Search

Background: Effective physical activity (PA) interventions are needed to counter the insufficient and declining levels of PA in youth. These require an updated, comprehensive planning framework that consolidates recent decades of progress in promoting PA in young children, children, and adolescents. Effective PA interventions require program planning and conceptual model development that target a coordinated and multilevel set of age-specific PA determinants. Accordingly, this paper presents a comprehensive planning framework that researchers can use to design intervention research to promote PA in youth. Methods: The first author conducted targeted searches through Google Scholar to compile PA models/frameworks/guides applicable to youth, a comprehensive set of PA determinants, and determinant-linked strategies to promote PA focusing on review articles. The information was summarized in tables, synthesized, and used to create a planning framework, all of which were reviewed by coauthors. Results: The APPLE Framework for Planning PA Opportunities for Youth (APPLE = Age, PA focus, Place and time, Leverage relevant influences and strategies, and ensure Enjoyable PA opportunities) incorporated all core elements from targeted reviews to create a comprehensive planning framework. The APPLE Planning Framework has a set of questions/prompts that guide the intervention planning process and conceptual model templates to organize planning efforts for designing intervention research. Conclusions: The APPLE Framework for Planning PA Opportunities for Youth will enable researchers to develop comprehensive conceptual models to guide the design of PA interventions for youth. Future research should refine the model and its components to enable PA intervention research in youth to move forward. [ABSTRACT FROM AUTHOR]

Background: Organizational adoption is a key but understudied step in translating evidence-based interventions into practice. The purpose of this study was to report recruitment strategies and factors associated with church enrollment and intervention adoption in a national implementation study of the Faith, Activity, and Nutrition (FAN) program. Methods: We worked with partners using multiple strategies to disseminate intervention availability. Interested churches completed an online form. To enroll, the church coordinator (FAN coordinator) and pastor completed baseline surveys and then received intervention online training access. We compared enrolled vs. non-enrolled churches on how they heard about the study and church characteristics. We compared intervention-adopting vs. non-adopting churches on Consolidated Framework for Implementation Research (CFIR) constructs using Fisher's exact tests, χ2, or independent sample t-tests and reported differences where p < 0.10, d≥|0.35|, or the difference in percentage points was ≥ 10. Results: We received 226 interest forms; 107 churches enrolled, and 85 churches adopted the intervention. Faith-based sources were the most, and paid media the least, effective in reaching churches, which were largely from the southeast with a Methodist or Baptist tradition (no differences by enrollment status). Enrolled churches were less likely to have 500 + worshipers and more likely to have attended a study information session than non-enrolled churches. Church (CFIR inner setting) and FAN coordinator characteristics, but not intervention characteristics, were related to intervention adoption. Conclusion: Partnerships, relationships, and "face time" are important for enrolling churches in evidence-based interventions. Church and church coordinator characteristics are related to intervention adoption. Further work on adoption conceptualization and operationalization is needed. [ABSTRACT FROM AUTHOR]

Many children do not realize the physical health, mental health, cognitive, and academic benefits of physical activity because they are insufficiently active. Effectively promoting physical activity in children requires understanding the determinants of physical activity. Parent physical activity and support for physical activity have emerged as central influences, but few studies have applied longitudinal designs and device-based measures of child physical activity. The purposes of this cohort study were to examine direct associations between parent physical activity and child physical activity, parent physical activity and parent support for physical activity, and parent support and child physical activity; and to examine indirect associations between parent physical activity and child physical activity, mediated through parent support behaviors. We used structural equation modeling with panel analysis to examine direct and indirect influences of parent physical activity and support on 7th grade children's physical activity, adjusted for 5th grade levels. Parent surveys were administered at the 5th grade time-point. Parent physical activity indirectly affected child physical activity, mediated through the parent support behavior of providing transportation for physical activity. Parent physical activity was also directly related to four parent support behaviors. Increasing parent support for child physical activity, and possibly parent physical activity, may be effective approaches to increasing child physical activity. Highlights: Parent physical activity is indirectly related to child physical activity. Parent physical activity influences child physical activity through parent support. Increasing parent instrumental support likely increases child physical activity. Increasing parent physical activity may increase child physical activity. [ABSTRACT FROM AUTHOR]

The purposes of this study are to describe a process of structuring a tool (later named LAST letter), present my personal experiences by using it, and examine its meaning and utility. The LAST letter structure was grounded in my heartfelt desire to communicate with my deceased father. Its components are consistent with concepts in the literature for narrative writing for grief, including writing letters to the deceased. I examined the LAST letter I wrote to my deceased father considering previously published writing interventions and the meaning reconstruction model, and I explored how writing it helped resolve my bereavement-related regrets, strengthened continuing bonds, and facilitated meaning-making and personal growth. Few studies have focused on bereavement in an older adult and reflected on how the death of a loved one in the social context of a nursing home influenced the grieving process, with special attention to the challenges of providing eldercare and end-of-life planning. The novel, flexibly structured LAST letter tool has the potential to resolve bereavement-related regrets and facilitate meaning-making and continuing bonds for the bereaved. [ABSTRACT FROM AUTHOR]

