Association between adverse childhood experiences and fruit and vegetable intake among a national sample of U.S. adults.

Few studies have examined the role adverse childhood experiences (ACEs) have on specific diet patterns. This study assessed the association between ACEs and daily fruit and vegetable intake (FVI). Data were derived from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) which surveys 50 states and three U.S. territories. Participants who completed the ACEs module were included in the analyses (N = 106,967). Total ACEs included the summed responses from the domains of abuse, household challenges, and neglect. FVI was reported by number of times consumed per day. The two fruit items included fruit (fresh, frozen, and canned) and fruit juice. The four vegetable items included leafy greens, fried potatoes, non-fried potatoes, and other vegetables. All fruit and vegetable items were analyzed separately to see which specific items drove the relationship between total ACEs and total FVI, equaling a total of 8 regression models. Every model controlled for poor mental health days, sex, age, ethnicity, income, body mass index, and physical activity. Total ACEs were positively associated with daily intake of fried potatoes (ß = 0.008, p =.025), other potatoes (ß = 0.008, p =.049), and other vegetables (ß = 0.024, p <.001). Total ACEs were negatively associated with daily intake of fruit (ß = -0.016, p <.001). ACEs had non-significant relationships with leafy greens and fruit juice. Findings suggests that those with increased ACEs scores report increased consumption of fried potatoes, non-fried potatoes, and other vegetables, and less of fruit. Findings highlight the need for understanding food context and preparation when analyzing the relationship between ACEs and diet intake.

A community-based, multi-level, multi-setting, multi-component intervention to reduce weight gain among low socioeconomic status Latinx children with overweight or obesity: The Stanford GOALS randomised controlled trial.

BACKGROUND: There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity. METHODS: We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836. FINDINGS: Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 9·5 (SD 1·4) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -0·25 [95% CI -0·90 to 0·40] kg/m2; Cohen's d=0.10; p=0·45). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-0·73 [-1·07 to -0·39] kg/m2, d=0.55); the same was true over 2 years (-0·63 [-1·13 to -0·14] kg/m2; d =0.33). No differential adverse events were observed. INTERPRETATION: The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities. FUNDING: US National Institutes of Health.

A Mixed Method Study to Inform the Implementation and Expansion of Pop-Up Parks for Economic, Behavioral, and Social Benefits.

The availability of parks and urban green spaces has been associated with a number of benefits, including increased physical activity, improvements in mental health, increases in social interactions, improvements to the environment, and increases in property values. The installation of temporary pop-up parks in urban areas is one way for urban communities to obtain these benefits. In this mixed-methods study, quantitative and qualitative data were gathered by researchers, the city council, a local investment company, and community residents that informed the initiation, iteration, and incremental expansion of a series of temporary, summer pop-up parks in the downtown business district of the City of Los Altos in Northern California over a 4-year period (2013-2016). Results showed that the parks were visited by a large, multigenerational group of users who engaged in leisure-time physical activity, shopped at local stores, attended programed events, and socialized with others. Direct observation and survey data gathered in year 2014 also indicated that foot traffic into businesses directly fronting on a pop-up park (n = 8) was higher during a 4-day period when the park was in place, as compared to a similar 4-day period before the park was installed. The majority of downtown business owners/managers reported no decrease in sales compared to the month before the pop-up park was installed. City sales tax data indicated increases in year-on-year sales tax revenue in the summer quarter of 2014 and 2016 compared with the year (2015) when there was no downtown pop-up park. Perspectives of community residents collected before, during, and after the installation of the pop-up parks indicated that the pop-up park created a vibrant space in an otherwise underutilized area that was enjoyed by a variety of people in a host of ways (e.g., children playing, families relaxing, people shopping and eating at downtown stores and restaurants, people of all ages attending scheduled park events). These results informed a number of discussions and meetings between key stakeholders about the pop-up parks, culminating in a temporary park that was held in a new location in 2017 that was substantially larger in size, installed for a longer time period, cost more, and had more scheduled park events. Results from this prospective investigation of the initial impacts of pop-up parks in this urban location provide insights regarding the potential benefits and viability of such temporary parks for residents and businesses alike.

