Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women.

OBJECTIVE: To examine the combined associations and relative contributions of leisure-time physical activity (PA) and cardiorespiratory fitness (CRF) with all-cause mortality. DESIGN: Prospective cohort study. Setting Aerobics centre longitudinal study. PARTICIPANTS: 31,818 men and 10 555 women who received a medical examination during 1978-2002. Assessment of risk factors Leisure-time PA assessed by self-reported questionnaire; CRF assessed by maximal treadmill test. Main outcome measures All-cause mortality until 31 December 2003. RESULTS: There were 1492 (469 per 10,000) and 230 (218 per 10,000) deaths in men and women, respectively. PA and CRF were positively correlated in men (r = 0.49) and women (r = 0.47) controlling for age (p < 0.001 for both). PA was inversely associated with mortality in multivariable Cox regression analysis among men, but the association was eliminated after further adjustment for CRF. No significant association of PA with mortality was observed in women. CRF was inversely associated with mortality in men and women, and the associations remained significant after further adjustment for PA. In the PA and CRF combined analysis, compared with the reference group "not meeting the recommended PA (< 500 metabolic equivalent-minute/week) and unfit", the relative risks (95% CIs) of mortality were 0.62 (0.54 to 0.72) and 0.61 (0.44 to 0.86) in men and women "not meeting the recommended PA and fit", 0.96 (0.61 to 1.53) and 0.93 (0.33 to 2.58) in men and women "meeting the recommended PA and unfit" and 0.60 (0.51 to 0.70) and 0.56 (0.37 to 0.85) in men and women "meeting the recommended PA and fit", respectively. CONCLUSIONS: CRF was more strongly associated with all-cause mortality than PA; therefore, improving CRF should be encouraged in unfit individuals to reduce risk of mortality and considered in the development of future PA guidelines.

Initiating and maintaining resistance training in older adults: a social cognitive theory-based approach.

Numerous research studies performed in "lab-gyms" with supervised training have demonstrated that simple, brief (20-30 min) resistance training protocols performed 2-3/week following the American College of Sports Medicine's guidelines positively affect risk factors associated with heart disease, cancers, diabetes, sarcopenia and other disabilities. For more than a decade, resistance training has been recommended for adults, particularly older adults, as a prime preventive intervention, and increasing the prevalence of resistance training is an objective of Healthy People 2010. However, the prevalence rate for resistance training is only estimated at 10-15% for older adults, despite the leisure time of older adults and access to facilities in developed countries. The reasons that the prevalence rate remains low include public health policy not emphasising resistance training, misinformation, and the lack of theoretically driven approaches demonstrating effective transfer and maintenance of training to minimally supervised settings once initial, generally successful, supervised training is completed. Social cognitive theory (SCT) has been applied to physical activity and aerobic training with some success, but there are aspects of resistance training that are unique including its intensity, progression, precision, and time and place specificity. Social cognitive theory, particularly with a focus on self-regulation and response expectancy and affect within an ecological context, can be directly applied to these unique aspects of resistance training for long-term maintenance.

Acquired immunodeficiency syndrome/human immunodeficiency virus risk behavior among gay men in small cities. Findings of a 16-city national sample.