Background: Nongovernment food assistance is typically provided to families by faith-based organizations, schools, and food banks. Community organizations appear to be strongly committed to these programs, but little is known about the basis for this commitment. Objectives: The aim of this study was to examine the values and identities of community organizations to understand the reasons for their commitment to providing nongovernment food assistance. Methods: Thirty-three in-depth interviews were conducted with 36 leaders at faith-based organizations (19 participants), schools (14 participants), and a local food bank (3 participants) in South Carolina. Observations were made, and informational documents (e.g., flyers and pamphlets) were reviewed. Thematic coding using the constant comparative method was guided by the policy concepts of organizational perspectives, values, and identities. Results: Nongovernment food programs offered participants volunteering opportunities to become involved with community organizations, which in turn increased financial support for the sustainability of these programs. School participants regarded themselves as a mechanism through which food programs were provided because of their commitment to students and believed they have limited capacity to make proposals to influence the food programs. Seeking to improve the well-being of the community by ending hunger was not the primary value on which organizations focused; instead, it was the process of fulfilling other values (e.g., forming or maintaining relationships within the community), maintaining identity, and appealing to their participants that strengthened their commitment to nongovernment food programs. Conclusion: Nongovernment programs are meant to be a solution to food insecurity complementary to government programs. Commitment to nongovernment programs fulfills organizational identities, wants, and assumptions, but a consequence of commitment to food programs, derived from fulfilling other values, is that the roots of hunger in a community become obscured and alternative solutions are ignored or rejected. [ABSTRACT FROM AUTHOR]

Background: The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children's physical activity, though the term "physical activity desert" has not come into wide use. Methods: This exploratory study operationalized the term "physical activity desert" and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities. Results: Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children. Conclusion: Children living in a "no park" zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of "physical activity desert." Future studies of physical activity deserts should be undertaken in larger and more diverse samples. [ABSTRACT FROM AUTHOR]

Background: Interventions promoting physical activity (PA) in youth have had limited success, in part because studies with methodological challenges have yielded an incomplete understanding of personal, social, and environmental influences on PA. This study described changes in these factors for subgroups of youth with initially high PA that decreased (Active-Decline) compared with children with initially low PA that decreased (Inactive-Decline) from fifth to ninth grades. Methods: Observational, prospective cohort design. Participants (n = 625) were fifth-grade children recruited in 2 school districts and followed from elementary to high school. Students and their parents responded to questionnaires to assess personal, social, and perceived physical environmental factors in the fifth (mean age = 10.5 [.5] y) and ninth (mean age = 14.7 [.6] y) grades. Analyses included a mixed-model 2-way repeated analysis of variances. Results: Children in the Active-Decline compared with those in the Inactive-Decline group showed a more favorable profile in 6 of 8 personal variables (perceived barriers, self-efficacy, selfschema, enjoyment, competence, and fitness motives) and 4 of 6 social variables (friend support, parent encouragement, parent support, and parent-reported support). Conclusions: The results suggest efforts to promote PA should target selected personal, social, and perceived environmental factors beginning before age 10 and continuing through adolescence. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) provides important health benefits to children, and a large percentage of children's PA occurs at home. The purpose of this study was to examine the associations between psychosocial, home, and neighborhood environmental factors and children's reported PA at home and in the neighborhood, during the transition from elementary to high school. Methods: A total of 555 participants (44% boys) were recruited in grade 5 and followed through grades 6, 7, and 9. Children self-reported PA in 3 locations--at home, in the neighborhood, and on the street. Children reported parent support and neighborhood environment, parents reported PA equipment, and a windshield survey assessed incivilities and outside PA equipment. Longitudinal Poisson models evaluated the relationships between environmental variables and 3 self-reported PA variables, adjusting for gender, race/ethnicity, and parent education. Results: Parent support and PA equipment were significant positive predictors of home PA. Child's perceived environment (positive) and incivilities (negative) were significant predictors of neighborhood PA. Parental support, perceived environment, and outside PA equipment were positive significant predictors of street PA. Conclusions: This study supports the need for both family and community/neighborhood PA interventions that encourage parents to support child PA and for communities to reduce incivilities. [ABSTRACT FROM AUTHOR]

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be "just right" and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability. [ABSTRACT FROM AUTHOR]

Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P  < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools. [ABSTRACT FROM AUTHOR]

