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Background: Creating activity-friendly communities (AFCs) is an important strategy to increase physical activity (PA). While cross-sectional links between community environments and PA are well documented, their causal relationships remain insufficiently explored. Methods: Using the accelerometer and survey data collected from adults who moved to an AFC (cases) and similar non-AFC-residing adults who did not move (comparisons), this pre–post, case-comparison study examines if moving to an AFC increases PA. Data came from 115 participants (cases = 37, comparisons = 78) from Austin, Texas, who completed 2 waves of 1-weeklong data collection. Difference-in-difference analyses and fixed-effect models were used to test the significance of the pre–post differences in moderate-to-vigorous PA (MVPA) between cases and comparisons, for the full sample and the subsample of 37 pairs matched in key covariates using the Propensity Score Matching method. Results: Average treatment effect generated based on Propensity Score Matching and difference-in-difference showed that moving to this AFC led to an average of 10.88 additional minutes of daily MVPA (76.16 weekly minutes, P =.015). Fixed-effect models echoed the result with an increase of 10.39 minutes of daily MVPA after moving to the AFC. We also found that case participants who were less active at baseline and had higher income increased their MVPA more than their counterparts. Conclusions: This study showed that, among our study sample, moving to an AFC increased residents' PA significantly when compared to their premove level and the comparison group. This causal evidence suggests the potential of AFCs as sustainable interventions for PA promotion. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes impacts millions and poor maintenance of diabetes can lead to preventable complications, which is why achieving and maintaining target A1C levels is critical. Thus, we aimed to examine inequities in A1C over time, place, and individual characteristics, given known inequities across these indicators and the need to provide continued surveillance. Methods: Secondary de-identified data from medical claims from a single payer in Texas was merged with population health data. Generalized Estimating Equations were utilized to assess multiple years of data examining the likelihood of having non-target (>7% and ≥7%, two slightly different cut points based on different sources) and separately uncontrolled (>9%) A1C. Adults in Texas, with a Type 2 Diabetes (T2D) flag and with A1C reported in first quarter of the year using data from 2016 and 2019 were included in analyses. Results: Approximately 50% had A1Cs within target ranges (<7% and ≤7%), with 50% considered having non-target (>7% and ≥7%) A1Cs; with 83% within the controlled ranges (≤9%) as compared to approximately 17% having uncontrolled (>9%) A1Cs. The likelihood of non-target A1C was higher among those individuals residing in rural (vs urban) areas (P <.0001); similar for the likelihood of reporting uncontrolled A1C, where those in rural areas were more likely to report uncontrolled A1C (P <.0001). In adjusted analysis, ACA enrollees in 2016 were approx. 5% more likely (OR = 1.049, 95% CI = 1.002-1.099) to have non-target A1C (≥7%) compared to 2019; in contrast non-ACA enrollees were approx. 4% more likely to have non-target A1C (≥7%) in 2019 compared to 2016 (OR = 1.039, 95% CI = 1.001-1.079). In adjusted analysis, ACA enrollees in 2016 were 9% more likely (OR = 1.093, 95% CI = 1.025-1.164) to have uncontrolled A1C compared to 2019; whereas there was no significant change among non-ACA enrollees. Conclusions: This study can inform health care interactions in diabetes care settings and help health policy makers explore strategies to reduce health inequities among patients with diabetes. Key partners should consider interventions to aid those enrolled in ACA plans, those in rural and border areas, and who may have coexisting health inequities. [ABSTRACT FROM AUTHOR]

