Engagement With Remote Delivery Channels in a Physical Activity Intervention for Senior Women in the US

PURPOSE

Identify the effects of engagement with different intervention delivery channels on physical activity (PA), and the participant subgroups engaging with the different channels, among Women's Health Initiative Strong and Healthy (WHISH) PA trial participants.

DESIGN

Secondary analysis of data from WHISH, a pragmatic trial that used passive randomized consent.

SETTING

United States (remote intervention in all 50 states).

SAMPLE

18,080 U.S. women, aged 68-99 years, assigned to the WHISH PA intervention arm.

MEASURES

6 dichotomous variables operationalized engagement: Engagement with Targeted Inserts, Email (opened), Email (clicked links), Website (logging in), Website (tracking), Interactive Voice Response (IVR). PA was measured using the CHAMPS PA questionnaire.

ANALYSIS

Linear regressions evaluated effects of engagement on PA. Conditional Inference Trees identified subgroups of participants engaging with different channels based on demographic and psychosocial variables.

RESULTS

Engagement with each channel, except IVR, was associated with significantly more hours/week of PA (square root coefficients .29 - .13, P values <.001). Consistently across channels, features that identified subgroups of participants with higher engagement included younger age, and higher levels of PA and physical function. Subgroups with the highest engagement differed from those with the lowest in most participant characteristics.

CONCLUSIONS

For equitable population-level impact via large-scale remotely-delivered PA programs, it may be necessary to identify strategies to engage and target harder to reach subgroups more precisely.

CLINICAL TRIAL REGISTRATION

The WHISH trial is registered at ClinicalTrials.gov (No. NCT02425345).

Pasos Hacia La Salud II: A Superiority RCT Utilizing Technology to Promote Physical Activity in Latinas

INTRODUCTION

Latinas face an increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA.

STUDY DESIGN

The researchers conducted a superiority randomized controlled trial (data collected 2018-2022, analyzed 2023).

SETTING/PARTICIPANTS

Participants were 195 Spanish-speaking Latinas ages 18-65 in the Providence, RI area.

INTERVENTION

The original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features.

MAIN OUTCOME MEASURES

Total weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months.

RESULTS

Participants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs 70.18 [9.99]) and accelerometer-measured (66.21 [18.26] vs 60.27 [16.00]) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 [23.35] vs 81.44 [1.82]) and accelerometer-measured (63.76 [15.12] vs 54.86 [14.59]) MVPA at 24 months. Baseline PA moderated the intervention effect.

CONCLUSIONS

This study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance.

TRIAL REGISTRATION

This study is registered at www.

CLINICALTRIAL

gov (NCT03491592).

The urgency of restructuring the landscape of behavioral medicine: Commentary from early-career diversity institute scholars

Structural and systemic barriers entrenched in academia have sustained for decades, and resulted in a lack of diversity in leadership positions, inequitable workloads for women and underrepresented racial/ethnic groups, and increasing issues with retention of faculty, particularly following the COVID-19 pandemic. Increasing opposition to diversity, equity, and inclusion (DEI) efforts in higher education via legislation, policies, and general anti-DEI sentiment contextualizes the importance of prioritizing DEI. The goal of this commentary is to open discussion among academic institutions regarding changes in DEI culture that will facilitate the growth of diverse early-career faculty (ECF). We use an adapted framework which incorporates DEI into a faculty competency model to (i) guide our discussion of the rationale for restructuring academic systems to promote DEI and (ii) recommend strategies for institutional progress for ECF that can translate across academic institutions. Implementing policies and practices that seek to recruit, retain, and support historically underrepresented ECF are needed, and may involve faculty mentorship programs, establishing equitable funding mechanisms, reforming faculty evaluation practices, and examining and correcting inequities in faculty workloads. The onus is on institutions to recognize and replace the exclusionary practices and biases that have existed within their walls, and continuously promote and monitor their DEI efforts and initiatives to ensure their efficacy. Inclusive academic cultures that demonstrate their value of diversity and commitment to equity promotion at all levels of the organization, including among ECF, are necessary for ensuring excellence in scholarship in academia.

