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Szeszulski, J, Lorenzo, E, Arriola, A, and Lee, RE. Community-based measurement of body composition in hispanic women: concurrent validity of dual- and single-frequency bioelectrical impedance. J Strength Cond Res XX(X): 000-000, 2019-We examined the concurrent validity of single-frequency (SF) and dual-frequency (DF) bioelectrical impedance (BIA) scales among Hispanic women participating in a community-based health promotion program in Arizona. Hispanic women (N = 14), age 31.9 ± 6.5 years old, with a mean body mass index (BMI) of 31.1 ± 8.1 kg·m, were measured using SF BIA, DF BIA, BMI, and skinfold calipers in 2017. Intrarater reliability and concurrent validity were calculated. Bland-Altman plots examined agreement of each BIA measure within measurement tools, between tools, and with skinfold calipers. Scatter plots were used to examine agreement between BIAs and BMI. Short-term intrarater reliability was perfect within measurements for SF and DF BIAs (α = 1.0). The coefficient of variation within a measurement tool (CV%) was slightly smaller for DF BIA (0.2%; n = 13) than for SF BIA (0.3%; n = 14). Concurrent validity measures revealed that DF (M = 39.3 ± 7.3% fat; within sample CV% = 18.6; n = 14) and SF (M = 39.4 ± 7.5% body fat; within sample CV% = 19.0; n = 14) BIAs were highly correlated (Pearson r = 0.885; p < 0.001; n = 14) and had an absolute mean difference of -0.2 ± 3.5% fat (range 0.7-6.0% fat; n = 14). The CV% between BIA measures was 5.4%. Dual-frequency and SF BIAs were both strongly correlated with BMI and skinfolds. There was evidence of bias between skinfolds and both BIA measures. Strength and conditioning practitioners should feel confident in using either SF or DF BIA measures with Hispanic women who participate in training interventions in community-based settings, because they offer similar measurement value.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

The COVID-19 crisis and parallel Black Lives Matter movement have amplified longstanding systemic injustices among people of color (POC). POC have been differentially affected by COVID-19, reflecting the disproportionate burden of ongoing chronic health challenges associated with socioeconomic inequalities and unhealthy behaviors, including a lack of physical activity. Clear and well-established benefits link daily physical activity to health and well-being—physical, mental, and existential. Despite these benefits, POC face additional barriers to participation. Thus, increasing physical activity among POC requires additional considerations so that POC can receive the same opportunities to safely participate in physical activity as Americans who are White. Framed within the Ecologic Model of Physical Activity, this commentary briefly describes health disparities in COVID-19, physical activity, and chronic disease experienced by POC; outlines underlying putative mechanisms that connect these disparities; and offers potential solutions to reduce these disparities. As behavioral medicine leaders, we advocate that solutions must redirect the focus of behavioral research toward community-informed and systems solutions.

We examined individual and parental demographics and home environment factors associated with locomotor skills in predominantly Hispanic preschool-aged children. We used questionnaires to survey parents, included inquiries regarding parenting practices, parents’ physical activity levels, and home-based physical activity resources; and we administered the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the CHAMPS Motor Skills Protocol (CMSP) to children to measure the quantity and quality of their locomotor skills. Participants were 144 parents and their children (78.9% Hispanic, 49.3% girls) recruited from urban, community-based childcare and education centers. We examined the relationship between survey measures and PACER and CMSP scores with forward-selection stepwise linear regression models. Overall, 142 children completed the PACER, and 91 completed the CMSP. At the individual level, a child’s age was positively associated with both PACER and CMSP scores, and girls had lower PACER scores than boys. In the home environment, parental promotion of more screen time was associated with a higher children’s PACER score. In addition, higher parent concern for children’s safety was associated with a lower PACER score. We identified several physical activity promoting parent practices as new home environment factors related to the preschool-aged children’s locomotor development. Additional studies are needed to test new hypotheses generated from these data. ClinicalTrials.gov Identifier: NCT03261492 (date of registration 8/25/17)

Since its inception in 2016, the establishment of learning communities led by senior Society of Behavioral Medicine (SBM) members has been central to the SBM’s Mid-Career Leadership Institute (Institute). At the beginning of an initial two-day intensive workshop, groups of approximately six fellows are placed together, and one or two senior SBM members are asked to lead group mentoring. Senior SBM members serve as mentors during quarterly calls that are conducted over the year in order for group members to develop and present an individual leadership project at the following annual meeting. Group mentoring relies on the social dynamic that emerges from the group’s own social norms and roles; it is designed to advance the careers of group members. To our knowledge, this is the first commentary describing a program of formal group mentoring for mid-career leadership development in a professional association. Based on the authors’ experience as mentors, thematic and descriptive analyses of the initial workshop evaluations, and contemporaneous notes, we discuss the structure, process, and project outcomes of the formal group mentoring in SBM’s Institute. Early process evaluation of the Institute suggests that the Fellows benefitted from the group mentoring experience.

Screen-based activities are associated with increased risk of obesity and contribute to physical inactivity and poor dietary habits. The primary aim of this study was to examine the associations among screen-based activities, physical activity, and dietary habits in school-aged children in Guadalajara, Puerto Vallarta, and Mexico City, Mexico. The secondary aim was to examine these associations across sex. The School Physical Activity and Nutrition survey was used to assess screen-based activities (TV watching, video game use, computer use), physical activity, and dietary habits. Organized activity/sports participation, unhealthy dietary habits, and household income were correlated with screen-based activities. While TV watching was associated with decreased participation in organized activity/sports participation, computer and video game use was associated with increased organized activity/sports participation. Boys engaged in more TV watching and video game use compared to girls. All screen-based activities were associated with age among boys, whereas video game and computer use were associated with higher income among girls. These findings suggest a need for sex- and age-specific strategies that acknowledge the differential use of screen-based activities across sex and age. Future research should continue to identify underlying correlates linking screen-based activities with health behaviors to inform strategies to reduce screen-time in Mexican children.

