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Assessed an interactive, computer-mediated intervention to help smokeless tobacco users quit by providing a user-friendly, personalized approach that engaged clients in the quitting process. Participant evaluation indicated that at 6-week follow-up, most had made an attempt to quit, and 58 percent were able to quit for at least 24 hours. Responses to the program were positive. (SM)

Tai Chi--Moving for Better Balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the RE-AIM framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings.

Background. The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. Methods. This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of fails; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. Results. At the end of the 6-month intervention, significantly fewer falls (n = 38 vs 73; p = .007), lower proportions of fallers (28% vs 46%; p = .01), and fewer injurious falls (7% vs 18%; p = .03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple fails in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio, .45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p < .001) in all measures of functional balance, physical performance, and reduced fear of failing. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. Conclusions. A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.

This study examined the role of falls self-efficacy as a potential mediator of the exercise and fear-of-falling relationship. The study sample involved 256 community-dwelling older adults aged 70-92 years (M = 77.48, SD = 4.95) who were recruited from a local health care system in Portland, Oregon, and participated in either a Tai Chi (n = 125) or a stretching control (n = 131) exercise intervention, three times per week, for 6 consecutive months. Measures of falls self-efficacy and tear of falling were assessed at baseline and at 3-month and 6-month follow-ups. Intention-to-treat analyses were conducted to evaluate the hypothesis of falls self-efficacy as a mediator of change in fear of falling that resulted from the 6-month Tai Chi intervention. Results supported the mediational hypothesis in that Tai Chi participants, who evidenced improvement in falls self-efficacy over the course of the intervention, reported greater reductions in fear of falling, compared with those in the stretching control condition. Results suggest that exercise interventions designed to improve falls self-efficacy are likely to reduce fear of falling in older adults.

This study examined heterogeneity in response patterns of the participants of the Survey of Activities and Fear of Falling in the Elderly (SAFFE) and their relationships to falls, functional ability, quality of life, and activity restriction measures in a cohort of 256 older people (mean age = 77.5 years). Participants recruited from local primary care clinics were administered the SAFFE instrument, an activity restriction measure, a combination of self-reported and performance-based functional ability tests, and quality-of-life measures. Latent class analyses identified two classes: Class 1 (n = 209), which had a low SAFFE fear of falling, and Class 2 (n = 47), which had a high SAFFE fear of falling. Subsequent analyses of variance indicated that the two-class (low fear and high fear) SAFFE fear of falling profiles discriminated fallers from nonfallers, and low and high levels of functional ability, activity restriction, and quality of life. The findings from this study suggest that variations in the SAFFE response patterns on a single dimension of fear of falling and that high levels of fear of falling measured by the SAFFE are linked to a range of adverse health consequences.

Abstract Background Smoking is related to many diseases, and the relapse to smoking after cessation in China is noticeable. We examined the attitudes of Chinese male smokers regarding smoking cessation and reasons for relapse. Methods We interviewed 201 male smokers in Hangzhou City, Zhejiang province, China who had tried to quit smoking at least once in order to identify reasons for quitting and situations triggering relapse. Results The most significant reported reasons for quitting included personal health (77.1%), the cost of cigarettes (53.7%), and family pressures to quit (29.9%). The most common factors triggering relapse were social situations (34.3%), feeling negative or down (13.4%) and times of being alone (8.4%). Conclusion Health and family concerns, personal factors, the influence of others and a lack of cessation resources were cited as salient factors concerning smoking cessation among male smokers in this study. Effective smoking control efforts in China will require attention to these influences if China is to curb its current smoking epidemic.

