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Objective: To compare potential correlates of physical activity between African American and white women. Methods: A random-digit-dialed telephone survey was conducted in central South Carolina. Bivariate and multivariate analyses focused on women aged 18+ (N = 1176). Results: African American women reported greater maintenance of sidewalks and public parks than did white women, who reported higher physical activity, exercise self-efficacy, access to indoor walking facilities, and knowledge of mapped-out walking routes. Exercise self-efficacy was the only significant correlate of physical activity among both African American and white women. Conclusions: Self-efficacy was a robust cross-sectional correlate of physical activity in women. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study was to explore women's knowledge and understanding of abnormal Pap tests and HPV. Forty-four in-depth interviews were conducted with low-income, highrisk human papillomavirus (HPV) positive women (ages 18-64 years). Major themes regarding abnormal Pap test results were: (a) getting cancer; (b) need for repeat Pap testing; (c) need for additional tests/treatment; (d) low concern; (e) variety of causes; (f) sexual transmission; and (g) connection to HPV/other sexually transmitted disease (STD). Major themes related to HPV were: (a) getting follow-up care and (b) association of HPV with cancer. Findings indicate a need for clear, consistent educational messages. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the association between BMI and physical activity based on the CDC-ACSM recommendation and a more demanding standard consistent with the IOM recommendation. METHODS: A random-digit-dialed survey (n=1810) used 2001 BRFSS questions to measure physical activity. RESULTS: Data revealed a monotonic association between BMI and physical activity level. Lower odds of meeting both recommendations were associated with higher BMI. The proportion meeting the CDC-ACSM recommendation was at least 3 times that of persons meeting the IOM-based recommendation. CONCLUSIONS: Meeting either recommendation was associated with BMI; however, a larger proportion of persons were meeting the less demanding CDC-ACSM recommendation. [ABSTRACT FROM AUTHOR]

Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Dystrophins and dystrobrevins are distantly related proteins with important but poorly understood roles in the function of metazoan muscular and neuronal tissues. Defects in them and their associated proteins cause a range of neuromuscular disorders. Members of this superfamily have been discovered in a relatively serendipitous way; we set out to compile a comprehensive description of dystrophin- and dystrobrevin-related sequences from available metazoan genome sequences, validated in representative organisms by RT-PCR, or acquired de novo from key species. Results Features of the superfamily revealed by our survey include: a) Dystrotelin, an entirely novel branch of the superfamily, present in most vertebrates examined. Dystrotelin is expressed in the central nervous system, and is a possible orthologue of Drosophila DAH. We describe the preliminary characterisation of its function, evolution and expression. b) A novel vertebrate member of the dystrobrevin family, γ-dystrobrevin, an ancient branch now extant only in fish, but probably present in our own ancestors. Like dystrophin, zebrafish γ-dystrobrevin mRNA is localised to myosepta. c) The extent of conservation of alternative splicing and alternative promoter use in the dystrophin and dystrobrevin genes; alternative splicing of dystrophin exons 73 and 78 and α-dystrobrevin exon 13 are conserved across vertebrates, as are the use of the Dp116, Dp71 and G-utrophin promoters; the Dp260 and Dp140 promoters are tetrapod innovations. d) The evolution of the unique N-terminus of DRP2 and its relationship to Dp116 and G-utrophin. e) A C-terminally truncated common ancestor of dystrophin and utrophin in cyclostomes. f) A severely restricted repertoire of dystrophin complex components in ascidians. Conclusion We have refined our understanding of the evolutionary history and isoform diversity of the five previously reported vertebrate superfamily members and describe two novel members, dystrotelin and γ-dystrobrevin. Dystrotelins, dystrophins and dystrobrevins are roughly equally related to each other. Vertebrates therefore have a repertoire of seven superfamily members (three dystrophins, three dystrobevins, and one dystrotelin), with one lost in tetrapods. Most invertebrates studied have one member from each branch. Although the basic shared function which is implied by the common architecture of these distantly related proteins remains unclear, it clearly permeates metazoan biology.

Background: Little is known about patterns of household food insecurity (HFI) across more than two time points in adults in the United States, the frequency predictors of different trajectories. The distinctions between persistent and transient food insecurity trajectories may be crucial to developing effective interventions., Objective: To characterize dominant trajectories of food security status over three time points between 2013 and 2016 and identify demographic, socioeconomic and health-related predictors of persistent and transient HFI., Design: Cohort study in disadvantaged communities in South Carolina., Setting: and subjects: 397 middle-aged participants, predominantly female, African American, living in USDA-designated food deserts., Main Outcome Measure: Household food insecurity over time using the 18-item USDA's Household Food Security Survey Module., Statistical Analyses Performed: Descriptive analyses of food security trajectories and multinomial regression analyses., Results: At baseline (2013-2014), 61% of households reported HFI during the previous 12 months, which decreased to 54% in 2015 and to 51% in 2016. Only 27% of households were persistently food secure, 36% experienced transient and 37% persistent food insecurity. Female sex (OR 2.7, 95%CI 1.2-5.9), being married or living with a partner (OR 2.4, 95CI% 1.1-5.3) and fair health status (OR 4.4, 95%CI 2.2-8.8) were associated with increased odds of persistent food insecurity. Fair health was also a significant predictor of transient food insecurity., Conclusions: These findings suggest that future research should focus on persistent versus transient trajectories separately and that tailored interventions may be needed to make progress on alleviating food insecurity among disadvantaged communities., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Effective recruitment and retention supports equitable participation in research. The aim of this article is to describe recruitment and retention methods among residents of highly disadvantaged, predominantly African American communities in the southeastern United States during the evaluation of a healthy food access initiative. We proposed that active and passive recruitment methods, intensive retention strategies, community outreach and involvement, over-enrollment to anticipate attrition, and applied principles of community participation would achieve the study's recruitment and retention goals. The enrollment goal of 560 was met at 94% (n = 527), and the retention goal of 400 was achieved (n = 408).

