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Objective: Studies have consistently shown that African American individuals lose less weight in response to behavioral interventions, but the mechanisms leading to this result have been understudied. Methods: Data were derived from the PROmoting Successful Weight Loss in Primary CarE in Louisiana (PROPEL) study, which was a cluster‐randomized, two‐arm trial conducted in primary care clinics. In the PROPEL trial, African American individuals lost less weight compared with patients who belonged to other racial groups after 24 months. In the current study, counterfactual mediation analyses among 445 patients in the intervention arm of PROPEL were used to determine which variables mediated the relationship between race and weight loss. The mediators included treatment engagement, psychosocial, and lifestyle factors. Results: At 6 months, daily weighing mediated 33% (p = 0.008) of the racial differences in weight loss. At 24 months, session attendance and daily weighing mediated 35% (p = 0.027) and 66% (p = 0.005) of the racial differences in weight loss, respectively. None of the psychosocial or lifestyle variables mediated the race‐weight loss association. Conclusions: Strategies specifically targeting engagement, such as improving session attendance and self‐weighing behaviors, among African American individuals are needed to support more equitable weight losses over extended time periods. [ABSTRACT FROM AUTHOR]

Objective: This study tested whether initial weight change (WC), self‐weighing, and adherence to the expected WC trajectory predict longer‐term WC in an underserved primary‐care population with obesity. Methods: Data from the intervention group (n = 452; 88% women; 74% Black; BMI 37.3 kg/m2 [SD: 4.6]) of the Promoting Successful Weight Loss in Primary Care in Louisiana trial were analyzed. Initial (2‐, 4‐, and 8‐week) percentage WC was calculated from baseline clinic weights and daily at‐home weights. Weights were considered adherent if they were on the expected WC trajectory (10% at 6 months with lower [7.5%] and upper [12.5%] bounds). Linear mixed‐effects models tested whether initial WC and the number of daily and adherent weights predicted WC at 6, 12, and 24 months. Results: Percentage WC during the initial 2, 4, and 8 weeks predicted percentage WC at 6 (R2 = 0.15, R2 = 0.28, and R2 = 0.50), 12 (R2 = 0.11, R2 = 0.19, and R2 = 0.32), and 24 (R2 = 0.09, R2 = 0.11, and R2 = 0.16) months (all p < 0.01). Initial daily and adherent weights were significantly associated with WC as individual predictors, but they only marginally improved predictions beyond initial weight loss alone in multivariable models. Conclusions: These results highlight the importance of initial WC for predicting long‐term WC and show that self‐weighing and adherence to the expected WC trajectory can improve WC prediction. [ABSTRACT FROM AUTHOR]

Background: Step-counting interventions with discrepant intensity emphases may elicit different effects. Methods: A total of 120 sedentary/low-active, postmenopausal women were randomly assigned to one of the following 3 groups: (1) 10,000 steps per day (with no emphasis on walking intensity/speed/cadence; basic intervention, 49 completers), (2) 10,000 steps per day and at least 30 minutes in moderate intensity (ie, at a cadence of at least 100 steps per minute; enhanced intervention, 47 completers), or (3) a control group (19 completers). NL-1000-determined steps and active minutes (a device-specific indicator of time at moderate+ intensity) were collected as process variables during the 12-week intervention. Outcome variables included systolic and diastolic blood pressure, anthropometric measurements, fasting blood glucose and insulin, flow-mediated dilation, gait speed, and ActiGraph GT3X+-determined physical activity and sedentary behavior. Results: The "basic group" increased 5173 to 9602 steps per day and 9.2 to 30.2 active minutes per day. The "enhanced group" similarly increased 5061 to 10,508 steps per day and 8.7 to 38.8 active minutes per day. The only significant change over time for clinical variables was body mass index. Conclusions: Interventions that use simple step-counters can achieve elevated volume and intensity of daily physical activity, regardless of emphasis on intensity. Despite this, few clinical outcomes were apparent in this sample of postmenopausal women with generally normal or controlled hypertension. [ABSTRACT FROM AUTHOR]

Walking cadence (steps per minute) is associated with the intensity of ambulatory behavior. This analysis provides normative values for peak 30-min cadence, an indicator of "natural best effort" during free-living behavior. A sample of 1,196 older adults (aged from 60 to 85+) with accelerometer data from the National Health and Nutrition Examination Survey 2005-2006 was used. Peak 30-min cadence was calculated for each individual. Quintile-defined values were computed, stratified by sex and age groups. Smoothed sex-specific centile curves across the age span were fitted using the LMS method. Peak 30-min cadence generally trended lower as age increased. The uppermost quintile value was >85 steps/min (men: 60-64 years), and the lowermost quintile value was <22 steps/min (women: 85+). The highest 95th centile value was 103 steps/min (men: 64-70 years), and the lowest 5th centile value was 15 steps/min (women: 85+). These normative values may be useful for evaluating older adults' "natural best effort" during free-living ambulatory behavior. [ABSTRACT FROM AUTHOR]

