Bayesian latent structure modeling of walking behavior in a physical activity intervention

The analysis of walking behavior in a physical activity intervention is considered. A Bayesian latent structure modeling approach is proposed whereby the ability and willingness of participants is modeled via latent effects. The dropout process is jointly modeled via a linked survival model. Computational issues are addressed via posterior sampling and a simulated evaluation of the longitudinal model's ability to recover latent structure and predictor effects is considered. We evaluate the effect of a variety of socio-psychological and spatial neighborhood predictors on the propensity to walk and the estimation of latent ability and willingness in the full study.

Promoting physical activity within under-resourced afterschool programs: A qualitative investigation of staff experiences and motivational strategies for engaging youth

Afterschool programs (ASPs) have become increasingly recognized as a key context to support youth daily physical activity (PA) accrual. Using Self-Determination Theory (SDT) as a framework, this study examined staff perspectives on the strengths and barriers within under-resourced ASPs for establishing a social-motivational climate for encouraging and supporting youth PA. Analysis of semi-structured staff interviews (28 staff; 7 ASPs) indicated that staff had knowledge and value for establishing a PA-supportive motivational climate. However, the feasibility of implementing PA curricula was identified as challenging across programs. Findings suggest increased need for staff training and supports to provide a PA climate that meets the developmental needs/interests of all youth, with particular attention toward increasing the PA of girls and older program youth. Furthermore, striking an appropriate balance between PA and other competing program demands (e.g., academics) will be required to optimize on the effectiveness of PA program components.

Associations between Culturally Relevant Recruitment Strategies and Participant Interest, Enrollment and Generalizability in a Weight-loss Intervention for African American Families

OBJECTIVE

Culturally relevant recruitment strategies may be an important approach for recruiting ethnic minorities for interventions. Previous research has examined associations between recruitment strategies and enrollment of African Americans (AA), but has not explored more deeply the role of incorporating sociocultural values into recruitment strategies. Our current study explores whether sociocultural recruitment mediums were associated with demographics, interest and enrollment in a weight-loss intervention.

METHOD

Sociocultural mediums included community partnerships, culturally relevant ads, sociocultural events, or word-of-mouth. Non-sociocultural mediums included community/school events that did not specifically target AAs. Analyses examined whether demographics of enrolled families differed by recruitment strategy and if recruitment strategy predicted scheduling a baseline visit, enrolling in a run-in phase, and enrolling in the intervention program.

RESULTS

Families recruited from culturally relevant ads, sociocultural events, or word-of-mouth were 1.96 times more likely to schedule a baseline visit (OR=1.96, 95% CI=1.05, 3.68) than families recruited from non-sociocultural mediums. No differences were found for sociocultural mediums on enrolling in the run-in phase or the intervention. However, among enrolled families, those recruited from sociocultural mediums were less likely to be employed (X(2) [1, N=142] =5.53, P<.05) and more likely to have lower income (X(2) [1, N=142] =13.57, P<.05).

CONCLUSION

Sociocultural mediums were associated with scheduling a baseline visit, but not enrollment. They were, however, effective in recruiting a more generalizable sample among enrolled participants based on demographic characteristics. Integrating sociocultural values into recruitment methods may be a valuable strategy for increasing interest in participation among underrepresented AA families.

Reliability of 24-Hour Dietary Recalls as a Measure of Diet in African-American Youth

BACKGROUND

Although it is a common practice to estimate dietary intake using three random 24-hour dietary recalls, some studies have suggested up to nine may be necessary to reliably estimate usual intake in youth. Given the resulting increase in resources and participant burden, more research is needed to determine whether this method is reliable, particularly in African-American youth at increased risk for obesity and other chronic diseases.

OBJECTIVE

This study estimated the reliability with which 24-hour dietary recalls measure energy, fat, fruit, and vegetable intake in African-American youth and examined how reliability changes as a function of the number of recalls.

DESIGN

This study used cross-sectional data collection across three studies.

PARTICIPANTS/SETTING

Participants were African-American youth (n=456, mean±standard deviation age 13.28±1.86 years, 64% were girls, mean±standard deviation body mass index [calculated as kg/m(2)] 31.45±7.94) who completed random 24-hour dietary recalls (67% completed three) conducted by research assistants using the Automated Self-Administered 24-Hour recall system (n=258) or registered dietitian nutritionists using the Nutrition Data System for Research (n=198).

MAIN OUTCOME MEASURES/STATISTICAL ANALYSES

Estimates provided by multilevel models were used to calculate the proportion of variance accounted for between individuals and the reliability of means within individuals as a function of the number of recalls.

RESULTS

Reliability estimates for assessing dietary outcomes using one to three recalls ranged from 11% to 62%. To achieve 80% reliability, the following number of recalls would need to be conducted: 8 for energy intake, 13 for fat intake, 21 to 32 for fruit intake, and 21 to 25 for vegetable intake.

CONCLUSIONS

The common practice of assessing dietary intake with three recalls does so with low reliability in African-American youth. Until more objective methods for reliably estimating usual intake are developed, researchers who choose to use 24-hour dietary recalls are encouraged to include estimates of the measure's reliability in a priori power calculations for improved decision making regarding the number of observations and/or sample size.

Qualitative Perspectives from African American Youth and Caregivers for Developing the Families Improving Together (FIT) for Weight Loss Intervention

This study obtained qualitative data from African American (AA) youth and caregiver dyads to inform the Families Improving Together (FIT) for Weight Loss Trial. Focus groups were conducted with 55 AA parent and caregiver dyads to gather perspectives on facilitators and barriers, motivators, and program preferences for health and weight loss using a socio-ecological framework. Four main themes emerged: using a positive health promotion framework for weight loss programs, social support and the role of parents in providing positive support, using a socio-ecological approach to examine factors that contribute to weight, and creating programs that are convenient, fun, and reduce barriers to participation. The findings from this study were used to develop the FIT intervention and indicate important individual, interpersonal, and environmental factors to consider when developing weight management and healthy lifestyle programs for AA families.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

Identification of predicted individual treatment effects in randomized clinical trials

