Search

Background: Gender differences in physical activity (PA) trajectories during adolescence are well documented, yet little research has examined whether the determinants of these trajectories vary by child’s gender. This study is one of few prospective examinations of gender differences in the influences of psychosocial and socioenvironmental factors on changes in objectively measured PA. Methods: Students and parents from elementary and middle schools located in 2 school districts in South Carolina were enrolled in a prospective cohort study of changes in children’s PA from elementary to middle school. Measures included children’s and/or parents’ ratings of various psychosocial and socioenvironmental factors as well as objectively measured PA, children’s anthropometric characteristics, and neighborhood factors at fifth and sixth grades. Results: Parents’ reports of children’s sport and class participation, parent-reported support for PA, and neighborhood resources for PA were protective against declines in PA for both boys and girls. The effects of 2 factors—children’s self-efficacy and parents’ leisure-time PA—on changes in PA over time were moderated by the child’s gender. Conclusions: A better understanding of these dynamics may inform the development of interventions.

Four expert panels from Australia, Canada, the United Kingdom, and the United States issued physical activity (PA) recommendations for young children that are quite similar. The aim of this study was to determine compliance with the new PA guideline (defined as ≥15 min/hr of total PA) in two independent samples of preschool children.We conducted a cross-sectional study of children attending preschools in Columbia, South Carolina. A total of 286 children in one sample and 337 children in a second sample participated. The main outcome of interest was total PA (sum of light, moderate, and vigorous intensity activity) measured by accelerometry. Compliance with the PA guideline was determined for both samples. Separately for each sample, mixed logistic models were used to determine whether there were differences in compliance with the PA guideline between groups based on sex, race/ethnicity, parent education, and weight status, controlling for preschool.Total PA was 14.5 and 15.2 min/hr in the first and second samples, respectively. The prevalence of meeting the PA guideline was 41.6% and 50.2% in the first and second samples, respectively. In both samples, more males than females met the guideline (53.5% vs. 33.5% and 57.6% vs. 45.9%) in the first and second samples, respectively (p0.05).Approximately one half of children in two independent samples met the guideline for PA in young children. Policies and practices designed to increase PA among preschool children are needed, given that most children are not meeting this PA guideline.

Background Interventions to prevent excessive gestational weight gain and promote postpartum weight loss have yielded modest results, particularly in overweight and obese women. Objectives To examine the impact of a theory-based lifestyle intervention on gestational weight gain, postpartum weight loss, and related maternal and child outcomes and to examine race differences in these outcomes. Design A randomized controlled trial (target N = 400; 200 intervention, 200 standard care; 200 African American, 200 white). Methods Overweight and obese African American and white women ≤ 16 weeks gestation are recruited from obstetrics and gynecology clinics in South Carolina. Intervention participants receive two in-depth counseling sessions (early pregnancy and postpartum), telephone counseling, behavioral podcasts, and social media support that target weight self-monitoring and increasing physical activity and healthy dietary behavior practices, guided by Social Cognitive Theory. Standard care participants receive monthly mailings and a matched number of podcasts on non-weight related topics. All intervention activities last from ≤ 18 weeks gestation to 6 months after delivery. Gestational weight gain is the primary outcome. Secondary outcomes are meeting gestational weight gain guidelines (inadequate, adequate, excessive), weekly rate of gestational weight gain, postpartum weight retention, physical activity and dietary behaviors, health-related quality of life, and offspring adiposity. Participants are assessed at baseline (≤ 16 weeks gestation), 32 weeks gestation, and 6 and 12 months postpartum, and offspring are assessed at 6 and 12 months. Summary HIPP is an innovative study that addresses significant gaps in the literature. Primary outcome results are expected in 2019.

Background Faith-based interventions hold promise for promoting health in ethnic minority populations. To date, however, few of these interventions have used a community-based participatory research (CBPR) approach, have targeted both physical activity and healthy eating, and have focused on structural changes in the church. Purpose To report the results of a group randomized CBPR intervention targeting physical activity and healthy eating in African-American churches. Design Group RCT. Data were collected from 2007 to 2011. Statistical analyses were conducted in 2012. Setting/participants Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study. Intervention Churches were randomized to an immediate (intervention) or delayed (control) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model. A CBPR approach guided intervention development. Intervention churches attended a full-day committee training and a full-day cook training. They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation. Main outcome measures Primary outcomes were self-reported moderate- to vigorous-intensity physical activity (MVPA), self-reported fruit and vegetable consumption, and measured blood pressure. Secondary outcomes were self-reported fat- and fiber-related behaviors. Measurements were taken at baseline and 15 months. Intent-to-treat repeated measures ANOVA tested group X time interactions, controlling for church clustering, wave, and size, and participant age, gender, and education. Post hoc ANCOVAs were conducted with measurement completers. Results There was a significant effect favoring the intervention group in self-reported leisure-time MVPA (d=0.18, p =0.02), but no effect for other outcomes. ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA (d=0.17, p =0.03) and self-reported fruit and vegetable consumption (d=0.17, p =0.03). Trainings were evaluated very positively (training evaluation item means of 4.2–4.8 on a 5-point scale). Conclusions This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA. This program has potential for broad-based dissemination and reach. Trial registration This study is registered at www.clinicaltrials.gov NCT00379925.

To identify similar patterns of physical activity (PA) and sedentary behavior in sixth-grade girls using cluster analysis; to determine which clusters of girls were associated with greater daily minutes of objectively measured PA; and to examine whether girls in these clusters experienced change in PA from sixth to eighth grade.An adventitious cohort of girls (n = 957) from the Trial of Activity for Adolescent Girls were measured at sixth and eighth grade. Activities were identified using the 3-day physical activity recall and a self-report survey and used to create clusters of sixth-grade girls who had similar PA/sedentary behaviors. Accelerometry was used to assess PA in sixth and eighth grade. Data analysis consisted of FASTCLUS procedure and mixed model repeated measures analyses in SAS statistical software.Cluster analysis yielded six clusters (C1: educational sedentary; C2: sports and play; C3: organized sports teams/classes/lessons in past year; C4: active transport and chores; C5: electronic media; C6: sleep). Sixth-grade girls in C2 and C3 had greater average daily minutes of moderate-to-vigorous physical activity (MVPA), metabolic equivalent of a physical activity-weighted MVPA, and vigorous physical activity compared with other clusters (p.05). In eighth grade, sedentary time increased and PA declined among girls in all clusters (p.05). Girls in C2 had the greatest decline in PA, whereas girls' PA in C3 declined less.Encouraging participation in organized sports teams/class/lessons in middle school girls may promote greater MVPA and vigorous physical activity than other activities and may help to better sustain PA levels over time.

