Effects of message framing on self-report and accelerometer-assessed physical activity across age and gender groups

This study compared message-framing effects on physical activity (PA) across age and gender groups. Participants included 111 younger and 100 older adults (68% were women), randomly assigned to read gain-framed or loss-framed PA messages in promotion pamphlets, and who wore accelerometers for the following 14 days. Using regression analyses controlling for demographic and health factors, we found significant age-by-gender-by-framing interactions predicting self-report (B = -4.39, p = .01) and accelerometer-assessed PA (B = -2.44, p = .02) during the follow-up period. Gain-framed messages were more effective than loss-framed messages in promoting PA behaviors only among older men. We speculated that the age-related positivity effect, as well as the age and gender differences in issue involvement, explained the group differences in framing. In addition, more time availability and higher self-efficacy among older men might have contributed to the results.

Concordance of physical activity trajectories among middle-aged and older married couples: impact of diseases and functional difficulties

OBJECTIVES

This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals' trajectories and those of their spouses'.

METHOD

Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals' trajectory memberships were predicted by their spouses' memberships, together with recent diseases and functional difficulties of both couple members.

RESULTS

In the main, corresponding husbands' trajectories predicted wives' trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses'. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships.

DISCUSSION

Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples.

Patients newly diagnosed with ulcerative colitis receive earlier treatment in surgical clinics

AIM

The diagnosis and treatment of ulcerative colitis (UC) is traditionally the realm of gastroenterologists. However, the symptoms of UC overlap with those of bowel cancer and patients may be initially referred to colorectal surgery clinics. The aims of this study were to define which specialty most frequently diagnoses UC and to determine if there were differences in management between the two specialities.

METHOD

The demographics, presenting symptoms and clinical management of patients with newly diagnosed UC were determined and compared by speciality clinic of initial referral. Histopathology reports and clinic letters were reviewed to identify patients newly diagnosed with UC at a large university teaching hospital from January 2007 to January 2012.

RESULTS

Patients were more commonly referred to colorectal surgeons (74 vs 41 patients) than gastroenterologists. Patients referred to gastroenterology were younger (36.0 vs 59.6 years, P < 0.01) but there were no significant differences in gender, presenting symptoms or disease extent. Rigid sigmoidoscopy ± biopsy was more commonly performed in colorectal clinic (93.2 vs 31.7%, P < 0.01). There was a significantly shorter delay in starting disease-specific treatment for those patients referred initially to colorectal surgery (13.8 vs 33.6 days, P = 0.01). Performing rigid sigmoidoscopy in clinic was associated with starting disease-specific treatment at this visit.

CONCLUSION

Patients with first presentation UC are more commonly seen in colorectal surgery clinics where rigid sigmoidoscopy is more frequently undertaken, allowing earlier commencement of UC treatment.

An examination of sex differences in relation to the eating habits and nutrient intakes of university students

OBJECTIVES

To examine sex differences in eating habits and nutrient intakes and explore whether eating habits mediate the effects of sex on nutrient intakes and whether sex moderates the effects of eating habits on nutrient intakes.

METHODS

Cross-sectional survey of eating habits and food-intake frequency in a convenience sample of college students.

RESULTS

Male students (n = 172) consumed a higher energy content from fat, a larger amount of fiber, and more fruits and vegetables, and engaged less often in various healthful eating habits (eg, reading food labels, having breakfast) than female students (n = 316). Sex predicted the 3 dietary nutrient intakes partially through eating habits. Interactions between sex and eating habits were nonsignificant.

CONCLUSIONS AND IMPLICATIONS

Results reinforce that university students' nutrient intakes are less than ideal. Women and men may have different needs for nutritional improvement. However, the effects of health promotion concerning eating habits may be similarly effective between the sexes.

The clinical characteristics of lupus related protein-losing enteropathy in Hong Kong Chinese population: 10 years of experience from a regional hospital

OBJECTIVE

The aim of our study was to investigate systemic lupus erythematosus (SLE) related protein-losing enteropathy (PLE) in the following areas: clinical features, laboratory, endoscopic and imaging characteristics, treatment and outcome.

