Mexican-American Children’s Perspectives: Neighborhood Characteristics and Physical Activity in Texas-Mexico Border Colonias [Journal of Environmental Health]

By Ory, Marcia G

Proquest LLC

Abstract The qualitative study described in this article investigated perceptions about environmental factors influencing physical activity (PA) among children from underserved neighborhoods known as colonias in the U.S.-Mexico border. Ten focus groups were conducted with 67 MexicanAmerican colonia children ages 8 to 13 living in one of the poorest border counties in the U.S. Analyses indicated that PA among children was influenced by neighborhood characteristics, including litter, speeding cars, unleashed dogs, and dark streets. The children also underlined intrapersonal and social environmental factors. Findings may inform policy makers and public health professionals about ways to promote PA among underserved children through urban planning and programs focusing on PA-supportive infrastructure, neighborhood safety, and family- and homebased physical activities.

Introduction

Physical activity (PA) is associated with optimal metabolic function, improved motor skills, increased fitness levels, and beneficial changes in body composition in young children (Barbeau, 2007; Hills, King, & Armstrong, 2007; Matvienko & Ahrabi-Fard, 2010; Pate et al., 2006). Sedentary children are at risk of obesity and cardiovascular disease in adulthood (Butte, Christiansen, & Sorensen, 2007; Dietz, 1997; Gopinath, 2011; Janz et al., 2002; Juonala, 2010; Tanha, 2011; Trost, Sirard, Dowda, Pfeiffer, & Pate, 2003). Despite the well-known benefits of being physically active, PA prevalence rates among youth in the U.S. fall short from the Healthy People 2020 objective of having at least 20.2% of all U.S. youths meeting federal PA guidelines (Centers for Disease Control and Prevention [CDC], 2011a). Currently, only 15.3% of high school students meet PA recommendations with lower rates among Hispanic youth (11.8%) compared to their non-Hispanic white counterparts (16.9%) (CDC, 2011b). Research with MexicanAmerican children 6-11 years of age found this population to be significantly less active than other ethnic groups (U.S. Department of Health and Human Services, 2005; WhittGlover et al., 2009).

Although the physical environment is recognized as an important influence of physical activity (de Vet, de Ridder, & de Wit, 2011; Sallis & Glanz, 2006), most of the research in this field has been conducted with adult and nonminority children samples. Systematic literature reviews show that land use mix, street connectivity, population density, cycling routes, short trip distance, access to facilities, and aesthetic features are predictors of active living (Fraser & Lock, 2011; Humpel, Owen, & Leslie, 2002; McCormack & Shiell, 2011; Saelens, Sallis, & Frank, 2003). Studies in the U.S. found that envi- ronmental determinants of PA among adults include presence of a mall (Michael, Beard, Choi, Farquhar, & Carlson, 2006); low household crowding (Keegan et al., 2012); homeownership (Hannon, Sawyer, & Allman, 2012); and curb cuts, crosswalks, and density of retail (King, 2008). Research in Canada and Japan found that having access to a variety of destinations is a predictor of walking (Gauvin et al., 2008) and population density and parks are associated with sports activity among adults (Hanibuchi, Kawachi, Nakaya, Hirai, & Kondo, 2011).

Although the environmental literature on young children's PA behavior is scarce, research has focused on urban areas and found that correlates to PA include highly dense neighborhoods with sidewalks, parks, schools (Babey, Hastert, Yu, & Brown, 2008; Dalton et al., 2011; Rodríguez et al., 2012), and land use mix (Voorhees, Yan, Clifton, & Wang, 2011). Veitch and co-authors (2010) found that Australian children living in a culde-sac played more in their own street than those not residing in cul-de-sac streets.

Evidence exists that communities where low-income minority families live have limited access to public parks, playgrounds, and recreation facilities (Boone, 2011; GordonLarsen, Nelson, Page, & Popkin, 2006; Powell, Chaloupka, Slater, & Harper, 2006; Powell, Chaloupka, Slater, Johnston, & O'Malley, 2007; Powell, Slater, & Chaloupka, 2004; Voss, Hosking, Metealf, Jeffery, & Wilkin, 2008). Yet these studies have focused on the association between the neighborhood's socioeconomic characteristics and PA, and little is known about the influence of the built environment among children living in impoverished neighborhoods. Our study was intended to address this literature gap by conducting focus groups to investigate perceptions about environmental factors influencing PA behaviors among MexicanAmerican children aged 8-13 years living in colonias in the Texas-Mexico border region. Colonias are impoverished neighborhoods along the U.S.-Mexico border and offer important settings to study environmentalphysical activity relationships in underserved and economically disadvantaged communities with inadequate infrastructure. Border residents experience great social and health disparities. People residing at the borderland are disproportionately affected by a lack of urban infrastructure, high prevalence rates of obesity and other chronic diseases, poor access to health care, lack of insurance, and poverty rates (Mier, Flores, Robinson, & Millard, 2004; Mier et al., 2008; Ory et al., 2009; Shapleigh, 2008).

