The Stanford Healthy Neighborhood Discovery Tool: a computerized tool to assess active living environments

BACKGROUND

The built environment can influence physical activity, particularly among older populations with impaired mobility. Existing tools to assess environmental features associated with walkability are often cumbersome, require extensive training, and are not readily available for use by community residents.

PURPOSE

This project aimed to develop and evaluate the utility of a computerized, tablet-based participatory tool designed to engage older residents in identifying neighborhood elements that affect active living opportunities.

METHODS

Following formative testing, the tool was used by older adults (aged ≥65 years, in 2011) to record common walking routes (tracked using built-in GPS) and geocoded audio narratives and photographs of the local neighborhood environment. Residents (N=27; 73% women; 77% with some college education; 42% used assistive devices) from three low-income communal senior housing sites used the tool while navigating their usual walking route in their neighborhood. Data were analyzed in 2012.

RESULTS

Elements (from 464 audio narratives and photographs) identified as affecting active living were commensurate with the existing literature (e.g., sidewalk features, aesthetics, parks/playgrounds, crosswalks). However, within each housing site, the profile of environmental elements identified was distinct, reflecting the importance of granular-level information collected by the tool. Additionally, consensus among residents was reached regarding which elements affected active living opportunities.

CONCLUSIONS

This tool serves to complement other assessments and assist decision makers in consensus-building processes for environmental change.

The Use of Behavior Change Techniques and Theory in Technologies for Cardiovascular Disease Prevention and Treatment in Adults: A Comprehensive Review

This review examined the use of health behavior change techniques and theory in technology-enabled interventions targeting risk factors and indicators for cardiovascular disease (CVD) prevention and treatment. Articles targeting physical activity, weight loss, smoking cessation and management of hypertension, lipids and blood glucose were sourced from PubMed (November 2010-2015) and coded for use of 1) technology, 2) health behavior change techniques (using the CALO-RE taxonomy), and 3) health behavior theories. Of the 984 articles reviewed, 304 were relevant (240=intervention, 64=review). Twenty-two different technologies were used (M=1.45, SD=+/-0.719). The most frequently used behavior change techniques were self-monitoring and feedback on performance (M=5.4, SD=+/-2.9). Half (52%) of the intervention studies named a theory/model - most frequently Social Cognitive Theory, the Trans-theoretical Model, and the Theory of Planned Behavior/Reasoned Action. To optimize technology-enabled interventions targeting CVD risk factors, integrated behavior change theories that incorporate a variety of evidence-based health behavior change techniques are needed.

Religious fatalism and its association with health behaviors and outcomes

OBJECTIVE

To examine the association between religious fatalism and health care utilization, health behaviors, and chronic illness.

METHODS

As part of Nashville's REACH 2010 project, residents (n=1273) participated in a random telephone survey that included health variables and the helpless inevitability subscale of the Religious Health Fatalism Questionnaire.

RESULTS

Religious health fatalism was higher among African Americans and older participants. Some hypotheses about the association between fatalism and health outcomes were confirmed.

CONCLUSION

Religious fatalism is only partially predictive of health behaviors and outcomes and may be a response to chronic illness rather than a contributor to unhealthy behaviors.

FEAST: Empowering Community Residents to Use Technology to Assess and Advocate for Healthy Food Environments

Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods.

Factors associated with participation in work-site wellness programs: implications for increasing willingness among rural service employees

The purpose of this study was to identify factors underlying decisions to participate in work-site wellness programs. A sample of 279 full-time workers from a service division of a rural Midwestern university completed a survey assessing demographic and job characteristics, health status and health behaviors, and Reasoned Action Approach (RAA) variables for participating in work-site wellness activities. Regression analyses identified factors associated with intention; multivariate analyses of variance compared low to high intenders on salient beliefs. In sequential regression analyses, constructs of RAA predicted intention over and above the three significant background variables of age, exercise in past month, and fruit and vegetable consumption (R (2) = .469, R (2) change = .409, p < .001). Attitude had the highest relative weight (β = .445, p < .001); perceived norm had a significant weight (β = .273, p < .001). Significant differences in beliefs were found. To increase participation, planners should design programs that provide benefits employees perceive as advantageous and ensure coworker and supervisor support.

