The Association of Loneliness with Diabetes Is Mediated by Physical Activity and BMI but Not Diet Quality

Loneliness is considered a predictor of poor health through numerous pathways. Mediators of this association has not been extensively explored. The study objective was to determine if diet quality and physical activity are parallel mediators with body mass index (BMI) as the third mediator in the association of loneliness with diabetes. The sample, middle-aged and older African American and White adults, 36-77 years, participated in the second follow-up wave of the prospective Healthy Aging in Neighborhoods of Diversity across the Life Span study, 2013-2017. Loneliness was measured by the UCLA 3-item loneliness scale. Participants were categorized as not diabetic, pre-diabetic, or diabetic based on fasting blood glucose, self-reports, or taking medication for diabetes. The Mean Healthy Eating Index-2010 score was calculated from two 24 h dietary recalls collected using the USDA automated multiple pass method. Physical activity was derived from the Baecke questionnaire. The Hayes PROCESS macro, model #80, was used to perform the mediational analysis. Covariates were age, sex at birth, race, income, alcohol intake, and education. Loneliness was inversely and significantly associated with diet quality and physical activity. The only significant indirect path was loneliness > physical activity > BMI > diabetes. Better understanding of modifiable lifestyle behaviors when developing interventions may improve mental health, thereby improving health.

Impact of a simulation-based education approach for health sciences: demo, debrief, and do

BACKGROUND

Skill-based practice (e.g., communication skills) is important for individuals to incorporate into students' learning and can be challenging in large classes. Simulation-based education (SBE) is a method where students can learn and practice skills in a safe environment to use in real world settings with assistance of peer coaching. The COVID-19 pandemic presented challenges to providing students with sufficient SBE. The purpose of this paper is to: a.) describe a SBE approach for health coaching referred to as "Demo, Debrief, and Do" (DDD), b.) discuss how this approach became important in COVID-19 classroom experiences, c.) describe the impact of DDD activity on students in a health sciences curriculum. DDD is a collaborative activity where graduate health coaching students demonstrate coaching skills, debrief their demonstration, and support undergraduate students to demonstrate (or do) their own coaching skills in a small virtual online setting.

METHODS

Qualitative feedback from 121 undergraduate students enrolled in 3 sections of a behavior change strategies course and quantitative surveys to examine their confidence in applying the skills and overall satisfaction with DDD were gathered.

RESULTS

The overall average confidence level following the lab was 31.7 (0-35). The average satisfaction level following the lab was 23.3 (0-25 range). The most common highlight of this DDD experience described was observing the coaching demonstration (i.e., demo), followed by the feedback (i.e., debrief), and the practice (i.e., do).

CONCLUSION

The (DDD) simulation approach fulfilled an educational need during the COVID 19 pandemic and filled a gap in offering SBE opportunities for both graduate and undergraduate students while learning effective client-communication skills health coaching delivery.

ENGAGING OLDER ADULTS IN HEALTH PROMOTION: PILOT STUDY OF TEAM GAMEPLAY OF AN EDUCATIONAL EXERGAME IN A SENIOR CENTER

Digital health games offer one innovative approach to engage older adults to support healthy aging. Multiple reviews have described the positive impact of health games. Limited research has examined multi-focus health games implemented in senior centers. Informed by healthy aging theory and community-engaged methods, our multi-disciplinary team developed/refined an educational exergame with a combined focus on educating about healthy lifestyle behaviors (i.e., physical activity, healthy eating), stimulating cognitive functioning, and engaging movement to support healthy aging. A pilot study (Nf13; mean age = 78, 100% female) examined team gameplay (4 sessions in two weeks) in a senior center. Teams (2–3 members) worked together to answer knowledge, trivia, and cognitive challenge questions and competed for the highest score. A post-gameplay survey asked about acceptability, usability (i.e., adapted System Usability Scale), and perceived game impact. Preliminary results suggest team gameplay was engaging and nearly all (>90%) agreed/strongly agreed that they enjoyed playing with others (i.e., on teams); were comfortable doing the physical movements during gameplay; were satisfied with game educational, trivia, and cognitive questions; enjoyed the social part of team gameplay; would recommend the game to others; and the game increased their knowledge and motivation regarding physical activity and healthy eating. The System Usability Scale was above 70, on average, suggesting above average usability for the game. Findings support use of this educational exergame as an innovative way to engage older adults in health promotion. Presentation will describe game development/refinement, senior center pilot, and implications for future research and senior center translation.

