Jean L. Wiecha

Household Television Access: Associations With Screen Time, Reading, and Homework Among Youth

OBJECTIVE We examined how household factors that mediate television access are associated with screen time (television, videos, movies, and computer and video games), reading, and homework. METHODS We conducted a self-report survey among 1197 sixth and seventh graders in 10 middle schools in 4 Boston-area communities in 1995. To assess independent associations, SUDAAN linear regressions were calculated to control for respondent characteristics and household access and to account for clustered sampling in the school-based design. RESULTS Total viewing (television, videos, movies, and computer and video games) averaged 3.35 plus minus 2.2 hours per day. In multivariate regressions, independent direct associations with total viewing were observed for the following categories: youth has a television in the bedroom: 0.64 hours per day (P <.001), never/seldom has family dinners: 0.55 hours (P <.01); no parental limits on television time: 0.48 hours (P <.01); and each additional television outside the youths bedroom, 0.12 hours (P <.05). Similar results held when television/video/movie use was examined separately from computer/video game use. Youth reported an average of 1.6 plus minus 1.1 hours of reading and homework per day. Parental limits on television time were associated with 0.21 hours more reading per day (P <.01), whereas a television in the bedroom was associated with 0.18 hours less (P <.01). CONCLUSIONS Reducing intrahousehold television access may enhance clinical, school, and community strategies to reduce youth television viewing and other screen time.

Effect of an After-School Intervention on Increases in Children's Physical Activity

PURPOSE Evaluate the effect of an after-school intervention on physical activity program changes and individual behaviors among children. METHODS A quasi-experimental evaluation of a YMCA-driven environmental change intervention with 16 intervention and 16 control sites in four metropolitan areas in the United States. Intervention sites participated in learning collaboratives designed to promote physical activity and nutrition through environmental change, educational activities, and parent engagement. Behavioral foci included increasing overall physical activity levels as well as combined moderate and vigorous physical activity and vigorous physical activity. Outcomes were assessed longitudinally using preintervention and follow-up surveys of program implementation and accelerometer measures of physical activity. ActiGraph accelerometer data were collected from a sample of 212 children, ages 5-11 yr, attending the programs. On average, 3 d of data were gathered per child. Reliability of the accelerometer counts averaged 0.78. Multivariate regression models were used to control for potential confounding variables and to account for clustering of observations. RESULTS Data indicate greater physical activity increases in children in intervention versus control sites after modest intervention implementation. Controlling for baseline covariates, children in intervention sites showed greater increases in average physical activity level than in control sites (76 counts per minute, P = 0.037, 95% confidence interval (CI) = 8.1-144) and more minutes of moderate and vigorous physical activity (10.5 min·d(-1), P = 0.017, 95% CI = 1.5-18.6), minutes of moderate physical activity (5.6 min·d(-1), P = 0.020, 95% CI = 0.99-10.2), and minutes of vigorous physical activity (5.1 min·d(-1), P = 0.051, 95% CI = 0.21-9.93). CONCLUSIONS Results indicate significant increases in daily physical activity among children in intervention versus control sites. This study documents the effectiveness of an environmental change approach in an applied setting.

Youth recall and TriTrac accelerometer estimates of physical activity levels.