Objectives: Individuals may engage in more than one risk behaviour at any given time. The extent to which risk behaviours cluster among African American adults has been largely unexplored. This study examined the prevalence and clustering of three risk behaviours among African American church members: smoking; low moderate-to-vigorous intensity leisure time physical activity (leisure MVPA); and low fruit and vegetable consumption. Design: Cross-sectional study. Setting: African Methodist Episcopal churches in South Carolina. Method: Participants self-reported leisure MVPA, fruit and vegetable consumption and smoking. The prevalence of single and multiple risk behaviours was computed. To examine whether risk behaviours clustered, a series of hierarchical log-linear models (SAS CATMOD) were fitted to the observed counts. Results: Of the 1123 participants, 7.0% smoked, 56.0% engaged in Conclusions: Church members who engaged in low levels of leisure MVPA were more likely to have low fruit and vegetable consumption, regardless of smoking status. These findings suggest that these two behaviours should not be considered in isolation from one another when developing behaviour change interventions; interventions targeting both behaviours may be more effective.

This note extends the score test statistics for overdispersion in Poisson and binomial regression models (Dean, 1992) to the zero-inflated models. Some general results are obtained, and examples illustrate the application of the extended results.

The negative binomial (NB) model and the generalized Poisson (GP) model are common alternatives to Poisson models when overdispersion is present in the data. Having accounted for initial overdispersion, we may require further investigation as to whether there is evidence for zero-inflation in the data. Two score statistics are derived from the GP model for testing zero-inflation. These statistics, unlike Wald-type test statistics, do not require that we fit the more complex zero-inflated overdispersed models to evaluate zero-inflation. A simulation study illustrates that the developed score statistics reasonably follow a χ2 distribution and maintain the nominal level. Extensive simulation results also indicate the power behavior is different for including a continuous variable than a binary variable in the zero-inflation (ZI) part of the model. These differences are the basis from which suggestions are provided for real data analysis. Two practical examples are presented in this article. Results from thes...

This note is motivated by recent works of Xie et al. (2009) and Xiang et al. (2007). Herein, we simplify the score statistic presented by Xie et al. (2009) to test overdispersion in the zero-inflated generalized Poisson (ZIGP) mixed model, and discuss an extension to test overdispersion in zero-inflated Poisson (ZIP) mixed models. Examples highlight the application of the extended results. The extensive simulation study for testing overdispersion in the Poisson mixed model indicates that the proposed score statistics maintain the nominal level reasonably well. In practice, the appropriate model is chosen based on the approximate mean-variance relationship in the data, and a formal score test based on asymptotic standard normal distribution can be employed for testing overdispersion. A case study is provided to illustrate procedures for data analysis.

This note discusses an extension to the score test statistics for overdispersion in Poisson and binomial regression models [Dean, C.B., 1992. Testing for overdispersion in Poisson and binomial regression models. J. Amer. Statist. Assoc. 87, 451–457]. Examples illustrate the application of the extended results.

The zero-inflated negative binomial (ZINB) model is used to account for commonly occurring overdispersion detected in data that are initially analyzed under the zero-inflated Poisson (ZIP) model. Tests for overdispersion (Wald test, likelihood ratio test [LRT], and score test) based on ZINB model for use in ZIP regression models have been developed. Due to similarity to the ZINB model, we consider the zero-inflated generalized Poisson (ZIGP) model as an alternate model for overdispersed zero-inflated count data. The score test has an advantage over the LRT and the Wald test in that the score test only requires that the parameter of interest be estimated under the null hypothesis. This paper proposes score tests for overdispersion based on the ZIGP model and illustrates that the derived score statistics are exactly the same as the score statistics under the ZINB model. A simulation study indicates the proposed score statistics are preferred to other tests for higher empirical power. In practice, based on the approximate mean–variance relationship in the data, the ZINB or ZIGP model can be considered, and a formal score test based on asymptotic standard normal distribution can be employed for assessing overdispersion in the ZIP model. We provide an example to illustrate the procedures for data analysis.

Weighted survey data with missing data for some covariates presents a substantial challenge for analysis. We addressed this problem by using a reweighting technique in a logistic regression model to estimate parameters. Each survey weight was adjusted by the inverse of the probability that the possibly missing covariate was observed. The reweighted estimating equations procedure was compared with a complete case analysis (after discarding any subjects with missing data) in a simulation study to assess bias reduction. The method was also applied to data obtained from a national health survey (National Health and Nutritional Examination Survey or NHANES). Adjusting the sampling weights by the inverse probability of being completely observed appears to be effective in accounting for missing data and reducing the bias of the complete case estimate of the regression coefficients.

Overdispersion is a common phenomenon in Poisson modeling. The generalized Poisson (GP) regression model accommodates both overdispersion and underdispersion in count data modeling, and is an increasingly popular platform for modeling overdispersed count data. The Poisson model is one of the special cases in the collection of models which may be specified by GP regression. Thus, we may derive a test of overdispersion which compares the equi-dispersion Poisson model within the context of the more general GP regression model. The score test has an advantage over the likelihood ratio test (LRT) and over the Wald test in that the score test only requires that the parameter of interest be estimated under the null hypothesis (the Poisson model). Herein, we propose a score test for overdispersion based on the GP model (specifically the GP-2 model) and compare the power of the test with the LRT and Wald tests. A simulation study indicates the proposed score test based on asymptotic standard normal distribution is more appropriate in practical applications.