Background: This study was designed to develop an evidence- and community- based falls prevention program--Tai Chi: Moving for Better Balance. Methods: A mixed qualitative and quantitative approach was used to develop a package of materials for program implementation and evaluation. The developmental work was conducted in 2 communities in the Pacific Northwest. Participants included a panel of experts, senior service program managers or activity coordinators, and older adults. Outcome measures involved program feasibility and satisfaction. Results: Through an iterative process, a program package was developed. The package contained an implementation plan and class training materials (ie, instructor's manual, videotape, and user's guidebook). Pilot testing of program materials showed that the content was appropriate for the targeted users (community-living older adults) and providers (local senior service organizations). A feasibility survey indicated interest and support from users and providers for program implementation. A 2-week pilot evaluation showed that the program implementation was feasible and evidenced good class attendance, high participant satisfaction, and interest in continuing Tai Chi. Conclusions: The package of materials developed in this study provides a solid foundation for larger scale implementation and evaluation of the program in community settings. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to provide preliminary evaluation of the feasibility, safety, and efficacy of a newly developed Tai Chi-based exercise program for older adults with Parkinson's disease (PD). Using a one-group pretest-posttest design, 17 community-dwelling adults (mean age 71. 51 years) with mild to moderate idiopathic PD (Stage I, II, or III on the Hoehn and Yahr scale) and stable medication use completed a 5-day, 90-min/day Tai Chi exercise-evaluation program. Outcome measures included face-to-face exit interviews on appropriateness and safety and physical performance (i.e., 50-ft speed walk, up-and-go, functional reach). At the end of this brief intervention, exercise adherence was 100% and the program was shown to be safe. Exit interviews indicated that the program was well received by all participants with respect to program appropriateness, participant satisfaction and enjoyment, and intentions to continue. Furthermore, a significant pretest-to-posttest change was observed at the end of the 5-day program in all three physical-performance measures (p < . 05). The results of this pilot evaluation suggest that Tai Chi is an appropriate physical activity for older adults with PD and might also be useful as a therapeutic exercise modality for improving and maintaining physical function. These preliminary findings warrant further investigation. [ABSTRACT FROM AUTHOR]

The article reports on a multilevel analysis conducted to examine change in neighborhood walking activity over a 12-month period in a community-based sample of 28 neighborhoods of 303 older adults age 65 and over. The study employed a multilevel (residents nested within neighborhoods) and longitudinal (4 repeated measures over 1 year) design and a multilevel analysis of change and predictors of change in neighborhood walking activity. Results indicated a significant neighborhood effect, with neighborhood-level walking characterized by a downward trajectory over time. Inclusion of baseline variables using selected perceived neighborhood-level social- and physical-environment measures indicated that neighborhoods with safe walking environments and access to physical activity facilities had lower rates of decline in walking activity. The findings provide preliminary evidence of neighborhood-level change and predictors of change in walking activity in older adults. They also suggest the importance of analyzing change in physical activity in older adults from a multilevel or macrolevel framework. [ABSTRACT FROM AUTHOR]

Over the past few years, attention has been drawn to the importance of neighborhood influences on physical activity behavior and the need to consider a multilevel analysis involving not only individual-level variables but also social- and physical-environment variables at the neighborhood level in explaining individual differences in physical activity outcomes. This new paradigm raises a series of issues concerning systems of influence observed at different hierarchical levels (e.g., individuals, neighborhoods) and variables that can be defined at each level. This article reviews research literature and discusses substantive, operational, and statistical issues in studies involving multilevel influences on middle-aged and older adults' physical activity. To encourage multilevel research, the authors propose a model that focuses attention on multiple levels of influence and the interaction among variables characterizing individuals, among variables characterizing neighborhoods, and across both levels. They conclude that a multilevel perspective is needed to increase understanding of the multiple influences on physical activity. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the relationship between physical activity and self-rated health of older adults at both the neighborhood level and the resident level. Methods. A multilevel design was used that involved neighborhoods as the primary sampling unit and residents nested within each neighborhood. Residents (N = 582, mean age = 73.99 years, SD = 6.26) from 56 neighborhoods in Portland, Oregon, were surveyed on neighborhood physical activity and health status. Results. Multilevel path analysis showed a positive relationship between physical activity and health status at the neighborhood level. In addition, perceptions of neighborhood social cohesion, access to physical activity facilities, safety for walking, and importance of physical activity involvement, were positively related to high levels of physical activity. At the resident level, education and walking efficacy were positively associated with older adult physical activity. Conclusions. The results provide evidence that neighborhood-level physical activity is positively linked to neighborhood-level self-rated health in older adults. [ABSTRACT FROM AUTHOR]