In most medical research, treatment effectiveness is assessed using the average treatment effect or some version of subgroup analysis. The practice of individualized or precision medicine, however, requires new approaches that predict how an individual will respond to treatment, rather than relying on aggregate measures of effect. In this study, we present a conceptual framework for estimating individual treatment effects, referred to as predicted individual treatment effects. We first apply the predicted individual treatment effect approach to a randomized controlled trial designed to improve behavioral and physical symptoms. Despite trivial average effects of the intervention, we show substantial heterogeneity in predicted individual treatment response using the predicted individual treatment effect approach. The predicted individual treatment effects can be used to predict individuals for whom the intervention may be most effective (or harmful). Next, we conduct a Monte Carlo simulation study to evaluate the accuracy of predicted individual treatment effects. We compare the performance of two methods used to obtain predictions: multiple imputation and non-parametric random decision trees. Results showed that, on average, both predictive methods produced accurate estimates at the individual level; however, the random decision trees tended to underestimate the predicted individual treatment effect for people at the extreme and showed more variability in predictions across repetitions compared to the imputation approach. Limitations and future directions are discussed.

Validation of Interviewer-Assisted Recall for Measuring Minutes of Moderate to Vigorous Physical Activity in Elementary School Children, Grades 3 and 5

OBJECTIVE

To test the validity of interviewer-administered recall for measuring moderate to vigorous physical activity (MVPA) in third- and fifth-grade children who reported physical activity (PA) only or both PA and diet, using a short (same-day recall in the afternoon) or long (previous-day recall in the morning) retention interval.

METHODS

Randomly selected children (n = 95) wore an accelerometer 1 day in school. Interviews occurred in the afternoon of the day on which the accelerometer was worn or on the next morning. Assignment to interview content was random. Spearman correlations were calculated between MVPA interview and MVPA accelerometer minutes.

RESULTS

The MVPA interview minutes were positively associated with the MVPA accelerometer minutes when the interview focused on PA only (r = .34; P = .02) but not when children recalled PA and diet (r = .12; P = .40). The MVPA interview minutes for the previous day was associated with the MVPA accelerometer minutes (r = .33; P = .02), but not for the same day (r = .17; P = .26).

CONCLUSIONS

A recall interview method that focuses solely on PA is a promising approach to assessing children's school-day PA.

The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities

BACKGROUND

The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities.

METHODS

Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months.

RESULTS

There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community.

CONCLUSIONS

Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).

An Evidence-based Guide for Obesity Treatment in Primary Care

On behalf of the Society of Behavioral Medicine, we present a model of obesity management in primary care based on the 5As counseling framework (Assess, Advise, Agree, Assist, and Arrange). Primary care physicians can use the 5As framework to build and coordinate a multidisciplinary team that: 1) addresses patients' psychosocial issues and medical and psychiatric comorbidities associated with obesity treatment failure; 2) delivers intensive counseling that consists of goal setting, self-monitoring, and problem solving; and 3) connects patients with community resources to assist them in making healthy lifestyle changes. This paper outlines reimbursement guidelines and weight-management counseling strategies, and provides a framework for building a multidisciplinary team to maximize the patient's success at weight management.

Multilevel Associations of Neighborhood Poverty, Crime, and Satisfaction With Blood Pressure in African-American Adults

BACKGROUND

African-American adults experience the highest rates of elevated blood pressure (BP), and this disparity may be linked to socioeconomic and neighborhood-related disadvantage. Based on a bioecological stress-buffering framework, relations of poverty and neighborhood environmental perceptions with BP were assessed using multilevel regression in at-risk African-American adults.

METHODS

This cross-sectional study used baseline data that were collected in 2008 as part of the Positive Action for Today's Health (PATH) trial (N = 409), a community-based intervention to increase walking in low-income, high-crime neighborhoods. BP and perceived neighborhood crime and satisfaction were investigated as individual-level indicators of health and neighborhood environment. Census block groups (N = 22) served as geographic proxies for neighborhoods, and poverty was obtained using 2010 U.S. Census data, to characterize the neighborhood-level socioeconomic environment.

RESULTS

There were no individual-level direct associations. Significant cross-product interactions demonstrated that with higher perceived crime, high satisfaction was associated with lower systolic (γ = 3.34) and diastolic (γ = -1.37) BP, but low satisfaction was associated with higher systolic (γ = 15.12) and diastolic (γ = 7.57) BP. Neighborhood-level poverty was associated with diastolic (γ = 11.48, SE = 4.08, P = 0.008) and systolic BP (γ = 12.79, SE = 6.33, P = 0.052). Variance in BP across block groups was low (intraclass correlation coefficients = 0.002-0.014) and there were no significant random effects.

CONCLUSIONS

Results supported hypotheses, with greater neighborhood satisfaction linked to lower systolic and diastolic BP when perceived crime was high. Neighborhood poverty was also linked to higher systolic and diastolic BP. Prevention efforts should further investigate whether attending to issues of poverty and related neighborhood perceptions reduces high BP in at-risk African-American communities.

Behavior matters: the relevance, impact, and reach of behavioral medicine

BACKGROUND/PURPOSE

Growing evidence suggests behavioral interventions that target a few key behaviors may be effective at improving population-level health outcomes; health status indicators; social, economic, and physical environments; personal capacity; and biological outcomes. A theoretical framework that targets both social and cognitive mechanisms of behavioral interventions is outlined as critical for understanding "ripple effects" of behavioral interventions on influencing a broad range of outcomes associated with improved health and well-being.

METHODS/RESULTS

Evidence from randomized controlled trials is reviewed and demonstrates support for ripple effects-the effects that behavioral interventions have on multiple outcomes beyond the intended primary target of the interventions. These outcomes include physical, psychological, and social health domains across the lifespan.

CONCLUSIONS

Cascading effects of behavioral interventions have important implications for policy that argue for a broader conceptualization of health that integrates physical, mental, and social well-being outcomes into future research to show the greater return on investment.

