Search

N/A

N/A

Existing literature discusses challenges in conducting community-engaged health behavior interventions. However, discussions associated with the barriers to executing community-engaged health behavior research with vulnerable populations are limited in the literature. This current issue provides lessons learned for the purpose of improving community-engaged research within communities that are under- resourced. The lessons learned stem from challenges with the recruitment and enrollment procedures and study design with a previous qualitative community-engaged research project. The research recommendations proposed are geared toward students preparing to engage in dissertation research and early-stage investigators who are interested in conducting research in under-resourced communities.

Background: Ecological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual’s behaviors and states. A new approach, microinteraction EMA (μEMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using μEMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated. Objective: This paper describes the μEMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the μEMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the μEMA app, changes made to the main TIME Study μEMA protocol and app based on the pilot feedback, and preliminary μEMA results from a subset of active participants in the TIME Study. Methods: The TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non–EMA burst days, participants answer μEMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and μEMA in a semistructured interview. A pilot study was used to test and refine the μEMA protocol before the main study. Results: Changes made to the μEMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 μEMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%). Conclusions: The TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that μEMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives. [ABSTRACT FROM AUTHOR]

Background: Although previous studies supported the health benefits of physical activity, these studies were limited to individual-level research designs. Building upon a social-ecological model, we examined the relationship between physical activity and community health--the health status of a defined group of people--while accounting for the potential endogeneity of physical activity to health. Methods: We obtained U.S. county-level data from the 2012 Behavioral Risk Factor Surveillance System survey and the 2014 County Health Ranking Database. We first conducted an ordinary least squares (OLS) regression analysis to examine the relationship between the rate of physical activity and community health measured by the average perceived health score for each county. We then conducted a 2-stage least squares (2SLS) regression analysis to investigate this relationship after accounting for potential endogeneity. Results: Results from the OLS analysis indicated that the rate of physical activity was positively associated with community health. Results from the 2SLS analysis confirmed that the physical activity rate remained positively associated with community health. Conclusions: In line with the social-ecological model, our findings provide the first evidence for the health benefits of county-level physical activity. Our results support extant research that has shown relationships between physical activity and individual-level, health-related outcomes. [ABSTRACT FROM AUTHOR]

Background: The importance of physical activity is well known.1 However, previous research suggests that breast movement during exercise can be painful, embarrassing, and anecdotally deter exercise participation.2,3 Therefore, this research investigates whether the breast influences physical activity participation. Methods: Female respondents (n = 249) completed a breast health and physical activity survey assessing bras and bra fit, physical activity, breast pain, comments and improvements, breast history, and demographics. Results: Results found that the breast was a barrier to physical activity participation for 17% of women. "I can't find the right sports bra" and "I am embarrassed by excessive breast movement" were the most influential breast related barriers to activity. Breast pain increased with vigorous activity and poor breast support. Breast health knowledge increased the use of a sports bra and levels of physical activity. Conclusions: The breast was the fourth greatest barrier to physical activity, behind energy/motivation (first), time constraints (second), and health (third), despite its omission from previous physical activity literature. As 33% of women were not meeting physical activity guidelines, increasing breast health knowledge may reduce barriers to physical activity. [ABSTRACT FROM AUTHOR]

Background: Seldom studies are about the relationship between built environment and physical activity, weight, and health outcome in meso- and microscales. Methods: 1100 residents aged 46 to 80 were recruited from 80 neighborhoods of 13 selected communities of Shanghai, China. An analysis of the relationship between dependent variables (physical activity, Body Mass Index [BMI], overweight/obesity, weight, and health outcomes) and independent variables (involved a geographic-information-system-derived measure of built environment) was conducted with hierarchical linear models. Results: Street connectivity was positively associated with physical activity (P < .01). River proximity was inversely related with overweight/obesity (P = .0220). Parkland and square proximity have a significant relationship with physical activity (P = .0270, .0010), BMI (P = .0260, .0130), and overweight/obesity (P = .0020, .0470). Land-use mix was positively associated with physical activity (P < .01) and inversely associated with BMI (P = .0240) and overweight/obesity (P = .0440). Green and open spaces were positively related with BMI (P < .01) and health status (P < .01). For residential style, residents living in a village were more likely to have a lower BMI and overweight/obesity than those living in an urban old or newer residential building. The direct effect of square proximity is much stronger than the indirect effect on BMI through physical activity. Conclusions: The findings can help planners build more pedestrian-friendly communities. They are also useful for creating interventions that are sensitive to possible environmental barriers to physical activity in older adults. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the longitudinal association between physical activity behavior at 11 years of age and the incidence of mental health problems from 11 to 15 years of age. Methods: Individuals born in the city of Pelotas, Brazil, in 1993 have been followed up since birth. At 11 and 15 years of age, mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ). At 11 years of age, physical activity was assessed through a validated questionnaire. The continuous SDQ score at 15 years was used as the outcome variable. The main exposure was physical activity behavior at 11 years of age divided into 3 categories (0, 1-299, ≥300 min/wk). Results: The incidence of mental health problems from 11 to 15 years was 13.6% (95% CI, 12.4-14.9). At 11 years, 35.2% of the adolescents achieved 300 min/wk of physical activity. In the unadjusted analysis, physical activity was inversely related to mental health problems (P = .04). After adjustment for confounders, the association was no longer significant in the whole sample but was still significant among boys. Conclusion: Physical activity appears to be inversely related to mental health problems in adolescence, but the magnitude of the association is weak to moderate. [ABSTRACT FROM AUTHOR]

Background: Individual, social, and community barriers to physical activity (PA) experienced by children with autism spectrum disorder (ASD) make PA participation more difficult and may contribute to increased screen time. Methods: We compared the prevalence of parent-reported barriers to PA among 58 typically developing (TD) children and 53 children with an ASD, 3 to 11 years, and assessed the association between barriers and PA participation and screen time among children with ASD. Results: Parents of children with ASD reported significantly more barriers than parents of TD children. Based on parent-report, 60% of children with ASD required too much supervision compared with no TD children (P < .001). Parents of children with ASD were more likely to report that adults lack skills needed to include their child (58%), that their child has few friends (45%), and that other children exclude their child (23%). The number of parent-reported barriers to PA was inversely correlated with the hours spent in PA per year (r = -0.27, P = .05) and positively related to total screen time (r = .32, P < .03). Conclusions: These findings underscore the need for community-based PA programs designed to meet the special requirements of this population and policies that compel schools and other government-supported organizations for inclusion and/or targeted programming. [ABSTRACT FROM AUTHOR]

