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Physical activity (PA) has been associated with a multitude of beneficial mental and physical outcomes. It is well documented, however, that there are health disparities and inequities for segments of the population, especially as related to PA. Engagement of traditionally minoritized populations into research is essential for justice in health. We discuss a community engagement model that can be used for recruiting and retaining traditionally minoritized populations into PA research, and then we go into three major ethnic/racial groups in the United States: Latinos, African Americans, and Asian Americans. Background information of each group, cultural values that play a role in health for each of the groups, and research demonstrating how culture plays a role in the formation and implementation of PA interventions in these groups is presented.

Purpose To explore the social context of physical activity (PA) among active Black women, we examine the patterns of PA engagement and the benefits of social support in PA maintenance. Design A cross-sectional study design and descriptive phenomenological approach were used to examine social support and lived experiences of active Black women. Setting The study setting was an online survey of active Black women, ages 21 to 71 years who were recruited from across the United States. Participants This secondary data analysis was conducted among a sample of 187 active Black women who maintained PA for ≥6 months. The mean age was 41 ± 12.3 years, 83.4% completed some college, 37.7% were married, and 30.0% had children. Measures Participants self-reported ‘with whom’ they engaged in PA and provided qualitative responses about their strategies for PA maintenance. Descriptive statistics were used to examine between-group differences among demographic characteristics and PA variables by category of PA engagement using SAS 9.4. Descriptive phenomenology was used to explore social support themes across and within categories of PA engagement. Results On average, the active Black women in this study reported engaging in 57.0 ± 18.9 minutes of moderate intensity leisure-time PA per session. Most engaged in PA alone (n = 87), with a group (n = 72), or with another individual (n = 28). Social context themes within categories included: alone – self-management, groups - motivation and accountability, family – values health, and friends – shared interests in PA. Subthemes across social context categories included: who? - people, what and how? - types of social support, and where? – place of social support. Conclusions Our findings suggest that some Black women may need added social support from others beyond family and friends, while other Black women may prefer additional self-management skills. Nonetheless, this study provides data for developing hypotheses about the mechanisms by which social context may facilitate PA maintenance among Black women. Therefore, intervention studies targeting PA maintenance among Black women should include an in-depth query of social support needs.

The 2016–2017 Inaugural Class of the Society of Behavioral Medicine Leadership Institute (SBM LI) debuted to an eager team of 36 mid-career fellows led by energetic mentors, professional coaches, and career development experts. Fellows were divided into learning communities of eight participants for deeper engagement. Our “Green Team” learning community bonded quickly and actively committed to our collective progress and projects. Upon returning home from the in-person sessions, our activities included monthly team conference calls and consultation with our mentors and selected coaches. The Green Team regularly communicated throughout the year, giving feedback to each other about our projects to be presented at the 2017 SBM Annual Meeting. We also discussed our mentoring and coaching experiences, leadership skills put to use at our institutions, and personal development. Contact continued via social media, email, teleconferencing, and collaborations at other professional meetings. The Green Team utilized the Tuckman and Jensen model of small group development to describe how we developed into a high-functioning group that maximized the resources afforded by the SBM LI to yield successful leadership outcomes. This commentary will offer an example of how a productive SBM LI team works collaboratively to utilize its mentors and resources for professional development.

PurposePhysical activity is known to provide important health benefits in school-age youth. However, until recently, few studies have examined associations between physical activity and health in young children. The purpose of this study was to conduct a systematic review of the relationship

This article describes effective interventions to promote regular physical activity and reduce sedentary behavior that were identified as part of the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.A comprehensive literature search was conducted of eligible systematic reviews, meta-analyses, and relevant governmental reports published between 2011 and 2016. For the physical activity promotion question, articles were first sorted by four social ecological levels of impact (i.e., individual, community, communication environment, and physical environment and policy levels) and then further sorted into more specific categories that emerged during the review process. For the sedentary behavior reduction question, the literature was sorted directly into emergent categories (i.e., youth, adult, and worksite interventions).Effective physical activity promotion strategies were identified at each level of impact, including those based on behavior change theories and those occurring at different settings throughout the community. Effective interventions also included those delivered in person by trained staff or peer volunteers and through different information and communication technologies, such as by phone, Web or Internet, and computer-tailored print. A range of built environment features were associated with more transit-based and recreational physical activity in children and adults. Effective sedentary reduction interventions were found for youth and in the workplace.A promising number of interventions with demonstrated effectiveness were identified. Future recommendations for research include investigating the most useful methods for disseminating them to real-world settings; incorporating more diverse population subgroups, including vulnerable and underrepresented subgroups; collecting cost data to inform cost-effectiveness comparisons; and testing strategies across different levels of impact to determine which combinations achieve the greatest effects on different modes of physical activity across the week.

