Olivia Affuso

Measuring parental support for children's physical activity in white and African American parents: the Activity Support Scale for Multiple Groups (ACTS-MG).

OBJECTIVES The Activity Support Scale (ACTS) was expanded for use with African American families. Its factorial invariance and internal reliability were examined for non-Hispanic white and African American parents. METHODS The ACTS was modified to improve its applicability to African American families based on information from five focus groups with 27 African American parents of elementary school-aged children. Between 2006 and 2008, the revised scale was administered to 119 African American and 117 non-Hispanic white parents in northeastern NY and Alabama. Its factorial invariance across race/ethnicity and internal consistency were examined. RESULTS Factor analysis of the revised scale, the Activity Support Scale for Multiple Groups (ACTS-MG), identified four parenting factors in white and African American parents including logistic support, modeling, use of community resources to promote physical activity (PA), and restriction of sedentary behaviors. Results supported the scales internal reliability and factorial invariance across race/ethnicity. CONCLUSION The ACTS-MG is appropriate for use with non-Hispanic white and African American families and will enable the extension of current research with white families to the examination of strategies supporting PA in African American families. Additional psychometric work with the ACTS-MG is encouraged.

The Geographic Distribution of Obesity in the US and the Potential Regional Differences in Misreporting of Obesity

Objective: State‐level estimates of obesity based on self‐reported height and weight suggest a geographic pattern of greater obesity in the Southeastern US; however, the reliability of the ranking among these estimates assumes errors in self‐reporting of height and weight are unrelated to geographic region.

The associations of perceived neighborhood disorder and physical activity with obesity among African American adolescents

BackgroundAccording to recent research studies, the built and socioeconomic contexts of neighborhoods are associated with African American adolescents’ participation in physical activity and obesity status. However, few research efforts have been devoted to understand how African American adolescents’ perceptions of their neighborhood environments may affect physical activity behaviors and obesity status. The objective of the current study was to use a perceived neighborhood disorder conceptual framework to examine whether physical activity mediated the relationship between perceived neighborhood disorder and obesity status among African American adolescents.MethodsThe data were obtained from a cross-sectional study that examined social and cultural barriers and facilitators of physical activity among African American adolescents. The study included a sample of 101 African American adolescents age 12 to 16 years and their parents who were recruited from the Birmingham, Alabama metropolitan area. The primary outcome measure was obesity status which was classified using the International Obesity Task Force cut off points. Moderate-to-vigorous physical activity was assessed via accelerometry. Perceived neighborhood disorder was assessed using the Perceived Neighborhood Disorder Scale. Mediation models were used to examine whether the relationship between neighborhood disorder and obesity status was mediated by physical activity.ResultsPerceived neighborhood disorder was significantly and positively related to obesity status and moderate-to-vigorous physical activity was inversely associated with obesity status. However, there was no evidence to support a significant mediating effect of moderate-to-vigorous physical activity on the relationship between neighborhood disorder and obesity status.ConclusionFuture studies should longitudinally assess perceived neighborhood disorder characteristics and childhood adiposity to examine the timing, extent, and the mechanisms by which perceived neighborhood disorder characteristics increase the risk of obesity.

Validity of self-reported leisure-time sedentary behavior in adolescents.

BackgroundTo evaluate the concordance between leisure-time sedentary behavior in adolescents assessed by an activity-based questionnaire and accelerometry.A convenience sample of 128 girls and 73 boys, 11-15 years of age (12.6 ± 1.1 years) from six states across the United States examined as part of the feasibility studies for the Trial of Activity in Adolescent Girls (TAAG). Three days of self-reported time spent watching TV/videos, using computers, playing video/computer games, and talking on the phone was assessed using a modified version of the Self-Administered Physical Activity Checklist (SAPAC). Criterion measure of sedentary behavior was via accelerometry over three days using a cut point of < 50 counts · 30 sec-1 epoch. Comparisons between sedentary behavior by the two instruments were made.ResultsAdolescents generally underestimated minutes of sedentary behavior compared to accelerometry-measured minutes. The overall correlation between minutes of sedentary behavior by self-report and accelerometry was weak (Spearman r = 0.14; 95% CI 0.05, 0.23). Adjustment of sedentary minutes of behavior for total minutes assessed using either percentages or the residuals method tended to increase correlations slightly. However, regression analyses showed no significant association between self-reported sedentary behavior and minutes of sedentary behavior captured via accelerometry.DiscussionThese findings suggest that the modified 3-day Self-Administered Physical Activity Checklist is not a reliable method for assessing sedentary behavior. It is recommended that until validation studies for self-report instruments of sedentary behavior demonstrate validity, objective measures should be used.

