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Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world’s youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature–physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature’s potential contribution to creating more equitable, green, livable cities with active inhabitants.

This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

(1) Background: Findings from observational studies of relations between neighborhood environments and health outcomes underscore the importance of both objective and perceived experiences of those environments. A clearer understanding of the factors associated with discrepancies between these two assessment approaches is needed to tailor public health interventions to specific populations. This study examined how individual and neighborhood characteristics affect perceptions of supermarket distance, particularly when perceptions do not match objective measures. (2) Methods: Participants were older adults (n = 880) participating in the Senior Neighborhood Quality of Life Study in the Seattle/King County, WA or Baltimore/Washington, DC regions. Two main analyses were conducted. The primary outcome for Analysis I was participants' geographic information systems (GIS)-based objective network distance to the closest supermarket. Generalized linear mixed models with block group-level random effects were used to assess associations between objective supermarket distance and individual/neighborhood characteristics. The primary outcome for Analysis II was a categorical "accuracy" variable, based on participants' perceived distance to the nearest supermarket/grocery store relative to the objective distance, assuming a walking speed of 1.0 m/s. Multivariate log-linear models fit neural networks were used to assess influential covariates. (3) Results: Several significant associations with objective distance to the nearest supermarket were observed, including a negative relationship with body mass index (BMI) (95% CI = -45.56, -0.23), having walked to the supermarket in the last 30 days (-174.86, -59.42), living in a high-walkability neighborhood, and residing in Seattle/King County (-707.69, -353.22). In terms of participants' distance accuracy, 29% were classified as accurate, 33.9% were "Underestimators", 24.0% "Overestimators", and 13.2% responded "Don't Know". Compared to

(1) Background: Findings from observational studies of relations between neighborhood environments and health outcomes underscore the importance of both objective and perceived experiences of those environments. A clearer understanding of the factors associated with discrepancies between these two assessment approaches is needed to tailor public health interventions to specific populations. This study examined how individual and neighborhood characteristics affect perceptions of supermarket distance, particularly when perceptions do not match objective measures. (2) Methods: Participants were older adults (n = 880) participating in the Senior Neighborhood Quality of Life Study in the Seattle/King County, WA or Baltimore/Washington, DC regions. Two main analyses were conducted. The primary outcome for Analysis I was participants' geographic information systems (GIS)-based objective network distance to the closest supermarket. Generalized linear mixed models with block group-level random effects were used to assess associations between objective supermarket distance and individual/neighborhood characteristics. The primary outcome for Analysis II was a categorical "accuracy" variable, based on participants' perceived distance to the nearest supermarket/grocery store relative to the objective distance, assuming a walking speed of 1.0 m/s. Multivariate log-linear models fit neural networks were used to assess influential covariates. (3) Results: Several significant associations with objective distance to the nearest supermarket were observed, including a negative relationship with body mass index (BMI) (95% CI = -45.56, -0.23), having walked to the supermarket in the last 30 days (-174.86, -59.42), living in a high-walkability neighborhood, and residing in Seattle/King County (-707.69, -353.22). In terms of participants' distance accuracy, 29% were classified as accurate, 33.9% were "Underestimators", 24.0% "Overestimators", and 13.2% responded "Don't Know". Compared to

INTRODUCTION:Older adults are a rapidly growing segment of the U.S. POPULATION:Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability. METHODS:Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017. RESULTS:The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time. CONCLUSIONS:Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.

Despite the crucial role of mentoring, little literature exists that addresses distance mentoring among health researchers. This article provides three case studies showcasing protégés at different stages of career development (one in graduate school, one as an early-stage researcher, and one as an established researcher). Each case study provides a brief history of the relationship, examines the benefits and challenges of working together at a distance, and discusses the lessons learned from both the mentor and the protégé over the course of these relationships. A mentoring model, examples of mentoring communications, and potential promising practices are also provided and discussed.

BackgroundPhysical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting.ObjectivesWe describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact.DiscussionEncouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol.ConclusionsWe provided the rationale

BACKGROUND:Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. METHODS AND RESULTS:Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. CONCLUSIONS:Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.

BackgroundPhysical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting.ObjectivesWe describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact.DiscussionEncouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol.ConclusionsWe provided the rationale

Despite the crucial role of mentoring, little literature exists that addresses distance mentoring among health researchers. This article provides three case studies showcasing protégés at different stages of career development (one in graduate school, one as an early-stage researcher, and one as an established researcher). Each case study provides a brief history of the relationship, examines the benefits and challenges of working together at a distance, and discusses the lessons learned from both the mentor and the protégé over the course of these relationships. A mentoring model, examples of mentoring communications, and potential promising practices are also provided and discussed.

