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This study tested whether socio-demographic factors moderated associations between psychological factors and Latinas' breast cancer screening behaviors. 222 churchgoing Latinas (40-65 years) in San Diego, CA completed surveys assessing socio-demographics (e.g., income and acculturation), psychological factors (e.g., perceived barriers to screening), and cancer screening behaviors. Multilevel models examined associations of socio-demographic and psychological factors (and their interactions) with adherence to annual mammography or clinical breast exam (CBE) screening. Although no main effects were found, there were moderation effects. Acculturation moderated associations between perceived barriers to screening and both screening outcomes, with inverse associations only among the high-acculturation group. Education moderated the relationship between perceived barriers to screening and CBE screening, with an inverse association only among the low-education group. Marital status moderated the relationship between depressive symptoms and CBE screening, with an inverse association only among single/non-partnered participants. Interventions are needed targeting psychological barriers to breast cancer screening among Latinas.

PurposeThis study tested whether a multilevel physical activity (PA) intervention had differential effects on PA according to participants' perceptions of their neighborhood environment.DesignTwo-group cluster randomized controlled trial.SettingSan Diego, California.SubjectsAnalytical sample included 319 Latinas (18-65 years) from churches randomized to the following conditions: PA (n = 8 churches, n = 157 participants) or attention control (n = 8 churches, n = 162 participants).InterventionOver 12 months, PA participants were offered free PA classes (6/wk), while attention control participants were offered cancer prevention workshops.MeasuresBaseline and 12-month follow-up measures included self-report and accelerometer-based moderate to vigorous physical activity (MVPA), sociodemographics, and perceived neighborhood environment variables.AnalysisMixed-effects models examined each PA outcome at 12-month follow-up, adjusted for church clustering, baseline PA, and sociodemographics. We tested interactions between 7 baseline perceived environment variables and study condition.ResultsNeighborhood esthetics was the only significant moderator of intervention effects on accelerometer-based MVPA and self-report leisure-time MVPA. Participants in the PA intervention had significantly higher PA at follow-up than attention control participants, only when participants evaluated their neighborhood esthetics favorably.ConclusionPerceived neighborhood esthetics appeared to maximize the effectiveness of a multilevel PA intervention among Latinas. For sustainable PA behavior change, the environments in which Latinas are encouraged to be active may need to be evaluated prior to implementing an intervention to ensure they support active lifestyles.

Female adolescents are less active than male peers in certain contexts including the neighborhood. Adolescents' physical activity can be explained by interactions between environmental and psychosocial factors, but few studies have tested such interactions in relation to context-specific behaviors. This study tested interactions between neighborhood environmental and psychosocial factors in relation to adolescents' context-specific physical activity. Data were collected in 2009-11 from 910 adolescents and a parent/guardian residing in the Baltimore/Seattle regions. Measures included adolescent-reported neighborhood leisure-time physical activity (LTPA) and non-neighborhood LTPA, accelerometer-based non-school moderate-to vigorous-physical activity (MVPA), psychosocial factors, and objective and parent-perceived neighborhood environmental factors. Gender-stratified mixed effects linear models tested associations of 6 environmental and 4 psychosocial factors and their interactions in relation to each physical activity outcome. The psychosocial factors had consistent associations with the physical activity outcomes but the environmental correlates were context-specific. Decisional balance (weighing of pros and cons of physical activity) moderated the association between recreation facility density and neighborhood LTPA among females, with a negative association only among those with high decisional balance (pros outweighed cons). Decisional balance also moderated associations of neighborhood walkability with non-school MVPA among females and non-neighborhood LTPA among males, with positive associations only among those with high decisional balance. Results support context-specific ecological models of physical activity. Targeting environmental factors that may promote opportunities for physical activity in specific contexts as well as adolescent decision-making may help promote their physical activity in those contexts, potentially leading to increased overall physical activity.