Public transportation is an essential component of building sustainable communities. However, its ridership remains low in most cities in the United States. Among the major barriers is the long distance to the bus stops, called the first-mile problem. Using a stated preference survey among 1056 residents of El Paso, Texas, this study addresses this problem by estimating additional transit trips that can be expected from the implementation of hypothetical, free shuttles between one's home and the closest bus stops. Participants reported 7.73 additional transit trips per week (469% increase from the current baseline), including 3.03 additional trips for work, 1.94 for daily errands, 1.64 for leisure or social, and 0.93 for exercise or sports. The percentage of transit non-users dropped from 77.6% (baseline) to 38.2%. With the free shuttle service, respondents would favor bus rapid transit more than regular buses (4.72 vs. 3.00 additional trips). Residents identifying as an existing transit user, being Hispanic/Latino, owning at least one automobile, living within 1 mile of a transit stop, and feeling safe while riding the bus would make significantly more transit trips due to the service. This study suggests that programs to address/reduce the first-mile problem could increase transit demand and, therefore, contribute to creating sustainable and more connected communities. [ABSTRACT FROM AUTHOR]

This study examined the associations of discrepancies between perceived and physiological fall risks with repeated falls. We analyzed the 2016 Medicare Current Beneficiary Survey of 2,487 Medicare beneficiaries aged ≥ 65 years with ≥ 1 fall. The outcome variable was repeated falls (≥ 2 falls), the key independent variable was a categorical variable of discrepancies between perceived (fear of falling) and physiological fall risks (physiological limitations), assessed using multivariate logistic regression. Among Medicare beneficiaries with ≥ 1 fall, 25.1% had low fear of falling but high physiological fall risk (Low Fear-High Physiological), 9.4% had high fear of falling but low physiological fall risk (High Fear-Low Physiological), 23.5% had low fear of falling and low physiological fall risks (Low Fear-Low Physiological), and 42.0% had high fear of falling and high physiological fall risks (High Fear-High Physiological). Having High Fear-High Physiological was associated with repeated falls (OR = 2.14; p <.001) compared to Low Fear-Low Physiological. Having Low Fear-High Physiological and High Fear-LowPhysiological were not associated with repeated falls. Given that High Fear-High Physiological was associated with repeated falls and that many at-risk Medicare beneficiaries had High Fear-High Physiological, prevention efforts may consider targeting those most at-risk including Medicare beneficiaries with High Fear-High Physiological. Assessing both perceived and physiological fall risks is clinically relevant, given it may inform targeted interventions for different at-risk Medicare beneficiaries among clinicians and other stakeholders. [ABSTRACT FROM AUTHOR]

Objective: This study will identify factors associated with higher hemoglobin A1c (A1c) values and diabetes-related costs among commercially insured adults in Texas diagnosed with type 2 diabetes. Research design and methods: This secondary data analysis was based on claims data from commercially insured individuals 18–64 years of age residing in Texas with diagnosed type 2 diabetes during the 2018–2019 study period. The final analysis sample after all the exclusions consisted of 34,992 individuals. Measures included hemoglobin A1c, diabetes-related costs, Charlson Comorbidity Index, diabetes-related complications, rurality and other socioeconomic characteristics. Longitudinal A1c measurements were modeled using age, sex, rurality, comorbidity, and diabetes-related complications in generalized linear longitudinal regression models adjusting the observation time, which was one of the 8 quarters in 2018 and 2019. The diabetes-related costs were similarly modeled in both univariable and multivariable generalized linear longitudinal regression models adjusting the observation time by calendar quarters and covariates. Results: The median A1c value was 7, and the median quarterly diabetes-related cost was $120. A positive statistically significant relationship (p = <.0001) was found between A1c levels and diabetes-related costs, although this trend slowed down as A1c levels exceeded 8.0%. Higher A1c values were associated with being male, having diabetes-related complications, and living in rural areas. Higher costs were associated with higher A1c values, older age, and higher Charlson Comorbidity Index scores. Conclusion: The study adds updated analyses of the interrelationships among demographic and geographic factors, clinical indicators, and health-related costs, reinforcing the role of higher A1c values and complications as diabetes-related cost drivers. [ABSTRACT FROM AUTHOR]

