While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. TRIAL REGISTRATION: clinicaltrial.gov Identifier = NCT03041415.

The built environment has been linked to physical activity (PA) behaviors, yet there is limited knowledge of this association among lower-income midlife and older adults who are insufficiently active. The present cross-sectional study utilized baseline data collected between October 2017 and November 2019 from a clustered randomized controlled trial to determine how built environment attributes were associated with PA behaviors among midlife and older adults (n = 255) residing in or near affordable housing sites (n = 10). At each site, perceptions of the built environment were collected and scored at the participant level via the abbreviated Neighborhood Environment Walkability Survey (NEWS-A), while objective built environment attributes were measured and scored by trained research staff using the Physical Activity Resource Assessment (PARA). Multiple PA behaviors—walking, total PA, and moderate-to-vigorous PA (MVPA) (min/wk)—were measured using the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Adjusted linear regression models examined associations between NEWS-A measures and PA behaviors, and site-level correlations between PARA measures and PA behaviors were examined using Spearman’s rank correlations. At the participant level, adjusted models revealed that a one point increase in the NEWS-A aesthetics score was associated with a 57.37 min/wk increase in walking (β = 57.37 [95% CI: 20.84, 93.91], p = 0.002), with a similar association observed for street connectivity and MVPA (β = 24.31 min/wk [95% CI: 3.22, 45.41], p = 0.02). At the site level, MVPA was positively correlated with the quality of the features of local, PA-supportive environmental resources (ρ = 0.82, p = 0.004). Findings indicate that participant- and site-level measures of the built environment may play a role in promoting PA behavior among this demographic and similar populations. Results also suggest that improvements in aesthetic attributes and street connectivity, along with enhancing the quality of local, PA-supportive environmental resources, may be effective strategies for promoting physical activity among lower-income midlife and older adults.

This investigation explored (1) correlations between midlife and older adults’ air quality perceptions with objective particulate matter 2.5 (PM_2.5) and diesel PM, and (2) correlations between air quality perceptions with health-related attributions among a sample of midlife and older adults (n = 66) living in or around senior affordable public housing sites in California’s San Francisco Bay Area. The adapted air quality perception scale was used to measure perceptions of air quality, while health-related attributions were obtained from the vitality plus scale (VPS), with higher values indicating worse perceptions of air quality and poorer responses to health-related attributions, respectively. Self-reported data were linked to zip code level PM_2.5 and diesel PM obtained from the CalEnviroScreen 4.0. All correlations were evaluated using Spearman’s rank correlations. The mean (SD) age was 70.6 (9.1) years, and 75.7% were female. We observed moderate, positive correlations between both PM_2.5 and diesel PM with three domains: perceptions related to protection measures against air quality, emotional/mental perceptions, and sensorial perceptions. We also found evidence of moderate, positive correlations between the domains of physical symptoms, perceptions related to protection measures against air quality, and emotional/mental perceptions with health-related attributions, such as sleep-related items and feelings of restlessness or agitation. Results from this exploratory study suggest that midlife and older adults’ perceptions of air quality may be moderately related to both objective air quality data and certain health behaviors and symptoms. Findings underscore the importance of considering individual perceptions as an additional area in public health strategies aimed at protecting midlife and older adults from the impacts of air pollution.

Large language models (LLMs) offer novel opportunities to support health behavior change, yet existing work has narrowly focused on text-only interactions. Building on decades of HCI research on effective behavior change interactions, we present Bloom, an application for physical activity promotion that integrates an LLM-based health coaching chatbot with existing design strategies and UI elements. As part of Bloom’s development, we conducted a redteaming evaluation and contribute a safety benchmark dataset. In a four-week randomized field study (N=54) comparing Bloom to a no-LLM control, we observed important shifts in psychological outcomes: participants in the LLM condition reported stronger beliefs that activity was beneficial, greater enjoyment, and more self-compassion. Both conditions significantly increased physical activity levels, doubling the proportion of participants meeting recommended weekly guidelines, though descriptively, we observed no advantage for the LLM condition in short-term physical activity levels. Instead, our findings suggest that LLMs may be more effective at shifting mindsets that precede longer-term behavior change.