There is a need for greater understanding of setting-specific influences on physical activity to complement the predominant research paradigm of individual-centered influences on physical activity. In this study, the authors used a cross-sectional multilevel analysis to examine a range of neighborhoodlevel characteristics and the extent to which they were associated with variation in self-reported physical activity among older adults. The sample consisted of 582 community-dwelling residents age 65 years and older (M = 73.99 years, SD = 6.25) recruited from 56 neighborhoods in Portland, OR. Information collected from participants and neighborhood data from objective sources formed a two-level data structure. These hierarchical data (i.e., individuals nested within neighborhoods) were subjected to multilevel structural-equation-modeling analyses. Results showed that neighborhood social cohesion, in conjunction with other neighborhood-level factors, was significantly associated with increased levels of neighborhood physical activity. Overall, neighborhood-level variables jointly accounted for a substantial variation in neighborhood physical activity when controlling for individual-level variables. [ABSTRACT FROM AUTHOR]

This study examined the effect of cobblestone-mat walking on health-related outcomes in older adults. Participants (mean age 72.6, N = 40) were randomized into either an 8-week cobblestone-mat walking activity (n = 22) or a control group (n = 18). Cobblestone-mat walking entailed three 45-min sessions per week. Primary outcomes included SF-12 (mental, physical), instrumental activities of daily living (IADLs), psychophysical well-being, daytime sleepiness, and pain. Secondary outcomes included resting blood pressure and perceived control of falls. The walkers experienced significantly improved SF-12 scores, IADLs, and psychophysical well-being and significantly reduced daytime sleepiness and pain. They also reported significantly improved perceptions of control over falls. A significant between-groups difference in resting diastolic blood pressure was observed, with reductions in the walkers. A significant within-group reduction in systolic blood pressure was observed in the walkers only. The data indicate that cobblestone-mat walking can significantly improve health-related outcomes in older adults. [ABSTRACT FROM AUTHOR]

Low-impact exercise that appeals to elderly adults and can be done almost anywhere provides both societal and individual benefits. One such program is Tai Chi, a traditional Chinese dancelike conditioning exercise. The article presents an easily adopted and adapted 8-form Tai Chi program (Easy Tai Chi) designed for older adults or individuals with mobility challenges or physical impairments. Derived from a simplified 24-form Yang-style Tai Chi, it stresses postural control and body-limb rotational movements. Easy Tai Chi can be performed either standing or sitting, depending on the physical and functional limitations of participants. Preliminary data indicate a number of health benefits of Easy Tai Chi compared with a traditional exercise program. Although subject to further empirical evaluation, Easy Tai Chi can be applied in research settings to investigate prevention or amelioration of hypokinetic diseases and in clinical settings to treat physically frail seniors or others with functional impairments of the musculoskeletal or cardiovascular system. [ABSTRACT FROM AUTHOR]

Background: Smoking is related to many diseases, and the relapse to smoking after cessation in China is noticeable. We examined the attitudes of Chinese male smokers regarding smoking cessation and reasons for relapse. Methods: We interviewed 201 male smokers in Hangzhou City, Zhejiang province, China who had tried to quit smoking at least once in order to identify reasons for quitting and situations triggering relapse. Results: The most significant reported reasons for quitting included personal health (77.1%), the cost of cigarettes (53.7%), and family pressures to quit (29.9%). The most common factors triggering relapse were social situations (34.3%), feeling negative or down (13.4%) and times of being alone (8.4%). Conclusion: Health and family concerns, personal factors, the influence of others and a lack of cessation resources were cited as salient factors concerning smoking cessation among male smokers in this study. Effective smoking control efforts in China will require attention to these influences if China is to curb its current smoking epidemic. [ABSTRACT FROM AUTHOR]

