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PURPOSE: Economic instability is a significant and growing problem among emerging adults in the United States. This study identifies adolescent factors across multiple levels of influence that predict homelessness and food insecurity five years later. METHODS: The analytic sample (n=2,110) completed a survey in 2015–16 (mean age 17) that assessed a range of demographic, behavioral health, family, peer, academic, and neighborhood factors, and a follow-up survey in 2019–20 (mean age 23) that assessed past-year homelessness and food insecurity. Logistic regression analyses were conducted for the full sample, and by race/ethnicity. RESULTS: At follow-up, 7.5% of participants reported homelessness, and 29.3% reported food insecurity. Multivariate analyses indicated that only adverse childhood experiences and weaker academic orientation predicted both outcomes. Future homelessness was additionally predicted by greater exposure to substance using peers during adolescence. Identifying as Hispanic, lower maternal education, and greater neighborhood disorganization were risk factors for future food insecurity, and living with both biological parents and better mental health were protective factors. Race/ethnicity stratified models showed variations in multilevel predictors of both outcomes, except for adverse childhood experiences, which was significant across all subgroups. CONCLUSIONS: Adverse childhood experiences and weaker academic orientation emerged as the most robust predictors of economic instability in emerging adulthood. However, a range of other modifiable multilevel predictors in adolescence were identified that were unique to homelessness or food insecurity and that varied by race/ethnicity. Results suggest the need for multilevel approaches early in life to reduce risk of economic instability during emerging adulthood.

Emerging adults (18–25 years), particularly racially/ethnically diverse and sexual and gender minority populations, may experience loneliness following major life transitions. How loneliness relates to health and health disparities during this developmental period is not well understood. We examine associations of loneliness with physical (self-rated health), behavioral (alcohol/marijuana consequences; nicotine dependence), and health behavior outcomes (weekday and weekend sleep; trouble sleeping), and investigate moderating effects by sex, race/ethnicity, and sexual/gender minority (SGM) status. Adjusted models using cross-sectional data from 2,534 emerging adults, predominantly in California, examined associations between loneliness and each outcome and tested interactions of loneliness with sex, race/ethnicity, and SGM status. Higher loneliness was significantly associated with worse self-rated health, higher marijuana consequences, less weekday sleep, and greater odds of feeling bothered by trouble sleeping. None of the interactions were significant. Findings suggest that interventions to reduce loneliness may help promote healthy development among emerging adults across subgroups. Supplementary Information The online version contains supplementary material available at 10.1007/s10865-021-00267-1.

Background Performing regular muscle-strengthening activity has numerous health benefits, including improvements in blood pressure, hemoglobin A1c, and lean body mass. Despite the disproportionate prevalence of lifestyle-related chronic disease in Latinas (diabetes, hypertension, obesity), most do not report meeting the national guidelines for muscle-strengthening activity. Existing physical activity (PA) research in Latinas has focused almost exclusively on aerobic PA. Our study examined Latinas’ sociodemographic and psychosocial correlates of meeting muscle-strengthening PA guidelines that can inform future PA interventions. Method A cross-sectional study of participants ( N = 436) enrolled in a randomized controlled trial promoting PA and cancer screening in Latinas was conducted, and t tests examined the associations between sociodemographic and psychosocial factors with self-reported muscle-strengthening activities. Hierarchical regression was conducted in separate blocks guided by the socioecological model (sociodemographic, individual, and interpersonal factors) to examine the independent contribution of each block to the outcome of meeting national guidelines for muscle-strengthening PA. Results Participants who met the national PA guidelines of ≥2 days/week of muscle-strengthening activities reported significantly higher social support for PA ( p < .001), greater use of behavioral strategies for PA ( p < .001), and lower barriers to PA ( p < .03) than those who did not meet the guidelines. Hierarchical binary logistic regression indicated behavioral strategies for PA was the only significant correlate of meeting the national guidelines for muscle-strengthening PA (odds ratio = 1.39, 95% confidence interval [1.18, 1.65], p < .001). Discussion/Conclusion Results support a hypothesis that instructing Latinas to use behavior change strategies could help them increase muscle-strengthening PA.