Formative Examination of a Multi-Focus Educational Exergame Designed for Older Adults

Exergames and digital health games have shown promising outcomes in older adults. Most games have had one focus (e.g., physical activity, cognitive functioning). We developed a demonstration version of a multi-focus educational exergame (i.e., healthy eating, physical activity, cognition) that builds on healthy aging theory. Community-engaged and mixed methods (e.g., surveys, focus groups) research approaches were used to examine preliminary game acceptability and usability. The game was demonstrated with 20 senior center members (95% female; 48% African American; 52% White; average age 64 years) and participants were able to play the game. The post-gameplay survey results support acceptability/usability of the game. For example, 87% of participants “agreed” or “strongly agreed” that they felt comfortable playing; the game instructions were clear; the text was readable; and gameplay was enjoyable. The majority also “agreed”/“strongly agreed” that the audio was appealing/helpful in playing the game (86%); sound quality was appropriate (78%); hand tracking was precise (57%), feedback on correct/incorrect responses was motivating (73%); they felt excited to get the correct answers (80%); they would play the game again (87%); and they would recommend it to a friend/family member (80%). When asked how often they would play it, the responses were: 33% five or more times/week; 27% three-four times/week; 20% one-two times/week; and 20% never. Observations and focus groups further clarified acceptability and identified areas for improvement (e.g., game instructions). Preliminary results support acceptability of this multi-component educational exergame with older adults and suggest the potential for future tailoring of this game.

Do Inflammation Markers Moderate Associations Between Caregiving and Quality of Life, Health, and Depression?

Engaging with Aging is an emerging framework proposed by Carnevali which provides a new lens to understand an active, conscious daily living process of coping with age-related changes (ARCs) taken on by older adults. Study aims were to 1) describe the ARCs experienced by community-dwelling older adults; 2) identify the strategies and resources used by older adults to accommodate the daily living challenges caused by the associated ARCs; and 3) evaluate the framework of EWA based on findings from aims 1 and 2. We conducted semi-structured interviews with 29 participants aged 64 to 98 online due to COVID-19 restrictions. We used a virtual card sort to assist data gathering. Fifteen ARCs (e.g., changes in hearing, changes in stability, changes in sleep, etc.) were mentioned by participants and their corresponding adaptations were discussed. We found that older adults linked their adaptations to their ARCs based on their changing capacities and needs. Commonly used adaptations included conserving energy, utilizing tools or technology, and being more conscious before and while taking actions. The challenges caused by COVID-19 in implementing the adaptations were also discussed (e.g., increased difficulty in understanding others due to mask-wearing). Our study substantiates the EWA framework by showing the commonality among older adults in linking ARCs with adaptations. Implications for clinicians and researchers include using EWA to help older adults identify personalized solutions that fit their capacities. Our study is late-breaking as we recently finished data analysis and the information included was not yet available by the previous submission deadline.

Utilizing Participatory Research to Engage Underserved Populations to Improve Health-Related Outcomes in Delaware

Cooperative Extension is a community outreach program. Despite its large reach, there is a need for the evaluation of changes in health-related outcomes for individuals engaged with Cooperative Extension. A team-based challenge was developed using community-engaged participatory research integrated with Cooperative Extension to encourage healthy eating and physical activity behaviors through Cooperative Extension programming. Thus, the primary purpose of this secondary analysis was to (1) evaluate changes in anthropometric outcomes and (2) evaluate changes in health behavior outcomes. Associations of anthropometric changes and health behavior changes with engagement in the three-month team-based challenge were explored. Anthropometrics were measured using standard procedures, and intake of fruits and vegetables and physical activity were self-reported. Of the 145 participants in the community-engaged participatory research portion of the study, 52.4% (n = 76) had complete anthropometrics before and after the team-based challenge and were included in this study. At 3 months, there was a significant reduction in body mass index (−0.3 kg/m², p = 0.024) and no significant change in waist circumference (p = 0.781). Fruit and vegetable intake significantly increased (+0.44 servings/day, p = 0.018). Physical activity did not significantly change based on (1) the number of days 30 or more minutes of physical activity was conducted (p = 0.765) and (2) Godin Leisure-Time Exercise Questionnaire scores (p = 0.612). Changes in anthropometrics and health behaviors were not associated with engagement in the team-based challenge. Using community-engaged participatory research with community outreach programs, such as Cooperative Extension, can improve health-related outcomes in underserved populations. However, despite a participatory approach, changes in anthropometrics and health behaviors were not associated with engagement in the developed team-based challenge.

