Jorge A. Banda

Mediating Effects of Group Cohesion on Physical Activity and Diet in Women of Color: Health Is Power

Purpose. To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention. Design. Longitudinal design. Setting. Harris County and Travis County, Texas. Participants. Community-dwelling African-American and Hispanic or Latina women. Intervention. Three hundred ten women were randomized to a PA (n = 204) or VF (n = 106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption. Measures. Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention. Analyses. The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis. Results. Women were middle aged (mean = 44.4 years) and overweight or obese (mean body mass index = 34.0 kg/m2). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p <. 05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes. Conclusions. Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.

Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS—A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention

OBJECTIVE To test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children. DESIGN Two-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36 months after randomization. PARTICIPANTS Seven through eleven year old, overweight and obese children (BMI ≥ 85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California. INTERVENTIONS Families are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families. MAIN OUTCOME MEASURE Body mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures. CONCLUSIONS The Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.

Comparing physical activity measures in a diverse group of midlife and older adults

PURPOSE To compare self-report and objective measures of moderate- and vigorous-intensity physical activity (MVPA min·d(-1)) in midlife and older adults. METHODS Seventy-one participants (69% female, 74.6% Caucasian, 25.4% African American) completed the Behavioral Risk Factor Surveillance System physical activity (PA) questions, the Aerobic Center Longitudinal Study PA short survey (PASS), and the Aerobic Center Longitudinal Study PA long survey (PALS) and wore an accelerometer for seven consecutive days. Accelerometer MVPA minutes per day were determined using 1- and 10-min MVPA bout methods. RESULTS Participants were older (mean ± SD; age = 57.4 ± 9.9 yr) and overweight (body mass index = 27.9 ± 4.9 kg·m(-2)) but otherwise healthy. Median (interquartile range) MVPA minutes per day were 42.9 (51.4) from the Behavioral Risk Factor Surveillance System PA questions, 51.4 (68.6) from the PASS, 25.7 (48.6) from the PALS, 32.4 (33.5) from the 1-min MVPA bout accelerometer data, and 4.6 (16.8) from the 10-min MVPA bout accelerometer data. Pearson correlations adjusted for participant demographics revealed low to moderate correlations between self-report and 1-min MVPA bout accelerometer-determined MVPA minutes per day (r = 0.11-0.31), with the PASS (P < 0.05) and PALS (P < 0.01) having significant correlations with accelerometry. Cohen κ coefficients showed poor agreement between all three questionnaires and 1-min MVPA bout accelerometry for having ≥150 MVPA min·wk(-1) (κ = 0.26-0.38, all P < 0.05). CONCLUSIONS Our results indicate that there was poor agreement between self-report and accelerometer-based assessments of PA in midlife and older adults.

Protective health factors and incident hypertension in men.

BACKGROUND Few studies have examined the association between a combination of lifestyle factors and the incidence of hypertension, particularly among men. This is important as lifestyle factors are often interrelated, and may often occur in combination. Thus, we investigated the individual and combined effects of body mass index (BMI), smoking status, alcohol intake, physical activity (PA), and cardiorespiratory fitness (CRF) on the incidence of hypertension in men. METHODS A total of 14,568 men (mean age = 44.0 + or - 9.3 years) from the Aerobics Center Longitudinal Study (ACLS) initially free of hypertension completed an extensive baseline examination during 1974-2003, and were followed for the incidence of hypertension. RESULTS A total of 1,959 men reported having hypertension during a mean of 10.7 + or - 7.6 years of follow-up. Our data indicated that a combination of five protective health factors significantly reduced the risk of hypertension by 47% (95% confidence interval (CI): 36-56%). We also found that whether all participants in our sample had five protective health factors, the incidence of hypertension would be expected to decrease by 29% (95% CI: 26-31%). Additionally, having a normal BMI and being a nonsmoker and physically fit were significantly and independently associated with a lower risk of developing hypertension. CONCLUSIONS Our results show that among men aged 20-82 years, a healthy lifestyle can significantly reduce the risk of developing hypertension, and should be considered for the prevention of this chronic condition.

Convergent Validity of Pedometer and Accelerometer Estimates of Moderate-to-Vigorous Physical Activity of Youth