BACKGROUND: Most research on acquired immunodeficiency syndrome has been conducted in several of the country's largest cities, and little is known about the current level of human immunodeficiency virus risk taking among gay men in other geographical areas. The purpose of this study was to determine the frequency of risk behavior practices among gay men in smaller communities. METHOD: A large sample of men who patronized gay bars in 16 small and moderate-size cities drawn from six states in four different regions of the country was surveyed to determine the frequency of high-risk behavior and factors influencing risk taking. Eighty-five percent of men in all cities' bars completed all survey measures. The community samples were 1991 men; mean age, 31.3 years; mean education, 10.6 years; 90% were white and 10% were of other ethnicities. All participants provided detailed information on their sexual behavior practices over the preceding 2 months and completed measures assessing their perceived peer norms concerning safer sex practices and risk avoidance, intentions to avoid risk, personal risk estimation, acquired immunodeficiency syndrome risk knowledge, perceived threat of acquired immunodeficiency syndrome/human immunodeficiency virus, and serostatus testing history. RESULTS: High-risk patterns were still common among gay men in these smaller cities; nearly one third of all men had engaged in unprotected anal intercourse an average of eight times in the past 2 months, usually outside monogamous relationships. High-risk behavior was most strongly associated with beliefs that safer sex practices would not be well accepted by peers, weak intentions to use condoms, underestimation of personal vulnerability to the acquired immunodeficiency syndrome, younger age, and higher levels of overall sexual activity. Nine percent of men tested said they were seropositive. CONCLUSIONS: Growing human immunodeficiency virus prevalence and continued high rates of risk behavior indicate that a new "front line" for human immunodeficiency virus prevention among homosexually active men has shifted to the country's smaller cities. Community prevention efforts in these areas are urgently needed to avert sharp increases in future human immunodeficiency virus infections in this population.

Pilot testing of a mindfulness- and acceptance-based intervention for increasing cardiorespiratory fitness in sedentary adults: A feasibility study.

OBJECTIVE: Vigorous physical activity (PA) has been promoted for improving cardiorespiratory fitness (CRF). However, therapeutic techniques designed to engage participants in vigorous PA have fallen short; one reason for this may be the unpleasant physical sensations associated with vigorous exercise (e.g., temporary shortness of breath and mild muscle soreness). Mindfulness and acceptance-based therapies such as Acceptance and Commitment Therapy (ACT) may be helpful at improving adherence to vigorous PA levels. In this open clinical trial, we sought to demonstrate the feasibility and acceptability of a mindfulness- and acceptance-based intervention for increasing CRF in sedentary adults and to generate initial outcomes data. DESIGN: Participants (N=24) engaged in a 10-week fitness walking program while attending regular group sessions based on ACT. MAIN OUTCOME MEASURES AND RESULTS: The feasibility and acceptability of the intervention were demonstrated through high levels of walking adherence (89.30%) and group session attendance (85.50%). A large significant decrease in total 1-mile walk test time [t(18)=4.61, p=.0002, d=.64] and a moderate significant increase in estimated VO2max [t(18)=-4.05, p=.0007, d=-.43] were observed. Analyses indicated a large significant increase in exercise-related experiential acceptance [t(18)=-9.19, p <.0001, d=-2.09]. CONCLUSION: This study demonstrates the feasibility and acceptability of an ACT-based intervention for supporting participation in vigorous PA in sedentary individuals.

High risk sexual behavior and alcohol consumption among bar-going gay men.

OBJECTIVES: To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men. METHODS: Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States. RESULTS: Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption. CONCLUSIONS: This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.

Walking to meet health guidelines: the effect of prompting frequency and prompt structure.

This study assessed the effects of frequency of prompting (phone calls once a week versus once every 3 weeks) and structure of prompting (high versus low structure) in 135 participants (132 women and 3 men) in a walking program designed to meet the American College of Sports Medicine's cardiovascular exercise goals. Survival analysis using 6 months of data points and using the criteria of walking at least 20 min a day for at least 3 times per week indicated an effect for more frequent versus less frequent prompting (46% and 13%) but not for high- versus low-structure prompting (30% and 31%). The results suggested the efficacy of frequent prompting delivered in inexpensive ways as a means to increase exercise adherence and the further parametric study of other basic behavior change strategies.

Social-cognitive determinants of nutrition behavior among supermarket food shoppers: a structural equation analysis.

