Diane Dowdy

Active for Life : Final Results from the Translation of Two Physical Activity Programs

BACKGROUND Most evidence-based programs are never translated into community settings and thus never make a public health impact. DESIGN Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008. SETTING/PARTICIPANTS Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white). INTERVENTION In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4. MAIN OUTCOME MEASURE Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure. RESULTS Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites. CONCLUSIONS Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adults health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

Results of the First Year of Active for Life: Translation of 2 Evidence-Based Physical Activity Programs for Older Adults Into Community Settings

OBJECTIVES Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults. METHODS Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys. RESULTS Participants (n=838) were aged an average of 68.4 +/-9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index. CONCLUSIONS The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials.

Sustainability of evidence-based community-based physical activity programs for older adults: lessons from Active for Life

Program sustainability in community and healthcare settings is critical to realizing the translation of research into practice. The purpose of this study is to describe the implementation and assessment of an intervention to increase organizational maintenance of evidence-based physical activity programs and the factors that impede or facilitate sustainability. All organizations implemented a sustainability action plan that included identifying factors related to sustainability, examining resources available, identifying program modifications to enhance sustainability, and long-term action planning. A mixed methods approach was used. Organizational (n = 12 sites) ability to demonstrate program effectiveness, align priorities with the organizational mission, and integrate the program within the existing infrastructure were strengths related to sustainability. Sites were more optimistic about program sustainability when they had less reliance on internal financial, but more reliance on internal human resources to run the program post-funding. The study resulted in a number of tools that can help community organizations plan for sustainability of physical activity programs.

Effects of Funding Allocation for Safe Routes to School Programs on Active Commuting to School and Related Behavioral, Knowledge, and Psychosocial Outcomes Results From the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) Study

Few controlled evaluations of Safe Routes to School (SRTS) initiatives have been conducted. The Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) study included three conditions: schools awarded infrastructure (I) projects (n = 23), schools awarded noninfrastructure (NI) projects (n = 21), and matched comparison (C) schools (n = 34). Fourth-grade children completed tallies to determine transport to/from schools. Serial cross-sectional surveys were collected from students and parents at baseline (2009) and follow-up (2012). Data were analyzed using mixed linear regression and growth curve models. Morning percent active commuting to school (ACS) in I and NI schools were higher than C schools (p = .024, p = .013, respectively). Afternoon percent ACS in NI schools decreased more over time compared with C schools (p = .009). I and NI school students had higher ACS self-efficacy; similar results were noted for parents in I schools. Policies that provide cost-reimbursement funding for SRTS achieve modest short-term ACS outcomes, with few differences between types of funding allocations.

Understanding the Challenges Encountered and Adaptations Made by Community Organizations in Translation of Evidence-Based Behavior Change Physical Activity Interventions: A Qualitative Study

Purpose. Designing programs for mid-life to older adults whose sedentary behaviors are associated with increased health risks is crucial. The U.S. Task Force on Community Preventive Services strongly recommends individually adapted behavior change programs as one approach to increasing physical activity in communities. The purpose of this study is to report challenges organizations faced when translating two evidence-based programs in real-world settings, adaptations made, and whether or not fidelity was negatively impacted by these adaptations. Design: A grounded theory approach to qualitative research was used. Setting and Participants: Nine community organizations across the country participated. Two organizations had more than one site participating, for a total of 12 sites from nine organizations. Within those organizations, 2796 participants were part of the program during the first 2 years. Participants were underactive (i.e., not meeting Centers for Disease Control and Prevention and American College of Sports Medicine recommendations) mid- to older-aged adults. Methods: Community organizations participated in monthly conference calls, and program information was entered into an electronic database regularly. Data obtained from the calls and database were used for analyses. Results: Challenges and adaptations emerged in three categories: (1) program logistics, (2) program theory, and (3) program philosophy. Conclusion: Challenges were present for community organizations; however, with some level of adaptation, the community organizations were able to effectively deliver and maintain fidelity in two evidence-based physical activity programs to a large and diverse group of mid- to older-aged adults.

Obesity-specific neural cost of maintaining gait performance under complex conditions in community-dwelling older adults.