Introduction: This longitudinal study determined if social cognitive variables influence physical activity in girls stratified on the basis of maturity status. Methods: Participants attended South Carolina public schools (Mage in 5th grade = 11.1 years) and included a cohort of 529 girls who provided physical activity data in the 5th grade and in 6th and/or 7th grade. The measure of maturity status was age at peak height velocity (APHV) estimated from maturity offset when the children were in the 5th grade. The Earlier Maturity (EM) group included girls whose APHV was one standard deviation or more below the mean APHV for the full sample. All other girls were placed in the Later Maturity (LM) group. Physical activity was assessed at each time point via accelerometry. Social‐cognitive variables were assessed at each time point by a questionnaire measuring self‐efficacy, enjoyment, competence, appearance, fitness, and social motives for physical activity. Growth curves for the total, Earlier Maturing, and Later Maturing groups assessed relationships between physical activity over time and time‐varying social cognitive variables. Results: Physical activity was lower in the Earlier Maturing group and was positively associated with self‐efficacy and enjoyment motivation in the total group. These relationships were observed in the 5th grade and maintained through 7th grade. In the Later Maturing group, we observed positive relationships between physical activity and self‐efficacy, enjoyment and competence motivation. Conclusions: Strategies to increase confidence, skills, and enjoyment of physical activity may only be effective for promoting activity among later maturing girls. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the impact of ecological health promotion interventions on organizational practices over time, especially in faith-based settings. This statewide dissemination and implementation study examined change in organizational practices and their predictors across a 24-month period, as well as maintenance of change. Methods: Using a pre-post quasi-experimental design, church coordinators from 92 United Methodist Churches in South Carolina (42% predominantly African American congregations) completed surveys at baseline, and immediate, 12-, and 24-months post-training regarding physical activity (PA) and healthy eating (HE) organizational practices consistent with the Faith, Activity, and Nutrition (FAN) program (opportunities, policies, pastor support, messages) and possible predictors. The study was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR). Mixed model repeated measures analyses examined change in organizational practices over time. Regression models examined CFIR predictors of 24-month PA and HE organizational practices, controlling for baseline practices. Churches were also classified as maintainers (implemented at 12 and 24 months), non-sustained implementers (implemented at 12 but not 24 months), delayed implementers (implemented at 24 but not 12 months), and low implementers (implemented at neither 12 nor 24 months) for each FAN component. Results: PA and HE organizational practices increased over time (p <.0001). CFIR domains (and constructs within) of intervention characteristics (adaptability, relative advantage, cost/time), inner setting (relative priority, organizational rewards, readiness, congregant needs), characteristics of the implementer (self-efficacy, perceived benefits), and implementation process (engaging opinion leaders, engaging champions) were important predictors of 24-month PA and HE organizational practices. Over half of churches implementing PA policies, PA messages, HE policies, and HE opportunities at 12 months were maintainers at 24 months, and one-third were maintainers for PA opportunities, HE messages, and PA and HE pastor support. Furthermore, 16% of 12-month non-implementers were delayed implementers at 24 months for PA policies and 31% were delayed implementers for HE policies. Conclusions: This study makes important contributions to the faith-based health promotion literature by including a large sample of churches, testing an ecological intervention approach, and assessing organizational practices over a 24-month period. Study findings can guide technical assistance and program adaptations over time. Trial registration: This study was registered in clinicaltrials.gov NCT02868866 on August 16, 2016. [ABSTRACT FROM AUTHOR]

This study examined associations of various elements of the home environment with after-school physical activity and sedentary time in 671 6th-grade children (Mage = 11.49 ± 0.5 years). Children's after-school total physical activity, moderate-to-vigorous physical activity, and sedentary time were measured by accelerometry. Parents completed surveys assessing elements of the home social and physical environment. Mixed-model regression analyses were used to examine the associations between each element of the home environment and children's after-school physical activity and sedentary time. Availability of home physical activity resources was associated positively with after-school total physical activity and negatively with after-school sedentary time in boys. Parental support was associated positively with after-school total physical activity and MVPA and negatively with after-school sedentary time in girls. The home physical environment was associated with boys' after-school physical activity and sedentary time, whereas the home social environment was associated with girls' after-school physical activity and sedentary time. [ABSTRACT FROM AUTHOR]

Background: The YMCA of USA recently adopted Healthy Eating and Physical Activity (HEPA) Standards for their summer-day-camps (SDCs). Standards call for staff to exhibit HEPA promoting behaviors while eliminating HEPA discouraging behaviors. No studies have evaluated training programs to influence policy specified staff behaviors and related changes in child activity in SDCs. Method: Four YMCA SDCs serving approximately 800 children/week participated in this no control group pre/post pilot study. Professional development training founded in the 5 Ms (Mission, Model, Manage, Monitor, Maximize) and LET US Play principles (lines; elimination; team size; uninvolved staff/kids; and space, equipment, and rules) was delivered to staff. Outcomes were staff promotion behaviors and child activity assessed via systematic observation instruments. Results: Twelve of 17 HEPA staff behaviors changed in the appropriate direction from baseline to postassessment with 5 behaviors reaching statistically significant changes. The percentage of girls and boys observed in moderate-to-vigorous physical activity increased from 15.3% to 18.3% (P > .05) and 17.9% to 21.2%, whereas sedentary behavior decreased from 66.8% to 59.8% and 62.3% to 53.6%, respectively. Conclusion: Evidence suggests that the professional development training designed to assist SDCs to meet the HEPA Standards can lead to important changes in staff behaviors and children's physical activity. [ABSTRACT FROM AUTHOR]

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting. [ABSTRACT FROM AUTHOR]

