Brent Hutto

Association of Environmental Factors to Meeting Physical Activity Recommendations in Two South Carolina Counties

Purpose. The purpose of the study was to examine associations between environment and policy factors and physical activity. Design. A random-digit-dialed, cross-sectional telephone survey was administered. Setting. The setting was a two-county area of eastern South Carolina. Subjects. Before weighting, the sample included 1936 adults; 36.9% African-American, 63.1% white, and 60.1% women. The age group distribution was 28.8% 55+ years, 39.3% 35–54 years, and 31.9% 18–34 years of age. The response rate was 62.9%. Measures. Six physical activity questions (2001 Behavioral Risk Factor Surveillance Survey [BRFSS]) were used to create a dichotomous variable, “meets/does not meet recommendation for moderate or vigorous physical activity.” Self-report items assessed knowledge, presence, and use of recreational facilities; presence of environmental and worksite supports; perceived safety; condition of sidewalks; and quality of street lighting Results. Linear and logistic regression were used to analyze the data. Unadjusted odds for meeting the recommendation were significantly greater for well-maintained sidewalks (OR = 1.90); safe areas for walking/jogging (OR = 1.39); knowledge of routes for bicycling (OR = 1.38) and walking/jogging (OR = 1.32); and worksites with sports teams (OR = 1.53), exercise facilities (OR = 1.33), flexible time for exercise (OR = 1.33), and preventive checkups (OR = 1.26). Among persons who met the recommendation, means were greater for number of known walking/jogging routes (p = .04); number of known bicycling routes (p < .01); number of days per month uses tracks, trails, routes, pathways (p < .01); and number of days per month uses outdoor recreation areas (p < .01). Conclusion. The results support an association between level of physical activity and environmental and policy factors in two southeastern counties in South Carolina. Limitations of the study include self-reported data and cross-sectional design.

A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS)☆

BACKGROUND Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population. OBJECTIVES STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods. DESIGN A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes. METHODS Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment. RESULTS Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants. SUMMARY STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.

An Evaluation of Printed HPV Educational Materials

HPV educationalmaterials should be a viable source of accurate and mean-ingful information for women and should complementclinician counseling to reinforce important HPV informa-tion and to assist women with medical decision making.The purpose of this study was to formally evaluate printedHPV educational materials by determining the readability,suitability, and HPV content of existing, printed HPV edu-cational materials selected by the authors.

Impact of a Community-Based Prevention Marketing Intervention to Promote Physical Activity Among Middle-Aged Women

A physical activity intervention applied principles of community-based participatory research, the community-based prevention marketing framework, and social cognitive theory. A nonrandomized design included women ages 35 to 54 in the southeastern United States. Women (n = 430 preprogram, n = 217 postprogram) enrolled in a 24-week behavioral intervention and were exposed to a media campaign. They were compared to cross-sectional survey samples at pre- (n = 245) and postprogram (n = 820) from the media exposed county and a no-intervention county (n = 234 pre, n = 822 post). Women in the behavioral intervention had statistically significant positive changes on physical activity minutes, walking, park and trail use, knowledge of mapped routes and exercise partner, and negative change on exercise self-efficacy. Media exposed women had statistically significant pre- to postprogram differences on knowledge of mapped routes. No-intervention women had significant pre- to postprogram differences on physical activity minutes, walking, and knowledge of mapped routes.

Patterns of Sedentary Behavior in US Middle-Age and Older Adults: The REGARDS Study.

