Are comorbidities associated with differences in healthcare charges among lung cancer patients in US hospitals? Focusing on variances by patient and socioeconomic factors

OBJECTIVE

The clinical aspects of lung cancer patients are well-studied. However, healthcare charge patterns have yet to be explored through a large-scale representative population-based sample investigating differences by socioeconomic factors and comorbidities.

AIM

To identify how comorbidities associated with healthcare charges among lung cancer patients.

METHODS

We examined the characteristics of the patient sample and the association between comorbidity status (diabetes, hypertension, or both) and healthcare charge. Multivariate survey linear regression models were used to estimate the association. We also investigated sub-group association through various patient and socioeconomic factors.

RESULTS

Of 212,745 lung cancer patients, 68.5% had diabetes and/or hypertension. Hospital charges were higher in the population with comorbidities. The results showed that lung cancer patients with comorbidities had 9.4%, 5.1%, and 12.0% (with diabetes, hypertension, and both, respectively) higher hospital charges than those without comorbidities. In sub-group analysis, Black patients also showed a similar trend across socioeconomic (i.e. household income and primary payer) and racial (i.e. White, Black, Hispanic, and Asian/Pacific Islander) factors.

DISCUSSION

Black patients may be significantly financially burdened because of the prevalence of comorbidities and low-income status. More work is required to ensure healthcare equality and promote access to care for the uninsured, low-income, and minority populations because comorbidities common in these populations can create more significant financial barriers.

Identifying Social Network Characteristics Associated With Youth Physical Activity Skill Competency at a Summer Care Program

While literature suggests that youth physical activity (PA) behaviors are affected by network influences, less is known about network influences on perceived skill competency, a component of physical literacy and self-efficacy. This study aims to provide an understanding of potential network characteristics which are associated with youth PA skill competency. Youth (n = 158) between the ages of 8 and 12 years recruited from two summer care programs (i.e., Boys & Girls Clubs) participated in researcher-administered surveys. Youth self-reported their age, sex, involvement in team sports, weekly PA, and skill competency assessed using a version of the PLAYself measure. Youth were also asked to report up to five people in the summer program and five out of the program with whom they interacted the most. Linear regression was used to evaluate associations between skill competency and demographics, PA, and social network characteristics. Skill competency was significantly associated (R2 = .17) with age (β = -.06, p = .01), sex (β = -.06, p = .01), sports team involvement (β = .16, p < .001), and weekly PA (β = -.20, p < .001). Skill competency was also significantly associated with the number of connections with whom the youth played frequently (β = .09, p < .001), the number of connections that helped the youth to be active (β = .18, p < .001), and the heterogeneity of the type of relationships within the youth's network (β = .11, p < .001). Skill competency scores were significantly associated with both individual variables and social network composition. In addition, youth with networks comprising several types of relationships (heterogeneity) reported a significantly high skill competency. PA interventions can be most effective when considering the reinforcing aspects of networks and skill competency.

Multifaceted Scoping Review of Black/African American Transportation and Land Use Expert Recommendations on Activity-Friendly Routes to Everyday Destinations

Promoting physical activity (PA) at the community level is a complex, multisector approach requiring researchers and practitioners to impact the individual, interpersonal, environment, and policy levels. One such strategy aiming to impact systems, policies, and environments is the Centers for Disease Control and Prevention's Activity Friendly Routes to Everyday Destinations (Routes to Destinations). This strategy specifically aims to connect pedestrian, bicycle, and public transportation systems with built environment and land use destinations. This article examines Black/African American transportation and land use experts' perspectives and concerns-across multiple mediums-around inequities that have discouraged PA among Black/African American persons specifically Routes to Destinations strategies. In March 2021, a multifaceted scoping review was conducted of peer-reviewed literature, gray literature, and social media authored by Black/African American transportation and land use experts focusing on policy, system, and environmental changes which promote or discourage equitable and inclusive access to physical activity. Themes from peer-reviewed and gray literature resources included: (1) Assessing Racism, Discrimination, and Segregation; (2) Addressing Equity and Inclusion Through Policy; (3) Community Engagement and Place-Based Interventions; (4) Infrastructure Changes; (5) Safety; and (6) Reporting Health Disparities. Twitter topic models suggested the main topics included elements of race/racism, equity, safety, infrastructure, and advancing social justice. Experts called for systemic and systematic change through new policies and implementation of existing policies as well as enhanced community inclusion in decision-making through ownership of policy and built environment change. Safety was discussed differently between peer-reviewed and gray literature and Twitter discussions indicating a publication bias.

Physical activity among transgender individuals: A systematic review of quantitative and qualitative studies

Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.

Personal Agency and Social Supports to Manage Health Among Non-Hispanic Black and Hispanic Men With Diabetes

The prevalence of type 2 diabetes (T2D) is increasing among non-Hispanic Black and Hispanic communities, especially among men who develop this chronic condition at earlier ages. Personal agency and social support are vital aspects to diabetes management. However, less is known about the relationship between these variables among men living with diabetes. The purposes of this study were to identify (1) levels of personal agency to manage health, (2) sources of social supports to manage health based on personal agency levels, and (3) factors associated with lower personal agency to manage health. Cross-sectional data from non-Hispanic Black (n = 381) and Hispanic (n = 292) men aged 40 years or older with T2D were collected using an internet-delivered questionnaire. Three binary logistic regression models were fitted to assess sociodemographics, health indicators, and support sources associated with weaker personal agency to manage health. About 68% of participants reported having the strongest personal agency relative to 32.1% reporting weaker personal agency. Men who relied more on their spouse/partner (odds ratio [OR] = 1.22, p = .025), coworkers (OR = 1.59, p = .008), or faith-based organizations (OR = 1.29, p = .029) for ongoing help/support to improve their health and manage health problems were more likely to have weaker personal agency. Conversely, men who relied more on their health care providers for ongoing help/support to improve their health and manage health problems were less likely to have weaker personal agency to manage health (OR = 0.74, p < .001). Findings suggest personal agency may influence men's support needs to manage T2D, which may also be influenced by cultural, socioeconomics, and the composition of social networks.