Objective : To examine diet quality and dietary intake among residents of disadvantaged neighborhoods in the Southeast United States (U.S.) and to examine associations between dietary and socioeconomic factors. Design : We examined baseline data from an evaluation study of a healthy food access initiative. Participants were recruited from two urban settings comprising seven neighborhoods of high household poverty (17% to 62%). Participants completed in-person interviews with measures of education, household income, and food security and one unannounced 24-hour dietary recall by telephone with trained registered dietitians. Food desert residence was coded based on U.S. Census data. Proportions meeting 2010 Dietary Guidelines for Americans and Healthy Eating Index 2010 (HEI-2010) scores were computed. Associations between dietary variables and participant's education, household income, food security, and food desert residence were tested. Results : Participants ( n  = 465) were predominantly African American (92%), women (80%), and overweight or obese (79%), and 52 ± 14 years of age. Sixty-three percent had low or very low food security, and 82% lived in census tracts of low income and low access to supermarkets (urban food desert). HEI-2010 scores averaged 48.8 ± 13.1. A minority of participants met dietary guidelines. Diet quality was lower among participants with lower education and among those from food insecure households ( p  < .05). Household income and food security were positively associated with meeting several dietary guidelines ( p  < .05). Food desert residence was unrelated to diet variables. Conclusions : In this disadvantaged population, significant nutritional concerns were observed, and socioeconomic factors were associated with diet quality and meeting dietary guidelines. Interventions must address broader economic, social, and policy issues such as access to affordable healthy foods.

A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Community Health Advisors (CHAs) contribute to health promotion program effectiveness, but their role in faith-based programs is understudied, and little is known about their role performance or satisfaction. In a dissemination and implementation study, 19 CHAs were trained to provide healthy eating (HE) and physical activity (PA) program training to church committees. Of these, 17 CHAs trained 347 attendees from 115 churches. Thirteen CHAs remained for the 12-month period and provided telephone-based technical assistance (TA) to churches. To evaluate their experiences and satisfaction, CHAs completed questionnaires at baseline and 12 months. Staff observers and church committee members evaluated CHAs' effectiveness as trainers. There were no significant changes in the CHAs' own body mass index, PA, fruit and vegetable intake, or self-rated health but significant increases in their perceived knowledge of PA (p = 0.01) and HE (p = 0.02). CHAs reported high agreement regarding the quality of their training for the role and moderate volunteer satisfaction on average but thought that the time required of them was somewhat more than expected, though they were interested in volunteering for a future, similar role. Church committee members agreed with CHAs' effectiveness as trainers and the helpfulness of the TA calls. Staff observers rated CHAs' as having covered 87.8% of church training content and agreed that, on average, the CHAs were effective trainers. Assessing CHAs' availability, clear communication about the time requirements, and over-recruitment to offset attrition and decrease the workload may be needed to improve retention and support satisfaction.

Background: Diet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality., Objective: The goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts., Design: A cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments., Participants/setting: Data collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH., Main Outcome Measure: HEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research., Analysis: Separate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P<0.05 and P<0.10 because of modest sample sizes in each community., Results: Across both models, significant direct effects on HEI-2010 scores included healthy eating identity (β=.295, Cleveland; β=.297, Columbus, P<0.05) and distance traveled to primary food store (β=.111, Cleveland, P<0.10; β=.175, Columbus, P<0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (β=-.125, P<0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R 2 =.282 and R 2 =.152, respectively)., Conclusions: Findings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away., (Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Faith-based health promotion programs have been effective in increasing healthy eating (HE) and physical activity (PA). Very few reports exist regarding church leaders' anticipated and experienced barriers and facilitators to program implementation. Pastors (n = 38, 70%) and program coordinators (n = 54, 100%) from churches (N = 54) who attended a program training answered open-ended questions about anticipated barriers and facilitators to implementing the HE and PA parts of the Faith, Activity, and Nutrition (FAN) program. Twelve months later, pastors (n = 49, 92%) and coordinators (n = 53, 98%) answered analogous questions about their experienced barriers and facilitators to implementing the HE and PA parts of the FAN program. Responses were coded using thematic analysis. Similar themes appeared at baseline and follow-up for anticipated and experienced barriers and facilitators. The most common barriers were no anticipated barriers, resistance to change, church characteristics, and lack of participation/motivation. The most common facilitators were internal support, leadership, and communication. Few differences were found between anticipated and experienced barriers and facilitators. Understanding these perspectives, particularly overcoming resistance to change and church characteristics through strong leadership and internal support from church leaders, will improve future program development, resources, and technical assistance in faith-based and non-faith-based communities alike., (� The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Interventions aimed at improving access to healthy food in low-income communities should consider the preferences of residents. Household food shoppers in two urban, low-income communities were asked about their preferences for vendors at, and qualities of, a potential nearby food hub. Universally, participants preferred availability of whole foods, primarily fruits and vegetables. They also favored cleanliness, quality, and affordability. The demographics and preferences of potential customers raise central issues that would need to be integrated into the development of a food hub, namely affordability (likely through subsidization), attention to accommodation and cultural accessibility, and programming that builds community.