Background: Millions of young children attend preschools and other structured child development programs, but little is known about their physical activity levels while in those settings. The purpose of this study was to describe the physical activity levels and demographic and school-related correlates of physical activity in children attending preschools, using a direct observation measurement system. Methods: The Observational System for Recording Physical Activity in Children-Preschool Version was used to measure physical activity levels and related factors in four hundred ninety-three 3- to 5-year-old children in 24 preschools. A minimum of six hundred 30-second observation intervals were recorded for each child. Physical (height/weight) and demographic data also were collected. Results: Children engaged in moderate-to-vigorous physical activity (MVPA) during less than 3% of the observation intervals and were sedentary during more than 80% of the observation intervals. Boys were more likely than girls to engage in MVPA (p = .01), and 3-year-old boys were more active than 4- and 5-year-old boys (p = .01). The preschool that a child attended explained 27% of the variance in activity levels. Conclusions: The study indicates that young children are physically inactive during most of their time in preschool. The preschool that a child attended was a stronger predictor of physical activity level than any other factor examined. Additional research is needed to identify the characteristics of preschools in which children are more active.

Background:Question order might affect self-reported regular physical activity (PA) measured with items from the Behavioral Risk Factor Surveillance System (BRFSS) PA module.Methods:A telephone survey was conducted using 2 forms (N = 1004, N = 212) with varying PA question order. The standard form presented moderate-PA, vigorous-PA, and walking questions, in that order, whereas the alternate form presented walking questions, followed by moderate-PA, and then vigorous-PA questions. Weighted, adjusted rates of vigorous PA, walking, meeting the Centers for Disease Control and Prevention (CDC) recommendation for moderate or vigorous PA, and moderate PA from each form were compared.Results:Vigorous PA and walking were similar regardless of question order. Meeting the CDC recommendation for moderate or vigorous PA was reported less often with the alternate form among 18- to 34-year-olds. Less moderate PA was reported with the alternate form overall and among 18- to 34-year-olds, women, whites, and those with a high school education or less.Conclusion:Estimating PA and walking across sociodemographic strata with differing patterns of PA requires asking moderate-PA and vigorous-PA questions before walking questions. Asking walking questions first might lead to bias, especially for moderate PA. Walking, added to a survey with BRFSS moderate and vigorous PA items, should be placed after moderate and vigorous PA. Walking questions first may cause bias, especially for moderate PA.

Recently the Institute of Medicine (Early childhood obesity prevention policies, Washington, DC, 2011) established a US guideline for preschool children and recommended 15 min or more of total physical activity (i.e., total accumulated light, moderate, and vigorous activity) per hour or 3 h per day assuming 12 h of wake time. Nevertheless, researchers have found that many young children do not meet the proposed guideline in early care and education programs.

Overdispersion is a common phenomenon in Poisson modeling, and the negative binomial (NB) model is frequently used to account for overdispersion. Testing approaches (Wald test, likelihood ratio test (LRT), and score test) for overdispersion in the Poisson regression versus the NB model are available. Because the generalized Poisson (GP) model is similar to the NB model, we consider the former as an alternate model for overdispersed count data. The score test has an advantage over the LRT and the Wald test in that the score test only requires that the parameter of interest be estimated under the null hypothesis. This paper proposes a score test for overdispersion based on the GP model and compares the power of the test with the LRT and Wald tests. A simulation study indicates the score test based on asymptotic standard Normal distribution is more appropriate in practical application for higher empirical power, however, it underestimates the nominal significance level, especially in small sample situations, and examples illustrate the results of comparing the candidate tests between the Poisson and GP models. A bootstrap test is also proposed to adjust the underestimation of nominal level in the score statistic when the sample size is small. The simulation study indicates the bootstrap test has significance level closer to nominal size and has uniformly greater power than the score test based on asymptotic standard Normal distribution. From a practical perspective, we suggest that, if the score test gives even a weak indication that the Poisson model is inappropriate, say at the 0.10 significance level, we advise the more accurate bootstrap procedure as a better test for comparing whether the GP model is more appropriate than Poisson model. Finally, the Vuong test is illustrated to choose between GP and NB2 models for the same dataset.

A majority of preschool-aged children spend a significant portion of every weekday in a preschool or child care setting, where they typically participate in limited physical activity. This study determined if an ecologic physical activity intervention in preschools increases children's moderate- to vigorous-intensity physical activity (MVPA).RCT, with preschool as the unit of randomization and analysis. Child physical activity was measured by accelerometry. Mixed model analysis of covariance with preschool as a random variable was used to test the effects of the intervention on physical activity in the total group and in sex-specific subgroups. Data were collected in 2008-2010 and analyzed in 2012-2014.Children in 4-year-olds' classrooms in 16 preschools, pair matched and assigned to intervention or control groups.The intervention focused on increasing children's physical activity by changing instructional practices. Researchers trained preschool teachers to engage children in physical activity during (1) structured, teacher-led physical activity opportunities in the classroom; (2) structured and unstructured physical activity opportunities at recess; and (3) physical activity integrated into pre-academic lessons. Research staff encouraged teachers to adapt the intervention to their classrooms.Minutes/hour of MVPA during the preschool day.In an analytic sample of 379 children (188 intervention, 191 control), those in the intervention schools engaged in significantly more MVPA than children in control schools (7.4 and 6.6 minutes/hour, respectively). This difference remained significant after adjusting for parent education and length of the school day (half versus full day). In the sex-specific analyses, the difference was significant for girls (6.8 vs 6.1 minutes/hour of MVPA, respectively) but not for boys (7.9 vs 7.2 minutes/hour, respectively).A flexible ecologic physical activity intervention that trains teachers to provide children with opportunities to be active throughout the school day increased MVPA in preschool children.

Undergraduate education focused on public health (UGPH) has burgeoned over the past decade (1, 2). While this trend is widely acknowledged, a critical analysis of drivers, constructs, and implications is missing from the published literature. The Research Topic comprising articles on UGPH attempts to address this gap in knowledge by providing descriptions of exemplary programs, curriculum recommendations, and commentaries on career relevancy for the future workforce. Our aim is to advance the field as more students, faculty, and universities explore how best to launch and integrate public health into the education of undergraduate college students. Moreover, we hope that those faculties and universities that have been engaged in public health undergraduate education for many years will recognize the contribution that they can make by documenting, disseminating, and re-examining their work. To the extent that we have become an evidence-driven society, the need for data is compelling. The academic enterprise would benefit from descriptive data that describe the landscape of the field as a basis for subsequent evaluation studies, research on pedagogy, and concrete information on career trajectories. We note three caveats about this compilation. First, we limited this collection of articles to those focused tightly on undergraduate education for the general public health degree in the US. We recognize that within the sub-specialty fields of public health (e.g., environmental health, health management and policy, nutrition, health education, and others), there are long-standing undergraduate, graduate, and post-graduate degree programs. We did not include these for a variety of reasons, including that many are driven by external licensing and credentialing criteria and distinct academic accrediting bodies. Such programs unquestionably have experience and examples that contribute to the issues raised by the papers in this volume. Second, we also recognize that public health can be taught as a secondary field of clinical disciplines, including medicine, nursing, veterinary medicine, and dentistry. This volume does not explore interrelated curricula or dual degree pedagogy. Finally, the methods by which public health is taught and practiced in the US may be quite different from how it is taught and practiced in other countries. We have left all of these expansive issues for future discussions.

