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Introduction: Favorable neighborhood-level social determinants of health (SDOH) are associated with less cardiovascular disease risk, but there is limited research evaluating their influence on cardioprotective behaviors. We evaluated the association between neighborhood-level SDOH and cardioprotective behaviors among members of predominantly Black churches in New Orleans, LA. Hypothesis: Participants residing in more-resourced neighborhoods will be more likely to engage in cardioprotective behaviors than participants residing in less-resourced neighborhoods. Methods: A health needs assessment was conducted during the planning phase of a local church-based health intervention. It included a survey distributed between November 2021-February 2022 to church members on their demographics, engagement in health-related behaviors, aspects of the neighborhood environment, and home address (which was linked to their census tract data and a corresponding social deprivation index [SDI]). We conducted descriptive analyses and multivariable logistic regression models to assess the influence of neighborhood predictor variables on the likelihood of engaging in cardioprotective behaviors. Results: Overall, there were 302 respondents, 77% were female, 99% were of Black race, and 50% completed an associate’s/bachelor’s degree or higher. Neighborhood social cohesion, availability of fruits and vegetables, and the neighborhood’s walkability and conduciveness to exercise were positively associated with the composite outcome of beneficial health behaviors after adjusting for age, sex, and education. [Table] Neighborhood predictors were not associated with medication adherence or regular medical care. Conclusions: Neighborhood-level SDOH were associated with cardioprotective behaviors in this group of predominantly Black church members in New Orleans.

Introduction: CVD is the leading cause of death in the US. Black populations are disproportionately affected by CVD. Further, Black populations have substantially high rates of religiosity. Previous research has demonstrated a positive correlation between religiosity and health, but the mechanisms are unclear. In this study, we describe the relationship between perceived religious influence on CVD health behaviors, risk factors and confidence in participating in medical care within predominantly Black churches in New Orleans, Louisiana. Hypothesis: Perceived religious influence on health is positively associated with CVD health behaviors, risk factors and confidence in participating in medical care. Methods: A survey in 302 members of 13 churches with predominantly Black congregations was conducted during the needs assessment of the Church-based Health Intervention to Eliminate Racial Inequalities in Cardiovascular Health (CHERISH) trial. Religious influence on health was assessed with two statements, (1) “Religious beliefs have great influence on my health” and (2) “I tend to avoid things harmful to my body because of religious beliefs” and measured with a five-point Likert scale ranging from “strongly disagree” to “strongly agree”. Outcomes included fruit and vegetable intake, physical activity, smoking status, self-reported hypertension, hypercholesterolemia, diabetes, and confidence in asking questions to provider and understanding treatment plans. Logistic regression and cumulative odds logistic regression models were used to examine the association with individual and composite outcomes, respectively, adjusting for age, sex, and education. Results: Survey respondents were 77% (233/302) female with a mean age of 65.5 years, and 72% (218/302), 56% (168/302), and 37% (111/302) reported hypertension, hypercholesterolemia, and diabetes, respectively. Perceived religious influence on health was associated with daily fruit and vegetable consumption (OR = 1.64; 95% CI: 1.01, 2.67), physical activity (OR = 1.76; 95% CI: 1.05, 2.96), composite health behaviors (OR = 1.59; 95% CI: 1.03, 2.48), confidence in asking questions to provider (OR = 3.46; 95% CI: 1.41, 9.12), and the composite confidence outcome (OR = 2.11; 95% CI: 1.06, 4.26). Avoiding harmful things because of religion was associated with physical activity (OR = 1.97; 95% CI: 1.17, 3.38) and composite health behaviors (OR = 1.56; 95% CI: 1.01, 2.42). There was no association between the exposures and self-reported hypertension, hypercholesterolemia, or diabetes. Conclusion: Perceived religious influence on health was associated with beneficial CVD health behaviors and confidence in participating in medical care. These findings may inform cultural tailoring of interventions to reduce CVD among the US Black population.

Background: COVID-19 restrictions and alterations to daily living (e.g. working from home, caregiving responsibilities) necessitated changes in physical activity (PA) behavior. Purpose: The purpose of this study is to understand how PA within specific domains and behavior settings changed during the COVID-19 pandemic. Methods: An e-survey, conducted April-June 2020, examined changes in PA across domains and settings in a national sample of adults (N=805; M age=38.7 ± 14.9 yrs; 78.0% female). Results: Respondents reported domain-specific increases in household and recreational PA, but decreases in active transportation, occupational PA, and public transportation use. Weekly minutes of PA changed significantly across all behavior settings, with reported increases in home-based, neighborhood, parks/trails, and total PA, and decreases in PA through recreational sports and fitness facilities. Total weekly PA minutes increased by 10.6% (Z= 4.428, p < .000). Those with caregiving responsibilities reported increases in household PA (2=9.82, p=0.007) and PA frequency (2=8.21, p=0.02). Those without caregiving responsibilities were more likely to report increases in sitting (2=20.55, p