Favorable perceptions of the built and social neighborhood environment may promote outdoor physical activity (PA). However, little is known about their independent and interactive effects on neighborhood-specific outdoor PA. We examined associations of perceived built and social neighborhood environment factors, and their interactions, with objectively-measured neighborhood outdoor moderate-to-vigorous physical activity (MVPA) among a sample of Latina women in San Diego, CA. Analyses included baseline data collected in 2011-2013 from 86 Latinas with ≥ 2 days of combined accelerometer and global positioning system data and complete survey measures. We examined objective neighborhood outdoor MVPA within 500-meter home buffers. Generalized linear mixed models examined associations of 3 perceived built (e.g., sidewalk maintenance) and 3 social environmental (e.g., safety from crime) factors with engaging in any daily neighborhood outdoor MVPA. Models tested interactions between the built and social environmental factors. Although the perceived neighborhood environmental factors were not significantly related to daily neighborhood outdoor MVPA, we found 2 significant interactions: perceived sidewalk maintenance x safety from crime (p = 0.05) and neighborhood aesthetics x neighborhood social cohesion (p = 0.03). Sidewalk maintenance was positively related to daily neighborhood outdoor MVPA only among Latinas that reported low levels of safety from crime. Neighborhood aesthetics was positively related to daily neighborhood outdoor MVPA only among Latinas with high neighborhood social cohesion. Findings suggest several built and social environmental factors interact to influence Latinas' neighborhood outdoor MVPA. Interventions are needed targeting both built and social neighborhood environmental factors favorable to outdoor PA in the neighborhood.

We employed a time series design to evaluate the impact of the 1989 California cigarette tax increase on cigarette consumption in California. Adult per capita consumption data from 1980 to 1990 were analyzed for California and the United States. Trend data indicated a sharp drop in California cigarette consumption coincident with the tax increase. Time-series regression analyses support this observation, and suggest that a 5% to 7% decline in consumption is attributable to the tax increase.

Background: Community-based interventions are needed to reduce the burden of childhood obesity.Purpose: To evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children.Methods: Thirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2(nd) grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors.Results: There were no significant intervention effects on children's BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring).Conclusion: A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors. [ABSTRACT FROM AUTHOR]

The community health worker (CHW) model has been successfully used to promote health and reduce adverse health outcomes in underserved communities. Although there is a general consensus that involvement of natural helpers from the targeted communities is a promising approach in the elimination of health disparities, there is less agreement on their responsibilities, scope of work, and reimbursement for their services (ranging from paid staff to unpaid volunteers). These differences in pay structure stem from philosophical differences, programmatic needs, and financial realities. Based on our experience with both the paid and volunteer approaches, we provide some lessons learned on how the CHW model can be integrated in our efforts to eliminate health disparities. [ABSTRACT FROM AUTHOR]

Background: Parenting interventions have achieved changes in factors associated with childhood obesity but few have tested the effects on multiple parental influences.Purpose: This study examined the efficacy of an intervention aimed at improving several dimensions of parenting related to childhood obesity.Design: The study used a 2 x 2 factorial design.Setting/participants: In 2003, a sample of 13 Southern California schools was randomized to one of four conditions: micro-environment only, macro-environment only, micro-plus-macro-environment, and no treatment control condition. Participants included 811 predominantly Mexican immigrant/Mexican-American mothers with children in kindergarten through second grade.Intervention: In both micro conditions, participants received monthly home visits by a promotora over a 7-month period plus monthly mailed newsletters.Main Outcome Measures: In 2008, intervention effects were examined on (1) parenting strategies, including limit setting, monitoring, discipline, control, and reinforcement related to children's diet and physical activity; (2) parental support for physical activity; (3) parent-mediated family behaviors such as family meals eaten together and TV watching during family dinners; and (4) perceived barriers and other parent cognitions related to children's eating and activity.Results: At the 2-year follow-up, significant improvements were observed in three of five parenting strategies, parental support, and two of four parent-mediated family behaviors among parents receiving the micro intervention (i.e., those who received promotora visits and monthly newsletters), as compared with those in the macro-only and control conditions.Conclusions: Aspects of parenting related to children's risk for obesity and related health outcomes are modifiable with the support of a promotora and print media. [ABSTRACT FROM AUTHOR]

