From Practice to Publication: The Promise of Writing Workshops.

Practitioners in health departments, university extension programs, and nonprofit organizations working in public health face varied challenges to publishing in the peer-reviewed literature. These practitioners may lack time, support, skills, and efficacy needed for manuscript submission, which keeps them from sharing their wisdom and experience-based evidence. This exclusion can contribute to literature gaps, a failure of evidence-based practice to inform future research, reduced ability to educate partners, and delays in advancing public health practice. Our article describes the writing workshops offered to Division of Nutrition, Physical Activity, and Obesity (DNPAO), Centers for Disease Control and Prevention (CDC) funded programs in 2021. This project consisted of three 60-minute introductory writing webinars open to all recipients, followed by a Writing for Publications workshop, an 8- to 9-week virtual learning/writing intensive for selected writing team applicants. The Society for Public Health Education staff, consultants, and CDC/DNPAO staff developed, refined, and presented the curriculum. The workshop for public health practitioner writing teams was offered to two cohorts and included extensive coaching and focused on potential submission to a Health Promotion Practice supplement, "Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field" (see Supplemental Material), which was supported by CDC/DNPAO. We describe the webinars, the workshop design, modifications, evaluation methods and results.

Differences in Resilience Mechanisms and Physical Activity among Women Experiencing Chronic Pain with Higher or Lower Resilience.

BACKGROUND: Chronic pain is a public health issue, with women being disproportionately impacted. Progressing from light physical activity to the recommended moderate to vigorous intensities is effective for chronic pain self-management, yet participation is low among women experiencing chronic pain. Researchers studying resilience approaches to chronic pain contend that women with higher resilience, or functioning well despite adverse life stressors including chronic pain, should have better resilience mechanisms and more physical activity participation. The purpose of this work was to examine whether women experiencing chronic pain, reporting higher versus lower resilience, differed in resilience mechanisms (pain acceptance, self-regulatory efficacy to overcome pain and related barriers to activity, and self-regulatory efficacy to schedule and plan activity) and physical activity (light, moderate-vigorous). METHODS: Adult women experiencing chronic pain (N = 269; Mage = 38.35, SD = 13.13 years) completed an online survey assessing study variables. RESULTS: A multivariate analysis of covariance comparing participants with higher (n = 131) and lower (n = 138) resilience, controlling for age and pain intensity, was significant (p < .001; η2partial = .17). Participants with higher resilience reported significantly higher pain acceptance, self-regulatory efficacy beliefs, and moderate-vigorous physical activity (p's < .01; η2partial = .03 to .14, small to large effects). Light activity did not differ. CONCLUSIONS: Novel findings illustrated that participants with higher resilience exhibited more favorable resilience mechanisms and participation in the recommended moderate-vigorous activity. If intervening among women with lower resilience to improve their resilience mechanisms and moderate-vigorous activity is effective, then intervention adoption and delivery across communities could promote improved pain self-management among women.

A proof-of-concept study on the impact of a chronic pain and physical activity training workshop for exercise professionals.

OBJECTIVES: Physical activity is essential for long-term chronic pain management, yet individuals struggle to participate. Exercise professionals, including fitness instructors, and personal trainers, are preferred delivery agents for education and instruction on chronic pain, physical activity, and strategies to use adherence-promoting behavioral skills. However, exercise professionals receive no relevant training during certification or continuing education opportunities to effectively support their participants living with chronic pain. Based on the ORBIT model for early pre-efficacy phases of development and testing of new behavioral treatments, the present Phase IIa proof-of-concept study was conducted. The purpose was to examine the impacts of a newly developed chronic pain and physical activity training workshop on psychosocial outcomes among exercise professionals. Outcomes included knowledge and attitudes regarding chronic pain, attitudes and beliefs about the relationship between pain and impairment, and self-efficacy to educate and instruct participants with chronic pain. METHODS: Forty-eight exercise professionals (Mage=44.4±11.0 years) participated in a three-hour, in-person workshop that was offered at one of four different locations. Participants completed pre- and post-workshop outcome assessment surveys. RESULTS: Mixed MANOVA results comparing time (pre- versus post-workshop) by workshop location (sites 1 to 4) illustrated a significant within-subjects time effect (p<0.001). All outcomes significantly improved from pre- to post-workshop (p's<0.001), demonstrating large effect sizes (partial eta-squared values ranging from 0.45 to 0.59). CONCLUSIONS: Findings offer early phase preliminary support for the effectiveness of the chronic pain and physical activity training workshop for exercise professionals. Based on ORBIT model recommendations, findings warrant future phased testing via a pilot randomized clinical trial as well as testing for impacts that trained professionals have on activity adherence among their clients living with chronic pain. Eventual workshop adoption by exercise professional certification organizations would ensure widespread and sustainable access to qualified exercise professionals to help individuals engage in physical activity. By increasing the capacity of available exercise professionals to deliver effective support, active individuals could better manage their chronic pain and live well.