Objective:Approximately one in ten adults under the age of 65 in the USA has a mobility impairing disability. People with mobility impairment generally have poorer dietary habits contributing to obesity and related negative health outcomes. This article presents the psychometric properties of the Food Environment Assessment Survey Tool (FEAST) instrument that measures barriers to accessing healthy food from the perspective of people with mobility impairment (PMI).Design:The current study presents cross-sectional data from two sequential independent surveys.Setting:Surveys were administered online to a national sample of PMI.Participants:Participants represented PMI living throughout the USA. The pilot FEAST survey involved 681 participants and was used to shape the final instrument; 25 % completed a retest survey. After following empirically and theoretically guided item reduction strategies, the final FEAST instrument was administered to a separate sample of 304 PMI.Results:The final twenty-seven-item FEAST instrument includes items measuring Neighbourhood Environment, Home Environment, Personal Control and Access to Support (Having Help, Food Delivery Services, Parking/Transportation). The final four scales had acceptable intra-class correlations, indicating that the scales could be used as reliable measures of the hypothesised constructs in future studies.Conclusions:The FEAST instrument is the first of its kind developed to assess the food environment from the perspective of PMI themselves. Future studies would benefit from using this measure in research and practice to help guide the development of policy aimed at improving access to healthy food and promoting healthy eating in community-dwelling PMI.

Summary To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA‐promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA‐promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA‐promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context‐specific priorities and exchanging lessons learned.

Street food stands (SFS) are an understudied element of the food environment. Previous SFS studies have not used a rigorous approach to document the availability, density, and distribution of SFS across neighborhood income levels and points of access in Mexico City. A random sample (n = 761) of street segments representing 20 low-, middle-, and high-income neighborhoods were assessed using geographic information system (GIS) and ground-truthing methods. All three income levels contained SFS. However, SFS availability and density were higher in middle-income neighborhoods. The distribution of SFS showed that SFS were most often found near homes, transportation centers, and worksites. SFS availability near schools may have been limited by local school policies. Additional studies are needed to further document relationships between SFS availability, density, and distribution, and current structures and processes.

Almost 1 in every 8 adults in the U.S. have a physical disability that impairs mobility. This participatory project aimed to identify and describe environmental and personal barriers to healthy eating among people with mobility impairments using a rigorous, structured mixed methodology. Community-dwelling adults with a self-reported mobility impairment (N = 20, M = 40.4 years old, 60% female) participated in nominal group technique focus groups. The Ecologic Model of Obesity grounded stimulus questions asked about barriers to obtaining and preparing healthy food. Participants emphasized common barriers across everyday settings&mdash, focusing, for example, on the ability to reach shelved food inside the home, navigating to and inside stores and restaurants, and using delivery services. Home environments often did not afford suitable spaces for food preparation and storage. Participants reported inadequate transportation and numerous additional barriers in many settings to be able to eat healthfully. Participants reported lack of accessible transportation and architectural barriers inside stores, restaurants, and their own homes, highlighting the need for efforts aimed at improving accessibility and usability. Findings support the use of the Ecologic Model of Obesity to guide research and suggest the need for improvement in assessment practices and policies that enhance access to healthy food.

Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.

Background: Active transportation (AT) increases physical activity, reducing cardiometabolic risk among non-Hispanic white adults; however, research on these linkages in racial/ethnic minority women is sparse. This study explored these associations in 327 African American and Hispanic/Latina women. Methods: This analysis used sociodemographics, self-reported AT via the International Physical Activity Questionnaire, accelerometer-measured moderate to vigorous physical activity (MVPA), body mass index, systolic and diastolic blood pressures, resting heart rate, and body fat percentage (BF). Unadjusted bivariate associations and associations adjusted for sociodemographic factors were examined. Results: AT users had higher levels of objective MVPA, but this was not statistically significant. AT was not associated with cardiometabolic risk factors in adjusted models (Ps > .05); however, systolic blood pressure was lower for AT users. MVPA was negatively associated with diastolic blood pressure and BF overall, body mass index and BF in African American women, and BF in Hispanic/Latina women (Ps Conclusions: MVPA was associated with improvements in body mass index, diastolic blood pressure, and BF among minority women, and these relationships may vary by race/ethnicity. Practitioners should recommend increased participation in MVPA. Future research, using longitudinal designs should investigate AT’s potential for increasing MVPA and improving cardiometabolic health along with the role of race/ethnicity in these associations.

This study investigated associations of neighborhood context with active transportation among women with children after controlling for sociodemographic variables. We used data from the Geographic Research on Wellbeing study (GROW). In 2012–2013, GROW surveyed mothers who participated in California's Maternal and Infant Health Assessment. The dependent variable was active vs. inactive transportation. Mothers were coded as doing active transportation if they responded that they “walked,” “walked and took public transportation,” or ‘rode a bike,” to most places they went in the previous 7 days, and were coded as doing inactive transportation if they responded that they “drove” any kind of vehicle or “got rides from someone else.” The independent variables were neighborhood-level (census tract) poverty, income inequality, and perceived neighborhood safety. Using a stratified sample of poor or near-poor (≤200% of the federal poverty level, N = 1231) and non-poor mothers (201+% of the federal poverty level, N = 1465), weighted logistic regression was conducted to estimate associations between neighborhood-level factors with active transportation after controlling for age, race/ethnicity, marital status, number of children, car ownership, education, family income, and population density. One in seven mothers reported active transportation with mothers in poor/near-poor families having a higher proportion of active transportation than mothers in higher income families (24% vs. 3%). In adjusted models, poor/near-poor mothers had twice the odds of using active transportation in very or somewhat unsafe neighborhoods compared with those in very safe neighborhoods. Neighborhood-level poverty and income inequality were not statistically significant. Results suggest that individual poverty is a primary driver of active transportation among mothers. Poor and near-poor mothers who perceived their neighborhoods as unsafe had higher odds of using active transportation. Policy and community resources should be allocated to provide safe routes in very unsafe areas where poor women live and where active transport is most likely to occur.