Background: Social network-driven approaches have promise for promoting physical activity in community settings. Yet, there have been few direct investigations of such interventions. This study tested the effectiveness of a social network-driven, group-based walking intervention in a medically underserved community., Methods: This study used a quasi-experimental pretest-posttest design with 3 measurement time points to examine the effectiveness of Sumter County on the Move! in communities in Sumter County, SC. A total of 293 individuals participated in 59 walking groups formed from existing social networks. Participants were 86% females, 67% black, and 31% white, with a mean age of 49.5 years. Measures included perceptions of the walking groups; psychosocial factors such as self-regulation, self-efficacy, and social support; and both self-reported and objectively measured physical activity., Results: The intervention produced significant increases in goal setting and social support for physical activity from multiple sources, and these intervention effects were sustained through the final measurement point 6 months after completion of the intervention. Nonetheless, few of the desired changes in physical activity were observed., Conclusion: Our mixed results underscore the importance of future research to better understand the dose and duration of intervention implementation required to effect and sustain behavior change.

Background: Little is known about the food acquisition and shopping habits of residents living in food deserts., Objective: To identify distinct food acquisition and shopping patterns among residents, most of whom (81%) live in food desert (low income and low access) census tracts, and characterize these patterns with respect to the residents' socioeconomic status, nutrition knowledge, and perceptions of their food environment., Design: This is a cross-sectional study., Participants/setting: Four hundred sixty-six primary food shoppers were included from two counties in South Carolina during 2013-2014., Main Outcome Measures: Participants' self-reported food acquisition and shopping habits, including shopping distance; frequency; store type; transportation mode; use of farmers' markets, food banks/pantries, and church/social service organizations, were used to develop shopping patterns and group residents. Supplemental Nutrition Assistance Program participation, food security, income, and education, nutrition knowledge, and perceptions of the food environment were used to characterize these groups., Statistical Analyses Performed: Latent class analysis and multinomial logistic regression were used to identify and characterize patterns, respectively., Results: Three patterns were identified, including those who use community food resources, are infrequent grocery shoppers, and use someone else's car or public transportation when shopping (Class 1) (35%), those who use community food resources and are more frequent and proximal shoppers (Class 2) (41%), and those who do not use community food resources and are distal shoppers (Class 3) (24%). Compared with Class 3, Class 1 had comparatively lower socioeconomic status. Class 2 also had comparatively lower socioeconomic attributes except for income. Class 2 was not significantly different from Class 1 except that a higher proportion in Class 1 saw food access as a problem. No significant differences across classes were found regarding fruit and vegetable recommendation knowledge., Conclusions: Shopping frequency, use of community food resources, transportation methods, and shopping distance were the key factors that defined distinct patterns among residents living in low-income areas. Future interventions to increase healthy food access in underserved areas should not only consider accessibility but also community food resource use., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Community health advisors (CHAs) have been widely involved in health promotion, but few details on role expectations, retention, and evaluation have been reported. In a dissemination and implementation (D&I) study of an evidence-based healthy eating and physical activity program, 59 churches were randomized to an intervention (n = 39) or control (delayed intervention) (n = 20) condition. In a novel approach, CHAs worked with church committees rather than congregants by providing training (n = 59) and technical assistance (n = 54) to the committees to implement a program focused on structural and policy-level changes to support congregants' behavioral changes. CHA training comprised self-study via electronic training modules, in-person training, and telephone-based training. Evaluation methods were pilot test participants' and CHAs' ratings of their training; observers' ratings of CHAs' church training delivery; church committee members' ratings of the training experience, including CHAs' performance; and data from the TA database to assess CHAs' adherence to the protocol. The main challenge was the early dropout of one CHA and the reduced role of another. CHAs trained 142 intervention and 60 control church committee members in nine sessions; they covered 99% (intervention) and 90% (control) of training content, indicating high fidelity. Observers' scored CHAs' teaching and facilitation skills at 96.7% (intervention) and 80% (control) of the possible score. CHAs completed 92% of intervention and 93% of control TA calls. The great majority of church participants' comments regarding CHAs were positive. This study demonstrates that with training and support, CHAs demonstrate high levels of intervention fidelity, confidence, and competence.

