Association of oral care with periodontitis and glycemic control among US adults with diabetes.

BACKGROUND: Studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is unclear whether oral self-care such as flossing may reduce risk for periodontitis and improve glycemic control among people with diabetes. The purpose of this study was to examine associations between oral care, specifically, flossing and preventive dental care, with periodontitis and glycemic control, among US dentate adults with diabetes. METHODS: We analyzed data from the National Health and Nutrition Examination Survey 2011-2014 for 892 participants aged 30 years and older with diabetes who completed the periodontal examination and lab test for hemoglobin A1c (HbA1c). Sampling weights were applied. Multivariable logistic regression and multivariable linear modeling were performed to examine the associations of flossing and preventive dental services on periodontal health and HbA1c levels, respectively, controlling for sociodemographic characteristics, health behaviors, and other risk factors. RESULTS: Among U.S. dentate adults with diabetes, 52.1% of flossers and 72.1% of non-flossers had periodontitis (p < 0.001). Flossers were 39% less likely to have periodontitis (Adj. OR 0.61, 95% CI 0.43-0.88) compared to non-flossers. Flossers had an average HbA1c reading 0.30% (95% CI 0.02%-0.58%) lower than non-flossers, adjusted for covariates (p = 0.037). Preventive dental visits were associated with reduced risk for periodontitis (Adj. OR 0.54, 95%CI, 0.38-0.75) but not glycemic control. CONCLUSION: Flossing was associated with periodontal health and glycemic control among US adults with diabetes. Although further research is needed, the findings support that oral self-care may be particularly beneficial for adults with diabetes.

The impact of ActiGraph's low-frequency extension filter on measurement of children's physical activity.

This study examines differences in accelerometer-based measurements of children's movement with and without applying ActiGraph's low-frequency extension (LFE) filter. Thirty children wore ActiGraph GT9X devices during structured physical activity (PA) periods. Raw accelerometry data for each activity period were processed with and without the LFE filter applied. For each activity period, paired t-tests were used to compare vector magnitude counts and minutes spent in moderate-to-vigorous physical activity (MVPA) with and without the LFE filter applied. Repeated measures MANOVA models were used for compositional data analysis of the percentage of time spent in sedentary behaviour and light, moderate, and vigorous PA with and without the LFE filter applied. Applying the LFE filter significantly increased vector magnitude counts and estimated minutes spent in MVPA for all activity periods when compared to the normal filter. For brisk walking, the LFE filter had a significant impact on the composition of time spent in sedentary behaviour and PA intensities. Children's activity data processed with the LFE filter may not be compatible with cut-points for activity levels developed with the normal filter, and caution should be taken when comparing children's activity levels or movement data between studies that do and do not use the LFE filter.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes.

INTRODUCTION: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. METHODS: We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices. RESULTS: Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes. CONCLUSION: Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Duration and stability of metabolically healthy obesity over 30 years.

BACKGROUND: Obese adults who are free from metabolic risk factors may develop risk factors over time. Our objective was to characterize development of obesity and duration of metabolically healthy obese (MHO) over 30 years. METHODS: Participants in CARDIA who developed obesity (BMI ≥ 30 kg/m2) at follow-up exams during years 7, 10, 15, 20, 25, and 30 were analyzed. MHO was defined as obese and having 0 or 1 risk factor: ≥SBP/DBP 130/85 mmHg; fasting glucose ≥100 mg/dL/5.55 mmol/L; fasting triglycerides (≥150 mg/dL/1.69 mmol/L); and HDL-C (men <40 mg/dL/1.036 mmol/L, women <50 mg/dL/1.295 mmol/L) or on any medication(s) for these conditions. MHO duration (years) and obesity duration (years) were estimated for each subsequent time-point; and an overall cumulative duration was also calculated over available follow-up. MHO duration (%) was approximated as MHO duration ÷ obesity duration. Stable MHO was defined as 100% MHO duration over follow-up, while transient MHO was defined as <1-99%. Chi-squared tests were used to compare proportions by sex and race across obesity phenotypes. Multivariable-adjusted ANCOVA, adjusting for baseline BMI, age, race, and sex, was used to analyze obesity duration in all individuals who developed obesity, and also compare MHO duration (%) across race and sex in transient MHO individuals. RESULTS: Of the 987 eligible participants who developed obesity, 51% were African American (AA), 56% were women. Higher percentages of AA were classified as transient MHO, and higher proportions of females were MHO (both p < 0.0001). Obesity duration (years) was higher in transient MHO compared with stable MHO (mean difference: 6.2 ± 0.5 years, p < 0.0001). Of those with transient MHO, African Americans (51.4 ± 1.6%) were more likely to have longer MHO duration compared to Caucasians (44.4 ± 1.9%, p = 0.005). CONCLUSION: MHO status can be a transient phenotype which differs by sex and race. Future studies are needed to explore modifiable lifestyle/behavioral predictors associated with longer MHO duration.

Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association.

Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiology-based literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.

Healthy eating index and metabolically healthy obesity in U.S. adolescents and adults.

OBJECTIVE: To determine whether dietary quality differs between metabolically-healthy-obese (MHO) and metabolically-abnormal-obesity (MAO) in a nationally representative sample. METHODS: National Health and Nutrition Examination Survey (NHANES) data (2007-2008; 2009-2010) were used to identify obese adolescents (≥95th body mass index (BMI) %tile) and adults (≥30kg/m(2)). MHO was defined as <2 abnormal cardiometabolic risk factors (elevated blood pressure, triglycerides, glucose, low high density lipoprotein cholesterol (HDL-C); or on medications). Healthy Eating Index 2005 (HEI-2005) scores were calculated from 24-hour recall data. General linear regression models determined whether HEI-2005 scores differed between MHO and MAO after controlling for age, race, gender, NHANES wave, BMI, physical activity and health status by age group (12-18; 19-44; 45-85years). RESULTS: Compared with MAO, MHO adolescents (n=133) had higher total HEI-2005 score, higher milk scores, and higher scores from calories from solid fats, alcohol beverages and added sugars. MHO women 19-44years (n=240) had higher total HEI-2005, higher whole fruit, higher whole grain and higher meat and bean scores compared with MAO. No significant differences were observed between MHO and MAO for HEI-2005 total scores in men 19-44years, or adults 45-85years. CONCLUSION: MHO adolescents and women 19-44years have better dietary compliance to the U.S. guidelines when compared with MAO, suggesting potential intervention targets to improve cardiometabolic risk within obesity.

The Effects of a Guided Mindful Walk on Mental Health in University Students.

College campuses in the United States are experiencing high levels of mental distress without adequate psychological resources to address the need. In addition, the majority of university students do not meet the physical activity guidelines for mental and physical health. Effective and time efficient resources are needed to address poor mental health and low physical activity among university students on college campuses. Mindful walking may be a promising solution. The purpose was to 1) measure change in mental health and 2) estimate physical activity from participation in a guided mindful walk in a diverse student sample. Students participated in a mindful walking route which included seven stops (0.85 miles) during the Spring 2022 semester. Undergraduate students (n = 44) were mean ± SD age 20.9 ± 3.8 years and 68% female. Validated surveys were given pre- and post-participation measuring mental health constructs of state mindfulness (Toronto Mindfulness Scale; TMS), state anxiety (visual analogue scale), and state stress (Short Stress State Questionnaire; SSSQ). Physical activity was estimated via steps on a Yamax pedometer worn at the hip. After the guided mindful walk, total state mindfulness score significantly improved (mean ± SD) (pre: 27.5 ± 8.2, post: 32.8 ± 9.5; p < 0.001); state anxiety significantly decreased (pre: 3.7 ± 2.4, post: 2.4 ± 2; p < 0.0001) and total state stress score was reduced (pre: 66.1 ± 10.7, post: 63.4 ± 8.3; p = 0.03). Physical activity averaged 1,726 ± 159 steps. Completion of a guided mindful walk can reduce anxiety and stress, while increasing mindfulness among university students.