Understanding Physiotherapists' Intention to Counsel Clients with Chronic Pain on Exercise: A Focus on Psychosocial Factors.

Purpose: Twenty percent of Canadians experience chronic pain. Exercise is an effective management strategy, yet participation levels are low. Physiotherapists can be key to counselling clients to engage in long-term unsupervised exercise. Yet, investigations that identify psychosocial factors related to physiotherapists' intention to counsel are lacking. The purpose of this study was to examine whether physiotherapists' knowledge of chronic pain, beliefs about pain, and self-efficacy to counsel on exercise predicted their intention to counsel clients with chronic pain on exercise. Method: Practicing physiotherapists (N = 64) completed an online survey that assessed their knowledge of chronic pain, beliefs about pain, self-efficacy, and intention to counsel. A two-step hierarchical multiple regression predicted intention. Step 1 controlled for years of practice, and Step 2 included study variables significantly correlated with intention. Results: Beliefs about pain (r = -0.35, p < 0.01) and self-efficacy (r = 0.69, p < 0.01) were significantly correlated with intention. The overall regression model was significant, F 3,60 = 18.73; p < 0.001. Self-efficacy was the sole significant predictor, t 60 = 5.71, p < 0.0001, sr 2 = 28%. Conclusions: Self-efficacy may facilitate physiotherapists' intention to counsel on exercise for chronic pain. If shown to be a causal factor, interventions that target a change in physiotherapists' self-efficacy should be pursued.

Objectif : une proportion de 20 % des Canadiens souffre de douleurs chroniques. L'exercice est une stratégie de prise en charge efficace, mais les taux de participation sont faibles. Les physiothérapeutes peuvent jouer un rôle déterminant dans les conseils aux clients afin qu'ils suivent un programme d'exercices non supervisés à long terme. Il n'existe pourtant pas d'études pour déterminer les facteurs psychosociaux liés à l'intention de conseiller des physiothérapeutes. La présente étude visait à examiner si les connaissances des physiothérapeutes à l'égard de la douleur chronique, leurs convictions au sujet de la douleur et leur auto-efficacité à donner des conseils sur l'exercice étaient prédictives de leur intention de donner des conseils sur l'exercice à leurs clients ayant des douleurs chroniques. Méthodologie : des physiothérapeutes en exercice (n = 64) ont rempli un sondage en ligne évaluant leurs connaissances sur la douleur chronique, leurs convictions au sujet de la douleur, leur auto-efficacité et leur intention de conseiller. Une analyse de régression hiérarchique multiple en deux étapes a prédit leur intention. L'étape 1 assurait un contrôle par rapport aux années d'exercice et l'étape 2 incluait des variables ayant une corrélation significative avec l'intention. Résultats : les convictions sur la douleur (r = ­0,35, p < 0,01) et l'auto-efficacité (r = 0,69, p < 0,01) avaient une corrélation significative avec l'intention. Le modèle de régression globale était substantiel : F 3,60 = 18,73; p < 0,001. L'auto-efficacité était le seul prédicteur significatif : t 60 = 5,71, p < 0,0001, sr 2 = 28 %. Conclusion : l'auto-efficacité peut faciliter l'intention des physiothérapeutes de donner des conseils sur l'exercice en cas de douleur chronique. S'il est démontré qu'il s'agit d'un facteur causal, il faudrait prévoir des interventions afin de changer l'auto-efficacité des physiothérapeutes.