National stakeholders in health system improvement and patient safety including accreditation bodies have requested health professional educational programs to include multiple interprofessional experiences through didactic and experiential opportunities. Clinical and population health faculty at the University of South Carolina redesigned and expanded an introductory interprofessional course to include more than 500 students from public health, social work, medicine, pharmacy, and nursing. Students participated in 3 live class meetings and completed required online coursework to explore concepts related to social determinants of health and health disparities, health system improvement, patient safety, cultural competency, and ethics to address interprofessional education core competencies. Course modifications and expanded student enrollment improved understanding of key health concepts and appreciation of interprofessional collaboration.

Within the past several years, accelerometry has emerged as an important means of assessing the duration and intensity of physical activity and has served to define primary outcome measures in several observational (1,4,20) and experimental studies (6,7,11,15,17). It is currently being used in the large group-randomized Trial of Activity in Adolescent Girls (TAAG) to examine the effect of a school- and community-based intervention on physical activity in middle-school girls. The uniaxial accelerometer considered in this trial, the ActiGraph, formerly known as the Computer Science and Applications (CSA) and Manufacturing Technologies Inc. (MTI) (ActiGraph, LLC, Fort Walton Beach, FL) is a small (5 × 4 × 1.5 cm) and lightweight (45 g) device that captures vertical acceleration. Acceleration is sampled 10× s−1, and the data are summed over a user-specified time interval (e.g., 30 s, 1 min) and the summed value or activity “count” is stored in memory. Although the measurement protocols vary, most studies involve monitoring physical activity over several days to ensure reliable estimates of usual physical activity behavior and to account for potentially important differences in activity patterns on weekdays versus weekend days (19). Participants are typically instructed to wear the accelerometer during waking hours, except when bathing and showering. Data from accelerometers are summarized in numerous ways, including the mean total count per day (11) and the mean minutes per day spent in moderate or vigorous physical activity (using established count cut points to distinguish specific intensity levels). The analysis is complicated in that 1) activity levels vary among days of the week and times of day and 2) over multiple days of monitoring, missing data arising from removal of the monitor are a common occurrence. Although participant noncompliance accounts for a large fraction of the missing data, legitimate reasons for removing the monitor, such as complying with mandated sports league safety regulations or participation in water-related activity (for monitors that are not waterproof), also contribute to data loss. Thus, the timing and amount of data contributed by each individual vary. If summary statistics are computed using the observed data only, these statistics have the potential to be biased. For example, the total count for a given day clearly underestimates the true level of activity on days in which the monitor is worn only part of a day. Some researchers have tried to minimize this bias by computing summary statistics after excluding accelerometer data on days in which the monitor is worn only part of the day. These are called incomplete days of observation. This strategy, however, is not without issues. First, even after excluding days with, say, less than 8 h of wearing time, the number of hours the monitor is worn is still likely to vary. Moreover, if included days have intervals when the subject was awake but not wearing the monitor, then total activity will be underestimated. Second, this approach ignores possible differences in activity levels on complete days and incomplete days, making the estimated summary statistics from complete days subject to selection bias. This paper proposes an analytical approach whereby the observed data are used to help predict activity levels for segments of the day in which the monitor is not worn. The resultant data set is pseudo-complete in the sense that each individual will have either observed or imputed data for all segments of each day in which the monitor was intended to be worn. Summary statistics are then estimated from this pseudo-complete data set. This imputation strategy is analogous to imputing missing item responses on multi-item questionnaires. The literature contains numerous examples in which this treatment of item nonresponse has been found to reduce bias effectively (5,21). In the following section, accelerometer data collected during the feasibility phase of the TAAG trial are used to demonstrate the potential for bias in estimating physical activity when all observed data are used as well as when a subset of data that excludes incomplete days of monitoring is used. We then describe procedures for filling in missing data using single imputation through expectation maximization (EM) and multiple imputation (MI) (9,14). The remaining sections of the paper describe the design of a simulation study to assess the effectiveness of the imputation approaches, present its results, and discuss the effectiveness of imputation as a strategy for dealing with missing data in the context of accelerometry.

Background:This study was performed to determine the relationship between leisure-time physical activity (LTPA) and the metabolic syndrome (MS) in 16,681 adults (43 ± 0.44 y) enrolled in NHANES III.Methods:LTPA was classified as regularly active (≥ 5 d/wk moderate and/or ≥ 3 d/wk vigorous), irregularly active (some LTPA), or inactive (no LTPA). The MS was positive with three or more conditions: 1) abdominal obesity, 2) low HDL-C, 3) hypertriglyceridemia, 4) elevated blood pressure, or 5) elevated glucose. Logistic regression examined the relationship between LTPA and the MS, adjusting for age, race, smoking status, and educational attainment stratified by gender.Results:In men only, irregular activity and inactivity was related to an increase in the MS (irregular: OR = 1.52 95% CI 1.11, 1.23; inactive: OR = 1.60, 95% CI 1.18, 1.98; test for trend P = 0.004). Inactivity increased the odds for abdominal obesity (P < 0.05).Conclusions:LTPA levels might influence the development of MS and abdominal obesity.