Study of Health and Activity in Preschool Environments (SHAPES) aimed to increase preschoolers' physical activity by engaging preschool teachers in professional development designed to modify instructional practices. SHAPES originated as a randomized controlled trial, tested in 16 preschools and disseminated to 4 control schools, and was shown to be effective in increasing preschool children's physical activity (Phase I, 2008–2012). This article describes the steps taken to translate an evidence-based physical activity intervention, SHAPES, from in-person delivery to online delivery of professional development to preschool teachers. In Phase II (2013–2016), professional development delivery was modified from an in-person to an online program for preschool teachers. Teacher implementation completeness and fidelity were examined in 10 pilot preschools and then replicated in 30 preschools. Large-scale dissemination of SHAPES began in Phase III (2017–2019), reaching 818 teachers from 228 unique centers after 2 years. The final SHAPES program consisted of six online modules, an accompanying guidebook, over 90 activities, self-assessment techniques, a video library, and an electronic community forum. The SHAPES core elements, defined in Phase I, were retained throughout all three phases. The Phase II change to online delivery was characterized by high levels of implementation completeness and fidelity. Results of Phase III statewide dissemination revealed comparable implementation completeness and fidelity. An intervention shown to be effective in a randomized controlled trial can be translated into an online professional development program and disseminated on a large scale in a timely manner. [ABSTRACT FROM AUTHOR]

Purpose: Our goal was to describe the types of physical activities and sedentary pursuits reported by children living in residential children's homes and make comparisons by age, gender, and race/ethnic groups. Methods: Participants were 263 children (52% male, 40% 11 to 14 years old, 53% White, 23% African American, and 24% other race/ethnic groups) in 23 residential children's homes in North and South Carolina. The median length of stay in the homes was 6 months. Physical activities and sedentary pursuits were reported over a 3-day period using the 3-Day Physical Activity Recall (3DPAR). Results: Boys reported participating in more basketball (P ≤ .001), football (P ≤ .001), and videogames or surfing the net (P ≤ .001) than did girls. Girls reported more cheerleading, social dance, and homework than did boys (P values ? .01). There were few race differences. Fewer older children reported participation in physical education classes, and more reported working part-time than younger children (P values ≤ .001). Conclusions: Children in residential homes appear to participate in activities that are similar to children living with their parents, with boys reporting more team activities and girls reporting more individual activities. However, children in residential children's homes may participate in some physical activities for shorter periods of time than children living with their parents. [ABSTRACT FROM AUTHOR]

Most people with arthritis are not regularly active. Understanding what factors influence exercise is essential for designing programs to increase participation. The objective of this study was to examine the correlates of exercise in people with arthritis. Using a cross-sectional design, sociodemographic, health-related, and psychosocial variables were collected from community-dwelling individuals with arthritis (N = 141). Associations with exercise level were examined with bivariate statistics (ANOVAs, chi-squares) and logistic-regression analyses. Exercisers were less likely than nonexercisers and insufficiently active people to report that arthritis negatively affected their physical and social functioning, and they reported more positive affect and greater self-efficacy (p < .05). Exercisers also reported less pain than nonexercisers (p < .05). In multiple logistic-regression analyses, self-efficacy and physical limitations remained independent predictors of exercise. The results suggest the need to target exercise self-efficacy when designing exercise interventions. Results also suggest the need to tailor exercise programs to individuals' physical limitations. [ABSTRACT FROM AUTHOR]

Background: Physical activity research on trails is limited. We compared rail-trail users and nonusers on demographics, physical activity, and barriers/concerns about trail use; and described use among men and women. Methods: Four hundred thirteen adults completed a physical activity survey during fall 1998. Chi-square statistics and t-tests were used to compare trail users to nonusers, and men and women on trail use. Results: More trail users (79%) performed recreational physical activity ³ 3 d/wk, compared to nonusers (47%). Walking was the most common activity for trail users and nonusers. Both groups shared concerns about safe access to the trail and certain trail conditions. A higher percentage of female versus male users traveled to the trail by walking, walked on the trail, used the trail with a friend, and perceived that if the trail were not available their activity would decrease. Conclusions: Trail users perform more recreational physical activity than nonusers. Gender differences in trail use patterns should be considered in the design and promo-tion of trails. [ABSTRACT FROM AUTHOR]

Little is known about the role of organizational or administrative support in implementation of health promotion interventions, particularly outside of school settings. The purpose was to determine the change in fruit and vegetable (FV) intake among children living in residential children's homes (RCHs) and assess the relationships among change in organizational support, intervention implementation, and child nutrition outcomes. Data were collected from 29 RCHs and 614 children living in RCHs, as part of a group randomized design with delayed intervention, at three cross-sectional waves: 2004, 2006, and 2008. RCH staff made environmental changes to increase intake of FV. Implementation and organizational support data were collected from staff at the RCHs. Child FV intake were measured via 24-h dietary recalls. A two-way (condition by time) repeated measures ANOVA was conducted to test whether FV intake increased in response to the intervention. A two-level path analysis with a robust maximum likelihood estimator was used to explore the relationships among organizational support, intervention implementation fidelity, and child FV intake. There was a significant increase in FV intake within all RCHs from 2004 to 2006 (P = 0.022 for the intervention group, P = 0.015 for the control group). This increase was maintained in both groups from 2006 to 2008 (post-intervention mean servings: intervention = 3.2 vs control = 3.4). Increases in organizational support resulted in greater overall implementation fidelity. When RCH staff, supervisors, and the RCH CEO were perceived to be supportive of the intervention, more environmental changes were made to encourage eating FV. Fostering organizational support may improve implementation of interventions. [ABSTRACT FROM AUTHOR]

