Antronette K. Yancey

Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)

This statement was reviewed by and has received the endorsement of the American College of Sports Medicine. Regular physical activity using large muscle groups, such as walking, running, or swimming, produces cardiovascular adaptations that increase exercise capacity, endurance, and skeletal muscle strength. Habitual physical activity also prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease. There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes,1 osteoporosis,2 obesity,3 depression,4 and cancer of the breast5 and colon.6 This American Heart Association (AHA) Scientific Statement for health professionals summarizes the evidence for the benefits of physical activity in the prevention and treatment of cardiovascular disease, provides suggestions to healthcare professionals for implementing physical activity programs for their patients, and identifies areas for future investigation. This statement focuses on aerobic physical activity and does not directly evaluate resistance exercises, such as weight lifting, because most of the research linking physical activity and cardiovascular disease has evaluated aerobic activity. Whenever possible, the writing group has cited summary articles or meta-analyses to support conclusions and recommendations. This evidence supports the recommendation from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) that individuals should engage in 30 minutes or more of moderate-intensity physical activity on most (preferably all) days of the week.7 Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting expenditure. Exercise is a subset of physical activity that is planned, structured, repetitive, and purposeful in the sense that improvement or maintenance of physical fitness is the objective. Physical fitness includes cardiorespiratory fitness, muscle strength, body composition, and flexibility, comprising a set of attributes that people …

Body image, perceived pubertal timing, and adolescent mental health

PURPOSE To examine the impact of gender, racial-ethnic group, and perceived pubertal timing on body image and adolescent mental health. METHOD A three-stage, area probability sample was selected which included 877 teens (13-18 years) with diverse social and demographic characteristics. Interviews in English or Spanish were conducted in person. The content emphasized emotional distress and problematic behavior, exposure to social stressors, coping resources and behaviors, and socioeconomic and demographic characteristics of the adolescent and his or her family. RESULTS Girls were more depressed and had lower self-esteem than boys, but not after controlling for body image. Hispanics were more depressed and had lower self-esteem than other racial-ethnic groups, a difference that remained when controlling for body image. African-Americans had the most positive body image, a finding that could not be attributed to higher self-esteem or fewer depressive symptoms. The impact of perceived pubertal timing on body image varied considerably by gender and across racial-ethnic group. CONCLUSIONS Negative feelings about their bodies contribute to the higher prevalence of depressive symptomatology and lower self-esteem among girls. African-Americans appear to take pride in their bodies in a manner that sets them apart from other teenagers, suggesting they hold a different ideal. Relative to teenagers of other racial-ethnic backgrounds, Hispanics may be at elevated risk for mental health problems.

Improving the nutritional resource environment for healthy living through community-based participatory research.

OBJECTIVES: To build health promotion capacity among community residents through a community-based participatory model, and to apply this model to study the nutritional environment of an urban area to better understand the role of such resources in residents’ efforts to live a healthy life.DESIGN: A multiphase collaborative study that inventoried selected markets in targeted areas of high African-American concentration in comparison with markets in a contrasting wealthier area with fewer African Americans.SETTING: A community study set in the Los Angeles metropolitan area.PARTICIPANTS: African-American community organizations and community residents in the target areas.INTERVENTIONS: Two surveys of market inventories were conducted. The first was a single-sheet form profiling store conditions and the availability of a small selection of healthy foods. The second provided detailed information on whether the store offered fruit, vegetables, low-fat dairy products, dried goods and other items necessary for residents to consume a nutritious diet.RESULTS: The targeted areas were significantly less likely to have important items for living a healthier life. The variety and quality of fresh fruit and vegetable produce was significantly lower in the target areas. Such products as 1% milk, skim milk, low-fat and nonfat cheese, soy milk, tofu, whole grain pasta and breads, and low-fat meat and poultry items were significantly less available.CONCLUSIONS: Healthy food products were significantly less available in the target areas. The authors conclude from these results that the health disparities experienced by African-American communities have origins that extend beyond the health delivery system and individual behaviors inasmuch as adherence to the healthy lifestyle associated with low chronic disease risk is more difficult in resource-poor neighborhoods than in resource-rich ones.