BACKGROUND: The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages. METHODS: Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents. RESULTS: Overweight children were less active compared to normal weight children. The parents of overweight children provided less instrumental support to engage in activity and set fewer limits on their child's activities. Similarly, parents of overweight children were less likely to control, but more likely to set limits on their child's diet compared to parents of normal weight children. Parents who rated their health more positively and were less acculturated were more likely to have children who were overweight. School and community level variables were not significantly correlated with children's weight. Adjusting for the aforementioned variables, parents' weight status was positively associated with children's weight. CONCLUSIONS: Social and structural environments in which Hispanic children are reared may play an important role in determining their risk for obesity and related behaviors. Parents' weight was among the strongest correlate of child weight; however, the extent to which this influence functions primarily through biological or social/structural influences is not entirely clear. The role of school and community factors on child's health practices and body mass index needs to be further examined. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We sought to examine the relationships between individual and area-based indicators of acculturation and metabolic syndrome (MetS) risk among a sample of Mexican American women living in the California-Baja California border region. METHODS: We examined data collected between October 2003 and December 2004 from 141 women (mean age = 47.07 years) who completed physical and psychosocial assessments. We reviewed medical records for laboratory values. RESULTS: Individual-level US acculturation was associated with a greater consumption of fruits, vegetables, and fiber; increased odds of engaging in health-enhancing levels of physical activity; and decreased odds of meeting the clinical criteria for MetS. Moreover, beyond the influence of individual-level factors, US neighborhood acculturation was associated with less fat intake. CONCLUSIONS: These findings provide preliminary evidence for a relationship between acculturation and the development of MetS in this population. Such information may assist efforts aimed at understanding and eliminating ethnic disparities in MetS risk and related health conditions. [ABSTRACT FROM AUTHOR]

Objective: To determine if overweight adolescent girls are more likely to overreport physical activity compared to normal-weight girls. Methods: Participation in physical activities and perceived intensity of activities were assessed from the previous day physical activity recall (PDPAR) in 1021 girls aged 11-14 years old (37% overweight). Daily minutes of moderate to vigorous physical activity (MVPA) were measured using accelerometery. Results: Girls in the 'at-risk for overweight' and 'overweight' categories had 17.7% and 19.4% fewer minutes of MVPA per block reported on the PDPAR compared to normal-weight girls (P<0.05). Conclusions: Overweight adolescent girls tend to overreport their total amount of physical activity. [ABSTRACT FROM AUTHOR]

Social-ecological (SE) models are becoming more widely used in health behavior research. Applying SE models to the design of interventions is challenging because models must be tailor-made for each behavior and population, other theories need to be integrated into multi-level frameworks, and empirical research to guide model development is limited. The purpose of the present paper is to describe a SE framework that guided the intervention and measurement plans for a specific study. The trial of activity for adolescent girls (TAAG) is a multi-center study of interventions to reduce the decline of physical activity in adolescent girls. The TAAG framework incorporates operant learning theory, social cognitive theory, organizational change theory and the diffusion of innovation model in a multi-level model. The explicit and practical model developed for TAAG has already benefited the study and may have elements that can generalize to other health promotion studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate (a) the relation between frequency of church attendance, self-rated health, and health behaviors controlling for potential confounders and (b) the influence of acculturation on church attendance and health behaviors. METHODS: Physical activity and dietary patterns, demographics, and acculturation levels were compared among Latinas who attended church frequently, infrequently, and not at all. RESULTS: Church attendance was independently and positively associated with healthier dietary and physical activity behaviors, but not with self-rated health. Acculturation attenuated the relation between physical activity and church attendance. CONCLUSION: Latinas' health behaviors and self-rated health may be related to other variables that explain the salutary effects of church attendance. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To test an original scale assessing perceived school climate for girls' physical activity in middle school girls. METHODS: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). RESULTS: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers' and boys' behaviors, respectively, fit the data well in both sixth and eighth graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls' self-reported physical activity. CONCLUSIONS: School climate for girls' physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity. [ABSTRACT FROM AUTHOR]