Objectives: We explored the importance of environmental and mobility strategies during early COVID-19 by age and ethnicity and investigated predictors of park visitations considering the COVID-19 impacts. Background: Parks are safe and accessible venues to stay active and reduce social isolation, which is especially important considering COVID-19 and the associated lockdowns. Methods: We analyzed online survey data from 683 residents (collected July 2020) of El Paso, TX, and objective measures of neighborhood park characteristics. Chi-square tests and mixed-effects logistic regression analyses were performed to examine the environmental/mobility strategies, personal and environmental factors, and park visitations, considering the COVID-19 impacts. Results: The percentage of those who visited (1+ times/week) parks or trails/paths in the neighborhood dropped from 41.7% to 19.5% since the start of COVID-19 (OR = 0.015, p <.001). Before COVID-19, middle-aged and older adults were less likely to visit parks than younger adults, while this difference became insignificant during early COVID-19. Hispanic adults were more likely to visit parks than non-Hispanics both before and during early COVID-19. Positive environmental predictors of park visitations included park availability in the neighborhood, proximity to the closest park, seeing people being physically active in the neighborhood, and neighborhood aesthetics. Conclusions: Proximately located parks, trails, and paths well integrated into residential communities, and high aesthetic quality of the neighborhood are the potential features of pandemic-resilient communities and should be considered an important national priority to maintain and promote the health and well-being of the population, especially during pandemics like COVID-19. [ABSTRACT FROM AUTHOR]

BackgroundThe benefits of physical activity for cancer survivors are well documented. However, few older cancer survivors are engaged in regular physical activity. Mobile technologies may be an effective method to deliver physical activity promotion programs for older cancer survivors. iCanFit, a mobile-enabled Web-based app, was developed based on formative research and usability testing. This app includes interactive features of physical activity, goal setting and tracking, and receiving personalized visual feedback. ObjectiveThe aim of this study is to pilot test the initial efficacy of iCanFit. MethodsOlder cancer survivors (N=30) were recruited online through our collaborative partnership with a cancer survivor's organization. After the participants completed an online baseline survey, they were asked to use the iCanFit website. Instructional videos on how to use the web app were available on the website. Participants were asked to complete a follow-up survey 2-3 months later. Participants’ physical activity, quality of life, and their experience with iCanFit were measured. ResultsA total of 30 participants completed the baseline survey, and 26 of them (87%, 26/30) also completed a follow-up survey 2-3 months later. The median age of participants was 69 years (range 60-78). Participants’ quality of life and engagement in regular physical activity improved significantly after the use of iCanFit. Participants indicated a general affinity towards the key function “Goals” in iCanFit, which motivated continued activity. They also provided suggestions to further improve the app (eg, adding a reminder functionality, easier or alternative ways of entering activities). ConclusionThe interactive Web-based app iCanFit has demonstrated initial efficacy. Even though our study was limited by a small sample size, convenience sampling, and a short follow-up period, results suggest that using mobile tools to promote physical activity and healthy living among older cancer survivors holds promise. Next steps include refining iCanFit based on users’ feedback and developing versatile functionality to allow easier physical activity goal setting and tracking. We also call for more studies on developing and evaluating mobile and web apps for older cancer survivors.

Objectives: Despite the well-established health benefits of regular participation in physical activity, most adults do not meet recommended exercise guidelines. In rural communities, limited local resources and geographic dispersion make engaging in regular activity particularly difficult. Web-based solutions offer a potential solution for addressing physical activity disparities between rural and urban areas. Methods: This study examined the physical activity logs of users (n = 6695) of a web-based platform called Walk Georgia, comparing residents of metropolitan and nonmetropolitan areas. We tabulated descriptive statistics for variables of interest, cross-tabulated for metropolitan and nonmetropolitan groups. We then used independent-samples t tests to compare logged activity between metropolitan and nonmetropolitan residing user groups. Results: In the analysis of group type (n = 6654), users were more likely to enroll in the program as part of a group than as individuals (n = 4391; 65.9%), particularly for users in metropolitan areas (3558 of 5192; 68.5%). Although the groups shared certain activities, nonmetropolitan residents were more likely than metropolitan residents to engage in maintenance-based activities. Nonmetropolitan residents earned fewer program points for their activity than metropolitan users (P =.007), largely because of lower average exercise difficulty (P <.001). Conclusions: The web-based platform was effective in helping individuals track physical activity. Despite engaging in similar amounts of physical activity by time, on average, users in nonmetropolitan areas engaged in less rigorous and more maintenance-based tasks than users in metropolitan areas. One strategy for increasing physical activity among rural populations may be to leverage social support provided by group enrollment in such programming. [ABSTRACT FROM AUTHOR]