Neighborhood Social Predictors of Weight-related Measures in Underserved African Americans in the PATH Trial

African Americans have the highest rate of obesity in the United States relative to other ethnic minority groups. Bioecological factors including neighborhood social and physical environmental variables may be important predictors of weight-related measures specifically body mass index (BMI) in African American adults. Baseline data from the Positive Action for Today's Health (PATH) trial were collected from 417 African American adults. Overall a multiple regression model for BMI was significant, showing positive associations with average daily moderate-to-vigorous physical activity (MVPA) (B =-.21, P<.01) and neighborhood social interaction (B =-.13, P<.01). Consistent with previous literature, results show that neighborhood social interaction was associated with healthier BMI, highlighting it as a potential critical factor for future interventions in underserved, African American communities.

A multilevel approach to examining time-specific effects in accelerometer-assessed physical activity

OBJECTIVES

Popular methods for analyzing accelerometer data often use a single physical activity outcome variable such as average-weekly or total physical activity. These approaches limit the types of research questions that can be answered and fail to utilize the detailed, time-specific information available from accelerometers. This study proposes the use of multilevel modeling, which tested intervention effects at specific time periods.

DESIGN

The motivating example was the Active by Choice Today trial. Simulations were used to test whether the application of time-specific hypotheses about when physical activity intervention treatment effects were expected to occur (e.g., after-school hours) increased power to detect effects compared to traditional methods.

METHODS

Six simulation conditions were tested: (1) no treatment effects (to test the type 1 error rate), (2) time-specific effects, but no traditionally-tested effects, (3) traditionally-tested effects, but no time-specific effects, and (4) combinations of traditional and time-specific effects in 3 proportions.

RESULTS

Results showed the proposed multilevel approach demonstrated appropriate type 1 error rates and increased power to detect treatment effects during hypothesized times by 31-38 percentage points compared to traditional approaches. This was consistent across varying proportions of traditional versus time-specific effects, and there was no loss of power using the multilevel approach when only traditional effects were present.

CONCLUSIONS

The current study showed potential advantages of testing time-specific hypotheses about intervention effects using a multilevel time-specific approach. This approach may show intervention effects when traditional approaches do not. Future research should explore the application of this additional analytic tool for accelerometer physical activity estimates.

The Healthy Communities Study Nutrition Assessments: Child Diet and the School Nutrition Environment

Multifaceted community interventions directed at improving food environments are emerging, but their impact on dietary change and obesity prevalence has not been adequately documented. The Healthy Communities Study (HCS) is seeking to identify characteristics and combinations of programs and policies that are associated with children's diets and obesity-related outcomes in various types of communities across the U.S. The purpose of this paper is to describe the methods used in 2013-2015 in the HCS to assess dietary intake, school nutrition environments, and other nutrition-related behaviors. The conceptual framework of the HCS is based on the socioecological model and behaviors shown in previous studies to be related to obesity in children guided selection of domains. Nine domains were identified as essential measures of nutrition in the HCS: (1) intake of selected foods and beverages; (2) food patterns and behaviors; (3) social support; (4) home environment; (5) school environment; (6) community environment; (7) breastfeeding history; (8) household food insecurity; and (9) dieting behaviors and body image. Children's dietary intake was assessed using a dietary screener and up to two automated 24-hour recalls. Dietary-related behaviors were assessed by a survey administered to the parent, child, or both, depending on child age. School nutrition measures were obtained from a combination of school staff surveys and researcher observations. Information from these measures is expected to contribute to a better understanding of "what is working" to improve the dietary behaviors that are likely to prevent obesity and improve health in children.

Social support buffering of the relation between low income and elevated blood pressure in at-risk African-American adults

Socioeconomic disadvantage has been linked to elevated blood pressure (BP), and the purpose of this study was to assess whether interpersonal social supports buffer these adverse relations in African-American adults. In three communities matched demographically, a subsample of participants (N = 204) of the Positive Action for Today's Health trial provided measures of perceived social support, annual household income, and BP. Multiple regression analyses with cross-product interactions were conducted using follow-up data. The sample had a mean age of 52.8 years (SD = 15.1), and was predominantly female (66 %) with a high body mass index (M = 33.5, SD = 14.7). Results indicated an inverse relation between social support and diastolic BP (B = -.178, p = .005), and also an interaction with income (p = .046), such that higher social support related to lower diastolic BP in the lowest-income individuals (B = -1.05). The same direct (B = -.141, p = .025) and interacting (B = -1.42, p = .040) social support effects were present for systolic BP, however the omnibus model for systolic BP was not significant, F(6, 196) = 1.80, p = .09. The hypothesized buffering effect of social support on the adverse relation of income to BP was partially supported in at-risk African-American adults. Future prevention efforts for reducing the impact of socioeconomic stress on BP may aim to increase perceptions of social support.

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure.

RESULTS

Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum.

DISCUSSION

Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.

Society of Behavioral Medicine position statement: elementary school-based physical activity supports academic achievement

The Society of Behavioral Medicine (SBM) urges elementary schools to provide children with ample opportunities to engage in physical activity during school hours. In addition to promoting overall child health, physical activity also supports academic achievement. In addition to improving their aerobic fitness, regular physical activity improves cognitive function, influences the brain, and improves mood in children. Better aerobic fitness and physical activity are associated with increased grade point averages and standardized test scores. Despite the documented relationship between physical activity, fitness, and academic achievement, few schools have implemented physical activity as a tool to improve academic performance. SBM recommends that elementary schools provide children with the recommended 60 min of moderate-to-vigorous physical activity during school hours. Further, SBM urges schools to work with the local school districts and state education departments to mandate minimum physical activity time for elementary school physical education.

A validation study concerning the effects of interview content, retention interval, and grade on children's recall accuracy for dietary intake and/or physical activity

BACKGROUND

Practitioners and researchers are interested in assessing children's dietary intake and physical activity together to maximize resources and minimize subject burden.

OBJECTIVE

Our aim was to investigate differences in dietary and/or physical activity recall accuracy by content (diet only; physical activity only; diet and physical activity), retention interval (same-day recalls in the afternoon; previous-day recalls in the morning), and grade (third; fifth).

DESIGN

Children (n=144; 66% African American, 13% white, 12% Hispanic, 9% other; 50% girls) from four schools were randomly selected for interviews about one of three contents. Each content group was equally divided by retention interval, each equally divided by grade, each equally divided by sex. Information concerning diet and physical activity at school was validated with school-provided breakfast and lunch observations, and accelerometry, respectively. Dietary accuracy measures were food-item omission and intrusion rates, and kilocalorie correspondence rate and inflation ratio. Physical activity accuracy measures were absolute and arithmetic differences for moderate to vigorous physical activity minutes.

