Dori Pekmezi

Rationale, design, and baseline findings from Seamos Saludables: A randomized controlled trial testing the efficacy of a culturally and linguistically adapted, computer- tailored physical activity intervention for Latinas

BACKGROUND Latinos are now the largest (and fastest growing) ethnic minority group in the United States. Latinas report high rates of physical inactivity and suffer disproportionately from obesity, diabetes, and other conditions that are associated with sedentary lifestyles. Effective physical activity interventions are urgently needed to address these health disparities. METHOD/DESIGN An ongoing randomized controlled trial will test the efficacy of a home-based, individually tailored physical activity print intervention for Latinas (1R01NR011295). This program was culturally and linguistically adapted for the target population through extensive formative research (6 focus groups, 25 cognitive interviews, iterative translation process). This participant feedback was used to inform intervention development. Then, 268 sedentary Latinas were randomly assigned to receive either the Tailored Intervention or the Wellness Contact Control arm. The intervention, based on Social Cognitive Theory and the Transtheoretical Model, consists of six months of regular mailings of motivation-matched physical activity manuals and tip sheets and individually tailored feedback reports generated by a computer expert system, followed by a tapered dose of mailings during the second six months (maintenance phase). The main outcome is change in minutes/week of physical activity at six months and one year as measured by the 7-Day Physical Activity Recall (7-Day PAR). To validate these findings, accelerometer data will be collected at the same time points. DISCUSSION High reach, low cost, culturally relevant interventions to encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.

Results of a Culturally Adapted Internet-Enhanced Physical Activity Pilot Intervention for Overweight and Obese Young Adult African American Women

Purpose: This study evaluated a culturally relevant, social cognitive theory–based, Internet-enhanced physical activity (PA) pilot intervention developed for overweight/obese African American (AA) female college students. Design: Using a 3-month, single group, pretest–posttest design, participants accessed a culturally relevant PA promotion website and engaged in four moderate-intensity PA sessions each week. Results: Study completers (n = 25, mean age = 21.9 years) reported a decrease in sedentary screen time (p < .0001); however, no changes in moderate-to-vigorous PA were reported (p = .150). A significant increase in self-regulation for PA (p < .0001) and marginally significant increases in social support (p = .052) and outcome expectations (p = .057) for PA were observed. No changes in body mass index (p = .162), PA enjoyment (p = .151), or exercise self-efficacy (p = .086) were reported. Conclusions: Findings of this exploratory study show some preliminary support for Internet-enhanced approaches to promote PA among overweight/obese AA women. Implications for Practice: Future studies with larger samples are needed to further explore culturally relevant Internet-enhanced PA programs in this underserved population.

Twelve-month physical activity outcomes in Latinas in the Seamos Saludables trial.

BACKGROUND Physical activity interventions designed for Latinas have shown short-term behavior change, but longer-term change and maintenance is rarely measured. PURPOSE To assess physical activity change at 12 months, following 6-month tapered completion of an RCT of a physical activity intervention for Latinas. METHODS Two hundred sixty-six underactive (<60 minutes/week physical activity) Latinas were randomized to an individually tailored, culturally and linguistically adapted physical activity intervention, or a wellness contact control. Participants received the materials through the mail for 6 months, then received booster doses at 8, 10, and 12 months. Minutes per week of moderate to vigorous physical activity were measured by the 7-Day Physical Activity Recall interview at baseline and 6 and 12 months. Data were collected at Brown University between 2009 and 2013, and analyses were conducted in 2013. RESULTS At 12 months, increases in moderate to vigorous physical activity were significantly greater in the intervention than in the wellness group (mean difference=52 minutes/week, SE=9.38, p<0.01), with both groups showing slight increases in moderate to vigorous physical activity from 6 to 12 months. Intervention participants were also more likely to meet national moderate to vigorous physical activity guidelines (OR=3.14, p=0.01). CONCLUSIONS The intervention was more effective than the wellness control at 12 months, and physical activity increases from baseline to 6 months were maintained, suggesting the intervention may lead to sustainable behavior change. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov NCT01583140.

Using interactive Internet technology to promote physical activity in Latinas: Rationale, design, and baseline findings of Pasos Hacia La Salud

Internet-based interventions show promise as an effective channel for promoting physical activity. However, a paucity of research has been conducted among underserved groups despite recent increases in Internet access and physical activity-related health disparities in these communities. Thus, the current randomized controlled trial will test the efficacy of an individually tailored, Internet-based physical activity intervention for Latinas. This program was culturally and linguistically adapted for the target population through extensive formative research. Two hundred eighteen sedentary Latinas were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. The Physical Activity Internet Intervention, based on Social Cognitive Theory and the Transtheoretical Model, utilizes a website with features including self-monitoring, goal setting, discussion forum, links to online resources, individually tailored and motivation-matched physical activity feedback reports, and exercise tip sheets. Participants receive regular emails over the first 6months with a tapered dose during the second 6months (maintenance phase) to alert them to new content on the website. The main outcome is differences in minutes/week of moderate to vigorous physical activity at six months as measured by the 7-Day Physical Activity Recall and accelerometer data. High reach, low cost, culturally relevant Internet-based interventions that encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.