Objective To study the association of family and social risk factors with psychopathology in a longitudinal study of adolescents. Method From 1986 to 1988, 3,419 seventh through ninth graders were screened with the Center for Epidemiologic Studies Depression Scale. The top decile scorers and a random sample of the remainder were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (n = 581). Follow-up interviews were completed 6 years later (mean age = 18.65; n = 490). Baseline variables are associated with baseline and follow-up diagnoses. Diagnoses are grouped by affective, disruptive, and anxiety disorders. Results The frequency of psychiatric diagnosis decreased from 19.9% (baseline) to 5.7% (follow-up). In multivariable logistic regression analyses controlling for race, gender, and socioeconomic status, baseline undesirable life events and low family cohesion are associated with any disorder and affective disorder at baseline. Not living with both biological parents at baseline increases the odds ratio (OR) for affective disorder at baseline (OR 3.45; 95% confidence interval [CI] = 1.68-7.08) and follow-up (OR 4.40; CI = 1.26-15.40). At baseline and follow-up, anxiety and affective disorders are associated with being white and anxiety disorder with being female. Conclusions Family structure and cohesion and stressful life events are associated with affective disorders in adolescents.

We evaluated perceived social and environmental supports for physical activity and walking using multivariable modeling. Perceptions were obtained on a sample of households in a southeastern county. Respondents were classified according to physical activity levels and walking behaviors. Respondents who had good street lighting; trusted their neighbors; and used private recreational facilities, parks, playgrounds, and sports fields were more likely to be regularly active. Perceiving neighbors as being active, having access to sidewalks, and using malls were associated with regular walking.

Background Estimating a person's history of occupational exposure in case-control studies is difficult. Methods Percent agreement between selected self-reported occupational exposures and job-exposure matrix (JEM) exposure assessment for all participants and various subgroups of a population-based case-control interview study of 486 leukemia subjects and 502 healthy controls in Shanghai was evaluated. Results With JEM as the “gold standard,” the sensitivities for self-reported exposures ranged from 0.75 to 0.98. However, that for pesticide exposure was 0.44 in subjects >51 years old. Self-reported exposures specificities ranged from 0.87 to 0.99. Agreement between self-reported exposures and JEM assessment was good (kappa coefficients [κ]: 0.48–0.84). Variations in agreement for benzene exposure between males and females as well as between the direct interview and surrogate interview subgroups were observed. Conclusions The levels of agreement between self-report and JEM in this study suggest that self-reported exposures are a suitable method for assessing occupational exposures in this population. Am. J. Ind. Med. 45:281–288, 2004. © 2004 Wiley-Liss, Inc.

Young adults are often in periods of transition, and lifestyle changes such as a decline in physical activity can occur during this period. The purpose of this study was to determine the relationships between demographic, biologic, lifestyle, social support index, environmental factors, and physical activity in young adults. The participants were 4,152 young adults from 18 to 30 years of age enrolled in the Third National Health and Nutrition Examination Survey (NHANES III). A moderate to vigorous physical activity (MVPA) score was calculated from responses to nine activities and up to four activities not previously listed. Multiple regression analyses were used to assess the relationship between MVPA and independent variables separately for men and women. Non-Hispanic Blacks were more active than non-Hispanic White or Mexican American men, whereas, among women, non-Hispanic Whites were more active. Education, social support index, and trying to lose weight were positively associated with MVPA, whereas being married was inversely related in both men and women. Among women, those who were unemployed, in better health, had smaller families, had lower body mass indexes (BMIs), and were not from the South had higher MVPA. Men who were in school during the past 12 months were more active than those who were not in school. The results from this study suggest that demographic and social factors are important determinants of physical activity in young adults and should be considered when planning interventions.

PROBLEM The impact of the Persian Gulf war on adolescents in Columbia, Charleston, and Sumter, SC. METHODS Four semiannual surveys measured adolescents' exposure to and evaluations of the Persian Gulf war, and the relationship between this exposure and mental distress. FINDINGS Of the sample, 814 (65.9%) reported being distressed by the war and 849 (69%) reported feeling better after the war ended. More than half the sample had a friend or relative sent to the war (n = 725, 58.8%), and of these, 458 were African American. Nine percent (n = 111) of the sample had a mother, father, or both a mother and a father in the war. CONCLUSIONS There was a positive correlation between adolescents' ratings on the Negative Impact of War Scores and Mental Distress Scores despite the easy victory and public support for the war in the United States. Females and African Americans viewed the war more negatively than did Caucasian males.

Background Perceptions of the environment and physical activity have been associated using survey methods, yet little is known about the validity of environmental surveys. In this study, perceptions of the environment at neighborhood and community levels were assessed (1) to determine validity by comparing respondent perceptions to objective measures and (2) to determine test–retest reliability of the survey. Methods A telephone survey was administered to a stratified sample of Sumter County, South Carolina adults. Respondents' home addresses were mapped using a geographic information system (GIS) ( n =1112). As an indicator of validity, kappa statistics were used to measure agreement between perceptions and objective measures identified at neighborhood and community levels using GIS. A second survey in an independent sample ( n =408) assessed test–retest reliability. Results When assessing perceptions of environmental and physical activity in a defined geographic area, validity and reliability for neighborhood survey items were κ=−0.02 to 0.37 and rho=0.42 to 0.74, and for community survey items were κ=−0.07 to 0.25 and rho=0.28 to 0.56. Conclusions Although causality between perception of access and safety and actual physical activity level cannot be assumed, those meeting national physical activity guidelines or reporting some physical activity demonstrated greatest agreement with access to recreation facilities, while those not meeting the guidelines demonstrated greater agreement with safety of recreation facilities. Factors such as distance and behavior may explain differences in perceptions at neighborhood and community levels. Using local environments with short distances in survey methods improves validity and reliability of results.

Background Active commuting to school by walking or bicycle is a potential source of continuous moderate activity for children that has been largely ignored in surveys of physical activity. The purpose of this study was to evaluate the analytical impact of omitting active commuting to school (walking or bicycling) on conclusions about children's physical activity levels. Methods The Russian Longitudinal Monitoring Study (RLMS) is the first nationally representative household survey in the Russian Federation. More than 6400 households from all regions of Russia were surveyed eight times between 1992 and 1998. Analysis was conducted using physical activity data (school physical education classes, out-of-school active pursuits and active commuting to school) obtained by parent-proxy on 1094 (572 boys, 522 girls) school-aged Russian children (mean age 10.2 ± 1.9 years) participating in the November 1998 round of the RLMS. Data were examined according to prevalence of achievement of health-related physical activity guidelines, active commuting to school behaviours included then omitted. Results Omitting active commuting to school resulted in a statistically significant decrease in the prevalence of achievement of health-related guidelines from 12% to 20%, similar for both genders. Likewise, the prevalence of sedentarism (defined as not meeting any of the guidelines) was increased by 17–22%. Conclusions The present findings suggest that, in order to avoid misclassification bias of children's physical activity levels, it is necessary to include questions about mode of commuting to school. The findings also carry practice implications: the commonplace need to get to and from school may be a missed opportunity for children's health-related physical activity in motorized societies.