Cost effectiveness of a technology-enhanced physical activity intervention for Latinas

Latinas report low levels of physical activity (PA) and disproportionate risk of lifestyle-related diseases. Enhancements to evidence-based PA interventions may increase efficacy; however, uptake of interventions will likely depend on costs. To describe costs and examine the cost-effectiveness of two interventions for helping Latinas reach national aerobic PA guidelines. Adult Latinas (N = 199) were randomly assigned to an Original theory-based mail-delivered intervention or an Enhanced version with texting and additional calls and materials. Meeting PA guidelines was measured by the 7-Day PA Recall interview at baseline, 6 and 12 months. Intervention costs were estimated from a payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as the additional cost per participant meeting guidelines in the Enhanced versus Original intervention. At baseline, no participants met guidelines. After 6 months, 57% and 44% in the Enhanced and Original arms met guidelines, respectively; at 12 months, rates fell to 46% and 36%. Cost per person of the Enhanced and Original interventions were $184 and $173 at 6 months, respectively, and $234 and $203 at 12 months. The primary additional expense in the Enhanced arm was staff time. ICERs were $87 per additional person meeting guidelines at 6 months (per sensitivity analysis, $26 if delivered by volunteers and $114 by medical assistants), and $317 at 12 months (sensitivity analysis: $57 and $434). Incremental costs per person meeting guidelines in the Enhanced arm were modest and could be warranted given the potential health benefits of meeting PA guidelines.

Pasos Hacia La Salud II: study protocol for a randomized controlled trial of a theory- and technology-enhanced physical activity intervention for Latina women, compared to the original intervention

Background

Latinas are at increased risk for many lifestyle-related chronic diseases and are one of the least physically active populations in the US Innovative strategies are needed to help Latinas achieve the health benefits associated with physical activity (PA). This manuscript describes the study protocol of the Pasos Hacia La Salud II Study, which builds upon our previous research to test an enhanced individually-tailored, text-message and website-delivered, Spanish-language intervention (enhanced intervention), in comparison to the original web-based Pasos Hacia La Salud Intervention (original intervention).

Methods

Sedentary Latinas between the ages of 18–65 will be recruited and will complete an orientation and baseline assessments. Participants will be subsequently randomized to the original intervention, or the Enhanced Intervention, which has greater targeting of theoretical constructs such as self-efficacy, enjoyment, and social support, and which uses text messages and more dynamic and refined website features to encourage increased website use. Using a linear mixed effects regression model, we will simultaneously estimate the intervention effects on mean accelerometer-measured hours/week of moderate-to-vigorous PA (MVPA) at 6, 12, 18, and 24 months, with a subject-specific intercept (intent-to-treat sample). Change in self-reported MVPA, measured via the 7-day Physical Activity Recall, will be assessed as a secondary outcome using a similar model. We will investigate potential mediators of the intervention effect using a multiple mediation approach, and potential moderators by evaluating potential interactions. As an exploratory outcome, we will study the differences (among both study arms) in cost, in US dollars, per minute increases in weekly mean MVPA.

Discussion

The original Pasos PA intervention showed efficacy in helping Latinas increase PA; we expect the Enhanced Intervention to help a larger proportion of participants to increase and maintain their PA long term. This web- and text-based enhanced intervention could have great reach and dissemination potential, which could be capitalized on in the future to help to advance health equity. Adaptations made in response to the COVID-19 pandemic are also described in this manuscript.

Trial registration

Clinical Trial Number: NCT03491592. First posted April 9, 2018.

Advocacy to support climate and health policies: recommended actions for the Society of Behavioral Medicine

Climate change poses serious threats to public health and is exacerbating health inequities. Policy changes are essential to mitigate climate change impacts on human and planetary health. The purpose was to describe recommendations by the Policy and Advocacy Subgroup of the Society of Behavioral Medicine (SBM) Climate Change, Behavior Change and Health Presidential Working Group (PWG). The Policy and Advocacy subgroup was comprised of experts in public health, climate policy, and health behavior change, who worked together to identify priorities and develop recommendations. We worked under the premise that building political will for climate policy action is the most urgent goal, and we recommended promotion of citizen advocacy for this purpose. Because citizen advocacy is a set of behaviors, SBM members can use behavioral science to identify and scale up interventions, working collaboratively with communities targeted for marginalization. Recommendations for SBM included establishing an organizational home for climate and health work, providing training and resources, engaging in climate advocacy as an organization, and networking with other organizations. Recommendations for a proposed SBM Climate and Health Committee, Council, or Special Interest Group included developing trainings and resources, seeking opportunities for networking and collaborations, and identifying a research agenda. Individual behavior changes are insufficient to address climate change; policy actions are needed. SBM and similar organizations can support their members to work in developing, evaluating, and scaling up advocacy interventions for action on climate policy to magnify the power of the health and medical sectors to protect planetary and human health.

