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Abstract: Objectives: Social Cognitive Theory (SCT) has often been used as a guide to predict and modify physical activity (PA) behavior. We assessed the ability of commonly investigated SCT variables and perceived school environment variables to predict PA among elementary students. We also examined differences in influences between Hispanic and non-Hispanic students. Design: This analysis used baseline data collected from eight schools who participated in a four-year study of a combined school-day curriculum and environmental intervention. Methods: Data were collected from 393 students. A 3-step linear regression was used to measure associations between PA level, SCT variables (self-efficacy, social support, enjoyment), and perceived environment variables (schoolyard structures, condition, equipment/supervision). Logistic regression assessed associations between variables and whether students met PA recommendations. Results: School and sex explained 6% of the moderate-to-vigorous PA models' variation. SCT variables explained an additional 15% of the models' variation, with much of the model's predictive ability coming from self-efficacy and social support. Sex was more strongly associated with PA level among Hispanic students, while self-efficacy was more strongly associated among non-Hispanic students. Perceived environment variables contributed little to the models. Conclusions: Our findings add to the literature on the influences of PA among elementary-aged students. The differences seen in the influence of sex and self-efficacy among non-Hispanic and Hispanic students suggests these are areas where PA interventions could be tailored to improve efficacy. Additional research is needed to understand if different measures of perceived environment or perceptions at different ages may better predict PA. [Copyright &y& Elsevier]

Abstract: The Pacific Tracker (PacTrac) is a computer program designed to analyse food intakes of individuals from the Pacific Region. PacTrac’s original output included servings of daily intake of food groups according to the United States Food Guide Pyramid, nutrient intake recommendations, and a comparison to other national nutrition recommendations. PacTrac was made available for public use through the Hawaii Foods website (hawaiifoods.hawaii.edu). PacTrac2 is an updated and expanded version of PacTrac that uses the United States MyPyramid/MyPlate food groups in household units of daily intake, rather than servings. In addition, the PacTrac2 includes a physical activity analysis tool which quantifies minutes of physical activities and their intensities based on energy estimates from the compendium of physical activity and research on children. An Expert System (ES) – a computerised decision tree to guide behaviour change – was developed using information on self-efficacy and stage of readiness to change, and the fruit and vegetable intake and physical activity information from PacTrac2. The ES produces reports for the child, the parent/guardian, and the child’s physician with child-specific strategies, targeted behavioural information, and feedback tailored to the child. PacTrac2-ES was designed for the Pacific Kids DASH for Health (PacDASH) intervention study, conducted in the Kaiser Permanente health care system in Hawaii. The intervention is based on the child’s self-efficacy and stage of readiness to change intake of fruits and vegetables and physical activity, with a goal of maintaining body weight to prevent obesity. The intervention is complemented with stage-based mailers addressing the environment for physical activity and fruit and vegetable intake and newsletters that address related behaviours (sedentary activity and a DASH eating approach). This project is the first to expand the PacTrac to contain children’s foods and physical activities from the Pacific Region and to use current US MyPyramid/MyPlate food and physical activity analysis and guidance systems, and to develop and implement an Expert System for fruits, vegetables and physical activity of 5–8-year-old children. The PacTrac2-ES was used in the PacDASH study and will be used for other programs to promote healthy eating and physical activity of children in the Pacific Region. [Copyright &y& Elsevier]