This study examines associations of changes in perceived and objective (census-based) neighborhood social environment variables during adolescence with alcohol and marijuana outcomes in emerging adulthood using two waves of data (2013-14 and 2019-20) from a cohort in Southern California (n = 1249). Increasing perceived disorganization predicted greater alcohol consequences and socialization with peers using marijuana. Decreasing objective neighborhood SES predicted fewer alcohol consequences and greater socialization with peers drinking alcohol. Unexpectedly, both decreasing and increasing perceived social cohesion predicted fewer alcohol consequences. Increasing perceived social cohesion predicted lower solitary alcohol use. Findings identify potential environmental targets to prevent substance use during the transition to emerging adulthood, but more research is warranted to understand the complex findings for alcohol consequences.

Background Text messages are useful for health promotion and can be modified during public health emergencies. Purpose Describe how we developed and implemented a physical activity (PA) text messaging component within a faith-based intervention, modified the text message content in response to the COVID-19 pandemic and evaluated participants’ perceptions of the modified text messages. Research Design and Study Sample PA promotion text messages were delivered to predominately Spanish-speaking, churchgoing Latino adults ( n = 284) in Los Angeles, California. In 2020, we modified the messages to disseminate COVID-19-related information and support and share virtual PA resources. Data Collection and Analysis We analyzed quantitative and qualitative survey data to gauge participants’ experiences with the text messages. Results COVID-19 related text messages were a feasible, acceptable addition to a PA intervention for a sample of Latinos. Conclusions Throughout the pandemic, the messages enabled continued communication and support for PA and protection from COVID-19 in a population at high-risk of health inequities.

Compared to the general adult population, military service members experience an excess burden of mental health problems (e.g., posttraumatic stress disorder, PTSD). Physical activity, screen time, and sleep (i.e., movement behaviors) are independently associated with mental health, but their combined effects are poorly understood, particularly in military populations. We analyzed data from active component service members in the national 2018 Health Related Behaviors Survey (N = 17,166). Weighted gender-stratified logistic regression models examined the associations of meeting recommended/healthy levels of moderate-to vigorous physical activity (MVPA), screen time, and sleep duration – separately and in combination (none, some, all) – with PTSD, suicide ideation, and serious psychological distress. In both men and women, meeting sleep recommendations was associated with reduced odds of each outcome. Meeting MVPA recommendations was associated with lower odds of serious psychological distress only in men (OR = 0.76, 95% CI: 0.58–1.00). No/low screen time was associated with lower odds of suicide ideation only in women (OR = 0.66, 95% CI: 0.45–0.95). The odds of all three outcomes were lower in those who reported some or all (vs. none) recommended/healthy movement behaviors, with the lowest odds found in the “all” group, suggesting a possible dose-response relationship. Findings can help inform multiple behavior change interventions to improve service members’ psychological fitness and military readiness.

Regular physical activity (PA) contributes to positive health outcomes, but a minority of US adults meet minimum guidelines for moderate-to-vigorous PA (MVPA) and muscle-strengthening, and Latinos are less likely than whites to meet these guidelines. Public parks can be leveraged for community PA but tend to be underutilized, while churches have reach within Latino communities and can influence parishioners' health.We are conducting a cluster randomized controlled trial to examine the impact of a multilevel, faith-based intervention linking Catholic parishes (n = 14) to their local parks on adult Latino parishioners' (n = 1204) MVPA and health-related outcomes. Our approach targets multiple levels (individual, group, church, and neighborhood-park) to promote health-enhancing PA through park-based exercise classes led by kinesiology students, peer leader-led walking groups, park-based church events, church-based PA support activities, and environmental advocacy. Data are collected at churches by trained bilingual/bicultural research assistants using accelerometry, surveys, and biometric procedures. We will implement a set of hierarchical repeated-measure linear models to examine effects on the primary outcome (MVPA) and secondary outcomes (self-reported PA, heart rate/fitness, waist circumference, waist-to-hip ratio, body fat, mental health, and perceived social support for PA). We will also conduct a process evaluation.To our knowledge, this will be the first study examining efficacy of an integrated church and park-based intervention on Latino adults' PA and represents a scalable model of PA programming for low-income communities. The intervention makes use of innovative partnerships within and across sectors - faith-based, local parks/city government, and local universities - further facilitating sustainability.govID: NCT03858868.

Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectories.The sample included 2995 emerging adults (mean ages = 18 to 24 years across six waves of data collection; 54% female) who provided data on sleep dimensions (quality, duration, and social jetlag) and frequency and consequences of alcohol and cannabis use. Longitudinal latent class analysis (LLCA) models characterized participants according to the three sleep dimensions. Latent growth models examined trajectories of frequency and consequences of alcohol or cannabis use over time among emergent sleep classes, with and without controlling for covariates.LLCA models identified four sleep classes: good sleepers (n = 451; 15.2%); untroubled poor sleepers (n = 1024; 34.2%); troubled, moderately good sleepers (n = 1056; 35.3%); and suboptimal sleepers (n = 460; 15.4%). Good sleepers reported significantly lower levels of alcohol or cannabis use and consequences, and less of an increase in alcohol consequences as compared to suboptimal sleepers.Persistent poor sleep health was associated with higher levels of alcohol and cannabis use and consequences, and greater increases in alcohol-related consequences during the transition from late adolescence to emerging adulthood. Findings have important clinical implications, highlighting that addressing multi-dimensional sleep health may be an important, novel target of intervention to reduce substance use frequency and consequences.

BackgroundCancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism.MethodsWe used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute’s Health Information National Trends Survey, 2011–2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism.ResultsBreast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism.ConclusionSimilar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.

Behavior change research to promote health and prevent disease increasingly relies on a complex set of interacting characteristics across levels of influence such as biological, psychological, behavioral, interpersonal, and environmental. How to best develop health-related interventions that incorporate the individual, the macro-environment, and their interactions remains a challenge. This article considers a set of key dimensions that constitute what we refer to as the ecology of research across a broad context of multilevel research (MLR), spanning fundamental multilevel research (FMLR), multilevel intervention research (MLIR), and multilevel implementation science (MIS). With the goal of promoting improvements in MLIR, we describe the inherent interdependencies among aspects of research and consider how the growth and development of evidence and resources influence the cross-talk among researchers from different perspectives (e.g., disciplines and domains). We propose a framework that highlights opportunities to reduce barriers and address gaps in areas critical to generating an evidence base through MLR, MLIR, and MIS. Overall, we aim to support strategic decisions that can accelerate our understanding of ML health outcomes and interactions among factors within and across levels, with the goal of strengthening the effectiveness of ML interventions across health-related outcomes.

There are a growing number of evidence-based lifestyle interventions for preventing chronic diseases and improving health and well-being. However, there is limited understanding of how these interventions could be implemented into real-world settings to achieve the desired health outcomes at both the individual and population levels. Implementation science bridges the research-to-practice gap by focusing on the use of effective strategies to adopt and integrate evidence-based health interventions. Implementation science is discussed in terms of frameworks, methods, measures, and examples of lifestyle medicine interventions. Specific recommendations are presented for lifestyle medicine with a focus on implementation science, including stakeholder engagement at multiple socioecological levels, resource incorporation and training, and building capacity for optimal lifestyle medicine delivery. Leveraging the fundamentals of implementation science can enhance the impact of lifestyle medicine in achieving a significant and positive population-level health impact.

Context Time spent in moderate-to-vigorous physical activity (MVPA), but not in sedentary behavior (SB), is related to cardiometabolic risk among non-Hispanic white youth. Objective Examine associations of SB and MVPA with cardiometabolic risk factors among Hispanic/Latino youth. Design Cross-sectional analysis. Setting Four US communities. Participants Hispanic/Latino youth (N = 1,426) ages 8 to 16 years. Measurements Associations of MVPA and SB, measured using 7-day accelerometer data (independent variables), with markers of glucose and lipid metabolism, inflammation, and endothelial function (dependent variables), were assessed in multivariable linear regression models while adjusting for sociodemographic characteristics and accelerometer wear time. Additional models controlled for obesity measures. Results SB comprised a mean (SD) of 75% (13%) of accelerometer wear time; mean (SD) time of MVPA was 35 min/d (22 min/d). Deleterious levels of high-density lipoprotein–cholesterol (HDL-C), triglycerides, insulin resistance, C-reactive protein, and plasminogen activator inhibitor-1 were associated with lower levels of MVPA and higher levels of SB (all P < 0.05). Associations of MVPA with log-transformed triglyceride concentrations (β per 15-min/d increment, −0.039; SE, 0.018; P = 0.037) and SB with HDL-C (β per 30-min/d increment, −0.63; SE, 0.26; P = 0.018), but not those with other markers, remained significant after adjusting for MVPA or SB and further adjustment for body mass index and waist circumference. Higher SB tertiles were associated with lower soluble receptor for advanced glycation end products in fully adjusted models (P for trend = 0.037). Conclusions Physiological precursors of diabetes and cardiovascular disease were associated with MVPA and SB among US Hispanic/Latino youth, a group that bears a disproportionate burden of metabolic disorders.