Background: Park features' association with physical activity among predominantly Hispanic communities is not extensively researched. The purpose of this study was to assess factors associated with park use and physical activity among park users in predominantly Hispanic neighborhoods. Methods: Data were collected across 6 parks and included park environmental assessments to evaluate park features, physical activity observations to estimate physical activity energy expenditure as kcal/kg/ minute per person, and park user interviews to assess motivators for park use. Quantitative data analysis included independent t tests and ANOVA. Thematic analysis of park user interviews was conducted collectively and by parks. Results: Parks that were renovated had higher physical activity energy expenditure scores (mean = .086 ± .027) than nonrenovated parks (mean = .077 ± .028; t = -3.804; P < .01). Basketball courts had a significantly higher number of vigorously active park users (mean = 1.84 ± .08) than tennis courts (mean = .15 ± .01; F = 21.9, η² = 6.1%, P < .01). Thematic analysis of qualitative data revealed 4 emerging themes--motivation to be physically active, using the play spaces in the park, parks as the main place for physical activity, and social support for using parks. Conclusion: Renovations to park amenities, such as increasing basketball courts and trail availability, could potentially increase physical activity among low-socioeconomic-status populations. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to determine the effects of a social-ecologic intervention on health-related fitness (HRF) knowledge and behaviors of students (n = 62) living in rural areas. Methods: A prepost test control group design was constructed. In addition, qualitative data were collected by focus group discussions in the experimental group. Physical activity environment of a middle school was changed based on the social-ecologic model (SEM) with a focus on intrapersonal, interpersonal, community level, organizational factors, and public policies related to physical activity behavior. Health related fitness knowledge (HRFK) test, pedometer, and perceived physical activity self-efficacy and social support questionnaires were used for data collection. Results: Experimental group had significant improvement in HRF knowledge scores, physical activity levels, and social support compared with the control school students. The focus group results also supported the quantitative findings by indicating a perceived increase in physical activity opportunities; knowledge sources; and support from others. Conclusions: This study underlines the importance and positive outcomes of SEM in improving HRF knowledge, physical activity level, and social support of students in rural middle school settings. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is an important component in the management of Rheumatoid Arthritis (RA). To date the correlates of PA have not been thoroughly investigated in the RA population. The aim of this systematic review was to determine the correlates of PA in the adult RA population. Methods: A search of Medline, EMBASE, AMED, CINAHL plus, Pubmed, Web of Science, and the Cochrane Library was conducted. A manual search of reference lists was conducted to compliment the electronic search. Ten studies fulfilled the inclusion criteria and were assessed for methodological quality. Results: Results determined correlates in 4 categories: sociodemographic, physical, psychological and social variables. The variables varied greatly and were inconsistently studied. Changes were noted from a previous review in 2005 in relation to the association between certain variables and PA, including age, gender, disease duration, pain, exercise beliefs and social support. Conclusions: Positive associations with PA were found for motivation, self-efficacy, health perception, and previous PA levels. Negative associations were found for fatigue, a coerced regulation style and certain physiological variables. In addition differences between correlates of PA in the adult RA population and other chronic disease and healthy adult populations have been demonstrated. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the relationship between steps per day and adiposity among college women. Methods: This study was cross-sectional and included women ages 18-25. Participants wore a pedometer for 7 consecutive days. Body composition was assessed using air-displacement plethysmography. Height, weight, and waist and hip circumferences were assessed. Results: The women took 10,119 ± 2836 steps per day. When divided into quartiles by steps, the top 2 quartiles of women in the study had significantly lower BMI, percent body fat, and waist and hip circumferences than the bottom quartile of women (P ≤ .05). Percent body fat was different between the bottom 2 quartiles and the top 2 quartiles (P ≤ .05). The odds of having a body fat of greater than 32% were reduced by 21.9% for every increase of 1,000 steps taken per day (P ≤ .05). Conclusions: Steps per day are related to body composition in young adult women, but this relationship weakens with progressively higher step counts. A reasonable recommendation for steps in young adult women that is associated with the lowest BMIs and body fat seems to be between 10,000-12,000 steps per day. [ABSTRACT FROM AUTHOR]

Background: To examine the association between accelerometer-assessed physical activity and visual acuity among a nationally representative sample of adults with evidence of diabetes. Methods: Six hundred seventy adult participants with diabetes (age 20 to 85) from the 2003-2006 NHANES cycles constituted the analyzed sample. Participants wore an accelerometer for 7 days to quantify time spent in sedentary behavior, light-intensity physical activity and moderate-to-vigorous physical activity. Visual acuity was objectively assessed for each eye. Results: In multivariable models, every 1-hour increment in daily sedentary behavior was associated with 23% greater likelihood (OR = 1.23; 95% CI: 1.01-1.52) of having uncorrected refractive error as opposed to normal sight. Performing more than 5 minutes of daily moderate-to-vigorous physical activity was associated with a 82% lower likelihood of having vision impairment as opposed to normal sight (OR = 0.18; 95% CI: 0.06-0.50) while every 1-hour increment in daily light-intensity physical activity was, after adjustments, independently associated with a 38% lower likelihood of vision impairment (OR = 0.62; 95% CI: 0.42-0.92). Conclusion: People with diabetes spending more time in sedentary behavior and less time performing light or moderate-to-vigorous physical activity are more likely to have poorer vision. [ABSTRACT FROM AUTHOR]

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

Background: Too much sitting, including time spent sitting in cars, is associated with poor health outcomes. Identifying the built-environment attributes that may reduce vehicular sitting time can inform future initiatives linking the public health, urban design, and transportation sectors. Methods: Data collected in 2003-2004 from adult residents (n = 2521) of Adelaide, Australia were used. Logistic regression analyses examined associations of prolonged time spent sitting in cars during leisure time (30 min/ day or more) with neighborhood walkability and its components (dwelling density; intersection density; land use mix; net retail area ratio). Results: Lower overall walkability was significantly associated with a higher odds (OR = 1.43, 95% CI: 1.21-1.70) of spending prolonged time in cars. For analyses with walkability components, lower net retail area ratio, lower residential density, and lower intersection density were significantly associated with prolonged sitting in cars. Conclusion: This study found that residents of high walkable neighborhoods tended to spend less time sitting in cars. In particular, higher net retail area ratio, an indicator of tightly spaced commercial areas, was strongly associated with less time in cars. Policy and planning initiatives to reduce car use require further evidence, particularly on the influence of neighborhood retail areas. [ABSTRACT FROM AUTHOR]