METHOD

A retrospective analysis was performed.

RESULTS

From 2001 to 2010, 48 patients had SLE related PLE and their clinical characteristics were: age 40.8 ± 14.3 years, male-to-female ratio 1:8.6, mean symptom duration 4.3 ± 3.4 weeks, initial presentation and concomitant activity of SLE in 21(43.8%) and 37 (77.1%) patients, <20% patients developed gastrointestinal (GI) symptoms, mean serum albumin level 24.4 ± 5 g/L. Thirty (62.5%) patients had diffuse non-erosive erythematous GI mucosa with chronic inflammatory cells in lamina propria. Protein leakage was at the small bowel in 15 (31.3%) patients, terminal ileum/caecum in 16 (33.3%) patients and ascending colon in 11 (22.9%) patients. Thirty (62.5%) patients responded initially well to a combination of prednisolone and azathioprine (AZA) and 33 (68.8%) patients were maintained well by the above therapy. Higher potent induction and maintenance therapy were required in patients with: proteinuria (p < 0.01), history of previous immunosuppressive therapy (p < 0.02) and requirement of higher potent induction therapy (p < 0.01). PLE as initial SLE presentation was associated with better prognosis. Four reversible adverse events were reported: one had AZA-induced pancreatitis, two developed AZA-induced hypoplastic anemia and one developed steroid psychosis. One patient developed shingles in the fourth month and responded to oral acyclovir. No thromboembolic events were reported and one patient died of SLE nephropathy.

CONCLUSION

There appears to be increasing prevalence of SLE related PLE. A diagnosis can be made using 99m Tc-labeled HSA scintigraphy. PLE generally responds well to immunosuppressive therapy.

Effects of a social-emotional and character development program on the trajectory of behaviors associated with social-emotional and character development: findings from three randomized trials

The effects of a school-based social-emotional and character development program, Positive Action, on the developmental trajectory of social-emotional and character-related behaviors was evaluated using data from three school-based randomized trials in elementary schools. Results come from 1) 4 years of data from students in 20 Hawai'i schools, 2) 3 years of data from students in 14 schools in Chicago and 3) 3 years of data from students in 8 schools in a southeastern state. Random intercept, multilevel, growth-curve analyses showed that students in both control and Positive Action schools exhibited a general decline in the number of positive behaviors associated with social-emotional and character development that were endorsed. However, the Positive Action intervention significantly reduced these declines in all three trials. Taken together, these analyses 1) give insight into the normative trajectory of behaviors associated with social-emotional and character development and 2) provide evidence for the effectiveness of Positive Action in helping children maintain a relatively beneficial developmental trajectory.

Social exchanges and subjective well-being: do sources of positive and negative exchanges matter?

OBJECTIVES

To decompose the effects of positive and negative social exchanges on well-being in terms of relationship type (vertically extended family, horizontally extended family, or nonfamily) and subjective closeness (close vs. peripheral).

METHODS

One thousand and five Chinese older adults rated each network member on positive and negative exchanges, which were aggregated for each relationship type and closeness category. Regression analyses estimated the influences of positive and negative exchanges on well-being, controlling for network size, health, and demographic factors.

RESULTS

Social exchanges with close and peripheral vertical family members as well as close horizontal family members were associated with well-being, whereas exchanges with nonkin did not contribute independent effects. These results were similar for both positive and negative exchanges.

DISCUSSION

Well-being is determined not just by social exchanges but also by where they come from. In this regard, the vertical family, the horizontal family, and the nonfamily represent a hierarchy of preference for Chinese older adults, which, to some extent, reflects the influence of familism.

Nephrotoxicity, including acquired Fanconi's syndrome, caused by adefovir dipivoxil - is there a safe dose?

WHAT IS KNOWN AND OBJECTIVE

Adefovir dipivoxil (ADV) is an oral bioavailable prodrug of adefovir that possesses potent in vitro activity against hepadnaviruses, retroviruses and herpes viruses. ADV is excreted unchanged in the urine through glomerular filtration and tubular secretion and is known to be nephrotoxic at doses of 60mg daily and above. Thus, the long-term safety of ADV, particularly nephrotoxicity, is a major concern. Our objective is to comment on the nephrotoxcicity of low-dose (10mg daily) ADV through a case report.

