Shira Dunsiger

Validation of Walk Score for estimating access to walkable amenities

Background Proximity to walkable destinations or amenities is thought to influence physical activity behaviour. Previous efforts attempting to calculate neighbourhood walkability have relied on self-report or time-intensive and costly measures. Walk Score is a novel and publicly available website that estimates neighbourhood walkability based on proximity to 13 amenity categories (eg, grocery stores, coffee shops, restaurants, bars, movie theatres, schools, parks, libraries, book stores, fitness centres, drug stores, hardware stores, clothing/music stores). Objective The purpose of this study is to test the validity and reliability of Walk Score for estimating access to objectively measured walkable amenities. Methods Walk Scores of 379 residential/non-residential addresses in Rhode Island were manually calculated. Geographic information systems (GIS) was used to objectively measure 4194 walkable amenities in the 13 Walk Score categories. GIS data were aggregated from publicly available data sources. Sums of amenities within each category were matched to address data, and Pearson correlations were calculated between the category sums and address Walk Scores. Results Significant correlations were identified between Walk Score and all categories of aggregated walkable destinations within a 1-mile buffer of the 379 residential and non-residential addresses. Test–retest reliability correlation coefficients for a subsample of 100 addresses were 1.0. Conclusion These results support Walk Score as a reliable and valid measure of estimating access to walkable amenities. Walk Score may be a convenient and inexpensive option for researchers interested in exploring the relationship between access to walkable amenities and health behaviours such as physical activity.

Walk score™ as a global estimate of neighborhood walkability.

BACKGROUND Walk Score recently has been demonstrated as a valid and reliable tool for estimating access to nearby facilities, a critical component of the physical activity environment. It has not yet been determined whether Walk Score relates to other critical components of the physical activity environment, including street connectivity, access to public transit, residential density, and crime. PURPOSE The aim of this study was to explore the relationship between Walk Score and objective/subjective measures of the physical activity environment. METHODS Walk Scores were calculated for residential addresses of 296 participants of two RCTs (2006-2009). Street connectivity, residential density, access to public transit provisions, and crime were objectively measured (GIS) and cross-referenced with Walk Scores and participants perceptions of the environment (e.g., perceived crime, access to physical activity facilities, perceived neighborhood walkability). Pairwise Pearson correlations were calculated in March 2010 to compare Walk Score to subjective/objective measures of neighborhood walkability. RESULTS Significant positive correlations were identified between Walk Score and several objective (e.g., street connectivity, residential density and access to public transit provisions) and subjective (e.g., summed score of the physical activity environment) measures of the physical activity environment. However, positive correlations also were observed between Walk Score and crime. CONCLUSIONS Collectively, these findings support Walk Score as a free, easy-to-use, and quick proxy of neighborhood density and access to nearby amenities. However, positive associations between Walk Score and reported crime highlight a limitation of Walk Score and warrant caution of its use.

Home‐based exercise among cancer survivors: adherence and its predictors

Objective: Evidence of the benefits of exercise for those treated for cancer has led to exercise interventions for this population. Some have questioned whether cancer patients offered a home‐based intervention adhere to the exercise prescribed.

Risk perception and smoking behavior in medically ill smokers: a prospective study

AIMS To examine the influence of risk perception on intentions to quit smoking and post-treatment abstinence. DESIGN Prospective and longitudinal. SETTING United States. PARTICIPANTS A total of 237 adult smokers (mean age 56 years) receiving medical care from home health-care nurses. Participants did not have to want to quit smoking to participate, but received cessation counseling within the context of their medical care. MEASUREMENTS Three measures of risk perception were given pre- and post-treatment: perceived vulnerability, optimistic bias and precaution effectiveness. Smoking status was verified biochemically at end of treatment and at 2, 6 and 12 months later. FINDINGS Principal components analysis supported the theoretical discriminability of the risk perception measures, and intercorrelations provided evidence for concurrent and predictive validity. Elevated risk perception was associated with a variety of socio-demographic and psychosocial characteristics. Optimistic bias was associated significantly with older age and ethnic minority status. Smokers in pre-contemplation had lower perceived vulnerability and precaution effectiveness and greater optimistic bias than those in contemplation and preparation. Smokers in preparation had higher perceived vulnerability and lower optimistic bias than those in earlier stages. Change in perceived vulnerability predicted smoking cessation at follow-up. Optimistic bias predicted a lower likelihood of cessation and precaution effectiveness predicted a greater likelihood of smoking cessation, but only among those with a smoking-related illness. CONCLUSIONS In patients receiving medical care from home health-care nurses, change in perceived vulnerability to smoking-related disease is predictive of smoking cessation. In those with smoking-related illnesses, optimistic bias predicts continued smoking while precaution effectiveness predicts cessation.

A culturally adapted physical activity intervention for Latinas: a randomized controlled trial.