A social-cognitive model of nutrition behavior (A. Bandura, 1997) was tested using structural equation modeling of data from 307 food shoppers recruited from 5 supermarkets in Southwest Virginia. The shoppers were participating in the baseline phase of an ongoing nutrition promotion program. As part of the evaluation, data were collected on the self-efficacy and outcome-expectations components of social-cognitive theory as well as on food purchases and intake. The structural analyses presented here support the social-cognitive model. Self-efficacy, physical outcome expectations, age, socioeconomic status, and number of children were important predictors of nutrition behavior among shoppers. Implications for interventions using social-cognitive variables to improve the nutritional content of food purchases and intake are discussed.

An experimental evaluation of a prototype public access nutrition information system for supermarkets.

Located the Nutrition for a Lifetime System (NLS-1), a prototype interactive information system, in a large supermarket to help users decrease high-fat food purchases and increase high-fiber food purchases. Study participants were randomly assigned to control (n = 23; used the NLS-1 to enter food purchases only) or experimental (n = 26; viewed videodisc instructional programs, received prompts, made commitments, received feedback from the NLS-1) conditions. According to data entered in the NLS-1 and actual food shopping receipts, experimental participants significantly reduced higher fat purchases. Increases in higher fiber purchases favored the experimental group but were not significant.

Family/media approach to HIV prevention: results with a home-based, parent-teen video program.

We describe the first study with a home-based HIV prevention video program for parents and young teenagers. The objectives of the program are to inform parents and teenagers about the causes and prevention of HIV infection and other sexually transmitted diseases, to increase family problem-solving skills, and to increase teen problem-solving and assertiveness skills. The objectives pertain to the goals of increasing skills needed to help teenagers avoid or manage high-risk behaviors and situations. Forty-five families with at least one 12- to 14-year-old were randomly assigned to either experimental (receive video program) or control (no video) conditions in a pretest-posttest design. After 6 months (Follow-Up 1), the experimental and control families were reassessed. The control families next received the video program, and the control families were assessed again (Follow-Up 2). The results indicate increases in parent and teen knowledge and skills only with video viewing. Approaches to improving the video program, particularly with teenagers, are discussed.

Factors predicting continued high-risk behavior among gay men in small cities: psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

A framework for health promotion and disease prevention programs.

There is a disquieting sense that many theoretically based health behavior change programs have been only minimally effective. Part of the problem may be that most current theories have considerable overlap, primarily focus on intraindividual and other individual-level variables, and tend to neglect the environment and issues related to program implementation. A framework is developed for health promotion and disease prevention programs that makes use of epidemiological and health indicator data and Healthy People 2000 goals to prioritize efforts, provides a schema to formulate programs on the basis of timing (prevention) and level of intervention, and addresses the marketing approach to target and implement programs. The framework integrates current theories to guide marketing and phases of research.

Development and evaluation of an HIV-risk reduction program for female college students.

College students are engaging in high rates of behavior related to risk of infection from Human Immunodeficiency Virus (HIV) and other sexually transmitted diseases (STDs). A cognitive-behavioral skills training program for heterosexual college females focused on sexual assertiveness skills and the reduction of risk-related behaviors was designed and evaluated compared with an education-only program. Participants completed pre-intervention, post-intervention, and one-month follow-up assessments of: (a) HIV/STD-related knowledge and beliefs; (b) sexual, alcohol, and drug-related behaviors; and (c) sexual assertiveness role-plays. Skills training participants compared to education-only participants scored higher on sexual assertiveness skills, specific knowledge of HIV infection, and self-efficacy to perform lower risk sexual behaviors and reported a reduction in risk-related behaviors at post-intervention and follow-up assessments. The effectiveness of behavioral skills in HIV risk-reduction programs for college students is discussed.

Differences in HIV risk characteristics between bisexual and exclusively gay men.