Research has rarely distinguished between non-work (NW) and work (W) active transport (AT) or investigated relationships to other domains of physical activity ([PA], like leisure time [LTPA] or work [WPA]). We investigated correlates of AT by employment status, accounting for LTPA and WPA, in a population-based sample of California mothers (N=2906) in the Geographic Research on Wellbeing (GROW) study (2012–2013). AT was measured by the National Household Travel Survey. LTPA was measured using the Stanford Leisure-Time Activity Categorical Item. WPA was measured with the Stanford Brief Activity Survey. Most employed mothers (53%) worked in sedentary jobs, and few (

The purpose of this integrative review was to analyze the state of science concerning the influence of parenting practices on children’s physical activity (PA) levels. A total of 38 studies met the inclusion criteria after full-text review. The body of research is limited in experimental designs with only three studies measuring the influence of the intervention on parenting practices. Seven of the 30 quantitative studies (23.3%) found significant associations between parental role modeling of PA and children’s PA levels. Seven of the eight (87.5%) qualitative studies identified parental role modeling of PA as important in promoting children’s PA. Sixteen of the 30 (53.3%) quantitative studies found that parental support of PA was significantly associated with children’s PA. Five of the eight (62.5%) qualitative studies identified logistic support as supporting PA in children. The science could be expanded by the development of randomized controlled trials aimed at this area.

Purpose: To investigate relationships among physical activity, changes in physical function, and health-related quality of life (HRQOL) among patients with pancreatic adenocarcinoma enrolled in a home-based exercise prehabilitation program. Methods: Patients with resectable pancreatic adenocarcinoma receiving preoperative chemotherapy and/or chemoradiation were enrolled on this prospective, single-arm trial and were advised to perform ≥60 minutes each of moderate-intensity aerobic exercise and strengthening exercise weekly. Activity was measured via self-report and accelerometers, including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary activity (SA). Physical function measures at baseline and restaging follow-up included 6-minute walk test (6MWT), 5 times sit-to-stand (5×STS), handgrip strength (HGS), 3-m walk for gait speed (GS), and the PROMIS Physical Function Short Form. HRQOL was measured via the FACT-Hep questionnaire. Results: Fifty participants with mean age 66 years (standard deviation = 8 years) were enrolled. The 6MWT, 5×STS, and GS significantly improved from baseline to restaging follow-up (P=.001, P=.049, and P=.009, respectively). Increases in self-reported aerobic exercise, weekly MVPA, and LPA were associated with improvement in 6MWT (β=.19, P=.048; β=.18, P=.03; and β=.08, P=.03, respectively) and self-reported physical functioning (β=.02, P=.03; β=.03, P=.005; and β=.01, P=.02, respectively). Increased weekly LPA was associated with increased HRQOL (β=.03, P=.02). Increased SA was associated with decreased HRQOL (β=-.02,P=.01). Conclusions: Patients with potentially resectable pancreatic cancer exhibit meaningful improvement in physical function with prehabilitation; physical activity was associated with improved physical function and HRQOL. These data highlight the importance of physical activity during treatment for pancreatic cancer.

Background In the context of health-related interventions, sustainability is the capacity to maintain the changes resulting from the intervention. These can be improved policies, practices or trends intended to improve population health. The Childhood Obesity Research Demonstration (CORD) project was a multi-site, multi-intervention collaboration testing the Obesity Chronic Care Model with interventions for childhood obesity prevention and management. We present the model, definitions and methodology used for the cross-site sustainability evaluation of CORD. Methods We applied the Ecologic Model of Obesity to childhood obesity interventions to operationalize four sustainability constructs: replicability, continuation of benefits, institutionalization, and community capacity. We used a triangulation approach and employed mixed methods to assess sustainability constructs at each level of the Ecologic Model of Obesity: Micro, Meso, Exo and Macro. We constructed checklists to count and code intervention activities, use of evidence-based practices among providers, and environmental factors and policies hypothesized to influence intervention sustainability. We developed in-depth interviews for principal investigators and project leads. We applied the Wilder Collaboration Factors Inventory with key stakeholders. Results Lessons learned suggested that sustainability constructs should be clearly identified and operationalized a priori. Constructs must be flexible to account for differences between intervention plans and implementation to obtain robust and informative data. Conclusion Strong links are needed among researchers, program implementers and communities to accomplish consistent, robust and valuable data collection efforts to assure sustainable and healthy communities.

This systematic review and meta-analysis examined the literature on early care and education center (ECEC)-based physical activity interventions to identify ecologic environmental factors that improve cardiovascular fitness (CVF) in preschool-aged children. Data sources included PubMed, Web of Science, Cochrane Library Trials, CINHAL, Science Direct, PsychINFO and SPORTDiscus. Peer-reviewed publications of studies that met the following criteria were eligible for inclusion: (1) mean age of participants between two and a half and five and a half years old enrolled in a pre-primary school; (2) randomized controlled trials or quasi-experimental interventions with a control group; (3) interventions occurring before, during, or immediately after school; (4) use of an objective measure or field-based estimate of CVF; (5) enrolled apparently healthy children. In June of 2018, titles (n = 1197) were reviewed for inclusion into the study and 74 abstracts/full texts were assessed for eligibility. Ten articles met all eligibility criteria and were included in the final review. A random effects meta-analysis suggested a moderate-to-large effect size for ECEC-based interventions to increase CVF (g = 0.75; 95%CI [0.40–1.11]). Interventions that included three or more ecologic environments (g = 0.79 [0.34–1.25]) were more effective than interventions occurring at the individual level (g = 0.67 [0.12–1.22]). Study quality was moderate, and (mean ± SD) 17.9 ± 4.3 (63.9%) of 28 checklist items were reported. Preliminary evidence suggests that ECEC-based interventions to increase CVF are highly effective at improving preschool children's exercise test scores. Although ECEC-based interventions show promise, the small number of studies included in this review limits confidence in these findings. Review registered at PROSPERO CRD42018099115. Keywords: Child, Preschool, Cardiorespiratory fitness, Systematic review, Physical activity, Social ecology