Faith-based settings offer opportunities for reaching populations at risk for chronic conditions and are optimal settings for dissemination and implementation (D&I) research. Faith, Activity, and Nutrition (FAN) is an evidence-based program designed to promote physical activity (PA) and healthy eating (HE) through church policy, systems, and environmental change. We report implementation fidelity for Phase 1 of the FAN D&I project, a countywide effort. The group randomized study included pre- and postintervention assessments of core PA and HE components. We compared implementation in early intervention (n = 35) versus delayed intervention (control, n = 19) churches; assessed individual church implementation; and examined the effects of level of implementation on church member outcomes. Implementation assessments were conducted with the FAN coordinator via telephone survey. Study outcomes were assessed with church members 8 to 12 months following baseline assessment via self-administered surveys. We found significantly higher levels of implementation for PA opportunities, PA and HE guidelines, PA and HE messages, and PA and HE pastor support in intervention versus control churches and showed church-level variation in PA and HE implementation. PA self-efficacy varied by level of implementation; high and low implementers did not differ in proportion of church members physically inactive, although low implementers had fewer members inactive than controls. The high level of implementation in intervention churches shows promise for broader dissemination of FAN. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: The purpose of this study was to characterize the temporal, social, and physical contexts for physical activities commonly reported in a diverse cohort of 753 boys and girls from fifth to seventh grade. METHODS: Data were obtained from a multilevel longitudinal study, the Transitions and Activity Changes in Kids. The Physical Activity Choices instrument assessed previous 5‐day participation in specific physical activities and their temporal, social, and physical contexts. Mixed model repeated measure analyses of variance and multinomial analyses examined sex differences and change over time. RESULTS: Fifth grade boys and girls reported participation in similar activities at similar frequencies, which declined significantly by seventh grade. One temporal pattern, playing with younger children, changed over time from “both inside/outside” to “outside” school. Boys and females reported more activities performed in class/team groups over time. Most activities took place primarily at home for all participants in both grades. CONCLUSIONS: Boys and girls reported declines in the variety and frequency of activities from fifth to seventh grade. There were sex‐specific patterns in physical activities and groups; however, all participants reported home as the primary location and a shift to class/team groups over time. Schools are well‐positioned to provide additional physical activity opportunities. [ABSTRACT FROM AUTHOR]

This study investigated the utility of the Study of Health and Activity in Preschool Environments (SHAPES) conceptual model, which targeted physical activity (PA) behavior in preschool children, by examining the relationship between implementation monitoring data and child PA during the school day. We monitored implementation completeness and fidelity based on multiple elements identified in the conceptual model. Comparing high-implementing, low-implementing, and control groups revealed no association between implementation and outcomes. We performed post hoc analyses, using process data, to refine our conceptual model’s depiction of an effective preschool PA-promoting environment. Results suggest that a single component of the original four-component conceptual model, providing opportunities for moderate-to-vigorous physical activity through recess for 4-year-old children in preschool settings, may be a good starting place for increasing moderate-to-vigorous physical activity. Interventions that are implemented with optimal levels of completeness and fidelity are more likely to achieve behavior change if they are based on accurate conceptual models. Examining the mechanisms through which an intervention produces its effects, as articulated in the conceptual model that guides it, is particularly important for environmentally focused interventions because they are guided by emerging frameworks. The results of this study underscore the utility of using implementation monitoring data to examine the conceptual model on which the intervention is based. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether naturally-occurring changes in children’s motives and beliefs are associated with the steep decline in physical activity observed from childhood to early adolescence. Methods: Latent growth modeling was applied in longitudinal tests of social-cognitive influences, and their interactions, on physical activity in a large cohort of boys and girls evaluated annually between 5th and 7th grades. Results: Measurement equivalence of motives and beliefs was confirmed between boys and girls. After adjustment for gender and maturity differences, physical activity declined less in children who reported the least decreases in self-efficacy for overcoming barriers to activity and perceived parental support. Physical activity also declined less in students who persistently felt they had more parental and friend support for activity compared to those who reported the largest decrease in support from friends. After further adjustment for race, the decline in physical activity was less in those who had the largest decrease in perceived barriers and maintained a favorable perception of their neighborhood environment. Changes in enjoyment and social motives were unrelated to change in physical activity. Conclusion: Using an objective measure of physical activity, we confirm that naturally-occurring changes in children’s beliefs about barriers to physical activity and their ability to overcome them, as well as perceptions of their neighborhood environment and social support, are concurrent with age-related declines in children’s physical activity. The longitudinal findings confirm these putative social-cognitive mediators as plausible, interacting targets of interventions designed to mitigate the marked decline in physical activity that occurs during the transition between elementary and middle schools. [ABSTRACT FROM AUTHOR]

Examining factors that influence implementation of key program components that underlie an intervention's success provides important information to inform the development of effective dissemination strategies. We examined direct and indirect effects of preschool capacity, quality of prevention support system and teacher characteristics on implementation levels of a component, called Move Outside (i.e., preschool classroom teachers to provide at least 40min of outdoor recess per day), that was fundamental to the success of a preschoolbased physical activity intervention. Level of implementation, defined as the percent of daily goal met for the Move Outside component, was assessed via direct observation. Items assessing preschool capacity, quality of prevention support system and teacher characteristics were selected fromsurveys and an environmental checklist completed by preschool directors and teachers. Preschool classroom was used as the unit of analysis (Year 1: n = 19; Year 2: n = 17). Results from Bayesian path analyses showed that the three factors were not significantly associated with level of implementation in Year 1, but preschool capacity was directly associated with level of implementation in Year 2 (β = 0.528, 95% CI: 0.134, 0.827). The current findings suggest that factors that influence level of implementation appear to differ as an intervention evolved over time. [ABSTRACT FROM AUTHOR]