PURPOSE The purposes of this study were to examine patterns of objectively measured sedentary behavior in a national cohort of US middle-age and older adults and to determine factors that influence prolonged sedentary behavior. METHODS We studied 8096 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a population-based study of black and white adults 45 yr or older. Seven-day accelerometry was conducted. Prolonged sedentary behavior was defined as accumulating 50% or more of total sedentary time in bouts of 30 min or greater. RESULTS The number of sedentary bouts greater than or equal to 20, 30, 60, and 90 min were 8.8 ± 2.3, 5.5 ± 1.9, 1.9 ± 1.1, and 0.8 ± 0.7 bouts per day, respectively. Sedentary bouts greater than or equal to 20, 30, 60, and 90 min accounted for 60.0% ± 13.9%, 48.0% ± 15.5%, 26.0% ± 15.4%, and 14.2% ± 12.9% of total sedentary time, respectively. Several factors were associated with prolonged sedentary behavior in multivariate-adjusted models (odds ratio [95% confidence interval]): older age (65-74 yr: 1.99 [1.55-2.57]; 75 yr or older: 4.68 [3.61-6.07] vs 45-54 yr), male sex (1.41 [1.28-1.56] vs female), residence in nonstroke belt/buckle region of the United States (stroke belt: 0.87 [0.77-0.98]; stroke buckle: 0.86 [0.77-0.95] vs non-belt/buckle), body mass index (BMI) (overweight: 1.33 [1.18-1.51]; obese: 2.15 [1.89-2.44] vs normal weight), winter (1.18 [1.03-1.35] vs summer), and low amounts of moderate-to-vigorous physical activity (MVPA) [0 min·wk: 2.00 [1.66-2.40] vs ≥150 min·wk). CONCLUSIONS In this sample of US middle-age and older adults, a large proportion of total sedentary time was accumulated in prolonged, uninterrupted bouts of sedentary behavior as almost one-half was accumulated in sedentary bouts greater than or equal to 30 min. Several sociodemographic (age, sex, and BMI), behavioral (MVPA), environmental (region), and seasonal factors are associated with patterns of prolonged sedentary behavior.

Comparing physical activity measures in a diverse group of midlife and older adults

PURPOSE To compare self-report and objective measures of moderate- and vigorous-intensity physical activity (MVPA min·d(-1)) in midlife and older adults. METHODS Seventy-one participants (69% female, 74.6% Caucasian, 25.4% African American) completed the Behavioral Risk Factor Surveillance System physical activity (PA) questions, the Aerobic Center Longitudinal Study PA short survey (PASS), and the Aerobic Center Longitudinal Study PA long survey (PALS) and wore an accelerometer for seven consecutive days. Accelerometer MVPA minutes per day were determined using 1- and 10-min MVPA bout methods. RESULTS Participants were older (mean ± SD; age = 57.4 ± 9.9 yr) and overweight (body mass index = 27.9 ± 4.9 kg·m(-2)) but otherwise healthy. Median (interquartile range) MVPA minutes per day were 42.9 (51.4) from the Behavioral Risk Factor Surveillance System PA questions, 51.4 (68.6) from the PASS, 25.7 (48.6) from the PALS, 32.4 (33.5) from the 1-min MVPA bout accelerometer data, and 4.6 (16.8) from the 10-min MVPA bout accelerometer data. Pearson correlations adjusted for participant demographics revealed low to moderate correlations between self-report and 1-min MVPA bout accelerometer-determined MVPA minutes per day (r = 0.11-0.31), with the PASS (P < 0.05) and PALS (P < 0.01) having significant correlations with accelerometry. Cohen κ coefficients showed poor agreement between all three questionnaires and 1-min MVPA bout accelerometry for having ≥150 MVPA min·wk(-1) (κ = 0.26-0.38, all P < 0.05). CONCLUSIONS Our results indicate that there was poor agreement between self-report and accelerometer-based assessments of PA in midlife and older adults.

Association of body mass index to meeting physical activity recommendations

OBJECTIVE To investigate the association between BMI and physical activity based on the CDC-ACSM recommendation and a more demanding standard consistent with the IOM recommendation. METHODS A random-digit-dialed survey (n=1810) used 2001 BRFSS questions to measure physical activity. RESULTS Data revealed a monotonic association between BMI and physical activity level. Lower odds of meeting both recommendations were associated with higher BMI. The proportion meeting the CDC-ACSM recommendation was at least 3 times that of persons meeting the IOM-based recommendation. CONCLUSIONS Meeting either recommendation was associated with BMI; however, a larger proportion of persons were meeting the less demanding CDC-ACSM recommendation.