Novel patterns of physical activity in a large sample of preschool-aged children.

BACKGROUND: Moderate-to-vigorous physical activity (MVPA), shown to be associated with health benefits, is not well-characterized in preschool-aged children. MVPA is commonly described as a threshold amount to achieve. We examined a novel way to characterize MVPA patterns in preschool-aged children by gender and age. METHODS: Preschool-aged children from Nashville, TN and Minneapolis, MN wore triaxial accelerometers. Four distinct MVPA patterns were identified: isolated spurt (IS), isolated sustained activity (ISA), clustered spurt (CS), and clustered sustained activity (CSA). Multivariable linear regression models were used to test associations of gender and age with each pattern. RESULTS: One thousand one hundred thirty-one children (3.9 years old, 51% girls, 30% overweight, 11% obese, and 76% Hispanic) wore accelerometers for 12.9 (SD = 1.4) hours/day for 6.7 (SD = 0.7) days. Children spent 53% of wear time in sedentary behavior and 13% in MVPA. On average, boys and girls achieved > 90 min/day of MVPA (98.2 min, SD = 32.3). Most MVPA (80%) was obtained in spurt-like (IS and CS) MVPA; however, girls spent a higher proportion of MVPA in IS and CS, and lower proportion of time in CSA (all p < 0.001). Controlling for gender, an increase of 1-year in age corresponded to a 1.5% increase in CSA (p < 0.05). CONCLUSIONS: How MVPA was obtained varied depending on the gender and age of the child. On average, boys spent more time in sustained MVPA than girls and MVPA was more sustained in older children. Utilizing these patterns could inform PA practice and policy guidelines. TRIAL REGISTRATION: NCT01316653 , date of registration: March 3, 2011; NCT01606891, date of registration: May 23, 2012.

Potential corner case cautions regarding publicly available implementations of the National Cancer Institute's nonwear/wear classification algorithm for accelerometer data.

The National Cancer Institute's (NCI) wear time classification algorithm uses a rule based on the occurrence of physical activity data counts-a cumulative measure of movement, influenced by both magnitude and duration of acceleration-to differentiate between when a physical activity monitoring (PAM) device (ActiGraph accelerometer) is being worn by a participant (wear) from when it is not (nonwear). It was applied to PAM data generated from the 2003-2004 National Health and Nutrition Examination Survey (NHANES 2003-2004). We discuss two corner case conditions that can produce unexpected, and perhaps unintended results when the algorithm is applied. We show, using simulated data of two special cases, how this algorithm classifies a 24-hour period with only 72 total counts as 100% wear in one case, and classifies a 24-hour period with 96,000 counts as 0.1% wear in another. The prevalence of like scenarios in the NHANES 2003-2004 PAM dataset is presented with corresponding summary statistics for varying degrees of the algorithm's nonwear classification threshold (T). The number of participants with valid days, defined as 10 or more hours classified as wear time in a 24-hour day, increased while the mean counts-per-minute (CPM) decreased as the threshold for excluding non-wear was reduced from the allowed 4,000 counts in an hour. The number of participants with four or more valid days increased 2.29% (n = 113) and mean CPM dropped 2.45% (9.5 CPM) when adjusting the nonwear classification threshold to 50 counts an hour. Applying the most liberal criteria, only excluding hours as nonwear which contained 1 count or less, resulted in a 397 more participants (7.83% increase) and 26.5 fewer CPM (6.98% decrease) in NHANES 2003-2004 participants with four or more valid days. The algorithm should be used with caution due to the potential influence of these corner cases.

Screen Media Exposure and Obesity in Children and Adolescents.

Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children's preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

Impacts of a Temporary Urban Pop-Up Park on Physical Activity and Other Individual- and Community-Level Outcomes.

Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face.

Parent's Physical Activity Associated With Preschooler Activity in Underserved Populations.