Studying positive outliers, individuals who have achieved success with long-term (>6 months) physical activity (PA) engagement, may be an important approach for understanding strategies for improving leisure-time PA maintenance among African American (AA) women. This cross-sectional, mixed-methods study 1) examined the personal characteristics, PA patterns and behavioral practices of positive outliers among AA women and 2) compared characteristics of those who maintain PA at recommended levels (HIGH, ≥150 minutes/week >6 months) with those who maintained low PA volumes (LOW, 6 months). A large sample of positive outliers completed this study (n=290) and most became physically active on their own (76.2%). These AA women were committed to maintaining an active lifestyle, accumulated 249.7±105.8 minutes of PA/week, and engaged in a variety of activities. Their behavioral practices included scheduling PA during the week (85.9%), goal-setting (82.4%), engaging in PA with others (55.9%), self-monitoring (78.3%), and having a backup plan for missed sessions (54.8%). HIGH maintainers (84.9%) made up most of the sample and these women were characteristically similar to LOW maintainers with few differences. HIGH maintainers have been active longer, achieved higher commitment scores, and engaged in PA at a higher frequency, duration, and intensity, resulting in higher weekly PA volume compared to LOW maintainers (273.8±96.1 vs. 114.4±24.3 minutes per week, p=

PURPOSE: To determine the effects of a 10-month secular (SEC) versus faith-integrated (FI) community-based physical activity (PA) intervention on cardiometabolic risk factors in low active, African-American women. METHODS: Participants (age: 55.4±11.6 years; body mass index (BMI): 36.0±7.9 kg/m(2); average baseline steps/day: 3,807±1,250) from a larger study (n=418) participated in a sub-study to measure cardiometabolic disease indicators (primary outcomes) and PA (secondary outcomes) pre- and post-intervention (SEC: n=42; FI: n=43). Height, weight, waist and hip circumferences, resting blood pressure, hemoglobin A1c, average steps/day, sedentary behavior, light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) were acquired at baseline and 10 months. Multivariate generalized linear mixed models that included churches as a random effect were used to compare mean changes in outcomes at 10 months between the two study groups (α=0.05). RESULTS: The FI group showed significant time effects for weight (93.4±2.4 to 92.2±2.3 kg), BMI (35.7±1.0 to 35.3±1.0 kg/m(2)), and waist circumference (106.9±2.2 to 103.8±2.5 cm), while the SEC group had a significant time effect for hip circumference (121.6±1.9 to 119.9±1.7 cm). There were no time effects in either group for blood pressure, hemoglobin A1c, steps/day, sedentary time, or MVPA. FI significantly decreased LPA in both 1-minute activity bouts (641±13 to 588±16 minutes/day) and 10-minute bouts (536±11 to 479±15 minutes/day). There were no significant differences between SEC and FI for any variable. CONCLUSIONS: The improvements in body weight, BMI, and waist circumference shown after the FI intervention could have long-term implications on cardiometabolic health, particularly if exercise is continued. Further research is needed to examine the effects of culturally-relevant interventions on chronic disease indicators in African-American women, particularly those established as high risk for cardiometabolic disease.

Physical activity is essential for overall good health and aids in the prevention and reduction of many diseases. In 2008, the U.S. Department of Health and Human Services (DHHS) issued the Physical Activity Guidelines for Americans to foster appropriate levels of physical activity at various ages of development. Despite these guidelines and the known benefit to being physically active; physical activity levels are significantly lower in Blacks, contributing to higher prevalence of poor health outcomes. Therefore, the purpose of this paper was to look at four national datasets [Youth Risk Behavior Survey (YRBS), Behavioral Risk Factor Surveillance System (BRFSS), The National Health and Nutrition Examination Survey (NHANES), and National Health Interview Survey (NHIS)] to identify any patterns and trends that could be used to improve physical activity behavior within this population. These national datasets were used to estimate the proportion of Black adults and youth meeting national physical activity recommendations overall—stratified by age, gender and other demographic characteristics, to help identify patterns. The proportion of Black youth reporting regular physical activity ranged from 33% to 52%; and of Black adults, 27% to 52%. Physical activity was highest among men, younger age groups, highest education and income groups, and those who were employed or married. Trends were consistent across surveys. Among Black youth, physical activity decline with increasing grade level, and improvements over the past 10 years have been minimal. The percentage of Black adults achieving physical activity guidelines has improved slightly over the last ten years, but physical activity participation is still low and continues to decline with age. Trends identified from examining these national datasets can be used to inform development of physical activity interventions aimed at promoting and maintaining regular physical activity behavior among high risk subgroups across the life span.