The Environmental Intervention in Children's Homes (ENRICH) study was the first published physical activity intervention undertaken in residential children's homes (RCHs). The study revealed differences in implementation across the homes, which may be a key factor that affects program effectiveness. The purpose of this study was to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation of the ENRICH intervention. This study analyzed the ENRICH process evaluation data collected from 24 RCHs. Bayesian Path analysis was used to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation. Level of implementation across RCHs was variable, ranging from 38 to 97 % (M = 68.3, SD = 14.45). Results revealed that organizational capacity and provider characteristics had significant direct associations with level of implementation. Neither direct nor indirect associations between quality of prevention support system and level of implementation reached statistical significance. Conducting formative assessments on organizational capacity and provider characteristics and incorporating such information in implementation planning may increase the likelihood of achieving higher levels of implementation in future studies. [ABSTRACT FROM AUTHOR]

Research examining sustainability of health promotion programs within organizational settings is limited. The Environmental Interventions in Residential Children's Homes (ENRICH) was a structural intervention that trained Wellness Teams (WTs) within residential children's homes (RCH) to target environmental changes that promote physical activity (PA) among residential youth. This study examines the sustainability of PA promoting environments and influences on sustainability within RCHs. A sustainability survey was administered to 14 RCHs 2 years after receiving ENRICH. Variables included sustainability of PA promoting environments, Organizational Influences, perceived organizational and individual benefits, and implementation of PA and general (i.e. Global) well-ness activities. Activities reported as sustained and barriers were used descriptively to inform sustainability. Path analyses explained the relationship between sustainability influences and sustainability of PA promoting environments. Sustainability was found in 8 of 14 (57%) RCHs. Sustained activities reflected greater Global versus PA implementation. Global implementation mediated the relationship between Organizational Influences and sustainability, which may have been more easily achieved since Global activities were most likely controlled by WTs and did not require extensive organizational support from RCH administrators. Results highlight the importance of defining and assessing different implementation types when measuring sustainability and influences on sustainability within RCHs organizations. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Preschool settings vary greatly, and research has shown that interventions are more successful when they can be adapted to individual settings. This is a descriptive case study of how 2 teachers successfully adapted and implemented a preschool physical activity intervention. METHODS The Study of Health and Activity in Preschool Environments ( SHAPES) was a 3-year physical activity intervention. A detailed case study of 2 high-implementing teachers was conducted. Multiple data sources included accelerometry, direct observation, teacher surveys, and intervention staff field notes. RESULTS Teacher A focused on integrating physical activity into a wide range of activities, including parent and community events. Teacher B focused on high-intensity, structured activities. Both teachers supported the intervention, worked closely with intervention staff, and operated their classroom as an autonomous unit with support from their directors. Teacher A provided an average of 31.5, 78.0, and 67.5 min of physical activity opportunity per day of observation during years 1, 2, and 3. Teacher B provided an average of 2.7, 33.5, and 73.3 minutes of physical activity opportunity per day of observation. CONCLUSION Successful implementation of physical activity interventions may look different in different contexts; thus, interventions should allow for flexible implementation. [ABSTRACT FROM AUTHOR]

This study describes the link between level of implementation and outcomes from an intervention to increase after school programs' (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying factors essential to meeting HE-PA Standards, while 10 control ASPs continued routine practice. All programs, intervention and control, were assigned a STEPs for HE-PA index score based on implementation. Mixed-effects linear regressions showed high implementation ASPs had the greatest percentage of boys and girls achieving 30min of moderate-to-vigorous physical activity (47.3 and 29.3%), followed by low implementation ASPs (41.3 and 25.0%), and control ASPs (34.8 and 18.5%). For healthy eating, high/low implementation programs served fruits and vegetables an equivalent number of days, but more days than control programs (74.0 and 79.1% of days versus 14.2%). A similar pattern emerged for the percent of days sugar-sweetened foods and beverages were served, with high and low implementation programs serving sugar-sweetened foods (8.0 and 8.4% of days versus 52.2%), and beverages (8.7 and 2.9% of days versus 34.7%) equivalently, but less often than control programs. Differences in characteristics and implementation of STEPs for HE-PA between high/low implementers were also identified. [ABSTRACT FROM AUTHOR]