Objective: Given that one in four older adults suffer potentially preventable falls annually, we aimed to identify areas with (a) delivery gaps of evidence-based programs (EBPs) targeting fall prevention among older adults, namely A Matter of Balance (AMOB), and (b) high rates of fall-related hospitalizations—hotspots. Method: Analyses included multiple geospatially linked datasets. Results: EBPs were delivered ≥1 time in 84 counties in 2012 and 90 counties in 2014. Factors associated with EPB delivery gaps (absence; p <.05) included high-density older adult areas, non-fall-related hospitalization hotspots, lower population density, nonmetropolitan areas, high-density Hispanic adult areas, and areas with limited access to home health care agencies. Hotspots for fall-related hospitalization numbered 64 in 2012 and 62 in 2014. Factors associated with hotspots included low-density older adult areas, having AMOB delivered ≥1 time annually, high population density, and high-density Hispanic adult areas. Discussion: In resource-finite settings (e.g., the aging services sector), identifying high priority areas allows for precise allocation of limited resources. [ABSTRACT FROM AUTHOR]

Introduction: Accessing care is challenging for adults with chronic conditions. The challenge may be intensified for individuals needing to travel long distances to receive medical care. Transportation difficulties are associated with poor medication adherence and delayed or missed care. This study investigated the relationship between those traveling greater distances for medical care and their utilization of programs to prevent and/or manage their health problems. It was hypothesized that those traveling longer distances for medical care attended greater chronic disease management programs. Methods: Thirty six thousand households in nine counties of central Texas received an invitation letter to participate in a mailed health assessment survey in English or Spanish. A total of 5230 participants agreed to participate and returned the fully completed survey. To investigate distance traveled for medical services and participation in a chronic disease management program, the analyses were limited to 2108 adults aged ≥51 years with one or more chronic conditions who visited a healthcare professional at least once in the previous year. Other variables of interest included residential rurality, health status, and personal characteristics. The data were first analyzed using descriptive and bivariate analyses. Then, an ordinal logistic regression model was fitted to identify factors associated with longer distances traveled to medical services. Additionally, a binary logistic regression model was fitted to identify factors associated with attending a chronic disease self-management program. Results: Among 2108 adults, rural participants (p<0.001), those with more chronic conditions (p<0.001), and those attending a chronic disease program (p=0.037) reported traveling further distances to medical services. Participants with limited activity (p<0.001), those from urban counties (p=0.017), and those who traveled further (p=0.030) were more likely to attend a chronic disease program. Conclusion: While further distances to healthcare providers was found to be a protective factor based on the utilization of community-based resources, rural residents were less likely to attend a program to better manage their chronic conditions, potentially choosing to use long distance travel to address urgent medical needs rather than focusing on prevention and management of their conditions. Important policy and programmatic efforts are needed to increase reach of chronic disease self-management programs and other community services and resources in rural areas and to reduce rural inequities. [ABSTRACT FROM AUTHOR]

Objective: We examined multilevel factors associated with hospital discharge status among older adults suffering a fall-related hospitalization.Data Sources: The 2011-2013 (n = 131,978) Texas Inpatient Hospital Discharge Public-Use File was used.Study Design/methods: Multilevel logistic regression analyses estimated the likelihood of being discharged to institutional settings versus home.Principal Findings: Factors associated with a greater likelihood of being discharged to institutional settings versus home/self-care included being female, white, older, having greater risk of mortality, receiving care in a non-teaching hospital, having Medicare (versus Private) coverage, and being admitted from a non-health care facility (versus clinical referral).Conclusions: Understanding risk factors for costly discharges to institutional settings enables targeted fall-prevention interventions with identification of at-risk groups and allows for identifying policy-related factors associated with discharge status. [ABSTRACT FROM AUTHOR]