Background: Negative health behaviors such as consumption of excess calories, low intake of fruits and vegetables, sedentariness and weight gain are associated with entry into college. Purpose: To determine if weight status is associated with students’ receipt of health promotion (nutrition, physical activity and stress reduction) information, and students’ interest in receiving these types of information from their college or university. Methods: Data from the Spring 2011 ACHA-NCHA II dataset was used to complete secondary data analyses. Students (N=116,254) from 148 postsecondary institutions completed the Spring 2011 ACHA-NCHA II survey. Logistic regression was used to examine the effect of BMI category on receipt of, and interest in receiving, health promotion information. Results: Approximately 32% of respondents were overweight or obese. Students in the obese class III category were the least likely to receive health promotion information and least likely to be interested in receiving the information. Conclusion: Weight status based on BMI classification is a weak predictor of the dissemination of health promotion information. The largest gaps related to the dissemination appear to be among obese students. Future research is needed to determine factors contributing to the observed gaps and strategies should be developed to reach underserved groups.

There is clear and consistent evidence that regular physical activity is an important component of healthy lifestyles and fundamental to promoting health and preventing disease. Despite the known benefits of physical activity participation, many people in the United States remain inactive. More specifically, physical activity behavior is socially patterned with lower participation rates among women; racial/ethnic minorities; sexual minority youth; individuals with less education; persons with physical, mental, and cognitive disabilities; individuals >65 yr of age; and those living in the southeast region of the United States. Many health-related outcomes follow a pattern that is similar to physical activity participation. In response to the problem of inequities in physical activity and overall health in the United States, the American College of Sports Medicine (ACSM) has developed a national roadmap that supports achieving health equity through a physically active lifestyle. The actionable, integrated pathways that provide the foundation of ACSM's roadmap include the following: 1) communication-raising awareness of the issue and magnitude of health inequities and conveying the power of physical activity in promoting health equity; 2) education-developing educational resources to improve cultural competency for health care providers and fitness professionals as well as developing new community-based programs for lay health workers; 3) collaboration-building partnerships and programs that integrate existing infrastructures and leverage institutional knowledge, reach, and voices of public, private, and community organizations; and 4) evaluation-ensuring that ACSM attains measurable progress in reducing physical activity disparities to promote health equity. This article provides a conceptual overview of these four pathways of ACSM's roadmap, an understanding of the challenges and advantages of implementing these components, and the organizational and economic benefits of achieving health equity.

Girls are less active than boys and in need of physical activity (PA) interventions. The time directly following school may be a prime opportunity to increase PA, specifically in girls. Afterschool programs and the staff who serve as role models play a critical role in promoting girls’ PA. However, staff do not always provide the support necessary to encourage girls to be active. Studies are needed to explore afterschool program staff’s perceptions of girls’ motivation, as well as their provision of support for autonomy, competence, and relationships with girls (relatedness) to understand how to best promote PA. The purpose of this study was to explore staff and girls’ perceptions of girls’ motivation for PA. The secondary purpose was to explore staff and girls’ perceptions of autonomy, competence, and relatedness support for PA. Interviews with staff (n = 45) and focus groups with girls (n = 88) occurred in 10 afterschool program sites. Half of staff compared with a majority of girls thought girls’ motivation was intrinsic and self-determined (e.g., participated for enjoyment). Three-fourths of staff reported attempting to gain girls’ input and a majority of girls felt they had autonomy to choose or input on the PA provided. Half of staff compared with a quarter of girls thought girls’ competence was negatively impacted by other children. Finally, staff and girls reported spending time together in sedentary pursuits. Efforts are needed to ensure staff: understand girls’ PA motivation, create an autonomy supportive environment, and engage girls in active pursuits.