Introduction. Coalitions are often composed of member organizations. Member involvement is thought to be associated with coalition success. No instrument currently exists for evaluating organizational member involvement in physical activity coalitions. This study aimed to develop a survey instrument for evaluating organizational member involvement in physical activity coalitions. The study was carried out in three phases: (a) developing a draft survey, (b) assessing the content validity of the draft survey, and (c) assessing the underlying factor structure, reliability, and validity of the survey. Method. A cross-sectional design was employed. In Phase 1, a team of experts in survey development produced a draft survey. In Phase 2, the content validity of the draft survey was evaluated by a panel of individuals with expertise in physical activity coalitions. In Phase 3, the survey was administered to 120 individuals on local-, state-, and national-level physical activity coalitions. Responses were subjected to an exploratory factor analysis in order to determine the survey’s underlying factor structure, reliability, and validity. Results. Phases 1 and 2yielded a survey instrument with demonstrated content validity. Phase 3 yielded a three-factor model with three subscales: Strategic Alignment, Organizational Alignment, and Providing Input. Each subscale demonstrated high internal consistency reliability and construct validity. Discussion. The survey instrument developed here demonstrated sound psychometric properties and provides new insight into organizational member involvement in physical activity coalitions. This instrument may be an important tool in developing a more complete picture of coalition functioning in physical activity coalitions specifically and health-based coalitions overall. [ABSTRACT FROM AUTHOR]

The objective of this research was to gain a deeper understanding of factors influencing the healthiness of food choice behaviors of community-dwelling adults with severe mental illness. Semi-structured interviews were conducted in an outpatient treatment facility with 20 program participants and 10 staff. Grounded theory analysis methods were used. Five dominant themes emerged: food availability, preference for simple food preparation, perceived cost of food, complexity of choice, and relative importance of healthy food choices. The theme of medication effects only emerged from staff interviews. This research can be useful to inform the design of nutrition interventions for this population. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a recognized public health concern. Inadequate proportions of children in the U.S, including those of preschool age, are meeting physical activity recommendations. In response to low numbers of preschool children attaining appropriate physical activity levels, combined with the large number of young children who attend preschool, researchers have identified the need to devise interventions to increase physical activity at preschools. However, few multi-component interventions to increase physical activity in preschool children exist. The aims of this study were to observe the effects of a multi-component intervention on physical activity, sedentary behavior, and physical activity energy expenditure in 3-5 year-old children; identify factors that associate with change in those variables; and evaluate the process of implementing the multi-component intervention. The purpose of this manuscript is to describe the study design and intervention protocol. Methods/design: The overall design of the Study of Health and Activity in Preschool Environments (SHAPES) was a two-year randomized trial (nested cohort design), with two conditions, two measurement occasions, and preschool serving as the unit of analysis. Sixteen schools (eight intervention and eight control) were enrolled. The intervention protocol was based on the social ecological model and included four main components: (a) indoor physical activity ("move inside"), (b) recess ("move outside"), (c) daily lessons ("move to learn"), and (d) social environment. Components were implemented using teacher and administrator trainings and workshops, site support visits, newsletters, and self-monitoring methods. Outcomes included accelerometer assessment of physical activity, sedentary behavior, and physical activity energy expenditure; weight status; and demographic factors; family/home social and physical environment; and parental characteristics. An extensive process evaluation battery was also used to monitor dose delivered by interventionists, completeness of intervention component delivery by teachers, and fidelity of teachers' implementation. Discussion: The study will address important gaps relative to increasing physical activity in preschool children. Few studies to date have incorporated a multi-component approach, rigorous measurement protocol, and thorough evaluation of intervention implementation. Trial registration: NCT01885325 [ABSTRACT FROM AUTHOR]

Objective Scales used to measure selected social-cognitive beliefs and motives for physical activity were tested among boys and girls. Methods Covariance modeling was applied to responses obtained from large multi-ethnic samples of students in the fifth and sixth grades. Results Theoretically and statistically sound models were developed, supporting the factorial validity of the scales in all groups. Multi-group longitudinal invariance was confirmed between boys and girls, overweight and normal weight students, and non-Hispanic black and white children. The construct validity of the scales was supported by hypothesized convergent and discriminant relationships within a measurement model that included correlations with physical activity (MET &bullet; min/day) measured by an accelerometer. Conclusions Scores from the scales provide valid assessments of selected beliefs and motives that are putative mediators of change in physical activity among boys and girls, as they begin the understudied transition from the fifth grade into middle school, when physical activity naturally declines. [ABSTRACT FROM AUTHOR]

This article presents a framework for developing and carrying out an implementation monitoring plan of a complex structural intervention in an organizational setting and describes seven steps for analyzing and reporting results for fidelity and completeness of implementation. This process is illustrated using the Environmental Interventions in Children’s Homes (ENRICH) Wellness Project. ENRICH aimed to promote physical activity and healthful nutrition behaviors among children residing in children’s group homes by working collaboratively with organizational staff. A comprehensive implementation monitoring plan was developed based on the particulars of the setting, context, and the program framework and used multiple data sources, criteria for evidence of implementation, and data triangulation to examine evidence for organizational implementation. Eleven of 17 organizations (65%) met the criteria for nutrition implementation whereas 9 of 17 (53%) met the criteria for physical activity implementation. Implementation data can be used descriptively, as described here, and may also be used in future outcome analyses to better understand project outcomes. The framework and evaluation approach are applicable to complex interventions in other organizational settings. [ABSTRACT FROM PUBLISHER]

Cigarettes are responsible for nearly 443,000 deaths per year in the United States. Eighty percent of adult smokers began smoking before the age of 18. In 2009, 17.2% of high school and 5.2% of middle school youths reported being a smoker. Research on school perceptions suggests that “engaged” students get more from school on all levels, including reduced health risk behaviors. The purpose of this study was to identify which school perceptions are protective against tobacco use in a sample of middle school youths. Results conclude that high levels of educational attachment are significantly associated with low levels of tobacco use. [ABSTRACT FROM AUTHOR]