STATISTICAL ANALYSES PERFORMED

For each accuracy measure, linear models determined effects of content, retention interval, grade, and their two-way and three-way interactions; ethnicity and sex were control variables.

RESULTS

Content was significant within four interactions: intrusion rate (content×retention-interval×grade; P=0.0004), correspondence rate (content×grade; P=0.0004), inflation ratio (content×grade; P=0.0104), and arithmetic difference (content×retention-interval×grade; P=0.0070). Retention interval was significant for correspondence rate (P=0.0004), inflation ratio (P=0.0014), and three interactions: omission rate (retention-interval×grade; P=0.0095), intrusion rate, and arithmetic difference (both already mentioned). Grade was significant for absolute difference (P=0.0233) and five interactions mentioned. Content effects depended on other factors. Grade effects were mixed. Dietary accuracy was better with same-day than previous-day retention interval.

CONCLUSIONS

Results do not support integrating dietary intake and physical activity in children's recalls, but do support using shorter rather than longer retention intervals to yield more accurate dietary recalls. Additional validation studies need to clarify age effects and identify evidence-based practices to improve children's accuracy for recalling dietary intake and/or physical activity.

Systematic review and meta-analysis of health promotion interventions for children and adolescents using an ecological framework

OBJECTIVE

To evaluate and quantify the evidence for health promotion interventions in children and adolescents.

METHOD

96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and self-reports of health behavior, as well as proxy measures such as fitness.

RESULTS

The aggregated effect was significant (g = .20, 95% confidence interval [CI] = 0.08-0.32, n = 96). A significant effect of intervention was observed at approximately 1-year follow-up (g = .07, 95% CI = 0.02-0.14, n = 20). The greatest risk of bias was failure to blind outcome assessment, which occurred in 21% of studies. Most studies lacked sufficient detail to determine the quality of their randomization sequence (58%). Additional concerns about risk of bias for individual studies were minimal. Overall, the quality of this finding was moderate using the Grading of Recommendations Assessment, Development, and Evaluation criteria.

CONCLUSION

Health promotion interventions are effective for modifying health behavior; however, effect sizes are small.

Associations of social and environmental supports with sedentary behavior, light and moderate-to-vigorous physical activity in obese underserved adolescents

Background

Evidence to support differential health impacts of sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) is building. However, few studies have examined individual, social, and environmental supports across the full range of sedentary and physical activities, including key influences such as self-efficacy, parenting factors, and home and neighborhood resources. This may be particularly important in underserved (low-income, minority), overweight/obese adolescents due to the social and environmental challenges (lack of resources, etc.) associated with increasing MVPA. This study evaluated a range of bioecological factors including individual (self-efficacy), parental (parental support, monitoring, limit-setting, and nurturance), and environmental (perceived home resources for PA and neighborhood support for PA) predictors of SB, LPA and MVPA in overweight/obese adolescents.

Methods

Overweight/obese and predominantly minority adolescents and caregivers (n = 181) completed measures in 2010 in the US including surveys assessing self-efficacy for PA, parenting variables related to PA and home and neighborhood supports for PA. Outcomes included 7-day accelerometer estimates of SB, LPA, and MVPA.

Results

Regression analyses showed parental social support and neighborhood support were significantly associated with LPA. No significant associations were found for SB or MVPA.

Conclusions

Results emphasized the importance of examining a range of sedentary and PA intensities and highlighted the role of parental and neighborhood social supports for LPA. These results have important implications that suggest that health promotion efforts should target social and environmental supports for increasing LPA in youth who are overweight/obese.

Positive Action for Today's Health (PATH): Sex differences in walking and perceptions of the physical and social environment

Research indicates that people from low socioeconomic and ethnic minority backgrounds disproportionately fail to meet the weekly national recommendations for physical activity. Perceptions of environmental factors may be significant barriers to walking in communities experiencing high rates of crime and poverty and may impact women and men differently. The present study investigated sex differences in the impact of perceptions of the environment and overall neighborhood quality on walking in an underserved population. Participants were 195 African American women and 95 African American men. Baseline data indicated that women reported greater concerns about safety, poorer perceptions of aesthetics, and lower neighborhood satisfaction than men. Regression analyses showed that perceptions of access to places for walking significantly predicted walking for both women and men and that sex moderated the effect of neighborhood satisfaction. These results suggest that interventions focused on building accessibility to places for walking while also addressing social environmental concerns are needed in high crime communities.

A pilot study of the effects of a tailored web-based intervention on promoting fruit and vegetable intake in African American families

BACKGROUND

The current study examined the effects of a Web-based tailored parenting intervention on increasing fruit and vegetable intake in African American families.

METHODS

Forty-seven African American parents (mean age, 41.32 ± 7.30; 93.6% female) with an adolescent (mean age, 13.32 ± 1.46; 59.6% female) participated in a Web-based autonomy-support parenting tailored intervention session to increase both parent and youth fruit and vegetable (F&V) intake. The session lasted 45-60 minutes and included three phases: a feedback phase; a Web-based information phase, and a goal-setting and action plan phase. Self-reported measures of parenting skills [based on autonomy (choice), support, and communication] and F&V intake (assessed as average daily intake) were assessed at baseline and at a 1-week follow-up session.

RESULTS

There was a significant increase in parents' self-reports of daily fruit intake from pretest to the 1-week follow-up. Parent and adolescent combined F&V intake also significantly increased from pretest to 1-week follow-up. Overall, parents reported that the program was easy to navigate and that they enjoyed participating in the Web-based online program.

CONCLUSIONS

Current findings provide preliminary support for an autonomy-support parent tailored Web-based program for improving dietary intake in African American families.

Feasibility and preliminary outcomes from a pilot study of an integrated health-mental health promotion program in school mental health services

The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.