Demographic Trends in Utah College Students' Vigorous Physical Activity, 2003-2007.

OBJECTIVES: This analysis of a large-scale survey of college students from 2003 to 2007 explores relationships between meeting vigorous physical activity (VPA) recommendations and key demographic, lifestyle, and personal characteristics. METHODS: Multivariate logistic regression modeling was used to analyze VPA data from the Utah Higher Education Health Behavior Survey, a descriptive cross-sectional survey conducted in 2003 (N = 4574), 2005 (N = 9673) and 2007 (N = 7938). RESULTS: Factors consistently associated with meeting VPA recommendations included involvement in extracurricular sports, being single, and daily consumption of fruits or vegetables. In contrast, factors such as older age (> 23 years old), having a particularly low (<18.5 kg˙m2) or high BMI (> 34.9 kg˙m2), and being a current smoker were associated with not meeting the VPA recommendation. This corroborates paradoxical findings that binge alcohol consumption correlates with meeting VPA. CONCLUSIONS: Findings support the need for targeted interventions among college students to support the establishment of long-term protective behavioral patterns against chronic disease risk throughout the life course.

Differences in psychosocial responses to pain between sufficiently and insufficiently active adults with arthritis.

OBJECTIVE: Adults with arthritis struggle to meet the physical activity recommendation for disease self-management. Identifying psychosocial factors that differentiate adults who meet (sufficiently active) or do not meet (insufficiently active) the recommendation is needed. This study sought to examine differences in psychosocial responses to arthritis pain among adults who were sufficiently or insufficiently active. DESIGN: This prospective study included adults with medically diagnosed arthritis (N = 136, Mage = 49.75 ± 13.88 years) who completed two online surveys: (1) baseline: pain and psychosocial responses to pain and (2) two weeks later: physical activity. MAIN OUTCOME MEASURES: Psychosocial responses examined in this study were psychological flexibility in response to pain, pain anxiety and maladaptive responses to pain anxiety. RESULTS: A between-groups MANCOVA comparing sufficiently active (n = 87) to insufficiently active (n = 49) participants on psychosocial responses, after controlling for pain intensity, was significant (p = .005). Follow-up ANOVA's revealed that sufficiently active participants reported significantly higher psychological flexibility and used maladaptive responses less often compared to insufficiently active participants (p's < .05). CONCLUSIONS: These findings provide preliminary insight into the psychosocial profile of adults at risk for nonadherence due to their responses to arthritis pain.

Barriers to Physical Activity Among Gay Men.

Gay men may not be physically active at recommended levels to achieve health benefits. Thus, a need exists to identify general (i.e., common across populations) and population-specific barriers that hinder or stop gay men from participating in physical activity (PA). Salient barriers may be identified through the extent each barrier limits PA (i.e., barrier limitation) and the level of one's confidence to overcome barriers and engage in PA (i.e., self-regulatory efficacy). The purposes of this study were to (1) provide a description of general and population-specific barriers to PA among sufficiently and insufficiently active gay men, (2) identify barrier limitation and self-regulatory efficacy for the reported barriers, and (3) examine the associations between meeting the current PA recommendation, barrier limitation, and self-regulatory efficacy. Participants were 108 self-identified gay males aged 21 to 64 years who completed a web-based survey. A total of 35 general barriers and no population-specific barriers were identified by the sufficiently and insufficiently active groups. The sufficiently active group reported higher self-regulatory efficacy and lower barrier limitation for nearly all reported barriers. A binary logistic regression used to examine the associations between PA, barrier limitation, and self-regulatory efficacy was statistically significant, χ(2)(2, N = 108) = 19.26, p < .0001, R(2) = .16. Only barrier limitation significantly contributed to the model. Future research should continue to examine barriers to PA among gay men to determine whether an intervention needs to be designed specifically for gay men or whether a one-size-fits-all intervention would be effective in helping all men overcome common barriers to engaging in PA.