Background. Early childhood is a critical life period for promoting health behaviors, and early child care and education centers (ECECs) are critical settings, as 60% of U.S. children attend ECECs. Yet few programs or curricula that promote physical activity and nutrition in this setting exist. This study explored the acceptability, feasibility, and sustainability of the Sustainability via Active Garden Education (SAGE) program. Method. Preintervention interviews were conducted to inform the design of SAGE and postintervention interviews were conducted to evaluate the implementation of SAGE in the ECEC setting. A constant comparison approach was used to capture emergent themes on acceptability, feasibility, and sustainability from interviews. Participants. ECEC directors ( N = 10, 90% female, 20% Hispanic, 30% African American). Results. Directors expressed that SAGE was acceptable and feasible as it was age-appropriate, engaging, and aligned with existing curricula and accreditation standards. Most directors reported that SAGE improved activity and nutrition related knowledge while building other social and academic skills (e.g., expanding vocabulary) that are critical to this important developmental period. Suggestions for improving the sustainability of the program included stronger parental involvement and opportunities for ECEC staff trainings.

Background We describe the development of sustainability via active garden education (SAGE), an early care and education (ECE) garden-based curriculum developed from a 5-year community partnership to link national health policy guidelines with ECE accreditation standards. Methods National health guidelines and ECE accreditation standards were reviewed, and community advisory board members, ECE staff, and parents provided feedback and support throughout the development of the curriculum. The SAGE curriculum components were guided by the Ecologic Model of Physical Activity and Social Cognitive Theory. Strengths-weaknesses-opportunities-threat analyses were used to refine and revise the curriculum to overcome challenges to implementation. Results Twelve 1-hour, developmentally appropriate, modularized lessons were created using the garden as a metaphor for human development. Lessons featured songs, simple games, pretend play, modeling, and garden activities. Parents were engaged via weekly newsletters with information about activities in the classroom, strategies to improve health habits at home, and free community resources. Conclusion SAGE partnered scientific theory and rigor with community ingenuity and innovation to create a clear translation of policy guidelines to easily implementable practice in a fun and engaging manner.

Background:Obesity is a critical problem among Mexican youth, but few studies have investigated associations among physical activity (PA) modes and anthropometrics in this population. This study examined associations among active commuting to school (ACS), sports or other organized PA, outdoor play, and body mass index (BMI) percentile and waist circumference (WC) among Mexican youth.Methods:Parents of school children (N = 1996, ages 6 to 14 years, 53.1% female) in 3 Mexican cities reported PA participation using the (modified) fourth grade School Physical Activity and Nutrition Survey. Trained assessors measured BMI percentile and WC in person.Results:Parents reported that 52.3% of children engaged in ACS, 57.3% participated in sports or organized PA, and a median of 2 days in the previous week with at least 30 minutes of outdoor play. In complete case analyses (n = 857), ACS was negatively associated with BMI percentile, and outdoor play was negatively associated with WC after adjusting for school, age, sex, and income. In analyses incorporating data from multiple imputation (N = 1996), outdoor play was negatively associated with WC (all Ps < . 05).Conclusions:ACS and outdoor play are favorably associated with anthropometrics and may help prevent childhood obesity in Mexico. ACS and outdoor play should be priorities for increasing youth PA in Mexico.

Differences in subjective and objective safety may be explained by moderators that shape parental perceptions of the environment. This study examined associations between subjective and objective measures of traffic and crime safety in preschool parents (N = 240) and potential moderators. Community cohesion, social control, and physical activity parenting practices were measured. Objective measures of crime and traffic were measured at the block-group level. Linear models revealed perceived traffic was negatively associated with the traffic hazards (b = −0.03; 95 % CI: −0.05, −0.01; p = .041). Acculturation moderated the relationship between perceptions of disorder and crime (b = 0.001; 95 % CI: 0.000, 0.003; p = .044). Poor community cohesion moderated the relationship between perceptions of disorder and crime (b = 0.0015; 95 % CI: 0.0002, 0.0028; p = .028). Perceived traffic safety was associated with the traffic hazard index in parents of boys (b = −0.04; 95 % CI: −0.07, −0.01; p = .027). Acculturation and community cohesion can be used to align misperceptions of safety to actual safety to promote outdoor play.

Online, virtual group interactions may help adherence to health promotion programs. The purpose of this study was to explore longitudinal relationships among dimensions of group cohesion and group-interaction variables to inform and improve group-based strategies within programs aimed at promoting physical activity in virtual communities. In all, 56 online virtual users completed a group dynamics–based physical activity promotion intervention and assessments of group cohesion and group interaction at baseline and 4 weeks. Friendly competition and cooperation were consistently strong predictors of cohesion. Facilitating a sense of friendly competition and cooperation may increase engagement in physical activity programs by bolstering group cohesion.

Psychological stressors can contribute to adverse health outcomes and lead to health disparities. To examine associations among psychological stressors, coping, blood pressure, body mass index, and body fat in ethnic minority women, we conducted a secondary analysis using data from 178 African American and Hispanic/Latina women who completed measures of perceived racial discrimination and stress, coping, blood pressure, and body composition. The mean age of participants was 45.3 (±9.3 years), and most were obese (74.2%) and had prehypertensive systolic blood pressure (125.7 ± 14.6 mmHg). Hierarchical multiple regression models indicated a significant negative relationship between racial discrimination and percent body fat, and positive associations between stress and blood pressure. Coping did not moderate the association between racial discrimination and blood pressure or body composition. Health care providers should consider psychological stressors as underlying causes for hypertension and address tailored stress-reduction coping strategies when treating African American and Hispanic/Latina women with hypertension.