Healthy Behaviors Associated with Changes in Mental and Physical Strength in Urban African American and White Adults

Over time, adherence to healthy behaviors may improve physical and mental strength which is essential for successful aging. A plausible mechanism is the reduction of inflammation. Research on the association of risky health behaviors on change in strength with age is limited. This study examined changes in the inflammatory potential of the diet, smoking, illicit drug use with changes in strength in a racially and socioeconomically diverse adult sample from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study. The dietary inflammatory index (DII) was calculated from 35 food components derived from multiple 24-h dietary recalls. Strength was evaluated by handgrip strength (HGS), SF-12 PCS and SF-12 MCS (physical and mental component scores). Repeated measures analyses were used to examine associations. At baseline, mean age was 48.4 ± 0.25 years, 56% of the sample were women, and 58% African American. Significant 4-way interactions were found between age, race, socioeconomic status, and DII for women, on change in HGS (p < 0.05) and in SF-12 PCS (p < 0.05) and for men, in change in SF-12 PCS (p < 0.05). Improvements in SF-12 MCS were associated with all three health behaviors as main effects. This study provided evidence that changes towards improving healthy behaviors, diet with anti-inflammatory potential, not smoking cigarettes and not using illicit drugs, were associated with improved strength. Health professionals, especially registered dietitians and health coaches, should create lifestyle interventions to reduce inflammation targeting change in more than one risky health behavior.

Exploring Technology Perceptions and Intentions to Use in Older Adults

By the year 2035, the older adult population is expected to expand to 78 million in the United States. Advancing technology has made aging in place a more accessible possibility; however, understanding what is preventing this population from adopting the advancing devices remains to be a challenge as the presence of a digital divide continues to exist. A 34-question survey adapted from the Technology Proficiency Self-Assessment Questionnaire, and the National Technology Readiness survey was administered to 101 participants over the age of 50 across five local senior centers. The average age range was 70-79 and most were female (79.2%), white (69%), and owned or had access to technology such as a computer or cell phone (93%). Examples of findings include 86% felt technology limited human interaction and 69% felt the use of technology could lead to security risk and a breach of privacy, while 79% felt technology could improve their quality of life. Results found 60-69-year-olds were significantly more likely (p&lt;.05) to have or use technology versus 80-89-year-olds. Correlation between perception and intent to use technology among older adults was positive with a coefficient value of .59(p&lt;.01). Showing a relationship between perceptions and behavioral intentions to use technology, specifically in 60-69-year-olds. This study found access to technology (i.e. computers, cell phones, internet) was not a driving factor of usage among the older population attending a senior center. To increase understanding further exploration of perceptions and intentions to use technology is warranted in the older adult population.

Factors Associated With Health Service Use Among Older Adults in a Mobile Veterans Program

The current retrospective, longitudinal study applied Andersen's Behavioral Model of Health Services Use to examine how demographic characteristics (age), available resources (e.g., a caregiver, the Mobile Veterans Program [MVP]) and health needs (e.g., cognitive and physical functioning, depressive symptoms) affect hospitalization and institutionalization outcomes among older adults using the MVP. Fifty-four Veterans (age 55 to 95) participating in the MVP for up to 2 years were examined using hierarchical linear modeling (HLM) and growth curve model. In the final HLM model, each 1-point increase in depressive symptoms was associated with 76% (p ≤ 0.05) greater risk of institutionalization and 40% (p ≤ 0.01) greater risk of hospitalization. Each 1-point increase in cognitive functioning was associated with 24% (p ≤ 0.05) lower risk of institutionalization. The relationship between caregiver burden and hospitalization was attenuated by frequency of MVP visits. Services focused on reducing depressive symptoms may influence health service use and reduce caregiver burden in this population. [Journal of Gerontological Nursing, 46(5), 15-22.].

The Association Between Fruit and Vegetable Consumption and Fruit and Vegetable Stage of Change in Underserved Communities Engaging With Cooperative Extension Services

OBJECTIVE

To compare differences in fruit and vegetable (FV) intake and FV stage of change in 2 diverse communities engaging with cooperative extension services (Extension).

METHODS

Cross-sectional study of FV behaviors of community members enrolled in a team-based challenge offered by Extension. t test and chi-square analyses examined differences in FV intake and FV stage of change. Linear regression examined the relationship between FV stage of change and FV intake, adjusting for demographics.

RESULTS

There was a significant (P = .01) difference in staging between the African American and Hispanic communities. Of individuals in the African American community, 60% were in the preparation stage; in the Hispanic community, 55% were in the precontemplation/contemplation stage. The FV stage of change was significantly associated with daily FV intake (β = .53; P < .001).

CONCLUSIONS AND IMPLICATIONS

To promote consumption of FVs better, nutrition education programs such as Extension should differentiate based on stages of change among subpopulations.