The health benefits of physical activity and spending time in nature are well established. However, children and adults in the United States are not participating in sufficient levels of physical activity and are not spending much time outdoors. Recently, increased access to nature for the health and wellness of all populations has seen growing public health attention, though a specific focus on nature-based physical activity has been limited. The purpose of this scoping review is to operationalize the health benefits of nature-based physical activity to provide guidance to program administrators, advocates, and researchers for nature-based physical activity to facilitate collaborations. Peer-reviewed literature was searched in PubMed, Medline, Web of Science, and Google Scholar as well as in published reviews of the literature. The literature was divided into three categories of: 1) amount and location of nature-based components and physical activity; 2) added health benefits of exposure to nature-based components and physical activity; and 3) nature-based components and physical activity effect on non-white, marginalized, and vulnerable populations. This review supports and encourages multiple strategies to increase nature-based physical activity as this provides even greater benefit to health and wellness than exposure to nature or physical activity alone. Although many of the physical and mental health benefits of nature and physical activity are well established, additional research is needed to better understand the relationship between exposure to nature and nature-based physical activity. However, the existing information justifies the promotion of nature-based physical activities in public health initiatives.

Community fears of gentrification have created concerns about building active living infrastructure in neighborhoods with low-income populations. However, little empirical research exists related to these concerns. This work describes characteristics of residents who reported 1) concerns about increased cost of living caused by neighborhood development and 2) support for infrastructural improvements even if the changes lead to a higher cost of living.Data on concerns about or support for transportation-related and land use-related improvements and sociodemographic characteristics were obtained from the 2018 SummerStyles survey, an online panel survey conducted on a nationwide sample of US adults (n = 3,782). Descriptive statistics characterized the sample, and χOverall, 19.1% of study respondents agreed that development had caused concerns about higher cost of living. Approximately half (50.7%) supported neighborhood changes for active living opportunities even if they lead to higher costs of living. Prevalences of both concern and support were higher among respondents who were younger and who had higher levels of education than their counterparts. Support did not differ between racial or ethnic groups, but concern was reported more often by Hispanic/Latino (28.9%) and other non-Hispanic (including multiracial) respondents (25.5%) than by non-Hispanic White respondents (15.6%). Respondents who reported concerns were more likely to express support (65.3%) than respondents who did not report concerns (47.3%).The study showed that that low-income, racial, or ethnic minority populations support environmental changes to improve active living despite cost of living concerns associated with community revitalization.

Neighborhoods play a central role in health and mental health, particularly during disasters and crises such as the COVID-19 pandemic. We examined changes in psychological distress following the pandemic, and the potential role of neighborhood conditions among 244 residents of New Orleans, Louisiana. Using modified linear regression models, we assessed associations between neighborhood characteristics and change in psychological distress from before to during the pandemic, testing effect modification by sex and social support. While higher density of offsite alcohol outlets (β = 0.89; 95% CI: 0.52, 1.23), assault rate (β = 0.14; 95% CI: 0.03, 0.24), and walkable streets (β = 0.05; 95% CI: 0.02, 0.07) in neighborhoods were associated with an increase in distress, access to neighborhood parks (β = −0.03; 95% CI: −0.05, −0.01), collective efficacy (β = −0.23; 95% CI: −0.35, −0.09), and homicide rate (β = −1.2; 95% CI: −1.8, −0.6) were associated with reduced distress related to the pandemic. These relationships were modified by sex and social support. Findings revealed the important but complicated relationship between psychological distress and neighborhood characteristics. While a deeper understanding of the neighborhoods’ role in distress is needed, interventions that target neighborhood environments to ameliorate or prevent the residents’ distress may be important not only during crisis situations.

Background: Sleep and diet contribute to cardiometabolic disease, but evidence is sparse for the association between these behaviors. This study analyzed the cross-sectional relationship between diet quality and multiple sleep outcomes in the Bogalusa Heart Study (BHS). Methods: Diet and sleep characteristics, including insomnia and sleep apnea symptoms, were measured with validated questionnaires. Poisson regression using generalized estimating equations with a log link estimated prevalence rate ratios (PRR) of sleep outcomes by dietary pattern scores (quintile (Q) and per SD). Models were adjusted for body mass index (BMI), multi-level socioeconomic factors, physical activity, depressive symptoms, and other potential confounders. Results: In 824 participants, higher diet quality, measured by the Alternate Healthy Eating Index-2010, was associated with lower sleep apnea risk score after adjustment (PRR [95% confidence interval (CI)] Q5 vs. Q1: 0.59 [0.44, 0.79], per SD increase: 0.88 [0.81, 0.95], p-trend < 0.0001). There were no statistically significant associations with the Healthy Eating Index 2015 or the Alternate Mediterranean dietary patterns, or for insomnia symptoms or a healthy sleep score. Conclusions: Higher diet quality, after adjustment for BMI, was associated with a lower sleep apnea risk score in a cohort with substantial minority representation from a semi-rural, lower-income community.