An Examination of Health Inequities among College Students by Sexual Orientation Identity and Sex.

BACKGROUND: Lesbian, gay, and bisexual (LGB) college students may have an increased number of health inequities compared to their heterosexual counterparts. However, to date, no research has provided a comprehensive examination of health-related factors by sexual orientation identity and sex among a national sample of college students. Thus, the purpose of this study was to examine physical, sexual, interpersonal relations/safety, and mental health inequities by sexual orientation identity and sex among a national sample of college students. DESIGN AND METHODS: Participants (n=39,767) completed the National College Health Assessment II during the fall 2008/spring 2009 academic year. Hierarchical binary logistic regression analyses were used to examine health inequities by sexual orientation identity and sex. RESULTS: LGB students compared to heterosexual students, experienced multiple health inequities including higher rates of being verbally threatened and lower rates of physical activity and condom use. CONCLUSIONS: An understanding of health inequities experienced by LGB college students is critical as during these years of transition, students engage in protective (e.g., physical activity) and risky (e.g., lack of condom use) health behaviours, establishing habits that could last a lifetime. Future research should be used to design and implement targeted public health strategies and policies to reduce health inequities and improve health-related quality of life among LGB college students. Significance for public healthHealth inequities based on sexual orientation identity and sex among college students is a critical public health concern. Based on the results of the current study, lesbian, gay, and bisexual (LGB) college students experienced multiple physical, sexual, interpersonal relations and safety, and mental health inequities. This understanding of health inequities experienced by LGB college students is critical as during these years of transition, students engage in protective (e.g., physical activity) and risky (e.g., lack of condom use) health behaviours, establishing habits that could last a lifetime. By intervening during the college years, targeted public health strategies and policies can be designed and implemented to reduce health inequities and improve health-related quality of life among LGB individuals during mid-to-later adulthood.

The Effect of an 8-Week Tai Chi Exercise Program on Physical Functional Performance in Middle-Aged Women.

The purpose of this study was to determine the effectiveness of an 8-week Tai Chi Chih exercise program on physical functional performance (PFP) among women aged 45 to 65 years. A quasi-experimental design with a nonequivalent comparison group was used. Forty-one healthy inactive women were assigned to either an intervention group (n = 19) or a comparison group (n = 19). A 60-min Tai Chi Chih exercise class was conducted twice a week for 8 weeks. PFP was measured at baseline and postintervention using the Continuous Scale Physical Functional Performance-10 (CS-PFP 10). Between-group differences were analyzed using one-way analysis of covariance (ANCOVA). After participating in the 8-week program, intervention group participants showed greater improvement in the CS-PFP measures (p < .05, η(2) > .06). However, the comparison group had little changes. The findings from this study suggest that participation in an 8-week Tai Chi Chih exercise program can improve PFP in healthy, community-dwelling middle-aged women.

Associations between physical activity and health-related factors in a national sample of college students.

OBJECTIVE: To examine associations between meeting the current moderate to vigorous physical activity (MVPA) recommendation and health-related factors in a national sample of college students. PARTICIPANTS: Participants (N = 67,861) completed the National College Health Assessment II during the Fall 2008/Spring 2009 academic year. METHODS: Hierarchical binary logistic regression was used to examine the contribution of 19 variables in explaining whether or not participants met the MVPA recommendation. RESULTS: Meeting the MVPA recommendation was associated with several protective factors among college students, including adequate daily fruit and vegetable consumption, positive perception of general health, healthy body mass index, consistent seatbelt use, not smoking cigarettes, less perceived depression, and adequate sleep. In addition, meeting the MVPA recommendation was also significantly associated with a few risky behaviors including binge drinking, physical fighting, and multiple sexual partners. CONCLUSIONS: College student PA interventions should consider also addressing fruit/vegetable consumption and binge drinking.

Sociodemographic and lesbian-specific factors associated with physical activity among adult lesbians.