Methods

Our study was conducted in colonias in Hidalgo County, Texas, listed by the U.S. Census Bureau as the second poorest county in the U.S. (Bishaw & Semega, 2008). Although no census data exist for colonias collectively, it is estimated 2,294 colonias are in the TexasMexico border region (Texas Secretary of State, 2011a). Forty-two percent of these colonias are located in Hidalgo County (Texas Secretary of State, 2011b) where the study was conducted (Figure 1).

Families living in colonias are one of the most disadvantaged, hard-to-reach minority groups in the U.S. Colonias are settlements located along the U.S.-Mexico border characterized by impoverished conditions and in many cases a lack of basic services (e.g., paving and street lighting) (Ward, 1999). Colonia residents are very poor (the average household income is less than $834 a month), have limited education (70% have less than a high school education), and have little access to medical services (Federal Reserve Bank of Dallas, 1995). The average number of young children per family in the border colonias is three (McCallum, 2004).

Data presented in our study are from the focus groups carried out as part of a two-year research project seeking to produce environmental policy recommendations to promote PA among economically disadvantaged MexicanAmerican children and their families living in border colonias. Ten focus groups were conducted between February and May 2010 with 67 children aged 8-13 years. Our study meets the guidelines suggested by researchers to reach saturation, namely convening three to four focus groups with 6-10 participants (Safman & Sobal, 2004).

A convenience sampling technique was used to recruit participants. Certified community health workers identified and recruited the participants. Eligibility criteria were living in a colonia, being a MexicanAmerican 8-13 years of age, being female or male, consenting to participate in the focus group, and having obtained parental consent.

Two moderators with experience working with Mexican-American youth facilitated the discussions. Focus groups were conducted in English or Spanish, depending on the language preference of participants. All children preferred English. Each focus group lasted approximately 45 minutes, after which participants received a stipend and were personally thanked for their attendance. At the end of the focus groups, children were asked to complete a questionnaire asking demographic information and questions related to PA behaviors. For focus group discussions, researchers used a theme guide that included topics related to environmental motivators and barriers to PA and elicited children's recommendations for a PA-supportive neighborhood. PA-related items in the questionnaire included questions from the physical activity questionnaire for older children (PAQ-C) and the middle school youth risk behavior survey (CDC, 2011a). The PAQ-C has been validated and tested for high reliability (Crocker, Bailey, Faulkner, Kowalski, & McGrath, 1997), including studies with Hispanic populations (Martinez-Gomez et al., 2009).

To obtain anthropometric measurements children were asked to remove their shoes. Body weight to the nearest 0.1 kg was measured with a digital balance. Body height was measured to the nearest 1 mm with a stadiometer. Body mass index (BMI) was calculated according to the CDC charts and percentile rankings (underweight: less than the 5th percentile; normal: 5th percentile to less than the 85th percentile; overweight: 85th to less than the 95th percentile; and obese: equal to or greater than the 95th percentile) (CDC, 2009). Our study was approved by the Texas A&M University institutional review board.

Focus group discussions were transcribed verbatim from audiotape. Researchers removed all subject identifiers to assure anonymity of participants. The research team reviewed and systematically coded the transcripts and identified key words and emerging themes. Researchers based the data analysis on the focus group analysis principles of Morgan and Krueger (Morgan, 1988, 1998; Morgan & Krueger, 1998). In cases of disagreement about themes during the coding process, the team discussed the issue until reaching a consensus. If no consensus emerged, the principal investigator's decision prevailed.

Results

Table 1 shows demographic characteristics and physical activity levels of children. Onehalf of the sample was female. The mean age of participants was 10.15 years (SD = 1.89). A majority of the participants were elementary school students (68.7%) and were born in the U.S. (79.1%). Forty percent of the children were obese. The majority did not meet PA recommendations (78.7%). On an average school day, most respondents reported spending one to two hours watching television (66.0%) and using the computer for activities not related to school (59.5%).

Four themes emerged from focus groups discussions: preferred PA locations, environmental facilitators, environmental barriers, and children's recommendations. Although the discussions focused on the physical characteristics of their neighborhoods in relation to their PA behaviors, participants also talked about the influence of intrapersonal and social environmental factors, including the health benefits of PA; neighborhood safety; parental involvement; time spent on TV, computers, and homework; school physical education (PE) classes; and the climate.

Preferred Locations to be Active

The majority of the children said their preferred locations to be physically active were their home (at the backyard and garage) and the park. A few participants had a preference for playing and exercising on the streets and at a community center or walking in the mall.

Physical Activity Facilitators

Participants were asked about their perceptions of the places where they exercised. Most children focused their initial comments on intrapersonal elements and the social environment highlighting that it was easy to be physically active due to the health benefits they felt. They also thought that being accompanied by family and friends made it easy to be physically active.

Participants said that PA was good because it helped them to wake up, grow, make them active, have energy, get in shape, forget about their problems, and lose weight. "What I like most, my favorite sport is softball because I get energy there and it feels something like I always want to play that for my whole life it feels...it is something special for me," one boy mentioned. A female participant stated, "I like. . .from outdoors...I like walking because I feel like...like my problems are out and everything." A few children said that when the activity was fun it made it easy to be active.