PurposeThe purpose of this study was to develop and evaluate the reliability and validity of self-efficacy and intentions measures for time spent in nature (TSN). TSN is related to improvement in psychological well-being and health, yet most American adults spend very little time in such settings. Theory-based interventions have been effective in increasing physical activity, a related behavior, and may be one mechanism to increase TSN. Self-efficacy and intentions have been shown to be strong predictors of health behaviors and are used across several theories. However, scales to measure these factors have not yet been developed and are needed to facilitate effective interventions.MethodsTSN self-efficacy and intentions scales were developed using a sequential nine-step procedure: identification of the domain and item generation; content validity; pre-testing of questions; sampling and survey administration; item reduction; extraction of factors; tests of dimensionality; tests of reliability; and tests of validity. The 14-member multidisciplinary, researcher and practitioner investigative team generated 50 unique items for self-efficacy and 24 unique items for intentions. After subjecting items to content validity and pre-testing, item sets were reduced to 21 assessing self-efficacy and nine assessing intentions. A nationwide sample of 2109 adult participants (49.7% female, Mean Age = 58.1; 59.8% White, 18.4% Hispanic, 13.3% Black) answered these items via an on-line survey.ResultsUsing split-half measures, principal components analysis indicated a one-factor solution for both scales. The factor structure was upheld in confirmatory factor analyses and had high internal consistency (α = .93 self-efficacy; .91 intentions). The scales were moderately correlated with each other (r = .56,p 2 > .20).ConclusionsThe study resulted in reliable and valid self-efficacy (14 items) and intentions (8 items) scales that can be used to develop future theory-based interventions to increase TSN and thereby improve population health.

BACKGROUND: Dementia and late-life cognitive decline are leading causes of death and disability in the United States. Prevention of these diseases, by maintaining brain health throughout the life course, is essential. Diet and lifestyle changes are the chief strategies aimed at primary prevention for many of the risk factors of cognitive decline. OBJECTIVE: The aim of this study was to examine the potential impact of dietary factors on cognitive function. METHODS: This prospective cohort study followed 516 young adults through midlife. The Youth/Adolescent Questionnaire was used to collect habitual nutrition data (mean age: 32.03 ± 5.96 y) at baseline. Scores from a neurocognitive battery were used to assess cognitive function (mean age: 49.03 ± 4.86 y) at follow-up and were transformed to z scores. Separate multivariable-adjusted linear regression models were fitted. The trend across quintiles for each dietary variable was assessed. RESULTS: Vitamin B-6, whole grains, processed meats, and foods fried at home all displayed significant linear trends in their relation with cognitive function. Dietary intake of vitamin B-6 and whole grains was directly associated with better cognitive function after adjustment for age, race, sex, and total calorie intake (β coefficient from linear regression and SE: 1.755 ± 0.621, P = 0.005, and 0.001 ± 0.000, P = 0.018, respectively). Processed meat and foods fried at home consistently displayed inverse associations with cognitive function across crude and adjusted models (linear trend P values were 0.05 and

Mental health conditions in childhood and adolescence are increasing in the U.S. population and require early intervention, as highlighted by a recent Surgeon General’s Advisory on Protecting Youth Mental Health. These health issues, which have been exacerbated by the COVID-19 pandemic, impair functioning, and may lead to longer term reductions in quality of life. Young adolescents are likely to experience stressors including academic pressure, feelings of loneliness and isolation, and excessive exposure to social media, all of which have been made worse by the pandemic and associated disruptions. Universal preventive programs at school serve as an important strategy for equipping youth with coping skills to address current and future social and emotional challenges. Yoga and mindfulness programs have emerged as a promising preventive approach for schools and have proven feasible and acceptable. The current study evaluated a universal, school-based mindfulness and yoga program among youth aged 11–14 in a racially diverse, urban setting in the United States. Outcomes of interest included symptoms of anxiety and depression. Anxiety and depression symptoms decreased in the intervention group, although these differences were not statistically significant. In the control group, anxiety symptoms decreased but depression symptoms increased. The resulting time effect indicated a significant decrease in anxiety symptoms, while the time by group effect revealed a strong trend in depression symptoms. Future research should investigate the utility of yoga and mindfulness interventions for early adolescents in a larger population, and the differences in intervention effect among subgroups, with attention to longer term outcomes.

INTRODUCTION A neighborhood's built environment is associated with physical activity among its residents, and physical activity is associated with depression. Our study aimed to determine whether the built environment was associated with depression among residents of the rural South and whether observed associations were mediated by physical activity. METHODS We selected 2,000 participants from the Bogalusa Heart Study who had a valid residential address, self-reported physical activity (minutes/week), and a complete Center for Epidemiologic Study-Depression (CES-D) scale assessment from 1 or more study visits between 1998 and 2013. We assessed the built environment with the Rural Active Living Assessment street segment audit tool and developed built environment scores. The association between built environment scores and depression (CES-D ≥16) in geographic buffers of various radii were evaluated by using modified Poisson regression, and mediation by physical activity was evaluated with mixed-effects models. RESULTS Depression was observed in 37% of study participants at the first study visit. One-point higher physical security and aesthetic scores for the street segment of residence were associated with 1.07 times higher (95% CI, 1.02-1.11) and 0.96 times lower (95% CI, 0.92-1.00) baseline depression prevalence. One-point higher destination scores (ie, more commercial and civic facilities) in radius buffers of 0.25 miles or more were associated with 1.06 times (95% CI, 1.00-1.13) the risk of depression during follow-up. Neighborhood poverty (defined as percentage of residents with incomes below the federal poverty level and dichotomized at 28.3%) modified cross-sectional and longitudinal associations. Associations were not mediated by physical activity. CONCLUSION The built environment was associated with prevalence and risk of depression, and associations were stronger in high-poverty neighborhoods. Built environment improvements to promote physical activity should take neighborhood context into consideration to minimize negative side effects on mental health in high-poverty communities.