Examine the impact of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF) on children's culinary self-efficacy, attitude, fruit and vegetable (FV) preferences, physical activity (PA), and body mass index. Randomized controlled trial. Eight elementary schools in 2 Northern Colorado districts. Fourth-grade students; 7-month interventions: school (S.FFF)—theory-based cooking + tasting lessons, active recess, lesson-driven cafeteria promotions; or school + family (S+F.FFF) with added family nights and home activities. Cooking self-efficacy and attitudes, FV preferences, PA, and measured height/weight. Individual outcomes nested by classroom, school, and district and assessed > 12 months with repeated measures controlled by sex and baseline cooking experience, with a significance level of P < 0.05. The sample included 1,428 youth, 38 teachers, 4 cohorts, 50% boys, 75% White, and 15% Hispanic. No intervention effect was observed. Those who cooked retained higher self-efficacy, attitude, and FV preferences (P < 0.001). Girls reported higher self-efficacy and attitude than boys. Moderate-to-vigorous PA and metabolic equivalent minutes increased for all students; boys retained higher levels (P < 0.001). Body mass index percentile remained stable. Cooking and sex were associated with all outcome measures and should be considered for intervention tailoring. Treatment impacts were not evident nesting by classroom, school, and district. Accurate assessment of school-based interventions requires rejecting student independence from group assignment assumptions. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To test the measurement properties of the Transtheoretical Model (TTM) relative to physical activity (PA) behavior. Design: Participants from an ethnically diverse sample in Hawaii (N = 700) completed questionnaires capturing each TTM construct. Method: The current study examined the factorial validity and longitudinal invariance of TTM constructs recently revised for PA. Results: Factorial validity was confirmed for each construct using confirmatory factor analysis with full-information maximum likelihood. Longitudinal invariance was evidenced across a shorter (3-month) and longer (6-month) time period via nested model comparisons. Conclusions: The questionnaires for each validated TTM construct are provided, and can now be generalized across similar subgroups and time points. Further validation of the provided measures is suggested in additional populations and across extended time points. [Copyright &y& Elsevier]

Abstract: Regular physical activity (PA) decreases the risk of several chronic diseases including some cancers, type II diabetes, obesity, and cardiovascular disease; however, the majority of US adults are not meeting the recommended levels to experience these benefits. To address this public health concern, the underlying mechanisms for behavior change need to be understood, translated and disseminated into appropriately tailored interventions. The Transtheoretical Model (TTM) provides a framework for both the conceptualization and the measurement of behavior change, as well as facilitating promotion strategies that are individualized and easily adapted. The purpose of this manuscript is to present the constructs of the TTM as they relate to PA behavior change. We begin with a brief synopsis of recent examinations of the TTM constructs and their application. Subsequent to its introduction, we specifically present the TTM within the PA context and discuss its application and usefulness to researchers and practitioners. Criticisms of the TTM are also noted and presented as opportunities for future research to enhance the valid application of the TTM. We offer general study design recommendations to appropriately test the hypothesized relationships within the model. With further examinations using appropriate study design and statistical analyses, we believe the TTM has the potential to advance the public health impact of future PA promotion interventions. [ABSTRACT FROM AUTHOR]

Abstract: The stages of change construct of the Transtheoretical Model have been successfully applied to examine physical activity adoption among adults. Thus far, little research on the stages of physical activity change has been focused on children. Therefore, the purpose of this study is to validate the stages of change with vigorous, moderate, and light physical activity, and sedentary behaviour among children. Two different samples (sample 1: n =513, 52% male; sample 2: n =258, 45% male) completed Godin''s Leisure-Time Exercise Questionnaire and the physical activity stage questions. One-way ANOVAs revealed significant differences in both the samples between the stages of change for vigorous (sample 1: F =15.9, df=4508, p <.0125, η 2 =.17; sample 2: F =12.8, df=4252, p <.0125, η 2 =.11) and moderate (sample 1: F =8.54, df=4508, p <.0125, η 2 =.07; sample 2: F =4.72, df=4252, p <.0125, η 2 =.06) physical activity. There are no or weak correlations found between the stages of change and light physical activity (sample 1: F =3.12, df=4508, ns, η 2 =.05; sample 2: F =3.38, df=4250, p <.0125, η 2 =.02), or sedentary behaviour (sample 1: F =.54, df=4508, ns, η 2 =.05; sample 2: F =3.13, df=4252, ns, η 2 =.00). These results extend the validation of the stages of physical activity to children''s moderate and vigorous intensity activities. [Copyright &y& Elsevier]