Purpose: This study describes the types and frequencies of musculoskeletal injuries among a cohort of adults with above average activity levels who were enrolled in the Aerobics Center Longitudinal Study (Dallas, TX). Methods: Participants were adults aged 20-85 yr who completed a baseline clinical examination (1970-1982) and returned a mailed follow-up survey in 1986. Participants (5,028 men, 1,285 women) were measured for aerobic fitness, height, and body weight during the baseline examination. They reported detailed information about their physical activity levels and injury experiences on the follow-up survey (1986). An injury was defined as any self-reported soft tissue or bone injury that occurred within the previous 12 months. Activity-related injuries were those injuries participants attributed to participation in a formal exercise program. Results: A quarter of all participants reported a musculoskeletal injury. Of these, 83% were activity-related. More than 66% of activity-related injuries occurred in the lower extremity; the knee was listed as the joint most often affected. There were no significant sex differences in the prevalence of injury, regardless of cause. Sport participants had the highest proportion of all-cause and activity-related musculoskeletal injuries among both men and women. Self-perceived severe injuries had a significant negative impact on physical activity levels since almost 1/3 of subjects reported permanently stopping their exercise program after injury. Conclusion: These results suggest the need for developing and implementing injury prevention programs targeted toward moderately active adults. ©2002The American College of Sports Medicine

This research tested the effects of a long-term psychosocial nursing intervention designed to decrease mental distress in adolescents following a catastrophic event. Advanced Practice Psychiatric Nurses conducted the Catastrophic Stress Intervention (CSI) in two South Carolina high schools for three years following Hurricane Hugo. The CSI consisted of nine protocols designed to decrease adolescents' mental distress by increasing their understanding of stress and by enhancing their self-efficacy and social support. Adolescents (N = 1030) were randomized to intervention or control groups and completed one baseline and five postintervention measures of mental distress, self-efficacy, and social support. The hypothesis was that intervention adolescents would have less mental distress than control adolescents. The research also addressed the particular time points at which differences between intervention and control adolescents might be shown. Repeated measures multivariate analysis of variance, with exposure to the hurricane, self-efficacy, and social support as control variables, showed that intervention adolescents reported less mental distress than control adolescents at 12, 18, and 24 months but that this difference dissipated by 30 and 36 months. Implications for the CSI and timing of interventions with adolescents after a catastrophic event are discussed.

To test the feasibility and acceptability of a theory-based lifestyle intervention designed to prevent excessive weight gain during pregnancy and promote weight loss in the early postpartum period in overweight and obese African American women. Sixteen pregnant women (B18 weeks gestation) were recruited from prena- tal clinics in Columbia, South Carolina in 2011 and assigned to a lifestyle intervention program. The inter- vention, guided by formative research, consisted of an individual counseling session followed by eight group sessions alternated with telephone counseling contacts that continued through 36 weeks of gestation. At 6-8 weeks postpartum, participants received a home visit and up to three counseling calls through week 12. Medical charts were reviewed for 38 contemporary controls who met the same inclusion criteria and attended the same prenatal clinics. Compared to controls, study participants gained less total weight, had a smaller weekly rate of weight gain across the 2nd and 3rd trimesters (0.89 vs. 0.96 lbs), and were less likely to exceed weight gain recommendations (56.3 vs. 65.8 %). At 12 weeks postpartum, study partici- pants retained 2.6 lbs from their prepregnancy weight, half of study participants were at their prepregnancy weight or lower, and only 35 % retained C5 lbs. The intervention also demonstrated success in promoting physical activity and reducing caloric intake, and was well-received by participants. The initial results were promising. The lessons learned can help inform future studies. The efficacy of our intervention will be tested in a large randomized controlled trial.

Participant-rated and compendium-coded intensity of daily physical activities were compared in 148 African American, 144 Native American, 51 non-Hispanic White women ages 40 to 91 years who completed 4 days of activity records. For compendium-coded intensity, reported activities were classified as light (3 metabolic equivalents [METS]), moderate (3-6 METS), or vigorous (6 METS) using the Compendium of Physical Activities (1), whereas these categories were self-assigned for participant-rated intensity. Minutes per day (min/d) spent in activities at each intensity level were computed. Relative to compendium-coded min/d, participants reported significantly greater time spent in light (+10 min/d; p.01) and vigorous (+17 min/d; p.001) activities, and less time spent in moderate activities (-27 min/d; p.001). Similarly, compendium-coded estimates yielded higher rates ofparticipants meeting Centersfor Disease Control and Prevention-American College of Sports Medicine and Surgeon General recommendations than participant-rated estimates (11-18% differences) but substantially lower rates meeting American College of Sports Medicine vigorous recommendations (22% difference). Further, 247 greater kilocalories per day were estimated based on compendium-coded intensity. Kilocalories per day estimates based on compendium codings were more highly associated with pedometer counts than those based on participant ratings (p.05). Studypatterns were generally seen across all sample subgroups. Discrepancies between participant and compendium estimates are likely to be most meaningful in studies estimating energy expenditure as it relates to health outcomes and in studies estimating vigorous activities.