Background: Computer-assisted techniques may be a useful way to enhance physical activity surveillance and increase accuracy of reported behaviors. Purpose: Evaluate the reliability and validity of a physical activity (PA) self-report instrument administered by telephone and internet. Methods: The telephone-administered Active Australia Survey was adapted into 2 forms for internet self-administration: survey questions only (internet-text) and with videos demonstrating intensity (internet-video). Data were collected from 158 adults (20-69 years, 61% female) assigned to telephone (telephone-interview) (n = 56), internet-text (n = 51), or internet-video (n = 51). Participants wore an accelerometer and completed a logbook for 7 days. Test-retest reliability was assessed using intraclass correlation coefficients (ICC). Convergent validity was assessed using Spearman correlations. Results: Strong test-retest reliability was observed for PA variables in the internet-text (ICC = 0.69 to 0.88), internet-video (ICC = 0.66 to 0.79), and telephone-interview (ICC = 0.69 to 0.92) groups (P-values < 0.001). For total PA, correlations (ρ) between the survey and Actigraph+logbook were ρ = 0.47 for the internet-text group, ρ = 0.57 for the internet-video group, and ρ = 0.65 for the telephone-interview group. For vigorous-intensity activity, the correlations between the survey and Actigraph+logbook were 0.52 for internet-text, 0.57 for internet-video, and 0.65 for telephone-interview (P < .05). Conclusions: Internet-video of the survey had similar test-retest reliability and convergent validity when compared with the telephone-interview, and should continue to be developed. [ABSTRACT FROM AUTHOR]

Background: Greenways (GW) can be sited and designed in a variety of ways. However, the extent to which siting and design relate to GW user's demographic characteristics and physical activity (PA) is unknown. The purpose of this study was to compare 2 GWs that differed in terms of their siting and design, with respect to the aforementioned variables. Methods: A trail intercept survey measuring PA, modes of GW access, and demographics was administered on 2 GWs (GWlinear vs. GWloop), which varied in siting and design characteristics. Results: GWlinear (n = 216), compared with GWloop users (n = 400), accumulated significantly greater volumes of PA from both accessing and using the GW (P = .012). GW linear users were more likely to be younger, male, and never married; they were also more likely to engage in transportational PA (10.6 vs. 0.3%, P ≤ .001) and access the GW via active transit modes (37.0% vs. 4.2%, P ≤ .001). Conclusions: GW siting and design appears to be related to user characteristics, and the types and volumes of PA performed. These results should be considered by GW planners and designers to best serve the PA needs of the community. [ABSTRACT FROM AUTHOR]

Background: Recently, investigators have begun to refine audit instruments for use in rural areas. However, no studies have developed a walkability summary score or have correlated built environment characteristics with physical activity behavior. Methods: The Rural Pedestrian Environmental Audit Instrument was developed specifically for use in rural areas. Segments surrounding participant's homes were selected to represent neighborhood streets (N = 116). Interrater reliability was conducted on a subset of streets (N = 42). Rural-specific domain and walkability scores were developed and correlated with individual-level data on perceptions of the neighborhood and self-reported physical activity behavior. Results: Interrater reliability for the instrument was substantial and all domains had high agreement. Walkability in the audited area was low with even the best segments demonstrating only moderate support for walking. There were no significant correlations between the neighborhood walkability score and self-reported neighborhood walkability, time spent walking, sedentary behavior, or BMI; however, a few correlations within the social/dynamic domain were significant. Conclusions: This study expands recent research reining audit instruments for rural areas. Findings suggest the usefulness of summarizing environmental data at the domain level and linking it to physical activity behavior to identify aspects of the neighborhood environment that are most strongly correlated with actual behavior. [ABSTRACT FROM AUTHOR]

Background: Few studies of older adults have compared environmental correlates of walking and physical activity in women who may be more influenced by the environment. Environmental measures at different spatial levels have seldom been compared. Findings from previous studies are generally inconsistent. Methods: This study investigated the relationship between the built environment and physical activity in older women from the Women's Health Initiative cohort in San Diego County (N = 5401). Built environment measures were created for 3 buffers around participants' residential address. Linear regression analyses investigated the relationship between the built environment features and self-reported physical activity and walking. Results: Total walking was significantly positively associated with the walkability index (β = .050: half-mile buffer), recreation facility density (β = .036: 1-mile buffer), and distance to the coast (β = -.064; P-values < .05). Total physical activity was significantly negatively associated with distance to the coast and positively with recreation facility density (β = .036: 1-mile buffer; P < .05). Conclusions: Although effect sizes were small, we did find important relationships between walkability and walking in older adults, which supports recommendations for community design features to include age friendly elements. More intense physical activity may occur in recreational settings than neighborhood streets. [ABSTRACT FROM AUTHOR]

Purpose: To describe caries prevalence and oral-health-related behaviours in a sample of homeless adults from the city of Porto, Portugal. Materials and Methods: Subjects attending any of two temporary shelters or two institutions that provide meal programmes were consecutively invited (n = 196); 42 (21.4%) refused to participate. Trained interviewers applied a structured questionnaire to obtain sociodemographic, behavioural, health and oral health status data. An oral examination was conducted to evaluate the past and present history of caries (Decayed Missing Filled Teeth [DMFT] index) and the presence of oral lesions. Those classified as houseless were considered for the present analysis (n = 141). The association between homelessness, sociodemographic and behavioural characteristics and oral health indexes was quantified through crude β coefficients and β coefficients adjusted for age, gender, education, nationality and duration of homelessness, as well as the respective 95% confidence intervals (CI). Results: The median age of the participants was 45 years, most were male (86.3%), reported having less than a 9th-grade education (80.1%) and were unemployed (82.1%). The median duration of homelessness was 24 months. The mean (SD) DMFT index, number of decayed, lost and filled teeth were 12.8 (7.9), 4.2 (4.4), 8.0 (7.6) and 0.6 (1.9), respectively. Older subjects and those homeless for longer periods presented higher DMFT index scores (β = 3.4, 95% CI: 0.0 to 6.8) and higher number of decayed teeth (β = 2.8, 95% CI: 0.4 to 5.2). Filled teeth were more frequent among the more educated (>9 vs ≤4 years: β = 1.6, 95% CI: 0.7 to 2.6). Conclusions: This population of homeless subjects showed poor oral health, particularly with respect to caries and missing teeth, resulting in high oral treatment needs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the construct validity and reliability of college students' responses to the Behavioral Regulation in Exercise Questionnaire (BREQ-2) to be used in campus recreation programs and physical activity and wellness courses. The BREQ-2 is a 19-item questionnaire used to assess exercise motivation through the application of five subscales. Five hundred eighty-nine students completed the BREQ-2. Using SPSS 20.0 and AMOS 20.0, a confirmatory factor analysis was conducted. A review of reliability coefficients indicated the internal consistency of factors would not be improved by removing survey items. The standardized parameter estimates of the five-factor model indicated the BREQ-2 is an adequate fit for measuring exercise motivation factors among this sample of American college students. [ABSTRACT FROM AUTHOR]