Introduction The purpose of this study was to provide a detailed description of completing the Attitudes and Avatars Instrument in the classroom and explore the feasibility and acceptability of the instrument. Methods The descriptive study included three written open-ended questions for data collection to which young adolescent boys responded after completing the Attitudes and Avatars Instrument. Results Fifty-nine boys between 11 and 14 years of age completed the instrument in the time allotted and had an overall positive reaction. Conclusion As the Attitudes and Avatars Instrument continues to develop as a screening instrument, it is imperative to obtain feedback from boys of diverse races and ethnicities.

Background:Mexican children often use active commuting to school (ACS). In order to maintain high levels of ACS it is important to understand correlates of ACS in this population. However, most evidence comes from high-income countries (HICs). We examined multilevel correlates of ACS in children attending public schools in 3 Mexican cities.Methods:Information on 1191 children (grades 3 to 5) attending 26 schools was retrieved from questionnaires, neighborhood audits, and geographic information systems data. Multilevel logistic modeling was used to explore individual and environmental correlates of ACS at 400-m and 800-m buffers surrounding schools.Results:Individual positive correlates for ACS included age (6–8 years vs 9–11 years, odds ratio [OR] = 1.5; 6–8 years vs ≥12 years: OR = 2.1) and ≥ 6 adults at home (OR = 2.0). At the 400-m buffer, more ACS was associated with lower walkability (OR = 0.87), presence of posted speed limits (< 6% vs > 12%: OR = 0.36) and crossing aids (< 6% vs 6–20%: OR = 0.25; > 20%: OR = 0.26), as well as higher sidewalk availability (< 70% vs > 90%: OR = 4.5). Similar relationships with speed limits and crossing aids were observed at the 800m buffer.Conclusions:Findings contrast with those reported in HICs, underscoring the importance of considering the local context when developing strategies to promote ACS. Future studies are needed to replicate these relationships and investigate the longitudinal impact of improving active transportation infrastructure and policies.

Reach is a key factor in translating research to practical application. This study examined reach and representativeness of a multi-city, randomized controlled community health trial in African American (AA) and Hispanic or Latina (HL) women. Participants completed measures of demographics, body mass index (BMI), percent body fat, resting heart rate, and blood pressure followed by a run-in procedure and a randomization meeting. AA were more likely to be screened out initially; HL were more likely to drop out. Participation did not differ by city or recruitment method. Women who completed the post-intervention assessment were more likely to be AA, older, and have higher socioeconomic status (p values

Background: Physical activity and exercise appear to benefit patients receiving preoperative treatment for cancer. Supports and barriers must be considered to increase compliance with home-based exercise prescriptions in this setting. Such influences have not been previously examined. Methods: The authors used quantitative and qualitative methods to examine potential physical activity influences among patients who were prescribed home-based aerobic and strengthening exercises concurrent with preoperative chemotherapy or chemoradiation for pancreatic cancer. Physical activity was measured using exercise logs and accelerometers. Social support for exercise and perceived neighborhood walkability were measured using validated surveys. Relationships between influences and physical activity were evaluated using linear regression analyses and qualitative interviews. Results: Fifty patients received treatment for a mean of 16 (9) weeks prior to planned surgical resection. Social support from friends and neighborhood esthetics were positively associated with physical activity (P Conclusions: Interpersonal and environmental motivators of exercise and physical activity must be considered in the design of future home-based exercise interventions designed for patients receiving preoperative therapy for cancer.

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3–5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.

Objective: Pilot test GoWoman, a small-group weight management intervention for mobility impaired women that was a disability- and gender-responsive adaptation of the Diabetes Prevention Program de...

PURPOSE: Guidelines recommend exercise to cancer survivors, but limited data exists regarding exercise among patients undergoing preoperative cancer treatment. We examined differences in weekly self-reported exercise and accelerometer-measured physical activity among participants in a home-based exercise program administered during preoperative treatment for pancreatic cancer. METHODS: Participants were encouraged to perform at least 60 minutes/week of moderate-intensity aerobic exercise and at least 60 minutes/week of full-body strengthening exercises concurrent with chemotherapy, chemoradiation therapy or both sequentially and received resistance equipment, program instruction, and biweekly follow-up calls to encourage adherence. Self-reported aerobic and strengthening exercise minutes were measured using daily logs, and physical activity was measured objectively using accelerometers. RESULTS: Fifty participants (48% female, mean age 66 ± 8 years) participated for an average of 16 ± 9 preoperative weeks. Participants reported overall means of 126 ± 83 weekly minutes of aerobic exercise and 39 ± 33 weekly minutes of strengthening exercise in daily logs. Participants performed 158.7 ± 146.7 weekly minutes of accelerometer-measured moderate-to-vigorous physical activity. There were no significant differences in exercise or physical activity between treatment phases. CONCLUSIONS: These findings suggest that it is feasible to target the entire preoperative course for exercise prescription. Although participants exceeded aerobic exercise recommendations on average, we observed low strengthening exercise adherence and wide variability in self-reported exercise and accelerometer physical activity variables. These findings suggest that additional support, including program adaptations, may be necessary to overcome barriers to exercise or improve motivation when prescribing exercise in this clinical scenario.