Research investigating HIV-risk sexual behaviors of men who have sex with men usually combines gay and bisexual men, treating them as a single, homogeneous group. However, gay and bisexual men may differ in their HIV risk behavior and in psychological characteristics indicative of risk. Exclusively gay (N = 1,180) and bisexual men (N = 136) completed anonymous surveys at gay bars. The surveys assessed demographic, psychological, and behavioral data related to sexual behavior and HIV risk. Relative to exclusively gay men, bisexual men had lower intentions to use condoms in their next intercourse occasion, reported a greater frequency of oral sex with men and more oral-sex partners, knew fewer people who were HIV positive, and perceived weaker peer norms favoring safer sex and risk avoidance. One-third of bisexual men reported engaging in unprotected anal intercourse, and 17% of bisexual men had multiple unprotected anal sex partners in the past two months. Interventions tailored to the needs of bisexual men are urgently needed and should focus on increasing intentions to use condoms, increasing HIV-risk sensitization, and fostering norms favoring safer sex and risk avoidance.

Psychosocial differences between recently HIV tested and non-tested gay men who reside in smaller US cities.

While a number of studies have examined behavioural and psychosocial correlates of HIV test seeking, most of this research has relied on samples of urban gay men. Less is known about HIV testing rates and factors associated with testing among gay and bisexual men who live in smaller cities. The present research administered surveys to 3969 non-exclusively partnered gay and bisexual men attending gay bars in small American cities to determine (a) rates of HIV test seeking, and (b) how tested and non-tested men differed on a battery of psychosocial indices. A total of 68% of men had been tested for antibodies to HIV--50% in the past year. Men tested for HIV in the past year, compared to men never tested for HIV, knew more people who were HIV positive or were diagnosed with AIDS, had a closer relationship with someone who had died of AIDS, were more likely to be ethnic minorities, reported more conversations with friends about safer sex, and had stronger intentions to use condoms during their next intercourse occasion. Our results indicate that HIV counselling and testing programmes comprise an important component of HIV prevention efforts assisting gay men residing in smaller USA cities.

Levels and predictors of HIV risk behavior among women in low-income public housing developments.

The prevalence of increases in human immunodeficiency virus infection and illness rates among urban disadvantaged women underscore the urgent need for acquired immunodeficiency syndrome prevention interventions for high-risk women. Few studies, however, have examined the factors contributing to risk in this population or predictors of risk taking and risk reduction. A total of 148 women, most of them of racial minorities, living in low-income public housing developments completed measures designed to assess risk for human immunodeficiency virus infection and to analyze factors related to risk taking, including knowledge about acquired immunodeficiency syndrome, behavior change self-efficacy, intention to use condoms, and social norm perception about safer sex practices. History of sexually transmitted diseases, low rates of condom use, and relationships with men who were injection drug users or who were not sexually exclusive were commonly reported. Women were divided into high- or low-risk categories based on behavior during the two preceding months. Women at low risk believed more strongly in personal efficacy of behavior change, were more committed to using condoms, and perceived risk reduction steps as more socially normative than high-risk women. Culturally tailored human immunodeficiency virus prevention interventions that address these dimensions are needed.

Nicotine fading, behavioral contracting, and extended treatment: effects on smoking cessation.

Twenty-eight subjects were randomly allocated to either a nicotine fading or a maintenance condition. The maintenance condition utilized behavioral contracting and extended treatment in addition to the nicotine fading to improve treatment outcome and avoid relapse. The maintenance condition achieved superior outcome on smoking measures at post-treatment and follow-up periods for self-reported smoking levels. Carbon monoxide levels were significantly lower for the maintenance condition at post-treatment, three month and six month follow-up. Saliva thiocyanate levels were significantly lower for the maintenance condition at the three month follow-up. Changes in health functioning indicated significantly lower diastolic and systolic blood pressure at six month follow-up for the maintenance condition. Additional research on nicotine regulation during nicotine fading and thiocyanate levels during experimental smoking would be useful. The use of behavioral contracting to enhance maintenance without therapeutic support warrants further research as well.

The Effects of the Safe-sun Program on Patrons' and Lifeguards' Skin Cancer Risk-reduction Behaviors at Swimming Pools.