Acute Effects of Walking and Standing on Executive Function in Children with Attention Deficit/Hyperactivity Disorder: A Feasibility Study.

Children with attention deficit/hyperactivity disorder (ADHD) struggle with executive functioning (EF). While physical activity (PA) benefits EF, little is known about the impact of specific activities like standing. The purpose of this study was to evaluate the feasibility of performing a rigorous experimental study to compare the effects of walking and standing on EF in children with ADHD. Six areas of feasibility were assessed: recruitment, randomization, treatment adherence, retention, acceptability of the intervention, and implementation. A randomized pilot study using three parallel conditions compared the effects of two modes of activity on EF in children 6-11 with ADHD. While there were no significant differences between walking and standing for EF, analyses suggest that it is feasible to compare effects of standing vs. walking on EF among children with ADHD. This study supports the feasibility of undertaking a larger scale study to evaluate the effect of standing on EF in children with ADHD.

Racial Differences in Blood Pressure and Autonomic Recovery Following Acute Supramaximal Exercise in Women.

Despite the growing popularity of high-intensity anaerobic exercise, little is known about the acute effects of this form of exercise on cardiovascular hemodynamics or autonomic modulation, which might provide insight into the individual assessment of responses to training load. The purpose of this study was to compare blood pressure and autonomic recovery following repeated bouts of acute supramaximal exercise in Black and White women. A convenience sample of twelve White and eight Black young, healthy women were recruited for this study and completed two consecutive bouts of supramaximal exercise on the cycle ergometer with 30 min of recovery in between. Brachial and central aortic blood pressures were assessed by tonometry (SphygmoCor Xcel) at rest and 15-min and 30-min following each exercise bout. Central aortic blood pressure was estimated using brachial pressure waveforms and customized software. Autonomic modulation was measured in a subset of ten participants by heart-rate variability and baroreflex sensitivity. Brachial mean arterial pressure and diastolic blood pressure were significantly higher in Blacks compared to Whites across time (race effect, p = 0.043 and p = 0.049, respectively). Very-low-frequency and low-frequency bands of heart rate variability, which are associated with sympathovagal balance and vasomotor tone, were 22.5% and 24.9% lower, respectively, in Blacks compared to Whites (race effect, p = 0.045 and p = 0.006, respectively). In conclusion, the preliminary findings of racial differences in blood pressure and autonomic recovery following supramaximal exercise warrant further investigations of tailored exercise prescriptions for Blacks and Whites.

A catalog of rules, variables, and definitions applied to accelerometer data in the National Health and Nutrition Examination Survey, 2003-2006.

INTRODUCTION: The National Health and Nutrition Examination Survey (NHANES) included accelerometry in the 2003-2006 data collection cycles. Researchers have used these data since their release in 2007, but the data have not been consistently treated, examined, or reported. The objective of this study was to aggregate data from studies using NHANES accelerometry data and to catalogue study decision rules, derived variables, and cut point definitions to facilitate a more uniform approach to these data. METHODS: We conducted a PubMed search of English-language articles published (or indicated as forthcoming) from January 2007 through December 2011. Our initial search yielded 74 articles, plus 1 article that was not indexed in PubMed. After excluding 21 articles, we extracted and tabulated details on 54 studies to permit comparison among studies. RESULTS: The 54 articles represented various descriptive, methodological, and inferential analyses. Although some decision rules for treating data (eg, criteria for minimal wear-time) were consistently applied, cut point definitions used for accelerometer-derived variables (eg, time spent in various intensities of physical activity) were especially diverse. CONCLUSION: Unique research questions may require equally unique analytical approaches; some inconsistency in approaches must be tolerated if scientific discovery is to be encouraged. This catalog provides a starting point for researchers to consider relevant and/or comparable accelerometer decision rules, derived variables, and cut point definitions for their own research questions.