INTRODUCTION: In the U.S., children from low-income families are more likely to be obese. The impact of parent modeling of physical activity (PA) and sedentary behaviors in low-income American ethnic minorities is unclear, and studies examining objective measures of preschooler and parent PA are sparse. METHODS: This cross-sectional study examined 1,003 parent-child pairs who were of low income, largely Latino and African American, and living in one of two geographically disparate metropolitan areas in the U.S. Parents and children wore GT3X/GT3X+ accelerometers for an average of >12 hours/day (7:00am-9:00pm) for 1 week (September 2012 to May 2014). Analysis occurred in 2015-2016. RESULTS: About 75% of children were Latino and >10% were African American. Mean child age was 3.9 years. The majority of children (60%) were normal weight (BMI ≥50th and <85th percentiles), and more than a third were overweight/obese. Children's total PA was 6.03 hours/day, with 1.5 hours spent in moderate to vigorous PA (MVPA). Covariate-adjusted models showed a monotonic, positive association between parent and child minutes of sedentary behavior (ß=0.10, 95% CI=0.06, 0.15) and light PA (ß=0.06; 95% CI=0.03, 0.09). Child and parent MVPA were positively associated up to 40 minutes/day of parent MVPA, but an inverse association was observed when parental MVPA was beyond 40 minutes/day (p=0.002). CONCLUSIONS: Increasing parental PA and reducing sedentary behavior correlate with increased PA-related behaviors in children. However, more work is needed to understand the impact of high levels of parental MVPA on the MVPA levels of their children.

Preserving older adults' routine outdoor activities in contrasting neighborhood environments through a physical activity intervention.

While neighborhood design can potentially influence routine outdoor physical activities (PA), little is known concerning its effects on such activities among older adults attempting to increase their PA levels. We evaluated the effects of living in neighborhoods differing in compactness on changes in routine outdoor activities (e.g., walking, gardening, yard work) among older adults at increased mobility disability risk participating in the LIFE-Pilot PA trial (2003-07; ages 70-89years; from Dallas, TX, San Francisco Bay area, Pittsburgh, PA, and Winston-Salem, NC). Analyses were conducted on the 400 LIFE-Pilot participants randomized to a one-year endurance-plus-strengthening PA intervention or health education control that completed one-year PA assessment (CHAMPS questionnaire). Outcomes of interest were exercise and leisure walking, walking for errands, and moderate-intensity gardening. Neighborhood compactness was assessed objectively using geographic information systems via a subsequent grant (2008-12). PA increased weekly exercise and leisure walking relative to control, irrespective of neighborhood compactness. However, walking for errands decreased significantly more in PA relative to control (net mean [SD] difference=16.2min/week [7.7], p=0.037), particularly among those living in less compact neighborhoods (net mean [SD] difference=29.8 [10.8] minutes/week, p=0.006). PA participants living in less compact neighborhoods maintained or increased participation in gardening and yard work to a greater extent than controls (net mean [SD] difference=29.3 [10.8] minutes/week, p=0.007). The results indicate that formal targeting of active transport as an adjunct to structured PA programs may be important to diminish potential compensatory responses in functionally impaired older adults. Structured endurance-plus-strengthening PA may help older adults maintain or increase such routine activities over time. TRIAL REGISTRATION: clinicaltrials.gov Identifier=NCT01072500.

The Effects of a Park Awareness Campaign on Rural Park Use and Physical Activity.

To examine the effects of a park awareness campaign on park use in 6 community parks. One-group pretest-posttest design. Six community parks located in a South Carolina county. Children, adolescents, and adults observed in community parks. A 1-month awareness campaign that culminated in single 1.5-hour events at 6 parks in April 2011 and May 2011. The System for Observing Play and Recreation in Communities was used to objectively measure park use in May 2010 (baseline) and May 2011 (postcampaign). Zero-inflated Poisson models tested whether the number of total park users and the number of park users engaged in sedentary, walking, and vigorous activities differed by observation date. Park use was significantly greater at baseline than postcampaign (97 vs 84 users, respectively; χ = 4.69, P = .03). There were no significant differences in the number of park users engaged in sedentary (χ = 2.45, P = .12), walking (χ = 0.29, P = .59), and vigorous (χ = 0.20, P = .65) activities between baseline and postcampaign. Although only 97 and 84 people were observed across all parks at baseline and postcampaign, a total of 629 people were observed during the 6 separate 1.5-hour campaign park events. This suggests that there is potential for greater park utilization in these communities, and important questions remain on how to conduct effective awareness campaigns and how to harness interest in park events for the purpose of contributing to future community-wide physical activity and health promotion efforts.