Acculturation is typically defined in terms of individual responses to a dominant culture. In the present study, we examined the effects of different levels of acculturation among family members. Specifically, we looked at the health and risk behavior in Mexican-American children as related to a variety of psychosocial predictors, especially the differences in orientation toward Mexican- and Anglo-American cultures between them and their parents. Mother and child pairs (n = 106) noted their orientation toward both Anglo and Mexican cultures. Childrenrsquos dietary and sedentary behaviors, tobacco and alcohol use (and susceptibility to use), and depressive symptoms were also measured. Males were more likely to be sedentary and consume higher levels of total fat and saturated fat, whereas girls reported higher levels of depression. Anglo-oriented youth consumed lower levels of calories from fat but also more alcohol than did their Mexican-oriented counterparts. The latter was particularly the case among those children who were relatively more Anglo oriented than were their parents. Parent--child acculturation differential in terms of the differences in Mexican orientation, in comparison, predicted susceptibility to tobacco use. However, the sum of the absolute values of these two differences predicted only lifetime alcohol use, and in a counter-intuitive direction. This familial measure of acculturation shows some promise, but additional formative research is needed to operationalize this construct. [ABSTRACT FROM AUTHOR]

Participants (N = 357) were randomly assigned to 1 of 3 conditions: lay health advisor (promotora) plus tailored print materials, tailored print materials only (tailored), or off-the-shelf print materials (control). The primary outcomes were calories from fat and daily grams of fiber. Secondary outcomes included total energy intake, total and saturated fat intake, and total carbohydrates. Adjusted for baseline values, calories from fat were 29%, 30%, and 30% for the promotora, tailored, and control conditions, respectively, and grams of fiber consumed were 16 g, 17 g, and 16 g. Significant Condition X Time interactions were not observed between baseline and 12-weeks postintervention. The LHA condition achieved significantly lower levels of energy intake, total fat and saturated fat, and total carbohydrates. The relative superiority of the promotora condition may derive from the personal touch achieved in the face-to-face interactions or from the women's use of print materials under the promotora's guidance. ((c) 2005 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups. Participants received either a culturally and linguistically appropriate session on infant immunization (intervention) or a session on prevention of Sudden Infant Death Syndrome (control). The main outcome measures were pre-post immunization knowledge change and infant immunization status at 92 days. Immunization knowledge increased significantly in the intervention group [p < .0001, 95%CI (1.76, 2.47)]. No difference was found between groups in immunization series initiation: 95 percent of the children in the intervention group were up-to-date by 92 days from birth, and 93 percent of the control group was up-to-date at 92 days. The lack of significant association between receiving immunization education and infant immunization series initiation suggests that parent education may be necessary but not sufficient for timely immunization, particularly in clinics with effective well-child programs. Given the significant increase in immunization knowledge, the broader and perhaps more important implication is that language- and culturally specific infant health education messages in the prenatal period may have a positive long-term impact on the child's health and promote well-child care overall. Future studies should assess the role of prenatal well-child education in the context of clinics with low immunization levels. [ABSTRACT FROM AUTHOR]

This report presents the final evaluation of Language for Health, part of a federally funded initiative to develop heart disease prevention interventions for low-literate populations. Language for Health specifically intervened with recent immigrants enrolled in English-as-a-second-language classes, incorporating nutritional behavior change materials into English-language curricula. Latino participants (n =732) were exposed to either nutrition education or stress management classes (attention-placebo group) designed specifically for low English-literate adults. Participants completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and weight. Self-report surveys were administered to collect students' nutrition-related knowledge, attitudes, self-reported fat avoidance behaviors, and demographic information. Data were collected at baseline, 3-month posttest, and 6-month follow-up. Results indicated long-term effects of the intervention on nutrition knowledge and fat avoidance, yet only short-term effects on total cholesterol:HDL ratio and systolic blood pressure. [ABSTRACT FROM AUTHOR]

Focuses on a study which describe the results and effectiveness of Language for Health, a nutritional-related cardiovascular health program for limited English proficient adults enrolled in English-as-a-second-language classes. Goal of the nutrition education program; Psychosocial outcomes related to nutrition; Methodology; Results and discussion.