Abstract: Objectives:: The present study assessed the generalizability of the Theory of Planned Behavior (TPB) applied to physical activity and to examine if the TPB operates equivalently across gender, age, and ethnic sub-groups. Design/Methods:: Measurement equivalence was evaluated for gender (male/female), age (19–34/35–54/55+) and ethnicity (Japanese/Hawaiian or part Hawaiian/Filipino/White) in a random sample (n =3533) using Multisample Structural Equation Modeling. Results:: Measurement equivalence was found for all variables and for their intercorrelations. Of the 100 possible TPB variable relationships between groups, only 6 were significant. The differences were found in explained variances of physical activity. Conclusions:: The findings indicate that TPB measures apply over a range of population sub-groups, and should be considered comprehensively when designing interventions. [Copyright &y& Elsevier]

Background and purpose. Research and application in the physical activity and exercise area are increasingly impacted by technology. The exponential growth of World Wide Web access and the proliferation of personal computers highlight the importance of this development. The purpose of this article is to discuss the current impact of technology on different aspects of physical activity interventions and potential future applications.Methods. Relevant literature is reviewed within each of the areas being discussed.Results and conclusions. Technology has contributed to a secular decline in physical activity; however, it allows a) the proactive recruitment of large populations, b) the individualization of interventions on a large scale, and c) the delivery of activity promoting interventions to large populations via differing channels. Support is emerging for individualized interactive physical activity interventions delivered to large samples. Yet-untested areas where technology may have a beneficial impact on physical activity adoption and maintenance are interactive TV and virtual reality. With the increased focus on environmental strategies, technology could also be used to modify home environments to facilitate incorporating physical activity into everyday life. Technology is also increasing its role in the business of physical activity/exercise. For example, web-based health sites are now listed on the stock market. Health and fitness centers are adopting high-tech entertainment capabilities to serve each client. Combining the individualized technology used in the adoption and maintenance research with the existing infrastructures in health and fitness centers could increase adherence within these centers. Currently, however, there is limited research and utilization of this technology for the promotion of physical activity and exercise at the population level. [Copyright &y& Elsevier]

Questionnaires to assess physical activity (PA) have served and continue to serve important purposes in both research and practical application as they capture the self-reported aggregation of the individual which is at times complemented with device-based measures. This paper presents an expert consensus on best practices and future directions regarding the use of PA questionnaires (PAQ). The expert panel discussions that informed this manuscript took place during the 2nd International Workshop of the Center for the Assessment of Physical Activity (CAPA), held in Karlsruhe, Germany in July of 2019. Practically, we recommend to identify already existing and published PAQs in order to address a specific research question. To facilitate this, a decision framework (decision guide aide) for selecting a PAQ, consisting of purpose, construct, measurement unit, recall period, population, setting, measurement quality, feasibility/ease of use, and resources is presented. These best practices are discussed to provide some standardization for the field. With regard to future research on PAQs, continued efforts to improve validity, reliability, and sensitivity to change; consider the recall period; incorporate information on or adapt for a specific cultural/ethnic/environmental context; and strategically combine PAQ with other PA assessment methods capitalizing on the advancement of technology, are needed. These recommended future directions are outlined in order to motivate and challenge researchers to continually improve the field of PAQ research. • Best practices include identifying already existing and published PAQs in order to address a specific research question. • To help select an existing PAQ a decision framework is presented consisting of purpose, construct, measurement unit, recall period, population, setting, measurement quality, feasibility/ease of use, and resources is presented. • Future PAQ research directions include continued efforts to improve validity, reliability, and sensitivity to change; consider the recall period; incorporate information on or adapt for a specific cultural/ethnic/environmental context; and strategically combine PAQ with other PA assessment methods capitalizing on the advancement of technology, are needed. [ABSTRACT FROM AUTHOR]

Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity. A random sample provided baseline data (n = 689; 63% female; M age (SD) = 47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals. Structural equation models revealed processes to cognitions to stage (AIC = 29313.093, BIC = 29514.883, CFI = 0.999, RMSEA = 0.006, SRMR = 0.026); processes to stage to cognitions (AIC = 27788.651, BIC = 27973.268, CFI = 0.978, RMSEA = 0.024, SRMR = 0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC = 13914.771, BIC = 14031.169, CFI = 0.981, RMSEA = 0.018, SRMR = 0.034), and stage to processes to cognitions (AIC = 22048.324, BIC = 22212.986, CFI = 0.976, RMSEA = 0.026, SRMR = 0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC = 10353.555, BIC = 10444.179, CFI = 0.937, RMSEA = 0.038, SRMR = 0.035). Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes. • The temporal sequencing of Transtheoretical Model (TTM) constructs was tested. • Data on TTM constructs related to physical activity were collected over two years. • A cyclical model where processes change initially led to cognition change was supported. • Cognition change was followed by stage change, which led back to processes change. • Renewed focus on processes is needed to further promote cognition change. [ABSTRACT FROM AUTHOR]

Objective To quantify the Head Start (HS) teacher mediating and moderating influence on the effect of a wellness policy intervention. Design Intervention trial within a larger randomized community trial. Setting HS preschools in Hawaii. Participants Twenty-three HS classrooms located within 2 previously randomized communities. Intervention Seven-month multi-component intervention with policy changes to food served and service style, initiatives for employee wellness, classroom activities for preschoolers promoting physical activity (PA) and healthy eating, and training and technical assistance. Main Outcome Measures The Environment and Policy Assessment and Observation (EPAO) classroom scores and teacher questionnaires assessing on knowledge, beliefs, priorities, and misconceptions around child nutrition and changes in personal health behaviors and status were the main outcome measures. Analysis Paired t tests and linear regression analysis tested the intervention effects on the classroom and mediating and moderating effects of the teacher variables on the classroom environment. Results General linear model test showed greater intervention effect on the EPAO score where teachers reported higher than average improvements in their own health status and behaviors (estimate [SE] = −2.47 (0.78), P < .05). Conclusions and Implications Strategies to improve teacher health status and behaviors included in a multi-component policy intervention aimed at child obesity prevention may produce a greater effect on classroom environments. [ABSTRACT FROM AUTHOR]

To describe the implementation and process characteristics of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF). Mixed methods. Elementary schools in 2 Northern Colorado school districts. Fourth graders (aged 9–11 years), parents, school staff, and implementation researchers; measured over 2 consecutive years in 8 schools (851 students, 45 classrooms). Social Cognitive and active learning theory-based classroom cooking with tasting lessons, active recess games, cooking with tasting food promotion during school lunch, family nights, and take-home intervention reinforcements. A 7-month program delivered by a trained intervention team. Implementation measures (observations and debriefings) assessed context, reach, dose delivered, fidelity, and dose received; process measures (surveys) assessed student and parent perceptions and intervention participation. Descriptive statistics for quantitative and themes for qualitative data. Minor adjustments in program delivery plans were required to accommodate changes in school schedules and policies. Process measures demonstrated > 90% achievement of goals for nearly all child-centered activities. One-quarter of eligible families participated in evening events, with strong parent and student approval. Fifty out of 116 parents (43%) completing an online survey reported preparing ≥ 1 of 5 recipes with their child. Fifty-nine percent of eligible students completed >1 of 10 take-home activity sheets with their parents. Engagement and commitment of the intervention team and school staff supported strong implementation. Participant responses were positive, but improvement in parent engagement requires investigation. [ABSTRACT FROM AUTHOR]

Summary: Obesity levels are rising rapidly in United States of America however, less is known about the obesity trends regarding the specific ethnicities prevalent in Hawai‘i, which may inform efforts to eliminate disparities. Objective: The purpose of this report is to analyze the body mass index (BMI) trends of the four major ethnicities in Hawai‘i (White, Japanese, Hawaiian, and Filipino) over the last ten years. Method: The BMI data overall and by ethnicity from 1999 to 2008 were utilized from the Behavioral Risk Factor Surveillance System (BRFSS). Results: We found that all ethnicities experienced a 47% increase in mean percent of obese persons. The Hawaiian ethnic group had the largest number of obese individuals, but they experienced the smallest increase. The Filipino ethnic group had less obese individuals, but they experienced the largest percentage increase. Conclusion: Based on these findings, obesity prevention efforts aimed at Hawai‘i''s multicultural population need to be improved and increased. [Copyright &y& Elsevier]