Effects of Varying Epoch Lengths, Wear Time Algorithms, and Activity Cut-Points on Estimates of Child Sedentary Behavior and Physical Activity from Accelerometer Data.

OBJECTIVE: To examine the effects of accelerometer epoch lengths, wear time (WT) algorithms, and activity cut-points on estimates of WT, sedentary behavior (SB), and physical activity (PA). METHODS: 268 7-11 year-olds with BMI ≥ 85th percentile for age and sex wore accelerometers on their right hips for 4-7 days. Data were processed and analyzed at epoch lengths of 1-, 5-, 10-, 15-, 30-, and 60-seconds. For each epoch length, WT minutes/day was determined using three common WT algorithms, and minutes/day and percent time spent in SB, light (LPA), moderate (MPA), and vigorous (VPA) PA were determined using five common activity cut-points. ANOVA tested differences in WT, SB, LPA, MPA, VPA, and MVPA when using the different epoch lengths, WT algorithms, and activity cut-points. RESULTS: WT minutes/day varied significantly by epoch length when using the NHANES WT algorithm (p < .0001), but did not vary significantly by epoch length when using the ≥ 20 minute consecutive zero or Choi WT algorithms. Minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA varied significantly by epoch length for all sets of activity cut-points tested with all three WT algorithms (all p < .0001). Across all epoch lengths, minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA also varied significantly across all sets of activity cut-points with all three WT algorithms (all p < .0001). CONCLUSIONS: The common practice of converting WT algorithms and activity cut-point definitions to match different epoch lengths may introduce significant errors. Estimates of SB and PA from studies that process and analyze data using different epoch lengths, WT algorithms, and/or activity cut-points are not comparable, potentially leading to very different results, interpretations, and conclusions, misleading research and public policy.

An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter?

BACKGROUND: Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability. METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence. RESULTS: Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4%) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4%) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis. CONCLUSIONS: The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation. TRIAL REGISTRATION: Clinicaltrials.gov Identifier = NCT01072500.

The associations between park environments and park use in southern US communities.

PURPOSE: To document park use and park and neighborhood environment characteristics in rural communities, and to examine the relationship between park characteristics and park use. METHODS: The System for Observing Play and Recreation in Communities measured use in 42 target areas across 6 community parks in May 2010 and October 2010. Direct observation instruments were used to assess park and neighborhood environment characteristics. Logistic regression was used to determine the relationship between the condition, number of amenities, and number of incivilities in a target area with target area use. FINDINGS: Ninety-seven people were observed across all parks during May 2010 data collection and 116 people during October 2010 data collection. Low park quality index scores and unfavorable neighborhood environment characteristics were observed. There was a significant positive association between number of incivilities in a target area and target area use (OR = 1.91; 95% CI: 1.09-3.38; P = .03). CONCLUSIONS: The number of people observed using the parks in this study was low, and it was considerably less than the number observed in other studies. The objective park and neighborhood environment characteristics documented in this study provide a more comprehensive understanding of parks than other studies. Further examining the complex relationship between park and neighborhood environment characteristics and park use is important, as it can inform park administrators and city planners of characteristics that are best able to attract visitors.

Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS-A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention.

OBJECTIVE: To test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children. DESIGN: Two-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36 months after randomization. PARTICIPANTS: Seven through eleven year old, overweight and obese children (BMI ≥ 85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California. INTERVENTIONS: Families are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families. MAIN OUTCOME MEASURE: Body mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures. CONCLUSIONS: The Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.

Mediating effects of group cohesion on physical activity and diet in women of color: health is power.

