A multilevel ecological approach to promoting walking in rural communities

Ross C. Brownson, Laura Hagood, Sarah L. Lovegreen, Betty Britton, Nicole M. Caito, Michael B. Elliott, Jennifer Emery, Debra Haire-Joshu, Dawn Hicks, Brenda Johnson, Janet B. McGill, Sandra Morton, Gary Rhodes, Tammy Thurman, Debra Tune

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61 Scopus citations


Background. Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This study's purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking. Methods. A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003-2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week. Results. At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking. Conclusions. Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.

Original languageEnglish
Pages (from-to)837-842
Number of pages6
JournalPreventive Medicine
Issue number5-6
StatePublished - Nov 2005


  • Community networks
  • Environment
  • Exercise
  • Intervention studies
  • Walking


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