Objective General practitioners (GPs) are highly underutilised in China with many patients going directly to hospitals when seeking routine care. Multiple countries around the world have successfully used GPs in routine care, and as such, China may benefit from the use of GPs. This study examines the status of, and factors associated with, knowledge related to GPs among outpatient populations from China's tertiary hospitals. Design This is a cross-sectional survey study. Study setting and participants The questionnaires were completed by 565 outpatients from four tertiary hospitals in China during 2016. Convenience sampling on different floors and throughout the outpatient building was carried out. Primary outcome measures We used the logistic regression models to identify GP-related knowledge among different populations. Results Overall, 50.27% of respondents said they had never heard of GPs. This was also true among females (adjusted OR (AOR)=1.57, 95% CI 1.43 to 2.71), older adults (AOR46-65=1.61, 95% CI 1.39 to 2.98; AOR>65=2.01, 95% CI 1.62 to 3.59), those with lower education level (AORBachelor's degree=0.61, 95% CI 0.20 to 0.81; AOR≥Master's degree=0.49, 95% CI 0.23 to 0.76), rural residents (AOR=1.51, 95% CI 1.35 to 2.82) and those with chronic disease (AORwithout chronic disease=0.61, 95% CI 0.22 to 0.71). What is more, less than one-in-ten (9.03%) outpatients were able to accurately describe what a GP was, with less than 30% accurately describing a GP among those receiving GPs' services. Conclusions Outpatients who could have received less costly health services from GPs in primary medical institutions were more likely to choose costlier specialist physicians in tertiary hospitals, which is likely linked to limited knowledge about GPs. Policy makers should invest in outreach efforts to improve public awareness of GPs, while at the same time conducting continued surveillance of these efforts to evaluate progress towards this goal. [ABSTRACT FROM AUTHOR]

Background: Identifying factors associated with recommended physical activity (PA) levels are critical in efforts to combat the obesity epidemic and related comorbidities.Methods: We conducted cross-sectional analyses of college students (n = 490) enrolled in a large southern state university in October of 2014. Our aim was to identify sociodemographic characteristics, technology use, and sleep patterns among college students and their independent relationship to recommended PA. An online survey was sent to all enrolled students. Logistic regression predicted achieving recommended ≥150 min per week of moderate-vigorous PA (MVPA) versus not (≤149 min MVPA).Results: Approximately 69% of study participants were males, 18% were Hispanic, and more than half (60%) were within the normal body mass index (12% were obese). The average age of students was 21 years. On a daily average, individuals used smartphones most often (nearly 4.4 h), followed by laptops at 4.0 h, desktops at 1.2 h, and tablets at 0.6 h. The mean number of hours individuals reported sleeping was 6.7. Sociodemographic factors associated with reporting ≥150 min of MVPA included being male (OR = 4.0, 95% CI 2.2-7.1) versus female, being non-Hispanic White (OR = 1.8, CI 1.1-3.2) versus being a member of minority race group. Behavioral factors associated with reporting ≥150 min of MVPA included technology use (being moderate-heavy (OR = 2.3, CI 1.1-4.8) or heavy (OR = 3.4, CI 1.6-7.5) users of technology), and receiving low-moderate (OR = 1.9, 1.01-3.7) levels of sleep versus the lowest level of sleep.Conclusions: In the current study, minority status and being female were the strongest sociodemographic factors associated with inadequate PA levels, while high technology use (primarily driven by smartphone use) were associated with recommended PA levels. Identifying factors associated with being physically active will allow for targeted interventions to improve the health of young adults. [ABSTRACT FROM AUTHOR]