Although studies indicate that public policy can influence the decrease in smoking behaviors, these policies have not necessarily transferred to home environments at the same rate. The authors surveyed 4,296 students in a southern urban area. African American students were 76.3% of the respondents and Caucasians accounted for 23.7%. African American homes are less likely to have full bans on smoking inside the home. Home smoking bans impact smoking behaviors, acceptance of smoking, susceptibility to smoking, smoking beliefs, and motivation to quit smoking. Along with home smoking bans, there are differences among African American and Caucasian youth in smoking exposure, behaviors, beliefs, and motivation to quit smoking. This study suggests that particularly in African American youth, educational efforts should be directed toward more restrictive home smoking policies to thwart the initiation of smoking in adolescents and to encourage positive attitudes toward smoking behaviors. (Contains 4 tables.)

Background: Previous investigations have shown that low academic achievers are more likely to smoke cigarettes, drink alcohol, and use marijuana and other illicit drugs. This study investigated the relationship between academic performance and substance use among public high school students in Mississippi. Methods: The sampling frame for the 2003 Mississippi Youth Risk Behavior Survey was obtained from the Mississippi Department of Education. A 2-stage cluster sample design produced a representative sample of Mississippi students in grades 9-12 who attended public schools. During the spring 2003, 34 of the 45 sampled schools (75.6%) participated. Results: A total of 1488 from the 1672 sampled students (89.0%) completed an 87-item questionnaire (overall response rate 67.3%). Low academic performance (students with mostly Cs or below) during the 12 months preceding the survey was more prevalent among males, non-Hispanic blacks, frequent smokers, binge drinkers, and marijuana users. Logistic regression identified gender, race, frequent smoking, and marijuana use as statistically significant factors associated with increased odds for low academic performance. Adjusted odds ratios were 1.2 for binge drinkers versus other students to 2.6 for non-Hispanic black students versus non-Hispanic white students. Conclusions: The present findings highlight the extensive use of cigarettes, alcohol, and marijuana among Mississippi public high school students. Because poor academic achievers are more prevalent among students who participate in these substance-use behaviors, multifaceted approaches that encourage high levels of academic performance, while dissuading student involvement in risky/problem behaviors, may both improve low levels of academic achievement and reduce behaviors that contribute to poor health in adulthood.

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.

This study found 20.4% of children attending a middle school located in rural Mississippi had used inhalants to "get high," a figure that is much larger than the national average. Many (3.4%) students reported they had used inhalants on 10 or more occasions. Inhalant use was most associated with being younger, ever smoking, riding with a driver who had been drinking, and being involved in a fight. Nearly twice as many younger students reported usage in our sample compared to other studies. Longitudinal studies need to be conducted to investigate whether use of inhalants is a precursor to other risky behaviors, and subsequent progression to alcohol abuse or illicit drug use. (Contains 2 tables.)

Researchers examined trends and compared subgroup differences in violence-related behaviors on school property among Mississippi public high school students from 1993 to 2003. Findings are based on data from the Mississippi Youth Risk Behavior Surveillance System (YRBSS), a representative sample (N = 9,058) of Mississippi high school students. Males, non-Hispanic Whites, heavy smokers, and binge drinkers reported violence-related behaviors on school property more frequently than their counterparts. A statistically significant linear decrease occurred during 1993-2003 in the percent of students carrying a weapon (p < 0.0001) and having a physical fight (p < 0.0001). The percent of students threatened or injured with a weapon on school grounds did not decrease significantly (p = 0.2800). Violence-related behaviors were reported somewhat less frequently among 12th graders but overall, grade was not a statistically significant factor. Trends observed in Mississippi appear to be occurring throughout the United States and perhaps globally. Parents, school officials, and community administrators are committed to reducing violence-related behavior on school property. Although the decreases are encouraging, the percent of students who reported violence-related behaviors remains at a level that causes serious concern. Efforts must continue and perhaps increase to curb behaviors that may lead to school violence. Future studies should elucidate mechanisms associated with the self-reported decreasing behaviors so intervention programs can be properly focused.

BackgroundLow levels of moderate-to-vigorous physical activity are associated with adverse health consequences. ObjectiveThe intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones. MethodsPotential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child’s activity at 6000 pedometer steps/day above their baseline levels and to monitor their child’s steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child’s physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child’s step counts daily. ResultsOut of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56%, 15/27 female; 59%, 16/27 African American) were enrolled and completed the study. Overall, 97.90% (2220/2268; 98.20%, 1072/1092 for MIG; 97.60%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P