Dietary interventions and quality of life: a systematic review of the literature.

OBJECTIVE To systematically review the literature to examine whether there has been adequate assessment of the effects of dietary intervention on quality of life (QOL) independent of weight loss, assess which instruments are being used to measure nutrition-related QOL, identify gaps in the literature, and suggest future directions. DESIGN Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS A total of 24 studies were eligible for inclusion. The Short Form-36 Health Survey was the most widely used instrument to assess QOL. Other disease-specific instruments were used. Several different dietary approaches (eg, low carbohydrate, low calorie, low fat, combinations) were recommended. Across studies, QOL generally improved after participating in behavioral weight loss interventions, but findings revealed a lack of evidence to definitively determine whether reported changes in QOL were a result of weight loss or independent of it. CONCLUSIONS AND IMPLICATIONS It is important to consider how making broad dietary recommendations for all individuals might affect overall QOL in both positive and negative directions when considering factors other than weight loss and health improvement. If dietary interventions are adversely affecting QOL in other domains (eg, social, economic) and this relationship is not being detected or reported by current research practices, barriers for successful and sustainable dietary changes may not be fully understood.

Body Image as a Mediator of the Relationship Between Body Mass Index and Weight-Related Quality of Life in Black Women

BACKGROUND Body image (BI) may be important in understanding weight-related attitudes and behaviors in black women. Specifically, body dissatisfaction may mediate the relationship between body mass index (BMI) and weight-related quality of life (QOL) in black women. We examined the relationship between BMI and weight-related QOL in black women and tested for mediation by body dissatisfaction. METHODS The sample included 149 black women recruited from Birmingham, Alabama, for a one-time clinic visit. BIs were self-reported using the Pulvers figure rating scale. Body discrepancy (BD), a surrogate measure of body dissatisfaction, was calculated as perceived current image minus ideal image. QOL was self-reported using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Baron and Kennys test for mediation was conducted where BMI was the predictor, IWQOL-Lite score was the outcome, and BD was the mediator under investigation. RESULTS Mean age was 40.5 years, and mean BMI was 36.1 kg/m(2). The mean IWQOL-Lite score was 81.1±15.8 out of 100. Participants had a BD score of 2.3, indicating a desire to be two figure sizes smaller than their current perceived body size. Tests for mediation revealed that BD partially mediated the relationship between BMI and IWQOL-Lite scores in this sample. CONCLUSIONS BD was in the pathway of the association between BMI and IWQOL-Lite scores. BI dissatisfaction may contribute to explaining more about black womens weight-related QOL beyond actual BMI alone. Additional research is needed to better understand black womens perception of weight and subsequent weight-related behaviors.

Getting carried away: a note showing baseline observation carried forward (BOCF) results can be calculated from published complete-cases results

Objective:Randomized controlled trials (RCTs) in obesity are plagued by missing data due to participant dropouts. Most methodologists and regulatory bodies agree that the primary analysis of such RCTs should be based on the intent-to-treat (ITT) principle, such that all randomized subjects are included in the analysis, even those who dropped out. Unfortunately, some authors do not include an ITT analysis in their published reports. Here we show that one form of ITT analysis, baseline observation carried forward (BOCF), can be performed utilizing only information available in a published complete-case (CC) analysis, permitting readers, editors, meta-analysts and regulators to easily conduct their own ITT analyses when the original authors do not report one.Method:We mathematically derive a simple method for estimating and testing treatment effects using the BOCF to allow a more conservative comparison of treatment effects when there are dropouts in a clinical trial. We provide two examples of this method using available CC analysis data from reported obesity trials to illustrate the application for readers who wish to determine a range of treatment effects based on published summary statistics.Conclusion:Commonly used CC analyses may lead to inflated type I error rates and/or treatment effect estimates. The method described herein can be useful for researchers who wish to estimate a conservative range of plausible treatment effects based on limited reported data. Limitations of this method are discussed.