Rationale, design, and baseline findings from HIPP: A randomized controlled trial testing a home-based, individually-tailored physical activity print intervention for African American women in the Deep South

African American women report high rates of physical inactivity and related health disparities. In our previous formative research, we conducted a series of qualitative assessments to examine physical activity barriers and intervention preferences among African American women in the Deep South. These data were used to inform a 12-month Home-based, Individually-tailored Physical activity Print (HIPP) intervention, which is currently being evaluated against a wellness contact control condition among 84 post-menopausal African American women residing in the metropolitan area of Birmingham, Alabama. This paper reports the rationale, design and baseline findings of the HIPP trial. The accrued participants had an average age of 57 (SD=4.7), a BMI of 32.1 kg/m(2) (SD=5.16) with more than half (55%) having a college education and an annual household income under

Promoting Physical Activity among Underserved Populations.

50,000 (53.6%). At baseline, participants reported an average of 41.5 min/week (SD=49.7) of moderate intensity physical activity, and 94.1% were in the contemplation or preparation stages of readiness for physical activity. While social support for exercise from friends and family was low, baseline levels of self-efficacy, cognitive and behavioral processes of change, decisional balance, outcome expectations, and enjoyment appeared promising. Baseline data indicated high rates of obesity and low levels of physical activity, providing strong evidence of need for intervention. Moreover, scores on psychosocial measures suggested that such efforts may be well received. This line of research in technology-based approaches for promoting physical activity in African American women in the Deep South has great potential to address health disparities and impact public health.

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

Underserved populations, including racial/ethnic minorities, individuals with low socioeconomic status, and individuals with physical disabilities, are less likely to engage in sufficient moderate to vigorous physical activity (MVPA) and are thus at increased risk of morbidity and mortality. These populations face unique challenges to engaging in MVPA. Learning how to overcome these challenges is a necessary first step in achieving health equity through health promotion research. In this review of the literature, we discuss issues and strategies that have been used to promote MVPA among individuals from underserved populations, focusing on recruitment, intervention delivery, and the use of technology in interventions. Physical activity promotion research among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of efficacy in the use of certain recruitment and intervention strategies including tailoring, cultural adaptation, incorporation of new technologies, and multilevel and community-based approaches for physical activity promotion among different underserved populations.

Impact of Baseline BMI upon the Success of Latina Participants Enrolled in a 6-Month Physical Activity Intervention

Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥6 months postintervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: self-determination theory, theory of planned behavior, social cognitive theory, transtheoretical model, and social ecological model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.

The Role of Physical Activity in Treatment of Substance Use Disorders

High rates of obesity in Latinas highlight the need to determine if physical activity interventions are equally effective across the body mass index (BMI) range. Thus, this study assessed how BMI impacts success of Spanish-speaking Latinas in a culturally and linguistically adapted theory-based physical activity intervention (N = 45). Longitudinal regression models tested the relationship between baseline BMI and outcomes. Overall, a trend for a negative association was found between baseline BMI and self-reported physical activity and theoretical constructs targeted by the intervention over time. For example, someone with a 25 kg/m2 BMI would report, on average, 27.5 more minutes/week of activity compared to someone with a 30 kg/m2 BMI at followup. Furthermore, higher baseline BMI was significantly associated with lower self-efficacy, behavioral and cognitive processes of change, and family social support over time. These findings suggest that participants with higher BMI may need additional intervention to promote physical activity.

Rationale, design, and baseline findings from a pilot randomized trial of an IVR-Supported physical activity intervention for cancer prevention in the Deep South: The DIAL study

The term “substance use disorders” encompasses a wide-range of problems. Such a diagnosis can accurately describe individuals who regularly smoke cigarettes, as well as chronic alcoholics and/or drug addicts (American Psychiatric Association, 2000). In many cases, substance abuse and dependence are associated with negative personal, social, occupational, and/or legal consequences, which can lead individuals to seek treatment. In fact, according to facilities that report to State administrative data systems, there were nearly 1.8 million admissions for treatment of alcohol and drug abuse in 2006 (National Institute on Drug Abuse, 2009). Recently, the focus of substance use treatment has begun to shift towards promoting global health and wellness changes as part of the recovery process (Read et al., 2001). For example, health-care providers often encourage lifestyle changes (e.g., increased physical activity) to facilitate psychological and physical recovery in persons with substance use disorders (Read et al.). Physical activity is a particularly appealing treatment option as it is easily accessible, low cost, and can be pursued on one’s own schedule. In this chapter, we provide an overview on substance use treatment, discuss the potential benefits of incorporating physical activity into such programs, and then examine the research literature on physical activity as an intervention for substance use disorders.