], quasiexperimental designs (n = 11) [16, 18, 22, 23, 27-29, 33, 35-37], pre-post-tests without control group (n = 3) [17,19,31], and secondary analyses (n = 5) [20,21,23,26,32]. The sample sizes at baseline varied from 200 to nearly 250,000 in 60 intervention areas, with study populations having a variety of socio-demographic and socioeconomic backgrounds.…”

A Community-Driven Approach to Generate Urban Policy Recommendations for Obesity Prevention

“…These obesogenic environments contribute to the rising obesity epidemic, in that they influence obesity-promoting behaviors in individuals or populations [ 17 ]. As such, there is an increasing focus on how to use policy approaches and how to design and target interventions at the neighborhood level, for instance, to increase physical activity levels, and thereby, in turn, prevent the increase in obesity and overweight [ 18 , 19 ].…”