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To determine differences in lifestyle modification practices and use of prescription drugs in a representative sample of Mexican American (MA), non-Hispanic White (NHW), and non-Hispanic Black (NHB) elderly Americans with metabolic syndrome (MetS).Data from the United States National Health and Nutritional Examination Surveys were used in this study. Lifestyle modification practices include ongoing physical activity, weight control, and ongoing diet modifications. Prescription drugs include anti-diabetic, anti-obesity, lipid-lowering, insulin sensitizers, renin-angiotensin system (RAS) blockers, fibrates, and cilostazol. Race/ethnic-specific prevalence odds ratios from the multivariate logistic regression analyses were used to determine associations between selected independent variables and MetS control (defined as the use of lifestyle modification practices or prescription drugs), adjusting for covariates.The rates of ongoing weight control (73.4% versus 68.1% in MA and 66.3% in NHW) and diet modification practices (78.1% versus 77.4% in MA and 66.7% in NHW) were higher among NHB, and rate of ongoing physical activity (61.8% versus 52.8% in NHW and 56.4% in NHB) was higher among MA participants compared to their other racial/ethnic elderly counterparts (P 0.001). Lipid-lowering and insulin-sensitizing drugs were the most commonly used prescription drugs in the last 30 days. The prevalence of nonuse of lifestyle modification practices or prescription drugs for MetS management was 15.1%, 21.3%, and 12.7% in MA, NHW, and NHB participants, respectively. MA, NHB race/ethnicity, a higher level of education, and increased BMI were significantly associated with increased odds of MetS control. Lack of drug prescription insurance and increased age were associated with decreased odds of MetS control.Given the clinical importance of MetS, improving knowledge-based health decisions relative to lifestyle modification practices is very important. Moreover, sources of low-cost medications that links elderly patients with drug prescription coverage programs may help to improve the management of MetS.

Aim To compare the strength of associations between surrogate indexes of insulin resistance (sIR) and risk of metabolic syndrome (MetS) in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) adults. Methods The 2013–2016 US National Health and Nutrition Examination Survey data (n = 3435) were used for this study. The associations between sIR that includes Triglyceride/HDL cholesterol ratio (TG/HDL-C), triglyceride glucose (TG) index, visceral adiposity index (VAI), lipid accumulation product (LAP), TG-body mass index (TG-BMI), and TG-waist circumference (TG-WC) and risk for MetS were determined using the prevalence odds ratio (OR) from the logistic regression analyses. Pseudo-R-squared tests were used to estimate the proportion of variance in MetS accounted for by each sIR. Akaike Information Criterion and Bayesian Information Criterion from the multinomial logistic regression analysis were used to compare models that included each sIR and its components separately as predictors of MetS. Areas under curves (AUC) from the receiver-operating characteristic (ROC) were used to detect their diagnostic capabilities. Results Compared with other sIR, TG-WC (AUC = 0.899; 95% CI: 0.884–0.913 in NHW) and (AUC = 0.893; 95% CI:0.871–0.915 in NHB), and LAP (AUC = 877; 95% CI: 0.861–0.894 in MA) exhibited the highest diagnostic and predictive accuracy for MetS. Compared with other sIR, TG-WC (OR = 22.8; 95% CI:16.6–31.0 in NHW) and (OR = 22.7; 95% CI:13.1–39.3 in NHB), and LAP (OR = 10.6; 95%:6.6–17.0 in MA) were most significantly associated with increased odds of MetS, adjusting for eGFR, age, marital status, CHD, CHF, income, education, physical activity, alcohol use, smoking and use of cholesterol-lowering medication. Conclusions TG-WC in NHW and NHB, and LAP in MA are more powerful than other proxies of IR in predicting MetS. TG-WC and LAP can serve as adjunctive tools for screening for MetS in NHW, NHB, and MA.

