Intake of Snacks and Sweets in a National Study of Built and Social Environments: The REasons for Geographic And Racial Differences in Stroke Study

BACKGROUND

Few national studies across the United States' rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults.

OBJECTIVE

This study examines associations of urbanicity/rurality-tailored measures of food store availability and neighborhood socioeconomic status (NSES) with the intake of snacks and sweets in a national sample of middle and older age adults.

METHODS

This cross-sectional study used food frequency questionnaire data collected in the REasons for Geographic And Racial Differences in Stroke study (N=21,204). What We Eat in America food group categorizations guided outcome classification into one main category (total snacks and sweets) and four subcategories (savory snacks and crackers; sweet bakery products; candy and desserts; nutrition bars and low-fat snacks and sweets). NSES and food store availability were determined using geographic information systems. Food store availability was characterized as geographic access to primary food stores (e.g., supermarkets, supercenters, and select food retailers) in urbanicity/rurality-tailored neighborhood-based buffers. Multiple linear regression was used to predict each outcome.

RESULTS

Living in neighborhoods with a high density of primary food stores was associated with 8.6%, 9.5%, and 5.8% lower intake of total snacks and sweets, sweet bakery products, and candy and desserts, respectively. Living in the highest NSES quartile was associated with 11.3%, 5.8%, and 18.9% lower intake of total snacks and sweets, savory snacks and crackers, and sweet bakery products, respectively. Depending on primary food store availability, higher household income was associated with significantly greater intake of nutrition bars and low-fat snacks and sweets. Living in a USDA-defined food desert was not associated with intake.

CONCLUSIONS

In a geographically diverse sample of middle and older age US adults, living in neighborhoods with no primary food stores or neighborhoods of low SES was associated with higher intake of total snacks and sweets and subgroups of snacks and sweets.

Body Mass Index Trajectories among the Healthy Communities Study Children: Racial/Ethnic and Socioeconomic Disparities in Childhood Obesity

The purpose of this study is to identify statistically distinguishable trajectories of childhood body mass index (BMI), an important indicator of developmental status of children, and to provide a summary description of demographic characteristics of children based on these distinctive trajectories. Using data from the Healthy Communities Study (HCS), a large longitudinal dataset with oversamples of Hispanic and Black children across 130 communities in the USA, a group-based trajectory analysis approach was used to estimate trajectories of children based on their BMI-z scores. The three most distinguishable BMI trajectory groups identified for the HCS children show no marked increase or decrease in standardized BMI over an age range of 2 to 11. Approximately 28.5% of children were in a trajectory group with consistently obese BMI-z scores for their sex and age. The patterns of BMI trajectory groups identified for boys and girls are similar, but BMI-z scores for boys tend to be slightly higher than those for girls. These BMI trajectories are characterized by racial/ethnic and socioeconomic status disparities. Hispanic and Black children were more likely to be in the obese trajectory group than White children. Children with parents having less education, or children from low family income level, were more likely to be in the obese trajectory group than counterpart children. The findings suggest that BMI disparities exist from the early years of childhood and persist across childhood, with higher BMI associated with Black and Hispanic children as well as those from low socioeconomic status backgrounds.

Park Area and Physical Activity Among Children and Adolescents: Findings From the Healthy Communities Study

BACKGROUND

There is currently a nationwide effort to bring parks and green spaces within a 10-minute walk of the home. We examined the association between park area within 1 km of a child's residence and self-reported park-specific physical activity (PA) along with accelerometer-derived moderate to vigorous physical activity (MVPA).

METHODS

A subsample of K through eighth-grade youth (n = 493) from the Healthy Communities Study reported whether they engaged in park-specific PA during the last 24 hours and wore an accelerometer for up to 7 days. Park area was defined as the percentage of park land in a 1 km Euclidean buffer around the participant's residence, categorized into quintiles. Analysis consisted of logistic and linear regression modeling with interaction effects that controlled for clustering within communities.