Finite Mixtures for Simultaneously Modelling Differential Effects and Non-Normal Distributions

Regression mixture models have been increasingly applied in the social and behavioral sciences as a method for identifying differential effects of predictors on outcomes. While the typical specification of this approach is sensitive to violations of distributional assumptions, alternative methods for capturing the number of differential effects have been shown to be robust. Yet, there is still a need to better describe differential effects that exist when using regression mixture models. The current study tests a new approach that uses sets of classes (called differential effects sets) to simultaneously model differential effects and account for non-normal error distributions. Monte Carlo simulations are used to examine the performance of the approach. The number of classes needed to represent departures from normality is shown to be dependent on the degree of skew. The use of differential effects sets reduced bias in parameter estimates. Applied analyses demonstrated the implementation of the approach for describing differential effects of parental health problems on adolescent body mass index using differential effects sets approach. Findings support the usefulness of the approach which overcomes the limitations of previous approaches for handling non-normal errors.

Updating the FORECAST formative evaluation approach and some implications for ameliorating theory failure, implementation failure, and evaluation failure

Historically, there has been considerable variability in how formative evaluation has been conceptualized and practiced. FORmative Evaluation Consultation And Systems Technique (FORECAST) is a formative evaluation approach that develops a set of models and processes that can be used across settings and times, while allowing for local adaptations and innovations. FORECAST integrates specific models and tools to improve limitations in program theory, implementation, and evaluation. In the period since its initial use in a federally funded community prevention project in the early 1990s, evaluators have incorporated important formative evaluation innovations into FORECAST, including the integration of feedback loops and proximal outcome evaluation. In addition, FORECAST has been applied in a randomized community research trial. In this article, we describe updates to FORECAST and the implications of FORECAST for ameliorating failures in program theory, implementation, and evaluation.

A pilot study of the effects of interview content, retention interval, and grade on accuracy of dietary information from children

OBJECTIVE

Investigate differences in dietary recall accuracy by interview content (diet only or diet and physical activity), retention interval (same day or previous day), and grade (third or fifth).

METHODS

Thirty-two children observed eating school-provided meals and interviewed once each; interview content and retention interval randomly assigned. Multivariate analysis of variance on rates for omissions (foods observed but unreported) and intrusions (foods reported but unobserved); independent variables: interview content, retention interval, grade.

RESULTS

Accuracy differed by retention interval (P = .05; better for same day [omission rate, intrusion rate: 28%, 20%] than previous day [54%, 45%]) but not interview content (P > .48; diet only: 41%, 33%; diet and physical activity: 41%, 33%) or grade (P > .27; third: 48%, 42%; fifth: 34%, 24%).

CONCLUSIONS AND IMPLICATIONS

Although the small sample limits firm conclusions, results provide evidence-based direction to enhance accuracy: specifically, to shorten the retention interval. Larger validation studies need to investigate the combined effect of interview content, retention interval, and grade on accuracy.

Project SHINE: effects of parent-adolescent communication on sedentary behavior in African American adolescents

OBJECTIVE

This study examined parenting variables (communication, monitoring) as moderators of a family-based intervention for reducing sedentary behavior (SB) in African American adolescents. As a secondary aim, a similar model was tested using adolescent weight status as the outcome.

METHODS

African American adolescents (n = 73; 12.45 ± 1.45 years; 60% girls; 63% overweight/obese) and caregivers were randomized to a 6-week interactive, parent-based intervention or general health condition. Parent-adolescent communication and monitoring of health behaviors were self-reported by parents. Adolescent SB was self-reported by youth.

RESULTS

There was a significant intervention by communication interaction, such that intervention families with more positive communication showed lower adolescent SB than those with less positive communication or those in the comparison condition. No effects were found for monitoring on SB or for the model with weight status as the outcome.

CONCLUSIONS

Parent-adolescent communication may be an effective component to integrate into health promotion programs for African American adolescents.

Physical activity as a mediator linking neighborhood environmental supports and obesity in African Americans in the path trial

OBJECTIVE

African Americans have the highest rates of obesity in the United States. Engaging in recommended levels of physical activity (PA) reduces risk for obesity. Social and environmental supports for PA may be important to increase PA. This study hypothesized that PA would mediate the effects of neighborhood and social supports for PA on body mass index (BMI).

METHOD

Baseline data were collected from 434 underserved African American adults in the Positive Action for Today's Health (PATH) trial. Features of the neighborhood environment (i.e., infrastructure for walking, access to services, and crime) and peer social support were measured with validated surveys. Moderate-to-vigorous PA (MVPA) was assessed based on 7-day accelerometry estimates (in minutes per day), and self-reported walking and exercise were obtained using the Four-Week Physical Activity History questionnaire.

RESULTS

The sample was predominantly female (63%) and obese (MBMI = 30.88 kg/m², SD = 8.43). Neither crime nor social support was significantly associated with either PA or BMI; thus, they were excluded from the final models. Infrastructure for walking predicted MVPA (B = 4.06, p = .01) and self-reported walking (B = 7.39, p = .03). A positive association between access to services and MVPA approached significance (B = 2.27, p = .06). MVPA (B = -0.07, p < .001) and self-reported walking (B = -0.02, p = .01) predicted BMI, but only MVPA mediated the effect of infrastructure for walking on BMI (B = -0.03, p = .04). No significant direct or indirect effects of predictors were found for self-reported exercise.

CONCLUSION

Findings suggest that MVPA is a mediator linking infrastructure for walking and BMI in underserved communities.