Objective: To examine (1) the association of a new supermarket opening with dietary intake and perceptions of healthy food availability, and (2) associations of distance to the primary food store and mean prices of fruits, vegetables, and sugary beverages with levels of consumption of these foods and body mass index in a low-income, southeastern community., Methods: The researchers used cross-sectional, self-administered questionnaire data and supermarket audit data collected in the supermarket community and comparison community before (2015) and after (2016) the supermarket opening. A difference-in-difference analysis employed propensity scores to compare pretest and posttest differences between communities., Results: There were no significant differences between communities on dietary behaviors. There was a significant cross-sectional, inverse association between distance to the primary food store and fruit and vegetable consumption among all respondents in 2016., Conclusions and Implications: The results suggest that adding a new discount supermarket is not necessarily associated with improvements in residents' fruit, vegetable, or sugary beverage consumption, or in their perceptions of the availability of healthy food in the neighborhood. However, distance to the store may be important., (Copyright © 2018. Published by Elsevier Inc.)

Introduction: Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study., Design: This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017., Setting/participants: Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated)., Intervention: Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance., Main Outcomes Measures: The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis., Results: Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group., Conclusions: This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination., Trial Registration: This study is registered at www.clinicaltrials.gov NCT02868866., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Food insecurity exceeds the 14% national level in severely disadvantaged households, and food shoppers seek food sources and assistance. In 513 predominantly African American households in South Carolina, USA, food security was a significant predictor of sources used, adjusted for socio-demographic characteristics (least-squares means = high food security, 2.10; marginal, 2.96; low, 2.91; very low, 3.40). The top sources were churches/social services, food bank/pantry, farmers' market, family/friend/neighbor, soup kitchen/shelter, and hunting/fishing/trapping. Adjusted odds were significantly greater among households of lower food security levels compared to high food security for food from church/social services, food bank/pantry, family/friend/neighbors, soup kitchen/shelter, and community/school/church garden.

Background: Food security is a severe problem in the United States. Few studies have examined its relationship with food shopping behaviors., Objective: This study aimed to examine the association between food security and store-specific and overall food shopping among residents of low-income neighborhoods., Design: We conducted a cross-sectional study., Participants/setting: Five hundred twenty-seven households were recruited from two counties in South Carolina from November 2013 to May 2014, and 474 households were included in the final analysis., Main Outcomes Measures: Food security was assessed using the 18-item US-Household Food Security Module questionnaire, and classified into three categories: high or marginal food security (FS), low food security (LFS), and very low food security (VLFS). Store-specific shopping behaviors including frequency, store type, and transportation were queried via in-person interview for the three most-frequented grocery stores. Distance from participants' homes to their reported stores was calculated using Geographic Information Systems., Statistical Analyses: Multivariate linear regression for analyses of distance and frequency and multinomial/ordinary logistic regression for analyses of store type and transportation were used., Results: Compared to FS participants, a significantly higher proportion of VLFS participants reported a convenience/dollar store as their most-frequented store (odds ratio [OR] 2.31, 95% CI 1.08 to 4.95) or a lack of transportation (OR 2.04, 95% CI 1.25 to 3.33). They also shopped less frequently (b=-.31, P=0.03) at their third most-frequented store and traveled fewer total miles for shopping (b=-4.71, P=0.04). In analyses considering all stores jointly, LFS participants had lower odds of shopping at both supermarkets and convenience/dollar stores (OR 0.44, 95% CI 0.21 to 0.91) compared to food-secure residents., Conclusions: The current findings suggest that households with VLFS tend to shop more frequently in stores that have less-healthful options, such as convenience/dollar stores. These findings lend support to ongoing community and policy interventions aimed at improving food access among food-insecure populations., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Low-income areas in which residents have poor access to healthy foods have been referred to as "food deserts." It is thought that improving food access may help curb the obesity epidemic. Little is known about where residents of food deserts shop and if shopping habits are associated with body mass index (BMI). We evaluated the association of food shopping and acquisition (e.g., obtaining food from church, food pantries, etc.) with BMI among 459 residents of low-income communities from two South Carolina counties, 81% of whom lived in United States Department of Agriculture-designated food deserts. Participants were interviewed about food shopping and acquisition and perceptions of their food environment, and weight and height were measured. Distances to food retail outlets were determined. Multivariable linear regression analysis was employed. Our study sample comprising largely African-American women had an average BMI of 32.5 kg/m². The vast majority of study participants shopped at supermarkets (61%) or supercenters/warehouse clubs (27%). Shopping at a supercenter or warehouse club as one's primary store was significantly associated with a 2.6 kg/m² higher BMI compared to shopping at a supermarket, independent of demographics, socioeconomics, physical activity, and all other food shopping/acquisition behaviors. Persons who reported shopping at a small grocery store or a convenience or dollar store as their tertiary store had a 2.6 kg/m² lower BMI. Respondents who perceived lack of access to adequate food shopping in their neighborhoods as a problem had higher BMI. Living in a food desert census tract was not significantly associated with BMI. Other shopping attributes, including distance to utilized and nearest grocery stores, were not independently associated with BMI. These findings call into question the idea that poor spatial access to grocery stores is a key underlying factor affecting the obesity epidemic. Future research should consider assessing foods purchased and dietary intake within a comprehensive study of food shopping behaviors and health outcomes among persons living in food deserts., Competing Interests: The authors declare no conflict of interest.