Population-wide initiatives aim to educate individuals about the benefits of walking, such as Step It Up! (United States), Walking for Health (England), and Canada Walks (Canada). Low-income women are a strategic group to target for walking communications because lower-income individuals and women have lower rates of physical activity than the general population and men. For messages to motivate mothers to walk, however, they need to frame walking in ways that makes walking sufficiently relevant and compelling. We investigated what walking means to low-income urban mothers as a first step toward identifying more compelling and motivating ways to frame and communicate about walking to them. Focus groups were conducted across seven different urban areas in the United States among low-income urban mothers (n=52) and transcribed. Grounded theory was used to code and analyze the data. This study identified salient beliefs, barriers, and life concerns that should be addressed when framing and branding walking to low-income urban mothers. Communications emphasizing dose-based recommendations (e.g., time, intensity) are irrelevant to mothers’ lives and also appear to be confusing as well as ineffective motivators. While some participants desired experiential benefits from walking, such as time with family, others sought instrumental benefits, such as losing weight. Regardless of the benefits desired, however, there was a general consensus that walking was a low daily priority. Thus, for messages to successfully promote walking, they need to imbue walking with a compelling meaning that makes walking relevant to mothers in ways that can help them achieve their daily needs and wants. In addition, future communications should address the potentially negative meanings and stress low-income mothers experience when walking is a compulsory form of transportation. These data offer insights into preliminary suggestions for framing walking to boost its daily relevance, desirability, and usefulness to low-income urban mothers.

Since 2004, the Active Living Research (ALR) Conference has focused on advancing knowledge and practice related to the creation of communities that increase opportunities for physical activity. Communities designed for active living are better for health, economic vitality, and environmental sustainability. The Annual ALR Conference serves as a premier venue for cross-disciplinary learning, as over 30 disciplines are represented among participants. This commentary serves as an introduction to a virtual Special Section of Journal of Transport and Health that includes several of the best transport-related studies that were presented at ALR 2017. The theme of the 2017 ALR Conference, Active Living across the Life Span, placed emphasis on the importance of promoting physical activity from childhood through mature adulthood and offered solutions for achieving this goal. The theme challenged attendees to consider the myriad needs across age cohorts and the ways that community design, policies, and programs affect opportunities for active living. The conference highlighted the importance of policy-relevant research and facilitated cross-sector exchange among scientists, practitioners, and policymakers to create and sustain active living environments where residents can grow, live, and thrive at any age. Jana Lyncott from the AARP Public Policy Institute delivered the Keynote Address on creating environments for active and engaged living for all ages. The presentation provided examples from communities across the United States that are promoting livability and fostering healthy, active, and engaged lifestyles. The presentation highlighted AARP's Livability Index, which scores neighborhoods and communities for the services and amenities that have a significant impact on residents. The featured panel included Drs. Adrian Bauman, NiCole Keith, and David Bann and focused on the challenges of integrating equity perspectives in research on active living across the lifespan. Dr. Bauman, from Australia, shared lessons from his research on middle-age-to-older adults and his international collaborations. Dr. Keith, from the United States, described the effort to ensure disadvantaged populations were given high priority in developing the multi-sector strategies of the US National Physical Activity Plan. Dr. Bann, from the UK, presented findings on active living across the lifespan from a large, long-term birth cohort study. The second panel featured Deputy Commissioner Adetokunbo 'Toks' Omishakin, (Tennessee Department of Transportation), Councillor Kristyn Wong-Tam (City of Toronto, Canada), and Otis Johnson (Former Mayor of Savannah, Georgia) and provided local and state examples of active transportation and lessons learned. A clear takeaway from the keynote and panelists was the need to integrate and apply life-course research and practice/policy lessons learned to most effectively create activity-supportive cities. The concept of active living includes physical activity for all purposes, including transport, recreation, occupation, and household. Active transport continues to be a dominant theme at ALR Conferences, and the link between transport and health outcomes is rising on research and policy agendas internationally, as shown by extensive coverage in Journal of Transport and Health and the 2016 Lancet Series on Urban Design, Transport, and Health. In the Lancet Series, Giles-Corti and colleagues (2016) reviewed a wide range of physical, mental, and social health problems linked with motorized transport. Stevenson and colleagues (2016) reported models that revealed a shift of just 10% of motorized trips to active modes could produce important reductions in mortality in cities as diverse as Copenhagen and Delhi. Thus, as co-chairs of the ALR 2017 Conference we want to thank Dr. Jennifer Mindell, Editor-in-Chief of Journal of Transport and Health, for facilitating this virtual special section of papers that will further advance evidence on active transport and health.