Objective: Little is known about high-intensity interval training (HIIT) in African-American (AA) women. The purpose of this pilot study was to evaluate the effects of HIIT and steady-state (SS) exercise on cardiometabolic risk factors in young AA women.Design: A 16-week exercise intervention was conducted 3x/week. Twenty-seven AA women were randomized to SS (n = 11; 32 continuous minutes of treadmill walking at 60–70% of maximum heart rate (HRmax)), or HIIT (n = 16; 32 min of treadmill HIIT alternating 3 min at 60–70% of HRmax with 1 min at 80–90% of HRmax). Two-way repeated measures ANOVA with intention-to-treat analysis was used to identify changes between groups. Significance was accepted at P ≤ 0.05.Results: Of the 27 women who entered the study (age: 30.5 ± 6.8 years; BMI: 35.1 ± 5.1 kg/m2; 5274 ± 1646 baseline steps/day), 14 completed the intervention. HIIT significantly decreased waist circumference (107.0 ± 11.3 to 105.1 ± 11.9 cm) compared to SS, which showed no change. There was a signi...

Older Latinos are the fastest growing cohort among older adults in the USA, and their lives are often fraught with comorbidities, such as diabetes and obesity. Strong evidence has demonstrated health benefits of regular physical activity for older adults. In spite of this, older Latinos participate in low levels of physical activity. Interventions designed to increase the physical activity of older Latinos are lacking, yet more are emerging as the number of older Latinos grows. Unfortunately, older Latinos face many impediments to participating in physical activity interventions that researchers are unaware of. The purpose of the current article was to identify barriers that researchers are likely to face in conducting physical activity interventions for older Latinos, highlighting recently identified barriers, and providing barriers we encountered specifically with older Latino adults; and strategies to overcome these barriers to implementation.

BACKGROUND: Community–academic partnerships play a vital role in ensuring the engagement of African American (AA) men in research. Project Brotherhood (PB) is a community organization that has played an integral role in advancing prostate cancer (PCa) research within two pilot projects supported by the Chicago Cancer Health Equity Collaborative (ChicagoCHEC). COMMUNITY PERSPECTIVE: It is rare to see community organizations led by AA men acknowledged for their role in advancing health equity research. We provide a community perspective of PB as a model in engaging AA men in research. PB has been recognized nationally by the Centers for Disease Control and Prevention (CDC) and others demonstrating their national footprint in advancing the inclusion of AA men in all aspects of research. We hope to demonstrate that engagement of AA men in research is important and feasible and to highlight PB as a national model in engaging AA men in research.

Although poor health-related behaviors that impact development of chronic diseases begin much earlier than when actual disease is evident, few studies have examined health behaviors in college students, who may be at an important transitional period where early intervention could prevent development of chronic diseases. The purpose of this study was to examine health-related factors in female college students ( N = 61) by race/ethnicity and weight status. We found significant differences in health profiles between non-Hispanic White (White) and African American students, including greater physical fitness and healthier diets among White students. Overweight/obese students had worse health profiles than healthy BMI students. Furthermore, weight status was significantly associated with cardiovascular fitness. This supports a focus on PA promotion for interventions in the period of emerging adulthood, alongside the other healthy behaviors, to elicit improvements in weight status and potential reduction of chronic disease risks.

The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides the evidence base for the Physical Activity Guidelines for Americans, 2nd Edition.The 2018 Physical Activity Guidelines Advisory Committee addressed 38 questions and 104 subquestions selected for their public health relevance, potential to inform public policies and programs, maturity of the relevant science, and applicability to the general US population. Rigorous systematic literature searches and literature reviews were performed using standardized methods.Newly described benefits of physical activity include reduced risk of excessive weight gain in children and adults, incidence of 6 types of cancer, and fall-related injuries in older people. Physical activity is associated with enhanced cognitive function and mental health across the life span, plus improved mental health and physical function. There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with elevated risk of all-cause and cardiovascular mortality, incident cardiovascular disease and type 2 diabetes, and selected cancer sites. A wide range of intervention strategies have demonstrated success in increasing physical activity.The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides compelling new evidence to inform physical activity recommendations, practice, and policy.

Background Worksites offer a unique opportunity to increase physical activity in persons with both active and sedentary lifestyles. Objective The objective of this study was to examine employee and supervisor perspectives on feasibility and acceptability of 10-minute Instant Recess ® physical activity videos in the worksite. Methods Convenience sample of public and private worksites in Minneapolis/St. Paul, MN. Employees (n = 187) at 13 worksites were recruited by a one-time email invitation to participate in a group Instant Recess break and complete a 15-question survey. One supervisor per site participated in a one-on-one interview to assess suggestions for feasibility of implementation. Likert-type survey responses were averaged per worksite and overall. Interview results were recorded, transcribed, and coded by two authors. Results Employees were extremely positive about enjoyment, increased productivity, comfort, and feasibility of doing Instant Recess at the same time and place every day (score = 4.29, 4.17, 4.25, and 4.37 out of 5, respectively). However, they did not feel comfortable leading an Instant Recess break (score = 2.68 out of 5). Supervisors voiced during the one-on-one interviews that they enjoyed Instant Recess (13 out of 13 supervisors), were enthusiastic about Instant Recess as a simple and cost-effective entry into worksite wellness (11 out of 13 supervisors), and felt that Instant Recess could be institutionalized by offering it daily at a set time and place (13 out of 13 supervisors). Conclusions Employees and supervisors at various worksites believed that it is feasible and desirable to offer 10-minute physical activity breaks using videos during the workday.