A majority of the children discussed that having a new park in the vicinity helped them to be more active. The consensus was that the park was nice and safe. Children liked that the park had football fields and basketball courts, a walking trail, areas covered with grass, monkey bars, slides, swings, and it was available for people of all ages. A few mentioned that having police patrolling the park and their neighborhoods facilitated their ability to exercise.

Physical Activity Barriers

When asked about what neighborhood characteristics kept children from being physically active, the majority of participants mentioned elements of both the social and physical environment, but highlighted that gangs and gunshots were the main obstacle. "Every night I hear gunshots," one girl said. A male participant added, "some people in the neighborhood have drugs and guns. That is why parents don't let their children go out and play."

Among the physical characteristics of the neighborhoods that affected the children's ability to be active, most participants mentioned that the trash on sidewalks, streets, and the park was a problem. Additional physical environmental barriers brought up in group discussions were speeding cars, bad weather, unleashed dogs, and no lights on the streets. One male participant complained, "I always have to clean the trash on the sidewalk." Children also said they were not active when it was too hot or cold or raining. "When it rains, it gets very muddy," one female child mentioned.

Participants also commented about additional social environmental barriers besides the presence of gangs and gunshots. The majority believed that children were not physically active because of spending time on television, computer, video games, or texting on their cell phones. One female child explained, "kids are too busy playing computers or video games or doing homework." Then a male participant added, "or texting in the phone," while another male stated, "maybe they are watching their favorite show and they can't go outside." Other participants considered that many children are not active because they are lazy, tired, or sleepy.

A majority of participants also said that homework requirements or being grounded by their parents kept them from being physically active. Also mentioned by a few participants was that some children preferred eating junk food instead of going outside to play or exercise. A few participants considered being obese to be a barrier to physical activity, but a few others said that kids who are skinny believed they don't need to exercise at all.Children's Recommendations

Children voiced that they would be more active if football fields and basketball courts were built in the neighborhood, if parents got more involved in exercise activities with them, and if they spent less time with television, video games, and computers. "[Our parents] can help us by playing with us or just like if they see us running, run with us or walk," one female child commented. "We can invite them [our parents] and play and run with them so they get active like us," a male participant added.

Participants also recommended getting less homework and having PE classes that were more fun. Children explained that fun exercises in PE would include going outside to play and do activities they enjoyed such as football, jumping on the trampoline, and playing hide-and-seek. Some children said they did not enjoy exercise at school because many times other kids made fun of them or bullied them during PE. A few participants said that PE activities were too hard to do, particularly when running and doing pushups, stretches, and scissors.

Discussion

Our study investigated perceptions of Mexican-American children living in socially and economically disadvantaged neighborhoods in the Texas-Mexico border region, known as colonias, about their neighborhood's influence on their PA behaviors. Our findings show that participants enjoyed being active around their home and at the park. They identified PA motivators and barriers within and beyond the neighborhood infrastructure, highlighting intrapersonal and social environmental factors influencing their active living.

Study results indicate that the majority of the colonia children in our study were sedentary and overweight or obese. They believed physical characteristics of their neighborhood hindered their ability to be active, including the trash on sidewalks, speeding cars, unleashed dogs, weather, and dark streets. Internationally emerging research suggests that neighborhood characteristics (e.g., sidewalks, street connectivity, green areas, mixeduse land) influence physical activity behaviors, but most studies have been conducted with adult and nonminority children samples (Berke, Koepsell, Moudon, Hoskins, & Larson, 2007; Gauvin et al., 2008; Lee & Moudon, 2004; Li et al., 2008; Lopez & Hynes, 2006; McMillan, 2005; Michael et al., 2006; Owen, Humpel, Leslie, Bauman, & Sallis, 2004; Saelens & Handy, 2008; Sallis & Glanz, 2006; Wendel-Vos, Droomers, Kremers, Brug, & van Lenthe, 2007). Furthermore, studies with young populations show conflicting results on the association between some features of the physical environment (e.g., litter, abandoned cars, traffic) and exercise among children (Molnar, Gortmaker, Bull, & Buka, 2004). For instance, a few studies show that neighborhood litter and graffiti are positively associated with PA in children (Hume, Salmon, & Ball, 2007; Romero et al., 2001). Another study, however, found no significant relationship (Franzini et al., 2009). Further, mixed land uses with destinations (nonresidential uses) nearby are often promoted as key features of walkable and activity-friendly environments (Gauvin et al., 2008; Michael et al., 2006; Saelens et al., 2003), but nonresidential land uses were shown to be deterrents for children's walking to school behaviors (Saelens & Handy, 2008). Stronger evidence exists, however, that children who have access to parks and recreational facilities are more active than those without access (Babey et al., 2008; Cohen et al., 2006; Pate et al., 2008; Tucker et al., 2009).

Participants in our study voiced that having a park close to their home helped them be active and recommended building football fields and basketball courts in their neighborhoods. This finding suggests that instead of investing in large, expensive parks in border colonias, one alternative could be building smaller playgrounds and sports fields in the heart of these neighborhoods. Additional research especially longitudinal studies with pre-post assessments and in more diverse types of underserved communities is warranted to further investigate the impact of the physical environment on active living among underserved young groups.