BACKGROUND:Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. METHODS AND RESULTS:Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. CONCLUSIONS:Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.

PurposeMacroscale built environment factors (e.g., street connectivity) are correlated with physical activity. Less-studied but more modifiable microscale elements (e.g., sidewalks) may also influence physical activity, but shorter audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of an abbreviated 54-item streetscape audit tool with multiple measures of physical activity in four age groups.MethodsWe developed a 54-item version from the original 120-item Microscale Audit of Pedestrian Streetscapes (MAPS). Audits were conducted on 0.25-0.45 mile routes from participant residences toward the nearest nonresidential destination for children (N=758), adolescents (N=897), younger adults (N=1,655), and older adults (N=367). Active transport and leisure physical activity were measured with surveys, and objective physical activity was measured with accelerometers. Items to retain from original MAPS were selected primarily by correlations with physical activity. Mixed linear regression analyses were conducted for MAPS-Abbreviated summary scores, adjusting for demographics, participant clustering, and macroscale walkability.ResultsMAPS-Abbreviated and original MAPS total scores correlated r=.94 The MAPS-Abbreviated tool was related similarly to physical activity outcomes as the original MAPS. Destinations and land use, streetscape and walking path characteristics, and overall total scores were significantly related to active transport in all age groups. Street crossing characteristics were related to active transport in children and older adults. Aesthetics and social characteristics were related to leisure physical activity in children and younger adults, and cul-de-sacs were related with physical activity in youth. Total scores were related to accelerometer-measured physical activity in children and older adults.ConclusionMAPS-Abbreviated is a validated observational measure for use in research. The length and related co

BACKGROUND: Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting. OBJECTIVES: We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact. DISCUSSION: Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol. CONCLUSIONS We provided the

Telephone-based interactive voice response (IVR) systems could be an effective tool for promotion of physical activity among older women. To test IVR feasibility, we enrolled 30 older women in a 10-week physical activity intervention designed around National Institute on Aging (NIA) Go4Life® educational materials with IVR coaching. Participants (mean age = 76 years) significantly increased physical activity by a mean 79 ± 116 (SD) minutes/week (p < .001). Participants reported that the Go4Life® materials, pedometer, and IVR coaching (70% reported easy technology) were useful tools for change. This pilot study demonstrates IVR acceptability as an evidence-based physical activity program for older women.

Growing evidence suggests that microscale pedestrian environment features, such as sidewalk quality, crosswalks, and neighborhood aesthetics, may affect residents' physical activity. This study examined whether disparities in microscale pedestrian features existed between neighborhoods of differing socioeconomic and racial/ethnic composition. Using the validated Microscale Audit of Pedestrian Streetscapes (MAPS), pedestrian environment features were assessed by trained observers along ¼-mile routes (N = 2117) in neighborhoods in three US metropolitan regions (San Diego, Seattle, and Baltimore) during 2009 to 2010. Neighborhoods, defined as Census block groups, were selected to maximize variability in median income and macroscale walkability factors (e.g., density). Mixed-model linear regression analyses explored main and interaction effects of income and race/ethnicity separately by region. Across all three regions, low-income neighborhoods and neighborhoods with a high proportion of racial/ethnic minorities had poorer aesthetics and social elements (e.g., graffiti, broken windows, litter) than neighborhoods with higher median income or fewer racial/ethnic minorities (p<.05). However, there were also instances where neighborhoods with higher incomes and fewer racial/ethnic minorities had worse or absent pedestrian amenities such as sidewalks, crosswalks, and intersections (p<.05). Overall, disparities in microscale pedestrian features occurred more frequently in residential as compared to mixed-use routes with one or more commercial destination. However, considerable variation existed between regions as to which microscale pedestrian features were unfavorable and whether the unfavorable features were associated with neighborhood income or racial/ethnic composition. The variation in pedestrian streetscapes across cities suggests that findings from single-city studies are not generalizable. Local streetscape audits are recommended to identify disparities and eff