COMMENT

The clinical features of nephrotoxicity because of ADV are described. A case report of acquired Fanconi's syndrome in a chronic hepatitis B patient treated with ADV 10mg daily is used to illustrate several key aspects.

WHAT IS NEW AND CONCLUSION

Adefovir dipivoxil can be nephrotoxic at conventional dosage and therefore, patients treated with long-term ADV should have regular monitoring of renal function, and calcium and phosphate levels.

Effects of the Positive Action programme on problem behaviours in elementary school students: a matched-pair randomised control trial in Chicago

This study examined the effects of the Positive Action (PA) programme in Chicago Public Schools on problem behaviours among a cohort of elementary school students from grade three through grade five. Using a matched-pair, randomised control design with 14 elementary schools, approximately 510 fifth-graders self-reported lifetime substance use, serious violence-related behaviour, and current bullying and disruptive behaviours. Three-level (i.e. students nested within schools within school pairs) overdispersed Poisson models were used to examine programme effects on the number of items endorsed for each of the four outcomes. Findings indicated that students in the intervention endorsed 31% fewer substance use behaviours (incidence rate ratio [IRR] = 0.69), 37% fewer violence-related behaviours (IRR = 0.63) and 41% fewer bullying behaviours (IRR = 0.59), respectively, compared to students in the control schools. Reduction in reported disruptive behaviours was of a similar magnitude (27%, IRR = 0.73), but was not statistically significant. These results replicate findings of an earlier randomised trial of the PA programme and extend evidence of its effectiveness to youth attending large urban school systems.

Transitional shifts in exercise behavior among women with multiple sclerosis

BACKGROUND

While physical activity is recommended to reduce symptomology associated with multiple sclerosis (MS) little has been done to explore the potential usefulness of theoretical models of exercise behavior change in individuals with MS. Based on the success of the transtheoretical model of exercise behavior change (TTM) in the general population and early promising results in those with MS, the TTM was tested in a sample of women with MS over a 1-year period, to examine its usefulness and the effect of TTM constructs on MS-related symptoms.

METHODS

This was a longitudinal study conducted over a 1-year period. Ambulatory women (N=86) with MS completed questionnaires assessing exercise behavior, TTM constructs, MS-related quality of life, pain, and fatigue at baseline and after 1 year. After categorization into transitional shift patterns reflecting naturally occurring exercise behavior change over the year, a series of mixed-design analyses of variance were conducted to examine TTM predictions and the relationship of the transitional shift patterns to MS-related quality of life, pain, and fatigue.

RESULTS

Significant interactions between transitional shift patterns and time (P < .05) indicated that changes in behavioral and cognitive processes of change and in self-efficacy were consistent with TTM predictions. Significant differences (P < .05) between the transitional shift groups in pain and fatigue in expected directions were also found.

CONCLUSIONS

Results supported the TTM proposed relationships, indicating the model's potential for motivating individuals with MS to increase their physical activity. Findings also support the notion that physical activity is useful in reducing MS-related symptoms and that lifestyle types of physical activity may be as useful as structured exercise in bringing about these outcomes.

Relapse of amoebic infection 10 years after the infection

A 52-year-old man with schizophrenia, who had a history of amoebic liver abscess treated with combination antimicrobial agents, presented 10 years later with severe rectal bleeding. Diagnosis of amoebic colitis was confirmed by histological examination of endoscopic biopsy. Doctors treating patients with amoebic infection should be aware of the risk of eradication failure. Post-treatment stool testing, preferably by antigen testing or polymerase chain reaction, should be performed after antimicrobial treatment.

Hepatocarcinogenesis of regenerative and dysplastic nodules in Chinese patients

OBJECTIVES

To determine the development rate of hepatocellular carcinoma and survival of patients diagnosed to have regenerative, and low-grade and high-grade dysplastic liver nodules.

DESIGN

Retrospective descriptive study.