Objective: To examine the relation between built environment factors (representing several dimensions of urban form of neighbourhoods) and walking activity at both the neighbourhood level and the resident level, in an older adult sample. Design, setting, participants: A cross sectional, multilevel design with neighbourhoods as the primary sampling unit and senior residents as the secondary unit. Five hundred and seventy seven residents (mean age =74 years, SD = 6.3 years) participated in the survey, which was conducted among 56 city defined neighbourhoods in Portland, Oregon, USA. Neighbourhood level variables were constructed using geographical information systems. Resident level variables consisted of a mix of self reports and geocoded data on the built environment. Main outcome measure: Self reported neighbourhood walking. Main results: A positive relation was found between built environment factors (density of places of employment, household density, green and open spaces for recreation, number of street intersections) and walking activity at the neighbourhood level. At the resident level, perceptions of safety for walking and number of nearby recreational facilities were positively related to high levels of walking activity. A significant interaction was observed between number of street intersections and perceptions of safety from traffic. Conclusions: Certain neighbourhood built environment characteristics related to urban form were positively associated with walking activity in the neighbourhoods of senior residents. Public health promotion of walking activity/urban mobility and the design of interventions need to consider the contribution of neighbourhood level built environment influences. [ABSTRACT FROM AUTHOR]

Background. The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. Methods. This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. Results. At the end of the 6-month intervention, significantly fewer falls (n = 38 vs 73; p = .007), lower proportions of fallers (28% vs 46%; p = .01), and fewer injurious falls (7% vs 18%; p = .03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio, .45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p < .001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. Conclusions. A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive... [ABSTRACT FROM AUTHOR]

This study examined the role of falls self-efficacy as a potential mediator of the exercise and fear-of-falling relationship. The study sample involved 256 community-dwelling older adults aged 70-92 years (M = 77.48, SD = 4.95) who were recruited from a local health care system in Portland, Oregon, and participated in either a Tai Chi (n = 125) or a stretching control (n = 131) exercise intervention, three times per week, for 6 consecutive months. Measures of falls self-efficacy and fear of falling were assessed at baseline and at 3-month and 6-month follow-ups. Intention-to-treat analyses were conducted to evaluate the hypothesis of falls self-efficacy as a mediator of change in fear of falling that resulted from the 6-month Tai Chi intervention. Results supported the mediational hypothesis in that Tai Chi participants, who evidenced improvement in falls self-efficacy over the course of the intervention, reported greater reductions in fear of falling, compared with those in the stretching control condition. Results suggest that exercise interventions designed to improve falls self-efficacy are likely to reduce fear of falling in older adults. [ABSTRACT FROM AUTHOR]

In research on elder physical activity and health, emphasis has predominantly centered on outcome, with little attention given to an examination of which recruitment strategies were most effective and why. This article reports on the strategies and methods used in recruiting participants for the Senior Health And Physical Exercise (SHAPE) project, a randomized trial of neighborhood walking. A multifaceted, staged protocol of computerized telephoning followed by direct mail and personal contact methods was employed to recruit a representative sample of 582 elderly participants (M=73.99 years, S.D.=6.25; 69% female) from 56 metropolitan neighborhoods in Portland, OR. Significant variations in distribution were found both between conditions (χ2=117.81, df=1, P<.001) and within the walking condition (χ2=91.77, df=4, P<.001), indicating that overall women and men tended to respond differentially to the different methods. Details and evaluation of recruitment strategies, costs, and implications of the findings for recruiting older adults to community-based physical activity programs are discussed. [Copyright &y& Elsevier]

Examines heterogeneity in response patterns of the participants of the Survey of Activities and Fear of Falling in the Elderly (SAFFE). relationship between SAFFE Fear of falling and activity level; Presentation of the mean scores and standard deviations for the dependent outcome variables by SAFFE Fear-of-Falling status.