Data supporting the inverse correlation of fish or long-chain ω-3 fatty acid (FA) (eicosapentaenoic acid plus docosahexaenoic acid) supplement consumption and coronary heart disease are inconclusive and may be confounded by other dietary and lifestyle factors. Using the Diabetic Control and Complications Trial (DCCT) database (n = 1,441), correlations between consumption of ω-3 FAs and saturated FAs to dietary variables (kilocalories, macronutrients, sodium, and cholesterol) and to age, gender, exercise level, and tobacco use were tested using Pearson correlation coefficients. Long-chain ω-3 FA intake inversely correlated with consumption of calories (r = −0.16, p <0.0001), percent calories from total fat (r = −0.14, p <0.0001), and percent calories from saturated FAs (r = −0.21, p <0.0001) and directly with dietary fiber intake (grams per 1,000 kcal, r = 0.20, p <0.0001). In the DCCT database, long-chain ω-3 FAs (i.e., fish consumption) inversely correlated with an overall low risk nutritional profile for coronary heart disease. In conclusion, these findings provide evidence that associations observed in studies suggesting a benefit of fish or long-chain ω-3 FAs may be due to a convergence of greater fish intakes with an overall healthier dietary pattern rather than with a specific effect of long-chain ω-3 FAs. [Copyright &y& Elsevier]

Abstract: Objective: Over 40% of Americans are sedentary and of those beginning an exercise program, 50% will drop out within 6 months. The Transtheoretical Model (TTM) is commonly used to describe exercise behavior and develop interventions for the initiation of exercise behavior. Less is known, however, about maintenance of exercise behavior and the construct associations for the action, maintenance, and termination stages of change. Thus, the purpose of this study was to examine which of the TTM constructs (i.e. decisional balance, processes of change, barriers-efficacy, and temptation) best distinguishes between the action, maintenance, and termination stages of change for men and women. Methods: Questionnaires measuring each of the TTM constructs were collected from 330 men (M age=27.14 years) and 380 women (M age=24.80years). Data were examined for sex differences and subsequently, two forward logistic regressions were conducted for each sex such that the dependent variables for the regressions were action/maintenance and maintenance/termination. Results: Compared to men, women reported significantly less barriers-efficacy (p=.04), greater pros of exercise (p=.004), and greater use of behavioral (p=.001) and experiential (p<.001) processes of change. For the men, affect temptation was the only significant correlate of action/maintenance (p=.02), while barriers efficacy (p=.001), environmental evaluation (p=.02), and affect temptation (p=.03) were associated with maintenance/termination. For the women, environmental reevaluation (p=.02) and social liberation (p=.05) were associated with action/maintenance, while barriers-efficacy (p=.003) was the only construct correlated with maintenance/termination. Conclusions: Stage and gender specific considerations are warranted when designing stage-matched exercise interventions for long-term maintenance of exercise behavior. [Copyright &y& Elsevier]