Growing evidence suggests that microscale pedestrian environment features, such as sidewalk quality, crosswalks, and neighborhood aesthetics, may affect residents' physical activity. This study examined whether disparities in microscale pedestrian features existed between neighborhoods of differing socioeconomic and racial/ethnic composition. Using the validated Microscale Audit of Pedestrian Streetscapes (MAPS), pedestrian environment features were assessed by trained observers along ¼-mile routes (N = 2117) in neighborhoods in three US metropolitan regions (San Diego, Seattle, and Baltimore) during 2009 to 2010. Neighborhoods, defined as Census block groups, were selected to maximize variability in median income and macroscale walkability factors (e.g., density). Mixed-model linear regression analyses explored main and interaction effects of income and race/ethnicity separately by region. Across all three regions, low-income neighborhoods and neighborhoods with a high proportion of racial/ethnic minorities had poorer aesthetics and social elements (e.g., graffiti, broken windows, litter) than neighborhoods with higher median income or fewer racial/ethnic minorities (p<.05). However, there were also instances where neighborhoods with higher incomes and fewer racial/ethnic minorities had worse or absent pedestrian amenities such as sidewalks, crosswalks, and intersections (p<.05). Overall, disparities in microscale pedestrian features occurred more frequently in residential as compared to mixed-use routes with one or more commercial destination. However, considerable variation existed between regions as to which microscale pedestrian features were unfavorable and whether the unfavorable features were associated with neighborhood income or racial/ethnic composition. The variation in pedestrian streetscapes across cities suggests that findings from single-city studies are not generalizable. Local streetscape audits are recommended to identify disparities and eff

Telephone-based interactive voice response (IVR) systems could be an effective tool for promotion of physical activity among older women. To test IVR feasibility, we enrolled 30 older women in a 10-week physical activity intervention designed around National Institute on Aging (NIA) Go4Life® educational materials with IVR coaching. Participants (mean age = 76 years) significantly increased physical activity by a mean 79 ± 116 (SD) minutes/week (p < .001). Participants reported that the Go4Life® materials, pedometer, and IVR coaching (70% reported easy technology) were useful tools for change. This pilot study demonstrates IVR acceptability as an evidence-based physical activity program for older women.

BackgroundLosing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention.MethodsThe Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150 min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon.ResultsThe average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions.ConclusionsThe PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further.

INTRODUCTION:Macro level built environment factors (eg, street connectivity, walkability) are correlated with physical activity. Less studied but more modifiable microscale elements of the environment (eg, crosswalks) may also affect physical activity, but short audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of a 15-item neighborhood environment audit tool with a full version of the tool to assess neighborhood design on physical activity in 4 age groups. METHODS:From the 120-item Microscale Audit of Pedestrian Streetscapes (MAPS) measure of street design, sidewalks, and street crossings, we developed the 15-item version (MAPS-Mini) on the basis of associations with physical activity and attribute modifiability. As a sample of a likely walking route, MAPS-Mini was conducted on a 0.25-mile route from participant residences toward the nearest nonresidential destination for children (n = 758), adolescents (n = 897), younger adults (n = 1,655), and older adults (n = 367). Active transportation and leisure physical activity were measured with age-appropriate surveys, and accelerometers provided objective physical activity measures. Mixed-model regressions were conducted for each MAPS item and a total environment score, adjusted for demographics, participant clustering, and macrolevel walkability. RESULTS:Total scores of MAPS-Mini and the 120-item MAPS correlated at r = .85. Total microscale environment scores were significantly related to active transportation in all age groups. Items related to active transport in 3 age groups were presence of sidewalks, curb cuts, street lights, benches, and buffer between street and sidewalk. The total score was related to leisure physical activity and accelerometer measures only in children. CONCLUSION:The MAPS-Mini environment measure is short enough to be practical for use by community groups and planning agencies and is a valid substitute for the full version that is 8 times

IntroductionMacro level built environment factors (eg, street connectivity, walkability) are correlated with physical activity. Less studied but more modifiable microscale elements of the environment (eg, crosswalks) may also affect physical activity, but short audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of a 15-item neighborhood environment audit tool with a full version of the tool to assess neighborhood design on physical activity in 4 age groups.MethodsFrom the 120-item Microscale Audit of Pedestrian Streetscapes (MAPS) measure of street design, sidewalks, and street crossings, we developed the 15-item version (MAPS-Mini) on the basis of associations with physical activity and attribute modifiability. As a sample of a likely walking route, MAPS-Mini was conducted on a 0.25-mile route from participant residences toward the nearest nonresidential destination for children (n = 758), adolescents (n = 897), younger adults (n = 1,655), and older adults (n = 367). Active transportation and leisure physical activity were measured with age-appropriate surveys, and accelerometers provided objective physical activity measures. Mixed-model regressions were conducted for each MAPS item and a total environment score, adjusted for demographics, participant clustering, and macrolevel walkability.ResultsTotal scores of MAPS-Mini and the 120-item MAPS correlated at r = .85. Total microscale environment scores were significantly related to active transportation in all age groups. Items related to active transport in 3 age groups were presence of sidewalks, curb cuts, street lights, benches, and buffer between street and sidewalk. The total score was related to leisure physical activity and accelerometer measures only in children.ConclusionThe MAPS-Mini environment measure is short enough to be practical for use by community groups and planning agencies and is a valid substitute for the full version that is 8 times longer