Regular and App-enhanced Maintenance of Physical Activity among Latinas: A Feasibility Study

Introduction

Few studies have focused on physical activity (PA) maintenance, particularly among minority populations; smartphone apps could provide valuable tools. This study aimed to 1) assess and understand PA maintenance among Latinas who completed a PA intervention; and 2) evaluate the feasibility, acceptability and preliminary efficacy of commercial smartphone apps as tools for PA maintenance.

Methods

For this feasibility study, 27 Latinas who completed a PA intervention and increased their PA were randomly assigned to enhanced maintenance (i.e., taught to use commercial smartphone apps, N=14), or regular maintenance (i.e., no additional treatment, N=13). After 3-months, the feasibility and acceptability of using apps for PA maintenance was assessed via survey questions, analyzed using descriptive statistics. PA was reassessed via the 7-day PA Recall and analyzed using longitudinal mixed effects regression models. Qualitative data were collected via open-ended interview questions and analyzed using thematic analysis.

Results

43% of enhanced maintenance participants reported using study apps at least "a little" and 21% using them "a lot." Although not statistically significant, enhanced maintenance participants reported a smaller drop in PA from post-intervention to post-maintenance, compared to regular maintenance participants. Several participants expressed approval of the apps, while others reported on factors that kept them from using the apps for PA maintenance.

Conclusion

Incorporating lessons learned from this study, larger randomized trials are warranted to evaluate the efficacy of using smartphone apps to support PA maintenance. The widespread use of apps could make them ideal tools to support PA maintenance after interventions in different settings.

Physical activity, well-being, and priorities of older women during the COVID-19 pandemic: a survey of Women's Health Initiative Strong and Healthy (WHISH) intervention participants

Sheltering-in-place, social distancing, and other strategies to minimize COVID-19 transmission may impact physical activity (PA) and well-being in older adults. To assess self-reported PA changes, well-being, and priorities of older women across the USA early in the COVID-19 pandemic. In May 2020, a 10-question survey was emailed to 5,822 women, aged over 70 years, who had been assigned to the Women’s Health Initiative (WHI) Strong and Healthy (WHISH) trial PA intervention and had provided email addresses. The survey assessed general and physical well-being, current priorities, and PA levels before and during the COVID-19 pandemic. Demographic and physical function data were collected previously. Descriptive analyses characterized participants’ priorities and PA changes from before the pandemic to the time of data collection during the pandemic. Differences in PA change by age, physical function, and geographic region were assessed by Kruskal-Wallis and post hoc Dunn tests. Among 2,876 survey respondents, 89% perceived their general well-being as good, very good, or excellent, despite 90% reporting at least moderate (to extreme) concern about the pandemic, with 18.2% reporting increased PA levels, 27.1% reporting no changes, and 54.7% reporting decreased PA levels. Top priorities “in the midst of the COVID-19 outbreak” were staying in touch with family/friends (21%) and taking care of one’s body (20%). Among priorities related to physical well-being, staying active was selected most frequently (33%). Support for maintaining PA in older populations should be a priority during a pandemic and similarly disruptive events.

Forming Habits, Overcoming Obstacles, and Setting Realistic Goals: A Qualitative Study of Physical Activity Maintenance Among Latinas

BACKGROUND

The impact of physical activity interventions for Latina women can be enhanced by identifying and implementing strategies to achieve long-term physical activity maintenance. Physical activity promotion research has mainly focused on physical activity initiation and we know little regarding individual, interpersonal, or environmental factors that influence maintenance of physical activity. This study aimed to qualitatively explore and understand factors associated with maintenance and non-maintenance of physical activity among Latinas.

METHODS

Semi-structured individual interviews were conducted with 21 Latinas who increased their physical activity as a result of an intervention, and who completed a 3-month maintenance period without contact from research staff. Data were analyzed using thematic analysis.

