Introduction
The Active Living Plan for Nacogdoches County is a set of strategies and initiatives which are aimed at increasing the overall wellness of its residents, by focusing on physical activity. This Plan is a living and always changing document to reflect the needs of its community. Due to these ever-changing needs, the strategies identified in each sector, are designed to be broad to be able to meet the needs of the overall community, rather than just one or two population groups.
The challenge of the Active Living Plan will not be to earn buy in, as the data and the evidence-based interventions speak for themselves. But rather to identify and develop the group that is willing to push the strategies and initiatives forward and make the Active Living Plan a reality. Because of this, community participation is vital to any intervention that wishes to be sustained into future generations, as it converts participants into stakeholders.
Local, State and National Data
The CDC estimates that nationally only one in five adults (about 21%) countrywide meet the national guidelines for physical activity. Furthermore, less than 3 out of 10 high school students participate in 60 minutes of physical activity daily. Disparities exist between different populations and age groups. More non-Hispanic white adults meet the 2008 Physical Activity Guidelines for aerobic and muscle-strengthening activity than non-Hispanic black adults and Hispanic adults. Men are more likely than women to meet the guidelines for aerobic activity, and younger adults are more likely to meet the aerobic activity guidelines than older adults. Adults with more education are more likely than those with less education to meet the guidelines, and adults whose family income is above the poverty level are more likely to meet the guidelines than adults whose family income is at or below the federal poverty level.*
2012 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive**
As the map above indicates, East Texas compares unfavorably with regards to physical activity nationwide. According to the 2015 Behavioral Risk Factor Surveillance System, the prevalence of physical activity or exercise in the past month in the state of Texas was 72.0%, while in Public Health Region 4/5N was 65.3%.*** In addition to Region 4/5N having a lower rate than the state in physical activity, in 2015, PHR 4/5N rate of over 18-year-old individuals who have had a heart attack, myocardial infarction, angina, coronary heart disease or stroke was 11.9%, compared to the state rate of only 8.8%.^ All conditions which are correlated with being physically inactive. Lastly, in 2015, the state rate of those individuals who were told by a doctor, nurse, or other health professional that they had diabetes (not including gestational) was 12.4%, compared to PHR 4/5N at 14.6%.^^
Data from the Nacogdoches County Health Facts Profile 2013, indicates heart disease, cancer and cardiovascular disease (stroke) as the top 3 causes of mortality.^^^ Obesity which is correlated with physical inactivity are both risk factors for heart disease and cardiovascular disease (stroke). Lastly, in 2009 Nacogdoches County was designated as a Medically Underserved Population (MUP) which is a designation given by the state governor. MUP’s are population areas in which a shortage of personal health services occurs which then in turn causes the population to have poor access to primary care. The less access an individual has, the more likely the individual will have conditions and diseases that will go undiagnosed and untreated.
Social Ecological Model of Behavioral Change
This data indicates a clear need for physical activity interventions, from policies to communities to individuals. Because physical activity does rely on both external, environmental factors as well as internal influences, we use the Social Ecological Model of Behavior Change to describe the process necessary to facilitate physical activity in Texas.
Individual: Addressing physical inactivity implies changing everyday behaviors. This means changing knowledge, attitudes and beliefs. This doesn’t happen alone. Formal and informal social networks often provide the motivation needed to engage in physical activity.
Interpersonal: Spouses, friends, family, peers, and coworkers represent potential sources of interpersonal influences. Interpersonal groups can facilitate individual behavior change by giving support and guidance to start making healthy lifestyle changes.
Organizations: Schools, workplaces, volunteer networks – these all have the capacity to help individuals make physical activity a part of their day through policy changes and promotion of healthy individual behaviors.
Communities: A community is essentially a large organization and consists of groups, residents and organizations that can work together to implement physical activity friendly changes to the area. For instance, communities can impact the connectedness and design of an area by designing parks, passing complete streets policies, or building trails. According to a student by T. R. Frieden in the American Journal of Public Health, April 2010, Vol. 100, No. 4, pg 590-595, “changing the environmental context so that individuals can easily take heart-healthy actions in the normal course of their lives can have a greater population impact that clinical interventions that treat individuals.” In fact, “interventions that change the context for individual behavior are generally the most effective public health actions.” To change habits, it is imperative to increase awareness and interest, but more than that, there needs to be an increase in accessibility and convenience. The first step is to make more walkable sidewalks and to make existing streets safer for biking and similar activities.
Society: Society reflects how all other components work together to create change. Policies and legislation supporting physical activity on a large scale helps individuals, interpersonal, organizational, and community-wide programs to function successfully.+