Background: This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention.Methods: We searched for published studies (1973-2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the "inner setting" of the organization, as defined by the Consolidated Framework for Implementation Research.Results: Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or "best practice" strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included "organizational climate" and "readiness for implementation." More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity.Conclusions: The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few measures have demonstrated reliability or validity were among the limitations highlighted in our review. Given these findings, we recommend that increased attention be devoted toward the development or refinement of measures using common psychometric standards. In addition, there is a need for measure development and testing across diverse settings, among diverse population samples, and for a variety of types of innovations. [ABSTRACT FROM AUTHOR]

Background: Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. Methods: The results of this study were produced through analysis of secondary data collected during the initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Results: Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. Conclusion: These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population. [ABSTRACT FROM AUTHOR]

Objective: The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China.Methods: A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality.Results: An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year.Conclusion: The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) is a major factor in maintaining health in aging populations. This study examines the influences of sociodemographic, health, and environmental characteristics on older adults' walking behaviors, and the role physicians can play in promoting physical activity.Methods: Online and paper surveys (n = 272) were distributed to community-dwelling older (age ≥ 60) adults from a large integrated healthcare system in two counties in Central Texas. Descriptive statistics were utilized to characterize participant's walking behaviors and places. Multivariate logistic regression was employed to predict being: 1) a frequent walker (i.e., walking at least three times a week); and 2) meeting the Centers for Disease Control and Prevention (CDC) PA recommendation through walking (i.e., walking ≥150 min per week), while considering sociodemographic, health, and environmental factors.Results: Individuals had a median age of 69 years, were of both genders (50.37 % female), and were primarily non-Hispanic White (84.87 %). While the majority (59.55 %) walked at least three times a week, only 27.86 % walked ≥150 min a week. Factors associated with a lower likelihood of being frequent walkers included experiencing poor mental health in the past month (OR = 0.345, 95 % CI = 0.185-0.645) and residing in areas with low or moderate (versus high) perceived neighborhood cohesion (OR = 0.471, 95 % CI = 0.228-0.974), while those in Census Tracts reflecting populations with a lower median age were more likely to report frequent walking behavior (OR = 1.799, 95 % CI = 1.034-3.131). Factors associated with a lower likelihood of meeting the CDC PA recommendation included being 60-69 years (versus 70 years or older) (OR = 0.538, 95 % CI = 0.290-0.997), experiencing poor mental health in the past month (OR = 0.432, 95 % CI = 0.198-0.944), and lacking social support for walking (OR = 0.383, 95 % CI = 0.154-0.957).Conclusion: Given the health benefits, PA promotion must be seen as a national responsibility. In particular, physicians have a major role to play in communicating the importance of PA to their older patients and making discussions about strategies for overcoming barriers to walking an integral part of their clinical encounter with these patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this research was to estimate peer effects on third grade students' BMI and to investigate the social and physiological explanations for such effects. Methods: The BMI of students from a childhood obesity intervention program (N = 573) was used to assess peer effects on students' BMI by identification of endogenous social effects. Results: Strong peer effects were found for the overall sample, girls and boys (p < .10). However, when classifying students into improvement versus non-improvement groups, the peer effect was found only among girls categorized in the improvement group (β =1.472) and boys in the non-improvement group (β = 1.176). Conclusions: Peer effects were found for students aged 8-11, with sex differences in the psychological and social behavioral motivations. [ABSTRACT FROM AUTHOR]