SETTING

Acute public hospital, Hong Kong.

PATIENTS

Patients with non-malignant liver nodules confirmed by imaging-guided liver biopsy between January 1997 and December 2008.

MAIN OUTCOME MEASURES

Rates of hepatocellular carcinoma development and survival.

RESULTS

A total of 147 patients with non-malignant liver nodules were followed up over a median duration of 29 months. The initial histological diagnosis included regenerative nodules (n=74), low-grade dysplastic nodules (n=34), and high-grade dysplastic nodules (n=39). The respective cumulative hepatocellular carcinoma development rate during the first, second, third, and fourth year were 3%, 5%, 9% and 12% for simple regenerative nodules, 29%, 35%, 38% and 44% for low-grade dysplastic nodules, and 38%, 41%, 51% and 51% for high-grade dysplastic nodules. The hepatocellular carcinoma development rate was highest in those with high-grade dysplastic nodules. Multivariate analysis showed that histological dysplastic changes were associated with increased alpha-fetoprotein levels and advanced age, which were both independent predictors of hepatocellular carcinoma development. Histological dysplastic changes, male sex, advanced age, prolonged prothrombin time, and ultrasound appearances were independent predictors of mortality.

CONCLUSION

The presence of dysplastic change in liver nodules increased the risk of hepatocellular carcinoma development and death.

HPV vaccination in Hong Kong: implications for medical education

OBJECTIVE

To explore the experience and attitudes of physicians in clinics, and to facilitate physicians' promotion of HPV vaccination.

DATA SOURCES

Primary data collected from conducting semi-structural in-depth interviews from May to June 2010 with 12 physicians in one district in Hong Kong to understand their experience of providing HPV vaccines, the difficulties in promoting HPV vaccines, and their attitudes towards HPV vaccination.

STUDY DESIGN

Physicians identified 4 categories of factors related to their experiences of and attitudes to providing HPV vaccination: (a) background information on HPV vaccination provided by physicians, (b) factors influencing women to receive vaccination, (c) physicians' recommendations to the public on HPV vaccines, and (d) physicians' perspectives on HPV vaccine promotion.

CONCLUSIONS

Our findings show that public knowledge on HPV and cervical cancer is insufficient and the role of government in vaccine promotion is unclear. Promotion strategies such as physicians' recommendation, financial assistance and health education provided by the government will influence HPV vaccination and its promotion.

The impact of an experiential education program on the self-perceptions and perceived social regard of physical education students

This study investigated the effectiveness of an 8-month Team Building through Physical Challenges (TBPC; Glover & Midura, 1992) program on the self-perceptions and perceived social regard of middle school physical education students (N = 1802). Data were analyzed using multilevel analyses where midpoint and final evaluations were conducted separately. Results revealed that at the midpoint evaluation, students in the experimental and control conditions were not different on any of the subscales assessed. At the end of the program, students in the experimental condition, compared with those in the control condition, showed significantly higher scores on 6 of the 10 subscales assessed and the effect sizes were medium to very large. The findings support the effectiveness of the TBPC program in creating positive psychological outcomes for students in a field-based setting.

Ten-year review of epidemiology, clinical features, and treatment outcome of achalasia in a regional hospital in Hong Kong

OBJECTIVE

To describe the epidemiology, clinical features, and treatment outcome of achalasia in Chinese patients.

DESIGN

Retrospective study.

SETTING

Major regional hospital, Hong Kong.

PATIENTS

Clinical records of patients with the diagnosis of achalasia from July 1997 to June 2007 were reviewed.

RESULTS

Thirty-two patients were diagnosed with achalasia during the study period. The mean age at diagnosis was 50 years (standard deviation, 20 years). The female-to-male ratio was 1.3:1. The main presenting symptoms were dysphagia (78%) and vomiting (50%). Nine laparoscopic and two open Heller's operations had been performed and 16 patients had undergone endoscopic dilatations. Four patients had botulinum toxin injection and four were taking calcium channel blocker (nifedipine) medications. Botulinum toxin injection and medical therapy had poor short- and long-term responses. Laparoscopic myotomy and pneumatic dilatation had comparable good short- and long-term responses.