An iSOPARC Case Study of Physical Activity at a Pop-Up Park

Purpose: Child physical activity (PA) is vital for physical and mental health, yet many children do not meet recommendations. Temporary, place-based programs designed to provide PA opportunities to youth could be a promising approach. This case-study describes familial PA at a suburban pop-up park (PUP) occurring on a weekend during the school year. Methods: iSOPARC (v 1.85) was used with double-rater reliability for a total of four rounds (one round every 30 minutes starting 15 minutes into the event) documenting the PA of individuals in each of the nine target areas at the PUP. PA was dichotomized into physically active (walking or vigorous) and sedentary (sitting or standing). Descriptive statistics were generated. Results: 179 individuals were observed (62% female, 26% children, 28% teens, 45% adults). Overall, 53% (n = 47) of children, 18% of teens (n = 11), and 17% (n = 14) of adults were observed as physically active. Per target area, percentages of physically active individuals were: 93% physically active (n = 14) at the playground, 44% physically active (n = 7) during basketball, 41% physically active (n = 9) during open play, 40% physically active (n = 4) during kickball, 24% physically active (n = 5) at check-in, 20% physically active (n = 6) in the snack area, 11% physically active (n = 2) during reading time, 10% physically active (n = 1) during lawn games, and 6% physically active (n = 2) during boxing. Conclusion: This observational case study provides an example of how PUPs during the school year may be a helpful tool to encourage weekend PA across communities. Future studies should consider the social environment on youth PA.

Cultivating an Active Living Plan Through a Social-Ecological Evaluation

Physical activity (PA) social-ecological model (SEM) posits the importance of several levels of influence critical for PA promotion within communities. The purpose of this study was to examine an SEM evaluation informing a county-wide active living plan in McLennan County, Texas in the United States. Mixed-methods evaluation occurred in 4 stages: (1) county policies (n = 15) were evaluated for PA promoting strategies; (2) PA resource assessments (PARAs) were conducted via Google Maps (n = 171); (3) surveys (n = 244) included the International Physical Activity Questionnaire and interpersonal and intrapersonal factors related to PA; and (4) focus groups (n = 5) were conducted with residents (n = 30), discussing barriers and facilitators to being active. Logistic regression determined significant associations between SEM factors and meeting PA recommendations. Policy scans and PARAs identified strengths and areas of improvement (eg, equitable project selection and disparities in resource quality). Residents reporting fewer barriers (OR = 0.89, P =.01), more perceived behavioral control (odds ratio [OR] = 1.38, P = .01), more social co-participation in PA (OR = 1.20, P = .03), and living in zip codes with higher mean PARA score (OR = 1.22, P = .04) were significantly more likely to meet PA recommendations (Nagelkerke R2 = 0.32). Focus groups also discussed safety and disparities in access and quality. This study suggests the utility of the SEM when evaluating and promoting community PA.

Intramural sports social networks and implications for college student physical activity, sense of community, and retention

Objective: This study examines associations between social networks developed through intramural sports and physical activity (PA), sense of community, and retention. Participants: College students participating in intramural sports at a large public university in the Southern United States (n = 250). Methods: Students self-reported PA, sense of community, retention, and social networks developed through intramural sports in Fall 2022. Logistic and linear regression determined significant individual and network factors associated with PA, sense of community, and retention. Results: Participants were significantly more likely to meet PA recommendations (Nagelkerke R²=.24) if they were younger, male, and reported more people in their networks were physically active often. Participants reported a greater sense of community (R² =.28) and retention intention (R² =.26) if they reported meeting PA recommendations, feeling closer to network members, and more relationships improving through intramurals. Conclusion: Results underline the importance of creating quality intramural experiences for college students.

I'll be there for you: The effects of exercise engagement on social support provision within undergraduate students' personal networks

Objective: To use social network analysis to examine exercise participation relative to health and wellness support provision within students' networks. Participants: 513 undergraduates from a large private university completed online surveys. Methods: Multilevel modeling assessed exercise engagement at the individual and dyadic level and support provision from network members. Results: More support was perceived by first and second-year students and individuals who reported more exercise engagement. Significant others, roommates, siblings, female network members, and those who exercised often provided greater support. Greater support was reported when both the participant and their social tie were involved in the campus group-exercise program. Conclusion: This study suggests individual and dyadic-level exercise was related to undergraduates feeling more supported. Findings support campus group exercise programs as opportunities to create reciprocal supportive ties for college students. Future research could further explore ways exercise and social support, particularly in group settings, affect health and well-being.

Bridging the Built and Social Environments: A Systematic Review of Studies Investigating Influences on Physical Activity

BACKGROUND

The purpose of this review was to examine articles assessing aspects of the built and social environment simultaneously, and how these environments influence physical activity (PA). A thorough review of studies is needed to identify patterns across studies and gaps for future research and practice.

METHODS

To be included, articles needed to contain: (1) self-report or objective measure of PA; (2) a measure of the built environment; (3) a measure of the social environment; and (4) an analysis between built environment, social environment, and PA. A systematic literature search of 4358 articles resulted in 87 articles.

RESULTS

Several populations were present within the sample including various age groups and different countries. As previously established, the built environment and social environment were consistently associated with PA; however, mediating factors between these 2 layers were less clear. Further, there was a lack of longitudinal and experimental study designs.