Associations among environmental supports, physical activity, and blood pressure in African-American adults in the PATH trial

High blood pressure disproportionately affects African-American adults and is a leading cause of stroke and heart attack. Engaging in recommended levels of physical activity reduces blood pressure, and social and physical environmental supports for physical activity may increase engagement in physical activity. Based on social cognitive theory within a bioecological framework, the present study tested hypotheses that perceived peer social support for physical activity and neighborhood walkability would be positively associated with physical activity, and that physical activity would mediate their relation with blood pressure. Baseline data were collected with 434 African-American adults in underserved communities (low income, high crime) participating in the Positive Action for Today's Health (PATH) trial. Perceived peer social support for physical activity and neighborhood walkability were measured with validated surveys. Physical activity was assessed with 7-day accelerometry (moderate-to-vigorous physical activity, min/day) and with a 4-week recall of walking. Three blood pressure assessments were taken by trained staff using standard protocols, with values from the second and third assessments averaged. The sample was predominantly female (63%), overweight (mean body mass index = 30.9, SD = 8.4), and had slightly elevated blood pressures with a mean systolic blood pressure of 132.4 (SD = 17.9) and a mean diastolic blood pressure of 81.4 (SD = 11.0). Results demonstrated that peer social support for physical activity (B = 2.43, p = .02) and neighborhood walkability (B = 2.40, p = .046) were significantly related to average daily moderate-to-vigorous physical activity. Neighborhood walkability was also significantly associated with self-reported average daily walking (B = 8.86, p = .02). Physical activity did not mediate their relation with blood pressure and no significant direct effects of these variables on blood pressure were found. The positive influence of social and physical environmental supports on physical activity in underserved African-American communities may guide intervention efforts and contribute to our understanding of physical activity and related health outcomes.

Qualitative developmental research among low income African American adults to inform a social marketing campaign for walking

Background

This study describes the development of a social marketing campaign for increasing walking in a low income, high crime community as part of the Positive Action for Today’s Health (PATH) trial.

Methods

Focus groups were conducted with 52 African American adults (ages 18 to 65 yrs), from two underserved communities to develop themes for a social marketing campaign to promote walking. Participants responded to questions concerning social marketing principles related to product, price, place, promotion, and positioning for increasing neighbourhood walking.

Results

Focus group data informed the development of the campaign objectives that were derived from the “5 Ps” to promote physical and mental health, social connectedness, safety, and confidence in walking regularly. Focus group themes indicated that physical and mental health benefits of walking were important motivators. Walking for social reasons was also important for overcoming barriers to walking. Police support from trusted officers while walking was also essential to promoting safety for walking. Print materials were developed by the steering committee, with a 12-month calendar and door hangers delivered to residents’ homes to invite them to walk. Pride Stride walks empowered community walkers to serve as peer leaders for special walking events to engage new walkers.

Conclusions

Essential elements for developing culturally tailored social marketing interventions for promoting walking in underserved communities are outlined for future researchers.

Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents

OBJECTIVE

This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income).

METHODS

Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI).

RESULTS

Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores.

CONCLUSIONS

A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

The associations of parenting factors with adolescent body mass index in an underserved population

BACKGROUND

The current study examined parental factors related to risk of adolescent obesity within the context of a family systems framework.

METHODS

Seventy predominantly African American, low-income caregiver-adolescent dyads participated in the study. Validated measures of parental perceived child risk for development of type 2 diabetes mellitus, parental limit setting for sedentary behavior, and parental nurturance were evaluated as predictors of adolescent body mass index.

RESULTS

In this cross-sectional study, multiple linear regression demonstrated that parents of adolescents with higher zBMI reported worrying more about their child's risk of developing type 2 diabetes mellitus. Parent limit setting was also a significant predictor of adolescent zBMI. Contrary to expectations, higher levels of nurturance were associated with higher adolescent zBMI. Post hoc analyses revealed a trend towards a significant interaction between nurturance and limit setting, such that high levels of both parental nurturance and limit setting were associated with lower adolescent zBMI.

CONCLUSIONS

Current findings suggest the importance of authoritative parenting and monitoring of adolescent health behaviors in the treatment of obesity.

Effects of parenting style and parent-related weight and diet on adolescent weight status

OBJECTIVE

This study examined the interaction between parental limit setting of sedentary behaviors and health factors (weight status, physical activity [PA], fruit and vegetable [FV] intake) on standardized body mass index (zBMI) in African American adolescents.

METHODS

Data were from 67 parent-adolescent dyads. Parental limit setting, PA and FV intake were assessed via self-report, and objective height and weight measurements were collected.

RESULTS

Regressions examined the interaction between parental limit setting and BMI, PA, FV intake on adolescent zBMI. The model for parent BMI and FV intake accounted for 31% of the variance in adolescent zBMI. A significant interaction for parent BMI by limit setting showed that as parental BMI increased, higher (vs. lower) limit setting was associated with lower adolescent zBMI. Higher parent FV consumption was associated with lower adolescent zBMI.

CONCLUSION

Future interventions should integrate parent limit setting and target parent fruit and vegetable intake for obesity prevention in underserved adolescents.

The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT Trial: a cross-sectional study

BACKGROUND

Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA).

METHODS

Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates).

RESULTS

Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA.

CONCLUSIONS

These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

Imputational modeling of spatial context and social environmental predictors of walking in an underserved community: the PATH trial

BACKGROUND

This study examined imputational modeling effects of spatial proximity and social factors of walking in African American adults.

PURPOSE

Models were compared that examined relationships between household proximity to a walking trail and social factors in determining walking status.

METHODS

Participants (N=133; 66% female; mean age=55 years) were recruited to a police-supported walking and social marketing intervention. Bayesian modeling was used to identify predictors of walking at 12 months.

RESULTS

Sensitivity analysis using different imputation approaches, and spatial contextual effects, were compared. All the imputation methods showed social life and income were significant predictors of walking, however, the complete data approach was the best model indicating Age (1.04, 95% OR: 1.00, 1.08), Social Life (0.83, 95% OR: 0.69, 0.98) and Income <$10,000 (0.10, 95% OR: 0.01, 0.97) were all predictors of walking.

CONCLUSIONS

The complete data approach was the best model of predictors of walking in African Americans.

Formative process evaluation for implementing a social marketing intervention to increase walking among African Americans in the Positive Action for Today's Health trial

OBJECTIVES

Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today's Health trial.

METHODS

We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months.

RESULTS

Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating.

CONCLUSIONS

Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.

A qualitative study for understanding family and peer influences on obesity-related health behaviors in low-income African-American adolescents

BACKGROUND

Given the cultural and developmental relevance of family members and peers in the lives of African-American adolescents, the present study used a bioecological framework to qualitatively explore the parenting context as well as specific family factors (support, rules, monitoring) and peer factors (support) related to weight status, physical activity (PA), and healthy eating in low-income African-American boys versus girls.