The importance of engaging in any type of physical activity regularly, for both physical and mental health, is well established, and may be particularly beneficial in protecting the body and limiting the damage caused by the coronavirus disease 2019 (COVID-19). Exposure to nature or green space also has positive physical and mental health benefits. Closures of parks and green spaces during the COVID-19 pandemic has limited the options for physical activity and may affect vulnerable populations more than others. We provide both short-term and long-term recommendations to encourage access to green space for people while allowing for physical distancing.

Many studies have demonstrated that collective efficacy is associated with positive health outcomes, lower crime, and violence in urban communities, and residents' emotional connection to their community. Remediation of blighted properties has been theoretically linked to increases in collective efficacy. The purpose of this study was to examine the impact of blighted property remediation on city non-emergency 311 calls for public incivilities and deterioration, as potential markers of collective efficacy. We used a quasi-experimental design to test whether 311 calls for service changed around remediated vacant lots in New Orleans, Louisiana, United States, many of which were left vacant after Hurricane Katrina in 2005. In six city neighborhoods eligible for blighted property remediation as part of a city program, 203 treated vacant lots were matched 1:3 without replacement to control lots that were eligible for but did not receive treatment. This yielded a total of 812 vacant lots partitioned within 48 months, or 38,976 lot-months. Controls were in the same New Orleans neighborhoods as their matched treatment lots but were at least 250 feet away to minimize contamination. Overall difference-in- differences models detected postintervention declines in calls related to dumping and garbage, and slight but mostly non-significant changes in calls between intervention and control lots in all but calls for dumping and vehicles. Blighted property remediation may have an impact on dumping and garbage, which is important. Despite being geographically specific, low-cost and longitudinal, the nature of 311 calls and structural and historic factors at play in both the concentration of vacant properties in communities and residents' willingness to call must be considered. Further analyses of changes in 311 data and additional qualitative inquiry are warranted to more fully determine the utility of these data.

Disparities in chronic disease and life expectancy remain a significant public health problem and are largely attributable to social determinants of health. Community health workers (CHWs) promote health equity through individual- and community-level activities, and leadership and advocacy skills training make CHWs more likely to catalyze structural change. CHWs are increasingly being integrated into clinical practices to support care management, creating a need for new grassroots community-level advocates. We adapted for community residents an existing CHW training curriculum focused on social determinants of health and effecting community change. We offered 36 hours of training at community-based locations in New Orleans, Louisiana. We assessed baseline civic and community participation and pre- and postknowledge for each lesson. Among 43 enrollees, 42 completed the program. The majority were Black (92.7%), female (92.7%), and retired or unemployed (77.5%), with a median age of 61.5 years. In the past year, 85% of participants had volunteered, 57.1% had been involved with a community organization, and 32.4% had contacted the city council. Participants demonstrated statistically significant increases in knowledge in 5 of 6 lessons. Our success in increasing knowledge of advocacy among a civically engaged group suggests that trainees may become community leaders in addressing social determinants of health.

Relationships of the built environment (BE) with physical activity (PA) and health outcomes have been reported, though data is limited in rural settings. This study was conducted to assess relationships between BE around the residence and death from chronic disease in rural residents. We hypothesized that BE more conducive to PA would be associated with lower odds of chronic disease death. Participants in the Bogalusa Heart Study, a long-running cohort study in rural Louisiana, with a valid address of residence and either deceased of a chronic disease (cases) or observed (controls) since 1998 were included (N=2,052). Cases were identified in the National Death Index (N=111). BE features on the street segment of residence were assessed with the Rural Active Living Assessment tool and Google Street View. Scores for walkability, overall and in domains (including path features, aesthetics, land use), were calculated for street segments and in buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations of BE scores with chronic disease death were assessed with generalized estimating equations logistic regression models that accommodated clustering in street segments and census tracts, and were adjusted for age, sex, race, census tract population density and percent living in poverty. Cases were of similar age (45 at death vs 44 at last visit), more likely to be male (59 vs 43%) and less likely to be white (52 vs 66%) than controls. Significant associations were observed between scores for path features, aesthetics and land use and odds of chronic disease death in buffers of 0.25, 0.50, 1.00 and 1.50 miles. In 0.25 mile buffers, 1-point higher scores for path features, aesthetics and land use were associated with 1.12 (95% CI 1.02, 1.23), 0.66 (95% CI 0.53, 0.82) and 0.49 (95% CI 0.32,0.76) times the odds of chronic disease death, respectively. Significant associations highlight the importance of land use development conducive to PA (i.e. higher density and better condition residential settlement) and improved community aesthetics (i.e. greenspace presence and maintenance) to improved health in rural populations. More research is needed to identify a mechanism for the unexpected association between path features (i.e. presence of a path) and increased odds of chronic disease death. Rural BE improvements face barriers (lower population density), and these reported associations may guide feasible approaches to improved rural health.

BackgroundEvidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques.MethodsLatent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15-74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA).ResultsNearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ≥2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; pConclusionThis first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.

Alessandra N Bazzano,1 Christopher E Anderson,2 Chelsea Hylton,3 Jeanette Gustat2 1Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; 2Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; 3Project Peaceful Warriors, New Orleans, LA, USA Objective: To assess the impact of a yoga curriculum in an elementary school on student quality of life, and to assess teacher and staff perception of potential barriers to, and benefits of, introducing yoga and mindfulness into the classroom.Methods: A randomized controlled trial was utilized to assess the impact of a brief intervention on third-grade students who screened positive for symptoms of anxiety. Students were randomized to an intervention group of 20 students receiving small-group yoga/mindfulness activities for 8 weeks between October 2016 and February 2017, and a control group of 32 students receiving care as usual. The Brief Multidimensional Students’ Life Satisfaction Scale-Peabody Treatment Progress Battery and the Pediatric Quality of Life Inventory (PedsQL) served as outcomes. Teachers were invited to participate in two professional development sessions about introducing yoga and mindfulness into the classroom, and completed a survey following each of the sessions.Results: In generalized estimating equation models adjusted for time, the yoga-based intervention was associated with a 14.17 unit increase in student emotional PedsQL (p-value 0.001) and a 7.43 unit increase in psychosocial PedsQL (p-value 0.01). Results were not attenuated by adjustment. Teachers and staff reported using yoga more frequently in the classroom following the second of two professional development sessions (p-value

Background: New licensing regulations require Louisiana early care and education centers (ECEs) to limit children's screen time and increase physical activity. A community– academic partnership involving academic, community, government, and ECE stakeholders launched two initiatives: (1) an evaluation of the implementation of licensing regulations at the local level and (2) a statewide effort to develop technical assistance for ECE directors. Objectives: To describe the methods and lessons learned and to establish recommendations based on this ongoing participatory action research. Methods: A case study approach was used to identify the lessons learned and recommendations thus far, based on partners' perspectives and ECE directors' participation. Lessons Learned: Recommendations include to share power and funding among stakeholders, to engage directors as partners to overcome recruitment challenges, and to start with the end in mind to ensure meaningful community engagement. Conclusions: This participatory action approach is leading to innovative, feasible strategies to increase children's physical activity.

Purpose: To assess predictors of stated support for policies promoting physically active transportation. Design: Cross-sectional. Setting: US counties selected on county-level physical activity and obesity health status. Participants: Participants completing random-digit dialed telephone survey (n = 906). Measures: Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle–pedestrian projects. Analysis: Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county. Results: Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs $1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (Conclusion: Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.

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

Research indicates that sleep duration and quality are inter-related factors that contribute to obesity, but few studies have focused on sleep chronotype, representing an individual's circadian proclivity, nor assessed these factors in racially diverse middle-aged samples. We examined the associations between chronotype and obesity among black and white men and women participating in the Bogalusa Heart Study (BHS).Body mass index (BMI) and sleep data were available for 1,197 middle-aged men and women (mean age 48.2 ± 5.3 years) who participated in the BHS 2013-2016. Based on the reduced Morningness-Eveningness Questionnaire's cutoff values for chronotypes, we combined 'definitely morning' and 'moderately morning' types into 'morning' type, 'definitely evening' and 'moderately evening' types into 'evening' type and kept those who were "neither" type in a separate group. We used 'morning' type as the referent group. Obesity was defined as a BMI ≥ 30. Multivariable logistic regression models were used to examine associations adjusting for sex, age, education, smoking, alcohol use and drug use, depression, shift work, physical activity and sleep duration.Evening chronotype, reported by 11.1% of participants, was associated with obesity after multi-variable adjustment, including shift work, physical activity and sleep duration (OR 1.67, 95% CI: 1.08-2.56). However, once stratified by race (black/white), this association was found only among white participants (OR = 1.91, 95% CI = 1.12-3.25) after full adjustment.In our biracial, community-based population, evening chronotype was independently associated with obesity, specifically among white participants. Further research is needed to identify behavioral, endocrine, nutritional and genetic pathways which underlie these associations.