OBJECTIVE: To examine the relationship between pedometer-determined ambulatory activity (steps/day) and body composition variables body mass index (BMI) and percentage body fat). DESIGN: Secondary analysis of a cross-sectional objective activity monitoring study for up to 21 consecutive days. SUBJECTS: A total of 109 apparently healthy adults (eight African American males, 23 African-American females, 33 Caucasian males, 45 Caucasian females), age 44.9±15.8 y, BMI=26.9±5.1 kg/m2. MEASUREMENTS: Pedometer-assessed ambulatory activity (steps/day), height and weight, and percentage body fat by bioelectrical impedance. RESULTS: Analyzed as both a continuous and a categorical variable (determined using 25th and 75th percentiles for distribution for steps/day), ambulatory activity was consistently related to body composition variables. Steps/day was inversely correlated with BMI and percentage body fat (r=−0.30, and r=−0.27, respectively, both P

Background.The prevalence of selected health indicators were compared among the Catawba Indians, African Americans, and whites in South Carolina, considering the possible role of rural locality and education.Methods.Catawba members were respondents of a 1998 survey (N = 808). Other South Car

Background: This paper describes physical activity the patterns of 2,101 Russian youth enrolled in the Russian Longitudinal Monitoring Survey (RLMS). The RLMS is a nationally representative household sample survey. Methods: Youth 14–18 years and parents of youth 6–13 years responded to survey questions about hours per week of light (cooking and laundry), moderate (walking, bicycling and sports), and vigorous physical activities (karate, wrestling and gymnastics). Sedentary activities (e.g. watching TV, music, homework) were categorized separately. Subjects were categorized for analyses by sex (boys n=1,072 and girls n=1,029) and age was grouped by school year: 6–11 years (elementary school), 12–16 years (high school), and 17–18 years. Mean hours per week by age and sex were computed for time spent in sedentary (≤1 MET), light (1.1–2.9 METs), moderate (3–6 METs), and vigorous (≥6 METs) activities. The proportion of youth meeting International PA Guidelines 1 (any intensity physical activity ≥30 mln/day, ≥5 days per week) and 2 (moderate to vigorous physical activity for three sessions per week) was computed for each group. Results: Russian boys and girls spent approximately 28 h/week in sedentary activities. Boys spent more time than girls in moderate (5.2 versus 4.1 h/week) and vigorous (2.5 versus 1.8 h/week) intensity activities; girls spent more time in household activities. Nearly 70% of Russian youth met Guideline 1, and fewer than 45% met Guideline 2. Conclusions: The results suggest that most Russian youth enrolled in the RLMS obtain sufficient amounts of any level of physical activity per week, but that efforts may be needed to promote more regular moderate to vigorous physical activity.

Objective: To assess the association between physical violence during the 12 months before delivery and maternal complications and birth outcomes. Methods: We used population-based data from 6143 women who delivered live-born infants between 1993 and 1995 in South Carolina. Data on women’s physical violence during pregnancy were based on self-reports of “partner-inflicted physical hurt and being involved in a physical fight.” Outcome data included maternal antenatal hospitalizations, labor and delivery complications, low birth weights, and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the associations between physical violence, maternal morbidity, and birth outcomes. Results: The prevalence of physical violence was 11.1%. Among women who experienced physical violence, 54% reported having been involved in physical fights only and 46% had been hurt by husbands or partners. In the latter group, 70% also reported having been involved in fighting. Compared with those not reporting physical violence, women who did were more likely to deliver by cesarean and be hospitalized before delivery for maternal complications such as kidney infection, premature labor, and trauma due to falls or blows to the abdomen. Conclusion: Physical violence during the 12 months before delivery is common and is associated with adverse maternal conditions. The findings support the need for research on how to screen for physical violence early in pregnancy and to prevent its consequences.

Objective To examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years. Method The second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents. Results Approximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD. Conclusions While relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.

This study assessed whether the presence of both natural parents in the home and the level of perceived emotional bonding in the family, as measured by the cohesion component of the Family Adaptability and Cohesion Evaluation Scales, were independent predictors of depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) in a diverse community sample of 3,191 young adolescents. In cross-sectional analysis, cohesion was significantly associated with depressive symptoms after controlling for family structure and parent education, but there were significant interactions of cohesion with race and gender. Higher CES-D scores were associated with lower cohesion scores, with partial R² values from 0.11 for African American female adolescents to 0.29 for White female adolescents. In longitudinal analysis, the Year 1 cohesion score explained only a small amount of the variance in Year 2 CES-D after controlling for Year 1 CES-D; however, the change in cohesion score from Year ...

Introduction The purpose of this case-control study was to determine whether smoking plays a role in tuberculin skin test conversion among the inmate population of South Carolina. Results The major findings of this study indicate that smokers were more likely to have become tuberculin skin test converters during incarceration than nonsmokers (odds ratio [OR] = 1.78, 95% confidence intervals [CI = 0.98, 3.21). Inmates who smoked 1 to 20 cigarettes per day prior to incarceration (OR = 1.32, 95% CI = 0.76, 2.31), and those who smoked >20 cigarettes per day prior to incarceration (OR = 1.75, 95% CI = 0.83. 3.71) were more likely to have become converters during incarceration than nonsmokers, suggesting a dose-response effect. Converters were found to have reduced their number of cigarettes smoked per day since incarceration. Those inmates smoking 1 to 10 cigarettes per day (OR = 1.88, 95% CI = 0.96. 3.69), and those who smoked >10 cigarettes per day since incarceration (OR = 1.87, 95% CI = 0.92. 3.78) were more likely to have become converters than nonsmokers. Interestingly, inmates who smoked for 15 years or less were more likely to have become tuberculin skin test converters than nonsmokers (OR = 1.60, 95% CI = 0.81, 3.16), while those smoking for more than 15 years were more likely to have become converters than nonsmokers while incarcerated (OR = 2.12, 95% CI = 1.03, 4.36). Conclusions This suggests that the cumulative effects related to the duration of smoking may be more important than the number of cigarettes smoked with regard to tuberculin skin test conversion. This is consistent with the understanding that long-term exposure to cigarette smoking has an adverse effect on the lung's defense mechanisms, namely mucociliary clearance of potential pathogens, such as Mycobacterium tuberculosis.

The purpose of this study was to determine the minimum number of days of accelerometry required to estimate accurately MVPA and total PA in 3- to 5-year-old children. The study examined these metrics for all days, weekdays, and in-school activities. Study participants were 204 children attending 22 preschools who wore accelerometers for at least 6 hr per day for up to 12 days during most waking hours. The primary analysis considered the intraclass correlation coefficient (ICC) for each metric to estimate the number of days required to attain a specified reliability. The ICC estimates are 0.81 for MVPA-all days, 0.78 for total PA-all days, 0.83 for MVPA weekdays, 0.80 for total PA-weekdays, 0.81 for in-school MVPA, and 0.84 for in-school total PA. We recommend a full seven days of measurement whenever possible, but researchers can achieve acceptable reliability with fewer days, as indicated by the Spearman-Brown prophecy: 3–4 days for any weekday measure and 5–6 days for the all-days measures.