METHODS

Qualitative data were obtained from African-American adolescents through focus groups. Adolescents (n = 45, 100% African American, 51% girls, 12.6 ± 1.2 years, 51% overweight/obese) were from two underserved communities in South Carolina (median income ≈$17,000-$22,000, high crime levels). Sessions were audiotaped, transcribed, and coded by independent pairs of raters (r = 0.75). QSR NVivo 8 was used to analyze data, and themes were categorized separately for boys and girls.

RESULTS

Adolescents reported themes of family warmth and control practices consistent with an authoritative style of parenting. Although adolescents wanted increased autonomy, they viewed parental monitoring as a favorable part of their relationship. Boys reported receiving more constructive feedback from parents about weight status and greater overall support for PA and diet than did girls. Girls reported more honest feedback from peers about weight status than did boys. Overall, adolescents acknowledged the unique opportunities of parents and peers in improving their health behaviors.

CONCLUSIONS

Findings suggest parents and peers interact in different ways with African-American boys and girls regarding their weight status and health behaviors. Future obesity prevention efforts in minority youth may need to target parenting skills that provide greater support to African-American girls. In addition, given peers influence PA and diet differently in boys and girls, interventions should strategically include parenting strategies that involve monitoring peer-adolescent interactions.

Assessing urban walking trail use and changes in the trail environment using systematic observational protocols

This study evaluated the extent to which two systematic observation protocols which were modified for underserved communities (low income, minorities) could be utilized to reliably assess (a) use of walking trails and (b) physical environmental features of these trails. This study was a supplement to the Positive Action for Today's Health (PATH) walking trial. The modified tools were shown to be reliable methods for (a) measuring trail use and (b) assessing physical features of the trail in underserved environments. Reliability data for measuring trail use were found to be high (ICC=.98, p<.01). Reliabilities for measuring features of the trail ranged from fair to highly reliable (κ=.77-1.00; ICC=.34-1.00). The observation tools that were customized for this study were shown to be reliable instruments for measuring trail use and assessing physical features of walking trails in underserved communities.

The association of self-efficacy and parent social support on physical activity in male and female adolescents

OBJECTIVE

Previous research has shown that cognitive factors may account for the relationship between interpersonal factors and health behaviors. Given these findings, the current study sought to further explore the direct and indirect relationship between parental social support and adolescent physical activity (PA).

METHOD

Data were collected from 1,421 sixth graders (73% Black, 54% females, 71% on free or reduced lunch) in South Carolina. Measures for emotional social support, instrumental social support, and adolescent self-efficacy (SE) were assessed and PA was assessed via accelerometry.

RESULTS

Parent instrumental social support was directly related to girls' PA and parent emotional social support was inversely related to girls' PA. Parent instrumental social support was indirectly related to boys' PA through boys' SE. The covaried association of SE with PA was significant for boys and marginal for girls.

CONCLUSIONS

SE for overcoming barriers may be an important construct for understanding the relationship between parent instrumental social support and boys' PA in underserved populations. The mechanisms for engaging in PA may be different for adolescent girls and boys.

A qualitative study of staff's perspectives on implementing an after school program promoting youth physical activity

Minimal effects found across youth physical activity (PA) interventions, and increased attention to circumstances that impede adequate delivery of program components, has highlighted the importance of learning from staff what is needed to foster staff comprehension and engagement for developing, adopting, and successfully implementing PA-based youth interventions. The purpose of this study is to address this knowledge gap by conducting a qualitative assessment of school staff perspectives on the positive aspects and challenges of implementing the 17-week ACT program, an after-school intervention that integrated motivational and behavioral components to promote PA in underserved adolescents. Interviews were conducted with one school staff member from each participating school for all four trial cohorts (N=12). Transcripts were coded by independent coders (r=.84) and content analyses of themes was performed using QSR NVivo. Themes were organized into five meta-themes: (1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects. Findings indicate that staff can be successful at understanding, valuing, and reaching fidelity in implementing climate-based mediation components. The insight gained from this study lays the foundation for understanding the components needed for establishing well-implemented, effective, and generalizable interventions for increasing youth PA.

Accelerometry cut points for physical activity in underserved African Americans

Background

Despite their increased use, no studies have examined the validity of Actical accelerometry cut points for moderate physical activity (PA) in underserved (low-income, high-crime), minority populations. The high rates of chronic disease and physical inactivity in these populations likely impact the measurement of PA. There is growing concern that traditionally defined cut points may be too high for older or inactive adults. The present study aimed to determine the self-selected pace associated with instructions to “walk for exercise” and the corresponding accelerometry estimates (e.g., Actical counts/minute) for underserved, African American adults.

Method

Fifty one participants (61% women) had a mean age of 60.1 (SD = 9.9) and a mean body mass index of 30.5 kg/m² (SD = 6.0). They performed one seated task, one standing task, and three walking tasks: “strolling”; “walking for exercise”; and “walking in an emergency.”

Results

The average pace for strolling, walking for exercise, and walking in an emergency were 1.62 miles per hour (mph; SD = .51), 2.51 mph (SD = .53), and 2.86 mph (SD = .58), respectively. The average Actical counts/minute for the five activities were: 4 (SD = 15), 16 (SD = 29), 751 (SD = 591), 2006 (SD = 1095), and 2617 (SD = 1169), respectively. Regression analyses showed that the predicted counts/minute for a pace of 2.0 mph (which is used as the criterion for moderate exercise in this study) was 1075 counts/minute (SEM = 73).

Conclusions

The cut point associated with subjectively determined moderate PA is similar to those previously published for older adults and extends the use of adjusted cut points to African American populations. These results indicate that accurate cut points can be obtained using this innovative methodology.