A process evaluation was conducted in conjunction with a controlled trial of a self-directed exercise program among people with arthritis to describe the program's reach; self-management behaviors, exposure to materials, program perceptions, satisfaction, and perceived benefits; compatibility with targeted participants' needs; and maintenance. Participants (n=197) were predominantly white, middle-aged, college-educated women. At 12 weeks, 73.2% had read ≥90% of the program materials (at nine months>70% had "occasionally" or "often" looked back over each of the five parts of the materials); 63.3% had set goals (52.5% at nine months), and 83.9% had "some" or "a lot" of success following their plan (64.2% at nine months), while 90.4% rated the program "good" or "excellent" (87.5% at nine months). At 12 weeks, the majority (89.3%) used written logs to self-monitor (mean=9.3 logs); by nine months, >70% never kept logs. Most (>80%) rated twelve of thirteen program components as helpful, and 98.6% would recommend the program. From 38% to 62.4% endorsed each of eight program benefits, with small declines of ≤9% at nine months. Qualitative response identified ways the program met and did not meet expectations. The main program compatibility issue was targeting all adults with arthritis, while featuring older adults in materials., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index., Methods: Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages., Results: Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02)., Conclusions and Implications: Future studies should examine associations between elements of the in-store food environment, purchases, and consumption., (Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Although social support is a frequently cited enabler of physical activity, few studies have examined how to harness social support in interventions. This paper describes community-based formative research to design a walking program for mobilizing naturally occurring social networks to support increases in walking behavior. Focus group methods were used to engage community members in discussions about desired walking program features. The research was conducted with underserved communities in Sumter County, South Carolina. The majority of focus group participants were women (76%) and African American (92%). Several important themes emerged from the focus group results regarding attitudes toward walking, facilitators of and barriers to walking, ideal walking program characteristics, and strategies for encouraging community members to walk. Most noteably, the role of existing social networks as a supportive influence on physical activity was a recurring theme in our formative research and a gap in the existing evidence base. The resulting walking program focused on strategies for mobilizing, supporting and reinforcing existing social networks as mechanisms for increasing walking. Our approach to linking theory, empirical evidence and community-based formative research for the development of a walking intervention offers an example for practitioners developing intervention strategies for a wide range of behaviors., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession., Purpose: To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice., Setting: A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain., Participants: Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada., Design: Qualitative analysis of secondary cross-sectional data using a grounded theory approach., Results: Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice., Discussion: The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy., Conclusions: Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues.

Background: Little evidence exists about processes in massage therapy practice. Investigating current frameworks is warranted. This qualitative study is a secondary data analysis using grounded theory to understand how massage therapy experts describe massage therapy practice., Methods: 31 massage therapy experts were invited to a 2-day symposium to discuss best practices for the profession. Through qualitative analysis, memoing, and discussion, the data were summarized into themes., Results: Three themes were identified around massage therapy practice: 1) client centered, 2) structure for practice, and 3) influencing factors. Each theme is clarified and expanded., Discussion: Conceptual models were developed for research and clinical practice and a definition for massage therapy practice was identified. Challenges and limitations are discussed., Conclusion: The goal of providing these models is to give massage therapists tools to deliver the best possible care. The models need testing to see if they help advance the profession., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Determine whether macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake, and psychosocial and behavioral factors are associated with household food security., Design: Baseline data from in-person interviews and telephone-based, 24-hour dietary recall from women recruited to a diet and physical activity controlled trial., Setting: Neighborhoods encompassing 18 urban census tracts in South Carolina., Participants: Participants (n=202) were predominantly African American (87%), overweight or obese women aged 25 to 51 years with mean body mass index of 40.6±8.7., Main Outcome Measures: Macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake (via multi-pass, 24-h recall); diet-related self-efficacy and social support, healthy/lowfat and emotional eating behaviors, and depressive symptoms., Results: Women in food-secure (FS) and food insecure (FI) households were not different on health and sociodemographic characteristics. Women in FI households had lower self-efficacy and healthy/low-fat eating behaviors, and higher emotional eating and depressive symptoms compared with women in FS households. The groups did not differ on social support. Significant dietary differences were few (FS>FI on protein and lean meat; FS