PURPOSE To examine significance of missing data and describe physical activity patterns using recall and accelerometer measures among youth in a nonlaboratory setting. METHODS Fifty-four middle-school students wore TriTrac-R3D monitors (TTM) and completed an interviewer-prompted 24-h recall during two, 5-d monitoring sessions. We coded 2860 30-min recall intervals to a standard MET compendium. Complete TTM data were gathered for 43 students. Ordinal multinomial models tested for bias in TTM estimates of activity levels due to: 1) exclusion of subjects with incomplete TTM data, and 2) exclusion of intervals within days due to missing TTM data. RESULTS Students with complete monitor data had an average 12.5 +/- 0.9 monitored hours per day over 5.5 +/- 2.1 d. Compared with students with incomplete monitoring data, they reported similar proportions of recall 30-min intervals at sedentary (68% vs 69%), light (14% vs 15%), moderate (11% vs 10%), and vigorous (7% vs 6%) intensity levels (P = 0.63). The proportion of recall intervals (within days) with and without simultaneous monitoring data did not differ by activity intensity (P = 0.64) across sedentary (69% vs 67%), light (14% vs 12%), moderate (11% vs 10%), and vigorous (6% vs 9%) categories. Recalls overestimated percent time per day in moderate and vigorous activity relative to TTM (22.8% vs 8.9%, P < 0.0001). Boys reported higher percent of time than girls in vigorous activity (10.9% vs 3.9%, P < 0.05). Girls reported more time than boys (9.5% vs 6.4%, P < 0.05) in light activities. No significant sex differences were observed using TTM. CONCLUSIONS Missing TTM data did not bias estimates of activity levels. Self-reported activity measures overestimated moderate and vigorous activity relative to the TTM and varied by sex.

Youths’ Perceptions of Overweight-related Prevention Counseling at a Primary Care Visit

Objective: We examined youths’ report of receiving specific overweight‐related preventive counseling and perceived readiness to adopt nutrition and physical activity behaviors recommended by their clinicians.

Development of the Community Healthy Living Index: a tool to foster healthy environments for the prevention of obesity and chronic disease.

OBJECTIVES This paper presents a new, comprehensive tool for communities to assess opportunities for active living and healthy eating and to mobilize all sectors of society to conquer obesity and chronic disease. METHOD Relevant existing tools and input from an expert panel were considered to draft the Community Healthy Living Index (CHLI). CHLI covers five major sectors where people live, work, learn, and play: schools, afterschools, work sites, neighborhoods, and the community-at-large. CHLI and the accompanying procedures enable community teams to assess programs, the physical environment, and policies related to healthy living and to plan improvement strategies. In 2008, with local YMCAs acting as conveners, community assessment teams from six US communities pilot-tested CHLI for cognitive response testing, inter-rater reliability, and implementation feasibility. CHLI was revised to reflect the test results. RESULTS Pilot analyses demonstrated that the process was feasible, with most questions being interpreted as intended and showing substantial to almost perfect agreement between raters. The final CHLI is being disseminated nationally. CONCLUSIONS Preliminary data illustrate CHLI obtains reliable results and is feasible to implement. CHLI is a promising tool for community-based prevention efforts to draw attention to opportunities for healthy living and create impetus for community changes.

Extra-team connections for knowledge transfer between staff teams

As organizations implement novel health promotion programs across multiple sites, they face great challenges related to knowledge management. Staff social networks may be a useful medium for transferring program-related knowledge in multi-site implementation efforts. To study this potential, we focused on the role of extra-team connections (ties between staff members based in different site teams) as potential channels for knowledge sharing. Data come from a cross-sectional study of after-school child-care staff implementing a health promotion program at 20 urban sites of the Young Mens Christian Association of Greater Boston. We conducted a sociometric social network analysis and attempted a census of 91 program staff members. We surveyed 80 individuals, and included 73 coordinators and general staff, who lead and support implementation, respectively, in this study. A multiple linear regression model demonstrated a positive relationship between extra-team connections (beta = 3.41, P < 0.0001) and skill receipt, a measure of knowledge transfer. We also found that intra-team connections (within-team ties between staff members) were also positively related to skill receipt. Connections between teams appear to support knowledge transfer in this network, but likely require greater active facilitation, perhaps via organizational changes. Further research on extra-team connections and knowledge transfer in low-resource, high turnover environments is needed.

Development of healthy eating and physical activity quality standards for out-of-school time programs.