Rural Food and Physical Activity Assessment Using an Electronic Tablet-Based Application, New York, 2013-2014

Introduction

A community’s built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement.

Methods

Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change.

Results

Twenty-four adults (mean age, 69.4 y [standard deviation, 13.2 y]), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use.

Conclusion

An electronic tablet–based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

A qualitative study of shopper experiences at an urban farmers' market using the Stanford Healthy Neighborhood Discovery Tool

OBJECTIVE

To understand factors which enhance or detract from farmers' market shopper experiences to inform targeted interventions to increase farmers' market utilization, community-building and social marketing strategies.

DESIGN

A consumer-intercept study using the Stanford Healthy Neighborhood Discovery Tool to capture real-time perceptions via photographs and audio narratives.

SETTING

An urban farmers' market in a large metropolitan US city.

PARTICIPANTS

Thirty-eight farmers' market shoppers, who recorded 748 unique coded elements through community-based participatory research methods.

RESULTS

Shoppers were primarily women (65 %), 18-35 years of age (54 %), non-Hispanic (81 %) and white (73 %). Shoppers captured 291 photographs (7·9 (sd 6·3) per shopper), 171 audio narratives (5·3 (sd 4·7) per shopper), and ninety-one linked photograph + audio narrative pairs (3·8 (sd 2·8) per shopper). A systematic content analysis of the photographs and audio narratives was conducted by eight independent coders. In total, nine common elements emerged from the data that enhanced the farmers' market experience (61·8 %), detracted from the experience (5·7 %) or were neutral (32·4 %). The most frequently noted elements were freshness/abundance of produce (23·3 %), product presentation (12·8 %), social interactions (12·4 %) and farmers' market attractions (e.g. live entertainment, dining offerings; 10·3 %).

CONCLUSIONS

While produce quality (i.e. freshness/abundance) was of primary importance, other contextual factors also appeared important to the shoppers' experiences. These results may inform social marketing strategies to increase farmers' market utilization and community-building efforts that target market venues.

Impacts of a Temporary Urban Pop-Up Park on Physical Activity and Other Individual- and Community-Level Outcomes

Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face.

Effects of Counseling by Peer Human Advisors vs Computers to Increase Walking in Underserved Populations: The COMPASS Randomized Clinical Trial

IMPORTANCE

Effective and practical treatments are needed to increase physical activity among those at heightened risk from inactivity. Walking represents a popular physical activity that can produce a range of desirable health effects, particularly as people age.

OBJECTIVE

To test the hypothesis that counseling by a computer-based virtual advisor is no worse than (ie, noninferior to) counseling by trained human advisors for increasing 12-month walking levels among inactive adults.

DESIGN, SETTING, AND PARTICIPANTS

A cluster-randomized, noninferiority parallel trial enrolled 245 adults between July 21, 2014, and July 29, 2016, with follow-up through September 15, 2017. Data analysis was performed from March 15 to December 20, 2018. The evidence-derived noninferiority margin was 30 minutes of walking per week. Participants included inactive adults aged 50 years and older, primarily of Latin American descent and capable of walking without significant limitations, from 10 community centers in Santa Clara and San Mateo counties, California.

INTERVENTIONS

All participants received similar evidence-based, 12-month physical activity counseling at their local community center, with the 10 centers randomized to a computerized virtual advisor program (virtual) or a previously validated peer advisor program (human).

MAIN OUTCOMES AND MEASURES

The primary outcome was change in walking minutes per week over 12 months using validated interview assessment corroborated with accelerometry. Both per-protocol and intention-to-treat analysis was performed.