PURPOSE: To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention. DESIGN: Longitudinal design. SETTING: Harris County and Travis County, Texas. PARTICIPANTS: Community-dwelling African-American and Hispanic or Latina women. INTERVENTION: Three hundred ten women were randomized to a PA (n  =  204) or VF (n  =  106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption. MEASURES: Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention. ANALYSES: The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis. RESULTS: Women were middle aged (mean  =  44.4 years) and overweight or obese (mean body mass index  =  34.0 kg/m(2)). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p < .05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes. CONCLUSIONS: Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.

School administrators' perceptions of factors that influence children's active travel to school.

BACKGROUND: Increasing children's active travel to school may be 1 strategy for addressing the growing prevalence of obesity among school age children. Using the School Travel Survey, we examined South Carolina school district leaders' perceptions of factors that influence elementary and middle school students walking to school. METHODS: Frequency distributions and chi-square tests were used to analyze the survey responses; open-ended questions were reviewed qualitatively for recurring topics and themes. RESULTS: School and district leaders (N = 314) most often reported street crossing safety (54.0%) and number of sidewalks (54.0%) as priority factors that should be addressed to increase students' active travel to school, followed by distance to school (46.0%), traffic volume (42.4%), parental attitudes (27.0%), traffic speed (26.7%), neighborhood condition (24.4%), and student attitudes (10.0%). Several respondents expressed concerns about liability issues related to students' active travel to school while others reported that schools are not responsible for students' safety once students leave school grounds. Independent of their comments about liability, respondents were concerned about the safety of students while walking to school. CONCLUSIONS: Those promoting active travel to school may benefit from addressing those factors perceived as most important by school and district leaders, including street crossing safety, number of sidewalks, and by educating school and district leaders about liability and safety issues related to students walking to school.

Body image and physical activity among Latina and African American women.

OBJECTIVES: Obesity in African American (AA) and Hispanic or Latina (HL) women has been partly attributed to low physical activity (PA) and cultural influences on body image. The purpose of this study was to determine the relationship among body mass index (BMl=kg/m2), body image perception (perceived and desired) and PA. DESIGN: The current study is a cross-sectional, secondary data analysis of the Health Is Power (HIP) project (1R01CA109403). SETTING: Women residing in Harris County, Houston and Travis County, Austin, Texas were recruited to participate in the study. PARTICIPANTS: Over four hundred (N=410) AA (N=262) and HL (N=148) women participated in the HIP project and were included in the current study. MAIN OUTCOME MEASURES: BMI, Pulvers' body image, PA and demographic data were collected from each participant. RESULTS: Women (mean age=45.2 yrs) were educated (44% college graduates) and obese (mean BMI =34.6 kg/m2). Less than half perceived themselves correctly regardless of actual weight and ethnicity (P<.001). Nearly three-fourths of AA (73.9%) and less than half of HL (42.9%) women who were normal weight desired to be obese, and only 39.4% of AA and HL women desired to be normal weight. Women varied on measures of PA (P<.05). Regression analyses showed objectively measured PA was significantly associated with BMI and ethnicity (P<.01). CONCLUSIONS: Results reveal dichotomous distortion in body images. Women need strategies to perceive normal weight as desirable for health and beauty, leading to increased PA and reducing obesity.

Convergent validity of pedometer and accelerometer estimates of moderate-to-vigorous physical activity of youth.