RESULTS

Important facilitators of physical activity maintenance described by participants included having made physical activity a habit; the ability to proactively overcome obstacles to engaging in physical activity, and satisfaction with outcomes obtained from engaging in physical activity. Additional facilitators mentioned by both maintainers and non-maintainers included having motivation, social support, and opportunities to be active. Both maintainers and non-maintainers reported high self-efficacy for PA maintenance in the future.

CONCLUSIONS

Guiding intervention participants to form habits and to set realistic expectations could help them to independently continue engaging in physical activity upon completion of physical activity interventions. Teaching them skills to proactively overcome obstacles may also be important for physical activity maintenance.

Sustainable Diets for Cardiovascular Disease Prevention and Management

PURPOSE OF REVIEW

Healthy dietary patterns are recommended for prevention of cardiovascular disease, which remains the leading cause of morbidity and mortality globally. In this review, we discuss dietary patterns that are not only optimal for CVD prevention and management but also sustainable in maximizing health, environmental, and economic benefits.

RECENT FINDINGS

The growing literature on sustainable diets in the context of environmental sustainability includes subtopics of climate change, land use, biodiversity loss, freshwater use, and reactive nitrogen emissions. Similarly, economic sustainability, beyond the retail cost of food, extends to healthcare costs and the economic costs of environmental destruction related to current agricultural practices and food choices. Dietary patterns that are high in plant foods and low in animal foods could maximize health, environmental, and economic benefits; however, questions remain about how to best promote these patterns to achieve wider adoption in an environmentally and economically sustainable way.

Lapse, Relapse, and Recovery in Physical Activity Interventions for Latinas: a Survival Analysis

BACKGROUND

Physical activity (PA) research extensively focuses on initiation of PA, yet lapse and relapse among PA intervention participants are less well understood, particularly among minority populations such as Latinas in the USA. This study aimed to (1) determine the probability of lapse during two PA interventions for Latinas; (2) assess demographic, psychosocial, and environmental predictors of the amount of time until first lapse; and (3) identify factors predictive of lapse recovery.

METHODS

Data from 176 Latina intervention participants were pooled. Survival functions and Kaplan-Meier curves were used to illustrate probability of lapse. Cox proportional hazard models assessed predictors of time to lapse. Logistic regressions identified predictors of lapse recovery.

RESULTS

The probability of lapse after 1 month of starting to exercise was 18%, escalating to 34% after 4 months. Predictors of earlier lapse included various psychosocial constructs (i.e., self-efficacy and various processes of change), but none of the measured environmental factors, and only one demographic factor (≥ 2 children under 18). Increased use of consciousness raising at 2 months was associated with lower likelihood of lapse recovery, yet use of behavioral processes of change at 6 months was associated with higher likelihood of recovery.

CONCLUSIONS

Lapsing may not be pre-determined by demographic and environmental characteristics. On the other hand, skills that can be learned through interventions, such as skills to improve self-efficacy, seem important in the delay or prevention of lapses. Results pertaining to lapse recovery are less clear.

Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors

BACKGROUND

Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors.

METHODS

In total, 693 participants aged 66-97 were sampled from two US locales in 2005-2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles.

RESULTS

More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC).

CONCLUSIONS

Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

Randomized Trial of a Physical Activity Intervention for Latino Men: Activo

INTRODUCTION

Latino men experience disproportionately high rates of diseases related to low physical activity, yet they are poorly represented in physical activity intervention trials. Efforts to promote physical activity in Latina women show promising results, yet such interventions are yet to be extended to Latino men. This study tested a computer expert system‒tailored, text messaging-supported physical activity intervention for underactive Spanish-speaking Latino men compared with a control group matched for contact time. Potential predictors of intervention success were also explored.

STUDY DESIGN

Randomized trial. Participants were randomized to receive a Tailored Physical Activity Intervention (Intervention) or a Wellness Control (Control). Data were collected in 2015-2017 and analyzed in 2018-2019.

SETTING/PARTICIPANTS

Insufficiently active Latino men (n=46).

INTERVENTION

Intervention participants received a baseline counseling session and then, individually tailored print materials and text messages on a tapered schedule for 6 months. Control participants received printed wellness materials and text messages on the same schedule.