Researchers have reported that the percentage of Americans considered overweight or obese continues to increase. Specific populations, such as university students, may be at greater risk for becoming overweight or obese. This can be combated by the significant health benefits accrued from regular exercise and physical activity; thus it is important that universities develop and implement methods to incorporate healthy living into its students' lives. The purpose of this paper is to provide a description of a college-student focused wellness initiative known as the Biggest User program. The Biggest User addresses components related to beginning and maintaining a healthy lifestyle with a particular focus on structured exercise, physical activity, and dietary choices. A secondary purpose of the paper is to provide a template for the creation of similar programs at university wellness centers, as such centers are increasingly seeking new and innovative approaches to improving health and wellness of its constituents (Talley, 2013). [ABSTRACT FROM AUTHOR]

Background: Despite well-documented health benefits, adults with a physical chronic condition do not meet the recommended physical activity (PA) guidelines. Therefore, secondary prevention programs focusing on PA are needed. Web-based interventions have shown promise in the promotion of PA behavior change. We conducted a systematic review to summarize the evidence about the effectiveness of web-based PA interventions in adults with chronic disease. Methods: Articles were included if they evaluated a web-based PA intervention and used a randomized design. Moreover, studies were eligible for inclusion if they used a non- or minimal-treatment control group and if PA outcomes measures were applied. Seven articles were included. Results: Three high-quality studies were statistically significant to the control group, whereas 2 high- and 2 low-quality studies reported nonsignificant findings. Conclusion: Our best evidence synthesis revealed that there is conflicting evidence on the effectiveness of web-based PA interventions in patients with a chronic disease. [ABSTRACT FROM AUTHOR]

Background: The International Physical Activity Questionnaire (IPAQ) is commonly used in surveys, but reliability and validity has not been established in the Danish population. Methods: Among participants in the Danish Health Examination survey 2007-2008, 142 healthy participants (45% men) wore a unit that combined accelerometry and heart rate monitoring (Acc+HR) for 7 consecutive days and then completed the IPAQ. Background data were obtained from the survey. Physical activity energy expenditure (PAEE) and time in moderate, vigorous, and sedentary intensity levels were derived from the IPAQ and compared with estimates from Acc+HR using Spearman's correlation coefficients and Bland-Altman plots. Repeatability of the IPAQ was also assessed. Results: PAEE from the 2 methods was significantly positively correlated (0.29 and 0.49; P = 0.02 and P < 0.001; for women and men, respectively). Men significantly overestimated PAEE by IPAQ (56.2 vs 45.3 kJ/kg/day, IPAQ: Acc+HR, P < .01), while the difference was non-significant for women (40.8 vs 44.4 kJ/kg/day). Bland-Altman plots showed that the IPAQ overestimated PAEE, moderate, and vigorous activity without systematic error. Reliability of the IPAQ was moderate to high for all domains and intensities (total PAEE intraclass correlation coefficient = 0.58). Conclusions: This Danish Internet-based version of the long IPAQ had modest validity and reliability when assessing PAEE at population level. [ABSTRACT FROM AUTHOR]

Background: This study compared moderate-to-vigorous physical activity (MVPA) and sedentary behavior in U.S.-born and foreign-born adolescents and young adults, and differences in behavior change from adolescence to young adulthood by nativity. Methods: Data on 2039 U.S.-born and 225 foreign-born participants from Project EAT-III (Eating and Activity in Teens and Young Adults) were used to examine MVPA, television/ DVD/video viewing, and computer use. Participants completed surveys at baseline in Minneapolis/St. Paul, MN secondary school classrooms in 1998-1999 (14.9 ± 1.6 y) and follow-up measures online or by mail in 2008-2009 (25.3 ± 1.6 y). Results: At both time points, foreign-born participants reported significantly lower levels of MVPA than their U.S.-born counterparts (P < .05). Foreign-born females at baseline and follow-up and foreign-born males at follow-up reported less television/DVD/video viewing compared with U.S.-born participants (P < .01). All participants experienced a significant decline in MVPA from baseline to follow-up (P < .001). Between-group analyses revealed a significantly greater decline in television/DVDs/video viewing for the foreign-born males compared with U.S.-born males from baseline to follow-up (mean change: foreign-born: -4.8 ± 1.32 hrs/wk, U.S.-born: -0.6 ± 0.6 hrs/wk; P < .01). Conclusions: Differences in activity patterns between foreign-born and U.S.-born youth into young adulthood may contribute to disparities in chronic disease risk. Nativity, along with the social, environmental, and cultural context, should be considered when designing programs to promote MVPA and prevent obesity. [ABSTRACT FROM AUTHOR]

Background: Brisk walking is recommended as a form of health-enhancing physical activity. This study determines the steps/minute rate corresponding to self-paced brisk walking (SPBW); a predicted steps/minute rate for moderate physical activity (MPA) and a comparison of the 2 findings. Methods: A convenience sample (N = 58: 34 men, 24 women, 31.7 ± 7.7yrs), wearing pedometers and a heart rate (HR) monitor, performed SPBW for 10 minutes and 5 indoor sessions, regulated by a metronome (ranging from 60-120 steps/minute). Using steps/minute and HR data of the trials, a steps/minute rate for MPA was predicted. Adjustments were subsequently made for aerobic fitness (using maximal oxygen uptake (VO2max) estimates), age, and sex as possible contributors to stepping rate differences. Results: Average steps/minute rate for SPBW was 118 ± 9 (116 ± 9; 121 ± 8 for men/women, respectively; P = .022); predicted steps/minute rate for MPA was 122 ± 37 (127 ± 36; 116 ± 39 for men/women, respectively; P < .99) and was similar to steps/minute rate of SPBW (P = .452), even after adjusting for age, sex, and aerobic fitness. Conclusion: Steps/minute rates of SPBW correlates closely with targeted HR for MPA, independent of aerobic fitness; predicted steps/minute rate for MPA relates closely to steps/minute rates of SPBW. Findings support current PA messages that use the term brisk walking as a reference for MPA. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity among Aboriginal women is a growing concern, with increasing prevalence rates linked to a sedentary lifestyle. Physical inactivity is a modifiable risk factor for unhealthy body weight; however before addressing health enhancing behaviors, understanding lifestyle practices, attitudes and beliefs are important. Methods: A mixed methods approach assessed physical activity (PA) practices (n = 58), and attitudes and beliefs (n = 19) among First Nations women. The Modifiable Activity Questionnaire assessed PA, and a focused ethnography explored attitudes and beliefs. Results: Self-reported PA was highest in the youngest age group. Both total and leisure-time PA decreased when house-related activities were not accounted for. Younger participants reported sport-related activities, while older participants reported traditional activities (eg, berry picking, fishing). Participants' believed PA promoted good health, yet personal (ie, lack of time), community-specific (ie, lack of opportunities/encouragement) and environmental (ie, inclement weather, safety) factors acted as barriers. Age-specific, women-only programs were highlighted as potential enablers. Conclusions: The findings highlight the need to assess cultural specific practices, attitudes and beliefs as PA programs that focus on reducing barriers identified in the community and are designed based on expressed interest and preferences may improve leisure-related PA levels among all age groups. [ABSTRACT FROM AUTHOR]