Background: Spaces that promote play are important for the physical, social, and psychological growth of children. Public spaces, including playgrounds, provide an important venue for children to engage in play. A simple tool is needed to evaluate playground features and conditions. Methods: A simple play space audit instrument to assess the presence and condition of playground features was tested on a sample of 70 playgrounds during the summer of 2017, in Chicago, IL. Duplicate observations were collected on 17 playgrounds. Frequencies of features were tabulated, and reliability of variables was assessed using percent agreement and kappa statistic. Scores were created to summarize playground “playability,” overall and within domains of general overview, surface, path, and play equipment/structure features. Results: The tool demonstrated acceptable reliability with high kappa values between .79 and .90 for all items in domains. The overall score, general overview score, and play equipment/structure scores were correlated with mean playground usage. Conclusions: This brief instrument allows reliable assessment of playground features and their conditions. The scoring method generates a summary of playground conditions and features, which facilitates comparison of playgrounds. This tool has the potential to assist communities in evaluating their play spaces and identifying where to focus resources for improvements.

Objective To prospectively assess the association of habitual glucosamine use with risk of cardiovascular disease (CVD) events. Design Prospective cohort study. Setting UK Biobank. Participants 466 039 participants without CVD at baseline who completed a questionnaire on supplement use, which included glucosamine. These participants were enrolled from 2006 to 2010 and were followed up to 2016. Main outcome measures Incident CVD events, including CVD death, coronary heart disease, and stroke. Results During a median follow-up of seven years, there were 10 204 incident CVD events, 3060 CVD deaths, 5745 coronary heart disease events, and 3263 stroke events. After adjustment for age, sex, body mass index, race, lifestyle factors, dietary intakes, drug use, and other supplement use, glucosamine use was associated with a significantly lower risk of total CVD events (hazard ratio 0.85, 95% confidence interval 0.80 to 0.90), CVD death (0.78, 0.70 to 0.87), coronary heart disease (0.82, 0.76 to 0.88), and stroke (0.91, 0.83 to 1.00). Conclusion Habitual use of glucosamine supplement to relieve osteoarthritis pain might also be related to lower risks of CVD events.

Satisfaction with body image is a factor related to health outcomes. The purpose of this study is to examine the relationship between body image satisfaction and body size perception in an urban, Black community sample in New Orleans, Louisiana. Only 42.2% of respondents were satisfied with their body image and 44.1% correctly perceived their body size. Most respondents chose an ideal image in the normal body mass index range with over half choosing an ideal image smaller than their actual size. Misperception was greatest among the heaviest respondents. Females, those who overestimated their size, those with an education beyond high school, and those who were active in order to lose weight were less likely to be satisfied ( p < .001). Those who were active but not trying to lose weight were more likely to be satisfied ( p < .001). This suggests that perception of and satisfaction with body size may play a role in health behavior decisions.

Greenways are linear open spaces, which are often used as trails for pedestrians and cyclists, but junctions with roads are a safety concern and act as a potential impediment to active transportation. This study evaluated crossing behavior patterns and safety at greenway&ndash, road junctions in New Orleans, LA. Crossing behaviors, safety and motor vehicle behavior were collected using direct observation methods. Intercept surveys were conducted to assess greenway use and safety perceptions. Logistic and negative binomial regression were used to assess the relationships between crossing signal (rectangular rapid flash beacon) activation and motor vehicle behavior. Fewer unsafe crossings occurred when the crossing signals were activated for cyclists and pedestrians (p-values of 0.001 and 0.01, respectively). There was no association between pedestrian use of crossing signals and motor vehicle stopping behavior but cyclists had significantly higher odds of motor vehicles failing to stop when the signal was activated (OR 5.12, 95% CI 2.86&ndash, 9.16). The activation of rectangular rapid flash beacons at urban greenway junctions with roads did not influence motor vehicle behavior. Differences in crossing safety by signal use cannot be attributed to the signal&rsquo, s influence on motor vehicle stopping behavior.

Parks can be an important, low-cost neighborhood resource to increase physical activity and reduce overweight and obesity. The quality of parks, however, may impact use. This study used observational data to examine the relationships between park quality, park usage and levels of physical activity among users in 31 parks within low-income, African American neighborhoods. Relationships between park use and park characteristics (signs of disorder, attractiveness, and number of activity settings) varied by gender and user activity level. No variables of interest were significant for overall number of male users, whereas, disorder and attractiveness were significant for overall number of female users. Parks with signs of disorder were associated with 49% fewer female users (IRR = 0.51, 95% CI = (0.34&ndash, 0.77)) and attractive parks with 146% more female users (IRR = 2.46, 95% CI = (1.39&ndash, 4.33)). Similar significant relationships were found among active but not sedentary female users. Communities may consider increasing park maintenance and addressing attractiveness in existing parks as a relatively low-cost environmental strategy to encourage park use, increase physical activity, and reduce the burden of obesity, especially among women in low-income, African-American communities.