CONCLUSIONS

Results suggest a need for longitudinal and experimental designs with validated and granular measures. As communities recover from the COVID-19 pandemic, a thorough understanding of how built environment factors enhance or detract from social connectedness and how this reciprocal relationship impacts PA behavior is needed for future policy, environment, and systematic change.

Differences in Physical Activity, Sedentary Behavior, and Mental Health of the Older Population in South Korea Based on Marital Status and Gender

The primary purpose of the present study was to assess differences in physical activity (PA), sedentary behavior (SB), and mental health (i.e., depression, suicidal thoughts, and cognitive function) by marital status (i.e., married and widowed) within an aging population in South Korea. PA, SB, and mental health were evaluated in 9092 older adults by comparing the married group (n = 5773, 73.2 ± 5.9 years, 63.5%) to the widowed group (n = 3319, 75.8 ± 6.8 years, 36.5%). Between-group differences in PA, SB, depression, and cognitive function were tested using independent t-tests, and the association between marital status and gender was evaluated using two-way ANOVA. Suicidal thoughts were analyzed using a Mann-Whitney U-test. Older adults in the widowed group participated in significantly less PA (p < 0.001) and had higher SB (p < 0.001) per week, especially the widows, who had significantly less PA (p < 0.01) and had higher SB (p < 0.001) compared to married women. Participants in the widowed group experienced more depression (p < 0.001) and suicidal thoughts (p < 0.001) and had significantly lower cognitive function compared to participants in the married group (p < 0.001). Between the two groups, widowers were more vulnerable to all mental health factors compared to those in the married group. At the same time, widows were only more vulnerable to depression and cognitive function compared to women in the married group. Findings indicated that the presence of a spouse is strongly associated with higher PA levels, lower SB, and better mental health among older adults. Spouses are the primary social supports and play a major role in the health and emotional well-being of the aging population. Given the importance of the spouse, our study suggests that health educators working with older widows should prioritize several different forms of social support to benefit their physical and mental health.

Health-Related Behaviors and Psychological Status of Adolescent Patients with Atopic Dermatitis: The 2019 Korea Youth Risk Behavior Web-Based Survey

OBJECTIVE

Atopic dermatitis (AD) is one of the common chronic diseases that occur in children and adolescents as a chronic relapsing pruritic inflammatory skin disease. This study investigated how AD is associated with stress and depressive symptoms in a large representative sample of adolescents in South Korea.

METHODS

The Korea Youth Risk Behavior Web-based Survey 2019 was used in this study (n = 57,069, weighted national estimates = 2,672,170). Multivariate logistic regression was used to determine significant associations between AD and mental health, measured by stress and depressive symptoms. Sub-group analysis was also conducted using various socio-economic variables.

RESULTS

Among the present sample, 6.5% of adolescents (n = 173,909) were diagnosed with AD in the past 12 months. After adjusting for other variables, AD diagnosis was associated with significantly higher odds of experiencing stress (OR = 1.43) and depressive symptoms (OR = 1.32) as compared to adolescents without AD. A similar trend is found in subgroup model analysis using socio-economic variables (ie, education levels, parent's income levels, and residence area). Specifically, female adolescents with AD, adolescents of low socio-economic status, those reporting smoking and drinking experience, and who do not participate in regular physical activity are more vulnerable to stress and depressive symptoms.

CONCLUSION

This is a noteworthy finding because it denotes that AD may lead to negative outcomes, like depressive symptoms or stress, which could be prevented if suspected early.

The Importance of Social Networks for Support and Health Beliefs throughout Pregnancy

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

Beyond Walking: An Assessment and Description of Streets as Potential Physical Activity Places in Low-Income Communities

Low-income communities often have fewer quality community-level physical activity places (PAPs) or resources (e.g., parks, playgrounds). When present, barriers like traffic, distance, and crime often prevent access. Creative solutions and better understanding of current and potential realistic PAPs are necessary for children and families to be active. Streets are rarely considered potential PAPs despite their ubiquity and accessibility. This article describes street segments as potential PAPs in two low-income Mexican-heritage colonias communities along the Texas-Mexico border. Promotora-researchers conducted PAP assessments of all street segments (n=867) in the two communities to describe the availability and quality of their physical activity features (e.g., basketball hoops, bicycles), amenities (e.g., paved driveways, yard space), and incivilities (e.g., vandalism, loose dogs). Streets in these communities did contain features and amenities associated with physical activity promotion. On average, street segments had 6.10 (SD=7.20) physical activity-promoting features, 27.65 (SD=27.30) physical activity-promoting amenities, and both were assessed as good-to-fair quality. Future physical activity programming should consider incorporating streets as potential PAPs to enhance physical activity and active play. Further, evaluating streets as PAPs in this way may provide insight into locations for temporary place-based programs such as Play Streets. Future research should also examine residents' perceptions of their streets as PAPs for safe physical activity and active play, not just as places to walk, and which PAP characteristics matter for safe physical activity and active play to occur on streets.

Real-Time Video Scan Method for Community Partner Use to Inform Play Streets Implementation

System for Observing Play and Recreation in Communities (SOPARC) can provide accurate assessment of physical activity; however, the skills, time, and human resources necessary to collect/interpret SOPARC data can be challenging for community organizations. This article describes a more accessible adaptation of SOPARC using video recordings for community organizations to obtain physical activity feedback at Play Streets. Narrated panoramic video scans occurred every 30 minutes at each Play Street using an iPad. Videographers narrated: (1) sex, (2) age group (child, teen, adult, senior), and (3) activity level (sedentary, walking, vigorous) for everyone recorded. SOPARC video scans, in-person iSOPARC observations, and interviews were conducted with Play Streets implementors to determine validity and feasibility. Validity was examined using Lin's concordance correlation coefficient (CCC). In-person and video scans showed near perfect agreement for sedentary individuals (CCC = .95) and substantial agreement for active individuals (CCC = .72). Overall, community partners felt that they "could see how [the scans] could be useful" and "help[ed] see a bit more clearly what's happening." The method described here is a more accessible systematic observation approach to measure physical activity for communities implementing Play Streets. Further, this method can be used without research training while still providing valuable activity feedback.