Background: Despite the health benefits associated with physical activity participation, activity levels of North American children are declining. In response, practitioners are placing emphasis on active forms of transportation to and from school. The purpose of this study was to explore the barriers and facilitators to active transportation to school (ATS) from the perspectives of practitioners. Methods: The perspectives of 19 practitioners (eg, health promoters, traffic engineers, police, etc.) from 3 communities in Alberta, Canada were captured using focus group interviews followed by content analysis. Results: Subthemes tied to barriers included logistics, lifestyle, safety, and lack of resources; while facilitators were comprised of collaboration, education, and leadership. The results were interpreted using an ecological model of health behavior. Conclusion: The most common ATS barriers: attitudes and safety concerns, lack of resources and time, and the nature of the natural and built environments were associated with the intrapersonal, organizational, and physical environmental factors, respectively. The most significant organizational facilitators concerned collaboration among parents, schools, businesses, community organizations, and government agencies. While the multifaceted nature of barriers and facilitators add complexity to the issue, it also challenges practitioners to think and act creatively in finding solutions. [ABSTRACT FROM AUTHOR]

Background: Precise measurement of physical activity (PA) is required to identify current levels and changes in PA within a population, and to gauge effectiveness of interventions. Methods: The Online Self-reported Walking and Exercise Questionnaire (OSWEQ) was developed for monitoring PA via the Web. Forty-nine participants (mean ± SD; age = 27 ± 11.9yrs) completed the OSWEQ and International PA Questionnaire (IPAQ) short form 3 times [T1/T2/T3 (separated by 7-days)] and wore an Actigraph-GT3X-accelerometer for 7-days between T2-T3. For each measure, estimates of average METminday1 and time spent in moderate PA (MPA), vigorous PA (VPA) and moderate and vigorous PA (MVPA) were obtained. Results: The OSWEQ and IPAQ demonstrated test-retest reliability for MPA, VPA, and MVPA minutes and average METminday1 between T1-T2 (OSWEQ range, r = .71-.77; IPAQ range, r = .59-.79; all, P < .01). The OSWEQ and IPAQ, compared with the GT3X, had lower estimates (mean error ± 95% PI) of MVPA MET⋅min⋅day-1 by 150.4 ± 477.6 and 247.5 ± 477.5, respectively. Conclusions: The OSWEQ demonstrates good test-retest reliability over 7-days and better group level estimates of MET⋅min⋅day-1 than the IPAQ, compared with the GT3X. These results suggest that the OSWEQ is a reliable and valid measure among young/working age adults and could be useful for monitoring PA trends over time. [ABSTRACT FROM AUTHOR]

Background: Perceived health status does not always reflect actual health status. We investigated the association between objective and self-rated measures of health status and hours of exercise per week in older adults. Method: As part of the TRIL clinic assessment, we gathered information from 473 community dwelling adults over the age of 65, regarding hours spent per week exercising, depression, personality, perceived health status, and objective health status (in the form of a comorbidity count). Regression analyses were performed on these data to investigate whether perceived health status, objective health status, personality and mood are associated with hours of exercise per week. Results: Perceived and objective health status were significantly but weakly correlated. Both perceived and objective health status, as well as depression, were independently associated with hours of exercise per week. Conclusions: We conclude that exercise uptake in older adults is contingent on both perceived and objective health status, as well as depression. Perceived health status has a stronger association with exercise uptake in older adults with lower depression levels. The current findings have implications for designing exercise interventions for older adults. [ABSTRACT FROM AUTHOR]

Longitudinal qualitative research (LQR) is an emerging methodology in health behavior and nursing research. Researchers are turning to LQR to understand experiences across time as well as identify facilitators and inhibitors of health/illness behaviors and transitions. Currently, a lack of information exists to guide researchers on LQR techniques and considerations. Our objective was to provide a methodological resource for health behavior and nursing researchers conducting LQR. LQR may be applied to understand any human experience, as well as the sequalae of the experience and is well suited for studying transitions and developmental or behavioral changes. Conducting LQR is resource intensive and requires flexibility and complex analyses. We discuss multiple components of LQR such as design considerations, analysis options, and our lessons learned. Despite complexities, LQR provides the opportunity to understand experiences across time within an individual and among a group resulting in holistic, in-depth understandings beyond a cross-sectional time point. [ABSTRACT FROM AUTHOR]

Background: Accelerometers have become one of the most common methods of measuring physical activity (PA). Thus, validity of accelerometer data reduction approaches remains an important research area. Yet, few studies directly compare data reduction approaches and other PA measures in free-living samples. Objective: To compare PA estimates provided by 3 accelerometer data reduction approaches, steps, and 2 self-reported estimates: Crouter's 2-regression model, Crouter's refined 2-regression model, the weighted cut-point method adopted in the National Health and Nutrition Examination Survey (NHANES; 2003-2004 and 2005-2006 cycles), steps, IPAQ, and 7-day PA recall. Methods: A worksite sample (N = 87) completed online-surveys and wore ActiGraph GT1M accelerometers and pedometers (SW-200) during waking hours for 7 consecutive days. Daily time spent in sedentary, light, moderate, and vigorous intensity activity and percentage of participants meeting PA recommendations were calculated and compared. Results: Crouter's 2-regression (161.8 ± 52.3 minutes/day) and refined 2-regression (137.6 ± 40.3 minutes/day) models provided significantly higher estimates of moderate and vigorous PA and proportions of those meeting PA recommendations (91% and 92%, respectively) as compared with the NHANES weighted cut-point method (39.5 ± 20.2 minutes/day, 18%). Differences between other measures were also significant. Conclusions: When comparing 3 accelerometer cut-point methods, steps, and self-report measures, estimates of PA participation vary substantially. [ABSTRACT FROM AUTHOR]