Background: Research shows high prevalence of complementary and alternative medicine (CAM) use in individuals with arthritis. Little is known about CAM use and objectively measured physical functional performance., Objective: The main objective was to determine if CAM use was associated with self-reported symptoms and physical functional performance in adults with arthritis. The secondary objectives were to describe the perceived helpfulness and correlates of CAM use., Methods: We analyzed cross-sectional data from a self-administered questionnaire and objectively measured physical functional performance prior to randomization to a self-paced exercise program or control condition (n = 401). We used the Fisher's exact test, analysis of variance, and general linear models to examine the association of CAM use with socio-demographic characteristics, symptoms and functional performance. Logistic regression computed the odds of perceiving CAM as helpful by level of use., Results: Most respondents had used CAM (76%). Dietary supplements were the most-used (53.1%). Female gender and college education predicted greater number of modalities used. Compared to non-users, use of any CAM was associated with greater fatigue and lower grip strength; relaxation techniques with lower walk distance and gait speed; dietary change with greater pain and stiffness and lower walk distance; and yoga with lower pain and stiffness, greater walk distance, chair stands, seated reach and gait, but lower grip strength. Perceived help was positively associated with the number of modalities used., Conclusions: Associations between CAM and symptoms or functional performance were mixed. Only yoga showed positive associations; however, yoga practitioners were more physically active overall than non-practitioners., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The Community Empowerment Center used a community-engaged approach to build capacity among residents to develop and implement interventions focused on creating a healthier environment. The Center partnered with residents living in a public housing community and adjacent low-income neighborhood and provided support through a mini-grant program. A six-session training program guided community members in mini grant development; 25 individuals attended at least one session. Six grant proposals were submitted; three were awarded $12,000 each for intervention implementation. Findings offer a model for engaging residents from low-resource settings in intervention development, implementation, and sustainability for community health promotion.

Objective: Understanding body size perceptions and discrepancies among African American women may have implications for effective weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women., Design: Cross-sectional using baseline data from a randomized controlled trial., Setting: 18 census tracts in a central South Carolina city where ≥ 25% of residents were below poverty income., Participants: 147 economically disadvantaged, overweight and obese African American women., Main Outcome Measures: Using Pulvers' figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women., Results: Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m(2) larger, P<.0001) than those established in the sample of White women., Conclusions: Although women desired a smaller body size, there nonetheless were misperceptions of body size and the associated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss.

Background: Walking interventions delivered by lay leaders have been shown to be effective. Knowing the characteristics of individuals who volunteer to be group leaders in walking programs could facilitate more efficient and effective recruitment and training., Methods: Walking group leaders were recruited into a community-based program and formed walking groups from existing social networks. Leaders and members completed a survey, participated in physical measurements, and wore an accelerometer. Regression models (adjusting for group clustering and covariates) tested psychosocial and behavioral differences between leaders and members., Results: The sample included 296 adults (86% women, 66% African American). Leaders (n = 60) were similar to members (n = 236) with respect to most sociodemographic and health characteristics, but were significantly older and more likely to report arthritis and high cholesterol (P-values < .05). Although leaders and members were similar in sedentary behavior and physical activity, leaders reported higher levels of exercise self-regulation, self-efficacy, and social support (P-values < .01). Leaders also reported greater use of outdoor trails (P = .005) and other outdoor recreation areas (P = .003) for physical activity than members., Conclusion: Although walking group leaders were no more active than members, leaders did display psychosocial characteristics and behaviors consistent with a greater readiness for change.

Background: Successful community groups have the capacity to mobilize community assets to address needs. Capacity-building education is integral to building competent communities., Objectives: A community-university team developed and pilot tested an education program for community advocates from disadvantaged neighborhoods with high chronic disease burden., Methods: The Community Advocacy and Leadership Program (CALP) included eight monthly workshops, a mini-grant opportunity, and technical assistance. A nominal group with community health practitioners, focus group with community advocates, and a literature search comprised a triangulated educational needs assessment. A participating pretest with 35 community health practitioners guided curriculum refinement. Seven representatives from three community groups in a medically underserved South Carolina county participated in pilot implementation and evaluation. Qualitative and quantitative data informed the process and impact evaluation., Results: The mean knowledge score at 1 month after the program was 77% (range, 52%-96%). The mean score on post-program self-assessment of skills improvement was 3.8 out of a possible 4.0 (range, 3.6-4.0). Two groups submitted successful community mini-grant applications for playground improvements, and the third group successfully advocated for public funding of neighborhood park improvements. Participants reported favorable impressions and both personal and community benefits from participation., Conclusions: A community-university partnership successfully conducted a local educational needs assessment and developed and pilot tested a capacity development program within a CBPR partnership. Successes, challenges, and lessons learned will guide program refinement, replication, and dissemination.

Background: Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed., Purpose: To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis., Design: Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014., Setting/participants: Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating)., Intervention: Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks., Main Outcome Measures: Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months., Results: Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity., Conclusions: The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327., (Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.)

Use of outdoor recreation areas (ORAs) is correlated with physical activity (PA) in community-dwelling adults. Additionally, the wide spread availability of ORAs, including their placement in disadvantaged neighborhoods, make them an especially promising venue through which to promote PA. The purpose of this study was to examine the combination of individual-level factors associated with ORA use in a socioeconomically diverse Southeastern US county. A 2011 random digit-dial survey included 829 adults aged 18+ years with complete data; questions assessed PA level and use/perceived safety of ORAs. Signal detection analysis, a non-parametric recursive partitioning technique, identified cutpoints for defining subgroups of respondents based on ORA use. Seven subgroups were defined ranging from 77.2 % ORA use (younger, met PA recommendations) to 31.8 % ORA use (older, perceived ORAs to be less safe). Signal detection did not identify gender or race as important for defining subgroups. Results suggest that gendered and ethnically-focused ORA promotion campaigns might be unnecessary. Instead, efforts could focus on increasing awareness of ORA facilities among older, less active adults.