Community health improvement plan: Study protocol for Kansas City's intervention and implementation evaluation

Objectives

Community health improvement plans (CHIPs) are foundational public health practice, yet no studies have been conducted to understand implementation of these plans. This evaluation study of the Kansas City CHIP aims to 1) identify implementation strategies used in the CHIP, 2) assess changes in implementation, service, and client outcomes, 3) assess contextual factors associated with implementation, and 4) understand social networks of coalitions who implement the Kansas City CHIP.

Study design

This study protocol uses a unique, mixed methods approach to evaluating process and outcomes of the Kansas City CHIP. This study is supported by Proctor's Model of Implementation, RE-10.13039/100003582AIM (reach, effectiveness, adoption, implementation, maintenance), and the practical, robust implementation and sustainability model (PRISM).

Methods

Staff and community members involved in implementing the Kansas City, Missouri CHIP will be invited to participate in an annual online survey, a series of focus groups, and quarterly implementation logs to assess implementation and sustainability.

Results

RE-AIM and PRISM constructs are the primary and secondary outcomes of interest. Results of this study will be available from the first year of implementation in 2023, with future results provided annually.

Conclusions

This project will fill a much-needed gap in the literature by understanding how large-scale coalitions implement projects that aim to improve population health and health equity. CHIPs have the potential to improve population health, yet few studies have been conducted on CHIPs, with no studies to date assessing outcomes. To support effective implementation and sustainability as well as improve public health outcomes, researchers need to evaluate CHIPs and develop models of implementation that can quickly be integrated into practice to improve populations’ health.

Egocentric network composition and structure relative to violence victimization among a sample of college students

ObjectiveTo use egocentric network analysis to understand how composition and structure of egonetworks relate to violence victimization among college students. Participants: 697 students from a large southeastern university completed online surveys. Methods: Hierarchical logistic regression analyses assessed the relationship between egocentric network variables and a history of violence victimization. Results: Being connected to others with a history of violence victimization increased a student's odds of indicating their own history of physical, emotional, and sexual violence victimization. Having less dense egonetworks was related to sexual violence victimization, while being connected to less people of the same gender was related to emotional violence victimization. Conclusion: The way college students' networks are composed and structured could help in understanding violence victimization in this population, and should be considered in prevention and reactionary efforts on campuses. These findings add to the current literature largely focused on individual-level risk factors related to violence.

Promotoras de Salud in a Father-Focused Nutrition and Physical Activity Program for Border Communities: Approaches and Lessons Learned from Collaboration

Promotoras de salud (promotoras) have been a valuable part of community research for Latino families, such as in the recruitment or delivery of health promotion programs. However, there has been limited discussion of how to integrate a promotora model into a father-focused program to support nutrition and physical activity within Latino families. This manuscript's purpose is to describe how to engage and collaborate with promotoras in a father-focused, family-centered program for Latino families living in colonias near the U.S.-Mexico border. As part of a longstanding community-academic partnership, the authors outline approaches and lessons learned from collaboration with promotoras during the design (including formative work and training), implementation, and evaluation of a behavioral program-¡Haz Espacio para Papi! (HEPP, Make Room for Daddy!). Promotoras' contributions supported the entire program, from design through evaluation. The team of all-female promotoras created a balance between the needs and preferences of the community and the goals and requirements of the research. While there is considerable time and human capital required for collaboration, the mutual benefits can make this work meaningful to all involved.

Conducting Physical Activity Research on Racially and Ethnically Diverse Adolescents Using Social Network Analysis: Case Studies for Practical Use

Adolescent physical activity (PA) is significantly impacted by peer behaviors through peer influence, peer selection, and popularity. However, the scales for these social constructs may not fully capture the detailed social networks and mechanisms responsible for PA behavior changes. This level of detail and granularity can be quantified and analyzed through social network analysis (SNA). To demonstrate the variety, utility, and efficacy of SNA in adolescent PA research, this article aims to provide four case studies on the collection of social network and PA data on ethnically and racially diverse adolescents. Through case studies, this article provides tangible ways in which SNA can be used to evaluate social influences on PA behaviors. Case studies are presented on: (1) Youth Engagement in Sport-an egocentric analysis of middle school youth participation in an experiential sport program with 3- and 6-month follow-ups; (2) Summer care program networks-an egocentric and whole network longitudinal study of adolescents at summer care programs; (3) The Convoy method-a qualitative egocentric discussion activity with adolescents from colonias on the Texas-Mexico border; and (4) A father-focused, family-centered health program-an egocentric experimental analysis of children participating in a health program. Data collection procedures are listed and example surveys are provided. Descriptive analyses are included, as are recommendations on further analysis techniques for each type of network data. Using SNA, researchers can understand social contexts in a more specific manner, better positioning interventions to alter such influences.

Associations Between Sexual Assault Victimization and Risky Drinking Within College Women's Personal Networks

Within a sample of college women, this study assessed if an individual's (i.e., ego) history of sexual assault was related to her connecting with risky drinkers, and if her social contacts (i.e., alters) who had experienced sexual assault were also people who engaged in risky drinking. Results suggest ego's history of sexual assault was associated with her connecting to risky drinkers. Generally, egos reported alters who experienced sexual assault were more likely to drink in higher quantities, except when the ego and alter both had experienced sexual assault. Findings highlight the importance of social connections for survivors of sexual assault.