This study evaluated the psychometric properties of the Spanish version of the God Locus of Health Control scale, a measure of the extent to which an individual believes God has control over one’s health, among a sample of churchgoing Latinas ( N = 398). Confirmatory factor analysis showed support for a one-factor structure and internal consistency reliability, as measured by Cronbach’s coefficient alpha, was good. Evidence for convergent validity was demonstrated by significant correlations in the expected magnitudes and directions with two measures of perceived religious involvement in health. These results suggest that the God Locus of Health Control scale can be used to examine the extent to which God is perceived to control an individual’s health among Latinas.

The present study evaluated the psychometric properties of the Spanish versions of the Perceived Religious Influence on Health Behavior scale and the Illness as Punishment for Sin scale in a sample of churchgoing Latina women (N= 404). For the Perceived Religious Influence on Health Behavior scale, confirmatory factor analysis provided support for the expected one- factor model, internal consistency reliability was good, and there was evidence of convergent validity. For the Illness as Punishment for Sin scale, confirmatory factor analysis provided support for the expected one-factor model, but on a revised, seven-item version of the measure. Internal consistency reliability and convergent validity for this revised version were good. It is recommended that future studies use the Perceived Religious Influence on Health Behavior scale and the revised Illness as Punishment for Sin scale when examining these constructs among Latina women.

Objectives. To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. Methods. We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. Results. Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. Conclusions. A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.

Schools are an important context to promote adolescent physical activity (PA). However, following ecologic frameworks, little is known about the influence of multiple school contextual levels – environment and policy – on adolescent PA. This study aimed to examine associations of school neighborhood environment factors and state laws with PA, and the moderating effects of school neighborhood socioeconomic status (SES) on these associations. Analyses used cross-sectional data from a national sample of middle (n = 387) and high (n = 591) school adolescents from the Family Life, Activity, Sun, Health, and Eating study conducted in 2014. Outcomes included self-report school-time PA and active transport to/from school (ATS), and estimated minutes/week of school-related moderate-to-vigorous PA (MVPA) and total MVPA. Separate regression models for middle and high school respondents examined state laws (school PA or physical education (PE) time requirements) and school neighborhood factors (density, age, and commute times), and their interactions with school neighborhood SES, in relation to each PA outcome, adjusting for socio-demographic and psychosocial factors. The high school models showed strong PE laws (B[SE]: 0.3[0.1], p = 0.02) and any PA law (B[SE]: 0.3[0.1], p = 0.0003) were related to higher school-time PA, and shorter school neighborhood commute times were related to lower ATS (OR [95% CI]: 0.4 [0.2–0.7]). We found similar associations with estimated school-related MVPA. The middle school models showed no significant state law or school neighborhood main effects. Interactions with school neighborhood SES were not significant. Our findings provide further support for state laws to promote PA in school regardless of school neighborhood SES., Highlights • Policy and school neighborhood correlates were found for high schoolers only. • State laws were related to higher school physical activity. • Short school neighborhood commute times were related to lower active transport. • No moderating effects by school neighborhood socioeconomic status were found.

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

Background. Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas’ activity and sedentary levels are unclear. Aim. To examine associations of acculturation with Latinas’ domain-specific and total PA as well as sedentary time. Method. We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA ( Fe en Acción/ Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Results. Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Conclusions. Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas’ PA and sedentary behaviors.

BACKGROUND: Over 60% of Latinas report not meeting moderate to vigorous physical activity (MVPA) guidelines of 150 minutes/week. Ecological models of health posit that intrapersonal and environmental factors interact with one another to influence physical activity. Understanding their interactions in relation to transportation behaviors may inform interventions to increase Latinas’ physical activity. PURPOSE: To 1) objectively estimate walking and vehicle time in Latinas, 2) examine the association of, and interactions between, intrapersonal (socio-demographics and weight status) and neighborhood environmental correlates with objective daily walking and vehicle time. METHODS: A subsample of Latinas (n=87) participating in a health intervention wore an accelerometer and GPS device for at least two valid wear days at baseline. The Personal Activity Location and Measurement System (PALMS) software estimated daily walking and vehicle time. Participants’ anthropometrics were measured, and they completed a survey assessing socio-demographic characteristics and perceived neighborhood environment. Generalized linear mixed models examined main effects and interactions of four intrapersonal and five environmental factors on daily walking and vehicle time. RESULTS: On average, participants walked 16 min/day and spent 69 min/day in a vehicle. Overweight/obesity was negatively associated with walking time (p=.04) and positively associated with vehicle time (p=0.01). Household income was positively associated with vehicle time (p=0.02). For daily walking time, two interactions were significant: perceived access to destinations X household income (p=0.01), and perceived sidewalk maintenance X acculturation (p= 0.01). For daily vehicle time, two interactions were significant: perceived access to destinations X weight status (p