Objectives: To identify sex-based differences in the perception of benefits and barriers toward exercise and to determine the sex- and age-based differences in the level of physical activity (PA) among adult residents of Karachi. Methods: Three hundred adult individuals were included in cross sectional survey conducted during July-October 2010. Perception of benefits and barriers to exercise and the level of PA were measured through a questionnaire. Differences in the perception of benefits and barriers of exercise and level of PA were calculated with age and sex strata. Results: Women perceived more barriers to exercise than men (P-value < 0.001). In all age strata women have higher ranks for domestic-related physical activity while men have higher ranks for job-related PA. Leisure time PA were significantly lower for females in all age groups. Total PA is also affected by age and socioeconomic status, higher among people having monthly income < 6000 rupees and lower in males > 45 years of age. Conclusion: Sex-based differences exists in the level of PA and perception regarding exercise in mega city of Pakistan. There is a need to design programs that influence PA determinants connected to sex to prevent impending epidemic of non communicable diseases. [ABSTRACT FROM AUTHOR]

Background: Behavioral interventions for weight-loss have been largely unsuccessful. Exercise is the strongest predictor of maintained weight loss and much of its effects may be from associated changes in psychosocial factors. Methods: Middle-aged, formerly sedentary adults with severe obesity were randomly selected to 6-month treatments of cognitive-behavioral exercise support paired with either standard nutrition education (n = 99) or nutrition change supported by cognitive-behavioral means with an emphasis on self-regulation (n = 101). Results: Overall improvements in self-efficacy and self-regulation for both exercise and managed eating, and mood, were found, with significantly greater improvements associated with the cognitive-behavioral nutrition condition in self-regulation for eating and mood. Change scores trended toward being stronger predictors of increased exercise and fruit and vegetable intake than scores at treatment end. Multiple regression analyses indicated that significant portions of the variance in both increased volume of exercise (R2 = 0.45) and fruit and vegetable intake (R2 = 0.21) were explained by changes in self-regulatory skill usage, self-efficacy, and mood. Conclusions: Cognitive-behavioral methods for improved eating paired with behavioral support of exercise may improve weight loss through effects on the psychosocial factors of self-regulation, self-efficacy, and overall mood more than when standard nutrition education is incorporated. [ABSTRACT FROM AUTHOR]

Background: Little is known about the associations between natural amenities, recreation facility density, and obesity, at a national level. Therefore, the purpose of this paper was to examine associations between countylevel natural amenities, density of recreation facilities, and obesity prevalence among United States counties. Methods: Data were obtained from a compilation of sources within the United States Department of Agriculture Economic Research Service Food Environment Atlas. Independent variables of interest were the natural amenities scale and recreation facilities per capita. The dependent variable was county-level obesity prevalence. Potential covariates included a measure of county-level percent Black residents, percent Hispanic residents, median age, and median household income. All models were stratified by population loss, persistent poverty, and metro status. Multilevel linear regression models were used to examine the association between obesity and natural amenities and recreation facilities, with "state" as a random effects second level variable. Results: There were statistically significant negative associations between percent obesity and 1) natural amenities and 2) recreation facilities per capita. Conclusions: Future research should examine environmental and policy changes to increase recreation facilities and enhance accessible natural amenities to decrease obesity rates. [ABSTRACT FROM AUTHOR]

Background: While there is an emerging body of literature showing variations in physical activity between seasons, further investigation is needed to better understand this association in preschool-age children. This study was designed to examine seasonal variation from fall to winter in physical activity among preschoolers. Methods: Forty-six preschool children from 2 preschools in a large Midwestern Metropolitan area completed weekly habitual physical activity measures in both fall and following winter. The habitual physical activity was quantified with the GT1M Actigraph uniaxial accelerometer. To determine seasonal differences in physical activity, a series of paired sample t tests were conducted. Results: Although overall physical activity level declined in winter, the magnitude of seasonality effects seem varied in terms of contexts. Compared with the decline during after-school time and during weekends, the differences in physical activity across the 2 seasons were much less evident during the time attending preschool and during weekdays. Conclusion: Seasonality in physical activity can be moderated by other contextual factors, such as preschool policies and curriculum. Preschools may serve as a major battlefield for fighting against physical inactivity and obesity during childhood due to their practical controllability. [ABSTRACT FROM AUTHOR]

Background: The Pregnancy Physical Activity Questionnaire (PPAQ) assesses physical activity practices of pregnant women. The purpose of this study was to identify specific pregnancy practices that were associated with a healthy gestational weight gain (GWG). Methods: Associations between PPAQ scores, pedometer steps, energy intakes (EI), energy expenditures (EE), and rate of GWG were assessed for 61 pregnant women in their second or third trimester during a home visit. Principle component analyses (PCA) were used to cluster PPAQ questions into Factors associated with either rate or total GWG, physical activity (PA), EE, EI, and parity. Results: PCA identified 3 Factors: Factor 1 associated EE with parity and child care; Factor 2 clustered several structured exercise activities; and Factor 3 grouped walking, playing with pets, and shopping with pedometer steps. Only Factor 3 clustered steps with weekly rate of GWG. EI was not associated with PA or GWG. Conclusions: PCA analysis identified 15 of 32 PPAQ questions that were related to increased physical activity in pregnant women, but only walking and pedometer steps were associated with GWG. Our analysis supports daily walking as the preferred PA for achieving a healthy rate of GWG. [ABSTRACT FROM AUTHOR]

Background: The built and social environments may contribute to physical activity motivations and behavior. We examined the extent to which the Theory of Planned Behavior (TPB) mediated the association between neighborhood walkability and walking. Methods: Two random cross-sectional samples (n = 4422 adults) completed telephone interviews capturing walking-related TPB variables (perceived behavioral control (PBC), attitudes, subjective norm, intention). Of those, 2006 completed a self-administered questionnaire capturing walkability, social support (friends, family, dog ownership), and neighborhood-based transportation (NTW) and recreational walking (NRW). The likelihood of undertaking 1) any vs. none and 2) sufficient vs. insufficient levels (≥150 vs. <150 minutes/week) of NTW and NWR, in relation to walkability, social support, and TPB was estimated. Results: Any and sufficient NTW were associated with access to services, connectivity, residential density, not owning a dog (any NTW only), and friend and family support. Any and sufficient NRW were associated with neighborhood aesthetics (any NRW only), dog ownership, and friend and family support. PBC partially mediated the association between access to services and NTW (any and sufficient), while experiential attitudes partially mediated the association between neighborhood aesthetics and any NRW. Conclusions: Interventions that increase positive perceptions of the built environment may motivate adults to undertake more walking. [ABSTRACT FROM AUTHOR]