California's Hispanic infants have lower immunization levels than non-Latino white infants, 53.7% versus 65.2%, respectively. Spanish-language radio is an effective mass media venue for imparting information to Latino populations. It has been demonstrated that lack of parental knowledge of infant immunization timing is associated with delayed immunization coverage. In an effort to improve Latino parent knowledge of immunization timing, two Spanish-language radio commercials were developed to be used in conjunction with community-based educational efforts. In order to gage the potential educational impact of the two commercials, they were pretested with a group of low-income Spanish-speaking Latino parents who represented members of the target population for whom the commercials were created. Both commercials were rated favorably by parents, and elicited immunization-specific responses. Although correct recall of the simplified, basic immunization schedule was low, the level of immunization response consistency and overall approval of both commercials appear to support their use as part of Latino infant immunization educational outreach in California. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) risk factors among Hispanic adults enrolled in English as a Second Language classes. Methods: Subjects (n=332) completed assessments of systolic and diastolic blood pressure, total and HDL cholesterol, body mass, smoking status, alcohol consumption, physical activity, family history of premature CVD, dietary fat intake, and six SES/social class indicators: Spanish literacy, acculturation to U.S. culture, years of education, years in the United States, income, and employment status. Results: In general, SES was inversely related to CVD risk factors. Conclusion: Although the patterns of relationships between the various SES indicators and CVD risk factors varied, so did findings by gender. [ABSTRACT FROM AUTHOR]

Objective. To monitor the implementation of tobacco control programs and research in accordance with California's Proposition 99, approved by the voters in 1988, which increased the state's cigarette tax by 25 cents and designated one quarter of the increased revenue--approximately $100 million per year--to develop statewide media campaigns and to fund local health departments, community-based organizations, schools, and agencies working with high risk populations. Methods. The authors evaluated the extent and the effectiveness of the implementation independently with standardized forms developed to track any tobacco-related information and activities, local media campaigns, changes in local policies and ordinances, training sessions, and prevention and cessation programs. Activities were reported on the forms to the authors monthly or quarterly. Results. The evaluation indicated that local health departments, community-based organizations, and other groups produced an exceedingly high volume of diverse tobacco control activities throughout the state. They reached a variety of ethnic groups and high risk populations with their programs. The data also show that local health departments and competitive grantees responded with an overall shift in their approach to tobacco control and moved from interventions focused primarily on individual people to broader, more community- and environment-oriented interventions. Additionally, analysis of the wholesale tobacco tax revenues revealed that per capita purchasing continued to decline in California at a rate greater than in the rest of the United States. Conclusion. The evaluation demonstrated that Proposition 99 accomplished much of what it set out to do--reducing tobacco prevalence, reaching out to underserved populations, and heightening the awareness of the dangers of environmental tobacco smoke. [ABSTRACT FROM AUTHOR]

The results of a four year demonstration project of preventive services for Medicare managed care enrollees suggest that health promotion programs can impact health behaviors and outcomes. The study provided selected preventive services to 1,800 Medicare enrollees in a managed care environment. Participants were randomly assigned to control and experimental groups with the experimental group receiving an intervention service package and the control group usual care. The results included enhanced health behavior practices, lower depression, and higher immunization rates among those individuals in the experimental group. This study suggests that selected preventive services can be provided in a managed care environment to Medicare enrollees with likely positive health status and utilization outcomes. [ABSTRACT FROM AUTHOR]