CONCLUSION

Achalasia affected all age-groups but there was a peak at middle age. Pneumatic dilatation and Heller's myotomy (open or laparoscopic approach) appeared able to maintain longer symptom responses than medical therapy and botulinum toxin injection.

Impact of a social-emotional and character development program on school-level indicators of academic achievement, absenteeism, and disciplinary outcomes: A matched-pair, cluster randomized, controlled trial

This paper reports the effects of a comprehensive elementary school-based social-emotional and character education program on school-level achievement, absenteeism, and disciplinary outcomes utilizing a matched-pair, cluster randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools (mean enrollment = 544) and was conducted from the 2002-03 through the 2005-06 academic years. Using school-level archival data, analyses comparing change from baseline (2002) to one-year post trial (2007) revealed that intervention schools scored 9.8% better on the TerraNova (2^nd ed.) test for reading and 8.8% on math; 20.7% better in Hawai'i Content and Performance Standards scores for reading and 51.4% better in math; and that intervention schools reported 15.2% lower absenteeism and fewer suspensions (72.6%) and retentions (72.7%). Overall, effect sizes were moderate to large (range 0.5-1.1) for all of the examined outcomes. Sensitivity analyses using permutation models and random-intercept growth curve models substantiated results. The results provide evidence that a comprehensive school-based program, specifically developed to target student behavior and character, can positively influence school-level achievement, attendance, and disciplinary outcomes concurrently.

Outcome of inoperable hepatocellular carcinoma patients receiving transarterial chemoembolisation: a real-life retrospective analysis in a Hong Kong regional hospital

OBJECTIVE

To evaluate survival and prognostic factors in patients with advanced hepatocellular carcinoma treated by transarterial chemoembolisation in a real-life clinical practice setting.

DESIGN

Retrospective study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

Patients with inoperable hepatocellular carcinoma diagnosed from January 1998 to December 2003 who received transarterial chemoembolisation.

RESULTS

A total of 74 patients were identified, and had a median survival of 214 days. The cumulative survival rates at 1, 2, and 3 years were 28%, 12%, and 7%, respectively. By multivariate analysis, superselective cannulation performed in transarterial chemoembolisation (hazard ratio=0.47; 95% confidence interval, 0.23-0.95; P=0.034), embolisation with gelfoam (0.30; 0.11-0.80; P=0.017), and treatment intervals of more than 45 days (0.33; 0.15-0.72; P=0.006) were independent predictors of good survival. Child-Pugh grade B cirrhosis (hazard ratio=5.62; 95% confidence interval, 2.11-14.97; P=0.001), and high pre-treatment serum alpha-fetoprotein level (2.93; 1.50-5.73; P=0.002) were independent predictors of poor survival.

CONCLUSIONS

In real-life clinical practice, survival of patients with inoperable hepatocellular carcinoma remains grave despite treatment. Patients with Child-Pugh grade A cirrhosis or with low pretreatment alpha-fetoprotein level are more suitable for this form of treatment. The procedure should be performed with superselective cannulation and embolisation with gelfoam.

Benefits of negative social exchanges for emotional closeness

Negative exchanges in social relationships have traditionally been studied as having negative consequences. This study explored whether they might have positive effects for relationship closeness. The sample included 351 adults, aged between 18 and 91 years, residing in Hong Kong, China. Closeness of social partners to the participants was measured by the Social Convoy Questionnaire, and the levels of negative exchanges and social support from each social partner were assessed. Multilevel analyses revealed that more negative exchanges were associated with a more positive change in closeness over a 2-year period, even after statistically controlling for social support and sociostructural characteristics of the participant and the social partner. Findings extended our knowledge on the positive effects of negative exchanges and their moderating conditions.

Longitudinal patterns of binge drinking among first year college students with a history of tobacco use

BACKGROUND

Underage heavy episodic drinking is a major contributor to alcohol-related morbidity/mortality. Reports indicate underage binge drinking among college students is widespread and has remained stable over the past decade. This study describes individual characteristics and calendar-specific events associated with binge drinking episodes over the course of freshman college academic year (2002-2003).