Harvest for Health Gardening Intervention Feasibility Study in Cancer Survivors

Abstract Background. Cancer survivors are at increased risk for second malignancies, cardiovascular disease, diabetes, and functional decline. Evidence suggests that a healthful diet and physical activity may reduce the risk of chronic disease and improve health in this population. Methods. We conducted a feasibility study to evaluate a vegetable gardening intervention that paired 12 adult and child cancer survivors with Master Gardeners to explore effects on fruit and vegetable intake, physical activity, quality-of-life, and physical function. Throughout the year-long study period, the survivor-Master Gardener dyads worked together to plan/plant three gardens, harvest/rotate plantings, and troubleshoot/correct problems. Data on diet, physical activity, and quality-of-life were collected via surveys; anthropometrics and physical function were objectively measured. Acceptability of the intervention was assessed with a structured debriefing survey. Results. The gardening intervention was feasible (robust enrollment; minimal attrition) and well-received by cancer survivors and Master Gardeners. Improvement in three of four objective measures of strength, agility, and endurance was observed in 90% of survivors, with the following change scores [median (interquartile range)] noted between baseline and one-year follow-up: hand grip test [+ 4.8 (3.0, 6.7) kg], 2.44 meter Get-Up-and-Go [+ 1.0 (+ 1.8, + 0.2) seconds], 30-second chair stand [+ 3.0 (+ 1.0, 5.0) stands], and six-minute walk [+ 11.6 (6.1, 48.8) meters]. Increases of ≥ 1 fruit and vegetable serving/day and ≥ 30 minutes/week of physical activity were observed in 40% and 60%, respectively. Conclusion. These preliminary results support the feasibility and acceptability of a mentored gardening intervention and suggest that it may offer a novel and promising strategy to improve fruit and vegetable consumption, physical activity, and physical function in cancer survivors. A larger randomized controlled trial is needed to confirm our results.

Is funding source related to study reporting quality in obesity or nutrition randomized control trials in top-tier medical journals

Background:Faithful and complete reporting of trial results is essential to the validity of the scientific literature. An earlier systematic study of randomized controlled trials (RCTs) found that industry-funded RCTs appeared to be reported with greater quality than non-industry-funded RCTs. The aim of this study was to examine the association between systematic differences in reporting quality and funding status (that is, industry funding vs non-industry funding) among recent obesity and nutrition RCTs published in top-tier medical journals.Methods:Thirty-eight obesity or nutrition intervention RCT articles were selected from high-profile, general medical journals (The Lancet, Annals of Internal Medicine, JAMA and the British Medical Journal) published between 2000 and 2007. Paired papers were selected from the same journal published in the same year, one with and the other without industry funding. The following identifying information was redacted: journal, title, authors, funding source and institution(s). Then three raters independently and blindly rated each paper according to the Chalmers method, and total reporting quality scores were calculated.Findings:The inter-rater reliability (Cronbachs alpha) was 0.82 (95% confidence interval=0.80–0.84). The total mean (M) and s.d. of Chalmers Index quality score (out of a possible 100) for industry-funded studies were M=84.5, s.d.=7.04 and for non-industry-funded studies they were M=79.4, s.d.=13.00. A Wilcoxon matched-pairs signed-ranks test indicates no significant rank difference in the distributions of total quality scores between funding sources, Z=−0.966, P=0.334 (two tailed).Interpretation:Recently published RCTs on nutrition and obesity that appear in top-tier journals seem to be equivalent in quality of reporting, regardless of funding source. This may be a result of recent reporting of quality statements and efforts of journal editors to raise all papers to a common standard.

Outside-of-school time obesity prevention and treatment interventions in African American youth

Outside‐of‐school time (OST; i.e. before/after‐school hours, summer time), theory‐based interventions are potential strategies for addressing increased obesity among African American youth. This review assessed interventions across multiple settings that took place during OST among African American youth aged 5–18 years old. Seven databases were searched for studies published prior to October 2013; 28 prevention and treatment interventions that assessed weight or related behaviours as a primary or secondary outcome were identified. Overall, these studies reported heterogeneous intervention length, theoretical frameworks, methodological quality, outcomes, cultural adaption and community engagement; the latter two attributes have been identified as potentially important intervention strategies when working with African Americans. Although not always significant, generally, outcomes were in the desired direction. When examining programmes by time of intervention (i.e. after‐school, summer time, time not specified or multiple time periods), much of the variability remained, but some similarities emerged. After‐school studies generally had a positive impact on physical activity, fruit/vegetable consumption and caloric intake, or body composition. The single summer time intervention showed a trend towards reduced body mass index. Overall findings suggest that after‐school and summer programmes, alone or perhaps in combination, offer potential benefits for African American youth and could favourably influence diet and physical activity behaviour.