Exercise in the Treatment of Addiction: A Systematic Literature Review

BACKGROUND

Exercise has been recognized as a promising and emerging treatment for individuals recovering from addiction. The purpose of this article was to systematically review scientific studies using exercise as a means to improve, sustain, or treat addictions, and to provide suggestions for the future use of exercise as a treatment method for addiction.

METHODS

Using PRISMA guidelines, a database search was conducted for articles that tested the impact of exercise interventions on addiction-related outcomes. To be included, peer-reviewed experimental design studies had to use human subjects to investigate the relationship between exercise and the treatment of or recovery from addiction. Garrard's Matrix Method was used to extract data from reviewed articles (n = 53).

RESULTS

Nearly three quarters of the studies reviewed documented a significant change in addiction-related outcomes (e.g., more days abstinent, reduced cravings) in response to exercise exposure, particularly while someone was receiving treatment at an in or outpatient clinic. Many studies investigated the effect of acute bouts of exercise on nicotine dependence, and many studies had small sample sizes, leaving room for future research on how exercise might benefit people recovering from substance and process addictions.

CONCLUSION

Results affirm that exercise can be a helpful aspect of addiction treatment. Future researchers should investigate different exercise settings (e.g., group-based exercise vs individual) and explore exercise maintenance and the long-term outcomes following discharge from treatment facilities.

I CrossFit; Do You? Cross-Sectional Peer Similarity of Physical Activity Behavior in a Group High Intensity Functional Training Setting

Physical activity (PA) is essential for physical, mental, and emotional health; however, few adults engage in enough PA. Group exercise environments such as CrossFit can promote sustained exercise habits through social influence, support, and norms. This cross-sectional study aims to provide evidence for PA social influence at CrossFit. CrossFit members (n = 62) reported PA, workout logging frequency, and members at their gym they: (1) work out with and (2) go to with personal matters. Separate linear network autocorrelation models (LNAMs) determined if individuals reported similar PA scores as those of their social ties at CrossFit that they work out with and/or those they go to for personal matters. Participants reported a mean of 2740.55 MET minutes/week (SD = 1847.08), working out with a mean of 9.89 members (SD = 6.26), and speaking to a mean of 2.66 members about personal matters (SD = 3.68). A person's PA was significantly associated with that of their ties they go to with personal matters (PE_p = 0.08, SE_p = 0.02), but was not associated with the PA of their ties they work out with (PE_w = 0.02, SE_w = 0.01). Social influence on PA levels was present when a deeper connection is made between members. Fostering and promoting deeper connections between members may help promote PA and continued exercise habits.

¿Qué Está Haciendo Papá? Mexican-Heritage Fathers' Physical Activity Networks After a Father-Focused Health Program

Physical activity (PA) is a public health priority due to holistic health benefits; however, many adults do not meet PA guidelines. Few studies have examined Mexican-heritage fathers' social networks, specifically with whom they are physically active. This study examines changes in Mexican-heritage fathers' PA networks after participation in a father-focused, family-centered health program. Families consisting of child (aged 9-11 years), mother, and father were recruited from colonias on the Texas-Mexico border for participation in a 6-week father-focused, family-centered program concentrated on healthy eating and active living. Fathers reported up to 5 people with whom they were active most in the previous month before and after the program as well as how often they were active with the person and what activities they did most often. Multilevel regression models examined changes in networks. Fathers (n = 42; mean age = 39.07 years, SD = 7.45) were significantly more likely to report more frequent PA with others after the program as compared with before. General active play and conditional support were mentioned most frequently. This study provides context to the social networks and PA behaviors of Mexican-heritage fathers and suggests that a father-focused, family-centered health program can increase the PA frequency with social network connections.

I Play, You Play, We Play: Concurrent Activity at Play Streets

Purpose: Despite multiple health benefits, many children and teens do not achieve recommended amounts of physical activity (PA). Temporary changes to the built environment like Play Streets, temporarily closing streets to create safe places to play, are one solution to encourage PA in summer months. Play Streets can promote social cohesion by creating opportunities for concurrent activity, being active in the same area simultaneously. This study assesses concurrent activity at Chicago PlayStreets. Methods: During summer 2018, the System for Observing Play and Recreation in Communities (SOPARC) and iSOPARC mobile application were used to measure PA at PlayStreets (n = 11) organized by eight community partners. Odds ratios were used to determine odds of observing an individual as active when in the same target area as another individual, and when in the same target area as an active individual, separated by sex and age categories. Results: Presence of an active individual significantly increased odds of observing an individual as active for several sex and age stratifications. Specifically, presence of active children or an active male adult significantly increased odds of observing children and teens as active. In contrast, presence of another person alone was not shown to significantly increase odds of observing an individual as active, except in two instances when stratified by sex and age. Conclusions: Active male adults have a significant positive impact on activity levels at PlayStreets underlining the importance of engaged male figures. Additionally, findings suggest that active children can promote PA among other children at PlayStreets.

Summer Friends and Physical Activity: Social Network Effects on Child Self-Reported Physical Activity at Summer Care Programs

Summer is a time of reduced physical activity (PA) for children; however, summer care programs (SCPs) can provide opportunities for children to be active and foster friendships. This study investigated associations between PA and friendship formation at SCPs. Children (ages 8-12 years) from two SCPs reported demographics, PA, and up to five friends at the program. Exponential random graph modeling determined significant factors associated with connections at each time point and between time points. PA was a significant factor in sending and maintaining friendship connections. A further understanding of the social dynamics which assist in the maintenance of PA behaviors during summer may improve the odds children engage in the recommended amounts of PA during this crucial time.

Assessing Social Network Influences on Adult Physical Activity Using Social Network Analysis: A Systematic Review

OBJECTIVE

Social network analysis (SNA) can measure social connectedness and assess impact of interpersonal connections on health behaviors, including physical activity (PA). This paper aims to systematically review adult PA studies using SNA to understand important social network concepts relative to PA.