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

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

Background:Greater neighborhood social cohesion is linked to fewer depressive symptoms and greater physical activity, but the role of physical activity on the relationship between neighborhood social cohesion and depression is poorly understood. The purpose of the study was to examine the effects of physical activity on the association between neighborhood social cohesion and depressive symptoms.Methods:Multivariate logistic regression tested the moderation of self-reported leisure-time moderate-to-vigorous physical activity (LTMVPA) and active use of parks or recreational facilities on the association between neighborhood social cohesion and depressive symptoms among 295 randomly selected Latino adults who completed a face-to-face interview.Results:After adjusting for age, gender, and income, neighborhood social cohesion and depressive symptoms were inversely related (OR = 0.8; 95% CI: 0.5–1.2). Active use of parks or recreational facilities moderated the association between neighborhood social cohesion and depressive symptoms but meeting the recommendations for LTMVPA did not. Latinos who reported active use of parks or recreational facilities and higher levels of neighborhood social cohesion had fewer depressive symptoms than peers who did not use these spaces.Conclusions:Future studies are needed to test strategies for promoting active use of parks or recreational facilities to address depression in Latinos.

Background: Associations between the built environment and physical activity (PA) may vary by sociodemographic factors. However, such evidence from international studies is limited. This study tested the moderating effects of sociodemographic factors on associations between perceived environment and self-reported total PA among adults from the International Prevalence Study. Methods: Between 2002 and 2003, adults from 9 countries (N = 10,258) completed surveys assessing total PA (International Physical Activity Questionnaire-short), perceived environment, and sociodemographics (age, gender, and education). Total PA was dichotomized as meeting/not meeting (a) high PA levels and (b) minimum PA guidelines. Logistic models tested environment by sociodemographic interactions (24 total). Results: Education and gender moderated the association between safety from crime and meeting high PA levels (interaction P P Conclusions: The limited number of moderating effects found provides support for population-wide environment–PA associations. International efforts to improve built environments are needed to promote health-enhancing PA and maintain environmental sustainability.

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

Cancer screening rates among Latinas are generally low, reducing the likelihood of early cancer detection in this population. This article examines the effects of a community intervention (Fe en Accion/Faith in Action) led by community health workers (promotoras) on promoting breast, cervical and colorectal cancer screening among churchgoing Latinas. Sixteen churches were randomly assigned to a cancer screening or a physical activity intervention. We examined cancer knowledge, barriers to screening and self-reported mammography, clinical breast exam, Pap test, fecal occult blood test and sigmoidoscopy or colonoscopy at baseline and 12 months follow-up. Participants were 436 adult Latinas, with 16 promotoras conducting a cancer screening intervention at 8 out of 16 churches. The cancer screening intervention had a significant positive impact on self-reported mammography (OR = 4.64, 95% CI: 2.00-10.75) and breast exams in the last year (OR= 2.82, 95% CI: 1.41-5.57) and corresponding reductions in perceived (87.6%) barriers to breast cancer screening (P < .008). Cervical and colorectal cancer screening did not improve with the intervention. These findings suggest Fe en Accion church-based promotoras had a significant impact on promoting breast cancer screening among Latinas. Colon cancer screening promotion, however, remains a challenge.

In the U.S., immigrants and racial/ethnic minorities (e.g., Latinos) often report unfavorable neighborhood environments, which may hinder physical activity (PA). Among Latinos, PA levels are disproportionately lower in foreign-born, female, older, and low-education individuals. It is unclear whether these subgroups, including those from multiple disadvantaged backgrounds (e.g., low education, foreign-born), perceive worse neighborhood environments for PA. This cross-sectional study aimed to examine differences in neighborhood environment perceptions among Latinos in the 2015 National Health Interview Survey (N = 4643, 59% foreign-born). Logistic regression models examined nativity&mdash, and its interactions with age, gender, and education&mdash, in relation to the perceived presence of transportation infrastructure (two items) and destinations (four items), controlling for self-reported walking. Models used sample weights and accounted for the complex survey design. Nativity was not significantly associated with neighborhood environment perceptions. However, nativity interactions with age and education showed the greatest inequities (lowest perceptions) of neighborhood infrastructure (e.g., fewer sidewalks) or destinations (e.g., fewer places to relax) among disadvantaged U.S.-born (older or low education) and advantaged foreign-born (higher education) Latinos. Findings suggest neighborhood perceptions are shaped by complex interactions of nativity with structural (education) and contextual (age) factors. Additional research is needed to complement our findings and inform environmental interventions targeting Latinos.