Objectives: To examine baseline predictors of moderate-to-vigorous intensity physical activity (MVPA) at the 12-week follow-up in a sample of adults with arthritis participating in a self-directed, multicomponent exercise program., Study Design: Pretest-posttest. Analyses were limited to those randomized to the exercise intervention., Methods: Participants (n = 152) completed a survey assessing demographic, health-related, and arthritis-related factors, and completed anthropometric and functional measurements at baseline. Self-reported MVPA was assessed at baseline and 12 weeks. Participants were classified as engaging in ≥2.5 or <2.5 h/week of MVPA at the 12-week follow-up. Baseline demographic, health-related, arthritis-related, and functional factors were examined as predictors of engaging in ≥2.5 h of MVPA., Results: At the 12-week follow-up, 66.5% (n = 101) of participants engaged in ≥2.5 h/week of MVPA. Those with a higher body mass index, more days with poor physical health, a greater number of health conditions, self-reported hypertension, self-reported high cholesterol, and greater pain and stiffness were less likely to engage in ≥2.5 h of MVPA at the 12-week follow-up; those with greater arthritis self-efficacy and better performance on the 6 minute walk test were more likely. None of the other factors examined were associated with MVPA., Conclusions: This study uncovered health-related, arthritis-related, and functional factors associated with MVPA that may help guide intervention strategies. Participants with less severe symptoms, better functional performance and fewer comorbidities at baseline were more likely to achieve the recommended MVPA level at 12 weeks; therefore self-directed PA interventions may be best suited for those with relatively good health status despite arthritis, while those with worse symptoms and health status may benefit more from other intervention delivery modalities such as structured, individualized programs where additional support for managing arthritis symptoms and comorbidity can be addressed., (Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Aim: To compare participation in breast, cervical and prostate cancer screening with colorectal cancer (CRC) screening., Materials & Methods: This random digit-dialed survey includes participants (aged 50-75 years) from South Carolina (USA). Past participation information in fecal occult blood test, flexible sigmoidoscopy, colonoscopy, mammography, clinical breast examination, Pap test, prostate-specific antigen and digital rectal examination was obtained.Adjusted odds ratios are reported., Results: Among European-American women, any cervical or breast cancer screening was associated with adherence to any CRC screening. Among African-American women, mammography was associated with adherence to any CRC screening. Digital rectal examination and prostate-specific antigen tests were associated with adherence to any CRC screening test among all men., Conclusion: Future research should explore approaches inclusive of cancer screening recommendations for multiple cancer types for reduction of cancer screening disparities.

Evidence suggests that depressive symptoms are associated with poorer dietary intake and inadequate physical activity; however, this association has not been examined in lower-income overweight and obese African American women. The objective of this cross-sectional study was to examine the associations between depressive symptoms and diet and physical activity in 196 women (87% African American; age, 25-51 years). Higher depressive symptoms were hypothesized to predict poorer diet quality, greater emotional eating, lower physical activity levels, and greater sedentary time. Depressive symptoms were measured using the validated short form of the Center for Epidemiological Studies Depression Scale. Dietary intake and quality were assessed using three 24-hour dietary recalls. Emotional eating was evaluated using 4 items from the emotional eating subscale of the Eating Behavior Patterns Questionnaire. Physical activity and sedentary time were objectively measured using the ActiGraph accelerometer. Linear regression models tested the associations between depressive symptoms and each dietary and physical activity outcome variable. Symptoms of depression were positively associated with total daily caloric intake from saturated fat and total sugars, as well as emotional eating scores (P < .05). Although not statistically significant, depressive symptoms were positively associated with sweetened beverage consumption (P = .06) and added sugars (P = .07). Depressive symptoms were not associated with total fat, sodium, fruit and vegetables, fast food consumption, the Alternate Healthy Eating Index score, moderate-to-vigorous physical activity, or sedentary time. Future studies should explore the mechanisms linking the identified associations between depressive symptoms and dietary intake, such as the role of emotional eating., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Arthritis self-efficacy is important for successful disease management. This study examined psychometric properties of the 8-item English version of the Arthritis Self-Efficacy Scale (ASES-8) and differences in ASES-8 scores across sample subgroups. In 401 participants with self-reported doctor-diagnosed arthritis, exploratory factor analysis and tests of internal consistency were conducted. Concurrent validity was examined by associating ASES-8 scores with disease-specific, psychosocial, functional, and behavioral measures expected to be related to arthritis self-efficacy. All analyses were conducted for the full sample and within subgroups (gender, race, age, education, and weight status). Exploratory factor analysis for the entire sample and in all 12 subgroups demonstrated a one factor solution (factor loadings: 0.61 to 0.89). Internal consistency was high for measures of Cronbach's alpha (0.87 to 0.94), omega (0.87 to 0.93), and greatest lower bound (0.90 to 0.95). ASES-8 scores were significantly correlated with all measures assessed (P < 0.05), demonstrating concurrent validity. Those with a high school education or greater had higher ASES-8 scores than those with less than a high school education (P < .001); no other subgroup differences were found. The ASES-8 is a valid and reliable tool to measure arthritis self-efficacy efficiently and thereby reduce participant burden in research studies.