Correlates of bike share use and its association with weight status at an urban university.

BACKGROUND: Research on the influences on bike share use and potential favorable relationships between use and obesity is limited, particularly in the U.S. context. Therefore, the aims of this exploratory study were to examine correlates of awareness and use of Boston's Bluebikes bike share system and assess the association between use and weight status. METHODS: Students, faculty, and staff (n = 256) at a public urban university completed an online survey that assessed sociodemographic, behavioral, and physical activity characteristics, Bluebikes awareness, and use of Bluebikes and personal bikes. Multivariable logistic regression models were estimated to examine associations between sociodemographic and behavioral factors and bike share awareness and use; and between use and overweight/obesity status. RESULTS: Respondents were mostly students (72.2%), female (69.1%), White (62.1%), and the mean age was 32.4±13.8 years. The percentage of respondents classified as aware of Bluebikes was 33.6% with only 12.9% reporting any use of the system. Living in a community where bike share stations were located (odds ratio (OR) = 2.01, 95% confidence interval (CI): 1.10, 3.67), personal bike ownership (OR = 2.27, 95% CI:1.27, 4.45), and not exclusively commuting to campus via car (OR = 3.19, 95% CI:1.63, 6.22) had significant positive associations with awareness. Living in a bike share community (OR = 2.34; 95% CI:1.04, 5.27) and personal bike ownership (OR = 3.09; 95% CI:1.27, 7.52) were positively associated with bike share use. Any reported use of Bluebikes was associated with 60% lower odds of being overweight/obese (OR = 0.40; 95% CI:0.17, 0.93). CONCLUSIONS: Several environmental and behavioral variables, including access to stations and personal bicycle ownership, were significantly associated with Bluebikes awareness and use. Findings also suggest a potential benefit to bike share users in terms of maintaining a healthy weight, though further longitudinal studies are needed to rule out the possibility that more active and leaner individuals tend to use bike share more frequently.

Association of Bone Mineral Density with Lean Mass, Fat Mass, and Physical Activity in Young Overweight and Obese Women.

To examine the associations between bone mineral density (BMD), body composition and habitual physical activity in women who are overweight/obese. We measured whole-body bone, and body composition (lean mass, fat mass, and total fat percent) via dual-energy x-ray absorptiometry (model General Electric Lunar whole-body scanner) in a diverse group of women (N=48, age 26.6+/-4.7 years, 63% Black) living in an urban setting. The relations between BMD with total fat percent [%]), lean mass (kg), fat mass (kg), and physical activity were examined using Pearson correlations and multiple linear regression models, adjusted for race, age, and dietary calcium. BMD was positively correlated with lean mass (r=0.43, p=0.002) and negatively correlated with total fat percentage (r=-0.31, p=0.03). Multiple linear regression models indicated BMD was positively associated with lean mass (ß: 0.007, p<0.001), and negatively associated with fat mass (kg) and total fat percentage (ß: -0.003, p=0.03; ß: -0.004, p=0.03, respectively). When stratified by race, these relations were maintained in white women but only lean mass in Black women. When stratified by age, the positive correlation between BMD and lean mass was significant in younger women (<30y) only. There were no significant relationships between BMD and any physical activity measures. Our results indicate that in young women who are overweight/obese BMD is significantly associated with body composition, both lean mass and total fat percentage, but not habitual physical activity. An emphasis on lean mass accrual may be valuable for young women, particularly Black women, to improve bone health.

Prevalence of cardiometabolic risk factor clustering and body mass index in adolescents.