Physical activity among African Americans (AA) is low; effective intervention strategies are needed. Community-based settings are useful for delivering health-related interventions in racial/ethnic minority communities. This article describes strategies used to recruit churches for participation in a 22-month intervention designed to increase physical activity levels in AA women. Initial recruitment efforts, led by AA study staff, included direct mailers, phone calls, and in-person meetings with church representatives. After 10 months, only five churches were enrolled. Seven community members with existing partnerships/contacts in the faith community were subsequently hired and an additional 26 churches were enrolled within 6 months. Overall response rate was 45%, and churches required 3.5 ± 3.0 months of multiple contacts prior to enrollment. The main primary contacts within churches were individuals with personal interest in the program and pastors. Prior relationship between the research team and churches did not appear to influence church enrollment as much as community member recruiters. The current study identifies several potential strategies that may be useful for increasing success in efforts to recruit AA churches into studies. Additional research is warranted that tests and compares a variety of recruitment strategies to determine the most successful strategies for recruitment in different populations.

Religious belief has been linked to a variety of positive mental and physical health outcomes. This exploratory study will address the relationship between religious involvement and social connectedness among African American women. Results from a physical activity intervention research project (N = 465) found that total religious support and social support were significantly negatively correlated with total religiosity, while total general social support was significantly positively correlated with total religious support. Overall, the study indicates that more research is needed on ways to encourage interaction between the positive dimensions of both religiosity and social support to bring about healthy behaviors.

Sedentary behaviour has been associated with increased morbidity and mortality, and successful strategies for addressing sedentary behaviour could have major public health implications. National objectively monitored and self-report data show higher rates of sedentary behaviour among racial/ethnic minority groups compared to whites and increasing rates of sedentary behaviour among immigrants, the longer they live in the United States. This chapter describes the prevalence of sedentary behaviour and factors associated with sedentary behaviour in racial/ethnic minority groups, including personal characteristics, built and sociocultural environments, knowledge/attitudes/beliefs, and historical context. This chapter also summarizes findings from interventions focused on decreasing screen time/sedentary behaviour among racial/ethnic minority children and adolescents and adults. Given the lack of definitive conclusions about successful strategies for addressing sedentary behaviour in racial/ethnic minority groups, the chapter concludes with suggestions for next steps for reducing sedentary behaviour using the African American Collaborative Obesity Research Network (AACORN) paradigm as an exemplar model for creating culturally appropriate interventions.

BackgroundAs the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.Methods/designThe Peer Empowerment Program 4 Physical Activity' (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18months, the intervention sites are further randomized to continued support or no support for another 6months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit), adoption & penetration (reach), fidelity (quantity & quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.DiscussionUsing a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.Trial registrationClinicalTrials.gov, USA ( NCT02405325 ). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set.

BACKGROUND: Churches are recognized for their potential capacity to provide health services and interventions to address health disparities in African-Americans (Blacks). Since Pastors are central community leaders, their support and involvement can influence both implementation and outcomes for church-based health programs. The purpose of this qualitative study was to explore pastors’ perceptions of congregant health status within the Black Church. METHODS: Semi-structured interviews were conducted with 11 pastors whose female congregants participated in a physical activity intervention. Thematic analysis techniques were used to analyze interview data. RESULTS: Three major themes emerged: 1) health risks in the African-American community, 2) health promotion in the Black Church, and 3) the importance of women in the Black family and the church. Pastors noted numerous health disparities affecting their congregants and the African-American community at large, including obesity and infant mortality. They viewed health holistically and included faith in their perspectives. According to pastors, holistic health was promoted through health ministry programming in Black churches. Women were described as the cornerstone of the Black Church, yet faced unique health concerns from their roles as family caretakers and congregants. DISCUSSION: Pastors shared their major concerns for congregant health status and the African-American community. Health interventions focusing on African-Americans in church settings should include pastor involvement and should incorporate holistic approaches to address health risks.