This study investigated the predictors of participation in a school-based, anti-tobacco activism program. Subjects in this study consisted of 7th grade students participating in the intervention component of Project S.H.O.U.T., a tobacco use prevention program in San Diego County, California. In the activism component, a newsletter containing an activism contest was distributed to each student. Small prizes were awarded to contest winners at each school. 'Activism' included letter and petition writing, anti-tobacco poster contests, merchant education, peer surveys and magazine subscription cards. A total of 170 students participated in the activities, with 81.1 percent participating two or more times. Of those who participated, 59 percent were female and 60 percent were White, non-Hispanic. Two sets of logistic analyses were conducted. Variables such as SES, gender, ethnicity, friends' tobacco use and parental tobacco use were used to predict participation in activism activities. The choice of variables was intended to provide information regarding activism participation in reference to known tobacco risk factors. Results of the first analysis indicated that students with a higher SES, and in an urban vs. rural location were more likely to participate in the activism activities. The second analysis used the same set of characteristics to predict 'ever-use' of tobacco. Results of this analysis indicated that male gender, low grades, White, non-Hispanic ethnicity, friends' and parents' tobacco use were positively associated with tobacco experimentation. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.Design: A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).Participants: A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.Intervention: Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.Main Outcome Measures: At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures.Results: In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.Conclusion: The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years. [ABSTRACT FROM AUTHOR]

The breast self-examination (BSE) practices of 1,453 Hispanic women in Phoenix, Arizona and San Diego, California were the focus of this study. Variables proposed as factors that influence the frequency and proficiency of BSE were demographic variables, particularly language and level of acculturation, having been taught BSE by a health professional, and experience with the disease. Results indicate that even though the majority of the women at both the Phoenix (78.1%) and San Diego (83.7%) sites had been taught BSE by a professional and most women in Phoenix (62.5%) and San Diego (63.4%) reported performing BSE within the past month, only 0.7% of the women at both sites were found to be proficient in the technique of BSE. Further, results indicate that language and acculturation were correlated with whether or not a woman performed BSE. These findings suggest that BSE education classes must provide information and techniques that promote proficiency in BSE, and must be designed to meet the unique needs of Hispanic women, particularly those of low acculturation levels. [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess the reliability and validity of a culturally adapted behavioral test of tobacco refusal skills (i.e., ability to turn down a cigarette offer) for Latino youth. Seventh grade students in San Diego, USA, and Tijuana, Mexico, listened to audiotaped tobacco offers either in English or Spanish, and their responses were recorded and coded for content and quality of tobacco refusals. The test was hypothesized to be sensitive to the effects of smoking prevention programms; therefore, validity was assessed in a quasi-experimental design with intervention and control groups. Subjects were tested at baseline and 6 months after the intervention group had completed a culturally adapted eightsession program that taught effective tobacco refusal strategies Intraclass test-retest reliabilities were .75 for boys and .57 for girls, and internal consistency coefficients were .73 for boys and .82 for girls. Analyses for boys indicated no differential change by condition in the types of refusals used pre-to-post, nor -any change in the quality of refusals to cigarette offers. For girls, the only intervention effect was a reduction in the use of aggressive responses. Results suggest limitations of the tobacco refusal skills test for Latinos. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe clinical services and health communication needs for recent immigrants. METHODS: A review of relevant health behavior and policy research published in the past 20 years was conducted. RESULTS: Health coverage for primary care, prenatal and safety net services needs to be continued for all immigrants. Legislative bodies should repeal those aspects of welfare reform laws that diminish funding for health programs. English training provides efficient and effective access to health care and health communication. Finally, health communication messages mediated by community health advisors constitute an effective alternative to mainstream health communication. CONCLUSIONS: Societies whose populations consist primarily of immigrants need to be better prepared to promote the health of this group. [ABSTRACT FROM AUTHOR]