OBJECTIVE: To establish prevalence of cardiometabolic risk factor clustering within US adolescent body mass index (BMI) groups. STUDY DESIGN: Data were obtained from National Health and Nutrition Examination Survey participants (12-18 years, n = 2457) recruited from 2001-2002, 2003-2004, 2005-2006, and 2007-2008 surveys. Prevalence of risk factor clustering (≥2 risk factors: triglycerides; high-density lipoprotein cholesterol; systolic/diastolic blood pressure; fasting glucose) was determined within Centers for Disease Control-defined BMI groups (normal weight, <85(th) percentile; overweight, 85th to 94th percentile; obese, ≥95th percentile). Logistic regression examined associations of risk factor clustering within BMI groups for sex, race/ethnicity, income, household size, smoking, age, and BMI z-score. RESULTS: Approximately 9%, 21%, and 35% of normal weight, overweight, and obese adolescents had risk factor clustering. Adolescents with risk factor clustering were less likely to be female (OR 95% CI: overweight, 0.33, 0.16-0.68; obese, 0.38, 0.18-0.78) and non-Hispanic black (normal weight, 0.31, 0.17-0.55; overweight, 0.22, 0.07-0.69; obese, 0.24, 0.12-0.50), but more likely to be a smoker (overweight: 4.32, 1.44-12.96), and have a higher BMI z-score (obese, 3.15, 1.29-7.68). Lower income was associated with risk factor clustering in overweight adolescents (0.28, 0.12-0.63), but a higher income was related to risk factor clustering in obese adolescents (1.90, 1.04-3.48). CONCLUSIONS: The prevalence of risk factor clustering increases across adolescent BMI categories; however, associations with sex, race/ethnicity, income, smoking, and BMI vary across groups.

Accelerometer-determined moderate intensity lifestyle activity and cardiometabolic health.

OBJECTIVE: Objective To assess the relationship between moderate intensity lifestyle activity (LA) and cardiometabolic health using accelerometer data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. METHODS: One thousand three hundred and seventy-one adults (50% men; 71% non-Hispanic white) provided valid data to quantify time in LA [760-2019 counts per minute (CPM)] and moderate-to-vigorous physical activity (MVPA; ≥ 2020 CPM). Associations between LA [minutes per day (min/day); steps per day (steps/day)], and cardiometabolic risk factors [triglycerides, HDL-cholesterol (HDL-C), blood pressure, glucose, waist circumference], metabolic syndrome, self-reported hypertension and diabetes were investigated using logistic regression. Analyses were adjusted for age, gender, race/ethnicity, and MVPA categories. RESULTS: Greater time in LA (min/day), independent from MVPA, was associated with lower odds of elevated triglycerides (OR, 95% CI per 30 LA minutes: (0.88, 0.80-0.98), low HDL-C (0.88, 0.83-0.94), elevated waist circumference (0.89, 0.84-0.95), metabolic syndrome (0.88, 0.80-0.97), and diabetes (0.65, 0.51-0.83) [corrected]. The same cardiometabolic risk factors were also significantly associated with LA steps/day. No significant association was found between LA (min/day or steps/day) and glucose or blood pressure. CONCLUSION: Accumulation of time or steps in LA is independently related to lower odds for certain cardiometabolic risk factors. Research should consider the effects of increasing LA, which could influence future physical activity recommendations.

Patterns of adult stepping cadence in the 2005-2006 NHANES.

OBJECTIVE: Laboratory studies of adult walking behavior have consistently found that a cadence of 100 steps/min is a reasonable threshold for moderate intensity. The purpose of this study was to determine cadence patterns in free-living adults, and in particular, time spent at increasing cadence increments including 100 steps/min and beyond. METHOD: 3744 adults ≥20 years provided at least one valid day (minimally 10/24 h of wear) of minute-by-minute accelerometer-determined step data during the 2005-2006 U.S. National Health and Nutrition Examination Survey (NHANES). Means for time spent (min/day) and steps/day were calculated for 8 cadence categories including zero and each incremental cadence band thereafter beginning with 1-19 through 100-119, and beyond to 120+steps/min. RESULTS: U.S. adults accumulate ≅4.8 h/day of zero cadence during wearing time, ≅8.7 h between 1 and 59 steps/min, ≅16 min/day at cadences of 60-79 steps/min, ≅8 min at 80-99 steps/min, ≅5 min at 100-119 steps/min, and ≅2 min at 120+steps/min. CONCLUSION: Self-selected walking at 100+steps/min was a rare phenomenon in this large free-living sample of the U.S. population, but study participants did accumulate ≅30 min/day at cadences of 60+steps/min.