Background Health care-associated infections are a cause of significant morbidity and mortality in US hospitals. Recent changes have broadened the scope of health care-associated infections surveillance data to use in public reporting and of administrative data for determining Medicare reimbursement adjustments for hospital-acquired conditions. Methods Infection surveillance results for catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia were compared with infections identified by hospital administrative data. The sensitivity and specificity of administrative data were calculated, with surveillance data considered the gold standard. Results The sensitivity of administrative data diagnosis codes for CAUTI, CLABSI, and ventilator-associated pneumonia were 0%, 21%, and 25%, respectively. The incorporation of additional diagnosis codes in definitions increased the sensitivity of administrative data somewhat with little decrease in specificity. Positive predictive values for definitions corresponding to Centers for Medicare and Medicaid services-defined hospital-acquired conditions were 0% for CAUTI and 41% for CLABSI. Conclusions Although infection surveillance methods and administrative data are widely used as tools to identify health care-associated infections, in our study administrative data failed to identify the same infections that were detected by surveillance. Hospitals, already incentivized by the use of performance measures to improve the quality of patient care, should also recognize the need for ongoing scrutiny of appropriate quality measures.

Objective To investigate the frequency and phenomenology of clinical, subsyndromal, and subthreshold phobias in young adolescents. Method: A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale were administered to 487 mother-child pairs. Results Prevalence rates of clinical, subsyndromal, and subthreshold phobia were 2.3%, 14.5%, and 22.2%, respectively. One-year incidence rates were 0.4%, 8.0%, and 16.9%, with 43.0% of phobic subjects categorized at the same or a more severe level after a year. Females, blacks, subjects not living with both biological parents, and older adolescents were more likely to meet the diagnostic criteria for clinical phobia. The majority (77%) of subjects with clinical phobia experienced multiple phobias. Subsyndromal (52%) and subthreshold (74%) phobics were more likely to experience simple phobias only. Conclusions Phobic symptoms are relatively common at a moderate level and in the majority of adolescents are somewhat transitory in nature. Characteristic symptomatology and comorbidity may facilitate earlier identification of subjects at risk of persistent symptomatology and in need of treatment.

A two-stage epidemiologic study conducted between 1986 and 1988 in the southeastern United States investigated family and psychosocial predictors of obsessive compulsive disorder (OCD) and subclinical OCD in young adolescents. In the first stage, a life-event schedule and a family adaptability and cohesion scale were administered to a community sample of 3,283 adolescents. In stage two, the Schedule for Affective Disorders and Schizophrenia in School Age Children and the Children's Global Assessment Scale were administered to 488 mother-child pairs. In multivariable models family cohesion was the only significant correlate of OCD (odds ratio=0.95, 95% confidence interval 0.91–0.98). Gender, race, age, socioeconomic status, guardian status, adaptability, undesirable life events and desirable life events were not found to be significant predictors of OCD in models adjusting for cohesion. Note of the above variables were significantly associated with subclinical OCD. However, separate analyses of the 41 individual life events indicated seven specific events were significantly associated with OCD or subclinical OCD. These findings are at odds with the theory that overinvolvement of family members is a risk factor for OCD, though an association with overly rigid family structure cannot be eliminated based on these data. Further exploration of family characteristics is warranted.

Objective To determine the association between combined monophasic oral contraceptive (OC) use and primary infertility. Design Case-control. Setting Women serving as controls of the Cancer and Steroid Hormone Study. Participants Women were 19 to 40 years of age at first conception or infertility diagnosis. Based on 24 consecutive months of unprotected intercourse without a recognized conception, 419 nulligravid women had primary infertility; controls were 2,120 fertile women. A calendar of each woman's reproductive history was used to determine fertility status and contraceptive use before infertility diagnosis or first conception. Main Outcome Measure Primary infertility. Results Combined monophasic OC use was associated with a lower frequency of primary infertility, particularly among younger (age 20 years) compared with older women (age 30 years) after adjusting for barrier method use and education. A similar association was found for duration of OC use. When adjusted for age at first conception or infertility and barrier method, both higher (>50 μ g) and lower (≤550 μ g) estrogen dose use were associated with decreased risk of primary infertility. Conclusion Combined monophasic OC use was associated with a lower frequency of primary infertility.

Potential correlates of delinquency among 180 youth with severe emotional disturbance were examined in this study. Specifically, the goal was to explore associations between major or minor offending, based on South Carolina Department of Juvenile Justice (DJJ) records and (a) prenatal, birth, or developmental factors; (b) family characteristics; (c) environmental characteristics; and (d) problem behaviors and symptoms. Participants were clients of the Continuum of Care for Emotionally Disturbed Children Division of the Office of the Governor in South Carolina and were in the legal custody of the South Carolina Department of Social Services. Polychotomous logistic regression modeling techniques were used to determine which variables were associated with major and minor offending, compared with youth not involved with DJJ. After adjusting for other variables, the factors significantly associated with minor offending included increasing age and parental incarceration. Factors significantly associated with major offending were increasing age, sibling incarceration, and running away.

Background:It is known that children are more physically active outdoors than indoors. However, few previous studies have observed the time course for physical activity as young children transition from indoor to outdoor activities.Methods:Participants were 3- to 5-year-old children enrolled in the Children’s Activity and Movement in Preschool Study (CHAMPS). Trained observers used the Observational System for Recording Physical Activity in Children-Preschool Version (OSRAC-P) to record children’s physical activity levels over 20 minutes in outdoor settings. The 20-minute outdoor observational period began immediately following the transition from indoors to outdoors.Results:Children’s activity levels were moderately high at the time of transition and declined over the 20-minute observation period. Different patterns, however, were observed for boys and girls. Overall, boys were more active than girls. Boys’ activity levels declined in a linear fashion over the 20-minute period, while girls’ activity levels increased slightly, decreased, and then increased slightly again.Conclusions:These data indicate that physical activity levels decline with increased duration of outdoor play. The frequency and duration of outdoor play should be investigated for the purpose of optimizing physical activity levels.