BACKGROUND: Although participation in moderate and vigorous physical activity (MVPA) results in health benefits, the majority of adult lesbians are not sufficiently active. The purpose of this study was to examine the relationships between sociodemographic factors (age, education level, body mass index [BMI], race, partner status, employment status, annual household income, general health status, diagnosis of chronic conditions, children under 18 years living at home) and lesbian-specific factors (connection with the lesbian community, public identification as a lesbian) to participation in MVPA. METHODS: Participants included 847 self-identified lesbians 18 to 74 years old (M(age) = 40.5; SD = 11.6) who completed a 20-minute, web-based survey. FINDINGS: The binary logistic regression model that included the 10 demographic factors was significantly associated with MVPA, χ(2) (15, N = 847) = 105.62, p < .001. However, when the two lesbian-specific factors were added, the model did not improve significantly, χ(2) (2, N = 847) = 5.20, p = .07. BMI and general health status were significantly associated with MVPA (Wald χ(2) (2) = 19.5, p < .001) and (Wald χ(2) (4) = 41.2, p < .001). Obese participants had 54.5% lower odds than healthy weight participants to engage in sufficient amounts of MVPA. Participants who reported general health status as excellent compared with those who reported poor had 12.7 times greater odds of engaging in sufficient amounts of MVPA. CONCLUSIONS: Future research should extend on this study by utilizing sampling methods that target the recruitment of lesbian women not actively involved in lesbian-related activities.

Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers.

The purpose of the current study was to determine the obesogenic practices in all-day child-care centers caring for preschool-aged children. This study used a cross-sectional, self-reported survey mailed to centers across Oklahoma (n=314). Frequency of responses and χ(2) were calculated comparing region and star rating. Items where the majority of centers frequently report best practices include: daily fruits served (76%), daily nonfried vegetables served (71%), rarely/never served sugary drinks (92%), rarely/never used food to encourage good behaviors (88%), staff join children at table most of the time (81%), staff rarely eat different foods in view of children (69%), visible self-serve or request availability of water (93%), regular informal communication about healthy eating (86%), opportunities for outdoor play (95%), not withholding activity for punishment (91%), accessible play equipment (59% to 80% for different types of equipment), and minimization of extended sitting time (78%). Practices where centers can improve include increasing variety of vegetables (18%), reducing frequency of high-fat meats served (74% serve more than once per week), increasing high-fiber and whole-grain foods (35% offer daily), serving style of "seconds" (28% help kids determine whether they are still hungry), nonfood holiday celebrations (44% use nonfood treats), having toys and books that encourage healthy eating (27%) and physical activity (25%) in all rooms in the center, a standard nutrition (21%) and physical education (50%) curriculum, and following a written physical activity policy (43%). Practitioners can use these data to develop benchmarks and interventions, as this was the first study to assess statewide obesogenic practices in child care.

General and arthritis-specific barriers to moderate physical activity in women with arthritis.

BACKGROUND: most women with arthritis are insufficiently active, despite the health benefits derived from participation in moderate physical activity (MPA). Understanding perceived barriers that make it difficult for women with arthritis to be active is needed to inform interventions. Barriers are often assessed through investigator-provided lists, containing mainly general, personal, and situational barriers, common across populations (e.g., lack of time). However, identifying an encompassing range of problematic barriers that challenge women's activity participation is needed. Such barriers may be general and arthritis specific (e.g., pain). Problematic barriers may be best identified through assessment of whether individuals actually experience these barriers (i.e., are present) and, for present barriers, their extent of limitation on activity. Thus, the primary study purpose was to examine whether the presence of general and arthritis-specific barrier categories and the limitation of these overall categories were significant predictors of participation in MPA among women with arthritis (n = 248). METHODS: on-line measures of barriers and MPA were completed. FINDINGS: a multiple regression model predicting activity was significant (r(2)(adjusted) = .22; p < .01). Both arthritis-specific and general barrier limitation were the strongest predictors of activity. Arthritis-specific personal barriers were reported as being present most often (e.g., pain). CONCLUSION: interventions should identify problematic barriers, taking into account the extent to which both general and disease-specific barriers limit activity, and then target their alleviation through the use of coping strategies as a way to improve activity adherence and health among women with arthritis.