Physical Activity and Enjoyment in Parent-Child Dyads During Shared Physical Activity.

Purpose: The purpose of this study was to compare objectively-measured physical activity (PA) and enjoyment of five shared PAs in parent-child dyads. Method: Thirty-one parent-child dyads (mean±SD; age, parents: 38.0 ± 6.6 years, children: 5.9 ± 1.7 years) completed separate PA sessions, which included five standardized PAs (brisk walking, jumping games, dancing, body-weight exercises, and tag games) in random order for each dyad. Parent and child moderate-to-vigorous PA (MVPA) and accelerometer counts per minute (CPM) were measured using Actigraph GT9X activity monitors. The Visual Analog Scale was used to assess enjoyment of children and parents. Repeated measures ANOVAs and paired t-tests determined differences in PA within and between children and parents for the activities, respectively. Friedman Tests with post hoc Wilcoxon signed-rank tests determined significant differences in enjoyment across the activities for children and parents and Wilcoxon signed-rank tests compared enjoyment between children and parents for each PA. Results: Jumping games resulted in the highest proportion of time spent in MVPA and highest overall CPM for children and parents (p < .05). Compared to parents, children spent proportionally more time in MVPA during jumping games, body-weight exercises, and tag games (all, p < .05). Tag games were the most enjoyable PA for children and parents (p < .05). Children enjoyed body-weight exercises more than parents (p < .05). Conclusions: Future indoor PA programs and research interventions that include parent-child dyads should consider implementing jumping games, body-weight exercises, and tag games during shared PA, which resulted in higher MVPA and enjoyment by both children and parents when compared to walking and dancing.

Age, Sex, and Race/Ethnicity Associations between Fat Mass and Lean Mass with Bone Mineral Density: NHANES Data.

Rising rates of obesity and osteoporosis have public health implications; hence, understanding the relationships between body composition (fat mass (FM) and lean mass (LM)) and bone mineral density (BMD) is important. The purpose of this study is to investigate these associations in a large representative sample. A cross-sectional analysis was conducted using National Health and Nutrition Examination Survey participants (n = 1717, age 44.1 ± 14.2 years) who had complete dual energy x-ray absorptiometry (total BMD g/cm2, FM kg, and LM kg) and covariate data. Hierarchical linear regression models were fitted, controlling for demographic and behavioral covariates. Stratum-specific models were fitted by race, sex, and age group. Significant negative associations were found for FM and BMD (ß = -0.003) and significant positive associations for LM and BMD (ß = 0.007). Stratum-specific analyses by race were consistent between groups, while variations in negative association magnitudes were seen in FM for sex (males ß = -0.005 vs. females ß = -0.002) and age (under 45 years of age ß = -0.005 vs. 45 years and older ß = -0.002). Consistent positive linear associations in total and stratum-specified models between LM and BMD could suggest a potential mechanical influence on bone health. The biological mechanisms driving the magnitude variations between FM and BMD by sex and age require more investigation.

Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project.

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women's only wellness center that exchanged ExRx for free access (1-3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21-78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were "readiness" and "right timing" for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were "mismatched expectations" and "competing priorities". Common themes among all women were "sense of community" and "ease of location". ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Associations between Walk Score and objective measures of physical activity in urban overweight and obese women.