RESULTS

Regression models estimated greater park-specific PA for participants in the fourth and fifth quintiles of park land. Age, sex, race ethnicity, and family income were unrelated to park-specific PA. Accelerometer analysis indicated that total MVPA was unrelated to park area. Older children (β = -8.73, P < .001) and girls (β = -13.44, P < .001) engaged in less MVPA. Seasonality significantly predicted both park-specific PA and total MVPA.

CONCLUSION

Increasing park area is likely to improve youth PA patterns, lending support for the 10-minute walk initiative.

A longitudinal examination of objective neighborhood walkability, body mass index, and waist circumference: the REasons for Geographic And Racial Differences in Stroke study

Background

Studies have shown neighborhood walkability is associated with obesity. To advance this research, study designs involving longer follow-up, broader geographic regions, appropriate neighborhood characterization, assessment of exposure length and severity, and consideration of stayers and movers are needed. Using a cohort spanning the conterminous United States, this study examines the longitudinal relationship between a network buffer-derived, duration-weighted neighborhood walkability measure and two adiposity-related outcomes.

Methods

This study included 12,846 Black/African American and White adults in the REasons for Geographic And Racial Differences in Stroke study. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and up to 13.3 years later (M (SD) = 9.4 (1.0) years). BMI and WC were dichotomized. Walk Score® was duration-weighted based on time at each address and categorized as Very Car-Dependent, Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Unadjusted and adjusted logistic regression models tested each neighborhood walkability-adiposity association. Adjusted models controlled for demographics, health factors, neighborhood socioeconomic status, follow-up time, and either baseline BMI or baseline WC. Adjusted models also tested for interactions. Post-estimation Wald tests examined whether categorical variables had coefficients jointly equal to zero. Orthogonal polynomial contrasts tested for a linear trend in the neighborhood walkability-adiposity relationships.

Results

The odds of being overweight/obese at follow-up were lower for residents with duration-weighted Walk Score® values in the Walker’s Paradise range and residents with values in the Very Walkable range compared to residents with values in the Very Car-Dependent range. Residents with duration-weighted Walk Score® values classified as Very Walkable had significantly lower odds of having a moderate-to-high risk WC at follow-up relative to those in the Very Car-Dependent range. For both outcomes, the effects were small but meaningful. The negative linear trend was significant for BMI but not WC.

Conclusion

People with cumulative neighborhood walkability scores in the Walker’s Paradise range were less likely to be overweight/obese independent of other factors, while people with scores in the Very Walkable range were less likely to be overweight/obese and less likely to have a moderate-to-high risk WC. Addressing neighborhood walkability is one approach to combating obesity.

The role of the built environment, food prices and neighborhood poverty in fruit and vegetable consumption: An instrumental variable analysis of the moving to opportunity experiment

The food environment has been associated with fruit and vegetable consumption, however many studies utilize cross-sectional research designs. This study examined 3,473 participants in the Moving to Opportunity experiment, who were randomized into groups that affected where they lived. The relationship between the built environment, food prices and neighborhood poverty, assessed over four to seven years, on fruit or vegetable consumption was examined using instrumental variable analysis. Higher food prices and neighborhood poverty were associated with lower fruit or vegetable consumption. Policies and programs that address food prices should be implemented and evaluated for their effects on fruit and vegetable consumption.

Virtual audits of the urban streetscape: comparing the inter-rater reliability of GigaPan® to Google Street View

Background

Although previous research has highlighted the association between the built environment and individual health, methodological challenges in assessing the built environment remain. In particular, many researchers have demonstrated the high inter-rater reliability of assessing large or objective built environment features and the low inter-rater reliability of assessing small or subjective built environment features using Google Street View. New methods for auditing the built environment must be evaluated to understand if there are alternative tools through which researchers can assess all types of built environment features with high agreement. This paper investigates measures of inter-rater reliability of GigaPan®, a tool that assists with capturing high-definition panoramic images, relative to Google Street View.

