Jay E. Maddock

The Relationship between Obesity and the Prevalence of Fast Food Restaurants: State-Level Analysis

Purpose. Obesity accounts for approximately 300,000 deaths a year in the United States, and prevalence rates have been increasing over the past decade. The nutrition environment may be contributing to this epidemic. This study examined the relationship between fast food restaurants and obesity on a state-wide basis. Design. A one-time cross-sectional analysis of secondary data was used for this study. Setting. The setting for this study was the United States. Subjects. State-level data were used as the unit of analysis. Alaska was excluded as an outlier, and the District of Columbia was added (N = 50). Measures. Measures included aggregate state-level means for square miles per fast food restaurant, population per fast food restaurant, population density, ethnicity, age, gender, physical inactivity, fruit and vegetable intake, and obesity rates. Data were obtained from the 2002 Behavioral Risk Factor and Surveillance Survey, the 2000 U.S. Census, and the 2002 U.S. Yellow Pages. Results. Multiple hierarchal regressions revealed that square miles per fast food restaurants and residents per restaurant accounted for 6% of the variance in state obesity rates after controlling for population density, ethnicity, age, gender, physical inactivity, and fruit and vegetable intake. The entire model explained 70% of the total variance in state obesity rates. Conclusions. These results indicate a correlational relationship between both the number of residents per fast food restaurant and the square miles per fast food restaurants with state-level obesity prevalence. Limitations include the use of correlational aggregate data.

Environmental and Social Correlates of Physical Activity in Neighborhood Parks: An Observational Study in Tampa and Chicago

This study used observational methods to examine physical activity (PA) and selected correlates in 28 parks in Tampa, Florida, and Chicago, Illinois. We observed 9,454 park users within predetermined activity zones and coded their activity as sedentary, walking (i.e., moderate intensity), or vigorous PA. In Tampa, higher temperature, unorganized activity, lower amounts of shade, lower neighborhood income, Hispanic neighborhood ethnicity, male gender and child age group were significantly associated with walking. Vigorous activity was not associated with income and ethnicity. Morning hours, unorganized activity, lower neighborhood income and African American neighborhood ethnicity were associated with walking in Chicago. Vigorous activity was associated with children, lower neighborhood income and African American ethnicity. Findings from this study can inform policy decisions and future research directions.

A Picture of the Healthful Food Environment in Two Diverse Urban Cities

Background Local food environments influence fresh produce purchase and consumption, and previous research has found disparities in local food environments by income and ethnicity. Other existing studies have begun to quantify the distribution of food sources, but there has been limited attention to important features or types of healthful food that are available or their quality or cost. Two studies assessed the type, quantity, quality and cost of healthful food from two diverse urban cities, Kansas City, Kansas and Missouri and Honolulu, Hawaii, and evaluated differences by neighborhood income and ethnic composition. Method A total of 343 food stores in urban neighborhoods were assessed using the one-page Understanding Neighborhood Determinants of Obesity (UNDO) Food Stores Assessment (FSA) measuring healthful foods. US Census data were used to define median household income and ethnic minority concentration. Results In Study 1, most low socioeconomic status (SES), high ethnic minority neighborhoods had primarily convenience, liquor or small grocery stores. Quality of produce was typically lower, and prices of some foods were more than in comparison neighborhoods. In Study 2, low SES neighborhoods had more convenience and grocery stores. Farmers’ markets and supermarkets had the best produce availability and quality, and farmers’ markets and pharmacies had the lowest prices. Conclusions Messages emphasizing eating more fruits and vegetables are not realistic in urban, low SES, high ethnic concentration neighborhoods. Farmers’ markets and supermarkets provided the best opportunities for fresh produce. Increasing access to farmers’ markets and supermarkets or reducing prices could improve the local food environment.

Examination of Trends and Evidence‐Based Elements in State Physical Education Legislation: A Content Analysis

OBJECTIVES To develop a comprehensive inventory of state physical education (PE) legislation, examine trends in bill introduction, and compare bill factors. METHODS State PE legislation from January 2001 to July 2007 was identified using a legislative database. Analysis included components of evidence-based school PE from the Community Guide and other authoritative sources: minutes in PE, PE activity, teacher certification, and an environmental element, including facilities and equipment. Researchers abstracted information from each bill and a composite list was developed. RESULTS In total, 781 bills were analyzed with 162 enacted. Of the 272 bills that contained at least 1 evidence-based element, 43 were enacted. Only 4 bills included all 4 evidence-based elements. Of these 4, 1 was enacted. Funding was mentioned in 175 of the bills introduced (37 enacted) and an evaluation component was present in 172 of the bills (49 enacted). CONCLUSIONS Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation.

The Theory of Planned Behavior within the Stages of the Transtheoretical Model: Latent Structural Modeling of Stage-Specific Prediction Patterns in Physical Activity.