RESULTS

Among the 245 participants randomized, 193 were women (78.8%) and 241 participants (98.4%) were Latino. Mean (SD) age was 62.3 (8.4) years (range, 50-87 years), 107 individuals (43.7%) had high school or less educational level, mean BMI was 32.8 (6.8), and mean years residence in the US was 47.4 (17.0) years. A total of 231 participants (94.3%) completed the study. Mean 12-month change in walking was 153.9 min/wk (95% CI, 126.3 min/wk to infinity) for the virtual cohort (n = 123) and 131.9 min/wk (95% CI, 101.4 min/wk to infinity) for the human cohort (n = 122) (difference, 22.0, with lower limit of 1-sided 95% CI, -20.6 to infinity; P = .02); this finding supports noninferiority. Improvements emerged in both arms for relevant clinical risk factors, sedentary behavior, and well-being measures.

CONCLUSIONS AND RELEVANCE

The findings of this study indicate that a virtual advisor using evidence-based strategies produces significant 12-month walking increases for older, lower-income Latino adults that are no worse than the significant improvements achieved by human advisors. Changes produced by both programs are commensurate with those reported in previous investigations of these behavioral interventions and provide support for broadening the range of light-touch physical activity programs that can be offered to a diverse population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02111213.

Testing the comparative effects of physical activity advice by humans vs. computers in underserved populations: The COMPASS trial design, methods, and baseline characteristics

While physical inactivity is a key risk factor for a range of chronic diseases and conditions associated with aging, a significant proportion of midlife and older adults remain insufficiently active. This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. The major objective of this 12-month cluster-randomized controlled trial is to test the comparative effectiveness of two linguistically and culturally adapted, community-based physical activity interventions with the potential for broad reach and translation. Ten local community centers serving a sizable number of Latino residents were randomized to receive one of two physical activity interventions. The Virtual Advisor program employs a computer-based embodied conversational agent named "Carmen" to deliver interactive, individually tailored physical activity advice and support. A similar intervention program is delivered by trained Peer Advisors. The target population consists of generally healthy, insufficiently active Latino adults ages 50years and older living within proximity to a designated community center. The major outcomes are changes in walking and other forms of physical activity measured via self-report and accelerometry. Secondary outcomes include physical function and well-being variables. In addition to these outcome analyses, comparative cost analysis of the two programs, potential mediators of intervention success, and baseline moderators of intervention effects will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yield as well as study baseline characteristics.

TRIAL REGISTRATION

clinicaltrial.gov Identifier=NCT02111213.

Salient beliefs about eating and buying dark green vegetables as told by Mid-western African-American women

Vegetables in the dark green group are the most nutritious, yet intake is low. Studies suggest that an increase in fruit and vegetables may improve diet-related health outcomes of African Americans. The aim of this exploratory study was to use the Reasoned Action Approach (RAA) to qualitatively assess salient, top-of-the-mind, beliefs (consequences, circumstances and referents) about eating and buying more dark green leafy vegetables each week over the next 3months. Adult (n=30), Midwestern African-American women, who buy and prepare food for their household participated in a face-to-face salient belief elicitation. A content analysis of verbatim text and a descriptive analysis were conducted. Findings suggest that the RAA can be used to identify salient consequences, circumstances and referents about eating and buying more dark green leafy vegetables. The use of the RAA allowed for the extraction of specific beliefs that may aid in the development of nutrition education programs that consider the varying priorities, motivators and barriers that subgroups within the population have in regard to buying and consuming dark green leafy vegetables.

A Theoretically-Grounded Investigation of Perceptions About Healthy Eating and mHealth Support Among African American Men and Women in New Orleans, Louisiana

There has been a surge in diet-related mobile health (mHealth) interventions. However, diet-related mHealth research targeted toward racial/ethnic populations has been relatively limited. Focus groups with African American men and women from New Orleans, Louisiana, were conducted to (1) describe perceptions about healthy eating, (2) determine the acceptability of mHealth interventions, and (3) identify preferred mHealth intervention features. Descriptive statistics and thematic content analyses were performed. Qualitative data were organized within the context of the Theory of Planned Behavior and Social Cognitive Theory's theoretical components. Results may inform the development of mHealth research to improve eating behaviors among the target population.