Abstract: Background: Immigration to the United States has been associated with obesity, yet the relationship of acculturation to obesity and energy balance (ie, physical activity/dietary intake) in adults is a complex issue. Limited longitudinal data are available on immigrant Asians and Pacific Islanders. Design: Analyses were conducted on baseline data and change data from baseline to 24 months in the hotel-based cluster-randomized Work, Weight and Wellness trial involving 15 control and 15 intervention hotels on the island of Oahu, Hawaii. Sample: Participants were adult employees of predominantly Asian and Pacific Islander ancestry who were assessed one or more times over the course of 24 months. The full sample consisted of 4,236 hotel workers (about 40% of hotel workforce) at baseline, 3,502 hotel workers at Year 1 and 2,963 hotel workers at the 24-month follow up. One thousand one hundred fifteen hotel workers had at least two measurements, and were included in the analysis. Intervention: The Work, Weight, and Wellness trial was designed to promote weight loss via motivation and support for increases in physical activity and increased access to and consumption of healthy low-fat/low-energy foods. The measure of acculturation consisted of a score that was a compilation of a participant''s age when he or she immigrated to the United States, country of birth, language spoken at home, and years of education. Statistical analyses: We used mixed effect regression models for cross-sectional baseline models and longitudinal multilevel regression analysis of change in diet and physical activity behaviors and obesity over time using a random intercept. Estimates of the intervention effect are expressed as an annual rate of change for all study outcomes. Results: At baseline acculturation was positively associated with body mass index; physical activity level; and fruit, meat, and sweetened drink intake level. In analyses of change across 24 months, acculturation did not significantly influence change in dietary intake or indexes of obesity (ie, body mass index or waist-to-height ratio). However physical activity increased significantly more in the intervention group during the course of the intervention compared with the control group, which decreased activity, when sociodemographic factors (including acculturation) and food intake behavior were controlled for. [Copyright &y& Elsevier]

Background: Measuring the way people vary across time in meeting recommended levels of physical activity should be a fundamental component of public health surveillance. However, we were unaware of prospective cohort studies that had examined this in a population base using convergent measures. Purpose: We examined agreement between two validated measures used to estimate periodic change in the rate of meeting U.S. Healthy People 2010 guidelines for participation in moderate or vigorous physical activity. Methods: A cohort (N = 497) from a random, multiethnic sample of adults living in Hawaii was assessed every 6-months for 2 years starting spring 2004. Latent transition analysis classified people as meeting or not meeting the guidelines. Intra-class kappa statistics and multinomial logistic regression analysis were used to evaluate agreement. Results: Agreement for classifying stable classes of people who met or did not meet the guideline each time was substantial for vigorous activity (kappa ∼ 0.65–0.70) but fair-to-moderate for moderate activity (kappa ∼ 0.38–0.48). Agreement was poorer for classifying people who transitioned between meeting and not meeting the vigorous guideline (kappa ∼ 0.45) or the moderate guideline (kappa ∼ 0.21–0.29). Conclusions: Rates of meeting the guidelines varied across time and were estimated differently by the two measures, especially for moderate activity. This finding illustrates an understudied problem for public health promotion. Accurate classification of change within people is necessary for determining exposure in outcome studies, personal determinants of sufficient activity, and for evaluating whether interventions are successful in sustaining increases in rates of meeting physical activity guidelines. [Copyright &y& Elsevier]

Objective: To meet the need for an interactive product on exercise during pregnancy and postpartum, we developed and evaluated a personally tailored multimedia CD-ROM.Methods: Pregnant and postpartum women, who were randomly assigned to either the experimental group (PregXercise CD-ROM) or the control group (CD-ROM with neutral content), navigated through the CD-ROM for 1 h. Main outcomes were exercise self-efficacy and knowledge.Results: In analyses of covariance, compared with the control group, the experimental group had significant increases in self-efficacy and knowledge.Conclusion: The multimedia CD-ROM delivering information about exercise motivation, guidelines, and prescription was effective in improving exercise self-efficacy and knowledge.Practice Implications: Our preliminary results illustrate that healthcare professionals and researchers may use interactive multimedia for improving exercise behavior and related outcomes with pregnant and postpartum women. [ABSTRACT FROM AUTHOR]

• Use 24h objective recording of physical activity in real life over a period of several days and weeks. • Accelerometers can easily be used in various applications like interventions, epidemiology and surveillance. • Consider existing validation studies when planning one's own studies and document as many technical decisions as possible. • Assess the type of activity performed during non-wear time and reasons for non-wear of the devices. • Accelerometers can collect even more data to evaluate with current sensors developments. [ABSTRACT FROM AUTHOR]