MAIN OUTCOME MEASURES

Primary outcome was a change in weekly moderate to vigorous physical activity from baseline to 6 months measured by accelerometers. Self-reported moderate to vigorous physical activity measured by the 7-day Physical Activity Recall Interview was a secondary outcome.

RESULTS

For Intervention participants, median accelerometer-measured moderate to vigorous physical activity increased from 10.0 minutes/week at baseline to 57.5 minutes/week at 6 months, whereas for Control participants, it increased from 21.0 minutes/week at baseline to 23.0 minutes/week at 6 months (p<0.05). Similar results were found for self-reported moderate to vigorous physical activity. At 6 months, 47% of Intervention participants met national guidelines of 150 minutes/week versus 25% of Control participants (p=0.15, not significant).

CONCLUSIONS

Findings suggest that an individually tailored intervention can successfully increase moderate to vigorous physical activity in underactive Latino men. Such technology-supported interventions have the potential for broad dissemination.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02512419.

Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study

INTRODUCTION

Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention.

METHODS/DESIGN

The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings.

RESULTS

Participants (N = 199) are Latinas 18-65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change.

CONCLUSION

Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.

Association Between Physical Activity Intervention Website Use and Physical Activity Levels Among Spanish-Speaking Latinas: Randomized Controlled Trial

Background

The internet’s low cost and potential for high reach makes Web-based channels prime for delivering evidence-based physical activity (PA) interventions. Despite the well-studied success of internet-based PA interventions in primarily non-Hispanic white populations, evidence on Spanish-speaking Latinas’ use of such interventions is lacking. The recent rise in technology use among Latinas in the United States, a population at heightened risk for low PA levels and related conditions, suggests that they may benefit from Web-based PA interventions tailored to their cultural and language preferences.

Objective

The goal of the research was to examine participant engagement with various features of an internet-based PA intervention for Latinas and explore how use of these features was differentially associated with adoption and maintenance of PA behavior change.

Method

Pasos Hacia la Salud tested a Spanish-language, culturally adapted, individually tailored, internet-based PA intervention versus a Spanish language, internet-based, Wellness Contact Control condition for underactive Latinas (N=205, mean age 39.2 [SD 10.5] years, 84% Mexican American). These analyses examined engagement with the website and explored how use was associated with adoption and maintenance of moderate to vigorous physical activity (MVPA) behavior.

Results

Overall, participants logged on to the website an average of 22 times (SD 28) over 12 months, with intervention participants logging on significantly more than controls (29 vs 14.7, P<.001). On average, participants spent more time on the website at months 1, 4, and 6 compared to all other months, with maximum use at month 4. Both log-ins and time spent on the website were significantly related to intervention success (achieving higher mean minutes of MVPA per week at follow-up: b=.48, SE 0.20, P=.02 for objectively measured MVPA and b=.74, SE 0.34, P=.03 for self-reported MVPA at 12 months, controlling for baseline). Furthermore, those meeting guidelines by the Centers for Disease Control and Prevention for PA at 12 months (≥150 minutes per week of MVPA) logged on significantly more than those not meeting guidelines (35 vs 20 over 12 months, P=.002). Among participants in the intervention arm, goal-setting features, personal PA reports, and PA tips were the most used portions of the website. Higher use of these features was associated with greater success in the program (significantly more minutes of self-reported MVPA at 12 months controlling for baseline). Specifically, one additional use of these features per month over 12 months translated into an additional 34 minutes per week of MVPA (goals feature), 12 minutes per week (PA tips), and 42 minutes per week (PA reports).

Conclusions

These results demonstrate that greater use of a tailored, Web-based PA intervention, particularly certain features on the site, was significantly related to increased PA levels in Latinas.

Trial Registration

ClinicalTrials.gov NCT01834287; https://clinicaltrials.gov/ct2/show/NCT01834287

Psychometrics of the self-efficacy for physical activity scale among a Latina women sample

Background

Even though Latinos have become a priority population for the promotion of physical activity in the United States, several widely used scales in physical activity promotion research have not been validated among this population, particularly in Spanish. This study aims to assess the validity and other psychometrics of the Self-Efficacy for Physical Activity scale among a sample of Spanish-speaking Latina women who participated in the Pasos Hacia La Salud intervention. We also explored alternatives for scale simplification.