Colonia children in our study underlined the influence of intrapersonal and social environmental factors on their PA levels. Intrapersonal factors included the perception that PA is beneficial to their health. Also, having parents and friends involved in the children's exercise activities made it easier for them to be active. Global literature reports that children from various U.S. and British settings are aware of the link between health and PA (Brockman, Fox, & Jago, 2011; Brockman, Jago, & Fox, 2011; Lee, Lai, Chou, Chang, & Chang, 2009; Pham, Harrison, & Kagawa-Singer, 2007). Additionally, studies using objective PA measures (e.g., accelerometers) show that involvement of parents and friends is significantly associated with PA behaviors among children (Jago, Davison et al., 2011; Jago, Macdonald-Wallis et al., 2011). Health promotion programs and strategies aiming to increase the PA levels of border colonia children should consider including familybased activities.

Besides the neighborhood characteristics, other social environmental factors were present that children in our study considered barriers to exercise, including neighborhood safety and time spent on television, computers, and video games. Our descriptive data showed that a majority of the participants reported spending one to two hours using media on school days. Evidence from previous studies shows a negative association between media-related sedentary behaviors and PA behaviors in children (Koezuka et al., 2006; McKenzie et al., 2008; Singh, Kogan, Siahpush, & Van Dyck, 2008; Spinks, Macpherson, Bain, & McClure, 2006). Studies on the association between perceived neighborhood safety or crime rates and children's PA levels present conflicting findings (Franzini et al., 2009; Hume et al., 2007; Liu, Colbert, Wilson, Yamada, & Hoch, 2007).

Children in our study offered insights on an additional social environmental element. To improve children's PA behaviors, study participants recommended PE classes that are fun and include outdoor activities. Our analyses indicate that "fun PE" meant having classes that offered activities that children enjoyed (e.g., trampoline jumping, playing hide-andseek) and not too hard to perform (e.g., pushups). Many study participants also said that bullying in PE should be eliminated. Previous research found that leisure-PA in school settings correlated positively with PA in children (McKenzie, Crespo, Baquero, & Elder, 2010). Additionally, previous studies indicate that bullying in PE classes is prevalent and negatively impacts children's participation (Parrish, Yeatman, Iverson, & Russell, 2011; Wang, Lannotti, & Luk, 2010).

Our study has some limitations. Due to the convenience sampling technique used to recruit the children and neighborhoods, study results cannot be generalized and are limited to the targeted population and its environment. Although the research team made their best effort to present rich descriptions of participants' perspectives about the environmental factors influencing their PA behaviors, it is worth noting that the children's comments were mostly descriptive, but not extensively elaborated. Participants' voices, however, may resonate with other researchers' or professionals' situations to a degree in which they could apply our findings (Locke, 1989).

Conclusion and Recommendations

To the best of our knowledge this is the first study that explores perceptions of PA-related environmental factors among Mexican-American children living in one of the most social and economically disadvantaged areas of the U.S. The way in which low-income minority children experience their physical environment in relation to their PA behaviors is not well understood. Given limited existing studies about environmental-PA relationships focusing on minority children, our study provides valuable insights that can help guide interventions to account for the complex interacting environmental, social, and individual influences on PA among this unique population. Our study brings novel insights regarding young minority children's perceptions about PA as influenced not only by the neighborhood infrastructure but also by other intrapersonal and social environmental factors. These results suggest the importance of considering an ecological approach (Sallis et al., 2006) when planning interventions and policies seeking to improve PA behaviors among disadvantaged populations.

Hispanic children in the U.S. are disproportionately affected by the obesity epidemic compared to other ethnic groups (Ogden, Flegal, Carroll, & Johnson, 2002). Thus, qualitative research such as our exploratory study may inform childhood obesity prevention program development and urban planning. The real-life perceptions of the children in our study revealed aspects of their neighborhoods and social context that should be taken into account in promoting a healthier environment that is more PA-supportive, culturally relevant, and effective for them. Further research using GIS techniques and a quantitative approach is warranted to test research hypotheses examining the impact changes in the physical and social environment may have on lifestyle behaviors at the U.S. border and among minority children and their families.

Findings from our study can guide environmental health professionals and policy makers to lead a policy development process that improves the built environment in border colonias and makes it more supportive of children's active living. Although environmental experts traditionally work to improve environmental conditions related to pollution, hazards, and outbreaks (National Environmental Education Foundation, 2009), Ponder and Dannenberg (2008) underline the key role of these experts in improving the built environment through participating in interdisciplinary teams with urban planners and others and promoting healthy community design choices.

Environmental policy recommendations can potentially emerge from an interdisciplinary approach with strong support from and collaboration with environmental health practitioners. Needed policy recommendations aimed to promote PA among minority children in low-income communities should address issues including neighborhood safety; PA-supportive infrastructure; regulations restricting unleashed dogs; strict traffic regulations; and urban development considering green areas, street connectivity, zoning, and mixed-land use.

Acknowledgement: Our study was funded by the Robert Wood Johnson Foundation (RWJF) through its national program, Salud America! The RWJF Research Network to Prevent Obesity Among Latino Children (www. salud-america.org). Salud America!, led by the Institute for Health Promotion Research at The University of Texas Health Science Center at San Antonio, Texas, unites Latino researchers and advocates seeking environmental and policy solutions to the epidemic.