The Importance of Inclusion for Cardiovascular Health Promotion Programs in Delaware

Individuals with disabilities experience greater rates of cardiovascular disease than individuals without disabilities. This increase can be attributed to decreased levels of physical activity, poor eating habits, and increased levels of diabetes, smoking, and obesity. Individuals with disabilities are often excluded from surveillance, treatment, and prevention efforts. Consequently, there is little known about their participation rates in health promotion and disease prevention programs. The aims of this investigation are (1) to examine time trends in cardiovascular disease and risk factors over a 10-year period by disability status and (2) to assess the inclusiveness of health promotion programs in Delaware. The percentage of individuals with disabilities increased from 18% in 2001 to 28% in 2011. Individuals with disabilities had higher rates of cardiovascular disease (t = 80.45; degrees of freedom [df] = 198; p < .0001) and obesity (body mass index > 30 kg/m2) than individuals without disabilities (t = 33.0; df = 198; p < .0001). They also reported less physical activity (t = 44.21; df = 198; p < .0001) and worse diet quality (t = 4.70; df = 198; p < .0001). There was a consistent lack of information about inclusion and participation of individuals with disabilities in health promotion programs. Making adaptations within cardiovascular disease prevention programs in Delaware is imperative to improving the health of individuals with disabilities. Ensuring cardiovascular disease programs are accessible and provide disability-specific trained staff will reduce barriers to participation so that all individuals can benefit.

Food Label Knowledge, Usage and Attitudes of Older Adults

Few recent studies have investigated food label practices in older adults. This cross-sectional study surveyed adults, 60 years and older in Delaware (n = 100, 82% female, 74% between 60 and 79 years, 49% Caucasian, 45% African Americans) to examine associations between food label knowledge, attitudes, and usage patterns. A 28-item questionnaire assessed knowledge, attitudes, usage, and demographic information. Bivariate analysis results showed food label knowledge was associated with education and monthly income. Those reporting a high school education or less incorrectly identified calorie (P < 0.05) and carbohydrate information (P < 0.03). Monthly income ≤$2000 was associated with incorrectly interpreting carbohydrate information (P < 0.03). Label usage was associated with being female (P < 0.001), having a high school education or less (P < 0.000), being 70 years or older (P < 0.05), and having a monthly income ≤$2000 (P < 0.001). Respondent's usage and perceived label comprehension was high; however less than half could correctly interpret label information. When shown samples of the US Food and Drug Administration's proposed new labels, subjects had a very favorable attitude toward the new changes. Increasing nutrition knowledge through education interventions appropriate for older adult consumers may improve comprehension of information on the food labels.

Community size as a factor in health partnerships in community parks and recreation, 2007

Introduction

Although partnerships between park and recreation agencies and health agencies are prevalent, little research has examined partnership characteristics and effectiveness among communities of different sizes. The objective of this study was to determine whether park and recreation leaders’ perceptions of partnership characteristics, effectiveness, and outcomes vary by community size.

Methods

A web-based survey was completed in 2007 by 1,217 National Recreation and Park Association members. Community size was divided into 4 categories: very small, small, medium, and large. Questions measured agencies’ recognition of the need for partnerships, their level of experience, and the effectiveness and outcomes of partnerships.

Results

Larger communities were significantly more likely to recognize the need for and have more experience with partnerships than smaller communities. Very small and large communities partnered significantly more often with senior services, nonprofit health promotion agencies, and public health agencies than did small and medium ones. Large and small communities were significantly more likely than very small and medium communities to agree that their decision making in partnerships is inclusive and that they have clearly defined goals and objectives. Large communities were significantly more likely than very small communities to report that their partnership helped leverage resources, make policy changes, meet their mission statement, and link to funding opportunities.

Conclusion

Community size shapes partnership practices, effectiveness, and outcomes. Very small communities are disadvantaged in developing and managing health partnerships. Increasing education, training, and funding opportunities for small and rural park and recreation agencies may enable them to more effectively partner with organizations to address community health concerns.

Wii Fit Balance Intervention in Community-Dwelling Older Adults

OBJECTIVE

The purpose of this exploratory study was to investigate the impact of the Nintendo(®) Wii Fit™ (Nintendo of America, Redmond, WA) on functional and perceived balance measures in an older adult population over a 4- or 8-week program.