This is the first study to test whether the stages of change of the transtheoretical model are qualitatively different through exploring discontinuity patterns in theory of planned behavior (TPB) variables using latent multigroup structural equation modeling (MSEM) with AMOS. Discontinuity patterns in terms of latent means and prediction patterns for the different stage groups were examined. Adults (n = 3,462) were assessed on their physical activity stages of change and TPB variables. The TPB was separately examined within the five stage groups. The TPB measurement model fit was acceptable. Latent mean analyses with post-hoc contrast and MSEM indicated discontinuity patterns. Results underscore the qualitative differences between the stages that may guide further research and the design of interventions integrating the approaches.

Formative Research to Develop a Mass Media Campaign to Increase Physical Activity and Nutrition in a Multiethnic State

Poor nutrition and physical inactivity are the second leading causes of preventable morbidity and mortality in the United States. Mass media campaigns have tremendous promise for reaching large segments of the population to influence these behaviors. There is still insufficient evidence in the literature, however, to recommend mass marketing campaigns for physical activity and nutrition. Successful mass media campaigns should have a formative research base that includes conducting preproduction research with the target audience, using theory as a conceptual foundation of the campaign, segmenting the audience into meaningful subgroups, and using a message approach that is targeted to and likely will be effective with the audience segment. In this study, these formative research steps were addressed to develop a mass media campaign based on the Theory of Planned Behavior to increase physical activity and fruit and vegetable consumption in 35–55-year-old adults in the state of Hawaii. For the walking campaign, our results identified time, a control belief, as the major barrier. For fruits and vegetable, the data suggested social norm (if others around me ate them) and control (if they were available). These data then were used to develop a mass media campaign based on these principals.

Development and validation of an appearance motivation attitudes scale for sun protection

A reliable two-factor instrument measuring appearance motivation attitudes for sun protection was developed using a longitudinal sample of beachgoers. At baseline, data on sun protection and appearance motivation attitudes were collected on 2324 individuals. Principal components analyses (PCA) indicated a two-factor solution measuring attitudes toward tan attractiveness and skin protection with only 2 items loading on the skin protection factor. At 12-months, the instrument was revised and shortened but including 3 new skin protection items. Split-half analyses were conducted to further refine and develop the instrument. PCA on half of the sample revealed a two-factor solution, which was confirmed using structural equation modeling on the remaining half. This resulted in a two correlated-factor, 10-item measure. Each factor was summed to create two scales. Both scales were internally consistent and demonstrated good external validity, correlating with sun protection specific Transtheoretical model variables. The tan attractiveness attitudes scale significantly improved prediction of sun protection outcomes over 24 months, over and above TTM variables.

Sexual and reproductive health knowledge among female college students in Wuhan, China.

The purpose of this study was to explore demographic correlates of sexual and reproductive health knowledge among Chinese female college students. A total of 4769 participants were surveyed about sexual and reproductive health knowledge and related sociodemographic factors, using random cluster sampling between 2005 and 2006, in 16 colleges and universities in Wuhan, China. To evaluate knowledge, the scores of 60 questions on reproduction, contraception, and sexually transmitted infections were combined for a possible score of 100. The average score on the knowledge scale was 42.6 ± 13.0 (1.1 to 79.7). Knowledge scores were statistically significant (P < 0.01) between different sociodemographic factors using χ2 test. Multilinear stepwise regression showed that 11 of 16 factors, including age, grade, major, menarche age, family residence, being the only child, and mother’s occupation were significantly related to knowledge. Female college students lack knowledge of sexual and reproductive health, and their knowledge was influenced by numerous sociodemographic factors.

Policy Influences on Community Trail Development

This study explores processes and policies that facilitate the development of community trails. With funding from Active Living Research and the research framework of the Physical Activity Policy Research Network (PAPRN), we conducted a multiple-site case study. A total of six trails in Hawaii, Massachusetts, Missouri, North Carolina, South Carolina, and Washington were chosen for study. The goals of this case study were to identify the policy influences on trail development, explore the roles of key players in trail development, and compare and contrast findings from the different trails. Trail development can be a long process. Some of the trails took over a decade to complete because of funding, opposition, and roadblocks in the form of design standard policies. Work in trail development requires a team of many players, and it is necessary to balance their varied motives to accomplish a shared overall goal. Foresight through the master planning process is also a vital component of successful trail development. Finally, community involvement is key. Communities contemplating trail development should explore the effects of policy on the trail projects reported here to proactively identify potential influence.

The Healthy Hawaii Initiative: A Social Ecological Approach Promoting Healthy Communities

Purpose. The tobacco settlement has provided the opportunity for the state of Hawaii to implement the Healthy Hawaii Initiative (HHI), targeting smoking, poor nutrition and physical inactivity. The purpose of this paper is to describe and document preliminary findings. Methods. The social ecological model is translated into practice through school and community grants to create systems, environmental and policy changes, teacher training on health and physical education standards, continuing education for the medical community in behavioral health, and a public education campaign. A comprehensive evaluation provides ongoing feedback for program improvement and progress on the effects of psychosocial mediators, behaviors, and long-term chronic diseases. Results and Discussion. Preliminary process results presented here are promising. The components are thought to interact synergistically to bring about behavior changes statewide. The HHI is one example of how to implement a multilevel initiative to target the three major behavioral determinants of chronic disease (tobacco use, physical inactivity, and poor nutrition) and build healthier communities.