The purpose of this study was to examine associations between the Walk Score and physical activity in young, overweight/obese urban women. Project Health included 45 White or African American women (BMI 31.5±3.9 kg/m2; age 26.5±4.6 years; 62% African American) living in the Boston area. An accelerometer estimated steps/day and mins/day in light physical activity (100-2019 counts-per-minute) and moderate-to-vigorous-physical activity (≥2020 cpm). Walk Score was used to estimate the walkability of home address by analyzing proximity to nearby amenities. General linear regression models estimated associations between total Walk Score and physical activity (light physical activity, moderate-to-vigorous-physical activity, steps, total activity counts, METs), adjusting for body mass index, age, race/ethnicity, seasonality, wear time, employment and student status. For physical activity variables that had significant associations with Walk Score (steps/day and steps/min), regression models were estimated for Walk Score sub-scores (parks, grocery, errands, shopping, dining/drinking, culture/entertainment and schools). Logistic regression models estimated the odds of meeting the guidelines for steps (≥10,000/day) and moderate-to-vigorous-physical activity (≥150mins MVPA/week) based on Walk Score. Participants had a Walk Score of 63.9±26.4, took 14,143±3,934 steps/day, and spent 206.2±66.0 mins/day in light physical activity and 46.7±17.5 mins/day in moderate-to-vigorous- physical activity. Walk Score was significantly and positively associated with steps/day (ß = 51.4, p = 0.01) and steps/min (ß = 0.06, p = 0.009) but was not associated with mins/day of light physical activity, moderate-to-vigorous-physical activity, total activity counts or METs. Parks, grocery, errands, shopping, dining/drinking, and culture/entertainment Walk Score sub-scores were significantly associated with steps and steps/min (all p<0.05), but not significantly associated for schools. Participants who lived in higher Walk Score neighborhoods were more likely to meet the step guidelines (OR, 95% CI: 1.59, 1.04-2.99) and moderate-to-vigorous-physical activity guidelines (1.63, 1.06-3.02), respectively, per 10-unit increase in Walk Score. These results indicate that living in a more walkable neighborhood may support walking behavior in young, urban-dwelling overweight/obese women and provide further evidence for the expanded use of urban planning and transportation policies to improve the walkability of urban neighborhoods.

Identifying adolescent metabolic syndrome using body mass index and waist circumference.

INTRODUCTION: Metabolic syndrome is increasing among adolescents. We examined the utility of body mass index (BMI) and waist circumference to identify metabolic syndrome in adolescent girls. METHODS: We conducted a cross-sectional analysis of 185 predominantly African American girls who were a median age of 14 years. Participants were designated as having metabolic syndrome if they met criteria for 3 of 5 variables: 1) high blood pressure, 2) low high-density lipoprotein cholesterol level, 3) high fasting blood glucose level, 4) high waist circumference, and 5) high triglyceride level. We predicted the likelihood of the presence of metabolic syndrome by using previously established cutpoints of BMI and waist circumference. We used stepwise regression analysis to determine whether anthropometric measurements significantly predicted metabolic syndrome. RESULTS: Of total participants, 18% met the criteria for metabolic syndrome. BMI for 118 (64%) participants was above the cutpoint. Of these participants, 25% met the criteria for metabolic syndrome, whereas only 4% of participants with a BMI below the cutpoint met the criteria for metabolic syndrome (P <.001). Girls with a BMI above the cutpoint were more likely than girls with a BMI below the cutpoint to have metabolic syndrome (P = .002). The waist circumference for 104 (56%) participants was above the cutpoint. Of these participants, 28% met the criteria for metabolic syndrome, whereas only 1% of participants with a waist circumference below the cutpoint met the criteria for metabolic syndrome (P <.001). Girls with a waist circumference above the cutpoint were more likely than girls with a waist circumference below the cutpoint to have metabolic syndrome (P = .002). Stepwise regression showed that only waist circumference significantly predicted metabolic syndrome. CONCLUSION: Both anthropometric measures were useful screening tools to identify metabolic syndrome. Waist circumference was a better predictor of metabolic syndrome than was BMI in our study sample of predominantly African American female adolescents living in an urban area.