Promoting outdoor play and participation in sports and organized physical activities in children may depend on neighborhood characteristics. This study investigated associations between neighborhood streets and physical activities among Mexican children ( N = 1,509, 6-11 years). Child sociodemographic characteristics and physical activity were measured in schools in Guadalajara ( n = 10), Mexico City ( n = 13), and Puerto Vallarta ( n = 3), Mexico, in 2012. Street segments within an 800 m radius around each school were measured using the Pedestrian Environment Data Scan. Most (75.8%) played outdoors; 47.4% participated in sports and 40% in organized physical activities. Fewer path obstructions and more pedestrian amenities were associated positively with outdoor play. Greater street cleanliness, more pedestrian amenities, and more path obstructions were associated with less participation in sports or organized activities. Walkability was negatively associated with all physical activities. Fostering safe and appealing streets may help promote outdoor play time, but not sports participation, for Mexican children.

OBJECTIVE African American (AA) women are at greater risk for cardiovascular disease (CVD) compared to White women, which can be attributed to disparities in risk factors. The built environment may contribute to improving CVD risk factors by increasing physical activity (PA). This study used recursive partitioning, a multivariate decision tree risk classification approach, to determine which built environment characteristics contributed to the classification of AA women as having 4 or more CVD risk factors at optimal levels. METHOD Recursive partitioning has the ability to detect interactions and does not have sample size limitations to detect effects. The Classification and Regression Trees (CR&T) growing method was used to group participants as having 4 or more versus 3 or fewer risk factors at optimal levels. Risk factors were smoking, body mass index (BMI), PA, healthy diet, cholesterol, glucose, and blood pressure. Built environment predictors were presence and quality of neighborhood PA resources (PARs), walkability, traffic safety, and crime. RESULTS Participants (N = 30, mean age of 54.1 ± 7.5) all had at least 1 risk factor at the optimal level, none had all 7, and 66.7% had 4 or more risk factors at optimal levels. The CR&T identified participants with few, low-quality neighborhood PARs and who were older than 55 as least likely to have 4 or more CVD risk factors at optimal levels. CONCLUSION Being younger than 55 years old and having many, high-quality neighborhood PARs may predict lower risk for CVD in AA women. Results should be used in future studies with larger sample sizes to inform logistic regression models. (PsycINFO Database Record

Objective. This cross sectional study aims to determine the effects of gender and parental perception of safety at school on children's physical activity (PA) levels. Materials and methods. Parents of school aged Mexican children residing in Guadalajara, Mexico City, and Puerto Vallarta, completed surveys about their children's PA measures. The physical activity indicators were evaluated using linear and logistical regression models. Results. Analysis did not indicate that gender moderated the relationship between parental perception of safety and PA measures, but significant gender issues exist with girls participating less than boys in the three measures of PA in this study (p

Objective: the RE-AIM framework has been widely used to evaluate internal and external validity of interventions aimed to promote physical activity, helping to provide comprehensive evaluation of the reach, efficacy, adoption, implementation and maintenance of research and programming. Despite this progress, the RE-AIM framework has not been used widely in Latin America. The purpose of this manuscript is to describe the RE-AIM framework, the process and materials developed for a one-day workshop in Guadalajara, and the acceptability and satisfaction of participants that attended the workshop. Methods: lecture, interactive examples and an agenda were developed for a one-day RE-AIM workshop over a three month period. Results: thirty two health care practitioners (M age = 30.6, SD=9.9 years) attended the workshop. Most (100%) rated the workshop as credible, useful (100%) and intended to apply it in current or future research (95%). Conclusion: results suggest intuitive appeal of the RE-AIM framework, and provide a strategy for introducing the utility and practical application of the framework in practice settings in Mexico and Latin America.

Integrating physical activity (PA) counseling in routine clinical practice remains a challenge. The purpose of this study was to evaluate the implementation and effectiveness of a pragmatic strategy aimed to improve physician PA counseling and patient PA. An effectiveness-implementation type-2 hybrid design was used to evaluate a 3-h training (i.e., implementation strategy-IS) to increase physician use of the 5-As (assess, advise, agree, assist, arrange) for PA counseling (i.e., clinical intervention-CI) and to determine if the CI improved patient PA. Patients of trained and untrained physicians reported on PA and quality of life pre-post intervention. Medical charts (N = 1700) were examined to assess the proportion of trained physicians that used the 5-As. The RE-AIM framework informed our evaluation. 305/322 of eligible physicians participated in the IS (M age = 40 years, 52% women) and 683/730 of eligible patients in the CI (M age = 49 years, 77% women). The IS was adopted by all state regions and cost ~ $20 Mexican pesos (US$1) per provider trained. Physician adoption of any of the 5-As improved from pre- to post-training (43 vs. 52%, p

Food resources in school neighborhoods can negatively influence diet; however, this environment is understudied. This study characterized the school neighborhood food environment in Guadalajara (n=11), Puerto Vallarta (n=7), and Mexico City (n=14). Convenience stores, table-service restaurants, and taco stands were highly available in all three cities. Grocery stores were highly available in Mexico City school neighborhoods, yet less frequently observed in Guadalajara and Puerto Vallarta. Socioeconomic differences in food cart and grocery store availability were observed in Guadalajara and Puerto Vallarta. Policy and intervention strategies are needed to address the saturation of food resources in Mexico school neighborhoods.

Culturally appropriate, innovative strategies to increase physical activity (PA) in women of color are needed. This study examined whether participation in SALSA, an 8-week randomized, crossover pilot study to promote PA, led to improved psychosocial outcomes and whether these changes were associated with changes in PA over time. Women of color (N = 50) completed Internet-based questionnaires on PA, exercise self-efficacy, motivational readiness, stress, and social support at three time points. Women reported high socioeconomic status, decreases in exercise self-efficacy, and increases in motivational readiness for exercise and a number of stressful events (p p = .043). Changes in psychosocial factors were associated with increases in PA. Latin dance improved motivational readiness for PA. Future studies are needed to determine whether Latin dance improves other psychological measures and quality of life in women of color in an effort to increase PA and reduce health disparities.