Objective: Physical activity (PA) is beneficial for health, yet most African American women do not achieve recommended levels. Successful, sustainable strategies could help to address disparities in health outcomes associated with low levels of PA. The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-based and a secular intervention for increasing PA with a selfguided control group. Design Setting Participants: This cluster randomized, controlled trial was conducted from 2010 – 2011 in African American churches (n=31) in suburban North Carolina. Participants were 469 self-identified low active African American women. Measures: Baseline data were collected on participant demographics, objective and self-reported PA, and constructs related to social ecological theory and social cognitive theory. Results: Complete baseline data were available for 417 participants who were aged 51.4 ± 12.9 years, with average BMI (kg/ m2) 35.8 ± 9.9; 73% of participants were obese (BMI >30). Participants averaged 3,990 ± 1,828 pedometer-assessed daily steps and 23.9 ± 37.7 accelerometer-assessed minutes of daily moderate-to-vigorous PA, and self-reported 25.4 ± 45.4 minutes of weekly walking and moderate- and vigorous-intensity PA. Baseline self-reported religiosity and social support were high. Conclusions: L.A.D.I.E.S. is one of the largest PA trials focused on individual behavior change in African American women. Baseline characteristics suggest participants are representative of the general population. Findings from the study will contribute toward understanding appropriate strategies for increasing PA in high-risk populations.Ethn Dis. 2017;27(3):257-264; doi:10.18865/ed.27.3.257

Exposure to physical and policy environments that limit availability, affordability and appeal of healthy eating and active living options is higher for U.S. blacks than whites. This may contribute to high risk of obesity in black communities and limit effectiveness of preventive interventions. Here, we assess applicability to black Americans of findings from a prior evidence review system designed to accelerate the discovery and application of policy and environmental strategies for childhood obesity prevention and assess external validity. The database included 600 peer-reviewed articles reporting data from 396 sets of studies (study groupings) published from January 2000 through May 2009 and pertained to 24 types of policy and environmental strategies. Only 33 study groupings (~8%) included ≥ 50% black Americans or reported subgroup analyses. Of 10 evaluation studies for interventions rated as effective for all populations in the primary review, 8 suggested effectiveness of child-focused interventions in school or child care settings for obesity- or physical activity-related outcomes in black Americans. Overall findings highlight the need for rigorous evaluations of interventions that reach black children in community or institutional settings, and conceptual frameworks and research designs geared to identifying ethnic or ethnicity-income group differences in intervention effects.

Obesity prevalence in black/African American children and adults of both sexes is high overall and compared with US whites. What we know, and do not know, about how to enhance the effectiveness of obesity prevention and treatment interventions in African Americans is the focus of the 10 articles in this special issue of Obesity Reviews. The evidence base is limited in quantity and quality and insufficient to provide clear guidance. With respect to children, there is relatively consistent, but not definitive support for prioritizing the systematic implementation and evaluation of child-focused interventions in pre-school and school settings and outside of school time. For adults or all ages, developing and refining e-health approaches and faith-based or other culturally and contextually relevant approaches, including translation of the Diabetes Prevention Program intervention to community settings is indicated. Major evidence gaps were identified with respect to interventions with black men and boys, ways to increase participation and retention of black adults in lifestyle behaviour change programmes, and studies of the impact of environmental and policy changes on eating and physical activity in black communities. Bold steps related to research funding priorities, research infrastructure and methodological guidelines are recommended to improve the quantity and quality of research in this domain.

The prevalence of obesity is high in the United States, and highest among racial and ethnic minority groups. This special issue of Obesity Reviews is based upon evidence reviews prepared for and presented at a national invited workshop convened by the African American Collaborative Obesity Research Network (AACORN) in August of 2012. A set of potential topics was developed, a priori, and AACORN network members and colleagues with relevant expertise were invited to lead evidence reviews. The result is 10 articles focused on providing a comprehensive picture of what is known and unknown about interventions to prevent and treat obesity or improve weight-related behaviours in African American adults and children. Evidence reviews included in this special issue focus on children and adolescents (n=2); adults from various perspectives (n=5); eHealth interventions (n=1); interventions within faith organizations (n=1); and environmental and policy change interventions (n=1). Overall, the reviews show a small evidence base for research on African Americans and call for additional prioritization of funding to include studies that can inform action and bring progress in obesity prevention and treatment in African Americans on par with the scope and seriousness of the problem.