DATA SOURCE

A search was performed using PsycINFO, MEDLINE, PubMed, and Web of Science.

STUDY INCLUSION AND EXCLUSION CRITERIA

To be included in the search, articles needed to 1) include a measure of PA, 2) conduct an SNA in which specific relationships were measured, and 3) conduct an analysis between social network measures and PA.

DATA EXTRACTION

Key study elements including network design and results were extracted.

DATA SYNTHESIS

Data were synthesized to answer 2 questions: 1) how has adult PA been investigated using SNA approaches and 2) how is an adult's social network associated with PA behaviors?

RESULTS

A final sample of 28 articles remained from an initial 11 085 articles. Network size, homophily, network composition, and network exposure to PA were all associated with individual level PA across studies. Lastly, longitudinal and intervention studies showed a more complex picture of social influence and diffusion of PA behavior.

CONCLUSIONS

Adults' PA behaviors are influenced by their networks. Capitalizing on this influence, researchers should engage not just individual behavior change but also the social influences present within the person's life.

Effectiveness of Disseminating School Physical Activity Information on Facebook during a Pandemic: A Mixed-Method Analysis

BACKGROUND

Social media is an important communication tool during times of crisis because of its vast reach. Understanding the effectiveness of sharing public health guidance and promoting schoolchildren's physical activity during the COVID-19 pandemic can inform dissemination best practices.

METHODS

We classified 418 posts from parent/community members of a school-based physical activity Facebook group by content type, and used concurrent mixed methods to examine (1) differences in dissemination effectiveness (reactions, shares, and comments) between two pandemic phases and (2) themes and sentiments of comments. Phase I included school closures through the release of national school re-entry guidelines (March 1, 2020 - May 15, 2020) and Phase II extended through the school year start (May 16, 2020 - August 1, 2020).

RESULTS

Policy and guidance posts prompted more comments while feel-good stories produced more reactions compared to other content types. Members reacted more during Phase II, which mainly consisted of policy and guidance (86%). Four major themes of information and resources, personal disclosures, questions and concerns, and support for educators emerged.

CONCLUSIONS

Sharing public health guidance for schoolchildren on social media was an effective strategy to disseminate information when in-person discourse was limited. Creating social media spaces where discussion is encouraged can provide social and emotional support for parents/community members.

Designing for Multilevel Behavior Change: A Father-Focused Nutrition and Physical Activity Program for Mexican-Heritage Families in South Texas Border Communities

Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.

The Effects of Play Streets on Social and Community Connectedness in Rural Communities

Promoting physical activity (PA) is a long-standing public health initiative to improve overall health and wellbeing. Innovative strategies such as Play Streets, temporary activation of public spaces to provide safe places for active play, are being adopted in urban and rural communities to increase PA among children. As part of these strategies, aspects of social and community connectedness may be strengthened. This study analyzes focus groups and interviews from rural Play Street implementation team members (n = 14) as well as adults (n = 7) and children (n = 25) who attended Play Streets hosted in rural North Carolina, Maryland, Oklahoma, and Texas to better understand the added benefits of Play Streets in community connectedness. Overall, elements of social support and social cohesion are mentioned most frequently with instrumental and conditional support; however, concepts of social capital, collective-efficacy, and social identification are also presented. Participants expressed that Play Streets provided more than just PA; they provided opportunities to access and share resources, build perceptions of safety and trust in the community, and develop relationships with others. Fostering community connection through Play Streets may reduce health inequities in rural communities by building community resilience. Community-based PA programming that enhance and capitalize on community connectedness could be effective ways to improving the overall health and wellbeing of residents.

¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families

Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children’s PA.

Active Play Network Influences on Physical Activity Among Children Living in Texas Colonias

Physical activity (PA) is beneficial for child health; however, few children meet PA guidelines. Social relationships impact child PA behaviors; however, little is known about this effect in Mexican-heritage populations. This study aims to understand associations between self-reported play networks and PA among Mexican-heritage children. Mexican-heritage children from colonias along the Texas-Mexico border (n = 44; 54.5% girls; mean age = 9.89 years, SD = 0.97) reported information on up to 5 people they played with most often. Linear regression was used to analyze the relationship between composition of children's social network and minutes of moderate- to vigorous-intensity PA (MVPA) and sedentary minutes per day measured by accelerometers. Children who reported a higher percentage of friends as opposed to family members attained significantly more minutes of MVPA per day (β = .27, P = .04). Children who reported playing with individuals in their network more often (β = ‒.28, P = .03) were sedentary for fewer minutes per day. Increasing the connections between children in the neighborhood or community, as well as increasing a child's frequency of active play, may be promising approaches to increasing MVPA and decreasing sedentary behaviors among Mexican-heritage children.

Social networks, group exercise, and anxiety among college students

This study aimed to evaluate the relationship between group exercise membership, social network characteristics, and general state anxiety in a sample of college students. Participants: 490 undergraduates from a private university in the southern US participated in the study. Methods: An egocentric network analysis was conducted to test whether demographic variables, leisure-time physical activity, group exercise membership, flourishing scores, and network variables were related to anxiety. Results: Regression analyses (R² = .174, F = 7.650, p < .0001) suggest group exercise membership (β = -.105, p = .034) and flourishing scores (β = -.342, p < .0001) were related to lower anxiety scores, while being a racial/ethnic minority (β = .094, p = .036), and having personal networks composed of more people who exercise often (β = .100, p = .025), were related to higher anxiety scores in this sample. Conclusions: Findings suggest a connection between group exercise membership, activity habits of peers, and anxiety. Encouraging group exercise participation could be an effective way of combating anxiety for college students.