Methods

Street segments (n = 614) in Pittsburgh, Pennsylvania in the United States were randomly selected to audit using GigaPan® and Google Street View. Each audit assessed features related to land use, traffic and safety, and public amenities. Inter-rater reliability statistics, including percent agreement, Cohen’s kappa, and the prevalence-adjusted bias-adjusted kappa (PABAK) were calculated for 106 street segments that were coded by two, different, human auditors.

Results

Most large-scale, objective features (e.g. bus stop presence or stop sign presence) demonstrated at least substantial inter-rater reliability for both methods, but significant differences emerged across finely detailed features (e.g. trash) and features at segment endpoints (e.g. sidewalk continuity). After adjusting for the effects of bias and prevalence, the inter-rater reliability estimates were consistently higher for almost all built environment features across GigaPan® and Google Street View.

Conclusion

GigaPan® is a reliable, alternative audit tool to Google Street View for studying the built environment. GigaPan® may be particularly well-suited for built environment projects with study settings in areas where Google Street View imagery is nonexistent or updated infrequently. The potential for enhanced, detailed imagery using GigaPan® will be most beneficial in studies in which current, time sensitive data are needed or microscale built environment features would be challenging to see in Google Street View. Furthermore, to better understand the effects of prevalence and bias in future reliability studies, researchers should consider using PABAK to supplement or expand upon Cohen’s kappa findings.

Built Environment Exposures of Adults in the Moving to Opportunity Experiment

This paper describes environmental exposures of adult participants in the Moving to Opportunity for Fair Housing (MTO) experiment over a four to seven year period from baseline to the interim evaluation. The MTO experiment randomized participants living in public housing or private assisted housing at baseline into experimental and control groups and provided a housing voucher for experimental group participants to move to neighborhoods with less than 10 percent of the population below the poverty line. However, few studies have examined how this move affected exposures to health promoting environments. We used data on residential locations of MTO participants and archival data on the built and food environment to construct environmental exposure variables. MTO participants in the experimental and Section 8 groups lived in neighborhoods with higher food prices, less high intensity development and more open space relative to the control group. The findings suggest that housing policies can have potential health consequences by altering health-related environmental exposures.

Reliability and validity of environmental audits using GigaPan® technology in parks

Park quality and features can contribute to more engaging places for play and recreation. However, assessing park characteristics remains a challenge. This study measured the reliability of GigaPan® as a method for assessing park characteristics as well as the validity of GigaPan® compared to Google Street View (GSV) and direct observation (DO). A total of 65 target areas (16 parks total) in Pittsburgh, PA were assessed using GigaPan®, GSV, and DO from July 2015–January 2016. For reliability and validity, 14 and 28 variables were examined, respectively. Cohen's kappa was used to assess inter-rater reliability. Sensitivity and specificity were used to measure validity. Of the 14 variables included in the inter-rater reliability analysis, five variables had almost perfect reliability (kappa > 0.80) and three variables had substantial reliability (kappa > 0.60). Of the 28 variables included in the validity analysis, GigaPan® was able to correctly classify 17 of the 28 variables and GSV was able to correctly classify 15 of the 28 variables with a sensitivity >80%. There were no significant differences between sensitivity and specificity between GSV and GigaPan®. GigaPan® performed similarly to GSV with DO being used as the gold standard. Further, GigaPan overall had high reliability among the features measured. A strength of GigaPan® is the ability to be implemented quickly in the field, making it a viable alternative to GSV particularly when temporality is an important factor.

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GigaPan®, a robot system for taking panoramic photos, had high reliability among the park attributes measured

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GigaPan® is a valid method to assess park attributes and offers some advantages over other methods

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GigaPan® had comparable validity to Google Earth for assessing features, amenities and incivilities

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GigaPan® should be used in future studies to help identify the association between park attributes and health outcomes

Impact of Rental Assistance on Modifiable Health Risk Factors and Behaviors in Adults

OBJECTIVES

Housing may influence health through various mechanisms and is recognized as a social determinant of health. This study investigated the influence of rental assistance on modifiable health risk factors and behaviors using data from the Panel Study of Income Dynamics (PSID). Participants receiving rental assistance were compared with participants not receiving rental assistance on body mass index (BMI), obesity, smoking, alcohol use and physical activity.