BACKGROUND Pedometer step-frequency thresholds (120 steps·min-1, SPM) corresponding to moderate-to-vigorous intensity physical activity (MVPA) have been proposed for youth. Pedometers now have internal mechanisms to record time spent at or above a user-specified SPM. If pedometers provide comparable MVPA (P-MVPA) estimates to those from accelerometry, this would have broad application for research and the general public. The purpose of this study was to examine the convergent validity of P-MVPA to accelerometer-MVPA for youth. METHODS Youth (N = 149, average 8.6 years, range 5 to 14 years, 60 girls) wore an accelerometer (5-sec epochs) and a pedometer for an average of 5.7 ± 0.8 hours·day-1. The following accelerometer cutpoints were used to compare P-MVPA: Treuth (TR), Mattocks (MT), Evenson (EV), Puyau (PU), and Freedson (FR) child equation. Comparisons between MVPA estimates were performed using Bland-Altman plots and paired t tests. RESULTS Overall, P-MVPA was 24.6 min ± 16.7 vs. TR 25.2 min ± 16.2, MT 18.8 min ± 13.3, EV 36.9 min ± 21.0, PU 22.7 min ± 15.1, and FR 50.4 min ± 25.5. Age-specific comparisons indicated for 10 to 14 year-olds MT, PU, and TR were not significantly different from P-MVPA; for the younger children (5-8 year- olds) P-MVPA consistently underestimated MVPA. CONCLUSIONS Pedometer-determined MVPA provided comparable estimates of MVPA for older children (10-14 year-olds). Additional work is required to establish age appropriate SPM thresholds for younger children.

Effects of Varying Epoch Lengths, Wear Time Algorithms, and Activity Cut-Points on Estimates of Child Sedentary Behavior and Physical Activity from Accelerometer Data

Objective To examine the effects of accelerometer epoch lengths, wear time (WT) algorithms, and activity cut-points on estimates of WT, sedentary behavior (SB), and physical activity (PA). Methods 268 7–11 year-olds with BMI ≥ 85th percentile for age and sex wore accelerometers on their right hips for 4–7 days. Data were processed and analyzed at epoch lengths of 1-, 5-, 10-, 15-, 30-, and 60-seconds. For each epoch length, WT minutes/day was determined using three common WT algorithms, and minutes/day and percent time spent in SB, light (LPA), moderate (MPA), and vigorous (VPA) PA were determined using five common activity cut-points. ANOVA tested differences in WT, SB, LPA, MPA, VPA, and MVPA when using the different epoch lengths, WT algorithms, and activity cut-points. Results WT minutes/day varied significantly by epoch length when using the NHANES WT algorithm (p < .0001), but did not vary significantly by epoch length when using the ≥ 20 minute consecutive zero or Choi WT algorithms. Minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA varied significantly by epoch length for all sets of activity cut-points tested with all three WT algorithms (all p < .0001). Across all epoch lengths, minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA also varied significantly across all sets of activity cut-points with all three WT algorithms (all p < .0001). Conclusions The common practice of converting WT algorithms and activity cut-point definitions to match different epoch lengths may introduce significant errors. Estimates of SB and PA from studies that process and analyze data using different epoch lengths, WT algorithms, and/or activity cut-points are not comparable, potentially leading to very different results, interpretations, and conclusions, misleading research and public policy.

The Associations Between Park Environments and Park Use in Southern US Communities

PURPOSE To document park use and park and neighborhood environment characteristics in rural communities, and to examine the relationship between park characteristics and park use. METHODS The System for Observing Play and Recreation in Communities measured use in 42 target areas across 6 community parks in May 2010 and October 2010. Direct observation instruments were used to assess park and neighborhood environment characteristics. Logistic regression was used to determine the relationship between the condition, number of amenities, and number of incivilities in a target area with target area use. FINDINGS Ninety-seven people were observed across all parks during May 2010 data collection and 116 people during October 2010 data collection. Low park quality index scores and unfavorable neighborhood environment characteristics were observed. There was a significant positive association between number of incivilities in a target area and target area use (OR = 1.91; 95% CI: 1.09-3.38; P = .03). CONCLUSIONS The number of people observed using the parks in this study was low, and it was considerably less than the number observed in other studies. The objective park and neighborhood environment characteristics documented in this study provide a more comprehensive understanding of parks than other studies. Further examining the complex relationship between park and neighborhood environment characteristics and park use is important, as it can inform park administrators and city planners of characteristics that are best able to attract visitors.

Screen Media Exposure and Obesity in Children and Adolescents

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children’s preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

Physical activity opportunities in low socioeconomic status neighbourhoods

Figure 1 Physical activity resources in public housing in lower SES neighbourhoods (top) and higher SES neighbourhoods (bottom). Increased availability of neighbourhood physical activity resources can help to promote physical activity among residents, even in very low socioeconomic status neighbourhoods.1 Residents of …

A pictorial view of the physical activity socialization of young adolescents outside of school

Childhood obesity prevention has fallen short of anticipated impact. Therefore, intervention programs need to be redirected to other potential settings to increase youth physical activity. This qualitative study, using autodriven interview techniques, was conducted to identify out-of-school settings that youth perceive as important for physical activity. Sixty-six children took photographs involving their physical activity involvement. A subsample completed follow-up focus groups. Salient themes included types of physical activities related to free play, fitness, organized sports, and chores. Most photographs included multiple children of similar age and were taken outdoors. Data suggest children associate chores with physical activity and engage in fitness-related activities. In addition, friends and family, the outdoors, and importantly, the home emerged as natural intervention components that may prove useful towards decreasing the physical inactivity and obesity of youth.