The 'Safe Sun' program had the goal of increasing patrons' and lifeguards' skin-protective behaviors and involved informational, prompting, feedback and goal-setting and incentive components coupled with pool lifeguards modeling protective behaviors such as wearing shirts, hats and sunglasses or staying in shaded areas. During two phases of a project involving 27 pools, it was found that while the program increased patrons' and lifeguards' protective behaviors, the largest changes were found at one pool where lifeguards were required to participate in the program. Patrons' protective behaviors at this pool increased from 30.7 percent to 52 percent, and lifeguards' protective behaviors increased from 40.8 percent to 95.7 percent. Social marketing, environmental change and institutionalization processes are needed to make skin-cancer prevention programs more effective.

The effects of a multimedia system in supermarkets to alter shoppers' food purchases: nutritional outcomes and caveats.

A randomized-control test of a multimedia nutrition intervention-the Nutrition for a Lifetime System (NLS©)- utilized supermarket receipts to examine effects of NLS treatment on the daily per person nutritional content of participants' supermarket purchases. In regression analyses controlling for background variables, baseline purchases and trends toward increased purchasing, NLS treatment contributed to lower levels of total fat and to higher levels of total fiber and servings of fruits and vegetables at post-test. Redemption of NLS coupons contributed to greater decreases in fat and increases in servings of fruits and vegetables in users' purchases. Implications for future interventions promoting healthier food choices include tailoring program content and addressing broader lifestyle issues such as caloric intake and expenditure.

Effects of regular and slow speed resistance training on muscle strength.

BACKGROUND: The study assessed a way to increase the intensity and effectiveness of resistance training by comparing training with a slower repetition speed to training with a conventional repetition speed. Slower repetition speed may effectively increase intensity throughout the lifting phase while decreasing momentum. METHODS: Two studies were done with untrained men (N=65) and women (N=82), (mean age=53.6) who trained two to three times per week for eight to 10 weeks on a 13 exercise Nautilus circuit performing one set of each exercise. Participants exclusively trained using regular speed repetitions for 8 to 12 repetitions per set at 7 sec each (2 sec lifting, 1 sec pause, 4 sec lowering) or a Super Slow training protocol where they completed 4 to 6 repetitions per set at 14 sec each (10 sec lifting, 4 sec lowering). All of the participants were tested for either the 10 repetition-maximum (RM) weightload (regular-speed group) or the 5-RM weightload (slow-speed group). RESULTS: In both studies, Super-Slow training resulted in about a 50% greater increase (p<0.001) in strength for both men and women than regular speed training. In Study 1, the Super-Slow training group showed a mean increase of 12.0 kg and the regular speed group showed an increase of 8.0 kg increase (p<0.001). In Study 2, the Super-Slow training group showed a 10.9 kg increase and the regular speed group showed an increase of 7.1 kg (p<0.001). CONCLUSIONS: Super-Slow training is an effective method for middle-aged and older adults to increase strength. Although studies still need to be done with at-risk populations, repetition speed should be considered when prescribing resistance training.

Flexible work schedules and family time allocation: Assessment of a system change on individual behavior using self-report logs.

This study assessed the effects of a flexible work schedule ("flextime") on time allocated to children and spouse by federal workers. Direct behavioral observations of family, home, and work functions were precluded because of the cost involved in observing many people for long periods of time. In order to obtain detailed individual data, participants completed hour-by-hour activity logs a mean of twice per week for 35 weeks. Participants received prior training on log completion, initial feedback on the detail of their log entries, and were prompted to complete the forms. Four different procedures assessing reliability indicated a corroboration rate of 80% with other sources. Log data were reliably reduced to nine categories such as "PM time with children" and 37 subcategories such as "time at dinner." The log data were presented in time-series form and the use of a quasi-experimental design showed that participants who altered their work schedule were able to spend more PM time with their families. The log data demonstrated that the capacity exists to assess closely the effects of large-scale changes at a micro-behavioral level, but other methods are needed to make complex self-reporting systems less expensive and more capable of immediate monitoring of the intervention's effects.