BACKGROUND: Pedometer step-frequency thresholds (120 steps·min-1, SPM) corresponding to moderate-to vigorous intensity physical activity (MVPA) have been proposed for youth. Pedometers now have internal mechanisms to record time spent at or above a user-specified SPM. If pedometers provide comparable MVPA (P-MVPA) estimates to those from accelerometry, this would have broad application for research and the general public. The purpose of this study was to examine the convergent validity of P-MVPA to accelerometer-MVPA for youth. METHODS: Youth (N = 149, average 8.6 years, range 5 to 14 years, 60 girls) wore an accelerometer (5-sec epochs) and a pedometer for an average of 5.7 ± 0.8 hours·day-1. The following accelerometer cutpoints were used to compare P-MVPA: Treuth (TR), Mattocks (MT), Evenson (EV), Puyau (PU), and Freedson (FR) child equation. Comparisons between MVPA estimates were performed using Bland-Altman plots and paired t tests. RESULTS: Overall, P-MVPA was 24.6 min ± 16.7 vs. TR 25.2 min ± 16.2, MT 18.8 min ± 13.3, EV 36.9 min ± 21.0, PU 22.7 min ± 15.1, and FR 50.4 min ± 25.5. Age-specific comparisons indicated for 10 to 14 year-olds MT, PU, and TR were not significantly different from P-MVPA; for the younger children (5-8 year- olds) P-MVPA consistently underestimated MVPA. CONCLUSIONS: Pedometer-determined MVPA provided comparable estimates of MVPA for older children (10-14 year-olds). Additional work is required to establish age appropriate SPM thresholds for younger children.

Multiple measures of physical activity, dietary habits and weight status in African American and Hispanic or Latina women.

Compared measures of physical activity and dietary habits used in the Health Is Power (HIP) study, and described the associations of physical activity and dietary habits among African American and Hispanic or Latino women, adjusted for weight status. Cross-sectional baseline data were compared for community dwelling, healthy African American (N = 262) and Hispanic or Latina women (N = 148) who participated in HIP. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) long form, the Check And Line Questionnaire (CALQ) log and accelerometry. Dietary habits were measured using NCI 24-h recall screeners, vegetable and fruit (VF) logs and the NCI Diet History Questionnaire (DHQ). Differences in physical activity and dietary habits were assessed using simultaneous 2 (ethnicity) × 3 (weight status) ANCOVAs adjusted for age and socioeconomic status. Women (M age = 44.4 ± 10.9 years) were obese (M = 34.0 ± 9.7 kg/m(2)), did not meet physical activity guidelines as measured by accelerometry (M = 19.4 ± 19.1 min MVPA/day) and ate few VF (M = 2.8 ± 2.7 servings/day). DHQ variables differed by weight status. IPAQ was associated with CALQ, and CALQ with accelerometry (P < .05). IPAQ was not associated with accelerometry. Regardless of ethnicity, normal weight women did more physical activity, reported more VF consumption, and consumed more fat calories than overweight and obese women (Ps < .05). African American women did more MVPA than Hispanic or Latino women (P < .001). Relationships between behaviors and weight status suggest accelerometry and DHQ are preferable, regardless of ethnicity; and studies may capture different domains of physical activity and dietary habits depending on measure used.

Development of an ecologically valid approach to assess moderate physical activity using accelerometry in community dwelling women of color: a cross-sectional study.

BACKGROUND: Women of color report the lowest levels of physical activity and highest rates of overweight and obesity in the US. The purpose of this study was to develop an individualized, ecologically valid, field based method to assess physical activity over seven days for community dwelling women of color using accelerometers. METHODS: Accelerometer-measured physical activity, Borg perceived exertion, demographics, blood pressure, heart rate, and anthropometric measures were collected from African American and Hispanic or Latina women (N = 209). A threshold for increased physical activity was determined for each participant by calculating the average count per minute (plus one standard deviation) for each participant collected during a self-selected pace that corresponded to a 'recreational' walk about their neighborhood. The threshold was then used to calculate the amount of time spent doing increased intensity physical activity during a typical week. RESULTS: Women were middle-aged and obese (M BMI = 34.3 ± 9.3). The average individual activity counts per day ranged from 482-1368 in African American women and 470-1302 in Hispanic or Latina women. On average, African American women spent significantly more time doing what was labeled 'increased' physical activity than Hispanic and Latino women. However neither group approached recommended physical activity levels, as African American women, averaged 1.73% and Hispanic and Latino women averaged 0.83% of their day engaged in increased physical activity (p < 0.05). CONCLUSIONS: This study presents a simple field-based method for developing accelerometer thresholds that identify personalized thresholds of moderate intensity physical activity that can be used by in community-based settings. Findings highlight a need for physical activity programs whose starting points are based upon the individual's typical baseline physical activity level, which is likely to be well below the minimum recommended published guidelines.