METHODS

Participants (N=1374) were age 18 to 62, head of household, and had not received rental assistance for four years prior to baseline. Treatment group participants (N=116) received rental assistance between baseline and the two-year follow-up. Comparison group participants (N=1258) were eligible for rental assistance two years after baseline but did not receive assistance. Models estimated the average treatment effect on treated (ATET) for each health indicator in each follow-up year. Participants were matched on age, race-ethnicity, gender, education, disability status, employment, household income and number of children in the household.

RESULTS

At the two-year follow-up, smoking was significantly higher among treatment group participants. A sensitivity analysis excluding permanently disabled participants showed significantly higher obesity in the treatment group two years after baseline. No significant differences were found four or six years after baseline on any outcome.

CONCLUSIONS

Rental assistance was associated with increased smoking and obesity two years after baseline, but did not influence BMI, alcohol consumption, or physical activity. Interventions to reduce smoking and obesity may improve the health of individuals who receive rental assistance.

Pathways to prevention: improving nonresident African American fathers' parenting skills and behaviors to reduce sons' aggression

This study describes a test of the Fathers and Sons Program for increasing intentions to avoid violence and reducing aggressive behaviors in 8- to 12-year-old African American boys by enhancing the parenting skills satisfaction and parenting behaviors of their nonresident fathers. The study included 158 intervention and 129 comparison group families. Structural equation model results indicated that the intervention was effective for improving fathers' parenting skills satisfaction, which was positively associated with sons' satisfaction with paternal engagement. Sons' paternal engagement satisfaction was positively associated with their intentions to avoid violence. Although aggressive behaviors were lower for comparison group sons, the intervention effectively reduced sons' aggressive behaviors indirectly by enhancing fathers' parenting behaviors. Support for family-centered youth violence prevention efforts is discussed.

Elder women's decision-making in breast cancer care: An Israeli study

PURPOSE

Much research has examined women's decision-making behaviour in breast cancer care. Patient age has shaped preferences, values, decision style and participation in treatment decisions. The aim of this study was to test the validity of the Michigan Assessment of Decision Style (MADS) (Pierce, 1995) in an older cohort and provide information on decision styles to identify areas of tailored decision support necessary for Israeli women.

METHODS

This study examined the decision-making styles of older Israeli women receiving routine mammography screening. Fifty two women over 65 years of age, attending a routine mammography screening, were administered a questionnaire containing demographic information and the MADS to determine hypothetical treatment decision-making. The MADS is a 16-item questionnaire assessing decision-making behaviour by characterizing four factors: avoiding, deferring, information-seeking and deliberation.

RESULTS

Age, family history of breast cancer, and having a current mammography were not significantly associated with any of the four MADS factors. Deliberation and Deferring had the highest mean scores, followed closely by Information-Seeking and Avoidance. Correlations among the factors indicate a significant, positive correlation between Deliberation and Information-Seeking and a significant negative correlation between Deliberation and Deferring, consistent with previous studies.

CONCLUSIONS

These findings indicate that older Israeli women's decision style is characterized by information seeking and deliberation reflecting a disposition towards engagement. The findings contribute to clinicians' understanding of women's preferences by countering the traditionally accepted stereotype that older women will employ a passive role when faced with an important health care decision.

The relationship between hospital size and ICU type on select adverse patient outcomes

The authors examined the relationships among hospital size and unit type, the prevalence of pressure ulcers, and rates of ventilator-associated pneumonia and catheter-related bloodstream infections in 25 intensive care units (ICUs) in 8 hospitals. Data came from the American Hospital Association survey, and nursing and infection control databases. Multiple regression was the main statistical technique. Pressure ulcer prevalence and catheter-related bloodstream infection rates were higher in large hospitals; ventilator-associated pneumonia rates were higher in surgical ICUs. Future researchers should include factors often hidden within hospital and unit characteristics to expose possible relationships that may be incorporated into interventions to prevent adverse outcomes.