This study used the 2010 Health of Houston Survey to examine the physical activity of Asian American adults living in Houston, Texas. Multivariate regression models were conducted to examine the number of moderate leisure physical activity days in the past week and likelihood of having sufficient levels of physical activity. The results showed that Asians were among the least physically active of the major racial/ethnic groups. Most notably, Asians were less likely than whites to have sufficient levels of physical activity and had similarly lower expected numbers of physical activity minutes and days. Within the Asian American population, Vietnamese adults had more physical activity minutes and days than their Chinese counterparts-after controlling for other sociodemographic and health factors. Age- and gender-adjusted rates suggested a significant gender disparity among the Vietnamese and South Asian adults (less so for the Chinese adults), but this varied across different age groups. Several factors emerged as significant predictors of physical activity for Asian Americans, including age, immigration status, speaking a non-English language at home, marital status, and neighborhood incivilities. Findings highlight the need for targeted, culturally appropriate interventions to promote physical activity in Asian American communities.

Background Low physical activity (PA) and fruit and vegetable (F&V) consumption in early childhood are continued public health challenges. This manuscript describes outcomes from two pilot studies for Sustainability via Active Garden Education (SAGE), a program designed to increase PA and F&V consumption among 3 to 5 year old children. Methods SAGE was developed using community-based participatory research (CBPR) and delivered to children (N = 89) in early care and education centers (ECEC, N = 6) in two US cities. Children participated in 12 one-hour sessions that included songs, games, and interactive learning activities involving garden maintenance and taste tests. We evaluated reach, efficacy, adoption, implementation, and potential for maintenance of SAGE following the RE-AIM framework. Reach was evaluated by comparing demographic characteristics among SAGE participants and residents of target geographic areas. Efficacy was evaluated with accelerometer-measured PA, F&V consumption, and eating in the absence of hunger among children, parenting practices regarding PA, and home availability of F&V. Adoption was evaluated by the number of ECEC that participated relative to the number of ECEC that were recruited. Implementation was evaluated by completion rates of planned SAGE lessons and activities, and potential for maintenance was evaluated with a parent satisfaction survey. Results SAGE reached ECEC in neighborhoods representing a wide range of socioeconomic status, with participants’ sociodemographic characteristics representing those of the intervention areas. Children significantly increased PA during SAGE lessons compared to usual lessons, but they also consumed more calories in the absence of hunger in post- vs. pre-intervention tests (both p

Few studies have examined neighborhood influences on physical activity (PA) among low-income African Americans living in public housing. This study measured the associations of PA resources and land use with PA among 216 African Americans living in 12 low-income housing developments in Houston, Texas. Neighborhood measures included both detailed information from in-person audits and geographic information systems (GIS) data. Hierarchical linear regression models tested the associations of neighborhood PA resource availability and quality and land use density and diversity with individual-level, self-reported PA. Land use diversity was positively associated with walking among men after controlling for other neighborhood characteristics. Policies that promote land use diversity or improve the pedestrian environment in areas with diverse destinations may encourage PA among public housing residents.

This study identified inconsistencies in physical activity (PA) reported at screening and baseline of a 6-month health promotion intervention and explored how these inconsistencies influenced intervention effectiveness in African American and Hispanic women. Participants completed a telephone screener to determine eligibility for a PA intervention. Inactive participants (≤90 minutes of PA/week) were invited to a baseline assessment, where they completed the International Physical Activity Questionnaire, measuring work, transportation, gardening/housework, and leisure-time PA. Women returned after 6 months to complete an identical post-intervention assessment. Despite being screened as inactive, baseline Questionnaire data indicated that 85.0% of participants (N = 274, M age = 44.6 years, M body mass index = 34.8 kg/m2) were active (>90 minutes of PA/week). Women who reported any work-related PA were 20.9 times more likely to be active at baseline than those who did not (p < .001). Participants who were inactive at both screening and baseline reported greater increases in domestic and gardening PA and total PA from baseline to postintervention (ps < .05). Overweight/obese ethnic minority women may misreport being physically inactive during screening if specific questions about type of PA are not included. Post hoc analyses controlling for screening inaccuracies may improve effectiveness of PA interventions and help intervention programs reach women who may benefit the most.

Perceptions of neighborhood attributes for physical activity may be influenced by individual level income. This study examined differences in perceptions of neighborhood attributes for walking and bicycling in high and low income African American women. African American women (n = 388) aged 20-65 years completed the International Physical Activity Prevalence Study's Environmental Survey Module. Independent t-tests determined differences in perceptions of neighborhood attributes by income group. Principal component factor analysis explored differences in factor structure for survey items. Low income African American women perceived their neighborhood as being less safe with regard to crime and traffic, having fewer free recreational opportunities, and having more public transportation stops nearby. Survey items weighed differently on each factor between income groups. Household income should be taken into consideration when interpreting perceptions of neighborhood for physical activity in African American women.

Resource-poor social environments predict poor health, but the mechanisms and processes linking the social environment to psychological health and well-being remain unclear. This study explored psychosocial mediators of the association between the social environment and mental health in African American adults. African American men and women (n = 1467) completed questionnaires on the social environment, psychosocial factors (stress, depressive symptoms, and racial discrimination), and mental health. Multiple-mediator models were used to assess direct and indirect effects of the social environment on mental health. Low social status in the community (p < .001) and U.S. (p < .001) and low social support (p < .001) were associated with poor mental health. Psychosocial factors significantly jointly mediated the relationship between the social environment and mental health in multiple-mediator models. Low social status and social support were associated with greater perceived stress, depressive symptoms, and perceived racial discrimination, which were associated with poor mental health. Results suggest the relationship between the social environment and mental health is mediated by psychosocial factors and revealed potential mechanisms through which social status and social support influence the mental health of African American men and women. Findings from this study provide insight into the differential effects of stress, depression and discrimination on mental health. Ecological approaches that aim to improve the social environment and psychosocial mediators may enhance health-related quality of life and reduce health disparities in African Americans.