Background: The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy. Objective: This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy. Methods: The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing. Results: Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved. Conclusions: The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Great

BackgroundDirect relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity.MethodsExploratory analyses used two cross-sectional studies of 2068 adults ages 20-65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001-2005 (adults) and 2005-2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant's home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample.ResultsOf 36 interactions evaluated across both studies, only 5 were significant (p< .05). Significant interactions did not consistently support a pattern of highest physical activity when safety was rated high and environments were favorable. There was not consistent evidence that safety concerns reduced the beneficial effects of favorable environments on physical activity. Only pedestrian safety showed evidence of a consistent main effect with physical activity outcomes, possibly because pedestrian safety items (e.g., crosswalks, sidewalks) were not as subjective as those on the crime and traffic safety scales.ConclusionsClear relationships between crime, pedestrian, and traffic safety with physical activity levels remain elusive. The development of more precise safety variables and the use of neighborhood-specific phy

BackgroundDirect relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity.MethodsExploratory analyses used two cross-sectional studies of 2068 adults ages 20-65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001-2005 (adults) and 2005-2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant's home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample.ResultsOf 36 interactions evaluated across both studies, only 5 were significant (p< .05). Significant interactions did not consistently support a pattern of highest physical activity when safety was rated high and environments were favorable. There was not consistent evidence that safety concerns reduced the beneficial effects of favorable environments on physical activity. Only pedestrian safety showed evidence of a consistent main effect with physical activity outcomes, possibly because pedestrian safety items (e.g., crosswalks, sidewalks) were not as subjective as those on the crime and traffic safety scales.ConclusionsClear relationships between crime, pedestrian, and traffic safety with physical activity levels remain elusive. The development of more precise safety variables and the use of neighborhood-specific phy

Recommended levels of physical activity may represent challenging targets for many older adults at risk for disability, leading to the importance of evaluating whether low-intensity activity is associated with health benefits. We examined the cross-sectional association between low-intensity walking activity (<100 steps/min) and health and physical function in a group of older adults. Participants (N = 187; age = 66.8; 91.4% African American; 76.5% female) wore a StepWatch Activity Monitor to measure components of low-intensity walking activity. Only 7% of participants met physical activity guidelines and moderate-intensity activity (≥100 steps/min) contributed only 10% of the total steps/day and 2% of the total min/day. Greater amount, frequency, and duration of low-intensity activity were associated with better self-report and performance-based measures of physical function, better quality of life, and fewer depressive symptoms (ps < .05). The cross-sectional relationship between low-intensity activity and health outcomes important to independent function suggests that we further explore the longitudinal benefits of low-intensity activity.

Background Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor. Methods Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions. Results Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one’s own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12). Conclusions Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

Background Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor. Methods Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions. Results Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one’s own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12). Conclusions Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

Background: Physical activity self-efficacy is conceptualized as a construct that is changeable and responsive to contextual factors. The current study applied mixed-effects location scale modeling to examine within-person variability in physical activity self-efficacy among middle-aged and older adults (N = 14 adults, mean age = 59.4 years) who were attempting behavior change. Methods: An electronic diary was used to record self-reported self-efficacy and physical activity via Ecological Momentary Assessment (EMA) twice a day (2:00 pm and 9:00 pm). Data from weeks 1-6 were analyzed using a Mixed-Effects Location Scale Model in SAS PROC NLMIXED. Results: Participants differed from each other in the degree to which physical activity self-efficacy varied from day to day (p = .03). Within-person variation in self-efficacy was negatively related to levels of brisk walking each week (p = .002), and decreased over time (p = .03). Conclusions: Preliminary results suggest that fluctuations in self-efficacy may be as important for predicting short-term behavior as the overall or mean level of self-efficacy.