New parameters for daytime wandering

This study aimed to describe wandering using new parameters and to evaluate parameters as a function of cognitive impairment and mobility. Forty-four wanderers in long-term care settings were videotaped 12 times. Rate and duration of wandering episodes were plotted and used to derive parameters from values above and below case medians, proportion of hours wandering, and time of day. Participants wandered during 47% of observations; on average, the hourly rate was 4.3 episodes, the peak hourly rate was 18 episodes, and the peak hourly duration was 19.9 minutes. Mini-Mental State Examination (MMSE) scores was negatively correlated with overall duration and number of observations during which duration exceeded 15 minutes per hour, was positively correlated with number of observations without wandering, and was not significantly correlated with rate-related parameters. Mobility correlated positively with rate and duration parameters. Interaction of MMSE score and mobility was the strongest predictor of wandering duration. Parameters derived from repeated measures provide a new view of daytime wandering and insight into relationships between MMSE score and mobility status with specific parameters of wandering.

Intensive care units, communication between nurses and physicians, and patients' outcomes

BACKGROUND

Various factors in hospitals can adversely affect patients' outcomes, including faulty communication between nurses and physicians. Whether specific communication elements (timeliness, accuracy, openness, understanding) can influence adverse outcomes is unknown.

OBJECTIVES

To determine the relationships between patients' outcomes and (1) nurses' perceptions of elements of communication between nurses and physicians and (2) characteristics of the practice environment.

METHODS

A cross-sectional survey design was used. Information on ventilator-associated pneumonia, bloodstream infection associated with a central catheter, and pressure ulcers was collected from 25 intensive care units in southeastern Michigan. Simultaneously, 462 nurses in those units (response rate, 53.3%) were anonymously surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the practice environment. The Intensive Care Unit Nurse-Physician Questionnaire was used to measure communication between nurses and physicians. Statistical tests included correlation and multiple regression. Analyses were conducted at the unit level.

RESULTS

Unit response rates varied from 6% to 100%. Together, variability in understanding communication and capacity utilization were predictive of 27% of the variance in ventilator-associated pneumonia. Timeliness of communication was inversely related to pressure ulcers (r= -0.38; P=.06), and workplace empowerment and scores on the Acute Physiology and Chronic Health Evaluation III were positive predictors of ventilator-associated pneumonia (R(2)=0.36; P=.005).

CONCLUSIONS

Not all elements of communication were related to the selected adverse outcomes. The connection between characteristics of the practice environment at the unit level and adverse outcomes remains elusive.

Need for Population Specific Validation of a Portable Metabolic Testing System: A Case of Sedentary Pregnant Women

Commercially available portable metabolic systems have been validated with samples of young, healthy, and well-fit subjects, but use of these systems with a special population, such as healthy but sedentary pregnant women, requires a unique set of considerations. These include a woman’s limited testing time necessary for fetal safety, relatively low oxygen consumption, and the unique physiology of pregnancy (woman, the placenta, and the fetus). The purpose of this study was to validate a portable metabolic testing system (VO2000) with healthy sedentary pregnant women. A total of 9 sedentary pregnant women who averaged 30 years of age (SD = 3), 93 kg (SD = 19) weight, 163 cm (SD = 7) height, and at 19 weeks’ gestation (SD = 5) volunteered to participate. Submaximum fitness tests using the Cornell protocol were conducted once with two systems (VO2000 and CPX/D, a reference) simultaneously, and then subsequently twice with one system (VO2000). The VO2000 consistently overestimated VO2 measurement, compared to the same manufacturer’s reference system, by 4.4 +/− 3.6 (SD) ml/kg/min, and when VO2000 was used twice, the mean difference was statistically significant (1.0 +/− 1.8 [SD] ml/kg/min; t(45) = 3.9, p < .001). The results of the study show that although VO2000 is an established and validated portable metabolic system for measurement on adult males and females who are relatively well fit, this portable system consistently overestimates VO2 readings for pregnant women compared to standard full-size system. Measurements, when repeated, were not consistent.

