Abiodun O. Oluyomi

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study.

BACKGROUND There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. METHODS Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. RESULTS Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤

The Association Between Physical Fitness and Academic Achievement in Texas State House Legislative Districts: An Ecologic Study

25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. CONCLUSIONS Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

The Utility of Geographical Information Systems (GIS) in Systems-Oriented Obesity Intervention Projects: The Selection of Comparable Study Sites for a Quasi-Experimental Intervention Design—TX CORD

BACKGROUND The association of physical fitness with cognitive function in children and adolescents is unclear. The purpose of this ecological study was to describe the association between academic achievement, body mass index (BMI), and cardiovascular fitness (CVF) in a large sample of elementary, middle, and high school students in Texas. METHODS FITNESSGRAM(®) results for 2,550,144 students were matched with standardized composite academic test (TAKS) results from 2008 to 2009. Analyses were conducted on the percent of students meeting TAKS standards by BMI and CVF quintiles. Analyses of variance with Tukey adjustment examined differences between the most favorable 5th quintile (referent) and all other quintiles. RESULTS The prevalence of students meeting the TAKS standard was significantly higher in the highest fitness category for BMI and CVF compared to all other categories, regardless of sex or grade category (p < .05). Linear modeling suggested a 5% increase in the prevalence of students meeting healthy BMI and CVF standards would result in a 2.25% and 0.65% increase in the prevalence of students meeting the TAKS standard (both p < .05). CONCLUSION Findings suggest a healthy BMI and CVF are associated with higher academic achievement, and the need for additional research examining the role of potential confounders and/or effect modifiers longitudinally.

A Contextual Look at Safe Routes to School Implementation in Texas

BACKGROUND The Texas Childhood Obesity Research Demonstration project (TX CORD) uses a systems-oriented approach to address obesity that includes individual and family interventions, community-level action, as well as environmental and policy initiatives. Given that randomization is seldom possible in community-level intervention studies, TX CORD uses a quasi-experimental design. Comparable intervention and comparison study sites are needed to address internal validity bias. METHODS TX CORD was designed to be implemented in low-income, ethnically diverse communities in Austin and Houston, Texas. A three-stage Geographical Information System (GIS) methodology was used to establish and ascertain the comparability of the intervention and comparison study sites. Census tract (stage 1) and school (stage 2) data were used to identify spatially exclusive geographic areas that were comparable. In stage 3, study sites were compared on demographic characteristics, socioeconomic status (SES), food assets, and physical activity (PA) assets. Students t-test was used to examine significant differences between the selected sites. RESULTS The methodology that was used resulted in the selection of catchment areas with demographic and socioeconomic characteristics that fit the target population: ethnically diverse population; lower-median household income; and lower home ownership rates. Additionally, the intervention and comparison sites were statistically comparable on demographic and SES variables, as well as food assets and PA assets. CONCLUSIONS This GIS approach can provide researchers, program evaluators, and policy makers with useful tools for both research and practice. Area-level information that allows for robust understanding of communities can enhance analytical procedures in community health research and offer significant contributions in terms of community assessment and engagement.

The Effect of Light Rail Transit on Physical Activity: Design and Methods of the Travel-Related Activity in Neighborhoods Study

In an effort to understand factors influencing the implementation and outcomes of the Safe Routes to School (SRTS) program in Texas, interviews were conducted in 2014 with 34 community- and state-level stakeholders involved in the 2007 SRTS grant program. Participants were asked a series of multiple-choice and open-ended questions about SRTS program planning, implementation, and sustainability. Transcribed responses were organized and grouped according to thematic elements using standard qualitative methods. Results indicate the SRTS program was perceived as beneficial by providing funds for both infrastructure and education projects. Although most community representatives reported accomplishments toward planned goals (improved infrastructure and perceived increase in active commuting), many had significant challenges including lack of communication and up-front funding, and difficulty navigating the regulatory process. Future SRTS programs should be structured to be more compatible with community-based needs and limitations, provide adequate underlying infrastructure and resources, and include at least partial funding up-front.

The association between physical fitness and academic achievement in Texas state house legislative districts

Background Use of mass transit has been proposed as a way to incorporate regular physical activity into daily life because transit use typically requires additional travel to access and depart the stop or station. If this additional travel is active, a small but potentially important amount of physical activity can be achieved daily. Although prior research has shown that transit use is associated with physical activity, important questions remain unanswered. Utilizing a major expansion of the Houston, TX, USA light-rail system as a natural experiment, the Houston Travel-Related Activity in Neighborhoods (TRAIN) Study was developed to address these unanswered questions. Purpose The purpose of the TRAIN Study is to determine if the development of light-rail lines in Houston, TX, USA will prospectively affect both transit use and physical activity over 4 years. We also aim to understand how contextual effects (i.e., moderators or interaction effects), such as the neighborhood built environment and socioeconomic factors, affect the primary relations under study. Methods The TRAIN Study is a longitudinal cohort design, in which participants are recruited at baseline from a 3-mile buffer around each of the three new lines and measured annually four times. Recruitment is accomplished via telephone contact, ads in newspapers and advertising circulars, and targeted community outreach. Data are collected via mail and include questionnaire-assessed factors, such as perceived neighborhood characteristics, attitudes about transportation, demographics, and reported physical activity; a travel diary; and accelerometry. Additionally, field-based neighborhood audits are conducted to capture micro-scale environmental features. To assess macro-scale environmental characteristics, we utilize GIS mapping and spatial analyses. Statistical analyses will be conducted using latent growth curve modeling and discrete choice models, with a focus on identifying moderating factors (i.e., statistical interaction effects). Selection bias will be controlled via propensity score analysis. Conclusion The TRAIN study is a unique opportunity to study how a multi-billion dollar investment in mass transit can simultaneously affect transportation needs and physical activity behavior. This comprehensive evaluation will provide needed evidence for policy makers, and can inform health impact assessments of future transportation projects around the world.

Parental safety concerns and active school commute: correlates across multiple domains in the home-to-school journey

BACKGROUND The association of physical fitness with cognitive function in children and adolescents is unclear. The purpose of this ecological study was to describe the association between academic achievement, body mass index (BMI), and cardiovascular fitness (CVF) in a large sample of elementary, middle, and high school students in Texas. METHODS FITNESSGRAM(®) results for 2,550,144 students were matched with standardized composite academic test (TAKS) results from 2008 to 2009. Analyses were conducted on the percent of students meeting TAKS standards by BMI and CVF quintiles. Analyses of variance with Tukey adjustment examined differences between the most favorable 5th quintile (referent) and all other quintiles. RESULTS The prevalence of students meeting the TAKS standard was significantly higher in the highest fitness category for BMI and CVF compared to all other categories, regardless of sex or grade category (p < .05). Linear modeling suggested a 5% increase in the prevalence of students meeting healthy BMI and CVF standards would result in a 2.25% and 0.65% increase in the prevalence of students meeting the TAKS standard (both p < .05). CONCLUSION Findings suggest a healthy BMI and CVF are associated with higher academic achievement, and the need for additional research examining the role of potential confounders and/or effect modifiers longitudinally.