Context Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. Evidence acquisition Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. Evidence synthesis Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora -led interventions. Conclusions Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

Background Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas’ PA. Methods We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA. Results Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women. Conclusions Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas’ PA.

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.

OBJECTIVE: To assess factors influencing perspectives on Brazil's national Family Health Program (PSF) by exploring satisfaction with PSF units and home-visit community health agents and perceptions about PSF unit accessibility among frequent users (primary caretakers of children under age 5) in Vespasiano, Minas Gerais. METHODS: Data were collected though cross-sectional household surveys to determine pro grammatic and demographic factors affecting user satisfaction with the PSF. Multivariate logistic modeling was used to estimate users' satisfaction with PSF units and agents and perceived access to PSF unit services. Chi-square and analysis of variance (ANOVA) tests were used to estimate statistical differences. RESULTS: The majority of caretakers were satisfied with both their PSF unit and their PSF community health agent and had received at least one monthly home visit from the health agent. Satisfaction with both the health agent and the unit was positively associated with per ceived access to the unit and frequency of agent home visits. Caretakers who reported that their PSF agent made one or more home visits per month were more likely to perceive the PSF unit as being "accessible" (or "sometimes accessible"). CONCLUSIONS: The current data are important indicators of population health in Minas Gerais, Brazil, and suggest that users' satisfaction with the PSF and perceptions about its accessibility can be improved by ensuring that all households receive at least one health agent home visit per month. These results could be applied to other parts of Brazil or Latin America to improve understanding of user perceptions of health systems.OBJETIVO: Evaluar los factores que influyen en las perspectivas sobre el Programa de Salud Familiar (PSF) del Brasil, mediante el análisis de la satisfacción de los usuarios frecuentes del PSF (cuidadores primarios de niños menores de 5 años) con las unidades y los agentes de salud comunitarios que efectúan las visitas a domicilio, y de la percepción de dichos usuarios respecto de la accesibilidad a la unidad del PSF en Vespasiano, Minas Gerais. MÉTODOS: Se recopilaron datos mediante encuestas transversales de hogares para determinar los factores programáticos y demográficos que afectaban la satisfacción de los usuarios con el PSF. Para estimar la satisfacción de los usuarios con las unidades y los agentes de salud del PSF y su percepción sobre el acceso a los servicios prestados por la unidad del PSF se usó un modelo logístico multifactorial. Para calcular las diferencias estadísticas se usaron las pruebas de ji al cuadrado y análisis de la varianza (ANOVA). RESULTADOS: La mayoría de los cuidadores estuvieron satisfechos tanto con su unidad del PSF como con su agente de salud comunitario del programa, de quien habían recibido al menos una visita a domicilio mensual. La satisfacción con este y con la unidad se asoció positivamente con la percepción de acceso a la unidad y con la frecuencia de las visitas a domicilio del agente. Los cuidadores que informaron que su agente del PSF hizo una o más visitas al domicilio por mes presentaron mayores probabilidades de considerar a la unidad del PSF como "accesible" (o "a veces accesible"). CONCLUSIONES: Los datos actuales son indicadores importantes del estado de salud de la población en Minas Gerais, Brasil, y sugieren que la satisfacción de los usuarios con el PSF y su percepción acerca de la accesibilidad a este pueden mejorarse si se garantiza que todos los hogares reciban al menos una visita a domicilio mensual del agente de salud. Estos resultados podrían aplicarse a otras zonas del Brasil o de América Latina para comprender mejor la percepción de los usuarios sobre los sistemas de salud.