Indices for studying urinary incontinence and levator ani function in primiparous women

Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation (t = 4.84, P = 0.000) and increased significantly at 12 months postpartum (t = -3.51, P = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r = -0.40, P = 0.007) and at 6 weeks postpartum (Pearson r = -0.33, P = 0.029). The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings.

Research Process in the Health Sciences: A Focus on Methods

Research in the health sciences is becoming increasingly challenging as data and methods advance in complexity. This article was written to provide an overview of the research process for complex and intricate projects, with a focus on methods. The insights regarding structuring and managing research projects are intended to guide researchers through all phases of the research process. Our key suggestions include the following: (1) conceptual and methodological complexity must be balanced, (2) skilled project managers and statisticians are needed, and can be rewarded for their contributions to projects in part through authorship, and (3) grants involving multiple investigators present problems related in part to the abstruseness of integrated methods and so require special solutions for effective management. Overall, we conclude that researchers are rewarded in a variety of ways when they remain focused on the original study aims, keep methods simple, utilize skilled staff, and engage in strategic planning.

Critical elements of documentation for data-based research

Scientific integrity and progress are enhanced by precise documentation of the conceptual development and information management aspects of research. Careful and complete documentation of the research process supports accurate reporting. The exercise of documenting data management activities provides an opportunity for nurse researchers to reflect on a study to guide current work and inform and enhance future research. The literature includes many references to the need for data management but contains little advice regarding the nuts and bolts of documenting data management activities. This article describes specific steps for documenting data-based research beginning with the study design and ending with data analysis. The documentation framework and examples presented are sufficient to guide the comprehensive record keeping required for complex studies and can be modified to meet the simpler needs of smaller research projects.

Using measures of agreement to develop a taxonomy of passivity in dementia

A comprehensive taxonomy categorizing passive behaviors in people with dementia was developed and revised through the use of expert raters. The taxonomy was first derived from the synthesis of 15 empirical studies that addressed this phenomenon, then was rated by an expert panel of six nurse-scientists with expertise in dementia and neuroscience research. This article describes the application of two measures of agreement, multiple rater kappa and proportion of agreement for multiple raters, calculated using Stata and SPSS, to evaluate and revise the taxonomy. The method proved useful for estimating the content validity of the taxonomy and provided evidence of stronger agreement among raters for the revised and final forms of the taxonomy. Nurse researchers will find this methodology to be an efficient, practical approach to applying measures of agreement for a variety of purposes, including taxonomy development.

Preventive oral health behaviors among African-Americans and whites in Detroit

OBJECTIVE

This study compared the preventive oral health behaviors of African-Americans and whites.

METHODS

Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits.

RESULTS

More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically.

CONCLUSIONS

African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.

Changes in physical activity beliefs and behaviors of boys and girls across the transition to junior high school

PURPOSE

This longitudinal study investigated gender-specific changes in physical activity beliefs and behaviors across the elementary to junior high school transition.

METHODS

Physical activity beliefs and behaviors were measured in a cohort of 132 racially diverse youth during the year prior to and following the transition. Questionnaires assessed variables hypothetically linked to activity. Physical activity was monitored with the Child/Adolescent Activity Log.

RESULTS

Gender differences in physical activity beliefs emerged. Across the transition, boys reported decreased efficacy, social support, and expectations (norms) to be physically active. Although girls also reported decreased social support for physical activity, they further reported exposure to fewer active role models and were less likely to perceive that the benefits of regular activity out-weighed the barriers following the transition. Gender differences in activity levels were apparent, with girls being less active than boys. Despite changes in physical activity beliefs across the school transition, no significant changes in actual level of activity occurred over this period. Although beliefs were significantly related to behaviors in the domain of physical activity, pretransition activity level was the best predictor of posttransition activity level.

