Charlotte A. Pratt

Promoting Physical Activity in Middle School Girls Trial of Activity for Adolescent Girls

BACKGROUND Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. DESIGN Group randomized controlled trial. SETTING/PARTICIPANTS Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). INTERVENTION A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. MAIN OUTCOME MEASURES The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. RESULTS After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. CONCLUSION A school-based, community-linked intervention modestly improved physical activity in girls.

Worksite Wellness Programs for Cardiovascular Disease Prevention. A Policy Statement From the American Heart Association

With >130 million Americans employed across the United States, workplaces provide a large audience for cardiovascular disease (CVD) and stroke prevention activities. Experience has shown that workplace wellness programs are an important strategy to prevent the major shared risk factors for CVD and stroke, including cigarette smoking, obesity, hypertension, dyslipidemia, physical inactivity, and diabetes. An estimated 25% to 30% of companies’ medical costs per year are spent on employees with the major risk factors listed above.1 Employees and their families share the financial burden through higher contributions to insurance, higher copayments and deductibles, reduction or elimination of coverage, and trade-offs of insurance benefits against wage or salary increases. When programs are successful, their influence extends beyond the individual workers to immediate family members, who are often exposed to their favorable lifestyle changes. Worksite wellness programs that can reduce these risk factors can ultimately decrease the physical and economic burden of chronic diseases, including CVD, stroke, and certain cancers. The societal benefits of a healthy employed population extend well beyond the workplace. As such, comprehensive, culturally sensitive health promotion within the workplace can improve the nation’s health. The Healthy People 2010 goal is for 75% of all worksites, regardless of size, to develop comprehensive wellness programming.2 However, the development of comprehensive programs takes time and resources, especially for smaller employers. Because program development and initiation can be resource intensive, the American Heart Association (AHA) supports incremental efforts to achieve a comprehensive worksite wellness program to address CVD and stroke prevention and makes the following recommendations. 1. Components of Wellness Programs

Formative Research in School and Community-Based Health Programs and Studies: “State of the Art” and the TAAG Approach

Formative research uses qualitative and quantitative methods to provide information for researchers to plan intervention programs. Gaps in the formative research literature include how to define goals, implementation plans, and research questions; select methods; analyze data; and develop interventions. The National Heart, Lung, and Blood Institute funded the Trial of Activity for Adolescent Girls (TAAG), a randomized, multicenter field trial, to reduce the decline in physical activity in adolescent girls. The goals of the TAAG formative research are to (a) describe study communities and schools, (b) help design the trial’s interventions, (c) develop effective recruitment and retention strategies, and (d) design evaluation instruments. To meet these goals, a variety of methods, including telephone interviews, surveys and checklists, semistructured interviews, and focus group discussions, are employed. The purpose, method of development, and analyses are explained for each method.

Childhood obesity prevention and treatment: recommendations for future research.

This report summarizes the National Heart, Lung, and Blood Institute Working Groups recommendations on future research directions in childhood obesity prevention and treatment. The Working Group consisted of leaders and representatives from public and private academic and medical institutions with expertise in a variety of health specialties. They reviewed the literature and discussed the findings as well as their own experiences in the prevention and treatment of childhood obesity. The Working Group made recommendations that were based on scientific importance, the potential likelihood of public health impact, and the feasibility and timeliness for childhood obesity prevention and treatment research. These recommendations are intended to assist investigators in the development of research agendas to advance the knowledge of effective childhood obesity prevention and treatment.

Reduction of Risk for Cardiovascular Disease in Children and Adolescents

Atherosclerotic cardiovascular disease (CVD) is the number 1 cause of death in the United States and other developed nations.1 After decades of study, risk factors for the development of atherosclerotic CVD have been identified. These risk factors include older age, male sex, a positive family history, hypertension, dyslipidemia, diabetes mellitus, cigarette smoking, and obesity.2 As these risk factors have been studied, it has become clear that both genetics and lifestyle are important contributors to increased risk. The primary lifestyle components are diet, physical activity, and smoking. A fundamental issue has been the timing of the development of atherosclerosis. Timing is critical because it determines, at least in part, when interventions should occur. Both the prevention of risk factor development (primordial prevention) and modification of risk factors once they are established (primary prevention) are important. An impediment to understanding the development of atherosclerosis has been the lack of simple, noninvasive methods to follow the atherosclerotic process longitudinally. This problem led to the Bogalusa Heart Study and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY).3–6 These pathology studies investigated the aorta and coronary arteries in autopsies of young individuals who died of accidental causes. The investigators were able to evaluate the extent of atherosclerosis and the presence of risk factors. They found that even relatively advanced levels of atherosclerosis, including fibrous plaques, can be present in adolescents and young adults. They also found that increased body mass index (BMI), systolic and diastolic blood pressures, and low-density lipoprotein cholesterol (LDL-C); low levels of high-density lipoprotein cholesterol (HDL-C); diabetes mellitus; and the presence of cigarette smoking were all associated with greater atherosclerotic plaque coverage and more advanced atherosclerotic lesions.3–6 Subsequent studies using noninvasive measures of atherosclerosis, including carotid intima-medial thickness (CIMT) and arterial distensibility, have resulted …

Design characteristics of worksite environmental interventions for obesity prevention.

Objective: This paper describes the design characteristics of the National Heart, Lung, and Blood Institute (NHLBI)‐funded studies that are testing innovative environmental interventions for weight control and obesity prevention at worksites.

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 need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.

Social-Cognitive Correlates of Physical Activity in a Multi-Ethnic Cohort of Middle-School Girls: Two-year Prospective Study

OBJECTIVE The study examined social-cognitive correlates of physical activity in a multi-ethnic cohort of girls from six regions of the United States who participated in the Trial of Activity for Adolescent Girls during their 6th and 8th grade school years. METHODS Girls completed validated questionnaires and wore accelerometers that measured weekly physical activity in the spring of 2002 and 2005. RESULTS In 8th grade, self-efficacy and perceived social support had indirect relations with physical activity mediated through perceived barriers, which was inversely related to physical activity. Self-efficacy also had a direct relation with physical activity. CONCLUSIONS Correlations were smaller than those obtained in studies that measured physical activity by self-reports, suggesting that previous estimates were inflated by common method artifact. Nonetheless, physical activity trials among girls during early adolescence might focus on increasing self-efficacy for overcoming barriers to physical activity and on ways by which perceived barriers can otherwise be reduced.

Mediators affecting girls' levels of physical activity outside of school: findings from the trial of activity in adolescent girls.

BackgroundProviding after school activities is a community level approach for reducing the decline in physical activity of girls as they reach early adolescence.PurposeThe purpose of this study was to examine psychosocial, environmental, and behavioral factors as potential mediators of after school physical activity in adolescent girls.MethodsWe assessed objectively measured levels of physical activity occurring outside of school and potential predictors and mediators of activity in girls participating in the Trial of Activity in Adolescent Girls (TAAG).ResultsWe found that the TAAG intervention had a statistically significant and positive effect on out of school activity in the 2006 cohort. Self-efficacy, friends’ social support, total social support, and difficulty getting to and from community activities mediated the level of moderate to vigorous physical activity in girls.ConclusionsParents, communities, and schools should provide and enhance opportunities outside of the school day for adolescents to be active. Reducing transportation barriers and enlisting social support appear to be key.