Making policy practice in afterschool programs: A randomized controlled trial on physical activity changes

INTRODUCTION In the U.S., afterschool programs are asked to promote moderate to vigorous physical activity. One policy that has considerable public health importance is Californias afterschool physical activity guidelines that indicate all children attending an afterschool program accumulate 30 minutes each day the program is operating. Few effective strategies exist for afterschool programs to meet this policy goal. The purpose of this study was to evaluate a multistep adaptive intervention designed to assist afterschool programs in meeting the 30-minute/day moderate to vigorous physical activity policy goal. DESIGN A 1-year group randomized controlled trial with baseline (spring 2013) and post-assessment (spring 2014). Data were analyzed 2014. SETTING/PARTICIPANTS Twenty afterschool programs, serving >1,700 children (aged 6-12 years), randomized to either an intervention (n=10) or control (n=10) group. INTERVENTION The employed framework, Strategies To Enhance Practice, focused on intentional programming of physical activity opportunities in each afterschool programs daily schedule and included professional development training to establish core physical activity competencies of staff and afterschool program leaders with ongoing technical assistance. MAIN OUTCOME MEASURES The primary outcome was accelerometry-derived proportion of children meeting the 30-minute/day moderate to vigorous physical activity policy. RESULTS Children attending intervention afterschool programs had an OR of 2.37 (95% CI=1.58, 3.54) to achieve the physical activity policy at post-assessment compared to control afterschool programs. Sex-specific models indicated that the percentage of intervention girls and boys achieving the physical activity policy increased from 16.7% to 21.4% (OR=2.85, 95% CI=1.43, 5.68) and 34.2% to 41.6% (OR=2.26, 95% CI=1.35, 3.80), respectively. At post-assessment, six intervention afterschool programs increased the proportion of boys achieving the physical activity policy to ≥45% compared to one control afterschool program, whereas three intervention afterschool programs increased the proportion of girls achieving physical activity policy to ≥30% compared to no control afterschool programs. CONCLUSIONS The Strategies To Enhance Practice intervention can make meaningful changes in the proportion of children meeting the moderate to vigorous physical activity policy within one school year. Additional efforts are required to enhance the impact of the intervention.

Correlates of physical activity among African American and white women.

OBJECTIVE To compare potential correlates of physical activity between African American and white women. METHODS A random-digit-dialed telephone survey was conducted in central South Carolina. Bivariate and multivariate analyses focused on women aged 18+ (N = 1176). RESULTS African American women reported greater maintenance of sidewalks and public parks than did white women, who reported higher physical activity, exercise self-efficacy, access to indoor walking facilities, and knowledge of mapped-out walking routes. Exercise self-efficacy was the only significant correlate of physical activity among both African American and white women. CONCLUSIONS Self-efficacy was a robust cross-sectional correlate of physical activity in women.

Accelerometer measured sedentary behavior and physical activity in white and black adults: The REGARDS study

OBJECTIVES Health disparities between subgroups may be partially due to differences in lifestyle behaviors such as sedentariness and physical activity. To obtain a more accurate description of these two lifestyle behaviors, accelerometry was employed among a large sample of white and black adults (ages 49-99 years) living in the United States. DESIGN Cross-sectional. METHODS 7967 participants from the REasons for Geographic and Racial Differences in Stroke cohort wore an Actical™ accelerometer ≥10h/day for ≥4 days. Time (mean minutes/day and proportion of total wear time) spent in sedentary behavior, light intensity physical activity, and moderate-vigorous intensity physical activity was compared by sex, age, body mass index, race, and geographic location. RESULTS Proportion of total wear time spent in sedentary behavior was 75-90%, light intensity physical activity was 10-23%, and moderate-vigorous intensity physical activity was 0-1.7% across subgroups. Mean moderate-vigorous intensity physical activity was 0-16min/day and associated with 3-12% accumulating ≥150min/wk using a 10-min bout criterion. Persons ≥85 years, those classified obese, persons living in the southeastern United States, and black women were the most inactive. The proportion achieving at least one 10-min bout of moderate-vigorous intensity physical activity per week was only 36%. The number of 10-min bouts/week was 1.5±0.08bouts/week. The distribution of weekly moderate-vigorous intensity physical activity was similar across nearly all subgroups with a distinct reverse J-shaped configuration. CONCLUSIONS The vast majority of white and black midlife and older adults in this study engaged sparingly in moderate-vigorous intensity physical activity, accumulated tremendous amounts of sedentary behavior, and seldom engaged in continuous bouts of health-enhancing physical activity.