Research has shown that children's dietary and activity-related behaviors are shaped by the family environment and parenting behaviors. The present study describes the development and validation of a bilingual (Spanish and English) scale assessing parenting strategies associated with children's dietary and activity-related behaviors in the home. Items were generated from focus groups with Latina mothers and a review of the literature, and two different samples were used to assess the scale's psychometric properties, including an examination of predictive validity using measured child body mass index. Factor analysis of the first sample (N=91) yielded a 5-factor solution (limit setting, monitoring, discipline, control and concern) and accounted for 65% of the variance. Confirmatory factor analyses on a second sample of Latina mothers recruited into a childhood obesity prevention study (N=714) showed that a 26-item 5-factor solution (limit setting, monitoring, discipline, control and reinforcement) provided the best fit for the data. Parenting strategies characterized as controlling were associated with a lower BMI among children. After using multiple samples and establishing its validity, the parenting strategies for eating and activity scale (PEAS) was found to be valid and reliable in measuring Latino parenting strategies related to children's dietary and activity-related behaviors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Few studies assessing sun safety behaviors have used validated survey instruments. Using an observational strategy, this study measured the validity of self-report of occupational sun protection behaviors. METHODS: Postal workers (N = 1,036) self-reported their frequency of protective clothing and sunglasses use during the past 5 workdays on Likert scales ranging from 'Never' to 'Always'. Responses were dichotomized by Always vs. all other responses. Data collectors observed these same behaviors during mail delivery several days before survey administration. Agreement between the two measures was computed. RESULTS: Self-report for all items was significantly related to observed behaviors, with Kappa values in the good to excellent range (Kappas = 0.51-0.83). CONCLUSIONS: For outdoor postal workers, survey items assessing recent occupational use of sun-protective items had high levels of validity. © 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. [ABSTRACT FROM AUTHOR]