The present study examined smoking culture and lifestyle Web sites listed on Yahoo!, a popular Internet search catalog, to determine whether the sites were easily accessible to youth, featured age or health warnings, and mentioned specific tobacco brands. A content analysis of photographs on these sites assessed the demographics of individuals depicted and the amount of smoking and nudity in the photographs. The sample included 30 Web sites, all of which were accessible to youth and did not require age verification services to enter them. Cigarette brand names were mentioned in writing on 35% of the sites, and brand images were present on 24% of the sites. Nearly all of the photographs (95%) depicted smoking, 92% featured women, and 7% contained partial or full nudity. These results underscore the need for greater research and monitoring of smoking-related Internet content by health educators and tobacco control advocates.

A reanalysis of data from the Gaudin, Polansky, Kilpatrick, and Shilton 1996 study of 185 low-income families combined information from neglectful families with information from the comparison group. Physical neglect was related to maternal depression, more adult problems, stressful life events, negative family affect, and low social support. Multivariate analyses indicated that a combination of higher maternal education, positive family affect, more supportive services, and fewer stressful life events predicted the provision of adequate physical care among low-income families.

Both physical and social environmental factors influence young children’s physical activity, yet little is known about where Hispanic children are more likely to be active. We assessed the feasibility of simultaneously measuring, then processing objective measures of location and physical activity among Hispanic preschool children. Preschool-aged Hispanic children (n = 15) simultaneously wore QStarz BT100X global positioning system (GPS) data loggers and Actigraph GT3X accelerometers for a 24- to 36-hour period, during which time their parents completed a location and travel diary. Data were aggregated to the minute and processed using the personal activity location measurement system (PALMS). Children successfully wore the GPS data loggers and accelerometers simultaneously, 12 of which yielded data that met quality standards. The average percent correspondence between GPS- and diary-based estimates of types of location was high and Kappa statistics were moderate to excellent, ranging from 0.49-0.99. The between-method (GPS monitor, parent-reported diary) correlations of estimated participant-aggregated minutes spent on vehicle-based trips were strong. The simultaneous use of GPS and accelerometers to assess Hispanic preschool children’s location and physical activity is feasible. This methodology has the potential to provide more precise findings to inform environmental interventions and policy changes to promote physical activity among Hispanic preschool children.

Findings from previous research linking sedentary time with cardiometabolic risk factors and body composition are inconsistent, and few studies address population groups most vulnerable to these compromising conditions. The purpose of this paper was to investigate the relationship of sitting time to cardiometabolic risk factors and body composition among African American women. A subsample of African American women (N=135) completed health and laboratory assessments, including measures of blood pressure, resting heart rate, cholesterol, triglycerides, glucose, body mass index, body fat, sitting time, and demographics. Simultaneous, adjusted regression models found a positive association between weekend sitting time and glucose and an inverse association between weekly sedentary time and cholesterol (ps<.05). There were no significant associations between sedentary behavior and body composition. The unexpected relationship between sedentary time and cholesterol suggests that the relationship of sedentary behavior to cardiometabolic risk factors may depend on existing characteristics of the population and measurement definition of sedentary behavior. Results suggest distinctly different relationships between weekend and weekday sitting time, implicating a need for careful measurement and intervention that reflects these differences.

Background. Mediating and moderating variables may interfere with the association between neighborhood availability of grocery stores (NAG) and supermarkets (NAS) and fruit and vegetable (FV) intake.Objective. The purpose of this study was to test mediation of home availability of FV (HAFV) and moderation of impact of weekly stressful events (IWSE) on the association between NAG and NAS with FV consumption among African American (AA) and Hispanic/Latina (HL) women.Methods. Three hundred nine AA and HL, 25–60 year old women in the Health Is Power (HIP) randomized controlled trial completed validated measures of HAFV, IWSE, and FV intake at baseline. Trained field assessors coded NAG and NAS. Institutional Review Board approval was obtained.Results. NAG and NAS were not associated with FV intake or HAFV, so HAFV was not a mediator. HAFV (std. Beta = .29,P<0.001) and IWSE (std. Beta = .17;P<0.05) were related to FV intake (R2 =0.17;P<0.001), but IWSE was not a moderator.Conclusion. Increasing HAFV and decreasing the IWSE should increase FV consumption. The extent to which the neighborhood environment is related to the home food environment and diet, and the mechanisms for the association between IWSE and diet should be examined in future research.

Background Physical activity (PA) adoption is essential for obesity prevention and control, yet ethnic minority women report lower levels of PA and are at higher risk for obesity and its comorbidities compared to Caucasians. Epidemiological studies and ecologic models of health behavior suggest that built environmental factors are associated with health behaviors like PA, but few studies have examined the association between built environment attribute concordance and PA, and no known studies have examined attribute concordance and PA adoption. Purpose The purpose of this study was to associate the degree of concordance between directly and indirectly measured built environment attributes with changes in PA over time among African American and Hispanic Latina women participating in a PA intervention. Method Women (N = 410) completed measures of PA at Time 1 (T1) and Time 2 (T2); environmental data collected at T1 were used to compute concordance between directly and indirectly measured built environment attributes. The association between changes in PA and the degree of concordance between each directly and indirectly measured environmental attribute was assessed using repeated measures analyses. Results There were no significant associations between built environment attribute concordance values and change in self-reported or objectively measured PA. Self-reported PA significantly increased over time (F(1,184) = 7.82, p = .006), but this increase did not vary by ethnicity or any built environment attribute concordance variable. Conclusions Built environment attribute concordance may not be associated with PA changes over time among minority women. In an effort to promote PA, investigators should clarify specific built environment attributes that are important for PA adoption and whether accurate perceptions of these attributes are necessary, particularly among the vulnerable population of minority women.