This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n = 28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3 ± 8.9 years; body mass index [BMI] 40.4 ± 8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g., from children or people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods.

Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: Participatory formative research guided the creation of a culturally tailored educational brochure about human papillomavirus (HPV) at an American Indian women's clinic., Method: A review of existing educational materials and in-depth interviews were conducted. Nine steps for creating health communications messages that were patterned after National Cancer Institute guidelines guided the brochure development process., Results: Of 95 women tested for HPV, 41% were positive, 32 (34%) agreed to the in-depth interview, and 9 agreed to the pretesting interview. Mean age was 41 years. Interviews revealed key themes concerning emotional reactions to abnormal Pap test results and HPV; need for basic information about HPV, Pap tests, and results; concerns about HPV stigma, sexual transmission, and communication with sexual partner; and the preferred source and format for HPV educational materials. A literature review revealed 12 areas of basic HPV content., Conclusions: A participatory process successfully engaged nursing staff and patients in creating culturally appropriate brochures for clinic use., Implications: This article provides specific steps for creating culturally tailored patient education materials.

Background: Our objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities., Methods: Self-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus and cervical cancer (n = 918). Random-digit dial, computer-assisted telephone interviews were used to contact eligible respondents (adult [ages 18-70] women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12., Findings: Although FHC+ was not predictive (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.55-2.51), private health insurance (OR, 2.35; 95% confidence interval [CI], 1.15-4.81) and younger age (18-30 years: OR, 7.76; 95% CI, 1.91, 3.16) were associated with recent Pap test behavior. FHC and cervical cancer screening associations were not detected in the sample., Conclusions: Findings suggest targeting older women with screening recommendations and providing available screening resources for underserved women., (Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Objectives: Few studies have objectively quantified sedentary behavior, particularly in special population subgroups. This study quantified the volume of and breaks from sedentary behavior in a sample of overweight and obese, primarily African American, women., Design: Cross-sectional., Setting: 18 census tracts in Columbia, South Carolina with higher than state and national poverty levels., Participants: 197 overweight/obese women (87% African American). Mean age 38.3 +/- 7.6 years, mean body mass index 40.6 +/- 8.8 kg/m2., Main Outcomes Measures: Using a cut point of < 100 counts/minute, estimated daily averages of: 1) total volume, 2) > or = 10, 30, and 60-minute bouts, and 3) patterns of sedentary behavior according to time of day and day of the week were computed. Total breaks, or interruptions, in sedentary time were also calculated., Results: Participants were sedentary 64.1% of the day, engaging in 10.5 +/- 2.8 daily bouts of sedentary behavior per hour of sedentary time; each bout lasted approximately 6.4 +/- 1.7 minutes. All participants engaged in > or = 1 daily bout of sedentary behavior > or = 10 and > or = 30 minutes, and most (83%) engaged in > or = 1 bout > or = 60 minutes. Participants were slightly more sedentary during the evening (6 pm-midnight) and on weekdays. On average, participants took 90.9 +/- 16.0 breaks from sedentary behavior; each break lasted 3.3 +/- .8 minutes., Conclusions: Women engaged in more sedentary behavior than that reported in national data sets. In an effort to improve public health, efforts should not only focus on increasing physical activity, but also on decreasing time spent sedentary.

OBJECTIVE. Healthcare-acquired infections (HAIs) cause substantial patient morbidity and mortality. Items in the environment harbor microorganisms that may contribute to HAIs. Reduction in surface bioburden may be an effective strategy to reduce HAIs. The inherent biocidal properties of copper surfaces offer a theoretical advantage to conventional cleaning, as the effect is continuous rather than episodic. We sought to determine whether placement of copper alloy-surfaced objects in an intensive care unit (ICU) reduced the risk of HAI. DESIGN. Intention-to-treat randomized control trial between July 12, 2010, and June 14, 2011. SETTINg. The ICUs of 3 hospitals. PATIENTS. Patients presenting for admission to the ICU. METHODS. Patients were randomly placed in available rooms with or without copper alloy surfaces, and the rates of incident HAI and/or colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in each type of room were compared. RESULTS. The rate of HAI and/or MRSA or VRE colonization in ICU rooms with copper alloy surfaces was significantly lower than that in standard ICU rooms (0.071 vs 0.123; P = .020). For HAI only, the rate was reduced from 0.081 to 0.034 (P = .013). CONCLUSIONs. Patients cared for in ICU rooms with copper alloy surfaces had a significantly lower rate of incident HAI and/or colonization with MRSA or VRE than did patients treated in standard rooms. Additional studies are needed to determine the clinical effect of copper alloy surfaces in additional patient populations and settings.