A social network approach to analyzing body dissatisfaction among sorority members using two network generators

Objective: This article uses social network analysis (SNA) to analyze how various measures of social connectedness relate to body dissatisfaction (BD) in sorority members.Participants: 208 sorority members participated in the study.Methods: Measures of social connectedness (network variables) were created based on two relational networks: persons members felt closest to and persons they spent the most time with. SNA tested whether demographic variables, body mass index (BMI), compulsive exercise, and network variables were related to BD in both networks.Results: Members reported BD was related to less social connectedness in the "close-to" and the "time-spent" networks, although specific network variables varied between the two. Compulsive exercise, BMI, and grade classification were related to BD in both networks.Conclusions: How a sorority member connects to others in her network could impact BD in this population. This study supports efforts facilitating increased social connection within a sorority as a means to decrease BD.

A social network analysis approach to group and individual perceptions of child physical activity

Child physical activity (PA) is influenced by social environment. Self-perception and perception of others' behaviors may impact health behaviors such as PA. This study examines associations between child networks, perception of their own PA and the network's perception of their PA. Children (n = 89, M age = 10.00, SD = 1.34) at a summer care program reported demographics (54% female; 46% Black), PA, and physical skill competency. Children indicated up to five people they interacted with the most while at the program and how active they perceived each person to be. Multilevel modeling was used to determine significant associations between skill competency, network measures, and child's perception of their own PA, the network's perception of their PA, and the absolute difference between the two. Children perceived themselves to be more physically active if they perceived their friends were more physically active. Children who were central in the network and more physically competent were perceived as more active by their peers. Absolute differences between self-reported and network perceived PA were significantly larger for females. This work builds on understanding of how network position may impact child PA perceptions at summer care programs. Implications of these perceptions for PA promotion programs are discussed.

Differences in Child Physical Activity Levels at Rural Play Streets Due to Activity Type and Sex

Children are significantly less active during summer months, and rural children may face unique barriers to engaging in physical activity. Play Streets is a low-cost way communities can provide safe play opportunities by activating public spaces. Four low-income rural communities received mini-grants to implement four three-hour Play Streets throughout summer 2017 for a total of 16 Play Streets. System for Observing Play and Recreation in Communities (SOPARC) and iSOPARC were used to assess physical activity. Chi-square tests of homogeneity determined significant differences in the proportion of children observed as active based on sex and target area type. Binomial logistic regression was used to determine if target area characteristics (i.e., type, equipped, supervised, organized) and presence of other active children or adults increased the odds of observing a child as active. In total, 1,750 children were observed across all 16 Play Streets; roughly half of all children (48.6% of boys, 48.7% of girls) were observed as active. There was no significant difference in proportion of children observed as active based on sex of the child (OR = 0.99, 95% CI:0.82-1.20). Significant differences in the proportion of active children were found between target area categories. Boys were significantly more likely to be observed as active in areas which were equipped or organized. All children were significantly more likely to be active if there was another active child present in the same area. These results add to the growing literature surrounding successful implementation of Play Streets in rural settings, social influence, and active play.

Network Analysis of the Social Environment Relative to Preference for and Tolerance of Exercise Intensity in CrossFit Gyms

Known for its ability to improve fitness and health, high-intensity functional training (HIFT) focuses on functional movements completed at high intensities, often yielding outcomes superior to repetitive aerobic workouts. Preference for and tolerance of high-intensity exercise are associated with enjoyment of and adherence to HIFT. Similarly, the social environment present within CrossFit, a popular group-based HIFT modality, is important to the enjoyment of and adherence to HIFT. This study aimed to test whether preference and tolerance were related to social connections within CrossFit networks. Linear network autocorrelation models (LNAMs) and exponential random graph models (ERGMs) were computed on sociometric and attribute data from members of three CrossFit networks (n = 197). LNAMs showed the preference and tolerance scores of someone's social connections were associated with their own in all three gyms, and ERGMs demonstrated preference and tolerance scores were associated with the presence of social ties within all networks. This study is the first to provide evidence for a relationship between social connections and preference and tolerance. Future longitudinal research is needed to determine if the social environment may influence and optimize a person's preference of and tolerance for HIFT.

Health coalition collaboration network, perceived satisfaction and success

PURPOSE

The health equity and prosperity of communities is closely linked to the effectiveness and success of local health coalitions. Social network analysis (SNA) is one mechanism to quantify and understand the factors leading to collaboration and effectiveness within these coalitions. This study aims to investigate network characteristics associated with perceived success and satisfaction in a health coalition and determine significant factors related to organizational collaborations.

DESIGN/METHODOLOGY/APPROACH

This study examined the Olympic Peninsula Healthy Community Coalition (OPHCC) which aims to prevent chronic disease in rural Clallam County, Washington. Representatives (n = 21) from member organizations (n = 18) were asked to report on organization characteristics, perceived satisfaction in coalition activities, perceived success toward coalition's mission, and collaborations with other organizations in the coalition. Multilevel modeling used to analyze whether an organization's position within the coalition network was associated with their perceived satisfaction and perceived success. Exponential random graph modeling was used to examine what factors may impact collaboration ties between coalition members.

FINDINGS

Organization representatives reported a total of 252 collaboration ties. In multilevel models, organization characteristics and network centrality scores accounted for between 61 and 68% of variance displayed in satisfaction scores and 45-61% of variance in perceived success scores. Exponential random graph modeling revealed activity level, for-profit status, and transitivity as significant factors in collaborative tie presence.

ORIGINALITY/VALUE

Encouraging consistent active participation, a balance of organizational type, and projects which require more than two collaborators may provide an environment for collaborative ties between organizations.