Background: Worksite wellness initiatives for health promotion and health education have demonstrated effectiveness in improving employee health and wellness. We examined the effects of a multifaceted health promotion campaign on organizational capacity to meet requirements to become CEO Cancer Gold Standard Accredited. Methods: We conducted an online survey to assess perceived organizational values and support for the five CEO Cancer Gold Standard Pillars for cancer prevention: tobacco cessation; physical activity; nutrition; cancer screening and early detection; and accessing information on cancer clinical trials. Baseline and follow-up surveys were sent 6-months apart to faculty, staff, and students at a school of public health to test the impact of a multifaceted health promotion campaign on perceived organizational change. Descriptive analyses were used to characterize percent improvement. Multivariate logistic regression analyses were used to control for participants' university status. Results: The current organizational culture highly supported tobacco cessation at both time points. Significant improvements (p < .05) from baseline to follow-up were observed for questions measuring organizational values for 'prevention, screening, and early detection of cancer' and 'accessing cancer treatment and clinical trials'. Conclusions: Health promotion and education efforts using multiple approaches were effective to improve perceived organizational values and support for cancer prevention and early detection, and increase access to information about cancer clinical trials. Future studies are needed to examine broader impacts of implementing worksite health promotion initiatives. [ABSTRACT FROM AUTHOR]

Background Despite recommendations for cancer screening for breast and colorectal cancer among the Medicare population, preventive screenings rates are often lower among vulnerable populations such as the small but rapidly growing older American Indian and Alaska Native (AIAN) population. This study seeks to identify potential disparities in the availability of screening services, distance to care, and the utilization of cancer screening services for Medicare beneficiaries residing in areas with a higher concentration of AIAN populations. Methods Using the county (n =3,225) as the level of analysis, we conducted a cross-sectional analysis of RTI International's Spatial Impact Factor Data (2012) to determine the level of disparities for AIAN individuals. The outcomes of interest include: the presence of health care facilities in the county, the average distance in miles to the closest provider of mammography and colonoscopy (analyzed separately) and utilization of screening services (percent of adults aged 65 and older screened by county). Results Counties with higher concentrations of AIAN individuals had greater disparities in access and utilization of cancer screening services. Even after adjusting for income, education, state of residence, population 65 and older and rurality, areas with higher levels of AIAN individuals were more likely to see disparities with regard to health care services related to mammograms (p ⩽.05; longer distance, lower screening) and colonoscopies (p ⩽ .05; longer distance, lower screening). Conclusions These findings provide evidence of a gap in service availability, utilization and access facing areas with higher levels of AIAN individuals throughout the US. Without adequate resources in place, these areas will continue to have less access to services and poorer health which will be accelerated as the population of older adults grows. [ABSTRACT FROM AUTHOR]

Poorly managed diabetes can lead to complications which account for a large portion of diabetes costs. Although diabetes self-management programs have been shown to be effective in reducing the risk of complications, low uptake of diabetes self-management training (DSMT) has been reported. Identifying factors associated with participation in DSMT among Medicare beneficiaries (MBs) with diabetes can provide information to improve uptake of these programs. DSMT is a Medicare-covered benefit. We analyzed the nationally representative 2018 Medicare Current Beneficiary Survey PUF of MBs aged ≥ 65 years with reported type 2 diabetes (n=1,056). A survey-weighted logistic model, adjusted for socio-demographics and co-morbidities, was performed to examine the relationship between participation of DSMT and two binary variables including: 1) whether providers gave instructions on how to take care of one's health; and 2) whether the Medicare program was easy/difficult to understand. Of study MBs, 49.6% self-reported participation in DSMT (a rate higher than other studies analyzing claims data). DSMT participants had higher rates of reporting the Medicare program was easy to understand (73.3% vs. 66.1%), and that providers gave instructions on how to take care of one's health (68.0% vs. 64.0%) than non-DSMT participants. Among the study MBs, those reporting the Medicare program was easy to understand were more likely to participate in DSMT (odds ratio (OR)=1.40, p<0.046). Surprisingly, those reporting that providers gave instructions on how to take care of one's health were not significantly associated with the participation of DSMT (OR=1.12, p<0.506). Our finding highlights that a better comprehension of the Medicare Program has a positive impact on the participation of DSMT. Interventions to improve MBs' understanding of the Medicare program and associated benefits may increase participation in DSMT. Disclosure: B. Ng: None. S. D. Towne: None. J. B. Lamanna: None. K. Kim: None. [ABSTRACT FROM AUTHOR]