The Theory of Planned Behavior (TPB) has been extensively used in predictive studies, but there have been considerably fewer experimental tests of the theory. One reason for this is that the guidance on developing concrete intervention strategies from the abstract theory is vague, and there are few exemplars of how to do this. The aim of this article is to provide such an exemplar. The development of an intervention to increase walking in the general public is described, based on the TPB, extended to include postvolitional processes. Identification of target constructs, elicitation of key salient beliefs underpinning these constructs, selection of appropriate behavior change techniques, and technique refinement. Each step is based on available evidence and consistent with theory. Perceived behavioral control (PBC) was identified as the key determinant of walking intentions, with an "intention-behavior gap" noted. A brief intervention was developed, using techniques to increase PBC by rehearsal of previous successful performance of behavior, along with planning techniques to translate motivation into behavior. This systematic approach taken should provide a model for others. The intervention has demonstrated efficacy in producing large changes in objectively measured walking behavior, in 2 separate evaluations reported elsewhere. [ABSTRACT FROM AUTHOR]

Background: National and international strategies to increase physical activity emphasize environmental and policy changes that can have widespread and long-lasting impact. Evidence from multiple countries using comparable methods is required to strengthen the evidence base for such initiatives. Because some environment and policy changes could have generalizable effects and others may depend on each country's context, only international studies using comparable methods can identify the relevant differences. Methods: Currently 12 countries are participating in the International Physical Activity and the Environment Network (IPEN) study. The IPEN Adult study design involves recruiting adult participants from neighborhoods with wide variations in environmental walkability attributes and socioeconomic status (SES). Results: Eleven of twelve countries are providing accelerometer data and 11 are providing GIS data. Current projections indicate that 14,119 participants will provide survey data on built environments and physical activity and 7145 are likely to provide objective data on both the independent and dependent variables. Though studies are highly comparable, some adaptations are required based on the local context. Conclusions: This study was designed to inform evidence-based international and country-specific physical activity policies and interventions to help prevent obesity and other chronic diseases that are high in developed countries and growing rapidly in developing countries. [ABSTRACT FROM AUTHOR]

Background: Predictive modeling for physical activity behavior has included many different psychological components, including planning, motivation, personality, and self-efficacy. However, habit formation in exercise maintenance has not been well explored and lacks reliable measurement tools. The current study explores novel survey questions that examine behavioral components of exercise habit, including frequency, environmental cuing, and temporal constancy of behavior. We then relate these concepts to an established psychological measure of habit, the Self-Report Habit Inventory (SRHI). Methods: One hundred and seventy-four exercisers were surveyed at 2 private fitness clubs. A single questionnaire was administered that included the SRHI and the novel behavioral questions developed from habit formation concepts. Results: Habit formation was reported by many of the exercisers. Participants scoring higher on the SRHI also reported higher frequency of physical activity and a higher probability of environmental cuing. Exercise frequency did not correlate well with environmental cuing. Conclusions: Habit formation appears relevant to the physical activity patterns of many regular exercisers. However, wide variation in response styles was evident suggesting further development and exploration of the novel questionnaire is warranted. The ultimate goals are to include habit in predictive models of physical activity, and then to inform interventions to increase exercise adherence. [ABSTRACT FROM AUTHOR]

Background: The indoor built environment has the potential to influence levels of physical activity. However, the extent to which architectural design in commercial buildings can influence the percentage of people choosing to use the stairs versus elevators is unknown. The purpose of this study was to determine if buildings with centrally located, accessible, and aesthetically pleasing staircases result in a greater percentage of people taking the stairs. Methods: Direct observations of stair and elevator use were conducted in 3 buildings on a university campus. One of the buildings had a bank of 4 centrally located elevators and a ire escape stairwell behind a steel door. The other 2 buildings had centrally located staircases and out-of-the-way elevators. Results: The percentage of people who ascended the stairs was 8.1% in the elevator-centric building, compared with 72.8% and 81.1% in the 2 stair-centric buildings (P < .001). In addition, the percentage of people who descended the stairs was 10.8% in the first building, compared with 89.5% and 93.7% in the stair-centric buildings (P < .001). Conclusions: The results of the current study suggest that if buildings are constructed with centrally located, accessible, and aesthetically pleasing staircases, a greater percentage of people will choose to take the stairs. [ABSTRACT FROM AUTHOR]

Background: In promoting physical activity, it is important to gain insight into environmental factors that facilitate or hinder physical activity and factors that may influence this environment--behavior relationship. As the personality factor of action orientation reflects an individual's capacity to regulate behavior it may act as a moderator in the environment--behavior relationship. The current study addressed the relationship between neighborhood walkability and walking behavior and the influence of action orientation on this relationship. Methods: Three hundred and forty-seven Dutch inhabitants [mean age 43.1 (SD 17.1)] completed a web based questionnaire assessing demographic variables, neighborhood walkability (Neighborhood Environment Walk- ability Scale), variables of the Theory of Planned Behavior, action orientation, and walking behavior. Results: The results show that high levels of neighborhood walkability are positively associated with walking behavior and that this influence is largely unmediated by cognitive processes. A positive influence of neighborhood walkability on walking behavior was identified in the action-oriented subpopulation, whereas in the state-oriented part of the population, this influence was absent. Conclusions: The findings suggest that the influence of neighborhood environment on walking behavior has a relatively large unconscious, automatic component. In addition, the results suggest that the walkability--walking relationship is moderated by action orientation. [ABSTRACT FROM AUTHOR]

Background: Participation bias in exercise studies is poorly understood among older adults. This study was aimed at looking into whether older persons who volunteer to participate in an exercise study differ from nonvolunteers. Methods: A self-reported questionnaire on physical activity and general health was mailed out to 1000 persons, aged 60 or over, who were covered by the medical insurance of the French National Education System. Among them, 535 answered it and sent it back. Two hundred and thirty-three persons (age 69.7 ±7.6, 65.7% women) said they would volunteer to participate in an exercise study and 270 (age 71.7 ±8.8, 62.2% women) did not. Results: Volunteers were younger and more educated than nonvolunteers, but they did not differ in sex. They had less physical function decline and higher volumes of physical activity than nonvolunteers. Compared with volunteers, nonvolunteers had a worse self-reported health and suffered more frequently from chronic pain. Multiple logistic regressions showed that good self-reported health, absence of chronic pain, and lower levels of physical function decline were associated with volunteering to participate in an exercise study. Conclusions: Volunteers were fitter and healthier than nonvolunteers. Therefore, caution must be taken when generalizing the results of exercise intervention studies. [ABSTRACT FROM AUTHOR]