References

Babey, S.H., Hastert, T.A., Yu, H., & Brown, E.R. (2008). Physical activity among adolescents. When do parks matter? American Journal of Preventive Medicine, 34(4), 345-348.

Barbeau, P. (2007). Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls. Obesity, 15(8), 2077-2085.

Berke, E.M., Koepsell, T.D., Moudon, A.V., Hoskins, R.E., & Larson, E.B. (2007). Association of the built environment with physical activity and obesity in older persons. American Journal of Public Health, 97(3), 486-492.

Bishaw, A., & Semega,J. (2008). Income, earnings, and poverty. Data from the 2007 American Community Survey. Retrieved from http:// www.census.gov/prod/2008pubs/acs-09 .pdf

Boone, H.J. (2011). Neighborhood socioeconomic status predictors of physical activity through young to middle adulthood: The CARDIA study. Social Science & Medicine, 72(5), 641-649.

Brockman, R., Fox, K.R., & Jago, R. (2011). What is the meaning and nature of active play for today's children in the UK? International Journal of Behavioral Nutrition and Physical Activity, 8(15), 1-7.

Brockman, R., Jago, R., & Fox, K. (2011). Children's active play: Self-reported motivators, barriers and facilitators. BMC Public Health, 11(1), 461.

Butte, N.E, Christiansen, E., & Sorensen, T.I. (2007). Energy imbalance underlying the development of childhood obesity. Obesity, 15(12), 3056-3066.

Centers for Disease Control and Prevention. (2009). Healthy weight-it's not a diet, it's a lifestyle! About BMI for children and teens. Retrieved from http://www.cdc.gov/healthyweight/assessing/ bmi/childrens_bmi/about_childrens_bmi.html

Centers for Disease Control and Prevention. (2011a). 2011 Middle school youth risk behavior survey. Retrieved from http://www.cdc. gov/healthyyouth/yrbs/pdf/questionnaire/2009MiddleSchool.pdf

Centers for Disease Control and Prevention. (2011b). Physical activity levels of high school students-United States, 2010. Morbidity and Mortality Weekly Report, 60(23), 773-804.

Cohen, D.A., Ashwood, J.S., Scott, M.M., Overton, A., Evenson, K.R., Staten, L.K., Porter, D., McKenzie, T.L., & Catellier, D. (2006). Public parks and physical activity among adolescent girls. Pediatrics, 118(5), 1381-1389.

Crocker, P.R.,Bailey, D.A., Faulkner, R.A., Kowalski, K.C., &McGrath, R. (1997). Measuring general levels of physical activity: Preliminary evidence for the physical activity questionnaire for older children. Medicine & Science in Sports & Exercise, 29(10), 1344-1349.

Dalton, M.A., Longacre, M.R., Drake, K.M., Gibson, L., AdachiMejia, A.M., Swain, K., Xie, H., & Owens, P.M. (2011). Built environment predictors of active travel to school among rural adolescents. American Journal of Preventive Medicine, 40(3), 312-319.

de Vet, E., de Ridder, D.T.D., & de Wit, J.B.E (2011). Environmental correlates of physical activity and dietary behaviours among young people: A systematic review of reviews. Obesity Reviews, 12(5), el30-el42.

Dietz, W.H. (1997). Periods of risk in childhood for the development of adult obesity. What do we need to learn? Journal of Nutrition, 118,1884S-1886S.

Federal Reserve Bank of Dallas. (1995). Texas colonias. A thumbnail sketch of the conditions, issues, challenges, and opportunities. Retrieved from http://econpapers.repec.org/bookchap/ fipfeddmo/1995tatsotca.htm

Franzini, L., Elliott, M.N., Cuccaro, P., Schuster, M., Gilliland, M.J., Grunbaum, J.A., Franklin, E, & Tortolero, S.R. (2009). Influences of physical and social neighborhood environments on children's physical activity and obesity. American Journal of Public Health, 99(2), 271-278.

Fraser, S.D., & Lock, K. (2011). Cycling for transport and public health: A systematic review of the effect of the environment on cycling. European Journal of Public Health, 21(6), 738-743.

Gauvin, L., Riva, M., Barnett, T., Richard, L., Craig, C.L., Spivock, M., Laforest, S., Laberge, S., Fournel, M.C., Gagnon, H., & Gagné, S. (2008). Association between neighborhood active living potential and walking. American Journal of Epidemiology, 167(8), 944-953.

Gopinath, B. (2011). Influence of physical activity and screen time on the retinal microvasculature in young children. Arteriosclerosis, Thrombosis, and Vascular Biology, 31(5), 1233-1239.

Gordon-Larsen, P., Nelson, M.C., Page, P., & Popkin, B.M. (2006). Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics, 117(2), 417-424.

Hanibuchi, T., Kawachi, I., Nakaya, T., Hirai, H., & Kondo, K. (2011). Neighborhood built environment and physical activity of Japanese older adults: Results from the Aichi Gerontological Evaluation Study (AGES). BMC Public Health, 11, 657.