The present study evaluated two relapse-prevention interventions intended to help women smokers maintain the "quit status" mandated during Navy basic training. Women with any smoking experience before entering the Navy (N = 2,781) were assigned to either a control group or to one of two intervention groups (access to a telephone help line or receive a series of monthly mailings) after graduating from basic training. Smoking/quit rates at 3, 6, and 12 months after graduation were assessed with mailed surveys. Response rates to the surveys ranged from 39% to 52%. There were no phone or mail intervention effects: cessation rates for the three conditions at the 12-month follow-up were 43% for control, 45% for the mail intervention, and 41% for the phone intervention. Results suggest the need for more aggressive relapse-prevention efforts, although quit rates were higher than expected "spontaneous" quit rates, indicating an impact of the totally smoke-free recruit training environment. [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) transmission from humans to mosquitoes is a poorly documented, but critical component of DENV epidemiology. Magnitude of viremia is the primary determinant of successful human-to-mosquito DENV transmission. People with the same level of viremia, however, can vary in their infectiousness to mosquitoes as a function of other factors that remain to be elucidated. Here, we report on a field-based study in the city of Iquitos, Peru, where we conducted direct mosquito feedings on people naturally infected with DENV and that experienced mild illness. We also enrolled people naturally infected with Zika virus (ZIKV) after the introduction of ZIKV in Iquitos during the study period. Of the 54 study participants involved in direct mosquito feedings, 43 were infected with DENV-2, two with DENV-3, and nine with ZIKV. Our analysis excluded participants whose viremia was detectable at enrollment but undetectable at the time of mosquito feeding, which was the case for all participants with DENV-3 and ZIKV infections. We analyzed the probability of onward transmission during 50 feeding events involving 27 participants infected with DENV-2 based on the presence of infectious virus in mosquito saliva 7-16 days post blood meal. Transmission probability was positively associated with the level of viremia and duration of extrinsic incubation in the mosquito. In addition, transmission probability was influenced by the day of illness in a non-monotonic fashion; i.e., transmission probability increased until 2 days after symptom onset and decreased thereafter. We conclude that mildly ill DENV-infected humans with similar levels of viremia during the first two days after symptom onset will be most infectious to mosquitoes on the second day of their illness. Quantifying variation within and between people in their contribution to DENV transmission is essential to better understand the biological determinants of human infectiousness, parametrize epidemiological models, and improve disease surveillance and prevention strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Current knowledge of dengue virus (DENV) transmission provides only a partial understanding of a complex and dynamic system yielding a public health track record that has more failures than successes. An important part of the problem is that the foundation for contemporary interventions includes a series of longstanding, but untested, assumptions based on a relatively small portion of the human population; i.e., people who are convenient to study because they manifest clinically apparent disease. Approaching dengue from the perspective of people with overt illness has produced an extensive body of useful literature. It has not, however, fully embraced heterogeneities in virus transmission dynamics that are increasingly recognized as key information still missing in the struggle to control the most important insect-transmitted viral infection of humans. Only in the last 20 years have there been significant efforts to carry out comprehensive longitudinal dengue studies. This manuscript provides the rationale and comprehensive, integrated description of the methodology for a five-year longitudinal cohort study based in the tropical city of Iquitos, in the heart of the Peruvian Amazon. Primary data collection for this study was completed in 2019. Although some manuscripts have been published to date, our principal objective here is to support subsequent publications by describing in detail the structure, methodology, and significance of a specific research program. Our project was designed to study people across the entire continuum of disease, with the ultimate goal of quantifying heterogeneities in human variables that affect DENV transmission dynamics and prevention. Because our study design is applicable to other Aedes transmitted viruses, we used it to gain insights into Zika virus (ZIKV) transmission when during the project period ZIKV was introduced and circulated in Iquitos. Our prospective contact cluster investigation design was initiated by detecttion of a person with a symptomatic DENV infection and then followed that person's immediate contacts. This allowed us to monitor individuals at high risk of DENV infection, including people with clinically inapparent and mild infections that are otherwise difficult to detect. We aimed to fill knowledge gaps by defining the contribution to DENV transmission dynamics of (1) the understudied majority of DENV-infected people with inapparent and mild infections and (2) epidemiological, entomological, and socio-behavioral sources of heterogeneity. By accounting for factors underlying variation in each person's contribution to transmission we sought to better determine the type and extent of effort needed to better prevent virus transmission and disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Prevalence of certain disordered eating behaviors is higher among Hispanic youth compared to non-Hispanics. Understanding the role of body image and social attitudes towards weight in disordered eating may inform treatment in Hispanic youth., Methods: We analyzed data from the Hispanic Community Health Study/Study of Latino Youth (SOL Youth). Our sample included 1,463 children aged 8-16 years from four sites (Bronx, Chicago, Miami, San Diego) assessed in 2011-2014. Body image discrepancy score was calculated as the difference between perceived ideal body image and actual body image using two numbered visual graphs: adolescent (n = 728) or child (n = 735), each with slightly different scales. Questionnaires measured influences from social attitudes toward weight and disordered eating behaviors. Three disordered eating behaviors (dieting, overeating, and compensatory behaviors) were analyzed as the dependent variable. Logistic regression models adjusted for age, sex, acculturative stress, and field center to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI)., Results: Mean body image discrepancy score was -0.79 for adolescents (SE = 0.08) and -0.50 for children (SE = 0.05), with a negative score signifying a perceived actual body image larger than their ideal. Body image discrepancy was strongly associated with dieting (dieting ≥5 times/year aOR = 0.64, 95% CI 0.53, 0.77) and compensatory behaviors (aOR = 0.65, 95% CI 0.50, 0.85) among adolescents, and was strongly associated with overeating among children (aOR = 0.74, 95% CI 0.61, 0.91). Significant associations were not observed with social attitudes towards weight., Conclusions: Associations observed with body image discrepancy and disordered eating behaviors can inform interventions in Hispanic/Latino youth, which should consider acculturative stress., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas., Methods: The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference., Results: After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference., Conclusions: Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits., Trial Registration: NCT01776632 , Registered March 18, 2011., (© 2022. The Author(s).)

Background: Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months., Trial Design: Clustered randomized controlled trial METHODS: Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team's support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees' capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors., Results: The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects., Conclusions: Structural and social change interventions can modify customers' behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products)., Trial Registration: NCT01475526., (© 2022. The Author(s).)