This review extends findings from four previous reviews of physical activity (PA) interventions among African Americans (AA) and includes papers published between January 2009 and August 2013. Eligible papers were retrieved using strategies employed in previous reviews. Overall, 16 relevant papers were identified, including four pilot studies and 12 full trials. Interventions were based on a variety of behavioural sciences theories. The most common setting for interventions was churches. Most interventions lasted >6 months; few interventions included >6 months of post-intervention follow-up. Overall, studies identified within-group differences showing positive improvements in PA, and most studies showed statistically significant between-group differences in at least one measure of PA. A quality score was used to rate various elements of the studies and provide a numerical assessment of each paper; scores ranged from 3 to 10 out of 13 possible points. The current review indicates a continued need for studies that use objective PA measures, assess long-term intervention impact, provide specific PA goals for interventions, include more attention to strategies that can increase retention and adherence among AA study participants, include AA men and determine the independent and synergistic effects of individual and environmental (socio-cultural and built) change strategies.

Purpose The church is a focal point for health education efforts in minority communities due to its status as one of the most prominent and stable institutions. This paper highlights an approach for identifying health programming targets in minority churches. Methods Twenty-four churches participated in a one-year Health Ministry Institute (HMI), designed to help churches develop sustainable ministries for health promotion. HMI attendees were instructed on conducting a Congregational Health Assessment (CHA) to identify prevalent health conditions and related behaviors in their churches. Churches collected CHAs over a one-month period. Data were analyzed and results were discussed during a HMI session and used to prioritize health-related issues that could be addressed at individual churches. Results Seventeen churches (71%) returned surveys ( n = 887; 70% female; 73% African American). Prevalent health conditions, participation in health-promoting behaviors, interest in learning to live healthy, and interest in health ministry activities were identified using the CHA. Conclusions The CHA shows promise for health assessment, and can be used to identify health issues that are of interest and relevance to church congregants and leaders. The CHA may assist churches with implementing effective and sustainable programs to address the identified health issues.

Background:Physical inactivity contributes to metabolic syndrome (MetS) in overweight/obesity. However, little is known about this relationship in prediabetes.Methods:The study purpose is to examine relationships between physical activity (PA) and MetS in prediabetes. The Healthy Living Partnerships to Prevent Diabetes tested a community translation of the Diabetes Prevention Program (DPP). Three hundred one overweight/obese prediabetics provided walking minutes/week (WM) and total activity minutes/week (AM) via the International Physical Activity Questionnaire. MetS was at least 3 of waist (men ≥ 102 cm, women ≥ 88 cm), triglycerides (≥150 mg·dl), blood pressure (≥130·85 mm Hg), glucose (≥100mg·dl), and HDL (men < 40mg·dl, women < 50mg·dl).Results:The sample was 57.5% female, 26.7% nonwhite/Hispanic, 57.9 ± 9.5 years and had a body mass index (BMI) 32.7 ± 4 kg·m2. Sixty percent had MetS. Eighteen percent with MetS reported at least 150 AM compared with 29.8% of those without MetS. The odds of MetS was lower with greater AM (Ptrend = .041) and WM (Ptrend = .024). Odds of MetS with 0 WM were 2.08 (P = .046) and with no AM were 2.78 (P = .009) times those meeting goal. One hour additional WM led to 15 times lower MetS odds.Conclusions:Meeting PA goals reduced MetS odds in this sample, which supported PA for prediabetes to prevent MetS.

Objective: While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence. Design and Methods: Data came from 4,008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1-mile buffer area. Obesity was defined as BMI ≥ 30 kg/m2. Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression. Results: Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual-level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15). Conclusions: Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.

Accurately assessing physical activity behavior in children, older adults, and adults with functional limitations is essential to further our understanding of determinants of physical activity behavior in these populations, and to designing, implementing, and evaluating interventions designed to increase physical activity participation. Objective methodologies to assess physical activity behavior, due to improvements in accuracy and precision over self-report measures, have become common in research and practice settings. This paper reviews the current use of objective methods to assess physical activity in observational, determinant, and intervention studies for children, older adults, and adults with functional limitations. Important considerations are presented when adopting prediction algorithms developed on one population, and using in another population that is markedly different in age, health, and functional status. Best practices are presented, along with future recommendations for research to advance this area of scientific inquiry.

The black elderly are disproportionately impacted by the health care crisis in the United States. Historically, the black church and black clergy—long considered the vanguards of the black community—have played important roles in addressing the health problems of the black elderly. Innovative models are needed to provide solutions for elderly health issues and to create a sustainable infrastructure for long-term health promotion. Entrepreneurial spirituality, a concept that seeks to understand how spirituality can impact an entrepreneur's decision making, is proposed as a framework for black clergy to develop a health education and training program for black elderly. This article provides an overview of the black elderly population, describes entrepreneurial spirituality in the context of building strategic alliances and partnerships to address pressing health needs, and gives recommendations for first steps in developing an education and training program.