METHODS

Students (N=827, age 18 years), with a prior history of tobacco use, attending a large Midwest university completed weekly web-based surveys on the number of drinks consumed for each of the past 7 days over the duration of 35 consecutive weeks (avg. number of weeks reported 16.0+/-10.5).

RESULTS

Average prevalence of binge episodes across the academic year was 17.2+/-14.4%, 23.6+/-8.3%, and 66.3+/-11.2% for weekdays, Thursdays, and weekend days, respectively. Two-level random effects logit survival models for repeated events indicated the prevalence of weekday and Thursday binge drinking was associated with specific university/community events (Local festival odds ratio [OR] 6.03, 95% confidence interval [CI] 4.34-8.36), holidays (New Year's Eve OR 18.48, CI 12.83-26.63), and academic breaks (Spring Break OR 6.45, CI 4.57-9.08). Expected associations of younger age of first heavy drinking, past 12-month drinking, and experiencing negative consequences from heavy drinking were observed.

CONCLUSIONS

Although individual characteristics were related to engaging in a binge episode, binge episodes were strongly associated with time-specific calendar events. Effective interventions to prevent immediate and long-term health consequences associated with binge drinking should consider environmental and institutional policy-level controls to reduce high levels of binge drinking on college campuses connected with holidays and university/community events.

Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii

OBJECTIVES

We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students.

METHODS

We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N = 1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N = 1225) substance use and violence.

RESULTS

Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR] = 0.41; 90% confidence interval [CI] = 0.25, 0.66) and violence (RR = 0.42; 90% CI = 0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio = 0.24; 90% CI = 0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors.

CONCLUSIONS

Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior.

Behavioral, demographic, psychosocial, and sociocultural concomitants of stage of change for physical activity behavior in a mixed-culture sample

PURPOSE

Examine behavioral, demographic, psychosocial, and sociocultural concomitants of the stages of change for physical activity behavior among college students in South Korea (n = 221) and the United States (n = 166).

METHODS

Measures obtained in this cross-sectional study included age; body mass index; nationality; gender; exercise behavior; processes of change; decisional balance; self-efficacy; stage of change; and predisposing, reinforcing, and enabling factors.

RESULTS

The amount of variance explained for stage of change by the transtheoretical model constructs (i.e., decisional balance, processes of change, self-efficacy) ranged from 11% to 29% (all p < .001), whereas the predisposing (2%; p = .052), reinforcing (3%; p = .06), and enabling (5%; p < .001) factors were not as important. In multivariate ordinal logistic regression analysis, gender (odds ratio [OR] = 3.3; p < .001), gender by nationality interaction (OR = .27; p < .01), weekly exercise behavior (OR = 1.04; p < .001), and behavioral processes of change (OR = 1.12; p < .001) were each significant concomitants of the stages of change.

DISCUSSION

In terms of physical activity behavior, South Korean women were more likely than South Korean men to be in the early stages, whereas American men were slightly more likely to be in the early stages than American women when all the concomitants were accounted for. Among the psychosocial stage of change concomitants, only the behavioral processes of change were found to be important.

Health worry, physical activity participation, and walking difficulty among older adults: a mediation analysis

This study examined the effect of health worry (i.e., cognitive aspect of anxiety resulting from concern for health) on walking difficulty in a nationally representative sample (N = 7,527) of older adults (M age = 76.83 years). The study further tested whether physical activity mediates the effect of health worry on walking difficulty in a 6-year follow-up design. Results of a mediation analysis using structural equation modeling showed that people with a high degree of health worry engaged in less physical activity (beta = -.24, p < .001), and people who participated in less physical activity were more likely to report walking difficulty at the 6-year follow-up (beta = -.22, p < .001). There was a significant indirect effect from health worry to walking difficulty through physical activity (beta = .05, p < .001), controlling for demographic, psychosocial, and health related factors. Results suggested that inducing threat and worry may not be effective for physical activity promotion in the older population. More promising coping and regulation strategies are discussed.