W Jack Rejeski,1 Robert Axtell,2 Roger Fielding,3 Jeffrey Katula,1 Abby C King,4 Todd M Manini,5 Anthony P Marsh,1 Marco Pahor,5 Alvito Rego,6 Catrine Tudor-Locke,7 Mark Newman,8 Michael P Walkup,9 Michael E Miller9  On behalf of the LIFE Study Investigator Group 1Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, 2Exercise Science Department, Southern Connecticut State University, New Haven, CT, 3Nutrtion, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, 4Department of Health Research and Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, 5Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, 6Department of Internal Medicine, Northwestern School of Medicine, Chicago, IL, 7Pennington Biomedical Research Center, Baton Rouge, LA, 8Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, 9Department of Biostatistical Sciences, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC, USA Abstract: The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial (Clinicaltrials.gov identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70–89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants' motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31

BackgroundOlder adults spend little time outdoors and many are physically inactive. The relationship between outdoor physical activity and self rated health has not been studied in older adults. This paper aimed to assess the relation of location of physical activity to self rated health and physical activity minutes. This was an observational study of ambulatory adults 66 years and older conducted in 2005–2008. Participants (N = 754) completed survey measures of physical activity location and self rated health, and wore an accelerometer to objectively assess physical activity. A mixed model linear regression procedure adjusted for neighborhood clustering effects. Differences in self rated health and physical activity minutes were compared across three physical activity settings (indoor only, outdoor only, both indoor and outdoor).ResultsMinutes of moderate to vigorous physical activity were significantly greater in those who were physically active at least once a week outdoors compared with those who were physically active indoors only. Self rated health was significantly related to being physically active but did not vary by location of activity.ConclusionsOlder adults who were physically active outdoors accumulated significantly more physical activity, but self-rated health was not significantly greater than those being physically active indoors.

In this article, associations between individual, social, and environmental factors and physical activity among 3,669 women (18-45 years) living in socioeconomically disadvantaged urban and rural areas were compared. In 2007-2008, participants reported levels of leisure-time physical activity (LTPA) and transport-related physical activity (TRPA) as well as five individual, four social, and three environmental factors. Physical activity self- efficacy demonstrated stronger associations with LTPA among urban relative to rural women; child care was associated with LTPA and intentions with TRPA among urban women only, and enjoyment was associated with TRPA among rural women only. Correlates of physical activity among urban and rural women were generally similar, although some tailoring of physical activity promotion strategies may be warranted.

BackgroundOlder adults spend little time outdoors and many are physically inactive. The relationship between outdoor physical activity and self rated health has not been studied in older adults. This paper aimed to assess the relation of location of physical activity to self rated health and physical activity minutes. This was an observational study of ambulatory adults 66 years and older conducted in 2005–2008. Participants (N = 754) completed survey measures of physical activity location and self rated health, and wore an accelerometer to objectively assess physical activity. A mixed model linear regression procedure adjusted for neighborhood clustering effects. Differences in self rated health and physical activity minutes were compared across three physical activity settings (indoor only, outdoor only, both indoor and outdoor).ResultsMinutes of moderate to vigorous physical activity were significantly greater in those who were physically active at least once a week outdoors compared with those who were physically active indoors only. Self rated health was significantly related to being physically active but did not vary by location of activity.ConclusionsOlder adults who were physically active outdoors accumulated significantly more physical activity, but self-rated health was not significantly greater than those being physically active indoors.

Context Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately. Objective To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. Design, Setting, and Participants Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. Intervention Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Main Outcome Measures Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non–high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. Results Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, –4.7 kg (95% confidence interval [CI], –6.3 to –3.1 kg), Zone, –1.6 kg (95% CI, –2.8 to –0.4 kg), LEARN, –2.6 kg (–3.8 to –1.3 kg), and Ornish, –2.2 kg (–3.6 to –0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Conclusions In this study, premenopausal overweight and obe

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Specific measures and procedures for reducing stress in women from dual-earner families were developed and evaluated. Preliminary research indicated that time management instruction and social support were two promising approaches for impacting upon stress levels in working wives. Fifty-six married women working in classified employee positions at a local university were assigned to one of four conditions in which they received either extensive time management instruction with a large degree of group support (Combination condition), extensive instruction with minimal group support (High Instruction condition), minimal instruction with a large degree of support (High Support condition), or neither intervention (a waiting-list control). Major variables of interest included amount of time reported in two targeted priority activities, changes in self-efficacy for specified time management-related tasks, amount of support received both within and outside of the group setting, and changes in global stress measures. Reliability on time spent in targeted activities was assessed via phone interviews with participants' spouses and participants themselves. Women in both conditions receiving extensive instruction reported significantly greater increases in such activities in comparison with High Support participants. Changes in time spent in targeted activities were maintained 3 months after the program ended. Both conditions receiving extensive instruction also reported a greater amount of self-efficacy at posttest than the two conditions receiving minimal or no instruction. In contrast, no significant differences among conditions were found on either of the two global stress measures. While there was evidence for the integrity of the group support manipulation, actual changes in group contacts were small for all conditions. Possible reasons for this were explored. In light of the strong inverse correlation found between outside support and stress, in-depth investigation of me