Objectives: To explore associations between physical activity (PA) literacy and psychosocial constructs for providing instrumental social support for youth PA. Methods: Ninety-one foster parents completed surveys assessing PA literacy (overall and specific), perceptions of child PA, coordination, PA enjoyment, psychosocial variables: positive/negative beliefs, normative beliefs, perceived behavioral control (PBC), and self-efficacy. Results: Race, negative beliefs, PBC, and foster parent sport involvement were associated with specific PA literacy. Race and education were associated with overall PA literacy. Conclusions: Lower PA literacy is associated with greater negative beliefs and lower perceived control suggesting greater perceived barriers and lower perceived support for/among African Americans and those with less education. [ABSTRACT FROM AUTHOR]

Objectives: To explore associations between physical activity (PA) literacy and psychosocial constructs for providing instrumental social support for youth PA. Methods: Ninety-one foster parents completed surveys assessing PA literacy (overall and specific), perceptions of child PA, coordination, PA enjoyment, psychosocial variables: positive/negative beliefs, normative beliefs, perceived behavioral control (PBC), and self-efficacy. Results: Race, negative beliefs, PBC, and foster parent sport involvement were associated with specific PA literacy. Race and education were associated with overall PA literacy. Conclusions: Lower PA literacy is associated with greater negative beliefs and lower perceived control suggesting greater perceived barriers and lower perceived support for/among African Americans and those with less education. [ABSTRACT FROM AUTHOR]

Churches and other faith-based organizations (FBOs) are a vital resource for HIV prevention and education efforts in African American communities. Few models describe how churches and FBOs have implemented such efforts within their congregations or communities, the challenges they faced, or the changes that resulted from such efforts. This article presents a framework for implementing HIV/AIDS prevention programs in African American churches based upon a qualitative investigation of Project FAITH (Fostering AIDS Initiatives that Heal), an HIV education and stigma reduction demonstration project conducted in South Carolina. Between 2007-2008 in-depth interviews were conducted with 8 pastors, 4 technical assistance providers, and 2 project champions; 22 care team members also participated in focus groups to identify domains associated with project implementation. Data analysis was conducted using a grounded theory approach and inputs, enablers, inhibitors, mediators, and outputs associated with HIV/AIDS prevention programs conducted as part of Project FAITH were identified. Furthermore, the framework includes the influences of public policy and stigma on the faith-based HIV/AIDS prevention programs in this study. The framework calls for the identification of individuals (members of the congregation and church leadership) who are passionate about and devoted to addressing HIV/AIDS, and provides specific mechanisms (i.e., health ministries) through which these individuals can organize, strategies for HIV/AIDS implementation, and areas of technical assistance and capacity building to maximize effectiveness of such efforts. [ABSTRACT FROM AUTHOR]

Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers’s diffusion theory and Rütten’s framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention. [ABSTRACT FROM PUBLISHER]

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, child's preferences for FV and AA of FV in homes of low-income Hispanic families with children 5–12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and child's preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV. [ABSTRACT FROM PUBLISHER]

Objective To test whether self-efficacy for overcoming barriers to physical activity has direct, indirect (i.e., mediated), or moderating relations with naturally occurring change in perceived social support and declines in physical activity during high school. Methods Latent growth modeling was used with measures completed in the 8th, 9th, and 12th grades by a cohort of 195 Black and White girls. Results Self-efficacy was stable and moderated the relation between changes in physical activity and perceived social support. Girls who maintained a perception of strong social support had less of a decline in physical activity if they also had high self-efficacy. However, girls having high self-efficacy had a greater decline in physical activity if they perceived declines in social support. Conclusions Randomized controlled trials of physical activity interventions based on social cognitive theory should consider that the influence of girls' perceptions of social support on their physical activity may differ according to their efficacy beliefs about barriers to physical activity. [ABSTRACT FROM AUTHOR]

Recent studies have found a relationship between access to neighborhood physical activity (PA) facilities and physical activity in youth. The purpose of this study was to assess whether proximity of commercial PA facilities was related to vigorous physical activity (VPA) in 12th grade girls, independent of sport participation and social-cognitive influences, including perceived features of the social and physical environment. Girls ( N = 1,126 girls; 55% black, body mass index = 25.0 ± 6.4) in 22 high schools completed questionnaires and provided home addresses. Using geographic information systems technology, commercial PA facilities were mapped and counted within 0.75- and 2.0-mile street network buffers around each girl’s home. Girls self-reported PA using the 3-day physical activity recall. Approximately 25% of girls had at least one PA facility within the 0.75-mile buffer, and 65% of girls had at least one PA facility within the 2.0-mile buffer. Models of the direct and indirect relations of commercial PA facilities at 0.75- and 2.0-mile buffers, sport participation, self-efficacy for overcoming barriers and perceived physical and social environment with VPA both had acceptable fit to data (root mean square error of approximation = 0.049 and comparative fit index = 0.91). The results indicate that proximity to multipurpose commercial PA facilities is a correlate of VPA independent of sport participation and perceived features of the social and physical environment. [ABSTRACT FROM AUTHOR]