BACKGROUND Recent evidence of obesity-related changes in the prefrontal cortex during cognitive and seated motor activities has surfaced; however, the impact of obesity on neural activity during ambulation remains unclear. The purpose of this study was to determine obesity-specific neural cost of simple and complex ambulation in older adults. METHODS Twenty non-obese and obese individuals, 65years and older, performed three tasks varying in the types of complexity of ambulation (simple walking, walking+cognitive dual-task, and precision walking). Maximum oxygenated hemoglobin, a measure of neural activity, was measured bilaterally using a portable functional near infrared spectroscopy system, and gait speed and performance on the complex tasks were also obtained. FINDINGS Complex ambulatory tasks were associated with ~2-3.5 times greater cerebral oxygenation levels and ~30-40% slower gait speeds when compared to the simple walking task. Additionally, obesity was associated with three times greater oxygenation levels, particularly during the precision gait task, despite obese adults demonstrating similar gait speeds and performances on the complex gait tasks as non-obese adults. INTERPRETATION Compared to existing studies that focus solely on biomechanical outcomes, the present study is one of the first to examine obesity-related differences in neural activity during ambulation in older adults. In order to maintain gait performance, obesity was associated with higher neural costs, and this was augmented during ambulatory tasks requiring greater precision control. These preliminary findings have clinical implications in identifying individuals who are at greater risk of mobility limitations, particularly when performing complex ambulatory tasks.

Food-shopping environment disparities in Texas WIC vendors: a pilot study.

OBJECTIVE To identify differences in food-shopping environments of Texas WIC vendors using a culturally adapted instrument. METHODS A survey tool was developed for measuring food availability, accessibility, and affordability in 111 WIC vendors in Texas. Two-tailed t-tests and Mann-Whitney tests were used for rural/urban and Texas-Mexico border/non-border area comparisons. RESULTS Prices were higher in rural areas than in urban areas for 2 key foods, fruits (p = .024) and milk (p = .007); non-border vendors had overall better food availability than border vendors; non-border vendors had better accessibility for fruits (p = .007) than border vendors. CONCLUSION In Texas, disparities in food-shopping environments are evident and can be assessed using a culturally adapted survey tool.

Evaluating the Influence of the Revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Allocation Package on Healthy Food Availability, Accessibility, and Affordability in Texas

BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was implemented to improve the health of pregnant women and children of low socioeconomic status. In 2009, the program was revised to provide a wider variety of healthy food choices (eg, fresh fruits, vegetables, and whole-grain items). OBJECTIVES The purpose of this study was to evaluate (1) the impact of the revised WIC Nutrition Programs food allocation package on the availability, accessibility, and affordability of healthy foods in WIC-authorized grocery stores in Texas; and (2) how the impact of the policy change differed by store types and between rural and urban regions. DESIGN WIC-approved stores (n=105) across Texas were assessed using a validated instrument (88 items). Pre- (June-September 2009) and post-new WIC package implementation (June-September 2012) audits were conducted. Paired-sample t tests were conducted to compare the differences between pre- and post-implementation audits on shelf width and number of varieties (ie, availability), visibility (ie, accessibility), and inflation-adjusted price (ie, affordability). RESULTS Across the 105 stores, post-implementation audits showed increased availability in terms of shelf space for most key healthy food options, including fruit (P<0.001), vegetables (P<0.01), cereal (P<0.001), and varieties of vegetables (P<0.001). Food visibility increased for fresh juices (P<0.001). Visibility of WIC labeling improved for foods such as fruits (P<0.05), WIC cereal (P<0.05), and whole-grain or whole-wheat bread (P<0.01). Inflation-adjusted prices decreased only for bread (P<0.001) and dry grain beans (P<0.001). The positive effects of the policy change on food availability and visibility were observed in stores of different types and in different locations, although smaller or fewer effects were noted in small stores and stores in rural regions. CONCLUSIONS Implementation of the revised WIC food package has generally improved availability and accessibility, but not affordability, of healthy foods in WIC-authorized stores in Texas. Future studies are needed to explore the impact of the revised program on healthy food option purchases and consumption patterns among Texas WIC participants.

A Contextual Look at Safe Routes to School Implementation in Texas

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.

Creating a Tipping Point: Texas Obesity Policy Actions in Review, 2000–2010

This paper discusses the historical context and current challenges of obesity prevention and control initiatives in Texas to understand how the obesity epidemic has been addressed by multiple interacting stakeholders over the past decade. By reviewing state reports and interviewing key decision makers, this paper chronicles recent efforts in Texas by highlighting health policy initiatives and champions who helped to create the foundation for obesity prevention and control. The findings outline the sentinel policy approaches that were implemented by public/private sector partnerships over the last decade, as well as the public figures that have been singular champions in creating the momentum for these changes. The efforts to address obesity with a collaborative approach in Texas have shown initial promise in creating a tipping point to control the obesity epidemic. These strategies can also serve as a model for obesity prevention and control at the national level.