Hannon, L., Sawyer, P., & Allman, R.M. (2012). The influence of community and the built environment on physical activity. Journal of Aging and Health, 24(3), 384-406.

Hills, A.P., King, N.A., & Armstrong, T.P. (2007). The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents: Implications for overweight and obesity. Sports Medicine, 37(6), 533-546.

Hume, C., Salmon, J., & Ball, K. (2007). Associations of children's perceived neighborhood environments with walking and physical activity. American Journal of Health Promotion, 21 (3), 201-207.

Humpel, N., Owen, N., & Leslie, E. (2002). Environmental factors associated with adults' participation in physical activity: A review. American Journal of Preventive Medicine, 22(3), 188-199.

Jago, R., Davison, K.K., Brockman, R., Page, A.S., Thompson, J.L., & Fox, K.R. (2011). Parenting styles, parenting practices, and physical activity in 10- to 11-year olds. Preventive Medicine, 52(1), 44-47.

Jago, R., Macdonald-Wallis, K., Thompson, J.L., Page, A.S., Brockman, R., & Fox, K.R. (2011). Better with a buddy: Influence of best friends on children's physical activity. Medicine and Science in Sports and Exercise, 43(2), 259-265.

Janz, K.E, Levy, S.M., Burns, T.L., Torner, J.C., Willing, M.C., & Warren, J.J. (2002). Fatness, physical activity, and television viewing in children during the adiposity rebound period: The Iowa bone development study. Preventive Medicine, 35(6), 563-571.

Juonala, M. (2010). Life-time risk factors and progression of carotid atherosclerosis in young adults: The cardiovascular risk in young Finns study. European Heart Journal, 31(14), 1745-1751.

Keegan, T.H., Hurley, S., Goldberg, D., Nelson, D.O., Reynolds, P., Bernstein, L., Horn-Ross, P.L., & Gomez, S.L. (2012). The association between neighborhood characteristics and body size and physical activity in the California teachers study cohort. American Journal of Public Health, 102(4), 689-697.

King, D. (2008). Neighborhood and individual factors in activity in older adults: Results from the neighborhood and senior health study. Journal of Aging and Physical Activity, 16(2), 144-170.

Koezuka, N., Koo, M., Allison, K.R., Adlaf, E.M., Dwyer, J.J., Faulkner, G., & Goodman, J. (2006). The relationship between sedentary activities and physical inactivity among adolescents: Results from the Canadian community health survey. Journal of Adolescent Health, 39(4), 515-522.

Lee, C., & Moudon, A.V. (2004). Physical activity and environment research in the health field: Implications for urban and transportation planning practice and research. Journal of Planning Literature, 19(2), 147-181.

Lee, P.H., Lai, H.R., Chou, Y.H., Chang, L.I., & Chang, W.Y. (2009). Perceptions of exercise in obese school-aged children. The Journal of Nursing Research, 17(3), 170-178.

Li, E, Harmer, P.A., Cardinal, B.J., Bosworth, M., Acock, A.JohnsonShelton, D., & Moore, J.M. (2008). Built environment, adiposity, and physical activity in adults aged 50-75. American Journal of Preventive Medicine, 35(1), 38-46.

Liu, G.C., Colbert, J.T., Wilson, J.S., Yamada, I., & Hoch, S.C. (2007). Examining urban environment correlates of childhood physical activity and walkability perception with GIS and remote sensing. In R.R. Jensen, J.D. Gatrell, & D. McLean (Eds.), Geo- spatial technologies in urban environments: Policy, practice, and pixels (2nd ed., pp. 121-140). Berlin: Springer-Verlag.

Locke, L.F. (1989). Qualitative research as a form of scientific inquiry in sport and physical education. Research Quarterly for Exercise and Sport, 60(1), 1-20.

Lopez, R.P., & Hynes, H.P. (2006). Obesity, physical activity, and the urban environment: Public health research needs. Environmental Health, 5, 25.

Martinez-Gomez, D., Martinez-de-Haro, V., Pozo, T., Welk, G.J., Villagra, A., Calle, M.E., Marcos, A., & Veiga, O.L. (2009). Reliability and validity of the PAQ-A questionnaire to assess physical activity in Spanish adolescents. Revista Española de Salud Publica, 83(3), 427-439.

Matvienko, O., & Ahrabi-Fard, I. (2010). The effects of a 4-week after-school program on motor skills and fitness of kindergarten and first-grade students. American Journal of Health Promotion, 24(5), 299-303.

McCallum, R.E. (2004). Child immunization education initiative. Hidalgo County Abridged report. College Station, TX: Texas A&M Health Science Center College of Medicine.

McCormack, G.R., & Shiell, A. (2011). In search of causality: A systematic review of the relationship between the built environment and physical activity among adults. International Journal of Behavioral Nutrition and Physical Activity, 8,125.

McKenzie, T.L., Baquero, B., Crespo, N.C., Arredondo, E.M., Campbell, N.R., & Elder, J.P. (2008). Environmental correlates of physical activity in Mexican American children at home. Journal of Physical Activity and Health, 5(4), 579-591.