SUBJECTS AND METHODS

Twenty-five participants (71.60±7.79 years old) from a local senior center played Wii Fit (balance games, hula hooping, and yoga) for 30 minutes 2 days per week in either a 4-week (n=16) or 8-week (n=9) program. An additional nine participants served as a control group. These participants were independent, community-dwelling healthy overweight older adults (mean body mass index, 27.19±4.99 kg/m(2)). Functional balance measures included the 8-foot time up-and-go, 30-second chair stands, and the Berg Balance Scale and perceived balance were measured using the following scales: Activities-specific Balance Confidence (ABC) Scale, Falls Self-Efficacy Scale, and the Activities of Daily Living (ADL) Scale.

RESULTS

A paired t test showed significant changes pre-post program in the mean scores of chair stands, Berg Balance Scale, and ADL Scale for the 4-week participants. For the 8-week participants, significant differences were seen pre-post-program for the Berg Balance Scale, ABC Scale, and ADL Scale. There were no statistical change in the control group in the Berg Balance, ABC, and ADL Scales.

CONCLUSIONS

The results of this study suggest that Wii Fit playing may be a vehicle for physical activity participation in the older adult population. It is necessary that research on the effects of exergaming on functional and perceived balance in the older adult population must continue.

The Role of Park Proximity and Social Support in Shaping Park Visitation, Physical Activity, and Perceived Health Among Older Adults

Background:

Health scholars purport that park proximity and social support promotes physical activity and health. However, few studies examine the combined contributions of these constructs in shaping physical activity and health.

Purpose:

In this study, the contributions of environmental and social characteristics in shaping park use, physical activity, and health are examined.

Methods:

A survey was distributed to 1515 older adults in Cleveland, Ohio. Results: Path analysis indicated that social support was directly related to health. Perceived park walking proximity was related to physical activity and health through park use frequency. Park proximity was directly related to park use duration.

Conclusions:

Results suggest that environmental and social characteristics contribute to physical activity and health, but perceptions may also be a prerequisite to park use, daily physical activity, and health.

Exercise and lymphocyte activation following chemotherapy for breast cancer

PURPOSE

To determine whether exercise training would increase lymphocyte activation in patients with breast cancer following chemotherapy. Activation was determined by the presence of CD4(+)CD69(+) T-helper lymphocytes, mitogen-induced proliferation, and levels of cytokines produced by mitogen-stimulated lymphocytes and in the patients' plasma.

METHODS

Patients with breast cancer (N = 28) who participated in a 6-month exercise program were compared with patients (N = 21) who did not exercise. Following chemotherapy, and 3 and 6 months later, patients underwent fitness evaluations and had blood drawn. The exercise program consisted of resistance training and aerobic activity at 60-75% functional capacity three times a week with a personal trainer. Immunochemistry and flow cytometry were used to measure the number of CD4(+)CD69(+) blood lymphocytes. Whole blood was stimulated with concanavalin A (ConA), phytohemagglutin (PHA), or pokeweed mitogen (PWM) to determine proliferation potential. Enzyme-linked immunosorbent assays (ELISA) were used to determine the concentration of interferon-gamma (IFN-gamma) and interleukin-6 (IL-6) in the culture medium of mitogen-stimulated lymphocytes as well as the plasma concentrations of IL-6, soluble IL-6 receptor, soluble gp130, and IFN-gamma. Analysis of groups across time was done using the Wilcoxon signed rank test, and comparisons of groups were done using the Mann-Whitney U test.

RESULTS

The exercising patients showed increases in maximal oxygen uptake and upper body strength. This group also showed a greater percentage of CD4(+)CD69(+) cells and a greater level of tritiated thymidine incorporation (DNA synthesis) when stimulated with ConA, PHA, and PWM at the end of the intervention. Plasma and mitogen-stimulated IL-6 and IFN-gamma production were similar in both groups.

CONCLUSION

Exercise may improve immune function by increasing lymphocyte activation in patients with breast cancer following treatment.

Validity of the body mass index silhouette matching test

OBJECTIVE

To determine the construct validity and utility of the Body Mass Index Silhouette Matching Test (BMI-SMT).

METHODS

One-hundred-seventy undergraduate students at a mid-Atlantic university completed the BMI-SMT, the Gardner 2-figure Silhouette Matching Test and were measured for height and weight.

RESULTS

Validity coefficients using Pearson r correlations ranged from 0.69 to 0.84 for comparisons between BMI values for the BMI-SMT, and the GSMT and actual BMI measures. Coefficients for weight values produced r-values ranging from 0.59 to 0.84. Analysis of the BMI-SMT ability to accurately assess weight classification indicated a tendency toward overestimation.

CONCLUSION

The BMI-SMT is a valid measure of body image perceptions and estimates of weight and BMI.