Healthcare avoidance among those with type 2 diabetes (T2D) can lead to increased risk for and severity of medical complications, resulting in potentially significant health and economic burdens. We examined the association between healthcare avoidance and diabetes-related care among Medicare beneficiaries with T2D. We analyzed the nationally representative 2017 Medicare Current Beneficiary Survey Public File of 2,001 Medicare beneficiaries aged ≥65 years with reported T2D. Three dichotomous outcomes were analyzed using multivariate survey-weighted logistic models including: i) self-testing blood glucose to manage one's diabetes; ii) having had a health professional's examination of one's feet in the last year; and iii) maintaining one's A1C ≤ 7.5% or average fasting blood test of ≤ 140 mg/dL all/most of the time (defined as "proper maintenance"). Among beneficiaries with T2D, 22.3% reported healthcare avoidance or "do anything to avoid going to the doctor." Of those with healthcare avoidance, 58.7% reported oral medication use alone, 12.2% reported insulin use alone, and 19.4% reported both insulin and oral medication use, while 9.7% reported not using any medication to manage their diabetes. Further, 13.6% reported self-testing blood glucose to manage their diabetes, 25.1% reported having a health professional examine their feet in the last year, and 72.1% reported proper maintenance of blood glucose. Those with healthcare avoidance were less likely to report proper maintenance of blood glucose (OR= 0.65; 95% CI = 0.44,0.95; p < 0.026). Healthcare avoidance was not associated with the i) and ii) outcomes. This study found that those with healthcare avoidance were less likely to maintain proper blood glucose levels, making them especially at-risk of experiencing potentially preventable complications and costly care. Thus, stakeholders should target interventions (e.g., clinical outreach) to reduce the likelihood of healthcare avoidance among this vulnerable population. Disclosure: B. Ng: None. S.D. Towne: None. J.B. LaManna: None. B.C. Peach: None. C. Park: None. [ABSTRACT FROM AUTHOR]

Healthcare avoidance by Medicare beneficiaries (MBs) with type 2 diabetes (T2D) can result in significant health and financial burdens. Timely detection/treatment of T2D-related complications can mitigate these burdens. There is limited research using the Anderson Model of Healthcare Utilization to examine healthcare avoidance among MBs with T2D. Therefore, we examined factors associated with healthcare avoidance among MBs with reported T2D. We analyzed two healthcare avoidance measures ("do anything to avoid going to the doctor (DATAGTTD)" and "try to keep sickness to themselves (TTKSTT)") using the nationally representative 2015 Medicare Current Beneficiary Survey (n=12,311) from CMS. MBs were stratified into two groups, those with and without T2D. We performed four survey-weighted logit models, with two healthcare avoidance variables on those with and without T2D, adjusting for covariates. Approximately 22.4% of MBs reported having T2D. Among those with and without T2D, 28.5% and 26.1% respectively reported they would DATAGTTD. Also, 37.8% of MBs with T2D and 39% of MBs without T2D reported they would TTKSTT. Two key factors were positively associated (P<.01) with DATAGTTD for both groups: 1) worrying about health more than others, 2) past experiences with doctors missing health issues. Also, reporting past experiences with doctors missing health issues was a key factor positively associated (P<.01) with TTKSTT for both groups. Other factors such as socio-economic status, physical limitations, depression, and cost were associated (P<.05) with TTKSTT and DATAGTTD. However, factors differed between those with and without T2D. Although over 90% of MBs with T2D have a regular doctor, one-third of them reported TTKSTT and one-fourth of them reported DATAGTTD. There is a need to address and improve doctor-patient communication for MBs with T2D to avoid unnecessary and costly healthcare avoidance for this particular at-risk group. Disclosure: B. Ng: None. B.C. Peach: None. C. Park: None. S.D. Towne: None. J.B. LaManna: None. [ABSTRACT FROM AUTHOR]