Context Recommended daily physical activity accumulated in short intervals (e.g., Evidence acquisition PubMed, MEDLINE, and Google Scholar databases were searched in August 2009 (updated search in February and July 2010) to identify relevant, peer-reviewed journal articles and abstracts on school-, worksite-, and faith-based interventions of short, structurally integrated physical activity breaks. Evidence synthesis The majority of interventions implemented daily physical activity bouts of 10–15 minutes in length. Schools were the most common settings among the 40 published articles included in this review. The rigor of the studies varied by setting, with more than 75% of worksite versus 25% of school studies utilizing RCT designs. Studies focused on a broad range of outcomes, including academic/work performance indicators, mental health outcomes, and clinical disease risk indicators, in addition to physical activity level. Physical activity was the most commonly assessed outcome in school-based studies, with more than half of studies assessing and observing improvements in physical activity outcomes following the intervention. About a quarter of worksite-based studies assessed physical activity, and the majority found a positive effect of the intervention on physical activity levels. About half of studies also observed improvements in other relevant outcomes such as academic and work performance indicators (e.g., academic achievement, cognitive performance, work productivity); psychosocial factors (e.g., stress, mood); and clinical disease risk indicators (e.g., blood pressure, BMI). The average study duration was more than 1 year, and several reported outcomes at 3–6 years. Conclusions Interventions integrating physical activity into organizational routine during everyday life have demonstrated modest but consistent benefits, particularly for physical activity, and these are promising avenues of investigation. The proportionately longer-term outcomes available in these studies compared with individual-level studies suggest that physical activity promotion strategies at the organizational level may be more sustainable.

Background: An increased prevalence of overweight/obesity among children has led to school district level policies to increase physical activity (PA) among elementary school students. Interventions are needed that increase activity levels without sacrificing time spent in academics. Objectives: We evaluated a policy implementation interven- tion for to increase in-school PA in elementary schools in Forsyth County, North Carolina, in a randomized study with a delayed intervention control group. Methods: The study included third- through fifth-grade classrooms in eight elementary schools. Instant Recess® was used to introduce 10-minute PA breaks in classrooms on schedules determined by teachers. Direct observation was used to measure activity levels, other student behaviors, and teacher behaviors related to PA in the classrooms. Results: Twenty-eight visits to schools were made during the spring and fall semesters of 2009. At baseline 11% to 44% of intervention and control schools were engaged in classroom- based PA. PA increased from baseline to spring follow-up in intervention schools and was maintained the following fall. Control schools decreased PA from baseline to spring and increased PA once they began the intervention. Students in classrooms engaged in Instant Recess exhibited statistically significant increases in light (51%) and moderate-intensity (16%) PA and increases in time spent in on-task behavior (11%). Control schools experienced similar benefits after they began implementing Instant Recess. Conclusions: Instant Recess is useful for increasing PA and improving behavior among elementary school children. Additional research may be needed to understand how to create policies supporting classroom activity breaks and how to assess policy adherence.

Objective To examine protocol fidelity among teachers involved in a six-month cluster-randomized physical activity (PA) intervention. Methods In 2011, preschools in Springfield, MA were randomized to short bouts of structured PA (SBS-PA, n = 5) or unstructured playtime (UPA, n = 5). SBS-PA provided structured PA in the classroom during the first 10 min of gross-motor playtime followed by 20 min of unstructured playtime. UPA consisted of 30 min of unstructured playtime. All teachers (SBS-PA and UPA) received a written study protocol and 1.5 h of training. SBS-PA also received videos to use to lead structured PA and 1.5 additional hours of training. Study fidelity and process evaluation were assessed twice weekly via semi-structured questionnaire. Results Only 56.6% of SBS-PA and 75.2% of UPA free playtimes lasted for 30 min; 86.3% of SBS-PA teachers implemented structured PA during the first 10 min of gross-motor playtime but only 67.2% delivered the intervention as instructed. Only 68.5% of SBS-PA teachers implemented the 20-minute unstructured playtime. SBS-PA teachers reported that time limitations was a major barrier in implementing the designed intervention. Pre-post changes in PA did not differ between groups. Conclusion Limited fidelity to intervention protocol likely impacted study findings. Future studies should focus on strategies to improve adherence among intervention leaders.