Perceptions of trained leaders on improving the public health impact of three arthritis foundation programs.

The Arthritis Foundation (AF) offers effective community-based programs to help manage arthritis, including aquatic, exercise, and self-help programs. Trained leaders can facilitate the adoption, maintenance, and reach of these programs and thus the impact on public health. This study identifies reasons for becoming AF aquatic, exercise, and/or self-help program leaders, AF program reach, and adoption and maintenance challenges encountered by individuals after being trained. Researchers interviewed by telephone 72 participants who attended an AF leader training workshop. Participants reported various reasons for becoming program leaders (e.g., a wish to help others). AF programs were mainly adopted and maintained in urban communities and in fitness/ health clubs, medical centers, or senior centers. Aquatics programs were the most frequently offered, and all programs had low reach (with a mean number of participants of 14.41, 12.50, and 11.00 for aquatic programs, exercise programs, and self-help programs, respectively. Challenges to adopting and maintaining programs include the time of year (e.g., winter, holidays) and lack of a facility to offer the program.

Physical activity in women with arthritis: examining perceived barriers and self-regulatory efficacy to cope.

OBJECTIVE: To examine whether the theory-based social cognitions of perceived barrier frequency, barrier limitation, and self-regulatory efficacy to cope were predictors of planned physical activity among adult women with arthritis. A secondary purpose was to identify and provide a phenomenologic description of the relevant barriers and coping strategies reported by study participants. METHODS: Eighty adult women (mean +/- SD age 49.09 +/- 12.89 years) with self-reported doctor-diagnosed arthritis participated in this observational study. Participants completed online survey measures of barriers to physical activity and, for each barrier, reported the frequency of occurrence and the extent of limitation. Measures of coping strategies for each barrier, efficacy to cope, and physical activity were also obtained. RESULTS: A multiple hierarchical regression analysis resulted in a model that significantly predicted physical activity (F[9,70] = 6.80, P < 0.01, adjusted R(2) = 0.40). Barrier limitation (standardized beta = -0.56) and efficacy (standardized beta = 0.20) were significant independent predictors. Phenomenologic findings indicated that arthritis-specific personal barriers (e.g., pain and fatigue due to arthritis) and arthritis-specific coping strategies (e.g., activity modification) were more commonly reported than generic barriers and coping strategies. CONCLUSION: Self-regulatory efficacy to cope and relevant perceived physical activity barriers, which were primarily arthritis-specific and moderately or more limiting to planned physical activity, were important social cognitive predictors of physical activity, a key nonpharmacologic arthritis treatment, among women with arthritis. Future research direction should examine potential moderators of the relationship between these predictors and physical activity, such as pain acceptance.

Partial examination of the public health impact of the People with Arthritis Can Exercise (PACE) program: reach, adoption, and maintenance.

OBJECTIVE: To partially evaluate the public health impact (i.e., reach, adoption, maintenance) of People with Arthritis Can Exercise (PACE) programs, which were initiated as a result of two PACE instructor-training workshops. DESIGN: The study design involved a one-time only, cross-sectional assessment of reach, adoption, and maintenance, conducted 6 months after the workshops. SAMPLE: Participants were 11 adults (n(females)=10) trained to be PACE instructors at one of the workshops. MEASUREMENTS: One-on-one phone interviews, developed using the RE-AIM framework, assessed reach, adoption, and maintenance. RESULTS: Eight of the 11 individuals trained as instructors subsequently began PACE in one of 10 organizations across various communities, indicating high program adoption. However, on average, only 7 individuals with arthritis participated in each PACE program, indicating a low program reach. Within 6 months of beginning PACE, only 3 organizations continued to offer PACE, indicating low program maintenance. Two primary challenges to initiating PACE included recruiting a sufficient number of people to participate in the program and in finding a convenient time to offer it so more individuals could join. CONCLUSION: The public health impact, as assessed by reach, adoption, and maintenance, of PACE programs initiated as a result of 2 instructor-training workshops was low.