A review of family and environmental correlates of health behaviors in high-risk youth

Disparities in the prevalence of obesity in youth place minority and low socioeconomic status youth at increased risk for the development of chronic disease, such as metabolic syndrome and type 2 diabetes. Contributing factors to the increases in obesity include a decline in positive health behaviors, such as making healthy dietary choices, engaging in physical activity, and limiting sedentary behaviors. Family and physical environmental contextual factors related to health behaviors are increasingly the focus of health behavior interventions in line with the bioecological model that encourages a system-focused perspective on understanding health behavior influences. Physical environmental characteristics, such as home and neighborhood characteristics and resources, provide the tangible means to support health behaviors and are important contextual variables to consider that may increase intervention effectiveness. Therefore, the current review seeks to highlight the importance of investigating influences of behavior beyond individual characteristics in understanding factors related to the risk of developing metabolic syndrome and type 2 diabetes in youth at high risk for developing chronic disease. The current study reviews the non-intervention literature on family and physical environmental factors related to health behaviors (i.e., diet, physical activity, and sedentary behavior) in youth who are considered to be at-risk for developing metabolic syndrome and type 2 diabetes. Results on 38 published articles of diet, physical activity, and sedentary behaviors showed support for the role of parenting and physical environmental factors, particularly parental monitoring and neighborhood context, such as social cohesion, as they relate to health behaviors in high-risk youth. Implications and recommendations for future research are discussed.

Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents

OBJECTIVE

This study reports the results of the "Active by Choice Today" (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents.

DESIGN

The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program.

MAIN OUTCOME MEASURE

The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention.

RESULTS

At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention.

CONCLUSIONS

Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA.

Results of the Heart Healthy and Ethnically Relevant Lifestyle trial: a cardiovascular risk reduction intervention for African American women attending community health centers

OBJECTIVES

We evaluated a theory-based lifestyle intervention targeting physical activity and dietary fat intake among African American women at high risk for cardiovascular disease.

METHODS

The Heart Healthy and Ethnically Relevant Lifestyle trial (2005-2008) randomly assigned 266 low-income African American women aged 35 years and older who were patients of South Carolina community health care centers into comprehensive or standard care interventions. Comprehensive participants received standard care (stage-matched provider counseling and assisted goal setting) plus 12 months of telephone counseling and tailored newsletters. Primary outcomes were 6- and 12-month self-reported physical activity and dietary fat intake.

RESULTS

Comprehensive participants were more likely than were standard care participants to decrease total physical activity (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.18, 8.25) and increase leisure-time physical activity (OR = 3.82; 95% CI = 1.41, 10.3) at 6 months (no 12-month differences). Mean reductions in Dietary Risk Assessment score occurred in both groups but were greater among comprehensive participants than among standard care participants (6 months, -8.50 vs -5.34; 12 months, -7.16 vs -3.37; P < .001).

CONCLUSIONS

The comprehensive intervention improved women's leisure-time physical activity and dietary fat intake, highlighting a replicable model to help primary care providers implement lifestyle counseling.

Neighborhood and parental supports for physical activity in minority adolescents

BACKGROUND

Few studies have examined environmental, home, and parental supports for physical activity in underserved adolescents (low income, ethnic minority). Given the increasing incidence of obesity in minority adolescents, it is important to better understand ecologic determinants of physical activity in these youth. This study used an ecologic model to evaluate the significance of neighborhood, home, and parental supports for physical activity on moderate-to-vigorous (MV) physical activity in underserved adolescents.

DESIGN

The study was a secondary data analysis of a randomized controlled school-based trial "Active by Choice Today" (ACT) for increasing physical activity in underserved sixth-graders. Schools were matched on school size, percentage minorities, percentage entitled to free or reduced-price lunch, and urban or rural setting prior to randomization. This study used a randomly selected sample of parents (n=280) from the intervention and control schools whose adolescent was enrolled in the larger trial.

SETTING/PARTICIPANTS

A total of 679 6th-grade students (mean age=11.4 years, 70% African-American, 76% free or reduced-price lunch, 52% female) participated in the larger trial. Parents of 280 youth were contacted to participate in a telephone survey and 198 (71%) took part in the study.

INTERVENTIONS

The ACT trial was designed to test the efficacy of a 17-week (1 academic year) motivational plus behavioral skills intervention versus comparison after-school programs on increasing physical activity. A telephone survey was developed and was administered within 6 months after the trial began on parents of 198 adolescents from the ACT randomized school-based trial during 2005-2007.

MAIN OUTCOME MEASURES

The primary outcome measure was adolescent MVPA based on 7-day accelerometry estimates from baseline to mid-intervention. The data were analyzed in 2010-2011 and included both parent and adolescent self-reports of environmental, home, and family supports for physical activity.

RESULTS

Regression analyses indicated a significant effect of parental and neighborhood supports for physical activity on adolescent MVPA. Adolescents who perceived higher (vs lower) levels of parental support for physical activity engaged in more minutes of MVPA (B=3.01, SE=1.38, p<0.05) at mid-intervention. Adolescents who lived in neighborhoods with more (vs fewer) supports for physical activity (parks, lighting), also engaged in more minutes MVPA (B=4.27, SE=2.15, p<0.05).

CONCLUSIONS

Support from parents and neighborhood quality are both associated with increased physical activity in underserved adolescents.

A computational study of the effect of windscreen shape and flow resistivity on turbulent wind noise reduction

In this paper, numerical simulations are used to study the turbulent wind noise reduction effect of microphone windscreens with varying shapes and flow resistivities. Typical windscreen shapes consisting of circular, elliptical, and rectangular cylinders are investigated. A turbulent environment is generated by placing a solid circular cylinder upstream of the microphone. An immersed-boundary method with a fifth-order weighted essentially non-oscillatory scheme is implemented to enhance the simulation accuracy for high-Reynolds number flow around the solid cylinder as well as at the interface between the open air and the porous material comprising the windscreen. The Navier-Stokes equations for incompressible flow are solved in the open air. For the flow inside the porous material, a modified form of the Zwikker-Kosten equation is solved. The results show that, on average, the circular and horizontal ellipse windscreens have similar overall wind noise reduction performance, while the horizontal ellipse windscreen with medium flow resistivity provides the most effective wind noise reduction among all the considered cases. The vertical ellipse windscreen with high flow resistivity, in particular, increases the wind noise because of increased self-generation of turbulence.

The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.

An overview of the "Positive Action for Today's Health" (PATH) trial for increasing walking in low income, ethnic minority communities

BACKGROUND

Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities.

DESIGN AND SETTING

Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months.

INTERVENTION

The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months.

CONCLUSIONS

Implications of this community-based trial are discussed.