Methods

Data from 205 women corresponding to baseline, 6-month, and 12-month time points were analyzed. Internal consistency was assessed. A series of Spearman correlations, t-tests, linear regressions, and logistic regressions were used to assess the concurrent and predictive validity of the Self Efficacy for Physical Activity scale against both self-report and accelerometer-measured physical activity, using both continuous and categorical outcome data. Item Response Theory and factor analysis methods were used to explore alternatives to simplify the scale. Psychometric tests were repeated with the simplified scale.

Results

Cronbach’s alpha for the original scale was .72, .76, and .78 for baseline, 6-month, and 12-month data respectively. All concurrent validity tests conducted with 6-month and 12-month data, but not with baseline data, were statistically significant. Self-efficacy at 6 months was also predictive of physical activity at 12 months for all tests except one. Based on plots of Option Characteristic Curves, a modified version of the scale was created. Psychometric results of the modified scale were similar to those of the original scale.

Conclusions

This study confirmed the scale’s reliability and validity, and revealed that the scale’s accuracy improves when some response items are collapsed, which is an important finding for future research among populations with low literacy levels.

Promoting Physical Activity among Underserved Populations

Underserved populations, including racial/ethnic minorities, individuals with low socioeconomic status, and individuals with physical disabilities, are less likely to engage in sufficient moderate to vigorous physical activity (MVPA) and are thus at increased risk of morbidity and mortality. These populations face unique challenges to engaging in MVPA. Learning how to overcome these challenges is a necessary first step in achieving health equity through health promotion research. In this review of the literature, we discuss issues and strategies that have been used to promote MVPA among individuals from underserved populations, focusing on recruitment, intervention delivery, and the use of technology in interventions. Physical activity promotion research among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of efficacy in the use of certain recruitment and intervention strategies including tailoring, cultural adaptation, incorporation of new technologies, and multilevel and community-based approaches for physical activity promotion among different underserved populations.

Pasos Hacia La Salud: a randomized controlled trial of an internet-delivered physical activity intervention for Latinas

Background

Internet access has grown markedly in Latinos during the past decade. However, there have been no Internet-based physical activity interventions designed for Latinos, despite large disparities in lifestyle-related conditions, such as obesity and diabetes, particularly in Latina women. The current study tested the efficacy of a 6-month culturally adapted, individually tailored, Spanish-language Internet-based physical activity intervention.

Methods

Inactive Latinas (N = 205) were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. Participants in both groups received emails on a tapered schedule over 6 months to alert them to new content on the website. The primary outcome was minutes/week of moderate to vigorous physical activity (MVPA) at 6 months as measured by the 7-Day Physical Activity Recall; activity was also measured by accelerometers. Data were collected between 2011 and 2014 and analyzed in 2015 at the University of California, San Diego.

Results

Increases in minutes/week of MVPA were significantly greater in the Intervention Group compared to the Control Group (mean difference = 50.00, SE = 9.5, p < 0.01). Increases in objectively measured MVPA were also significantly larger in the Intervention Group (mean differences = 31.0, SE = 10.7, p < .01). The Intervention Group was also significantly more likely to meet national physical activity guidelines at 6 months (OR = 3.12, 95 % CI 1.46–6.66, p < .05).

Conclusion

Findings from the current study suggest that this Internet-delivered individually tailored intervention successfully increased MVPA in Latinas compared to a Wellness Contact Control Internet Group.

Trial registration

NCT01834287.

Type II diabetes disparities in diverse women: the potential roles of body composition, diet and physical activity

The rates of diabetes in the USA are rapidly increasing, and vary widely across different racial/ethnic groups. This paper explores the potential contribution of body composition, diet and physical activity in explaining diabetes disparities across women of different racial and ethnic backgrounds. For body composition, racial/ethnic groups differ widely by BMI, distribution of body mass and quantity and type of adipose tissue. Dietary patterns that vary across race/ethnicity include consumption of meat, added sugars, high-glycemic carbohydrates and fast food. Additionally, physical activity patterns of interest include aerobic versus muscle-strengthening exercises, and the purpose of physical activity (leisure, occupation, or transportation). Overall, these variables provide a partial picture of the source of these widening disparities, and could help guide future research in addressing and reducing diabetes disparities.