Purpose The purpose of this study was to examine whether persons who are aware of their prediabetes were more likely than persons with normal glycemia to report lifestyle changes (weight control, physical activity and fat/calories intake), and to determine the interactive effect of persons aware of their prediabetes and persons reporting doctor/health care provider’s (DHCP) advice on overall lifestyle change. Methods Data from the 2005 to 2006 and 2007 to 2008 US National Health and Nutrition Examination Surveys were used for this investigation. Odds ratio from multiple logistic regression analysis was used to determine whether persons who are aware of their prediabetes were more likely than persons with normal glycemia to report lifestyle changes. Results Persons who are aware of their prediabetes were more likely than persons with normal glycemia to report increased weight control (OR = 1.72; 95% CI = 1.34–2.20) and physical activity (OR = 1.28; 95% CI = 1.02–1.61), and reduced fat/calorie intake (OR = 1.82; 95% CI = 1.41–2.34), after adjusting for age, BMI, persons reported DHCP advice, race/ethnicity, sex, education and household income. Persons who reported DHCP advice were more likely than persons who did not report DHCP advice to report increased weight control (OR = 1.87; 95% CI = 1.67–2.09) and physical activity (OR = 1.59; 95% CI = 1.43–1.78), and reduced fat/calorie intake (OR = 2.19; 95% CI = 1.96–2.46), after adjusting for confounders. There was no significant interaction between persons aware of their prediabetes and persons that reported DHCP advice with reported overall lifestyle change. Conclusions Creating diabetes risk awareness in at-risk groups and increased counseling of at-risk groups by doctors/health care providers may be the keys to prevent diabetes.

To analyze relationships between demographic characteristics of Georgia school systems and: (1) compliance with the Child Nutrition and WIC Reauthorization Act (CNRA); and (2) strength of wellness policy goals in nutrition, physical activity, and other school-based activities.Each local school district submitted their school-board-approved wellness policy to researchers. Each policy was reviewed and coded for compliance with CNRA and evaluated on the strength of its goals.Public school districts.One hundred seventy-six of 180 Georgia public school systems participated.Independent variables were demographic characteristics of Georgia school systems. Dependent variables were ratings from the policy evaluation instrument, grouped into composite indices to compare the strength (ie, ratings) of wellness policy goals.Pearson correlation, cross-tabulation.Significant positive associations were found between academic performance and: strength of overall wellness policy goals (P.05), goals in nutrition education (P.01), and other school-based activities (P.01). Economic status of the student population was found to be positively associated with strength of nutrition education goals (P.05).Districts with stronger academic performance had more comprehensive overall wellness policy goals and stronger goals in nutrition education and other school-based activities.

Obesity and its medical consequences are more prevalent among AfricanAmerican (AA) than European-American females,' and this ethnic difference is evident among children and adolescents.' While the higher rate of obesity in AAs is not entirely understood, it is likely that excess caloric intake and inadequate physical activity contribute to the problem."' Adiposity and diet and exercise patterns track from childhood through ad~lthood; '~~ providing a rationale for early interventi0n.j Health promotion programs should be matched to the social, cultural, and environmental characteristics of the target population.' For inner-city low-income AAs, these factors include unique attitudes regarding ideal body type, greater tolerance of o~enveight,~,' unique dietary patterns,''J' lower exercise rates," and environments that may impede healthy eating and physical acti~ity.~ There is a need for culturallv sensitive obesity prevention and treatment programs for AAs.j Few such programs have been developed, and most have targeted adult^'^-'^ or families.15 In response to this need, we developed a nutrition and physical activity intervention (a.k.a. G O GIRLS!) designed for innercity, overweight,AA adolescent females.