McKenzie, T.I., Crespo, N.C., Baquero, B., & Elder, J.P. (2010). Leisure-time physical activity in elementary schools: Analysis of contextual conditions. The Journal of School Health, 80(10), 470-477.

McMillan, T.E. (2005). Urban form and a child's trip to school: The current literature and a framework for future research. Journal of Planning Literature, 19(4), 440-456.

Michael, Y., Beard, T., Choi, D., Farquhar, S., & Carlson, N. (2006). Measuring the influence of built neighborhood environments on walking in older adults. Journal of Aging and Physical Activity, 14(3), 302-312.

Mier, N., Flores, I., Robinson, J.R.C., & Millard, A.V. (2004). Cultural, demographic, educational, and economic characteristics. In R.S. Day (Ed.), Nourishing the future. The case for community-based nutrition research in the Lower Rio Grande Valley (pp. 15-24). Houston, TX: The University of Texas School of Public Health at Houston.

Mier, N., Ory, M.G., Zhan, D., Conkling, M., Sharkey, J.R., & Burdine, J.N. (2008). Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border. Social Science & Medicine, 66(8), 1760-1771.

Molnar, B.E., Gortmaker, S.L., Bull, EC., & Buka, S.L. (2004). Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. The Science of Health Promotion, 18(5), 378-386.

Morgan, D.L. (1988). Focus groups as qualitative research. Newbury Park, CA: Sage Publications.

Morgan, D.L. (1998). The focus group guidebook (Vol. 1). Thousand Oaks, CA: Sage Publications.

Morgan, D.L., & Krueger, R.A. (1998). The focus group kit. Thousand Oaks, CA: Sage Publications.

National Environmental Education Foundation. (2009). Position statement: Health professionals and environmental health education. Retrieved from http://www.neefusa.org/pdf/PositionStatement.pdf

Ogden, C.L., Flegal, K.M., Carroll, M.D., & Johnson, C.L. (2002). Prevalence and trends in overweight among U.S. children and adolescents, 1999-2000.Journal of the American Medical Association, 288(14), 1728-1732.

Ory, M.G., Conkling, M., Bolin, J.N., Prochaska, J.D., Zhan, D., Burdine, J.N., & Mier, N. (2009). Sociodemographic and healthcare characteristics of colonia residents: The role of life stage in predicting health risks and diabetes status in a disadvantaged Hispanic population. Ethnicity & Disease, 19(3), 280-287.

Owen, N., Humpel, N., Leslie, E., Bauman, A., & Sallis, J.E (2004). Understanding environmental influences on walking; Review and research agenda. American Journal of Preventive Medicine, 27(1), 67-76.

Parrish, A.M., Yeatman, H., Iverson, D., & Russell, K. (2011). Using interviews and peer pairs to better understand how school environments affect young children's playground physical activity levels: A qualitative study. Health Education Research, 27(2), 269-280.

Pate, R.R., Colabianchi, N., Porter, D., Almeida, M.J., Lobelo, E, & Dowda, M. (2008). Physical activity and neighborhood resources in high school girls. American Journal of Preventive Medicine, 34(5), 413-419.

Pate, R.R., Davis, M.G., Robinson, T.N., Stone, E.J., McKenzie, T.L., & Young, J.C. (2006). Promoting physical activity in children and youth. Circulation, 114(11), 1214-1224.

Pham, K.L., Harrison, G.G., & Kagawa-Singer, M. (2007). Perceptions of diet and physical activity among California Hmong adults and youths. Preventing Chronic Disease, 4(4), A93.

Ponder, P., & Dannenberg, A.L. (2008). Role of environmental health professionals in improving the built environment. Journal of Environmental Health, 71(1), 22-23.

Powell, L.M., Chaloupka, E, Slater, S., & Harper, D. (2006). Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: A national study. Amercan Journal of Public Health, 96(9), 1676-1680.

Powell, L.M., Chaloupka, E, Slater, S., Johnston, L.D., & O'Malley, P.M. (2007). The availability of local-area commercial physical activity-related facilities and physical activity among adolescents. American Journal of Preventive Medicine, 33(4 Suppl.), S292-S300.

Powell, L.M., Slater, S., & Chaloupka, H (2004). The relationship between community physical activity settings and race, ethnicity, and socioeconomic status. Evidence-Based Preventative Medicine, 1(2), 135-144.

Rodríguez, D.A., Cho, G.H., Evenson, K.R., Conway, T.L., Cohen, D., Ghosh-Dastidar, B., Pickrel, J.L., Veblen-Mortenson, S., & Lytle, L.A. (2012). Out and about: Association of the built environment with physical activity behaviors of adolescent females. Health Place, 18(1), 55-62.

Romero, A.J., Robinson, T.N., Kraemer, H.C., Erickson, S.J., Haydel, K.E, Mendoza, E, & Killen, J.D. (2001). Are perceived neighborhood hazards a barrier to physical activity in children? Archives of Pediatric & Adolescent Medicine, 155(10), 1143-1148.

Saelens, B.E., & Handy, S.L. (2008). Built environment correlates of walking: A review. Medicine Science in Sports and Exercise, 40(Suppl. 7), S550-S566.