Background: Many cancer survivors experience declines in health-related quality of life (HRQOL) and increases in fatigue as a result of cancer and its treatment. Exercise is linked to improvements in these outcomes, but little is known about the role of sedentary behavior. In a large, ethnically-diverse cohort of breast cancer survivors, we examined the relationship between sedentary time, HRQOL, and fatigue, and examined if that relationship differed by recreational moderate-vigorous physical activity (MVPA) level. Methods: Participants were 710 women diagnosed with stage 0-IIIA breast cancer in the Health, Eating, Activity, and Lifestyle Study. Women completed questionnaires at approximately 30-months postdiagnosis (sedentary time; recreational MVPA) and 41-months postdiagnosis (HRQOL; fatigue). In multivariate models, we regressed these outcomes linearly on quartiles of daily sedentary time, and a variable jointly reflecting sedentary time quartiles and MVPA categories (0; >0 to <9; =9 MET-hrs/wk). Results: Sedentary time was not independently related to subscales or summary scores of HRQOL or fatigue. In addition, comparisons of women with high vs. low (Q4:Q1) sedentary time by MVPA level did not result in significant differences in HRQOL or fatigue. Conclusion: In this breast cancer survivor cohort, self-reported sedentary time was not associated with HRQOL or fatigue, 3.5 years postdiagnosis. [ABSTRACT FROM AUTHOR]

Background: Parks and other forms of green space are among the key environmental supports for recreational physical activity. Measurements of green space access have provided mixed results as to the influence of green space access on physical activity. Methods: This cross-sectional study uses a geographical information system (GIS) to examine the relationships between the amount of and distance to green space and county-level (n = 67) moderate and vigorous physical activity (MVPA) in the state of Florida. Results: The gross amount of green space in a county (P < .05) and the amount of green space within deined distances of where people live (1/4 mile, P < .01; 1/2 mile, P < .05; 1 mile, P < .01) were positively associated with self-reported levels of MVPA. Distance to the nearest green space and the amount of green space furthest from where people live (10 miles) were not significantly associated with MVPA. All measures were weighted by the population living in census tracts. Conclusions: The results suggest that there is an association between the accessibility created by having more green space closer to home and MVPA, but this holds only for areas up to and including 1 mile from home. [ABSTRACT FROM AUTHOR]

Background: Pedometers are becoming widely accepted for physical activity measurement. To use step data effectively, an index which categorizes steps/day by < 5000, ≥ 5000, ≥ 7500, ≥ 10,000, and ≥ 12,500 steps/ day has been previously proposed. However, evidence is insufficient to validate this index compared with health outcomes. This study examined the association of steps/day categories with cardiovascular (CVD) risk. Methods: Cross-sectional data from the National Health and Nutrition Survey of Japan 2006, including 1166 men and 1453 women aged 40-64 years, were analyzed to calculate odds ratios (OR) for having CVD risk including overweight/obesity, blood pressure, high density lipoprotein cholesterol, hemoglobin A1c, and clustered risk factors by steps/day categories. Results: Among men, inverse gradient associations between steps/day categories and CVD risk (overweight/obesity, blood pressure, HbA1c, and clustered risk factors) were observed. Among women, those taking ≥ 5000 steps/day had substantially lower risk of overweight/ obesity and high blood pressure compared with those taking < 5000 steps/day. However, additional decreases of OR by taking more steps were modest among women. Conclusions: CVD risk was generally lower with higher steps/day categories. Given the limitations of cross-sectional design, further studies, especially using longitudinal designs, are needed to precisely calibrate the association between steps/day and CVD risk. [ABSTRACT FROM AUTHOR]

Background: The ability to design or reconfigure communities to be more supportive of physical activity has broad public health implications. Assessing the context and locations of specific behaviors will lead to a better understanding of how neighborhood attributes influence overall physical activity. Methods: A cross-sectional survey was used to assess physical activity before and after residents moved to Mueller, a New Urbanist-inspired community in Austin, Texas. Context-specific physical activity and the locations where these activities took place were examined. Results: Overall, residents reported that they increased their physical activity by 66.4 minutes (95% CI: 32.8-100.1) per week after moving to Mueller. For recreational walking, residents reported an average of 159.8 minutes inside Mueller after moving, an increase from 91.7 minutes before their move (P < .001). Correspondingly, residents walked 18.6 fewer minutes per week outside Mueller (P < .001). For transport-related walking, the mean number of minutes spent walking outside Mueller remained constant, but the time spent walking inside the neighborhood decreased an average of 10.8 minutes per week after moving (P = .02). Conclusions: The most notable increase was seen in walking for recreation inside the neighborhood. Results of this natural experiment strongly suggest the environmental impact on physical activity and underscore the importance of investigating the context and locations where different types of physical activity occur. [ABSTRACT FROM AUTHOR]

Background: Aristotle was a seek-test-treat intervention during an outbreak of human immunodeficiency virus (HIV) infection among people who inject drugs (PWID) in Athens, Greece that started in 2011. The aims of this analysis were: (1) to study changes of drug injection-related and sexual behaviors over the course of Aristotle; and (2) to compare the likelihood of risky behaviors among PWID who were aware and unaware of their HIV status.Methods: Aristotle (2012-2013) involved five successive respondent-driven sampling rounds of approximately 1400 PWID each; eligible PWID could participate in multiple rounds. Participants were interviewed using a questionnaire, were tested for HIV, and were classified as HIV-positive aware of their status (AHS), HIV-positive unaware of their status (UHS), and HIV-negative. Piecewise linear generalized estimating equation models were used to regress repeatedly measured binary outcomes (high-risk behaviors) against covariates.Results: Aristotle recruited 3320 PWID (84.5% males, median age 34.2 years). Overall, 7110 interviews and blood samples were collected. The proportion of HIV-positive first-time participants who were aware of their HIV infection increased from 21.8% in round A to 36.4% in the last round. The odds of dividing drugs at least half of the time in the past 12 months with a syringe someone else had already used fell from round A to B by 90% [Odds Ratio (OR) (95% Confidence Interval-CI): 0.10 (0.04, 0.23)] among AHS and by 63% among UHS [OR (95% CI): 0.37 (0.19, 0.72)]. This drop was significantly larger (p = 0.02) among AHS. There were also decreases in frequency of injection and in receptive syringe sharing in the past 12 months but they were not significantly different between AHS (66 and 47%, respectively) and UHS (63 and 33%, respectively). Condom use increased only among male AHS from round B to the last round [OR (95% CI): 1.24 (1.01, 1.52)].Conclusions: The prevalence of risky behaviors related to drug injection decreased in the context of Aristotle. Knowledge of HIV infection was associated with safer drug injection-related behaviors among PWID. This highlights the need for comprehensive interventions that scale-up HIV testing and help PWID become aware of their HIV status. [ABSTRACT FROM AUTHOR]