Although the adverse effects of elevated glucose on cognitive function have been well-documented, most cognitive evidence comes from older adults. In this study, we make use of repeated measurements across five decades of the Bogalusa Heart Study and latent class methodology to examine the association of glucose from childhood through early adulthood on cognitive function in middle age. From our cohort of n=1,298 adults, after adjustment for age, sex, race, BMI, diabetic status, smoking, physical activity, and depressive symptoms, we identified four trajectory classes of glucose over the life course: (1) “healthy and stable;” (2) “healthy but slightly increasing;” (3) “decreasing;” and (4) “sharply increasing” (Figure). The distributions of trajectory class membership were modeled with a relative cognitive z-score, computed from a battery of tests covering major neuropsychological domains. Mean z-scores, where higher indicates better relative cognitive function, for classes 1-4 were 1.04, 0.85, 0.19, and -6.69, respectively. Parameter estimates were positive for classes 1-3, and negative for class 4 (p Disclosure P. Stuchlik: None. O. Carmichael: None. E. Harville: None. H. He: None. M. Romero: None. J. Gustat: None. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis. L.A. Bazzano: None.

BACKGROUND: Short sleep duration has been consistently associated with obesity. However, few studies in adults have assessed whether this association varies by sex and race. METHODS: In the 2013–2016 examination of 1,116 participants from the biracial Bogalusa Heart Study, habitual sleep duration was measured in categories ( 8 hours) using self-report. Anthropometry was performed and adiposity was assessed using body mass index (BMI) and waist circumference. Linear regression models estimated the relationship between sleep duration and adiposity adjusting for age, education, employment, bed partner status, depressive symptoms, smoking status, physical activity, and the use of alcohol and sleeping pills. Effect modification by sex and race was examined using cross-product terms in the models and marginal means were reported. RESULTS: Of 1,116 participants (mean age 48.2 years), 58.3% were female, and 31.7% were black. In adjusted analyses, women sleeping < 6 hours had a 3.2 (95% CI 1.4, 5.0) kg/m2 greater BMI and 6.1 (1.8, 10.4) cm greater waist circumference compared to women sleeping 7–8 hours. In contrast, men had similar BMIs and waist circumferences regardless of sleep duration (p’s for interaction = 0.04 & 0.11). There was no effect modification by race. CONCLUSIONS: In this sample, lower habitual sleep duration was associated with greater adiposity among women compared to men. Further research is needed to understand the potential mechanisms of the adverse metabolic effects of short sleep in women.

Background: To assess how perceptions of the community built environment influence support for community policies that promote physical activity (PA). Methods: A national cross-sectional survey assessed perceptions of the local built environment and support of community policies, including school and workplace policies, promoting PA. A random digit–dialed telephone survey was conducted in US counties selected on Behavioral Risk Factor Surveillance System data for high or low prevalence of obesity and inactivity. A total of 1208 subjects were interviewed, 642 from high-prevalence counties and 566 from low-prevalence counties. Analyses were stratified by county prevalence of obesity and inactivity (high or low). Linear models adjusted for covariates were constructed to assess the influence of built environment perceptions on policy support. Results: Perception of more destinations near the residence was associated with increased support for community policies that promote PA, including tax increases in low-prevalence (obesity and inactivity) counties (P P Conclusions: Support for community policies promoting PA varies by perception of the built environment, which has implications for policy change.

SummaryBackground Obese adults have a higher risk of obstructive sleep apnoea (OSA); however, the relationship between childhood obesity and adult OSA risk is unclear. Objectives This study aimed to examine overweight/obesity (OW) in childhood and risk of OSA in middle age. Methods Childhood OW status was classified as never OW, weight cycling, persistent OW and incident OW. After 35 years of follow-up, high risk for OSA was determined by a positive score in ≥2 domains on the Berlin Questionnaire with obesity removed from scoring. Results At initial assessment, mean (SD) age was 9.9 (2.9) years, and 23.9% were OW. Overall, 25.7% had scores indicating a high risk for OSA. Compared with participants who were never OW, those with persistent OW and incident OW were 1.36 (95%CI: 1.04–1.77) and 1.47 (1.11–1.96) times more likely to be high risk for OSA, after adjustment for multiple risk factors and adult OW status. Participants with an OW duration of 1–4 years, 5–8 years, and 8+ years were 0.96 (0.44–2.09), 1.20 (0.70–2.04) and 1.52 (1.22–1.90) times more likely to be high risk for OSA compared with those who were never OW (P for trend: 0.0002). Conclusions These results suggest that childhood OW is associated with a high risk of OSA in middle age.

Objectives. We evaluated organization- and network-level factors that influence organizations’ perceived success. This is important for managing interorganizational networks, which can mobilize communities to address complex health issues such as physical activity, and for achieving change. Methods. In 2011, we used structured interview and network survey data from 22 states in the United States to estimate multilevel random-intercept models to understand organization- and network-level factors that explain perceived network success. Results. A total of 53 of 59 “whole networks” met the criteria for inclusion in the analysis (89.8%). Coordinators identified 559 organizations, with 3 to 12 organizations from each network taking the online survey (response rate = 69.7%; range = 33%–100%). Occupying a leadership position (P Conclusions. Organizations’ perceptions of success can influence decisions about continuing involvement and investment in networks designed to promote environment and policy change for active living. Understanding these factors can help leaders manage complex networks that involve diverse memberships, varied interests, and competing community-level priorities.