Understanding African American women's decisions to buy and eat dark green leafy vegetables: an application of the reasoned action approach

OBJECTIVE

Examine intentions to buy and eat dark green leafy vegetables (DGLV).

DESIGN

Cross-sectional survey assessing demographics, behavior, intention, and Reasoned Action Approach constructs (attitude, perceived norm, self-efficacy).

SETTING

Marion County, Indiana.

PARTICIPANTS

African American women responsible for buying and preparing household food.

MAIN OUTCOME MEASURE(S)

Reasoned Action Approach constructs explaining intentions to buy and eat DGLV.

ANALYSIS

Summary statistics, Pearson correlations, and multiple regression analyses.

RESULTS

Among participants (n = 410, mean age = 43 y), 76% and 80%, respectively, reported buying and eating DGLV in the past week. Mean consumption was 1.5 cups in the past 3 days. Intentions to buy (r = 0.20, P < .001) and eat (r = 0.23, P < .001) DGLV were positively associated with consumption. Reasoned Action Approach constructs explained 71.2% of the variance in intention to buy, and 60.9% of the variance in intention to eat DGLV. Attitude (β = .63) and self-efficacy (β = .24) related to buying and attitude (β = .60) and self-efficacy (β = .23) related to eating DGLV explained significant amounts of variance in intentions to buy and eat more DGLV. Perceived norm was unrelated to either intention to buy or eat DGLV.

CONCLUSIONS AND IMPLICATIONS

Interventions designed for this population of women should aim to improve DGLV-related attitudes and self-efficacy.

Where Are the Fresh Fruits and Vegetables?: A Systematic Exploration of Access to Food Stores Offering Fresh Fruits and Vegetables as Told by Midwestern African American Women

This exploratory study systematically examined Midwestern African American women's (n = 273) access to food stores offering more than 5 fresh fruits and vegetables daily. Access to potential (within 0.5 miles of household) and realized (where participant buys fruits and vegetables most often) food stores was assessed. Descriptive analyses revealed that participants lived closer to food stores not offering more than 5 fresh fruits and vegetables daily. Participants purchased fresh fruits and vegetables from food stores that were an average of 1.2 miles further than the closest food stores offering more than 5 fresh fruits and vegetables daily to their household. Results highlight complexities of the food environment and the need to further investigate factors influencing food-related behaviors.

Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods

Physical inactivity is a key risk factor for a range of chronic diseases and conditions, yet, approximately 50% of U.S. adults fall below recommended levels of regular aerobic physical activity (PA). This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. Text messaging (SMS) represents a convenient and accessible communication channel for delivering targeted PA information and support, but has not been rigorously evaluated against standard telehealth advising programs. The objective of the On The Move randomized controlled trial is to test the effectiveness of a linguistically and culturally targeted SMS PA intervention (SMS PA Advisor) versus two comparison conditions: a) a standard, staff-delivered phone PA intervention (Telephone PA Advisor) and b) an attention-control arm consisting of a culturally targeted SMS intervention to promote a healthy diet (SMS Nutrition Advisor). The study sample (N = 350) consists of generally healthy, insufficiently active Latino adults ages 35 years and older living in five northern California counties. Study assessments occur at baseline, 6, and 12 months, with a subset of participants completing 18-month assessments. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of PA, assessed via validated self-report measures and supported by accelerometry, and physical function and well-being variables. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. Trial Registration: clinicaltrial.gov Identifier = NCT02385591.