Disparities in Physical Activity and Sedentary Behaviors Among US Children and Adolescents: Prevalence, Correlates, and Intervention Implications

Regular physical activity is important for health benefits among youth, but disparities exist. This paper describes disparities in physical activity participation and sedentary behaviors among youth in the United States, provides intervention implications, and offers recommendations for future research focused on reducing disparities related to levels of physical activity. Secondary analysis of national accelerometer data showed that achievement of recommended levels of physical activity ranged across subgroups from 2% to 61%. Mean hours per day spent in sedentary behavior ranged from 5.5 to 8.5. The largest disparities were by gender and age. An improved understanding of correlates may inform the design of interventions to increase physical activity in targeted subgroups. Additional theoretically based research is needed to elucidate which factors contributing to physical activity disparities are amenable to change via intervention. To eliminate health disparities, changes in policies that have an impact on physical activity may be necessary to promote physical activity among high-risk youth.

Heterogeneity of Health Disparities Among African American, Hispanic, and Asian American Women: Unrecognized Influences of Sexual Orientation

OBJECTIVES This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County. METHODS Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed. RESULTS Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women. CONCLUSIONS Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.

The Assessment of Ethnic Identity in a Diverse Urban Youth Population

This article examines the assessment of ethnic identity in a multiethnic, probability sample of urban adolescents using the Multigroup Ethnic Identity Measure (MEIM). The concept of ethnic identity captures the incorporation of ethnicity into self-perception, providing a pivotal link to the social psychological consequences of minority status. A more generalizable psychometric examination of an instrument used extensively in research on African American youth to capture this phenomenon is warranted. This investigation seeks to identify revisions of the MEIM that would render it more useful for interethnic and intraethnic comparisons, utilizing a sample more heterogeneous and representative than those of prior studies. Item and exploratory factor analyses indicate that 10 of 14 items can be combined into a short form (MEIM-S) that measures aspects of this phenomenon that are comparable across ethnic groups, and identify two factors. In general, Whites score significantly lower than African Americans, Asian Americans, and Latinos, whose scores tend to be similar to one another, consistent with the literature on interethnic variation in the salience of ethnic identity.

Preventing Chronic Disease in the Workplace: A Workshop Report and Recommendations

Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work-family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace.

The California Endowment's Healthy Eating, Active Communities Program: A Midpoint Review

OBJECTIVES We conducted a midpoint review of The California Endowments Healthy Eating, Active Communities (HEAC) program, which works in 6 low-income California communities to prevent childhood obesity by changing childrens environments. The HEAC program conducts interventions in 5 key childhood environments: schools, after-school programs, neighborhoods, health care, and marketing and advertising. METHODS We measured changes in foods and beverages sold at schools and in neighborhoods in HEAC sites; changes in school and after-school physical activity programming and equipment; individual-level changes in childrens attitudes and behaviors related to food and physical activity; and HEAC-related awareness and engagement on the part of community members, stakeholders, and policymakers. RESULTS Childrens environments changed to promote healthier lifestyles across a wide range of domains in all 5 key childhood environments for all 6 HEAC communities. Children in HEAC communities are also engaging in more healthy behaviors than they were before the programs implementation. CONCLUSIONS HEAC sites successfully changed childrens food and physical activity environments, making a healthy lifestyle a more viable option for low-income children and their families.

Walking the Talk: Fit WIC Wellness Programs Improve Self-Efficacy in Pediatric Obesity Prevention Counseling

Six sites of the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-post test design with intervention and control groups was used; outcome measures included staff perceptions of the interventions effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy. Intervention site staff were more likely to report that the workplace environment supported their efforts to make healthy food choices (P <.001), be physically active (P <.01), make positive changes in counseling parents about their childrens weight (P <.01), and feel more comfortable in encouraging WIC clients to do physical activities with their children (P <.05).

Ethnic and Sex Variations in Overweight Self- perception: Relationship to Sedentariness

Objective: With increasing frequency, health promotion messages advocating physical activity are claiming weight loss as a benefit. However, messages promoting physical activity as a weight loss strategy may have limited effectiveness and cross‐cultural relevance. We recently found self‐perceived overweight to be a more robust correlate of sedentary behavior than BMI in Los Angeles County adults. In this study, we examined ethnic and sex differences in overweight self‐perception and their association with sedentariness in this sample.