Background: Glucosamine is a common supplement for treating osteoarthritis, while its effectiveness on osteoarthritis and joint pain continues to be debated. Recently emerging evidence from animal studies and cross-sectional studies in humans suggest that glucosamine may have potential benefits on reduction of cardiovascular disease (CVD) and mortality; however, evidence from prospective studies is lacking. Methods: In the UK biobank cohort study, a total of 466,039 participants without CVD at baseline completed the questionnaire on supplement use, including glucosamine, were analyzed in this study. These participants were enrolled from 2006 to 2010 and followed up to 2016. Cox proportional hazards models were used to compare hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD events in participants who did and did not use glucosamine. Findings: During a median of 7·0 years of follow-up, we documented 10,204 incident cases of CVD events, 3,060 cases of CVD death, 5,745 cases of CHD and 3,263 cases of stroke. After adjustment for age, sex, body mass index, race, lifestyle factors, dietary intakes, medication use and other supplements use, glucosamine use was associated with significantly reduced risks of total CVD events (HR: 0·85: 95% confidence interval [CI], 0·80-0·90), CVD death (HR: 0·78: 95% [CI], 0·70-0·87), CHD (HR: 0·82: 95% [CI], 0·76-0·88) and stroke (HR: 0·91: 95% [CI], 0·83-1·00). In addition, the associations of glucosamine use with risks of total CVD events and CHD were more pronounced in smokers than non-smokers (P-interaction=0·018 and 0·004, respectively). Interpretation: Beyond its original use for treating osteoarthritis, habitual use of glucosamine supplement was associated with significantly reduced risks of CVD events, especially among smokers. Further investigations in both prospective cohorts and clinical trials are warranted to verify our findings. Funding: The study was supported by grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383, DK078616). Declaration of Interest: We declare no competing interests. Ethical Approval: All participants provided written informed consent and the study was approved by the NHS National Research Ethics Service. The present analysis was approved by the Tulane University (New Orleans, Louisiana) Institutional Review Board. Data from 502, 616 participants were available for our study.

Background:The study’s purpose is to describe the development and evaluate the reliability (inter-observer agreement) and validity (rater agreement with a gold standard) of a direct observation instrument to assess park characteristics that may be related to physical activity.Methods:A direct observation instrument of 181 items was developed based on a conceptual model consisting of the following domains: features, condition, access, esthetics, and safety. Fifteen pairs of observers were trained and sent to two parks simultaneously to assess two Target Areas each.Results:Overall domain reliability was 86.9%, and overall geographic area reliability was 87.5%. Overall domain validity was 78.7% and overall geographic area validity was 81.5%.Conclusions:Inter-rater reliability and validity were generally good, although validity was slightly lower than reliability. Objective items showed the highest reliability and validity. Items that are time-sensitive may need to be measured on multiple occasions, while items asking for subjective responses may require more supervised practice.

Evidence has suggested the existence of a bi-directional relationship between cardiovascular disease and physical performance in elderly adults, with several potential common mechanisms including chronic inflammation and sarcopenia. Yet, there remains little data on the relationship between CVD risk and physical performance in mid-life. The objective of this study was to determine if global cardiovascular risk measures were associated with score on the short physical performance battery (SPPB) in a mid-life cohort of African-American and white adults followed since childhood. Our study included 845 participants of the Bogalusa Heart Study cohort. We separately examined the relationships between both 10-year AtheroSclerotic CardioVascular Disease (ASCVD) and Framingham CHD risks and poor physical performance, defined as SPPB

209 The 2010 National Physical Activity Plan (NPAP) includes a wide-ranging set of policies, programs, and initiatives directed at increasing physical activity across the United States (US).1 It is the first comprehensive, national planning tool devoted entirely to supporting physical activity in the US. The NPAP brings together 8 disciplines in the pursuit of a multi-sector approach to promoting physical activity: public health; health care; education; mass media; business and industry; volunteer and non-profit organizations; parks, recreation, fitness, and sports; and transportation, land use, and community design.2 A companion guide for implementing the NPAP, entitled Make the Move, was developed by the National Coalition for Promoting Physical Activity.3 It includes resources, anecdotal success narratives, and sets short-term goals related to championing physical activity through the NPAP. The document provides physical activity practitioners with measurable outcomes and objectives for change as they work through the NPAP by showcasing successful examples of implementation strategies from around the US. Currently, Texas is one of only a few states to develop a state-level plan devoted entirely to physical activity planning and promotion. Most other states include physical activity as part of a chronic disease or obesity plan.4 The physical activity plan in Texas is in addition to its state-level obesity plan.5,6 Active Texas 2020 is the product of collaboration among the Governor’s Council on Physical Fitness, the University of Texas Health Science Center at Houston, the Michael and Susan Dell Center for Advancement of Healthy Living, the University of Texas at Austin, and the Austin Mayor’s Fitness Council. Like the NPAP, it is a multi-sector plan designed to incorporate stakeholders from a diverse group of community sectors.7-15

Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.