OBJECTIVE: To assess factors influencing perspectives on Brazil's national Family Health Program (PSF) by exploring satisfaction with PSF units and home-visit community health agents and perceptions about PSF unit accessibility among frequent users (primary caretakers of children under age 5) in Vespasiano, Minas Gerais. METHODS: Data were collected though cross-sectional household surveys to determine pro grammatic and demographic factors affecting user satisfaction with the PSF. Multivariate logistic modeling was used to estimate users' satisfaction with PSF units and agents and perceived access to PSF unit services. Chi-square and analysis of variance (ANOVA) tests were used to estimate statistical differences. RESULTS: The majority of caretakers were satisfied with both their PSF unit and their PSF community health agent and had received at least one monthly home visit from the health agent. Satisfaction with both the health agent and the unit was positively associated with per ceived access to the unit and frequency of agent home visits. Caretakers who reported that their PSF agent made one or more home visits per month were more likely to perceive the PSF unit as being "accessible" (or "sometimes accessible"). CONCLUSIONS: The current data are important indicators of population health in Minas Gerais, Brazil, and suggest that users' satisfaction with the PSF and perceptions about its accessibility can be improved by ensuring that all households receive at least one health agent home visit per month. These results could be applied to other parts of Brazil or Latin America to improve understanding of user perceptions of health systems.

Objectives To describe both conditions of a two-group randomized trial, one that promotes physical activity and one that promotes cancer screening, among churchgoing Latinas. The trial involves promotoras (community health workers) targeting multiple levels of the Ecological Model. This trial builds on formative and pilot research findings. Design Sixteen churches were randomly assigned to either the physical activity intervention or cancer screening comparison condition (approximately 27 women per church). In both conditions, promotoras from each church intervened at the individual- (e.g., beliefs), interpersonal- (e.g., social support), and environmental- (e.g., park features and access to health care) levels to affect change on target behaviors. Measurements The study’s primary outcome is min/wk of moderate-to-vigorous physical activity (MVPA) at baseline and 12 and 24 months following implementation of intervention activities. We enrolled 436 Latinas (aged 18–65 years) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer, attended church at least four times per month, lived near their church, and did not have a health condition that could prevent them from participating in physical activity. Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months. Summary Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities.

Physical activity (PA) prevalence among U.S. Latino/Hispanic adults of diverse backgrounds is not well known. This study describes PA among a representative sample of U.S. Latino/Hispanic adults.A population-based cohort of Hispanic/Latino adults (aged 18-74 years) participating in the Hispanic Community Health Study/Study of Latinos from March 2008 to June 2011 (N=16,415) was recruited in four urban areas from Miami, the Bronx, Chicago, and San Diego. Participants wore an Actical hip accelerometer for 1 week (n=12,253) and completed the Global Physical Activity Questionnaire (n=15,741). Data were analyzed in 2015.Based on accelerometry, Hispanics/Latinos engaged in 23.8 minutes/day (10.3 minutes/day when only considering minutes from sustained 10-minute bouts) of moderate to vigorous PA (MVPA). Individuals of Puerto Rican and Dominican background had the most minutes/day of MVPA (32.1 and 29.1, respectively), whereas those of Cuban background had the fewest (15.3). Based on the Global Physical Activity Questionnaire, 65% of Hispanic/Latinos met the aerobic component of 2008 Physical Activity Guidelines for Americans. Men and individuals of Puerto Rican background had the most minutes/day of leisure-time MVPA (30.3 and 30.2, respectively). Individuals of Puerto Rican and Dominican background had the most minutes/day of transportation-related PA (48.7 and 39.7, respectively). Individuals of Mexican and Central American background had the most minutes/day of work-related MVPA (90.7 and 93.2, respectively).Among Hispanics/Latinos, self-reported data provided information on the type of PA and helped explain variability identified from accelerometer-assessed PA. These findings highlight variability in PA among Hispanics from diverse ethnic backgrounds.

Physical inactivity is one of the most important contributors to the global burden of disease and has become a global public health priority. We review the evidence on physical activity (PA) interventions, actions, and strategies that have the greatest potential to increase PA at the population level. Using the socio-ecological framework to conceptualize PA interventions, we show that PA can be targeted at multiple levels of influence and by multiple sectors outside the health system. Examples of promoting PA on a national scale are presented from Finland, Canada, Brazil, and Colombia. A strong policy framework, consistent investment in public health programs, multi-sectoral support and actions, and good surveillance characterize each of these success stories. Increasing PA globally will depend on successfully applying and adapting these lessons around the world taking into account country, culture, and context.