An evaluation of the Nashville REACH 2010 community health screening strategy

Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for reducing disparities in heart disease and diabetes among African Americans in North Nashville, Tenn. We evaluated our screening efforts by asking 4 questions: (1) Are the screening participants representative of the target population? (2) How often were screening participants with possible undiagnosed hypertension, high cholesterol, and diabetes identified? (3) How often were screening participants with an elevated risk for developing hypertension, high cholesterol, and diabetes identified? and (4) How often did we identify screening participants with known hypertension, high cholesterol, and diabetes whose disease management was suboptimal? Results from 1757 persons screened were compared to telephone surveys from 16,199 Nashville residents. Those screened were younger and healthier than the target population. Rates of potentially undiagnosed cases among African Americans were 0.8% for diabetes, 17.4% for hypertension, and 32.7% for high cholesterol. High-risk individuals were identified 13.1% of the time for diabetes, 45.3% of the time for hypertension, and 21.3% of the time for total cholesterol. Rates of poorly controlled known disease were 23.5% for diabetes, 39.0% for hypertension, and 58.2% for total cholesterol. Although we reached a younger and healthier group than the community population, community-based screenings identified many people with potential health risks. We present a model of how to organize and implement successful community-based screening.

A Mixed Method Study to Inform the Implementation and Expansion of Pop-Up Parks for Economic, Behavioral, and Social Benefits

The availability of parks and urban green spaces has been associated with a number of benefits, including increased physical activity, improvements in mental health, increases in social interactions, improvements to the environment, and increases in property values. The installation of temporary pop-up parks in urban areas is one way for urban communities to obtain these benefits. In this mixed-methods study, quantitative and qualitative data were gathered by researchers, the city council, a local investment company, and community residents that informed the initiation, iteration, and incremental expansion of a series of temporary, summer pop-up parks in the downtown business district of the City of Los Altos in Northern California over a 4-year period (2013-2016). Results showed that the parks were visited by a large, multigenerational group of users who engaged in leisure-time physical activity, shopped at local stores, attended programed events, and socialized with others. Direct observation and survey data gathered in year 2014 also indicated that foot traffic into businesses directly fronting on a pop-up park (n = 8) was higher during a 4-day period when the park was in place, as compared to a similar 4-day period before the park was installed. The majority of downtown business owners/managers reported no decrease in sales compared to the month before the pop-up park was installed. City sales tax data indicated increases in year-on-year sales tax revenue in the summer quarter of 2014 and 2016 compared with the year (2015) when there was no downtown pop-up park. Perspectives of community residents collected before, during, and after the installation of the pop-up parks indicated that the pop-up park created a vibrant space in an otherwise underutilized area that was enjoyed by a variety of people in a host of ways (e.g., children playing, families relaxing, people shopping and eating at downtown stores and restaurants, people of all ages attending scheduled park events). These results informed a number of discussions and meetings between key stakeholders about the pop-up parks, culminating in a temporary park that was held in a new location in 2017 that was substantially larger in size, installed for a longer time period, cost more, and had more scheduled park events. Results from this prospective investigation of the initial impacts of pop-up parks in this urban location provide insights regarding the potential benefits and viability of such temporary parks for residents and businesses alike.

Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The Steps for Change randomized controlled trial design and methods

While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. TRIAL REGISTRATION: clinicaltrial.gov Identifier = NCT03041415.

Religiosity and Excess Weight Among African-American Adolescents: The Jackson Heart KIDS Study

Recent studies suggest that religion and spirituality can yield health benefits for young African-Americans. We examined the relationship between religious practices, spirituality, and excess weight among African-American adolescents (N = 212) residing in the Deep South. Results from modified Poisson regression analysis indicate that adolescents who prayed daily had a lower prevalence of excess weight (PR 0.77 [95% CI 0.62-0.96]) than those who did not. This relationship was only significant for 12-15 year-old participants in age-stratified analysis. These findings suggest that preventive interventions offered to children and younger adolescents can have implications for weight status across the lifespan.