Physical Activity Space Methodology for Assessment and Prioritization (PASMAP): Combining systematic observations with community perceptions to identify community physical activity resource priorities

Despite benefits of physical activity (PA), most Americans are not regularly active, with notable disparities for residents of low-income communities. PA is positively correlated with resource availability and quality, which can be measured and quantified by PA resource assessment tools. However, community members' perceptions are often not considered. This study incorporates community perceptions with systematic environmental observations to identify community PA resource priorities. The PA Space Methodology for Assessment and Prioritization (PASMAP) includes three phases. Phase 1: Promotora-researchers completed 57 PA Resource Assessments (PARAs) in colonias along the Texas-Mexico border assessing quantity and quality of features, amenities, and incivilities. Characteristics were ranked using average PARA scores from all PA spaces. Phase 2: community advisory board (CAB) members (n = 36 from 3 CABs) ranked the importance of each feature, amenity, and incivility respectively; rankings were averaged and ordered. Phase 3: differences between phases 1 and 2 were calculated. Large differences indicated high discordance between systematic observations and perceived importance. Phase 1: highest ranked PARA characteristics were sidewalks, non-street lighting, and noise. Phase 2: CAB members ranked trails/paths, sidewalks, play equipment, bathrooms, drinking fountains, substance abuse evidence, and litter most important. Phase 3: multiple characteristics had high discordance: trails/paths, fenced-in open fields (features), drinking fountains (amenity), and litter (incivility); low quantity/poor quality yet perceived as highly important. Discordant characteristics identified through PASMAP provide evidence-based, community-valued recommendations on PA resource priorities for planning and advocacy. Future work should incorporate perceptions from additional community members and apply PASMAP methods to other environmental assessments.

Network Autocorrelation of Perceived Physical Activity Skill Competence Among Adolescents at a Summer Care Program: A Pilot Study

PURPOSE

This study investigates the possible association between adolescent friendship networks and perceived physical activity skill competence in a summer care program.

DESIGN

Adolescents participated in researcher-administered surveys at the start (T1) and end (T2) of summer.

SETTING

Adolescents at a Boys & Girls Club were sampled.

SAMPLE

Adolescents (age 8-12) completed researcher-administered surveys at T1 (n = 100; µ age = 9.9 years; 47% male; 55% Black) and T2 (n = 77; µ age = 9.8 years; 51% male; 49% Black).

MEASURES

Perceived skill competence was measured by asking adolescents to rate how good they felt they were at physical activity at the club. Adolescents were also asked to provide names of up to 5 peers whom they hung around with, talked to, and did things with the most while at the club.

ANALYSIS

Linear network autocorrelation models were used to determine network effects or clustering of perceived physical activity skill competence within the club.

RESULTS

There were significant network effects for adolescent perceived skill competency scores at T1 (β = 0.05, p < 0.01) and T2 (β = 0.05, p = 0.02), indicating adolescent perceived skill competence scores were associated with those of their friends.

CONCLUSIONS

Practitioners may wish to encourage the use of group or collaborative skill competency improvement activities as well as possibly pairing adolescents with differing skill competencies to foster improvement and possible diffusion of perceived skill competency.

The social network of medical case managers, housing providers, and health department staff in the Ryan White HIV/AIDS Program: A Midwest case study

BACKGROUND

Broad networks of providers in the Ryan White system are essential to end the HIV epidemic. Yet, there is little evidence that has assessed social networks of providers within HIV care networks. The purpose of this study is to provide a cross-sectional analysis of the role medical case managers (MCM), housing providers (HP), and health department staff (HDS), play in a Ryan White-funded area.

METHODS

All MCMs, HPs, and HDS (N = 57) in a Midwest Transitional Grant Area were invited to participate in a social network survey. Social network composition scores, exponential random graph modeling and ANOVA tests were conducted using SPSS and R Studio.

RESULTS

Communication in this network was significantly more likely between SW of the same provider type (e.g. MCMs communicating with other MCMs, β = .87, p<.001). HDS reported larger overall social networks (F(2,54) = 4.59, p = <.01), larger networks with other provider types (F(2,54) = 9.23, p<.001), and higher quality of relationships with other provider types (F(2,54) = 3.90, p<.05) than MCM or HP. HDS were more likely to communicate across the system than MCMs or HPs (β = .75, p<.001).

DISCUSSION

HDS play an important role in communicating across provider types in care delivery for HIV. Our results indicate that health departments represent essential agencies for broad dissemination of resources and knowledge, and may bridge communication barriers for coordination of housing support and HIV care delivery.

Assessing Physical Activity in Temporary Spaces: Application of SOPARC / iSOPARC® for Play Streets

Purpose: The System for Observing Play and Recreation in Communities (SOPARC) is a valid, reliable method for understanding how people engage in physical activity (PA) in various permanent settings (e.g., parks) and contexts. However, its utility, reliability, and validity in temporary spaces has not been examined. Temporary spaces can provide PA opportunities often absent in low-income communities due to inadequate safe permanent PA spaces. Play Streets involve temporary closure of streets or other publicly accessibly spaces (e.g., parking lots, open-fields) to create safe play spaces for a specified time-period. We describe the utility, reliability, and validity of using SOPARC to assess PA in temporary spaces like Play Streets. Method: Trained SOPARC/iSOPARC (iPad App) research staff completed systematic observations during Play Streets occurring in four diverse low-income rural U.S. communities during summer 2017. Results: We successfully used iSOPARC to document PA and how spaces were used at Play Streets (n = 16), confirming its utility, reliability, and validity. Unlike observations of permanent spaces, target areas could not be pre-established since play spaces often changed during set-up, requiring time onsite to identify target areas and boundaries. Play areas frequently appeared and/or disappeared during Play Streets, and this was systematically addressed by using physical target area boundaries instead of activities. Conclusions: Understanding how temporary spaces are used for PA is critical for promoting their use. SOPARC/iSOPARC methods are useful in a Play Streets' context; however, systematic methods and training are needed to address inherent unpredictable and dynamic changes within and across target areas.