Introduction Physical inactivity is a risk factor for hypertension. The objective of this study was to examine the association between self-reported leisure-time physical activity and hypertension among Brazilian adults categorized by sex and body weight. Methods The study used data from adult respondents in 26 capital cities and the Federal District to VIGITEL (N = 54,353), Brazil’s 2008 national surveillance system for risk and protective factors for chronic diseases. We conducted a multivariate logistic regression analysis to investigate the association between self-reported leisure-time physical activity and hypertension and examined whether sex or body weight modified this relationship. Results The prevalence of self-reported hypertension was high among women, older people, and people with fewer years of education. Overall, leisure-time physical activity decreased with increasing age, increased with increasing education level, and was higher among men than women. The association for leisure-time physical activity and hypertension was modified by sex but not body weight. Leisure-time physical activity reduced the odds of hypertension in men. Conclusion On the basis of self-reporting, leisure-time physical activity may be protective against hypertension in Brazilian men. Inclusion of other physical activity domains in the analyses may be necessary to fully understand the complex relationship between physical activity and hypertension by sex. In addition, public health priorities in Brazil for improving physical activity can target the entire population and not just those who are overweight or obese.

Objectives: To present outcomes of a controlled two-group clustered randomized community trial promoting breast, cervical, skin and colorectal cancer screening (CS) among churchgoing Latinas through promotoras (lay health advisors). Design: Sixteen churches were randomly assigned either to the CS or a physical activity (PA) condition. Sixteen promotoras at the 8 CS churches intervened at the individual- (knowledge and beliefs), interpersonal- (social support and sharing personal experiences), organizational- (space at church for program activities), and environmental- (access to health care) levels to affect changes in target behaviors. Approximately 27 women per church were recruited to participate in the study. Measurements: The study's primary outcome was being current on recommended mammography, clinical breast exams, sigmoidoscopy and colonoscopy, fecal occult blood test, and cervical cancer tests based on self-report at baseline and 12 and 24 months following implementation of intervention activities. Participants were 436 Latinas (aged 18-65 years; 91% Mexican immigrants) who met activity-level criteria for the PA condition, attended church at least four times per month, and lived near their church. Enrolled participants were asked to complete measures assessing PA and cancer screening as well as their correlates at each measurement point (e.g., health insurance, perceived barriers to screening, and knowledge about each cancer). Results: The CS intervention had a significant positive impact on self-reported uptake of mammography and breast exams. Pap smear tests were already reported at high baseline rates and did not change as a function of the intervention. Colorectal cancer screening rates were low and did not improve with the intervention. Summary: Promotoras working in their own churches can have a significant impact on promoting breast cancer screening among Latinas. The use of colon cancer screening remains a difficult challenge, however, with improved methods still being needed. Citation Format: John P. Elder, Elva M. Arredondo, Jessica Haughton, Lilian G. Perez, María Elena Martínez. Fe en Acción/Faith in Action: Promotion of cancer screening among churchgoing Latinas. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A23.

CONTEXT: Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. EVIDENCE ACQUISITION: Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. EVIDENCE SYNTHESIS: Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions. CONCLUSIONS: Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

Background Toenail disorders are frequent, especially onychomycosis. The interobserver variability of nail signs needs to be known before these signs can be confidently applied for diagnosis. Objectives To describe observer agreement in toenail findings as described by dermatologists in standard clinical practice, focusing on signs that could be useful for diagnosis of onychomycosis. Methods Prospective cross-sectional study in five dermatology departments. Eighty-six patients with abnormal toenails that could have onychomycosis as a differential diagnosis were independently examined by a pair of dermatologists using a predefined questionnaire, to describe the presence of 10 findings on previous history and 14 physical signs. Results Agreement was fine for previous history findings: it was very good (k > 0·81) for previous diagnosis of diabetes, smoking and use of public dressing rooms or swimming pools. Agreement was good (k 0·61-0·80) for immune suppression (drugs or cancer), previous diagnosis of fungal disease and worsening in the last year. It was moderate (k 0·41-0·60) for previous diagnosis of arterial disease, trauma induced by work or sports, and distal vs. proximal or lateral vs. central start of the lesion. Agreement was worse for physical signs: we found good agreement for the presence of the same disease in fingernails, abnormal plantar desquamation, deformity causing nail trauma, and subungual hyperkeratosis. It was moderate for the presence of nail destruction, tinea interdigitalis, onycholysis, and the type of material obtained by subungual curettage (dust vs. hard). Agreement was fair (k 0·21-0·40) for the presence of longitudinal or transverse striae, trachyonychia, pachyonychia, and change in colour of the nail plate. Pitting was too infrequent to allow for k calculation. Chance expected agreement was between 51% and 84% for all signs except pitting. Conclusions Agreement is adequate for most signs. It is low for the presence of longitudinal or transverse striae, trachyonychia, and change in colour of the nail plate. Pitting is rare in toenails. © 2009 British Association of Dermatologists.