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Background: Women with higher body mass index report low rates of and face unique barriers to exercise. Increasing exercise participation can improve mental and physical health independent of weight loss; however, most exercise programs targeting this population focus predominately on losing weight. This paper aims to describe the development of Fit&Fab, a community-based exercise intervention focused on increasing exercise participation and enjoyment for women with obesity. Methods: In partnership with the YMCA, we recruited women ages 35–64 years (body mass index ≥ 30) to participate in 4 focus groups to understand exercise preferences. Formative work was used to identify theory constructs and associated intervention components. Women from the focus groups were recruited for a community advisory board that finalized the intervention design, recruitment, and evaluation plan. Results: Focus groups participants (N = 29) preferred to exercise without men and wanted a cohort-style class that included women of similar exercise levels and body types, incorporated social support, fun activities, and broke exercise into smaller bouts. They wanted a supportive instructor who was fit but understood weight-related challenges. The community advisory board and research team used focus group findings to inform design of the final intervention including group exercise classes, psychosocial support sessions, personalized training, exercise tracking, outcome monitoring, and rewards. Conclusions: Our findings emphasize the need to focus on exercise enjoyment and benefits other than losing weight to improve exercise participation among women with higher body mass index. In addition to having outcomes other than weight loss, exercise interventions with this population should also consider group composition, instructor, and class format. [ABSTRACT FROM AUTHOR]

Alcohol mixed energy drinks (AmED) may promote excessive alcohol intake and risk-taking among college students. Objective: To understand the relationship between AmED use and risky behavior as well as attitudes and motivations for AmED use. Participants: Undergraduate college students N = 422 (Study 1), N = 37 (Study 2). Methods: Using a mixed-methods approach, we first surveyed undergraduate students about their AmED and alcohol consumption and a series of risk behaviors, self-efficacy, and beliefs (Study 1). We then conducted focus groups within the same population to better understand attitudes, knowledge, and motivations for using AmED (Study 2). Results: Recent AmED use was significantly associated with an increased number of reported binge drinking occasions and self-reported driving while intoxicated events. Our qualitative data analyses revealed two major themes associated with AmED consumption: factors encouraging AmED use and decisions about driving while under the influence of alcohol. Conclusions: These findings add to the literature of beliefs and motivations for AmED use among college students.

Ending the HIV epidemic in the United States will require addressing social determinants contributing to poor care engagement among people living with HIV (PLH), such as food insecurity. Food insecurity is associated with poor care engagement among PLH. Yet, few studies have examined the perspectives of healthcare and social services providers on addressing food insecurity in HIV care. Guided by the Social Ecological Model, we conducted semi-structured interviews with 18 providers in New York State to understand barriers and facilitators to addressing food insecurity in HIV care. Thematic analysis illustrated eight themes across various levels of the Social Ecological Model. At the patient-level, providers perceived patients' feelings of embarrassment, shame, and judgement, and low health literacy as barriers. At the provider-level, challenges included limited time. Facilitators included fostering strong, patient-provider relationships. Barriers at the clinic-level included limited funding, while clinic resources served as facilitators. At the community-level, challenges included intersecting stigmas arising from community norms towards PLH and people who receive food assistance and limited access to healthy food. Findings suggest the need to incorporate their insights into the development of interventions that address food insecurity in HIV care. [ABSTRACT FROM AUTHOR]

Action Through Churches in Time to Save Lives (ACTS) of Wellness was a cluster randomized controlled trial developed to promote colorectal cancer screening and physical activity (PA) within urban African American churches. Churches were recruited from North Carolina (n = 12) and Michigan (n = 7) and were randomized to intervention (n = 10) or comparison (n = 9). Intervention participants received three mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate--vigorous PA. Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight, and baseline values. Baseline screening was high in both intervention (75.9%, n = 374) and comparison groups (73.7%, n = 338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison, respectively (p = 0.25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval [6.8, 8.7]) for intervention and 8.7 (95% confidence interval [7.6, 9.8]) for the comparison group. There were no significant changes (p = 0.15) in PA for intervention (-0.30 MET-hours/week) compared with the comparison (-0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs, and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.

Objective: To examine the feasibility and implementation of an optimal defaults intervention designed to align grocery purchases with a diet recommended for people with or at-risk for type 2 diabetes. Design: This was a 5-week pilot randomised trial with three groups: in-person grocery shopping, shopping online and shopping online with 'default' carts. Participants were asked to shop normally in Week One, according to group assignment in Weeks Two–Four (intervention period), and as preferred in Week Five. All groups received diabetes-friendly recipes via email each intervention week. Setting: Participants grocery shopped in person or online. Grocery receipt forms, enrolment information and exit surveys were collected remotely and used to assess feasibility and implementation. Participants: Sixty-five adults with or at-risk for type 2 diabetes. Results: Sixty-two participants completed the exit survey and fifty-five submitted receipts all 5 weeks. Forty utilised recipes, 95 % of whom indicated recipes were somewhat or very useful. Orange chicken, quesadillas and pork with potato and apples were the most liked recipes. Most Defaults group participants accepted at least some default cart items. Recipes with the highest default acceptance were whole grain pasta and chicken, quesadillas with black beans and chicken with olives. Participants' primary concerns about the intervention were costs associated with online shopping, inability to select preferred foods and some recipes including ingredients household members would not eat. Conclusions: The study had high retention, data were successfully collected remotely and the intervention was acceptable to most participants. Tailoring recipes to household preferences may be beneficial in future studies. [ABSTRACT FROM AUTHOR]

"Wellness for African Americans Through Churches" was a randomized trial that tested the effectiveness of tailored print and video (TPV) and/or lay health advisors (LHA) at increasing recreational physical activity (RPA), fruit and vegetable (F&V) consumption, and colorectal cancer (CRC) screening in African American churches. Baseline data revealed lower screening and RPA rates among obese individuals but no weight-related differences in F&V consumption. This analysis examined if intervention effectiveness was also moderated by participant weight group. Regression analyses tested for interactions between intervention and weight group for screening and RPA. Weight group was found to be a moderator of intervention effectiveness (p = 0.02); normal and overweight individuals receiving the LHA intervention increased RPA more, whereas obese individuals responded better to TPV. For CRC screening, the interaction term was not significant; weight alone was related to screening at follow-up (p = 0.049), with obese individuals reporting less screening. These results suggest that weight tailoring may improve the effectiveness of behavior change interventions. (Contains 3 tables and 1 figure.)

Objective: The goal of this study was to examine the potential of an optimal‐defaults intervention to promote grocery purchases corresponding to a diet for diabetes. Methods: In total, 65 adults diagnosed with or at increased risk for type 2 diabetes who grocery shopped at one of two study stores were randomized to one of three groups: Defaults, Online, or Control. All groups received diabetes‐friendly recipes. In addition, the Online group was asked to grocery shop online during a 3‐week intervention, and the Defaults group was asked to shop online, with their online grocery carts prefilled with food items needed to prepare provided recipes. Participants provided weekly grocery receipt data at baseline, at each week of the 3‐week intervention, and at post‐intervention. Results: Overall, the Defaults group had grocery purchases of a significantly greater nutritional quality versus other groups (F = 16.3, p < 0.001). Between‐group comparisons of least‐squares means showed consistent effects of the Defaults intervention while intervention components were in place, with a similar pattern for energy and carbohydrate content of grocery purchases. Conclusions: These results build upon emerging evidence that optimal defaults can promote healthier grocery purchases. Continued examination of this approach could promote healthy food acquisition in accordance with individual dietary preferences and needs. [ABSTRACT FROM AUTHOR]