BACKGROUND Out-of-school time (OST) programs serve over 8 million children per year and have ample opportunity to promote health through menu and physical activity choices. Until recently, however, the field has lacked a comprehensive set of operationalizable standards for healthy eating and physical activity. The National AfterSchool Association adopted voluntary healthy eating and physical activity quality standards (HEPAQS) in April, 2011. METHODS We describe the development of HEPAQS. This work reflects a social ecological model for changing childrens eating and activity behaviors through program-level interventions. The standards were developed using a national, mixed-methods needs assessment, review of existing standards and expert recommendations, and a participatory process of discussion, review, and consensus engaging 19 influential service and policy organizations and agencies in the Healthy Out-of-School Time (HOST) coalition, which we convened in 2009. RESULTS The HOST coalition approved a final version of the HEPAQS in January, 2011. The 11 standards address content, curriculum selection, staff training, program support, and environmental support for healthy eating and physical activity. In April, 2011, the HEPAQS were adopted by the National AfterSchool Association, and have subsequently been widely disseminated. Extensive adoption and implementation efforts are underway. CONCLUSIONS The availability of a comprehensive set of standards for healthy eating and physical activity in OST provides practical information to help community-based youth-serving organizations participate in obesity and chronic disease prevention. A working awareness of their content will be useful to scientists undertaking health promotion studies in the out-of-school time setting.

Multiple Program Participation: Comparison of Nutrition and Food Assistance Program Benefits with Food Costs in Boston, Massachusetts.

The values of government cash and food assistance benefits are compared to estimated food costs in Boston for households whose sole source of income is Aid to Families with Dependent Children (AFDC) and who have housing in the private sector. Methods developed by the General Accounting Office (GAO) in 1978 are replicated. GAO found that the value of combined benefits can exceed the cost of the United States Department of Agricultures Thrifty Food Plan. Key assumptions underlying GAOs methodology are challenged, and an alternate method is applied. The new results contradict GAOs conclusions and suggest that Boston food costs exceed the combined value of benefits that AFDC households may receive, although participation in multiple food assistance programs is more beneficial than receipt of benefits from single programs. The authors conclude that food stamps and AFDC benefits indexed to actual costs of living are needed to meet the food needs of low-income families in Boston.

Informal training in staff networks to support dissemination of health promotion programs.

Purpose. To study informal skill transfer via staff networks as a complement to formal training among afterschool childcare providers implementing a health promotion program. Design. Cross-sectional, sociometric network analysis. Setting. Boston Young Mens Christian Association (YMCA) afterschool programs implementing the iPLAY program. Participants. All 91 staff members at 20 sites were eligible; 80 completed the survey (88% response rate). Measures. At the network level, network density measured system-level connectedness. At the staff level, the independent variable was out degree, the number of individuals to whom respondents noted a program-related connection. The dependent variable was skill gains, the number of key implementation skills gained from the network. Analysis. We mapped the staff program-related social network. We utilized multiple linear regression to estimate the relationship between out degree and skill gains, and we adjusted for clustering of staff in sites. Results. Most staff (77%) reported gaining at least one skill from the network, but only 2% of potential network connections were established. The regression model showed that out degree (i.e., number of program-related contacts) was significantly associated with skill gains (β = .48, p < .01) independent of other variables. Conclusion. Informal skill transfer in staff networks may be a useful complement to formal training for implementation of health promotion programs, but informal skill transfer was likely underutilized in this network. Future research employing longitudinal and/or multisite data should examine these findings in greater detail.

Effects of a multicomponent wellness intervention on dyslipidemia among overweight adolescents

Abstract Behavioral changes are the first line of treatment for dyslipidemia in adolescents, but outcome data on the effectiveness of this approach are inconsistent. This study aims to assess the effect of a 13-week multicomponent wellness intervention program, which included weekly nutrition classes and structured cardiovascular, flexibility, and strength training on dyslipidemia in nine overweight/obese [body mass index (BMI) ≥85th percentile] and nine lean (BMI <85th percentile) adolescents. Clinical measurements and lipid profile assessment were performed before and after the intervention. At the completion of the study, the overweight/obese adolescents demonstrated a 15% increase in high-density lipoprotein cholesterol (HDL-C) levels (mean, 47±8 vs. 54±5 mg/dL), whereas there was no improvement in BMI or other measurements. The participants in the lean group showed no change in their anthropometric and serum parameters. A multicomponent wellness intervention resulted in a significant increase of cardioprotective HDL-C levels, which have been associated with coronary health in adulthood.