CONCLUSIONS

These data indicate that physical activity beliefs of adolescents change over the school transition. These changes are significantly, but not highly, related to level of physical activity. Future research should explore the influences of activity-related affect and social and physical contexts on physical activity across adolescence.

Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth

OBJECTIVE

To test the effect of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence and pelvic muscle strength in primigravidas during pregnancy and postpartum.

METHODS

A prospective trial randomized women into treatment (standardized instruction in pelvic muscle exercise) or control (routine care with no systematic pelvic muscle exercise instruction). Urinary incontinence symptoms were measured by questionnaire. Pelvic muscle strength was quantified by an instrumented gynecologic speculum. Time points were 20 and 35 weeks' gestation and 6 weeks, 6 months, and 12 months postpartum.

RESULTS

Outcomes are reported for 46 women with vaginal or cesarean birth and for a subsample of 37 women with vaginal birth. Longitudinal analyses are reported for cases with complete data across time points. Diminished urinary incontinence symptoms were seen in the treatment group, with significant treatment effects demonstrated at 35 weeks' gestation (F [1,43] = 4.36, P = .043), 6 weeks postpartum (F [1,43] = 4.94, P = .032), and 6 months postpartum (F [1,43] = 4.29, P = .044). A repeated measures analysis of variance showed a significant interaction between time and treatment for urinary incontinence (F [4, 41] = 2.83, P = .037). A significant effect of initial pelvic muscle strength was demonstrated; ie, pelvic muscle strength at 20 weeks' gestation predicted significantly 12-months postpartum strength (F [1, 13] = 8.12, P = .014). Group differences in pelvic muscle strength were observed (the treatment group had greater strength at 6 weeks and at 6 months postpartum than did controls), but these differences were not statistically significant.

CONCLUSION

Practice of pelvic muscle exercise by primiparas results in fewer urinary incontinence symptoms during late pregnancy and postpartum.

Usefulness of multiple equations for predicting preventive oral health behaviors

Canonical correlation analyses of a previous dental survey suggested that dental checkups, flossing, and tooth brushing could all be predicted from a single equation. Most theories and research about the influence of beliefs on behavior, however, suggest different behaviors will be best predicted by different behavior-specific measures. The current survey investigated influences on brushing, flossing, and dental checkups in a probability sample of adults in the Detroit tri-county area. Both behavior-specific variables, such as perceived benefits and costs of flossing, and general variables, such as gender, were included as predictors. Canonical correlation analysis indicated three equations were needed to predict the three oral health behaviors. Flossing frequency, for example, was best predicted by confidence in flossing ability and beliefs about the benefits of and barriers to flossing. The results suggest that even these closely related behaviors are best predicted using separate equations that include mostly behavior-specific predictors.

Equivalence of the original and revised dental anxiety scales

PURPOSE

The Corah Dental Anxiety Scale (DAS) was introduced in 1969 as a brief, valid, and reliable instrument to measure anxiety about dental visits. Since then, changes in language usage and dental practice have rendered the scale outdated. In 1994, Ronis introduced the Dental Anxiety Scale-Revised (DAS-R), a version of the DAS revised to acknowledge the roles of dental hygienists and female dentists in the dental office. The current study was conducted to determine whether the original and revised scales are equivalent.

METHODS

The study tested the equivalence of the two scales by including both in a questionnaire filled out by 141 male and female college students. Psychometric equivalence was examined by comparing the means, and reliabilities (alphas) of the two scales and by correlating the two scales with each other.

RESULTS

Mean scores, variances, and reliabilities of the two versions of the scale did not differ. The Pearson correlation between the two scales was .98.

CONCLUSIONS

It appears that the DAS-R is psychometrically equivalent to the DAS and can be used in its place whenever more up-to-date wording is desired.