BACKGROUND In the U.S., Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention. Thus, the purpose of the current study was to culturally and linguistically adapt an empirically supported, individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program. DESIGN An RCT was conducted. SETTING/PARTICIPANTS The sample included 93 overweight/obese (80%) Latinas with low income and acculturation. INTERVENTION Data were collected in 2007-2008 and analyzed by intent-to-treat in 2009. Participants were randomly assigned to either (1) a culturally and linguistically adapted physical activity intervention (Seamos Activas) or (2) a wellness contact control condition. MAIN OUTCOME MEASURES Self-report physical activity, as measured pre- and post-intervention (6 months, 87% retention) by the 7-Day Physical Activity Recall. RESULTS Moderate-intensity (or greater) physical activity increased from an average of 16.56 minutes/week (SD=25.76) at baseline to 147.27 (SD=241.55) at 6 months in the intervention arm (n=45), and from 11.88 minutes/week (SD=21.99) to 96.79 (SD=118.49) in the wellness contact control arm (n=48). No between-group differences were seen in overall physical activity. Intervention participants reported significantly greater increases in cognitive (F[1, 91]=9.53, p=0.003) and behavioral processes of change (F[1, 91]=8.37, p=0.005) and available physical activity supplies and equipment at home (F[1, 91]=4.17, p=0.04) than control participants. CONCLUSIONS Results supported the hypothesized feasibility, acceptability, and preliminary efficacy of individually tailored physical activity print interventions among Latinas. Although more research is needed to corroborate these findings, such high-reach, low-cost approaches have great potential to positively affect public health. TRIAL REGISTRATION NCT00724165.

Exercise and relaxation intervention for breast cancer survivors: feasibility, acceptability and effects

Objective: Although evidence mounts regarding the beneficial effects of physical activity (PA) interventions for breast cancer survivors, not all interventions have produced significant improvement in mood. Relaxation training may be a promising strategy for enhancing mood effects from these interventions. The goals of Be Calm and Move On were to assess the feasibility, acceptability and preliminary effects of a 12‐week combined PA and relaxation intervention for breast cancer survivors.

Nurse–Community Health Worker Team Improves Diabetes Care in American Samoa: Results of a randomized controlled trial

OBJECTIVE To evaluate the effectiveness of a culturally adapted, primary care–based nurse–community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures. RESEARCH DESIGN AND METHODS Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care. RESULTS Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA1c was 9.8% at baseline. At 12 months, mean HbA1c was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = −0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA1c of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups. CONCLUSIONS A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.

User attitudes towards physical activity websites in a randomized controlled trial

OBJECTIVE To better understand the mixed findings regarding the efficacy of Internet-based physical activity interventions, we examined the use and usefulness of particular website components that may lead to improvements in intervention efficacy. METHOD Participants were sedentary individuals from a 12-month randomized controlled physical activity trial conducted in Providence, Rhode Island and Pittsburgh, Pennsylvania from 2003-2006. The present study included participants from the Tailored Internet arm (n=81; instantaneous web-based tailored feedback to participants) or the Standard Internet arm (n=82; websites currently available to the public). We obtained objective data via the intervention websites and subjective usefulness data via questionnaires. RESULTS The Tailored Internet arm logged onto their website significantly more times than the Standard Internet arm (median 50 vs. 38; p<.05). Among participants in the Tailored Internet arm, the self-monitoring feature (i.e., logging) followed by goal setting were rated as the most useful website components. CONCLUSION Logins in the current study were substantially higher compared to previous studies. Participants endorsed goal setting and self-monitoring as being most useful, which are critical components for health behavior change. Future studies should continue to examine these features and improve the perceived usefulness of other theory-based strategies.

Association of fish oil supplement use with preservation of brain volume and cognitive function

The aim of this study was to investigate whether the use of fish oil supplements (FOSs) is associated with concomitant reduction in cognitive decline and brain atrophy in older adults.

Moderate Intensity Exercise as an Adjunct to Standard Smoking Cessation Treatment for Women: A Pilot Study

Previous randomized controlled trials have not supported moderate intensity exercise as an efficacious adjunct to smoking cessation treatments for women; however, compliance with exercise programs in these studies has been poor. The purpose of this pilot study was to estimate the effects of moderate intensity exercise on smoking cessation outcomes under optimal conditions for exercise program compliance. Sixty previously sedentary, healthy, female smokers were randomized to an 8-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either 150 min/week of moderate intensity exercise or contact control. Participants attended a median of 86.4% and 95.5% of prescribed exercise/control sessions, respectively. There was a moderate, though statistically nonsignificant, effect of exercise at post-treatment for objectively verified 7-day point prevalence abstinence (48.3% vs. 23.3%; OR = 3.07, 95% CI: 0.89-11.07) and prolonged abstinence (34.5% vs. 20.0%; OR = 2.11, 95% CI: 0.56-8.32). Effects were attenuated when controlling for potential confounders, and after a 1-month, no-treatment period. The findings provide a preliminary indication that, given adequate compliance, moderate intensity exercise may enhance short-term smoking cessation outcomes for women; however, a larger trial is warranted.