Saelens, B., Sallis, J., & Frank, L. (2003). Environmental correlates of walking and cycling: Findings from the transportation, urban design, and planning literatures. Annals of Behavioral Medicine, 25(2), 80-91.

Safman, R.M., & Sobal, J. (2004). Qualitative sample extensiveness in health education research. Health Education and Behavior, 31(1), 9-21.

Sallis, J.E, Cervero, R.B., Ascher, W., Henderson, K.A., Kraft, M.K., & Kerr, J. (2006). An ecological approach to creating active living communities. Annual Review of Public Health, 27, 297-322.

Sallis, J.E, & Glanz, K. (2006). The role of built environments in physical activity, eating, and obesity in childhood. Future Child, 16(1), 89-108.

Shapleigh, E. (2008). Texas borderlands 2009. Ground zero of health care in America. Retreived from http://shapleigh.org/system/reporting_document/file/207/Borderlands_Health_Chapter_02.29.pdf

Singh, G.K., Kogan, M.D., Siahpush, M., & Van Dyck, P.C. (2008). Independent and joint effects of socioeconomic, behavioral, and neighborhood characteristics on physical inactivity and activity levels among U.S. children and adolescents. Journal of Community Health, 33(4), 206-216.

Spinks, A., Macpherson, A., Bain, C., & McClure, R. (2006). Determinants of sufficient daily activity in Australian primary school children. Journal of Paediatrics and Child Health, 42(11), 674-679.

Tanha, T. (2011). Lack of physical activity in young children is related to higher composite risk factor score for cardiovascular disease. Acta Paediatrica, 100(5), 717-721.

TexasSecretary of State. (2011a). Colonias FAQs. Retrieved from http://www.sos.state.tx.us/border/colonias/faqs.shtml

TexasSecretary of State. (2011b). Colonias in Hidalgo County. Retrieved from http://www.co.hidalgo.tx.us/DocumentView.aspx? DID=3559

Trost, S.G., Sirard, J.R., Dowda, M., Pfeiffer, K.A., & Pate, R.R. (2003). Physical activity in overweight and nonoverweight preschool children. International Journal of Obesity, 27(7), 834-839.

Tucker, P., Irwin, J.D., Gilliland, J., He, M., Larsen, K., & Hess, P. (2009). Environmental influences on physical activity levels in youth. Health Place, 15(1), 357-363.

U.S. Department of Health and Human Services. (2005). Overweight and physical activity among children: A portrait of states and the nation 2005. Retreived from http://mchb.hrsa.gov/overweight/

Veitch, J., Salmon, J., & Ball, K. (2010). Individual, social and physical environmental correlates of children's active free-play: A crosssectional study. International Journal of Behavioral Nutrition and Physical Activity 7,11.

Voorhees, C.C., Yan, A.E, Clifton, K.J., & Wang, M.Q. (2011). Neighborhood environment, self-efficacy, and physical activity in urban adolescents. American Journal of Health Behaviors, 35(6), 674-688.

Voss, L.D., Hosking, J., Metealf, B.S.Jeffery, A.N., & Wilkin, T.J. (2008). Children from low-income families have less access to sports facilities, but are no less physically active: Cross-sectional study (EarlyBird 35). Child: Care, Health & Development, 34(4), 470-474.

Wang, J., Lannotti, R.J., & Luk, J.W. (2010). Bullying victimization among underweight and overweight U.S. youth: Differential associations for boys and girls. Journal of Adolescent Health, 47(1), 99-101.

Ward, P.M. (1999). Colonias and public policy in Texas and Mexico: Urbanization by stealth. Austin, TX: University of Texas Press.

Wendel-Vos, W., Droomers, M., Kremers, S., Brug, J., & van Lenthe, E (2007). Potential environmental determinants of physical activity in adults: A systematic review. Obesity Reviews, 8(5), 425-440.

Whitt-Glover, M., Taylor, W., Floyd, M., Yore, M., Yancey, A., & Matthews, C. (2009). Disparities in physical activity and sedentary behaviors among U.S. children and adolescents: Prevalence, correlates, and intervention implications. Journal of Public Health Policy, 30(1), S309-S334.

Neida Mier, PhD

School of Rural Public Health

Texas A&M Health Science Center

Chanam Lee, PhD

College of Architecture

Texas A&M University

Matthew Lee Smith, MPH, PhD, CHES

College of Public Health

University of Georgia

Xiaohui Wang, PhD

Department of Mathematics

The University of Texas Pan American

David Irizarry

School of Rural Public Health

Texas A&M Health Science Center

Elias H. Avila-Rodriguez, PhD

Facultad de Medicina y Nutrición

Universidad Juárez del Estado de Durango

Laura Trevino, ME

College of Architecture

Texas A&M University

Marcia G. Ory, PhD

School of Rural Public Health

Texas A&M Health Science Center

Corresponding Author: Neida Mier, Associate Professor, School of Rural Public Health, Texas A&M Health Science Center, McAllen Campus, 2101 S. McColl Rd., McAllen, TX 78503. E-mail: nmiei<Stamhsc.edu.

Copyright:	(c) 2013 National Environmental Health Association
Wordcount:	6423